Adverse Privileging Action Summary Part Three

This article concludes our series of summaries about Adverse Privileging Actions and how they impact medical providers in their military and civilian careers.  Read on to educate yourself about the Appeals Board, the Decision of the Surgeon General, Separation from Federal Service, and Notification to State Licensing Authorities.

Step Nine – Appeals Board

If the request for reconsideration is denied, the staff of the SG is tasked with formulating a second clinical peer review, a legal review of the due process procedures, and creating an appeal board process to review all past proceedings and recommendations by other committees.  They will also determine whether substantial evidence supports the decision of the MTF Commander, review all information provided by the provider, and review the records of the hearing. This new committee is mandated to include at least three privileged providers of similar medical service to the contended provider. Copies of all documents and information relevant to the investigation and the case are given to the board.   After an evaluation, the board will advise the SG of its findings and recommendations [inclusive of the recommendations discussed in previous steps]. 

Step Ten – Decision of Surgeon General 

After the completion of the appeal board, their recommendation, along with all relevant information, past recommendations, hearings, and investigations will be provided to the SG who will make the final decision on the case. Though not bound by the board, if the decision of the SG is different from the recommendation proposed by the board, the SG is mandated to provide rationale for their decision. To ensure that the decision of the SG is fair and unbiased, no other parties [CC, Peer Review, Appeals Board] will have additional influence or input into the decision. If the decision upholds the adverse privileging action, it is the job of the SG to report to the necessary regulatory agencies and the provider will be notified through written document of the final decision. The SG will also advise the MTF Commander with clear guidelines as to how the MTF is expected to act in the future regarding the employment/utilization of the provider. 

Step Eleven – Separation from Federal service

When a provider loses their license/clinical privileges, as occurs during an adverse privileging action, it is a basis for removal from military/civilian service. If an adverse privileging action, i.e. suspension, restriction, reduction, or revocation of a provider’s privileges occurs, an administrative review involving local chains of command is held in the MTF to determine whether the said provider should be removed from Federal service. If a provider leaves his position with a less-than-full scope of practice, the MTF is still mandated to report the adverse privileging action to professional regulating authorities, and additional consequences may be issued.

Step Twelve – Notification to State Licensing Authorities

As notification of the NPDB is mandated by both the AR and the DoDM, the adverse privileging action will be reported. In accordance with this, any facilities and health care entities that the provider clinically practices in will be sent a copy of the report of the clinical privileging action. The NPDB will then provide this report to the proper state licensing boards in the state[s] that the health care entity is located, as well as any state[s] where the provider holds a medical practice license.

For additional information about your rights during this process or to discuss your particular case with an attorney, please contact Rees, Kincaid and Stanfield via email at jon@rklawoffice.com or telephone at 913-827-3729.

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