ISMS Bylaws

CHAPTER XII. PEER REVIEW

Part 1. Definitions. Peer review is the inclusive term for medical review by practicing physicians of the utilization of medical services, quality of care, professional competency and patient relations issues. Medical Society peer review shall be conducted by the county society where the physician holds membership or where the incident which served as the basis for the peer review complaint occurred. Ethical relations issues identified during deliberations of the county peer review committee or, where appropriate, the District Peer Review Committee may be referred to either the county or district Ethical Relations Committee, as deemed appropriate by the county (district) committee.

Should an adverse decision be made against a physician by a county society where the reviewed practitioner does not hold membership, that decision will have the weight and effect of a decision made by his own county society. Peer Review Committees should apply standards developed by appropriate physician organizations; such standards to be tempered by customs and practice followed in the local community in which the evaluation is undertaken. Decisions and recommendations of Peer Review Committees shall be advisory only.

Part 2. Component Society Procedures.

1. Responsibilities -- Each component society may have, either by appointment or election, a review committee whose duties it shall be to review all proper complaints and inquiries brought before it by physicians, patients and, at local option, other parties. In the event a component society shall choose not to appoint or elect its own review committee, the component society may, by action of a majority of its members eligible to vote, delegate the peer review functions to an appropriate physician organization competent to perform these functions within the geographic area served by the component society or to a District Peer Review Committee as provided for hereinafter. The District Peer Review Committee shall function and operate on behalf of any component society that does not establish such a committee.

2. Procedures -- The review committee of the component society shall establish reasonable rules of procedure but shall not be bound by technical rules applied in courts of law or in administrative hearings conducted by governmental agencies. All complaints and inquiries shall be reduced to writing and shall be signed by the individual making the complaint or inquiry. Complaints received by the Illinois State Medical Society shall be referred to the proper component society or district committee.

3. Timely Reviews ‑- The review committee of the component society shall consider all complaints and inquiries properly filed with the society in a timely manner and shall render its advice within a reasonable period of time following the receipt of a properly submitted complaint or inquiry. In the event the component society shall fail to act in a timely fashion, as required in its rules of procedure, the party submitting the complaint or inquiry may petition the Peer Review Appeals Committee of the Illinois State Medical Society, as provided for hereinafter, to take jurisdiction of the complaint or inquiry.

4. Appeals ‑- Such parties to the proceedings as delineated below, conducted by the component society may petition the Peer Review Appeals Committee of the Illinois State Medical Society to review certain local proceedings of the component society or district committee. A petition for an appeal must set forth one of the following grounds as a basis for the appeal:

   1. Procedural Error ‑- The peer review proceeding was not conducted in accordance with written rules established by the component society, district committee, or the Illinois State Medical Society.

   2. Bias ‑- The proceeding was conducted in a biased or arbitrary manner.

   3. Incomplete Information ‑- If information not available to the component society or district committee is submitted to the State Peer Review Appeals Committee, the committee will first determine the relevancy of the new information. The case will be referred to the component society or district committee for reconsideration if the information is deemed to be pertinent and significant by the state committee.

A member of the Illinois State Medical Society, who is a party to a peer review proceeding and who has received a final determination from the component society, may file an appeal with the State Peer Review Appeals Committee, in accordance with Section D, as stated above, as a matter of right. A patient who brings a complaint shall enjoy the privilege of petitioning the state committee to review the decision of a component society and the state committee shall, in its sole discretion, determine whether or not to accept the case on appeal. No other parties shall enjoy the privilege to appeal a decision of the component society.

In the event of an appeal to the Illinois State Medical Society, the component society shall send to the Illinois State Medical Society a copy of the complaint, the exhibits and the findings and recommendations of the component society or district committee. The right to appeal to the Illinois State Medical Society Peer Review Appeals Committee shall be limited to 30 days after the decision of the component society or district committee, unless the appellant can provide an acceptable reason for additional time.

Part 3. District Committee. The delegates in each multi-county Illinois State Medical Society district, and in a single county district, the component society shall establish a District Peer Review Committee to function in those instances when the component society chooses to delegate to its District Peer Review Committee the responsibility to perform the review functions set forth in this chapter. Upon completion of hearings of each complaint or inquiry referred to it by the component society, the district committee shall render its findings and recommendations to the component society for affirmation. The District Peer Review Committee shall also consider complaints or inquiries assigned to it by the Illinois State Medical Society Peer Review Appeals Committee in those instances when it is determined by the state committee that a component society has failed to act in a timely fashion or has a conflict of interest on a peer review complaint or inquiry submitted to it. In a single county district the component society Peer Review Committee shall be the District Peer Review Committee. In instances in which a component society Peer Review Committee in a single county district has failed to act in a timely fashion or has a conflict of interest on a peer review complaint or inquiry, the State Peer Review Appeals Committee shall have the power, on its own initiative, to intervene and act on the complaint or inquiry.

Part 4. Illinois State Medical Society Procedures.

1. There shall be created a Peer Review Appeals Committee, appointed by and reporting directly to the Board of Trustees. The committee shall consist of seven members who shall serve one-year terms but, in no event, more than five consecutive one-year terms. Vacancies shall be filled by appointment by the Board.

   The Peer Review Appeals Committee shall review appeals of decisions of component or district Peer Review Committees in accordance with the provisions of Part 2 (D) of this chapter. The state committee shall determine the validity of the alleged grounds and, if found valid, remand the case to the local or district committee for a rehearing. If the alleged grounds are found invalid, the decision of the district or county committee shall be deemed to be reaffirmed. The decision of the Peer Review Appeals Committee shall be forwarded first to the county or district committee and then to the appellant. The state committee shall have authority to assign cases to district peer review committees in accordance with Part 3 of this chapter. Decisions of the state committee shall be final.

2. The state Peer Review Appeals Committee shall adopt appropriate rules for the conduct of its business and shall act on all appropriately filed appeals in a timely manner. The state committee shall notify the appropriate component society of its decision in a given case prior to its notification of the parties to the appeal.

3. If, in the judgment of the state committee, a matter submitted to it on appeal is deemed to be more appropriately treated as an ethical relations issue, the committee shall refer that case for disposition to the Judicial Panel, created under Chapter XI of these Bylaws.

Part 5. Automatic Reciprocal Membership Revocation. ISMS shall revoke the membership of any member physician whose membership has been revoked by a medical specialty society with membership in the AMA House of Delegates for reasons of unethical behavior, unprofessional conduct or practice, including, but not limited to, falsifying membership or licensure applications, providing false or misleading expert witness testimony, or being convicted of providing false or misleading expert witness testimony. This revocation shall be automatic upon notification of a final decision of the specialty society. No appeal is permitted.

Part 6. Due Process Safeguards. The Peer Review Appeals Committee is authorized and directed to make any report required by state or federal law with respect to actions it takes and to do so by transmittal to the appropriate officer of the Society as determined from time to time by the Board of Trustees.

prev. chapter | bylaws | next chapter