title: Peer review.
abstract: Peer review is essential for ensuring quality medical care. In the 1980s a physician-plaintiff prevailed in lawsuit filed against peer reviewers who excluded the physician from a hospital's medical staff. The peer reviewers had acted to preserve their own economic interests. A multimillion-dollar verdict against the peer reviewers destroyed the community's only multispecialty practice and received national attention. Congress reacted by passing the Health Care Quality Improvement Act that granted sweeping, legal immunity for peer reviewers but also created the National Practitioner's Data Bank. The combination of the establishment of a public repository for physicians malpractice and medical staff privileging activity in combination with the near complete legal protection of peer reviewers has converted peer review from an evaluative to a punitive process. The peer review process and the laws that govern it should be reformed to regain its ability to improve and assure quality without being a threat to physicians.
authors.affiliation: Department of Surgery, VA Greater Los Angeles Health Care System, and the UCLA School of Medicine, Box 95-6904, Los Angeles, California 90095-6904, USA. ELivingston@metnet.ucla.edu
authors.forename: E H
authors.initials: EH
authors.lastname: Livingston
authors.forename: J D
authors.initials: JD
authors.lastname: Harwell
mesh_terms: D006801:Humans; D008504:Medical Staff Privileges; D016749:National Practitioner Data Bank; D018024:Peer Review, Health Care / Q000331:legislation & jurisprudence* / Q000639:trends; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence*; D014481:United States