Understanding the current state of peer review in Florida.

• Author: Lacktman, Nathaniel (Nate)
• Position: Letters - Letter to the editor

I applaud the efforts of federal and state government to promote health care transparency through public reporting of certain quality of care information (e.g., AHCA's publication of hospital readmission rates, CMS' Hospital Compare and Nursing Home Compare), but confidentiality of medical staff peer review and quality improvement information has been--and is--a key catalyst for promoting the candor and honesty necessary for effective peer review. Thus, I read with great interest the article on Florida's Amendment 7 ("Riding the Red Rocket: Amendment 7 and the End to Discovery Immunity of Adverse Medical Incidents in the State of Florida," March). The author includes a thorough discussion of the case law development, but describes as "curious" the Florida Supreme Court's ruling that "only calls into question the validity of the statutory immunities, rather than declares them unconstitutional." I would like to address that question.

Hospitals, physicians, and the lawyers who work with or against them must keep in mind that, although Amendment 7 and its subsequent cases removed many discovery protections on records of adverse medical incidents, those cases did not invalidate certain protections afforded by other Florida statutes, including: physicians' immunity from damages for participation in peer review; confidentiality of certain quality reports held by the state (e.g., AHCA); and physicians' protection against compelled testimony. Those important ancillary protections to the peer review structure were not the subject of Amendment 7 and, accordingly, those statutory provisions remain in effect to promote open and honest quality of care discussions among hospitals, physicians, and other health care providers. Furthermore, because the scope of Amendment 7 is limited to records of "adverse medical incidents," it would appear peer review information is not discoverable if the care was deemed "acceptable," the patient death deemed "unpreventable," or the physician file contains behavior or other information unrelated to conduct "that caused or could have caused injury or death of a patient."

Peer review and quality improvement protections serve to maintain and improve the quality of medical services, allow physicians to police themselves without burdening the court system, protect patients, and save lives.

Participation in peer review is a difficult, albeit important, task which becomes even more so when physicians encounter deficient quality...