Guam Hospital Institutes Off-Island Third-Party Peer Review

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Certain cases to be reviewed by Chicago physician team

By Jasmine Stole

HAGÅTÑA, Guam (Marianas Variety Guam, Jan. 6, 2014) – Guam Memorial Hospital has instituted a new step in its peer review process. The hospital now has the means to have certain patient cases reviewed by an off-island team of physicians, according to Joseph Verga, CEO of GMH.

In November, the hospital entered into a contract with Dr. Steven Lowenthal and his team of multi-specialists to further examine cases sent to it by GMH.

Lowenthal is a physician from Chicago, who specializes in peer review, Verga said. He added that peer review by a third party is something the hospital has not had before.

"We will send cases to him and he will issue an independent review and judgment of the quality of care that the patient received," Verga said. Lowenthal may make recommendations or suggestions as to how the hospital may improve, based on the case.

Until the implementation of this policy, the peer review process at GMH was done in-house. The process for an independent reviewer to look into local patient cases was not available to GMH.

The first case for Lowenthal’s review was sent to him about two and a half weeks ago, Verga said.

All hospitals are required to practice peer review. Physicians examine a fellow practitioner's competence or professional conduct, should a case outcome trigger further evaluation. Patient outcomes that are unexpected, undesirable, or vary from the standard consequence, and outcomes that cause a physician’s methods to come into question may trigger the peer review process.

During a peer review, the physicians examining the case determine if the doctor in question was in compliance with safety standards and conformed to a high quality of care. A decision of recommendation or reprimand may then be made.

The need for an outside physician to further review cases has long been suggested, Verga said. The lack of medical specialists and the risk to impartial judgment among physicians who are friends prompted the suggestion that an unbiased, outside party look into flagged cases from GMH.

"Sometimes we don’t have doctors that are able to do a peer review on another doctor. You might have physicians that are close friends with each other," Verga said. "Or there were just never enough qualified physicians to do the review. We have one neurosurgeon here at any given time. If the case called for a neurosurgeon (to review), there’d be no one to do it."

Physicians may even request an external peer review for a second opinion on a case, Verga said.

The contract with Lowenthal will cost less than $15,000. The contract amount, Verga said, was earmarked in this year’s budget for the hospital. "It’s a very small, limited contract at this point. Going forward, we’ll probably have to expand it, but at this point, we’re going to see how it goes," the hospital administrator said.

Sending a case to Lowenthal and his team for review costs the hospital about $1,000 per case. Verga said with less than $15,000 allocated for the contract, GMH can send about 14 cases to Chicago for review and remain within the hospital’s budget. The hospital administration will be very judicious during the external peer review process, he said.

The value of an external review outweighs the cost. Verga said the new policy will allow for more objective findings, without internal politics and is a great resource.

"Some departments were not even doing peer review here. That’s an accountability issue," Verga said. This recent change to policy will provide for more accountability among the hospital staff, he said.


According to Verga, the hospital’s accreditation is also affected by the peer review policy. He said GMH’s lack of external peer review was a large threat to getting the facility accredited. He assured the Joint Commission that there would be a mechanism put in place to improve the process and moved ahead with the external peer review contract with Lowenthal.

The peer review services were procured through the government of Guam’s request for bid process. Lowenthal’s bid was chosen because he offered the needed services at the lowest cost, Verga said. Verga said he was delighted Lowenthal was the most qualified candidate and hopes to bring the physician to the Guam hospital in the future.

Verga said he anticipates Lowenthal will act as an objective reviewer and, should the visit materialize, to act as a consultant to improve the internal peer review mechanisms at GMH.

"The measure of success for peer review is difficult to pin down," Verga said. "I haven’t set any benchmark levels at this point because it is so new. I’m just going to have to see how this is."

Baby’s finger cut

Last week, reports surfaced of a newborn baby whose right pinky finger was partially missing. The baby had been placed in the care of GMH personnel. Johanna Borja, the newborn’s mother reported leaving her child with the personnel and returning to find that the baby’s pinky had been severed.

Verga said the incident is under investigation and said it is not a case Lowenthal would likely review because it was not an error made by a doctor, and thus would not be a case for a physician peer review.

"The investigation, what we're doing with the baby, is called a root cause analysis where we look at all the circumstances that surrounded it, really drill down, and look at the root causes and why things happened, and then put together an action plan based on what we find," he said. "That's not a peer review issue."

According to the Joint Commission Resources, Lowenthal is a board certified urologist, with a high level of knowledge in "organizational quality and safety processes and medical staff affairs." Lowenthal has more than 25 years of experience in health care and has enacted quality and safety strategies that have led to reliable, reproducible patient results.

Lowenthal is a senior vice president of medical affairs and a chief medical officer at the Rush-Copley Medical Center in Chicago.

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