What is the Difference Between a Doctor’s Summary Suspension and a Full Suspension After Peer Review?
Few things strike fear into a physician’s heart like the word “suspension.” But not all suspensions are created equal. There is a profound legal, practical, and career-altering difference between a summary suspension (sometimes called an “immediate” or “precautionary” suspension) and a regular disciplinary suspension that comes at the end of a full peer-review investigation.
If you’re a physician, a summary suspension can happen to you tomorrow morning with almost no warning, while the other usually takes months or years to unfold.
Here’s the breakdown.
1. Summary Suspension – The Nuclear Option
When it happens A summary suspension is triggered the moment the hospital’s Medical Executive Committee (MEC) or CEO believes a physician represents an imminent danger to patient safety or the orderly operation of the hospital. Classic examples include:
- Gross intoxication or impairment on duty
- Clear evidence of egregious clinical errors that have already harmed patients
- Sexual misconduct with a patient or staff member
- Falsification of medical records that directly threatens care
- Threatening violence in the hospital
In real life and practice surgeons are often criticized for poor surgical skills even when outcomes are excellent. The five genuine grounds listed above are often not the basis for in the real world summary suspension. Recommending surgery when not justified, misdiagnosis, bad relations with staff impacting patients and other more subjective so called failings are treated as emergencies so that they very limited due process protections of summary suspension allow a hospital or medical staff to crush a physician.
How fast it happens Immediately — often within hours. You can be walked off the floor mid-shift by security while your colleagues watch.
Process (or lack thereof) There is no pre-deprivation hearing. The bylaws of virtually every hospital in the United States (required by Joint Commission standards and most state laws) explicitly allow the MEC or CEO to act first and ask questions later when patient safety is at stake.
You are handed a letter, your hospital privileges are terminated effective immediately, your name is removed from the call schedule, and a report is filed with the National Practitioner Data Bank (NPDB) within 30 days — often before you’ve even had a chance to tell your side of the story.
Duration Technically temporary, but “temporary” can mean 6–18 months or longer while the investigation and hearing process grinds forward. Many physicians never recover their privileges even if eventually exonerated, because the stigma is permanent.
Due process Almost none at the outset. Federal law (HCQIA) and most state laws consider this deprivation of due process constitutionally acceptable when there is an emergency threat to patients. You get a post-suspension hearing (usually within 7–30 days, depending on the bylaws), but by then:
- Your income has stopped
- Your malpractice carrier has likely been notified
- An NPDB report is already on file
- Your reputation in the medical community is severely damaged
Even if you win the hearing and are reinstated, the career damage is often irreversible.
2. Regular Disciplinary Suspension – The Lengthy, Formal Route
When it happens This is the suspension that results from a standard peer-review investigation into allegations of substandard care, unprofessional behavior, disruptive conduct, or violation of hospital policies that do not rise to the level of imminent danger. 90% of the cases should proceed with this process but in practice this fair hearing system follows a summary suspension. While the peer review process seems to involve physician to physician, the medical staff and MEC almost always are consulting with a medical staff attorney.
Examples:
- Pattern of poor outcomes or documentation over time
- Repeated failure to complete medical records
- Chronic disruptive or abusive behavior without immediate patient risk
- Billing irregularities
- Minor impairment issues being managed through a monitoring program
Process Full peer-review process:
- Complaint → investigation by a committee
- Physician is given written notice of the allegations and evidence
- Physician submits a written response and often appears at an in-person hearing
- A fair hearing panel (usually other physicians) makes a recommendation
- MEC votes → Board of Trustees final decision
This entire process frequently takes 6–24 months.
California's Business and Professions Code § 809.1 requires that a licentiate subject to a final proposed action by a peer review body be given written notice of the action, the reasons for it, and the right to request a hearing. If a hearing is requested, the licentiate must receive notice of the reasons for the action, the hearing's time and place, and the opportunity to contest the charges (Bus. & Prof.Code § 809.1)
Due process Extensive. You have the right to:
- See the evidence
- Bring an attorney (in most bylaws)
- Call and cross-examine witnesses
- Present your own witnesses and documents
- Receive a written report with findings of fact
While it is not criminal-court level due process, it is vastly more than the “trust us, it’s an emergency” approach of a summary suspension.
Duration Usually a defined period — 30, 60, 90 days, or until certain conditions are met (e.g., completion of anger-management training, proficiency assessment, etc.). It can also be indefinite with the right to reapply after a set time.
Reportability Still reported to the NPDB, but the narrative is often less damaging because you had a chance to defend yourself and the final report reflects that process.
Side-by-Side Comparison
| Aspect | Summary Suspension | Regular Disciplinary Suspension |
|---|
| Trigger | Imminent danger to patients | Pattern of misconduct or substandard care |
| Speed | Immediate (hours) | Months to years |
| Pre-suspension hearing | None | Required |
| Post-suspension hearing | Yes, but after the fact | The hearing happens before the final decision |
| Income loss begins | Immediately | Usually after final adverse decision |
| NPDB report timing | Within 30 days (often before you can respond) | After final decision, reflects hearing record |
| Career damage | Catastrophic and often permanent | Serious but recoverable in many cases |
| Legal immunity for hospital | Very strong (HCQIA safe harbor) | Strong, but slightly easier to challenge |
The Bottom Line for Physicians
A summary suspension is the hospital equivalent of being SWAT-teamed out of the building. It is designed to be fast and brutal because patient safety is the overriding concern. Once it happens, the burden shifts entirely to you to prove you are not a danger — a burden that is extraordinarily difficult to meet after the fact. The summary suspension process is regularly abused by medical staff, the MEC and hospitals. It requires top legal representation to respond to a summary suspension and to head it off whenever possible.
The Horowitz law office represents doctors in these high stakes peer review battles. Daniel Horowitz and Molly Northrup have years of experience and a creative pro-physician approach that maximizes your position.
