Healthcare Practitioners and On-Call Duties: Top Questions on Liability Risks

Medical staff bylaws specify an organization’s structure and decision-making functions. Bylaws also outline the obligations and requirements that healthcare professionals must meet in order to secure and maintain privileges at the facility. The rules almost invariably require healthcare practitioners to be available after hours and on weekends to provide call support.

To determine the extent of your obligations, review the bylaws of each facility where you have admitting and surgical privileges. Key elements to scrutinize include requirements for the frequency of your availability to provide consultation, situations that may be addressed remotely by telehealth applications versus circumstances that mandate onsite interactions with patients, the amount of time permissible to arrive at the facility once a call for consultation is placed, and the rules governing backup referrals in the event of a conflict.

Failing to comply with on-call obligations can result in adverse reports and monetary fines of up to $50,000 for each violation involving on-call practitioners who fail to respond as required.

Yes. Failure to comply with medical staff bylaw requirements may result in serious consequences for a practitioner that could include fines, sanctions, and even the loss of privileges.

One facility’s actions to limit or curtail privileges to admit patients and/or perform surgical procedures would likely result in a cascade of negative events. Depending on the jurisdiction, a licensing board report may be required, leading to an investigation and possibly an evidentiary hearing. In these situations, an administrative law judge would ordinarily render findings and conclusions, which may result in fines, sanctions, and limitations to practice.

Facility privileges are ordinarily required to participate in CMS and third-party payer networks. The requirements for privileges are specifically detailed in the conditions of participation and payer-provider agreements.

Losing network privileges with one payer often requires self-reporting to other healthcare organizations and payers. Consequently, even a single event may generate a domino-like effect involving numerous entities. These events can have a catastrophic financial impact on a practice.

Whether you are required to see a patient in your office for follow-up evaluation and treatment depends on the obligations established in the facility bylaws. A high percentage of emergency visits require subsequent clinic appointments to help ensure continuity of care. Colleagues at the facility who specialize in your field may be willing to see the patient, thereby relieving you of your contractual obligation. Review the facility’s applicable bylaws and consult with your medical staff office. Make arrangements in advance to promote compliance and avoid problems, including a failure of patient care coverage and potential impairment to your ability to practice at that facility.

It is incumbent upon you to know the rules of your institution and the applicable federal and state laws governing ED encounters (such as EMTALA). These rules and regulations preclude a covered entity from denying patients an appropriate screening examination, care to stabilize emergency situations, and either admission for observation or transfer to another facility as indicated. EMTALA imposes specific obligations on practitioners—including delivering care that is consistent with the community standard—which, if not followed, could lead to sanctions.

Depending on the facility bylaws and the patient’s clinical presentation, you may be obligated to see the patient in order to comply with your legal obligations. The facility’s bylaws may create an exclusion in that situation, thereby allowing the institution to contact another specialist on the on-call list and excusing your involvement. Consult in advance with the medical staff office and personal counsel to discuss this type of scenario.

Seeing a previously discharged patient in the ED may reestablish the clinical relationship. Conferring with the medical staff office and reviewing the bylaws proactively with counsel may create a viable solution to provide the required care and avoid reinstating the practitioner-patient relationship. Steps you might take include detailing clear, written instructions in the patient record and written instructions to be provided at discharge to the individual as to what subsequent follow-up is needed and when and by whom it may be obtained. The practitioner can state in a follow-up letter that although care was provided to treat the emergency, the patient remains dismissed from the practice.

Generally, no, unless your state medical practice act or hospital bylaws require office call coverage. Contact the licensing board in your jurisdiction and the medical staff offices of the facilities where you hold privileges. Your office website, answering service, and practitioner-patient service agreement and conditions of treatment should be clear about your on-call availability.