In a fight that could have wide-ranging implications, Los Angeles County supervisors are pushing to see confidential medical records used by county doctors to evaluate their peers to determine whether they have met accepted standards of care, saying they need the information to ensure patient safety and justify settling malpractice claims against the county.
Access to such information emerged as an issue earlier this year after concerns were raised about peer review at Olive View- UCLA Medical Center. An anonymous letter to state regulators alleged that among other problems at the county hospital's neonatal intensive care unit, doctors and staff were not meeting to discuss medical mistakes and that peer review was "missing."
In May, Supervisors Michael D. Antonovich and Gloria Molina sent a letter to John Schunhoff, interim chief of the county's Department of Health Services, requesting access to relevant peer review records at Olive View. They cited county counsel's advice that they had authority to review the documents "for the purposes of monitoring and oversight."
Soon after, hospital officials made peer review documents for the last year for the neonatal unit available to supervisors' deputies. Antonovich's health deputy, Fred Leaf, said they were satisfied that peer review was being conducted and gave officials more time to comply with a request to see a list of all peer-reviewed cases at the hospital over the last two years.
Olive View officials have since refused to release records, a position supported by leaders at the county's three other hospitals. They are negotiating with the county's chief executive, William T Fujioka, who declined to comment.
Schunhoff said part of the purpose of peer review is for doctors to root out mistakes and create corrective plans to prevent them countywide. Opening up peer review to outside scrutiny could make doctors and staff reluctant to report such mistakes, he said.
"We have to maintain that confidentiality but ensure that information becomes a part of corrective action and is shared across facilities," Schunhoff said.
Olive View administrators sent an e-mail to doctors Tuesday reminding them of their responsibility to prepare for and attend peer review committee meetings.
Administrators had sent an e-mail to members of the professional staff association that represents doctors to announce a special meeting with its lawyer Sept. 3 to discuss supervisors' request for what the association called "unprecedented access" to peer review. The association at Harbor-UCLA Medical Center also called a special meeting Thursday to discuss the issue.
A Harbor-UCLA doctor who asked not to be identified for fear of retaliation said he and his peers are outraged, afraid that opening peer review to supervisors could lead doctors to stop reporting problems and prompt more malpractice lawsuits.
"The concept of peer review is that I can confidentially review my colleagues and if I see a problem with my colleague, I can report it," the doctor said. "If they force us to do this, then I'm going to be very reluctant to [report peers] because of the consequences. Who knows where these reports go, the medical and legal aspects."
Patient safety experts and hospital industry officials said opening peer review to outside scrutiny would be unprecedented and could have a chilling effect on doctors' willingness to honestly assess their peers.
Dr. Robert Wachter, a patient safety expert at UC San Francisco, said it would be "extraordinarily unusual for members of a board of supervisors to be looking at individual peer review reports."
"It's a hornet's nest that's being opened here," said Jim Lott, executive vice president of the Hospital Assn. of Southern California.
But Molina says she needs to see such records to identify patient safety problems and justify settling multimillion-dollar medical malpractice claims. A study released Aug. 13 showed that the county has faced fewer malpractice claims in recent years yet paid out more, about $12 million last year compared with about $8 million in 2007.
"The biggest issue for me is the risk management aspect of it — that is, let's not do it again," Molina said. "Because if you don't know, you can't correct it."
Molina said she learned from the board's experience closing troubled Martin Luther King Jr./Drew Medical Center not to trust medical staff to police themselves. She questioned whether there was enough state and county oversight of peer review.
"The state has all sorts of processes for transparency, accountability of doctors and all medical personnel," she said. "But again, it's only as effective as the reports of the information they get."
During the last four years, the county has settled more than a dozen Olive View malpractice cases, county records show, with the costliest involving botched deliveries. State regulators have fined Olive View in connection with four medical errors and three failures to report medical errors since 2007.
The regulators fined Olive View $25,000 in 2008, after a patient whose gallbladder was removed at the hospital developed a massive infection and died. The hospital's corrective action plan promised "additional peer review" of the physician responsible for supervising a resident who cared for the woman. In January 2010, supervisors approved a settlement with the patient's relatives for $382,500.
The same day, supervisors agreed to pay a $5.9-million settlement to a mother after an obstetrician delayed her cesarean delivery at Olive View in April 2008 and one of her twins sustained a brain injury, according to county records. State regulators faulted the hospital's nurses for failing to advocate for the patient.
A year before, supervisors agreed to pay a $4.5-million settlement to the mother of a baby who sustained severe brain damage after a prolonged cesarean delivery at Olive View in September 2007, according to county records. The hospital was later fined $1,600 for its 15-day delay in reporting the botched delivery to state regulators.
According to records reviewed by The Times, the same obstetrician delivered both babies and has no record of discipline or malpractice claims with the state medical board. She has since left Olive View and is now working at Kaiser Permanente's Woodland Hills Medical Center, staff said.
Supervisors Don Knabe and Mark Ridley-Thomas said they were willing to compromise with doctors on a policy that allows the board to see portions of peer review documents. Supervisors have also floated the options of removing doctors' names, inviting medical staff to supervise the review or having a medical expert review the records for the board.
"My hope is that this can be resolved without a needless legal battle," Ridley-Thomas said.