Tag Archives: HCQIA

Medical Staff Bylaws Are Not Contracts in Delaware

One of the fundamental issues in credentialing disputes is whether the Medical Staff Bylaws constitute contracts between the Hospital and the individual physicians.  If the Medical Staff Bylaws do constitute a contract, then the due process provisions contained in the Bylaws are guaranteed to the physician, regardless of the Health Care Quality Immunity Act (HCQIA). … Continue Reading

California Decision Allows Physician to Challenge Sham Peer Review as Whistleblower Retaliation

In Fahlen v. Sutter Central Valley Hospitals, the California Supreme Court found: A physician is not required to first exhaust his administrative remedies through the medical staff appeals process in order to challenge sham peer review as whistleblower retaliation; and Dr. Fahlen qualified as a whistleblower for purposes of the California Whistleblower Act. The California … Continue Reading

Louisiana Becomes Medical Staff Bylaws Equal Contract State

In Granger v. Christus Health Central Louisiana d/b/a Christus St. Francis Cabrini, the Louisiana Supreme Court ruled that medical staff bylaws are a contract between the hospital and a the medical staff member.  The court ruled: “In promulgating the Bylaws and in accepting the applications of the physicians who sought medical staff membership in their … Continue Reading

Court Allows Complaint Alleging Wrongful Data Bank Report as Intentional Infliction of Distress

Sheikh v. Grant Regional Health Center is another case in a growing body of evidence that courts are granting less leeway and protection to hospitals which abuse the HCQIA immunity and reporting protections. This is not a final decision awarding damages! It is only a decision by a Wisconsin federal district court rejecting the hospital’s motion … Continue Reading

Washington Court Denies HCQIA Immunity for Inadequate Investigation

The cases where hospitals are denied HCQIA immunity are few and far between, especially when that denial is predicated upon the due process requirement of HCQIA, because of the due process exception condoning procedures that are fair under the circumstances. In Smigaj v. Yakima Valley Memorial Hospital Association, the Washington Court of Appeals reversed a … Continue Reading

Physician Avoids HCQIA Presumption of Immunity

The presumption of immunity granted by the Health Care Quality Improvement Act (HCQIA) in peer review disputes is always a significant hurdle for physicians. In Zawislak v. Memorial Hermann Hospital System (which some readers may recognize from the excess benefit and physician recruitment IRS issues involving the hospital in the late 1990s), the hospital suspended Dr. … Continue Reading

US DC of Massachusetts Orders Production of Performance Evaluations to Medical Resident

In Gargiulo v. Baystate Health, Inc., Dr. Debra Gargiulo alleged that she was discriminated against on the basis of her age and disability by Baystate Health in violation of both federal and state law. As part of her claim, the plaintiff sought production of numerous documents relating to her records, evaluations and reports, as well as … Continue Reading

Lack of Adverse Final Outcome Not Necessarily a Valid Peer Review Defense

In Georgopoulos v. Humility of Mary Health Partners Inc., Dr. Georgopoulos was placed upon a six month surgical proctoring requirement because of extended operating times and excessive use of blood products.  In addition to many procedural defenses, Dr. Georgopoulos’s primary substantive defense is that his patient survival and freedom from major cardiac events were within … Continue Reading

Physician’s Clinical Privileges Suspended for Long History of Disruptive Conduct

The memorable lesson of Sternberg v. Nanticoke Memorial Hospital is that the Delaware Supreme Court upheld a grant of summary judgment to the hospital on the basis of immunity under the Health Care Quality Improvement Act (HCQIA), despite: ·         The physician was admittedly a competent orthopaedic surgeon; and ·         There had been no evidence of … Continue Reading

Medical Staff and Employment Issues Collide Again

The Mississippi State Appeals Court affirmed a summary judgment decision by a Mississippi State Court in the case of C. Jake Lambert, Jr. M.D. v. Baptist Memorial Hospital-North Mississippi, Inc. and Baptist Memorial Health Services, Inc.   Dr. Lambert was a medical staff member of Baptist Memorial Hospital (Hospital) and an employee of Baptist Memorial Health … Continue Reading

Professional Review Activity vs. Professional Review Action

The case of Wood v. Archbold Medical Center Inc., presents an interesting twist regarding HCQIA immunity. The holding basically provides that “professional review activity” is a lesser level of adverse activity and need not meet the due process standards of HCQIA in order for a hospital to retain HCQIA. In Dr. Wood’s situation, there were three … Continue Reading

Update: Discovery of Peer Review Records

Physician credentialing disputes often involve and may depend upon proof of “unequal treatment.” These situations arise when hospitals allege certain substandard performance or conduct by physicians, but the physician’s defense is that they are no different than anyone of the physicians, that the issues are common and that they are being discriminated against. In order to prove … Continue Reading

California Federal Court Denies Attorneys Fees in HCQIA Case

Fox v. Good Samaritan presents two interesting variations on issues commonly raised in peer review cases. The case originated 10 years ago and arises out of the suspension of Dr. Fox after he refused to designate a coverage physician with clinical privileges equal to his own. When Good Samaritan Hospital suspended his clinical privileges, following medical staff … Continue Reading

Patient Safety and Quality Improvement Act (PSQIA) May Change Federal Common Law Privilege

In KD v. United States, a decision by the United States District Court for the District of Delaware, both granting and denying a motion for a protective order in parts, indicates that PSQIA of 2005 has changed its opinion regarding the protection of peer review documents under federal common law privilege.  The opinion notes that … Continue Reading

Fundamental Fairness Trumps Technical Violations of Bylaws

In Ramamurthy v. JFK Medical Center and Solaris Health System the Appellate Division of the Superior Court of New Jersey affirmed a summary judgment dismissing Dr. Ramamurthy’s Petition for Injunctive Relief, which sought a court order prohibiting a suspension imposed by the hospital. Dr. Ramamurthy had argued at the trial court level that the hospital had … Continue Reading

Montana Physician Obtains Injunction Preventing National Practitioner Data Bank Report

The Montana Supreme Court held in John Doe, M.D. v. Community Medical Center that the Health Care Quality Improvement Act (HCQIA) does not preempt state law regarding injunction and breach of contract, thereby allowing the lower court to issue an injunction against Community Medical Center prohibiting it from issuing a Data Bank report regarding the … Continue Reading

Ad Hoc Medical Staff Committees Protected by HCQIA

In Feller v. Miriam Hospital, the Rhode Island Superior Court provides additional guidance regarding immunity protection pursuant to the Health Care Quality Improvement Act (HCQIA).  In that case, Dr. Joseph Feller was practicing at Miriam Hospital in Rhode Island. He encountered some disciplinary issues in 2002 and agreed to both monitoring by a hospital appointed panel … Continue Reading

Fourth Circuit Decision Identifies Importance of State Peer Review Immunity Statutes

In Isaiah v. WMHS Braddock Hospital Corporation and Memorial Hospital and Medical Center of Cumberland, the Fourth Circuit affirmed an order granting summary judgment against Dr. Isaiah in favor of WMHS Braddock Hospital on the basis that summary judgment was appropriate under both HCQIA and the Maryland statutes providing immunity for peer review activity (Md. … Continue Reading

Must Hospitals Provide Credentialing Information for Physicians?

  Is there a duty for a hospital to answer a credentialing inquiry from another institution? A hospital’s refusal to answer an inquiry presumably has the same impact as an employer’s refusal to answer a request for references: when the inquiring party receives no response, they presume, and usually rightly so, that the party to whom … Continue Reading

HCQIA Immunity Requires Due Process

In Hussein vs. Duncan Regional Hospital, United States District Court for the Western District of Oklahoma denied immunity under the Health Care Quality Improvement Act (HCQIA) to Duncan Regional Hospital because it terminated a physician’s privileges and reported him to the National Practitioners Data Bank (NPDB) without providing notice or an opportunity to be heard.  … Continue Reading