Medical Peer Review - Abuse

Abuse

Sham peer review is a name given to the abuse of a medical peer review process to attack a doctor for personal or other non-medical reasons.

Controversy exists over whether medical peer review has been used as a competitive weapon in turf wars among physicians, hospitals, HMOs, and other entities. The American Medical Association conducted an investigation of medical peer review in 2007 and concluded that while it is easy to allege misconduct, proven cases of malicious peer review are rare.

Abuse is also referred to as "malicious peer review" by those who consider it endemic, and they allege that the creation of the National Practitioner Data Bank under the 1986 Healthcare Quality Improvement Act (HCQIA) facilitates such abuse, creating a 'third-rail' or a 'first-strike' mentality by granting significant immunity from liability to doctors and others who participate in peer reviews.

The California legislature framed its statutes so as to allow that a peer review can be found in court to have been improper due to bad faith or malice, in which case the peer reviewers' immunities from civil liability "fall by the wayside".

Many medical staff laws specify guidelines for the timeliness of peer review, in compliance with JCAHO standards.

Some physicians allege that sham peer review is routinely conducted in retaliation for whistleblowing, although a study of the phenomenon did not support this charge.

Cases of alleged sham peer review include Khajavi v. Feather River Anesthesiology Medical Group, Mileikowsky v. Tenet, and Roland Chalifoux.

Defenders of the Health Care Quality Improvement Act state that the National Practitioner Data Bank protects patients by helping preventing errant physicians who have lost their privileges in one state from traveling to practice in another state. Physicians who allege they have been affected by sham peer review are also less able to find work when they move to another state, as Roland Chalifoux did. Moreover, neither opponents or supporters of the NPDB can be completely satisfied, as Chalifoux' case shows that just as physicians who were unjustly accused may be deprived of work in this way, those who have erred might still find work in other states.