QUESTION

Should I challenge an adverse decision from a hospital peer review in court?

SHORT ANSWER
In Illinois, there is limited judicial review available in certain cases.
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Courts generally treat the peer review process with great deference. In Illinois, as in the majority of jurisdictions, courts adhere to a “rule of non-review” in cases involving private hospital staff privileges. Under this rule, internal staffing decisions of private hospitals are subject to very limited judicial review as courts recognize that private hospital officials are better qualified than the judiciary to make these staffing decisions. However, an exception to the rule applies where the decision involves a revocation, suspension or reduction of staff privileges. In such cases, the hospital’s action is subject to limited judicial review to determine whether the decision complied with the hospital’s bylaws. Courts will also review a private hospital’s action if actual unfairness on the part of the hospital, its committees, or individual members of the committees is demonstrated in the record. Notably, claims against individual peer review participants are challenging as federal and state law provide immunity from claims for damages arising from a peer review if the physician was afforded certain due process protections.  Given these hurdles, litigation relating to hospital peer review is tilted dramatically in favor of the hospital.  Nonetheless, litigating an adverse peer review decision may make sense if the hospital failed to follow its bylaws, or the physician can demonstrate actual unfairness, such as actual personal bias by the decision-makers. Again, a careful review of your case is a prerequisite to any decision to litigate an adverse decision.

If you are a physician subject to peer review, or a facility initiating one, ASG Law can help you develop and implement an appropriate strategy.