Due process: First things first in peer review

A lawsuit on the summary suspension of a California physician's hospital privileges speaks to broader concerns about peer review.

The summary suspension of a physician's hospital privileges is a crisis response to patients put in peril. In California, where an important legal case is being played out on the issue, the standard set by law is one of "imminent danger" to patients.

So how does it figure that a summary suspension -- the abrupt barring of a doctor from practice at a hospital -- can be based on a list of allegations that rapidly grew to 37 items, some going back as far as 10 years and including charges with no direct connection to recent patient care? ("Suspended California physician's hearing put on hold" AMNews, June 18).

That question is at the heart of a friend-of-the-court brief by the California Medical Assn. and the AMA in connection with an appeal filed by ob-gyn Gil N. Mileikowsky, MD. He has gone to court to finally get a peer review hearing on his November 2000 summary suspension from Tenet HealthSystem's Encino-Tarzana Regional Medical Center. (Tenet has said it does not comment on pending litigation. In a recent court filing, Tenet and the other defendants strongly stand by the appropriateness of their actions in this matter.)

The CMA-AMA brief takes no sides on the underlying disputes of the case but strongly contends that a two-part process is required. Start with an expedited, limited-scope hearing -- in this case there are charges proximate to the time the doctor was suspended -- on whether the drastic step of a summary suspension is warranted. Unless, at the expedited hearing, there is a finding of imminent danger, the physician could continue to practice until a full hearing is held on termination of staff privileges. [...]