Roland Chalifoux, Jr, private practice; West Virginia School of Osteopathic Medicine.
One of the first notable sham peer reviews took place in Oregon in the early 1980s. The physician who took it up with the courts was Dr. Patrick, and the Supreme Court ruled in his favor. As a result of the publicity surrounding this case, the Healthcare Quality Improvement Act (HCQIA) was enacted in 1986. One of the concerns that arose from the Patrick case was a fear that no physician would want to participate in peer review if he or she could be potentially liable for a bad report. The HCQIA gave immunity to hospitals and reviewers participating in peer review.
This immunity has been abused by hospitals and physicians to harm “disruptive” physicians (ie, whistleblowers) or financial competitors. All one must say is: “Dr. Joe Blow is a bad doctor, which is my professional opinion in this peer review, and this hospital should get rid of him.” And poof! Dr. Joe Blow, patient advocate, financial competitor, is gone! And the accusing physician is immune!
A wonderful series has recently been written by Steve Twedt of the Pittsburgh Post-Gazette called the “Cost of Courage,” detailing a number of physicians who have suffered from sham peer review and the consequences they have had to pay (http://www.post-gazette.com/pg/03299/234499.stm).
So What Is a Sham Peer Review?
A sham peer review exists when a practitioner undergoes chart review during which “serious” deficiencies are determined to exist and, therefore, “the practitioner must be prevented from being a risk to the public safety.” This conclusion is obtained by either:
- Declaring that the practitioner does not practice within the guidelines of the standard of care – regardless of whether that is true. (Several examples include the panel rejecting literature to support a position and being told, “We don't care what the literature shows” and “That institution doesn't know what they are doing.” In essence, a new standard of care is established – because that is not what the victim does.)
- Commissioning an outside review with prearranged outcomes. There are peer-review firms with dubious reputations who will perform a review that reflects the desired outcome of the employer.
For the full text of this article, go to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681729/
MedGenMed. 2005; 7(4): 47.
Published online 2005 November 15.
Copyright ©2005 Medscape