§11151. Definitions — Inbound Citations
42 U.S.C. § 11151
Cited by 152 provisions in release 119-102.
Citations to 42 U.S.C. § 11151 as a whole
-
(6) to hospitals and other health care entities (as defined in section 431 of the Health Care Quality Improvement Act of 1986 [42 U.S.C. 11151]), with respect to physicians or other licensed health care practitioners that have entered (or may be entering) into an employment or affiliation relationship with, or have applied for clinical privileges or appointments to the medical staff of, such hospitals or other health care entities (and such information shall be deemed to be disclosed pursuant to section 427 [42 U.S.C. 11137] of, and be subject to the provisions of, that Act [42 U.S.C. 11101 et seq.]), but only with respect to information provided pursuant to subsection (a)(1)(A),
Citations to §11151(2)
-
(1) Each Board of Medical Examiners—(A) which revokes or suspends (or otherwise restricts) a physician’s license or censures, reprimands, or places on probation a physician, for reasons relating to the physician’s professional competence or professional conduct, or(B) to which a physician’s license is surrendered,shall report, in accordance with section 11134 of this title, the information described in paragraph (2).
-
(b) If, after notice of noncompliance and providing opportunity to correct noncompliance, the Secretary determines that a Board of Medical Examiners has failed to report information in accordance with subsection (a), the Secretary shall designate another qualified entity for the reporting of information under section 11133 of this title.
-
(1) Each health care entity which—(A) takes a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days;(B) accepts the surrender of clinical privileges of a physician—(i) while the physician is under an investigation by the entity relating to possible incompetence or improper professional conduct, or(ii) in return for not conducting such an investigation or proceeding; or(C) in the case of such an entity which is a professional society, takes a professional review action which adversely affects the membership of a physician in the society,shall report to the Board of Medical Examiners, in accordance with section 11134(a) of this title, the information described in paragraph (3).
-
(2) A health care entity may report to the Board of Medical Examiners, in accordance with section 11134(a) of this title, the information described in paragraph (3) in the case of a licensed health care practitioner who is not a physician, if the entity would be required to report such information under paragraph (1) with respect to the practitioner if the practitioner were a physician.
-
(b) Each Board of Medical Examiners shall report, in accordance with section 11134 of this title, the information reported to it under subsection (a) and known instances of a health care entity’s failure to report information under subsection (a)(1).
-
(2) If, after notice of noncompliance and providing an opportunity to correct noncompliance, the Secretary determines that a Board of Medical Examiners has failed to report information in accordance with subsection (b), the Secretary shall designate another qualified entity for the reporting of information under subsection (b).
-
(d) Any reference in this subchapter to a Board of Medical Examiners includes, in the case of a Board in a State that fails to meet the reporting requirements of section 11132(a) of this title or subsection (b), a reference to such other qualified entity as the Secretary designates.
Citations to §11151(3)
-
(B) in the case of a suspension or restriction of clinical privileges, for a period of not longer than 14 days, during which an investigation is being conducted to determine the need for a professional review action; or
-
(2) precluding an immediate suspension or restriction of clinical privileges, subject to subsequent notice and hearing or other adequate procedures, where the failure to take such an action may result in an imminent danger to the health of any individual.
-
(b) Nothing in this subchapter shall be construed as requiring health care entities to provide clinical privileges to any or all classes or types of physicians or other licensed health care practitioners.
-
(A) takes a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days;
-
(B) accepts the surrender of clinical privileges of a physician—(i) while the physician is under an investigation by the entity relating to possible incompetence or improper professional conduct, or(ii) in return for not conducting such an investigation or proceeding; or
-
(1) at the time a physician or licensed health care practitioner applies to be on the medical staff (courtesy or otherwise) of, or for clinical privileges at, the hospital, information reported under this subchapter concerning the physician or practitioner, and
-
(2) once every 2 years information reported under this subchapter concerning any physician or such practitioner who is on the medical staff (courtesy or otherwise) of, or has been granted clinical privileges at, the hospital.
-
(a) The Secretary (or the agency designated under section 11134(b) of this title) shall, upon request, provide information reported under this subchapter with respect to a physician or other licensed health care practitioner to State licensing boards, to hospitals, and to other health care entities (including health maintenance organizations) that have entered (or may be entering) into an employment or affiliation relationship with the physician or practitioner or to which the physician or practitioner has applied for clinical privileges or appointment to the medical staff.
Citations to §11151(4)(A)
-
(b) If the Secretary has reason to believe that a health care entity has failed to report information in accordance with section 11133(a) of this title, the Secretary shall conduct an investigation. If, after providing notice of noncompliance, an opportunity to correct the noncompliance, and an opportunity for a hearing, the Secretary determines that a health care entity has failed substantially to report information in accordance with section 11133(a) of this title, the Secretary shall publish the name of the entity in the Federal Register. The protections of subsection (a)(1) shall not apply to an entity the name of which is published in the Federal Register under the previous sentence with respect to professional review actions of the entity commenced during the 3-year period beginning 30 days after the date of publication of the name.
-
(b) 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):(1) The physician has been given notice stating—(i) that a professional review action has been proposed to be taken against the physician,(ii) reasons for the proposed action,(i) that the physician has the right to request a hearing on the proposed action,(ii) any time limit (of not less than 30 days) within which to request such a hearing, and(C) a summary of the rights in the hearing under paragraph (3).(2) If a hearing is requested on a timely basis under paragraph (1)(B), the physician involved must be given notice stating—(A) the place, time, and date, of the hearing, which date shall not be less than 30 days after the date of the notice, and(B) a list of the witnesses (if any) expected to testify at the hearing on behalf of the professional review body.(3) If a hearing is requested on a timely basis under paragraph (1)(B)—(A) subject to subparagraph (B), the hearing shall be held (as determined by the health care entity)—(i) before an arbitrator mutually acceptable to the physician and the health care entity,(ii) before a hearing officer who is appointed by the entity and who is not in direct economic competition with the physician involved, or(iii) before a panel of individuals who are appointed by the entity and are not in direct economic competition with the physician involved;(B) the right to the hearing may be forfeited if the physician fails, without good cause, to appear;(C) in the hearing the physician involved has the right—(i) to representation by an attorney or other person of the physician’s choice,(ii) to have a record made of the proceedings, copies of which may be obtained by the physician upon payment of any reasonable charges associated with the preparation thereof,(iii) to call, examine, and cross-examine witnesses,(iv) to present evidence determined to be relevant by the hearing officer, regardless of its admissibility in a court of law, and(v) to submit a written statement at the close of the hearing; and(D) upon completion of the hearing, the physician involved has the right—(i) to receive the written recommendation of the arbitrator, officer, or panel, including a statement of the basis for the recommendations, and(ii) to receive a written decision of the health care entity, including a statement of the basis for the decision.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).
-
(A) subject to subparagraph (B), the hearing shall be held (as determined by the health care entity)—(i) before an arbitrator mutually acceptable to the physician and the health care entity,(ii) before a hearing officer who is appointed by the entity and who is not in direct economic competition with the physician involved, or(iii) before a panel of individuals who are appointed by the entity and are not in direct economic competition with the physician involved;
-
(i) before an arbitrator mutually acceptable to the physician and the health care entity,
-
(ii) to receive a written decision of the health care entity, including a statement of the basis for the decision.
-
(b) Nothing in this subchapter shall be construed as requiring health care entities to provide clinical privileges to any or all classes or types of physicians or other licensed health care practitioners.
-
(d) Nothing in this chapter shall be construed as affecting in any manner the rights and remedies afforded patients under any provision of Federal or State law to seek redress for any harm or injury suffered as a result of negligent treatment or care by any physician, health care practitioner, or health care entity, or as limiting any defenses or immunities available to any physician, health care practitioner, or health care entity.
-
(1) Each health care entity which—(A) takes a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days;(B) accepts the surrender of clinical privileges of a physician—(i) while the physician is under an investigation by the entity relating to possible incompetence or improper professional conduct, or(ii) in return for not conducting such an investigation or proceeding; or(C) in the case of such an entity which is a professional society, takes a professional review action which adversely affects the membership of a physician in the society,shall report to the Board of Medical Examiners, in accordance with section 11134(a) of this title, the information described in paragraph (3).
-
(2) A health care entity may report to the Board of Medical Examiners, in accordance with section 11134(a) of this title, the information described in paragraph (3) in the case of a licensed health care practitioner who is not a physician, if the entity would be required to report such information under paragraph (1) with respect to the practitioner if the practitioner were a physician.
-
(b) Each Board of Medical Examiners shall report, in accordance with section 11134 of this title, the information reported to it under subsection (a) and known instances of a health care entity’s failure to report information under subsection (a)(1).
-
(1) A health care entity that fails substantially to meet the requirement of subsection (a)(1) shall lose the protections of section 11111(a)(1) of this title if the Secretary publishes the name of the entity under section 11111(b) of this title.
-
(2) Information required to be reported under section 11133(b) of this title shall also be reported to the appropriate State licensing board in the State in which the health care entity is located if it is not otherwise reported to such board under subsection (b).
-
(a) The Secretary (or the agency designated under section 11134(b) of this title) shall, upon request, provide information reported under this subchapter with respect to a physician or other licensed health care practitioner to State licensing boards, to hospitals, and to other health care entities (including health maintenance organizations) that have entered (or may be entering) into an employment or affiliation relationship with the physician or practitioner or to which the physician or practitioner has applied for clinical privileges or appointment to the medical staff.
-
(1) Information reported under this subchapter is considered confidential and shall not be disclosed (other than to the physician or practitioner involved) except with respect to professional review activity, as necessary to carry out subsections (b) and (c) of section 11135 of this title (as specified in regulations by the Secretary), or in accordance with regulations of the Secretary promulgated pursuant to subsection (a). Nothing in this subsection shall prevent the disclosure of such information by a party which is otherwise authorized, under applicable State law, to make such disclosure. Information reported under this subchapter that is in a form that does not permit the identification of any particular health care entity, physician, other health care practitioner, or patient shall not be considered confidential. The Secretary (or the agency designated under section 11134(b) of this title), on application by any person, shall prepare such information in such form and shall disclose such information in such form.
Citations to §11151(5)
-
(3) the name (if known) of any hospital with which the physician or practitioner is affiliated or associated,
-
(a) It is the duty of each hospital to request from the Secretary (or the agency designated under section 11134(b) of this title), on and after the date information is first required to be reported under section 11134(a) of this title)—1(1) at the time a physician or licensed health care practitioner applies to be on the medical staff (courtesy or otherwise) of, or for clinical privileges at, the hospital, information reported under this subchapter concerning the physician or practitioner, and(2) once every 2 years information reported under this subchapter concerning any physician or such practitioner who is on the medical staff (courtesy or otherwise) of, or has been granted clinical privileges at, the hospital.A hospital may request such information at other times.
-
(1) at the time a physician or licensed health care practitioner applies to be on the medical staff (courtesy or otherwise) of, or for clinical privileges at, the hospital, information reported under this subchapter concerning the physician or practitioner, and
-
(2) once every 2 years information reported under this subchapter concerning any physician or such practitioner who is on the medical staff (courtesy or otherwise) of, or has been granted clinical privileges at, the hospital.
-
(b) With respect to a medical malpractice action, a hospital which does not request information respecting a physician or practitioner as required under subsection (a) is presumed to have knowledge of any information reported under this subchapter to the Secretary with respect to the physician or practitioner.
-
(a) The Secretary (or the agency designated under section 11134(b) of this title) shall, upon request, provide information reported under this subchapter with respect to a physician or other licensed health care practitioner to State licensing boards, to hospitals, and to other health care entities (including health maintenance organizations) that have entered (or may be entering) into an employment or affiliation relationship with the physician or practitioner or to which the physician or practitioner has applied for clinical privileges or appointment to the medical staff.
-
(b) The Secretary of Health and Human Services shall seek to enter into memoranda of understanding with the Secretary of Defense and the Administrator of Veterans’ Affairs to apply the provisions of subchapter II of this chapter to hospitals and other facilities and health care providers under the jurisdiction of the Secretary or Administrator, respectively. The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memoranda and on the cooperation among such officials in establishing such memoranda.
Citations to §11151(6)
-
(b) Nothing in this subchapter shall be construed as requiring health care entities to provide clinical privileges to any or all classes or types of physicians or other licensed health care practitioners.
-
(c) Nothing in this subchapter shall be construed as affecting, or modifying any provision of Federal or State law, with respect to activities of professional review bodies regarding nurses, other licensed health care practitioners, or other health professionals who are not physicians.
-
(d) Nothing in this chapter shall be construed as affecting in any manner the rights and remedies afforded patients under any provision of Federal or State law to seek redress for any harm or injury suffered as a result of negligent treatment or care by any physician, health care practitioner, or health care entity, or as limiting any defenses or immunities available to any physician, health care practitioner, or health care entity.
-
(1) the name of any physician or licensed health care practitioner for whose benefit the payment is made,
-
(3) the name (if known) of any hospital with which the physician or practitioner is affiliated or associated,
-
(2) A health care entity may report to the Board of Medical Examiners, in accordance with section 11134(a) of this title, the information described in paragraph (3) in the case of a licensed health care practitioner who is not a physician, if the entity would be required to report such information under paragraph (1) with respect to the practitioner if the practitioner were a physician.
-
(A) the name of the physician or practitioner involved,
-
(1) at the time a physician or licensed health care practitioner applies to be on the medical staff (courtesy or otherwise) of, or for clinical privileges at, the hospital, information reported under this subchapter concerning the physician or practitioner, and
-
(2) once every 2 years information reported under this subchapter concerning any physician or such practitioner who is on the medical staff (courtesy or otherwise) of, or has been granted clinical privileges at, the hospital.
-
(b) With respect to a medical malpractice action, a hospital which does not request information respecting a physician or practitioner as required under subsection (a) is presumed to have knowledge of any information reported under this subchapter to the Secretary with respect to the physician or practitioner.
-
With respect to the information reported to the Secretary (or the agency designated under section 11134(b) of this title) under this subchapter respecting a physician or other licensed health care practitioner, the Secretary shall, by regulation, provide for—
-
(1) disclosure of the information, upon request, to the physician or practitioner, and
-
(a) The Secretary (or the agency designated under section 11134(b) of this title) shall, upon request, provide information reported under this subchapter with respect to a physician or other licensed health care practitioner to State licensing boards, to hospitals, and to other health care entities (including health maintenance organizations) that have entered (or may be entering) into an employment or affiliation relationship with the physician or practitioner or to which the physician or practitioner has applied for clinical privileges or appointment to the medical staff.
-
(1) Information reported under this subchapter is considered confidential and shall not be disclosed (other than to the physician or practitioner involved) except with respect to professional review activity, as necessary to carry out subsections (b) and (c) of section 11135 of this title (as specified in regulations by the Secretary), or in accordance with regulations of the Secretary promulgated pursuant to subsection (a). Nothing in this subsection shall prevent the disclosure of such information by a party which is otherwise authorized, under applicable State law, to make such disclosure. Information reported under this subchapter that is in a form that does not permit the identification of any particular health care entity, physician, other health care practitioner, or patient shall not be considered confidential. The Secretary (or the agency designated under section 11134(b) of this title), on application by any person, shall prepare such information in such form and shall disclose such information in such form.
-
(c) The Secretary of Health and Human Services shall seek to enter into a memorandum of understanding with the Administrator of Drug Enforcement relating to providing for the reporting by the Administrator to the Secretary of information respecting physicians and other practitioners whose registration to dispense controlled substances has been suspended or revoked under section 824 of title 21. The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memorandum and on the cooperation between the Secretary and the Administrator in establishing such a memorandum.
Citations to §11151(7)
-
(a) Each entity (including an insurance company) which makes payment under a policy of insurance, self-insurance, or otherwise in settlement (or partial settlement) of, or in satisfaction of a judgment in, a medical malpractice action or claim shall report, in accordance with section 11134 of this title, information respecting the payment and circumstances thereof.
-
(d) In interpreting information reported under this subchapter, a payment in settlement of a medical malpractice action or claim shall not be construed as creating a presumption that medical malpractice has occurred.
-
(C) The term “medical malpractice or medical product liability action or claim” means a medical malpractice action or claim (as defined in section 11151(7) of this title) and includes a liability action or claim relating to a health care provider’s prescription or provision of a drug, device, or biological product (as such terms are defined in section 321 of title 21 or section 262 of this title).
Citations to §11151(8)
-
(2) There is a national need to restrict the ability of incompetent physicians to move from State to State without disclosure or discovery of the physician’s previous damaging or incompetent performance.
-
(4) The threat of private money damage liability under Federal laws, including treble damage liability under Federal antitrust law, unreasonably discourages physicians from participating in effective professional peer review.
-
(5) There is an overriding national need to provide incentive and protection for physicians engaging in effective professional peer review.
-
(2) Notwithstanding any other provision of law, no person (whether as a witness or otherwise) providing information to a professional review body regarding the competence or professional conduct of a physician shall be held, by reason of having provided such information, to be liable in damages under any law of the United States or of any State (or political subdivision thereof) unless such information is false and the person providing it knew that such information was false.
-
(b) 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):(1) The physician has been given notice stating—(i) that a professional review action has been proposed to be taken against the physician,(ii) reasons for the proposed action,(i) that the physician has the right to request a hearing on the proposed action,(ii) any time limit (of not less than 30 days) within which to request such a hearing, and(C) a summary of the rights in the hearing under paragraph (3).(2) If a hearing is requested on a timely basis under paragraph (1)(B), the physician involved must be given notice stating—(A) the place, time, and date, of the hearing, which date shall not be less than 30 days after the date of the notice, and(B) a list of the witnesses (if any) expected to testify at the hearing on behalf of the professional review body.(3) If a hearing is requested on a timely basis under paragraph (1)(B)—(A) subject to subparagraph (B), the hearing shall be held (as determined by the health care entity)—(i) before an arbitrator mutually acceptable to the physician and the health care entity,(ii) before a hearing officer who is appointed by the entity and who is not in direct economic competition with the physician involved, or(iii) before a panel of individuals who are appointed by the entity and are not in direct economic competition with the physician involved;(B) the right to the hearing may be forfeited if the physician fails, without good cause, to appear;(C) in the hearing the physician involved has the right—(i) to representation by an attorney or other person of the physician’s choice,(ii) to have a record made of the proceedings, copies of which may be obtained by the physician upon payment of any reasonable charges associated with the preparation thereof,(iii) to call, examine, and cross-examine witnesses,(iv) to present evidence determined to be relevant by the hearing officer, regardless of its admissibility in a court of law, and(v) to submit a written statement at the close of the hearing; and(D) upon completion of the hearing, the physician involved has the right—(i) to receive the written recommendation of the arbitrator, officer, or panel, including a statement of the basis for the recommendations, and(ii) to receive a written decision of the health care entity, including a statement of the basis for the decision.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).
-
(1) The physician has been given notice stating—(i) that a professional review action has been proposed to be taken against the physician,(ii) reasons for the proposed action,(i) that the physician has the right to request a hearing on the proposed action,(ii) any time limit (of not less than 30 days) within which to request such a hearing, and(C) a summary of the rights in the hearing under paragraph (3).
-
(i) that a professional review action has been proposed to be taken against the physician,
-
(i) that the physician has the right to request a hearing on the proposed action,
-
(2) If a hearing is requested on a timely basis under paragraph (1)(B), the physician involved must be given notice stating—(A) the place, time, and date, of the hearing, which date shall not be less than 30 days after the date of the notice, and(B) a list of the witnesses (if any) expected to testify at the hearing on behalf of the professional review body.
-
(i) before an arbitrator mutually acceptable to the physician and the health care entity,
-
(ii) before a hearing officer who is appointed by the entity and who is not in direct economic competition with the physician involved, or
-
(iii) before a panel of individuals who are appointed by the entity and are not in direct economic competition with the physician involved;
-
(B) the right to the hearing may be forfeited if the physician fails, without good cause, to appear;
-
(C) in the hearing the physician involved has the right—(i) to representation by an attorney or other person of the physician’s choice,(ii) to have a record made of the proceedings, copies of which may be obtained by the physician upon payment of any reasonable charges associated with the preparation thereof,(iii) to call, examine, and cross-examine witnesses,(iv) to present evidence determined to be relevant by the hearing officer, regardless of its admissibility in a court of law, and(v) to submit a written statement at the close of the hearing; and
-
(i) to representation by an attorney or other person of the physician’s choice,
-
(ii) to have a record made of the proceedings, copies of which may be obtained by the physician upon payment of any reasonable charges associated with the preparation thereof,
-
(D) upon completion of the hearing, the physician involved has the right—(i) to receive the written recommendation of the arbitrator, officer, or panel, including a statement of the basis for the recommendations, and(ii) to receive a written decision of the health care entity, including a statement of the basis for the decision.
-
(b) Nothing in this subchapter shall be construed as requiring health care entities to provide clinical privileges to any or all classes or types of physicians or other licensed health care practitioners.
-
(c) Nothing in this subchapter shall be construed as affecting, or modifying any provision of Federal or State law, with respect to activities of professional review bodies regarding nurses, other licensed health care practitioners, or other health professionals who are not physicians.
-
(d) Nothing in this chapter shall be construed as affecting in any manner the rights and remedies afforded patients under any provision of Federal or State law to seek redress for any harm or injury suffered as a result of negligent treatment or care by any physician, health care practitioner, or health care entity, or as limiting any defenses or immunities available to any physician, health care practitioner, or health care entity.
-
(1) the name of any physician or licensed health care practitioner for whose benefit the payment is made,
-
(3) the name (if known) of any hospital with which the physician or practitioner is affiliated or associated,
-
(B) to which a physician’s license is surrendered,
-
(A) the name of the physician involved,
-
(A) takes a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days;
-
(B) accepts the surrender of clinical privileges of a physician—(i) while the physician is under an investigation by the entity relating to possible incompetence or improper professional conduct, or(ii) in return for not conducting such an investigation or proceeding; or
-
(i) while the physician is under an investigation by the entity relating to possible incompetence or improper professional conduct, or
-
(C) in the case of such an entity which is a professional society, takes a professional review action which adversely affects the membership of a physician in the society,
-
(2) A health care entity may report to the Board of Medical Examiners, in accordance with section 11134(a) of this title, the information described in paragraph (3) in the case of a licensed health care practitioner who is not a physician, if the entity would be required to report such information under paragraph (1) with respect to the practitioner if the practitioner were a physician.
-
(A) the name of the physician or practitioner involved,
-
(1) at the time a physician or licensed health care practitioner applies to be on the medical staff (courtesy or otherwise) of, or for clinical privileges at, the hospital, information reported under this subchapter concerning the physician or practitioner, and
-
(2) once every 2 years information reported under this subchapter concerning any physician or such practitioner who is on the medical staff (courtesy or otherwise) of, or has been granted clinical privileges at, the hospital.
-
(b) With respect to a medical malpractice action, a hospital which does not request information respecting a physician or practitioner as required under subsection (a) is presumed to have knowledge of any information reported under this subchapter to the Secretary with respect to the physician or practitioner.
-
With respect to the information reported to the Secretary (or the agency designated under section 11134(b) of this title) under this subchapter respecting a physician or other licensed health care practitioner, the Secretary shall, by regulation, provide for—
-
(1) disclosure of the information, upon request, to the physician or practitioner, and
-
(a) The Secretary (or the agency designated under section 11134(b) of this title) shall, upon request, provide information reported under this subchapter with respect to a physician or other licensed health care practitioner to State licensing boards, to hospitals, and to other health care entities (including health maintenance organizations) that have entered (or may be entering) into an employment or affiliation relationship with the physician or practitioner or to which the physician or practitioner has applied for clinical privileges or appointment to the medical staff.
-
(1) Information reported under this subchapter is considered confidential and shall not be disclosed (other than to the physician or practitioner involved) except with respect to professional review activity, as necessary to carry out subsections (b) and (c) of section 11135 of this title (as specified in regulations by the Secretary), or in accordance with regulations of the Secretary promulgated pursuant to subsection (a). Nothing in this subsection shall prevent the disclosure of such information by a party which is otherwise authorized, under applicable State law, to make such disclosure. Information reported under this subchapter that is in a form that does not permit the identification of any particular health care entity, physician, other health care practitioner, or patient shall not be considered confidential. The Secretary (or the agency designated under section 11134(b) of this title), on application by any person, shall prepare such information in such form and shall disclose such information in such form.
-
(c) The Secretary of Health and Human Services shall seek to enter into a memorandum of understanding with the Administrator of Drug Enforcement relating to providing for the reporting by the Administrator to the Secretary of information respecting physicians and other practitioners whose registration to dispense controlled substances has been suspended or revoked under section 824 of title 21. The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memorandum and on the cooperation between the Secretary and the Administrator in establishing such a memorandum.
Citations to §11151(9)
-
(1) If a professional review action (as defined in section 11151(9) of this title) of a professional review body meets all the standards specified in section 11112(a) of this title, except as provided in subsection (b)—(A) the professional review body,(B) any person acting as a member or staff to the body,(C) any person under a contract or other formal agreement with the body, and(D) any person who participates with or assists the body with respect to the action,shall not be liable in damages under any law of the United States or of any State (or political subdivision thereof) with respect to the action. The preceding sentence shall not apply to damages under any law of the United States or any State relating to the civil rights of any person or persons, including the Civil Rights Act of 1964, 42 U.S.C. 2000e, et seq. and the Civil Rights Acts, 42 U.S.C. 1981, et seq. Nothing in this paragraph shall prevent the United States or any Attorney General of a State from bringing an action, including an action under section 15c of title 15, where such an action is otherwise authorized.
-
(b) If the Secretary has reason to believe that a health care entity has failed to report information in accordance with section 11133(a) of this title, the Secretary shall conduct an investigation. If, after providing notice of noncompliance, an opportunity to correct the noncompliance, and an opportunity for a hearing, the Secretary determines that a health care entity has failed substantially to report information in accordance with section 11133(a) of this title, the Secretary shall publish the name of the entity in the Federal Register. The protections of subsection (a)(1) shall not apply to an entity the name of which is published in the Federal Register under the previous sentence with respect to professional review actions of the entity commenced during the 3-year period beginning 30 days after the date of publication of the name.
-
(1) Except as provided in paragraph (2), subsection (a) shall apply to State laws in a State only for professional review actions commenced on or after October 14, 1989.
-
(a) For purposes of the protection set forth in section 11111(a) of this title, a professional review action must be taken—(1) in the reasonable belief that the action was in the furtherance of quality health care,(2) after a reasonable effort to obtain the facts of the matter,(3) after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances, and(4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph (3).A professional review action shall be presumed to have met the preceding standards necessary for the protection set out in section 11111(a) of this title unless the presumption is rebutted by a preponderance of the evidence.
-
(i) that a professional review action has been proposed to be taken against the physician,
-
(A) where there is no adverse professional review action taken, or
-
(B) in the case of a suspension or restriction of clinical privileges, for a period of not longer than 14 days, during which an investigation is being conducted to determine the need for a professional review action; or
-
(a) Except as specifically provided in this subchapter, nothing in this subchapter shall be construed as changing the liabilities or immunities under law or as preempting or overriding any State law which provides incentives, immunities, or protection for those engaged in a professional review action that is in addition to or greater than that provided by this subchapter.
-
(A) takes a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days;
-
(C) in the case of such an entity which is a professional society, takes a professional review action which adversely affects the membership of a physician in the society,
Citations to §11151(10)
-
(1) Information reported under this subchapter is considered confidential and shall not be disclosed (other than to the physician or practitioner involved) except with respect to professional review activity, as necessary to carry out subsections (b) and (c) of section 11135 of this title (as specified in regulations by the Secretary), or in accordance with regulations of the Secretary promulgated pursuant to subsection (a). Nothing in this subsection shall prevent the disclosure of such information by a party which is otherwise authorized, under applicable State law, to make such disclosure. Information reported under this subchapter that is in a form that does not permit the identification of any particular health care entity, physician, other health care practitioner, or patient shall not be considered confidential. The Secretary (or the agency designated under section 11134(b) of this title), on application by any person, shall prepare such information in such form and shall disclose such information in such form.
Citations to §11151(11)
-
(1) If a professional review action (as defined in section 11151(9) of this title) of a professional review body meets all the standards specified in section 11112(a) of this title, except as provided in subsection (b)—(A) the professional review body,(B) any person acting as a member or staff to the body,(C) any person under a contract or other formal agreement with the body, and(D) any person who participates with or assists the body with respect to the action,shall not be liable in damages under any law of the United States or of any State (or political subdivision thereof) with respect to the action. The preceding sentence shall not apply to damages under any law of the United States or any State relating to the civil rights of any person or persons, including the Civil Rights Act of 1964, 42 U.S.C. 2000e, et seq. and the Civil Rights Acts, 42 U.S.C. 1981, et seq. Nothing in this paragraph shall prevent the United States or any Attorney General of a State from bringing an action, including an action under section 15c of title 15, where such an action is otherwise authorized.
-
(A) the professional review body,
-
(2) Notwithstanding any other provision of law, no person (whether as a witness or otherwise) providing information to a professional review body regarding the competence or professional conduct of a physician shall be held, by reason of having provided such information, to be liable in damages under any law of the United States or of any State (or political subdivision thereof) unless such information is false and the person providing it knew that such information was false.
-
(b) 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):(1) The physician has been given notice stating—(i) that a professional review action has been proposed to be taken against the physician,(ii) reasons for the proposed action,(i) that the physician has the right to request a hearing on the proposed action,(ii) any time limit (of not less than 30 days) within which to request such a hearing, and(C) a summary of the rights in the hearing under paragraph (3).(2) If a hearing is requested on a timely basis under paragraph (1)(B), the physician involved must be given notice stating—(A) the place, time, and date, of the hearing, which date shall not be less than 30 days after the date of the notice, and(B) a list of the witnesses (if any) expected to testify at the hearing on behalf of the professional review body.(3) If a hearing is requested on a timely basis under paragraph (1)(B)—(A) subject to subparagraph (B), the hearing shall be held (as determined by the health care entity)—(i) before an arbitrator mutually acceptable to the physician and the health care entity,(ii) before a hearing officer who is appointed by the entity and who is not in direct economic competition with the physician involved, or(iii) before a panel of individuals who are appointed by the entity and are not in direct economic competition with the physician involved;(B) the right to the hearing may be forfeited if the physician fails, without good cause, to appear;(C) in the hearing the physician involved has the right—(i) to representation by an attorney or other person of the physician’s choice,(ii) to have a record made of the proceedings, copies of which may be obtained by the physician upon payment of any reasonable charges associated with the preparation thereof,(iii) to call, examine, and cross-examine witnesses,(iv) to present evidence determined to be relevant by the hearing officer, regardless of its admissibility in a court of law, and(v) to submit a written statement at the close of the hearing; and(D) upon completion of the hearing, the physician involved has the right—(i) to receive the written recommendation of the arbitrator, officer, or panel, including a statement of the basis for the recommendations, and(ii) to receive a written decision of the health care entity, including a statement of the basis for the decision.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).
-
(B) a list of the witnesses (if any) expected to testify at the hearing on behalf of the professional review body.
-
The Secretary may establish, after notice and opportunity for comment, such voluntary guidelines as may assist the professional review bodies in meeting the standards described in section 11112(a) of this title.
-
(c) Nothing in this subchapter shall be construed as affecting, or modifying any provision of Federal or State law, with respect to activities of professional review bodies regarding nurses, other licensed health care practitioners, or other health professionals who are not physicians.
Citations to §11151(12)
-
(b) If the Secretary has reason to believe that a health care entity has failed to report information in accordance with section 11133(a) of this title, the Secretary shall conduct an investigation. If, after providing notice of noncompliance, an opportunity to correct the noncompliance, and an opportunity for a hearing, the Secretary determines that a health care entity has failed substantially to report information in accordance with section 11133(a) of this title, the Secretary shall publish the name of the entity in the Federal Register. The protections of subsection (a)(1) shall not apply to an entity the name of which is published in the Federal Register under the previous sentence with respect to professional review actions of the entity commenced during the 3-year period beginning 30 days after the date of publication of the name.
-
The Secretary may establish, after notice and opportunity for comment, such voluntary guidelines as may assist the professional review bodies in meeting the standards described in section 11112(a) of this title.
-
(5) such other information as the Secretary determines is required for appropriate interpretation of information reported under this section.
-
(d) The Secretary shall study and report to Congress, not later than two years after November 14, 1986, on whether information respecting small payments should continue to be required to be reported under subsection (a) and whether information respecting all claims made concerning a medical malpractice action should be required to be reported under such subsection.
-
(C) such other information respecting the circumstances of the action or surrender as the Secretary deems appropriate.
-
(b) If, after notice of noncompliance and providing opportunity to correct noncompliance, the Secretary determines that a Board of Medical Examiners has failed to report information in accordance with subsection (a), the Secretary shall designate another qualified entity for the reporting of information under section 11133 of this title.
-
(C) such other information respecting the circumstances of the action or surrender as the Secretary deems appropriate.
-
(1) A health care entity that fails substantially to meet the requirement of subsection (a)(1) shall lose the protections of section 11111(a)(1) of this title if the Secretary publishes the name of the entity under section 11111(b) of this title.
-
(2) If, after notice of noncompliance and providing an opportunity to correct noncompliance, the Secretary determines that a Board of Medical Examiners has failed to report information in accordance with subsection (b), the Secretary shall designate another qualified entity for the reporting of information under subsection (b).
-
(d) Any reference in this subchapter to a Board of Medical Examiners includes, in the case of a Board in a State that fails to meet the reporting requirements of section 11132(a) of this title or subsection (b), a reference to such other qualified entity as the Secretary designates.
-
(a) The information required to be reported under sections 11131, 11132(a), and 11133 of this title shall be reported regularly (but not less often than monthly) and in such form and manner as the Secretary prescribes. Such information shall first be required to be reported on a date (not later than one year after November 14, 1986) specified by the Secretary.
-
(b) The information required to be reported under sections 11131, 11132(a), and 11133(b) of this title shall be reported to the Secretary, or, in the Secretary’s discretion, to an appropriate private or public agency which has made suitable arrangements with the Secretary with respect to receipt, storage, protection of confidentiality, and dissemination of the information under this subchapter.
-
(a) It is the duty of each hospital to request from the Secretary (or the agency designated under section 11134(b) of this title), on and after the date information is first required to be reported under section 11134(a) of this title)—1(1) at the time a physician or licensed health care practitioner applies to be on the medical staff (courtesy or otherwise) of, or for clinical privileges at, the hospital, information reported under this subchapter concerning the physician or practitioner, and(2) once every 2 years information reported under this subchapter concerning any physician or such practitioner who is on the medical staff (courtesy or otherwise) of, or has been granted clinical privileges at, the hospital.A hospital may request such information at other times.
-
(b) With respect to a medical malpractice action, a hospital which does not request information respecting a physician or practitioner as required under subsection (a) is presumed to have knowledge of any information reported under this subchapter to the Secretary with respect to the physician or practitioner.
-
With respect to the information reported to the Secretary (or the agency designated under section 11134(b) of this title) under this subchapter respecting a physician or other licensed health care practitioner, the Secretary shall, by regulation, provide for—
-
(a) The Secretary (or the agency designated under section 11134(b) of this title) shall, upon request, provide information reported under this subchapter with respect to a physician or other licensed health care practitioner to State licensing boards, to hospitals, and to other health care entities (including health maintenance organizations) that have entered (or may be entering) into an employment or affiliation relationship with the physician or practitioner or to which the physician or practitioner has applied for clinical privileges or appointment to the medical staff.
-
(1) Information reported under this subchapter is considered confidential and shall not be disclosed (other than to the physician or practitioner involved) except with respect to professional review activity, as necessary to carry out subsections (b) and (c) of section 11135 of this title (as specified in regulations by the Secretary), or in accordance with regulations of the Secretary promulgated pursuant to subsection (a). Nothing in this subsection shall prevent the disclosure of such information by a party which is otherwise authorized, under applicable State law, to make such disclosure. Information reported under this subchapter that is in a form that does not permit the identification of any particular health care entity, physician, other health care practitioner, or patient shall not be considered confidential. The Secretary (or the agency designated under section 11134(b) of this title), on application by any person, shall prepare such information in such form and shall disclose such information in such form.
-
(4) The Secretary may establish or approve reasonable fees for the disclosure of information under this section or section 11136 of this title. The amount of such a fee may not exceed the costs of processing the requests for disclosure and of providing such information. Such fees shall be available to the Secretary (or, in the Secretary’s discretion, to the agency designated under section 11134(b) of this title) to cover such costs.
-
(a) The Secretary shall report to Congress, annually during the three years after November 14, 1986, on the implementation of this chapter.
-
(b) The Secretary of Health and Human Services shall seek to enter into memoranda of understanding with the Secretary of Defense and the Administrator of Veterans’ Affairs to apply the provisions of subchapter II of this chapter to hospitals and other facilities and health care providers under the jurisdiction of the Secretary or Administrator, respectively. The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memoranda and on the cooperation among such officials in establishing such memoranda.
-
(c) The Secretary of Health and Human Services shall seek to enter into a memorandum of understanding with the Administrator of Drug Enforcement relating to providing for the reporting by the Administrator to the Secretary of information respecting physicians and other practitioners whose registration to dispense controlled substances has been suspended or revoked under section 824 of title 21. The Secretary shall report to Congress, not later than two years after November 14, 1986, on any such memorandum and on the cooperation between the Secretary and the Administrator in establishing such a memorandum.
Citations to §11151(13)
-
(1) The increasing occurrence of medical malpractice and the need to improve the quality of medical care have become nationwide problems that warrant greater efforts than those that can be undertaken by any individual State.
-
(2) There is a national need to restrict the ability of incompetent physicians to move from State to State without disclosure or discovery of the physician’s previous damaging or incompetent performance.
-
(1) If a professional review action (as defined in section 11151(9) of this title) of a professional review body meets all the standards specified in section 11112(a) of this title, except as provided in subsection (b)—(A) the professional review body,(B) any person acting as a member or staff to the body,(C) any person under a contract or other formal agreement with the body, and(D) any person who participates with or assists the body with respect to the action,shall not be liable in damages under any law of the United States or of any State (or political subdivision thereof) with respect to the action. The preceding sentence shall not apply to damages under any law of the United States or any State relating to the civil rights of any person or persons, including the Civil Rights Act of 1964, 42 U.S.C. 2000e, et seq. and the Civil Rights Acts, 42 U.S.C. 1981, et seq. Nothing in this paragraph shall prevent the United States or any Attorney General of a State from bringing an action, including an action under section 15c of title 15, where such an action is otherwise authorized.
-
(2) Notwithstanding any other provision of law, no person (whether as a witness or otherwise) providing information to a professional review body regarding the competence or professional conduct of a physician shall be held, by reason of having provided such information, to be liable in damages under any law of the United States or of any State (or political subdivision thereof) unless such information is false and the person providing it knew that such information was false.
-
(1) Except as provided in paragraph (2), subsection (a) shall apply to State laws in a State only for professional review actions commenced on or after October 14, 1989.
-
(A) Subsection (a) shall apply to State laws in a State for actions commenced before October 14, 1989, if the State by legislation elects such treatment.
-
(a) Except as specifically provided in this subchapter, nothing in this subchapter shall be construed as changing the liabilities or immunities under law or as preempting or overriding any State law which provides incentives, immunities, or protection for those engaged in a professional review action that is in addition to or greater than that provided by this subchapter.
-
(c) Nothing in this subchapter shall be construed as affecting, or modifying any provision of Federal or State law, with respect to activities of professional review bodies regarding nurses, other licensed health care practitioners, or other health professionals who are not physicians.
-
(d) Nothing in this chapter shall be construed as affecting in any manner the rights and remedies afforded patients under any provision of Federal or State law to seek redress for any harm or injury suffered as a result of negligent treatment or care by any physician, health care practitioner, or health care entity, or as limiting any defenses or immunities available to any physician, health care practitioner, or health care entity.
-
(d) Any reference in this subchapter to a Board of Medical Examiners includes, in the case of a Board in a State that fails to meet the reporting requirements of section 11132(a) of this title or subsection (b), a reference to such other qualified entity as the Secretary designates.
-
(1) Information required to be reported under section 11131 of this title shall also be reported to the appropriate State licensing board (or boards) in the State in which the medical malpractice claim arose.
-
(2) Information required to be reported under section 11133(b) of this title shall also be reported to the appropriate State licensing board in the State in which the health care entity is located if it is not otherwise reported to such board under subsection (b).
-
(1) Information reported under this subchapter is considered confidential and shall not be disclosed (other than to the physician or practitioner involved) except with respect to professional review activity, as necessary to carry out subsections (b) and (c) of section 11135 of this title (as specified in regulations by the Secretary), or in accordance with regulations of the Secretary promulgated pursuant to subsection (a). Nothing in this subsection shall prevent the disclosure of such information by a party which is otherwise authorized, under applicable State law, to make such disclosure. Information reported under this subchapter that is in a form that does not permit the identification of any particular health care entity, physician, other health care practitioner, or patient shall not be considered confidential. The Secretary (or the agency designated under section 11134(b) of this title), on application by any person, shall prepare such information in such form and shall disclose such information in such form.
Citations to §11151(14)
-
(1) Information required to be reported under section 11131 of this title shall also be reported to the appropriate State licensing board (or boards) in the State in which the medical malpractice claim arose.
-
(2) Information required to be reported under section 11133(b) of this title shall also be reported to the appropriate State licensing board in the State in which the health care entity is located if it is not otherwise reported to such board under subsection (b).
-
(a) The Secretary (or the agency designated under section 11134(b) of this title) shall, upon request, provide information reported under this subchapter with respect to a physician or other licensed health care practitioner to State licensing boards, to hospitals, and to other health care entities (including health maintenance organizations) that have entered (or may be entering) into an employment or affiliation relationship with the physician or practitioner or to which the physician or practitioner has applied for clinical privileges or appointment to the medical staff.