Customize your JAMA Network experience by selecting one or more topics from the list below.
Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
To the Editor: The article by Dr Baldwin and
colleagues1 and the accompanying Editorial
by Dr Brennan2 fail to note that in small
hospitals where physicians wear many hats (peer review, credential committee,
service chiefs), physicians must hide behind the curtain of confidentiality
by either perjuring themselves or making credentialing a sham. As a member
of a credentials committee, one is required to state that there is no knowledge
of information that might have an adverse effect on the application. Since
the board of trustees ultimately determines privileges based on recommendations
of the credentials committee (whose decisions reflect administrative or peer
review recommendations), withholding peer review information will reduce the
reporting to the National Practitioner Data Bank (NPDB). This is particularly
true when peer review involves retrospective evaluations over periods longer
than 2 years. In such instances, a physician may be recredentialed twice without
jeopardy and no reporting to the NPDB will occur.
The Health Care Quality Improvement (HCQI) Act is flawed and real-time
reporting to the NPDB will not occur until it is amended. Quality oversight
in the future must include changes in the HCQI Act so that physicians who
are in small hospitals are not placed in the untenable position in which they
now find themselves. Brennan knows that his statement, "As with all tort law,
malpractice is intended to deter poor-quality care by fixing economic sanctions
onto practitioners who injure patients as a result of negligence" is fallacious.
Tort law is designed to improve the economic condition of those who practice
it. The record speaks for itself.
Frable FL. The National Practitioner Data Bank and the Quality of Peer Review. JAMA. 2000;283(7):886–887. doi:10.1001/jama.283.7.882
Coronavirus Resource Center
Create a personal account or sign in to: