Physician on Administrative Leave or Under Peer Review in Ohio: What Happens Next and What Not to Do

The call comes without warning. A department chair or someone from human resources tells you that you are on administrative leave, or that your privileges are suspended pending an investigation, or that a peer review committee has questions about your cases. You are told not to come in and not to discuss it. Then the line goes quiet. Here is what is happening, what the law requires of the hospital, and the early mistakes that cost physicians later.

First question: is this an employment action or a medical staff action?

Physicians commonly have two relationships with the hospital. One is an employment contract with the hospital or its group. The other is medical staff membership and clinical privileges, governed by the medical staff bylaws, the credentials policy, and the fair hearing plan. They run on different rules, different decision makers, and different paper.

Administrative leave is usually an employment action. Your contract controls whether you are paid during the leave, what counts as cause, whether you get notice and a chance to cure, and what happens to tail coverage and your non-compete if the relationship ends. Many physician agreements let the employer terminate immediately if privileges are suspended, restricted, or revoked, and some are triggered by the mere opening of an investigation. Read those clauses now.

A suspension of privileges, a focused review of your cases, or a referral to the medical executive committee is a medical staff action, governed by the bylaws and by federal law, and it carries the reporting consequences discussed below. You may be in both processes at once. Treat them separately, and ask in writing which body acted, under what authority, and what document governs the next step.

Get the bylaws and the fair hearing plan today

If you have lost intranet access, ask the medical staff office in writing for current copies of the medical staff bylaws, the credentials or peer review policy, and the fair hearing plan. These tell you who can impose a summary suspension, how long it can last before the medical executive committee must act, what triggers a hearing right, how many days you have to request one, and whether counsel may participate. Pull your employment agreement too, and look for the cause definition, notice and cure terms, pay during leave, and any clause tying termination to privileges or investigations.

What federal law requires: the HCQIA standards

The Health Care Quality Improvement Act, 42 U.S.C. 11101 through 11152, gives hospitals and peer review participants immunity from money damages when a professional review action meets the standards in 42 U.S.C. 11112(a). The immunity is from damages only. It does not bar a challenge to the action, and under 42 U.S.C. 11111(a) it does not reach claims under federal or state civil rights laws.

The four standards in 42 U.S.C. 11112(a) are a reasonable belief that the action furthered quality health care, a reasonable effort to obtain the facts, adequate notice and hearing procedures or other procedures fair under the circumstances, and a reasonable belief that the action was warranted by the facts. The statute presumes these were met unless the physician rebuts the presumption by a preponderance of the evidence, which is why the record you build during the process matters.

The safe harbor: what adequate notice and a hearing look like

42 U.S.C. 11112(b) lists procedures that, if followed, are deemed to satisfy the notice and hearing requirement. Hospitals build their fair hearing plans around this list:

• Written notice that an action has been proposed, the reasons, your right to request a hearing, the time limit to request one (at least 30 days), and a summary of your hearing rights.
• If you request a hearing on time, notice of the place, time, and date (at least 30 days after the notice) and a list of expected witnesses.
• A hearing before an arbitrator mutually acceptable to you and the hospital, or before a hearing officer or panel appointed by the hospital who are not in direct economic competition with you.
• The right to counsel or another representative of your choice, a record, cross-examination, evidence regardless of courtroom admissibility, and a written closing statement.
• A written recommendation from the hearing body and a written decision from the hospital, each stating its basis.

These rights can be waived, failing to appear without good cause forfeits the hearing, and a hospital that falls short of this list has not automatically lost immunity. Invoke every right the bylaws give you, in writing, within the deadline.

The 14-day investigation window and summary suspension

42 U.S.C. 11112(c) carves out two situations where the full notice and hearing process is not required up front: a suspension or restriction of not longer than 14 days while an investigation determines whether a professional review action is needed, and an immediate suspension where failing to act may result in imminent danger to the health of any individual, with notice and hearing to follow.

This is the first clock. Once a suspension runs past 14 days, or becomes a proposed professional review action, you should be receiving the notice described above. Count from the date of suspension and put the deadlines in writing to the medical staff office.

The 30-day clock: when the action becomes reportable to the NPDB

Under 42 U.S.C. 11133(a) and 45 C.F.R. 60.12, a hospital must report to the National Practitioner Data Bank a professional review action, based on competence or professional conduct, that adversely affects clinical privileges for longer than 30 days, and any surrender or restriction of privileges while you are under investigation for possible incompetence or improper professional conduct, or in return for not conducting one.

The NPDB Guidebook, the agency's own interpretation, adds detail that matters:

• The label does not control. A suspension or restriction, whether called immediate, summary, emergency, or precautionary, must be reported if it is in effect for more than 30 days. The clock starts the day you cannot practice the full scope of your privileges, regardless of how the hospital writes it.
• A leave of absence can be reportable. A leave taken while under investigation is a reportable surrender if it restricts your ability to exercise privileges; a leave that leaves privileges fully intact is not. Reframing a suspension as a leave does not help: in the Guidebook's example, a summary suspension followed by a leave request still had to be reported if the suspension was not lifted within 30 days.
• An investigation stays open until the body conducting it takes final action or formally closes it, and the NPDB reads the word expansively. A routine review of all practitioners, or a routine review of one practitioner, is not an investigation, but a focused inquiry into one physician's cases can be, even before anyone calls it that. Your knowledge of the investigation is irrelevant; in the Guidebook's example, a physician who gave up a health plan panel membership for personal reasons without knowing an investigation had started was still reported.
• Administrative actions that involve no professional review action are not reportable, and 42 U.S.C. 11151(9) excludes actions based primarily on matters such as fees, advertising, or association with other practitioners.

If a report is filed, 45 C.F.R. 60.21 lets you add a statement that permanently accompanies it, place it in disputed status, and, if the hospital does not revise it or respond within 60 days, request Secretarial review. That review asks only whether the report is accurate and whether the action was reportable; the Secretary will not consider the merits of the action or the fairness of the process. You can also self-query the NPDB under 45 C.F.R. 60.18.

Ohio's layer: the Medical Board and the peer review privilege

Under R.C. 4731.224(B)(1), a hospital's chief administrator or executive officer must report to the State Medical Board, within thirty days after it is imposed, any formal disciplinary action against a licensee: any action resulting in the revocation, restriction, reduction, or termination of clinical privileges for violations of professional ethics or for reasons of medical incompetence or medical malpractice. That expressly includes a summary action, an action effective notwithstanding appeal rights, and a surrender of privileges while under investigation or to avoid one. Action taken solely for late records or missed staff meetings is excluded. The statute requires the report to include a summary of the underlying facts. The Board's facility reporting rule, Ohio Adm.Code 4731-15-02, speaks of sixty days after completion of the action; the statute's thirty days after imposition is the shorter period and the one to assume.

The Board can then open its own investigation. The grounds in R.C. 4731.22(B) that track hospital peer review include a departure from, or failure to conform to, minimal standards of care of similar practitioners, whether or not actual patient injury is established (R.C. 4731.22(B)(6)), and inability or impairment of the ability to practice (R.C. 4731.22(B)(19) and (B)(26)). The Board matter is a separate proceeding, and anything you write to the hospital can find its way there.

The peer review privilege works against you when you want documents. R.C. 2305.252 makes the proceedings and records of a peer review committee confidential and not subject to discovery or introduction into evidence in a civil action against a health care entity or provider arising out of matters the committee reviewed, and R.C. 2305.25 defines peer review committee broadly to include credentialing and quality committees and the hearing process that follows. Information available from original sources, such as the patient chart, is not protected because the committee saw it, but you must get it from the original source. R.C. 2305.251 adds immunity from damages for the hospital and committee members, and division (D) protects people who supply information without malice and in the reasonable belief that it is warranted by the facts. Your fair hearing may be the only point where you can see and test the case against you. Use it.

What not to do

The most expensive mistakes happen in the first days, usually in an effort to make the problem go away quietly.

• Do not resign, request a leave, or agree to stop exercising privileges while an investigation is open. Each can be a reportable surrender under 42 U.S.C. 11133 and R.C. 4731.224, and that report follows you to every future credentialing and licensing application.
• Do not accept an informal resolution without knowing whether it restricts your privileges and for how long. Proctoring that requires the proctor to be present or to approve a procedure before you act, a mandatory consultation that requires another physician's sign-off, or a limit on a category of procedures is a restriction; retrospective chart review by a proctor is not. Past 30 days a restriction is reportable even if you agreed to it.
• Do not call colleagues to get your side out. Violating a no-discussion instruction becomes a conduct issue layered on top of the clinical one, and the people you call may be interviewed.
• Do not access the charts in question unless the hospital has authorized it for your response. Reviewing records of patients you are no longer treating can be framed as a privacy violation.
• Do not send an angry email. Everything you write will be read by the committee, the hospital's lawyers, and possibly the Medical Board. Write short, factual, dated responses. Ask for the specific concerns, the case identifiers, and the governing bylaw provision, and answer what is asked.
• Do not miss a deadline. The 30 days to request a hearing in 42 U.S.C. 11112(b) is a floor for the hearing request only; bylaws often set shorter deadlines for interim steps. Calendar every date.

Counsel at the hearing, and the longer tail

The safe harbor in 42 U.S.C. 11112(b)(3) includes representation at the hearing by an attorney or other person of the physician's choice, and most fair hearing plans track it. Some bylaws limit counsel to advising rather than speaking, so check. Either way the preparation is the same: organizing the chart evidence, identifying whether any panel member is a direct economic competitor, arranging your own expert review of the cases, and making sure the record reflects every procedural shortfall, because that record is what you will rely on if the dispute goes further.

Plan for the questions that come later. Credentialing applications, payer enrollment forms, and license renewals ask whether your privileges have ever been suspended, restricted, or relinquished while under investigation. Under R.C. 4731.22(A) and (B)(5), misrepresentation in securing a license is itself a ground for Board discipline. Answering truthfully and consistently is far easier when the underlying action was handled correctly, documented, and, where appropriate, accompanied by your own statement in the NPDB record.

Sobel Law Solutions represents Ohio physicians in these matters on a flat-fee advisory basis during the leave, investigation, and hearing stages, and litigates when necessary. Initial consultations are free.

Frequently Asked Questions

Is administrative leave reportable to the National Practitioner Data Bank?

It depends on what the leave actually does to your privileges, not what it is called. Under 42 U.S.C. 11133 and 45 C.F.R. 60.12, a professional review action based on competence or conduct that adversely affects clinical privileges for more than 30 days must be reported. The NPDB Guidebook treats a suspension the same whether it is labeled summary, precautionary, emergency, or administrative. A leave that leaves your privileges fully intact is not reportable. A leave that prevents you from exercising privileges while you are under investigation can be treated as a reportable surrender or restriction. Ask the hospital in writing whether your privileges remain in effect.

Can the hospital suspend my privileges without a hearing?

For a limited time, yes. 42 U.S.C. 11112(c) allows a hospital to suspend or restrict privileges for not longer than 14 days while it investigates whether a professional review action should be taken, and allows an immediate suspension where failing to act may result in imminent danger to any individual's health. In both situations, the notice and hearing process must follow. Once the hospital proposes a professional review action, 42 U.S.C. 11112(b) describes the notice you should receive, including the reasons, the right to request a hearing, and at least 30 days to make that request. Your medical staff bylaws and fair hearing plan set the specific steps.

Should I resign while under investigation to avoid a report?

Resigning is one of the most damaging steps a physician can take at this stage. Under 42 U.S.C. 11133(a) and 45 C.F.R. 60.12, a hospital must report a physician's surrender of clinical privileges while under investigation for possible incompetence or improper professional conduct, or in exchange for not conducting one. Ohio law imposes a parallel duty to report that surrender to the State Medical Board under R.C. 4731.224. The NPDB Guidebook also says the physician's awareness of the investigation does not matter. A report of surrender while under investigation stays in the Data Bank and must be addressed on future credentialing and licensing applications.

Can I get the peer review committee's file on my cases?

Usually not through litigation. R.C. 2305.252 makes the proceedings and records of a peer review committee confidential and not subject to discovery or introduction into evidence in a civil action against a health care entity or provider arising out of matters the committee reviewed. Information available from original sources, such as the patient chart, is not protected merely because the committee reviewed it, but you must obtain it from the original source. Your best access to the hospital's case against you is the fair hearing itself, where 42 U.S.C. 11112(b) contemplates a witness list, cross-examination, and a record. Request everything the bylaws allow, in writing, before the hearing.

Does the hospital have to tell the Ohio Medical Board?

In many situations, yes. R.C. 4731.224(B)(1) requires a hospital's chief administrator or executive officer to report any formal disciplinary action to the State Medical Board within thirty days after it is imposed. Formal disciplinary action means any action resulting in the revocation, restriction, reduction, or termination of clinical privileges for violations of professional ethics or for reasons of medical incompetence or medical malpractice. It includes summary actions and a surrender of privileges while under investigation. Actions taken solely for late medical records or missed staff meetings are excluded. The Board may then open its own investigation under R.C. 4731.22, which is a separate proceeding from the hospital's.