American Medicine is at a crossroads. The Semmelweis Society spotlighted the incredible danger to the public at its annual meeting May 11 2008. At the center of the conference were repeated findings that sham peer review is harming patients, and leading to cost increases, decreased quality, and in many cases excess deaths. Peer review is supposed to be the safeguard of the public, but instead has been used to suppress doctors who stand up for their patients.
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The Semmelweis Society teamed up with Government Accountability Project (GAP), led by legal director Tom Devine Esq, and with the International Association of Whistleblowers (IAW). The Semmelweis society, named after the Hungarian physician Ignaz Semmelweis who revolutionized global health by showing that simple handwashing saves lives, is composed of doctors, patients and citizens who ask for a return of integrity to medicine. HMOs are a danger to both medicine, and to society.
Victims of “sham” or “bad faith” peer review rarely gain access to any independent due process to challenge this unique form of retaliation, which in many cases results in the end of their careers as physicians. Bad faith peer review against one physician can and does persuade others to remain silent rather than advocate on behalf of their patients. Speakers at the conference urging integrity in medicine, and an end to sham peer reviews included:
* Patrick Campbell MD - Provided evidence to the FBI that lead to the successful raid at Tenet's Redding Hospital, where 83% of cardiovascular surgeries were found to be unnecessary. Unfortunately, the Justice Department failed to reward him. Dr. Campbell sued and prevailed through a landmark court of appeal decision.
* Roland Chalifoux DO - Neurosurgeon, President of the Semmelweis Society, who blew the whistle on competitors in Fort Worth Texas.
* Michael Bennett - President of the Coalition for Patients' Rights (CPR). Mr. Bennett lost his father due to an infection he received at the hospital. Mr. Bennett is a nationally recognized patient safety advocate.
Alan Dershowitz, the Counsel of Record for an amicus brief in a “sham” peer review case, wrote: the goals of the HCQIA and peer review are undermined, not promoted, when “qualified physicians are punished and excluded from practice because they have chosen to stand up for a patient. Whenever fewer physicians are willing to criticize the medical community out of fear of the dire consequences of a fundamentally unfair, bad faith peer review, an essential prong in the checks and balances integral to a successful health care program will be silenced.”
Without structural accountability, any structure is vulnerable to being exploited for unacceptable hidden agendas. That is what has happened with peer review.
The IAW unanimously adopted the GAP-Semmelweis plan for reform, and urged Congress to explore ways to prevent the misuse of peer review, including:
1. Launch a Government Accountability Office investigation to assess the vulnerability and extent of hospitals abusing the peer review process to retaliate against physician whistleblowers.
2. Conduct oversight hearings for a public forum on any significant GAO findings. Collectively with our partners in this area, we have heard the stories of hundreds of physician whistleblowers whose careers have been ruined because they chose to advocate for patient safety or challenged inadequate care at hospitals. These individuals are ready and willing to bear witness with first-hand accounts of their experiences.
3. Amend the HCQIA to help curb abuses of the peer review process. One possibility would be to add an affirmative defense of “whistleblower retaliation” to the HCQIA. A physician could then take this claim to an outside body, which could make a ruling as to whether whistleblower retaliation was a contributing factor in any employment decision. This type of independent review is necessary, and is similar to steps Congress is on the verge of taking to reform the security clearance process for national security employees.
4. Pass H.R. 4047, the Private Sector Whistleblower Protection Streamlining Act of 2007. Introduced by Reps. Lynn Woolsey and Education and Labor Committee Chairman George Miller, this legislation would streamline protections for all private sector employees, and protect physicians who are retaliated against for blowing the whistle on inadequate health care.
5. Pass H.R. 4650, the Congressional Disclosures Act of 2007. The legislation, introduced by Rep. Al Wynn, would give federal workers, contractors, and any other employee of an organization that receive payments from the federal government, including hospitals, access to court when they are prosecuted or otherwise harassed for blowing the whistle directly to Congress.
GAP is also pushing for this expansive definition of employee to be included in congressional efforts to overhaul protections for contractors in H.R. 985, Rep. Waxman's whistleblower legislation, which passed the House in March, and is soon to be reconciled with Senate whistleblower legislation.
Patients, citizens and taxpayers all have a stake in protecting the nation's health system. The inspiration of Ignaz Semmelweis was alive at this expanding annual event.
James J. Murtagh Jr.
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