Tuesday, August 31, 2004

Does Due Diligence Matter???
Lifted from Overlawyered, the story of a $366 million verdict against the medical director of a hospital cath lab, the head of the cardiology section, and the chief of medicine surrounding a suspension of Dr. Poliner's cardiac cath privileges. Apparently there were some concerns over Dr. Poliner's work expressed by nursing staff. There was also an allegation of wrong site intervention. A peer review committee suspended his privileges, which were re-instated after outside review. As Mr Frank succinctly puts it:
So far, so good, right? After all, we're told by the plaintiffs' bar that the medical malpractice crisis would go away magically if the medical profession would just police its own, and that's exactly what happened here. Can you imagine what a trial lawyer would do with the peer review committee's conclusions if the hospital did nothing and had been sued for Poliner's work afterwards?
Dr. Poliner then goes on to sue the physicians involved.
The suit alleges that doctors who were competing with Dr. Poliner for patients accused him of poor patient care, and that Dr. Knochel (chairman of internal medicine) and Presbyterian relied on the competitors rather than independent reviews to conclude that Dr. Poliner's right to perform catheterizations and echocardiograms should be suspended.

In May 1998, Dr. Knochel forced Dr. Poliner to quit doing catheterizations while the hospital reviewed his work.

A month later, a peer review committee of doctors, most of whom competed for patients with Dr. Poliner, summarily suspended his "cath" and "echo" privileges at Presbyterian. In November 1998, the hospital's medical board voted to restore Dr. Poliner's privileges after a number of nationally recognized cardiologists in a hearing stoutly defended the quality of Dr. Poliner's work. However, the medical board also upheld Dr. Knochel's earlier decision to suspend Dr. Poliner's privileges.
The suits against the peer-review committee were dismissed, but the suits against the others was allowed to proceed, with the results described above. The hospital plans an appeal. Now other than the punishment of a hospital trying to maintain quality, two other issues come out of this. First:
"From time to time, hospitals and members of the medical staff leadership must make decisions relating to patient care and safety, and these decisions sometimes affect an individual doctor's privileges at that hospital," the hospital said in a statement.
That is, the chairs of departments and other physician leaders who are often the initial contacts in such issues may be exposed to liability in carrying out their responsibilities under hospital bylaws. Given the difficulty in finding physicians to fill those roles, this will only further serve to discourage physicians from taking leadership positions on their medical staffs.
Secondly, and here is where IMHO the hospital dropped the ball, was the lack of outside review. Outside of a large metropolitan area, such as Atlanta for example, it is difficult to find members of a peer-review committee who are not in competition with or refer patients to, a physician who may be under investigation. Hospital medical staffs are some of the most ruthless political operations today, some make Tammany Hall look like amateur hour. These situations almost always require outside review to maintain impartiality. The problem then becomes finding a reviewer to do this, as they may be liable in a suit as well. I have told the story before of a physician who threatens to sue his own specialty organization when they agree to review his situation. Needless to say they beat a hasty retreat. So outside review may not be possible.
The way to fix this? Expand the peer review protection to members of the medical staff engaging in good-faith quality assurance and to outside reviewers.

Cross-posted at Galen's log
Weblog Commenting and Trackback by HaloScan.com

This page is powered by Blogger. Isn't yours?