Dr. Lawrence Huntoon is a man on a mission.
For years now, he has been on call to groups around the country, willing to raise a cry against the abuses of a peer review system which he says is being manipulated to muzzle whistleblowers and rein in healthcare competitors.
The Association of American Physicians and Surgeons (AAPS) formed a new committee three years ago to explore sham peer review shortly after the Pittsburgh Post-Gazette ran an exposé on the problem in Pennsylvania. Huntoon was named chairman of the AAPS Committee to Combat Sham Peer Review, and he's been touring the country to raise the alarm.
"It's a significant and growing problem," asserted Huntoon. "And it's not just a doctor problem; it's also a patient problem. When physicians are afraid to come forward, bring out complaints," he said, everyone is hurt. Physicians who can play a vital role in improving the quality of care are effectively silenced. And patients who rely on the protection of some of healthcare's greatest advocates are left vulnerable.
"Hospitals use it as a tool to retaliate, delineate against physicians who compete against them," added Huntoon. This could include physicians with a financial interest in a competing surgery center or who offer the same kind of diagnostic work as hospitals earn money from.
"It can be a variety of things," he said. "A lot of hospitals don't like competition."
There's nothing new about peer review. Physicians have long practiced peer review as a way to counsel doctors who may be straying from the standards of the profession. But the AAPS says that the threat of a career-damaging rebuke is now being used to retaliate rather than counsel.
The problem, Huntoon pointed to, is the Health Care Quality Improvement Act of 1986, which provided immunity to physicians providing peer review. That immunity, he said, has turned a well-intentioned program into a source of abuse. Now the implicit threat of a peer sanction is enough to keep doctors quiet.
Kenneth Westhues at the University of Waterloo in California has compared it to incidents of university "mobbing," where academic groups target professors through a sham review process.
The newspaper exposé by reporter Steve Twedt outlined several cases of doctors who claimed to have been unfairly disciplined by peer review groups after warning of unsafe conditions in hospitals or dangerously shoddy healthcare practices of colleagues.
Some physicians have successfully fought back against what they alleged was an abusive peer review process. Dallas cardiologis t Lawrence Poliner was awarded $22.5 million by a Texas appeals court last October after fighting for eight years to reverse the actions of a hospital peer-review board. The board had suspended his cath lab privileges after citing the physician for safety concerns. The medical review panel, he told the court, was made up of other cardiologists competing for his business.
Poliner didn't deny that he had made a few mistakes. But the decision by the review group was unduly harsh, the court decided. His settlement was reduced from a jury's award of $366 million, which the appeals court found excessive.
Huntoon said that review panels are often a tool of hospitals used against whistleblowers raising complaints about unsafe practices. Instead of seeing a hoped-for corrective action from their complaint, physicians instead have found themselves listed as "disruptive and abusive" in the National Practitioner Data Bank, which can make them effectively unemployable.
Huntoon, a neurologist, has also been sounding the alarm over a new set of rules from the Joint Commission on Accreditation of Healthcare Organizations — which accredits more than 15,000 healthcare organizations and programs — that will give hospitals even more power over physicians. Peer review groups will be allowed to discipline doctors for nonverbal expressions, such as facial expressions, mannerisms and body language.
"That's a scary thing," said Huntoon, who is also the editor of the Journal of American Physicians and Surgeons. "It will absolutely make the situation worse."
For now, Huntoon said the AAPS is on its own in advocating an end to sham peer review.
"We're the only national medical organization doing anything to combat this problem," said Huntoon. "The AMA favors absolute unity for peer reviewers that protects the good and the bad."