Public Health Law Map - Beta 5 - Medical and Public Health Law Site

The act states that its notice and hearing requirements are not the only way to provide
adequate due process for peer review. The courts, however, will tend to regard these
statutory requirements as minimums. These requirements were developed in court
cases against governmental medical care institutions. The effect of the act is to
require private institutions seeking immunity to comply with the same due process
requirements as public institutions. Since most private hospitals already meet this
standard, this should not require substantial changes in hospital procedures. It will
require other medical care entities, such as private clinics, to use formal, hospital-
style proceedings rather than the informal procedures that are the norm in these
environments.
The act only covers peer review activities carried out in a reasonable belief that they
will improve the quality of medical care. The best evidence of a proper review
decision is a written set of standards that explain what is expected of a physician
practicing in the entity. These should be detailed and straightforward. They must be
intelligible to jurors and physicians, as well as to attorneys. For hospitals, most of the
relevant standards are already in force as part of the Joint Commission requirements.
The problem is that few physicians are familiar with these requirements. These
standards must be made available to members, and prospective members, of the
medical staff. Adherence to these standards must be an explicit condition of medical
staff privileges.
It is critical that the medical care entity enforce all standards uniformly. There cannot
be a double standard based on economic performance or personal relationships. If,
for example, delinquent chart completion is used as a ground for the termination of
staff privileges, then the hospital must ensure that all members of the medical staff
complete their charts on time. Disparate enforcement of standards is less defensible
than having no standards.
The only way to provide even-handed enforcement of standards is to shift from
exception-oriented review to review based on statistical and population analysis. In
some areas, such as completion of medical records, the hospital keeps data on every
physician. The data can be compiled into profiles to establish the norm and standard
deviations for chart completion. Physicians exceeding a set deviation would be
flagged and counseled. If their performance did not improve, they would be
terminated. In other areas, such as surgical complications, indirect measures are
much less effective. These require that a random sample of charts from every
physician be reviewed for problems.
E. Documenting the Peer Review Process
The key to preventing litigation over peer review proceedings is careful documentation
of a well-organized, exemplary process. It is not enough for an individual member to
act properly. Every member of the committee must be above reproach because it is the
committee that acts and will be sued. The hospital bylaws should require each
committee member to disclose all personal and business dealings with members of the
medical staff who might come before the committee. This information can be protected
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