Peer Review Litigation

An adverse peer review can have a long term adverse effect on physicians.   Peer Review reports which result in an adverse action require a hospital to report that action to the National Practitioner Data Bank.  Physicians who are not members in good standing with the medical staff of a hospital cannot practice medicine at the hospital.  An adverse action may haunt a physician’s profile for the rest of his or her career.

While the court’s can help protect against an improper adverse ruling, physician’s can’t utilize the court system until they have exhausted their rights within what is referred to as the “fair hearing process” within the hospital administration.

Time is critical.  When a physician learns that a hospital committee is making an adverse recommendation to the hospital, that action is considered an adverse action under the HCQIA (Health Care Quality and Improvement Act).  Adverse recommendations in turn, give rise to certain procedural due process protections.

From the receipt of notice, the physician has 30 days to request a hearing in writing.  Counsel, or a member of the hospital staff may represent the physician.  Failure to make the demand may result in a waiver of a physician’s right to a hearing.

For example, peer review recommendations are only entitled to protection if they meet certain criteria.  The recommendation must be made because the committee had an objective, reasonable belief that its action furthered quality care.  The committee must have made an objective reasonable effort to secure facts.  The physician must have been given due process (including notice and a hearing).  Finally, the organization must have a reasonable belief that its actions were warranted.

Romanowsky law will assure that the physician is given appropriate documents upon which the investigative panel will make its decision.    The physician has the right to confront, cross-examine, and appear before adverse witnesses.

The process is lengthy.  The body of case law surrounding these issues is extensive.  It’s a perilous journey.  Contact Romanowsky Law today to help guide your way.