Members of the California Medical Association, following a similar move by their colleagues in Oregon, plan to look into the misuse of the hospital peer review process to target physicians.

		Special Report: Cost of Courage Read Steve Twedt's articles about how America's physicians, sworn to protect their patients from harm, increasingly face a surprising obstacle -- their own hospitals.

At its House of Delegates meeting this week in Sacramento, the doctors' group voted to investigate whether doctors are unfairly being labeled "disruptive."

The California resolution was prompted by an ongoing dispute between administrators at a Ventura County, Calif., community hospital and its physicians regarding changes in the hospital's code of conduct and noncompete policies.

Last year, the medical staff of Community Memorial Hospital of San Buenaventura sued the hospital "to prevent the hospital from endangering patient care" by allowing physicians to practice there who had not been granted privileges and had not been approved by the medical staff.

The disagreement also led to the departure of longtime orthopedist Dr. John Hill not long after his colleagues had elected him chief of staff.

Hill said he faced reprisals after questioning the quality of care provided by a newly hired group of radiologists at Community Memorial. The hospital says Hill held a small financial stake in a competing medical facility and so was barred from sitting on some committees with access to sensitive financial information.

"They were saying I violated the bylaws of the board, but they wouldn't provide me with a copy of those bylaws," Hill said.

Hill said a recent Post-Gazette series prompted him "as much as anything" to introduce the resolution this week. The series, "The Cost of Courage," documented instances in which physicians who blew the whistle on poor patient care faced reprisals, including loss of privileges and being reported to a national data bank of sanctioned physicians. Several doctors said their careers were effectively crippled once they were listed in the National Practitioner Data Bank.

"I didn't realize how pervasive this was until I read those stories," Hill said.

Among those who disagree with Hill are officials for the California Healthcare Association, representing nearly 500 hospitals and health systems in the state.

What happened in Ventura was the exception, not the rule, said Lois Richardson, legal counsel for the California Healthcare Association. "I don't think anyone is pleased about it, but it's not a common situation."

Dorel Harms, vice president for professional services at the healthcare association, said the concept behind Hill's resolution would give the medical staff overall responsibility for dealing with questions of individual doctors' conduct "and we certainly don't support that. The hospital needs to have this authority because it is responsible for what goes on in the hospital."

Richardson also noted that California state law prohibits retaliation against physicians who advocate for patients and, as a result, "very disruptive physicians, who are harassing employees and who even their colleagues say are disruptive, say, 'I was yelling at the nurse because she was not providing adequate patient care.' "

Since the Post-Gazette series ran in October, Pennsylvania legislators have introduced two bills to broaden protection of medical workers who report substandard care. In November, the Oregon Medical Association's House of Delegates voted to launch its own investigation of "the misuse of the disruptive physician doctrine," citing the Post-Gazette stories and the dismissal of a Medford physician. The Oregon group hopes to make a final decision on how to proceed by its annual meeting next month.

In January, the Association of American Physicians and Surgeons, a group of about 4,000 doctors nationwide, said it, too, will look into the issue in coming months.