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Enough is enough: court affirms termination of dr.'s privileges: case on point: Ghanem v Presbyterian Intercommunity Hosp., 2003 WL 21143332 -CA. (Legal Focus on Hospital Law Issues).

ISSUE: When is enough really enough? That was the situation with which the California courts were confronted in this interesting case. The case involved a physician who was out of step and out of tune with hospital protocol and procedure. The hospital gave the physician ample opportunity to rehabilitate himself and even invited him to correct his deficiencies. However, when it was discovered that the physician had predated a significant entry on a patient's medical chart, it was the proverbial straw that broke the proverbial camel's back.

CASE FACTS: Dr. Shahram Ghanem had staff privileges at Presbyterian Intercommunity Hospital for over 15 years. He routinely admitted patients to the hospital and routinely treated patients with multiple medical problems. Dr. Ghanem specialized in cardiology and utilized the hospital for over 95 percent of his hospital practice. He was also the on-call physician for providing medical services to patients admitted to the mental health unit of the hospital who did not have a regular medical doctor. In August of 1995, hospital officials asked Dr. Ghanem to sign an agreement as a condition to reappointment to the medical staff. The agreement recited that he had been "counseled regarding compliance with required standards of behavior for a Medical Staff member at this Hospital." The agreement also recited that the hospital could not reappoint the physician to the medical staff unless he agreed to comply, and fully complied, with the standards of the medical staff. The agreement specified that the physician's failure to comply with theses standards shall "result in his termination from the Medical Staff of the Hospital." The agreement listed 15 factually specific conditions for reappointment. These were based on prior incidents of alleged misconduct. Examples of these conditions included agreeing (1) not to raise his voice, or shout at any person in the hospital; (2) not to be discourteous to nurses, patients, visitors, or anyone else in the hospital; and (3) not to make unreasonable demands on nurses or other staff persons. The conditional reappointment was only for one year. Dr. Ghanem also signed a similar one-year conditional reappointment agreement in December 1996 to extend his staff privileges through 1997. In 1996, hospital officials and physicians at the hospital noted several deficiencies with respect to patient care. Hospital administration advised the chief of staff, Dr. Imparato, to provide written documentation of the alleged deficiencies. Dr. Imparato encouraged nurses, doctors, and other staff persons to write up incidents of alleged deficiencies on Notification Forms. In 1996 alone, approximately 59 Notification Forms were filed. Dr. Ghanem was the subject of more Notification Forms than any other hospital staff person. In July 1998, the hospital again reappointed Dr. Ghanem to the medical staff for one year. His letter of reappointment acknowledged that he had complied with the terms of his prior reappointment. However, there had been an incident in which Dr. Ghanem had delayed in intervening with a patient complaining of a chest pain, which evolved into an acute myocardial infarction. Accordingly, as a condition of his reappointment in 1998, the hospital required Dr. Ghanem to attend at least 25 hours of continuing medical education in courses with a focus on diagnosis and management of acute myocardialease specialist consulting on a patient for whom Dr. Ghanem was the admitting physician, found a progress note on the patient's chart written by Dr. Ghanem, dated for the following date, August 15. The specialist immediately showed the chart to Dr. Imparato. The consultant reported his findings to a nurse who filed a Notification Form. Suspecting that Dr. Ghanem had deliberately falsified the progress note in the medical record, the Medical Executive Committee (MEC) elected to investigate the incident. An ad hoc Peer Review committee was appointed. After a hearing and an appeal to the Hospital's Judicial Review Committee, Dr. Ghanem's hospital privileges were revoked. Dr. Ghanem brought suit against the hospital. The Superior Court, Los Angeles County, denied Dr. Ghanem's petition for a preemptory writ of mandate to compel his reappointment. Dr. Ghanem appealed.

COURT'S OPINION: The Court of Appeals of California affirmed the judgment of the lower court denying Dr. Ghanem's petition to compel his reappointment. The court held, inter alia, that the hospital was warranted in revoking privileges.

LEGAL COMMENTARY: This case illustrates the great lengths to which some hospitals go to give physicians the opportunity to rehabilitate themselves. However, there comes a time when "enough is enough." Editor's Note: Some might question whether the hospital, in extending opportunities to Dr. Ghanem to rehabilitate himself, might have left itself at risk for liability for any negligence committed by Dr. Ghanem, Both hospital administrators and their legal counsel should be sensitive to the fact that there is a point beyond which a hospital might be guilty of negligence in allowing a problem physician retain his staff privileges.
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Article Details
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Author:Tammelleo, A. David
Publication:Hospital Law's Regan Report
Geographic Code:1U9CA
Date:Jul 1, 2003
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