Medical peer reviews, which typically are initiated by a complaint from the hospital’s medical staff president, clinical department chairman, or other medical staff officer, against a physician member of the medical staff, is the process by which a hospital evaluates a physician’s clinical performance or professional conduct to ascertain whether the physician has complied with the medical staff bylaws or has failed to meet the appropriate standard of care/conduct. A peer review is typically triggered by a patient care incident or professional misconduct. Because a medical peer review can result in a physician disciplinary action (i.e., a “corrective action”) including the restriction or termination of a physician’s clinical privileges, and the reporting of the corrective action to the National Practitioner Data Bank (i.e., NPDB), it may have serious long-term adverse consequences with respect to the physician’s reputation, ability to obtain/maintain privileges at other hospitals, and indeed his/her ability to continue to practice medicine.
Hospitals are required to report corrective actions affecting a physician’s clinical privileges for longer than 30 days to the NPDB. Further, hospitals must report a physician’s voluntary surrender or restriction of clinical privileges while under a peer review investigation, or to avoid an investigation, prior to a disciplinary action. Once the medical peer review process has begun, it can be extraordinarily difficult to put a halt to it, and avoid professional injury to the physician.
“Sham Peer Review” is an abuse of the peer review process, taken in bad faith, and disguised to look like legitimate peer review. There are a host of pre-sham peer review tactics used by hospitals including: wrongfully singling out a physician in morbidity and mortality conferences, creating a hostile work environment (i.e., constant scrutiny of the physician’s cases), co-management policies whereby a less qualified physicians are allowed to overrule the attending specialist, and wrongfully labeling a physician as a “disruptive physician.” A “sham peer review” process often follows these tactics. Physicians need to take appropriate steps when these tactics are taken against them, including hiring an attorney experienced in the handling of “sham peer review” cases. “(https://think-gen.com/barney-cohen-healthcare-attorney/ ) Sham peer review” is typically about hospital politics disguised as patient care concerns. Frequently, “sham peer review” occurs when a hospital is conducting a purge of independent practicing physicians in favor of hospital employed physicians.
Two physicians have sham peer review hotlines. The Center for Peer Review Justice may be contacted at info@PeerReviewjustice.org or telephone (504-621-1670). The Association of American Physicians and Surgeons’ Sham Peer Review hotline, operated by Lawrence Huntoon, MD, a nationally acclaimed physician’s advocate, can be contacted by calling: (800) 635-1196 or writing to: email@example.com for an attorney referral.
Courts generally afford great deference to a hospital’s peer review determination. However, where the corrective action decision involves a revocation, suspension or reduction of staff privileges, the hospital’s action is subject to limited judicial review to ascertain whether there was a substantive or procedural due process violation on the part of the hospital, or the medical staff investigation or hearing committee, or a conflict of interest for an individual member of the peer review investigation or hearing committee (i.e., a competitor of the charged physician).
Getting an experienced physician disciplinary action attorney involved early in the medical peer review process can protect a physician’s career. Ideally, this should occur as soon as the physician receives the complaint and prior to a peer review investigation because the result of the investigation may be reportable to the National Practitioner Data Bank.
I am highly experienced in the representation of both healthcare systems and physicians in peer review disciplinary actions. If you are the subject of a peer review/corrective action, Concierge Healthcare Attorneys, LLC can assist you in navigating through this difficult, and often arcane process.
For additional guidance see: