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 physician summary suspension. 

The basic facts of this case are that a physician was investigated for ordering tests for family members. During the hospital’s investigation regarding this issue, the investigating committee concluded that the physician’s “demeanor and refusal or inability to coherently answer routine and legitimate questions regarding the volume and nature of the tests caused me to have serious and legitimate concerns regarding his mental health and ability to exercise good judgment,” upon which the committee summarily suspended the physician’s clinical privileges. As with most medical staff bylaws, the bylaws in the current case require a finding that the physician’s continued practice posed “the substantial likelihood of imminent impairment of the health or safety of any patient, prospective patent, employee or other person present in the hospital.” 

The physician’s contention was that the hospital had not proven just cause for a summary suspension, and therefore breached its bylaws and accordingly could not issue a report to the National Practitioner’s Data Bank regarding the suspension. The hospital argued that HCQIA preempted state law and required the hospital report.

The Montana Court held that HCQIA did not specifically preempt the state rules regarding breach of contract and injunctions, and that, since the state presumably retained authority to regulate physician conduct and protect its citizens, there was therefore a presumption against preemption. The dissenting opinion stated that this holding would eviscerate HCQIA, and protect physicians rather than patients, contrary to the intent of the statute.