Tag Archives: Credentialing and Peer Review

Peer Review Confidentiality Cases Distinguish Peer Review from Risk Management

Two recent malpractice cases indicate the distinction between ordinary risk management processes and peer review issues. In Johnson v. Detroit Medical Center, a Michigan state court held that a physician’s credentialing file was protected by the confidentiality provisions of Michigan’s Peer Review Confidentiality Statute, and also protected the physician’s operative logs because the doctor/patient privilege protects … Continue Reading

Third Circuit Affirms Judgment for Hospital on Physician Race Discrimination Claims

Ray v. Pinnacle Health Hospitals, Inc. is an interesting physician discrimination case, not because it presents new concepts, but more so because of the use of the hospital’s quality assurance data in the discovery and summary judgment process. The Third Circuit is merely affirming the grant of summary judgment by the United States District Court … Continue Reading

Wrongful Databank Report Does Not Justify Defamation Action

Frengell v. InterCare Community Health Network demonstrates the counterintuitive nature of certain peer review actions. Dr. Frengell’s employment was terminated following the inappropriate prescription of narcotics. InterCare reported Dr. Frengell to the National Practitioners’ Data Bank, although the report was not required and the court concluded, and InterCare admitted, that it had not provided any due … Continue Reading

Public Policy of Preserving Physician Patient Relationships Rejected

In Genchi v. Lower Florida Keys Hospital District, a Florida State Appeals Court took the opposite view from the Arkansas Supreme Court in Baptist Health, posted just last week, regarding the importance of preserving physician/patient relationships. In Baptist Health, the Arkansas Supreme Court recognized the potential interference with physician patient relationships posed by the use … Continue Reading

Baptist Health Decision Invalidates Economic Credentialing

After years of litigation and appeals, the Arkansas Supreme Court has finally decided in Baptist Health v. Murphy that the economic credentialing policy tortiously interfered with the physician/patient relationships of a group of its staff cardiologists and enjoined Baptist Health from using its economic credentialing policy to deny staff appointments and clinical privileges to 12 … Continue Reading

Professional Review Activity vs. Professional Review Action

The case of Wood v. Archbold Medical Center Inc., presents an interesting twist regarding HCQIA immunity. The holding basically provides that “professional review activity” is a lesser level of adverse activity and need not meet the due process standards of HCQIA in order for a hospital to retain HCQIA. In Dr. Wood’s situation, there were three … Continue Reading

Exhaustion of Administrative Remedies Requirement Reaffirmed

In Vranos v. Skinner, the Massachusetts Appeals Court reaffirmed the doctrine of exhaustion of administrative remedies. The Court affirmed the dismissal of the lawsuit arising out of a summary suspension of a physician’s staff privileges. The bylaws of Franklin Medical Center contained the typical internal grievance procedures. Dr. Vranos alleged that the hospital had not complied with his … Continue Reading

Update: Discovery of Peer Review Records

Physician credentialing disputes often involve and may depend upon proof of “unequal treatment.” These situations arise when hospitals allege certain substandard performance or conduct by physicians, but the physician’s defense is that they are no different than anyone of the physicians, that the issues are common and that they are being discriminated against. In order to prove … Continue Reading

California Federal Court Denies Attorneys Fees in HCQIA Case

Fox v. Good Samaritan presents two interesting variations on issues commonly raised in peer review cases. The case originated 10 years ago and arises out of the suspension of Dr. Fox after he refused to designate a coverage physician with clinical privileges equal to his own. When Good Samaritan Hospital suspended his clinical privileges, following medical staff … Continue Reading

Patient Safety and Quality Improvement Act (PSQIA) May Change Federal Common Law Privilege

In KD v. United States, a decision by the United States District Court for the District of Delaware, both granting and denying a motion for a protective order in parts, indicates that PSQIA of 2005 has changed its opinion regarding the protection of peer review documents under federal common law privilege.  The opinion notes that … Continue Reading

Fundamental Fairness Trumps Technical Violations of Bylaws

In Ramamurthy v. JFK Medical Center and Solaris Health System the Appellate Division of the Superior Court of New Jersey affirmed a summary judgment dismissing Dr. Ramamurthy’s Petition for Injunctive Relief, which sought a court order prohibiting a suspension imposed by the hospital. Dr. Ramamurthy had argued at the trial court level that the hospital had … Continue Reading

Connecticut Supreme Court Reinstates Physician’s Peer Review Damages

The Connecticut Supreme Court issued an interesting decision in the case of Harris v. Bradley Memorial Hospital & Health Center Inc. in May of 2010, which was precipitated by the summary suspension of Dr. Harris. Not only did it overturn the trial court’s grant of judgment notwithstanding the verdict in favor of the hospital, after a … Continue Reading

Discovery of Peer Review Materials

Two recent decisions emphasize the ongoing battle for discovery of peer review information in negligence cases, and confirm that confidentiality is alive and well, but no longer automatic.  In Shell v. Sudan, the United States District Court for the District of Nebraska ordered that deposition questions regarding a hospital risk analysis tool were not precluded … Continue Reading

Medical Staff Bylaws as Contracts

Cases with opposing interpretations on this issue were decided within the past month. Heretofore, the basic question had been whether medical staff bylaws constituted contracts under state law. The majority of courts deciding these cases have concluded that medical staff bylaws were valid contracts. In the states with the opposite holdings, the basic theory was that bylaws merely … Continue Reading

Huron Hospital (Cleveland Clinic) Case Highlights Appropriate Investigation and Discriminatory Treatment Issues

In Badri v. Huron Hospital, which is part of the Cleveland Clinic Health System, the District Court for the Northern District of Ohio granted summary judgment to the defendant hospital in which Dr. Badri was alleging violations of the Americans with Disabilities Act, the Rehabilitation Act, and the typical emotional distress, tortuous interference, defamation and … Continue Reading

Joint Commission Approves MS.01.01.01 effective March 31,2011

NAMSS announces the following: TJC Board of Commissioners Approves MS.01.01.01 Posted: 15 Mar 2010 11:40 AM PDT Chuck Mowll, Executive Vice President of Business Development and Government and External Relations, has announced that The Joint Commissioner’s (TJC) Board of Commissioners has approved the Task Force revision of MS.01.01.01 (formerly MS.1.20) for implementation. MS.01.01.01 will be … Continue Reading

Tennessee Appellate Court Allows Termination of Privileges for Bylaws Violation

In Patterson v. Methodist Health Care-Memphis Hospitals, the Tennessee Court of Appeals affirmed an order of summary judgment, allowing a Tennessee hospital to terminate the medical staff membership and clinical privileges of two physicians for a breach of contract. The contract was established by the medical staff bylaws, which required a certain level of continuous uninterrupted … Continue Reading

Hospital Uses After-Acquired Evidence to Support Summary Suspension of Physician

Dr. Gary Ritten was a medical staff member at Lapeer Regional Medical Center in Indiana. He was summarily suspended in September 2005, allegedly in retaliation for refusing to transfer a patient who had not been stabilized as required by EMTALA. The suspension was initially rescinded by the Medical Executive Committee, although it was reinstated by the hospital’s … Continue Reading

New Data Bank Regulations Implement Social Security Act §1921 – MMPPA §5(h)

  New Data Bank Regulations Implement Social Security Act §1921 – MMPPA §5(h) The Medicare and Medicaid Program Protection Act (MMPPA) added Soc. Sec. §1921. This law expanded state licensure reporting obligations to match those already in place for the Healthcare Integrity and Protection Data Bank (HIPDB), which became active in 1999. These regulations will make reporting … Continue Reading

HCQIA Immunity: Perfect Investigations and Furthering Self-Quality Health Care

The case of Cowell v. Good Samaritan Community Health Care, a state court case in Washington, provides guidance on two of the four elements of HCQIA immunity, i.e. that the action was reasonably taken in the furtherance of quality health care and the necessary substance to establish a reasonable investigation.  Dr. Cowell raised an unusual … Continue Reading

Hospital Bears Burden of Proving Peer Review Privilege

In Bansal vs. Mount Carmel Health Systems, Inc., an Ohio state appellate court ruled that the hospital had failed to prove that documents were protected by Ohio’s statutory peer review privilege (Ohio Rev. Code § 2305.25), and reversed a trial court summary judgment decision. Dr. Girraj K. Bansal was removed from the hospital’s call schedule, and then brought … Continue Reading