California law requires certain peer review organizations responsible for reviewing the medical care of physicians to make reports regarding physicians to the Medical Board of California (“Board”). And these reports can trigger Board investigations and even license discipline. This is the often misunderstood – but almost always detrimental – “805 Report.”
The report is named after Business and Professions Code § 805 which requires such reports. While many physicians complete their entire medical careers without having an 805 Report, the consequences of such a report to the Board can be devastating and are far reaching.
Who Must File
Business and Professions Code § 805(a)(1)(B) requires a “peer review body” to file an 805 Report with the Board under certain circumstances. “Peer review body” is defined in several ways discussed below, but generally involves some sort of medical group, committee of a hospital, clinic or other group of physicians responsible for reviewing the patient care of its staff members or colleagues. Specifically, peer review bodies include the following:
- A healthcare facility or a clinic licensed under the Health and Safety Code or an ambulatory surgical center certified to participate in the Federal Medicare Program;
- A healthcare service plan or disability insurer that contracts with licensees to perform and provide services;
- A medical or podiatric professional society that is a non-profit organization having at least 25% of its members be physicians or podiatrists;
- Any committee consisting of or employing more than 25 licensees of the same class which purpose is to review quality of care provided by members or employees.
Because peer review bodies can suffer a $50,000.00 fine for a failure to submit an 805 Report to the Board or a $100,000.00 fine for an intentional failure to report, peer review bodies have strong incentives to report any and all peer review issues, and often to the physician’s detriment, they do so diligently.
Peer review issues
Within 15 days of the date of any of the following occurrences, the peer review body must file an 805 Report with the Board:
- The peer review body denies or rejects the licensee’s application for staff privileges or membership for a medical disciplinary cause or reason;
- A licensee’s staff privileges, membership, or employment are revoked for a medical disciplinary cause or reason;
- Restrictions are imposed or voluntarily accepted on staff privileges, membership, or employment for a total of 30 days or more within any 12-month period for a medical disciplinary cause or reason;
- If the licensee resigns, goes on a leave of absence, withdraws or abandons an application for renewal of privileges or withdraws or abandons an application for renewal of privileges after receiving notice of a pending investigation initiated for a medical disciplinary cause or reason; and
- A summary suspension of staff privileges, membership, or employment that is imposed for a period in excess of 14 days.
Medical Disciplinary Cause or Reason
Business and Professions Code § 805(1)(b)(6) defines “medical disciplinary cause or reason” as “that aspect of the licentiate’s competence or professional conduct that is reasonably likely to be detrimental to patient safety or to the delivery of patient care.” Simply stated, if the issue involves patient care at all, the peer review body will report it.
While 805 Reports made to the Board from peer review bodies are not public records, the Board investigates them and they can easily turn into disciplinary actions. In fact, the peer review body has often done the Board’s work for it in investigating a patient care issue involving the physician which can easily turn into charges of negligence.
A 2008 study entitled Comprehensive Study of Peer Review in California Final Report by Lumetra1 confirms that the Medical Board received 167 805 Reports in fiscal year 2003, 139 in 2004, 106 in 2005, 147 in 2006, and 124 in 2007. The most common reason for 805 reports is imposition of summary suspension on staff privileges and licensee resignations from the staff.2
Tips for Physicians Dealing with Peer Review
When a physician is a member of a peer review body and has an issue involving patient care, the peer review body’s obligation to issue an 805 Report will likely be triggered. Accordingly, the physician should immediately seek competent and experienced healthcare legal counsel to address these issues at the earliest possible stages of the peer review process. Because peer review involves a direct conduit to the Medical Board and often involves negative findings, expert medical chart review, and other criticisms already investigated before the physician gets a chance to respond, a licensed physician cannot procrastinate dealing with a peer review matter before it escalates into a Board disciplinary action.