Interview with Dr. Lawrence Huntoon – 341
In today's episode, Dr. Lawrence Huntoon offers insights into sham peer review, an all-to-common abuse of the peer review process.
Dr. Huntoon is editor-in-chief of the Journal of American Physicians and Surgeons and an expert on this topic. During our discussion, he highlights the importance of early recognition, prompt legal representation, and aggressive defense in response to sham peer review to safeguard your career.
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Understanding Sham Peer Review
Dr. Lawrence Huntoon defines sham peer review as an abuse of the peer review process, emphasizing actions taken in bad faith for motives other than improving quality care or patient safety. He delves into the various tactics and underlying motives hospitals employ. And he emphasizes the importance of recognizing early signs of sham peer review.
Protecting Against Adverse Actions
Exploring the consequences of sham peer review, Larry describes the devastating impact on physicians' careers, such as adverse action reports to the National Practitioner Data Bank. He provides insights into the fraudulent tactics employed by some hospitals. He urges physicians to be vigilant during informal meetings, emphasizing the value of legal representation to navigate these complex situations.
Dr. Lawrence Huntoon's Advice on Preventing Sham Peer Review
Be aware of underlying motives: Sham peer review often occurs due to personal animus, retaliation against whistleblowers, anti-competitive purposes, racial discrimination, or other improper motives. Recognizing these motives early on can be crucial.
Summary
For further information or assistance, Dr. Huntoon suggests contacting the Association of American Physicians and Surgeons (AAPS). AAPS provides resources, including a sham peer review hotline and limited legal consultation services. You can visit the AAPS website for more information or call their hotline for assistance.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- Association of American Physicians and Surgeons website
- AAPS Sham Peer Review Resources
- AAPS Sham Peer Review Hotline: 1-800-635-1196
- Why You Must Wake Up Before Bad Behavior Ruins Your Career – 296
- The Interesting Life of the Professional Development Coach with Dr. Ryan Bayley – 064
- Dr. Debra Blaine's Coaching Services
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Transcription PNC Podcast Episode 341
The Ultimate Swindle Known As Sham Peer Review
- Interview with Dr. Lawrence Huntoon
John: Several years ago, I was at a conference in Chicago and I was there to learn about nonclinical careers, and there were a bunch of doctors there that were seeking to leave medicine. Most of them were because of burnout or just didn't like the lifestyle, but there were several that left because they were forced out of medicine for a variety of reasons, most of which involve being reported to the National Practitioner Data Bank. And since that time, I've learned more about this, and I was reading an article in the Journal of the American Physicians and Surgeons about Sham Peer review. I thought I'd better find out more about that. And I think it's something you'll want to learn about too so maybe you can avoid this particular reason for leaving medicine. With that, I'd like to welcome Dr. Lawrence Huntoon to the show. Hello, Dr. Huntoon. How you doing?
Dr. Lawrence Huntoon: I'm very well, thank you. Thank you for having me on the podcast today.
John: Yeah. I'm really happy to have you here because I have several questions. I will say for the listeners that there is a lot that Dr. Huntoon has written about this topic, so we'll be just scratching the surface. But before we get into that, just tell us a little bit about your background, Larry, and how you got into this.
Dr. Lawrence Huntoon: First of all, I'm a physician. I'm a board certified neurologist. I also have been trained as a medical scientist. I have a PhD in physiology with specialization in neurophysiology. And back in 2003, an award-winning journalist by the name of Steve Twedt, did a series of articles for the Pittsburgh Post-Gazette called The Cost of Courage, where he discussed a lot of instances where physicians were whistleblowers, were retaliated against by hospitals, and in some cases that involved sham peer review. Hospitals don't always like to hear what's wrong as far as in their facilities. Maybe they haven't got equipment that works, maybe there's problems with the staff, but sometimes they don't like to hear about that. And so, instead they go to kill the messenger. And that's what that series of articles was about. He's no longer with the Pittsburgh Post-Gazette, but at that time the AAPS board of directors said, "Look, we're starting to get a lot of calls from physicians that this is affecting throughout the nation. We need to do something to investigate this and see how we can help these victims of sham peer review. Early in 2004, the AAPS Board of Directors formed the AAPS committee to combat sham peer review, and I became chairman of that committee, and I have done that ever since.
John: Okay. You've seen a lot of examples of sham peer review and have been involved heavily in that. Can you tell us maybe a little more specifically what you define as sham peer review? And we'll go from there.
Dr. Lawrence Huntoon: Well, I'll go over the concise definition, then I'll go over the legal definition. Basically sham peer review is abuse of the peer review process for some purpose other than quality care and patient safety. The definition that I have published is sham peer review is an adverse action taken in bad faith by a professional review body for some purpose other than the furtherance of quality care or patient safety, and that is disguised to look like legitimate peer review. The hospitals have found lots of ways to abuse the peer review process, make it look like they're doing legitimate peer review, when the purpose that they're doing it for has nothing to do with patient quality or patient safety.
John: Now, I'm assuming, and I think from reading the journal that you believe and as I believe that a good peer review is appropriate and makes sense and it can help protect patients. The distinction is in the sham peer reviews, they're using a process that was designed to help the patients, but it really isn't being used for that purpose at this point.
Dr. Lawrence Huntoon: Right. And I want to make clear that I support, as does the AAPS, we support a good faith peer review. We support that. The only type we oppose is that type that's done in bad faith, again, for some underlying motive that has nothing to do with quality care or patient safety. We support a good faith peer review.
John: Now, in my recollection, medicine has evolved hugely in the last 30 or 40 years. There's always been some type of so-called quality improvement, and in fact, peer review was probably the main way that we did quality improvement, let's say 30 years ago. But now we can measure performance in different ways. And then the Medicare or CMS started saying we need to do specific types, what was it the acronym FPP? Did you see an increase in sham peer review when they started pushing all of this other type of more formalized peer review that was mandated?
Dr. Lawrence Huntoon: Not really. It's sort of just kept studying even increased over time. That what you're talking about is something that the Joint Commission came up with. It must have been about 2008. They defined OPPE as Ongoing Professional Practice Evaluation. And this is the type of peer review that occurs, and every physician in the hospital is subject to that. They will pull charts based on certain criteria, a patient that readmitted to the hospital within 24 hours after discharge, or died within 24 hours as a complication of surgery. And they have various criteria. All doctors are subject to that. It's kind of a screening type of peer review. And then the joint commission also defined FPPE - Focused Professional Practice Evaluation. And as that name implies, that's a type that is focused on a specific physician and would otherwise be characterized generally as a physician peer review.
John: Okay. But the big distinction here is if someone was having a subject as FPPE for legitimate reasons, fine, it's just something a joint commission requires, and you're going to go through that process. But really the sham peer review is when it just starts from the wrong place for the wrong reasons. And maybe you can explain some of the reasons that the hospitals or other members of the medical staff or other interested parties might start to invoke some type of sham peer review.
Dr. Lawrence Huntoon: And I've written an article on this, "Risk Factors for Sham Peer Review." I've given presentations on this. But there are many underlying motives that we've encountered for sham peer review. It might be retaliation against a physician whistleblower, and I don't particularly like the term "physician whistleblower." These are basically strong patient advocates who speak out in favor of things for the patient. And that's what gets characterized as physician whistleblower. Also sham peer review is often used in cases of personal animus. Maybe the people get in power and they don't like this particular doctor and they're going to get him. It will be done for anti-competitive purposes if there's maybe two or three of that type of doctor in that specialty at the hospital. If one of them gets in power, they may look to eliminate some of the competition. I've seen racial discrimination under underlying sham peer review. There's just a ton of improper motives that we've encountered that underline sham peer review.
John: Can you give us some examples? I know you've been involved with many cases, and I think you actually testify in some of these cases that make it their way to court. But what do they look like at the beginning? How might we recognize that "Wait a second, this doesn't sound like the kind of peer review I'm used to?" And we'll go from there.
Dr. Lawrence Huntoon: Yes. I'm a court qualified expert in sham peer review in federal court as well as a number of state courts. And you asked how do you recognize it early on? And I would say if it smells bad, it probably is bad. But what you're looking for there is you begin to encounter things that just don't seem fair at all. And of course, I've written articles on tactics that are characteristic of sham peer review. I've given talks on that.
But you start seeing things like the ambush tactic. And the ambush tactic is a tactic that's characteristic of sham peer review. That's where they invite the doctor into maybe the administrator's office, and they don't tell the doctor what it's about ahead of time. And they tell the doctor, "Look, this is just an informal friendly meeting. We want you to come." And the doctor may ask, "Well, what's it about so I can prepare?" And they don't tell him. And then the doctor gets into this so-called friendly informal collegial meeting, and he finds himself sitting across the table from the CEO of the hospital, the chief of staff, and probably the attorney for the hospital. And every one of those individuals knows exactly what it's about. The only one in the room who doesn't is the doctor that's been called in for the ambush. There's a lot of tactics like that. And the thing they have in common is they violate due process and fundamental fairness.
John: Now, I'm going to get to the meat of some other cases. But just to kind of jump ahead a little bit, what is the devastating outcome if this doesn't go as we plan as physicians, but as the way the administrator or the other physician wants it to go? What does that usually result in if we don't know how to defend ourselves?
Dr. Lawrence Huntoon: Well, it results in an adverse action report to the National Practitioner Data Bank. And the National Practitioner Data Bank was created as a result of a law passed in 1986 called the Healthcare Quality Improvement Act. And the Data Bank actually went into effect in 1990. And so, what the Data Bank is, it's a national repository for adverse actions that have been taken against physician hospital privileges or medical licensure actions, that sort of thing.
And there's other types of Data Bank reports. The one I'm talking about here are the adverse action reports. And what it does, it basically transforms a local action at a local hospital to a devastating national action. Because here's what happens. Every hospital is required to query the Data Bank before they admit someone on staff. They're also required to query that Data Bank every two years for renewal of medical staff privileges. If you're applying to a hospital and you have one of these adverse action reports in the Data Bank, the hospital basically considers you to be damaged goods and they don't want to put you on staff. You will have trouble getting on medical staff, you'll have trouble getting the medical license. You'll have trouble staying on insurance panels if that's what you're doing, renewing staff privileges or renewing licensure. It creates an incredible number of domino effects that are very bad for the physician.
John: It might result in you getting kicked off the staff that you're on now or being somehow penalized, which has to be reported. Basically it can destroy your career overnight.
Dr. Lawrence Huntoon: Yes, it can totally ruin it or end it.
John: Exactly. It's like one of those things where you spent whatever number of years of your life with your education, your training and experience, and it's pretty much gone if there's an adverse listing in the Data Bank. Now we get reported, of course, for lawsuits. I don't think a single or a couple lawsuits on the Data Bank means that much depending on the size and the frequency and so forth. But this is a different situation where there's definitely an adverse result that's reported that usually indicates a negative. It is supposed to be evidence that you're at some level a poor physician, I guess is the way I would say it.
Dr. Lawrence Huntoon: There are five different types of Data Bank reports, and I've found that hospital attorneys just love to confuse the Data Bank reports when you get into trial in front of a jury. And they bring up this idea of these Data Bank reports having to do with malpractice actions and malpractice settlements. And they say, "Well, it didn't seem to hurt the doctor that much. He's got two of these malpractice reports or settlements in the national practitioner Data Bank. What's the big deal?"
And so, I explained to the jury, that the types of reports involving malpractice settlements and whatnot, that's maybe like getting shot in the foot. You can continue to limp along, whereas one of these Data Bank reports having to do with removal of hospital privileges, it's like getting shot in the head. It ends your career and ends your world as you know it.
John: All right. Well, let's get back into how we can try and avoid some of this. I read something you wrote, I believe, or maybe it was in a video, that there are certain physicians who seem to be at risk. It doesn't have anything to do with, let's say, the quality of their practice, but because of adverse relationship with the hospital or financial situations. So, what are some of those that if you fall into this category, you might be a little bit more aware that this could come up?
Dr. Lawrence Huntoon: Well, of course, any disputes with the hospital administration is likely going to put a target on your back. But we've been able to identify certain specialties that get attacked more than others. And I think that those specialties that are at the top of that list tend to be those that receive very high compensation. These might be neurosurgeons that involve spine surgery, maybe anesthesiologists, and I've listed the whole list down there as far as risk fact, the article I wrote on risk factors. A lot of that has to do with money. Again, you're looking at anticompetitive type actions in some cases where you can get rid of a competitor, that leaves a bigger pie for the person who did the sham peer review.
John: Yes. Now I think you also mentioned sometimes, maybe a solo practitioner, just for whatever reason, they are a little more independent, a little more autonomous, they want to do things their own way, and all of a sudden we find that the hospital thinks, "Well, we've got to get them off the staff."
Dr. Lawrence Huntoon: Yes. The main reason solo physicians tend to get attacked is not because they necessarily like to do things their own way. It's because they don't have any support structure in the hospital. If you're a member of some big group, you've got that big group kind of supporting you and protecting you in the hospital. Solo physicians or those who are new on staff may not have that, and therefore they're vulnerable. Foreign physicians, the same thing. They tend to be vulnerable to these types of attacks. And sometimes the attacks are based on discrimination, blatant discrimination.
John: Now, I would think, "Well, let's see if a physician is actually employed by a hospital or a health system, they have a contract, they can always cancel a contract if they don't like this particular person." But that doesn't necessarily prevent you from this sham peer review.
Dr. Lawrence Huntoon: There's two different issues there. There's an employment issue and a medical staff privilege issue. And a lot of these employment contracts, almost all of them are going to have a no cause clause in it whereby they give a certain number of days notice, maybe 90 days notice, and they can terminate your employment contract without giving a reason. That's a no cause clause. And they often do that. They may have a non-compete clause as well.
When they terminate your employment, you're not allowed to work within a certain number of miles of that particular hospital. Having your employment terminated does not get reported to the Data Bank. But if they decide that they want to take a privileging action against you, that is one way they look to terminate the contract and harm you at the same time. These contracts require, of course, that you maintain medical staff privileges at the hospital where you have the contract. And if they can get rid of those privileges, that ends the contract and they get to harm you as well.
And so, in one particular case I saw, the hospital had recruited a specialty surgeon in to start sort of a new area of specialty in that hospital. And after about a year, the hospital determined, "Well, this doctor is not bringing in as much revenue to the hospital as we thought, so we need to get rid of that doctor." And so, rather than just terminating the contract and letting the doctor move on, they did a sham peer review. They brought false charges against the doctor, fabricated charges, and they got rid of the doctor's privileges. And of course, that got rid of the contract as well.
John: One of the things I remember when I was a CMO of a hospital was that we would sometimes face an issue like we thought the quality could be bad but because we didn't do this very often, it didn't really seem like we knew what we were doing in terms of trying to just go through this process, keeping it up and up. But at the same time, the CEOs talking to the COO and the CFO have their input and he's a finance guy, he is not really a quality guy. And then all of a sudden, "Well, we got to bring our attorney in." And so, now, the whole hospital has started to amass this whole thing involving multiple parties and not even necessarily the medical staff yet at that point. And then here you are, the physician come in for this informal meeting, as you mentioned earlier. Can you expound on how some of the cases have gone when they get to that point?
Dr. Lawrence Huntoon: It's been my experience. I've encountered a lot of people in the hospital administrations who don't know what they're doing at all. That includes the hospital leadership, maybe the chief of staff and whatnot. They don't know what they're doing at all. Maybe they haven't done it before or have not done it that much. And the problem is they tend to look to find an outcome that they desire and they don't really care about following the medical staff bylaws. Well, the medical staff bylaws are there to provide some due process and fundamental fairness to the accused physician. And if they've got some outcome in mind, well, it doesn't really matter, and they don't follow the bylaws. I encounter that I would say fairly frequently. And it does happen in places where they don't do many of these or have never done them before.
John: Yeah. And if the idea is maybe they have some kind of inkling or they just don't like the person, like you said, and so everything is jumbled together, the emotions. Maybe the doctor irritated someone by something that they said or could be anything I can imagine. And now they have this little ball rolling, this snowball, and it's like, "Okay, let's figure out how we can use all, whether it's our contract, whether it's our bylaws or a combination of those to get our end result, which is we just maybe decide we don't want this person here." They don't really seem to be too concerned about "What is the final consequence for the doctor?" All they want is for the doctor to be gone.
Dr. Lawrence Huntoon: Right, right. And the other thing I'd point out is sometimes you'll hear these peer reviews go forward and people will testify, "Well, I would've done that surgery differently. I don't take that approach. I take a different approach." But that shouldn't be part of taking an action against a physician. There's always room for improvement in our care. But what the important thing is, did the care provided, did that fall below the standard of care? Not "If you didn't do it my way, then you're not doing it right." No. That's not the standard of care. And sometimes they will portray it wrongfully as that. I see that a lot.
John: One of the things that was mentioned in one of the articles you wrote that I read, and I've heard this before, but if you're in the middle of this process, at whatever level, you're the physician and one of the things you hear is this comment. "Well, maybe if you just withdraw now, either this privilege or withdraw from the hospital, we won't do a report to the Data Bank." And so, why is that a huge red flag?
Dr. Lawrence Huntoon: Well, number one, that's fraud. And I just wrote an article about that in the December, 2023 issue of the journal. I see that a lot. A lot of the hospital administrations and leadership, including the chief of staff will tell the doctor, "Look, this will go better for you and you won't have to engage in all this messy peer review if you just resigned now and we won't report you to the Data Bank." That's fraud. And it's totally false. What happens is they get the doctor, the naive doctor who doesn't know any better. "Oh yeah, that sounds good to me. I'm getting out of here. I don't want to be here anyway, I'm resigning right now." After that, what we see is the hospital reports the doctor to the Data Bank the very next day. And the report that is made has standardized language, which says, "Doctor resigned while under or to avoid investigation." That makes the doctor look like he pled guilty. He just wanted out of there or didn't want to face the music or whatever.
And the other thing hospitals like about that, number one, they get to harm the doctor. They like that. Number two, once you resign, you don't have any due process rights like a peer review hearing or appeals process because you are no longer a member of the medical staff. So, it's a big win-win for the hospital when they can convince a doctor to resign while under or to avoid an investigation. And of course, we're beginning to see lawsuits where the hospital attorney, the hospital CEO and others that have been involved in that fraud are sued for fraud. And there is no immunity for fraud.
John: Interesting. Have there been some successes in that realm where they were found guilty of fraud?
Dr. Lawrence Huntoon: What happens is, when you sue a hospital attorney, he doesn't particularly like being accused of fraud. And that may not go too well in terms of his reputation. What you see is, all of a sudden, the hospital may have been dragging its feet and saying, "No, we're not going to settle this case. We're not going to avoid that report in the Data Bank because we're legally obligated to report you." You sue the hospital attorney, CEO and maybe the chief of staff for fraud because they committed fraud. And all of a sudden, things change. And so, what I've seen recently is, for example, a settlement where the hospital agrees to void the Data Bank report and put the doctor back on staff without restrictions. And of course, provide the doctor with some compensation for what they've done. They don't want to go to trial on that at all.
John: Yeah, that makes sense. Well, to give you a lot more leverage than it sounds like there has been in the past. So, that's good to know.
Dr. Lawrence Huntoon: And I'll say that it's very important to know that once you get a Data Bank report, it's impossible, nearly impossible to get that out of there. And the hospitals will always claim, "Well, we can't void a Data Bank report. We're required by law to report it." And they'll whine and whine but they can, and they do when you've applied the right leverage to get it done on.
John: Okay. Well, we've learned a lot so far. I want to ask one more specific question, and then I want you to tell us about the AAPS and the journal and that sort of thing. And you probably addressed this earlier, but let's say I'm brought into one of those meetings, all of a sudden I'm looking at the CEO and the chief of the medical staff and an attorney. They're saying they're going to have a conversation. Should I just run out of the room immediately and call my lawyer? Should I just listen? I think in one of the articles you gave us advice on how to go into that meeting, what you could do, at least if your spider sense is going off a little bit. What are your suggestions for that if we find ourselves in that situation?
Dr. Lawrence Huntoon: Well, it's hard to avoid the meeting. Because if you avoid the meeting, they'll say, "Well, the doctor's not being cooperative. We're just trying to help him by tying him to the post in front of the firing squad. We're just trying to help him." And so, you can't really avoid it without them portraying it that way. You can listen. And again, the ambush tactic is done for one purpose and one purpose only. It makes the doctor look guilty. Because if they're talking about maybe three or four patients that they feel you provided poor quality care to, well, you didn't know about that ahead of time and you're busy trying to remember while you're sitting in this stressful meeting, "What? These patients? I don't recall exactly what I did at that time." And so, when you flounder around and you're trying to remember to defend yourself, and you do a poor job of defending yourself for that reason, you look guilty. And again, that's the purpose. They want you to look guilty in front of the assembled members at such a meeting like that.
John: Oh boy. Yeah. Maybe you should bring someone with you to any meeting, so at least you have... And who would know what kind of meeting it's going to be if it's not got a label or a purpose?
Dr. Lawrence Huntoon: Here's the thing. The medical staff bylaws often forbid the physician to bring anyone with him, most certainly not an attorney, to one of these informal, friendly, collegial meeting. We're just a bunch of friendly doctors getting to gather to discuss things. They also often won't allow the doctor to bring an attorney to a meeting before the investigative committee to explain his side of the story. And oftentimes, most times, they will not allow a doctor to bring an attorney to a meeting before the MEC, the Medical Executive Committee to explain his care.
Now, they've gone even further than that in some cases. Going to peer review, once they've proposed an adverse action, you have the right to peer review and appeals in the hospital. Guess what? Some hospitals tell the doctor, "Yes, you can bring your attorney to the peer review hearing, but no, the doctor can't talk." The doctor can't raise objections. The doctor can't cross examine witnesses and doctors are not well prepared to do that. Doctors who don't have a JD degree aren't attorneys and they've function poorly as attorneys. They've done that in some cases. And to me, you have a right to representation under the Healthcare Quality Improvement Act. But to me, that's not representation when you put a piece of duct tape over your attorney's mouth and he sits there in the peer review hearing and can't say anything.
John: Wow. It doesn't sound like it's very hopeful that you're going to come out successful in these, unless you do everything right along the way. And then once the process gets going, of course, you want to have a good attorney, as you mentioned earlier, that knows how to deal with these kinds of situations.
I'm going to have another question to ask that's related, but first, tell us about the association and why listeners might want to get the journal, why they might want to join the association, that sort of thing.
Dr. Lawrence Huntoon: The Association of American Physicians and Surgeons was established in 1943, and we have been the voice for private physicians ever since. Our motto is "omnia pro aegroto" which in Latin means "all for the patient." And that's where we stand basically. And we believe in protecting the sacrosanct patient physician relationship. We believe that physicians are the ones that should be practicing medicine as opposed to insurance bureaucrats and government bureaucrats, often who are not physicians at all, not licensed to practice medicine, yet they tend to direct the way medicine is practiced.
One of the three benefits you get as an AAPS member is that you get access to the AAPS sham peer review hotline. And I have run that hotline on a pro bono basis for 20 years now. And so, that gives you, as soon as you join, you have access to the AAPS sham peer review hotline. You also have access to the nation's top attorney in sham peer review matters. We call it our AAPS Free Limited Legal Consultation Service. And you can discuss these things with a very knowledgeable attorney. Know that I'm not an attorney, I don't give legal advice or legal opinions, but we have an attorney who is very experienced at that. Those are some of the things you get as benefits as an AAPS member.
John: What is the website? Is it aaps.com?
Dr. Lawrence Huntoon: No, it's aapsonline.org. The best way to join probably is the 800 number. 1-800-635-1196. And as soon as you join, like I said, you have access to those free benefits.
John: Actually, I joined today. I thought I was a member already because I get the journal.
Dr. Lawrence Huntoon: No, you were a member back in February.
John: Oh, was I? Oh gosh. Okay. Well, I just renewed it. They get the journal automatically if they're a member, correct?
Dr. Lawrence Huntoon: Yes. Yes.
John: What's usually in the journal?
Dr. Lawrence Huntoon: It's the Journal of American Physicians and Surgeons, and we're a member of the Directory of Open Access Journals. And what that means is we don't charge people to download our articles. Our articles are downloadable free of charge, the full article. We don't require any usernames or passwords. You just go on the website. If you find an article you want to read, you download it and read it. That's what the journal is about. And it's been in existence since 2003 and I've been the editor and chief since 2003.
John: Okay. Let's see. Other things I wanted to mention or have you even tell us about. Supporting this relationship between the physicians and patients and the original way that medicine was to be practiced. One thing is insurance out or no interference. There is a big interest in direct primary care and cash-based businesses and other iterations. And so, I think you were telling me that you do or the association does presentations to physicians who are interested in learning more about how to make the transition. And that would include being off of Medicare or CMS.
Dr. Lawrence Huntoon: Right. AAPS has run "Thrive, Not Just Survive" workshops for many, many years. And those talks and presentations are all available on the AAPS website. I myself ran a third party free opted out of Medicare practice, and I was in solo neurology practice for 34 years until the government put us out of business in 2020 by these harsh, unwarranted and totally ineffective lockdowns that were done. And that put us out of business. It put a lot of small businesses out of business, and we were a small business.
John: Yeah. That was really harmful to a lot of businesses, a lot of physicians, small groups and so forth. And in retrospect really to pretty much almost totally unnecessary I would say. That's my belief. It's a little bit political, but whatever, we won't get into that right now. But another resource for listeners, if they're thinking, "Wow, I'd like to opt out of Medicare, I'd like to opt out of all insurance companies." There's some resources there at the association.
All right. Anything else I'm not asking you about that is important for us to know about the association or about the journal at this point?
Dr. Lawrence Huntoon: No, but I think you asked the question "Is there any way that we can avoid this at my hospital, for example, sham peer review?" And the answer to that unfortunately is no. Sham peer review does not occur in a vacuum. It occurs in an environment of turf battles and personal jealousy, personal animus, and a whole lot of things like that. It really isn't possible to find a way to prevent it at any particular hospital. And the trouble we have is trying to get support from a number of physicians, particularly in the hospital where they know sham peer review is going on against one of their colleagues. These are the so-called bystanders, who know what's going on, turn their head away and don't do anything to help stop it. And this is like bullying. Sometimes all it takes is one of these bystanders to stand up and say "We don't think this is right what you're doing, and you ought to stop it" to derail the thing. But many of these bystanders think "This'll never happen to me because I'm a good physician. I practice very good medicine. This won't happen to me." So, they don't want to get involved.
John: Yeah. I suppose there's some risk in doing that. Looking at it though from the other side as a physician, there are surgeon centers. Some surgeons can work there and not have to rely on the hospital, and if that's owned and run by physicians, hopefully they won't be pursuing sham peer review in that setting and avoiding the insurers. At the end of the day, maybe the only way for some of us to have traditional good relationships with our patients and practice medicine is to opt out of some of those onerous systems.
Dr. Lawrence Huntoon: One thing I'd like to point out is some people say, "Oh, the doctors are doing that for greed." And that generally from my experience is not true, certainly in the AAPS. What they're doing is they get tired of these bureaucrats interfering with the way they practice medicine and they kick these bureaucrats out of their exam room. And that's the real benefit. And you can set your own prices at reasonable levels that patients can afford.
John: Yeah. And we've talked to physicians here on the podcast who can spend more time with their patients. The patients are happier, the physicians are happier, and it doesn't cost the patients any more if it's set up properly and they get better care really. All right. This has been very inspirational. It's scary, but the fact that there are resources there to help us. Did we talk about the hotline for sham peer review? Is that the same 800 number?
Dr. Lawrence Huntoon: Yeah, they call the 800 number and they join and then they just ask the business manager who's going to be answering the phone, "How can I get access to the AAPS sham peer review hotline?" And he'll put them in contact with it. I'm always happy to talk with members about their individual situations and offer helpful information, particularly early on. Don't wait until the matter has been going on for four or five years and you've gone through a massive litigation and then "Can you help me?" Early on is best.
John: Yeah. I can see how that'd be a fantastic resource and just help point them in the right direction and some of the articles and the videos and giving advice and talk about maybe how to find an attorney. That can all be very helpful early on, obviously, than waiting into the second or third year or longer. This has been really great, Larry, thanks a lot for coming on the podcast and sharing this with us today. I think it's an important message.
Dr. Lawrence Huntoon: It's been my privilege. Thank you for having me on the podcast today.
John: All right. With that, I'll say bye-bye till next time.
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Transcription PNC Podcast Episode 341
The Ultimate Swindle Known As Sham Peer Review
- Interview with Dr. Lawrence Huntoon
John: Several years ago, I was at a conference in Chicago and I was there to learn about nonclinical careers, and there were a bunch of doctors there that were seeking to leave medicine. Most of them were because of burnout or just didn't like the lifestyle, but there were several that left because they were forced out of medicine for a variety of reasons, most of which involve being reported to the National Practitioner Data Bank. And since that time, I've learned more about this, and I was reading an article in the Journal of the American Physicians and Surgeons about Sham Peer review. I thought I'd better find out more about that. And I think it's something you'll want to learn about too so maybe you can avoid this particular reason for leaving medicine. With that, I'd like to welcome Dr. Lawrence Huntoon to the show. Hello, Dr. Huntoon. How you doing?
Dr. Lawrence Huntoon: I'm very well, thank you. Thank you for having me on the podcast today.
John: Yeah. I'm really happy to have you here because I have several questions. I will say for the listeners that there is a lot that Dr. Huntoon has written about this topic, so we'll be just scratching the surface. But before we get into that, just tell us a little bit about your background, Larry, and how you got into this.
Dr. Lawrence Huntoon: First of all, I'm a physician. I'm a board certified neurologist. I also have been trained as a medical scientist. I have a PhD in physiology with specialization in neurophysiology. And back in 2003, an award-winning journalist by the name of Steve Twedt, did a series of articles for the Pittsburgh Post-Gazette called The Cost of Courage, where he discussed a lot of instances where physicians were whistleblowers, were retaliated against by hospitals, and in some cases that involved sham peer review. Hospitals don't always like to hear what's wrong as far as in their facilities. Maybe they haven't got equipment that works, maybe there's problems with the staff, but sometimes they don't like to hear about that. And so, instead they go to kill the messenger. And that's what that series of articles was about. He's no longer with the Pittsburgh Post-Gazette, but at that time the AAPS board of directors said, "Look, we're starting to get a lot of calls from physicians that this is affecting throughout the nation. We need to do something to investigate this and see how we can help these victims of sham peer review. Early in 2004, the AAPS Board of Directors formed the AAPS committee to combat sham peer review, and I became chairman of that committee, and I have done that ever since.
John: Okay. You've seen a lot of examples of sham peer review and have been involved heavily in that. Can you tell us maybe a little more specifically what you define as sham peer review? And we'll go from there.
Dr. Lawrence Huntoon: Well, I'll go over the concise definition, then I'll go over the legal definition. Basically sham peer review is abuse of the peer review process for some purpose other than quality care and patient safety. The definition that I have published is sham peer review is an adverse action taken in bad faith by a professional review body for some purpose other than the furtherance of quality care or patient safety, and that is disguised to look like legitimate peer review. The hospitals have found lots of ways to abuse the peer review process, make it look like they're doing legitimate peer review, when the purpose that they're doing it for has nothing to do with patient quality or patient safety.
John: Now, I'm assuming, and I think from reading the journal that you believe and as I believe that a good peer review is appropriate and makes sense and it can help protect patients. The distinction is in the sham peer reviews, they're using a process that was designed to help the patients, but it really isn't being used for that purpose at this point.
Dr. Lawrence Huntoon: Right. And I want to make clear that I support, as does the AAPS, we support a good faith peer review. We support that. The only type we oppose is that type that's done in bad faith, again, for some underlying motive that has nothing to do with quality care or patient safety. We support a good faith peer review.
John: Now, in my recollection, medicine has evolved hugely in the last 30 or 40 years. There's always been some type of so-called quality improvement, and in fact, peer review was probably the main way that we did quality improvement, let's say 30 years ago. But now we can measure performance in different ways. And then the Medicare or CMS started saying we need to do specific types, what was it the acronym FPP? Did you see an increase in sham peer review when they started pushing all of this other type of more formalized peer review that was mandated?
Dr. Lawrence Huntoon: Not really. It's sort of just kept studying even increased over time. That what you're talking about is something that the Joint Commission came up with. It must have been about 2008. They defined OPPE as Ongoing Professional Practice Evaluation. And this is the type of peer review that occurs, and every physician in the hospital is subject to that. They will pull charts based on certain criteria, a patient that readmitted to the hospital within 24 hours after discharge, or died within 24 hours as a complication of surgery. And they have various criteria. All doctors are subject to that. It's kind of a screening type of peer review. And then the joint commission also defined FPPE - Focused Professional Practice Evaluation. And as that name implies, that's a type that is focused on a specific physician and would otherwise be characterized generally as a physician peer review.
John: Okay. But the big distinction here is if someone was having a subject as FPPE for legitimate reasons, fine, it's just something a joint commission requires, and you're going to go through that process. But really the sham peer review is when it just starts from the wrong place for the wrong reasons. And maybe you can explain some of the reasons that the hospitals or other members of the medical staff or other interested parties might start to invoke some type of sham peer review.
Dr. Lawrence Huntoon: And I've written an article on this, "Risk Factors for Sham Peer Review." I've given presentations on this. But there are many underlying motives that we've encountered for sham peer review. It might be retaliation against a physician whistleblower, and I don't particularly like the term "physician whistleblower." These are basically strong patient advocates who speak out in favor of things for the patient. And that's what gets characterized as physician whistleblower. Also sham peer review is often used in cases of personal animus. Maybe the people get in power and they don't like this particular doctor and they're going to get him. It will be done for anti-competitive purposes if there's maybe two or three of that type of doctor in that specialty at the hospital. If one of them gets in power, they may look to eliminate some of the competition. I've seen racial discrimination under underlying sham peer review. There's just a ton of improper motives that we've encountered that underline sham peer review.
John: Can you give us some examples? I know you've been involved with many cases, and I think you actually testify in some of these cases that make it their way to court. But what do they look like at the beginning? How might we recognize that "Wait a second, this doesn't sound like the kind of peer review I'm used to?" And we'll go from there.
Dr. Lawrence Huntoon: Yes. I'm a court qualified expert in sham peer review in federal court as well as a number of state courts. And you asked how do you recognize it early on? And I would say if it smells bad, it probably is bad. But what you're looking for there is you begin to encounter things that just don't seem fair at all. And of course, I've written articles on tactics that are characteristic of sham peer review. I've given talks on that.
But you start seeing things like the ambush tactic. And the ambush tactic is a tactic that's characteristic of sham peer review. That's where they invite the doctor into maybe the administrator's office, and they don't tell the doctor what it's about ahead of time. And they tell the doctor, "Look, this is just an informal friendly meeting. We want you to come." And the doctor may ask, "Well, what's it about so I can prepare?" And they don't tell him. And then the doctor gets into this so-called friendly informal collegial meeting, and he finds himself sitting across the table from the CEO of the hospital, the chief of staff, and probably the attorney for the hospital. And every one of those individuals knows exactly what it's about. The only one in the room who doesn't is the doctor that's been called in for the ambush. There's a lot of tactics like that. And the thing they have in common is they violate due process and fundamental fairness.
John: Now, I'm going to get to the meat of some other cases. But just to kind of jump ahead a little bit, what is the devastating outcome if this doesn't go as we plan as physicians, but as the way the administrator or the other physician wants it to go? What does that usually result in if we don't know how to defend ourselves?
Dr. Lawrence Huntoon: Well, it results in an adverse action report to the National Practitioner Data Bank. And the National Practitioner Data Bank was created as a result of a law passed in 1986 called the Healthcare Quality Improvement Act. And the Data Bank actually went into effect in 1990. And so, what the Data Bank is, it's a national repository for adverse actions that have been taken against physician hospital privileges or medical licensure actions, that sort of thing.
And there's other types of Data Bank reports. The one I'm talking about here are the adverse action reports. And what it does, it basically transforms a local action at a local hospital to a devastating national action. Because here's what happens. Every hospital is required to query the Data Bank before they admit someone on staff. They're also required to query that Data Bank every two years for renewal of medical staff privileges. If you're applying to a hospital and you have one of these adverse action reports in the Data Bank, the hospital basically considers you to be damaged goods and they don't want to put you on staff. You will have trouble getting on medical staff, you'll have trouble getting the medical license. You'll have trouble staying on insurance panels if that's what you're doing, renewing staff privileges or renewing licensure. It creates an incredible number of domino effects that are very bad for the physician.
John: It might result in you getting kicked off the staff that you're on now or being somehow penalized, which has to be reported. Basically it can destroy your career overnight.
Dr. Lawrence Huntoon: Yes, it can totally ruin it or end it.
John: Exactly. It's like one of those things where you spent whatever number of years of your life with your education, your training and experience, and it's pretty much gone if there's an adverse listing in the Data Bank. Now we get reported, of course, for lawsuits. I don't think a single or a couple lawsuits on the Data Bank means that much depending on the size and the frequency and so forth. But this is a different situation where there's definitely an adverse result that's reported that usually indicates a negative. It is supposed to be evidence that you're at some level a poor physician, I guess is the way I would say it.
Dr. Lawrence Huntoon: There are five different types of Data Bank reports, and I've found that hospital attorneys just love to confuse the Data Bank reports when you get into trial in front of a jury. And they bring up this idea of these Data Bank reports having to do with malpractice actions and malpractice settlements. And they say, "Well, it didn't seem to hurt the doctor that much. He's got two of these malpractice reports or settlements in the national practitioner Data Bank. What's the big deal?"
And so, I explained to the jury, that the types of reports involving malpractice settlements and whatnot, that's maybe like getting shot in the foot. You can continue to limp along, whereas one of these Data Bank reports having to do with removal of hospital privileges, it's like getting shot in the head. It ends your career and ends your world as you know it.
John: All right. Well, let's get back into how we can try and avoid some of this. I read something you wrote, I believe, or maybe it was in a video, that there are certain physicians who seem to be at risk. It doesn't have anything to do with, let's say, the quality of their practice, but because of adverse relationship with the hospital or financial situations. So, what are some of those that if you fall into this category, you might be a little bit more aware that this could come up?
Dr. Lawrence Huntoon: Well, of course, any disputes with the hospital administration is likely going to put a target on your back. But we've been able to identify certain specialties that get attacked more than others. And I think that those specialties that are at the top of that list tend to be those that receive very high compensation. These might be neurosurgeons that involve spine surgery, maybe anesthesiologists, and I've listed the whole list down there as far as risk fact, the article I wrote on risk factors. A lot of that has to do with money. Again, you're looking at anticompetitive type actions in some cases where you can get rid of a competitor, that leaves a bigger pie for the person who did the sham peer review.
John: Yes. Now I think you also mentioned sometimes, maybe a solo practitioner, just for whatever reason, they are a little more independent, a little more autonomous, they want to do things their own way, and all of a sudden we find that the hospital thinks, "Well, we've got to get them off the staff."
Dr. Lawrence Huntoon: Yes. The main reason solo physicians tend to get attacked is not because they necessarily like to do things their own way. It's because they don't have any support structure in the hospital. If you're a member of some big group, you've got that big group kind of supporting you and protecting you in the hospital. Solo physicians or those who are new on staff may not have that, and therefore they're vulnerable. Foreign physicians, the same thing. They tend to be vulnerable to these types of attacks. And sometimes the attacks are based on discrimination, blatant discrimination.
John: Now, I would think, "Well, let's see if a physician is actually employed by a hospital or a health system, they have a contract, they can always cancel a contract if they don't like this particular person." But that doesn't necessarily prevent you from this sham peer review.
Dr. Lawrence Huntoon: There's two different issues there. There's an employment issue and a medical staff privilege issue. And a lot of these employment contracts, almost all of them are going to have a no cause clause in it whereby they give a certain number of days notice, maybe 90 days notice, and they can terminate your employment contract without giving a reason. That's a no cause clause. And they often do that. They may have a non-compete clause as well.
When they terminate your employment, you're not allowed to work within a certain number of miles of that particular hospital. Having your employment terminated does not get reported to the Data Bank. But if they decide that they want to take a privileging action against you, that is one way they look to terminate the contract and harm you at the same time. These contracts require, of course, that you maintain medical staff privileges at the hospital where you have the contract. And if they can get rid of those privileges, that ends the contract and they get to harm you as well.
And so, in one particular case I saw, the hospital had recruited a specialty surgeon in to start sort of a new area of specialty in that hospital. And after about a year, the hospital determined, "Well, this doctor is not bringing in as much revenue to the hospital as we thought, so we need to get rid of that doctor." And so, rather than just terminating the contract and letting the doctor move on, they did a sham peer review. They brought false charges against the doctor, fabricated charges, and they got rid of the doctor's privileges. And of course, that got rid of the contract as well.
John: One of the things I remember when I was a CMO of a hospital was that we would sometimes face an issue like we thought the quality could be bad but because we didn't do this very often, it didn't really seem like we knew what we were doing in terms of trying to just go through this process, keeping it up and up. But at the same time, the CEOs talking to the COO and the CFO have their input and he's a finance guy, he is not really a quality guy. And then all of a sudden, "Well, we got to bring our attorney in." And so, now, the whole hospital has started to amass this whole thing involving multiple parties and not even necessarily the medical staff yet at that point. And then here you are, the physician come in for this informal meeting, as you mentioned earlier. Can you expound on how some of the cases have gone when they get to that point?
Dr. Lawrence Huntoon: It's been my experience. I've encountered a lot of people in the hospital administrations who don't know what they're doing at all. That includes the hospital leadership, maybe the chief of staff and whatnot. They don't know what they're doing at all. Maybe they haven't done it before or have not done it that much. And the problem is they tend to look to find an outcome that they desire and they don't really care about following the medical staff bylaws. Well, the medical staff bylaws are there to provide some due process and fundamental fairness to the accused physician. And if they've got some outcome in mind, well, it doesn't really matter, and they don't follow the bylaws. I encounter that I would say fairly frequently. And it does happen in places where they don't do many of these or have never done them before.
John: Yeah. And if the idea is maybe they have some kind of inkling or they just don't like the person, like you said, and so everything is jumbled together, the emotions. Maybe the doctor irritated someone by something that they said or could be anything I can imagine. And now they have this little ball rolling, this snowball, and it's like, "Okay, let's figure out how we can use all, whether it's our contract, whether it's our bylaws or a combination of those to get our end result, which is we just maybe decide we don't want this person here." They don't really seem to be too concerned about "What is the final consequence for the doctor?" All they want is for the doctor to be gone.
Dr. Lawrence Huntoon: Right, right. And the other thing I'd point out is sometimes you'll hear these peer reviews go forward and people will testify, "Well, I would've done that surgery differently. I don't take that approach. I take a different approach." But that shouldn't be part of taking an action against a physician. There's always room for improvement in our care. But what the important thing is, did the care provided, did that fall below the standard of care? Not "If you didn't do it my way, then you're not doing it right." No. That's not the standard of care. And sometimes they will portray it wrongfully as that. I see that a lot.
John: One of the things that was mentioned in one of the articles you wrote that I read, and I've heard this before, but if you're in the middle of this process, at whatever level, you're the physician and one of the things you hear is this comment. "Well, maybe if you just withdraw now, either this privilege or withdraw from the hospital, we won't do a report to the Data Bank." And so, why is that a huge red flag?
Dr. Lawrence Huntoon: Well, number one, that's fraud. And I just wrote an article about that in the December, 2023 issue of the journal. I see that a lot. A lot of the hospital administrations and leadership, including the chief of staff will tell the doctor, "Look, this will go better for you and you won't have to engage in all this messy peer review if you just resigned now and we won't report you to the Data Bank." That's fraud. And it's totally false. What happens is they get the doctor, the naive doctor who doesn't know any better. "Oh yeah, that sounds good to me. I'm getting out of here. I don't want to be here anyway, I'm resigning right now." After that, what we see is the hospital reports the doctor to the Data Bank the very next day. And the report that is made has standardized language, which says, "Doctor resigned while under or to avoid investigation." That makes the doctor look like he pled guilty. He just wanted out of there or didn't want to face the music or whatever.
And the other thing hospitals like about that, number one, they get to harm the doctor. They like that. Number two, once you resign, you don't have any due process rights like a peer review hearing or appeals process because you are no longer a member of the medical staff. So, it's a big win-win for the hospital when they can convince a doctor to resign while under or to avoid an investigation. And of course, we're beginning to see lawsuits where the hospital attorney, the hospital CEO and others that have been involved in that fraud are sued for fraud. And there is no immunity for fraud.
John: Interesting. Have there been some successes in that realm where they were found guilty of fraud?
Dr. Lawrence Huntoon: What happens is, when you sue a hospital attorney, he doesn't particularly like being accused of fraud. And that may not go too well in terms of his reputation. What you see is, all of a sudden, the hospital may have been dragging its feet and saying, "No, we're not going to settle this case. We're not going to avoid that report in the Data Bank because we're legally obligated to report you." You sue the hospital attorney, CEO and maybe the chief of staff for fraud because they committed fraud. And all of a sudden, things change. And so, what I've seen recently is, for example, a settlement where the hospital agrees to void the Data Bank report and put the doctor back on staff without restrictions. And of course, provide the doctor with some compensation for what they've done. They don't want to go to trial on that at all.
John: Yeah, that makes sense. Well, to give you a lot more leverage than it sounds like there has been in the past. So, that's good to know.
Dr. Lawrence Huntoon: And I'll say that it's very important to know that once you get a Data Bank report, it's impossible, nearly impossible to get that out of there. And the hospitals will always claim, "Well, we can't void a Data Bank report. We're required by law to report it." And they'll whine and whine but they can, and they do when you've applied the right leverage to get it done on.
John: Okay. Well, we've learned a lot so far. I want to ask one more specific question, and then I want you to tell us about the AAPS and the journal and that sort of thing. And you probably addressed this earlier, but let's say I'm brought into one of those meetings, all of a sudden I'm looking at the CEO and the chief of the medical staff and an attorney. They're saying they're going to have a conversation. Should I just run out of the room immediately and call my lawyer? Should I just listen? I think in one of the articles you gave us advice on how to go into that meeting, what you could do, at least if your spider sense is going off a little bit. What are your suggestions for that if we find ourselves in that situation?
Dr. Lawrence Huntoon: Well, it's hard to avoid the meeting. Because if you avoid the meeting, they'll say, "Well, the doctor's not being cooperative. We're just trying to help him by tying him to the post in front of the firing squad. We're just trying to help him." And so, you can't really avoid it without them portraying it that way. You can listen. And again, the ambush tactic is done for one purpose and one purpose only. It makes the doctor look guilty. Because if they're talking about maybe three or four patients that they feel you provided poor quality care to, well, you didn't know about that ahead of time and you're busy trying to remember while you're sitting in this stressful meeting, "What? These patients? I don't recall exactly what I did at that time." And so, when you flounder around and you're trying to remember to defend yourself, and you do a poor job of defending yourself for that reason, you look guilty. And again, that's the purpose. They want you to look guilty in front of the assembled members at such a meeting like that.
John: Oh boy. Yeah. Maybe you should bring someone with you to any meeting, so at least you have... And who would know what kind of meeting it's going to be if it's not got a label or a purpose?
Dr. Lawrence Huntoon: Here's the thing. The medical staff bylaws often forbid the physician to bring anyone with him, most certainly not an attorney, to one of these informal, friendly, collegial meeting. We're just a bunch of friendly doctors getting to gather to discuss things. They also often won't allow the doctor to bring an attorney to a meeting before the investigative committee to explain his side of the story. And oftentimes, most times, they will not allow a doctor to bring an attorney to a meeting before the MEC, the Medical Executive Committee to explain his care.
Now, they've gone even further than that in some cases. Going to peer review, once they've proposed an adverse action, you have the right to peer review and appeals in the hospital. Guess what? Some hospitals tell the doctor, "Yes, you can bring your attorney to the peer review hearing, but no, the doctor can't talk." The doctor can't raise objections. The doctor can't cross examine witnesses and doctors are not well prepared to do that. Doctors who don't have a JD degree aren't attorneys and they've function poorly as attorneys. They've done that in some cases. And to me, you have a right to representation under the Healthcare Quality Improvement Act. But to me, that's not representation when you put a piece of duct tape over your attorney's mouth and he sits there in the peer review hearing and can't say anything.
John: Wow. It doesn't sound like it's very hopeful that you're going to come out successful in these, unless you do everything right along the way. And then once the process gets going, of course, you want to have a good attorney, as you mentioned earlier, that knows how to deal with these kinds of situations.
I'm going to have another question to ask that's related, but first, tell us about the association and why listeners might want to get the journal, why they might want to join the association, that sort of thing.
Dr. Lawrence Huntoon: The Association of American Physicians and Surgeons was established in 1943, and we have been the voice for private physicians ever since. Our motto is "omnia pro aegroto" which in Latin means "all for the patient." And that's where we stand basically. And we believe in protecting the sacrosanct patient physician relationship. We believe that physicians are the ones that should be practicing medicine as opposed to insurance bureaucrats and government bureaucrats, often who are not physicians at all, not licensed to practice medicine, yet they tend to direct the way medicine is practiced.
One of the three benefits you get as an AAPS member is that you get access to the AAPS sham peer review hotline. And I have run that hotline on a pro bono basis for 20 years now. And so, that gives you, as soon as you join, you have access to the AAPS sham peer review hotline. You also have access to the nation's top attorney in sham peer review matters. We call it our AAPS Free Limited Legal Consultation Service. And you can discuss these things with a very knowledgeable attorney. Know that I'm not an attorney, I don't give legal advice or legal opinions, but we have an attorney who is very experienced at that. Those are some of the things you get as benefits as an AAPS member.
John: What is the website? Is it aaps.com?
Dr. Lawrence Huntoon: No, it's aapsonline.org. The best way to join probably is the 800 number. 1-800-635-1196. And as soon as you join, like I said, you have access to those free benefits.
John: Actually, I joined today. I thought I was a member already because I get the journal.
Dr. Lawrence Huntoon: No, you were a member back in February.
John: Oh, was I? Oh gosh. Okay. Well, I just renewed it. They get the journal automatically if they're a member, correct?
Dr. Lawrence Huntoon: Yes. Yes.
John: What's usually in the journal?
Dr. Lawrence Huntoon: It's the Journal of American Physicians and Surgeons, and we're a member of the Directory of Open Access Journals. And what that means is we don't charge people to download our articles. Our articles are downloadable free of charge, the full article. We don't require any usernames or passwords. You just go on the website. If you find an article you want to read, you download it and read it. That's what the journal is about. And it's been in existence since 2003 and I've been the editor and chief since 2003.
John: Okay. Let's see. Other things I wanted to mention or have you even tell us about. Supporting this relationship between the physicians and patients and the original way that medicine was to be practiced. One thing is insurance out or no interference. There is a big interest in direct primary care and cash-based businesses and other iterations. And so, I think you were telling me that you do or the association does presentations to physicians who are interested in learning more about how to make the transition. And that would include being off of Medicare or CMS.
Dr. Lawrence Huntoon: Right. AAPS has run "Thrive, Not Just Survive" workshops for many, many years. And those talks and presentations are all available on the AAPS website. I myself ran a third party free opted out of Medicare practice, and I was in solo neurology practice for 34 years until the government put us out of business in 2020 by these harsh, unwarranted and totally ineffective lockdowns that were done. And that put us out of business. It put a lot of small businesses out of business, and we were a small business.
John: Yeah. That was really harmful to a lot of businesses, a lot of physicians, small groups and so forth. And in retrospect really to pretty much almost totally unnecessary I would say. That's my belief. It's a little bit political, but whatever, we won't get into that right now. But another resource for listeners, if they're thinking, "Wow, I'd like to opt out of Medicare, I'd like to opt out of all insurance companies." There's some resources there at the association.
All right. Anything else I'm not asking you about that is important for us to know about the association or about the journal at this point?
Dr. Lawrence Huntoon: No, but I think you asked the question "Is there any way that we can avoid this at my hospital, for example, sham peer review?" And the answer to that unfortunately is no. Sham peer review does not occur in a vacuum. It occurs in an environment of turf battles and personal jealousy, personal animus, and a whole lot of things like that. It really isn't possible to find a way to prevent it at any particular hospital. And the trouble we have is trying to get support from a number of physicians, particularly in the hospital where they know sham peer review is going on against one of their colleagues. These are the so-called bystanders, who know what's going on, turn their head away and don't do anything to help stop it. And this is like bullying. Sometimes all it takes is one of these bystanders to stand up and say "We don't think this is right what you're doing, and you ought to stop it" to derail the thing. But many of these bystanders think "This'll never happen to me because I'm a good physician. I practice very good medicine. This won't happen to me." So, they don't want to get involved.
John: Yeah. I suppose there's some risk in doing that. Looking at it though from the other side as a physician, there are surgeon centers. Some surgeons can work there and not have to rely on the hospital, and if that's owned and run by physicians, hopefully they won't be pursuing sham peer review in that setting and avoiding the insurers. At the end of the day, maybe the only way for some of us to have traditional good relationships with our patients and practice medicine is to opt out of some of those onerous systems.
Dr. Lawrence Huntoon: One thing I'd like to point out is some people say, "Oh, the doctors are doing that for greed." And that generally from my experience is not true, certainly in the AAPS. What they're doing is they get tired of these bureaucrats interfering with the way they practice medicine and they kick these bureaucrats out of their exam room. And that's the real benefit. And you can set your own prices at reasonable levels that patients can afford.
John: Yeah. And we've talked to physicians here on the podcast who can spend more time with their patients. The patients are happier, the physicians are happier, and it doesn't cost the patients any more if it's set up properly and they get better care really. All right. This has been very inspirational. It's scary, but the fact that there are resources there to help us. Did we talk about the hotline for sham peer review? Is that the same 800 number?
Dr. Lawrence Huntoon: Yeah, they call the 800 number and they join and then they just ask the business manager who's going to be answering the phone, "How can I get access to the AAPS sham peer review hotline?" And he'll put them in contact with it. I'm always happy to talk with members about their individual situations and offer helpful information, particularly early on. Don't wait until the matter has been going on for four or five years and you've gone through a massive litigation and then "Can you help me?" Early on is best.
John: Yeah. I can see how that'd be a fantastic resource and just help point them in the right direction and some of the articles and the videos and giving advice and talk about maybe how to find an attorney. That can all be very helpful early on, obviously, than waiting into the second or third year or longer. This has been really great, Larry, thanks a lot for coming on the podcast and sharing this with us today. I think it's an important message.
Dr. Lawrence Huntoon: It's been my privilege. Thank you for having me on the podcast today.
John: All right. With that, I'll say bye-bye till next time.
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