Today, Korody Law scored a huge win for our client, an Army physician who had been in a summary suspension status for almost a year. The military physician’s clinical privileges were fully reinstated! This reinstatement means that the no clinical adverse action will be taken against the physician and Revision-To-Action Report will be filed the National Practitioner Data Bank (NPDB).
Procedural Background
The physician was placed in a summary suspension following allegations of poor documentation and clinical incompetency. The investigation lingered for some time because the physician was a specialist and the military treatment facility (MTF) had to find an available peer who perform the quality assurance investigation (QAI). The governing regulation, DHA-PM 6025.13, requires specific qualifications for QAI investigating officers.
Because the summary suspension remained in effect at the 30 day mark, our client was reported to the NPDB for the summary suspension. Approximately 3 months after our client was placed in the summary suspension, the physician received a copy of a proposed adverse action (revocation) and highly redacted copy of the QAI report.
Korody Law’s Advocacy
Once the firm was retained, we sent our notice of representation to the MTF commander and began speaking with the credentialing office and the MTF lawyer. We made it clear that our client indicated that the allegations were baseless and that our client intended to exercise every due process right available with the assistance of counsel.
Once the QAI report was received, it became abundantly clear that the clinical adverse action process mandated by DHA-PM 6025.13 had been violated. Namely, our client was denied the opportunity to review and respond to the QAI report prior to the Credentials Committee making a recommendation to the MTF commander. We also identified that the QAI report was deficient in many ways. We documented our concerns by letter to the MTF commander. A revised QAI report was released that corrected certain deficiencies but continued to unfairly assess our client’s practice.
In preparation for the peer review hearing, we repeatedly requested all records for the cases reviewed as part of the QAI, including all imaging, laboratory reports, nurse notes, and operating reports. Our client had previously been stripped of access to the electronic medical records systems. After much advocacy, we finally received the requested months later, only to realize during our review with our client that we were missing critical records. We were able to obtain some of the missing records.
We also retained an expert on our client’s behalf and worked closely with the expert to review certain cases that were deemed “egregious” violations of the standard of care by the investigating officer. Our expert disagreed and wrote a full report on these cases. Our expert’s report was longer and more detailed on a few cases than was the entire QAI report.
We spoke to numerous witnesses on behalf of client who corroborated issues with the MTF’s EMR system and our client’s reporting. We identified other providers who had observed our client’s clinical practice and believed our client was competent. We prepared these witnesses to testify at the hearing. We obtained affidavits from former patients regarding our client’s care.
We also identified, after reviewing all of the MTF’s evidence, additional due process violations. We again documented our objections in writing to the MTF commander. By this time, the MTF had our expert report and witness list for the peer review hearing. The week prior to the hearing, the MTF commander withdrew the proposed revocation of clinical privileges and remanded the case to a new, Ad-Hoc Credentials Committee to review the case and any materials provided by our client. Our client was given 15 days to provide any additional materials.
We wrote a letter on behalf of our client explaining the major points supporting reinstatement. We assisted our client in drafting a comprehensive review of all the cases reviewed by the QAI investigating officer that culminated in a document over 200 pages (with records inserted).
As a result of the efforts put forth by Korody Law and our client, the MTF commander reinstated our client following a review by the new Ad-Hoc Credentials Committee. As a result of the reinstatement, no clinical adverse action was taken and a Revision-To-Action Report was made to the NPBD.
Military Adverse Clinical Actions
If you are a privileged provider and receive a Notice of Summary Suspension under DHA-PM 6025.13, call Korody Law for a free case evaluation. As demonstrated by this case, you need an experienced attorney who can ensure that your due process rights are protected and that you have a fair opportunity to respond to the allegations against you before a clinical adverse action is taken. Attorney Patrick Korody has represented military privileged providers – physicians, dentists, pharmacists, nurse practitioners, and nurses – facing clinical adverse actions for more than 10 years.