How should I handle peer review?

You receive a letter from the Chief of Staff, the Department Chair or the MEC. They are reviewing your charts. You have had some adverse outcomes but so have all the other physicians on the Medical Staff—including those now reviewing you. What should you do?

Does hiring experienced peer review counsel send a negative message that you know you are in trouble? Is it better to go it alone, hoping to smooth over whatever problems may occurred? What are the risks of trying to handle your peer review yourself?

Most physicians reading this article have never experienced a hostile peer review that may appear on the surface to be routine when, in fact, a decision has been made that, “You must go.” Routine appearing investigations may spiral out of control more quickly than you can imagine, especially when Administration and Medical Staff Leadership fail to follow the “Rules of the Road,” the Medical Staff Bylaws.

All physicians are given a copy of the Bylaws during the credentialing process. Few study them, especially if they are credentialed at multiple hospitals. After all, Bylaws are written by lawyers, not by doctors. But now they become critically important. What exactly is being investigated? What are my rights during this investigation? Do I have to be concerned about a report to the Medical Board or the National Practitioner Data Bank? Can I just resign and go away quietly?

Good questions, but each requires an understanding of the law—both state and federal—governing peer review. The most important issue raised in the preceding paragraph is the wisdom of resigning so that you can go away quietly. Unfortunately, the Health Care Quality Improvement Act (HCQIA) of 1986, which created the Data Bank, makes resignation while under investigation (whether or not you were aware you were being investigated) Data Bank reportable. There are simple ways to avoid this risk.

Most hospital Bylaws limit the visible role of lawyers for either side during the early stages of an investigation, but be aware that the hospital has (or should have) counsel involved, behind the scenes, from the inception. So, too, should you. Errors made during an investigation may provide the legal issues necessary to set aside Adverse Action taken against you. Never assume, “This could never happen to me.” It could.

If you are the subject of a peer review investigation, consider the stakes and decide, early on, if you want to handle the investigation on your own. If not, we are here to help you. Contact me at Cal@RaupLaw.com

Questions? Contact Cal Today!

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