Remedying the Faults of Peer Review

Surgical Rounds®July 2014

Although hospitals routinely implement peer review processes to ensure that physicians are meeting the prevailing standards of care, the procedure has been associated with controversy.

Although hospitals routinely implement peer review processes to ensure that physicians are meeting the prevailing standards of care, the procedure has been associated with controversy since the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) first began requiring it in 1952.

For example, in a widely publicized 1986 lawsuit, a general and vascular surgeon who left a clinic to start his own practice alleged that his former partners utilized the peer review process in a way that led to the termination of his privileges at the hospital where they were all employed. When the case was elevated to the United States Supreme Court, it was resolved with a $2.2 million award to the plaintiff, as it was clear the defendants had acted out of personal economic interest.

Many physicians deemed the case profoundly disturbing and became hesitant to participate in peer review in its aftermath. To address their concerns, Congress passed the Health Care Quality Improvement Act (HCQIA), which created reviewer immunity and established the National Practitioner Data Bank that prevents physicians who have employment-ending performance issues from simply moving to another state to practice medicine.

However, Dinesh Vyas and Ahmed E. Hozain of the Department of Surgery at Michigan State University argued in a recent review article published in the World Journal of Gastroenterology that although the peer review process improves care quality, the HCQIA’s immunity clause likely emboldens abuses resulting in sham peer reviews, which are characterized as being “called for by either a single (physician) or group of physicians, conducted in order to lead to adverse action taken by the review committee.”

The authors also contended that powerful competitors and outspoken physicians or whistleblowers are most likely to be targeted for sham peer review, and the victims of such review have no legal recourse.

Examining possible future directions, Vyas and Hozain indicated standardization, external peer review processes, and legislative reform are needed to improve the current peer review system, and they called for physicians, professional societies, and hospital administrators to push for such enhancements.

“Immunity granted under HCQIA serves to protect hospitals and peer reviewers from litigations from appropriately sanctioned physicians. Unfortunately, HCQIA extends these immunities to sham peer reviews,” Vyas and Hozain concluded. “In the hypercompetitive and highly political United States medical system, this immunity has been abused and has led to the devastating destruction of many physicians careers. Considering Congressional and Judicial forbearance on this crisis, significant leadership by physicians, professional societies, and hospital administrators is needed in order to remedy the faults of peer review.”

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