Hospitals Block FP From Colonoscopy Privileges

FP David Kresnicka, M.D., of Cedar Rapids, Iowa, has sought colonoscopy privileges for six years in two local hospitals. He's taken colonoscopy courses -- one from the AAFP -- and has performed about 500 colonoscopies in a rural hospital. "I've never had perforations, never had bleeds, and I reach the cecum about 98 percent of the time," he says.

Kresnicka's and other FPs' efforts to procure procedural privileges hit a new hurdle this summer when the American College of Gastroenterology sent hospital administrators materials warning them about the "potential litigation exposure" inherent in credentialing physicians who lack board certification in gastroenterology or eligibility for such certification. The mailing repeated materials ACG circulated in 1993.

"I laughed when I saw the (ACG) materials," says Kresnicka. "They keep getting more protective of their turf with each statement. It's more about money than it is about patient care."

Kresnicka shared the recent ACG statement with the AAFP this fall, and the Academy issued a response Dec. 12.

Kresnicka has done sigmoidoscopies for about 30 years. At the Cedar Rapids hospitals where he would like to do colonoscopy, he already has privileges to perform flexible sigmoidoscopy with biopsy and polypectomy.

"About six years ago, one hospital in Cedar Rapids passed a rule saying you had to do 50 colonoscopies under preceptorship. I got up to 41, and the administration stopped allowing me to do them under supervision. Then they changed the required number to 100. I've been told you have to have a residency in general surgery or gastroenterology or the equivalent."

His patients lose out. Some of them go to other physicians at a Cedar Rapids facility. "I've had some complaints from patients that the specialists don't always communicate well after the procedure and sometimes just tell the family, 'Our office will contact you,'" says Kresnicka. About 90 percent of his patients who need colonoscopies have Kresnicka do them in a hospital in Vinton, Iowa, 20 miles away. "A lot of my patients probably wouldn't have colonoscopies done by a stranger," he says. "But it's hard to have patients go out of town, especially in winter."