Because of Mary's extensive background in health law and ethics, Mary have
been appointed Risk Manager of an organization. The organization is a large integrated delivery system with a Medical Center and clinics throughout the state. The organization also has various state contracts to provide care for state program beneficiaries. The organization is in a contract with the state to provide Managed Medicaid dental services. Mary sit on the Credentialing Committee and is also an advisor to the Medical Director.
Monday morning when Mary arrive at the office, Mary have a voicemail from the Medical Director of the organization.
"Hey, this is Jenna."
"We've got a big problem here. Did you read the Sunday papers? One of our providers is in some trouble. He's the only provider of pediatric dentistry to our Medicaid population." "I need you to look into the Medical Staff Bylaws for employed and contract providers applicable to our organization, and then we have to come up with a plan. We really need to get out in front of this."
Newspaper Article: Football Equipment Tampering May Lead to Criminal Charges
Years from now, they'll still be talking about the bizarre saga of the razor-sharp buckle on the helmet of a player in a November 6 football game between Linsly Academy and St. Benedict XVI. Right now, though, they're talking criminal behavior. As of Monday, no charges had been filed against either the player or his father, who claimed responsibility for sharpening the buckle. But, the district attorney of Alamo County is on the case and said charges may be coming. The episode started to unfold during the first quarter of the Academy's 16-14 double-overtime win. Two Academy players found that they were bleeding from wounds to their hands and arms; one had sustained three cuts that would require 10 stitches. A third teammate, whose arm was covered with scratches, told his coaches, "It feels like they've got razor blades out there." Referee Bob Renner ran a quick check of the St. Benedict players' equipment and found what he thought were two defective chin-strap buckles on the helmet worn by junior center Mike Miller. After removing them, he gave the first to a St. Benedict assistant and pocketed the other.
After the game, officials found that the buckle in Renner's possession had been milled to razor sharpness. (The St. Benedict assistant coach said he had thrown away the first buckle, and a search of the field failed to turn it up.) On November 8, the Ohio High School Activities Association began an investigation, which resulted in Miller's being discharged from the team and then expelled from school. After the expulsion, Miller's father, Homer, a pediatric dentist, told St. Benedict XVI principal Rev. Benjamin Schmidt that he had done the milling.
Homer was upset that in the previous week's game against St. John's High, Mike had been a victim of what the father considered excessive head-slapping. According to Schmidt, this was the elder Miller's solution to that. Several observers describe Homer, who was working on the sideline chain gang during the Linsly Academy-St. Benedict game, as a hothead. He was so vocal in his criticism of the officiating during St. Benedict's game against Carlow High on Sept. 21 that he was asked to leave the sideline crew. Apparently, the elder Miller is not always so bellicose; people close to Mike's sporting events describe Homer as "mouthy" and "macho" but also say that he "loves children" and frequently performs charitable dental work on Maryngsters from low-income families. More than one source describes Mike as a nice, levelheaded kid. Neither the father nor son has talked to the press.
Investigators have not ruled out the possibility that the buckle sharpening was team wide, but the hope remains that this was an isolated incident. Or, as D.A. Dan Marino puts it, "a really dumb idea confined to some really dumb people."
Medical Staff Bylaws
Section I: Termination or Suspension of Medical Staff Membership, Reduction of Clinical Privileges, and Other Corrective Action
1. Grounds for Action:
a. Non-compliance with Medical Staff Bylaws, and Rules and Regulations -- This shall include, but not be limited to, failure to disclose information pertinent to and necessary in the evaluation of a member's qualifications for appointment or reappointment to the Medical Staff.
b. Violation of Specific Rules of the Medical Center or this Medical Staff -- This shall include, but not be limited to, failure to complete medical records, failure to adhere to approved admitting and discharge policies, or failure to discharge responsibilities relative to consultation and call.
c. Misconduct -- This shall include, but not be limited to, violations as indicated in I.1.b above, abandonment of a patient, conviction of a crime, disruptive behavior, unethical behavior, or falsification of records.
d. Care Below Applicable Standards -- This shall include, but not be limited to, incompetence, unprofessional conduct (as excluded from I.1.c above), failure to adhere to patient care policies of the Medical Center, clinical performance below the standards of practice established by the clinical service, provision of sub-optimal and/or substandard care, substantial or consistent misdiagnosis, and/or a demonstrated lack of clinical competence.
e. Personality Conflict -- Continuous inability to work in harmony with others or evidence of disruptive behavior or conduct detrimental to patient care may be cause for such 3 action.
f. Improper use of Medical Center resources.
Now that Mary have reviewed the scenario and the bylaws, address these questions:
-What actions should Mary take, based on the bylaws that she has in place?
-If charges are filed by the District Attorney against the dentist but he hasn't yet gone to trial, can action be initiated against his privileges?
-With the information Mary currently have, does Mary need to report the dentist to the NPDB? If so, for what reason(s)? If not, why not, and what action would need to be taken for reporting to be appropriate?