Documentation in Peer Review Meetings: How Much Is Just Right?
January 1st, 2019
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The need for documentation of peer review meeting minutes is clear, but there are two schools of thought on how detailed records should be: general and broad to prevent their being used against participants in future challenges to their decisions, or detailed so that they provide a solid explanation and defense.
Many healthcare attorneys come down firmly on the side of keeping detailed records of peer review meeting minutes, says Karen Owens, JD, an attorney with Coppersmith Brockelman in Phoenix. But detailed does not mean anything akin to a transcript.
Hitting that sweet spot can be tricky for some hospitals.
A very brief account of the meeting serves little purpose, Owens says, while a meatier version can be useful in adversarial proceedings and serves as a record of what the committee has done in the past. The committee can draw on those records to guide its future actions.
In most states, peer review minutes are confidential and not discoverable in state court proceedings, Owens notes. However, they may be discoverable in federal proceedings. But even if they are not used in court, peer review minutes can be used in other disputes stemming from a physician against whom the peer review committee takes adverse action, Owens explains.
For example, if a physician may lose privileges, the minutes often are made available to the physician in preparation for the hearing. Owens believes it is appropriate for the physicians to have the minutes of the meeting.
“The minutes can be useful in showing that the medical staff committee, in particular the medical executive committee, has considered an issue, thought through it, and there was appropriate consideration of the options. That can be very helpful in establishing the medical executive committee’s position,” Owens says. “For that reason, I like minutes that contain some real substance.”
Show Issues Were Discussed
Meeting minutes should reflect that the pros and cons of any adverse action were adequately discussed, and the substance of those discussions should be described briefly, Owens says.
The goal is to show that the committee discussed evidence, concerns, and options in a thorough manner but without providing excessive detail about the discussion or who said what, Owens says.
“I’m not in favor of meeting minutes that are essentially transcripts because that does not make sense and it is not efficient. I certainly would never recommend that minutes state the name of a particular physician member who made a statement,” she explains. “That creates undue attention to a single physician who made a statement rather than the committee’s action and how it came to that decision. I’d like the minutes to show that the committee thought about the issues and took action after reasonable discussion.”
Hospitals vary widely in how they record peer review committee minutes, Owens says. She has worked with hospitals facing adversarial challenges by physicians and found that the committee minutes were far too detailed, with quotes attributed to named physicians.
“They include lots of information that is not necessary to understand why the committee did what it did,” Owens says. “The minutes should provide that clear picture of how the committee reached its decision but without any extraneous information that will only draw focus away and create drama about something besides the real issue at hand.”
Too much is not good, but Owens also has found that scanty meeting minutes create unnecessary problems. For instance, physicians justifiably argue that removing or limiting privileges is a major step that should come only after serious consideration, and hospitals should be able to show how the committee reached that decision, she says.
“I’ve seen minutes that just said, ‘Discussion was held’ and then the committee’s decision, with no information about how that decision was reached,” Owens says. “That’s not good at all. The minutes are supposed to provide some history of what happened.”
Minutes, Not a Transcript
Remember that peer review meeting minutes are not, and should not be, a transcript of the meeting, Owens says. What to include in the minutes is up to the hospital.
How much detail to include in the meeting minutes is the difficult point for hospitals. Some physicians and peer review leaders argue that the committee’s decision is what really matters and including details of the discussion leading to that decision can put too much focus on the individual participants rather than what the committee as a whole decided, Owens explains.
“That can lead to all kinds of mischief even if individuals aren’t named. You can still have people saying they know who was on the committee and that person’s comments are identifiable even without a name attached, and that physician has an interest in seeing adverse action against the physician in question,” she says. “That’s why minutes need to be very carefully drafted, reviewed, and considered. When there is likely to be an adversarial proceeding, such as a medical staff hearing, it is a good idea to have legal counsel review the minutes before they are finalized.”
Also, it is not just about how much detail should be included — it is about which details to include.
To illustrate the danger of poorly conceived minutes, Owens offers the example of minutes from a peer review meeting in which members discussed allegations of another physician’s misbehavior. The minutes indicate that one committee member said, “This physician is so stupid.” In the context of the meeting, that comment might have been understood by all present as shorthand to mean the physician had made a series of poor choices.
“But you don’t want to put ‘This physician is stupid’ in the minutes. I have seen things very similar to that in peer review minutes because you had someone who had not been trained in taking minutes, so they were just writing down what he or she heard,” Owens explains. “A short phrase like that might be written down as a summary of the point being made or an example of many comments without considering whether it was appropriate and truly told the story of what the committee was doing. It creates a distraction that the physician can focus on and try to dissect as evidence of bias.”
There also is a theoretical risk of stifling debate on peer review committees if the members feel such comments, or detailed accounts of the discussion, are going to end up in the minutes, Owens says. Fortunately, most proceedings from the medical executive committee do not involve issues or actions that will prompt a challenge from physicians, so committee members tend not to be shy about speaking their minds, she notes.
However, a habit of producing overly detailed meeting minutes could change that when a sensitive issue arises. The risk is highest when the meeting minutes are written in such a way as to allow the identification of committee members by those with the right knowledge, Owens notes. Peer review processes can be crippled if participants do not trust the hospital to protect their confidentiality, she says.
Train Staff for Discretion
A member of medical staff services will be responsible for producing peer review committee minutes, and that person should be adequately trained on what the hospital wants regarding content and level of detail, Owens says. Professional organizations such as the National Association Medical Staff Services in Washington, DC, offer training on writing minutes, but quality improvement or peer review professionals should assist with training and emphasize the pitfalls of providing too little or too much detail.
A good idea is to provide examples of both good and bad committee meeting minutes, Owens suggests.
“You also can review the draft meeting minutes over a period of time, helping that person get a feel for what is and is not desired in the minutes, until you reach a point at which you’re satisfied they have a good understanding. It takes experience to get that kind of understanding,” she says. “It takes discretion and thinking about what is appropriate in each instance. That requires paying attention to the substance of what is going on in the meeting and what the consequences might be.”
- Karen Owens, JD, Coppersmith Brockelman, Phoenix. Phone: (602) 381-5463. Email: [email protected].
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