Physician peer review should be medicine’s most effective method to ensure quality patient care within hospitals, unfortunately it falls short of this goal. Peer review is required under Federal Medicare Conditions of Participation (regulations), and by the respective States (statutes and regulations). Although responsible, federal and state oversight agencies have not been able to ensure the provision of effective peer review. Evidence of the failure of federal and state oversight can be found upon detailed review of lawsuits brought against institutions, particularly successful Qui Tam lawsuits (whistle blower suits). We offer two reports (Redding Medical Center, Redding California, St. Joseph’s Hospital, Towson, Maryland) that demonstrate required peer review failed, and oversight failed, resulting in harm to hundreds of patients at each hospital over several years. These two cases are just the tip of the iceberg and most physician acknowledge in private that peer review need to significantly improve to become effective.
Peer review is provided by members the hospital medical staff to review selected based upon the medical staff’s predetermined criteria (e.g. unexpected return to the operating room, unexpected blood loss, unanticipated complications, adverse outcomes etc.). The process is confidential and protected from medical liability litigation. It is designed to identify physician misjudgment, omissions and errors and some cases, identifies provision of medically unnecessary services. Findings may motivate the reviewed physician to seek more education and change behavior in order to improve outcomes. Some physicians are required to seek remedial training and in egregious situations, discipline against a physician may be recommended. However, these remedies are infrequently applied as explained in our reports.
Without effective hospital peer review, a meaningful number of patients will continue to needlessly suffer and die due to medical errors, unnecessary procedures and complications all of which raise the cost of care. Peer review can become more effective and we offer a number of recommendations to improve peer review.