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Peer Review Committees – Liabilities and Immunities

Posted Date: June 5th, 2014 | Categories: Health Care & Businesses


Ohio law defines a Peer Review Committee as a utilization review committee, quality assessment committee, performance improvement committee, tissue committee, credentialing committee, or other committee that conducts professional credentialing or quality review activities involving the competence of, professional conduct of, or quality of care provided by health care providers, including individuals who provide health care and entities that provide health care; or a committee conducts any other attendant hearing process initiated as a result of a peer review committee’s recommendations or actions. 

Peer Review Immunity

Physicians serving on peer review committees are immune for any acts, omissions, decisions, or other other acts, conducted within the scope of the committee functions provided that: 

1)     Acts without malice; 

2)     Acts in a reasonable belief that such action or recommendation is warranted by known facts; and 

3)     Can show that a reasonable effort has been made to obtain the facts pertaining to the matter on which the act or recommendation is made. 

Peer Review Committees include all of the following: 

  • A peer review committee of a hospital or long-term care facility or a peer review committee of a nonprofit health care corporation that is a member of the hospital or long-term care facility or of which the hospital or facility is a member; 
  • A peer review committee of a community mental health center; 
  • A board or committee of a hospital, a long-term care facility, or other health care entity when reviewing professional qualifications or activities of health care providers, including both individuals who provide health care and entities that provide health care; 
  • A peer review committee, professional standards review committee, or arbitration committee of a state or local society composed of members who are in active practice as physicians, dentists, optometrists, psychologists, or pharmacists; 
  • A peer review committee of a health insuring corporation that has at least a two-thirds majority of member physicians in active practice and that conducts professional credentialing and quality review activities involving the competence or professional conduct of health care providers that adversely affects or could adversely affect the health or welfare of any patient; 
  • A peer review committee of a health insuring corporation that has at least a two-thirds majority of member physicians in active practice and that conducts professional credentialing and quality review activities involving the competence or professional conduct of a health care facility that has contracted with the health insuring corporation to provide health care services to enrollees, which conduct adversely affects, or could adversely affect, the health or welfare of any patient; 
  • A peer review committee of a sickness and accident insurer that has at least a two-thirds majority of physicians in active practice and that conducts professional credentialing and quality review activities involving the competence or professional conduct of health care providers that adversely affects or could adversely affect the health or welfare of any patient; 
  • A peer review committee of a sickness and accident insurer that has at least a two-thirds majority of physicians in active practice and that conducts professional credentialing and quality review activities involving the competence or professional conduct of a health care facility that has contracted with the insurer to provide health care services to insureds, which conduct adversely affects, or could adversely affect, the health or welfare of any patient; 
  • A peer review committee of any insurer authorized under Title XXXIX of the Revised Code to do the business of medical professional liability insurance in this state that conducts professional quality review activities involving the competence or professional conduct of health care providers that adversely affects or could affect the health or welfare of any patient; 
  • A peer review committee of the bureau of workers’ compensation responsible for reviewing the professional qualifications and the performance of providers conducting medical examinations or file reviews for the bureau. 

Confidentiality 

  • All records and proceedings of peer review committees are strictly confidential and shall be used only in the proper functions of the committee. 
  • A right of action similar to what a patient may have against a physician for misuse of information, data, reports, or records arising out of the physician-patient relationship may be initiated against a member of a peer review committee for misuse of any information, data, reports, or records furnished to the committee by an attending physician. 

If you have additional questions regarding the contents of this section, please contact the the Jones Law Group at (614) 545-9998.

 



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