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Trouble in the medical staff: a practical guide to hospital initiated quality assurance.

This article offers a practical guide to hospital initiated quality assurance. After outlining the hospital's duty of care, the Article discusses both offensive and defensive strategies for dealing with the problem of an impaired or incompetent medical staff member. While the Article advocates informal resolution of the problem, it encourages the hospital and the medical staff to build a defense to liability based on strict adherence to hospital bylaws, rules and regulations governing medical staff organization, privileges and evaluation. The Article's ultimate concern is to avoid an escalated situation involving multiple lawsuits, patient harm, humiliation to the practitioner, and economic loss.