For purposes of the protection set forth in section professional review action must be taken-of this title, a
A professional review action shall be presumed to have met the preceding standards necessary for the protection set out in section of this title unless the presumption is rebutted by a preponderance of the evidence.
A health care entity is deemed to have met the adequate notice and hearing requirement of subsection (a)(3) with respect to a physician if the following conditions are met (or are waived voluntarily by the physician):
The physician has been given notice stating-
If a hearing is requested on a timely basis under paragraph (1)(B), the physician involved must be given notice stating-
If a hearing is requested on a timely basis under paragraph (1)(B)-
A professional review body's failure to meet the conditions described in this subsection shall not, in itself, constitute failure to meet the standards of subsection (a)(3).
For purposes of sectionof this title, nothing in this section shall be construed as-
42 U.S.C. § 11112
- clinical privileges
- The term "clinical privileges" includes privileges, membership on the medical staff, and the other circumstances pertaining to the furnishing of medical care under which a physician or other licensed health care practitioner is permitted to furnish such care by a health care entity.
- health care entity
- The term "health care entity" means-(i) a hospital that is licensed to provide health care services by the State in which it is located,(ii) an entity (including a health maintenance organization or group medical practice) that provides health care services and that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the Secretary), and(iii) subject to subparagraph (B), a professional society (or committee thereof) of physicians or other licensed health care practitioners that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the Secretary).
- The term "physician" means a doctor of medicine or osteopathy or a doctor of dental surgery or medical dentistry legally authorized to practice medicine and surgery or dentistry by a State (or any individual who, without authority holds himself or herself out to be so authorized).
- professional review action
- The term "professional review action" means an action or recommendation of a professional review body which is taken or made in the conduct of professional review activity, which is based on the competence or professional conduct of an individual physician (which conduct affects or could affect adversely the health or welfare of a patient or patients), and which affects (or may affect) adversely the clinical privileges, or membership in a professional society, of the physician. Such term includes a formal decision of a professional review body not to take an action or make a recommendation described in the previous sentence and also includes professional review activities relating to a professional review action. In this chapter, an action is not considered to be based on the competence or professional conduct of a physician if the action is primarily based on-(A) the physician's association, or lack of association, with a professional society or association,(B) the physician's fees or the physician's advertising or engaging in other competitive acts intended to solicit or retain business,(C) the physician's participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis,(D) a physician's association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care practitioner or professional, or(E) any other matter that does not relate to the competence or professional conduct of a physician.
- professional review body
- The term "professional review body" means a health care entity and the governing body or any committee of a health care entity which conducts professional review activity, and includes any committee of the medical staff of such an entity when assisting the governing body in a professional review activity.