An Iowa Appellate Court has reversed the earlier trial court decision in Estate of Horst G. Blume v. Marian Health Center, first reported in the MedLaw Blog on April 9, 2007. 

The trial court previously held the hospital had breached the medical staff bylaws and was therefore excluded from the benefit of Health Care Quality Improvement Act immunity because it had failed to provide the due process procedures provided in its bylaws and required by the statute. The Appellate Court has reversed that decision on the basis that there were additional immunity provisions provided in the bylaws themselves, as follows:

“The practitioner extends absolute immunity to… the hospital… for any actions… taken… by this hospital… relating to… proceedings for suspension… of clinical privileges or for… revocation of appointment, or for any other disciplinary action.”

This case illustrates the unusual outcome where the court is actually enforcing the bylaws but the hospital has immunity nonetheless. The full text of the decision is attached in the link below.$File/blume.pdf

This is way too much immunity! One must ask why a medical staff would adopt bylaws including specific due process rights but also include a provision that the hospital is immune from violation of those rights. At least the much-maligned immunity provided by the Healthcare Quality Improvement Act requires compliance with due process procedures in order to qualify for immunity. 

Joint Commission MS 1.20, which is subject to intense review at this point, will provide hospital medical staffs the opportunity to reevaluate their bylaws. The medical staff leaders should make sure that these unlimited immunity provisions are not included in the bylaws.