The case of Cowell v. Good Samaritan Community Health Care, a state court case in Washington, provides guidance on two of the four elements of HCQIA immunity, i.e. that the action was reasonably taken in the furtherance of quality health care and the necessary substance to establish a reasonable investigation. 

Dr. Cowell raised an unusual argument to defeat HCQIA immunity. She alleged that the conduct which was the subject of the peer review investigation caused no harm to patients, therefore, an adverse peer review action designed to eliminate that conduct obviously did not serve to further quality health care. 

As noted in the BNA Health Care Reporter, “The court found these arguments “misdirected” because they focused on whether Cowell actually harmed patients and whether the defendants’ actions actually improved health care at the hospital. The court said that HCQIA is not dependent upon those facts; the professional review need not result in actual improvement in health care – it need only be directed to actions reasonably believed to further quality.”

Dr. Cowell also complained about three instances which she believed established the lack of a reasonable investigation. The court responded by quoting the famous excerpt from Singh vs. Blue Cross/Blue Shield of Massachusetts, which states that physicians are entitled to “a reasonable investigation under the Act, not a perfect investigation.”