I read the article in the August issue of Southern California Physician, "All Is NOT Calm on the Hospital-Medical Staff Front." I would like to add some thoughts to support the arguments in that piece.

In 1990, the hospital bar outlined its strategy to gain more control over physicians in hospitals. We have posted one of the letters that reveals the strategy on our Association of American Physicians and Surgeons Web site at www.aapsonline.org, under the "Hall of Shame."

Over the past 16 years, the hospital bar has been gradually implementing many of the strategic moves outlined in the letter. Of particular concern is the growing problem of sham peer review. Sham peer review is being used by hospital administrations to control and eliminate physician whistleblowers and other targeted physicians.

A typical sham peer review scenario goes something like this: A conscientious doctor reports a quality care problem or patient safety problem to the hospital administration. This might be anything from an anesthesiologist falling asleep during surgery to a malfunctioning piece of equipment that could harm patients. Instead of fixing the problem, the hospital misuses the peer review process to silence the physician whistleblower.

The hospital administration and unethical physician collaborators then search for some pretext upon which to attack the physician whistleblower. This might involve the hospital trumping up or even fabricating charges against the physician. The truth and facts do not matter in a sham peer review since the hospital controls the entire process.

The hospital then goes through the motions of providing a hearing to the accused physician, yet the outcome is predetermined. The physician's due process rights are often utterly trampled. At the conclusion of the process, the physician's privileges to practice at the hospital are terminated. The physician is reported to the National Practitioner Data Bank, and the physician's career is essentially over.

The AAPS is focused on combating sham peer review. I am currently touring the country giving talks on the subject to medical societies and medical staffs in an attempt to alert our colleagues. Legal seminars actually teach hospital administrators how to do this sort of thing. AAPS produced an educational DVD in 2004 on sham peer review that reveals some of the tactics being taught at these legal seminars. Interested physicians can obtain the DVD from Jane Orient, MD, the executive director of AAPS, at 520/323-3110, or use the search tool to find sham peer review articles on our journal Web site at www.jpands.org.

L.R. Huntoon, MD, PhD, FAAN
Editor in Chief
Journal of American Physicians and Surgeons
Tucson, Ariz.