Appeals Court Holds Wa. Hospital Not Entitled to HCQIA Immunity in Physician Suspension Suit
A Washington state appellate court recently held that a hospital that failed to make a reasonable effort to obtain the facts underlying a physician’s suspension or give reasonable notice of the same lost its statutory immunity under the Health Care Quality Improvement Act (HCQIA). The decision is notable because even though the plaintiff physician’s suspension lasted for a very short time, the court still held that the hospital’s hasty actions were enough to deprive it of protection from the physician’s lawsuit.
In Smigaj v. Yakima Valley Memorial Hospital Association, Dr. Diana Smigaj was an obstetrician/gynecologist (obgyn) who was on the medical staff of Yakima Valley Memorial Hospital (the “Hospital”). After concerns arose regarding the quality of care provided by Smigaj, a peer review committee at the Hospital recommended the suspension of her medical staff privileges. The medical chief of staff agreed and notified Dr. Smigaj of the suspension; however, the Hospital’s Medical Executive Committee (“MEC”) reinstated her privileges 11 days later. The reinstatement was not retroactive.
Accordingly, Smigaj sued the Hospital and several physicians/administrators, claiming that the suspension was arbitrary and capricious, motivated by gender discrimination and anticompetitive bias, a breach of the hospital’s bylaws, and a breach of contract and fiduciary duty.
The trial court granted the Hospital’s motion to dismiss, finding that it was entitled to immunity under HCQIA. However, the appellate court reversed.
HCQIA generally affords hospitals immunity for “professional review actions” so long as the following conditions are met:
1) The professional review action was taken in the reasonable belief that it was in furtherance of quality healthcare;
2) The professional review decision was made after a reasonable effort to obtain the facts;
3) The physician received adequate notice and procedures that are fair under the circumstances;
4) The action was taken in the reasonable belief that, under the facts known, a suspension was warranted.
After the jump - why HCQIA did not apply
After review, the appeals court held that a reasonable jury could conclude that the Hospital failed to meet the second and third elements required for HCQIA immunity.
No Reasonable Effort to Obtain the Facts
The appeals court concluded that the fact-finding process conducted by the Hospital was not objectively reasonable. Specifically, the court noted that the Hospital had failed to obtain an outside reviewer’s assessment on certain cases until after the suspension had been imposed, and instead relied on hearsay from another physician. Additionally, the peer review committee did not interview any of the Hospital’s nurses or physicians before imposing the suspension, including the obgyn department chair. Accordingly, the Hospital’s “investigation” was not reasonable.
No Adequate Notice or Fair Process
The adequate notice element in HCQIA contains two exceptions: if during the suspension, an investigation is being conducted to determine the need for a professional review action; or if the imminent danger exception applies.
The appeals court concluded that neither exception applied and accordingly, the Hospital was required to provide Dr. Smigaj with “adequate notice and hearing procedures.” The court noted that the Hospital had failed to inform Dr. Smigaj that the peer review committee was considering or recommending the suspension of her hospital privileges, and that she was not informed of such until the medical chief of staff called to tell her she was suspended. Additionally, while she was invited to attend an MEC meeting where the suspension would be considered, she was told that she could not bring an attorney and was not entitled to hearing rights. Finally, Dr. Smigaj alleged that the hearing was not fair because three physicians who were in direct competition with her served on the peer review committee as decision-makers. Accordingly, the appeals court held that Dr. Smigaj had established by a preponderance of the evidence that the peer review’s process was unfair under the circumstances.
Conclusion
The Smigaj decision demonstrates that physicians who feel they have been wrongly treated or had adverse professional review actions levied against them may have recourse. However, time is always of the essence in such matters. Accordingly, it is important for physicians who wish to challenge hospital decisions to immediately obtain legal counsel so that the rights they have maybe protected. For additional information, contact Mercedes Varasteh Dordeski at (248) 952-0400.
The case is Smigaj v. Yakima Valley Mem’l Hospital. Ass’n., No. 29415-3-III (Wash. Ct. App. Jan. 10, 2012). For a copy of the opinion, click here
