Physician Beware ! The medical group and/or hospital(s) that you associate with can control your license and your career. The peer review process provides great powers and protections to the MEC which often consists of the very people you trusted to share you career. Now they have turned against you and their rights and their powers are extraordinary.

Choose Your Peers Carefully

Peer Review, summary suspensions, resignation while under investigation are all triggers for license harms arising primarily from medical board reporting and review as well as National Practitioner Data Bank (NPDB) reporting. License and credentialling disclosures must include these peer review imposed sanctions and these must be explained for an entire career. Great care must be taken when lesser restrictions such as performance improvement plans can trigger reporting when a physician resignations during the existence of a PIP.

Your peers can quickly become your persecutors and their conduct quickly and easily triggers state and federal protections that give them governmental type powers. So when you sign on with a medical group or hospital, remember that you are empowering them in case of a conflict.

The MEC Has Governmental Agency Type Protections

When an MEC investigation leads to sanctions the by-laws will outline the procedures for having a contested hearing. However, the investigation, the sanctions, the gathering of evidence against you and even the conduct of the hearing enjoy astounding protections. These protections are far greater than protections afforded to police or prosecutors.

The ultimate hearing is termed “peer review”but the entire process is afforded great protections. In California the Supreme Court in the case titled, Kibler v. Northern Inyo County Local Hospital District (2006) 39 Cal.4th 192 held that private hospital’s peer review process was entitled to a level of deference usually reserved for governmental entities enforcing public rights. The court held that peer review was an official proceeding because the Legislature accorded physician peer review decisions “a status comparable to that of quasi-judicial public agencies”. The immunities that arise from this quasi-public status are tremendous. California Evidence Code section 1157 provides for protection against disclosure of peer review related complaints even when a formal proceeding has not started.

New Definition as to “When” a Peer Review Investigation has Commenced

A recent development is a broadening as to when an investigation is deemed to have commenced. This can effect many rights and trigger a myriad of protections to the instigating parties.

Recently the concept of resignation under investigation received attention when a California Court greatly broadened the concept of an MEC investigation. In (Wisner v. Dignity Health (2022) 85 Cal.App.5th 35 [300 Cal.Rptr.3d 359, 370, 85 Cal.App.5th 35]) the court relied upon the NPDB Guidebook (National Practitioner Data Bank Guidebook) for determining what was or was not an “investigation”.

The court stated that “[w]e agree with the NPDB Guidebook that the definition of an investigation cannot be controlled by a hospital’s bylaws, policies, or procedures.” Until this ruling, many physician lawyers relied upon the by-laws to determine this issue of law. It made sense. The by-laws govern MEC actions and review. The by-law definitions should apply to define the term “investigation”.

The Court differed:

“To hold otherwise would result in ad hoc reporting and reporting inconsistencies across the multitude of health care entities throughout the nation,” frustrating the purpose of the reporting requirement. (Rogers, supra, 139 F.Supp.3d at p. 142; Doe v. Leavitt, supra, 552 F.3d at pp. 82-85.)

We note that the NPDB Guidebook’s interpretation also is consistent with the ordinary definition of an investigation as an inquiry or examination of a person or thing. (Oxford English Dict. Online (2022) [as of Oct. 17, 2022], archived at

In other words, rather than have different hospitals, different medical groups, different lawyers, different courts apply their own interpretations of the word “investigation”, the courts should rely upon the commonsense meaning of the word as defined by the dictionary and a major national institution, the NPDB.

The broader interpretation is that “for the purpose of the mandatory reporting requirements, an “investigation” commences as soon as there is a focused “inquiry” into potential misconduct.”

This decision also has implications when MEC conduct is challenged in court. SLAPP protections and litigation privilege protections can be triggered by less than a formal investigation.

If you are facing a peer review investigation the legal rules are stacked against you.

Get immediate professional help. Call our peer review legal team* at (925) 283-1863

* Our peer review legal team includes physician lawyer, Dr. Mark Ravis, legendary trial lawyer Daniel Horowitz and other highly experienced physician attorneys and paralegals.