TERRIFYING RESULTS OF "PHYSICIAN PEER REVIEW FRAUD"
 ( SHAM PEER REVIEW)

by Richard Willner, CEO
The Center for Peer Review Justice

Regarding "Suspended Physician's Hearing Put on Hold" (AMNews ): The concept of a patent's alleged "imminent danger" coupled with legal immunities guaranteed by the federal Health Care Quality Improvement Act of 1986 ( "HCQIA") and similar state laws, followed by the Courts' reluctance it second guess physicians' "professional" opinions, can lead to terrifying results for the physician under fire. Both medical institutions ( e.g. hospitals) and state medical boards can play the "summary suspension" trump card on a hapless victim without fear of significant legal liability or effective judicial review. The physician being so attacked has little recourse, and he or she may suffer terrible and irreparable monetary loss, even if demonstrably "not guilty".

Suppose, for example, a hospital and/or members of its staff want to get rid of a "difficult" doctor, or one who is just too successful (too competitive). Clandestine collection of numerous "questionable" cases, sometimes spanning a number of years (as in the case of Dr Gil Mileikowsky detailed in the AMNews story) can be performed as a "quality assurance" function and the physician's credential's summarily suspended "pending due process hearings" which take literally months or even years. During that time, the physician is forced to use other facilities, if available, or begin the (long) application process to move to a different facility. Remember, however, that their other hospitals or clinics ( and other states) must be informed of the summary suspension at the index institution, often precluding the practitioner's ability to practice anywhere. After all, a summary suspension only occurs if the doctor is thought to be "dangerous" to patients. This is especially damaging to a surgeon, ob-gyn, or other practitioner who is dependent upon hospitals for practice. And if the doctor does NOT inform other institutions of the suspension, that in itself is grounds for denial, suspension or expulsion from a medical staff. Also note that any suspension which lasts longer than 30 days is reportable to the National Practitioner Data Bank ("NPDB"), The snowball effect is incredible!

Another scenario: A "good ole boy" clique or a hospital administrator takes offense at a target doctor and sends a few select anonymous complaints to the state medical board. Perhaps someone also had a chat with a buddy on the board itself (with no discernible paper trail, though). If the board can be convinced that the doctor is enough of a threat to someone, or that he or she can be made to LOOK like a threat, at least on paper, the upshot might be summary suspension of the victim's license, pending "investigation and due process hearings" which, again, takes months. In the meantime, the physician is without a license - i.e. without a means to earn a living. Often, the only way to avoid bankruptcy and closure of a practice is to plea bargain with the medical board, in effect pleading "guilty" to some aspect of the charges (called a "consent order" in some states). The physician is then under the magnifying glass of the board for the rest of his or her medical career, an entry is made into the National Practitioner Data Bank ( "NPDB" or "Data Bank"), and all future dealings with hospitals or other entities are shrouded in the taint of a data bank entry and an action against the license by a medical board. These days, you cannot even easily run to another state. And since it is a consent order, it is VOLUNTARY. When you gripe about it to your friends or colleagues, they remind you : "Well, didn't you sign that thing voluntarily?" Wrong -doing is basically admitted. And admitted wrong-doers are not the objects of much sympathy.

What recourse does the victim physicians have? If you think you are right, stand and fight. Then you pay for lawyers, your practice ( i.e. income) declines, and your reputation0n suffers. In fact, if one fights TOO hard, and alleges that the allegations are spurious and defamatory, a physician runs the risk of "offending" the original accusers and their friends. After all, they are acting in "good faith", aren't they? Well, maybe yes, maybe no. In Dr Gil Mileikowsky's case, dredging up 10 year old incidents to make the case for "imminent" patient danger seems a bit suspicious. AMNews has previously reported on a case from New Orleans wherein one or more of the committee doctors acting in "good faith" apparently purposefully lied or hid important information during the administrative process.

In any case, it is clear that this type of action is a very suitable weapon for professional assassination. And if the assassins are "caught"? They hide behind the Health Care Quality Improvement Act of 1986 ( "HCQIA")and claim peer review immunity. The mantra is: "Well we were just concerned about the safety of the patients. We're sorry we got the facts wrong. We really meant well..." In such a situation, unless the victim really has a believable "smoking gun", the perpetrators get off with no fine or penalty, and the victim physician, who many have lost months or years of practice, not to mention attorney fees and other costs, simply gets to go back to work with a bloodied and battered reputation. In court, the judge will defer to the doctors. After all, HE did not attend medical school, THEY did. If they were scared for patient safety, well, they are professionals and we should trust them. The court will not substitute its judgment for the judgment of the medical professionals. And doctors ARE supposed to police themselves, aren't they?

But, hey! Are these scenarios common? After all, we ARE professionals. How often does assassination by peer review actually occur? The reader is directed to the Center for Peer Review Justice ( www.PeerReview.org ) and other organizations to read about hundreds of hair-raising stories of physicians and surgeons who have had their reputations and livelihoods destroyed by Physician Peer Review Fraud ( Sham Peer Review), done by some of our more unscrupulous colleagues. One of the best defenses against winding up a victim like Dr Gil Mileikowsky is to first be aware of the magnitude of this problem and the danger that this could happen to you! The next step: Make good friends with the Center for Peer Review Justice and their independent lawyers who know HCQIA and Healthcare law.

The AMA News article that I referenced was written on June 18, 2001. Today is September 7, 2011, ten (10) years later. Physician Peer Review Fraud (Sham Peer Review) has become far more popular and far more destructive to a doctor's career!

This is America!! Why no Justice for Physicians and Surgeons?

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