U.S. DOD Form dod-secnavinst-6320-23
�
�
. . . .
Mb
.
DEPARTMENT OF THE NAVY
Office of the Secretary
Washington, DC 20350-1000
SECXAVI!%ST
ci&-1 E-@QJ
29 Trbu L/
6320.23
lIUMED-3S
7 February
1990
-.
SECNAV INSTRUCTION
From:
To:
Secretary of the Navy
All Ships and Stations
Subj:
CREDENTIALS REVIEW AND
CLINICAL PRIVILEGING OF
HEALTH CARE PROVIDERS
DoD Directive 602S, 11 of
20 May 88 (NOTAL)
(b) DoD Directive 6025.13 of
17 Nov 88 (NOTAL)
(c) SECNAVINST 6401.2A
(d) SECNAVINST 5212. SC
(e) SECNAVINST 1920.6A
(f) CP1 752 (NOTAL)
(g) CPI 432 (NOTAL)
(h) 29 CFR 1613.701 Q ~
(N OTAL)
(i) SECNAVINST 1850.4B (NOTAL)
(J) SECNAVINST 5310016
(k) Title 10, United States Code,
Section 1102 (NOTAL)
(1) SECNAVINST 5720.42D
(m) SECN.AVINST 5211.5C
(n) SECNAVINST 1120.6B (NOTAL)
‘- (o) SECNAVINST 1120.8B (NOTAL)
(p) SECN.4VINST 1120. 12A (NOTAL)
(q) SECNAVINST 1120.13A (NOTAL)
Ref:
(d
. .
Encl:
1.
Definitions
Reportable Misconduct
Peer Review Panel Procedures
Individual Credentials Fiie
Contents for New Accessions,
Employees Entering Civil Service,
and Contractors and Others
Entering Under an Initial Contract
or Agreement
(s) Instruction Sheet, Health Care
Provider Adverse Clinical
Privileges Action Report,
(RCS-DD-HA(AR)1611)
(1)
(2)
(3)
(4)
Purpose.
and implemem
----
6320.23
To establish policy and procedures
reference
(a), and paragraphs
F3b(l)
and (2), and F3c(1) through (4) of
reference
(b) on review of credentials,
clinical
privileging and utilization of health care
providers,
as defined in enciosure
(i).
This instruction
appiies to all
2. Applicability.
military (active duty and Reserve) and civilian
health care practitioners
and clinical support staff
(as defined in enclosure
(1)), who are assigned
to, employed by, contracted
to, or under
partnership
agreement
with Department
of the
JNavy (DON’) activities or are enrolled in a Navy
sponsored
training program.
Terms
3. Definitions.
are defined in enclosure
used
(1).
in this instruction
4. Policy. Department
of the Navy policy is
that all health care practitioners
who are to be
responsible
for making independent
decisions to
diagnose,
initiate, aher, or terminate
a regimen
of medical or dental care will be subject to
credentials
review and wiil be granted a
professional
staff appointment
with delineated
clinical privileges by a designated
privileging
authority prior to providing care independently.
Practitioners
must possess a current, valid license
or certification,
a licensure or certification
waiver, or be specifically authorized
to practice
independently
without a license or certification
or
waiver of same, as prescribed
in reference
(c), to
be eligible for a professional
staff appointment
and clinicai privileges.
a. Privileging authorities shall define, profile,
evaluate, and periodically
reassess (at intervals
not to exceed 2 years) the clinical performance
and conduct of all assigned health care pro~’iders
following the guidelines of this instruction.
b. Privileging authorities shall maintain an
individual credentials
file (ICF) on all heallh
care practitioners
and an individual professional
file (IPF) on all clinical support staff as specified
Additionally,
commanding
in this instruction.
officers of fixed medical trea[men~ facilities
(MTFs) and dental treatment
facilities (DTFs)
SEC XAVIXST
6320.23
7 February 1990
will maintain ICFS and IPFs on health care
providers \vho are assigned to other activities,
designated
by the Chief, Bureau of .Yledicine
Disposition or ICFS and
Surgery (BLJIED).
IPFs will follow reference
(d).
competence.
Clinical
not maintain required
rent competence
are
separation
for cause
military personnel
or
including termination
references
(f) or (g)
as
and
c. Privileging authorities
\\’ill maintain
clinical performance
profiles (CPP) documenting
applicable
activities, as specified in paragraph
13b of this instruction,
for all health care
practitioners
providing direc[ patient care
services.
support staff who do
qualifications
or cursubject to processing for
under reference
(e) for
administrative
action
of employment
under
for civilian employees.
g. Interns may not be granted clinical
privileges during their internship.
Health care
practitioners
enrolled in residency or fellowship
training programs may not be granted clinical
privileges in their (raining specialty, but may
apply for and be granted clinical privileges in the
health care specially for which they are already
fully quulified.
The practice of granting
professional
staff appointments
and clinical
d. Privileging authorities will granl clinical
privileges to health care practitioners
using
standardized,
speciohy specific pri~ilege sheets
which reflecl the currentl!
recogni~.ed scope of
privileges to residents and fellows should be the
exception
ralher than the rule, should impact
upon the training program as little as possible,
and should only be considered
to meet the
operational
needs of the DOS.
DOS treatment facilities may employ and grant staff
appointments
and clinical privileges [o civilian
practitioners
\tho are currently enrolled in
graduaw medical education
(G\l E) programs
onl~ if the practitioner
meets all the following
criteria:
care appropriate
to each health care specially.
Commanding
officers are to ensure that health
care practitioners
provide services and treatments
consistent
with their approved
clinical prit.ileges.
e. Eligible health care practitioners
shall be
required,
upon repor{ing [or clinical du!), to
request a professional
slaff appointment
and the
broadest scope of core and supplemental
privileges commensurate
will] lheir Ie\el of
professional
qualification.
currenl competence,
the supporl Ie\’el af’ailable, and the health care
demands
placed on Lhe treatment
fucilils.
Those
who fail to maintain required qualifications
or
those who do not request such pri~ilege~ are
subject to processing
for separation
for cause
under reference
(e) [or mili[ar) personnel
or
adminisua[ive
acuon including termination
of
employmen[
under references
(f) or (g) for
civilian employees.
Commanding
officers \vill
ensure [he practitioners
conform m (his guidance
and will initiate the required admini~~rative
action
in a timely manner uhen prtic[i[ioners
fail [o do
so. Commanding
officers have a duly to pro~ide
practitioners
lhe resources and training necessar!
to enable Lhem to meet d~eir prescribed
responsibilities,
(1) They have completed
requirements
of their
current
all [he clinical
program.
(2) Their current [raining program
responsibilities
are limited to research activities.
maintain
their
(3) The! are seeking
their clinical skills.
employment
to
(4) The! hale the \vri[ten approval of
training program director to be employed.
h, Commanding
officers will assign
nontrainee
practitioners,
who fail to qualify for
clinical privileges and are required to practice
under supervision,
duties commensurate
with
lheir Iicensure or certification,
education
and
training, and currenl competence
as specified in
paragraphs
4f through -!h.
f. Commanding
officers will assign clinical
support staff clinical responsibilities
commensurate ivith their health status, Iicensure or certification, education
and [rainin~, find curren~
2
SECNAVINST
CI?-1
6320.23
Ii?!Juv1993
b ‘1’tlcdcsignatcci
prm’tilioncrs
privileging
assigned
authority
for
to tlw fleet, excluding
tlw
I:lcct Mtirinc Force (FMF), k the fleet type commander
c)r [lcct dental
6. Investigation
(R
officer for dentists,
and Disposition
of Allega-
tions of IIcalth Care Provider
Inlpaknent.
(;omnl.lncilrlg officers will invcstifq~tc, wi[hc~ut
cic>i.i},:Illcg;ltions
ment (pll~sical,
5. Authority
to Grant
Appointments
and Clinical
l’hc Chief, l]urcdu
iHt;hlEI)),
[(;1
quired
Profcssioilal
tx)nciuct, substan~i:lrd
Privileges.
c)f Mc(iicinc
scming
S[aff
:lnd
or professional”
SLIrgc>ry
cure pr(wicicr
~’:irc pr(n’id(.rs,
t)n Accredita-
form:lncc
pcrft~rmancc,
ticrcliction,
Allegations
by health
care pr(wicicrs
ignatwi
nonju~iicial.
hcmby
authorized
pointments
staff ap-
plic:lblc
privilqrs.
privileging
autk)ri[y
for
up(m rcccipt
pmctitioncrs
as the privi]cging
kvho arc commanding
authoriti~’s
action
~’olvc~i and to prcscrvc
cffcctil’cncss
or
officers of
of hcztlth
listed in enclosure
to safeguard
the integrity
of the commands
llcaltll care providers
zs ap-
[he righLs of the parties
a. Alle~~tic)ns ofcriminal
for
action
of allcgatic)ns
is required
ticn[ care, to prowct
practitioners
assigned to fixed M’I”Fsor ll’l’l;s is
the commanding
offkcr of the tr~utmcnt f~cility.
The Assistant Chief for I Icalth Care Opc’rations
and the Assistant Chief for Ikntistry,
Il[;hlf;l)
are designated
rcceiveci up
termination,
or acivcrsc privileging
care prxwicicr misconciuct
(2). Prompt
a. I%e dcsigmt[cd
pcr-
r~’tircmcnt also stxlll bc invcsti~~tcd. Commanciing f)fl;cers \\’ill initiate aciministrdtil’e, judicial,
and arc
t{) gr~nt prc)fcssion;ll
and clinical
rcporwhle
(2), by h~’alth
of subsundard
10 1 year foll(nl’ing scpamtion,
of C} llll;hll;l>
or mis-
and mc)r~l
incluciing
tion of I Icztlth Care Organizations
st;lnci:ircls, is
designated
the corpor~te” privileging a~]lllority
for all DON prwtitioncrs.
‘1’l~L”
foll(nvin~ ;lrc dcsrcprcscntati~ws
impair-
{Jr profcssi(mal)
nlis~’{)ntiuct Iistc-d in cnclosurc
as tlw g(~vcrning Ixxly, re-
by the J(>int Cc)mn]ission
of hcaith
mental,
pain-
and
involvcci.
misc{)nciuct
will bc referred
by
to the
Naval Criminal [nvcstig~tivc Service and other
autimritics
h(~l~iing jurisciiction owr the alleged
fmcd MTFs or 1>’I”Fsrcspcctiwly.
offenses.
-
3
(R
SECNAV[NST 6320.2~
7Fcbruary
1990
(b) As s(x)n as cvi~icncc is i~icntifrcd that
tlw ;lllcg;itions, c)r tlw invcstigatic)n sub-
s~]pports
sl.lnti:ltcs
tlw allcg:ttions,
[Ilc privileging
author-
ily will suspend the pmcti[ion~’r’s clinical
privi]cgcs tind initifitc tllc l)ccr Review l>ancl proccciurc prcscribcci
in cnclosurc
(S).
((i) ‘1’11(’
wx)pL’ of practice
11~..llttlu:tr~. pr;l~llllon~’rs
of privilcgcci
Ifill not be suspcndtxl
cx~’cl>t t]nck’r ll)c guidclin~’s
\\ 11~’nt>riill~’ging aullloritics
in this instruction.
suspend clinical priv-
llL’~L”s,[lIcy IY’illini[ialc tlw l)ccr Review Panel pro~’c~llrrc pr~x-ribc~i in Cnclosurc (j).
(.3) Nonprii)ilcgcCi practi[ioncrs,
including
j>r.l~[][ioncr tr;linccs in inscn’icc tmining progr.lms, wllosc
profcssion:ll”
duu[ rnuy ad~crscly
impairment
or miscon-
affcc[ tl~cir ability to provide
safe, quali[y care must be immediately
removed
frt)m dlr~’ct p~[icnt ctirc acti~’itics. Such CLSCSwill
lx’ in~cstig;l[cd, rcvic~lfcd, anti resolved in the
s;tmc rnanncr
pri~llcgcci
tlon
(Xcs
as prcscribcci
practi(ioncrs
in [his instruction
lvilh tllc following
for
cxccp-
tlut Cic31solely ~vith the issues of fail-
ure to m:lkc s~[isfautory progress in GME
programs, ir,cluciing bolll inscrvice and outscniuc
progrdms,
c!urcs cst;lblisl~cd
\vill bc aci~ircssd
by tl~c Cl III(;A!I;IJ.
L’.I Ic:lltll c:lrc pr~ctitioncrs
tll~lr prii llcgcs slispcnc!ed
s[.il”l’~~’1~()IMlw bcrn
~vho have had
or Clinical support
rcn~(n’cci from direct
c;lrc ;lc[i~ri[lus urrticr this instruction
tllcir permission,
un~icr procc-
grantcci
patient
will have
uncicr rcfcrcncc
(j), to