Practical Tips for Navigating a Peer Review Hearing
This article was originally published by Much Shelist, P.C. Read it on the Much website.
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Peer review hearings are part of the healthcare system’s structure of checks and balances. Their purpose is to assure that physicians and other medical professionals maintain the highest standards of medical practice. These reviews produce an impartial evaluation of a physician’s performance by their peers. The goal is to hold medical professionals accountable for their work, endorse safety, and support the healthcare system.
The initiation of a peer review hearing often arises from questions surrounding a physician’s clinical competence or professional conduct. These concerns may result from a patient complaint, a series of medical errors, unprofessional conduct, or anxiety about a physician’s health, potentially impacting their ability to practice. In states like California, reporting requirements may also spark a hearing.
The intent of these hearings is not punitive, but rather to address the situation and implement necessary measures to insure patient safety. The structure of a clinical peer review process can vary depending on the role of the medical professional, the situation, and the healthcare institution’s policies.
Practical Tips
If you are the subject of a peer review action, your approach can significantly influence the outcome. The following strategies may help resolve the matter at the lowest possible level:
1. Do Not Resign While the Matter Is Pending
Resigning or allowing your privileges to lapse during an investigation can be treated the same as a revocation. In many cases, it may be reported to the National Practitioner Data Bank (NPDB) and other regulatory bodies, which can have long-term professional consequences.
2. Respond Thoughtfully and Strategically
If you are given the opportunity to submit a written response, take it seriously. Review all relevant medical records, research applicable clinical standards, and prepare a well-organized, objective, and professional explanation.
3. Focus on Your Conduct
The review concerns your actions, not those of colleagues. Avoid deflecting responsibility or making accusations. Address what you did (or did not do) and why.
4. Remain Professional and Composed
Maintain objectivity throughout the process. Avoid emotional or defensive responses. Assume the committee members are performing their responsibilities in good faith.
5. Address Facts, Not Motives
In both written and verbal responses, focus on documented facts. Do not speculate about others’ motivations.
6. Support Statements with Evidence
Base your arguments on verifiable facts, medical records, and established guidelines. If the committee does not have access to certain documentation, such as office records, protocols, published standards, or algorithms, provide copies with your response.
7. Follow Professional Communication Standards
Your written correspondence should reflect professionalism in tone, structure, and clarity. Errors or emotionally charged language can undermine your credibility.
8. Request Complete Records
If you do not have access to all materials being considered, formally request them. Review hospital policies, department procedures, and medical staff bylaws that govern the review process.
9. Cite Authoritative Medical Literature
Where appropriate, support your clinical decisions with references to peer-reviewed journals, textbooks, and accepted guidelines. Attach complete and legible copies, including full publication details (title, authors, publication date, volume, and page numbers).
10. Consult with a Physician Defense Attorney
Contact an experienced physician defense attorney as early as possible. Particularly, one familiar with medical staff bylaws, hospital peer review processes, and reporting requirements.
Potential Outcomes
The outcomes of a peer review hearing can range widely. Committees may find no cause for concern and recommend that no action be taken, which would allow the physician to continue their practice as normal.
Conversely, they might suggest actions that can range from additional training or supervision to implementing restrictions on the physician’s practice. In extreme situations, the committee might recommend suspension or termination of the medical professional’s hospital privileges. An unfavorable outcome from a peer review hearing can have an immediate and lasting impact on a physician’s reputation, career progression, and ability to practice medicine.
Appealing the Outcome
If a physician disagrees with the outcome of a medical board hearing, they may have the right to appeal. The specifics of this process are dependent on the healthcare institution’s policies. They typically require written appeal requests, presenting arguments against the decision, and potentially, a second hearing. Given the potential for further professional and legal repercussions, having a physician defense attorney during an appeal is crucial. In California, a negative appeal outcome may also mandate reporting to the Medical Board, further highlighting the seriousness of these proceedings.
Speak to a Physician Defense Attorney
Fenton Jurkowitz Law Group is well versed in medical peer reviews and has worked with medical professionals through this process. Whether you need assistance understanding the process, building a defense, or appealing the outcome of a clinical peer review, we can help guide you through the appropriate legal processes. If you are looking for a physician peer review lawyer or a healthcare attorney in Los Angeles, reach out and fill out our online contact form.