Even if a physician provides high quality care, his or her colleagues may pursue an adverse peer review action in bad faith, due to unrelated economic, personal, or political motives.
The consequences of an adverse peer review action to a physician can hardly be understated. Because of National Practitioner Databank (“NPDB”) reporting requirements, physicians can effectively lose their ability to practice medicine if they become the subject of a single adverse peer review or credentialing action. An adverse databank report becomes a scarlet letter emblazoned upon a physician’s application to join any other facility’s medical staff, and even insurance networks. An adverse NPDB report can also trigger a wave of adverse actions by other credentialing bodies, such as existing insurance networks, professional organizations, and even the Board of Medical Examiners. Many credentialing bodies will act solely on the basis of the initial adverse action, without independently determining whether that adverse action was warranted.
Many credentialing bodies believe that they have absolute immunity – and they act accordingly. Once a credentialing organization decides to pursue adverse action, they will often flout their own rules to obtain that pre-ordained result.
A physician facing the prospect of an adverse peer review action, or filing a lawsuit arising from the peer review process, needs the assistance of an experienced attorney who understand how the peer review process works and who has a strong command of the federal and state statutes and case law that peer reviewers use to stack the deck in their favor.
For most of his career, Mark Hammervold represented Hospitals in professional review and adverse actions against physicians and in credentialing/peer review lawsuits across the country. He understands these institutions’ playbook and knows how to beat them. He has also successfully defended physicians in adverse actions against privileges, medical licenses, and insurance network participation.
Representative work representing hospitals from published cases:
McCord v. HCA Health Services of Tennessee, Slip. Op. No. M2014-00142-COA-R3-CV, (Tenn. Ct. App. Apr. 27, 2015) (affirming summary judgment obtained in favor of the hospital)
Link = https://www.tncourts.gov/sites/default/files/mccorddavid.opn2_.pdf
Raja v. Englewood Community Hospital, No. 8:12-cv-02083-JDW-AEP (M.D. Fla. Aug. 6, 2013) (dismissing the physician plaintiff’s claims for retaliation and breach of contract)
Link = https://scholar.google.com/scholar_case?case=3390868733068273306
Raja v. Englewood Community Hospital, No. 8:12-cv-02083-JDW-AEP (M.D. Fla. Nov. 7, 2013) (denying the physician plaintiff’s motion to reconsider final dismissal of his breach of contract claim)
Link = https://scholar.google.com/scholar_case?case=9109600494681357470