Adverse Privileging Action Summary Part Two

This article continues our series of summaries about Adverse Privileging Actions and how they impact medical providers in their military and civilian careers.  We invite you to continue reading to learn more about Action by the MTF Commander, The Hearing Board, the MTF Commander’s Final Decision, and the Request for Reconsideration.

This article continues our series of summaries about Adverse Privileging Actions and how they impact medical providers in their military and civilian careers. We invite you to continue reading to learn more about Action by the MTF Commander, The Hearing Board, the MTF Commander’s Final Decision, and the Request for ReconsiderationStep Five – Action by the MTF Commander

The Commander may accept or reject the recommendation. When rejecting, he or she may choose from the same list of options available in step four. He or she gets 10 calendar days to make the decision and the Commander must explain, in writing, the reasons for any departure from the recommended action. Next, the MTF Commander will provide written notification to the provider of their decision as well as the basis for the action. If this action is to suspend, restrict, reduce, revoke, or deny the privileges of the provider, then the provider may request a formal hearing. Careful thought should be given before executing a waiver of the formal hearing since the decision is final and then reportable to regulatory and licensing agencies. The provider should not consider waiver until after consulting with qualified counsel.

Step Six – The Hearing Board

Upon receipt of notice of the MTF Commander’s decision, the provider has 10 duty days to request a hearing. The hearing board will then be created and is mandated not to contain any members of the prior peer review to assure impartiality of the decision. The board will review relevant case information, as well as question witnesses prior to the hearing. The provider is also encouraged to provide witnesses and obtain legal counsel; though any legal counsel is not permitted to question witnesses or answer/ask questions, they are permitted to advise the provider during the hearing. The IO will likely attend the hearing to provide additional information but is not permitted to serve on the hearing board in order to prevent bias. After the hearing, the board will evaluate both the findings of the hearing as well as relevant documents and statements to determine a recommendation. This recommendation, similar to the ones outlined in previous steps, includes the option of full reinstatement of privileges, outlining specific deficiencies in the performance of the provider and establishing specific requirements [including supervision, required consultation with other providers related to patient care, etc.], suspension, reduction or restriction for a specific amount of time, release from Federal employment, revocation, or an additional reconvening of the hearing to consider additional evidence. The decision by the board is reached based on majority vote, and unless the decision is to reconvene the hearing, the recommendation and a recording of the hearing is forwarded to the MTF Commander. 

Step Seven – MTF Commander’s Final Decision

After receiving all the information relevant to the case, the MTF Commander has 10 days to reach a final decision on the case. Once again, they are not bound by the recommendation of the hearing board, but if the action is different than the one recommended the Commander is required to provide reasoning as to why. After a decision is reached, the provider is notified of the decision and reasoning behind it; if the decision of the Commander is to deny, restrict, reduce, suspend, or revoke the privileges of the provider, they are notified of their right to appeal the decision to the Surgeon General [SG]. It is important to note that the actions listed constitute an adverse action and are mandated to be reported to the National Practitioner Data Bank [NPDB] and other regulatory/licensing agencies, which will largely impact the ability of a provider to practice. Though the right to an appeal can be waived, it is recommended that a provider requests an appeal due to the potential permanent damage an adverse action can have on the livelihood of a provider.

Step Eight – Request for reconsideration

If an appeal is desired by the provider, a written request for reconsideration can be submitted to the MTF Commander. This request is meant to identify ‘errors of fact or procedure that form the basis of the request’ [AR 40-68, paragraph 10-10 (2)]. It is the job of the provider to specify the grounds of the request. If the Commander decides to grant this request, the decision is reconsidered on the basis that the provider outlined. If the Commander denies this request, the case is automatically submitted to the office of the Surgeon General that services the provider, whose staff will begin steps to evaluate the request. 

Thanks again for reading about steps five through eight on our overview of the Adverse Clinical Privileging process.  We look forward to sharing steps 9-12 in the next few weeks.  As always, for more information about this topic or others on this website, please contact us at 913-827-3729.

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