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| − | HCQIA is the Health Care Quality Improvement Act of 1986. It confers qualified immunity from litigation for peer review organizations if they satisfy the following "reasonableness standards" under 42 U.S. C. Sec. 11112(a): | + | HCQIA is the Health Care Quality Improvement Act of 1986, which authorized the federal government to establish a National Practitioner Data Bank for the blacklisting of physicians by hospitals. |
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| | + | Specifically, the law requires reporting by "[e]ach health care entity which-- |
| | + | (A) takes a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days; |
| | + | (B) accepts the surrender of clinical privileges of a physician-- |
| | + | (i) while the physician is under an investigation by the entity relating to possible incompetence or improper professional conduct, or |
| | + | (ii) in return for not conducting such an investigation or proceeding; or |
| | + | (C) in the case of such an entity which is a professional society, takes a professional review action which adversely affects the membership of a physician in the society, shall report to the Board of Medical Examiners ..." 42 U.S.C. § 11133(a). |
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| | + | The state medical board then reports the information to the National Practitioners Data Bank. |
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| | + | HCQIA confers qualified immunity from litigation for peer review organizations if they satisfy the following "reasonableness standards" under 42 U.S. C. Sec. 11112(a): |
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| | ...the professional review action was taken | | ...the professional review action was taken |
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| | at extreme disadvantage. | | at extreme disadvantage. |
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| − | Sec. 11111(a)(4), for instance, presumes that the hospital has met due
| + | Section 11111(a)(4), for instance, presumes that the hospital has met due |
| | process standards as outlined in Sec. 11111(a). This presumption shifts | | process standards as outlined in Sec. 11111(a). This presumption shifts |
| | the burden of proof to the accused physician to prove that the hospital did not | | the burden of proof to the accused physician to prove that the hospital did not |
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| | And, last but not least, so as to strongly discourage physicians who | | And, last but not least, so as to strongly discourage physicians who |
| | are victims of an unjust sham peer review, from pursuing justice in | | are victims of an unjust sham peer review, from pursuing justice in |
| − | the courts, there is a loser pays provision of HCQIA - Sec. 11113. If the physician does not prevail in the action, the physician can be liable for defendants' legal fees. | + | the courts, there is a loser pays provision of HCQIA - Section 11113. If the physician does not prevail in the action, the physician can be liable for defendants' legal fees. |
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| | Physicians who are strong, outspoken advocates for quality care and patient safety in hospitals frequently face retaliation by hospitals via sham peer review. The result of a "successful" bad faith peer review conducted by a hospital is typically the end of the physician's medical career. | | Physicians who are strong, outspoken advocates for quality care and patient safety in hospitals frequently face retaliation by hospitals via sham peer review. The result of a "successful" bad faith peer review conducted by a hospital is typically the end of the physician's medical career. |