Recalling Previous Battles Over Hospital Privileges
A fellow podiatrist recently called and wanted my advice on what to do after retirement. In the course of our conversation, we talked about our journey during the first years of practice. He commented that he had struggles with discrimination by hospitals. He assumed that I had these problems based on my previous “Forum” columns.
I assured him that I did have challenges but never considered them interesting enough to write about.
However, the call did spark my curiosity so I dug out an old file titled “Hospital Privileges Fiasco.” It contained letters that I wrote and received during the mid-‘70s. All of the letters pertained to my requests for hospital privileges. It is depressing to read them now but I actually enjoyed the challenge as a young podiatrist.
My community had two small hospitals when I started practice in 1975. One was a Catholic institution operated by an order of Dominican sisters that was dwindling in membership. The hospital was old and poorly equipped. The sisters struggled to keep the place running while caring for most of the poor and indigent patients in the community. The staff was mostly general practitioners who did some surgery, delivered babies and ran their own clinics.
The other hospital was new. All of the specialists in the community admitted their patients at this facility. This was the preferred hospital for sophisticated medical and surgical care. This is where most of my patients wanted to go for surgical procedures.
The Catholic hospital granted me limited privileges and the new place refused to accept my application. The administrator told me that the hospital powers that be did not think podiatry was an appropriate service for their staff and might harm the facility’s reputation as a quality hospital.
I let him know that I had $10,000 saved to raise legal hell for him and the hospital. He warned me that I would lose everything if I did that. I said, “Lose what? I do not have anything.”
I pestered the administrator for two years and finally obtained privileges as an affiliate provider. My privileges were limited to the four lesser toes distal to the metatarsal heads and did not include bunion surgery. All of my work needed to be supervised by an MD (we had no DOs). All of my work had to be under local anesthesia with no sedation.
I let six months go by before scheduling any work. One of the employees of the new hospital needed bunion surgery and wanted the new place. The administrator granted me “one-time” privileges to perform the operation.
When it was complete, I asked if I could now do bunion surgery. He said, “No. This was a one-time privilege.” I demanded due process and that he show me where my work was substandard. I also let him know that I had saved $15,000 for the legal battle. I got the privileges. My new territory was everything distal to the metatarsal bases.
Six months later, I scheduled a patient with a dorsal cuneiform exostosis and let the administrator know that I could remove the half of the bump from the metatarsal but needed an orthopedist to remove the other half from the cuneiform. He granted me “one-time” privileges for the procedure. This time I let him know that I had $20,000 saved for the legal battle. In that manner, I worked my way up to the ankle, got to use general anesthetic and no longer needed a babysitter for each case.
These were my struggles but I enjoyed the battle and caused the administrator more grief than he caused me. He knew it would cost the hospital hundreds of thousands to defend a discrimination suit. I knew I probably would not win but enjoyed tormenting him by reminding him of that option and that I was saving for the fight.
Power shifted in our community when a larger order of sisters bought the Catholic hospital and later bought the newer place. I was chairman of the board of trustees of the older hospital. When the dust settled, I became chairman of the board of both hospitals.
One of our first tasks was to recruit a new administrator for the merged hospitals. Of course, my old friend was a candidate for the job but unfortunately he was not selected. I felt sad that the battle was over when I signed the letter notifying him that he was being replaced. Yes, I have had struggles but they have been stimulating and fun.