Professional Documents
Culture Documents
Abuse of The "Disruptive Physician" Clause: Editorial
Abuse of The "Disruptive Physician" Clause: Editorial
Lawrence R. Huntoon, M.D., Ph.D. Although the disruptive-physician clause and sham peer review
are current weapons of choice used by hospital administrations
Buried deep in the “Corrective Action” section of most medical across the country, more weapons of physician destruction loom on
staff bylaws is a provision known as the “Disruptive Physician” the horizon.
clause. It is arguably the most dangerous and, in recent years, the Physicians should be aware of the “Code of Conduct” and
most abused provision in medical staff bylaws. “Exclusion from the Hospital Premises” clauses currently being
The term “disruptive physician” is purposely general, vague, promoted by the hospital bar.
subjective, and undefined so that hospital administrators can AAPS has posted a letter dated January 31, 2003, to the
interpret it to mean whatever they wish. General Counsel of the Joint Commission on Accreditation of
How this treacherous trap got into medical staff bylaws is no Healthcare Organizations (JCAHO), which was drafted by the
mystery in most instances. It was added at the urging of hospital leaders of the credentialing and peer review practice group of the
administrators, often with help from a medical staff president who American Health Lawyers Association, in the Hall of Shame on
was duped into believing that the clause would only be used in those our website (see www.aapsonline.org). The letter is rated “R” for
extreme cases where a physician was found running drunk or naked stark Reality. Physicians need to wake up quickly and take notice
through the halls of the hospital. because this is what hospitals really have in mind for medical staffs
Lack of vigilance by physicians, and failure of medical staffs to across the nation. Interested readers can also learn more about the
obtain independent legal advice on changes to the bylaws, allowed hospital industry’s strategic plan, developed in 1990: see
most hospital administrations to insert this clause without difficulty “Hospital Industry Reveals Its Strategic Plan: Control Over
or any meaningful opposition. Physicians” in theAAPS Hall of Shame.
Why this clause was strategically placed in medical staff bylaws Physician vigilance, and advice from knowledgeable,
is also no mystery. It is part of the strategic plan developed in 1990 independent counsel, are key to preventing further abuse of medical
by the hospital industry. The stated goal was to gain more control staff bylaws by hospital administrations.
over physicians in hospitals. Abuse of the disruptive-physician
clause and increasing use of sham peer review has allowed hospital Lawrence R. Huntoon, M.D., Ph.D., is a practicing neurologist and
administrations to make great strides in achieving that goal. editor-in-chief of the Journal of American Physicians and Surgeons.
Attorneys who specialize in representing hospitals have
definite recommendations on how “disruptive physician” can be Memo to the Disruptive Physician
defined by a hospital, in order to remove a targeted physician from
staff. In fact, some law firms offer seminars for hospital officials Oh how we strive
and their legal representatives that teach optimal methods for For quality high,
eliminating certain physicians that the hospital dislikes. Here are a For health
few of the criteria for identifying a “disruptive physician”: And most of all safety.
1. Political: Expressing political views that are disagreeable to the But a word to the wise:
hospital administration. Reproof we despise
2. Economic: Refusing to join a physician-hospital venture, or to And outspoken physicians:
participate in an HMO offered to hospital employees, or We hate thee.
offering a service that competes with the hospital.
3. Concern for quality care: Speaking out about deficiencies in Feel free to opine,
quality of care or patient safety in the hospital, or simply bringing But note we define
such concerns to the attention of the hospital administration. All critics
4. Personality: Engaging in independent thought or resisting a As never constructive.
hospital administration’s “authority.”
5. Competence: Striving for a high level of competence, or And, thus shall ensue
considering oneself to be right most of the time in clinical A sham peer review
judgment. And henceforth
6. Timing: Making rounds at times different than those of the “herd.” You’re labeled “disruptive.”
Office Consolidation
Note
All persons making use of this consolidation are reminded that it has no
legislative sanction, that amendments have been embodied for convenience of
reference only. The official Statutes and Regulations should be consulted for all
purposes of interpreting and applying the law.
Regulations
The following is a list of the regulations made under the Alberta Evidence Act
that are filed as Alberta Regulations under the Regulations Act
Chapter A-18
Table of Contents
1 Definitions
Application of Act
2 Application of Act
Competency of Witnesses
3 Admission of witness with interest, etc.
4 Competency as witnesses
5 Evidence as to intercourse
6 Incriminating questions
7 Questions re adultery
8 Communications made during marriage or adult interdependent
relationship
9 Quality assurance records
Corroborative Evidence
10 Evidence re breach of promise
11 Evidence in action by heir, etc.
12 Evidence in action by lunatic, etc.
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ALBERTA EVIDENCE ACT Chapter A-18
Attendance of Witnesses
21 Action against witness disobeying subpoena
Examination of Witnesses
22 Cross-examination
23 Proof of contradictory statement
24 Proof of previous conviction of witness
25 Contradiction of witness
Apology
26.1 Effect of apology on liability
Electronic Records
41.1 Definitions
41.2 Application
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Section 1 ALBERTA EVIDENCE ACT Chapter A-18
41.3 Authentication
41.4 Application of the best evidence rule
41.5 Presumption of integrity
41.6 Standards
41.7 Proof by affidavit
41.8 Cross-examination
Signatures of Judges
42 Judicial notice of signatures
43 Proof of signature
44 Proof of foreign judgments
Notarial Documents
45 Notarial documents
Proof of Wills
51 Probate of will, etc., as evidence
52 Death outside Alberta
Copies of Instruments
53 Copy of registered document as proof
54 Original document and copy
55 Proof of telegrams, etc.
Miscellaneous
56 Case before foreign court
57 Attestation as to validity of instrument
58 Comparison of disputed writing
59 Impounding documents
60 Recitals, etc., 20 years old
61 Proving old documents
62 Construction of Act
63 Proving death of member of Forces
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Section 1 ALBERTA EVIDENCE ACT Chapter A-18
Definitions
1 In this Act,
Application of Act
Application of Act
2 This Act extends and applies to evidence offered or taken
(a) orally,
(b) by interrogatories,
4
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Section 3 ALBERTA EVIDENCE ACT Chapter A-18
(c) by affidavits,
(e) otherwise,
Competency of Witnesses
Competency as witnesses
4(1) The parties to an action and the persons on whose behalf the
action is brought, instituted, opposed or defended are, except as
otherwise provided in this Act, competent and compellable to give
evidence on behalf of themselves or of any of the parties.
Evidence as to intercourse
5 Without limiting the generality of section 4, a spouse or an
adult interdependent partner may in an action give evidence that he
or she did or did not have sexual intercourse with the other spouse
or adult interdependent partner at any time or within any period of
time before or during the marriage or adult interdependent
relationship.
RSA 2000 cA-18 s5;2002 cA-4.5 s15
5
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Section 6 ALBERTA EVIDENCE ACT Chapter A-18
Incriminating questions
6(1) A witness shall not be excused from answering any question
on the ground that the answer may tend to incriminate the witness
or may tend to establish the witness’s liability to prosecution under
an Act of the Legislature.
(2) A witness who testifies in any proceedings has the right not to
have any incriminating evidence so given used to incriminate that
witness in any other proceedings, except in a prosecution for
perjury or for the giving of contradictory evidence.
RSA 1980 cA-21 s6;1985 c15 s1
Questions re adultery
7(1) No witness in an action whether a party to it or not is liable to
be asked or shall be bound to answer a question tending to show
that the witness has been guilty of adultery unless the witness has
already given evidence in the same action in disproof of the alleged
adultery.
6
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Section 9 ALBERTA EVIDENCE ACT Chapter A-18
(i) appointed by
7
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Section 10 ALBERTA EVIDENCE ACT Chapter A-18
(3) Subsection (2) does not apply to original medical and hospital
records pertaining to a patient.
(5) Neither
nor
creates any liability on the part of the person making the disclosure
or submission.
RSA 2000 cA-18 s9;2008 cH-4.3 s8
Corroborative Evidence
9
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Section 15 ALBERTA EVIDENCE ACT Chapter A-18
(2) When an oath is duly administered and taken, the fact that the
person to whom it was administered has at the time of taking the
oath no religious belief does not for any purpose affect the validity
of the oath.
RSA 1980 cA-21 s15
Administration of oath
15(1) An oath may be administered in the form and manner
following:
The person taking the oath shall hold the Bible or New
Testament, or Old Testament in the case of an adherent of
the Jewish religion, in the person’s uplifted hand and the
officer administering the oath shall say: “You swear that
the evidence you give as touching the matters in question
in this action or matter shall be the truth, the whole truth
and nothing but the truth. So help you God”, to which the
person being sworn shall say “I do” or give his or her
assent to it in a manner satisfactory to the court or to the
officer administering the oath.
Scottish oath
16 If a person to whom an oath is to be administered desires to
swear with uplifted hand in the form and manner in which an oath
is usually administered in Scotland the person shall be permitted to
do so, and the oath shall be administered to the person in that form
and manner without further question.
RSA 1980 cA-21 s17
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Section 18 ALBERTA EVIDENCE ACT Chapter A-18
Statutory declaration
18 Any person authorized by law to administer oaths or to take
affidavits in any matter may receive the solemn declaration of any
person making it before the authorized person, in the following
form, in attestation of the execution of any writing, deed or
instrument or of the truth of any fact or of any account rendered in
writing:
Evidence of child
19(1) In a legal proceeding where a child of tender years is offered
as a witness and the child does not, in the opinion of the judge,
justice or other presiding officer, understand the nature of an oath,
the evidence of the child may be received though not given on oath
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Section 20 ALBERTA EVIDENCE ACT Chapter A-18
if, in the opinion of the judge, justice or other presiding officer, the
child is possessed of sufficient intelligence to justify the reception
of the evidence and understands the duty of speaking the truth.
Attendance of Witnesses
Examination of Witnesses
Cross-examination
22(1) A witness may be cross-examined with regard to previous
statements made by the witness in writing, or reduced to writing,
and relative to the matter in question, without the writing being
shown to the witness.
(3) The judge or other person presiding may, at any time during
the trial or proceeding, require the production of the writing for the
judge’s or the other presiding person’s inspection, and may on
production make any use of the writing for the purposes of the trial
or proceedings that the judge or other presiding person thinks fit.
RSA 1980 cA-21 s23
(2) A certificate
(a) that specifies the substance and effect only, omitting the
formal part, of the charge and the conviction, and
(3) A fee of not more than $1 may be demanded or taken for the
certificate.
RSA 1980 cA-21 s25
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Section 25 ALBERTA EVIDENCE ACT Chapter A-18
Contradiction of witness
25(1) A party producing a witness shall not be allowed to impeach
the witness’s credit by general evidence of bad character but the
party may contradict the witness by other evidence.
(2) When
then, whether or not that person is a party to the action, proof of the
conviction or the finding of guilt, as the case may be, is admissible
in evidence for the purpose of proving that the person committed
the offence.
(a) the officer having the custody of the records of the court
in which the offender was convicted or found guilty, or
Apology
15
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Section 27 ALBERTA EVIDENCE ACT Chapter A-18
(2) The exemplification of the letters patent has the like effect for
all purposes against the Crown as well as against all other persons
as the letters patent exemplified by it have.
RSA 1980 cA-21 s28
17
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Section 30 ALBERTA EVIDENCE ACT Chapter A-18
Judicial notice
32 Notwithstanding anything in this Act, every Act or regulation
of Alberta or of Canada and every proclamation and every order
made or issued by the Governor General or the Governor General
in Council or by the Lieutenant Governor or the Lieutenant
Governor in Council, and every publication of them in the Canada
Gazette or The Alberta Gazette, shall be judicially noticed.
RSA 1980 cA-21 s33
Privileged document
34(1) When a document is in the official possession, custody or
power of a member of the Executive Council, or of the head of a
department of the public service of Alberta, but a deputy head or
other officer has the document in the deputy head’s or other
officer’s personal possession and is called as a witness, the deputy
head or other officer, acting by the direction and on behalf of the
member of the Executive Council or head of a department, is
entitled to object to the production of the document on the ground
that it is privileged.
19
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Section 35 ALBERTA EVIDENCE ACT Chapter A-18
(a) the book was, at the time of the making of the entry, one
of the ordinary books kept in the branch,
20
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Section 36 ALBERTA EVIDENCE ACT Chapter A-18
Conclusiveness of documents
39 If an Act or regulation provides that a document is evidence of
a fact without anything in the context to indicate that the document
is conclusive evidence, then the document is admissible in
evidence in any action, and the fact is deemed to be established in
the absence of any evidence to the contrary.
RSA 1980 cA-21 s40
21
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Section 40 ALBERTA EVIDENCE ACT Chapter A-18
22
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Section 41 ALBERTA EVIDENCE ACT Chapter A-18
(a) a government;
(a) that the book or record was at the time of the making of
the entry one of the ordinary books or records of the bank,
(b) that the entry was made in the usual and ordinary course
of business,
24
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Section 41.1 ALBERTA EVIDENCE ACT Chapter A-18
(9) The costs of an application to a court under this section and the
costs of anything done or to be done under an order of the court
made under this section are in the discretion of the court.
(10) The court may order the costs or a part of the costs to be paid
to any party by the bank when the costs have been occasioned by
default or delay on the part of the bank.
Electronic Records
Definitions
41.1 In this section and sections 41.2 to 41.8,
25
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Section 41.2 ALBERTA EVIDENCE ACT Chapter A-18
Application
41.2(1) Sections 41.3 to 41.8 do not modify any common law or
statutory rule relating to the admissibility of records, except the
rules relating to authentication and best evidence.
Authentication
41.3 A person seeking to introduce an electronic record as
evidence has the burden of proving its authenticity by evidence
capable of supporting a finding that the electronic record is what
the person claims it to be.
2001 cE-5.5 s33
Presumption of integrity
41.5 For the purposes of section 41.4(1), in the absence of
evidence to the contrary, the integrity of the electronic records
system in which an electronic record is recorded or stored is proved
26
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Section 41.6 ALBERTA EVIDENCE ACT Chapter A-18
Standards
41.6 For the purpose of determining under any rule of law
whether an electronic record is admissible, evidence may be
presented in respect of any standard, procedure, usage or practice
on how electronic records are to be recorded or stored, having
regard to the type of business or endeavour that used, recorded or
stored the electronic record and the nature and purpose of the
electronic record.
2001 cE-5.5 s33
Proof by affidavit
41.7 The matters referred to in sections 41.4(3), 41.5 and 41.6
may be established by an affidavit given to the best of the
deponent’s knowledge or belief.
2001 cE-5.5 s33
Cross-examination
41.8(1) A deponent of an affidavit referred to in section 41.7 that
has been introduced in evidence may be cross-examined as of right
by a party to the proceedings who is adverse in interest to the party
who introduced the affidavit or caused the affidavit to be
introduced.
(2) Any party to the proceedings may, with leave of the court,
cross-examine a person referred to in section 41.5(c).
2001 cE-5.5 s33
27
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Section 42 ALBERTA EVIDENCE ACT Chapter A-18
Signatures of Judges
(2) For the purposes of this section, the members of the Canadian
Transport Commission are deemed judges.
RSA 1980 cA-21 s43
Proof of signature
43(1) No proof is required of the handwriting or official position
of any person certifying to the truth of a copy of or extract from a
proclamation, order, regulation or appointment.
28
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Section 45 ALBERTA EVIDENCE ACT Chapter A-18
Notarial Documents
Notarial documents
45(1) A copy of a notarial act or instrument in writing
(2) The certified copy so received has the same force and effect as
the original would have if produced and proved.
(b) that the copy is not a true copy of the original in some
material particular, or
Protest as evidence
46(1) A protest of a bill of exchange or promissory note
purporting to be under the hand of a notary public wherever made
shall be received in evidence as proof, in the absence of evidence to
the contrary, of the allegations and facts stated in the protest.
(a) a judge,
(b) a magistrate,
30
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Section 48 ALBERTA EVIDENCE ACT Chapter A-18
31
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Section 49 ALBERTA EVIDENCE ACT Chapter A-18
Informalities in affidavits
49 An informality in the heading or other formal requisites of an
affidavit, declaration or affirmation made or taken before a
commissioner authorized to take affidavits under the
Commissioners for Oaths Act or under this Act is not an objection
to the reception in evidence of the affidavit, declaration or
affirmation if the court before which it is tendered thinks proper to
receive it.
RSA 1980 cA-21 s50
Proof of Wills
32
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Section 53 ALBERTA EVIDENCE ACT Chapter A-18
Copies of Instruments
(b) in the notice shall name some convenient time and place
for the inspection of it.
(2) The copy may then be inspected by the opposing party and
without further proof is sufficient evidence to prove the contents of
the original document and shall be accepted and taken instead of
the original unless the party receiving the notice within 4 days after
the time mentioned for the inspection gives notice that the party
intends to dispute the correctness or genuineness of the copy at the
trial or proceeding, and to require proof of the original.
Miscellaneous
and
(b) may give all directions with regard to the time and place
of the questioning and all other matters connected with it
that seem proper.
35
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Section 57 ALBERTA EVIDENCE ACT Chapter A-18
Impounding documents
59 When a document is received in evidence, the court admitting
it may direct that it be impounded and kept in custody for any
period and subject to any conditions that seem proper or until the
further order of the court, as the case may be.
RSA 1980 cA-21 s60
Construction of Act
62 The provisions of this Act shall not be taken to exclude any
method of proving documents or facts in any other way in which
they may by law be proved.
36
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Section 63 ALBERTA EVIDENCE ACT Chapter A-18
(b) stating that the person has been officially reported as dead
or presumed to be dead, and
is sufficient proof of the death of that person and of all the facts
stated in the certificate for any purpose to which the authority of
the Legislature extends, and also of the office, authority and
signature of the person giving or making the certificate without any
proof of the person’s appointment, authority or signature.
RSA 1980 cA-21 s64
37
Editorial:
The Psychology of Sham Peer Review
Lawrence R. Huntoon, M.D., Ph.D. Sham peer review is by nature a group effort involving
collaboration between unethical hospital administrators and
unethical physician attackers. The psychodynamics involve both
As sham peer review has spread across the nation, it has left
the excitement of the hunt and the raw power of the lynch mob that
behind a trail of broken and ruined lives and careers of good
often develops a life of its own, leading to actions that individuals
physicians. Although each case is unique, there are certain common
would likely not take if acting alone. It is the psychology of
features underlying the psychology of sham peer review.
predators versus prey. Others are drawn into the group hunt via the
same type of macabre attraction that often compels people to turn
Psychology of the Sham Peer Review Process
their heads and gawk as they drive slowly by the car wreck, looking
for any sign of mangled or dead bodies.
Sham peer review is a premeditated process that begins long
The power to snuff out the career and livelihood of a fellow
before the actual sham peer review hearings and formal
physician in the blink of an eye provides a certain pathological
proceedings. It begins in the minds of those who set out to destroy a satisfaction and excitement for some attackers. To share in the
targeted physician. Improper motives, having nothing to do with “group hunt” is to share in some of the power and excitement. And
furthering quality care, drive the process. the nearly absolute immunity the attackers enjoy under the Health
The process of sham peer review frequently involves a Care Quality Improvement Act (HCQIA) and the doctrine of
progressive series of small attacks leading up to a final formal judicial nonintervention further emboldens and enhances the power
proceeding designed to end the targeted physician’s medical career. of the attackers.
Sometimes these trial runs may go unnoticed or seem insignificant
to the targeted physician. Meanwhile, the hospital often secretly Psychology of the Physician Victim
collects, compiles, and even solicits documentation to be used in
the final attack at a later date. Facing superior power and numbers, the targeted physician
The final attack (formal sham peer review proceeding) is often soon understands that he is the prey and the hunt is on. The final
well planned and well choreographed so as to give the appearance attack is often unleashed quite suddenly and with great fury. The
of a legitimate, good-faith peer review action. The appearance of resultant shock and awe often causes a sudden loss of energy and a
due process and fundamental fairness is given top priority, although mental numbness that impairs the physician victim’s ability to
substantive due process and fundamental fairness are always defend himself effectively. This often further excites the predators
lacking in sham peer review. as the deer stands motionless, caught in the headlights.
Shock and awe is followed quickly by denial and disbelief. This
Psychology of theAttackers is frequently accompanied by a strong belief that the truth will save
the victim and set him free. Meanwhile, the stigma attached to mere
Although there are some cases in which one or a few allegations of wrongdoing produces an intended isolation of the
participants in the sham peer review proceedings are lazy and targeted physician. As a result, the physician victim often shuns
negligent and simply defer to the leaders of the attack in casting contact with colleagues, further assisting the predators in cutting
their vote against the targeted physician, in most instances those the prey out from the herd in preparation for the kill.
who participate in the sham proceedings know exactly what is At this stage, alone and isolated, facing almost certain demise,
going on. extreme fear sets in. How will the physician provide for his spouse
The psychology of the attackers is a combination of the and children? How will he cope with the bills that are mounting up
psychology of bullies and that of the lynch mob. The attacks are now that the attack has stopped cash flow? How will he survive?
typically led by one or a few bullies who have gained positions of Constantly living in an adrenaline-soaked fight-or-flight state
power over others and who enjoy exercising and abusing that power further depletes the victim’s energy and is often accompanied by
to attack and harm the vulnerable. Although there is always some significant depression, complete with severe sleep disturbance (too
improper motive that precipitates the attack, the attack itself often much or too little), weight loss, and a pervasive feeling of
serves to distract attention from the bully’s own underlying helplessness and hopelessness. The risk of “death by stress” or
shortcomings, deficiencies, insecurities, and cowardice. suicide is very real at this stage.
Enablers are those physician bystanders who are aware that the Lawrence R. Huntoon, M.D., Ph.D., is a neurologist practicing in New York
sham peer review attack is taking place, but who stand by and do and serves as Chairman of the AAPS Sham Peer Review Committee.