Saturday, November 25, 2006

Sham Peer Review And Futility Protocols

In 1949, an article by Dr. Leo Alexander entitled Medical Science Under Dictatorship was published in the New England Journal of Medicine. Dr. Alexander participated, as a prosecution medical expert, in the trials of Nazi physicians at Nuremberg. He wrote the article, in part, to illuminate the reasons that German physicians participated in the euthanasia of incurables and the disabled as well as the commission of medical experimentation on human beings.

First, there was prepatory propaganda, designed to counter attitudes of compassion for the ill, directed to both physicians and the public. Second, influential scientists were allowed personal, career benefits due to their access to body parts for experimentation. Third, some were motivated by fear that their careers would be adversely impacted because they would be labeled traitors, communists or accomplices to acts against the State. As Dr. Alexander points out:

These cases illustrate a method consciously and methodically used in the SS, an age-old method used by criminal gangs everywhere: that of making suspects of disloyalty clear themselves by participation in a crime that would definitely and irrevocably tie them to the organization.


The important lesson here is that this motivation, with which one is familiar in ordinary crime, applies also to war crimes and to ideologically conditioned crimes against humanity---namely, that fear and cowardice, especially fear of punishment or of ostracism by the group, are often more important motives than simple ferocity or aggressiveness.

Of particular interest to me in this article was the successful resistence of the doctors in The Netherlands to the efforts of the Nazis to force them into the fold and to send their sick charges to the "death factories" or to euthanize them, themselves. The tactics used against the Dutch physicians included threats to revoke the physician's licenses to practice.

This brings me to "sham peer review", which has been described in the hyperlinked article as:

peer review done in bad faith for some purpose other than the furtherance of quality care

A recent case involving sham peer review so enraged a jury as to bring about a verdict of $366 million against the offending hospitals, although the Court reduced it to $22.5 million.

According to Dr. Lawrence R. Huntoon, sham peer review usually occurs like this:

A conscientious doctor reports a quality care problem or patient safety problem to the hospital administration. This might be anything from an anesthesiologist falling asleep during surgery to a malfunctioning piece of equipment which places patients at risk for harm.

Instead of fixing the problem, some hospitals misuse the peer review process to attack and silence the physician whistleblower.

The hospital administration and unethical physician collaborators then search for some pretext upon which to attack the physician whistleblower. This might involve the hospital bringing trumped up charges against the physician or it might involve bringing totally false and/or fabricated charges against the physician. The truth and the facts do not matter in a sham peer review in the hospital since the hospital controls the entire process.

The hospital then goes through the motions of providing a hearing to the accused physician, which they call;fair,8; yet the outcome of the hearing is predetermined. The physician's due process rights are often utterly trampled. At the conclusion of the process, the physician's privileges to practice at the hospital are terminated. The physician is reported to the National Practitioner Data Bank, and the physician's career is essentially over. Once a physician receives a negative report in the National Practitioner Data Bank, it is unlikely that physician will ever work in any hospital again anywhere in the nation.

Sham peer review is also being used by unethical physicians to attack other physicians so as to eliminate competition. It is a process which is being driven by money. As reimbursements to hospitals and physicians decline, sham peer review increases.

What has all this to do with futility protocols? One of the accusations that often brings about a sham peer review is that the physician is a "disruptive physician." How does one defend oneself against such a nebulous label? As Dr. Huntoon says,
;Those physicians who fail to pledge allegiance to the mainstream; viewpoint are at risk for being labeled disruptive physicians, which can lead to termination of a physician's career.

If there is pressure placed on physicians to trigger futility protocols, what better tool can there be to coerce compliance than sham peer review? There are no consequences for giving false testimony--the liar is given immunity, although there are some chinks in the armor of immunity developing. Also see: Bruce B. Feyz, M.D. v Mercy Memorial Hospital et al., Supreme Court of Michigan No. 128059 (June 24, 2006)
Due process protections for physicians during peer review are wholly insufficient. Does this sound familiar?

Do you disbelieve that peer review and abusive attention by a physician's licensing board can and is being used in cases where physicians wish to treat patients against the will of the hospital? If so, go read this.