内容

目次

Chapter 1—Threshold Issues 1.1 What Is "Peer Review"? 1.2 Why Peer Review? Chapter 2—Characterizing the Nature of the Concern 2.1 Determining the Nature of the Concern 2.2 General Categories of Concerns 2.3 Reasons That Justify Professional Review Actions Chapter 3—The Health Care Quality Improvement Act 3.1 Assessing Where the Entity Is in the Process 3.2 Hospital and Medical Staff Bylaws 3.3 HCQIA 3.4 State Peer Review Statutes 3.5 Practicalities of Dealing with the Medical Staff Chapter 4—Process for Initiating an Investigation 4.1 Introduction 4.2 Bylaws Provisions Relating to Investigations 4.3 Notifying Physician of Investigation 4.4 The Investigating Body 4.5 Maintaining Confidentiality 4.6 The Implications of Investigations or Reporting Requirements 4.7 Form of the Investigation Report Chapter 5—Use of Informal Resolution in Peer Review 5.1 The Value and Need for Informal Resolution 5.2 What Is Informal Resolution? 5.3 When Should Informal Resolution Be Used? And When Should It Be Avoided? 5.4 What May Be Resolved Informally? 5.5 Informal Resolution Approaches and Tools 5.6 Documentation and Impact of the Informal Process on Formal Investigation 5.7 Disposition of Records of Informal Process 5.8 Reporting Requirements 5.9 Authority to Supervise the Process Chapter 6—Summary Suspension of Physician Privileges 6.1 Grounds for Summary Suspension 6.2 Legal Authority to Impose Summary Suspension 6.3 Personnel Authorized to Impose a Summary Suspension 6.4 Procedures for Implementing Summary Suspensions 6.5 Procedural Rights Triggered by Summary Suspensions 6.6 Reporting Requirements for Summary Suspensions Chapter 7—Automatic Relinquishment of Clinical Privileges 7.1 Grounds for Automatic Relinquishment 7.2 Procedural Rights Triggered by Automatic Relinquishment 7.3 Federal and State Reporting Requirements Chapter 8—Notice 8.1 General Rules 8.2 Specificity of Statement of Reasons 8.3 Hearing Rights and Procedures 8.4 Witness List 8.5 Waiver of Hearing Rights Chapter 9—Pre-Hearing Discovery 9.1 Background 9.2 Legal Requirements 9.3 General Criteria to Use in Deciding Whether to Disclose Documents to the Practitioner 9.4 Practical Considerations Chapter 10—The Hearing Officer or Panel 10.1 Selection of a Hearing Officer or Hearing Panel Chairperson 10.2 Competence and Competitive Position of Panel Members 10.3 Objections of Practitioner at Beginning of Hearing Process 10.4 Utilization of Panel or Hearing Officer 10.5 Practical Considerations Chapter 11—Role of Legal Counsel 11.1 Levels of Involvement 11.2 Right to Counsel 11.2.2 State Law 11.2.3 Tactical Considerations 11.2.4 Right to Assistance of Counsel 11.2.5 Representation by a Non-Lawyer Chapter 12—Presentation of the Case 12.1 Burden of Proof 12.2 Required Evidentiary Standard 12.3 Evidentiary Issues Chapter 13—Making a Hearing Record 13.1 Form of the Record 13.2 Special Considerations for Public Hospitals Chapter 14—Hearing Panel Report 14.1 Legal Requirements 14.2 General Suggestions 14.3 Content of the Written Recommendation - Elements 14.4 Disposition of Hearing Panel Report 14.5 Action on Hearing Panel Report Chapter 15—Appellate Review and Final Board Decision 15.1 Internal Appellate Review 15.2 Final Board Decision 15.3 Additional Evidence 15.4 Standard of Review 15.5 Inconsistent Findings 15.6 Mandatory Reporting Requirements 15.7 Technical Violations of Bylaws Chapter 16—Injunctions Challenging Peer Review Actions 16.1 Peer Review Actions Subject to Judicial Review 16.2 Bases for Injunction Actions Challenging Peer Review Actions 16.3 Practical Considerations Chapter 17—Special Considerations for the Peer Review of Employed Physicians 17.1 Risks Associated with "Ad Hoc" Approach to Peer Review of Employed Physicians 17.2 Options for the Peer Review of Employed Physicians 17.3 Coterminous Provisions in Employment Contracts Chapter 18—Using a Patient Safety Organization to Protect Peer Review Information 18.1 Using a Patient Safety Organization to Protect Peer Review Information Chapter 19—Allied Health Professionals 19.1 Allied Health Professionals Chapter 20—HIPAA Privacy Rule Considerations 20.1 HIPAA Privacy Rule Considerations Appendix A—Cases Where Practitioners Alleged Violations of the ADA Appendix B—Cases Dealing With Behavioral Issues Appendix C—Exclusive Contract Cases Appendix D—HCQIA Cases Appendix E—Bases for Professional Review Actions Appendix F—Illustrative Summary Suspension Cases Index