The Healthcare Quality Improvement Act (“HCQIA”) provides immunity to hospitals and other healthcare entities that utilize the peer review process in healthcare professional review actions. The law was passed to prevent inappropriate use of the physician peer review process, as well as to protect individuals participating in the peer review process from exposure to retaliatory legal actions brought by physician under review. The HCQIA employs procedural protections of due process for physicians subject to review, while also ensuring the hospitals and doctors are granted immunity from liability associated with the result of the peer review determinations and findings. The implementation of the HCQIA resulted in the requirement that disciplinary action taken against a doctor be reported to the National Practitioner Data Bank (“NPDB”). If a health care entity fails to report any action that adversely impacts a physician’s clinical privileges for a period longer than 30 days or accepts the surrender of a physician’s clinical privileges while the physician is under investigation for incompetence or improper professional conduct, the entity can be subject to the loss of immunity protections for up to 3 years.
HCQIA provides a general restriction on disclosure of the NPDB reports, however the NPDB unequivocally entitles and requires hospitals to view reports regarding healthcare professionals applying for medical staff positions or clinical privileges, and biennially for any employees or physicians maintaining privileges at the hospital. Navigating the narrative of adverse reports submitted to the NPDB is crucial and can be highly impactful on a physician’s career. While avoiding the reporting of adverse events in their entirety is ideal, in situations where reporting is unavoidable it is essential that physicians seek support to mitigate the impact as quickly and effectively as possible.
The goal of HCQIA was to “improve the quality of medical care by encouraging physicians to identify and discipline other physicians who are incompetent or who engage in unprofessional behavior.” The protections provided by the Act include immunity for the hospital and physicians who conduct peer review hearings from liability and damages in lawsuits brought by physicians who were the subject of the hearing and subsequently lost hospital privileges. The Act requires compliance with due process and other standards provided in the bill in order to merit the immunity protections. The criteria for immunity from claims for damages arising from a peer review hearing requires: (1) the peer review be related to a patient care issue; (2) the peer review be based on a reasonable investigation; (3) the physician was given fair process during the peer review – i.e. the right to have an attorney involved, a record of the proceedings, ability to call witnesses, present evidence and submit a written statement at the closing of the hearing; and (4) the investigation justifies taking an adverse action against the physician. While the goal of HCQIA is to promote the improvement of medical care through peer review hearings instead of adjudicating through the conventional litigation route, it is tantamount that the criteria for compliance with due process and eligibility for immunity for participating hospitals and physicians remain present. Although the Act seeks to protect parties from exposure and avoid legal recourse, seeking legal counsel for guidance and support is advised.
Frier Levitt has extensive experience representing physicians and healthcare providers with respect to NPDB reporting and navigating the parameters of immunity imposed by the HCQIA. While hospitals are generally subject to certain immunities during the peer review process, it is imperative to ensure compliance is maintained on all fronts and due process rights are complied with. Contact us today to learn more about how to properly navigate and mitigate the impacts of NPDB reporting and peer review meetings.
