Lawyer for Medical Peer Review

Understanding the California Medical Peer Review Process

The California medical peer review process is essential for monitoring and enhancing the quality of care provided by healthcare professionals. However, it can sometimes be misused, leading to unwarranted inquiries and threats to the licenses of highly qualified physicians.

The Horowitz Medical Group is led by attorney Daniel Horowitz and Physician/Lawyer Mark Ravis . Our lawyers are experts in defending doctors at all stages of the peer review process, ensuring that their rights are protected and that they receive fair treatment

Understanding the Peer Review Process:

• Purpose: The peer review process aims to evaluate a healthcare professional’s clinical performance, medical decisions, and adherence to standards of care.
• Peer Evaluation: Ideally, this evaluation is conducted by other healthcare professionals in the same geographical area and, when possible, in the same or similar field or specialty.
• Challenges: Unfortunately, the process can be tainted by internal conflicts, cherry-picking of difficult cases, and unfair criticisms.

By understanding these dynamics, physicians can better navigate the peer review process and protect their professional standing.

HOW TO RESPOND TO PEER REVIEW

What is an 805 REPORT?

Peer review moves quickly and adverse consequences can take place in matter of weeks.

California Business & Professions Code section 805 requires reporting of discipline (including interim discipline) of physicians to the Medical Board of California.  Summary suspensions almost always result in reporting.  Here is the reporting part of the statute (edited and highlighted):

Section 805 - 805 report by peer review body  

 (b) The chief of staff of a medical or professional staff or other chief executive officer, medical director, or administrator of any peer review body and the chief executive officer or administrator of any licensed health care facility or clinic shall file an 805 report with the relevant agency within 15 days after the effective date on which any of the following occur as a result of an action of a peer review body:

The items that must be reported are summarized as follows:  (Sourced from the Medical Board of California website)

• A peer review body denies or rejects a licensee’s applications for staff privileges or membership for a medical disciplinary cause or reason;
• A licensee’s staff privileges, membership, or employment are revoked for a medical disciplinary cause or reason;
• Restrictions are imposed, or voluntarily accepted, on staff privileges, membership, or employment for a total of 30 days or more within any 12 month period for medical disciplinary reasons;
• If the resignation, leave of absence, withdrawal or abandonment of application or for renewal of privileges occurs after receiving notice of a pending investigation initiated for a medical disciplinary cause or reason;
• A summary suspension of staff privileges, membership, or employment is imposed for a period in excess of 14 days.

This reporting period is a commonly used “hammer” wielded by the attorney for Medical Staff against the target physician.  The physician is often trapped.  Once the process is started can the physician just pack up and move to a better environment?   Here is what the NPDB says.  Basically it parses the issue.  Is it a resignation while “under investigation?”   Or is it a resignation during a “routine review process” e.g. a non-triggered OPPE.