Once an allegation is made against a healthcare practitioner that will require peer review, it is important to conduct a thorough and impartial investigation, says Kathy H. Butler, JD, an officer with Greensfelder, Hemker & Gale in St. Louis.
The caregiver should be informed of the issues of concern in writing during the investigation process and provided the opportunity to respond to the concerns of the professional review bodies. Where appropriate, outside experts can be helpful in objectively evaluating clinical issues. Hospitals should adhere to the standards set forth under the HCQIA.
“If a professional review body proposes discipline that will adversely affect a [caregiver’s] clinical privileges or medical staff membership, most hospitals and medical staffs have adopted the standards and processes set forth in HCQIA,” Butler notes. “[This] ensure[s] the hospital and those who participate in the peer review process get the benefit of the legal protections afforded by the HCQIA.”
What follows is a summary of the HCQIA standards:
• The accused must be provided with notice of the professional review action proposed, the reasons for the proposed action, that the accused has the right to request a hearing (and the time limit for making the request) and a summary of rights in the hearing;
- If a hearing is requested timely, the accused must be notified of the place, time, and date of the hearing and a list of witnesses (if any) expected to testify at the hearing on behalf of the professional review body;
- The hearing must be held before an arbitrator mutually acceptable to the healthcare entity and the accused, a hearing officer who is appointed by the entity and who is not in direct economic competition with the healthcare practitioner involved, or a panel of individuals who are appointed by the entity and are not in direct economic competition with the accused;
- At the hearing, the accused has the right to be represented by an attorney or other person of his or her choice; to have a record made of the proceedings; to call, examine, and cross-examine witnesses; to present evidence the hearing officer determines to be relevant; and to submit a written statement at the close of the hearing;
- After the hearing is complete, the accused can receive the written recommendation of the arbitrator, officer, or panel, including a statement of the basis for the recommendation, and can receive a written decision of the healthcare entity, including a statement explaining the decision.
Generally, it is important to follow these standards prior to the finalization of any discipline decision. However, these procedures will not apply in situations where an immediate suspension or restriction of clinical privileges is determined to be necessary to protect against an imminent danger to the health of any individual. In those cases, immediate action is permitted, subject to subsequent notice, hearing, or other adequate procedures.