The Health Care Quality Improvement Act, a 1986 federal law designed to protect patients by encouraging doctors to report incompetent colleagues, is now being weaponized to silence physicians who raise safety concerns and destroy their careers, according to a proposal published by two retired emergency medicine physicians, Patricia Robitaille and Coleen Rickabaugh. The proposal, detailed on Robitaille's Substack and covered by The Heartland Institute in June 2026, argues that hospitals and healthcare corporations have learned to exploit the law's peer review process to fabricate complaints against ethical practitioners while enjoying legal immunity from consequences.

When Congress passed the Health Care Quality Improvement Act in 1986, peer review committees were typically made up of independent doctors who could objectively evaluate their colleagues. But the structure has fundamentally changed. The proposal states that "healthcare entities have been increasingly able to channel fabricated human resource concerns into peer reviews which are intended to silence and suppress legitimate physician concerns related to clinical practice, patient outcomes, and patient safety." Today, physicians are often direct employees of hospitals, and the committees that oversee peer review are appointed by and answerable to the corporation, the proposal notes. The American Medical Association made similar observations in a 2024 document, stating that "peer review committees are typically not independent, and often comprise hospital-employed physicians who have agreed to make decisions on behalf of the organization." A 2011 document from the American College of Emergency Physicians defines "sham peer review" as "the abuse of a medical peer review process to attack a doctor for personal or other non-medical reasons," and notes that vague terms like "Disruptive Physician" can be manipulated to target doctors who "properly defend patient care" or "seek to improve various clinical practices."

According to Robitaille and Rickabaugh, the process itself is designed to break physicians financially and emotionally. There's no mandated timeframe for hearings, which can drag on for months or years, Robitaille told Health Care News in a joint interview. "During this process, time is elapsing," Robitaille said. "You have no income. You're running out of money. Your spirit is waning. Your clinical skills are not being utilized." Hospitals aren't required to notify doctors when an investigation begins, which means physicians who resign to escape a toxic workplace can unknowingly be reported to the National Practitioner Data Bank for resigning while under investigation—a career-ending mark. The proposal states that healthcare entities "initiate the investigation, gather and control the facts, obscure discovery through privilege, appoint the hearing officer and committee members, select witnesses of their choosing, and through the actions of the hearing officer, are able to suppress the testimony of witnesses proposed by the physician."

The proposed reforms would require hospitals to notify physicians of investigations promptly, maintain their due process rights, and strip legal immunity from hospitals and corporations that misuse peer review. The proposal also recommends creating an administrative database to punish administrators who abuse the process. But Steven Kritz, a retired physician with 50 years of experience who was himself placed in the National Practitioner Data Bank after trying to reprimand an incompetent colleague, questions whether reform can work. Hospital administrators "can now order the physicians around or they'll have the physicians do the dirty work," Kritz said, pointing to COVID-19 as an example where doctors faced firing and loss of board certification if they didn't follow orders. Rickabaugh acknowledged that reform "does not prevent employer malfeasance across the board," but argued that ending financial immunity for healthcare systems in bad-faith peer review would allow wronged physicians to seek redress in court and make hospitals think twice about reputational harm. Whether individual doctors will challenge their employers "will always be a matter of moral conviction," she said—a recognition that even the best legal protections can't force courage.