TEXAS MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution 406 (A-07)
Subject: Physician Rights and Sham Peer Review
Introduced by: Harris County Medical Society
Referred to: Reference Committee on Socioeconomics
Whereas, Patient safety and quality is an ongoing and important concern of physicians and health care institutions; and Whereas, Review of medical care often requires physician involvement and oversight, and legal protection of the confidentiality of these efforts is important for all concerned parties to the process; and
Whereas, Because it is not possible to record 100 percent of any clinical encounter in the medical record, involvement of the physician whose care is being reviewed is often essential for an understanding of the nuances and the critique of the medical care; and
Whereas, All physicians, whose care is being reviewed should be notified of the review process, allowed due process and the right to be heard, provided findings and recommendations, and should be provided full and appropriate substantive and procedural due process before any punitive action is taken against the physician or health care provider; and
Whereas, Peer review protections can and should be limited to an evaluation of the quality and safety of patient care and should not be used for non-patient care issues to penalize physicians for other business, financial or administrative reasons; and
Whereas, There may be the need for appropriate mechanisms to handle "disruptive physicians" who seriously jeopardize patient care, are impaired, or fail to exhibit appropriate professional conduct within facilities; and
Whereas, Inappropriate use of peer review protections and process has been referred to as "sham" peer review, and there is a real potential to misuse required guidelines for "disruptive physicians"; therefore be it
RESOLVED, That the Texas Medical Association work to assure that accused physicians are granted reasonable rights and due process for peer review and quality assessment efforts; and be it further
RESOLVED, That TMA solicit member input and address issues related to misuse of peer review process or "disruptive physicians" policies by health care facilities or peer review entities; and be it further
RESOLVED, That TMA work to educate and inform members about the potential misuse of peer review; and be it further
RESOLVED, That TMA work to end the use of "disruptive physicians" policies which are extended to non-patient care issues, such as economic credentialing, failure to support marketing or business plans of the hospital or health care facility, or are used as a recourse because the physician has raised serious quality or patient safety issues regarding the facility, and their practice.
Relevant TMA Policy
265.005 Clinical Competence : Quality, appropriateness, and necessity of medical decisions are clinical decisions to be based on clinical data judged by clinically competent persons. In addition, the Texas Medical Association supports legislation and regulations which stipulate that only persons with demonstrable clinical competence for the clinical decisions under review may make the review decisions concerning quality, appropriateness, and/or medical necessity of care related to a specific patient. In addition, TMA supports legislation and regulations requiring any managed care plan wishing to deny coverage or alter a clinical decision for care based on quality, appropriateness, and/or necessity of that care may do so only through clinically competent peer review of all pertinent clinical data (Substitute Res. 28AA, p 182C, A-94; reaffirmed CSE Rep. 3-A-04).
TMA House of Delegates: TexMed 2007