IV.C.2. Request for Adverse Action and Notice - Required elements, format, and suggestions

1. Due Process is for non-promotion, non-reappointment and termination but NOT probation.
2. IMPORTANT - Due Process consists of 2 parts:
   1. The Request for Adverse Action (described below): The Request for Adverse Action is sent to the Department Head, not House Officer. Once the Department Head has reviewed the request and agrees, he/she creates a short letter called the Notice
   2. The Notice – a short letter from the department head stating he/she supports the proposed adverse action. The Notice is attached to the Request for Adverse Action, and BOTH are delivered to the House Officer by mail or hand-delivered AND sent by email with a read receipt notice.
3. LSU GME Due Process is complex, and the timing is concise and crucial. It is vital that you follow the Due Process exactly as outlined. Failure to follow the Due Process timeline often leads to cases being overturned and legal action occurs.
4. Follow the Request for Adverse Action template in Appendix A. It should be detailed and include specific examples, dates, and witnesses.
5. The required FOUR components of The Request for Adverse Action are:
   1. The proposed disciplinary action - if possible, the CCC should meet and recommend the proposed disciplinary action.
   2. A list of deficiencies/Reasons for Action: list the deficiencies by competency and ensure they are detailed
   3. List of all known documentary materials that you will use at a hearing – programs should try to avoid listing the residency binder, as they will have to allow the resident/fellow to review the entire binder.
      1. It is suggested that departments provide a list of deficiencies and list individually the documents that support those deficiencies: letters, test scores, evaluations, emails, incident reports and other documents that refer to each allegation.
   4. List of witnesses to be called and summary of their expected testimony. In cases where the documentary evidence is the House Officer record, the summary for the witness may be, "will attest to accuracy of information in the file or an incident in the file." The Department may also list the deficiency, then list a witness that will attest to that deficiency or incident (ex. – Incident 4 - Dr. XXXXX was late for OR on XX/XX/XXXX. In the list of witnesses say, "Dr Jones will attest to his arriving late for OR as described in number 4 above.").
6. Collect and list deficiencies by competency. Most will be for patient care, medical knowledge, professionalism, communication. For example:
   1. Patient Care
      1. List specific occurrences in OR/wards, etc. and dates
      2. Include House Officer's statement about not being safe in OR
      3. Specific instances in the past – always put specifics including dates and even who will testify about it
      4. Inability to make decisions
      5. Lack of integrity
      6. Poor judgment
      7. Specific skills they should be able to perform, but can't – start IV, induce anesthesia, etc.
   2. Professionalism – listing specific examples
      1. Unexcused absences
      2. Unprofessional behavior with staff or families or other docs
      3. Repeated tardiness
      4. Lying
      5. Email, Facebook, HIPAA violations, etc.
      6. Other unprofessional behavior
      7. Failure to keep CAP contract in effect
      8. Failure to meet terms of probation
      9. Failure to comply with rules, regulations, House Officer contract, House Officer manual
      10. Noncompliance with program or school policies – e.g., moonlighting
   3. Medical knowledge
      1. Failure to provide care equivalent to peers
      2. Milestone issues
      3. Evaluation issues – may include other competencies
      4. Failure to meet program requirement – certain score on in-service exams, failure to meet program timeline – e.g. pass USMLE by some specific date
      5. Not complying with terms of probation – e.g., reading certain things

7. A sample Request for Adverse Action has been included in Appendix A.