AMNews: Jan. 5, 2009. Supreme Court asked to examine Texas peer review case … American Medical News

AMNews: Jan. 5, 2009. Supreme Court asked to examine Texas peer review case … American Medical News
The U.S. Supreme Court could be the next stop for a lawsuit that peer reviewers have followed closely. A Dallas cardiologist is asking the high court, which only takes up a small number of cases it is requested to consider each year, to review his lawsuit claiming unlawful peer review.

The case has led physicians serving on peer review panels and hospital officials to worry that peer review immunity could be eroded. And it has given physicians who believe they were improperly peer reviewed hope for retribution.

Interesting.  I only know of peer-review inside my own division, and don’t know anything about this case other than what’s in the news.  I can understand a need for checks and balances in any system, but wonder if tearing peer review apart is the right answer.

Updated: I should clarify the basic problem with peer review, and what’s at stake.

Peer review is meant to be just that, a review of a doctors’ work viewed through the eyes of their peers, i.e., docs who do the same work.  Ideally, they’re the perfect people to throw the flag when there’s a foul, and as far as I know (and, lawyers, that’s all I know) it works like it’s supposed to.

Nearly without exception those subjected to discipline will complain of personality conflict, or business conflict, and there’s the rub: determining whose complaint about their discipline is meritorius and those who are covering their troubles with obfuscation.  It doesn’t help that peers who do the review in the non-hospital based disciplines are nominally colleagues but are also competitors with egos and agendas.  It is a given that those ase motives are left at the closed door of peer review, but there’s always going to be friction over an adverse decision.

I’d like to point out here that just because peer review is unhappy with someone doesn’t automatically result in adverse action, there’s usually the hospital Medical Board or Credentials Committee that has to actually impose a discipine, so there is some outside oversight (which relies on the peer review for the nuance of whether care was appropriate for their discipline).  If this sounds incestuous it’s not supposed to, nor is it supposed to be in practice.

Again, all I know of this case is what I’ve read in the papers, and so far (knock wood) I haven’t fallen afoul of a peer review action, but I (and everyone else in my position) has recourse in the event of an adverse review.

So, again I hope peer review is left intact as a tool for self-policing.


Comments

  1. Goatwhacker says:

    I’d like to point out here that just because peer review is unhappy with someone doesn’t automatically result in adverse action, there’s usually the hospital Medical Board or Credentials Committee that has to actually impose a discipine, so there is some outside oversight (which relies on the peer review for the nuance of whether care was appropriate for their discipline). If this sounds incestuous it’s not supposed to, nor is it supposed to be in practice.

    In smaller hospitals the physicians on Peer Review also tend to dominate the Credentials Committee and at times the Hospital Board. At it’s best Peer Review is a great way to monitor and improve care, unfortunately like most things it’s often not at it’s best and is used as a tool in turf wars and stifling competition. In theory it’s a great way for docs to work together as equals but in practice some docs are more equal than others.

    I have not run afoul of a peer review committee either but have seen them misused more than once, and the unlucky physicians seemed to have very little recourse.