Contra Costa County Lawyer for Medical Peer Review
What is the California Medical Peer Review Process?
In California, as in all states, medical peer review is a process designed to police and improve the quality of medical care provided by healthcare professionals. This process involves the evaluation of a healthcare professional's clinical performance, medical decisions, and overall adherence to standards of care by their peers. This is generally interpreted as other healthcare professionals in the same geographical area and when possible in the same or similar field or specialty.
The DREADED 805 REPORT
California Business & Professions Code section 805 requires reporting of discipline (including interim discipline) of physicians to the Medical Board of California. Here is the reporting part of the statute (edited and highlighted):
Section 805 - 805 report by 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: (Sourced from the Medical Board of California website)
- 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.
A physician on staff at a hospital resigned her clinical privileges during a routine review that applied to all practitioners holding clinical privileges. Should this be reported to the NPDB?
No. A routine review process under which a health care entity evaluates, against clearly defined measures, the privilege-specific competence of all practitioners is not considered an investigation for the purposes of reporting to the NPDB. Therefore, this resignation would not be considered a resignation while under investigation and should not be reported to the NPDB. If, as a result of the routine review, the health care entity decides to start a targeted investigation of a specific physician, and that physician resigns during the targeted investigation, the resignation would be considered a resignation while under investigation and should be reported to the NPDB.
Peer Review Triggers
The most common “hostile” Peer review triggers are complaints by patients, nurses or other physicians. Many hospitals have internal (computerized) complaint systems so that groups such as nurses can gang up and file multiple complaints in a short period of time. There are normal medical staff/MEC contacts through the OPPE process but an OPPE can be routine or a prelude to an FPPE as well.
The most dangerous t
An FPPE, a PIP (Performance Improvement Plan), failures to obtain privileges, failures to obtain broader privileges, adverse medical events, complaints about a physician’s demeanor are often “dealt with” on an informal basis. Do not be fooled by the informality. Any on the record MEC interaction will carry immediate consequences and long term threats. The informal resolutions may resolve matters or may be the “we gave him a chance” prelude to a summary suspension.
Self Help is Often Harmful
Efforts to bypass an attorney can cement negative impressions and reduce the options available once you obtain competent medical legal counsel. There have been cases where physician self help has led to criminal charges of intimidating a witness! Large medical groups and hospitals almost always have the best possible legal representation hiding behind their collegial “aw shucks” approach. In most cases they expect that you will retain counsel and may take advantage of you if you don't.
Peer Review Conduct & Misconduct is Protected
The Peer Review process is not just the hearing. Legally, any criticism may be deemed “peer review”. Peer review activity is largely protected so that people lodging complaints (even in bad faith) have protection from being sued. (See Bonnie v. St. Joseph)
A California medical license attorney knows the dangers of California Evidence Code section 1157. Evidence Code section 1157 provides near complete protection from disclosure of any statements made by participants in the peer review process. (Federal law does not generally recognize this privilege.) California law balances the need for confidentiality vs. the need of a physician to sue for false accusations.
Peer Review Hearings
The Horowitz Medical Law Group consists of the most experienced medical lawyers and paralegals working with Daniel Horowitz. The medical peer review process is a quasi-judicial proceeding that has some aspects of fairness and due process. There is no substitute for a top experienced trial lawyer when an evidentiary hearing is scheduled in the peer review process. Evidence preparation, witness preparation and the hard won battle scars of a true trial lawyer can make the difference between success and failure. Daniel Horowitz has literally thousands of contested evidentiary hearings and jury trials as lead counsel. He is the best medical case lawyer for a contested peer review hearing.
We Understand the Details and Get “into the weeds”
Our experience on other cases can benefit your case. For example, we are presently litigating a highly contentious case against John Muir Hospital in Walnut Creek, California. The case against John Muir involves our claim that they failed to follow established safety rules regarding the blood sugar levels for surgical patients. We claim that John Muir retaliated against the doctor who advocated for these protocols. This knowledge is then applied to other cases in our office. Defending surgeons facing peer review for high SSI rates raises the issue – who is at fault, the doctor or the hospital. Putting the hospital in the hot seat we have challenged their perioperative protocols. Their lack of a specific (or proper) perioperative glycemic order set raised the core question that protected our client. Did the peer reviewed surgeon cause the high SSI rate or was the hospital the cause ? [As many surgeons know, the SSI infection rate for many surgeries can be doubled by failing to keep blood sugar under control. Recent studies show that POD and POCD may be strongly affected as well. (See Article)] To learn more about the lawsuit that Daniel Horowitz has pending against John Muir hospital, click here. So our experience and attention to medical detail can be the difference between winning and losing. Put differently, you get a highly specialized defense from the Horowitz office. Cookie cutter does not exist in your world of excellent medicine and cookie cutter does not exist in our office.
Dan Horowitz handled my complex business issue with magnanimity, compassion, care, promptness, and utmost professionalism. I'm an Attorney and would highly recommend him to other professionals (and others alike) because he's the very BEST at what he does and has an uncanny knack at finding unique resolutions with unparalleled speed and efficiency. What is quite outatanding is that he treats each client with kindness and compassion as if a family member- Lovely K.
I cannot express enough gratitude for the outstanding legal services provided by Daniel Horowitz. He not only possesses an in-depth understanding of the law but also demonstrated a genuine commitment to me. He took the time to listen attentively to my concerns, providing clear and concise explanations of the legal processes involved in my case. He made me feel heard and supported during this tumultuous time. What impressed me most was his unwavering dedication to achieving the best possible outcome for me. The attention to detail and strategic approach to my case were evident at every stage. I am eternally grateful towards Daniel for what he has done for me and I wholeheartedly recommend his services to anyone seeking legal representation. Thank you Dan- Kento T.
Daniel and his team did an excellent job. He was always readily available to take my call and provided peace of mind through a stressful situation.- Reid V.
My experience with Dan was great. I appreciate the knowledge Dan has and the professionalism they exhibit. I would highly recommend the Law Office Of Daniel Horowitz. My family and I are truly grateful we worked with him.- Brandon D.
There are lawyers and then there are real lawyers. Dan Horowitz is a real lawyer in every since of the word. Dan is a Certified Specialist in Criminal Law. You will not find very many attorneys having such recognition especially one that hits on all cylinders as Dan. In addition to his knowledge of the law and his experience, which I found to be unmatched, i appreciated the fact that he at all times is genuine, which for me says it all. Thank you Dan.- Cory N.
“The Best Attorney I Could Have Asked For.”- Katherine Ryken
Dan Horowitz was the best attorney I could have asked for during a difficult time in my career. From the moment I met him, I felt believed, respected, and safe. He and his team were endlessly responsive and empathetic to me and my family. He fought for my case day and night, always keeping my best interests at the forefront of his mind. As I learned from Dan, it is never a good time in oneâ€™s life to need legal representation - but if you need it, Dan is your person, your advocate, and your best friend. We are forever grateful for his tireless commitment to justice for the people.- Katherine R.
He is approachable but serious. Mr. Horowitz is the perfect balance of what someone wants in a lawyer. Not only is he approachable enough to gain and value your trust, but he's a bulldog in the courtroom. Despite his kindness, I have never once doubted his ability to provide me with THE BEST representation in court. I'm so thankful to have found a lawyer capable of such a delicate balancing act.- Molly A.