Maryland Peer Review Statute

The information on this page was last updated by Horty, Springer & Mattern on June 14, 2018.

MARYLAND

PEER REVIEW

Md. Code Ann., Health Occ. § 1-401. Medical review committees

Definitions

(a)(1) In this section the following words have the meanings indicated.

(2)(i) “Alternative health care system” means a system of health care delivery other than a hospital or related institution.

(ii) “Alternative health care system” includes:

1. A health maintenance organization;

2. A preferred provider organization;

3. An independent practice association;

4. A community health center that is a nonprofit, freestanding ambulatory health care provider governed by a voluntary board of directors and that provides primary health care services to the medically indigent;

5. A freestanding ambulatory care facility as that term is defined in § 19-3B-01 of the Health–General Article; or

6. Any other health care delivery system that utilizes a medical review committee.

(3) “Medical review committee” means a committee or board that:

(i) Is within one of the categories described in subsection (b) of this section; and

(ii) Performs functions that include at least one of the functions listed in subsection (c) of this section.

(4)(i) “Provider of health care” means any person who is licensed by law to provide health care to individuals.

(ii) “Provider of health care” does not include any nursing institution that is conducted by and for those who rely on treatment by spiritual means through prayer alone in accordance with the tenets and practices of a recognized church or religious denomination.

(5) “The Maryland Health Care Commission” means the State agency described in § 19-103 of the Health–General Article.

(6) “The Maryland Institute for Emergency Medical Services Systems” means the State agency described in § 13-503 of the Education Article.

Medical review committee; in general

(b) For purposes of this section, a medical review committee is:

(1) A regulatory board or agency established by State or federal law to license, certify, or discipline any provider of health care;

(2) A committee of the Faculty or any of its component societies or a committee of any other professional society or association composed of providers of health care;

(3) A committee appointed by or established in the Department or a local health department for review purposes;

(4) A committee appointed by or established in the Maryland Institute for Emergency Medical Services Systems;

(5) A committee of the medical staff or other committee, including any risk management, credentialing, or utilization review committee established in accordance with § 19-319 of the Health–General Article, of a hospital, related institution, or alternative health care system, if the governing board of the hospital, related institution, or alternative health care system forms and approves the committee or approves the written bylaws under which the committee operates;

(6) A committee or individual designated by the holder of a pharmacy permit, as defined in § 12-101 of this article, that performs the functions listed in subsection (c) of this section, as part of a pharmacy’s ongoing quality assurance program;

(7) Any person, including a professional standard review organization, who contracts with an agency of this State or of the federal government to perform any of the functions listed in subsection (c) of this section;

(8) Any person who contracts with a provider of health care to perform any of those functions listed in subsection (c) of this section that are limited to the review of services provided by the provider of health care;

(9) An organization, established by the Maryland Hospital Association, Inc. and the Faculty, that contracts with a hospital, related institution, or alternative delivery system to:

(i) Assist in performing the functions listed in subsection (c) of this section; or

(ii) Assist a hospital in meeting the requirements of § 19-319(e) of the Health–General Article;

(10) A committee appointed by or established in an accredited health occupations school;

(11) An organization described under § 14-501 of this article that contracts with a hospital, related institution, or health maintenance organization to:

(i) Assist in performing the functions listed in subsection (c) of this section; or

(ii) Assist a health maintenance organization in meeting the requirements of Title 19, Subtitle 7 of the Health–General Article, the National Committee for Quality Assurance (NCQA), or any other applicable credentialing law or regulation;

(12) An accrediting organization as defined in § 14-501 of this article;

(13) A Mortality and Quality Review Committee established under § 5-801 or a Morbidity, Mortality, and Quality Review Committee established under § 18-107 of the Health–General Article;

(14) A center designated by the Maryland Health Care Commission as the Maryland Patient Safety Center that performs the functions listed in subsection (c)(1) of this section; or

(15) The Maryland Health Care Commission or its staff, when performing the functions listed in subsection (c) of this section, provided that the data or medical information under review is furnished to the Maryland Health Care Commission by another medical review committee.

Medical review committee; functions

(c) For purposes of this section, a medical review committee:

(1) Evaluates and seeks to improve the quality of health care provided by providers of health care;

(2) Evaluates the need for and the level of performance of health care provided by providers of health care;

(3) Evaluates the qualifications, competence, and performance of providers of health care; or

(4) Evaluates and acts on matters that relate to the discipline of any provider of health care.

Records not admissable or discoverable

(d)(1) Except as otherwise provided in this section, the proceedings, records, and files of a medical review committee are not discoverable and are not admissible in evidence in any civil action.

(2) The proceedings, records, and files of a medical review committee are confidential and are not discoverable and are not admissible in evidence in any civil action arising out of matters that are being reviewed and evaluated by the medical review committee if requested by the following:

(i) The Maryland Department of Health to ensure compliance with the provisions of § 19-319 of the Health–General Article;

(ii) A health maintenance organization to ensure compliance with the provisions of Title 19, Subtitle 7 of the Health–General Article and applicable regulations;

(iii) A health maintenance organization to ensure compliance with the National Committee for Quality Assurance (NCQA) credentialing requirements; or

(iv) An accrediting organization to ensure compliance with accreditation requirements or the procedures and policies of the accrediting organization.

(3) If the proceedings, records, and files of a medical review committee are requested by any person from any of the entities in paragraph (2) of this subsection:

(i) The person shall give the medical review committee notice by certified mail of the nature of the request and the medical review committee shall be granted a protective order preventing the release of its proceedings, records, and files; and

(ii) The entities listed in paragraph (2) of this subsection may not release any of the proceedings, records, and files of the medical review committee.

Exceptions

(e) Subsection (d)(1) of this section does not apply to:

(1) A civil action brought by a party to the proceedings of the medical review committee who claims to be aggrieved by the decision of the medical review committee; or

(2) Any record or document that is considered by the medical review committee and that otherwise would be subject to discovery and introduction into evidence in a civil trial.

Immunity from civil liability

(f)(1) A person shall have the immunity from liability described under § 5-637 of the Courts and Judicial Proceedings Article for any action as a member of the medical review committee or for giving information to, participating in, or contributing to the function of the medical review committee.

(2) A contribution to the function of a medical review committee includes any statement by any person, regardless of whether it is a direct communication with the medical review committee, that is made within the context of the person’s employment or is made to a person with a professional interest in the functions of a medical review committee and is intended to lead to redress of a matter within the scope of a medical review committee’s functions.

Construction with §§ 14-410, 14-412

(g) Notwithstanding this section, §§ 14-410 [Records not admissible or discoverable] and 14-412 [Immunity from liability] of this article apply to:

(1) The Board of Physicians; and

(2) Any other entity, to the extent that it is acting in an investigatory capacity for the Board of Physicians.

§ 1-402. Construction with federal law

Health Care Quality Improvement Act

(a) In accordance with the Health Care Quality Improvement Act of 1986, the state elects not to be governed by the provisions of the Act that provide limitations on damages for suits brought under State law against medical review bodies and to physicians participating in professional peer review activities.

Suits under State law

(b) For suits brought under State law, the State shall be governed by this title.

§ 14-502. Immunity from liability

Maryland Institute for Emergency Medical Services Systems

(a) In this section, “the Maryland Institute for Emergency Medical Services Systems” means the State agency described in § 13-503 of the Education Article.

In general

(b) This section applies to:

(1) The Faculty;

(2) A component medical society of the Faculty;

(3) A committee of the Faculty or of a component medical society of the Faculty;

(4) A committee appointed by or established in the Maryland Institute for Emergency Medical Services Systems;

(5) A hospital, related institution, or other health care facility staff committee;

(6) A hospital, related institution, or other health care facility credentials committee or its equivalent;

(7) The chief executive officer of a hospital, related institution, or other health care facility;

(8) The dean of any medical school in this State;

(9) A member of the Board;

(10) A casualty insurer writing medical professional liability insurance in this State;

(11) A utilization committee of:

(i) A nonprofit health service plan; or

(ii) A health insurer doing business in this State;

(12) The chief executive officer of an alternative health system;

(13) The medical director of an alternative health system;

(14) A medical review committee appointed by or established in an alternative health system; and

(15) A physician.

Immunity from liability

(c) A person described in subsection (b) of this section shall have the immunity from liability described under § 5-638 of the Courts and Judicial Proceedings Article for giving information to any hospital, hospital medical staff, related institution, or other health care facility, alternative health system, professional society, medical school, or professional licensing board.

Md. Code Ann., Cts & Jud Pro § 5-637. Medical review committees

Medical review committee defined in Health Occupations Article

(a) In this section “medical review committee” has the meaning stated in § 1-401 of the Health Occupations Article.

Members of medical review committees

(b) A person who acts in good faith and within the scope of the jurisdiction of a medical review committee is not civilly liable for any action as a member of the medical review committee or for giving information to, participating in, or contributing to the function of the medical review committee.

§ 5-638. Persons providing physician information

Definitions

(a)(1) In this section the following words have the meanings indicated.

(2) “Alternative health care system” has the meaning stated in § 1-401 of the Health Occupations Article.

(3) “Hospital” has the meaning stated in § 19-301 of the Health-General Article.

(4) “Physician” has the meaning stated in § 14-101 of the Health Occupations Article.

(5) “Related institution” has the meaning stated in § 14-101 of the Health Occupations Article.

Persons not civilly liable

(b) A person described in § 14-502(b) of the Health Occupations Article is not civilly liable for giving information to any hospital, hospital medical staff, related institution, or health care facility, alternative health system, professional society, medical school, or professional licensing board, if the person:

(1) Gives the information in good faith and with the intention of aiding in the evaluation of the qualifications, fitness, or character of a physician; and

(2) Does not represent as true any matter that the person does not reasonably believe to be true.

Md. Code Regs. § 10.07.01.22. Practitioner Performance Evaluation.

A. Consistent with the standards of the Joint Commission for focused and ongoing professional performance evaluations, the hospital shall establish a practitioner performance evaluation process that objectively evaluates the performance of each member of the medical staff.

B. The hospital’s practitioner performance evaluation process shall include a review of care which shall:

(1) Be undertaken for cases:

(a) Chosen at random; and

(b) With unexpected adverse outcomes;

(2) Be based on objective review standards;

(3) Include a review of the appropriateness of the plan of care for the patient, particularly any medical procedures performed on the patient, in relation to the patient’s condition; and

(4) Be conducted by members of the medical staff, or at the discretion of the hospital, by external reviewers, who:

(a) Are the same specialty as the member of the medical staff under review;

(b) Have been trained to perform practitioner performance evaluation; and

(c) Are not otherwise associated with the case under review.

(C) A hospital shall take into account the results of the practitioner performance evaluation process for a member of the medical staff in the reappointment process.