Decisions concerning medical staff membership and privileges are made through a process of hospital peer review. Every licensed hospital is required to have an organized medical staff responsible for the adequacy and quality of the medical care rendered to patients in the hospital. Arnett v. Dal Cielo 14 Cal.4th 4, 10 (1996). The medical staff must adopt written bylaws which provide formal procedures for the evaluation of staff applications and credentials, appointments, re-appointments, assignment of clinical privileges, appeals mechanisms and such other conditions which the medical staff and governing body deem appropriate.
The medical staff acts mainly through peer review committees, which, among other things, investigate complaints about physicians and recommend whether staff privileges should be granted or renewed. California has codified the peer review process in Business and Professions Code section 809 et seq. The primary purpose of the peer review process is to protect the health and welfare of the people of the state by excluding through the peer review those medical practitioners who provide substandard care or who engage in professional misconduct. This process also allows hospitals to remove incompetent physicians from a hospital’s staff to reduce exposure to possible malpractice liability. Kibler v. Northern Inyo County Local Hospital Dist. 39 Cal.4th 192, 199 (2006). Another purpose which is equally important is to protect the employment and the rights of competent medical doctors from being barred from practical of medicine for arbitrary and discriminatory reasons. As one court noted, peer review that is not conducted fairly and results in the unwarranted loss of a qualified physician’s right or privilege to use a hospital’s facilities deprives the physician of a property interest directly connected to the physician’s livelihood. Anton v. San Antonio Community Hosp. 19 Cal.3d 802, 823 (1977).
The effect of denying staff privileges extends beyond reducing or eliminating a doctor’s access to the facility that denies the privileges. The same hospital is required by section 805(b) to report certain disciplinary actions to the Medical Board. A hospital considering whether to grant or renew a physician’s staff privileges must contact the Medical Board to learn if some other facility has reported a disciplinary action involving the physician as per section 805.5(a). A hospital is also usually required to report disciplinary actions to the National Practitioner Data Bank, established for the purpose of tracing the activities of incompetent physicians. 42 U.S.C. 11133(a). Thus, a hospital’s decision to deny staff privileges may have the effect of ending the physician’s career. Mileikowsky v. West Hills Hosp. and Medical Center (2009).
The peer review process, while generally delegating responsibility to the private sector to monitor the professional conduct of physicians, establishes minimum protections for physicians subject to adverse action in the peer review system. Smith v. Selma Community Hospital 164 Cal.App.4th 1478, 1484(2008). Where a peer review committee recommends a “final proposed action” that will require a hospital to file a report with the Medical Board, the affected physician is entitled to notice and may request a hearing for the purpose of determining if the recommendation is reasonable and warranted. The hearing shall be held as determined by peer review body, before a trier of fact, which shall be an arbitrator or arbitrators selected by a process mutual acceptable to the licentiate and the peer review body, or before a panel of unbiased individuals, which shall include, where feasible, an individual practicing the same specialty as the licentiate. At the hearing, both parties have the right to call, examine and cross examine witnesses and to present and rebut evidence. Upon the completion of the hearing, the parties are entitled to the written decision of the trier of fact, including findings of fact and a conclusion articulating the connection between the evidence produced at the hearing ad the decision reached. Section 809.4(a)(1).
It is important that the physician cooperates with any investigation into his conduct or practice of medicine, since a physician’s refusal to cooperate in the investigation of reported problems may support a recommendation that the physician’s staff privileges be denied. Webman v. Little Co. of Mary Hospital 39 Cal.App.4th 592, 602-603 (1995). However, it is also settled that a physician may not be denied staff privileges merely because he is argumentative or has difficulty getting along with other physicians or hospital staff, when those traits do not related to quality of medical care the physician is able to provide. Miller v. Eisenhower Medical Center 27 Cal.3d 614, 627-629 (1980).