The process of peer review is governed by the hospital bylaws.
a.    Complaint is given to the department head to which the physician is involved.  Informal process.  The department head, either b/c of repeated violations, or if particular egregious, or if administrations thinks particular egregious, then the process may be elevated.
b.    If the complaint does not go beyond the department head, it is more informal.  In informal process, physician does not need an attorney; the action will not be reported to the board or state.  If physician resigns, it is not reported.
c.    Once it goes past the department head, the process is more formal.  Then everything must be reported to the state and national boards.
(1)    There is an ad-hoc committee.
(2)    Physician gets notice, is called in, and the committee decides what to do.
(3)    Committee may receive testimony of experts, etc.
(4)    Doctor can attend hearing and bring an attorney.
(5)    Ad hoc committee, which is part of the credentialing committee then makes its recommendation to the executive committee.
(6)    If limitations are for more than 30 days, it has to be reported to the state board of medical examiners.  Texas doesn’t even care about the number of days.  If limitation to physician’s privileges at all, then it is reported to the Texas State Board of Medical Examiners.