More peer review could turn private

A provider-backed bill has stalled in the Senate that would allow nonphysicians to work on peer review committees and therefore protect what they have to say in the peer review process from becoming public, The State reported.

In 2005, doctors at Piedmont Medical Center in York County, S.C., allegedly gave patient Hayley Tindall too much Pitocin, causing her uterus to rupture and killing her baby, the lawsuit against the hospital and physicians claimed. A judge ordered the hospital to disclose their peer review documents about the event.

In South Carolina, the law protects the privacy of peer review documents by a "committee of a medical staff of a licensed hospital," which the courts have interpreted to mean only physicians and that committees with nonphysician providers are not protected under the law, the article noted. The proposed bill would extend the protection to nonphysician providers such as nurses and administrators.

The peer review process, by definition, is intended to be an internal process to learn from mistakes. Proponents of the proposed law argue that opening up peer review to the public could be dangerous and undermine the purpose of peer review.

Like the debate over opening up the National Practitioner Data Bank (NPDB) information to the public, providers contend that the media can distort information. In September 2011, the U.S. Health & Human Services temporarily shut down access to the NPDB public data file, a stripped-down copy that doesn't identify providers by name. However, reporters were able to glean information from the public file with other research to pinpoint physicians. In November, HHS reopened up the public use file with a new data use agreement that spelled out that users only use the data for statistical analysis and specifically not to identify providers.

"Acknowledging that NPDB public-use files could be subject to misinterpretation by the public is not a compelling reason to block access to it," Fazal Khan, associate professor at University of (Athens) Georgia School of Law, said in an American Medical News ethics forum response.

Khan said in the case of morbidity and mortality conferences or other peer review sessions, identifying physicians could be a harmful breach of confidentiality because participants in these quality review processes would not be as honest, therefore affecting safety negatively.

However, as other states have demonstrated, public access doesn't hurt quality, he noted. Khan said at least 17 states don't consider the malpractice and disciplinary histories of individual physicians to be confidential and have laws that make such information available online.

"[A]s states such as California and New York have discovered, providing public access to individual physician disciplinary and malpractice payment records has not undermined institutional quality-control measures like peer review of adverse outcomes, which weakens claims for keeping such information confidential."

For more information:
- read the State article
- see the bill
- read the amednews ethics forum response

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