Monday, August 22, 2011

HOW TO PROMOTE SHAM PEER REVIEW WITHOUT EVEN TRYING

AB 655 (Hayashi) is supposed to be about improving peer review in our hospitals. It's supposed to be about protecting patients. The intent of the bill is to create legislation to facilitate the transfer of peer review information among hospitals. Sadly, the bill is so carelessly written that it would also allow false and defamatory material to be transferred. Although this weakness in the proposed legislation has been repeatedly pointed out to the author, the Assemblywoman has remained unconvinced, in part because the bill is sponsored by the California Medical Association (CMA) but not without internal controversy. Some CMA members are mystified that a physicians' organization would support a bill that hands over power to hospital administrations.

One portion of the proposed legislation states that "all relevant (italics added) peer review information ... shall be made available to the licentiate." Fair enough, right? The physician undergoing peer review gets to know what kind of information is being passed around, right? No, wrong!

The word "relevant" is the bug in this sandwich. It means that the hospital in charge of transferring the peer review material and/or the hospital receiving it will get to decide what's relevant or isn't.

Solution: drop the word, "relevant" and make sure that all, all of the transferred information, is given to the physician undergoing peer review.

Another part of the bill lets the hospital off the hook entirely. Here's how it's done: the bill says that a responding peer review organization "is not obligated" to produce the pertinent peer review information unless the doctor undegoing peer review signs a release.

Solution: the responding peer review organization should not release anything at all until and unless the physician undergoing peer review signs a release.

Hayashi and staff have ignored this advice for the entire career of this bill to date. The bill should be annointed The Sham Peer Review Enabling Bill.

AB 655 (Hayashi) in its present form is an invitation to lawsuits, in fact, it's a litigator's dream, a nightmare for good doctors who run afoul of hospital administrations, and a catastrophe for patients.

The California Society of Industrial Medicine and Surgery (CSIMS) is opposed, the Union of American Physicians and Dentists (UAPD) is watch, and the California Neurology Society (CNS) has declined to have a position.

3 comments:

  1. As usual Dr Weinmann (David the Goliath killer) is on the mark.

    California Supreme court mentions "it is not inconceivable a governing body would wish to remove a
    Physician from a hospital staff for reasons having no bearing on quality of care." Mileikowsky, M.D. v. West Hills Hospital (2009) 45 Cal.4th 1259.
    In specific Smith v. Selma Community Hospital (2008) 164 Cal.App.4th 1478, 80 Cal.Rptr.3d 745, f there was evidence suggesting a hospital's governing board might have sought to terminate a physician’s privileges for reasons not bearing on quality of care

    It is known that the governing body have taken action against physicians for causes other than patient safety Smith vs Selma community hospital 164 Cal.App.4th 1478 (2008

    Preamble in CA B&P 809 regarding Physician disciplinary actions clearly mention legislative intent that a peer review conducted badly results in public safety threat by denying access to care .

    Mass hysteria about bad doctors peaked in 80's and 90's wherein public got concerned about bad physicians moving from one facility to another without accountability.

    Medical profession has its share of bad members just as the public and they deserve to be disciplined
    On the other side there is increasing tendencies of some hospitals to misuse the immunity statutory provisions of peer review to carry on vindictive actions in bad faith against physicians who have developed adversarial relationship because of whistle-blowing, policy differences and financial disputes .
    The hospital corporations are now backed by a industry created which includes corporate law firms , think tanks( Horty Springer from Philadelphia) and compliant hearing officers who are selected on their track record and judicial philosophy as evidenced by their Amicus Curiae filings in higher courts on behalf of hospital legal interests .

    Real threat to public in mass scale comes from medical industrial complex. Not a day passes without revelation in national of hundreds if not thousands of patients getting hurt by shoddy medical devices hoisted on unsuspecting public without proper clinical trials. Also by unnecessary procedures(mainly cardiac and Orthopedic ) and expensive unneeded diagnostic studies.
    The issues are gargantuan and are equivalent to few jumbo planes crashing everyday. We seem to focus on the cabin crew stewards (physicians) instead of Pilots(CEOs) , traffic controllers( Corporate Executives) and maintenance crew
    B&P code 809 needs to be tightened and loopholes closed so that there is no chance for misuse

    R.V.Rao M.D.

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  2. Thank you, Dr. Rao,

    Your insightful comment is likely to be the basis for a future piece in this blog.

    Meanwhile, you may want to review a recent case certified for partial publication by the Court of Appeal of California, 2nd Appellate District,
    Division Four, B209056 (Los Angeles County Super. Ctg. # BS105623), filed 8/19/11, Osamah A. El-Attar v Hollywood Presby Med Ctr, especially pages 15-17 that cite Mileikowsky v West Hills re "peer review that is not conducted fairly ... "

    CMA provided amicus on behalf of defendant and respondent, Hollywood Presby Med Ctr.

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