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Doctors Judging Doctors - Peer Review and the Lin Case

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Doctors Judging Doctors - Peer Review and the Lin Case

After decades of peer review being the law of the United States you would think most of the basic issues are well established.  But they are not. Recently the Court of Appeal in Lin v. Board of Directors of PrimeCare Medical Network, Inc. (2025, Cal. Ct. App., Fourth Dist., No. D084821; 108 Cal.App.5th 1163) addressed the question of who can judge doctors and discipline doctors in a hospital or medical network setting.  The case is interesting as it outlines the typical stages of peer review and interesting in its holding that only doctors can assess the medical work of other doctors.  Here is an outline of the case.

Sneak Peak:  The court held that under California Business and Professions Code § 809.05, medical peer review must be conducted by licentiates (licensed physicians or surgeons).

I. Background and Facts

  • Parties and Context:
    • Plaintiff/Petitioner: Dr. Jason Lin, a physician employed by a medical group (San Bernardino Medical Group/OptumCare Medical Group).
    • Defendant/Respondent: Board of Directors of PrimeCare Medical Network, Inc., a private corporation licensed as a health care service plan under California's Knox-Keene Act. PrimeCare contracts with health plans (e.g., Blue Shield, Blue Cross) to provide medical services and was delegated to conduct peer review for Dr. Lin's employing medical group.
  • Inciting Incident:
    • A patient (elderly) complained that Dr. Lin grabbed/shook/hit her hand/wrist during an office visit argument.
    • Dr. Lin admitted to the contact in his notes, explaining it was to stop the patient from arguing; he later stated he would have "slapped [the patient] across the face" if he could have.
  • Initial Disciplinary Action:
    • PrimeCare's Chief Medical Officer (CMO) summarily suspended Dr. Lin's clinical privileges the next day, citing "imminent danger to the health of any individual" under statutory authority.
    • PrimeCare's Corporate Quality Improvement Committee (CQIC) upheld the suspension pending Dr. Lin's completion of an anger management course.
  • Formal Review Process:
    • Dr. Lin requested a formal hearing.
    • A Judicial Hearing Committee (JHC), composed of licensed physicians (licentiates), conducted an evidentiary hearing.
    • The JHC concluded that PrimeCare failed to prove the summary suspension was reasonable and warranted, as the incident was isolated and did not demonstrate imminent danger.
    • The JHC recommended lesser measures: anger management training and a chaperone for patient interactions, but found the suspension unjustified.
  • Board's Intervention:
    • Under PrimeCare's Fair Hearing Plan, the Board of Directors (including non-licentiate members) reviewed the JHC's decision, deeming it inconsistent with the burden of proof.
    • The Board independently reviewed and reversed the JHC, maintaining the suspension until anger management was completed and imposing a six-month chaperone requirement upon return.
  • Lower Court Proceedings:
    • Dr. Lin filed a petition for writ of administrative mandamus in Superior Court (San Bernardino County).

    • The trial court granted the petition, ruling the Board exceeded its authority by independently reviewing and reversing the JHC.

II. Holding (Court of Appeal Decision, Published February 19, 2025)

  • Affirmance of Trial Court:
    • The California Court of Appeal affirmed the trial court's judgment.
    • The Board exceeded its jurisdiction and committed a prejudicial abuse of discretion by conducting an independent review and reversal of the JHC's decision.
  • Key Legal Reasoning:
    • Under California Business and Professions Code § 809.05, medical peer review must be conducted by licentiates (licensed physicians or surgeons).
    • PrimeCare, as a Knox-Keene licensed health care service plan functioning as a peer review body, is subject to this requirement.
    • The Board's composition included non-licentiates, so it lacked statutory authority to perform peer review functions, including independent reversal of a licentiate committee's decision.
    • The sole statutory exception (allowing governing bodies to participate in peer review) applies only to acute care hospitals, not to entities like PrimeCare.
    • Interpreting the Fair Hearing Plan to permit the Board such authority was inconsistent with the statute.
  • Remedy:
    • The Court ordered the Board to adopt the JHC's decision.
    • Dr. Lin's privileges were to be reinstated.
    • PrimeCare was required to report the reinstatement to relevant authorities (e.g., for correction of any prior adverse reports).

This case reinforces strict limits on who may conduct medical peer review in California, particularly for non-hospital entities, emphasizing protection of due process in physician discipline. As of December 17, 2025, a petition for review was apparently under consideration by the California Supreme Court, but the appellate decision stands.

The medical lawyers at the Horowitz physician practice can protect you if the OPPE or FPPE process is being used to marginalize or harm you.  Call us for an initial consultation at (925) 283-1863