The Scope of Credentialing

The Scope of Credentialing 
This session is chaired by MLSQ committee member Dr Jenny Schafer.

The Scenario

The setting is a large regional hospital in a relatively disadvantaged town.  There is difficulty attracting staff, and most positions are filled by locums, newly arrived IMG’s and rotating registrars.

A patient presents on a Friday evening, another victim of drug related gang violence.  He had been pinned to a wall by a car and sustained multiple injuries. He was resuscitated by the ED and then whisked off to theatre by the enthusiastic surgical registrar, who happened to be walking past the ED on his way home.

Unfortunately, while performing surgery, the patient deteriorated and died on the table.  This led to a Coroners notification, investigation and plenty of media attention.  All staff were interviewed by police, hospital and external investigators.

The surgical consultant says he wasn’t properly informed of the patient.  The registrar indicated that he isn’t really supervised, and just told to “get on with it”.  Rumours around the hospital are that this registrar is a bit gung-ho and overconfident.

During the investigation, the surgical resident revealed that she had been exposed to racial and sexual harassment and bullied and belittled by the surgical consultant.  She had made the surgical registrar aware of this, but nothing had been done.  She had mentioned it to the DMS, who chalked it up to a “personality clash” and told her she needed to harden up.  The consultant denies all allegations and angrily indicates he intends to sue for defamation.

The anaesthetic registrar, when questioned about the clinical incident, indicated that she had possibly made an error of judgment due to fatigue.  She had worked lots of on-call, filled in for illness and stayed behind to help when needed, which was often.  She felt that this rotation and the fatigue had ruined her life.  The anaesthetic head of department was aware of the hours she was working, and refused to grant much of her claimed overtime, indicating it wasn’t in the budget and we all “just had to do what we had to do for the patients 

The ED resident who managed the patient, subjected to the investigation and questions about his management, became increasingly despondent and went on sick leave.  He subsequently brought legal action against the hospital for psychosocial injury, alleging that he had spoken to the emergency director about difficulties managing the endless flow of sick and injured patients, and feeling unsupported and unable to provide the care he felt they deserved.  As a result, he has developed insomnia, anxiety and has been diagnosed with PTSD.  He is unsure if he will return to the hospital or even the profession.

The director of surgery, considering the allegations, has come under scrutiny.  As part of this, it is revealed that he was employed at a time of crisis in an area of need, both clinically and politically.  His appointment was signed off by the DMS, medical credentialling committee and regional office.

Dr Bavahuna Manoharan in this episode will cover

• Liability of administration in credentialling
• Scope of practice – how do you determine and supervise it?