Physician PEER REVIEW Defense 

Peer Review Defense by Daniel Horowitz: A Nationally Recognized Legal Commentator and Trial Lawyer

Daniel Horowitz and his team of physician peer review attorneys specialize in defending physicians facing peer review.   The peer review defense process often begins with the shock of a summary suspension.  Other times the peer review process starts with an informal inquiry and a request for a written response to vague quality of care questions.   Peer review lawyers should be contacted as soon as possible as these informal inquiries are the initial steps in a much more formal - and threatening process.

With a proven track record against sham peer review and retaliatory peer review, Daniel Horowitz looks to extricate his clients from a legal process that never favors the physician.  Peer review ostensibly is a fair and balanced inquiry but under the guise of “patient safety” the process always places the doctor on the defense.  

The experienced legal team includes Physician and Lawyer Mark Ravis and Brookes Hammock, a physician defense attorney formerly with the medical board of Ohio.

Call the Horowitz Medical Group at 925-291-5388

A. Lawyer as Peacemaker (if Possible)

A physician peer review attorney is part negotiator and part litigator. Dr. Mark Ravis (MD/JD) and Daniel Horowitz look for common ground shared by our doctors and investigating medical staff committees so that fractured relationships can be repaired, and our doctors can return to their normal life and normal practice.  (With sham peer review this process is difficult as the termination of privileges and imposition of sanctions is the intended purpose of the hijacked peer to peer review process.)

B. Lawyers Fighting Sham or Unfair Peer Review

If a fair resolution is impossible our attorneys will present a medically valid defense to the allegations.  We will raise standard and creative defenses based upon existing law and law that is developing and favorable to our doctors.  We vigorously cross examine adverse medical witnesses using our very extensive trial experience.  As a veteran of thousands of hearings and hundreds of jury trials, few lawyers can match the courtroom experience of Daniel Horowitz.   As client oriented lawyers we are acutely aware that the hearing process is emotionally painful, unfairly expensive and has no guarantee of victory.  When we are forced into a battle to protect your career we always respect and acknowledge your feelings, financial interests and your long term accomplishments and goals.

Blogs on Peer Review

 Disruptive Physician 

Sham Peer Review  

Article on the El-Attar case

What is Physician Peer Review

The Peer Review Lin Case

What Constitutes the Actual Start of Peer Review

The AMA, Due Process & Peer Review

Summary Suspension of Doctors

Rules Governing an MEC Summary Suspension

HOW TO RESPOND TO PEER REVIEW

What is an 805 REPORT After a Summary Suspension or Negative Peer Review Result?

Peer review moves quickly and adverse consequences can take place in matter of weeks.

California Business & Professions Code section 805 requires reporting of discipline (including interim discipline) of physicians to the Medical Board of California. Summary suspensions almost always result in reporting. Here is the reporting part of the statute (edited and highlighted)  As noted by the Medical Board of California “805 reports are not public documents available to consumers; however, copies may be requested by certain health care facilities licensed pursuant to California Health and Safety Code 1200-1209 for credentialing purposes. This does not cause the 805 report to become public record. ”   However the effect of the 805 report and the suspension that led to its filing are quite public and damaging.

Bottom line is that once an 805 report is filed you will have to defend yourself to the Medical Board of California.   Our peer review legal team sees ahead and prepares your peer review (or summary suspension) defense with the understanding that the same allegations may be independently evaluated by the MBC.  Be aware that if you resign after peer review has started, that resignation is reportable both to the MBC and to the National Practitioner Data Bank (NPDB).

The reporting requirement to the medical board is triggered  "Only if the 805 report indicates hospital disciplinary action that resulted in the termination or revocation of a licensees' staff privileges based on medical disciplinary cause or reason. The licensee's profile will display "Hospital Discipline" as secondary status. Further details are available under the Public Record Actions section. The extent of detail available is limited to the reporting entity name, a brief description of action, and effective date of action."

Section 805(b) A report by a peer review body  

 (b) The chief of staff of a medical or professional staff or other chief executive officer, medical director, or administrator of any peer review body and the chief executive officer or administrator of any licensed health care facility or clinic shall file an 805 report with the relevant agency within 15 days after the effective date on which any of the following occur as a result of an action of a peer review body:

The items that must be reported are summarized as follows:   

• A peer review body denies or rejects a licensee’s applications for staff privileges or membership for a medical disciplinary cause or reason;
• A licensee’s staff privileges, membership, or employment are revoked for a medical disciplinary cause or reason;
• Restrictions are imposed, or voluntarily accepted, on staff privileges, membership, or employment for a total of 30 days or more within any 12 month period for medical disciplinary reasons;
• If the resignation, leave of absence, withdrawal or abandonment of application or for renewal of privileges occurs after receiving notice of a pending investigation initiated for a medical disciplinary cause or reason;
• A summary suspension of staff privileges, membership, or employment is imposed for a period in excess of 14 days.

This reporting period is a commonly used “hammer”, wielded by the attorney for Medical Staff against the target physician. The physician is often trapped. Once the process is started can the physician just pack up and move to a better environment? Here is what the NPDB says.  Basically it parses the issue.  Is it a resignation while “under investigation?” Or is it a resignation during a “routine review process” e.g. a non-triggered OPPE.

 Business and Professions Code Sections 800 and 805(f), allow a doctor to submit "additional exculpatory or explanatory statements" to supplement the (negative) 805 report. This doctor provided explanation will be provided with the 805 report to any party who receives the report.  The MBC says this "Pursuant to Business and Professions Code Sections 800 and 805(f), a licensee may submit "additional exculpatory or explanatory statements" to supplement the 805 report. This addendum will be disseminated with the 805 report to any eligible requesting party."

Medical Board of California 805 Reporting Forms