Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca10-93-03054/USCOURTS-ca10-93-03054-0/pdf.json

Nature of Suit Code: 890
Nature of Suit: Other Statutory Actions
Cause of Action: 

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PUBLISH . ~· 1 J.J .!:J u 

Unltfd ~aates Court of Appeal3 

UNITED STATES COURT OF APPEALS 1'Mlth Ci~f!nit 

TENTH CIRCUIT 

ALAN C. HANCOCK, M.D., a Kansas ) 

citizen, ) 

) 

Plaintiff-Appellant, ) 

) 

"· ) ) 

BLUE CROSS-BLUE SHIELD OF KANSAS, ) 

INC., a Missouri corporation, ) 

) 

Defendant-Appellee. ) 

APR 1 1 1994 

!~OBERT L. HOECKER c~---~~ 

No. 93-3054 

APPEAL FROM THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF KANSAS 

(D.C. 92-CV-2408) 

Gregory M. Dennis (Thomas A. Hamill with him on the briefs) of 

Perry & Hamill, Overland Park, Kansas, for Plaintiff-Appellant. 

Terri Savely Bezek (James R. Goheen with her on the brief) of 

McAnany, Van Cleave & Phillips, P.A., Kansas City, Kansas, for 

Defendant-Appellee. 

Before LOGAN and McKAY, Circuit Judges, and SAM,* District Judge. 

McKAY, Circuit Judge. 

* Honorable David Sam, United States District Judge for the 

District of Utah, sitting by designation. 

Appellate Case: 93-3054 Document: 01019287087 Date Filed: 04/11/1994 Page: 1 
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Plaintiff physician's allegations in the trial court, which 

we accept as true for purposes of this appeal, state that he had a 

Participating Primary Care Physicians Contract with defendant Blue 

Cross and Blue Shield of Kansas City, Inc. Defendant initiated a 

decredentialing procedure for the purpose of terminating the 

physician's contract. In a letter to the physician, the Defendant 

informed him that under their procedures he could have a lawyer 

present but that the lawyer could not cross-examine witnesses nor 

argue the case. Plaintiff physician was decredentialed. He 

thereafter brought an action in the federal district court seeking 

declaratory and injunctive relief to set aside the decredentialing 

proceeding. He based his action on a claim of federal question 

jurisdiction arising under the Health Care Quality Improvement Act 

of 1986, 42 U.S.C.A. § 11101 et seg. More specifically, he 

claimed a violation of section 11112(b) (3) (C) (i) of the Act which 

he claimed guaranteed him a right to full representation and participation of counsel in the proceeding. The trial court concluded that the Health Care Quality Improvement Act does not 

create a private cause of action and therefore dismissed the case 

for a lack of subject matter jurisdiction. 

Because we agree with the trial court that the Act does not 

create a cause of action and no other basis for federal jurisdiction is alleged, we AFFIRM the decision of the trial court. 

Because the trial court's opinion succinctly and accurately 

reviews the sole issue in this case, we adopt and set forth in hoc 

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Appellate Case: 93-3054 Document: 01019287087 Date Filed: 04/11/1994 Page: 2 
verba the relevant discussion of the issue from that opinion as 

follows: 

Congress enacted the HCQIA to improve the quality of health care and to reduce the number of incompetent physicians. See 42 u.s.c. § 11101. Congress determined 

that both goals could be attained through "effective 

professional peer review." Id. Accordingly, the HCQIA 

eliminates many deterrents to effective professional 

peer review of physician competence by providing immunity from damage suits to professional peer review 

groups and individuals acting in support of those 

groups. See 42 u.s.c. § 1111l{a) {1); see also Decker v. 

IHC Hospitals. Inc., Nos. 91-4160 & 91-4161, slip op. at 

8 {lOth Cir. Dec. 29, 1992). 

The HCQIA's granting of professional peer review 

immunity, however, is conditioned by two factors. First, 

a professional peer review group must provide adequate 

due process protection to the physician subjected to 

review. See 42 U.S.C. § 11112. The HCQIA details a 

number of procedures which Congress deemed to be adequate due process, and creates a rebuttable presumption 

that the professional peer review group met the due process requirements even if it did not follow the HCQIA's 

procedures. Id. Second, the peer review group must 

take any action it deems necessary with the reasonable 

belief that its action will further quality health care. 

Id. A professional peer review group that fails to fulfill either condition is not entitled to the immunity 

afforded it by the HCQIA. See G9ldsmith v. Harding Hospitals. Inc., 762 F .. supp. 187, 188 {S.D. Ohio 1991); 

see also Austin v. McNamara, 979 F.2d 728, 733 {9th Cir. 

1992) . 

In this case, plaintiff premises its action solely 

upon defendant's alleged violation of the HCQIA's due 

process requirements. See 42 U.S.C. § 11112(b) (3) {C) (i) 

("in the hearing the physician has the right ... to 

representation by an attorney .... "). However, the 

HCQIA does not expressly create a cause of action in 

favor of a physician against a professional peer review 

group that has violated its due process requirements. 

See Goldsmith, 762 F. Supp. at 188. Therefore, to survive the present motion to dismiss, plaintiff's action 

must be implicitly sanctioned by the HCQIA. In Cart v. 

Ash, 422 U.S. 66 (1975), the Supreme Court noted that 

there are four factors relevant to the determination of 

whether a private cause of action may be implied from a 

statute that does not expressly provide for one. Those 

factors include: 

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Appellate Case: 93-3054 Document: 01019287087 Date Filed: 04/11/1994 Page: 3 
(1) whether the plaintiff is a member of the 

class for whose special benefit the statute 

was enacted; (2) whether there is any indication of legislative intend, explicit or 

implicit, to create or deny a remedy; (3) 

whether it would be consistent with the underlying purposes of the legislative scheme to 

imply a remedy; and (4) whether the cause of 

action is one traditionally relegated to state 

law in an area basically the concern of the 

states, so that it would be inappropriate to 

infer a cause of action based solely on federal law. 

Goldsmith, 762 F. Supp. at 188 (citing Cart v. Ash, 422 

u.s. at 78). 

A weighing of the factors outlined in Cart v. Ash 

leads the court to conclude that Congress did not intend 

to create a cause of action for the benefit of physicians to enforce provisions of the HCQIA. From a reading of the HCQIA and· its legislative history, the court 

concludes that Congress merely intended, in enacting the 

HCQIA, to ensure effective professional peer review of 

physician competence by providing immunity from damage 

suits to those professional peer review groups that comply with the HCQIA. See 42 U.S.C. § 11101 et ~; H.R. 

Rep. No. 99-903, 99th Cong., 2d Seas. 2, reprinted in 

1986 U.S. Code Cong. & Ad. News 6384-405. Since the 

court concludes that the HCQIA was not enacted to benefit physicians subject to peer review, such as plaintiff, plaintiff cannot persuade the court that an 

implied cause of action exists for him under the HCQIA. 

Cart v. Ash, 422 U.S. at 78. The few courts that have 

addressed this issue have arrived at the same conclusion. The court finds those decisions to be persuasive. 

See Goldsmith, 762 F. Supp. at 188-90 (the court thoroughly discussed the Cart v. Ash factors in light of the 

HCQIA and held that no private cause of action may be 

inferred from the HCQIA); see also Caine v. Hardy, 715 

F. Supp. 166, 170 (S.D. Miss. 1989), rev'd on other 

grounds, 905 F.2d 858 (5th Cir. 1990), superseded by, 

943 F.2d 1406 (5th Cir. 1991) (en bane) (aff'g district 

court), cert. denied, 112 S. Ct. 1474 (1992); and 

Regualos v. Community Hasp. Assoc., 1991 WL 239953 at *4 

W.D. Mich. Aug. 7, 1991). 

Memorandum and Order of Feb. 10, 1993, No. 92-2408-GTV, at 4-7. 

The judgment of the district court is AFFIRMED. 

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