
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC11112]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
   CHAPTER 117--ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES
 
        SUBCHAPTER I--PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES
 
Sec. 11112. Standards for professional review actions


(a) In general

    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.

(b) Adequate notice and hearing

    A health care entity is deemed to have met the adequate notice and 
hearing requirement of subsection (a)(3) of this section with respect to 
a physician if the following conditions are met (or are waived 
voluntarily by the physician):

                    (1) Notice of proposed action

        The physician has been given notice stating--
            (A)(i) that a professional review action has been proposed 
        to be taken against the physician,
            (ii) reasons for the proposed action,
            (B)(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) Notice of hearing

        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) Conduct of hearing and notice

        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) of this section.

(c) Adequate procedures in investigations or health emergencies

    For purposes of section 11111(a) of this title, nothing in this 
section shall be construed as--
        (1) requiring the procedures referred to in subsection (a)(3) of 
    this section--
            (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

        (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.

(Pub. L. 99-660, title IV, Sec. 412, Nov. 14, 1986, 100 Stat. 3785.)

                  Section Referred to in Other Sections

    This section is referred to in sections 11111, 11113, 11114 of this 
title.
