Appeal of Disciplinary Action Policy

I. Purpose of policy

The purpose of this policy is to set forth a fair, reasonable and readily accessible policy and process for appeal of Disciplinary Actions by residents training in Graduate Medical Education (GME) training programs accredited by the Accreditation Council of Graduate Medical Education (ACGME).

II. Policy scope

This policy applies to all ACGME-accredited residency and fellowship programs at Dartmouth-Hitchcock (D-H).

III. Definitions

Resident: Any physician in an accredited graduate medical education program, including residents and fellows.

Designated Institutional Official (DIO): The individual in a sponsoring institution who has the authority and responsibility for all of the ACGME-accredited GME programs.

IV. Policy statement

  • A Resident who receives a notice of recommendation of Disciplinary Action (as defined in the Disciplinary Action Policy) will be permitted to appeal the recommended action in accordance with the procedure outlined herein.
  • D-H prohibits retaliation against an individual who, in good faith, appeals a Disciplinary Action or participates in the review or resolution of a Disciplinary Action under this policy.
  • No Report of Disciplinary Action Until Appeal Concluded or Appeal Rights Expired. No Report of Disciplinary Action Until Appeal Concluded or Appeal Rights Expired. As noted in the GME Disciplinary Action Policy, no report of Disciplinary Action to any outside entity, including but not limited to any certifying body, professional association, or other training program, may be made until the appeal process has concluded, any appeal rights have expired, or the Resident has withdrawn the appeal (unless any such disclosure is authorized in writing by the Resident or disclosed pursuant to compulsory legal process, in which case the Office of General Counsel should be consulted prior to such disclosure). The foregoing shall not prevent the Program or GME Office from notifying necessary persons or entities that the Resident is on leave for purposes of ensuring appropriate patient coverage.
  • A Resident may appeal Disciplinary Action recommended pursuant to the Disciplinary Action policy as follows:
    1. Initiating the Appeal
      1. Filing of Appeal with Graduate Medical Education Office:
        1. To initiate the appeal process, the Resident must submit a written request for appeal to the DIO within ten (10) days of receipt of the notice of recommendation of Disciplinary Action.
        2. Notice of request for appeal may be submitted by the Resident utilizing internal D-H electronic mail. After this time period, the Resident’s right to appeal is forfeited and the recommended Disciplinary Action shall become final.
      2. Convening and Constitution of Ad Hoc Appeal Panel:
        Within ten (10) days of receipt of the request for appeal by the DIO, the DIO or his/her designee will appoint an ad hoc review panel to hear the Resident’s appeal. The DIO or his/her designee shall select and form a panel consisting of the DIO or his/her designee, the Chief Medical Officer or his/her designee, a resident or fellow (not from the clinical department of the program in which the Resident participates), and two Program Directors (not from the clinical department of the program in which the Resident participates) or one Program Director and one physician faculty member (not from the clinical department or program in which the Resident participates) (hereafter called the “Panel”).
      3. Panel Chair:
        The Panel will be chaired by the DIO or his/her designee (the “Panel Chair”). No person who has actively participated in the initiation or recommendation of the Disciplinary Action or who has personal direct knowledge of the facts underlying the basis for the proposed Disciplinary Action shall be appointed to the Panel. Personal direct knowledge means that the person has either witnessed the facts in question underlying the proposed adverse action, or has first-hand knowledge of the Resident’s performance (e.g., participated in evaluation of the Resident and such evaluation is a basis for the proposed Disciplinary Action).
      4. Scheduling of Hearing:
        The GME Office will schedule the appeal hearing and notify the Panel of the hearing date. The appeal hearing should occur within fifteen (15) days of appointment of the Panel. The Panel Chair may, upon written request of either the Resident or the Program Director, for good cause shown, or on his/her own for other reasonable reasons, extend or reschedule the hearing date. Any extension of the hearing date shall require the generation of a new hearing notice.
      5. Notice of Hearing:
        The GME Office will send a hearing notice to the Resident and Program Director. The hearing notice will contain the names of the Panel members; the date, time, and location of the appeal hearing; and the deadline to submit evidence. The GME Office will send the notice at least ten (10) days’ prior to the hearing date. This notice requirement to the Resident may be met by regular US Postal Service with a copy to the Resident’s Dartmouth-Hitchcock e-mail address. Notice to the Program Director may be accomplished via Dartmouth-Hitchcock email.
      6. Withdrawal of Appeal:
        The Resident may, at any time, withdraw the appeal by informing the DIO in writing of his/her decision to withdraw the appeal. The withdrawal of the appeal shall become binding immediately upon receipt of a withdrawal of the appeal by the DIO. Once withdrawn, an appeal may not be reinstated.
    2. Evidence
      1. Any written evidence that the Resident or the Program Director wishes the Panel to consider must be submitted to the GME Office at least five (5) days prior to the appeal hearing date. Failure to submit evidence in the time and manner required by the GME Office may result, at the discretion of the Panel Chair, in the material not being considered by the Panel.
      2. The GME Office will facilitate the exchange of evidence between the Resident and the Program Director and will provide copies of all evidence to the Panel.
      3. Witnesses:
        The Resident and the Program Director may invite up to three (3) witnesses each to present before the Panel. The Resident and Program Director may also ask others not invited to speak to submit written statements which must be submitted to the GME Office at least five (5) days prior to the hearing date. Failure to submit written statements in the time and manner set forth herein may result, at the discretion of the Panel Chair, in the material not being considered by the Panel.
    3. Appeal Hearing
      1. The Resident must be physically present at the hearing. Failure by the Resident to be present in person shall be deemed a withdrawal of the appeal by the Resident.
      2. The Panel chair has wide discretion with respect to conducting the appeal hearing. In general, appeal hearings will proceed according to the following format:
        1. The Program Director may make a presentation to the Panel up to twenty (20) minutes. The Program Director shall then have an opportunity to present witnesses.
        2. The Resident may make a presentation to the Panel up to twenty (20) minutes. The Resident shall then have an opportunity to present witnesses.
        3. The Program Director and the Resident will each have the opportunity to ask questions of the other’s witnesses.
        4. The Program Director and the Resident will each have up to ten (10) minutes to respond to the statements made by the other.
        5. At any time during the hearing, the Panel may ask questions of witnesses, the Resident and/or the Program Director.
        6. The Panel may also, at its sole discretion and without special notice, recess the hearing and reconvene later in order to study new evidence presented during the hearing.
      3. Neither the Resident nor the Program Director may be assisted or represented during the appeal hearing by counsel. Nothing in this policy shall be construed as prohibiting either the Program Director or the Resident from soliciting the advice of counsel at any time before or after the hearing. No inference may be drawn against an individual as a result of that individual’s having sought the advice of counsel.
      4. Appeal hearings are confidential. Only participants as outlined in this policy and Panel members may attend. The hearing may not be audio or video recorded, though general minutes shall be maintained by the Panel chair or its designee. To the greatest extent permitted by law, hearing minutes shall be confidential and protected under New Hampshire Quality Assurance statutes or other state and federal confidentiality laws.
      5. The hearing is not controlled by legal rules of evidence or procedure. The Panel shall consider such evidence as reasonable persons are accustomed to rely on in the conduct of serious affairs. The Panel shall decide all other procedural matters not specified in this policy. The Panel and Dartmouth-Hitchcock may rely on and accept as true, any finding of fact contained in a final decision by the applicable licensing, certifying, or regulatory authority.
    4. Deliberation and Decision
      1. Following the appeal hearing, the Panel shall deliberate privately.
      2. If the Panel determines that additional meetings are required after the initial appeal hearing above, a final determination by the Panel must be made within twenty (20) days of the initial hearing meeting.
      3. The final decision as to whether to uphold, modify, or reverse the proposed Disciplinary Action will be made by a majority vote of the Panel members. A decision to uphold the recommended Disciplinary Action may be made by the Panel upon a finding that the recommended Disciplinary Action is reasonable under the circumstances.
      4. The Panel will prepare a written decision setting forth its conclusions and reasoning in support of those conclusions.
      5. The Panel’s decision will be sent to the Resident, the Program Director and the DIO within ten (10) days after the final determination of the Panel.
      6. The decision of the Panel shall be final and binding.
      7. The Panel’s decision must be documented in the Resident’s file in MedHub.
    5. Legal Actions
      • No legal action concerning Disciplinary Action may be brought by a Resident unless and until:
        • The Resident has filed a written request for an appeal of the recommended Disciplinary Action following the procedure and within the time prescribed above; and
        • The Resident has been notified in writing of the decision of the Panel or the Panel has failed to take any action on the Resident’s written request for appeal within the time prescribed above.
    6. Time Limits and Computation of Time
      1. Time Limit: Time limits set forth in this policy must be adhered to by both the Resident and D-H unless extended for good cause at the discretion of the DIO or his/her designee. A Resident who fails to meet the time limits for submitting a request for an appeal hearing shall forfeit his/her right to an appeal. A Resident who fails to appear at a hearing will be deemed to have withdrawn the appeal. In either case (failure to file an appeal or failure to appear) further legal action is precluded.
      2. Computing Time: The following rules apply in computing any time period specified in this policy:
        1. When the period is stated in days or a longer unit of time:
          1. Exclude the day of the event that triggers the period;
          2. Count every day, excluding intermediate Saturdays, Sundays, and legal holidays; and
          3. Include the last day of the period, but if the last day is a Saturday, Sunday, or legal holiday, the period continues to run until the end of the next day that is not a Saturday, Sunday, or legal holiday.
        2. If the period would end on a Saturday, Sunday, or legal holiday, the period continues to run until the same time on the next day that is not a Saturday, Sunday, or legal holiday.
        3. Legal holidays are those designated as such by Dartmouth-Hitchcock policy.
    7. Reporting Requirements
      • Under New Hampshire law, certain actions involving physician discipline or adverse action must be reported to the Board of Medicine. In addition, behavior incompatible with the role of a physician including illegal, immoral or unethical behavior must also be reported to the Board of Medicine. Required reports shall be made by D-H following the conclusion of the appeal process, if invoked by the Resident, or following conclusion of the time period for the Resident to request an appeal (pursuant to the Appeal of Disciplinary Action Policy). The DIO is designated as the Dartmouth-Hitchcock representative who will make required reports in connection with GME matters to the New Hampshire Board of Medicine. The DIO is encouraged to consult with the Office of General Counsel for guidance in making required reports.

D-H Policy ID: 11322