A suspension or revocation of medical staff privileges is one of the most harrowing experiences a physician can imagine. The damage from an adverse determination by a hospital’s formal hearing panel can be devastating.
You can face the short-term effects of the inability to practice at the related facility, but also there is potential for related peer review actions by other credentialed entities including, reporting to the National Practitioner Data Bank (NPDB), reporting to and potential sanctions from medical board certification organizations, public and private insurance carriers, professional liability carriers and state boards of medicine.
The cornerstone of the defense of a physician under medical peer review will be to challenge the hospital’s conformance to the requirements of the Health Care Quality Improvement Act of 1986 (HCQIA) and the institution’s bylaws. It is imperative to begin to build an effective defense as soon as possible given the short timeframes for requesting a fair hearing, obtaining and reviewing relevant medical records and documentary evidence and obtaining expert witness support.
A checklist of critical information to compile as soon as possible in any potential physician peer review case includes the following: