Each step in the grievance process involves a different group, with specified responsibilities. The cases of Drs. Quinn and Ogden proceeded through the following committees.
Committee on Professionalism (COP)
The Committee on Professionalism (COP) is the AAOS body charged with determining whether a grievance merits a formal hearing at which both the Grievant (person who files the grievance) and the Respondent (person accused in the grievance) present their positions. Parties to a grievance may be represented by counsel and may present witnesses to support their positions. During a hearing before the COP Hearing Panel, each party is limited to a 30-minute presentation. In addition, both the Grievant and the Respondent have an opportunity to question the other party.
AAOS provides each COP member with all grievance material submitted by both the Grievant and the Respondent. The COP then meets to discuss the issues in each matter and determine whether a prima facie case exists. Such a finding would lead to a formal grievance hearing, based on the merits of the information received to support the allegations.
Prior to the grievance hearing, members of the hearing panel (the members of the COP) carefully review the grievance documents and prepare individual questions to aid them during deliberations.
At the grievance hearing, both the Grievant and the Respondent are allowed to present evidence, including witnesses if necessary, and be represented by counsel if desired. The hearing panel for these two cases included COP members Dale R. Butler, MD; Richard A. Brown, MD; Murray J. Goodman, MD; Michael H. Gordon, MD; William J. Hopkinson, MD; Vincent J. Silvaggio, MD; and Richard E. Strain, Jr., MD. It was chaired by Peter J. Mandell, MD, chair of the COP.
Also present at the grievance hearing were Russ Pelton, JD, and staff from the AAOS office of general counsel. No other guests or observers are permitted at grievance hearings.
The session is officially transcribed by a court reporter. The COP then meets in executive session to determine its final recommendations.
“Hearing Panel members questioned the Grievant and the Respondent during the presentations,” Dr. Mandell recalled. “The interactive nature of the hearings resulted in responses that we were able to weigh, along with printed material, during our deliberations.”
During its deliberations, the COP reached a provisional agreement on proposed professional compliance action. Later, the COP verified their findings against the official transcript. Finally, the panel approved a report summarizing critical grievance issues and consensus opinions reached during deliberations. This report, which contained the COP’s recommendations for professional compliance action, was sent to both the Grievant and the Respondent.
In one case, a letter appealing the COP’s recommendations was sent to the AAOS general counsel’s office, within the time limit stated in the Professional Compliance Program Grievance Procedures. The general counsel’s office advised both the Grievant and the Respondent that the appeal had been forwarded to the Judiciary Committee for its review.
Either party to a grievance may appeal to the Judiciary Committee based on a belief that the COP erred in its recommendations for professional compliance action. No new material may be introduced at an appeal hearing. Appealing to the Judiciary Committee is required if either the Grievant or the Respondent wishes to make a direct appeal to the Board of Directors (BOD).
The Judiciary Committee, chaired by Richard D. Schmidt, MD, conducted the appeal hearing. Committee members Joseph C. DeFiore, MD; Richard A. Geline, MD; and Thomas M. Green, MD, as well as Mr. Pelton and staff from the AAOS office of general counsel, were present. The Grievant, accompanied by counsel, attended the appeal hearing. The Respondent submitted a written statement that was entered into the official transcript.
Members of the Judiciary Committee prepared for the hearing by reviewing all of the grievance documents as well as the COP’s recommendations for professional compliance action.
“Our charge was either to uphold the COP’s recommendations or to make our own recommendations for professional compliance action based on the information presented at the grievance hearing,” said Dr. Schmidt. Members of the Judiciary Committee were able to question the Grievant and consider his responses during their deliberations, which immediately followed the appeal hearing.
A Judiciary Committee report, detailing its recommendations to the BOD and approved by all Committee members present at the appeal hearing, was sent to both the Grievant and the Respondent. In addition, the AAOS general counsel’s office advised the parties that the matter would be presented to the Board at its next scheduled meeting.
Board of Directors
The Board met in executive session on Dec. 1, 2006, and considered the two grievances separately. One Board member recused himself from participating in one of the two grievances presented at the December meeting. None of the parties to either grievance was present at the Board meeting. Mr. Pelton, non-voting Council Chairs and staff members from the office of the general counsel were present to observe the proceedings, which were officially transcribed by a court reporter.
Drs. Mandell and Schmidt summarized their committees’ findings and recommendations and the Board reached its final decision with a secret, written ballot. Official professional compliance action taken by the BOD must be approved by at least two-thirds of the voting members present and voting.
The AAOS notifies the fellowship of all professional compliance actions taken by the Board of Directors through AAOS publications. In addition, notice of the professional compliance action is sent to the American Board of Orthopaedic Surgery (ABOS), the appropriate state orthopaedic society, state medical board, state licensing board, and, as appropriate, other medical associations. The AAOS also notifies the National Practitioner Data Bank (NPDB) of any professional compliance action relating to patient health or welfare, including expert witness testimony.