Question

1.What is the most important suggestion the law firm gives as it relates to "Recommendations for the Subject of a Hospital Peer Review Hearing?

2. What issues of confidentiality and liability does the hospital's peer review function present?

Answer 1

1

The HCQIA also provides standards for professional review actions that must be met before the peer review body or individuals described in the Act will be entitled to the immunities from damages provided in the Act. To qualify for the protections of the Act, the following conditions must be met:

[a] professional review action must be taken

(1) in the reasonable belief that the action was in the furtherance of quality health care,

(2) after a reasonable effort to obtain the facts of the matter,

(3) after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances, and

(4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph .

The HCQIA provides a basis against which effective peer review can be measured when professional review actions have the adverse effect of reducing, restricting, suspending, revoking, denying, or failing to renew clinical privileges or membership in a health care entity."31 Professional review actions are limited to those actions taken or made in the conduct of professional review activity that is "based on the competence or professional conduct of an individual physician (which conductaffects or could affect adversely the health or welfare of a patient or patients) and which affects (or may affect) adversely the clinical privileges, or membership in a professional society, of the physician."32 While the HCQIA may do no more than provide a framework within which peer review should be conducted, that alone is a step in the right direction for effective peer review.

2

Confidentiality and privilege are two compatible, yet distinct, concepts. Privilege addresses a person's right not to have another testify as to certain matters as part of a judicial process, while confidentiality addresses the obligation to refrain from disclosing information to third parties other than as part of legal process. Confidentiality may be imposed by law or by agreement. In many cases, if there is a privilege against testifying, there is also a requirement to keep information confidential; for instance, many states which recognize the attorney-client privilege or physician-patient privilege also provide that the attorney or physician can be subject to state license disciplinary action for willful betrayal of a professional confidence. 83 This is, however, not the case with all privileges. For example, although the spousal privilege prevents one spouse from testifying against another regarding certain communications, a spouse is not required by law to keep all spousal communications confidential outside of the judicial context. Indeed tabloids and other publications might not survive if it were not for the telling of spousal secrets. The only recourse of a spouse against another for telling secrets may be to stop talking to the spouse or divorce. In the case of peer review, voluntary revelation of peer review findings may be particularly damaging to the process.

https://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?referer=https://www.google.co.in/&httpsredir=1&article=1308&context=jlh