Facing a hospital peer review proceeding or receiving a notice of a complaint or investigation by a medical licensing board can be a frightening experience if you are a physician, nurse, dentist, or pharmacist. Your career and ability to work in your profession are at stake. These proceedings are often governed by complicated state and federal laws. You do not want to make the mistake of trying to resolve the complaint on your own. You need the assistance of an experienced medical defense attorney who has an understanding of the peer review and medical board licensing complaint processes. This will ensure that you receive due process and that all of your defenses are raised so that you avoid the potentially devastating consequences of a loss of hospital credentials or your license.
Understanding the Hospital Peer Review Process in Texas
A hospital peer review is a process by which a doctor is investigated by a committee of his peers who make a decision on his hospital credentials, and can have even greater long-term consequences on his ability to practice medicine. These decisions are often reported to the National Practitioner Data Bank and the Texas Medical Board, which can result in further disciplinary proceedings. A peer review is often begun if a physician’s performance or behavior is being questioned. The issues in these cases generally fall into one of three categories:
- Clinical competence
- Physical or mental impairment
- Disruptive behaviors
The process of a hospital peer review is governed by Texas law and the federal Health Care Quality Improvement Act of 1986 (HCQIA). The hospital’s own by-laws and credentialing paperwork may expand on a physician’s rights. In some cases, the problem will be addressed informally by the chief of staff or department head. The physician could be offered counseling, receive a warning, or be required to take a leave of absence while receiving substance abuse treatment. In more formal hospital peer reviews, the process will include the following:
- Investigation. After a complaint, poor patient outcome, or disruptive behavior, an ad-hoc committee or Medical Executive Committee (MEC) will investigate the incident and collect evidence. At the beginning of the investigation, the physician who is being investigated should be notified. If medical care is being questioned, medical records will be obtained and may be sent out to be reviewed by physicians outside the hospital. At the end of the investigation, the MEC makes a recommendation, which can include suspension, modification, or revocation of the doctor’s privileges.
- Fair hearing. If the doctor disputes the investigation’s decision, he can request a fair hearing. This is a hearing conducted in front of a panel of hospital physicians and a hearing officer who resolves disputes and ensures that the procedure follows HCQIA requirements. The physician is entitled to be represented by an attorney, present evidence, and cross-exam witnesses. A decision is made by the panel following the hearing.
Medical Board Licensing Complaints
At the Hart Law Firm, we also assist physicians, nurses, pharmacists, and dentists in the Dallas-Fort Worth area facing licensing or other disciplinary actions by a Texas state licensing board. A medical professional who receives a notice of complaint and investigation from his licensing board should take the notice very seriously and contact an experienced medical defense attorney as soon as possible. Suspension or revocation of a professional license is a possible consequence of an investigation—with even more long-term career and malpractice insurance issues. Governing boards and the issues they investigate in Texas include:
- Texas Medical Board. The Texas Medical Board has the authority to take disciplinary actions against medical doctors (MDs) and Doctors of Osteopathy (DOs). Issues that can be investigated include medical record keeping, breaches in the standard of care, non-therapeutic prescriptions, abuse of drugs or alcohol, behavioral transgressions, and discipline by peers.
- Texas Board of Nursing. The Texas Board of Nursing has authority to discipline nurses for violations of the Nursing Practices Act and board rules and regulations. Substance abuse, practice violations, nurse peer review disciplinary proceedings, documentation errors and falsification, and patient abuse are just some of the issues handled in these hearings.
- Texas Board of Pharmacy. The Texas Board of Pharmacy regulates pharmacists and pharmacies. Some of the behaviors that can result in a disciplinary proceeding include DWI violations, substance and alcohol abuse, and criminal conduct. A pharmacist could have his license suspended or revoked for dispensing errors, non-therapeutic dispensing of medications, improper storage or prevention of losses of controlled substances, unprofessional conduct, and much more.
- Texas Board of Dental Examiners. The Texas Board of Dental Examiners can discipline or revoke the licenses of dentists in our state. Investigations can be for administrative violations, like failing to display a registration, or more serious violations, such as fraudulent billing, substance abuse, violations of the standard of care, and discipline by a peer group.
There is a detailed administrative hearing process that must be followed in these disciplinary proceedings, but they are sometimes violated. Many doctors and other medical professionals make the mistake of assuming that they will be treated fairly in these proceeding and speak directly with investigators. This can result in them facing disciplinary actions that may have been avoided with the assistance of an attorney.
Contact Our Office for Help With Your Peer Review and Medical Licensing Board Investigation
Are you facing a peer review or a medical licensing board investigation? Our compassionate and experienced medical defense attorney is here to discuss your situation and help you build a strong defense to the disciplinary actions you face. To learn more about your legal options, contact us online or call us directly at 817.380.4888 to schedule a free consultation.