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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;
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.
Financial Disclosure: Author Greg Freeman, Editor Jonathan Springston, Editor Jill Drachenberg, Nurse Planner Nicole Huff, MBA, MSN, RN, CEN, Consulting Editor Patrice Spath, MA, RHIT, Editorial Group Manager Leslie Coplin, and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.