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Allied Health Professionals and Hospital Privileges: An Introduction to the Issues
Published online by Cambridge University Press: 27 April 2021
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The concept of allied health professionals practicing in hospitals arouses the opposition of many in the medical establishment. What is the nature of this conflict, and how can it be resolved? This article gives an overview of the reasons that allied health professionals are demanding hospital privileges, as well as the reasons that such privileges are opposed by physicians. In the author's opinion, the medical establishment should learn to accept practice in hospitals by non-physician providers, and can expect considerable legal opposition if it does not.
The first problem is to define what is meant by “allied health professional.” Generally, the term is applied to any health care provider who is not in the “MOD” group, which traditionally has included medicine (MD), osteopathy, and dentistry, although pursuant to certain federal regulations podiatry also falls within the MOD group. Thus, in a general sense, “allied health professionals” means everyone else who directly provides health care services.
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- Copyright © 1982 American Society of Law, Medicine & Ethics
References
Accreditation Manual for Hospitals 1982 Edition (Joint Commission on Accreditation of Hospitals, Chicago, 11.) (1981) at 211 (glossary).Google Scholar
Id. at 96. The author firmly believes that application of the term “allied health professional” to podiatrists is incorrect, for reasons that are given in the text. For purposes of this article, however, the terms will be used generally to include podiatrists. There is also a separate section devoted to nurse anesthetists in the JCAH manual. Id. at 4.Google Scholar
Specific information on podiatric training and residencies can be obtained by contacting the American Podiatry Association, 20 Chevy Chase Circle, N.W., Washington, D.C. 20015. Much of this information is compiled in a booklet, The Role of Podiatry With Hospitals which the APA will make available upon request. Specific descriptions of podiatric surgery on a technical basis are provided in Model Screening Criteria for the Review of Surgical Procedures and Associated Care Rendered by Podiatrists, (American Podiatry Association and the Department of Health, Education and Welfare Washington, D.C.) (July 1975).Google Scholar
This type of information is provided by the American College of Nurse-Midwives, 1012 Fourteenth Street, N.W., Suite 801, Washington, D.C. 20005.Google Scholar
The forum for this educational process is usually in hospital committees that hear requests for privileges from health care providers or appeals of denials of privileges. All such appeals generally terminate with the governing body, e.g., Board of Directors, which has ultimate responsibility for running the hospital. See Governing Body in Accreditation Manual for Hospitals, supra note 1, at 51–56. Health care providers contemplating litigation are well-advised to pursue appeals to the governing body as a decision of a hospital may neither be “official” nor “final” without its ruling.Google Scholar
42 U.S.C. §1395.Google Scholar
42 U.S.C. §1395 x(r).Google Scholar
See, e.g., 42 C.F.R. §405.1023 (1981). These regulations provide that “physicians” should be awarded privileges appropriate to their specialty.Google Scholar
VA. Code §32.1-134.2 (1979) (grant or denial of privileges to podiatrists must be based on applicants' license, judgment, competence and experience).Google Scholar
Accreditation Manual for Hospitals, supra note 1, at 97.Google Scholar
VA. Code §32.1-134-2 (1979).Google Scholar
VA. Code §18.2-499 (1975).Google Scholar
See, e.g., VA. Code §32.1-134-1 (1979).Google Scholar
42 U.S.C. §1983.Google Scholar
See, e.g., Shaw v. Hospital Authority of Cobb County, 507 F.2d 625 (5th Cir. 1975).Google Scholar
Federal courts have been resistant to utilizing claims of denial of equal protection under 42 U.S.C. §§1983 and 1985 for other than traditional minorities (race, sex) for fear that these statutes can be used to create a general federal tort law for any group claiming to be a minority. See Canlis v. San Joaquin Sheriff's Posse Commitatus, 641 F.2d 711 (9th Cir. 1981).Google Scholar
During the judicially activist 1950s and 1960s, Hill-Burton had been utilized as a tool to prevent racial discrimination against health care providers. See, e.g., Simpkins v. Moses H. Cone Memorial Hospital, 323 F.2d 959 (4th Cir. 1963). Many federal courts are now retreating from this activism, particularly as constitutional claims of health care providers have shifted from equal protection to due process denials. The Fourth Circuit Court of Appeals has itself retreated from its use of Hill-Burton to provide state action, holding that “state action” does not flow from these funds. See Modaber v. Culpepper Memorial Hospital, 674 F.2d 1023 (4th Cir. 1982).Google Scholar
See 15 U.S.C. §§1, 2.Google Scholar