If you have never experienced a disruptive physician either on your staff or applying for staff privileges, you can expect at some point that you will. Many hospitals, even after having experienced the agony of handling one of these problem physicians, will fail to anticipate that it can and probably will happen again. They find themselves inventing rules, policies and procedures as they proceed.

Successful management includes:

Have a bylaw or policy in place.

Case law has been accumulating in recent years asserting a hospital’s right (and even duty) to deny, suspend or revoke staff privileges on the basis of an “inability to work harmoniously with others”: Nanavats v. Burdette Tomlin Memorial Hospital (526 A. 2 d. N.J. 1987) eventually reached the New Jersey Supreme Court. The charges were:

• Unfair criticism of nursing staff causing a breakdown in morale and discipline.
• Questioning patients as to why they had chosen another physician.
• Pre-emption of hospital beds contrary to hospital policy.

The court stated “in evaluating a physician for staff membership, a hospital may consider not only technical skills, but also his or her ability to work with others. Consequently, a hospital may adopt a bylaw providing that the inability of a doctor to work with others as grounds for denying or terminating staff privileges....For disharmony to constitute a good cause for dismissal from a hospital staff, however, it is unnecessary that it cause actual harm to patients.” In Robbin v. Ong, 452 F Supp 116 (SD. GA 1978) and in other cases the court has made two basic points:

• Hospital staff appointment is a privilege and not a right.
• A direct relationship to patient care need not be demonstrated for action against a physician because of his behavior to proceed.

In Miller v. Eisenhauer Medical Center, the California court stated “ability to work with others is not sufficient grounds for action against a disruptive physician” but there must be “a real or substantial danger that patient care would be impaired.” Fortunately, this option is in the minority.