Legal representation for peer review

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Tips to Prepare For Clinical Privileges and Peer Review Hearings Part 2 of 2

Attorney Indest headshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In Part 1 of this blog, I began a list of tips that should serve you well if you are notified by your hospital or medical staff that you are the subject of internal or external peer review hearings.

20 Tips For Successful Outcome in Peer Review Hearings (Continued):

10. If you are given the opportunity to meet with the reviewers or provide information to them, do so. If you haven’t been offered this, ask for it in writing.

11. Make sure any written response is provided in a typewritten letter formal not via e-mail, text or YouTube posting or handwritten note.

12. In your written statement or response, if you use any abbreviations, spell them out completely the first time you use them and place the abbreviation after, in parentheses. Remember, future reviews of your statement may not be physicians (e.g., a judge) or may not be in your medical specialty.

13. It is never too early to engage experienced health car legal counsel to assist you in such matters. But if you do, make sure you do hire an actual health law attorney who has experience with medical staff peer review hearings. This is no place for a plaintiff’s personal injury attorney, a criminal defense attorney or your tax, or business lawyer.

14. If you find out that your matter is being sent out to an external peer review organization you should retain an experienced health law attorney immediately and obtain your own medical expert review.

15. If the care being examined involved another physician as well as you, or if the care was of a patient referred by another physician, see if that physician supports the care you provided and will provide you a letter or statement saying that.

16. If the allegation being reviewed involves facts that you know are not true, see if you can obtain evidence of this. For example, I had a case where nursing staff filed a complaint against my client a male OB/GYN claiming that the mother of a minor female patient had demanded that her daughter only be examined by a female doctor. We are able to obtain an affidavit from the mother swearing that she had never stated that. The peer review matter was dismissed and closed.

17. If it appears that you are being targeted for repeated peer review complaints or investigations, it is time to get out of that place. Read the handwriting on the wall. However, see #1 above. Do not resign with any type of peer review pending.

18. Remember that peer review proceedings are supposed to be confidential. Therefore work through your legal counsel in obtaining outside reviews. Do not discuss the matter with those outside the medical staff.

19. Although the peer-review process is confidential, it is not supposed to be “secretive.” The person who is the subject of peer review should have access to the complaint and medical records involved. This should not be a Star Chamber proceeding. Make a polite written request for copies of such materials or to be allowed to review them and make notes.

20. In many cases, you may find that you did make a mistake, violate a policy or procedure, skip a step in an algorithm, fall below the standard of care, or otherwise screw up. Except in cases of the most egregious situations, your best course o action may be to admit this, explain how this happened, and outline steps you are taking to make sure it does not happen again. This is especially true when it is your first “offense” and you have many years of otherwise excellent performance. The medical staff usually wants to make sure that when a mistake occurs, the health provider has the ability to recognize it and learn from it.

Follow These Tips for The Best Results in a Peer Review Matter.

If you follow these tips, you have the best chance of coming out of the peer review without problems. However, in a really serious case, where many records are being reviewed and the allegations appear to be very serious, then it is most important to retain an experienced health care attorney at the earliest opportunity and take that attorney’s advice. You will be in for the fight of your professional life.

Click here to read Part 1 of this Blog.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in the Process of Peer Review Hearings.

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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer-review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians, health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.
Copyright © 2019 The Health Law Firm. All rights reserved.

Tips to Prepare For Clinical Privileges and Peer Review Hearings Part 2

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In Part 1 of this blog, I began a list of tips that should serve you well if you are notified by your hospital or medical staff that you are the subject of an internal or external peer review action.

Click here to read Part 1.

20 Tips For Successful Outcome in Peer Review (Continued):

10. If you are given the opportunity to meet with the reviewers or provide information to them, do so. If you haven’t been offered this, ask for it in writing.

11. Make sure any written response is provided in a typewritten letter formal not via e-mail, text or YouTube posting or handwritten note.

12. In your written statement or response, if you use any abbreviations, spell them out completely the first time you use them and place the abbreviation after, in parentheses. Remember, future reviews of your statement may not be physicians (e.g., a judge) or may not be in your medical specialty.

13. It is never too early to engage experienced health car legal counsel to assist you in such matters. But if you do, make sure you do hire an actual health law attorney who has experience with medical staff peer review actions. This is no place for a plaintiff’s personal injury attorney, a criminal defense attorney or your tax, or business lawyer.

14. If you find out that your matter is being sent out to an external peer review organization you should retain an experienced health law attorney immediately and obtain your own medical expert review.

15. If the care being examined involved another physician as well as you, or if the care was of a patient referred by another physician, see if that physician supports the care you provided and will provide you a letter or statement saying that.

16. If the allegation being reviewed involves facts that you know are not true, see if you can obtain evidence of this. For example, I had a case where nursing staff filed a complaint against my client a male OB/GYN claiming that the mother of a minor female patient had demanded that her daughter only be examined by a female doctor. We are able to obtain an affidavit from the mother swearing that she had never stated that. The peer review matter was dismissed and closed.

17. If it appears that you are being targeted for repeated peer review complaints or investigations, it is time to get out of that place. Read the handwriting on the wall. However, see #1 above. Do not resign with any type of peer review pending.

18. Remember that peer review proceedings are supposed to be confidential. Therefore work through your legal counsel in obtaining outside reviews. Do not discuss the matter with those outside the medical staff.

19. Although the peer-review process is confidential, it is not supposed to be “secretive.” The person who is the subject of peer review should have access to the complaint and medical records involved. This should not be a Star Chamber proceeding. Make a polite written request for copies of such materials or to be allowed to review them and make notes.

20. In many cases, you may find that you did make a mistake, violate a policy or procedure, skip a step in an algorithm, fall below the standard of care, or otherwise screw up. Except in cases of the most egregious situations, your best course o action may be to admit this, explain how this happened, and outline steps you are taking to make sure it does not happen again. This is especially true when it is your first “offense” and you have many years of otherwise excellent performance. The medical staff usually wants to make sure that when a mistake occurs, the health provider has the ability to recognize it and learn from it.

Follow These Tips for The Best Results in a Peer Review Matter.

If you follow these tips, you have the best chance of coming out of the peer review without problems. However, in a really serious case, where many records are being reviewed and the allegations appear to be very serious, then it is most important to retain an experienced health care attorney at the earliest opportunity and take that attorney’s advice. You will be in for the fight of your professional life.

Click here to read Part 1 of this Blog.

For more information, read one of my prior blogs on peer review hearings, avoiding the disruptive physician label and clinical privileges.

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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians, health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.
Copyright © 2019 The Health Law Firm. All rights reserved.

Tips to Prepare For Clinical Privileges and Peer Review Hearings Part 1

Attorney Indest headshotIf you are a physician or licensed other licensed health professional with clinical privileges in a hospital, chances are that one day you will be subject to peer review hearings. It may be a simple one-time matter based on an adverse outcome, or it may be a lengthy process involving a large number or your 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 be begun because of an unexpected adverse outcome. It may be begun because a patient files a medical malpractice lawsuit. It may result from a statistical review by the Utilization Review office or 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 Should Not Be Treated Lightly.

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 Hearings.

The 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.

1. Do not resign or allow your clinical privileges to expire while the matter is pending. If you do so, this will be treated similarly to having your privileges revoked in clinical privileges matters 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.

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 reference 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 a title page, publication info, date, volume, pages, etc.

To find out the rest of the tips, don’t miss Part 2 of this blog series.

For more information, read one of my prior blogs on peer review hearings, avoiding the disruptive physician label and clinical privileges.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in Clinical Privileges and the Peer Review Process.

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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer-review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians, health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.
Copyright © 2019 The Health Law Firm. All rights reserved.

Inmates Family Sues Jail After Improper Care

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Orange Country Jail Sued.

A wrongful death suit has been filed against Orange County Jail due to what some are saying was a preventable death.  The suit was filed directly against Robert Buck, the head of the jails health services department, along with four nurses that cared for the late inmate.

Dog Bites Leads to Death In Jail.

In 2015, Max Gracia was arrested. During his arrest, he sustained many bites from one of the police dogs. He was treated in the hospital until he was stable. Once he was moved to the jail cell he was found unconscious and later died in the hospital. The autopsy reported that he died from an E Coli infection that stemmed from the dog bites. His mother, Willine Gracia, has filed the wrongful death suit claiming that her son received subpar care and as a result died.

Claimants Allege “A Culture of Neglect.”

Reportedly the medical staff of the jail stated that Garcia was exaggerating or faking the illness. The lawsuit claims the jail has a “culture of neglect”and this was really what was at work here.  Willine Gracia states that she hopes that this lawsuit will bring attention to the wrongful health care services so many inmates receive.

Providing Representation For All Health Care Professionals.

Our firm has represented a number of nurses, physicians and other health care professionals who provide care in jails and prisons, as well as in other government facilities and institutions.  We routinely represent physicians, nurses and advance practice nurses who work for the VA, the Department of Health, the county, the military, the Indian Health Service and other government agencies.  Although government employees may have personal immunity from civil suits, they are not protected against termination and other employment actions, complaints against their professional license, National Practitioner Data Bank reports, and other types of administrative actions;  our firm represents them in all of these.  The government is not going to represent you in these.  Call us at the first sign of a legal problem.
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.

Sources:

Hayes, Christal. “Family Sues Orange County Jail, Nursing Staff after Inmate’s Death from Police-Dog Bite.” OrlandoSentinel.com, 1 Aug. 2017. (Print).

Walden, Tiffany. “Inmate Son Suffered Seizure before Death, Mom.” Orlando Sentinel. (16 Aug. 2016). Web.

Key Words: Legal representation for government physicians, legal representation for government nurses, legal defense of professional licensure cases, legal representation for Board of Nursing cases, legal representation for Board of Medicine cases, Board of Nursing investigation defense attorney, legal representation for peer review, legal representation for administrative actions, legal representation for VA physicians, legal representation for VA nurses,  health care lawyer, The Health Law Firm reviews

“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.Copyright © 2017 The Health Law Firm. All rights reserved.

 

Mentally Ill Inmate Gouges Out Own Eyes, Sues County for Negligence

5571 darken lighten center w skin softBy Carole C. Schriefer, R.N., J.D.

On December 7, 2017, a mentally ill inmate in the Boulder, Colorado, jail sued a sheriff in federal court, claiming that the jail staff failed to stop the man from using his fingers to gouge out his own eyes after several prior attempts to do so. The inmate sued him and 21 other jail employees in U.S. District Court in Denver. He claimed that he blinded himself because they failed to heed warning signs to treat his mental illness, according to the civil lawsuit filed by his Denver civil rights attorneys.

Inmate Negligence.

The inmate, who is now blind and suffers from deep, severe schizophrenic psychosis, is seeking monetary awards for negligence, including compensatory damages for physical and psychological injuries including pain and emotional distress and humiliation. He suffers from auditory and visual hallucinations, delusions and paranoia, according to the lawsuit.

On December 17, 2016, the inmate curled up in a ball in his cell with fingernails that hadn’t been cut for six weeks and plucked both of his eyes “completely out of his head,” the lawsuit says. The lawsuit also says jailers failed to respond to a series of precursor events in which the inmate said he would gouge his eyes out. In early 2016, he banged his head into his toilet, breaking seven teeth, the lawsuit says. Additionally, there were several prior attempts by the inmate to committed suicide.

Shane McGurk, the jail’s mental health program director, sought an emergency court order to get him psychiatric treatment. The judge ordered deputies to immediately take him to get psychiatric treatment. However, according to the lawsuit, the orders were ignored and the “Defendants’ willful and deliberate indifference to the inmate’s serious medical needs directly led to his self-mutilation, head and vertebrae injury, broken teeth and ultimately, to his permanent blindness.”

The jail failed to properly train officers in how to care for a mentally ill inmate, the lawsuit said.

This is not the first time an inmate or their families have sued for improper care during incarceration. Click here to read one of my prior blogs on a similar case.

It is an unfortunate reality that our society today tends to ignore citizens with true and severe mental health illnesses, choosing to treat them as criminals, instead. Instead of allocating funds for treatment, acting in a preventative manner, it prefers to spend the money for prisons and paying for incarceration. This is a complete shame. This poor, mentally ill individual suffers the consequences. Unfortunately, the officials who run our jails and prisons also suffer by being the treater of last resort, which is grossly unfair to them, as well. Our jail and prison officials should have a “safety relief valve” available to them where they can divert individuals who have been incarcerated because of their mental illnesses and obtain appropriate treatment for them.

Providing Representation For All Health Care Professionals.

Our firm has represented a number of nurses, physicians and other health care professionals who provide care in jails and prisons, as well as in other government facilities and institutions. We routinely represent physicians, nurses and advance practice nurses who work for the VA, the Department of Health, the county, the military, the Indian Health Service and other government agencies. Although government employees may have personal immunity from civil suits, they are not protected against termination and other employment actions, complaints against their professional license, National Practitioner Data Bank reports, and other types of administrative actions; our firm represents them in all of these. The government is not going to represent you in these. Call us at the first sign of a legal problem.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Mitchell, Kirk. “Mentally Ill inmate sues for negligence.” The Denver Post. (December 8, 2017). Web.

Mitchell, Kirk. “Psychotic Boulder jail inmate gouges out own eyes, sues county for negligence.” The Denver Post. (December 7, 2017). Web.

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

KeyWords: Legal representation for government physicians, legal representation for government nurses, legal representation for mental health professionals, mental health defense attorney, legal representation of mental health counselors, mental health counselor defense attorney, legal defense of professional licensure cases, legal representation for Board of Nursing cases, legal representation for Board of Medicine cases, Board of Nursing investigation defense attorney, legal representation for peer review, legal representation for administrative actions, legal representation for health care professionals, legal representation for psychiatrists, psychiatrists defense attorney, defense counsel for mental health professionals, health care lawyer, The Health Law Firm reviews

“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.Copyright © 2017 The Health Law Firm. All rights reserved.

20 Tips to Help You Survive Facing Peer Review for Your Hospital Clinical Privileges-Part 2 of 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In Part 1 of this blog I began a list of tips that should serve you well if you are notified by your hospital or medical staff that you are the subject of an internal or external peer review action. Click here to read Part 1.

20 Tips For Successful Outcome in Peer Review (Continued):

10.    If you are given the opportunity to meet with the reviewers or provide information to them, do so.  If you haven’t been offered this, ask for it in writing.

11.    Make sure any written response is provided in a typewritten letter formal not via e-mail, text or YouTube posting or handwritten note.

12.    In your written statement or response, if you use any abbreviations, spell them out completely the first time you use them and place the abbreviation after, in parentheses.  Remember, future reviews of your statement may not be physicians (e.g., a judge) or may not be in your medical specialty.

13.    It is never too early to engage experienced health car legal counsel to assist you in such matter.  But if you do, make sure you do hire an actual health law attorney who has experience with medical staff peer review actions.  This is no place for a plaintiff’s personal injury attorney, a criminal defense attorney or your tax, or business lawyer.

14.    If you find out that your matter is being sent out to an external peer review organization you should retain an experienced health law attorney immediately and obtain your own medical expert review.

15.    If the care being examined involved another physician as well as you, or if the care was of a patient referred by another physician, see if that physician supports the care you provided and will provide you a letter or statement saying that.

16.    If the allegation being reviewed involves facts that you know are not true, see if you can obtain evidence of this.  For example, I had a case where nursing staff filed a complaint against my client a male OB/GYN claiming that the mother of a minor female patient had demanded that her daughter only be examined by a female doctor.  We are able to obtain an affidavit from the mother swearing that she had never stated that.  The peer review matter was dismissed and closed.

17.    If it appears that you are being targeted for repeated peer review complaints or investigations, it is time to get out of that place.  Read the handwriting on the wall.  However , see #1 above.  Do not resign with any type of peer review pending.

18.    Remember that peer review proceedings are supposed to be confidential.  Therefore work through your legal counsel in obtaining outside reviews.  Do not discuss the matter with those outside the medical staff.

19.    Although the peer review process is confidential, it is not supposed to be “secretive.”  The person who is the subject of peer review should have access to the complaint and medical records involved.  This should not be a Star Chamber proceeding.  Make a polite written request for copies of such materials or to be allowed to review them and make notes.

20.    In many cases, you may find that you did make a mistake, violate a policy or procedure, skip a step in an algorithm, fall below the standard of care, or otherwise screw up.  Except in cases of the most egregious situations, your best course o action may be to admit this, explain how this happened, and outline steps you are taking to make sure it does not happen again.  This is especially true when it is your first “offense” and you have many years of otherwise excellent performance.  The medical staff usually wants to make sure that when a mistake occurs, the health provider has the ability to recognize it and learn from it.

Follow These Tips for The Best Results in a Peer Review Matter.

If you follow these tips, you have the best chance of coming out of the peer review without problems.  However, in a really serious case, where many records are being reviewed and the allegations appear to be very serious, then it is most important to retain an experienced health care attorney at the earliest opportunity and take that attorney’s advice.  You will be in for the fight of your professional life.

Click here to read Part 1 of this Blog
.

For more information, read one of my prior blogs on peer review, avoiding the disruptive physician label and clinical privileges.


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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians,  health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.
Copyright © 2018 The Health Law Firm. All rights reserved.

Houston Heart Surgeon Wins $6.4 Million Defamation Case Regarding Peer Review

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On March 29, 2017, a Houston heart surgeon was awarded $6.4 million in damages after a jury found that Memorial Hermann Health System (Memorial) defamed his reputation. The suit arose out of a peer review proceeding against Dr. Miguel Gomez. He claimed that the peer review was not about the quality of health care, but was to retaliate against him for moving his lucrative practice to a competing hospital.

Dr. Gomez sued Memorial in 2012, contending the hospital launched a “whisper campaign” to smear his reputation to keep patients from following him to his new location.

Hospitals and Peer Review.

Dr. Gomez’s case involved peer review, a confidential process conducted by committees of physicians to detect and discipline physicians whose quality of care is not up to par. Traditionally, it had been used solely to protect patients from physicians whose medical skills are not what they should be or who have a number of adverse outcomes. Dr. Gomez alleged that Memorial completely misused the peer review process, manipulating data on the outcome of his surgeries to suggest that his patients were more likely to die than those of other surgeons.

This case may help open the eyes of the public and the courts to the many cases in which this happens. It highlighted the fierce battle among hospitals for market share and the lengths to which they may go to protect their territory. Hospitals fight hard to hold onto specialists like Dr. Gomez, who perform procedures with high profit margins and who bring in a large amount of income to the hospital.

For more information on the importance of the peer review process, click here to visit our web page.

The Jury’s Verdict in an Unusual Case.

The jury determined that a comment from a Memorial employee about Gomez’s “bad quality, high mortality rates, unnecessary surgeries,” was false and damaged Gomez’s reputation. The jury also found that another employee’s comment about Memorial’s decision to share Gomez’s peer review data with referring cardiologists was false and defamatory. Additionally, the jury also found Memorial acted with malice by making false statements about the surgical competence of Dr. Gomez.

Peer Review Privilege Difficult to Overcome for a Physician Plaintiff.
The federal Health Care Quality Improvement Act (HCQIA) provides a privilege from civil liability for hospitals and medical staff members involved in the peer review process. Additionally, most states have state laws in place which provide even greater protections from suits such as the one field by Dr. Gomez. This greatly stacks the deck against physicians who are wronged by such misconduct and makes it very hard for them to receive justice, especially in the court system. Often a physician seeking relief from the courts must plead and prove “intentional malice”or “intentional fraud” by those involved, or some other standard that is artificially high and difficult to overcome.

Dr. Gomez’s case is a rare one. Most cases such as this do not make it to trial. They are either dismissed by the courts on motions to dismiss or for summary judgment, or they are settled.

Economic Credentialing or Sham Peer Review.

What Dr. Gomez was subjected to is known as “economic credentialing.” This is when decisions are made by a hospital or medical staff to take adverse action against a physician based on monetary or income factors instead of based on quality of care standards. Given that peer review is supposed to be based on protecting patients from those with substandard medical skills, using the peer review process because of economic considerations is a corruption of the peer review process.

Most often physicians find themselves the victim of such phony or sham peer review complaints filed by a competing physician or medical group. Our firm is routinely consulted by physicians complaining of such actions. However, often the physician does not have the financial resources to fight a protracted peer review battle and then proceed in court, if necessary, as Dr. Gomez did. Hospitals and medical staff leadership need to become more sensitive to this issue and act to stop such proceedings when there is clearly little or no evidence of a physician’s incompetence. Unfortunately, they most often do not.

As Dr. Gomez’s verdict shows, hospitals do improperly use the peer review process to protect market share by targeting doctors who don’t funnel business to their facilities and networks. This verdict should send a strong message to hospitals about the consequences of misusing the peer review process for business purposes.

To read one of my prior blogs on the confidentiality of peer review, click here.

Will Dr. Gomez’s Case Survive Appeal?

The real question is whether or not Dr. Gomez’s case will survive appellate review. Other court cases have made it as far as Dr. Gomez’s case only to be reversed by an appellate court. Hopefully, the evidence and legal arguments made in this trial will be sufficient to convince any court of appeals that the jury and trial judge’s decisions were correct. Otherwise, it will stand for the proposition that individual physicians have no remedy for such egregious and intentional misconduct.

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.

Sources:

Sexel. L.M. “Heart surgeon wins $6.4 million verdict in defamation case against Memorial Hermann.” Houston Chronicle. (March 29, 2017). Web.

Kane Russell Coleman Logan PC. “Houston Physician Wins Defamation Suit in Connection with Peer Review.” AHLA Weekly. (March 30, 2017). Web.

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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, legal representation for cases of improper restraint of trade, health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.
Copyright © 2017 The Health Law Firm. All rights reserved.

20 Tips to Help You Survive Facing Peer Review for Your Hospital Clinical Privileges-Part 2 of 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In Part 1 of this blog I began a list of tips that should serve you well if you are notified by your hospital or medical staff that you are the subject of an internal or external peer review action. Click here to read Part 1.

20 Tips For Successful Outcome in Peer Review (Continued):

10.    If you are given the opportunity to meet with the reviewers or provide information to them, do so.  If you haven’t been offered this, ask for it in writing.

11.    Make sure any written response is provided in a typewritten letter formal not via e-mail, text or YouTube posting or handwritten note.

12.    In your written statement or response, if you use any abbreviations, spell them out completely the first time you use them and place the abbreviation after, in parentheses.  Remember, future reviews of your statement may not be physicians (e.g., a judge) or may not be in your medical specialty.

13.    It is never too early to engage experienced health car legal counsel to assist you in such matter.  But if you do, make sure you do hire an actual health law attorney who has experience with medical staff peer review actions.  This is no place for a plaintiff’s personal injury attorney, a criminal defense attorney or your tax, or business lawyer.

14.    If you find out that your matter is being sent out to an external peer review organization you should retain an experienced health law attorney immediately and obtain your own medical expert review.

15.    If the care being examined involved another physician as well as you, or if the care was of a patient referred by another physician, see if that physician supports the care you provided and will provide you a letter or statement saying that.

16.    If the allegation being reviewed involves facts that you know are not true, see if you can obtain evidence of this.  For example, I had a case where nursing staff filed a complaint against my client a male OB/GYN claiming that the mother of a minor female patient had demanded that her daughter only be examined by a female doctor.  We are able to obtain an affidavit from the mother swearing that she had never stated that.  The peer review matter was dismissed and closed.

17.    If it appears that you are being targeted for repeated peer review complaints or investigations, it is time to get out of that place.  Read the handwriting on the wall.  However , see #1 above.  Do not resign with any type of peer review pending.

18.    Remember that peer review proceedings are supposed to be confidential.  Therefore work through your legal counsel in obtaining outside reviews.  Do not discuss the matter with those outside the medical staff.

19.    Although the peer review process is confidential, it is not supposed to be “secretive.”  The person who is the subject of peer review should have access to the complaint and medical records involved.  This should not be a Star Chamber proceeding.  Make a polite written request for copies of such materials or to be allowed to review them and make notes.

20.    In many cases, you may find that you did make a mistake, violate a policy or procedure, skip a step in an algorithm, fall below the standard of care, or otherwise screw up.  Except in cases of the most egregious situations, your best course o action may be to admit this, explain how this happened, and outline steps you are taking to make sure it does not happen again.  This is especially true when it is your first “offense” and you have many years of otherwise excellent performance.  The medical staff usually wants to make sure that when a mistake occurs, the health provider has the ability to recognize it and learn from it.

Follow These Tips for The Best Results in a Peer Review Matter.

If you follow these tips, you have the best chance of coming out of the peer review without problems.  However, in a really serious case, where many records are being reviewed and the allegations appear to be very serious, then it is most important to retain an experienced health care attorney at the earliest opportunity and take that attorney’s advice.  You will be in for the fight of your professional life.

Click here to read Part 1 of this Blog
.

For more information, read one of my prior blogs on peer review, avoiding the disruptive physician label and clinical privileges.


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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians,  health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.
Copyright © 2018 The Health Law Firm. All rights reserved.

Inmates Family Sues Jail After Improper Care

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Orange Country Jail Sued.

A wrongful death suit has been filed against Orange County Jail due to what some are saying was a preventable death.  The suit was filed directly against Robert Buck, the head of the jails health services department, along with four nurses that cared for the late inmate.

Dog Bites Leads to Death In Jail.

In 2015, Max Gracia was arrested. During his arrest, he sustained many bites from one of the police dogs. He was treated in the hospital until he was stable. Once he was moved to the jail cell he was found unconscious and later died in the hospital. The autopsy reported that he died from an E Coli infection that stemmed from the dog bites. His mother, Willine Gracia, has filed the wrongful death suit claiming that her son received subpar care and as a result died.

Claimants Allege “A Culture of Neglect.”

Reportedly the medical staff of the jail stated that Garcia was exaggerating or faking the illness. The lawsuit claims the jail has a “culture of neglect”and this was really what was at work here.  Willine Gracia states that she hopes that this lawsuit will bring attention to the wrongful health care services so many inmates receive.

Providing Representation For All Health Care Professionals.

Our firm has represented a number of nurses, physicians and other health care professionals who provide care in jails and prisons, as well as in other government facilities and institutions.  We routinely represent physicians, nurses and advance practice nurses who work for the VA, the Department of Health, the county, the military, the Indian Health Service and other government agencies.  Although government employees may have personal immunity from civil suits, they are not protected against termination and other employment actions, complaints against their professional license, National Practitioner Data Bank reports, and other types of administrative actions;  our firm represents them in all of these.  The government is not going to represent you in these.  Call us at the first sign of a legal problem.
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.

Sources:

Hayes, Christal. “Family Sues Orange County Jail, Nursing Staff after Inmate’s Death from Police-Dog Bite.” OrlandoSentinel.com, 1 Aug. 2017. (Print).

Walden, Tiffany. “Inmate Son Suffered Seizure before Death, Mom.” Orlando Sentinel. (16 Aug. 2016). Web.

Key Words: Legal representation for government physicians, legal representation for government nurses, legal defense of professional licensure cases, legal representation for Board of Nursing cases, legal representation for Board of Medicine cases, Board of Nursing investigation defense attorney, legal representation for peer review, legal representation for administrative actions, legal representation for VA physicians, legal representation for VA nurses,  health care lawyer, The Health Law Firm reviews

“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.Copyright © 2017 The Health Law Firm. All rights reserved.

 

Mentally Ill Inmate Gouges Out Own Eyes, Sues County for Negligence

7 Indest-2008-4By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 7, 2017, a mentally ill inmate in the Boulder, Colorado, jail sued Sheriff Joe Pelle in federal court, claiming that the jail staff failed to stop the man from using his fingers to gouge out his own eyes after several prior attempts to do so. Ryan Partridge sued Pelle and 21 other jail employees in U.S. District Court in Denver. He claimed that he blinded himself because they failed to heed warning signs to treat his mental illness, according to the civil lawsuit filed by Denver civil rights attorneys David Lane and Kathryn Stimson.

Inmate Negligence.

The inmate, who is now blind and suffers from deep, severe schizophrenic psychosis, is seeking monetary awards for negligence, including compensatory damages for physical and psychological injuries including pain and emotional distress and humiliation. He suffers from auditory and visual hallucinations, delusions and paranoia, according to the lawsuit.

On December 17, 2016, Partridge curled up in a ball in his cell with fingernails that hadn’t been cut for six weeks and plucked both of his eyes “completely out of his head,” the lawsuit says. The lawsuit also says jailers failed to respond to a series of precursor events in which the inmate said he would gouge his eyes out. In early 2016, he banged his head into his toilet, breaking seven teeth, the lawsuit says. Additionally, there were several prior attempts by the inmate to committed suicide.

Shane McGurk, the jail’s mental health program director, sought an emergency court order to get him psychiatric treatment. The judge ordered deputies to immediately take him to get psychiatric treatment. However, according to the lawsuit, the orders were ignored and the “Defendants’ willful and deliberate indifference to Mr. Partridge’s serious medical needs directly led to his self-mutilation, head and vertebrae injury, broken teeth and ultimately, to his permanent blindness.”

The jail failed to properly train officers in how to care for a mentally ill inmate, the lawsuit said.

This is not the first time an inmate or their families have sued for improper care during incarceration. Click here to read one of my prior blogs on a similar case.

It is an unfortunate reality that our society today tends to ignore citizens with true and severe mental health illnesses, choosing to treat them as criminals, instead. Instead of allocating funds for treatment, acting in a preventative manner, it prefers to spend the money for prisons and paying for incarceration. This is a complete shame. This poor, mentally ill individual suffers the consequences. Unfortunately, the officials who run our jails and prisons also suffer by being the treater of last resort, which is grossly unfair to them, as well. Our jail and prison officials should have a “safety relief valve” available to them where they can divert individuals who have been incarcerated because of their mental illnesses and obtain appropriate treatment for them.

Providing Representation For All Health Care Professionals.

Our firm has represented a number of nurses, physicians and other health care professionals who provide care in jails and prisons, as well as in other government facilities and institutions. We routinely represent physicians, nurses and advance practice nurses who work for the VA, the Department of Health, the county, the military, the Indian Health Service and other government agencies. Although government employees may have personal immunity from civil suits, they are not protected against termination and other employment actions, complaints against their professional license, National Practitioner Data Bank reports, and other types of administrative actions; our firm represents them in all of these. The government is not going to represent you in these. Call us at the first sign of a legal problem.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Mitchell, Kirk. “Mentally Ill inmate sues for negligence.” The Denver Post. (December 8, 2017). Web.

Mitchell, Kirk. “Psychotic Boulder jail inmate gouges out own eyes, sues county for negligence.” The Denver Post. (December 7, 2017). Web.

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.

KeyWords: Legal representation for government physicians, legal representation for government nurses, legal representation for mental health professionals, mental health defense attorney, legal representation of mental health counselors, mental health counselor defense attorney, legal defense of professional licensure cases, legal representation for Board of Nursing cases, legal representation for Board of Medicine cases, Board of Nursing investigation defense attorney, legal representation for peer review, legal representation for administrative actions, legal representation for health care professionals, legal representation for psychiatrists, psychiatrists defense attorney, defense counsel for mental health professionals, health care lawyer, The Health Law Firm reviews

“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.Copyright © 2017 The Health Law Firm. All rights reserved.

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