Neurosurgeons in small communities often supplement their practices by performing back and spine surgeries. And if the hospital failed and had to cut back services, that would hurt the community of about 25,000, the hospital said. The physicians said the hospital doesn't have the right to deny privileges without even looking at the qualifications of the doctor who's applying, and they said the hospital violated its bylaws when it decided to close privileges for all orthopedic surgeons. A lower court agreed with Orthopedic Surgery Specialists that the hospital should have to extend privileges. But the South Dakota Supreme Court sided with the hospital.
Medical societies say the hospital's rationale for denying privileges is wrong.
The staff should be open to all physicians who are qualified. The AMA last year adopted a policy against hospitals' using economic criteria unrelated to quality of care or professional competency to decide whether a physician should be given staff privileges, a practice commonly called economic credentialing. Also last year, the AMA asked the Dept. of Health and Human Services' Office of Inspector General to look at exclusive credentialing and to issue a fraud alert warning hospitals and physicians about the practice. Exclusive credentialing takes the focus off what's best for the patient, the AMA said, and therefore is among the most flagrant types of kickbacks. In South Dakota, physicians say the next step is to ask state legislators to pass a law barring hospitals from making staff privilege decisions based on economic reasons.