Abusive, powerful physicians within the hospital structure abuse competition by unfairly micro-inspecting medical charts, and commonly nit-picking behavior that they like to characterize as disruptive and dangerous to the providing of good patient care.
Peer review committees must be held to the highest ethical standards because of the disastrous effect that they can have on a physician's reputation and livelihood when they make factually unfounded allegations against a fellow physician.
IT IS MY OPINION THAT THOSE TAKING PART IN THE PEER REVIEW PROCESS BE SUBJECT TO SUITS FOR LIBEL AND DEFAMATION. HONEST PEER REVIEWERS SHOULD HAVE NOTHING TO FEAR FROM BEING HELD UP TO THE LIGHT OF REVIEW.
GENERAL COMMENTARY: If you, as a hospital staff member, have any suspicion, however small, that you may be having or are headed toward a problem, you probably are. The medical staff has the inherent, initial power to suspend or otherwise curtail a physician's activity in the hospital, without a full, proven basis for discipline. Hospital staff physicians are uniquely in danger of irreparable damage to their reputation and practices. Physicians called before peer review bodies must therefore be fully prepared to defend the actions that are alleged to be substandard.
The physician must first request and obtain a full copy of all relevant documents medical records. The subject physician must then review, with an attorney that knows medicine and how to best present the explanations before the peer review body. Prepare a global defense, including a good basic knowledge of the medical issues, and how they are addressed in the current medical literature. Carefully evaluate the attitudes, competence, and background of all adverse witnesses. Marshall your own appropriately chosen witnesses, including expert medical witnesses, as necessary. The initial peer review meeting probably will not permit your witnesses to appear, but they can be very helpful in preparing you for that initial meeting with the peer review committee. The subject physician must maintain a strict, professional attitude, respectful of the peer reviewers. However, one should not be afraid to respectfully disagree with unfounded or unfair criticisms. Careful preparation for peer review sessions is extremely important. Bring relevant notes and memoranda with you to the peer review meeting.
Should the process go beyond the initial peer review meeting, and/or a disciplinary action be taken or proposed, the subject physician is entitled to a judicial review hearing on the merits of the charges against him/her.
The physician should keep a commonly occurring "wrinkle" in mind. If the medical staff cannot find true negligence or incompetence in the physician's care and treatment, the medical staff may take the following steps, if they really want to rid themselves of the subject physician. Those on the peer review panel may try to goad the subject physician into losing his temper, and then declare him as a psychiatrically unfit physician. Their next step is to suspend the physician until the physician takes and passes a psychiatric examination by their chosen psychiatrist. This can be fraught with danger. There are ways to protect oneself in such a situation. Control your anger and always maintain a strictly professional attitude. It may be difficult, but DO it.
Although any disciplinary investigation is supposed to be strictly confidential, news that the subject physician is under investigation, especially for psychiatric reasons, can leak out very readily, thus damaging the physician before he/she has had a chance to defend against the allegations. Vigorous steps should be taken to prevent this from happening.
In my representation of the physician in these circumstances, I aim at a tight control over the various aspects of the case, such as:
In assisting a physician who already has competent counsel to represent him/her, I offer: