By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
As a licensed healthcare professional with hospital clinical privileges, you may be subject to a peer review or investigation. This could happen at some time in your career. It can be a simple one-time issue, from a patient complaint or a bad outcome. Or, it can be a long process with many cases and records.
A peer review action may be initiated because of a patient complaint. It may be commenced because of complaints filed by hospital staff. It may begin because of an unexpected adverse outcome. Similarly, it may start when a patient initiates a medical malpractice lawsuit. It may result from a statistical review by the Utilization Review office or the Quality Improvement office.
A Notice of a Peer Review Must Be Treated Seriously.
No matter where it comes from, the health professional being reviewed must take the peer review seriously, even if it seems small or unfair. The actions you take might solve the issue early. However, they might also result in a hearing. This could lead to negative action. Additionally, it may involve a report to the National Practitioner Data Bank (NPDB). This could end your career.
Tips to Survive Peer Review.
Here are tips to help someone who is facing a peer review. These tips can help resolve the issue at the lowest level possible.
The following tips assume you know about an initial peer review matter. You should also know the facts of the subject being investigated.
1. Do not resign or allow your clinical privileges to expire while the matter is pending. If you do this, it will be treated like having your privileges taken away. It will be reported to the NPDB and other organizations.
2. Provide a response or explanation if given the opportunity. Make sure you review the records and research the medical issues. Provide a clear, organized, and professional response.
3. Remember that this review is only about you and your actions. It is not about anyone else and this is not the place to make accusations about others. Discuss what you did (or did not do); do not point the finger at others and argue that they have done the same thing or worse.
4. Remain objective. Do not lose your temper and respond in a defensive, inflammatory matter. Assume that everyone is just trying to do their jobs.
5. In any written response, address the facts. Do not address what you think the motives of other individuals are.
6. Make sure your response is objective. Try to avoid subjective statements. Speak in terms of provable facts and what the record or other documents show. If you have documents (e.g., office records, algorithms, standards, guidelines) that those conducting the peer review do not have, attach them to your response.
7. Make sure your response is professional. Follow the rules for professional correspondence, that I wrote about in a prior blog about this. [Note: Add link.]
8. If you don’t have all of the records on the matter, ask for them. Also, obtain and review any applicable hospital or department policies and procedures. Review the medical staff Rules and Regulations, as well.
9. Support and explain what you did logically and with reference to medical journal articles and medical treatises. Attach legible copies of any relevant medical literature (or relevant portions of it). Make sure to fully identify any medical literature you attach. Include the title page, publication info, date, volume, and pages.
This is part 1 of a 2-part blog series. Click here to read part 2.
Don’t Wait Until It’s Too Late; Contact a Health Law Attorney Experienced in the Process of Peer Reviews.
If you are involved in a peer review process, quickly hire an experienced health care lawyer to help you. The lawyers at The Health Law Firm have experience with various “fair hearings.” These hearings are related to healthcare issues and providers.
At the Health Law Firm, we provide legal services for physicians and other healthcare providers. This includes nurse practitioners, nurses, dentists, psychologists, and psychiatrists. It also includes mental health counselors, medical students, and interns. Hospitals, surgical centers, pain management clinics, and nursing homes are part of this group, too. Any other health care provider is included as well. We represent facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. We also represent physicians and health care providers in complex litigation in both state and federal courts.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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