1. (a) Texas Civil Statutes, Article 4525b §1(2) states, "Peer review means the evaluation of professional nursing services, the qualifications of professional nurses, the quality of patient care rendered by professional nurses, the merits of complaints concerning professional nurses and professional nursing care, and determinations or recommendations regarding complaints". The peer review process is one of fact finding, analysis and study of events by registered nurses in a climate of collegial problem solving focused on obtaining all relevant information about an event. Once a decision is made that a nurse is subject to peer review, Texas Civil Statutes, Article 4525b, §1A(4) provides that the nurse is entitled to minimum due process. The purpose of this rule is to define minimum due process, to provide guidance to facilities in developing peer review plans, to assure that nurses have knowledge of the plan, and to provide guidance to the peer review committee in its fact finding process.

2. (b) In order to meet the minimum due process required by the NPA, the Peer Review Committee must:

   1. (1) provide written notice to the nurse that his/her practice is being evaluated, that the peer review committee will meet on a specified date not more than 30 calendar days from date of notice, and enclose a written copy of the peer review plan, policies and procedures;

   2. (2) include in the written notice:

      1. (A) a description of the event(s) to be evaluated in sufficient detail to inform the nurse of the incident, circumstances and conduct (error or omission), including date(s), time(s), location(s), and individual(s) involved. The patient/client shall be identified by initials or number;
      2. (B) name, address, telephone number of contact person to receive the nurse's response;
   3. (3) provide the nurse the opportunity to review, in person or by attorney, the documents concerning the event under review, at least 15 calendar days prior to appearing before the committee;

   4. (4) provide the nurse the opportunity to:

      1. (A) appear before the committee;
      2. (B) make a verbal statement;
      3. (C) ask questions and respond to questions of the committee; and
      4. (D) provide a written statement regarding the event under review;
   5. (5) conclude its evaluation no more than 14 calendar days from the committee meeting stated in the notice;
   6. (6) provide written notice to the nurse of the findings of the committee when the review has been completed; and
   7. (7) provide the nurse with reasonable opportunity to rebut the committee's findings in writing which shall become a permanent part of the record.
3. (c) The peer review process is not a hearing or substitute for a legal procedure; therefore, court procedures and rules and the presence of attorneys are not required. Although legal representation is not required, should the Peer Review Committee have an attorney as a member or in a representative capacity, the nurse is entitled to legal representation and parity of participation by counsel. "Parity of participation by counsel" means that the nurse's attorney is able to participate in the peer review process to the same extent and level as the facility's attorney; e.g., if the facility's attorney can question witnesses, the nurse's attorney must have the same right.
4. (d) Peer review plans shall contain written procedures to maintain confidentiality of information presented to and/or considered by the peer review committee which is not subject to disclosure except as provided by Texas Civil Statutes, Article 4525b, §3. Disclosure/discussion by a nurse with the nurse's attorney is proper because the attorney is bound to the same confidentiality requirements as the nurse.
5. (e) The 74th Legislature expressly included vocational nurses in the peer review provisions of the Texas Civil Statutes, Article 4525b. The procedural standards found in subsections (a)-(d) of this section apply to LVNs.
6. (f) The 75th Legislature added provisions for an RN to request Peer Review when a nurse is requested to engage in conduct that the nurse believes is in violation of his/her duty to a patient. The procedure for a request of Peer Review under these "safe harbor" type protections must be made at the time the RN is requested to engage in the conduct and written on forms provided by the board.

Source Note:The provisions of this §217.17 adopted to be effective September 1, 1999, 24 TexReg 4001.