The Semmelweis Society: Medical Credentials, Privileges, and Unbiased Peer-Review. Safe Practices.
Proposed Survey
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This survey was submitted to be conducted anonymously at a booth at the 2003 Clinical Congress of the American College of Surgeons.  We will submit it  to other specialty societies.  Results will be published here and emailed yearly to physicians and to medical students each summer as they interview for the Match...

            Who selects cases for peer-review?  Who decides procedure?  Do you trust them to be impartial?  Are patients and physicians protected?  The survey is anonymous.

 

   "Six of my cases were brought up for review by a tissue committee controlled by competitors.  A nurse (sic), employed by the Saint Francis Hospital, testified that I had the highest rate of complication.  Why such testimony was admitted is a matter of some interest, in itself.  Liability for bearing false witness is an important related matter, in itself, and falls under the topic of immunity.  Under our gracious new laws, I would not be able to win $500,000 today were a nurse again caught committing libel."  Verner S. Waite M.D., FACS. The Semmelweis Society

 

'Medical peer review is the process by which a committee of physicians investigates the medical care rendered by a colleague in order to determine whether accepted standards of care have been met. The professional or personal conduct of a physician may also be investigated. If the committee finds that the physician departed from accepted standards, it may recommend limiting or terminating the physician's privileges at that institution. If the physician's privileges are restricted for more than 30 days, federal law requires the peer review committee to report that fact to the National Practitioner Data Bank (1).

There is no federal statute that requires peer review committees to observe due process, which the Supreme Court has defined as (1) giving written notice of the actions contemplated, (2) convening a hearing, (3) allowing both sides to present evidence at the hearing, and (4) having an independent adjudicator (2). Prior to the Health Care Quality Improvement Act of 1986 (HCQIA) (3), the effects of an adverse peer review finding were restricted to the hospital involved. Because the HCQIA mandates the reporting of disciplinary actions of peer review committees to the National Practitioner Data Bank, such a report could harm a physician's career throughout the nation (1-4).'  Scott Segall J.D., Nathan Pearl M.D.

 

1. The Public Interest:  Dr. Waite was falsely accused by competitors importuning a subordinate.  Have you seen destructive peer-review?  Are your patients--is your practice--procedurally-protected from predatory, for-profit peer-review?  Do you know what due process is?  Which peer-review procedures might protect both patients and physicians?  Do you know of any standards for conducting fair peer review, because neither JCAHO, nor HCQIA (1986), nor the Bennett Law (1972) requires due-process peer-review.

 

2.  Participation:  Rather than await legislation, would you hear cases outside your district as a professional responsibility (No stipend; costs paid by physicians rather than by a hospital, a HMO, or by Hillary) to distant colleagues, in exchange for their hearing your cases?

 

3. Case Selection:  How should cases be chosen for review?  Do you prefer random, non-punitive peer review (along the lines of Tumor Board), to render peer-review educational rather than punitive, reducing the stigma of review? 

 

4.   Jury-Selection:  Do you prefer veto-power (voir dire)in jury selection of peers acceptable to all, to promote impartiality?

 

5.   Practice-Selection:  Can libel increase liability?  Does legal immunity from prosecution for libelous peer-review affect your choice of where to practice in an age of several National Data Banks and rising malpractice insurance costs?

 

6.  Education:  Does impartial review promote discussion at M&M and other conferences?

 

7.  Suggestions:  Are there better ways than due process to achieve equitable peer review, to protect the patient and the physician?  Would you like to see this topic included in Post-Graduate Course on Liability at medical meetings?

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