### IN THE COURT OF APP EALS OF TENNESS EE AT NAS HVILLE Ma rc h 8, 200 7 S es sio n

JO SEPH C. CURTSI NGER, J R., M.D. v. H CA, INC., ET AL


### .
Appeal f rom the Chancer y Court for Davidson Cou nty No. 04-3026-III Ellen Hobb s Lyle, Chancellor

No. M2006- 00590-COA-R 3-CV - F iled on Ap ril 27, 2007

Surg eon filed a ction ag ainst hospital a nd other re lated per sons and entities seekinginjunctive relief

and mon e tary dama g e s f

or the a lle g e dly

imp ro pe r r e vo c a tio n o f h is hos pit a l pri vil e g e s and the fa lse repor ting of such to the State Medica l Boa rd and the National Practitioner Data Bank. The trial court g rante d Def

endants pa

rtial summary

judgme nt on all monetary claims asser ted by surg eon pursua

nt to the Hea lth Care Qua lity Improvement Act (HCQI A) and the Tenne ssee Peer Review L aw. Ha ving found that surg eon failed to show by a pre pondera

nce of the evidenc e that De fenda nts did not satis fy the fo ur pr on g te st fo r immunit y pr ov ide d und e r HCQ I A, we a ff ir m th e de c isi on

of the tr ia l c ourt

in

a ll r e sp e c ts.

Tenn. R. App . P . 3 Appeal as of Right; Judgme nt of th e Chancer y Court Affi rm ed

W I L L I AM B. C A IN , J ., delivere d the opinion of the cour t, in which P ATR I C I A J. C O T T RE LL and F R ANK G. C L EME NT , J R ., J J ., joined.

Matthew B . Z enner , Nashville, Tenne ssee, f or the a ppellant, J oseph C. Curtsinge r, Jr., M.D.

C.J . Gideon, Timothy

McIntire, Na shville, Tennessee , for the ap p ellees, H CA Hea lth Services of Tenne ssee, Inc. d/b/a Southern Hills Medica l Center, Victor E. Giovanetti, J oseph A. Wieck, M.D., and Malc olm E. Baxter, M.D.

OP IN ION

Ap pe lla nt, Dr . Jose phCur

tsi ng e r, is a

surg e on a nd fo rm e r m e mbe r o f t

he Sou the rn

Hi lls Medica l Center (SHMC) staff . On J uly 2, 2003, Dr. Curtsi ng er rece ived a notice of suspension from SHMC for alleg edly

ref using to re spond to three e merg ency room ca l ls on J une 30, 2003, and f or alleg edly eng ag ing in a pattern of unprofe ssional and disruptive behavior towards patients and other SHMC employ ees. A n investigation was conduc ted as a result of the suspension and the Me dical Exe c uti ve Com mit te e (M EC) de te rm ine d o n July 10 , 2 00 3, that D r. Cur

tsi ng e r w ou ld r e ma in suspended until various cond i t i o ns were satisfied. In a letter dated July

22, 2003, Dr. Curtsing er ag ree d to the conditions, requeste d termination o f h i s s uspension and aske d that he be pla ced on-2-

voluntary leave of abse nce pe nding the satisfac tion of the conditi ons. On J uly 24, 2003, the MEC terminated D r. Curtsinge r’s suspension and g rante d his request for leave of abse nce.

Be lieving that he had satisfied the conditions for re instatement, Dr. Curtsing er r equeste d on Au g us t 22 , 2 00 3, that hi s le a ve of a bs e nc e be te rm inate d a

nd that he be re in state d to the SHM C medical staf

f. Upon c onsideration of the rec ommendations o f t h e M E C, the SHMC Board of Trustee s conditionally approve d Dr. Curtsinge r’s reque st f or reinstateme nt so long as he e x ecute d an ag ree ment with SHMC. However Dr. Curtsinge r re fused to execute the ag ree ment, claiming that it divested him of rig hts gua rante ed to him under SHMC By laws. As a r esult of Dr. Curtsing er’ s ref usal to sign the a g ree ment, the M E C rec ommended that the B oard of Trustee s deny

Dr. Curtsinge r’s re quest for r einstatement.

On J anuar

y 26, 2004, Dr. Curtsing er w as af forde d a fair hear ing appea l to prese nt evidence in favor of

his reinstatement a

nd to refute the alleg ations of the MEC. On Fe bruar y 12, 2004, the MEC recommende d denial of D r. Curtsinge r’s re instatement, which be came final since D r. Cur tsi ng e r d id n ot r e qu e st a pp e llate re vie w. B e c a

us e the pr of

e ssi on a l r e vie w a c tio n a dv e rs e ly aff ecte d Dr. Curtsi ng er’ s clinical privil eg es for a per iod longe r than thirty (30) da y s, SHMC reported the adve rse pr ofessional pe er r eview a ction to the State Medica l Boa rd and the National Prac titioner Data B ank on Apr il 13, 2004.

On October 22, 2004, Dr. Curtsing er f iled an ac tion ag ainst Defe ndants alleg ing va rious

c la ims ari sin g fr om his pe rm ane nt su sp e ns ion inc lud ing (1 ) br e a c h of c on tr a c t; (2 ) i nte rf e re nc e wi th his prospective e conomic adva ntag es; (3) interfe renc e with his rig ht to practice his profession and civil conspirac y ; (4) violations of the Sherman A nti-Trust Act and c onspiracy to restra in trade; (5)

wr on g ly and ina c c ur a te ly

re po rt inghis a dv e rs e pe e r r e vie w a c tio n to the Natio na l Pr a c tit ion e r D a ta Ba nk; and (6) ba d faith and libel. On January 7, 2005, Def

en d an t s fi l ed a motion for partial

su m m ar y j u d gm ent alleg ing that they wer e immune from a

ny monetary

damag es asse rted by

Dr. Curtsinge r pursua

nt to the Health Care Quality I mprovement Act (HCQI A) a nd the Tenne ssee Pee r Review L aw.
Dr. Curtsing er sought additional time for discovery in order to g ain m ore infor mation prior to responding to D efe ndants’ motion for partial summary judgme nt. On Marc h 16, 2005, the trial court denied Dr. Curtsing er’ s discovery reque st, on the g rounds that the re quested infor mation was privileg ed and ba

rre d from discove ry

under the Tenne ssee Peer Review L aw a nd the Tenne ssee Supreme Court’s de cision in E yr i n g v. Fort Sanders Parkwest Me d. Ctr., Inc. , 991 S.W .2d 230 (T e nn .1 99 9)

. Th e c ourt e nte re d a br ie fi ngsc he du le a llo wi ngDr . Curt sin g e r u nti l Apr il 8 , 2 00 5, to respond to De fenda

nts’ motion, and Defe ndants until Apr il 15, 2005, to r eply . On April 15, 2005, Def endants soug ht leave of

court to file unde r sea l the ad d i t i o nal af fidavits of Drs. Wieck a

nd Giovanetti, which the c ourt g rante d on April 28, 2005.

On June 8, 20 05 , th e tr ia l c ourt g ra nte d D e fe nd ants ’ mot ion fo r pa rt ia l su mma

ry jud g me nt, finding that Defendants we re immune fr om monetary damag es for

the pee r re view ac tion taken ag ainst Dr. Curtsing er pur suant to HCQI A and the Tennessee Peer R eview L aw. On F ebrua ry 21,-3-

2006, the cour

t entere d an ag ree d order volunta ri l y d i s m issing all of D r. Curtsinge r’s re maining

c la ims wi tho ut p re

jud ic e

. Dr . Curt sin g e r a

pp e a ls a rguin g that th e tr ia l c ourt

e rr e d in (1 ) d e nyinghim the opportunity

to eng ag e in discover

y prior to re sponding t o De fe n d an ts’ motion for partial

su mma ry jud g me nt; (2 ) a llo wi ngDe fe nd ants to s ub mit a dd iti on a l a ff

idavits in su pp or t of the ir motion; (3) gr anting Def

endants partial summary judgme nt pur suant to H CQI A and the T ennesse e Peer Revie w L aw; and ( 4) finding that the info rm at i o n s u p plied by Def endants to the National Practitioner Data B ank wa s sufficiently acc urate and not made in ba d faith or with malice

.

I. D I S COVE RY
As an initial matter, Dr . Curtsinge r ar g ues that the trial c ourt err ed in deny ing him the opportunity

to eng ag e in discover

y prior to responding to Defe ndants’ motion for par tial summary judgme nt. Howeve r pursua nt to the Tennesse e Peer

Review L aw, a

plaintiff in a prof

essional pee r revie w cour

t action does not h av e an u n fe t tere d rig ht to discovery as it relate s to the deliberative proce ss in a profe ssional peer revie w i nvestig ation. Tenne ssee Code A nnotated sec tion 63-6-219(e ) pr ov ide s th a t:
(e) All inf ormation, interviews, incident or other repor ts, state ments, memoranda or oth e r data fu

rn ish e d to any c omm itt e e a s de fi ne d in thi s se c tio n, and any fi nd ing s, conclusions or re commendations resulting from the proce eding s of such committee

are decl ared to b e pr ivi le g e d. Al l su c h in fo rm a tio n, in a ny fo rm wh a tso e ve r, so furnished to, or gene rate d by , a medica l peer revie w committee, shall be pr ivilege d. The re cords a

nd proce eding s of a n y s u ch committees are confide ntial and shall be used by such committee, a

nd the member s thereof

only in the exercise of

the prope r functions of the committee, and shall not be public rec ords nor be available for c ourt subpoena or

for discove ry

proce eding s. One (1) proper function of suc h committees sh a ll i nc lud e a dv oc a c y fo r ph y sic ians be fo re oth e r m e dic a l pe e r r e vie w c omm itt e e s, peer revie w org anizations, he alth car e entities, private a nd g overnme ntal insurance

car riers, national o r l o cal accr editation bodies, and the state board of medical examiners of t his or any

other state. T he disclosure of conf idential, privileg ed pee r revie w committee information to such entities during advoca cy , or as a report t o the board of medical e x aminers under § 63-6-214( d), or to the aff ecte d phy sician under revie w, does not constitute either a wa iver of c onfidentiality or privileg e. Not hing contained in this subsection (e ) applies to re cords made in th e re gu l ar c ourse of bu sin e ss b y a

ho sp ita l or

oth e r p ro vid e r o f h e a lthc are and inf or ma tio n, do c ume nts

or re cords other

wise ava ilable from origina l sources a re not to be c onstrued as immune from discover

y or use in any

civil proce eding s merely beca use they wer e prese nted during proce eding s of such c ommitt ee.

I n Eyring , 991 S.W .2d at 239, the Te nnessee Suprem e C o u rt addressed the a pplication of Te nn e sse e Cod e Anno ta te d s e c tio n 6 3- 6- 21 9( e ) i n a dis c ov e ry

pr oc e e din g . Sa id t

he Court :-4-

This statute cre ates a

broad pr ivilege from dis cl o s u re f or “[a]ll i nformation, interviews, incide nt or other r eports, stateme nts, memoranda or other data ... a

nd any fi n d i n gs co n cl u s i o n s o r r ec o m m en d at i o n s re s u l t i n g fr o m t h e [ co m m i t t ee s '] proce eding s.” Id. I n our view, this broa d lang uag e enc ompasses any and all matter s
re la te d to the pe e r r e vie w p ro c e ss i tse lf . We re je c t E y ri ng ' s c on te nti on

that th e statut e g rants an implicit rig ht to any information “f

urnish ed t o o r resulting fr om the pr oc e e din g s” of

the pe e r r e vie w c omm itt e e s.

I t appea rs, howeve r, that the broa d lang uag e exte n d ing the privileg e fr om discovery must be reconc iled with the statutory require ment that the plaintiff bea r the burden of producing evidenc e of malice and bad faith. We the ref ore ag ree with the trial court' s ruling a llowing Ey ring t o co n d u ct discovery for the limited purpose of i n v es t i gat i n g t h e c o m m i t t ee m em b er s ' go o d fa i t h
, m al i ce , an d

re as o n ab l e k n o wl ed ge or belief, b ut prohibiting any inquiry into the peer

revie w proc ess itself. Cf. Alexande r v. Memphis Individual Prac. Ass'n, 870 S.W .2d 278 (Tenn.1993)

. Ac co rd i n gl y , we co n cl u d e t h at t h e t ri al co u rt wa s co rr ec tan d t h at t h e b ro adl an gu age of the statut e e nc omp a sse s any and a ll m a tte rs re la te d to the pe e r r e vie w p ro c e ss.
Eyring , 991 S.W .2d at 239.

We t he re fo re mus t de te rm ine wh e the r D r. Cur tsi ng e r’ s d isc ov e ry

re qu e st w a s li mit e d to investigating the MEC’s g ood faith, malice , and re ason ab le knowledg e or be lief or whe ther the

re qu e st d e lv ed in to t

he pe e r r e vie w p ro c e ss i tse lf . T he dis c ov e ry

wh ic h D r. Cur

tsi ng e r s ou g ht t o obtain specific ally

included:

1. Wh at fac tor the def

endants a dvance that would lead a rea sonable pe rson to the conclusion th at a p at i ent incident of a n undefine d nature that prec eded D r. Curtsinge r’s re appointment to the SHMC st aff in ear ly 2003 supports a conc lusion that there exis ted a “ substantial likelihood of imm inent injury ”; 2

. Wh a t f

a c to r th e d e f

e n d an ts a d v an c e a s le a d in g a r e a s o n a b le p e r s on to the

c on c lus ion

ho w a n unid e nti fi e d Jun e 20 03 e nc ounte r w ithan e mpl oy ee su pp or ts a conclusion that there exis ts a “substantial likelihood of imminent injury ”; 3. Three alleg ed ref

usals on J une 30 to r espond to g ener al surg ery on call assig nment in the emer g ency

depar tment since the proof

will show that the on call sche dule g iven to Dr. Curtsinge r showed that he was not on c al l t hat nig ht and that Dr. Curtsing er offe red to c ome in if the doctor w ho was on c all could not be re ache d; 4. Why com me n ts ma d e to o th e r s e xp r e s s in g c o n c e r na b o u t D r

. A n g ie L ar s on somehow j ustified the conclusion that there was a substantial likelihood of immi nent i n j u r y; 5. An e xplanatio n o f w hy the su mma ry su sp e ns ion

of no n- e xiste nt p ri vil e g e s w a s in further ance of quality health car e by preve nting a substantial likelihood of imm inent i n j u r y;-5-

6. How the de nial of [ a] nonexis tent reque st to return to staf f wa s in furthera

nce of qu a l i t y [ ] h e a l t h c ar e b y p r e v e n t [ i n g ] a s u b s t an t i a l l i k e l i h o o d

o f i m m i n e n ti n

j u r y; 7. How the he aringresulted in a de ter m i n at i o n by the def endants that the pla intiff should not be reinstated to the staf f whe n the fa ir hea

ring comm i t t ee fo u nd in the plaintiff’s fa

vor; and 8. The fac ts de fenda

nts r ely upon in e stablishing a rea sonable investig ation into the various ac cusations and how the y justified a conclusion that the actions taken wer e in further ance of qualit y healthca re to prevent a substantial likelihood of imminent i n j u r y.

Dr. Curts i n ger ’s d i s co v ery re qu es tp ri m ar i l y

co n ce rn edt h e r ea s o n i n g b eh i n d t h e p rofessional pe e r r e vie w c omm itt e e ’s de c isi on to d e ny Dr . C urt si ng e r r e ins ta te me nt. Cle arl y , th is i nq uir y int o the deliber ative proc ess is prohibited by the Tennessee Peer ReviewL aw. L ikewise, the r emaining discovery reque sts c oncer

ned fac ts obta ined by

the profe ssional peer

revie w committee surr ounding four incide nts upon which Dr. Curtsing er’ s summary suspension was base d, the e f f o r ts to o b tain such fac ts, and other fac ts conce rning later inc idents of alleg edly disruptive behavior . Ba sed on the broa d langua g e of

Te nn e sse e Cod e Anno ta te d se c tio n 63 -6 -2 19 (e ), we a g re e wi th the tr ia l c ourt that th is information is not discovera ble because it constitutes “information

... or ot her data furnishe d to any committee as de fined in this section, and a ny finding s, conc lusions or recommendations resulting fr om t he pr oc e e din g s o f s uc h c omm itt e e .” Ac c or din g ly , w e fi nd no me ri t in Dr . Curt sin g e r’ s f ir st assig nment of er

ror.

II. S U BM IS SI O N O F A D D I TI ON A L A FF I D A V I TS

Dr

. Cur tsi ng e r ne xt c on te nd s that the tr ia l c ourt e rr e d in a llo wi ng De fe nd ants to submi t

a dd iti on a l a ff

ida vit s pri or to r uli ngon De fe nd ants ’ m oti on

fo r p art ia l summa

ry jud g me nt. On

Ap ri l 28, 20 0 5
, th e tr ia l c o u rt g r an te d D e f e n d an ts ane xte n s io no f

ti me in w h ic h to f

il e u n d e r s e a l the

a ff ida vit s o f t wo ME C me mbe rs , pr ov idi ng the c ourt wi th c on fi de nti a l in fo rm a tio n th a t D e fe nd ants

wer e g iven in making their pee r re view dete rmination, althoug h the cour t found that Dr. Curtsing er had “de monstrated suff

icient fa cts to meet the burden of proof filed by the def endants.” The c ourt

rea soned that “t he purpose of summary judgme nt is to l ower

costs and incr ease eff

iciency by

na rr ow ingthe i ssu e s f

or tr ia l. I n th e int e re sts of

e ff ic ie nc y of tim e and

mon e y , th e Court

is pe rs ua de d to a llo w the de fe nd ants to fi le the a dd iti on a l pa pe rs to pr ov ide the Court

c omp le te fa c ts t o m a x i m i z e t h e e f

f i c i e n c i e s o f t h e m o t i o nf o r p art i a l s u m m ar

y j u d g m e n tan d

b e c a u s e H C Q IA immunit y is a question of law f

or the Court to dec ide.” Dr . Curtsinge r contends that in allowing Def endants to file a dditional aff idavits, the t rial court violated Tennessee Rule of Civil Procedur e 56.04 which states that “ [t ]he adverse party may serve and file opposingaff idavits not later than five (5) da y s befor e the he aring .” We disag ree

.

Te nn e sse e Rul e of Civ il Pro c e dure 56 .0 6 pro vid e s tha t “ [t]he c ourt may pe rm it a ff

ida vit s to be supplemente d or opposed by depositions, answe rs t o interrog atories, or further aff idavits.” And

re lie f fr om the de a dli ne s impo se d by the Te nn e sse e Rul e s o f C ivi l Pr oc e dure re sts so un dly wi thi n t h e discre tion of the trial cour t. Kenyon v . Handal
, 1 2 2 S. W. 3 d 7 4 3
, 7 5 3 ( T e n n

. Ct

. A p p

. 2003).T he C our t woul d not e t hat t he provi s i ons of H C Q I A ar e “ es s ent i al l y i dent i cal t o t hos e of t he T enn es s ee P eer 1

R evi ew Law

. ” I

r ons i de v. Si m i Val l ey H os p. , 18 8 F.3d 35 0
, 35 3

- 5 4 (6t h C i r. 1 9 9 9 ).

-6- Mo re ov e r, Dr . Curt sin g e r w a s b y no me ans pr e

jud ic e d by

the c ourt ’s de c isi on

to a llo w D e fe nd ants to s ub mit a dd iti on a l a ff

ida vit s si nc e the c ourt

a lso pr ov ide d D r. Cur

tsi ng e r wit

h ad dit ion a l ti me in which to file supplementa l affida vits and reply b ri ef

s. Thus, we find no e rror in the trial court’ s decision to allow De fenda nts to submi t additional aff idavits prior to ruling on Def endants’ motion fo r p art ia l summa

ry jud g me nt.

III

. P A R TI A L S UM M ARY J UDGMENT UNDE R HC QIA

A N D THE T ENN ESS EE P E E R R E V I E W L AW
Dr. Curtsing er’ s primary contention on appe al conc erns the tr ial court’s de cision to gr ant Def endants’ motion for pa

rtial summary

judgmen t t h er eby

dismiss ing a ll of Dr. Curtsing er’ s monetary claims. Under

HCQI A and the T ennessee Peer Review L aw , the individuals and

1 ins tit uti on s p art ic ipatin g in o r a ssi stingwi th a pr of e ssi on a l me dic a l r e vie w p ro c e ss a re g e ne ra lly g rante d immunit y

from monetar

y damag es for

their ac tions. 42 U.S.C. § 11111; Tenn.Code Ann § 63 -6- 21 9(d )(1 ); Pe

y ton v . J oh ns on City

Me d. Ctr

. , 101 S.W .3d 76, 78 (Tenn.Ct.App.2002). T he purpose of

g ranting such individuals and entities immunit y i s “t o encour ag e committees made up of Tenne ssee’ s licensed phy sicians to candidly , conscie ntiously , and objec tively ev aluate a

nd revie w their peer s’ profe ssional c onduct, competenc e, and ability to prac tice medicine .” Te nn.Code Ann. § 63-6-219( b)(1) . Howeve r, i n order for imm unity to apply
, the professional revie w action must be
take n:
(1 ) i n th e re a so na ble be lie f t

hat th e act io n wa s in

the fu rt he ra nc e of qu a lity he a lth

car e; (2) a fter a rea sonable e ffor

t to obtain the fac ts of the matter; (3) a fter a dequate notice and he aringproce dures a re a ffor ded to the phy s ician involved or af

ter such o ther proc edure s as ar e fa ir to the phy sician under the circ umstances; and (4) in the r e a s o n a

b le b e li e f th a t t h e a c ti o nw a s w ar

r an te d b y th e f a c ts k n o w na f te r such re asonable eff

ort to obtain fac ts and afte r mee ting the r eq u irements of parag raph ( 3)...

42 U.S.C. §11112(a).

HCQI A and the T enne s s ee P ee r R ev i ew L aw al s o p ro v i d e a p re s u mp t i o nt h at t h e p ro fe s s i onal

re v ie w a c ti o n p r o p e r ly me t th e f o u r p r o n g te s t f

o r im mu n it y , u n le s s th e p la in ti f

f can r ebut the presumption by

a pre pondera

nce of the evidenc e. 42 U.S.C. § 11112(a) ; Tenn.Code Ann. § 63- 6- 21 9( d) (3 ); Pey ton , 101 S.W .3d at 83. Acc ording ly
, the standard for revie wing a g rant of summar y judgmen t u n d er HCQI A and the T ennesse e Peer Review L aw is “unc onventional: althoug h the defe ndant is the moving pa rty , we must examine the rec ord to deter mine whether

the plaintiff ‘satisfied his burden of producing evidenc e that would allow a r easona ble jury to conclude that the-7-

Hospital’s pee r re view disciplinary proce ss failed to mee t the standards of HCQI A.’” Brader v. Allegheny

Gen. Hosp.
, 1 6 7 F. 3 d

8 3 2
, 8 3 9 (3 rdC i r. 1 9 9 9 ) ( qu o t i n g Bryan v. Jame s E. Holmes Re

g’l Me d. Ctr

. , 3 3 F .3 d 1 31 8, 1334 (1 1th Cir .1 99 4) ). Th e re fo re , it is n ot o ur

du ty a t th is t ime to de te rm ine wh e the r t

he dis c ipl ina

ry a c tio n ta

ke n b y De fe nd a nts a g a ins t D r. Cur

tsi ng e r w a s c or

re c t, bu t r a the r, wh e the r Dr . Cur tsi ng e r ha s show n by a pr e po nd e ra nc e of the e vid e nc e that D e fe nd ants failed to satisfy

the four pr ong test provided in 42 U.S.C. § 11112(a).

I n doing so, w e must first addre ss whether the trial cour

t properly found that the prof

essional

re vie w a c tio n w a s ta

ke n “ in t he re a so na

ble be lie f t

hat th e a cti on

wa s in the fu rt he ra nc e of qu a lity he a lthc are .” 42 U.S .C

. § 1111 2( a )( 1) . We us e an o bje c tiv e sta nd ard of re a so na ble ne ss i n determ i n i n g t h e sufficiency of the ba sis of Defe ndants’ ac tion. Pey ton , 101 S.W .3d at 84. The

re a so na ble be lie f sta

nd ard pr ov ide d in

42 U. S.C. § 1 11 12 (a )( 1) is s a tis fi e d “ if the re vie we rs , w ith th e i n f o r m a t i o na v a i l a

b l e t o t h e m a tt h e t i m e o f th e p r o f e s s i o n a l r e v i e w a c t i o n , w o u l d r e a s on a bly have c oncluded th at their a ctions would restrict incompe tent behavior or would protec t patients.” Pey ton , 101 S.W .3d at 84 (quoting H.R.Rep. No. 903, 99th Cong., 2d Sess. 10 (1986) ).

Ba sed on the a ff

i d av i t s o f Drs. Giovane tti and Wi eck, w e ag ree with the trial court that Def endants rea sonably believed that Dr. Curtsinge r’s disruptive behavior and his f ailure to re spond to three e merg en cy ro o m ca l ls on J une 30, 2003, would hinder quality health ca

re. D r. Wieck dis c us se d th e inc ide nts wh ic h r a ise d c on c e rn ov e r D r. Cur

tsi ng e r’ s pe rs on a l and

pr of e ssi on a l a bil ity to interac t with patients and other SHMC employ ees in his af fidavit, wher e he stated:

...Specifica lly , there wer e re ports that, in October 2002, Dr. Curtsing er disrupte d the ER by “ra nting an d raving ” for

at least one hour re g ardingthe proc ess by which a patie nt c a me int o th e ER. Dr . Curt sin g e r’ s d isr up tive beh avi or

and ina pp ro pr ia te commentar

y aff ecte d the ER nursing staff a nd at least a few phy sicians. And during the hospitaliz ation of this s am e p ati ent, she re ndere d a complaint about Dr

. Curtsinge r... 7. A sec ond collegi al i n t er vention with Dr. Curtsinge r wa s held by the Surg ical Ad vis or y Com mit te e in F e br

ua ry 20 03

. Th e c oll e g ia l in te rv e nti on wa s h e ld b e c a

us e of re ports that Dr. Curtsing er ref used to issue a STAT order for asmall bowel followthroug h exam that he order ed to rule out a possible bowel obstruction and to spea k direc tly with the on-ca ll ra d i o logist to discuss the nee d for the pr ocedur e. The conflict pe rsisted for approximately six hours and left the patient and her family upset and the nur sing staf

f fr ustrated.

... a. A patient compl ai n t ab o ut statements made by Dr. Curtsing er on No v e mb e r

1 9
, 2 0 0 2
, d

u r in g th e c o u r s e o f

D r

. Curts in g e r ’ s f

in al examination of the patient. Reportedly with thr ee visitors pre sent, Dr. Curtsinge r made the following statements to the patient: (1) “You

ne e d to take y our a ss t o M e ha rr y to h a ve it loo ke d at wh e re it is f re e ;” and (2) “You ne ed to g et y our ac t straig ht beca use being a cook isn’t cutting it, and you need to g et a r eal job with bene fits.”-8- b. Dr. Ang ie L arse n advised the Chief of Staff on June 30, 2003 that Dr . Curt s i n g e r

h a d m a d e d e m e an i n g an d

p o t e n t i a l l y , p r o f

e s s i o n a lly dama g ing c omm e nts a

bo ut h e r. Spe c if

ic a lly , h e ha d d isc us se d w ith other membe rs of the Me dical Staff a nd nurses his stated opinion that Dr . L ars e n w a s e mot ion a lly and me nta lly un sta

ble and the po ssi bil ity that she mig ht be suffe ring a “ne rvous bre akdown.”

c

. T h e CE O w a s a d v is e d th a t D r

. Curts in g e r

h a d c o mme nted t o a
nurs e that sh e sh ou ld “ g e t out [of Sou thern Hills ]” w hil e sh e c ou ld and that [Sout hern H ills] is goingdown.”

... 13. J ust after

the J uly 2003 summary

suspension was lifted, a patient who wa s schedule d to ha

ve a proce dure at Southern Hills c omplained that Dr. Curtsing er ha d lied to h er ab o u t t wo m atters. F irst, Dr. Curtsinge r lied to her a bout why the previously s chedule d proce dure ha d to be re -sche duled. Second, Dr . Curtsinge r either s t at ed to the patient or g ave the patient the impression that a pa rticular phy sician wa s his partner.

Dr. Curtsing er how ever

argues that his alleg e d ly

d is r u p ti v e beha

vior could not have hindere d qu ali ty he a lth c are be c a

us e his be havio r ha d no e ff e c t on his qu a lif

ic a tio ns and c omp e te nc e a s a surg eon. A similar ar g ument was made and dismissed by the cour t in Gordon v. Lewistown Hosp.
, 42 3 F .3 d 1 84 (3 rd

Cir .2 00 5) . Sa id t

he c ourt :

I t is Go rd on ' s p os iti on that the pr of e ssi on a l c on du c t a t is su e did no t a ff e c t a dv e rs e ly the hea lth or welfa

re of patients as re quired by

§ 11151(9), and ther efor e ther e wa s no profe ssional reviewaction to conf er immunity

on the Hospital. He a sserts that he only could be e x pelled fr om the medi ca l staff a s a re sult of a profe ssional review action if it was ba sed on either his competenc e or his prof essional conduc t, which

c on du c t af

fe c ts or c ou ld af

fe c t adv e rs e ly the he a lthor we lf are of a patie nt o r p a tie nts

. See 42 U. S.C. § 1 11 51 (9 ). Sin c e his pr of e ssi on a l c omp e te nc e ha s n e ve r b e e n in d i s p ute, Gordon a

rg ues that he w as expelled for his conduc t in violating the Conditi ons-his t el ephone conver sation with Mrs. Seecor a and the J une 4th letter. Ac c or din g to Go rd on , in or de r t o q

ua lif y its a c tio ns ba se d o n t hat con duc t a s a “prof e s s io n a l r e v ie w a c ti o n ” e n ti tl e d to im mu n it y u n d e r th e H CQ I A
, th e H o s p it al bore the burden to showthat his conduct “c ould affe ct adve rsely the hea lth or welfa

re of patients”.

... Such unprofe ssional conduct on the pa rt of a phy sician is within the purview of a “ profe ssional reviewaction” u n d er the HCQI A. The pla in lang uag e of the

s tatute in d ic a te s th e b r e a d th o f “ c o n d u c t” e n c o mp a s s e d w it

h in th e d e f

in it ion of

“ pr of e ssi on a l r e vie w a c tio n” by the inc lus ion of c on du c t that “ c ou ld a ff e c t a dv e rs e ly the hea lth or welfa

re of a patient.” 42 U.S.C. § 11151(9). The statute contemplates not only potential harm through use of the ter m “could,” but it also af

fords prote ction to a c tio ns take n a g a ins t phy sic ian c on du c t that e ith e r imp a c ts or po te nti a lly

imp a c ts-9-

patient “we lfare ” adve rsely , meaningpatient “we ll be ing in a ny respe ct; prosper ity .” Bl ac k 's L aw Di ct i o n ary

(W es tGr o u

p , 7 t h E d

. 1 9 9 9 ). E v en i f t h e s t at u t o ry l an gu age
wa s d e e me d to be a mbi g uo us , th e le g isl a tiv e his tor y wo ul d su pp ort the same construction. See He a lthCare Qu a lity I mpr ov e me nt A c t of

19 86 , H .R. 55 40 , 9 9th Cong.2d Session (1986)
, 132 Cong. Rec. at 30768 (Oc t. 14, 1986) (“c ompetence and pr of e ssi on a l c on du c t sh ou ld b e int e rp re te d in a wa y tha t is su ff ic ie ntl y br oa d to protec t leg itimate actions based on matters t hat raise conce rns for patients or patient

car e.”) . Other c ourts simil arly have a pplied immunit y

in circumstanc es whe re a phy sician' s unprofe ssional “conduc t” was a n issue in the cha l l en ged prof essional revie w ac tions. See, e .g., Brader v. Alleghe ny Ge n. Hosp., 167 F. 3 d 8 32, 835 (3d C i r

. 1 9 9 9 ) ( a f

f i r m i n g s u m m ar

y j u d g m e n ti nf

a v o r o f H o s p i t a l a f

f o r d e d H C Q IA immunit y fo r p eer revie w dec isions invol ving a surg eon cha

rac terized as “a dis ru pti ve fo rc e in t

he ho sp ita l” ); Bryan v. J

ames E. Holme

s Reg'l Med. Ctr., 33 F.3d 1318, 1324 (11th Cir.1994) (g ranting immunit y when phy sician' s privileg es re voked for inappropriate and unprofessional behavior stemming from his “being a volcanictempere d perf

ectionist, a diffic ult man with whom to work, and a person who regularly viewed it as his oblig ation to criticize staff members at [t he Hospital] for pe rc e ive d in c omp e te nc e or ine ff ic ie nc y ,” so me of wh ic h oc c ur re d in f ro nt o f p a tie nts

a b o u tt o u n d e r g o s u r g e ry); Morgan v. Pe aceH ealth, Inc., 101 Wash.App. 750, 14 P.3d 773 (2000) (upholding immunit y when phy sician' s privileg es s u s pended f or
se xua l ha

ra ssm e nt a

nd ina pp ro pr ia te beh a vio r w ithpatie nts ); Mey ers v. C o l u mb i a / HC A He a lthcare Corp., 3 4 1 F .3 d 4 61 (6 th C ir .2 00 3) (u ph old ingimmun ity wh e n ph y sic ian' s re a

pp oin tme nt de nie d be c a us e of fa ilure to tim e ly di scl ose d is c ip li n ar

y a c ti o n s in an o th e r s tate , p e r s o n a li ty p r o b le m an d v ar io u s in c ide nts of dis ru pti ve be havio r) ; Impe rial v. Suburban Hosp. Ass' n, 37 F.3d 1026 ( 4th Cir.1994) (af firming district court orde r g ranting summ ar y j udg ment to hospital where ph y sic ian' s r e a

pp oin tme nt t o s ta ff

de nie d on ba sis of

ho sp ita l' s c on c lus ion

that hi s profe ssional activiti es d id not meet standard of car e, he w as def

icient in his recor d ke e pin g , p a tie nt m ana g e me nt, and wo rk re la tio ns hip s w ithhe a lthc are pr of e ssi on a ls at the hospital).

Gordon , 423 F.3d at 202-204.

Be cause “‘[q]ualit y

healthca re’ is not limi ted to clinical compe tence , but includes matters of g ener al behavior and ethica l conduct,” Mey ers v. Columbia/HCA Healthcare Corp. , 341 F.3d 461, 469 (6th Cir.2003), we f

ind no merit in Dr. Curtsinge r’s arg ument that the pee r re view committee could not have r easona

bly believed that his disrupti ve beha vior and unprof

essional conduct towa

rds patients and fe llow employ ees w ould jeopardize the qua lity of hea lthcare at SHMC.

Def endants also based Dr. Curtsinge r’s suspension on evidenc e that Dr . Curtsinge r re fused to respond to three calls fr om the SHMC emerg ency room on J une 30, 2003. Dr. Wieck explained the June 30 , 2 00 3, inc ide nt i n h is a ff ida vit :-10-

8. Fr om ap p r o xim a te ly

1 2 :4 3 a

. m. thr o u g h 4 :2 8 a

. m. o nJu n e 3 0
, 2 0 0 3
, D r. Cur tsi ng e r r e fu se d to a c c e pt t hr e e c a lls fr om the ER fo r s ur g ic a l c on su ltatio ns . A ll thr e e p a ti e n ts w e r e v e r

y il l w it h s e r io u s c o n d it io n s r e qu ir in g th e s e r vices of a surg eon; additionally , eac h case was an emer g ency

. The first ca ll concer ned a patient wi th a co lla

ps e d lung

. Th e se c on d ca ll co nc e rn e d a pat ie nt wh o h a d b e e n s ta bb e d in the buttocks are a with a Ginsu knife; the ER phy sician nee ded a sur g eon bec ause he

c ou ld n ot s top the ble e din g . T he thi rd a nd fi na l ca ll co nc e rn e d a 49 y e a r o ld f e ma le with an ac ute abdomen. L ater on J une 30th, emer g enc[y ] surg ery was re quired for this patient beca

use it was dete rmined she ha d a per forated colon. 9. Dr. Curtsinge r was the surg eon on call fr om 0700 on J une 29, 2003 throug h 0700 on J une 30, 2003, ac cordingto the ER’s revised c all schedule

. The reports from the hospital perso n n el who conta cted Dr . Curtsinge r whe n surg ical consultations wer e neede d did not indicate that Dr. Curtsi ng er offer ed to respond to the call if another ph y sic ian d id n ot. To the c on tr ary , it wa s r e po rt e d th a t D r. Cur tsi ng e r’ s r e sp on se to

e a c h c a ll f ro m th e ER w a s th a t he wa s no t on c a ll and Dr

. An g ie L ars on wa s o n c a ll. For tunately , Dr. L arse n ag ree d to a cce pt the three calls. The only repor t or indication that D r. Cur

tsi ng e r did no t re fu se to co me in to the ho sp ita l to se e the se patie nts c a me from Dr . Curtsinge r at a

later time.

Whil e Dr . Curtsinge r conte nds that his failure to re spond to the emer g ency room ca lls was

mere ly a re sult of chang es beingmade to the p re viously posted schedule without his not ice, Dr

. Gi ov ane tti e x pl ain ed in his a ff ida vit that th e mis take c re a te d a n una c c e pta

ble and po te nti a lly dang erous inter

ruption to the call sche dule.

5. Whe n D r. Cur

tsi ng e r d id n ot pr omp tly and a pp ro pr ia te ly

re sp on d to the thr e e c a lls from the Eme rg ency

Room betwee n 12:43 a.m. and 4:28 a.m. on J une 30, 2003, Dr

. Curtsinge r interr

upted the c al l schedule. A side from Dr . Curtsinge r’s late r explanation, there wa s no i n d i ca t ion from the re ports of Dr. Curtsig ner’ s behavior that he of fe re d to re sp on d to t

he c a lls if Dr . A ng ie L ars e n r e fu se d to se e the patie nts

. Dr

. Cur tsi ng e r’ s re po rt e d re fu sa l to i mme diate ly re sp on d to the c a lls by

c omi ngint o see the patients and the de lay s that resulted fr om the ef forts to locate a surg eon willing to eva luate the patients could have ha rmed them. Ove rnig ht calls to surg eons from the e merg ency

room for sur g ical consultations ar e usually neces s i t ated by

ur g e nt p a tien t care n e e ds . T he c a lls on June 30 , 2 00 3 w e re no dif fe re nt. No t on ly did Dr . Curt sin g e r’ s c on du c t di sr up t th e fl owof

patie nt c are in th e ER
, but it a lso posed an imminent threat of harm to patients. M o re o v er , if this behavior by Dr. Curtsinge r wa s repe ated, patients would ag ain be place d in ha rm’s way

. The Rules and Regulations for Southern Hills’ Medica l Staff provide that call cove rag e must be uninterrupted twe nty -four hours per day , seven da

y s per wee k. Thus, repor

ts of Dr. Curtsinge r’s re sponses to the t hree calls on J une 30, 2003, also constitut ed a w illful dis re g ard fo r t he Me dic a l Sta ff

B y laws , Ru le s, and

Re g ulatio ns

.-11-

Dr. Curtsing er’ s arguments fail to prese nt any evidenc e that the pr ofessional re view ac tion taken by SHM C w a s mo tiv a te d by any thi ng oth e r tha

n a re a so na

ble be lie f that th e a c tio n w ou ld f ur the r q ua lity health ca re.

Under the sec ond prong o f t h e immunit y test provided under

HCQI A, we must dete rmine whether the ac tion was taken “ afte r a r easona ble ef fort to obtain the fa cts of the matter .” 42 U.S.C § 1 11 12 (a )( 2)

. I n ma

kin g su c h a

de te rm inatio n, we mus t de c ide wh e the r “ the tot a lity of the pr oc e ss leadingup to the Board’ s ‘prof essional re view ac tion’ ... evidenc ed a r easona ble ef fort to obtain the fac ts of the matter.” Mathews v. Lancaster Ge n. Hosp. , 87 F.3d 624, 637 ( 3rd Cir.1996).

De sp ite Dr . Curt sin g e r’ s ar g ume nts to the c on tr ary , the re wa s an e xten siv e re vie w p ro c e ss conducte d in this matter. First, an investigation was conduc ted into Dr. Curtsinge r’s a lleg ed patter n of dis ru pti ve be havio r as we ll as the e ve nts oc c ur ri ngon June 30 , 2 00 3. Th e ME C th e re a ft e r h e ld a spec ial meeting during which time the MEC deter mined that Dr. Curtsinge r’s behavior war rante d

su sp e ns ion . T he ME C adv ise d Dr . Curt sin g e r o f h is r ig ht u nd e r S MH C B y laws to a

fa ir he ari ngin

or de r t o o pp os e the sanc tio ns imp os e d b y the ME C. A ft e r D r. Cur

tsi ng e r a pp lie d f or re ins ta te me nt, Dr . Curt sin g e r’ s c a se w as furth e r i nv e sti g a te d a nd dis c us se d b y

the Me dic a l Sta ff

Cr e de nti a ls Commi ttee, the MEC, a

nd the Boa

rd of Trustee s. On J anuar

y 27, 2004, Dr. Curtsing er w as af forde d a fa ir hea ring befor e the pe er r evie w comm ittee wher e he a nd his attorney

wer e able to present evidenc e in suppor

t of his r einstatement and to r efute the alleg ations asserte d by the MEC. The pee r revie w co m m i t t ee later pre sented their r eport to the MEC and the B oard of Trustee s, which ultimately

resulted in Dr . Curtsinge r’s pe rmane nt suspension. Dr. Curtsinge r’s a rg ument s that he was not af

forde d a peer review hearing befor e the MEC first issued sanctions aga inst him, that he alleg edly complied with all the re quirements set for th by the MEC for re i n statement, and that he

en g ag ed in no disruptive behavior afte r the initial sanc tions issued by the MEC, f ail to r aise a g enuine issue t o rebut the presumption that the profe ssional reviewaction wa s taken a fter a “re asonable eff

ort to obtain the fac ts.”

The third ele ment of the HCQIA immunity test is whether “ adequat e n o t ice a nd hear ing proce dures [were ] afforde d to the phy sician involved.” 42 U .S

. C

. § 1 1 1 1 2 (a )(3) . A hea lth care entity is deeme d to have satisfied the third prongof 42 U.S.C. § 11112(a)( 3) if the r equire ments set fo rt h in 42 U. S.C. § 1 11 12 (b ) a

re me t:

A hea lth care e ntity

is deemed to have met the a dequate notice and he aring require ment of subsec tion (a)( 3) of this sectio n with respec t to a phy sician if the following conditions are me t (or ar e wa ived voluntarily by the phy sician): (1) Notice of propose d action The phy sician has be en g iven notice stating

-- (A)( I ) that a pr ofessional re view ac tio n h as b ee n proposed to be taken ag ainst the phy sician, (ii) re asons for the proposed a ction, (B )(I ) that the phy sician has the r ight to re quest a he aringon the proposed a ction,-12-

(i i ) a n y t i m e l i m i t(o f n o tl es s t h an 3 0 d ay s ) wi t h i n wh i ch t o re qu es t s u ch a h ea ri n g, and (C) a summar

y of the rig hts in the hearingunder pa rag raph ( 3). (2) Notice of hea

ring I f a hear ing is r equeste d on a timely basis under para g raph (1)( B), t h e phy sician involved must be g iven notice stating

-- ( A ) t h e p l a c e , t i m e , an d d a t e , o f t h e h e ar i n g , w h i c h d a t e s h a l l n o t b e l e s s t h an3 0 d ays afte r the date of the notice , and (B ) a list of t he witnesses (if any) ex pecte d to testify at the hea ring on behalf

of the p r o f e s s i o n a l r e v i e w b o dy. (3) Conduct of he aringand notice I f a he aringis requeste d on a timely basis under pa

rag raph ( 1)(B )-- (A) subject to subpa

rag raph (B ), the hear ing shall be held (as deter min ed b y the health ca re e ntity )-- ( I) b e f o r e an ar b i t r a t o r m u tu a l l y a c c e p t a

b l e t o t h e p h ys i c i an an d t h e h e a l t h c ar e e n t i t y, (ii) b ef o re a hea ring office r who is appointed by the entity and who is not in direct economic c ompetition with t he phy sician involved, or (iii) befor e a pa

nel of individuals who are appointed by the entity and are not in direct economic c ompetition with t he phy sician involved; (B ) the right t o t h e h earing may be for feited if the phy sician fa ils, without g ood

cause , to appea

r; (C) in the hea

ring the phy sician involved has the r ight-

- (I ) to repr esentation by

an attorne y

or other pe rson of the phy sician' s choice
, (ii) to have a record made of the proceeding s, copies of w hich may be obtained by

the phy sician upon pay

ment of an y

rea sonable c harg es assoc iated with the pre paration there of, (i ii) to c a ll, e xami ne , a

nd c ro ss- e xami ne wi tne sse s, (i v) to p re se nt e vid e nc e de te rm ine d to be re le va nt by the he ari ngof

fi c e r, re g ard le ss of its admissibil ity

in a cour t of law, a nd (v) to submit a written stateme nt at the close of the hea ring ; and (D) upon c ompletion of the hea ring , the phy sician involved has the r ight-

- (I ) t o r e c e ive the wr itt e n r e c omm e nd a tio n o f t he arb itrato r, off

ic e r, or pa ne l, including a

statement of the ba sis for the re commendations, and (ii) to rec eive a written decision of t he health car e entity
, including a s tatement of the basis for the de cision.

U.S.C. § 11112(b).

I n this case, De fenda

nts clear ly

complied with the conditions contained in 42 U.S.C. § 11112(b). Dr . Curtsinge r wa s provided n o t i ce of his first summary suspension and the re asons there for on July

2, 2003, as we ll as notice of his sec ond summary suspension and the re asons there for on Dec ember

4, 2003. Due to t h e ad v er se re commendation of the MEC, Dr. Curtsinge r wa s informed of

his right to re quest a he aringwithin fourtee n day s, which he e x erc ised. Dr. Curtsing er-13-

was notified of the date, time a nd place of the he aringas we ll as the g rounds for the adver se ac tion taken a g ainst him. During the he aringon J anuar y 26, 2004, Dr. Curtsing er w as re prese nted by counsel a nd the fa ir hea

ringcommittee hea

rd extensive test i m o n y

from seve ral hospital staff

memb e r s an d

p h y s ic ia n s

. D r

. Curts in g e r

w a s p r o v id e d

a c o p y o f th e r e c o mm e n d a ti o n s r esulting from the he aringon Fe bruar y 12, 2004.

Howeve r, Dr. Curtsing er doe s not challeng e the suf f ic ie n c y o f th e n o ti ce a

nd hear ing a ffor ded to hi m afte r the sec ond summary suspension, rather , Dr. Curtsing er c ontends that his alleg ed misconduct resulted in two separ ate pr ofessional pe er r eview a ctions and thus, he wa s entitled to two separ ate investig ations and t wo fa i r hearing s. We addresse d this same issue in Pey ton , wher e the phy sician ar g ued that his summary suspension and his subsequent per manent s u s p en s ion were separ ate a nd distinct peer r eview a ctions war ranting separ ate compliance with the provisions of 42 U. S.C. § 1 11 12 (a ) i n e a c h in sta nc e . Sa id t

he Court :
Dr. Pey ton argues there wer e two distinct peer revie w ac tions which took place and the Hospital is, theref ore, r equire d to comply

with the standards of

§ 11112 for e ach pa

rticular action. More spe cifica lly , Dr. Pey ton asserts the summary suspension was a pe er revie w action, and the subsequent per manent suspension wa s

a s e p ar a te an d d is ti n c t p e e r r e v ie w a c ti o n

. We n e e d n o t d e c id e w h e th e r th ese w ere two separ ate peer revie w ac tions or whether one is simply

a continuation of the other. The issue c an be r esolved by looking to the plain languag e of § 11112( c)( 2), which states that for pur

poses of § 11111(a)
, “nothing in this section shall be construe d as

.. . p re c lud ingan im me diate su sp e ns ion or re str ic tio n o f c lin ic a l pri vil e g e s, su bje c t to subsequent notice and hear ing or other adequate proce dures, whe re the failure to take

su c h a n a c tio n may re su lt in an imm ine nt da ng e r to the he a lth of an in div idu a l.” Th is is ex actly what happe ned in the pre sent ca se. Dr. Pey ton's hospi t al p ri v i leg es we re summarily

suspended, a

nd he was there afte r provided w ith the nece ssary protec tions set forth in the statu te. I n light of our conclusion above that the re vocation of D r. Pey ton's pr ivilege s was under taken in a r easona

ble belief “that the action wa s in the further ance of quality

health ca

re” , we must likewise conc l u d e t he summary

su sp e ns ion

wh ic h o c c ur

re d o n Apr il 24, 19 94 , wa s tak e n be c a us e the fa ilure to d o s o may have r esulted in an imminent dang er to the he alth of an individual. 42 U.S.C. § 11112(c) (2).

Pey ton , 101 S.W .3d at 88.

42 U.S.C. § 11112(c)(2) rec og nizes that cer tain actions, which may

result in the imminent dang er to the he alth of an individual, justify immediate suspension subject to subse quent notice and hear ing. T he MEC summarily suspended Dr . Cur t singe r following his refusa l to respond to three

emer g ency

room ca lls, whic h may

rea sonably

have be en expected to r esult in the immi nent dang er to the health of a patient. Dr. Curtsi ng er was t here afte r afforde d the necessar y statutory

protec tions p r o v id e d in 4 2 U

. S. C. § 1 1 1 1 2 ( b )

. T h e r e f o r e , b a s e d

on P ey t on and the pr ovisions of 42 U.S.C. §-14-

11 11 2( c )( 2) , w e fi nd

no me ri t in

Dr . Cu rt sin g e r’ s c on te nti on

that he wa s e nti tle d to tw o s e pa rate investigations and hear ings in orde r to fulfill the requir ements of 42 U.S.C. § 11112(a) (3).

T h e f in a l p r o n g o f th e H CQ I A im mu n it y te s t p r o v id e s th a t th e p e e r r e v ie w a c ti o n mu st be
take n “ in t he re a so na

ble be lie f t

hat th e a c tio n wa s wa

rr ante d by the fa c ts kn ow n a ft e r s uc h r e a so na ble eff ort to obtain fac ts and afte r mee ting the r equire ments of par ag raph ( 3).” 42 U.S.C. § 11112(a)(4)

. “Our analy sis unde r § 11112(a) (4) closely trac ks our analy sis unde r § 11112(a) (1).” Sugarbaker v

. SS M H e alt h Ca re , 1 90 F .3 d 9 05 , 9 16 (8 th C ir .1 99 9) . Wh ile Dr . Curt sin g e r c ha lle ng e s c e rt a in

un de rl y ingfa c ts u

po n w hic h De fe nd ants re lie d, he ha s no t sh ow n th a t th e fa c ts w e re “ so ob vio us ly mistaken or inade quate a s to make re liance on the m unrea sonable.” Ma the ws , 8 7 F

. 3 d a t6 3 8

. In light of the evidenc e docume nting Dr . Curtsinge r’s p at t ern of disruptive behavior

and his alleg ed ref usal to r espond to thr ee emer g ency room calls, we f ind that there is no g enuine issue a s to whether De fe nd ants ’ a c tio n w a s ta ke n in the re a so na

ble be lie f t

hat it wa s w arr ante d b y

the fa c ts.

Ha vin g fa ile d to sh owby

a pr e po nd e ra

nc e of the e vid e nc e that D e fe nd ants did no t c omp ly with the four prong test provided in 42 U.S.C. § 11112(a), w e af firm the dec ision of the trial court g ranting Def

endants pa

rtial summary

judgme nt pursuant to HCQI A and the T ennesse e Peer Review L aw.

IV. I NF ORMATI ON S U PP LI ED TO THE N A TI ON A L P RACT I T I ONE R D AT A B ANK
Dr. Curtsing er la stly

contends that t h e t ri al cour t erre d in finding that the information supplied by Def

endants to the National Practitioner Data Ba nk was sufficie ntly acc urate and not

ma de in b a d fa ith or wi th ma lic e

. Ac c or din g to 42 U. S.C. § 11 13 3( a )( 1) , “ Ea c h h e a lthc are e nti ty which take s a prof

essional re view ac tion that adverse ly aff ects the c linical privileg es of a phy sician for a period a l o ng er tha

n 30 day s shall report [the ac tion] to the [S tate] Boar d of Medica l Ex aminers.” The State B oard of Medica l E x am i n ers is t hen re quired to re port the same to the National Prac titioner Data B ank. 45 C.F.R. § 60.9(b) . 42 U.S.C. § 1 1 1 3 7 (c ) protects healthca re entities who are require d to issue professional r eview a ction repor ts by stating that, “[n] o person or entity

... shall be held liable in a ny civil a ction with r espec t to any repor t ma de under

this subchapter ... without knowledg e of the falsity of the information contained in the repor t.” Ther efor e, hea lthcare

e nti tie s “ are e nti tle d to immun ity fo r r e po rt ingun less the re is s uf fi c ie nt e vid e nc e fo r a

jur y to conclude that the re port was f alse a nd the re porting party knew it was fa lse.” Mey ers v. Logan Me m. Hosp. , 82 F.Supp.2d 707, 716 (W.D.Ky .2000).

Dr. Curtsing er c laims that every statement i n Def

endants’ r eport wa s false or should not have been r e p o rte d

. We th e r e f o r e mu s t r e v ie w th e r e c o r d an d th e r e p o rt p r o v id e d to th e National Practitioner Data B ank in orde r to deter mine whether there was evidence of knowing falsity . The repor t stated:

Phy sician wa s suspended by the hospital medical e x ec u tive committee for dis ru pti ve /in a pp ro pr ia te be havio r i nv olv ingpatie nts , e mpl oy e e s and ph y sic ians

. Summary suspension was lifted c ontinge nt on phy sician’s g oing on a leave of-15-

absenc e and be ing e valuated by the state i m p ai re d phy sician’s org anization (Tenne ssee Me dical F oundation or TMF ). Phy sician coope rate d with the TMF a nd

a pp lie d fo r pe rm iss ion to e nd his le a ve and

be re ins ta te d to the ho sp ita l st a ff . Wh ile ph y sic ian ’ s r e qu e s tf

o r r e i n s t a t e m e n tw a s p e n d i n g , t h e M E C a g a i ns u s p e n d e d h is privileg es, base d on repor ts of continued disruptive behavior . Phy sician re quested a fa ir hea ring

. The hearing resulted in a determination by the MEC that the phy sician should not be reinstated to the staf f, due to his disruptive behavior . Phy sician did not appea l the MEC’s determination.

After revie wing the re cord, w e find that Dr . Curtsinge r fa iled to present a ny evidenc e, other than his own subjective be lief, that the stateme nts made to the National Practitioner Data B ank we re false, muc h less that Def

endants we re a

war e that the statements wer e false. We the ref ore a ffirm the trial court’s judgme nt, e ntitli ng Def endants to immunity for repor ting the a ction of the pe er r eview committee to the State Medica l Boa rd and the National Prac titioner Data B ank.

V. C ONCL US I ON

I n consideringthe Motion for Summary J udg ment in this case, we have f ollowed the blueprint laid out for this Court by J udg e Swiney

in Pey ton , 101 S.W .3d 76. Therei n , this Court

car efully explains t he “unc onventional” standa rd for summary judgme nt ma

ndated by 42 U.S.C. § 11112(a) and universally followed in fede ral c ourt dec ision. This “unconventional” standa rd wa s
no t m an d a t e d b y t h e U

. S

. C o n g r e s s i n a v a c uu m

. I t r e p r e s e n t e d a p o l i c y d e c i s i o n b y C o n g r e ss t o
e nc oura g e se lf

-p oli c ingby

he a lth c are pr of

e ssi on a ls in re sp on se to wh a t it de te rm ine d to be a c ri sis

.
Whe n Co ng re ss p a sse d th e HC QIA i n 1 98 6, it wa s re sp on din g to a c ri sis in the monitoring of

health care profe ssionals. Although state licensing boards ha d long

mon ito re d th e c on du c t and c omp e te nc e of the ir ow n h e a lthc are wo rk e rs , Co ng re ss fo un d th a t “ [t]he inc re a sin g oc c ur re nc e of me dic a l ma lpr a c tic e and the ne e d to improve the quality of medical c are have be come nationwide problems that war rant g re a te r e ff

or ts tha n thos e that can be un de rt ake n by any ind ivi du a l State .” 42 U. S.C. § 1 11 01 (1 ). F ind ingthat in com pet ent “p hy sic ians fi nd it a ll t o[o] e a sy

to m ov e to differ ent hospitals or states and c ontinue their pra ctices i n t h ese new locations,” Congr ess mandate d the cr eation of a national database that re corde d incidents of malprac tice and that was available for all health car e entities to r ev i ew when

scre ening potential emplo y ee s

. H.R .Rep. No. 99-903, a t 2, re pr int e d in 1986 U.S.C.C.A.N.6384, 6385 (here inafter “H.R.Rep. No. 99- 903") . Be fore pass age of the HCQI A in 1986, threats of antitrust action and other lawsuits often dete rre d health ca re e ntities from conducting eff ective peer revie w. I n order to encour ag e the ty pe of pe er r eview that would expos e incompete nt phy sicians, the HCQIA shields health car e entities and individual phy sicians from liability for damag es for actions perf ormed in the course of monitoring the competenc e of health care personne l. See M a th e ws v

. La n c a s te r G e n

. Hosp. , 87 F.3d 624, 632 ( 3d Cir.1996) (desc ribing-16-

le g isl a tiv e histo ry

of the HC QIA) ; Br

y an v . J am es E . H

olm es R e g’ l M e d. Ctr

. , 33 F.3d 1318, 1332 (11th Cir.1994) (listing Congr essional motivations for passing the HCQI A). The HCQIA m andate s that a hea lth care entity ’s re view of the competenc e of a phy sician shall not result i n its li ability “in damag es under

any law of the United S tat es or o f a

ny State ,” if su c h a pe e r r e vie w “ me e ts a ll the sta nd ard s sp e c if

ie d in section 11112(a ) of this title.” 42 U.S.C. § 11111(a).

Singh v. Blue Cross/Blue Shield of Mass., Inc. , 308 F.3d 25, 31 ( 1st Cir.2002) (footnote omitted).

As the Singh court stated in f ootnote:

Since HCQI A immunity

may only b e o v ercome by

a pre pondera

nce of the evidenc e, the statutor y p resumption in favor of the hea lth care entity

shifts to the plaintiff “not only

the burde n of produc ing e vidence but the burden of per suasion as well.” See J erome A. Hoff man, Thinking About Presumptions: T he Presum

ption of Agency f rom Ownership as Study Spec imen , 48 Ala. L .Rev. 885, 896-97 (1997) (examining the “Tha

y er- Wigmore eff

ect” and the “Morg an eff

ect” of pre sumptions). O f c o u r s e , a

d e f e n d an tm o v i n g f

o r s u m m ar y j u d g m e n t o n t h e b a s i s o f H C Q IA immunit y can c hoose to submit evidentiary materia l in support of

its mot ion instead of re lyingso le ly

on the e vid e nti ary

we ig ht o f t

he statut or

y pr e su mpt ion . T hat is a
c ho ic e fo r t

he lit ig ant.

308 F.3d at 33 n.5.

I n the contex t of sus taining the g rant of a summary judge ment motion by

the trial cour

t, the U.S. Third Circuit Court of Appea ls in Brader , 167 F.3d 832, state d:

I n th is c a se , a

ph y sic ian w ho ha d b e e n dis c ipl ine d by his ho sp ita l so ug ht t o have a c ourt re vis it that a dv e rs e me dic a l and a dmi nis tr a tiv e jud g me nt. Th is i s prec isely the ty pe of c ase that Congre ss intended t o fore close in passing the HCQI A. “[t] h e int ent of [the HCQI A] was not to dist urb, but to reinfor ce, the pree x isting reluc tance of cour

ts to subst itute their j udg ment on the merits for that of hea lth care pr of e ssi on a ls a

nd of the g ov erni ng bo die s o f h os pit a ls i n a n a re a wi thi n th e ir expertise.” Bryan , 33 F.3d at 1337. We conclude that Bra der ha s failed to re but the presumption that AGH met the re qu ir e me nts fo r immunit y un de r t he HC QIA. He ha s f

a ile d to c ome fo rt

h w ith sufficie nt evidence to allow a rea sonable jury to conclude that the Hosptial did not pr ov ide him wi th a de qu a te and a pp ro pr ia te pr oc e dure s, or

tha t A GH did

no t a c t a t a ll times in the reasona

ble belief that its actions would f

urther quality health car e. The g rant of summar

y judgme nt to AGH will theref ore be aff irmed.

167 F.3d at 843.-17-

As was the c ase in Pey ton , Dr. Curt s in g e r h a s f a il e d the “unconve ntional” summary judgme nt standard in this ca se.
Havingfound no merit in Appellant’ s assig nments of err or, we aff irm the judg ment of the trial court in all re spects. The costs of appe al ar e asse ssed ag ainst Appellant, Dr. Curtsing er.

___________________________________ WI L L I AM B. CAI

N, J UDGE