Hospital Peer Review Issues

  • What Every Physician Needs to Know About Medical Staff and Other Types of Disciplinary Proceedings
  • Should Due Process be part of Hospital Peer Review?
  • AMA Policies on Due Process
  • Federal legislation provides credentialing organizations a golden opportunity to gain immunity for their decisions - the act provides near complete immunity to claims for monetary damages arising from peer review actions
  • Northeast George Medical Center Inc. v. Davenport; GA., No. S99G1082\ The Georgia state Supreme Court ruled that the Health Care Quality Improvement Act (HCQIA) does not require that doctors receive "formal and precise" reasons before revocation of staff privileges, nor does it limit the number and scope of reasons given by a hospital
  • No HCQIA Immunity for Peer Reviewers of Disruptive Physician!
  • Manzetti v. Mercy Hospital of Pittsburgh - Pennsylvania Supreme Court held on July 18, 2001, that the hospital and reviewers were entitled to immunity under HCQIA.

  • < Under most hospital bylaws, by the time the physician gets to the fair hearing panel, the burden has shifted against the physician with the requirement that the physician prove by clear and convincing evidence that all prior decisions were arbitrary and capricious or factually baseless. Practical experience demonstrates this is a virtually impossible burden to sustain and standard to satisfy.

    The Supreme Court also held that the "reasonable effort" prong of the four-part HCQIA immunity test is satisfied if the review activities are "sensible," but they do not have to be "flawless." Thus, the Supreme Court has countenanced due process violations and errors in the peer review process.

  • Donnell v. HCA Health Services of Kansas, Inc.,  physician peer reviewers are immune from liability under HCQIA even if their investigations are sloppy, negligent, and wrong. Physicians must prove bad faith and malice to have a peer review decision overturned

  • Gordon v. Lewistown Hospital, 714 A.2d 539   Court found that there is a presumption of validity of the hospital's disciplinary procedures. An outside consultant was retained. The Hearing Officer was an attorney, who was determined not to be in economic competition with the physician, but was a neutral party. Even though some of the physician's direct economic competitors were involved in the decision, and there was evidence of a history of hostility toward him, none of those individuals participated in drafting the outside report. The Court then looked to the totality of the process leading to the professional review action. Under that broad test, even though some parts of the process were critically flawed and biased, the Court said, in totality, the physician got all the process he was due.

  • Swinging Pendulum of Peer Review Immunity
    Early Intervention Strategy
    A physician subjected to peer review may have little chance of surviving unless early and aggressive measures are taken. Understanding the case law and limitation on judicial remedies, it is prudent for the physician and counsel to quickly retain the best conceivable expert in the subject area to address the outside reviewer report. In many cases, it becomes very clear that the outside reviewer's report significantly overstates quality of care infractions, is based on no published peer reviewed medical journal articles or positions, and is academically pedantic without taking into consideration reasonable and acceptable standards of care.
    Successful resolution using this strategy can be achieved with minimal disruption to the physician, including perhaps CME and monitoring, without causing a damaging Data Bank entry

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