JCAHO On "Disruptive" Doctors: Fundamentally Clueless

Was I "disruptive" at Randolph Hospital? Damned straight. In a very good way. And proud of it.

According to the AMA News, the Joint Commission is calling on hospitals to crack down on "disruptive" health care professionals, over concerns that such behavior impacts patient care. A new commission standard taking effect in January 2009 will require hospital administrators to adopt codes defining disruptive behavior and develop procedures to discipline medical staff and other health professionals who behave badly.

What about standards of behavior for hospital administrators? What about discipline for their bad behavior? Who is checking up on them?

Certainly NOT JCAHO.

Ahead of the standard, the commission in July issued a sentinel event alert highlighting the problem and making recommendations on how hospitals should handle it. The accreditation organization defines a sentinel event as "any process variation for which a recurrence would carry a significant chance of a serious adverse outcome."

That's hysterical . . . given that I reported a "sentinel event" and got fired for it. And I've talked to JCAHO twice - and they had/still have no mechanisms in place for doctors to fight back against unethical/dirty-dealing hospital administrators.

The moves are drawing fire from doctors. They say disruptive behavior policies, which can cover everything from criminal assaults to condescension, are often too vague and used against physicians who may step on toes when advocating for patients or who own competing specialty hospitals and ambulatory surgical centers.

Some worry that the commission's actions could make it easier for hospitals to target outspoken medical staff members.

Disruptive behavior policies have "already been used to remove from the medical staff physicians who have a different opinion from administration," said Jay A. Gregory, MD, chair of the American Medical Association's Organized Medical Staff Section Governing Council. "We'll see more of that as time goes on.

"If somebody's not a 'team player,' individuals will try to remove them from the team, and the disruptive physician policy is one mechanism by which that can be done," said Dr. Gregory, a general surgeon and trustee at the Muskogee Regional Medical Center in Oklahoma.

Ah . . . the "team player" line. The memories flood back. Of course at Randolph, had I been a "team player", I would have rolled over and gone back to sleep and risked letting a baby die.

Not . . . a team . . . I play on.

For the record, JCAHO does not have a clue.

Excuse me. I have to go hurl now.