Category Archives: Credentialing and Peer Review

Subscribe to Credentialing and Peer Review RSS Feed

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

Attorneys’ Fees Awarded in Failed Peer Review Dispute Pursuant to State Law

In Crow v. Penrose-St. Francis Healthcare System, a Colorado Appeals Court awarded attorneys’ fees to a hospital that successfully defended the claim by a physician seeking damages for breach of contract and torte claims.  The Colorado Rules of Civil Procedures authorized an award of attorneys’ fees when a trial court dismissed an action under Section … 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 Cannot Revoke Settlement Agreement

Bissada v. Arkansas Children’s Hospital (the “Hospital”) presents an atypical peer review case. The Eighth Circuit Court of Appeals affirmed summary judgment entered on behalf of the Hospital by the District Court on the basis of the existence of a Settlement Agreement, instead of relying upon the usual HCQIA peer review immunity protections.  Dr. Bissada practiced … Continue Reading

Credentialing Injunction Settled for $4,000,000

On January 21, 2009 I posted an article describing the preliminary injunction obtained by Jesse Cole, M.D. against St. James Healthcare in Montana, pursuant to which Dr. Cole’s clinical privileges were reinstated.  For more information, see the website describing the final settlement in that case in which St. James Healthcare paid $4,000,000 to settle the litigation.… 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

Wyoming Supreme Court Permits Termination of Disruptive Surgeon

Defining and disciplining disruptive physicians has been a difficult problem for hospital administration and the medical staff for quite some time now, long enough for the Joint Commission to actually require leadership standard LD.3.10 beginning in 2009. Medical staffs have frequently been torn between protecting their members, who are frequently high performing physicians, while maintaining appropriate … 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

U.S. District Court Holds that State Peer Review Confidentiality is Trumped by Federal Discovery Rights

In Sabharwal v. Mount Sinai Medical Center, Queens Hospital Center, and Won Chee, the plaintiff alleged employment discrimination in that she was subjected to a hostile work environment and unlawful discrimination by not being reappointed as the Assistant Director of Anesthesia on account of age, sex and disability. The plaintiff requested production of certain records maintained … Continue Reading

Removal of Independent Contractor Did not Violate Due Process

Schueller v. Goddard is a fairly typical hospital staffing scenario. Dr. Schueller was an independent contractor with an emergency services group, which in turn had an exclusive service contract with Drew Memorial Hospital in Arkansas. The 8th Circuit Court of Appeals affirmed a grant of summary judgment by the District Court in favor of the hospital and … Continue Reading

Female ObGyn Loses Pay Discrimination Claim

In Leitgen v. Franciscan Skemp Healthcare, Inc., 7th Cir. appeals court confirms summary judgment by the district court denying Dr. Leitgen’s claim of discriminatory pay practices.The physicians at Franciscan Skemp Healthcare were paid a salary plus a bonus. The bonus for professional fees for obstetrical delivery services were collected and paid to the participating GbGyns equally … Continue Reading

Peer Review Confidentiality Cases Distinguish Peer Review from Risk Management

Two recent malpractice cases indicate the distinction between ordinary risk management processes and peer review issues. In Johnson v. Detroit Medical Center, a Michigan state court held that a physician’s credentialing file was protected by the confidentiality provisions of Michigan’s Peer Review Confidentiality Statute, and also protected the physician’s operative logs because the doctor/patient privilege protects … Continue Reading

Third Circuit Affirms Judgment for Hospital on Physician Race Discrimination Claims

Ray v. Pinnacle Health Hospitals, Inc. is an interesting physician discrimination case, not because it presents new concepts, but more so because of the use of the hospital’s quality assurance data in the discovery and summary judgment process. The Third Circuit is merely affirming the grant of summary judgment by the United States District Court … Continue Reading

Wrongful Databank Report Does Not Justify Defamation Action

Frengell v. InterCare Community Health Network demonstrates the counterintuitive nature of certain peer review actions. Dr. Frengell’s employment was terminated following the inappropriate prescription of narcotics. InterCare reported Dr. Frengell to the National Practitioners’ Data Bank, although the report was not required and the court concluded, and InterCare admitted, that it had not provided any due … Continue Reading

Public Policy of Preserving Physician Patient Relationships Rejected

In Genchi v. Lower Florida Keys Hospital District, a Florida State Appeals Court took the opposite view from the Arkansas Supreme Court in Baptist Health, posted just last week, regarding the importance of preserving physician/patient relationships. In Baptist Health, the Arkansas Supreme Court recognized the potential interference with physician patient relationships posed by the use … Continue Reading

Baptist Health Decision Invalidates Economic Credentialing

After years of litigation and appeals, the Arkansas Supreme Court has finally decided in Baptist Health v. Murphy that the economic credentialing policy tortiously interfered with the physician/patient relationships of a group of its staff cardiologists and enjoined Baptist Health from using its economic credentialing policy to deny staff appointments and clinical privileges to 12 … 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

Exhaustion of Administrative Remedies Requirement Reaffirmed

In Vranos v. Skinner, the Massachusetts Appeals Court reaffirmed the doctrine of exhaustion of administrative remedies. The Court affirmed the dismissal of the lawsuit arising out of a summary suspension of a physician’s staff privileges. The bylaws of Franklin Medical Center contained the typical internal grievance procedures. Dr. Vranos alleged that the hospital had not complied with his … 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