Medical Peer Review

Medical Peer Review

Medical Peer Review Immunity

Medical peer review is a process by which a reviewing body reviews the care and treatment given by physicians to patients who suffered an unfavorable medical outcome to determine whether poor medical treatment or decisions was the cause of the unfavorable outcome. Based on a determination that occurrences of medical malpractice were increasing and that there was a need to improve the quality of medical care in the United States, Congress enacted the federal Health Care Quality Immunity Act (HCQIA). The HCQIA immunizes hospitals and medical staff participating in professional peer review from civil lawsuits. The HCQIA is premised on the notion that meaningful peer review is only possible if those participating cannot be held liable for statements made or information provided during the peer review process. The HCQIA provides that no person providing information to a professional review body regarding the competence or professional conduct of a physician can be held, by reason of having provided such information, to be liable in damages unless such information is false and the person providing it knew that such information was false.

For a peer review action to qualify for immunity under the HCQIA, it must qualify as a “professional review action.” A professional review action is an action or recommendation of a professional review body which is taken or made in the conduct of professional review activity, based on the competence or professional conduct of an individual physician that either affects or could affect adversely the health or welfare of a patient and that affects or may affect adversely the physician’s clinical privileges or membership in a professional society. A “professional review body” is a health care entity and the governing body or any committee of a health care entity that conducts professional review activity. The definition of a professional review body includes any committee of the medical staff of such an entity when it is assisting the governing body in a professional review activity.

A professional review action by a professional review body is protected by immunity only if the following requirements are met:

  • The action must have been taken with a reasonable belief that the action was in the furtherance of quality health care.
  • The action must have been taken after a reasonable effort to obtain the facts of the matter.
  • The action must have been taken after adequate notice and hearing procedures were afforded to the physician.
  • The action must have been taken in the reasonable belief that the action was warranted by the facts known.

Under the HCQIA, there is a presumption that the above requirements have been met. Thus, as long as the above requirements have been met, professional review bodies and their members are immune from any actions by physicians who have been subjected to a loss of hospital privileges or other adverse actions against them as the result of a negative finding by the professional review bodies. Moreover, physicians do not have a right to sue professional review bodies for any failure to comply with the requirements of the HCQIA.

Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.

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