Unfortunately, one does not always recognize when a target is
forming on one’s own back until too late
"Sham peer review is a spreading malignancy. Physicians need to become aware of this career-ending bear trap. As the corpses of ruined physician careers begin to pile up, many physicians will recognize that they could be next."
Professional peer review is intended to protect the public from incompetent or unethical practitioners. However, it could and often does remove the most honest, ethical, and competent physicians, to the advantage of unscrupulous competitors.
the American College of Legal Medicine. Approximately onefourth of this latter group of physicians with law degrees became lawyers after they themselves became victims of sham peer review
The National Practitioner Databank (NPDB) transforms “disciplinary” actions into a professional death sentence.
Pray tell me why a rebuttal of a NPDB report has to have only a certain allowed length in this day and age of the internet with petabytes of storage capacity on servers?
"Following the Patrick case, the federal government passed the Health Care Quality Improvement Act (HCQIA) in 1986 under pressure from the medical industry, including the AMA, to give both hospitals and peer-review panels legal immunity from lawsuits. This same law created the National Practitioner Database (NPDB). HCQIAwent into effect in 1990."
"Protection of the accusers was deemed to be a higher priority than protecting an innocent physician from false accusations and ruin of his career."
Leymann’s contribution was to document beyond any doubt the same reality among adults, even in the cool, rational, professional, bureaucratic, policy-governed setting of a workplace. The tactics differ. Workplace mobbing is normally carried out politely, without any violence, and with ample written documentation. Yet even without the blood, the bloodlust is essentially the same: contagion and mimicking of unfriendly, hostile acts toward the target; relentless undermining of the target’s self-confidence; group solidarity against one whom all agree does not belong; and the euphoria of collective attack
The impulse to gang up, to join with others against what is perceived to be a common threat, lies deep in human nature. It is not easily outlawed. A policy forbidding it may, in practice, become a weapon for convicting some mobbing target of a punishable offense and thereby aiding in his or her humiliation. The evidence is clear by now that policies against sexual harassment have often been used as tools for harassing innocent but disliked workmates. Anti-mobbing policies may turn out to be even more versatile tools for such mischief.
It can be no sufficient compensation to a corpse to know that the dynamite that laid him out was not of as good a quality as it had been supposed to be. – Mark Twain
Sham peer review is a fast growing problem in American medicine, as government and its private partners (such as HMOs) try to impose “group think” on physicians Hospitals, especially those linked closely with HMOs, routinely use sham peer review as their weapon of choice to remove vociferous physicians who openly raise concerns about quality of care, and as a means of eliminating economic competitors. When hospital administrators “make an example” of one or two leaders among independent physicians, fear is instilled and compliance from the “herd” is often improved. Because of a 1986 law known as the Health Care Quality Improvement Act (HCQIA), hospitals are free to launch attacks against independent-minded physicians with little risk of liability. False and damaging charges against ethical and competent physicians enjoy immunity as long as the hospital disguises the process as a method for furthering quality care. The hospital controls the entire process. It organizes secret ad hoc committees. The administration often handpicks the so-called “peer” review committees and hearing panels.
The effect of a sham peer review on a physician victim is devastating. If the hospital continues a suspension for a mere 31 days, the condemned physician is reported to the National Practitioner Data Bank (NPDB). Meanwhile, a carefully orchestrated “whisper campaign” is initiated. This further sullies the targeted physician’s reputation among his colleagues and patients, making it difficult for the physician to continue to practice and earn a living. The financial crisis created by the concomitant negative cash flow to legal counsel and loss of clinical privileges adds to the personal stress of the physician and his family
"Months later a “blue ribbon” appeals committee was convened. Committee members were very carefully chosen. The committee consisted of three chief administrators from three affiliated HMO hospitals. These three businessmen, with no training or experience in medicine or psychiatry, were asked to make “fair” judgments about complex medical and psychiatric issues. The outcome was preordained. The attorneys orchestrating the event were again flown in from distant HMO headquarters. As expected, the “blue ribbon” committee of HMO hospital executives found in favor of the hospital."
The HCQIA immunity provisions that protect malicious hospitals and peer reviewers need to be repealed. Some would argue that removing the nearly absolute immunity enjoyed by peer reviewers would discourage people from coming forward with legitimate complaints, and discourage physicians from serving on legitimate peer review panels. This argument, however, fails to consider the enormity of the harm currently being done to patients in environments where physicians are afraid to criticize hospital staff or procedures. Moreover, if the Constitution guarantees substantive due process, how can we justify providing anything less in something as important as peer review? Legitimate legal procedures occur in an open public court. Secrecy protects the villains. Openness and transparency protect the accused. Accountability protects the integrity of the peer review process.
'After the successful conclusion of my case and the ensuing publicity, I began receiving numerous phone calls and letters from other physicians who had been shammed. Although my attorney and I originally thought that it was just a local mob of physicians bent on killing off local competition (me), it soon became obvious that the problem of sham peer review was widespread. Seeing a need to help these other physician victims, I used a portion of the $559,000 to found the Semmelweis Society, named for the mid-19 century Viennese physician who crusaded for sterile conditions at his hospital. The guiding principle of this Society is that peer review should be done with clean hands."
Don't you dare go against the herd
"Cook commented adversely on his residency and referred inter alia to Dr. Hassan's personality as “MILITANT vs. authority” and “[t]ends to identify with the underdog.”
What Factors Place One at Risk for Sham Peer Review?
Summary Suspension:Weapon of Choice in Sham Peer Review
"Summary suspension, which typically has “privileged and confidential” stamped prominently on the front page for the protection of the accusers, is intended only for rare instances in which there is imminent danger to a patient or patients. The intended effect and result of summary suspension are several: It causes the immediate interruption of the targeted physician’s income at a time when he will incur significant legal expenses. It will provide immediate damage to the targeted physician’s reputation in the eyes of his colleagues and patients. It provides a “shock and awe” effect that is emotionally devastating to the targeted physician, who may instantly find himself ostracized by his colleagues. No one wants to be near the fly when the spider comes for his meal."
Once the summary suspension process has been initiated, a committee or committees are appointed to carry out the sentence. These ad hoc committees are almost always stacked with physicians who are either employed by or contracted with the hospital. The hospital also will frequently involve the medical staff president or chief of staff in the scheme, providing him with contrived, slanted, or biased data that he does not have the time or the inclination to investigate on his own. The key factor is that the hospital administration maintains complete control of the process at all times. In order to further the process, the hospital may begin a rumor campaign, leaking allegations to the medical staff and the community at large. Charges against the targeted physician may be as vague as they are numerous. In some cases the victim may be denied access to his own hospital charts, which he needs to defend himself. In certain cases, a court order has been required just to obtain these records. Moreover, the usual rules of evidence do not apply to these quasi-judicial proceedings. Nearly all medical staff bylaws contain the phrase “the proceedings are semi-judicial and the rules of evidence do not apply” or something similar. The process is so biased in favor of the hospital, that “if a hospital and its medical staff henchmen wish to eliminate a solo practitioner, regardless of how good a doctor he is, they can probably succeed, if they are patient and follow the rules” (Peacock EE, personal communication, 1996).
If a physician loses in the peer review proceeding, recourse is very limited. More than 500 other California physicians have been denied their day in court since my case in 1984 because of the legal shield of immunity. Federal court is still available to those who are able to sustain themselves in an office-only practice and who have $500,000 to spend on legal fees. It costs the accused victim $200 per hour to educate his lawyer about the sham peer review process and medical care. This educational process can take literally hundreds of hours. The accusers, of course, pay nothing. Young physicians just out of residency may be particularly vulnerable and unable to fight back due to their financial condition. Most medical students and residents have no idea the dangers that await them in the realm of sham peer review. It is a non-covered topic in medical schools and residency programs.
One of the most difficult obstacles to overcome, other than physician apathy, is the reluctance of physicians to fight for one of their own colleagues who is under attack. It has been said that the hunted physician will find that the sham peer review process is a lot like hunting gazelles in Africa. Thousands of gazelles will be grazing peacefully on the plain. When a lion decides to attack a chosen victim, most of the herd will continue grazing placidly as the surprised victim attempts to run for its life. Physicians of the herd simply believe that unfair peer review isn’t their problem and will never happen to them.
Sham peer review, in addition to depriving physicians of their livelihood, is inimical to excellent patient care and deprives patients of access to good physicians. Physicians must not stand mute but must work to correct this problem.
Excerpts mainly from Article by
Verner S. Waite, M.D., F.A.C.S., a general surgeon, is the founder of theSemmelweis Society. He may be contacted at (714) 995-7242.
"Sham peer review is a spreading malignancy. Physicians need to become aware of this career-ending bear trap. As the corpses of ruined physician careers begin to pile up, many physicians will recognize that they could be next."
Professional peer review is intended to protect the public from incompetent or unethical practitioners. However, it could and often does remove the most honest, ethical, and competent physicians, to the advantage of unscrupulous competitors.
the American College of Legal Medicine. Approximately onefourth of this latter group of physicians with law degrees became lawyers after they themselves became victims of sham peer review
The National Practitioner Databank (NPDB) transforms “disciplinary” actions into a professional death sentence.
Pray tell me why a rebuttal of a NPDB report has to have only a certain allowed length in this day and age of the internet with petabytes of storage capacity on servers?
"Following the Patrick case, the federal government passed the Health Care Quality Improvement Act (HCQIA) in 1986 under pressure from the medical industry, including the AMA, to give both hospitals and peer-review panels legal immunity from lawsuits. This same law created the National Practitioner Database (NPDB). HCQIAwent into effect in 1990."
"Protection of the accusers was deemed to be a higher priority than protecting an innocent physician from false accusations and ruin of his career."
Leymann’s contribution was to document beyond any doubt the same reality among adults, even in the cool, rational, professional, bureaucratic, policy-governed setting of a workplace. The tactics differ. Workplace mobbing is normally carried out politely, without any violence, and with ample written documentation. Yet even without the blood, the bloodlust is essentially the same: contagion and mimicking of unfriendly, hostile acts toward the target; relentless undermining of the target’s self-confidence; group solidarity against one whom all agree does not belong; and the euphoria of collective attack
The impulse to gang up, to join with others against what is perceived to be a common threat, lies deep in human nature. It is not easily outlawed. A policy forbidding it may, in practice, become a weapon for convicting some mobbing target of a punishable offense and thereby aiding in his or her humiliation. The evidence is clear by now that policies against sexual harassment have often been used as tools for harassing innocent but disliked workmates. Anti-mobbing policies may turn out to be even more versatile tools for such mischief.
It can be no sufficient compensation to a corpse to know that the dynamite that laid him out was not of as good a quality as it had been supposed to be. – Mark Twain
Sham peer review is a fast growing problem in American medicine, as government and its private partners (such as HMOs) try to impose “group think” on physicians Hospitals, especially those linked closely with HMOs, routinely use sham peer review as their weapon of choice to remove vociferous physicians who openly raise concerns about quality of care, and as a means of eliminating economic competitors. When hospital administrators “make an example” of one or two leaders among independent physicians, fear is instilled and compliance from the “herd” is often improved. Because of a 1986 law known as the Health Care Quality Improvement Act (HCQIA), hospitals are free to launch attacks against independent-minded physicians with little risk of liability. False and damaging charges against ethical and competent physicians enjoy immunity as long as the hospital disguises the process as a method for furthering quality care. The hospital controls the entire process. It organizes secret ad hoc committees. The administration often handpicks the so-called “peer” review committees and hearing panels.
The effect of a sham peer review on a physician victim is devastating. If the hospital continues a suspension for a mere 31 days, the condemned physician is reported to the National Practitioner Data Bank (NPDB). Meanwhile, a carefully orchestrated “whisper campaign” is initiated. This further sullies the targeted physician’s reputation among his colleagues and patients, making it difficult for the physician to continue to practice and earn a living. The financial crisis created by the concomitant negative cash flow to legal counsel and loss of clinical privileges adds to the personal stress of the physician and his family
"Months later a “blue ribbon” appeals committee was convened. Committee members were very carefully chosen. The committee consisted of three chief administrators from three affiliated HMO hospitals. These three businessmen, with no training or experience in medicine or psychiatry, were asked to make “fair” judgments about complex medical and psychiatric issues. The outcome was preordained. The attorneys orchestrating the event were again flown in from distant HMO headquarters. As expected, the “blue ribbon” committee of HMO hospital executives found in favor of the hospital."
The HCQIA immunity provisions that protect malicious hospitals and peer reviewers need to be repealed. Some would argue that removing the nearly absolute immunity enjoyed by peer reviewers would discourage people from coming forward with legitimate complaints, and discourage physicians from serving on legitimate peer review panels. This argument, however, fails to consider the enormity of the harm currently being done to patients in environments where physicians are afraid to criticize hospital staff or procedures. Moreover, if the Constitution guarantees substantive due process, how can we justify providing anything less in something as important as peer review? Legitimate legal procedures occur in an open public court. Secrecy protects the villains. Openness and transparency protect the accused. Accountability protects the integrity of the peer review process.
'After the successful conclusion of my case and the ensuing publicity, I began receiving numerous phone calls and letters from other physicians who had been shammed. Although my attorney and I originally thought that it was just a local mob of physicians bent on killing off local competition (me), it soon became obvious that the problem of sham peer review was widespread. Seeing a need to help these other physician victims, I used a portion of the $559,000 to found the Semmelweis Society, named for the mid-19 century Viennese physician who crusaded for sterile conditions at his hospital. The guiding principle of this Society is that peer review should be done with clean hands."
Don't you dare go against the herd
"Cook commented adversely on his residency and referred inter alia to Dr. Hassan's personality as “MILITANT vs. authority” and “[t]ends to identify with the underdog.”
What Factors Place One at Risk for Sham Peer Review?
Summary Suspension:Weapon of Choice in Sham Peer Review
"Summary suspension, which typically has “privileged and confidential” stamped prominently on the front page for the protection of the accusers, is intended only for rare instances in which there is imminent danger to a patient or patients. The intended effect and result of summary suspension are several: It causes the immediate interruption of the targeted physician’s income at a time when he will incur significant legal expenses. It will provide immediate damage to the targeted physician’s reputation in the eyes of his colleagues and patients. It provides a “shock and awe” effect that is emotionally devastating to the targeted physician, who may instantly find himself ostracized by his colleagues. No one wants to be near the fly when the spider comes for his meal."
Once the summary suspension process has been initiated, a committee or committees are appointed to carry out the sentence. These ad hoc committees are almost always stacked with physicians who are either employed by or contracted with the hospital. The hospital also will frequently involve the medical staff president or chief of staff in the scheme, providing him with contrived, slanted, or biased data that he does not have the time or the inclination to investigate on his own. The key factor is that the hospital administration maintains complete control of the process at all times. In order to further the process, the hospital may begin a rumor campaign, leaking allegations to the medical staff and the community at large. Charges against the targeted physician may be as vague as they are numerous. In some cases the victim may be denied access to his own hospital charts, which he needs to defend himself. In certain cases, a court order has been required just to obtain these records. Moreover, the usual rules of evidence do not apply to these quasi-judicial proceedings. Nearly all medical staff bylaws contain the phrase “the proceedings are semi-judicial and the rules of evidence do not apply” or something similar. The process is so biased in favor of the hospital, that “if a hospital and its medical staff henchmen wish to eliminate a solo practitioner, regardless of how good a doctor he is, they can probably succeed, if they are patient and follow the rules” (Peacock EE, personal communication, 1996).
If a physician loses in the peer review proceeding, recourse is very limited. More than 500 other California physicians have been denied their day in court since my case in 1984 because of the legal shield of immunity. Federal court is still available to those who are able to sustain themselves in an office-only practice and who have $500,000 to spend on legal fees. It costs the accused victim $200 per hour to educate his lawyer about the sham peer review process and medical care. This educational process can take literally hundreds of hours. The accusers, of course, pay nothing. Young physicians just out of residency may be particularly vulnerable and unable to fight back due to their financial condition. Most medical students and residents have no idea the dangers that await them in the realm of sham peer review. It is a non-covered topic in medical schools and residency programs.
One of the most difficult obstacles to overcome, other than physician apathy, is the reluctance of physicians to fight for one of their own colleagues who is under attack. It has been said that the hunted physician will find that the sham peer review process is a lot like hunting gazelles in Africa. Thousands of gazelles will be grazing peacefully on the plain. When a lion decides to attack a chosen victim, most of the herd will continue grazing placidly as the surprised victim attempts to run for its life. Physicians of the herd simply believe that unfair peer review isn’t their problem and will never happen to them.
Sham peer review, in addition to depriving physicians of their livelihood, is inimical to excellent patient care and deprives patients of access to good physicians. Physicians must not stand mute but must work to correct this problem.
Excerpts mainly from Article by
Verner S. Waite, M.D., F.A.C.S., a general surgeon, is the founder of theSemmelweis Society. He may be contacted at (714) 995-7242.
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