Susan Day, MD, filed a lawsuit against Spectrum Health Medical Group in Grand Rapids, Mich., alleging the hospital conducted a "sham peer review" while she underwent breast cancer treatment. The review ultimately led to her firing and a medical license review, according to Michigan Live.
Here are eight insights:
1. Dr. Day's lawsuit alleges age discrimination, sex discrimination and violations of the Americans with Disabilities Act against SHMG. She claims the chief of orthopedic surgery was looking to benefit from her client base, indicating SHMG physicians are paid for patient volume.
2. Dr. Day was terminated from the hospital Jan. 1. The hospital has yet to file a response to Dr. Day's lawsuit but denied all allegations.
3. Along with alleging the chief of orthopedics favored physicians, Dr. Day said she also found the center in violation of Medicare rules for billing. She reported the violation to the chief of surgery and took her medical leave of absence at the same time.
4. The lawsuit alleges Dr. Day's first peer review was correct and sufficient. A fellow physician was given one of Dr. Day's case files and determined the surgery was done competently. The six-physician review panel also found her case was performed correctly.
5. Dr. Day claims after the initial peer review, the chief of orthopedic surgery sought out additional files for review. The review was done externally instead of the typical internal peer review. During the time of the reviews, Dr. Day was undergoing breast cancer treatment and was unable to review the case files or
contend any allegations.
6. The external review deemed Dr. Day's surgeries were not medically necessary for the patient. When the review was done, SHMG had to reimburse six insurers for the surgeries. And at this time Dr. Day was not able to provide additional information to justify the surgeries.
7. While the external investigation was performed, Dr. Day was suspended with pay pending the investigation. Later SHMG filed a report claiming Dr. Day singed a last chance agreement, requiring her to agree to put patients at risk. Dr. Day refused to sign the agreement.
8. The state Department of Licensing and Regulatory Affairs' medical board is currently investigating Dr. Day's case. Her medical license will expire Jan. 31, 2019, pending intervention.