2007 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Third C ir c uit 6-7-2007 

# B h att v . B rownsvi lle Ge n H o sp P re c e de nt i al or N on-P re c e de nt i al : N on-P re c e de nt i al D ocke t N o . 06-1472

F o llow thi s and a dd it ion al works at : http://d i git alc ommon s .l a w . vi ll anova . e du/thirdc irc uit_2007

Thi s de c i sion i s brou ght t o you for f re e and ope n a c c e s s by the O p inion s of the U nit e d S t at e s C our t of Appe al s for the Third C irc uit at V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. It h as be e n a c c ept e d for inclusion in 2007 D e c i sion s by an authori z e d a dmini s tr at or of V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. F or more inform at ion, p le as e c ont a ct Be n j amin . C arl s on@l a

w . vi ll anova . e du . Re c omme nde d C it at ion " B h att v . B rown s vi lle Ge n H osp " (2007). 2007 D e cisio n s . P ape r 988. http://d i git alc ommon s .l a

w . vi ll anova . e du/thirdc irc uit_2007/988NOT P RE CE DE NT I AL UN I TED STATES CO UR T OF A PP EALS F O R T H E T H IR D C IR C U IT

___________ N o. 06- 1472

___________ N A R E S H I. B H A T T , M .D ., A ppel l ant

v. BR OWNS VI L L E GE NE RA L HOS P I T AL

___________ O n A p p ea l from the U n it ed S tat es D istri ct C o u rt f o r th e W e ste rn D istric t o f P e n n sy lv a n ia ( D . C . C i vi l N o. 03- cv- 1578) D i s tr i ctJ udge: T he H onor abl e Thom as M . H ar di m an

___________ Subm i t t ed U nderT hi r d C i r cui tL A R 34. 1( a)

M ay16, 2007 B efore: F ISH E R , N Y G A A R D , and R O T H , C i rcui tJudg es.

( Fi l ed J une 7, 2007)2 ___________ OPI NI ON O F THE COURT

___________ N Y G A A R D , C i r cui tJ udge. D r. N a re sh B h a tt su e d B ro w n sv ill e G e n e ra l H o sp ital, cla im in g th a t itre v o k e d h is s t aff pr i vi l eges and i nt er fer ed w i th hi s m edi cal pr act i ce i n vi ol at i on of 42 U . S. C . §1981, an d in v iolati o n o f it s o w n F air H ea ri n g P lan. T h e D istri ct C o u rtg ran ted s u m m ary ju d g m e n t a g a in s t B h a tt’ s c la im s . W e w ill a f f ir m . I. D r . B hatts erved on the medi cal s t aff atr egi onal hos pi t al s i n Penns y l vani a, inclu d ing B row n sv il le G en era l H o sp it al, fo r ov er tw en tyy ea rs. In 1 9 9 8 , the H o sp it al’s M edi cal E xecut i ve C om m i t t ee be gan i nves t i gat i ng B hatt ’ s pat i entcar e pr act i ces , and r e q u i r e d h i m t o c o mpl e t e t e n h o u r s o f d i a b e t i c p a t i e n tma n a g e me n t . I n 2 0 0 0 , th e M EC learn ed that B h atth ad b ee n fo rce d to resign fro m U n ion tow n H o sp it al, an d the H o sp it al’s U t i l i zat i on R evi ew C om m i t t ee r efe rr ed s ever al of B hatt ’ s chart s t o the M E C forfurther in v e s tig a tio n . T h e M E C f

o rm e d a su b c o m m itt e e w h ich m e t w ith B h a tt reg a rd in g f lu id m an ag em en t pro b lem s, tr an sfu sion issue s, an d inap p rop ri ate testi n g . S ev era l m o n ths later, th e U R C re f

e rre d m o re c h a rts to th e M E C f o r re v iew , an d th e M E C f o rw a rd e d f

o u r c h a rts3

to D r. M a rk R o b e rts, a t th e U n iv e rsityo f P itt sb u rg h , fo r a n o u tsid e a ss e ss m e n t. R o b e rts re p o rte d th a t, “in th re e o f th e f o u r c h a rts th e re a re m u lti p le e x a m p les o f c a re th a t ar e , in m yopi ni on, s ubs t ant i al l ybel ow r eas onabl e s t andar ds of ca r e forthe compl ai nt s and di agnos es forw hi ch the pat i ent s pr es ent ed. ” R obert s al s o s t at ed thatB hattm i s s ed

“ o b v io u s a n d sig n if

ica n t sig n s o f

w o rse n in g c lin ica l sta tu s” a n d th a t “in a p p ro p ria te f lu id m a n a g e m e n t w a s a s ig n if ic a n t c o n tr ib u to r” to th e d e a th o f o n e p a tie n t. T he M E C m ett o cons i deral l of the var i ous r eport s , and vot ed t o r ecomm end revocati on of B hatt ’s st aff m em bershi p an d cli nical pri vil eges. P ursuantt o it s procedu res , the H os pi t al gr ant ed B hatta hea r i ng befor e i t s Fai rH ear i ng C ounci l ( FH C ) . B hattand the M E C w ere r epresent ed b ycou nsel , present ed d ocu m entaryevidence, exam i ned and cross e x a m in e d w itn e ss e s, a n d p re se n ted o ra l ar g u m e n ts. A f ter th e p a rties w e re p e rm itt e d to su b m itw ri tt en stat em en ts, the F H C d eli b era ted f o r ov er tw o h o u rs, an d v o ted to af firm the M E C ’ s r ecomm endat i on. T he M E C ’ s r ecomm endat i on w as l at eraff i r m ed bythe H o s p ita l’ s A p p e lla te R e v ie w C o m m itte e a n d B o a rd o f D ir e c to rs , re s p e c tiv e ly. II . F i rs t , B hattcl ai m s the H ospit al cho se t o revok e his st aff p ri vil eges be cause h e i s a nat i ve of I ndi a. A s evi dence , he al l eges thatD r . J ohn E w al d and J ames D avi s , E s q. , m ade ethni cal l yder ogat oryr emar ks t ow ar d hi m . E w al d w as chi ef of s t aff atthe H os pi t al and c h a irm a n o f

th e M E C w h e n it rec o m m e n d e d re v o c a tio n o f B h a tt’s p riv ileg e s, a n d D a v is w a s la te r a m e m b e r o f

th e B o a rd o f

D ir e c to rs .4

L ik e th e D istric t C o u rt, w e a c c e p t B h a tt’s a v e rm e n ts a s tru e a n d su f f icie n t to es t abl i s h a p rim a fa c ie cl ai m of di s cr i m i nat i on, and the part i es agr ee thatthe H os pi t al proffered legi t i m at e, no n-di scr i m i natoryreas on s suffi ci ent t o rebut B hatt ’s p rim a fa c ie cl ai m . H ow ever , w e al s o agr ee w i th the D i s tr i ctC our tthatB hattfai l ed t o s how thatthe H os pi t al ’ s pr offe r ed r at i onal e w as m er el ypr et extual . Fi r s t , the al l eged s t at ement s by E w a ld a n d D a v is a re n o t en tit led to m u c h w e ig h t. E v e n if a c c e p ted a s tru e , the yw e re b o th i s ol at ed, s tr ayr emar ks bynon- deci s i on- m aker s . Second, B hattpr es ent ed no evi dence that anynon- I ndi an phy s i ci ans , w i th s i m i l arpat i entcar e pr obl ems, enj oy ed bett ertr eatm entby the H os pi t al . Fi nal l y , B hattpr es ent ed one w i tnes s , D r . H aus , w hos e t es t i m onyw as contr adi ct ed bythe conc l us i ons of fi ft een otherphy s i ci ans , s ever al of w hom w er e I ndi an. B h a tt a ls o c la im s th a t th e H o s p ita l in te rf e re d w ith h is m e d ic a l p ra c tic e b y , i nt er a lia , d isre sp e c tin g h is p a tien ts, d e layi n g p a tien t tes ts, a n d w ith h o ld in g h is m a il af ter h is pr i vi l eges w er e s us pended. A s the D i s tr i ctC our tpoi nt ed out , how ever , ther e i s no evi dence thats ugges t s ei therD r . E w al d orM r . D avi s w er e i nvol ved i n thes e ac t i ons , or thatany one el s e i nvol ved w as m ot i vat ed byethni c pr ej udi ces agai ns tB hatt . B hattfai l ed t o pr oduce e vi dence t o s uppor ta p rim a fa c ie d isc rim in a tio n c laim o n th is p o in t. Fi nal l y , B hattcl ai m ed the H os pi t al br eac hed i t s ow n Fai rH ear i ng Pl an by a p p o in tin g F H C m e m b e rs b ias e d a g a in st h im , d e layi n g h is h e a rin g , an d p re v e n tin g h im f ro m c a lli n g w itn e ss e s a n d in tro d u c in g c e rta in e x h ib its. T h e H e a lth C a re Q u a lity I m pr ovementA ctgr ant s a hea l th car e pr ovi derpr es um pt i ve i m m uni tyfr om s ui t s br ought5

a s a re su lt o f

a “ p ro f e ss io n a l re v iew a c tio n .” W e a g re e w ith th e D istric t C o u rt th a t B h a tt f a ile d to d e m o n s tr a te th a t th e H o s p ita l w a s n o t e n title d to im m u n ity u n d e r t h e A c t. II I. B h a tt fa iled to p re se n t ev id e n c e su f f icie n t to a v o id su m m a ryju d g m e n t ag a in st h is d is c ri m in a tio n a n d s ta te la w b re a c h o f c o n tr a c t c la im s . W e w ill a f f ir m .