(a) The Department shall maintain a process to conduct peer review evaluations for licensed medical providers with known or suspected substandard clinical practices or clinical misconduct which includes acts, demeanor, or conduct likely to be detrimental to patient safety or the delivery of medical care.
(b) These non-routine, for cause evaluations shall be conducted:
(1) Based upon referrals, pursuant to section 3999.136 or the outcome of safety assessments, pursuant to section 3999.138.
(2) By the Medical Peer Review Committee (MPRC) to determine when privileges should be suspended, revoked, restricted or modified.
(A) The MPRC shall consider all available relevant information in peer review evaluations including, but not limited to:
1. The licensed medical provider's actions, conduct, or decision(s) under consideration and the extent to which they did or could have affected patient care, patient safety, or the delivery of safe and effective medical care in the facility.
2. The licensed medical provider's prior history of similar conduct.
3. The licensed medical provider's prior peer review history, whether routine or non-routine, and relevant prior history with administrative discipline.
4. Any physical, medical, or mental health condition suffered by the licensed medical provider that affects the licensed medical provider's ability to provide safe, effective, and competent care.
5. The licensed medical provider's willingness to accept and incorporate corrective measures to prevent future occurrences of similar conduct, actions, or decision-making.
(c) The MPRC may take one or more of the following actions:
(1) Request additional information.
(2) Refer to the institution to provide training, education, proctoring, performance monitoring, or for a physical or mental health evaluation.
(3) Refer the matter back to the institution for a case conference or education to be provided to all licensed medical providers.
(4) Open a Peer Review Formal Investigation.
(5) Send the Provider Network a Potential Quality Issue when the clinical concerns involve a non-departmental licensed medical provider.
(6) Send a letter of concern when the clinical issues involve a medical provider under contract with a non-Provider Network affiliate.
(7) Conduct a safety assessment.
(8) Prepare a Final Proposed Action and refer the matter to the Health Care Executive Committee with a recommendation to:
(A) Modify, restrict, suspend, deny, or revoke the clinical privileges of the licensed medical provider.
(B) Issue a letter of admonition, censure, reprimand, or warning.
(9) Close the matter.
Credits
Note: Authority cited: Section 5058, Penal Code. Reference: Section 5054, Penal Code; and Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern District of California.
History
1. New section filed 7-1-2019 as an emergency; operative 7-1-2019 (Register 2019, No. 27). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 12-9-2019 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 12-5-2019 as an emergency; operative 12-10-2019 (Register 2019, No. 49). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 3-9-2020 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 3-9-2020 as an emergency; operative 3-10-2020 (Register 2020, No. 11). A Certificate of Compliance must be transmitted to OAL by 6-8-2020 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 3-9-2020 order transmitted to OAL 6-8-2020 and filed 7-20-2020 (Register 2020, No. 30).
This database is current through 5/3/24 Register 2024, No. 18.
