Decredentialing process gets public safety spotlight

Last week, the Public Safety Commission examined the continued tension between the city’s medical director and the Austin/Travis County Emergency Medical Services Association over decredentialing.

Medical Director for Austin/Travis County EMS Dr. Paul Hinchey spoke to commissioners about the de-accreditation process, and why it was employed despite the fact that it does not offer a way for emergency medical technicians who have lost their credentials to appeal.

“I have an unassailable duty to protect the interests of the public,” said Hinchey. “I can’t surrender my responsibility to someone else.”

Hinchey said that his office tried to promote a culture that encourages reporting errors, because they mostly stem from behaviors that can be changed. However, he said, those are not the errors that warrant decredentialing.

“The piece that can’t be counseled is reckless behaviors,” said Hinchey. “Flagrantly reckless behaviors we do not try and remediate. You do not get a second chance at reckless behaviors.”

Since 2012, Hinchey has decredentialed six field providers. According to Austin/Travis County Emergency Medical Services Association President Tony Marquardt, this is more than any other major city in Texas.

“What we are missing here is due process,” said Marquardt. “We’ve never disagreed that the medical director should have control of who practices under their license; it’s important. We also think it’s equally important to have accountability.”

Marquardt said the city needed a metric to better define credentialing in general and provide oversight of the process.

“If we are deciding things without due process … that’s really something that should have some oversight,” said Marquardt.

In an email, Marquardt told the Austin Monitor that he is “alarmed the situation has been allowed to perpetuate so long given the signs of a distressed workforce,” and offered a synopsis of a 2012 grievance hearing over a decredentialing. That hearing resulted in a ruling that the employee be reinstated, but that was overruled by city management. A synopsis of that case can be found here at the end of this article.

In November 2012 voters approved civil service for EMS workers. Assistant City Attorney Michael Cronig told the commission that issues of decredentialing do not appear before the Civil Service Commission and shouldn’t, because it isn’t a disciplinary matter, but a matter of not having the license to do the job.

“If someone is not able to practice medicine under Dr. Hinchey’s license, that is a requirement of being a medic in this system. And if Dr. Hinchey won’t let a medic practice medicine, you can’t be a paramedic anymore,” said Cronig.

Cronig explained that, because the paramedics practice under Hinchey’s medical license, he is ultimately responsible for whether they should be allowed to practice medicine.

“The city and the association do not have the authority to tell Dr. Hinchey who he has to allow to practice medicine under his license,” said Cronig. “Even if the Civil Service Commission could consider non-disciplinary matters, they don’t have the authority to override his authority when it comes to medical decisions.

“The decision whether to credential a medic rests solely with Dr. Hinchey,” said Cronig.

Hinchey said his office tries to encourage reporting errors and working through remediation, and that self-reports were up 50 percent last year.

“This is not a punitive environment where we are willy-nilly dealing the hand of destruction,” said Hinchey. “This is simply us safeguarding the public.”

According to the OMD Operating Guidelines used by Hinchey, credentials can be revoked in cases of: integrity violation, intentionally withholding care, intentionally harming a patient, impairment by drugs or alcohol while on duty, or failure to remediate.

If the director recommends revoking credentials, medics (or firefighters) can review the evidence, present their side of the story and have legal representation during their meeting with the medical director.

The review process is confidential. A letter is sent to the chief, who then has the option of terminating the employee — who has no right of appeal — or reassigning them to a non-civil service position.

Hinchey said he would love to be able to discuss decredentialing in more detail, but there is a provision in the law that protects them from discovery, and he was bound by that.

“I would love to be able to discuss these cases, because I think if you saw them, you would all agree the judgment was fair,” said Hinchey.

“My goal is to have zero decredentialings. If we can get to that place, I will be thrilled,” he continued. “If we can eliminate reckless behavior, no one will get decredentialed. That is, by far, our goal.”

Public Safety Commission Chair Kim Rossmo said that, at a minimum, perhaps the perception problem about how the process is used could be changed. Other than that, he said that given the restrictions under state law, he “wasn’t sure what kind of fundamental change could occur.”

This story has been updated to include the pdf below and to expand Dr. Hinchey’s job title.

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