A Physician's Guide to Navigating Peer Review

I asked Karin Zaner, a director with the Dallas law firm Kane Russell Coleman & Logan PC, to share her tips for how physicians can best deal with the hospital peer review process.

Martin Merritt: Peer review can be one of the most traumatic experiences for a physician. What tips can you share with physicians to guide them through the process?

Karin Zaner: My experience in medical peer review began in 1999, when my firm represented Dr. Lawrence Poli

ner in his federal court lawsuit against Presbyterian Hospital of Dallas and obtained a $366 million verdict, which was the ninth largest jury verdict in the country in 2004. This verdict was later reversed by the 5th Circuit due to federal peer review immunity - a real life lesson showing the clear lack of legal accountability in peer review. I now advise my physician clients on a wide variety of health law matters, including determining the best strategy to protect a physician's record when a peer review occurs. When a physician faces peer review (whether due to standard of care or an allegation of disruption), that physician must respond quickly and with credibility. Here are my 10 tips.

Tip 1: Get the bylaws of the organization. Bylaws contain crucial deadlines and due process rights. Insist these be followed.
Tip 2: Hire legal counsel. Whether behind the scenes or on the front lines, getting counsel involved early can limit mistakes and minimize damage.
Tip 3: Respond in writing in a factual tone. Communicating medical facts with corroborating evidence helps the committee understand the case and get your side of the facts into the peer review file.
Tip 4: Maintain credibility. Do everything you can to present the medical facts in an unbiased and reasoned tone. Avoid becoming defensive and do not exaggerate - credibility is key.
Tip 5: Be there for every meeting. Take full advantage of every opportunity to make a personal connection and explain the medical facts to the committee.
Tip 6: Don’t resign or let privileges lapse. If the review is focused on you, to avoid a negative report to the state licensing board or the federal data bank, assume an “investigation” exists and get legal help before you resign or let your privileges lapse.
Tip 7: Understand your legal options. The law in your state may provide options for litigation, but they will be very limited. Consult with counsel to be sure you understand your rights.
Tip 8: Do everything necessary to win at the “fair hearing” stage. Spend your resources on counsel, expert witnesses, and services that will maximize the chance of getting your privileges back at the hospital at the “fair hearing” level.
Tip 9: Look for opportunities for resolution. While preparing for the hearing, be creative and flexible in determining a resolution you can live with.
Tip 10: Practice where you are welcome. Practicing medicine is hard enough. Practicing medicine under a microscope is a recipe for disaster. If it is clear the hospital is not a good fit for you, make your exit with the help of legal counsel.

MM: Do you have any additional thoughts for our readers?

KZ: The best way to succeed in the peer review process is to avoid problems in the first place. Document the medical record well. Respect the healthcare team, which means heading off complaints of disruption. Respect your patients as, even though you meet the standard of care, hospital administration must deal with patient complaints of rudeness. Choose your hospital carefully, and consider maintaining privileges at more than one hospital if your subspecialty requires it. Be active on medical staff committees, which will help you diffuse problems as they surface. Taking care of your patients is not enough - you also have to pay attention to the business and political atmosphere at the hospital. If you cannot resolve conflicts informally, take your practice elsewhere with the help of legal counsel.