The American Medical Association and Peer Reviews (Part 2)

The full document that is the topic of this posting can be opened by clicking the following link:
www.ama-assn.org/ama1/pub/upload/mm/471/annotatedb.doc

I believe that the following recommendations from the American Medical Association (AMA) seem to be in the right direction:

"The general consensus of the testimony is that peer review should focus on quality improvement and patient safety rather than physician discipline.  Specific recommendations include that: 1) the definition does not extend to physician wellness programs; 2) the report should state that a physician’s participation in peer review should not appear in a credentialing file; 3) physicians should enjoy strong due process in peer review proceedings, 4) the negative unintended consequences of a peer review system should be mitigated, including concerns that physicians can unfairly be targeted through peer review processes for reasons not related to quality, and (5) creating definitions for such terms as “unintended consequences,” “communication skills,” “professionalism,” and “system-based practice.”  Therefore, your Reference Committee recommends referral of Board of Trustees Report 18.

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Here is the part of the report that pertains to the legal protections for the peer review process:
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DISCLAIMER

The following is a preliminary report of actions taken by the House of Delegates at its 2008 Annual Meeting and should not be considered final.  Only the Official Proceedings of the House of Delegates reflect official policy of the Association.

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES (A-08)

Report of Reference Committee B

Craig W. Anderson, MD, Chair

In keeping with Resolution 601 (A-96), the Reference Committee recommends the following consent calendar for acceptance:

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recommended for referral

24.          Board of Trustees Report 18 – Legal Protections for Medical Peer Review

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(24) BOARD OF TRUSTEES REPORT 18 - LEGAL PROTECTIONS FOR MEDICAL PEER REVIEW

RECOMMENDATION:

Mr. Speaker, your Reference Committee recommends that Board of Trustees Report 18 be referred.

HOD ACTION: Board of Trustees Report 18 referred.

Board of Trustees Report 18 recommends that our American Medical Association adopt the following definition of peer review including the definitions of the structural elements that support medical peer review process and the remainder of this report be filed.

Peer review is the task of self-monitoring and maintaining the administration of patient safety and quality of care, consistent with optimal standards of practice. It is the mechanism by which the medical profession fulfills its obligation to ensure that its members are able to provide safe and effective care, whereas credentialing is the process to verify practitioner qualifications at the time of initial appointment or reappointment to a health care institution. Effective peer review is an essential hallmark of the medical profession; it is the practice of medicine. Elements of medical care, which describe the knowledge, skills, attitudes, and educational experiences of physicians and provide the foundation of physician activities, are subject to peer review and its protections. Those elements include, but are not limited to the following: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

Good faith peer review is the mechanism by which the medical profession fulfills its obligation to ensure that its members are able to provide safe and effective care; effective peer review is an essential hallmark of the medical profession. The responsibility assigned to and scope of peer review is the practice of medicine. The process of peer review is conducted by physicians who are within the same geographic area or jurisdiction and medical specialty of the physician subject to review to assure that all physicians consistently maintain optimal standards of competency to practice medicine. Physicians outside of the organization that is convening peer review may participate in that organization’s peer review of a physician if the reviewing physician is within the same geographic area or jurisdiction and medical specialty as the physician who is the subject of peer review.

Medical Peer Review Organizations. Any panel, committee, or organization that is composed of physicians or formed from a medical staff, which engages in or utilizes peer reviews concerning physician well-being (eg, fitness to practice medicine) or the care and treatment of patients for the purposes of self-monitoring and maintaining the administration of patient safety and quality of care consistent with optimal standards of practice is a medical peer review organization. The responsibility of a medical peer review organization is to assure (1) that all physicians consistently maintain optimal standards of competency to practice medicine and (2) the quality, safety, and appropriateness of patient care services. The medical peer review committee’s obligations include review of allegations of infirmity (eg, fitness to practice medicine), negligent treatment, and intentional misconduct. Peer review protections and privilege should extend to investigation and subsequent correction of negligent treatment and intentional misconduct.

Proceedings. Proceedings include all of the activities and information and records of a peer review committee. Proceedings are not subject to discovery and no person who was in attendance at a meeting of a peer review organization shall be permitted or required to testify in any such civil action as to any evidence or other matters produced or presented during the proceedings of such organization or as to any findings, recommendations, evaluations, opinions, or other actions of such organization or any members thereof. However, information, documents, or records otherwise available from original sources are not to be construed as immune from discovery or use in any such civil action merely because they were presented during proceedings of a peer review organization, nor should any person who testifies before a peer review organization or who is a member of a peer review organization be prevented from testifying as to matters within his/her knowledge; but such witness cannot be asked about his/her testimony before a peer review organization or about opinions formed by him/her as a result of the peer review organization hearings.

Peer Review Activity. Peer review activity means the procedure by which peer review committees or quality assessment and assurance committees monitor, evaluate, and recommend actions to improve and assure the delivery and quality of services within the committees' respective facilities, agencies, and professions, including recommendations, consideration of recommendations, actions with regard to recommendations, and implementation of actions.

Peer Review Records. Peer review records mean all complaint files, investigation files, reports, and other investigative information relating to the monitoring, evaluation, and recommendation of actions to improve the delivery and quality of health care services, licensee discipline, or professional competence in the possession of a peer review committee or an employee of a peer review committee.

Privilege. The proceedings, records, findings, and recommendations of a peer review organization are not subject to discovery or use. Information gathered by a committee is protected. Purely factual information, such as the time and dates of meetings and identities of any peer review committee attendees is protected. Peer review information otherwise discoverable from “original sources” cannot be obtained from the peer review committee itself. In medical liability actions, the privilege protects reviews of the defendant physician’s specific treatment of the plaintiff and extends to reviews of treatment the physician has provided to patients other than the plaintiff.

Confidentiality. Peer review records and deliberations are confidential and may not be disclosed outside of the judicial process.

Peer Review Immunity. To encourage physician participation and ensure effective peer review, entities and participants engaged in peer review activities should be immune from civil damages, injunctive or equitable relief, and criminal liability.

Your Reference Committee heard complimentary testimony on our Board’s work to establish a thorough definition of peer review in this report. Your Reference Committee also heard significant testimony asking our AMA to continue investigating several peer review issues before the report is approved. The general consensus of the testimony is that peer review should focus on quality improvement and patient safety rather than physician discipline. Specific recommendations include that: 1) the definition does not extend to physician wellness programs; 2) the report should state that a physician’s participation in peer review should not appear in a credentialing file; 3) physicians should enjoy strong due process in peer review proceedings, 4) the negative unintended consequences of a peer review system should be mitigated, including concerns that physicians can unfairly be targeted through peer review processes for reasons not related to quality, and (5) creating definitions for such terms as “unintended consequences,” “communication skills,” “professionalism,” and “system-based practice.” Therefore, your Reference Committee recommends referral of Board of Trustees Report 18.