Representing Physicians in Hospital-based Professional Review Actions
| Publication year | 1996 |
| Pages | 57 |
| Citation | Vol. 25 No. 2 Pg. 57 |
1996, March, Pg. 57. Representing Physicians in Hospital-Based Professional Review Actions
The Health Care Quality Improvement Act of 1986 ("Act") provides physicians with the right to legal representation in any professional review hearing brought by a hospital or other health care entity.(fn1) Effective legal representation of physicians who are the subject of a hospital professional review action requires skilled advocacy coupled with a thorough knowledge of the procedural and substantive law relevant to the professional review and hearing process.
The intent of this article is to provide interested lawyers with some necessary information to represent better the legal interests of their physician clients.
At the federal level, the Act governs professional review actions involving physicians. The purpose of the Act is to encourage both identification of and action against incompetent physicians or physicians who engage in unprofessional conduct.(fn2) These goals are sought to be accomplished in part by the creation of a National Practitioner Data Bank for the purpose of collecting and disseminating information concerning adverse actions affecting the staff membership, clinical privileges, licensure and malpractice claims experience of physicians. In addition, the Act provides health care entities engaging in professional review activities with qualified immunity from damages for actions taken as a result of the professional review activity, in order to encourage appropriate action against incompetent physicians or physicians who engage in unprofessional conduct.
To qualify for immunity under the Act, a professional review committee must meet certain requirements. Knowledge of these requirements is necessary to determine whether the physician client has been deprived of certain procedural or substantive rights. These requirements are as follows:
1. The committee must have a reasonable belief its action is in furtherance of quality health care.(fn3) In this regard, courts consider whether the committee conducted a thorough investigation that focused on specific concerns regarding patient care and whether the committee's conclusions are supported by an evaluation of an outside agency or independent reviewer.(fn4)
2. The committee must make a reasonable effort to obtain the facts of the matter.(fn5) The existence of a reasonable effort is determined on a case-by-case basis. A review of specific cases by the committee, followed by independent review and an opportunity to discuss the management of those cases, has been found to constitute a reasonable effort.(fn6)
3. The committee must protect the fair hearing rights of the physician under review by means of an adequate notice and a fair hearing process.(fn7) A physician may waive the notice and hearing requirements. Absent a waiver, the notice must be in writing, must contain a statement of the proposed action and the reasons for it, and must set forth the time within which the physician may request a hearing, which must not be less than thirty days in order for the notice to be adequate. A...
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