Health Care Quality Improvement Act of 1986

How did Sham Peer Review come about? Dr. Patrick was a general and vascular surgeon who joined the staff at Columbia Memorial Hospital in 1972,  the only hospital in Astoria, Oregon.  Most of the staff members of the hospital were partners or employees of the Astoria Clinic.  Dr. Patrick chose to open a private practice of his own. As a result, the Clinic physicians refused to refer patients to him, instead referring patients to surgeons as far as 50 miles away. Clinic physicians were reluctant to assist Dr. Patrick in surgeries, declined to provide consultations, and refused to provide backup coverage. In 1981, one of the Astoria Clinic surgeons requested the Executive Committee of the hospital initiate a review of Dr. Patrick’s hospital privileges. It was a sham peer review, and the committee recommended that Dr. Patrick’s privileges be terminated.

Dr. Patrick went through the hospital committee hearing system. Realizing that he wouldn’t get an unbiased hearing, he resigned rather than risking termination of his privileges. He then filed suit under the Sherman Antitrust Act. His contention was that the partners of the Astoria Clinic had initiated peer review proceedings against him to reduce competition rather than to improve patient care. He was awarded a substantial jury award, which was subsequently overturned by the Ninth Circuit Court of Appeals. He appealed to the U.S. Supreme Court.

Dr. Lawrence Huntoon and the Association of American Physicians and Surgeons (AAPS) filed an amicus brief in support of Dr. Patrick. Filing briefs opposing Dr. Patrick were the American Medical Association (AMA), the American Hospital Association, and many others. The Supreme Court overturned the decision of the Court of Appeals. They concluded that the state had to actively supervise the conduct and actually have the power to review and overturn peer review decisions.

However, this decision didn’t last. The federal government passed the Health Care Quality Improvement Act (HCQIA) in 1986 under pressure from the medical industry, including the AMA, to give both hospitals and peer review panels legal immunity from lawsuits. This same law created the National Practitioner Data Bank (NPDB). HCQIA went into effect in 1990.

HCQIA was enacted to protect he public from incompetent physicians by allowing those physicians on peer review committees to communicate in an open and honest environment and theoretically weed out incompetent physicians, without a retaliatory lawsuit by the reviewed physician. However, this hasn’t happened by any stretch. Instead, it has helped promote an environment that protects those physicians on a peer review committee when they manipulate the review process by maliciously disciplining those physicians that may be in political or economic competition.

My summary suspension occurred in 2011. Every few months since then I have searched for any new information or progress on possibly modifying HCQIA. There are only a handful of articles. One is titled Twelve Signs of Sham Peer Review. (Found on Semmelweis Society International- published by admin. on 2/11/06 in Corruption, HCQIA, Healthcare, Hospital, Retaliation, Sham Peer Review and Whistleblower).

 

The 12 Signs of Sham Peer Review:

  1. A doctor with a good history and reputation suddenly deemed to have questionable performance indicators. Absent external causes such a recent substance abuse, or mental illness and unusual stress of some kind, physicians don’t suddenly turn south in terms of professional judgment and performance.
  2. The presence of “gunny sacking” issues. Gunny sacking refers to the dredging up of old issues long since resolved to demonstrate present problems.
  3. The existence of an “insider” clique of physicians who fiercely maintain control of peer review and credentials positions and pass key medical staff positions back and forth among themselves- while excluding “outsiders”.
  4. The lack of clear, definitive standards in medical staff bylaws for “disruptive conduct,” denial or non-renewal of privileges or other discipline. (In a recent conference it was mentioned that an “inappropriate look” can now be construed as “disruptive.” Years ago it was the surgeons that threw instruments in the OR that were called out for being disruptive- as they should have been.)
  5. Medical staff acting in excess of authority or violation of the medical staff bylaws. Failure to follow the letter of the procedures set forth in the investigative process frequently implies a separate agenda.
  6. The existence of a personal animus on the part of those participating in the investigative or hearing process is a clear marker of retaliatory intent.
  7. The existence of a conflict of interest on the part of those participating in the peer review proceedings can violate fundamental conflict of interest principles. This would cast doubt on the genuineness of the quality of care issues.
  8. Minor issues of quality of care magnified beyond a reasonable expectation. Every professional makes mistakes and many of us are lucky when they don’t precipitate major problems for our patients and clients. When a reviewing committee loses its perspective and elevates otherwise minor issues into major violations, judgment becomes flawed and impaired.
  9. The “piling on” of complaints. The medical staff appears to throw every thinkable transgression, real and imaged, on the part of the physician against the wall in the hope that something will stick.
  10. Disparate, discriminatory treatment. When a physician on the “outside” is treated substantially different with respect to the intensity of scrutiny than a physician on the “inside,” where it is clear that the insiders are not demanding from themselves and other insiders the same degree of practice performance as the physician under review.
  11. In the failure to seek all relevant information concerning an issue before a rush to judgment- key physicians or nursing staff members not interviewed and the charts not carefully reviewed. The sample of cases reviewed in order to reach a judgment on competence is extremely narrow.
  12. The existence of only a pretense to a sincere concern about quality or safety of patient care. The lack of consistency in concern about quality of patient care can be a tip-off of a separate agenda or ulterior motive in the proceedings.

 

In my case of Sham Peer Review, I found  that 11 of the above signs were present.

 

Due Process and the Presumption of Innocence

An accused murderer has a better chance of being acquitted and having a clean record than an accused physician under HCQIA.  In a murder case, due process is mandatory and the alleged is presumed innocent until proven guilty. However, the accused physician is guilty until proven innocent since the burden of proof has switched from accuser to accused.

If a physician is reported to the Data Bank, they are black listed for their entire career. In Texas alone, in 2004, 68% of adversely peer-reviewed doctors were adjudicated by the Texas Licensing Board, yet those affected physician’s adverse reports are still in the Data Bank. (MedGenMed. 2005; 7(4):47).  It takes time for the medical boards to review the cases. My case was in 2011. I received a letter for the Medical Board of Texas in 2013 saying the matter was closed and they didn’t feel any further disciplinary action was needed. I was relieved and assumed my name would be taken off the Data Bank. I was told no, but I could list my “side” of the story. As one can imagine, it just came across as a whining doctor who was just making excuses for her behavior. I don’t believe a single employer who interviewed me actually read the Data Bank report. Once they queried the bank and saw my name there, they washed their hands of me and my application for employment.

 

 

I predicted my own fate….

I have recently found some renewed enthusiasm for writing on my blog. I read about an exciting new center for physicians rights appropriately called CPR- Center for Physician Rights that was started by Dr. Kernan Manion. He was subjected to mistreatment by the North Carolina PHP and the medical board and subsequently lost his license in 2013. I am excited and hopeful that this organization can help stop the unfair treatment for now countless physicians. I have provided a link to his group on the sidebar.

In searching for material for my blog, I found a letter I wrote to the Chief of Staff of the hospital where I worked dated back to March 2008. First, a little background.

I left the physician I originally joined in 2002 and opened my own office in March 2005. I had no complaints or issues for three years prior. Four months after I opened my office I started getting “notices” of inadequate care of various patients or “inappropriate” comments I apparently made. My clinical decisions were constantly questioned by nursing who would call one of the other more senior physicians for clarification. The physician I originally joined, Dr. X didn’t speak to me for a year after I opened my practice. Our department consisted of  only three doctors, Dr X, Dr. Y and me- the only female.  Out of incredible frustration I requested a meeting with the Chief of Staff along with the other doctors in my department. Below is the letter  I submitted as exactly written back in 2008.

 

 

Dear Dr. Z,

Since I opened my own office there has been an obvious and palpable tension between Dr. X an myself. Although he hasn’t been openly hostile in public, his manner and inability to communicate with me in a professional and collegial manner has been apparent and has progressively accelerated. I have been told by nurses that he has made disparaging remarks on the nursing station about my patient care and I am also aware that he has asked numerous physicians about my performance in medical record keeping presumably to use as ammunition at the peer review meeting. I have read incriminating comments made by him in my patient’s chart which could be quite damaging to me in a potential lawsuit by said patient. I am also aware that the hospital peer review asked the head nurse on labor and delivery if the nurses had any problems with my performance prior to the peer review meeting, again presumably to “make a case”. This amounts to professional harassment, economic favoritism of one physician over another, abuse of power of those physicians on various committees, failure of due process and grounds for legal action.

(This was written prior to a peer review meeting regarding my delinquent medical records- I was placed on probation for not finishing my dictations in a timely fashion.)

I find it reprehensible that I have been left with a situation in which I feel my every move, patient encounter, and conversation is scrutinized and reported to an authority within the hospital . There is an obvious conflict of interest where my economic competitor is scrutinizing my patient’s charts and using hi position on various committees to report any and all perceived digressions. This is an untenable situation and no respected and clinically competent physician should be expected to work in such a hostile environment. This situation places me at a potential risk of Medical Board action should the situation escalate. My only obvious choice at this point is no longer share call with Dr. X which will again potentially result in retaliation on his part.

 

 

My summary suspension was issued in May of 2011. In retrospect, I should have started to move my practice at the point I wrote the letter. It would have been very difficult as I would have to sell my house and office building as I was in solo practice, divorced, and managing the office as well.

Hind sight is always 20/20. The writing was on the wall.

 

 

A First Generation Immigrant

I am a first generation Turkish- American woman. My father,  a Turkish Airforce cadet,  won a scholarship to study engineering at the University of Illinois at Champagne/Urbana in the early sixties.  I was born during his Master’s study.  My older brother, also a physician, was born in Turkey five years prior. My father studied English for six months at Georgetown University before beginning his Engineering studies.  After six years of study, we moved  back to Turkey so my father could  fulfill his military obligation. Back in Turkey  he witnessed a lot of corruption in his profession of Structural Engineering. More than once he was threatened or coerced into signing off on unsafe building projects. It was completely against my father’s nature to submit shoddy or unsafe work.

My father is a very disciplined and ethical man with a strong work ethic. I believe he took after his grandfather who was appointed to be senator from my father’s home town of Malatya when Turkey first formed its democratic government in 1923. My great- grandfather was politically very outspoken. He never actually  served in the senate, though.  Someone poisoned his tea and he died at the age of forty-two.

Dismayed by the corruption in Turkey, my father decided to move back to the US to pursue his career. He found a job in Detroit, Michigan. Detroit is just across the border from Windsor, Ontario, Canada. We settled in Canada until my mother and brother could secure their American visas.  Four years and two American visas later ,we moved to Southern California , when I was nine years old.

My brother was to pave my way into medicine. My father wanted him to be a doctor. I remember them sitting at the kitchen table discussing what MCAT scores he would need to get into medical school with his GPA. My father always reminded us that when he came to the US he didn’t even speak the language and he got his bachelor’s and his master’s degrees. He told us,  “I am paying for your education, you speak the language. You should be able to get at least a master’s degree,  if not better.” I can’t imagine moving to another country and studying their language for just six months and even passing a single class. My parents left their entire family in Turkey and built a life for their children. They wanted their children’s success to be proof of the value of their sacrifices.

It is in this context of my childhood that failure was just not an option. I was not as focused as my brother initially for years of sacrifice. It took my parents some pushing and prodding. As a female applicant in the late 80’s I was part of 30% of the entering class,  so I had somewhat of an advantage as a minority applicant.  I interviewed at six medical schools. I was accepted at five and an alternate in the sixth. The first two years of medical school were awful. I was living alone,  on the east coast miles away from family,  and in constant fear of failing out of school.  I thought about quitting twice but managed to hang in there. The clinical years were much better and I got my confidence back.  I cried tears of joy through our entire graduation ceremony. I couldn’t believe I actually made it.

My parents were devastated when I had to close my practice after the case of Sham Peer Review.  I was divorced at the time with minimal savings. I spent months looking for a job that was commuting distance of my ex-husband since we shared custody of our children. I was offered several jobs only to have the offers retracted when they found out I was named on the  Medical Practitioner’s Data Bank. My medical license was not suspended but because I had a summary suspension of my hospital privileges the effect was just as bad. Physicians in  surgical specialties, like Ob/Gyn, need hospitals for a significant portion of their practices. I was told that hospital committees would be hard pressed to grant me hospital privileges again. I was severely depressed, embarrassed and ashamed. I felt I had let my parents down. I am so grateful that I had my children which served as a buffer against self harm. More than once I thought I had no reason to live.

Eventually,   I found some part time work at a hormone replacement clinic and then as a wound care doctor. I worked for about a year in a small African country delivering babies but missed my kids terribly so I returned to the US.  I started taking a lot of Family Medicine CME courses and eventually found a rewarding outpatient job as an Ob/Gyn/Family Medicine physician at an FQHC- a Federally Qualified Healthcare Clinic.  It’s been seven years now and I still have PTSD from the ordeal.  Experts on Sham Peer Review cases have observed patterns around the circumstances and types of doctors that are targeted by hospital committees and State Boards. The targeted doctors are often foreign born, foreign trained and apparently those with foreign names. Small town hospitals, new grads and female physicians are also commonly targeted. My first job interviewer as I finished my residency suggested I change my first name. I thought it was ludicrous, but now I understand.  I achieved my MD with my maiden, very foreign surname. Changing any part of my name would be an insult to my parents that was beyond repair. It was never an option. I couldn’t have finished my studies without their unending support and my parents still proudly state that both their children are physicians.

 

 

 

A random act of psychosis

My son texted me a few weeks ago. “Hey mom. What was the name of Dr. C’s husband that you used to work with?” I told him I didn’t remember. I left practice after the peer review incident in 2011 and haven’t had contact with any of the doctors. He mentioned his name and then I remembered who he was talking about. He said mom, look up Seguin doctor murders. I saw his picture. His face looking sad, maybe even remorseful. I’m not quite sure. But I did know him. I had hung out with his wife a lot. My boys had been to his house. We all went out on his boat. He loved to bake bread. He was the reason I bought my bread machine. He was a doctor. He was one of the most brilliant men I have ever met. According to multiple news reports,  he had just murdered a couple on a Sunday morning that had come over to his mother’s house to help her move furniture. He shot one, paused, then shot the other one. Their three boys were watching in their pick-up truck. Three boys that I had delivered- ages 10, 8 and 7. Now they were orphaned in an instant.

When I first read the article in the paper I didn’t realize he had shot one of my patients. I saw the couple’s beautiful picture and just thought the woman looked familiar. Her name didn’t ring a bell. I had difficulty sleeping the next couple of nights. I never knew anyone that had committed a murder. I kept trying to imagine what was going through his head just before he pulled the trigger. I had admired this man’s intellect before. I found it fascinating to be around him. He never acted violent. He was mostly reserved, possibly depressed but never crazy. The first few times I visited his wife, he didn’t say much and just walked into another room. Then the next several visits he was very cordial. He offered me a blanket once because I was feeling chilled while we socialized on the couch. He adored his daughters and appeared to be a very attentive stay at home dad. He hadn’t worked in years,  I assumed because of his long periods of depression.

He had spent six months in a Psychiatric hospital as a medical student. He apparently recovered and finished medical school and residency and did practice I believe for sometime. I remember asking his wife,  who worked as a part-time Geriatric Psychiatrist, why she stayed with him. He always seemed so sullen. She said he was brilliant and she was attracted to his mind. So was I. He and his wife apparently divorced in 2012, a year after I left Seguin. I never kept in touch with either of them. His ex-wife was good friends with the administrator who initiated  the Sham Peer Review,  so I didn’t want anything to do with her. I could have become better friends with him, though. He was exactly the type of man I was always attracted to.

At some point his mother apparently moved into the second house on their property. I wonder if she understood her son’s mental state. I wonder if I would have understood if I continued my friendship. When he was arrested he claimed that he thought people were coming to harm his mother after he discovered some illegal activity on line. He believed that in  the previous couple of weeks there were threats on line that showed that people were close to finding him. He wouldn’t speak around any radios or monitors while in custody. Somewhere during the previous six years his mental status deteriorated to the point of psychosis.

A couple days after reading the article I texted my old office manager. She responded that the young woman was our patient. She reminded me of her maiden name which finally rang a bell. I had delivered her boys and her sister’s kids. She was one of my low income patients.  She was very sweet, humble and adored her kids. I never met her husband. He came in to her life after she had the boys.

She and her husband were just at the wrong place, at the wrong time. Our lives are full of many such random events. That day a random act of psychosis was the random event that ended their lives.

 

 

 

 

 

 

 

 

Medical Assistant Bad Behavior

bullying 3

So I have had the same medical assistant now for almost three years. Or rather I had up until three weeks ago. Last Thanksgiving she texted me asking if I would call in a few Tramadol for her teenage son who isn’t my patient. She said he hurt his back. The ibuprofen wasn’t helping and the Tylenol with codeine made him sleepy. I texted her back that he needed to see his Pediatrician because he isn’t my patient.

She was my patient and I kept a chart on her care and her medications. So fast forward a month and a half and the clinic where I work received a call from a pharmacist that flagged her name. After some detective work we discovered she had been calling in prescriptions for pain medication for herself, her son, her daughter and son in law while using my name as authorization.  Large numbers of Tramadol. I was so hurt and angry all at the same time. Every holiday I bought her gifts. I baked cookies and bread for her. I listened to her cry when her granddaughter moved away. I taught her medicine. And yet, she risked my license without a second thought, apparently.

We used to have fun working together. The clinic hasn’t seemed the same without her and now we’re interviewing for a new medical assistant. I had my own private practice some years ago. I had a medical assistant who stole several thousand dollars in cash- slowly over the course of a few months. I helped her and her family out and yet she stole.

These women both went on to get new jobs in no time at all. The assistant from my prior practice got a job with a local judge. I called the judge and told him she stole from me. He hired her anyway. Years later I found out that she stole from him! Last I heard she was doing working during the week and doing jail time on the weekend.

At my  current job I was told I can’t call her new employer and tell him what happened because we could be sued! Her new employer called for verification of employment and HR told them we would not rehire her, but that’s all they said. I have no doubt she will continue her same tactics. We did file a police report and filed a case with the Narcotic division- with the officer who deals with phone in prescription abuse. There is an entire department for this. But he said that not much will happen to her. She may lose her MA license- apparently she never had one anyway. They’ll send her to rehab. It’ not a felony to impersonate a physician.

Now as a physician I have no recourse if someone maligns me under the guise of a Sham Peer Review. I wanted to sue the physicians who ruined my reputation for Defamation of character. I was told not to bother as I wouldn’t get too far and it would cost thousands of dollars. It is incredible to me that I did exactly what was expected as a physician in training and practice and end up losing the ability to practice my specialty because of a couple of unscrupulous people. My medical assistants had more rights than me.

Doctors have slowly signed over any power they had to lawyers, administrators and insurance companies for the sake of a good income. The few that have stood up to power have been crucified, burned at the stake, etc…..

 

Emergency Meeting

what-is-the-14th-amendment-due-p-760x507The vice CEO- a short woman with short curly hair who always wore tight skirts and high heels- called me on a Monday morning to schedule an urgent meeting in the board room on Wednesday evening. I told her my son has a soccer match. “It’s very important. This is concerning your career, after all.” she snorted.  I’m sorry, I said. I can come Thursday at the earliest. So Thursday rolled around and I entered the conference room where there was a rather large file in front of each chair around the table, a total of a dozen or so chairs. The room slowly filled with doctors and administrators. I opened the file. It was all about my time at the hospital- all nine years. My heart sank. I knew what was about to happen. They were about to end my career.

bullying 2

The Peer Review Committee chair then began the meeting by saying that we have been called to meet because one of the other obstetricians- the only other female on a staff of four obstetricians filed a formal compliant that I mismanaged one of her patients over the previous weekend when I was on call. She didn’t call me to discuss her concerns or ask questions regarding her patient. This is rather non collegial and unusual, especially since I had never had any issues or run ins with this doctor before. Oh and the nurses in the emergency room also reported that I told a different  patient that she should sue the emergency room doctor for mismanaging my patient. When I started to ask him to explain he raised his index finger and shook it in my face and saying no further questions and that I’ll receive information about it at a later date.

It was May 2011 and I’d been in Texas for nine years at this point. I had been on and off administrative probation signing off on my charts late. I had several nurse complaints for missing an occasional delivery or an “unprofessional” comment over the course of nine years. I had no malpractice cases or bad outcomes. I had no patient complaints.  I had two malpractice cases in the six prior years I worked in California. I joined the American College of Legal Medicine and attended several of their conferences as a result of these cases.  It was there I learned about Sham Peer Review years before it happened to me. I met doctors who had to stop practicing medicine because of a sham peer review. Several had become lawyers. I had attended a lecture on how administrators attend conferences on how to get rid of unsavory doctors through sham peer review. So as soon as I walked in the conference room, I knew exactly what was going on.

The Executive Committee of the hospital issued a Summary Suspension after the Peer Review committee grilled me with numerous questions about minor incidents that they had diligently documented over the course of nine years. The actual patient case wasn’t even discussed.  A summary suspension is issued when a doctor is considered an immediate risk to the public and she is walked off the hospital premises and is forbidden from setting foot on the hospital grounds again. I was  forced to relinquish my hospital privileges and was unable to deliver my patients’ babies. The next nearest hospital was thirty minutes away. I was treated like a criminal. I couldn’t even get my favorite blue clogs from my locker. The head of the executive committee was an Orthopedic surgeon who also sat in the role of administrative/physician liaison. He had recently divorced his wife and married the vice CEO  of the hospital who had also recently divorced her husband to marry the surgeon. The orthopedic surgeon recently formed a group specialty practice in which he hired several physicians two of whom sat on the peer review committee- one was the chair. The female physician who entered the complaint was his latest, newest employee. Also, in a moment of seriously bad judgment, I went out on a couple of dates with the vice CEO’s ex husband almost a year after her divorce. I figured she’s remarried and wouldn’t care. So why did I so urgently lose my hospital privileges? Competition, petty female jealousy? I’ll never know.

I was told I had until Monday morning to resign my privileges and immediately close my practice or they would report me to the National Practioner Data Bank. The data bank is basically a black list similar to the McCarthy era regarding physician bad behavior or drug and alcohol issues. It is a career kiss of death to be on this data bank and hospitals will hold this over doctor’s heads. It was obvious I couldn’t continue working in such an environment, so  I wrote a letter asking to resign in three months in order to deliver the numerous patients I had that were pregnant and due to deliver.  They refused. So I decided not to resign, but instead went through the hospital’s appeal process which was what we call a Kangaroo Court.

I had to hire a lawyer that dealt with peer review and medical board cases. We had a “mini trial”. I was asked to defend issues, comments, complaints or anything else that had been placed in my file over the course of nine years. Big brother was closely watching, listening and taking notes. It was dizzying to say the least. Interestingly enough, I had literally no bad outcomes. No malpractice cases, no patient deaths, nothing. I was very careful to practice within the scope of my skills. I didn’t do any risky surgeries or complicated cases without adequate experienced backup surgeons.

The mini trial consisted of an Ad Hoc Committee of three physicians- two of who the hospital picked, and one who I picked. The committee members after hearing my “defense” of the issues that were raised wrote a letter recommending unanimously that I be allowed to resign and resume my career elsewhere and that reporting me to the Data Bank would be an unnecessary hardship and it could permanently damage my ability to practice my trained specialty. They did say that even though I at times was unprofessional in my speech and manner in how I conducted myself at the hospital, my patient care was never substandard.  I was relieved. This committee sent its recommendations back to the Executive Committee which was headed by the orthopedic surgeon. The response was- we don’t care- we’re not going to let her resign and we will report her to the Data Bank. I appealed to the Board of Directors of the hospital who kept the ruling the same with no further explanation.

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I received no due process. So much for the United States Constitution. So much for years of sacrifice and thousands of dollars of student loans and a greedy, power hungry couple can virtually wipe out my career. I cannot sue any member that sat on that committee. No judge will hear the case due the HCQIA law. Until this law is amended we will lose many doctors to this abusive system. The really sad thing is that most doctors don’t know this can happen, and the ones that do, don’t care or don’t think it can happen to them.  All of my colleagues knew what happened to me. With the exception of the doctor that I asked to serve on the ad hoc committee, no one spoke up for me.

Gregory R. Piche has an excellent book, “Sham Peer Review- The Power of Immunity and The Abuse of Trust”. In it he outlines those who are typically victims of the inappropriate exercise of institutional power. He states they tend to be new members of the medical staff, women, minorities and foreign born physicians. Doctors that are making significantly more money than their peers in the same specialty or a doctor who is an innovator/inventor is commonly a target.

Basically, if you veer away from the herd you are easy prey.

Welcome to my Blog

My name is Aysun Alagoz, MD.  I am an Obstetrician/Gynecologist living in  Corpus Christi, Texas. I’ve been practicing medicine now for twenty-one years. The last four years I have been doing primarily Family Medicine due to a Sham Peer Review case in a small town about forty minutes east of San Antonio, Texas.

So what is Sham Peer Review?  It is an adverse action taken in bad faith by a professional review body for purposes other than the purpose of quality health care and it is disguised to look like legitimate peer review.

So to further clarify:

Peer Review- defined as the evaluation of scientific, academic or professional work by others working in the same field.

Sham- defined as something that is not what it seems to be and is intended to deceive people or someone.

So a Sham Peer Review is a method unscrupulous hospital administrators and physicians use to discipline,  then subsequently cancel a doctor’s hospital privileges mortally wounding her ability to practice in the community.

So, historically, it was always thought that doctors should police themselves. Medical Boards of each state are set up to make sure this gets done. Medical Boards exist to “protect the public” from bad, incompetent and otherwise unsavory doctors. Which of course used to mean doctors that abuse drugs or alcohol and scrub into surgeries “under the influence”. This has changed to the extent that multiple different behaviors- constituting a “Disruptive Physician”  can result in a Peer Review case.    All doctors that have hospital privileges are required to follow the hospital bylaws. If they deviate from these bylaws, they are subject to a Peer Review. Peer review members are other physicians with privileges at the hospital. In 1986 the HCQIA law was passed which stated that all members of the peer review committee shall be immune to lawsuits. Predictably, this has led to all types of abuse and corruption with those in positions of power.

The following is an excellent article about Sham Peer Review by Dr. Lawrence Huntoon who works tirelessly for the Association of American Physicians and Surgeons.

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Unfortunately most physicians don’t really care much about Sham Peer Review or really understand the ramifications of what can happen to their career if they are sucked into a peer review. Hospitals use peer review to silence potential whistleblowers within a hospital system as well.  So basically doctors just turn away from dangerous or inappropriate care for fear of endangering their careers.

Patients need to care that this is happening to their caring and ethical doctors. Patient safety should be paramount. After all, these are HOSPITALS!! I hope to educate doctors and patients about this epidemic of physician silencing! I was silenced along with hundreds of doctors across the country. I have survived the colossal hit and am continuing on with my life- not my specialty though. That has come and gone. I have now survived two malpractice cases- one resulting in a  malpractice trial, a medical board inquisition, where I some how managed to avoid a physician health program, and a Sham Peer Review. And yet all I ever wanted to do was take care of patients. I never imagined I would have to fight so hard to hold on to the only career I ever wanted.