COMMENTARY

Author's Reply to the "Readers' Responses in Regard to 'Sham Peer Review'"

Roland F. Chalifoux, Jr., DO

February 02, 2006

To the Editor,

My sincere appreciation to MedGenMed for publishing my article on bad faith (aka sham) peer review.[1] The term bad faith is a more proper term because it demonstrates the fact that the accusers/instigators of the hearing know full well that the goal that they are attempting to achieve is not improvement in patient care -- which it should be -- but, in fact, a hearing to humiliate/destroy a physician's career.

A problem exists with HCQIA, and these examples are well demonstrated by the thousands of cases that are being defended by Semmelweiss and the AAPS [Association of American Physicians and Surgeons]. Unfortunately, the AMA [American Medical Association] and the AOA [American Osteopathic Association] are waiting for the problem to come to critical mass before they will do anything to have Congress modify the legislation, stating that medicine needs "peer review" in order to police itself. Unfortunately, as demonstrated by the IOM [Institute of Medicine][2] report and other data, doctors cannot do a good job "policing" themselves because HCQIA has created an imbalance in favor of hospitals and administrators over good doctors who want to improve patient care and outcome. The public and doctors alike believe in "good faith peer review"; however, until the playing field is balanced and the burden placed on hospitals to "prove" that a doctor was not practicing good, safe medicine as opposed to only being required to "state the problem," doctors need to be wary of the fact that they have little to no rights when practicing medicine. Neither hospital politics nor unfair economic competition should take precedent over good patient care. Congress unknowingly allowed this to happen with the law known as the Health Care Quality Improvement Act of 1986 (HCQIA). Unfortunately, it is now up to Congress or the courts to fix the problem of hospitals being accountable for their actions.

The timing of these articles could not be more perfect in that the AAPS, along with Allan Dershowitz, have submitted to the Supreme Court a case involving a physician (Mileikowsky v Tenet, US Supreme Court, Petition for a Writ of Certiorari)[3] who was acting in a patient's best interest and was subsequently "removed" from the medical staff, because the administration did not appreciate the fact that this doctor was acting in the patient's best interest when he acted as a whistleblower to improve medical conditions for patients. Larry Poliner, MD, a cardiologist from Dallas, Texas, was awarded $360 million by a jury who was disgusted at how both a hospital administrator and several of his cardiology "buddies" used unfair peer review in an attempt to ruin Dr. Poliner, who was actually having better heart catheterization outcomes.[3] In this day and age, when we all want a patient's bill of health, let's not forget that in order for patients to receive such benefits, doctors need not fear reprisal from their economic competitors or hospital administrators for practicing medicine in the patient's best interest. Currently, this system does not exist.

Sincerely,

Roland F. Chalifoux Jr., DO

Editor's Note:

Charles Bond, author of the "Editorial in Response to 'What Is a Sham Peer Review?'" was shown the reader response letters and chose not to respond.


Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eye only or for possible publication via email: glundberg@medscape.net

References

  1. Chalifoux R, Jr. So what is a sham peer review? MedGenMed. 2005;7:47. Available at: http://medgenmed.medscape.com/viewarticle/515862 Accessed November 15, 2005.

  2. Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine; 1999.

  3. White N. Surgeon awarded $366 million for revoked hospital privileges. Lawyers Weekly USA. Available at: www.lawyersweeklyusa.com/usa/6topten2004.cfm Accessed January 23, 2006.