How To Destroy A Physician - Part 4 - Ulterior Motives

Even though peer review processes are essential for quality care, the current system in the US is open for exploitation and corruption.  As promised, here are some scenarios when a bad-faith peer review may be initiated, in no special order.

• Competition with other established staff members.
• Competition against the hospital itself, since this may be easier than trying to enforce a no-compete clause.
• Professional jealousy (yes, it does exist). 
• The physician may be a perfectionist, too thorough, who likes that?
• A whistle blower.
• A physician whose opinions are not conforming with the culture of the establishment in the hospital.
• A surgeon who is not liked by some OR staff who favor another surgeon
• A physician who is not liked by some connected nurses

These are just examples.  You never know where the smearing may come from.  Remember, the peer review process can be initiated by a hearsay evidence.  The system is so badly open to exploitation, that the above reasons may start a process that may end a physician's career in the USA.

How To Destroy A Physician: Part 3

Well, I can't think of any better addition to the series "How To Destroy A Physician" than this article that I stumbled upon at link  http://www.peerreview.org/articles/destroy.htm

I believe it deserves to occupy part 3 of the series, with full credit being due to the author, William K. Reid, M.D noticing that I am quoting it from the www.peerreview.org website.  Here goes:

HOW TO DESTROY YOUR COMPETITOR (OR SOMEONE YOU DO NOT LIKE) WITH MEDICAL PEER REVIEW

See www.semmelweissociety.net Bring the peer review action in the following ways; 1. Cut the physician's support staff. This generates inefficiency and disharmony in the remaining staff. It also lays the basis for the following.   2. Place a 'mole' in the office staff to collect a list of alleged wrongdoing, including the most trivial rumors and innuendoes. It is not the validity of these allegations, but the volume of the list, which matters. The target physician will be unable to address all the items if it is long, and the community will be more likely to believe it. It is preferable to use an outsider, newly hired, as the mole. Once the target physician is gone, fire the mole. 3. Include the Chief of Staff and two other adversarial physicians in the scheme. They can actually be kept ignorant of the true motives behind the attack. All physicians are busy and might accept data from authoritative figures, without carefully confirming their validity. Tell these doctors, for example, that the target has serious problems, which cannot be revealed without "hurting" him or her, implying personal failings, which must be kept confidential.  Hospitals which have this process well greased will usually have the same doctors "elected  to key positions year after year. They will maintain a clique of insiders who can be relied on to be supportive. 4. Begin a rumor campaign. Leak allegations to the entire medical staff and community at large. This can be done very cryptically. Any secretary who must type up corporate documents may unwittingly serve the purpose. 5. Restrict the physician's access to records. This will hamper efficiency and prevent proof of competency. 6. Use the most severe punishment (especially summary suspension) at the very outset of the review process. This will emotionally damage the target physician and his/her family, creating a shock effect. It also promotes the community's doubts about the physician's competence and character. This trauma may be all it takes to scare the physician out of town. A hasty departure only further damages the target's credibility, so that he/she will be presumed guilty. The immunity provided by the 1986 law prevents any scrutiny of the decision. 7. Limit the target physician's access to allegations, and keep them as vague as possible. The broader and more nebulous the charge, the harder it is to address it. Make the list as long as possible, even adding half-truths, frivolous allegations, rumors, and outright lies. The target will hardly have time even to read the list, and might succumb without a fight. The sheer length and vagueness of the list assures failure of the target to refute all the charges. One added advantage to a massive list is that any physician asked to review the cases will also be overwhelmed and be more likely to accept the hospital's version of the cases. 8. Prevent the target from obtaining privileges at other institutions. Then, spread rumors to the staff about the rejections by other institutions. This maneuver also keeps the target broken financially, unable to sustain legal aid. 9. Set up hearings so that only a few key insiders know what is happening. By this point, the whole hospital staff may have ostracized the target physician, if the rumors are sufficiently scandalous. 10. To help implement the plan, hire an aggressive law firm that favors corporate interests. Hospitals that routinely practice these schemes seem to use the same law firm. 11. Break the physician financially. Keep the list of allegations and the list of witnesses as long as possible. This will prolong the legal nightmare for the target, producing massive legal fees. The hospital can easily outlast the targeted physician in a protracted legal battle. Clearly such dealings are not isolated incidents. It may well be that this systematic attack on individual physicians is being formulated by law firms that cater to aggressive hospitals, particularly those hospitals with monopolistic aims. The hospital's success in such attacks is almost guaranteed by the new federal law. Even when the hospital committee flagrantly denies due process to the physician, there is no longer a mechanism for exposing such practices. The 1986 law provides a degree of immunity that effectively veils their proceedings. Our best initial recourse is public awareness. If you have had a similar experience, or any insights into hospital-privilege battles, I would be pleased to hear from you. William K. Reid, M.D

How to destroy a physician - Part 2 Choosing the Right Target

The typical profile of a good physician/surgeon who would be subjected to a damaging hospital peer review is someone who can be perceived as being an easy target.  She/he can have any one or more of the following characteristics:

1.  A solo physician, or a physician whose practice partner is not part of the good ol' boys circle.
2.  A physician whose medical practice partner is actually not supportive.
3.  A physician whose partner is being attacked indirectly.
4.  A physician belonging to an unusual profile (eg, a foreign-born physician, an African American physician, a good-looking feminine female surgeon, an unpopular religious affiliation, .... you got the picture)
5.  A physician from out-of-state with very, if any, networking connections in the community of the hospital.

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 ....