Medical Tuesday Blog
Sham Peer Review Reaches Global Concerns
A global epidemic of attacks on ethical physicians, which endangers patients, was the focus of the 13th UNESCO World Conference on Bioethics, Medical Ethics & Health Law recently in Jerusalem.
Lawrence Huntoon, M.D., Ph.D., was the keynote speaker on “Sham Peer Review: a Worldwide Phenomenon.” Dr. Huntoon, a neurologist practicing in New York, is editor-in-chief of the
Sham peer review targets physicians in a potentially career-ending administrative process, for reasons other than legitimate patient-care concerns, such as anti-competitive motives.
Doctor Huntoon has now favored us with an up-to-date editorial on what may happened to physicians falsely accused by his hospital competitors of inadequate or in-appropriate medical care to eliminate competitors. Read his editorial in the Winter 2018 issue of the Journal of American Physicians and Surgeons, National Practitioner Data Bank Guidebook. The NPDB is sometimes referred to as the permanent tomb for physicians.
The Healthcare Integrity and Protection Data Bank (HIPDB) was created by Section 221(a) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Section 1128E of the Social Security Act, Public Law 104-191). This data bank collected and disclosed final adverse actions taken by federal and state agencies and health plans, including healthcare-related criminal convictions, against practitioners, providers, and suppliers. In 2010, the NPDB and HIPDB were merged into the NPDB as per Section 6403 of the Patient Protection and Affordable Care Act (Public Law 111-148).
All information in the NPDB is permanently maintained unless it is voided by the NPDB or the reporting entity. Reporting entities are solely responsible for the accuracy of the information in NPDB reports. NPDB does not make determinations regarding the accuracy of reported information, validity, merit or lack thereof of reported adverse actions.
The NPDB Guidebook serves as a policy manual that implements laws governing the NPDB. Implementing regulations are found at 45 CFR Part 60. The NPDB Guidebook was revised in
April 2015 and again in October 2018. Certain changes in the two most recent revisions of the NPDB Guidebook favor hospitals.
It is important for physicians to understand what is in the NPDB Guidebook, as it determines whether an adverse privileging action taken by a hospital is reportable or not, and thus, whether the physician’s career is ruined or ended. Parentheses with letters and numbers below (e.g. E-1) reference the section and page number of the NPDB Guidebook from which information derives. . .
The reality is that an adverse action report (AAR) in the NPDB is often the controlling factor in decisions of licensure and medical privileging. Hospitals rarely look past the “scarlet letter” (Jesse A. Cole, M.D. vs. St. James Healthcare, Montana Second Judicial District Court, No. DV-07-44, Memorandum and
Order, June 1, 2007) of an adverse action report on a physician in deciding whether to grant or renew hospital privileges. . .
Physicians and dentists are the subject of adverse action reports in the NPDB by hospitals and state licensing boards.
Nurse practitioners and other nonphysician practitioners may be reported for adverse privileging actions by hospitals, based on professional conduct or professional conduct deficiencies, but a reporting entity is not required to report them, even though their competence or conduct issues adversely affect or could
adversely affect patient safety and welfare. Reporting of these “other practitioners” is considered optional. (C-7)
Read the entire Editorial at http://jpands.org/jpands2304.htm It may save your professional life!
The largest settlements in Sham Peer Review, where hearsay is frequently accepted by hospitals as factual, are by doctors with adequate funds who are able to bypass the hospital Kangaroo Courts and proceed immediately to Civil Courts with the same safeguards that all Americans are entitled to receive.
Physician professional organizations should be able to protect their members by insisting on the same safeguards that criminals such as murderers and rapists receive.