Buy My Book Here

Fox News Ticker

Please check out my new books, "Bullied to Death: Chris Mackney's Kafkaesque Divorce and Sandra Grazzini-Rucki and the World's Last Custody Trial"

Sunday, January 6, 2008

Peer Review: Judge, Jury and Executioner...

Hospital peer review is a process by which doctors can held accountable for whatever mistakes they may have made by their colleagues. Here is how it works.

Medical peer review is the process by which a committee of physicians investigates the medical care rendered in order to determine whether accepted standards of care have been met.

A Medical Peer Review is meant to provide independent medical opinions conducted by an objective group of physicians and relevant medical staff that quickly resolve complex problems that hospitals, physicians and insurance carriers face. They are often used to help solve systems problems endemic to healthcare institutions and thereby reduce legal liability associated with them. The review of chart notes and other medical reports are used to help render objective written opinions.

Unfortunately, it has been used in corrupt institutions like Grady Hospital as a means of retaliation rather than a fair and impartial method of reviewing medical performance. That's because the job of accuser, judge, jury as well as prosecutor usually falls into the hands of the same group of people. Many times peer review is a tool used by administrators as a means of retaliation against whistle blowers in their department. The watch dog group, the Semmelweis Society, has documented corrupt peer reviews.

Professional peer review is intended to protect the public fromincompetent or unethical practitioners. However, it could andoften does remove the most honest, ethical, and competentphysicians, to the advantage of unscrupulous competitors. The
Health Care Quality Improvement Act (HCQIA), which wasenacted with the support of the American Medical Association,immunizes false testimony, thus allowing gossip to be convertedinto testimony and depriving physicians of independent judicial review. The accused physician is often ruined financially. The victim must pay his own legal fees, whereas his accusers are not responsible for any legal fees, which are paid by the hospital. TheNational Practitioner Databank (NPDB transforms disciplinary actions into a professional death sentence. The abuse of the process is, unfortunately, widespread.

The article continues...

My own experience with sham peer review began in 1979. As is true in many cases of sham peer review, the attack was initiated byjealous competitors who viewed a hospital computer printout anddiscovered that I was doing approximately twice the volume thatthey were doing. Never mind the fact that I was going into thehospital, at hours when they would not, to take care of gunshotwounds and indigent patients. My numbers were larger, and they were intent on doing something about it. And thus the first attackagainst mewas launched.

The pretext concerned a 6-year-old boy who presented to the hospital at an inconvenient hour with an epidural hematoma (life threatening hemorrhage on
the brain). I prevailed upon a neurosurge on friend of mine to come into the hospital. I assisted him in the surgical evacuation of the hematoma, and the child's life was saved.Although I was only the assistant surgeon on the case, competitors brought charges against me, accusing me of operating outside of my area of competence and expertise. My qualifications, however,as assistant surgeon in this case included training at City Hospitalwhere I did 19 emergency neurosurgical cases. And in this
case,three neurosurgeons had refused to come in to the hospital to care for the comatose child before I was called. This was a true emergency,I responded appropriately, and the documentation in the chart was accurate and complete. As I soon discovered, however,truth is not an impediment to sham peer review.

The surgery department held a fact-finding meeting, which was tape recorded, and two nights later a formal peer review hearing was conducted. Since the tape was favorable to my case, thehospital CEO ordered it to be destroyed. I continued to obtain appropriate consultations when needed, and my privileges remained intact. But this was only the beginning. Other chargessoon followed. Attackers coordinated their lies and stories, and it was open season again. Often the only evidence they could offer is so because I say it is so. off with his head!. It was a collaboration
between Alice in Wonderland and prestigious purveyors. The charges against me
were mounting, and the predators were moving in for the kill...

The problem is quite simple and yet it is an epidemic, pardon the pun, at many hospitals. The problem is that the same folks that bring charges against you also run the peer review as well as act as the jury. This is, of course, a stacked deck against the accused. The problem becomes even more troubling when that accused is themselves a whistleblower. If someone is making incendiary charges against hospital officials, a corrupted peer review process is a great tool to eliminate them. (in my most recent article about the fiasco at CMU I found a similar problem. The same administration that brought charges against Dennis Lennox will also be in charge of his punishment) Clearly, the medical peer review process is corruptable unless the judge, jury and prosecutor are NOT the same as the ones doing the accusing.

In the case of Grady Hospital, court documents show that peer review was used as a retaliatory tool against Dr. Jim Murtaugh. Since his is the only case to be unsealed, we don't know how many whistleblowers were threatened with retaliation at Grady with this corrupt method.

In the case of Kevin Kuritzky, he wasn't retaliated by peer review because he was still a medical student. That said, the some corrupt process applied to his review in his case of expulsion. The same individual, William Casarella, who brought charges against Kuritzky was also in charge of the panel that ultimately decided his fate. Like I mentioned earlier, the same dynamic is in place at Central Michigan University with regard to the disciplinary action against Dennis Lennox.

A corrupt medical review process has now formally been referred to as sham peer review, and that is what it is. If the same group is not only charging you, but prosecuting you and deciding your fate, then the whole entire process is a sham. It also becomes a tool of corruption and its original purpose is twisted again beyond all recognition.

In Georgia, State Senator David Shafer is looking to propose legislation to keep medical peer review from being corrupted. The answer appears simple to me. The panel deciding a professional's fate must be independent. That means that either a panel is formed to decide all medical peer review for the hospitals in the state or at least that the panel has no ties to the hospital in question. For instance, Grady Hospital would go to hospitals in the area or state in order to form a panel for peer review. The same should be true in the case of cases like Kevin Kuritzky and Dennis Lennox. Outside panels must also be set in place in order to keep those processes from being corrupted as well.

No comments: