Friday, September 24, 2010

How to destroy a physician - Part 1: A step-by-step guide utilizing the hospital peer review mechanism

(Used by some hospital administrations.  Why? We'll get to that in another posting)
 Step 1:  Do not tell the physician that there is anything wrong.  If you do, the conscientious physician my take appropriate steps to improve her/his performance, quality of care, and outcomes without any disciplinary actions.  Don't let that happen.  Make your case as solid as possible to screw the doctor.  After all, it is not about improving care, it's all about getting rid of that particular doc. Be focused and let me repeat: your goal is nothing short of destroying the career of that physician.
Step 2:  Gather as much damaging information as you can, behind the scenes.  Most doctors are not entirely perfect.  You, of course, should demand no less than perfection from the target physician.  After all, you're the good guys.
Step 3: Set up a "peer review committee" as per your hospital Bylaws.  Point out that there are concerns about that physician's performance or patient care or disruptive behavior, whatever.  You don't have to produce specific documented evidence. Just set the tone for the process to take the desired direction.  Even though the initiating hint may be just a hearsay thing, believe it or not, hearsay is good enough to initiate the process.  Don't worry, the standards of the process are low enough to allow for that.
Step 4:  A professional performance committee, if that is what you have in your Bylaws, is then to be involved.  You may very well have same people sharing both committees, to maintain the desired direction. Makes it easier for everyone.
Step 5: Get an external reviewer who is inclined to be harsh.  If the reviewer thinks that she/he is asked to be critical in order to improve the quality of the care, the reviewer will feel an obligation to be as critical as possible. Don't admit that you are considering to terminate a physician's privileges and destroy a career.  The reviewer will do the job and wouldn't want to know that.  Doctors, particularly surgeons, tend to be really hard on each other.
Step 6:  If you are lucky, and you mostly will be, to get some negative reviews, you won.  Start an investigation.  The physician is now on the path of no return to career destruction.  From now on, whatever the physician says to defend himself/herself will appear meaningless.  After all, the "experts" have said their saying.  I have to remind you that you are not using any criticisms in a constructive manner, you are using criticisms as an evidence in a destructive process. It is that simple.
Note:  If at any point, before starting an investigation, a physician indicates the slightest intent to not stay on staff for whatever reason, don't let that happen.  Don't respond to such a request.  Wait till an investigation is started first.  If a physician resigns while under investigation, such has to be reported to the National Practitioner's Data Bank (NPDB), which would be just fantastic to compromise that physician's chances to be employed anywhere in the USA or anywhere in many other countries.  You've trapped your target.  Play chess?  Like a check-mate?
 Step 7:  Proceed as per the Bylaws.  You've done your homework very well.  No member of any committee, past that step, will do much due diligence to turn down your extensive efforts to keep up the quality of care.  You've got a peer review, external reviewers, the professional performance people, and the investigating committee, all done their parts.  The sheer volume of the generated material is much more than what most members of a Medical Executive Committee are willing to thoroughly read.  They will trust that you did your due diligence. Try to hide any positive comments or reviews that may have come up during the investigation.  The MEC, most likely, will be inclined to accept your recommendations if you have a role in addressing the MEC.  If you won't have the chance yourself to present the "facts" and the desired outcome to the MEC, don't worry too much.  Tremendous damage has already been inflicted.  If you chose your target wisely, no one will take an action other than your desired end result.
Step 8:  If the physician asks for a "fair hearing", sure, why not?  If your lawyers did a good job in drafting the Bylaws, which the lambs (I mean the physicians) have already known and (yeah, right!) accepted, then you really are in good shape.  The "fair hearing" panel probably is not required to test the merits of your Medical Executive Committee's recommendations (that is, an adversarial action against your target).  All they have to determine is whether the recommendation is a reasonable conclusion based on a factual basis.  With all the committees involved, and the hundreds of pages of documents, a hearing panel will have hard time saying that you do not have a factual basis.  You just have to be "reasonable".  That is all the standard that you need to destroy a physician's career.  The only way really your target can win in a fair hearing is to have a high level of evidence (not just reasonable .. double standard .. wink, wink!) that the recommendation of your Medical Executive Committee has been pretextual.  Slim chance to produce such an evidence, of course.
You've succeeded in sealing a decision to impose an adversarial disciplinary action.  How that would lead to the destruction of the doctor's career? --- To Follow ....

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