Hospital Internal Investigations in PA & How a Lawyer Can Save Your License

An Investigation May Start “Routine,” But They Can Cost You Your License

You’re a nurse at Jefferson, a physician at Temple, or an advanced practice provider on the front lines at Main Line Health. Then, you receive a message: “We’d like to meet about a patient safety concern.” There’s no mention of discipline. No use of the word “investigation.” But make no mistake, your professional future may already be in jeopardy.

In Pennsylvania, internal hospital inquiries often begin quietly but escalate quickly. What starts as a seemingly routine review can rapidly snowball into a formal investigation, loss of privileges, referral to the State Board, or even a report to the National Practitioner Data Bank (NPDB)—a mark that can follow you for life.

That’s why healthcare professionals across Greater Philadelphia turn to Fienman Defense when their license, reputation, and career are on the line. Attorney Michael Fienman has over a decade of experience defending doctors, nurses, and other licensed professionals to navigate peer review proceedings, avoid NPDB reporting, and address criminal charges when necessary.

Don’t wait until it’s too late. Call counsel the moment the first email arrives. Contact Fienmn Defense for a free and confidential consultation.

What Triggers a Hospital Internal Investigation?

Internal investigations don’t always begin with some dramatic event. Often, they’re sparked by a vague concern, a box checked in a chart review, or a whispered comment in a team meeting. But once Risk Management or HR gets involved, things can move fast.

Here are a few common scenarios that trigger hospital investigations in Pennsylvania:

Patient Safety Events

Let’s say you managed a high-acuity care case that didn’t go as planned. While a bad outcome alone doesn’t imply fault, hospitals must investigate. Even when you followed protocol, if someone perceives a lapse in judgment, communication, or documentation, you could become the focus of a broader internal review.

Unexpected Patient Death or Rapid Deterioration

If a patient unexpectedly codes, deteriorates post-op, or dies during your shift, your involvement may be scrutinized, especially if documentation is sparse or there’s a delay in care that raises eyebrows.

Medication Errors or Charting Discrepancies

Whether it’s a misdose, omission, or inconsistency in your documentation, even small charting errors can trigger pharmacy audits and deeper dives into your clinical decision-making. EMR flags, override logs, or mismatched MAR entries are common launch points for review.

Co-Worker Complaints

Even if you meant no harm, hospitals treat interpersonal complaints involving harassment, bullying, or unprofessional conduct seriously—especially when they involve hierarchy, gender, race, or team cohesion. These “behavioral” concerns are among the most common (and subjective) triggers.

Anonymous Hotline Reports

Hospitals maintain compliance hotlines that allow anyone, from staff, patients, and families, to report concerns. A vague complaint like “Dr. Smith seems impaired” or “That nurse rushed care” can trigger a formal investigation, even if there’s no specific allegation.

Impairment Concerns: Substance Use, Burnout, or Fatigue

If someone suspects you’re impaired, even without proof, you may be reported to a wellness or monitoring program. Slurred speech, a missed med pass, showing up late, or seeming “off” during a shift can raise red flags, even if the cause is exhaustion or stress.

Deviation from Protocol

Imagine you performed a procedure solo that normally requires a team or skipped a required consent step during a rushed call. Even seasoned providers can fall outside the lines, and hospitals will assess whether the deviation was justified or potentially negligent.

Controlled Substance Handling or Prescribing Irregularities

Frequent overrides of automated medication dispensing machines (e.g., Pyxis), missing narcotics, or prescribing patterns that raise internal analytics can lead to pharmacy audits and disciplinary inquiries, especially amid the opioid crisis.

Credentialing, Reappointment, or CME Shortfalls

If you miss a deadline for CME reporting, have gaps in credentialing paperwork, or have a flagged malpractice history on a reappointment application, hospitals may open a formal review even if the underlying issue is clerical.

Patient or Family Complaints

A family member calls the administration about perceived rudeness or lack of communication. A discharged patient files a grievance over their care. Even if the complaint is subjective or unfounded, it often becomes part of your personnel or credentialing file and may trigger a deeper inquiry.

Remember, internal investigations often begin with low-visibility events but rarely stay small. If you’re under scrutiny by people you’ve never met, and your professional standing is at stake, it’s in your interests to discuss the matter with an attorney of your own.

What To Do in the First 24 Hours of a Hospital Investigation

When you’re first notified, whether by email, an informal hallway conversation, or a meeting request from Risk Management, your reaction in those first 24 hours is critical. This is not the time to explain, speculate, or assume good intentions.

Step 1: Call a Healthcare Defense Attorney

Hospitals assemble legal and compliance teams quickly. What you say in the first 24–48 hours often shapes the entire trajectory of the case, and missteps early on can’t always be undone. Before speaking to HR, Risk Management, or your department head, call an attorney who handles hospital investigations and professional license defense in Pennsylvania.

Being cooperative” doesn’t mean waiving your rights. Strategic silence is often the best protection.

Preserve Every Relevant Record

Start your own documentation immediately—before memories fade or evidence disappears.

• Save all emails, meeting invites, and internal messages.
• Take detailed notes after every conversation or event (with dates/times).
• Avoid discussing the issue via text or email with colleagues—those messages can be used against you.
• Record any steps you took during the incident (e.g., chart entries, shift handoffs).

A clear, timestamped record can become your strongest defense later.

Clarify the Meeting’s Purpose & Your Rights

Before attending any meeting, ask three questions:

• Is this voluntary or mandatory?
• Is it investigatory or performance-based?
• Could it lead to discipline or licensure consequences?

These answers affect whether you can remain silent, request legal counsel, or involve a union representative. Never assume it’s “just a conversation.”

If the meeting could impact your license, privileges, or job, it’s best to treat it like a legal proceeding and involve an attorney early.

 Your Rights in an Internal Hospital Investigation

During a hospital investigation in Pennsylvania, your rights aren’t always obvious, and in some cases, they depend entirely on who your employer is and whether you’re unionized. Misunderstanding can lead to self-incrimination, waived protections, or career-ending outcomes.

Here’s how it usually breaks down:

Private Hospitals (e.g., Jefferson, Main Line Health, Penn Medicine)

If employed by a private hospital, you do not have constitutional Fifth Amendment protections during internal investigations. Refusing to answer questions or declining a meeting may be grounds for termination.

In these situations, it’s best to work with your attorney to limit the scope of questioning, request confidentiality, or negotiate interview conditions that minimize legal exposure.

Public Hospitals (e.g., Temple, VA, County facilities)

At public institutions, your statements can implicate both disciplinary and criminal consequences. Two legal doctrines may apply:

• Garrity Warning: If your participation is voluntary, anything you say can be used against you in criminal court.
• Kalkines Warning: If your participation is compelled, your statements receive criminal immunity—but they can still be used for disciplinary action (including termination or license referral).

Often, the warning you receive determines your rights. Never assume immunity unless your lawyer confirms.

Union Employees (Nurses, Techs, Support Staff)

If you’re part of a union, and the meeting is investigatory and could reasonably lead to discipline, your Weingarten rights usually apply. This means that you can request that a union representative be present. However:

• Optional meetings may not trigger representation rights.
• You must affirmatively request your union rep. Having one is not automatic.

Internal Healthcare Investigations: The Bottom Line

As you can see, your rights in a hospital investigation aren’t one-size-fits-all. They hinge on where you work (private vs. public), how the meeting is structured (voluntary vs. compelled), and whether you’re entitled to union representation. Misreading these factors can put your license and your livelihood at risk.

So, your first move should not be reactive, whether you’re facing peer review, a compliance inquiry, or a disciplinary hearing. Fienman Defense routinely helps healthcare professionals across Pennsylvania understand their rights, assert them, and avoid irreversible missteps.

Due Process, Peer Review & Fair Hearings for Healthcare Workers

Learning that you’re under investigation is jarring enough, and knowing what to expect is hard. And while you might expect “due process” from the outset, many of your rights as a healthcare worker under federal and state law don’t kick in until much later in the peer review timeline.

What is the Health Care Quality Improvement Act?

The Health Care Quality Improvement Act (HCQIA) provides baseline due process rights only during formal peer review proceedings. These include:

• Advance notice of allegations
• The right to present evidence in your defense
• Legal representation during hearings
• The ability to cross-examine witnesses
• A written report with findings and conclusions

These rights typically don’t apply in early-stage inquiries like “informal” interviews, root cause analyses, or quality assurance reviews. At those points, you may be questioned without counsel, without access to the evidence or allegations.

Is Root-Cause Analysis Protected Under PRPA?

In Pennsylvania, many healthcare professionals assume that internal documents like QA memos, peer notes, and root-cause summaries are protected under the Peer Review Protection Act (PRPA). But PRPA only protects records that meet very specific legal criteria:

• They were created by or for a designated peer review committee
• They are for the sole purpose of peer review
• The documents are in strict compliance with the statute’s procedural requirements

If a document doesn’t meet all three, it may appear later in malpractice litigation or state disciplinary proceedings.

What’s the National Practitioner Data Bank & Why You Should Care?

The National Practitioner Data Bank (NPDB) is a federal database that tracks nationwide adverse actions against healthcare providers. Hospitals, credentialing bodies, and state boards use it regularly.

The NPDB reports include:

• Suspensions or restrictions on privileges longer than 30 days
• Voluntary resignations during investigations
• Adverse license actions (including reprimands or probation)
• Medical malpractice judgments or settlements

A single report can follow you for the rest of your career and limit your ability to get hospital privileges or employment, even if you were never criminally charged. Therefore, every decision you make during an internal investigation, from submitting a statement to signing a settlement, should be evaluated through an NPDB lens.

What Are the Hospital Investigation Red Flags to Watch For?

Not every internal meeting means you’re in trouble, but certain situations should immediately raise concern. If any of the following occur, it’s a signal that your hospital may already be building a disciplinary record, preparing to report you to the State Board, or contemplating NPDB reporting.

You’re Told the Meeting Is “Voluntary”—But They Ask About Clinical Decisions

It might sound casual: “We just want to clarify what happened with that trauma patient last Tuesday.” But if the questions shift into clinical care, patient outcomes, or policy deviations, this is no longer a friendly check-in. Hospitals often label meetings “non-disciplinary” to bypass formal protections, but that doesn’t mean your answers are without consequences.

You’re Asked for a Written Statement—Before You Know the Charges

Hospitals may ask for a “summary of events” or “clarification memo” without telling you what you’re accused of. This often happens early, under the guise of fairness or quality assurance. But anything you submit may be entered into your personnel file, shared with peer review, or used against you in licensing board inquiries.

You’re Denied Legal or Union Representation

Stop immediately if you ask to bring legal counsel or a union rep and the request is denied. Voluntary meetings mean you can walk away. And if it’s investigatory, you may have enforceable rights under your union contract or hospital policy.

You’re Contacted by the Police or an External Investigator

If law enforcement, Medicaid fraud investigators, or third-party auditors reach out to you, even informally, you should assume the matter may involve criminal exposure. Hospitals will often cooperate fully with these agencies, and what you say to one can be subpoenaed by the others.

The Hospital Mentions Suspension, Emergency Review, or Peer Committee Referral

These terms indicate you’ve entered a formal disciplinary track. Whether labeled “precautionary,” “administrative,” or “pending investigation,” a suspension, even a temporary one, can trigger a mandatory NPDB report and often leads to state licensing board scrutiny.

In each of these cases, calling a healthcare defense attorney is not optional; it’s essential.

How a Lawyer Can Help Protect Or Even Save Your License

In short, a qualified healthcare defense attorney isn’t just reacting to a crisis if you’re under investigation. They’ll actively work to shape the outcome. For Pennsylvania healthcare professionals, calling an attorney early could mean the difference between clearing your name and losing your career.

Here’s what an experienced attorney like Michael Fienman can do for you:

• Analyze the Risk Early: Attorneys can spot red flags in meeting notices, email language, and hospital procedure that often signal an escalation—even before you’re formally notified.
• Control the Narrative: From written responses to internal memos, everything you say or submit can be used against you. A lawyer helps you craft strategic language that clarifies facts without making self-incriminating admissions.
• Negotiate with Risk Management & HR: A lawyer can often limit the scope of questioning, request confidentiality, or advocate for non-disciplinary resolutions behind the scenes.
• Prepare You for Interviews or Hearings: Legal counsel can help you practice answering questions, understand what’s likely to be asked, and avoid landmines that could trigger NPDB reports or board referrals.
• Mitigate Disciplinary Consequences: If allegations are substantiated, your attorney can negotiate consent agreements, diversion programs, or settlement terms that protect your license and reputation.
• Prevent NPDB or Licensing Board Fallout: Strategic timing, voluntary actions, and legal framing can often avoid mandatory reporting—if handled proactively.
• Coordinate Criminal Defense if Needed: If the investigation overlaps with potential criminal issues (e.g., fraud, drug diversion, patient harm), your healthcare lawyer can seamlessly coordinate with criminal defense counsel to protect your rights across all fronts. 

FAQs: Internal Healthcare Investigations

Can I “Plead the Fifth” in a Private Hospital Investigation in PA?

The Fifth Amendment only applies to government actions, and not private employers. Suppose you refuse to answer questions during an internal investigation at a private hospital. In that case, it can be treated as insubordination and may result in termination, even if you try to avoid self-incrimination.

What If I Work at a Public Hospital—Do Garrity or Kalkines Protect Me?

Yes, but it depends on the type of warning issued. Under a Garrity warning, participation is voluntary, and anything you say can be used in a criminal case. Under a Kalkines warning, your statements are compelled and can’t be used criminally—but they can still be used for internal discipline or license action. Always ask what warning applies before speaking.

Do I Get a Lawyer in a Peer-Review Hearing?

If the hearing falls under the formal protections of HCQIA, you’re entitled to legal counsel, the opportunity to present evidence, and a written decision. However, many early-phase reviews like chart audits, QA meetings, or “peer discussions” may not permit legal representation. That’s why hiring a lawyer early is critical.

Can My Union Rep Attend a Peer-Review Interview?

Only if the meeting is investigatory and disciplinary action is a reasonable outcome. This is protected under Weingarten rights, but voluntary meetings or informal reviews may not qualify. You must affirmatively request union representation—it is not automatic.

Should I Go to the Meeting If I Haven’t Been Told What It’s About?

No, not without first clarifying the purpose. You have a right to know if the meeting is voluntary or mandatory, and whether it’s investigatory. You should speak to a healthcare defense attorney before attending if it could lead to discipline or licensure consequences.

Am I Required to Submit a Written Statement?

No, but hospitals often request one. Submitting a written statement without reviewing the bylaws, policies, or the nature of the complaint can be risky. Written responses may be used against you by licensing boards, in peer review, or even in court. Always consult with your attorney first.

Will This Be Reported to the State Licensing Board?

Possibly. If the investigation results in disciplinary action, suspension, resignation under review, or any impairment concerns, the hospital may report it to your licensing board. This is why every step—from what you say to what you sign—should be reviewed by counsel.

What If I’ve Already Signed Something?

You may still have options. Do not assume the issue is closed or you waived all your rights. An attorney can assess whether your statement or agreement is enforceable, and help mitigate any downstream impact (such as licensing or NPDB exposure).

Can They Suspend Me Without a Hearing?

Yes. Many hospitals have summary suspension powers that allow immediate action when patient safety is at stake. However, this usually triggers a formal review process. Legal intervention at this point can help you challenge the basis for suspension and preserve your license.

Should I Resign Before Things Escalate?

Not without speaking to an attorney. A resignation during investigation may be reported to the NPDB and your licensing board—even if no formal charges were filed. This can impact your ability to work elsewhere. Strategic exit planning should always involve legal counsel.

What If the Issue Involves Criminal Allegations, Like Fraud or Drug Diversion?

You need a lawyer immediately, not just for licensure defense but for criminal defense. Do not give any written or verbal statements until you’ve consulted an attorney. Hospitals may coordinate with law enforcement or state agencies without telling you.

Your Medical License Deserves a Stellar Defense

If you’re facing a hospital investigation in Pennsylvania, you’re not just dealing with HR. You’re facing a process that can trigger discipline, licensure action, NPDB reporting, or criminal exposure.

Since 2010, attorney Michael Fienman has represented healthcare professionals across Pennsylvania, including Philadelphia, Montgomery, Delaware, and Bucks Counties, as well as Harrisburg, York, Hershey, Scranton, and Pittsburgh, helping them protect their licenses, reputations, and careers. He also frequently assists nurses and other licensed health professionals who live or work outside Pennsylvania but face disciplinary actions reported back to the Pennsylvania licensing boards.

From trauma teams at Jefferson and Main Line Health to surgical staff at Temple and community-based practices, Fienman Defense has guided providers through internal reviews, peer proceedings, and formal board investigations with discretion and proven results.

Our Record Protecting Licensed Professionals

• Psychiatrist Keeps License After Ethics Complaint: Our client was accused of inappropriate dispensing. The complaint was dismissed without disciplinary action after presenting evidence of proper procedures and professional conduct.
• Nurse Avoids Suspension After DUI Charge: Despite a recent conviction, we negotiated terms with the State Board of Nursing that allowed the nurse to keep working under probation with mandatory counseling.
• Real Estate Agent Retains License After Client Complaint: A dispute with a client could have resulted in a suspension. Our defense showed the agent complied with all industry standards, and the board closed the case.
• Physician Assistant Protects Career & Avoids Charges: Attorney Fienman defended a Central PA Physician Assistant caught in a DEA probe after her supervising doctor mishandled narcotics. By managing the hospital investigation and negotiating with DEA agents, he preserved her job, avoided disciplinary action, and protected her license.

Call Fienman Defense Today

Whether you’re being asked for a written statement, called into a meeting without details, or told you’re “not under investigation,”—don’t go it alone. Fienman Defense offers free, confidential consultations to help you understand your rights, respond strategically, and avoid irreversible damage. Call (215) 839-9529 or contact us online for a free and confidential consultation.