Singularity Health Law Blog

SHAM PEER REVIEW BOOK INTERVIEW: Greg Piche´

Those that are interested can find an interview of the author of Sham Peer Review by the Denver Press Club at the following link.

http://denver.granicus.com/MediaPlayer.php?view_id=96&clip_id=5585

PEER REVIEW DAMAGES CLAIM WEARS THIN.

“Yo-yo litigation” bouncing back and forth between trial courts and appellate courts is wearing and expensive. Dr. Richard Chudacoff, M.D. should be able to attest to that.  Prior to moving to Las Vegas, Nevada in 2008, he was a renowned minimally invasive gynecological surgeon at Baylor University in Texas. In May of 2008, the University Medical Center of Southern Nevada, where he was an assistant professor, abruptly suspended his clinical privileges without notice or hearing. The action was described as a “routine administrative action” and not a 30 day emergency action based on immanent harm to patients. His university employment terminated because of the loss of his privileges.  The university hospital  forwarded a report of the suspension to the National Practitioner Data Bank in Washington asserting that the suspension resulted from “substandard or inadequate care.” Subsequently the “fair hearing” panel hearing his case disagreed with the grounds for the suspension and sent a recommendation to the Medical Executive Committee that his suspension be lifted and it was, in October, 2008.

PRO-SE DOCTOR WINS SUMMARY JUDGMENT OVERCOMING HCQIA IMMUNITY .

An Albuquerque Obstetrician/Gynecologist, filed a pro-se lawsuit in Federal District Court in New Mexico claiming that a hospital which permanently suspended his privileges deprived him of his civil rights overcame the hospital’s defense of immunity under the Health Care Quality Improvement Act of 1986 (“HCQIA”). In Chinonyerem Osuagwu v. Gila Regional Medical Center, (No. 1:11 -cv-1 3/27/12), Dr. Osuagwu presented evidence that Gila Regional failed to follow its own bylaws and failed to provide him due process in permanently suspending his privileges without meeting the requirements of HCQIA for immunity.  One of the defendants, Dr. Romillard, a non -practicing gynecologist advised the hospital’s peer review committee as to why Dr. O’s privileges should be suspended.

 

SHAM PEER REVIEW OF AFRICAN AMERICAN DOCTOR?

 

Dr. Vincent L. Guinn, an African American Cardiologist, brought a sham peer review suit against Mount Carmel Health and a number of physicians in the U.S. District Court in the Southern District of Ohio.  He alleged two principal federal claims: antitrust conspiracy and monopolization and a violation of his civil rights.  Mt. Carmel summarily suspended Dr. Guinn’s privileges after a colleague alleged that he had placed an intracardial device in a patient “pocket” that had broken down and was infected.  The defendants sought to have the two claims dismissed for lack of standing under a number of different theories. The Court in Guinn v. Mount Carmel Health, et al., S.D. Ohio, No. 2:09-cv-226, 2/27/12, dismissed the antitrust case on the pleadings, but chose to allow Dr. Guinn to move forward with his discrimination case.

 

Comment on "Eight Reforms To Medical Peer Review Post."

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.

EIGHT REFORMS TO MEDICAL PEER REVIEW

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.

 

10 CRITICAL PRO IMMUNITY PEER REVIEW CASES: No 1.

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. 1: Poliner v. Texas Health Systems, 537 F 3d 368 (5th Cir., 2008)

The Fifth Circuit Court of Appeals reversed the $33 Million Dollar Judgment awarded the plaintiff in Poliner. The Poliner case raised a lot of eyebrows both because of the amount of the original damages award of $360 Million Dollars and its success in overcoming immunity claims under the Health Care Quality Improvement Act of 1986 ("HCQIA"). The trial court reduced the award to $33 Million Dollars prior to the appeal.   Dr. Poliner, an interventional cardiologist, claimed that he was forced to agree to an abeyance of his privileges in lieu of a summary suspension and was prevented from performing procedures in the the defendant's catherization laboratory while an investigation was pending, only posted about $10,000 dollars in actual damages. His case went to a jury solely on defamation grounds.

10 CRITICAL PRO IMMUNITY PEER REVIEW CASES: Number 4.

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. 4:   Austin v. McNamera, 979 F.2d 728 (9th Cir., 1992)

Dr. George Austin was a neurosurgeon who received medical staff privileges at Santa Barbara Cottage Hospital. Dr. McNamera was the Chief of Staff at Cottage Hospital. Dr. Austin complained that he was attacked by other members of the medical staff in front of nurses and that other neurosurgeons at the hospital refused to cover for him. The medical staff commenced an investigation of his cases by members of the medical staff and two outside reviewers. The outside reviews were generally favorable to him despite some limited reservations. Three days after HCQIA  became law, Dr. McNamera summarily suspended Dr. Austin for seven months.  During his suspension he continued his practice at other local hospitals where his privileges remained intact. 

10 CRITICAL PRO IMMUNITY PEER REVIEW CASES: Number 9

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. 9: Sugarbaker v. SSM Health Care, d/b/a St. Mary’s Health Center,  190 F. 3rd 905 (8th Cir. 1999)

Dr. Sugarbaker was general surgeon practicing in Jefferson City, Missouri in 1995. A member of the medical staff raised concerns about his surgical technique and timing and he received a precautionary suspension of his privileges when he refused to refrain from practice voluntarily.  His performance was reviewed by a number of committees and although the executive committee sought to permanently terminate him, other committees opted for restrictions and monitoring. He eventually lost all of his privileges in 1999 when he refused to abide by the conditions imposed on him.

 

10 CRITICAL PRO IMMUNITY PEER REVIEW CASES: Number 10

 

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. 10: Reyes v. Wilson Memorial Hospital, 102 F Supp. 2d 798 (S.D. Ohio, 1998).

Dr. Reyes was a board certified internist who did not get along with his colleagues at the hospital. Having been summarily suspended in a peer review process, he sued the hospital for antitrust violations and and state law torts, to which the defendants raised the issue of immunity. According to an affidavit filed by Dr. Reyes in opposition to a motion for summary judgment,  he suffered the resentment of his fellow doctors because of the effect his method of practice had on the income of the Defendants. Plaintiff occasionally referred patients to hospitals other than Wilson Memorial and to doctors other than those named as Defendants. Dr. Reyes' practice of referring patients to other hospitals and to other doctors caused the Defendants to suffer a loss of income .