By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
A peer review action action may be initiated because of a patient complaint. It may be commenced because of complaints filed by hospital staff. It may be begun because of an unexpected adverse outcome. It may be begun because a patient files s medical malpractice lawsuit. It may result from a statistical review by the Utilization Review office or from the Quality Improvement office.
This is part 1 of a 2 part blog series. Click here to read part 2.
A Notice of A Peer Review Must Be Treated Seriously.
Regardless of the source, or how petty or meritless it may seem, the health professional who is the subject of the peer review must treat it seriously. The actions you take may resolve the matter at a preliminary stage or it may cause an escalation to a hearing, adverse action, and a National Practitioner Data Bank (NPDB) Report, with career-ending results.
Tips to Survive Peer Review.
Following are tips that the individual who is the subject of a peer review action that may help you to resolve it at the lowest level feasible under the circumstances.
The following tips assume that you have been notified of an initial peer review matter ant the facts or subject being investigated.
1. Do not resign or allow your clinical privileges to expire while the matter is pending. If you do so, this will be treated in a similar manner to having your privileges revoked in a clinical privileges matter and it will be reported out as such to the NPDB and other reporting organizations.
2. Provide a response or explanation if given the opportunity. But make sure you have reviewed the records, researched the medical issues as appropriate, and provide a well-organized, thought-out, objective 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). Be sure to completely identify any medical literature you attach by including title page, publication info, date, volume, pages, etc.
I will continue these tips in Part 2 of this blog.
Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in the Process of Peer Reviews.
If you are the subject of a peer review proceeding, immediately retain experienced, knowledgeable health care counsel to represent you. The attorneys of The Health Law Firm have experience in most, if not all, types of “fair hearings” involving health care issues and health care providers.
At the Health Law Firm we provide legal services for physicians and other health care providers. This includes nurse practitioners, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. 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.
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