Participants in the hospital peer review process enjoy enormous protections under federal and state law. We contend that these protections—immunity, evidentiary privilege, and confidentiality—impede quality improvement in health care. As a result of these protections, the current peer review system produces both improper severity and improper leniency. We propose to reform the system by eliminating all federal and state statutory protections for the peer review process. A public process that is open to review and open to challenge by all interested parties will better promote health-care quality.