Saturday, May 7, 2011

So What Is a Sham Peer Review? A MedGenMed Article


Roland Chalifoux, Jr, DO, Neurosurgeon; Clinical Instructor; West Virginia University Visiting Professor
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 (

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
MedGenMed. 2005; 7(4): 47.
Published online 2005 November 15.
Copyright ©2005 Medscape

Friday, May 6, 2011

What the Future Holds in Health Care

By Richard Willner

 The question before the legislature is should young people be required to sacrifice their civil liberties just to become a physician.

Or should these young people choose another course with …less irrational legal constraint like finance for example.

Should they be required to sacrifice family life and hundreds of thousands of dollars just to work for the momentary pleasure of some corporate hospital huckster.

Depending upon how the legislature comes down on the immunity question , The answer is pretty obvious isn’t it?

A bright future for medicine depends on creating a safe environment to practice medicine.

They take this all consuming journey to learn to take care of human beings. This is not an act of Revolt against society.

This is an act of optimism and love and dedication to the well being of our country and to the human race.

Medical education is not undertaken to take orders from the AMA or the hospital industry or to sanctify any substitute agenda besides the doctor patient relationship PERIOD.

Doctors do not become doctors to get into a battle with lawyers or corporations or insurance companies or the legislature.

Their fatal flaw is that they think that the rules of evidence that apply to medicine, the natural law, should apply to the legal environment of medical practice.

They also have the reasonable expectation that they will be judged with fairness and equanimity in the law just like any other citizen.

Currently nothing could be further from the truth. Doctors have no civil liberties.

Working as a Doctor us best compared to living in Russia under communism.

While the practice of medicine has its own politics there is nothing sacred about medical politics. There is nothing sanctified about medical politics.

So here we see in 2 extremes of medicine the good and the bad. The sanctified and the profane.

About 10% of doctors belong to the AMA close to 90% do not. Does that mean that 90% of doctors are suspect. Hardly.

So what should the legislature do to insure a bright future for healthcare.

According to the principles of the natural law they should sanctify optimism and idealism of those who are thinking about becoming doctors by refusing to rob them of the full rights of American citizenship, as the peer review process implies, just because they become doctors.

Alternatively they can choose to sanctify the peer review process over the rights of independent physicians, the agenda of medical politics and screw every doctor who chooses to practice in the state.

The answer will determine the future of health care. It is also simple and time tested.

Richard Willner directs the The Center for Peer Review Justice
He can be reached at e-mail: