Bad Faith Peer Review

[spalatin]

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There has been considerable publicity recently on a topic that will eventually concern us all. Last August in Time Magazine, an article about the Semmelweis Society was published. The Semmelweis Society was founded to fight bad faith peer review in which a hospital decides to use the peer review system to remove a doctor from the hospital staff. They claim that hospitals are abusing the peer review system to remove economic competitors from their staff.

Hospitals claim they are removing doctors with poor records. Last summer a cardiologist in Dallas was awarded a $366 million verdict by a jury for a hospital's bad faith peer review.

The Michigan Supreme Court is presently considering whether or not hospitals can be sued by doctors when they retaliate against a doctor by removing his privileges when he tries to improve patient care. The questions before the Court are: Should hospitals not be subject to judcial review, even when they break the law in disciplining a doctor through bad faith? and Are hospitals immune from judicial review even when they act with malice? and what is the definition of malice? (Feyz v. Mercy Memorial Hospital, in which Doctor Feyz an internist there since 1978 was subject to retaliation and removal of privileges when he wrote standing orders for nurses to ask his patients if they were using their prescription drugs as indicated on the labels after the hospital told him not to order nurses to do this. http://courts.michigan.gov/supremecourt/Clerk/05-06/128059/128059-index.html#background)

I'm curious if any of you know of anyone who has ever been unjustly punished by a hospital, program or med school and what happened. If one of you computer geniuses know how to set up a poll, I'd be curious to know the answers to these questions.

1. Have you personally been subject to what you think is retaliation, program action, like probation, threats of dismissal or similar for addressing an ACGME or RRC or patient care related issue?
2. Do you know of anyone else who has been subject to the above?
3. Do you think this is a matter of concern in your program?
4. Do you think this is a matter of concern in residency in general?

 

[docB]

I’d say that this is an uphill battle for the physician. When you get privileged at a hospital you sign off that you will abide by the med staff bylaws and that for any disputes you will adhere to the process prescribed by the bylaws. If you don’t do those things you’re going to have a tough time in a suit.

As for this particular case about standing orders every hospital I’ve ever worked at required that standing orders or protocols be approved by the med exec committee. If the committee doesn’t approve the orders there’s no recourse except to find out what they didn’t like and try to accommodate them.

The fact that the suit is trying to hold hospitals accountable “just like any other private employer” is strange because in the non-academic world most docs are not employed by the hospital. The are granted privileges by the hospital to see patients there.

The issue of “bad faith peer review” sounds like instances of a group of colleagues ganging up on someone to get them out of the institution, presumably on dubious charges. While that’s clearly wrong it happens in every industry. Medicine is actually shielded in many ways because the med exec would have to go through the charade of the peer review process rather than just firing someone.

The issue of residents or students being subject to all this has some important differences. In that case you’re not talking about peer review. If you annoy enough people bad enough a PD will find a way to get rid of you. In that case there will be a specific process involved but those processes can be easily manipulated.

 

[Shammed]

Unfortunately there is a tremendous amount of ignorance surrounding "bad faith peer reivew". I know personally the Physician in Dallas who won the $366 million dollar verdict. I know his lawyer as well. His lawyer told me the jury was so disgusted at the behavior of the hospital and other physicians that they awarded this ridiculous verdict - which has subsequently been reduced.

The real issue that allows this to continue is the blanket immunity afforded the accusers and that total lack of standardization in how thesereviews proceed. They are no more then a kangaroo court; that is to say, a hearing is held to give the appearance of affording the accused due process but the outcome is pre-decided.

Federal statute protects the accusers.

The persons who are proponents of this travesty of justice are now advocating persecuting the "disruptive physician" - using a definition of disruptive that is so broad that one could conceivably accuse someone of being disruptive based on their gender, race, or religious beliefs.

We must all advocate integrity, honesty, as well as standards in these procedures.

I recommend reading the series call "the cost of courage" written by Steve Twedt in the Pittsburgh newspaper.