Until my retirement three years ago I was Associate Director for Research and Disputes for HRSA's National Practitioner Data Bank. For over 10 years I read every Secretarial Review request, assigned every case to staff reviewers, and approved every decision before forwarding it for final approval and signature by the Director. In other words, I have great familiarity with this matter.
Before turning to the eight suggestions, I must take issue with the implication that a report to the NPDB can destroy a career. It is the underlying actions that hurt careers, not reports to the Data Bank. Applications for licensure, privileges, etc., require physicians to disclose more than is required to be reported to the Data Bank. For example, the Data Bank does not require reporting of pending cases; applications do. Honest physicians have nothing to fear from Data Bank reports; they have to disclose the same information regardless of the Data Bank.
It also should be noted that there are thousands of physicians with multiple reports in the Data Bank who continue to practice and, often, to have even more actions taken against them and reported. If the Data Bank ended careers, physicians would not continue to have action after action taken against them.
The fundamental problem with medical peer review today is that there are large segments of medical practice that are more art than science and that all professionals are human beings and occasionally make mistakes. The system of peer review provided under the Health Care Quality Improvement Act of 1986 (“HCQIA”) sets up an intensely adversarial system in which those privileged to review their peers are not accountable for bias, bad faith or malice if there is any colorable justification for complaint about the judgment or quality of care provided by the reviewed physician. Further, the results can destroy a peer reviewed physician who may up with a “record” in the National Practitioner Data Bank.
This is a series describing the ten important pro-immunity peer review cases where court have granted immunity to peer reviewers under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”).
No. 2: Singh v. Blue Cross and Blue Shield, Inc. of Massachusetts, 308 F. 3d 25 ( 1st Cir., 2002)
Dr. Singh, an internist, filed suit against the Blues of Massachusetts and an independent consultant over a recommendation for his exclusion from insurance plans based on concerns over the allegedly excessive use of pain medication for chronic problems and usually lengthy regimens of antibiotics for his patients. He sued for breach of contract, tortious interference with business relationships with patients, defamation and violation of state consumer protection statutes. After a “fair hearing” his exclusion was reversed and he was reinstated as a provider in the insurer’s system.
This is a series describing the ten important pro-immunity peer review cases where court have granted immunity to peer reviewers under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”).
No. 5: Bryan v. James E. Holmes Regional Medical Center, 33 F.3d 1318 (11th Cir. 1994).
Dr. Bryan received a $4.2 Million Dollar breach of contract award by a federal jury in the case in the District Court. The 11th Circuit Court of Appeals reversed. Dr. Bryan was by all accounts an excellent surgeon, but a less than competent human being. He was known to be ‘volcanic tempered perfectionist,” with an odd sense of humor. (He told a nurse that her patient had hanged himself in his room, to keep her on her toes.) The hospital and the medical staff tried a variety of graduated suspensions to try to curb Dr. Byran’s behavior. He had a penchant for slapping nurses on their hands when he disliked their performances. He collected over 50 written complaint reports from various staff.
This is a series describing the ten important pro-immunity peer review cases where court have granted immunity to peer reviewers under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”).
No. 6: Brader v. Allegheny General Hospital,167 F. 3d 832 (3d Cir. 1999)
Dr. Brader, a surgeon with a history of disruptive conduct within Allegheny hospital, tried to attack the dismissal of his lawsuit against the hospital on the by attacking the validity data and conclusions set forth in several reports undertaken by outside and inside hospital reviewers concerning his preoperative and intraoperative judgments as a means of establishing bias on the part of the hospital decision makers. The Court again warned that the standard under immunity has nothing to do with getting the facts right or wrong, it simply comes down to whether the defendants were operating in a reasonable belief that they were furthering quality health care and making reasonable efforts to gather the relevant facts.
This is a series describing the ten important pro-immunity peer review cases where court have granted immunity to peer reviewers under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”).
No. 7: Meyers v. Columbia/HCA Healthcare Corp., 341 F 3d 461 (6th Cir., 2003)
Dr. Robert Meyers applied for and received provisional privileges at Logan Memorial Hospital in Russellville, Kentucky. He applied for active privileges a year later and met resistance because of a history of disruptive conduct at other facilities, a less than candid disclosure of his past problems with medical staffs and concerns over the quality of his care. Dr. Meyers admitted that he had a “personality problem.” The Hospital Board of Trustees appointed a hearing committee of non-physicians because of Dr. Meyer’s complaints about competitors sitting on his investigation panels. The Board voted to deny him privileges because of his inability to work cooperatively with others and his failure to meet the ethical standards of the facility.
This is a series describing the ten important pro-immunity peer review cases where court have granted immunity to peer reviewers under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”).
No. 8: Gabaldoni, M.D. v. Washington County Hospital Association et al., 250 F. 3d 255 (4th Cir., 2001)
Dr. Gabaldoni, was an obstetrician/gynecologist practicing in Virginia. and the holder of hospital privileges at Washington County Hospital Association (“WCHA”). In 1995 he applied for a two year extension of his privileges. The WCHA Board of Trustees elected to deny his request for an extension of privileges and to terminate his existing privileges.The grounds given included his alteration of the chart of a patient who died while under his care; multiple grievances regarding clinical judgment and the number of malpractice complaints settled on his behalf.
This is a series describing the top ten “no immunity” sham peer review cases where defendants’ motions for summary judgment based upon the immunity provided under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”) were denied in state or federal courts.
NUMBER 1: Brown v. Presbyterian Healthcare Services et al; 101 F.3d 1324 ( 10th Cir. 1996)
This case arose in the enchanted state of New Mexico. The Plaintiff, Arlene M. Brown, M.D. was a family practice physician in Riodoso, New Mexico. Also practicing in Riodoso was Dr. Vickie Willliams andOB/Gyn Physician and an economic competitor of Dr. Brown, who particip
This is a series describing the top ten “no immunity” sham peer review cases where defendants’ motions for summary judgment based upon the immunity provided under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”) were denied in state or federal courts.
NUMBER 2: Clark v. Columbia/HCA Information Services, Inc. , 25 P 3d 215 (Nev. 2001).
Dr. Clark was a child psychiatrist with privileges at West Hills Hospital in Reno owned by Columbia/HCA. The medical staff made him the subject of peer review for “disruptive conduct:” because he complained to outside third parties about the quality of psychiatric care provided to children in the hospital and had policies regarding pre-mature discharges of patients when their insurance money ran out. The hospital raised other quality of care issues, but the prosecution of the peer review issues centered on his so-called disruptive conduct or whistle-blowing. He first filed an antitrust claim in federal court where he was dismissed out because of a lack of evidence to support those claims. The federal judge indicated that his claims would probably be barred by HCQIA immunity anyway.
This is a series describing the top ten “no immunity” sham peer review cases where defendants’ motions for summary judgment based upon the immunity provided under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”) were denied in state or federal courts.
NUMBER 7: In Re: Peer Review Action, 749 N.W. 2d 822 (Minn. Ct. App 2008)
This was an action against an anonymous physician who appears to be a surgeon for imposition of a 120 suspension and 5 years probation for disruptive conduct. The hospital had a disruptive physician policy that provided for graduated sanctions with notice and the opportunity to develop conflict resolution skills. The hospitals Vice-President of Medical Services commenced an investigation of the physician on the basis of claims of disruptive conduct with only one specific date mentioned where the physician was alleged to have been “uncompromising with an anesthesiologist”, where he or she lost his or her temper and let forth a stream of profanity. (We know this is a male don’t we?) During the process of addressing this issue before a hearing committee the committee found ample evidence of disruptive behavior and did not address the physician’s concern about the lack of notice and opportunity to self correct.
