PEER REVIEW LITIGATION REQUIRES PRIOR
EXHAUSTION OF ADMINISTRATIVE REMEDIES
The Colorado Supreme Court decided that physicians must exhaust administrative remedies before seeking injunctive relief or monetary damages in court; in the case of Crow vs. Penrose-St. Francis Health Care System, the Court stated:
“Because the governing board has yet to reach its final decision on the physician’s peer review, the physician has not exhausted his administrative remedies and his case was not ripe for judicial review. Therefore, the Supreme Court orders the District Court to grant the hospital’s motion to dismiss the physician’s claims.”
Dr. Crow was summarily suspended by St. Francis Health Care System. The Court reviewed the hospital’s bylaws and concluded that it had a five-step peer review process:
1. An ad hoc peer review committee investigates complaints and makes recommendations to the credentials committee;
2. The credentials committee reviews the issue and makes a recommendation to the medical executive committee;
3. The medical executive committee reviews the issue and makes a recommendation to the governing board of the hospital;
4. The physician has the right to a medical staff hearing regarding any adverse recommendation; and
5. The physician has an appellate hearing to an appeals committee following an adverse decision of the medical staff committee.
The Court further determined that the first three steps of the peer review process had been completed promptly, but that the hospital had attempted on eleven separate occasions to schedule the medical staff hearing but all of those had been rejected by the physician, while the physician asserted that he had a right to require the hospital to produce the medical records that were the subject of the hearing in order to properly defend himself. With respect to the last issue, the Court concluded that the physician had ample opportunity to review the medical records at the hospital at anytime.
The Colorado Supreme Court’s conclusion was based upon both specific Colorado statute and general common law. The Court concluded that a peer review process was an administrative proceeding under Colorado law and that exhaustion of administrative remedies was specifically required as a condition precedent to litigation. The Court also concluded that the general rule among the states required exhaustion of administrative remedies.
The Court also concluded that it need not decide the issue of peer review immunity pursuant to the Health Care Quality Improvement Act because that issue was not ripe for decision in the context of this case. The full text of the opinion is at the following link: