Hearing Officer Approach At Peer Review Hearings.  Mr. Roth’s overarching focus is to ensure that: (i) the proceeding is fair, which includes making certain that an impartial judicial review committee/fair hearing panel (JRC) is appointed; (ii) both parties are afforded the opportunity to present all relevant evidence and argument in support of their respective positions; and (iii) proper decorum is maintained throughout the proceeding as is needed for the hearing process to be fair and efficient.  An implicitly critical component of Mr. Roth’s duties as the hearing officer is to serve as the legal advisor to the JRC. In this role, Mr. Roth works to ensure that the JRC fully considers the evidence and argument presented by the parties and issues a decision, which is supported by the evidence, is well reasoned, and sets forth all of the panel’s findings and conclusions in accordance with applicable law.  And when Mr. Roth is the arbitrator, he follows the same principles. At the conclusion of each hearing, Mr. Roth compiles a Hearing Officer Record for potential use in any type of appeal pursued by either or both parties.

In sum, Mr. Roth understands the paramount importance of peer review proceedings to be fair to all parties in order to properly balance essential public policies of safeguarding the rights of physicians (and practitioners) to practice their profession and patients to receive quality care.

Examples of Clinical Matters in Dispute at Roth’s JRC/Fair Hearing Proceedings:

• OB/GYN's treatment of unstable newborn; response to urgent C-section in several cases; working relationship with nurses and hospital administration; and reasonableness of prior proctoring requirement.

• Surgeon's technical proficiency in placing central lines; management of a patient's complications after performance of a carotid endarterectomy; and related medical judgment.

• Anesthesiologist's skills in airway management; selection and dosing of anesthetic agents and intravenous fluids; and related medical judgment.

• Whether an anesthesiologist’s positive test results on a random drug test were based upon the anesthesiologist’s accidental exposure to drug during surgery or self-medication, and whether the anesthesiologist timely advised medical group of positive test result.

• Whether an endocrinologist improperly delayed diagnosis/treatment or exercised inappropriate clinical judgment/decision-making in connection with the care and treatment of patient born with congenital hypothyroidism; and whether the endocrinologist timely commenced cabergoline therapy in light of a patient’s condition and elevated level of a particular hormone.

• Whether a surgeon negligently divided a patient’s anterior rectus sheath during surgery.

• Whether a surgeon should have recognized that a patient who was presenting at the emergency room had a duodenal perforation,

• Whether a surgeon met the standard of care related to suturing a mesh prior to closing on an open ventral hernia repair.

• Whether an internist recognized and appropriately treated patient presenting at an emergency room for an elevated creatinine level and whether the internist then timely recognized and treated the patient’s diabetic ketoacidosis.

• Whether a surgeon should have resected a patient’s bowel and performed an anastomosis versus completing the surgery more quickly by performing a jejunostomy;

  
  

Examples of Non-Clinical Matters in Dispute at Roth’s JRC/Fair Hearing Proceedings:

• Whether investigation and findings of medical executive committee were procedurally unfair and improperly influenced by department chair who was a former business partner of the physician being subject to the adverse action.

• Whether a medical staff re-constituted an ad hoc committee in order to obtain a result that differed from the original ad hoc committee’s decision.

• Whether a medical executive committee summarily suspended a competing physician’s clinical privileges for the competitive advantage of committee members.

• Whether a medical executive committee’s decision to revoke a physician’s medical staff membership based upon the physician’s alleged non-disclosure of prior criminal conviction in application for staff privileges was reasonable and warranted.

• Whether a physician’s primary office and residence were located within the hospital’s geographic area in accordance with the hospital’s medical staff bylaws.

• Whether a health plan’s credentialing committee should have granted clinical privileges to a psychiatrist notwithstanding the psychiatrist’s prior conviction for mail fraud.

• Whether a primary care physician’s practice was properly and fairly terminated by a health plan based upon the plan’s scoring of the practice on its referral audits, medical records audits, and facility site audits.

Examples of Matters in Dispute at Roth’s Appellate Review Proceedings

• Whether substantial evidence supported a JRC’s findings that a pathologist made incorrect diagnoses, did not correct incorrect diagnoses, did not perform indicated staining of anatomic tissue, and made improper interpretations of tissue samples.

• Whether a fair hearing committee was improperly constituted due to non-inclusion of a vascular surgeon on the committee.

• Whether substantial evidence supported a JRC’s findings on the issue of whether an obstetrician-gynecologist directed patient to push when dilated only 7 centimeters and did not use aseptic technique when repairing the patient’s vulva.

• Whether substantial evidence supported a JRC’s finding on the issue of whether an obstetrician-gynecologist provided timely coverage and made themself available after inducing trial labor on a vaginal-after-c-section patient.

Roth’s Prior Practice for Clients Focused on Medical Staff and Credentialing.  During Mr. Roth’s over 35 years in private practice, he worked with hospital and health plan clients (and their physicians) on various medical staff and medical staff related matters. For example, Mr. Roth: (i) served as special outside counsel to study and advise a dental school and its related teaching hospital and staff on establishing and operating quality assurance/peer review/credentialing programs; (ii) drafted a fair hearing plan for a health plan; (iii) reviewed and revised medical staff bylaws for several hospitals; (iv) advised clients on compliance issues respecting NPDB/adverse action reporting requirements; and (v) served on a medical staff’s bioethics committee. 

Roth’s Appointment and Retention Analogous to Serving as an Arbitrator in Peer Review Proceedings.  By gubernatorial appointment, Mr. Roth served for several years on the licensing board of a California Department of Consumer Affairs (including two terms as president) where his statutory duties included making decisions on matters of licensure and discipline respecting licensees.  Further,  Mr. Roth served as the Reconsideration Hearing Officer at over 200 hearings at which he ruled on disputes between a Medicare health plan and its enrollees that primarily related to: (i) whether an enrollee was justified in obtaining out-of-plan and/or out-of-area care, (ii) whether the enrollee had been properly enrolled in the plan and thereby bound by the plan’s coverage terms, and (iii) to what extent the plan or the enrollee should be responsible for the costs of goods and services incurred out-of-plan/out-of-area by the enrollee.