The Voice of Risk Management

When I decided to write this piece about Risk Management, I spoke with a couple of people in the department that came to me for treatment, as all hospital staff (and, as you will see later, all county workers) could do. I told them about some early disturbing experiences and that I wanted to be able to offer a balanced view of the Risk Management/Quality Control department of a large, urban county hospital. They were happy to help and knowingly shook their heads when I told them of the following experience. They knew who it had been. She no longer worked there.

In my third year at Highland Hospital, I answered my phone to hear, "You need to go home, now." All I could think to say was, "Excuse me?" The "Voice" said, "This is so-and-so from Risk Management, and you are to stop treating and go home right now."

I don't know if the glee I heard in her voice was real or my fear tingeing the conversation. I had worked at the medical center under a certain amount of trepidation. While many people were friendly and supportive, there was also a large faction of doctors who felt that treating addicts with acupuncture was fine, but were adamantly opposed to my desire to expand the acupuncture scope of practice at the medical center. I don't know why, but the chief of the Surgery Department spearheaded this opposition, and almost the entire department fell in step. Occasionally, on slow days, I had a hard time dispelling the paranoid fantasy that the county sheriffs who patrolled the hospital would walk into my clinic and escort me out of the building. It took all my presence of mind to ask "The Voice" what the problem was.

Again with what sounded like joy, she said, "Your licensure is not valid, thereby leaving the medical center open to malpractice. I want you to close the acupuncture clinic and go home." I agreed to stop treating, but that she would have to talk to my supervisor who was also the chief of the Chemical Dependency/Mental Health department and my union rep about the going home part. There was a silence on the other end of the phone. Risk Management administrators are not used to being challenged.

I took advantage of the silence to ask why she thought my license was not valid. After a long conversation, this is what became clear: the state of California requires renewal by the last day of your birthday month and the medical center requires renewal by the first day. It took phone calls to the state Acupuncture Board in Sacramento and a written statement from my supervisor, but I was allowed to continue to work with the provision that I renew as soon as possible. No problem.

The staff from Risk Management told me they deal with liability issues such as making sure that all practitioners are current in their licensure and are credentialed by the medical center to treat patients. It also handles what is euphemistically called "negative outcomes," which can lead to their other responsibilities: lawsuits and malpractice claims.

The Quality Assessment aspect of Risk Management, deals with systems and systems failures. They handle customer satisfaction (which really, of course, is about customer dissatisfaction) and availability of services; in short, complaints.

Credentialing is a process through which the medical center issues you the right to treat and, more importantly, adds you to their malpractice insurance coverage. It consists of answering the same questions on the same form every two years about where you went to school, in what other hospitals you have worked, private practice issues, whether you have ever been disciplined by the Medical Quality Control Board, and if so, "explain." This form is then signed by you, your supervisor and the medical director of the program.

You also must sign an ethics oath, a confidentiality and security agreement; get two medical-center credentialed practitioners to sign a statement that they know you to be an ethical practitioner and undergo peer review. In my case, this involves paying an outside acupuncturist to come in once a year and "peer review" my work.

Plus, everyone working in the medical center has to complete annual competency modules, which include instruction and testing in abuse reporting, body mechanics, cultural competency, HIPPA, OSHA, patient rights, patient safety initiatives, internal and external emergencies, disasters and codes, chemical spills, bomb threats, fire hazards, electrical safety, hazardous materials, blood-borne pathogens, radiation safety and security services. All these, plus proof of TB screening, an up-to-date CPR certificate and a criteria-based performance evaluation by your supervisor are then turned into Credentialing with a copy of a malpractice insurance rider obtained from administration, proof of state required CEUs, a photocopy of your acupuncture license and a check for $100.

Once approved, your privileges to practice at the hospital are renewed for the next two years. It sounds daunting, but this is the cheapest, easiest, most all-inclusive malpractice insurance with which I have ever dealt.

My second encounter with "The Voice" was when she called about three months after the "You need to go home, now" event. She told me that Risk Management had decided that since I was treating Highland Hospital chemical-dependency staff (who were county employees), I would have to open treatment not only to all medical center staff but to all Alameda County staff in order to avoid any potential discrimination suits. In effect, she was mandating an expansion of acupuncture, at least in the area of the treatment of staff that I could not have imagined. Alameda County employs about 10,000 people, the medical center employs about 2,800, and the Highland Hospital campus alone employs about 1,900.

In reality, only a small number of this vast number of people actually came for treatment, mostly due to time constraints; they were, after all, at work. I was sure this would be a good step towards expanding acupuncture treatment within the medical center to include patients beyond the Chemical Dependency clinic. The networking alone with staff that was supportive of acupuncture would be monumental. I could not have been happier, but I made myself sound worried. I didn't want to disappoint "The Voice".