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Thursday, May 22, 2008

Lennox, Kuritzky, and Sham Peer Review

Medical peer review is a process by which doctors that have been accused of stepping out of bounds are judged by their peers.

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.

The term has been improperly used, however, as a synonym for performance appraisal. Several organizations have co-opted the term "peer review" as a guise for performance appraisals meant to be used as negotiating tools.

A medical peer review committee can act at the request of a patient, a physician, or an insurance carrier depending on the politics of the venue.

When medical peer review is corrupted it is known as sham peer review.

Sham peer review or malicious peer review, a concept explained by Roland Chalifoux in Medscape General Medicine, is the practice of using a medical peer review process to remove a doctor who is seen to be disruptive, too great an advocate for change, or competitive with other doctors within the same institution.[1] While technically sham peer review is a concept that applies to every discipline, it has most commonly been applied to the healthcare industry recently.

In healthcare, the lines between peer review of physicians and performance appraisal by non-peers has been blurred. Administrators, nurses, and even patients play a role in performance appraisals, while peer review is a system that is only supposed to involve the physicians themselves.

Scientific peer review has traditionally been held to be achievable only when research and investigations are able to be examined openly. Medical peer review, in contrast, is protected from open examination by rules of confidentiality. In this way it also diverges from true peer review.

I have over the last several months introduced examples of how sham peer review has threatened doctor's livelihood and disrupted their lives in tragic ways.

In South Carolina, Dr. Blake Moore discovered that one of the nurses, Lynetted Vaughn, on staff at his hospital, Williamsburg Community Hospital, was administering legal doses of drugs to terminally ill patients. In other words, he discovered a serial killer. He reported her activities to hospital administration. Vaughn is exactly the sort of medical professional that medical peer review was intended for. Unfortunately, rather than disciplining Vaughn (for what should have been the beginning of criminal proceedings), the entire hospital administration turned on Dr. Moore himself.

A colleague accused him of making racist remarks, and this started a long process of sham peer review. In that case, as with all cases of sham peer review, the problem could be defined by this: judge, jury, and executioner. The employee who accused him of racism had been sent at the behest of the hospital administration to claim false charges. Dr. Moore was a whistleblower and sham peer review is a common tactic of corruptors to deal with whistleblowers. The problem was that the peer review was being administered by other corrupt entities that were in bed with the administration.

In Texas, Dr. Shirley Pigott became a target of yet another sham peer review. What she discovered was that her main insurance provider, Blue Cross/Blue Shield, had determined that she was charging them an unacceptable level of fees and they decided to use sham peer review to punish her and force her to cut her fees. BCBS used Dr. Keith Miller, who was simultaneously head of the Texas Medical Board's Disciplinary Committee and a part of the super secret Blue Cross Blue Shield Texas Medical Advisory Board, to orchestrate a sham peer review against her. In fact, there are likely thousands of doctors in Texas that were the victims and I highlighted to stories of two others, Dr. Bill Rea and Dr. Chris Kuhne, here.

The reasons for sham peer review range because this is a problem that is systemic. (I hope to introduce many more stories of medical professionals that had been wronged in the months to come)It ranges from punishing rivals, to whistleblowers, to jealousy, to mere corrupt individuals drunk on power. The thing that ties them together is that corrupt forces join together to create charges, prosecute them, and make judgement. If the same corrupting force charges a doctor, prosecutes the doctor, and acts as the jury, you can see that the proverbial deck is stacked against that doctor. That of course is a sham and that is why it is referred to as sham peer review.

Now, the only difference between the cases of Kevin Kuritzky and Dennis Lennox and the standard sham peer review is that neither Kuritzky or Lennox were doctors. In fact, what first drew me to the situation surrounding CMU was the similarities between the way in which the administration treated Lennox and they way in which Emory University treated their student, Kevin Kuritzky.

Kuritzky began reporting serious abuses in patient care at Emory's teaching hospital, Grady Hospital. Rather than having his concerns looked at, the administration deemed Kuritzky a threat. Emory employed William Casarella to not only investigate charges against Kuritzky but to prosecute the charges and act as the head of the jury at Kuritzky's disciplinary hearing. As such, 41 days prior to graduating from medical school, Kevin Kuritzky was expelled.

Emory claims Kuritzky was dismissed for "plagiarism, repeatedly missing required clerkship training involving patient care, lying to his professors, and engaging in other unprofessional, dishonest and unethical conduct."

In fact, Kuritzky has told me that just prior to the start of his expulsion hearing, Casarella approached him and told him that he was through. Does this sound like Kuritzky was part of a fair process?

So, we get to the situation surrounding the confrontation between Dennis Lennox and CMU. The elements here are largely the same. Lennox ran a painstaking campaign for more than a year to try and expose corruption that he saw in the hiring of Gary Peters to the distinguished Griffin Chair. Peters was simultaneously running for U.S. Congress in a district hundreds of miles away. As such, Lennox felt that Peters should choose one or the other. He continued to challenge the administration and refused to drop the matter until Peters made the choice.

He was ultimately proven right as last week CMU announced that they would likely change their policy and force all administration to choose between running for Congress and serving in the administration.

Of course, as the events were unfolding, the administration didn't see it that way. Thus, in October, Lennox was approached by a member of the administration, Peter Kofer, in the evening inside a university building. Because Lennox refused to identify himself, Kofer immediately took formal action. Kofer's complaint went directly to Peter Voison who is not only a member of the CMU staff but a colleague of Peter's himself. This incident lead to formal charges and ultimately a formal disciplining of Lennox. The disciplinary hearing was conducted in secret without Lennox' attendance, so we don't know who was on the jury. That said, I think we can all bet that the jury was made up entirely of colleagues of Gary Peters.

The common elements are the same. The same corrupt administration that viewed Lennox as a threat brought charges against him. They prosecuted the charges and they acted as the jury. In fact, in Lennox' case, the administration was so brazen that the hearing was held without his attendance. He wasn't even allowed to be there to defend himself. If the same corrupt administration brings charges against you, prosecutes them, and acts as the jury, then that is a sham.

What both Kuritzky and Lennox faced was the academic equivalent of sham peer review. It's important to keep that in mind as we analyze the outcome of the fiasco that surrounded Lennox, CMU, and Gary Peters. Last week, the administration announced that they would likely change their policy and Peters would be forced to choose between running for Congress and being a Griffin Chair.

While that is great, what hasn't been resolved is what will happen to th perpetrators of the sham that targeted Lennox. The common thread of any third world nation is obscene corruption at all levels. The sham perpetrated on Lennox exposed a corruption at all levels of the university. His case received a great deal of media attention. Yet, at all times, the case against him moved forward with no one in the administration ever stepping in to do the right thing. From the President, Michael Rao, to the Dean of Students, Pamela Gates, to everyone else, these folks were either actively in on the sham or they looked the other way while it continued.

Sham peer reviews don't happen by accident. They are carefully orchestrated to create a desired outcome. Neither was the sham perpetrated against Dennis Lennox merely a twist of fate or an accident. This was a carefully orchestrated plot that either involved all levels of the administration or merely had some look the other way. As such, if the administration is allowed to continue with their jobs in tact, then the message is that the sham perpetrated against Lennox is acceptable. Furthermore, these shams don't happen in a vacuum. If this administration orchestrated this sham on Lennox, they will do it again. They must be held accountable for their corruption or CMU will find itself tolerant of more of it in the future. Unless we want to deal with the next Dennis Lennox the next time they step out of line, the entire administration must be held to account for the sham that they orchestrated.

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