Aug. 25, 2020  
Department of Licensing and Regulatory Affairs  
Bureau of Professional Licensing, Boards and Committees Section  
Public Health Code - Disciplinary Rules  
ARS #2019-104 LR  
Attention: Policy Analyst  
P.O. Box 30670  
Lansing, MI 48909  
BPL-BoardSupport@michigan.gov  
On behalf of Sparrow Health System, I respectfully submit the following comments on the  
proposed Public Health Code - Disciplinary Rules.  
Under the “Historical Records” section, Sparrow strongly opposes the proposed rule that  
would authorize the department “to obtain and maintain,” as part of a licensee’s or  
registrant’s individual historical record, “reports or information from a professional peer  
review organization.” [R 338.1603(a)].  
This proposed rule is contrary to Michigan’s peer review statutes. Under existing law, the  
reports and information of a professional peer review organization are confidential and  
protected against disclosure. The Michigan Supreme Court has ruled that these statutory  
protections prohibit the Department from obtaining records, data, and knowledge  
gathered by or for individuals and committees with assigned review functions. In  
particular, the Supreme Court held that the department cannot obtain protected  
information for use in carrying out its responsibilities under Article 15 of the Public Health  
Code, which includes MCL 333.16211, the statute governing permanent historical  
records.  
This proposed rule is inconsistent with Michigan’s strong commitment to patient safety  
and quality improvement. Data gathered by a licensed health facility for quality  
improvement or professional practice review purposes should not be included in a  
licensee’s or registrant’s historical record. The confidentiality protections for information  
collected for quality improvement enable providers to work to improve patient safety and  
reduce the incidence of adverse events. Professional practice evaluation is the process by  
which a health facility, using its own medical staff, performs a peer review of a  
practitioner's professional practice for performance improvement and to ensure safe and  
high-quality patient care.  
As the Michigan Supreme Court has frequently emphasized, the assurance of  
confidentiality provided by the peer review statutes is essential to the candid and  
conscientious assessment of clinical practice and patient safety. Disclosure of information  
collected and evaluated by professional peer review organizations would be a significant  
and undesirable threat to the confidentiality essential to effective peer review. The threat  
is further aggravated because a licensee or registrant is entitled to review his or her  
historical record under MCL 333.16211(6). The licensee or registrant would be free to  
publicly and widely disclose the confidential peer review information.  
We understand that individual historical records can be obtained, with certain exceptions,  
through the Freedom of Information Act. Unlike other information in a historical record  
that is specifically exempt from FOIA disclosure, such as participation in the Health  
Professional Recovery Program, it is not at all certain that peer review information would  
be protected against public disclosure.  
The prospect that the Department, the licensee, and even the public, could obtain the  
confidential information collected and evaluated by a professional peer review  
organization would undermine the critical process used to promote and improve the  
safety and quality of patient care in Michigan.  
Sincerely yours,  
John A. Shaski  
Government Relations Officer  
Sparrow Health System  
August 25, 2020  
Department of Licensing and Regulatory Affairs  
Bureau of Professional Licensing  
Boards and Committees Section  
Public Health Code - Disciplinary Rules  
ARS #2019-104 LR  
Attention: Policy Analyst  
P.O. Box 30670  
Lansing, MI 48909  
Re: Public Health Code – Disciplinary Rules  
Submitted electronically to BPL-BoardSupport@michigan.gov  
To Whom It May Concern:  
On behalf of Henry Ford Health System (HFHS), I respectfully submit the following comments on the  
proposed Public Health Code - Disciplinary Rules.  
HFHS is a Michigan-based, not-for-profit corporation and one of the nation’s largest, integrated health care  
systems, with over 33,000 employees, headquartered in Detroit, where we have been committed to  
improving the health and well-being of the community for over 100 years. HFHS offers health care services  
across the continuum through a diverse network of facilities in Southeast Michigan (Metro Detroit) and  
South Central Michigan (Jackson). In the Detroit area, HFHS includes five acute-care hospitals, including our  
flagship hospital - Henry Ford Hospital - a large academic located within the city of Detroit, an inpatient  
psychiatric facility, and a network of outpatient medical facilities staffed by members of the Henry Ford  
Medical group (HFMG). HFMG is a salaried, multi-specialty group practice of some 1,200 clinicians, and has  
been fully integrated in administrative, clinical, and medical information functions with Henry Ford Hospital  
(HFH).  
HFHS’s main concern is that the proposed rule contains provisions that impact individual and health care  
facility rights, with a potentially chilling effect on peer review. We believe this will negatively impact patient  
safety and quality of care improvement activities throughout the system.  
Specifically, HFHS is opposed to the provision that would provide authorization to the Department to  
“obtain and maintain reports or information from a professional peer review organization” as part of a  
licensee or registrant’s individual historical record. This goes against Michigan’s current peer review  
regulations, which indicate that the reports and information of a professional peer review organization are  
confidential and cannot be disclosed. This statutory protection blocks the Department from accessing  
records, data, and knowledge gathered by or for individuals and committees with assigned review  
functions.  
The proposed rule conflicts with HFHS’ commitment to patient safety and quality improvement activities.  
Data collected by a licensed health facility for quality improvement or peer review purposes should be  
omitted from a licensee or registrant’s historical record, not only due to the current Michigan peer review  
statutes, but because we believe that this information could be misinterpreted. Our concern is that the  
potential misinterpretation of this data if shared with the Department may deter health care providers  
from obtaining candid data for quality improvement purposes and providing honest peer reviews, which  
could have a negative impact on patient safety and quality of care.  
We agree with the Michigan Health & Hospital Association’s (MHA’s) assessment that the prospect that the  
Department, the licensee/registrant, and even the public, could obtain the confidential information  
collected and evaluated by a professional peer review organization would undermine the critical process  
used to promote and improve the safety and quality of patient care not only at HFHS, but across the state.  
Thank you again for the opportunity to comment on the proposed rule.  
Sincerely,  
Michelle Johnson Tidjani, Esq.  
Senior Vice President, General Counsel & Corporate Secretary  
Henry Ford Health System  
2
Aug. 25, 2020  
Department of Licensing and Regulatory Affairs  
Bureau of Professional Licensing  
Boards and Committees Section  
Public Health Code - Disciplinary Rules  
ARS #2019-104 LR  
Attention: Policy Analyst  
P.O. Box 30670  
Lansing, MI 48909  
BPL-BoardSupport@michigan.gov  
Greetings:  
On behalf of the Michigan Health & Hospital Association (MHA), we respectfully submit the  
following comments on the proposed Public Health Code - Disciplinary Rules.  
Under the “Historical Records” section, the MHA strongly opposes the proposed rule that would  
authorize the department “to obtain and maintain,” as part of a licensee’s or registrant’s  
individual historical record, “reports or information from a professional peer review organization.”  
[R 338.1603(a)].  
This proposed rule is contrary to Michigan’s peer review statutes. Under existing law, the  
reports and information of a professional peer review organization are confidential and protected  
against disclosure. The Michigan Supreme Court has ruled that these statutory protections  
prohibit the Department from obtaining records, data, and knowledge gathered by or for  
individuals and committees with assigned review functions. In particular, the Supreme Court  
held that the department cannot obtain protected information for use in carrying out its  
responsibilities under Article 15 of the Public Health Code, which includes MCL 333.16211, the  
statute governing permanent historical records.  
This proposed rule is inconsistent with Michigan’s strong commitment to patient safety and  
quality improvement. Data gathered by a licensed health facility for quality improvement or  
professional practice review purposes should not be included in a licensee’s or registrant’s  
historical record. The confidentiality protections for information collected for quality improvement  
enable providers to work to improve patient safety and reduce the incidence of adverse events.  
Professional practice evaluation is the process by which a health facility, using its own medical  
staff, performs a peer review of a practitioner's professional practice for performance  
improvement and to ensure safe and high-quality patient care.  
As the Michigan Supreme Court has frequently emphasized, the assurance of confidentiality  
provided by the peer review statutes is essential to the candid and conscientious assessment of  
clinical practice and patient safety. Disclosure of information collected and evaluated by  
professional peer review organizations would be a significant and undesirable threat to the  
confidentiality essential to effective peer review. The threat is further aggravated because a  
licensee or registrant is entitled to review his or her historical record under MCL 333.16211(6).  
The licensee or registrant would be free to publicly and widely disclose the confidential peer  
review information. MHA has consulted with health law counsel and understands that individual  
historical records can be obtained, with certain exceptions, through the Freedom of Information  
Act. Unlike other information in a historical record that is specifically exempt from FOIA  
disclosure, such as participation in the Health Professional Recovery Program, it is not at all  
certain that peer review information would be protected against public disclosure.  
The prospect that the Department, the licensee, and even the public, could obtain the  
confidential information collected and evaluated by a professional peer review organization  
would undermine the critical process used to promote and improve the safety and quality of  
patient care in Michigan.  
Please reach out to me with any with questions.  
Respectfully submitted,  
Amy Barkholz  
General Counsel & Board Secretary  
Michigan Health & Hospital Association  
(517) 703-8632  
abarkholz@mha.org  
;