§671D-11 - Standards for professional review actions.

[§671D-11] Standards for professional
review actions. (a) For purposes of the protection set forth in section
671D-10, a professional review action must be taken:

(1) In the reasonable belief that the action was in
the furtherance of quality health care;

(2) After a reasonable effort to obtain the facts of
the matter;

(3) After adequate notice and hearing procedures are
afforded to the physician involved or after such other procedures as are fair
to the physician under the circumstances; and

(4) In the reasonable belief that the action was
warranted by the facts known after such reasonable effort to obtain facts and
after meeting the requirement of paragraph (3).

A professional review action shall be presumed to
have met the standards necessary for the protection set out in section 671D-10
unless the presumption is rebutted by a preponderance of the evidence.

(b) A health care entity shall be deemed to
have met the adequate notice and hearing requirement of subsection (a)(3) with
respect to a physician if the following conditions are met or are waived
voluntarily by the physician:

(1) The physician has been given notice stating:

(A) That a professional review action has been
proposed to be taken against the physician and the reasons for the proposed
action;

(B) That the physician has the right to
request timely hearings on the proposed action, and any time limit of not less
than thirty days within which to request such a hearing; and

(2) If a hearing is requested on a timely basis under
subsection (b)(1)(B), the physician involved must be given notice stating:

(A) The place, time, and date of the hearing,
which date shall not be less than thirty days after the date of the notice; and

(B) A list of the witnesses, if any, expected
to testify at the hearing on behalf of the professional review body.

(3) If a hearing is requested on a timely basis under
subsection (b)(1)(B), the health care entity shall determine that the peer
review hearing shall be held according to one of the following options, and the
hearing shall be so held, subject to the provisions of subsection (b)(4),
before:

(A) An arbitrator mutually acceptable to the
physician and the health care entity; or

(B) A hearing officer who is appointed by the
entity and who is not in direct economic competition with the physician
involved; or

(C) A panel of individuals who are appointed
by the entity and are not in direct economic competition with the physician
involved.

(4) The right to the peer review hearing may be
forfeited if the physician has failed, without good cause to appear.

(5) In any peer review hearing held under this
chapter, the physician involved has the right to:

(A) Be represented by an attorney or other
person of the physician's choice;

(B) Have a record made of the proceedings,
copies of which may be obtained by the physician upon payment of any reasonable
charges associated with their preparation;

(D) Present evidence determined to be relevant
by the hearing officer, arbitrator, or panel, regardless of its admissibility
in a court of law; and

(E) Submit a written statement at the close of
the hearing.

(6) Upon completion of any peer review hearing held
under this chapter, the physician involved has the right to receive:

(A) The written recommendation of the
arbitrator, officer, or panel, including a statement of the basis for the
recommendations; and

(B) A written decision of the health care
entity, including a statement of the basis for the decision.

A professional review body's failure to meet the
conditions described in this subsection shall not, in itself, constitute
failure to meet the standards of subsection (a)(3).

(1) Requiring the procedures referred to in
subsection (a)(3):

(A) Where there is no adverse professional
review action taken;

(B) In the case of a suspension or restriction
of clinical privileges, for a period of not longer than fourteen days, during
which an investigation is being conducted to determine the need for a
professional review action; or

(2) Precluding an immediate suspension or restriction
of clinical privileges, subject to subsequent notice and hearing or other
adequate procedures, where the failure to take such an action may result in an
imminent danger to the health of any individual. [L 1989, c 354, pt of §3 and c
363, pt of §3]