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.
Should a Physician’s Resignation During a Routine Review Be Reported to the NPDB?
If a physician on staff at a hospital resigns their clinical privileges during a routine review that applies to all practitioners, should this be reported to the National Practitioner Data Bank (NPDB)? The answer is no.
A routine review process, where a healthcare entity evaluates the privilege-specific competence of all practitioners against clearly defined measures, is not considered an investigation for NPDB reporting purposes. Therefore, such a resignation is not deemed a resignation while under investigation and should not be reported to the NPDB.
However, if the routine review leads to a targeted investigation of a specific physician, and that physician resigns during this targeted investigation, it would be considered a resignation while under investigation and must be reported to the NPDB.
Peer Review Triggers
The most common “hostile” Peer review triggers are complaints by patients, nurses or other physicians. Many hospitals have internal (computerized) complaint systems so that groups such as nurses can gang up and file multiple complaints in a short period of time. There are normal medical staff/MEC contacts through the OPPE process but an OPPE can be routine or a prelude to an FPPE as well.
FPPE (also called an FPR)
An FPPE (sometimes termed an FPR, Focused Practitioner Review) a PIP (Performance Improvement Plan), failures to obtain privileges, failures to obtain broader privileges, adverse medical events, complaints about a physician’s demeanor are often “dealt with” on an informal basis. Do not be fooled by the informality. Any on the record MEC interaction will carry immediate consequences and long term threats. The informal resolutions may resolve matters or may be the “we gave him a chance” prelude to a summary suspension.
Peer Review Conduct & Misconduct is Protected
The Peer Review process is not just the hearing. Legally, any criticism may be deemed “peer review”. Peer review activity is largely protected so that people lodging complaints (even in bad faith) have protection from being sued. (See Bonnie v. St. Joseph)
A California medical license attorney knows the dangers of California Evidence Code section 1157. Evidence Code section 1157 provides near complete protection from disclosure of any statements made by participants in the peer review process. (Federal law does not generally recognize this privilege.) California law balances the need for confidentiality vs. the need of a physician to sue for false accusations.
What is the Peer Review Privilege and Are There Exceptions?
Don't Treat Yourself!
We Understand the Details and Get “into the weeds”
Our experience on other cases can benefit your case. For example, we are presently litigating a highly contentious case against John Muir Hospital in Walnut Creek, California. The case against John Muir involves our claim that they failed to follow established safety rules regarding the blood sugar levels for surgical patients. We claim that John Muir retaliated against the doctor who advocated for these protocols. This knowledge is then applied to other cases in our office. Defending surgeons facing peer review for high SSI rates raises the issue – who is at fault, the doctor or the hospital. Putting the hospital in the hot seat we have challenged their perioperative protocols. Their lack of a specific (or proper) perioperative glycemic order set raised the core question that protected our client. Did the peer reviewed surgeon cause the high SSI rate or was the hospital the cause ? [As many surgeons know, the SSI infection rate for many surgeries can be doubled by failing to keep blood sugar under control. Recent studies show that POD and POCD may be strongly affected as well. (See Article)] To learn more about the lawsuit that Daniel Horowitz has pending against John Muir hospital, click here. So our experience and attention to medical detail can be the difference between winning and losing. Put differently, you get a highly specialized defense from the Horowitz office. Cookie cutter does not exist in your world of excellent medicine and cookie cutter does not exist in our office.
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