Texas Defense Attorneys

Nursing Peer Review Defense

Nursing Peer Review Committees (NPRCs) are committees established by a hospital, nursing school, nursing home, home health agency, travel nursing agency, or other health care facility to review nursing practice. The general goals of the nursing peer review process are to review and analyze the facts and problem-solve solutions to prevent the incident under review from occurring again. The NPRC is also tasked with determining whether or not a nurse has engaged in conduct that must be reported to the Board of Nursing for investigation.

Given the significant threat of being reported to the Texas Board of Nursing, it can be risky to go into an NPRC meeting without a knowledgeable advocate to help advise and prepare you. In the peer review setting, it is important to make sure the health care facility follows the required procedures and to help avoid a potential BON complaint, which could lead to long-lasting consequences. Having the insight of an attorney who is intimately familiar with a nurse’s peer review rights and the mandatory minimum due process can make the difference in an NPRC determination to report a nurse to the BON.

Our attorneys at Lype, Dest & Smith Lawyers have represented numerous nurses in nursing peer review proceedings at hospitals, home health agencies, and long-term care and other facilities. This experience covers a broad variety of NPRC referrals with a range of circumstances. We have represented nursing clients at every stage of the peer review process, from the initial NPRC notice letter to ultimate BON referral. This experience results with our attorneys spending your valuable resources on the facts of the case and best strategy of approach, rather than researching the Nursing Practice Act and/or BON rules. Our extensive and diverse knowledge of nursing peer review has given us the expertise to represent clients in any NPRC situation.

Common Types of Nursing Peer Review Referrals:

Our attorneys have represented nursing clients in cases involving many different types of referrals. Some of the most common types of incidents review by nursing peer review committees include alleged:

• Medication errors
• Failure to notify the physician of a change in patient condition
• Failure to carry out physician orders
• Inappropriate restraint of a patient
• Inaccurate documentation
• Communication breakdowns
• Delay of care

Nursing Peer Review Procedure

When a hospital or other health care facility/company receives a peer review referral for a nurse for one or more incidents, the NPRC chairperson must provide the nurse with sufficient advance written notice of the incident(s) under review, including the date, time, patient(s) involved, and a description of the nurse’s actions or inactions which are being reviewed. Prior to the NPRC meeting date, the nurse and/or their attorney must be given an opportunity to review the materials being provided to the NPRC members, which can include statements, disciplinary actions, and medical records. At least two days before the meeting date, the nurse must be given the names of any witnesses who will be interviewed by the committee members at the meeting, and a copy of any written witness testimony.

At or prior to the NPRC meeting, all committee members, participants, witnesses, and anyone else involved will usually be required to sign a confidentiality agreement. Nursing peer review proceedings are strictly confidential, and those involved may not discuss any details about the nurse or incident under review outside the peer review setting.

The NPRC meeting usually begins with the chairperson explaining the process and rules of the proceedings, the incident under review, and the determination options available to the committee. The facility may call witnesses to present their knowledge of the incident and answer the committee’s questions. The nurse under review may also question the witnesses and call their own. The nurse is also given an opportunity to present their side of the story, provide the committee with their own supporting evidence, and answer any questions asked of them. Once the NPRC meeting is concluded, the committee must complete their review and reach a determination within two weeks. After reaching a determination, the nurse must be provided with the committee’s decision in writing.

The NPRC committee must make a determination from the following options:

• The nurse engaged in conduct subject to reporting to the Board of Nursing
• The nurse engaged in conduct subject to reporting, however the conduct is classified as a minor incident which does not need to be reported to the BON if the facility can appropriately remediate the nurse’s practice
• The nurse did not engage in conduct subject to reporting to the Board of Nursing

With their determination, the NPRC can also make recommendations for remediating the nurse’s practice and/or changing policies or procedures to ensure patient safety and minimize adverse events. After receiving the NPRC’s determination, the nurse may provide a written rebuttal to committee within 10 days, which will become a part of the peer review record.

Betty Smith

Ms. Smith’s practice focuses on administrative and health care law with a primary emphasis on professional license defense. She has represented numerous clients before various state agencies including the Texas Board of Nursing, Texas Medical Board, Texas Department of Licensing and Regulation, and the Texas Real Estate Commission.

Years of experience: 7 years
Bar number: 24102510 (TX) & 36027 (LA)
Location: Austin, TX
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Representative Cases

• RN v. Hospital

Client was called before a Nursing Peer Review Committee (NPRC) for allegations that she failed to timely notify the attending physician of a Category III fetal heart rate tracing and failed to go up the chain of command. Client retained the Firm after NPRC proceedings had concluded, and the committee determined that Client’s actions warranted reporting to the BON. After submitting a rebuttal statement to the NPRC on Client’s behalf identifying numerous due process violations, the hospital decided to conduct NPRC proceedings de novo (anew). After comprehensive review of the records and hours of one-on-one preparation with the client, the hospital cancelled its NPRC review of the client prior to the committee meeting and reversed its decision to report her to the BON.

• APRN v. Hospital

Client was referred to the Nursing Peer Review Committee for allegedly not following up with radiology after ordering STAT imaging for a patient who presented with worsening scrotal pain and swelling. Client retained the firm to advise and prepare him and to ensure the hospital was following the correct procedures. After careful review of the documentation and circumstances, Client successfully presented his case to the NPRC and avoided a report to the BON.

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What our clients are saying about us

Anonymous

A thorough and experienced lawyer. We are grateful to have Dan and his staff helped us with our case, dealing with Texas Medical Board. Dan is honest, experienced and very thorough. He was supportive throughout the proceedings. His caring and calm nature has made us feel at ease during the whole process. His office staff was professional and responsive. Dan responded to our phone calls and emails promptly. We wholeheartedly recommend Dan and his firm without any reservation.

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Our Practice Areas

Texas Medical Board Defense
Physician peer review and credentialing
Nursing Peer Review
Texas Pharmacy Board Defense
Texas Board of Nursing Defense
Texas Dental Board Defense
Texas Board of Law Examiners Defense
Medicare and Medicaid Exclusions, Payor Audits, and Related Enforcement Actions
DEA Defense
Professional License Defense
BHEC Defense