What to do if in a Peer Review Investigation

When a physician suspects that they are about to be investigated, it is crucial to take proactive steps to protect their professional reputation and ensure due process. Here are several actions a physician can consider:

  1.  Consult with Legal Counsel

   -  Immediate Legal Advice : Contact an attorney who specializes in healthcare law as soon as possible. Legal counsel can provide guidance on how to navigate the investigation process, help understand rights and obligations, and advise on how to respond to inquiries or actions.

   -  Review Documentation : An attorney can assist in reviewing relevant documentation, such as medical staff bylaws, employment contracts, and previous performance evaluations, to understand the basis and scope of potential investigations.

  2.  Understand the Grounds for Investigation

   -  Investigate the Basis : Determine if the investigation is related to clinical performance, professional conduct, or compliance issues. Understanding the specific concerns can help in preparing an appropriate response.

   -  Know Your Rights : Familiarize yourself with the medical staff bylaws and hospital policies regarding investigations and peer review processes. These documents often outline the rights and procedures you are entitled to during an investigation.

  3.  Gather and Review Records

   -  Collect Relevant Documentation : Gather all relevant medical records, correspondence, and documents that may be pertinent to the investigation. This includes patient records, emails, and any communication that might support your case.

   -  Maintain Confidentiality : Ensure that the handling of records complies with privacy laws, such as HIPAA, and hospital policies on confidentiality.

  4.  Prepare a Response

   -  Written Response : Prepare a clear, concise, and factual written response to any allegations or inquiries. Avoid emotional language and stick to verifiable facts.

   -  Cooperate with Investigators : While it is essential to protect your rights, cooperation with the investigation process is also crucial. Non-cooperation can be viewed unfavorably and may complicate the situation.

  5.  Seek Support from Professional Organizations

   -  Professional Societies : Reach out to professional organizations such as  your local medical society, or the American Medical Association (AMA) or specialty-specific societies. These organizations can offer resources, advice, and potentially legal support.

   -  Peer Support : Engaging with trusted colleagues or mentors can provide emotional support and practical advice.

  6.  Consider Voluntary Actions

   -  Proactive Measures : Depending on the nature of the concerns, consider taking proactive steps such as enrolling in continuing education courses, seeking peer review of your work, or voluntarily participating in a performance improvement plan.

   -  Voluntary Suspension : In some cases, a temporary voluntary suspension or reduction of privileges might be considered to address immediate concerns while the investigation is ongoing.

  7.  Document Everything

   -  Keep Records : Maintain detailed records of all interactions related to the investigation, including meetings, phone calls, and written communications. Documenting these interactions can be invaluable if there are disputes about what was said or agreed upon.

  8.  Prepare for Possible Outcomes

   -  Contingency Planning : Prepare for various outcomes, including possible disciplinary actions or recommendations. Understanding potential consequences can help you make informed decisions throughout the process.

   -  Appeal Processes : Be aware of the appeal processes available if the investigation leads to an adverse action. Knowing the steps to appeal can help in planning your response.

  Conclusion

Proactive engagement and preparation are key when facing a potential investigation. By consulting with legal counsel, understanding the grounds for investigation, gathering and reviewing records, preparing a factual response, seeking support from professional organizations, considering voluntary actions, documenting everything, and preparing for possible outcomes, physicians can navigate the investigation process more effectively and protect their professional standing.

For detailed guidelines on peer review and hearing processes, refer to relevant sections of your medical staff bylaws.  If you would like to schedule a consult with and attorney, click on the schedule button for a paid for appointment.  

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