Physician peer review


Hospital bylaws as well as state and federal legislation requires that medical care and treatment be monitored and reviewed. Generally, this is accomplished by physicians reviewing physicians. Often however, the process is initiated or begun by a person who is not a physician, frequently a nurse. Administrative persons may or may not have ulterior motives in their selection of certain charts or physicians for review and not others. 

The intent of peer review is to limit the ability of incompetent practitioners to practice medicine. This is a commendable purpose and in the ideal world, should function more effectively than other punitive measures such as medical malpractice. The importance of a properly functioning peer review committee is of such public importance that state and federal statutes indemnify these committees and their members from legal retribution by any physician who is an object of disciplinary action.

Unfortunately, especially in small institutions, peer review is utilized as a method of eliminating competition or punishing unpopular practitioners. Politics all too often determines the findings and recommendations of these so-called peer review committees. The standard, however, required by law, does not allow for unfair treatment by a biased committee.

The health care quality assurance act protects peer review committees from exposure to litigation related to their acts as long as they act in good faith and according to statute. Members of peer review committees should not have a conflict of interest with respect to the practitioner that is being investigated. The most obvious type of conflict of interest is economic competition, but there are other levels of competition and conflict.

The peer review committee should act in accordance with the bylaws of the institution which it is serving. Adequate and sufficient notice must be provided to the affected practitioner. Fair hearings should be afforded the affected practitioner. Members of the committee with a potential conflict of interest should excuse themselves from the proceedings, particularly any vote. The proceedings must be fair to the affected practitioner, or else the entire procedure can be subject to challenge.

Extraordinary measures to be taken by a peer review committee should include:

  1. Agreement by the affected practitioner that members of the committee do not have a conflict of interest and/or a statement to that effect by each member.
  2. Structuring a hearing in a manner that is fair and agreeable to the affected practitioner.
  3. Strict confidentiality such that there is no discussion of committee matters outside of the committee, nor any dissemination of written documents outside of the file which is marked "privileged and confidential."
  4. Free and open discussion by members within the committee meetings.

Peer review committees are afforded certain legal privileges, which can protect both the practitioner and the members of the committee from legal discovery. However, to insure this privilege, the proceedings of the committee must remain confidential. In its strictist definition, this requires all proceedings to be conducted within the confines of the committee structure. There should be no dissemination by written or verbal means regarding the committee's activities. When the committee violates these guidelines which are protected by statute often to protect the practitioner from false accusations, liability for damages could certainly result.

In conclusion, peer review committees function to review and discipline incompetent practitioners. They are protected by statute as long as they adhere to the bylaws and statutes that govern their activities. Specifically, they must be fair to the affected practitioner by giving notice and by avoiding any potential conflict of interest. They must maintain confidentiality of the proceedings. The challenges to do so are demanding, especially in small or rural settings. If a peer review committee does not adhere to these guidelines, the statutory protection may be forfeited, and litigation by an affected practitioner for damages might occur.