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 grant of summary judgment by a lower court based upon HCQIA immunity.
Although the opinion is fairly lengthy, the key facts with respect to the reversal of summary judgment are as follows:
1. Dr. Smigaj was preliminarily and summarily suspended because of quality of care concerns;
2. Her privileges were reinstated subject to a concurrent three month review of her cases;
3. Dr. Smigaj was again suspended upon the recommendation of the hospital’s Perinatal Quality Assurance Committee (PQAC). The appellate court concluded that the hospital was not entitled to HCQIA immunity because the professional review action failed to satisfy two of the four HCQIA requirements. The court concluded that Dr. Smigaj had been unable to rebut the presumption that the hospital acted in the reasonable belief that the action was taken for the furtherance of quality health care and that it was reasonably warranted by the facts, but the court concluded that the hospital had neither conducted a reasonable investigation, nor provided due process.
A reasonable investigation was not conducted because the PQAC failed to review the external reviewer’s report or discuss the issue directly with the external reviewer prior to the issuance of the suspension, but instead relied upon third party summaries of the report, and it conducted no internal investigation of its own. The hospital failed to provide due process because Dr. Smigaj was not advised that a suspension of her privileges was being considered until after the suspension, did not receive the external expert report until after her suspension, and was not present during any discussion by the PQAC with the external reviewer. This last one obviously suggests that even had the PQAC met with the external reviewer prior to the suspension, that meeting would have been insufficient if Smigaj was not given the opportunity to be present and rebut the report.
Furthermore, the court was concerned because three members of the PQAC were economic competitors of Dr. Smigaj.
Finally, and for good measure, the appellate court reversed the trial court’s award of attorneys’ fees to the hospital in the amount of $534,415.
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