Successful Peer Review Case: A Year-Long Battle for Due Process
At Concierge Healthcare Attorneys, LLC., we recently resolved a complex peer review case involving a surgeon in an upper Midwestern State. The case arose as the hospital began transitioning to an employed-physician model, seeking to phase out its non-employed, voluntary medical staff. Our client, a non-employed surgeon with privileges to treat patients at the hospital, was among those targeted in what appeared to be a strategic effort to remove voluntary non-employed physicians from the medical staff through sham peer reviews.
The medical executive committee of the hospital’s medical staff recommended the termination of our client’s medical staff privileges following a peer review of over a dozen cases. Our client pursued his due process rights afforded by the medical staff bylaws and requested a “fair hearing.” The process that ensued was complex and consumed the better part of a year, during which our client continued practicing at the hospital. The hospital then summarily suspended our client based on a re-review of cases spanning multiple years. The summary suspension likely violated the medical staff bylaws as cases that were years old did not present an imminent threat to the health or safety of any patients as required by the medical staff bylaws.
The NPDB requires hospitals and healthcare entities to report certain actions, including professional review actions that adversely affect a physician’s clinical privileges for more than 30 days. Summarily suspending a physician’s privileges often falls within these criteria, particularly due to an adverse action related to the physician’s competence or conduct. To avoid being reported to the NPDB, our client sought and obtained a preliminary injunction against the hospital. The preliminary injunction prevented the hospital from making an NPDB report but did not stop the not so “Fair Hearing” from proceeding.
Preparing for the Hearing
Both sides conducted extensive pre-hearing preparation, including written discovery and obtaining expert opinions. Defending against allegations in over a dozen cases required meticulous effort, as peer review cases often present complexities far exceeding those of typical medical malpractice claims. Despite these challenges, we secured expert testimony that our client adhered to the standard of care. That said, the Hearing Officer denied our request for discovery depositions of the Hospital’s experts.
Resolution Through Settlement
A couple of weeks before the hearing commenced, the parties entered into mediation discussions, and soon after that, the case was resolved. According to the terms of the settlement agreed to by the parties, our client relinquished his privileges at the hospital while maintaining privileges at the community surgi-center and a couple of other hospitals. The parties agreed to an NPDB report, which included the hospital’s position and a full-throated response from our client. He also received a six-figure settlement. Today, the surgeon continues to practice at the area surgi-center and other hospitals where he has strong relationships and ongoing privileges.
Conclusion
This case highlights the importance of making the most of the due process accorded physicians challenging an adverse action, along with thorough preparation for a Fair Hearing, a clear understanding of the case’s strengths and weaknesses, and strategic conciliation negotiations. While no settlement leaves either side completely satisfied, our client emerged with financial compensation, preserved professional opportunities, and an NPDB report incorporating his response to the Hospital’s report—a testament to the power of skilled advocacy.
If your medical practice or career is threatened, Concierge Healthcare Attorneys, LLC. protects your rights and fights for the best possible outcome. Contact us today to learn more.