Colorado Medical Society

Cover: New peer review law advances patient safety

Tuesday, May 01, 2012 01:00 PM

Strong coalition, bi-partisan support bring legislative success, governor’s signature

Colorado Medical Society’s goal of making Colorado the safest state in the nation for patients moved closer to reality with the reauthorization of The Colorado Professional Review Act.

Governor John Hickenlooper signed House Bill 12-1300 on June 5, concluding an often contentious 18-month process that ended successfully thanks in large part to the steadfast support of the bill sponsors, state Rep. Bob Gardner (R-Colorado Springs) and state Sen. Irene Aguilar, MD (D-Denver).

A strong coalition of health care organizations and their lobby teams also championed the effort, which survived an 11th hour negotiation marathon while the sunset legislation was held hostage to a series of demands from the trial attorneys.

“The key to resolving a hostage situation is to hold firm on the fundamentals of the issue, never blink, and seek a fair and rational solution,” said CMS CEO Alfred Gilchrist. “Given the risks of playing chicken with a sunset bill, where an entire body of evolved and complex peer review law drops dead if the clock runs out, our bill sponsors and our coalition lobby team showed remarkable steadiness and judgment under excruciating pressure.”

As signed into law, HB 12-1300:

Colorado Medical Society has long recognized that effective peer review is a key component to improving patient safety. Following passage of sunset legislation in 2010 to modernize the state’s Medical Practices Act and to extend the life of the Colorado Medical Board, CMS took the unusual step of requesting the state to review the body of law governing peer review.

“Making the health care system safer over the long haul is a grind, not a sprint,” said Zak Ibriham, MD, who co-chairs CMS’ Ad Hoc Work Group on Patient Safety. “We understood there would be risks associated with putting peer review through the sunset process, but at the end of the day we knew the law needed to be updated to keep pace with the rapidly evolving patient safety movement.”

A broad based coalition of organizations representing physicians, nurses, physician assistants, hospitals, medical schools, and health plans worked together from the inception of the sunset process. The influence associated with a large coalition composed of highly regarded professionals and organizations was needed when the state’s most powerful trial lawyers surfaced in the final weeks of the legislative session to insist on lawsuit-friendly last-minute amendments to the bill.

The bill’s sponsors, along with the coalition, successfully fought back trial lawyer “asks” that would have:

An accord with Colorado Trial Lawyers Association was reached that does not affect physicians but will impact hospitals and ambulatory surgical centers by allowing these entities to be held liable for negligent credentialing and privileging processes involving an APN, PA or physician. A hospital or ambulatory surgical center can be liable when it fails to act reasonably when making a privileging decision (when it knew or should have known an APA, PA or physician is incompetent, but allows the privileges anyway). It is important to note that professional review participants continue to be immune from liability and that the professional review records remain protected and confidential.

Ultimately, the peer review statute was substantially strengthened and streamlined by being pushed through the sunset process.

Despite the tension that accompanies these kinds of policy debates in a highly politicized environment, the end result was conclusive and established a solid legal premise for the importance of protecting peer review systems.

Holland Hoskins, an attorney representing the CTLA, testified in support of the sunset legislation to the Senate Health and Human Services Committee and acknowledged “Peer review is a time-honored practice that is very important and has been around for a long time. It is important for better quality of medicine and patient safety. We (CTLA) agree that confidentiality and privilege should be maintained.”

At the formal signing event with Gov. Hickenlooper, CMS President F. Brent Keeler, MD, said: “On behalf of Colorado physicians and the patients and communities we serve, I wish to thank the dedicated work of the bill sponsors, the governor’s office and the many organizations that helped move Colorado’s patient safety movement forward by supporting HB 12-1300.”