Being investigated by a medical peer review board can result in serious damage to a doctor’s career well beyond losing privileges at a hospital. These investigations usually explore a physician’s competency, physical or mental impairments, or disruptive behaviors. The harsh consequences can include suspension, revocation, or restrictions of hospital privileges and reporting the results to the National Practitioner Database and the Texas Medical Board. If you are the subject of a medical peer review, you need to understand the process and why it is important to defend yourself.
Investigative Stage in Medical Peer Reviews
The medical review process is governed by the federal Health Care Quality Improvement Act of 1986 (HCQIA) and Texas law. The process is often expanded upon in a hospital’s by-laws and credentialing paperwork. The review is generally conducted by the Medical Executive Committee (MEC). There are two phases to the process: the Investigative Stage and the Fair Hearing.
The MEC will generally begin the investigation process by sending the physician a formal notice of the allegations. If the allegations deal with the medical care a doctor has provided, the committee will often obtain patient records and send them to doctors in the physician’s practice area for an external peer review. Once the review is complete, the MEC or another medical panel will interview the doctor.
The doctor being investigated does not have much ability to defend himself at this stage of the process. His access to the medical records may be limited, and he may be prohibited from talking to witnesses. However, it is essential for a physician to retain an experienced attorney to start building a strong defense and to protect his rights.
Once the investigation is complete, the MEC will make a recommendation. If the recommendation is for a modification, suspension, or revocation of the doctor’s privileges, he must be provided with a written notice of the decision, the reasons behind the recommendation, and his right to a Fair Hearing. In Texas, physicians can also attempt to mediate the decision.
What Is a Fair Hearing?
If a physician disputes a peer review decision, he can request a Fair Hearing. This is a hearing conducted at the hospital by a panel of other physicians, which ideally should include a doctor practicing in the same specialty. An attorney is appointed to oversee the proceedings, resolve disputes, and ensure that the hearing is conducted in compliance with the HCQIA and state laws. The doctor being investigated has the following due process rights:
- To be represented by an attorney or other person of his choice
- To have a record made of the hearing
- To call and cross-examine witnesses
- To present evidence regardless of its admissibility in court
- To submit a statement at the end of the hearing
Under the hospital’s by-laws, the doctor may also be given other rights, including the right to discovery of evidence that the MEC has against him. At the end of the hearing, the panel will make a recommendation. A physician can often appeal the decision to the hospital’s governing board.
The Hart Law Firm Represents Doctors
Are you being investigated in a hospital peer review? Given the possible effect this could have on your career, you cannot afford to go it alone. Our experienced attorney, Walt Taylor, has helped many physicians successfully defend themselves at these hearings. Please feel free to contact Walt online or call him directly at 817.380.4888 to schedule your free consultation.
We help medical professionals throughout Texas including Arlington, North Richland, Grapevine, Bedford, Hurst, Euless, Irving and all points in between.