Court to examine possible conflict over hospital board's role in staff privileges case

A California cardiologist was denied his reappointment when the hospital's governing board appointed its own peer review panel.

By Tanya Albert Henry — Posted Aug. 11, 2009

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A California appeals court will determine whether a hospital's lay governing board can set aside the medical staff executive committee's peer review decision and appoint its own panel to review a physician's medical staff privileges.

Hollywood Presbyterian Medical Center's medical staff executive committee, or MEC, found no reason to deny cardiologist Osamah El-Attar, MD, his medical staff reappointment. But the hospital's governing board appointed its own peer review panel, which included physicians with economic ties to the hospital. That panel refused to renew Dr. El-Attar's medical staff privileges.

In court documents, hospital officials said they acted within the state's laws that allow the MEC to delegate its authority; a lower court agreed. But Dr. El-Attar and the California Medical Assn. say the peer review was not conducted properly.

In a friend-of-the-court brief, the CMA argued that medical staff bylaws require the medical staff to appoint peer review hearing officers and that California law does not support the hospital governing board's action.

"Along with California's long history of laws declaring medical staffs as 'self governing,' there are also limited laws providing the governing body with oversight authority over peer review, but only in carefully defined and limited circumstances," the CMA brief states (emphasis in original). "Those laws require that the governing board may not take action in quality matters unless and until the medical staff has acted and failed to assure quality, or otherwise failed to act at all."

For example, California law says that if the medical staff does not investigate, even though the evidence shows that it should, the hospital governing board can request an investigation.

"Importantly, however, the governing board has no authority to take its own review action against a medical staff member unless the medical staff fails to take action in response to a direction from the governing board," the CMA brief states, citing California law.

Also at issue in the case, El-Attar v. Hollywood Presbyterian Medical Center, is the standard used to determine whether peer review panel members are impartial.

Physicians and patients deserve fairness in the peer review process, said CMA legal counsel Astrid Meghrigian. "If physicians believe their colleagues aren't going to be treated fairly, they aren't going to participate in the system. That is not good for physicians or patients."

In court documents, hospital executives said peer review panel members did not have an economic interest in the outcome of the hearing, so they were impartial and shouldn't be disqualified from serving on the panel. The lower court ruled that the standard for impartiality should be whether there is a "direct financial benefit."

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