Massachusetts law requires hospitals to institute peer review, quality assessment, and risk management programs. Hospitals must have policies and procedures for reporting behavior by hospital staff that might be inconsistent with or harmful to good patient care or safety. See M.G.L. c. 111, § 203. The by-laws of a hospital or medical staff must establish a framework for the investigation, review, and resolution of such reports (“disciplinary proceedings”). Id.
Short of termination, summary suspension of a physician’s privileges is the most severe peer-review based disciplinary proceeding a hospital can institute. Unlike other disciplinary proceedings, summary suspension results in the immediate revocation of a practitioner’s clinical privileges. Summary suspension generally is imposed when a practitioner’s conduct is deemed an immediate threat to the health, safety, or life of patients or hospital staff. Accordingly, summary suspension is typically imposed immediately, before any extensive proceedings.
While one would think that “immediate threat to patient safety” is clear cut, hospital bylaws may leave the interpretation of that standard to the hospital committee authorized to impose a summary suspension.
Most bylaws provide that after a hearing is claimed, the hospital will appoint a panel or “ad hoc committee” to decide whether the summary suspension will be rejected, upheld, or modified. The committee is typically comprised of other physicians with clinical privileges at the hospital, although its makeup can be subject to limitations, the most common of which is that economic competitors may not serve. The hospital’s bylaws will also provide the procedures for the hearing, including:
- timeframe for assertion of the right to a hearing;
- timeframes for the receipt and filing of notices;
- the method for selecting a panel/hearing officer;
- right to call witnesses and be represented by counsel; and,
- any other special Procedures for Summary Suspensions.
Although summary suspension is not a final adverse action until after the hospital committee adjudicates the matter following a hearing, Massachusetts requires hospitals to report a summary suspension to the Board of Registration in Medicine. See M.G.L. c. 112, §5B. The Board is obligated to investigate and adjudicate the matter before entering a final decision and order against the practitioner’s license. See 243 CMR 1.00. Additionally, pursuant to the Health Care Quality Improvement Act of 1986 (42 U.S.C. §11101, et seq.), hospitals must report a summary suspension based on professional incompetence or misconduct to the National Practitioner’s Data Bank (NPDB) if the suspension is for more than 30 days.
While the summary suspension process is nominally a peer review process, in practice it is often much more like a trial where each party – the hospital committee issuing the suspension, the physician, and the hearing panel – is represented by legal counsel. Physicians should not attempt to navigate these waters without legal counsel. The stakes are very high, and a summary suspension can have career altering or even career ending consequences.