How do Peer Review Actions Work?

The peer review is the process by which a committee comprised of licensed medical personnel at a hospital evaluates physicians applying for staff privileges, establishes standards and procedures for patient care, assesses the performance of physicians currently on staff, and reviews other matters critical to the hospital’s functioning.

Decisions made by a medical staff’s peer review committee or hearing panel, sometimes called a judicial review committee (“JRC”) regarding the membership and privileges of a medical staff member or applicant can be appealed to the governing body of the hospital or medical facility. This appeals process is usually laid out in the hospital’s or facility’s Medical Staff Bylaws. While most Medical Staff Bylaws are usually similar, some institutions or organizations may have specific processes that must be followed explicitly.

Within a designated timeframe after the decision by the Hearing Committee has been reached, either party may request an appeal for review by an Appellate Review Committee. If an appeal is not requested within the designated period, the Hearing Committee's decision will take effect.

The Governing Body (sometimes called a Governance Advisory Council) shall affirm the Decision by the Hearing Committee if it is supported by substantial evidence, following a fair procedure.

Grounds for an appeal can differ depending on what is outlined in the particular hospital’s or facility’s Bylaws. Common grounds for appeal include:

• Substantial non-compliance with the procedures required by the Bylaws or applicable law which creates demonstrable prejudice against the licensee.
• The decision was not supported by substantial evidence based upon the hearing record.
• The decision is not sustainable in light of new evidence.

Once a request for an appeal has been submitted, the Governing Body typically has fifteen (15) working days after receipt of such notice of appeal to schedule and arrange for an appellate review if he/she determines that valid grounds for review have been stated.

The Governing Body will often nominate an “Appellate Review Committee” that will review the administrative record from the peer review proceeding; it may also sometimes accept new oral or written evidence, subject to any restrictions laid out in the Bylaws. The Appellate Review Committee can send the matter back to the Hearing Committee in order to consider new evidence or testimony.

You have the right to be represented by legal counsel for the appeal and to present a written statement in support of your position on appeal.

If your appeal to the Appellate Review Committee is unsuccessful, you can further appeal the matter by submitting a Petition for Writ of Mandate to the Superior Court to review the actions of the Appellate Review Committee and Hearing Committee to determine if there were any substantial errors that would result in prejudice against you and your legal rights.

Schedule a Free Consultation With a Medical License Attorney Regarding Your Peer Review Hearing

If you are the subject of a peer review hearing, do not delay seeking the advice and counsel of an experienced medical license attorney well-versed in the peer review process in order to position yourself for the best outcome. To schedule a FREE initial phone consultation with one of our attorneys to help evaluate your present situation, please fill out our online form or call us at (650) 212-4900 or toll free at 800-LAW-MDJD (800-529-6353).

Our firm has offices located in the San Francisco Bay Area and the Central Coast serving clients throughout California.