FI RST DI VI SI ON

BA RNES, P. J.

, M C M I LLI A N and M ERCI ER, JJ.

N O T IC E : M otions for r e c ons i de r a tion m us t be

ph y sic a l ly r e ce iv ed i n our c le r k ’s offic e w ithin te n

da y s of the da te of de c is ion to be de e m ed tim e ly file d.

http://w w w .ga a ppe a l s .us /r ule s

June 29, 2017



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A1 7 A0 11 4 . KOLB v . NORTHSIDE HOSPITAL.

M C M ILLI A N , J u dg e.

Su s an Ko l b

, M .D., ap p eal s t h e t ri al co u rt ’ s g ran t o f s u m m ary ju d g m en t to

No rt h s id e H o s p it al (“ N o r t h s i d e”) o n h er cl ai m s fo r b reach of co n tract

, n eg l i g en ce,

t o rt i o u s i n t erferen ce w i t h bu s i n es s an d co n t ract u al rel at i o n s

, an d at t o rn ey fees ari s i n g

o u t o f t h e s u s p en s i on o f h er m ed i cal s t aff p ri v il eg es at t h e h o sp i t al

. At i s s ue i n t h i s

ap p eal is wh et her t h e fed eral Heal t h C a r e Q u a l i t y Im p ro v em en t Act o f 1 9 8 6 (t h e

“ HCQIA”), 4 2 U SC § 1 1 10 1 et s eq

., b ars Dr. Ko l b ’ s reco v e r y o f m o ney d am ag es

ag ai n s t No rt h s i d e. Becau s e we fi n d t h at HCQIA i m m u n i t y ap p l i es as a m at t er o f l aw,

we affi rm t h e t ri al co u rt ’ s g ran t o f s u m m ary ju dg m en t i n fav o r o f No rt h s i d e.“ Su m

m ary ju d g m en t i s p ro p er wh en th ere i s n o g en u i n e i s su e of m at eri al fact

an d t h e m o v an t i s en t i tl ed t o ju d g m en t as a m at t er o f l aw. OCGA § 9 -1 1 -5 6 (c). W e

rev i ew a g ran t o r d en i al o f s u m m ary ju d g m en t d e n o vo an d co ns t ru e t he ev i d en ce in

t h e l i g ht m o st fav o rab l e t o th e n o n m o v an t .” (Ci t at i o n o m i tt ed

. ) El d er v. Ha yes

, 3 3 7

Ga. Ap p . 8 2 6 , 8 2 7 (7 8 8 SE2 d 9 1 5 ) (2 0 1 6 ).

So v i ewed

, t h e e v i d e n c e s h o ws th at D r. Ko l b i s a p l as t i c s u rg eo n l i cen s ed to

p ract i ce in t h e St at e o f G e o r g i a. Sh e b ecam e a m em b er o f t h e m ed i cal s t aff at

No rt h s id e o n J an u ary 1

, 19 9 2

. In l at e Oct o b er 2 00 7

, D r. W ay ne L. A m bro ze, wh o was

v i ce ch ai rm an o f t h e M ed i cal Ex ecu t i v e Co m m i t t ee (t h e “ M EC ” ) a n d v i ce ch i ef o f

s t aff at No rt h si d e, n o t i fi ed Dr. Ko l b i n a t el ep h o n e cal l t h at h er p ri v i l eg es t o p ract i ce

at t he h o s p i t al were b ei n g s u m m ari l y s u s pen d ed

. Dr. Am b ro ze, al o n g w i th Dr. Di an e

W i seb ram

, t h e ch ai rm an o f t he M EC, m a d e t h e d eci s i on t o s u s p en d Dr. Ko l b ’ s

p ri v i leg es aft er recei v in g rep o rt s fro m v a r i o u s No rt h s i d e st aff m em b ers ab o u t Dr.

Ko l b.

On No v em

b er 1

, 2 0 0 7, Drs

. W i s eb ram an d A m b ro ze s en t Dr. K o l b a l e t t er

fo rm al l y n o t i fy in g h er o f h e r s u s p en s i o n an d as s ert i n g t hat it was b as ed o n a

“ r e a s o n ab l e s u s p i ci o n o f i m p ai rm en t

, ” ari s i ng fro m rep o rt s o f s t at em en t s t h at Dr.

Ko l b had m ad e (t h e “ Su s p en s i o n L e t t e r”). Th e l et ter s t at ed t hat b efo re Dr. Ko l b ’ s

2p ri v i leg es co u l d b e rei n st at ed

, N o r t h s i d e req u ired t h at s he s u b m i t t o a m ed i cal an d

p s y ch i at ri c ev al u at i o n

, wi t h t h e res u l t s fu rn i sh ed t o t h e h o sp i t al

, an d fu rt her i n fo rm ed

h er t h at u n d er t he h os p i t al ’ s “ M ed i cal St aff By -l aws ” (t h e “ By l aws ”), s h e was en t i t l ed

t o a fai r h eari n g o n h er s u s p en s i o n

.

Dr. Ko l b o p t ed fo r a fai r h eari n g

, i n l i eu o f t h e m ed i cal an d p s y ch i at ri c

ev al u at i on s

, an d i t was sch ed ul ed fo r Jan u ary 7

, 20 0 8

. An ou t s i d e at t o rn ey was

en g ag ed t o s erv e as t he h eari n g o ffi cer, an d fo u r ph y s i ci an s n o t p rev i o u s l y i n v o l v ed

i n t h e d eci s i on t o s u s p en d Dr. Ko l b were ap p oi n ted as m em b ers o f t h e Fai r Heari n g

Co m m i t t ee (FHC). At Dr. Ko l b ’ s req u es t

, th e co m m i t t ee m em

b ers were s u b

ject ed to

a nu m b er o f v o i r d i re qu es t i o n s s u b m i t t ed b y h er co u n s el

, an d s he rai s ed n o o b ject i o n

t o t h ei r s erv ice. Bo t h Dr. Ko l b an d t h e M EC were rep res en t ed b y c o u n s e l at t h e

h eari n g

, wh i ch s p an n ed t wo ev en i n g s an d i n cl u d ed o v er ei g h t h o u rs of ev i d en ce an d

arg u m en t o n J an u ary

7 an d Feb ru ary

5 , 2 0 0 8

.

Th e FHC i s s u ed a w ri t t en rep o rt i n l at e Feb ru ary 2 0 08 co ncl u d i n g t h a t t h e

M E C “ pres en t ed su ffi ci en t ev i d en ce to co n v i n ce t h e Fai r Heari n g Co m m i t t ee, b y a

p rep o n d eran ce o f t h e ev i d en ce, t h at i t s act i o n i n i m p o s i ng a s u m

m ary s u sp en s i o n o f

D r. Ko l b ’ s p ri v i l eg es was b as ed i n fact an d was n ot arb i t rary

, u nreas o n a b l e

, o r

cap ri ci ou s

. ” Th e FHC al s o fo u n d t h at “ i t co u l d n o t

, i n g o o d fai t h

, m ak e an y

3reco m

m en d at i o n t h a t Dr. K o lb b e al lo wed to co nt i n u e t o pract ice at No rt h s i d e

Ho s pi t al wi t h o u t an ap p ro p ri at e ev al u at i o n an d i n t erv en t i o n

. ” Nev ert h el es s, t h e FHC

s t at ed t h at “ wi th a t h oro u g h l on g -t erm i n d ep en d en t ev al u at i o n an d co m p l i an ce wi th

an y reco m

m en d ed t reat m en t an d m o n i t o ri n g

, [i t ] fel t t h ere m i g h t b e a l i m i t ed

o p p o rt u ni t y fo r Dr. Ko l b t o dem o n s t rat e h er ab i l i t y to pract i ce at No rt hs i d e Ho s p i t al

i n th e fu t u re” an d l is t ed reco m m en d ed s t ep s fo r h er t o fo l lo w t o seek rei ns t at em en t

.

Dr. K o l b ap p eal ed t he FHC’ s d eci s i o n t o an Ap p el l at e Rev i ew Co m m i t t ee,

co m p ri s ed o f t h ree m em

b ers o f No r t h s i d e’ s Bo ard of Di rect ors (t h e “ Ap p el l at e

Co m m i t t e e ” )

. At Dr. Ko l b ’ s req u es t

, n o o ral arg u m en t was h el d b efo re t h at

co m m i t t ee. In i ts wri t t en d ec i s i on i n May 2 0 0 8

, th e Ap p el l at e Co m m i t t ee

u n an im o u s l y fo un d th at th e FHC’ s d eci s i o n reg ard i n g t he s u sp en s io n of Dr. Ko lb

“ was ju s t i fi ed an d was n o t arb i t rary

, un re as o n ab l e o r cap ri ci o u s .” Ho wev er, t h e

A ppe lla te C om m itte e r e c om

m e nde d c e rt ai n m o d i fi cat i o n s t o t h e F H C ’ s r e c om m e nde d

s t ep s fo r Dr. Ko l b to fo l l o w b efo re s eek i n g rei ns t at em en t o f h er p ri v i l eg es at

No rt h s id e. No th i n g i n th e reco rd s h o ws t h at Dr. Ko l b fo l lo wed t h e reco m m en d at i on s

o f ei t her t h e Heari n g o r t h e Ap p el l at e Co m m it t ees

. 1

1 Ad d i t i o nal fact s w i l l b e reci t ed as n eces s ary to ad d res s Dr. Ko l b ’ s arg u m en t s

.

4Ov er fo u r y ears l at er, D r. Ko l b i n i t i at ed t h i s act i o n

, a n d sh e n o w ap p eal s t h e

t ri al co u rt ’ s g ran t o f s u m m ary ju d g m en t o n her cl ai m s

, arg u in g t h at th e t ri al co u rt

ap p li ed an i n co rrect s t an d ard o f rev i ew b y fai l i n g t o v i ew th e fact s in t h e li g h t m o s t

fav o rab l e t o h er an d i n s t ead g i v i n g u n d ue d eferen ce t o t h e h o s p it al ’ s d eci s i o n , t hu s

d ep ri v i n g h er o f a m ean i n g fu l rev i ew o f t h e reco rd

. Sh e al so arg u es t hat un d er t h e

p ro p er s t an d ard o f rev i ew, a ju ry co u l d fi nd t h at No rt h s id e was n ot en t i t l ed to

i m m u ni t y fro m d am ag es u n d er t h e HCQIA.

1

. As an i ni t i al m at t er, we n o t e t h at “ HCQIA i m m u n i t y i s a q u es t i o n o f l aw fo r

t h e co u rt t o d eci d e an d m ay b e res ol v ed wh e n e v e r t h e reco rd i n a p art i cu l ar cas e

b eco m es s u ffi ci en t l y d ev el o p ed .” (Ci t at i o n an d p u nct u at i o n o m i t t ed .) Ta yl o r v.

Ken nes t on e Ho sp

., In c.

, 2 6 6 G a. Ap p

. 1 4

, 1 4 (5 9 6 SE2 d 17 9 ) (2 0 0 4 ). See al s o Br ya n

v. Ja mes E. Ho l mes R eg i o n a l Med

. Cen ter

, 3 3 F 3 d 1 3 1 8

, 1 3 3 2 (III) (A) (1 1 t h Ci r.

1 9 9 4 ). Here, t h e p art i es ag ree t h at t h e HCQIA g o vern s t h e p eer r ev i ew d eci s i o n

res u l ti n g i n Dr. Ko l b’ s su s p en si o n

, al th o u g h t h e y dispute w h e the r N or thside c o m

p l i ed

wi t h t he s t at u te i n co n d uct i n g t h at rev iew. See 4 2 U S C § 1 1 1 5 1 (9 ) (d efi n i n g

“ p ro fes s i o n al rev i ew act i o n ”). Th e HCQIA p ro v i d es im m u n i t y fro m m o n et ary

d am ag es fo r p ro fes s i o n al rev i ew act i o n s t ak en

5(1 ) i n t he reas o n ab l e b el i ef t h at t h e act i o n was i n fu rt h eran ce o f q u al i t y

h eal th care,

(2 ) aft er a reas o nab l e effo rt t o o bt ai n t h e fact s o f t h e m at t er,

(3 ) aft er ad eq u at e no t i ce an d h eari n g p ro ced ures are a f f o rd ed t o th e

p h y s i ci an i n v o l ved o r aft er s u ch o t h er p ro ced u res as a r e fai r t o th e

p h y s i ci an u n d er t he ci rcu m s t an ces , an d

(4 ) i n t h e reas on a b l e b el i ef t h at t h e act i o n w as warran t ed b y t h e fact s

k n o wn aft er s u ch reas on ab l e effo rt t o ob t ai n fact s an d aft er m eet i n g th e

req u irem en ts o f p arag rap h (3 ).

4 2 U SC § 1 1 1 1 2 (a). See al s o 4 2 USC § 1 1 1 1 1 (a) (1 ) (p ro v id i n g t h at p ro fes s i o n al

rev i ew act i o n s m eet i n g t h e req u i rem en t s of § 11 1 1 2 (a) i n su l at e, i nt er al i a, t h e

p ro fes s i on al rev i ew b o d y

, it s m em b ers

, an d s t aff fro m li ab i l i ty fo r m o ney d am ag es

u n d er fed eral o r s t at e l aw fo r cl ai m s ari s i ng o u t of t h ei r act i o n s

, wi t h cert ai n l i m i t ed

ex cep t i o n s n o t ap p l i cab l e h ere). 2

2 W e n ot e t h at Geo rg i a al s o h as an im m un i t y p ro v i s io n

, wh i ch i s n o t at i s s u e

i n t hi s ap p eal . Un d er t h at p ro v i s i o n

,

No p ro fes s io n al h eal th care p ro v id er n o r an y i n d i v i d u al wh o s erv es as

a m em ber o r em p l o y ee o f a pro fes s i o n al h eal t h care p ro vi d er o r rev i ew

o rg an i zat i o n n o r an y

i nd i v i d u al wh o fu rn i s h es co u n sel o r s erv i ces t o a

p ro fes s io nal h eal th care p ro vi d er o r rev i ew org an i zat i o n s h al l be h el d

,

6Un d er 4 2 USC § 1 1 1 1 2 (a), p ro fes s i o n al rev iew act i o n s are p res u m ed t o h av e

m et t h es e s t at u t o ry req ui rem en t s

, an d t h e b urd en is o n th e o p p o s i ng p art y t o reb u t t h at

p res u m p t i o n b y a p rep on d eran ce o f t h e ev i d en ce. T h erefo re, “ t h e p res u m p t i o n

l an g u ag e i n [t h e] HCQIA m ean s t hat t h e p l a i n ti f f b ears th e b u rd en o f p ro v i n g t h at t h e

p eer rev i ew p ro ces s was no t reas o n ab l e.” (Em p h as i s i n o ri g i n al

. ) Br

ya n

, 3 3 F3 d at

1 3 3 3 (III) (A). 3

2

. D r. Ko l b fi rs t arg u es t h at t h e t ri al co u rt erred i n g i v i n g great d eferen ce to

No rt h s id e’ s d eci s i o n t o s u s p en d h er pri v i l eg es i ns t ead o f co ns t ru i n g t he ev i d en ce in

h er fav o r o n s u m

m ary ju d g m en t

.

b y reas o n o f th e perfo rm an ce of p eer rev iew act i v i t i es

, to h av e v i o l at ed

an y cri m i n a l l a w o r t o b e ci v i l l y l i ab le u n der an y l aw u n l es s he w as

m o t i v at ed b y

m al i ce t o ward an y p ers on affect ed b y s u ch act i v i t y

.

OCGA § 3 1 -7 -1 3 2 (a).

3 As on e co urt has ex p l ai n ed

, t he s tat u t o ry p res u m p ti o n rel i ev es d efen d an t p eer

rev i ew p art i ci pan t s o f t h ei r in i t i al b u rd e n o n s u m m ary ju dg m en t o f p ro v i d i n g

ev i d en t i ary s u p p o rt fo r t h e i r c on t en t i on t h at t h ey are en t i t l ed t o im m u n i t y

, an d t h e

p l ai n t i ff’ s “ b u rd en i s n o d i fferen t t han t h at o f t h e no n m o v an t wh o m u s t d em o n s t rat e

t h e ex i s t en ce o f a g en u i ne i s s u e as t o an y m at eri al fact o n al l of t h e el em en t s o f t h e

cl ai m al l eg ed o n ce a m o v an t fo r su m m ary ju d g m en t fi l es a p ro p e r l y s u p p o rt ed

m o ti o n

. ” (Ci tat i o n s o m i t t ed

. ) S in g h v. Bl ue Cr o s s / B l u e Sh i el d o

f Ma s s

. , In c.

, 3 0 8 F3 d

2 5 , 3 2 -3 3 (1 st Ci r. 2 0 0 2 ).

7Th i s Co u rt h as h el d t h at i n rev i ewi n g t h e i s s u e o f i m m u n i t y u n der th e HCQIA

o n su m m ary ju d g m en t

, a “ t ri al co u rt i s req u ired t o d et erm i n e, vi ewi n g t h e f act s i n t h e

l i gh t mo s t f a vo ra b l e t o t h e p la i n t i

f f

, wh et h er a reas o n ab l e j u ry co u ld co n cl u d e t h at t h e

p l ai n t i ff h as sh o wn b y a p rep o n d eran ce o f t h e ev i d en ce t h at t h e p eer rev i ew act i v i ti es

d i d n o t m eet t h e s t a n d a r d s s et fo rt h i n t h e A ct .” (Ci t at i o n an d p u n ct u at i o n o m i t t ed ;

em ph as i s i n o ri g in al .) Pa t t o n v. S t

. Fr a n ci s Ho sp

. , 26 0 Ga. Ap p

. 2 02

, 2 0 5 (1 ) (b ) (5 8 1

SE2 d 5 5 1 ) (2 0 0 3 ). See al s o Da ven p o r t v. No r t h ea s t Ga

. Med

. Cen t er

, 2 4 7 Ga. Ap p.

1 7 9

, 1 8 0 (5 42 SE2 d 5 2 5 ) (2 0 0 0 ). See al s o Br ya n

, 3 3 3 F3 d at 1 3 3 3 -3 4 (III) (A).

Ho wev er, t h i s Co u rt al s o h as h el d t h at t h e HCQIA “ g ran t s b ro ad d i s cret i o n to

h o s p it al s wi th reg ard t o s t aff p ri v i l eg e d eci s i o n s

, an d o u r ro l e on rev i ew o f s u ch

act i on s i s n o t t o s u b s t i t u t e o u r ju d g m en t fo r t h at of t he h o s p i t al ’ s g ov ern i n g b o ard o r

t o rewei g h t he ev i den ce reg ard i n g t h e t erm i n a t i o n o f m ed i cal s t aff p ri v i l eg es .”

(Ci t at i o n an d p u n ct u at i o n o m i tt ed .) Pa t t o n

, 2 6 0 Ga. Ap p

. at 2 0 7-0 8 (1 ) (c) (i v ). See

al s o Un i v. Hea l t h S

vcs ., In c. v. Lo ng , 2 7 4 Ga. 8 2 9 , 8 2 9 (5 6 1 SE2 d 7 7 ) (2 00 2 ). Th i s

Co u rt

, o n o ccas i o n

, h as ex p res s ed t h i s s t an d ard as gi v i n g “ d eferen ce” t o a ho s p i t al ’ s

8rev i ew deci s i o n

. 4 See Bu r r o wes v. No r t hs i d e Ho s p.

, 2 9 4 Ga. Ap p

. 4 7 2

, 4 76 (2 ) (6 7 1

SE2 d 1 7 6) (2 0 0 8).

Here, t h e t ri al co u rt fo u nd t h at n o g en u i n e i s s u es o f m at eri al fact ex i s t ed an d

reci ted t h e s t an d ard s t h at “ i t s ro l e was n ot to su b st i t u t e i t ju d g m en t reg ard i ng a

p h y s i ci an ’ s co m

p et en cy fo r th e m ed i cal ju d g m en t o f t h e ho s pi t al ” a n d t h at i t was

req u i red t o g i ve “ great d eferen ce t o t h e h o s p i t a l ’ s m ed i cal d eci s i o n an d t h at o f t h e

g o v ern i n g bo d y o f t h e ho s p it al .” Al t h o u g h t h e t ri al co u rt d i d n o t ex p res s l y reci t e t h e

re q u i rem en t th at t h e ev i d en ce m u s t b e co n st ru ed i n t h e l i gh t m o s t fav o rab l e t o Dr.

Ko l b, we fi n d no i nd icat i o n t h at th e tri al co u rt fai l ed t o d o s o

. See Pa t to n

, 2 6 0 Ga.

Ap p

. at 20 5 (1 ) (b ). Bu t p ret erm i t t i n g wh et h er t he t ri al co u rt p ro perl y co ns t ru ed t h e

ev i d en ce, o u r rev iew o f t h e t ri al co u rt ’ s o rd er o n ap p eal i s d e n o v o

, an d we ap p l y t h e

s t an d ard s et fo rt h i n Pa t t o n i n o u r rev i ew o f t h e ev i d en ce.

4 Al t h ou gh Dr. Ko l b arg u es t h at s u ch d eferen ce s h o ul d ap p l y on l y i n s it u at i on s

wh ere a p h y s i ci an ’ s p ri v i l eg es are s u s p en d ed b as ed on h i s p ro fes si on al co m p et en cy

,

we fi nd n o l eg al b as i s fo r s u ch a l i m i t at i o n. See, e.g

., Da ven p o rt

, 2 4 7 G a. Ap p

. at 1 8 6

(1 ) (a) (refu s i n g t o s u b s ti t ut e co u rt ’ s o p in i o n fo r t h at of h o s p i t al g ov ern i n g b o ard o r

t o rewei g h t h e ev i d en ce wh ere h o s p i t al rev o cat io n o f s t a f f pri v i l eg es was b as ed o n

i s su es t h at “ w ere n o t p ri m ari l y m ed i cal i n t erm s of s p eci fi c p at i en t care i s s u es ”); s ee

al s o Ro bb i ns v. On g

, 4 5 2 FSu p p

. 1 1 0

, 1 1 5 (S.D. Ga. 19 7 8) (ap p ly i n g d eferen ce wh ere

d o ct o r’ s co m

p et en ce was n o t at i s s u e, b u t i n s t ead t h e fai l u r e t o ren ew h i s h o s p i t al

p ri v i leg es was b as ed o n “ t u rm oi l an d d i s ru p t i o n ” h e b ro u gh t t o t h e h o s p i tal ).

93

. Dr. K o l b al s o co nt en d s t h a t th e t ri al co u rt erred i n g ran t in g s u m m ary

ju d g m en t t o No rt h s i d e b ecau s e, v i ewi n g t h e ev i d en ce i n t h e p ro p er li g h t

, a reas o n ab l e

ju ry co u l d co n cl u d e b y a p rep o n deran ce o f t h e ev i d en ce t h at N o rt h s i d e fai l ed to

co m p l y w i t h th e HCQIA b y (1 ) ad m i t t in g t h at Dr. Ko l b ’ s care o f h er p at i en ts was n ot

at i s s u e; (2 ) fai l i n g t o fo l lo w i t s o wn By l aws ; (3 ) s u s p en d i n g D r. Ko l b wi t h o ut

co n du ct in g an i n v es t i g at i o n ; an d (4 ) i m p ro p erl y fo cu s i ng o n h er rel i g io n

.

(a) Th e fi rs t req u i rem en t fo r i m m u n it y u n d er t h e HCQIA i s t hat No rt h s i d e’ s

ac t i o n b e t ak en i n t h e reas o n ab l e b el i ef t h at i t “ was i n fu rt h eran ce of q u al i t y h eal th

care.” 4 2 USC § 1 1 1 1 2 (a) (1 ). Dr. K o l b co n ten d s t hat No rt h si d e d i d n o t m eet t h i s

r e q u i rem en t becau s e h er su s p en s i o n was no t bas ed o n i s s ues i n v o l v i ng h er p at i e n t

care.

“ A p r o f

e s s i o n al rev i ew act i o n i s tak en i n th e reas o nab l e b el i ef t h at i t i s in

fu rt heran ce o f q ual i t y h eal t h care i f o n t h e ev i den ce t h en b efo re t h em

, t h e rev i ewers

wo u l d r e a s o n ab l y h av e co n cl u d ed t h at t h ei r act i o n wo ul d res t ri ct i nco m p et en t

b eh av i o r o r wo u ld p ro t ect p at i en t s .” (Ci t at i o n an d p u n ct u at i on o m i t t ed .) Pa t t o n

, 2 6 0

G a. Ap p

. at 20 6 (1 ) (c) (i ). “ Th e Act d o es n o t req u i re t h at t h e pro fes s i o n al r e v i e w

res u l t i n a n act u al im

p ro vem en t o f t h e q u al i t y o f h eal t h care. Ou r fo cu s i s o n t h e

reas on ab l en es s o f t h e p eer rev i ewers ’ b el i ef t hat t h ey were fu rt h eri n g t h e q u al i t y o f

10h eal t h care.” (Ci t at i o n s an d p un ct u at i o n o m i t t ed .) Pa t r i ck v. Fl o yd M ed

. Cen t er

, 2 5 5

Ga. Ap p . 4 3 5 , 4 4 0 (3 ) (a) (i ) (5 6 5 SE2 d 4 9 1 ) (2 0 0 2 ).

(i ) In su m m ari l y su s p en d i n g Dr. Ko l b ’ s m ed ical p ri v il eg es

, No rt h s i de ci t ed a

reas on ab l e s u s p ici o n o f im p ai rm e n t b a s e d o n rep ort s t h at s h e h ad m ad e st at em en t s

i n d i cat i n g t h at s h e carri ed a g un b ecau s e t h ere was a b o u n ty on h er head ; t h e DeKal b

Co u n t y p o l i ce h ad reco m

m en d ed t h at s h e carry a w eap o n aft er m u l t i p le as s as s i n at i o n

at t em p t s ag ai n s t h e r ; t h e g ov ern m en t m ay b e aft er h er b ecau s e s h e h ad rem o v ed a

m i cro ch i p i m

p lan t ed i n a p at i en t i n t h e fed eral wi t n es s p ro t ect io n p ro g ram ; s h e i s t h e

rei n carn at i on o f Li zzi e Bo rd en ; t h e m i li t ary wan t ed t o h ire h er “ t o co n du ct ‘ rem o t e

v i ewi n g’ 5 t h ro u g h o u t -o f-b o d y ex p eri en ces ; ” an d s he u s es h er p s y ch i c p o wers t o h el p

p eo pl e fi n d t h i n gs

.

At t h e f a i r h eari n g

, Dr. W i seb ram

, t h e M EC ch ai rm an

, t es t i fi ed ab o u t a

co n vers at i on s he h ad w i t h D r. Ko l b s h o rt l y b efo re t h e s u s p en si o n o n an u n rel at ed

m at t er. Sh e s ai d t h at d u ri n g t h at co n vers at i o n, Dr. Ko l b v o l u n t eered th at s he carri ed

5 Dr. Ko l b ex p l ai n ed at t he h eari n g t h at rem o te v i ewi n g “ is wh ere y ou g o i n to

a d ark en ed ro o m ” an d aft er b ei n g g i v en co ord i n at es

, “ y o u g o in t o a s t at e o f

m ed i t a t i o n a n d g o t h ere an d t hen y o u d es cri b e wh at y o u s ee an d y o u act u al l y d raw

a p i ct u re o f i t

. ” Sh e s tat ed t h at t h i s p ro ced u re i s u s ed b y th e m i l i t ary

, t h e Un i t ed

Nat i o n s, t h e FBI, an d t he CIA “ [t ] o d et erm i n e wh ere t hi n g s are an d wh ere p eo p l e are

an d wh at ’ s g o i n g o n .”

11a g u n b ecau s e t h ere h ad b een t hree as s as s i nat i o n at t em p ts o n h er l i fe. Th e M EC al s o

p res en t ed t es t i m o n y f

ro m o t h er h os p i t al p ers o n n el reg ard i n g i n t eract i o n s t h ey h ad

wi t h Dr. Ko l b

, wh i ch t h ey h ad rep ort ed t o v ari o us au t h o r i t i e s at No rt h s i d e. Th es e

rep o rt s i n cl u d ed t es t im o n y t h a t Dr. Ko l b h ad s t at ed t hat a m an u fact u rer of s i l i co n e

was t ry in g t o k i l l h er an d t h e FBI m i g h t b e aft er h er; s he carri es a g u n b ecau s e t h ere

i s a bo u nt y o n h er h ead (an d i n Oct o b er 20 0 7

, s h e ap p eared to h a v e h e r g u n i n t h e

area o u t si d e t h e o p erat in g ro om ); t h e m i li t ary wan t ed t o h i r e h e r to d o rem o t e

v i ewi n g; t h e g o v ern m en t m ay b e aft er h er becau s e s h e rem o v ed a m icro ch i p fro m a

fed eral w i t n es s; an d a s i l i co ne m an u fact u rer an d / o r t h e g o v ern m en t w as ou t t o g et h er

an d h ad p o s s i b l y h i red a h it m an

. K aren Parh am

, t h e o p erat i o ns co o rd i n at o r at a

No rt h s id e faci li t y

, t es t i fi ed t h at i n Oct o b er 2 00 7

, s om e o f h er s t aff rep o rt ed t h at t h ey

were nerv o u s ab o u t w o rk i n g wi t h Dr. Ko lb b e c a us e s h e “ k i n d o f fri g ht en ed t h em a

l i tt l e b i t ” wh en s he m ad e s u ch s t at em en t s

. Parh am o b t ai n ed wri t t en rep o rt s fro m t h es e

individ u al s an d fo rward ed t h em t o No rt h s i d e’ s ri sk m an ag em en t d ep art m e nt. A nothe r

wi t n es s t es t i fi ed t h a t Dr. Ko l b ’ s s tat em en t ab o u t h er g u n m ad e h er v ery co n cern ed

ab o ut h er o wn s afet y

.

Dr. Am b ro ze t es t i fi ed t h at t h e m ai n co n cern beh i n d Dr. Ko l b ’ s s us p en s i o n was

t h e i s s ue o f t h e g u n

, ex p l ai n i ng

,

12“ [M ] y res p o n s i b i l it y as p art of m ed i cal s t aff l ead ers h i p i s t o p ro t ect st aff

an d pat ien t s

. An d t o m e, i f

. . . y o u ’ re d el u s i o n al an d y o u hav e a g u n o n

cam p u s

, we’ v e go t a p ro b l em

. An d

, on t h e o t h er h an d

, i f t h ere are

as s as s i n s aft er y ou an d y o u ’ re aware o f t h i s an d y o u feel y o u need a g u n

t o pro t ect y o urs el f, t h en ou r s taff an d p at i en t s are s t i l l in dan g er o f b ei n g

cau g h t i n t h e cro s s fi re.

. . . So ei t h er way

, I ju s t co u l d n o t s e e

. . .

av o i di n g t h e s u s p en s i on

.

D r. W i s eb ram co n fi rm ed t h at th e m ai n co n cern b eh i n d t h e s u s p en s i o n i n v o l v ed Dr.

Ko l b’ s p os s es s i o n o f t h e g u n an d t h e s tat em en t s fro m t h e s t aff. Sh e ex p l ai n ed

,

W e were co n cern ed ab o u t i f, i n d eed

, s he d i d h av e as s as s i n at i on at tem p t s

a g a i n s t h e r l i fe, s o m eb o dy i s g o i n g t o co m e i n t h i s h o s p i t al an d sh o o t

h er. An d we’ re g o i n g t o h av e a s h oo t -o ut i n fro n t of ou r h o s p i t al w h i l e

s o m eb o dy i s t ry i n g t o as s as s i n at e h er an d

, y o u k n ow, as s um i n g th at th e

as s as s i n at io n at t em

p ts co u l d b e real

, i s s o m eb o d y g o i n g t o co m e i n t h i s

h o s p i t al an d o p en fi re o n h er, t ak e ou t s om e o f y ou r n u rs es an d o u r

p at i en t s

.

Al t h ou g h Dr. Ko l b d en i ed m ak i n g s om e o f t h e s t a t e m e n t s an d p res en t ed

ev i d en ce t o ex p l a i n o t h e r s t at em en t s an d h er reas o n s fo r carry i ng t h e g u n

, s h e

t es t i fi ed t h at s h e h ad reas o n t o b el i ev e t hat th ere h ad b een s ev eral at tem p t s o n h er l i fe,

13an d al th o u g h s he d i d n o t rep o rt t h em t o p o l ice, sh e a d m i t t e d t h at s h e t o l d Dr.

W i seb ram

ab o ut t h em

.

W e fi n d t h at t h i s a n d o t h er ev i d en ce p res en t ed b y Dr. Ko l b

, i n cl u d i n g

t es t i m o ny fro m a p s y ch i at ri s t s he h i red t o p erfo rm an ev al u at i o n fo r t h e h eari n g

, were

i n s u ffi ci en t t o ov erco m e t h e p res u m p t io n t h at t h e M EC act ed i n t h e reas o n ab l e b el i ef

t h at h er s u s p en si o n was in fu rt h eran ce o f q u al i ty h eal t h care. See Da ven p o r t

, 2 4 7 Ga.

Ap p

. at 1 8 5 (1 ) (a) (rev o cat i on o f m ed i cal s t aff p ri v i l e g e s m ad e i n th e reas o n ab l e

b el i ef t hat i t was i n fu rt h eran ce o f q u al i t y h e a l t h care, wh ere n u m ero u s co m p l ai n t s

were s u b m i t t ed reg ard i n g t h e d o ct o r’ s cal l co verag e, co m p li an ce wi t h h os p i t al ru l es

an d p o l i ci es , an d i n teract i o n wi t h n u rs i ng p ers o n n el ).

(i i) Dr. Ko l b fu rt h er as s ert s t h at No rt h s i d e i m p ro p erl y fo cu s ed o n her rel i g i ou s

an d s p i ri t u al b el i efs i n st ead o f p at i en t care i n s u sp en d i n g h er p r i v i l eg es

. In s u p p o rt

o f t h is arg u m en t, sh e ci t es t he t es t i m o n y o f t h ree M EC w it nes s es

, wh o tes t ifi ed t h at

Dr. Ko l b s o m et i m es read t h e au ras of p at i en ts an d s taff, s he b el i ev ed i n cl ai rv o y an ce

an d p s y ch i c p o wers

, an d s h e s o m et i m es p ract i ced Rei k i wi t h h er p at i en t s

. On e o f

t h es e wi t n es ses s ai d t h at a g es tu re Dr. Ko l b p erfo rm ed wi th h er h an d o v er a p at i en t

was “ eeri e” an d a fo u rt h wi tn es s s ai d t h at h er co m m en t s ab o ut rem ot e v i ewi n g m ad e

t h e wi tn es s feel u n co m fo rt a b l e

. Al th o ug h a n u m b er o f wi t n es s es ci t ed Dr. Ko l b ’ s

14s p i ri t u al pract i ces

, t h e reco rd d em o n s t rat ed t h at s uch m at t ers were n ot t h e p ri m ary

b as i s fo r h er s us p en s i o n

. As Dr. W i s eb ram s t at ed , “ W e weren ’ t as co n cern ed ab o ut

h eal i ng po w ers o r p s y ch ic p o wers

. W e were co n cern ed ab o u t a g u n .” Th e Su s p en s i o n

Let t er i t s el f m ad e t h i s p oi n t , s tat i n g t h at

M ed i cal St aff l ead ers h i p h as d et erm i n ed t h at th e s t at em en t s n o ted

ab o v e, i n p art i cu l ar t h e rep eat ed s tat em en t s ab o u t m u l t i p l e as s as s i nat i o n

at t em pt s an d s tat em en t s t h at y o u are carry i n g a h an d g u n

, co n s t it u t e s u ch

a d i rect an d i m

m ed i at e t h reat

, w h i ch req u i r e s th at act i o n b e t ak en

i m m ed i at el y t o pro tect t h e l i fe, h eal t h an d /o r w el fare o f No r t h s i de’ s

p at i en t s an d s t aff . . . .

Dr. Ko l b h as i nt ro d uced n o co m p et en t e v i d en ce t hat an y b ias ag ai n s t h er

rel i g io u s an d s p i ri t ual b el i efs was a d eci di n g f a c t o r in th e rev iew p ro ces s

. “ In an y

ev en t cl ai m s o f bi as are i rrel ev an t t o t h e reas o n ab l en es s s t an d ard s o f 42 USC § 1 1 1 1 2

(a) of t h e Act ,” becau se Geo rg i a “ h as ad o pt ed an o b ject i v e s t an d ard o f reas o nab l en es s

i n t hi s co nt ex t .” (Ci t at i o n an d p u n ct u at i o n o m i t t ed

. ) Pa t r ick

, 25 5 Ga. Ap p

. at 4 4 0 (3 )

(a) (i ).

Th erefo re, ev en co n s t ru i n g t h e ev i d en ce i n Dr. Ko l b ’ s fav or, we fi n d t h at Dr.

Ko l b fai l ed t o d em o n s trat e t h at a reas o n ab l e j u ry co u l d co ncl u d e t h at s h e h as s h o wn

15b y a p rep o n d eran ce o f t h e ev i den ce t h e M EC’ s d eci s i o n t o s u sp en d h er was n o t b as ed

o n a reas o n ab l e b el i ef t h at i t was fu rt h eri n g t h e q u al i t y o f h eal t h care at t h e h o s p i t al

.

(b ) Dr. Ko l b ad d it i o n al l y arg u es t h at No rt hs i d e fai l ed t o fo l l ow t h e p ro ced u res

o u t l i ned i n i t s By l aws fo r in t erv en t i on s fo r i m pai red p ro v i d ers

, an d t h u s

, t h e M EC’ s

d eci s i o n was p er s e u n reas o n ab l e.

Th e Su s pen s io n Let t er s t at ed t h at th e No rt hs i d e i m p ai red p ro v i d er co m

m i t t ee

h ad d et erm i n ed

t h ere are su ffi ci en t s peci fi c, co n t em p o ran eo us p h y si cal

, b eh av i o ral o r

p erfo rm an ce i n d i cat ors co n s i s ten t w i t h s u b s t an ce ab u s e or o t h er

p s y ch i at ri c o r m ed i cal co n d i t i o n s t o s u p p o rt t h e reas o n ab le s us p i ci on o f

i m p ai rm en t wh i ch m ay affect y o u r cl in i cal ju d g m en t or m ay o t h erwi s e

co n s t i t ut e a d i rect an d i m

m ed i at e t h reat t o th e h eal t h

, wel fare an d s afet y

o f p at ien ts o r o t h ers i n t he h o sp i t al

.

Ci t i n g § 8 .4 o f t h e By l aws g o v ern in g s u m m ary su s p en s i o n s

, t h e Su sp en s io n Let t er

s t at es t h at “ a [p ] ract i t i o n er wh o i s su ffer i n g a n i m p ai rm en t m ay b e s u m

m ari l y

s u s p en d ed

. . . b a s ed o n co nd u ct wh i ch co n s t i t u t es a d i rect an d im m ed i at e t h reat to

t h e p h y s i cal o r m en t al h eal t h

, wel fare, an d s afet y o f p at i en t s , o t h er Pract i t io n ers , o r

Ho s pi t al p ers o n nel

. ” A nd as q u o t ed ab o v e, t h e l et t er s t at ed t h at t h e M EC h ad

16d et erm i n ed t h at D r. Ko l b ’ s st at em en t s reg ard in g as s as s i n at i on at t em p t s an d h er g u n

co n st i t u t ed s u ch a d i rect an d i m m ed i at e t h reat

.

Al t h ou g h Dr. Ko l b arg u es t h at No rt h s i d e fai l ed t o ab i d e b y t h e p ro ced u res

o u t l i ned i n t h e Im

pai red Pro v id er Po li cy u n der § 8

. 5 o f t he By l aws

, No rt h s i d e as s ert s

t h at t h o s e p ro ced u res were n o t ap p li cab l e t o h er s u m m ary s u sp en s i o n u n d er § 8 .4

.

Ho wev er, p ret erm i t t i n g wh et h er N o rt h s id e v i ol at ed i ts own By l aws

, “ [t ] h e HCQIA

d o es n o t req u i r e t h at h eari ng p ro ced u res s at is fy a h o s p i t al ’ s b y l aws i n o rd er fo r

i m m u ni t y t o ap p l y .” Ta

yl o r

, 2 6 6 Ga. Ap p

. at 20 (2 ). See al so Meyer s v. Lo g a n Mem.

Ho s p.

, 82 FSu p p 2 d 7 0 7

, 7 1 5 (W .D. Ky

. 20 0 0 ) (“ [T] h ere i s no s t at u t o ry req u i rem en t

s et fo rt h i n t h e HCQIA t hat a p eer rev i ew pro ceed i n g m u s t b e c o n d u c t ed in

acco rd an ce wi t h a h o s p i t al ’ s o wn s p eci fi c i nt ern al b y l aws o r p ro ced u res .”) (ci t at i on s

an d p u n ct u at i on o m i t t ed ). In fact

, “ HCQIA i m m u ni t y ex ten d s t o cl a i m s ari s i n g o ut

o f al l eg ed b y l aws v i o lat i o n s t h at o ccu r i n t h e co u rs e o f peer rev i ew.” Ta yl o r

, 2 6 6 Ga.

Ap p . at 2 1 (3 ). See Pa tt o n

, 2 60 Ga. Ap p

. at 20 2

. A cco rd i n g l y

, t h i s g ro un d p ro v i d es

n o b as is fo r rev ers al

.

(c) Dr. Ko l b fu rt h er co n t en d s t h at No rt h s i d e i s n o t en t i t l ed t o HCQIA i m m u n i t y

b ecau s e i t s u s p en d ed h er wi t h o u t co n d uct i ng an y i n v es t i g at i o n

. On e fact o r req u i red

t o q u al i fy fo r i m

m un i t y i s t h at t h e p eer re v i ew act io n b e t ak en “ aft er a reas o n ab l e

17effo rt t o ob t ai n t he fact s o f t h e m at t er.” 4 2 USC § 1 11 1 2 (a) (2 ). “ [T] h e det erm i n at i v e

i n q u i ry on t h i s i s s u e i s w h et h er o r n o t t h e t o t al i t y o f t h e p ro ces s l ead i n g u p t o t h e

b o ard ’ s d eci s i o n ev i den ced a r e a s o n ab l e effo rt t o o bt ai n th e fact s o f t h e m at t er.”

Pa t t o n

, 2 6 0 Ga. Ap p

. at 2 0 7 (1 ) (c) (i i ). See Da ven p o r t

, 2 47 Ga. Ap p. at 18 5 (1 ) (b )

.

H e r e

, the e vide nce s h o wed t h at No rt h s i d e’ s l ea de r ship be c a m e c onc e r ne d a bout

rep o rt s fro m v ari o us s t aff m em b ers co ncern i n g Dr. Ko l b ’s s t at em en t s reg ard i n g

t h reat s t o h er l i fe t h at h ad res u l t ed i n h er carry i n g a g u n

. Dr. Ko l b h ers el f v o l u n t ari l y

rep eat ed s o m e of t h es e st at em en t s i n a co n v ers at i o n wi t h D r. W i s eb ram b efo re t h e

s u m m ary s u s p en s i o n

. Al t h o u gh fo l l o wi n g t h e s u s p en s io n

, t h e M EC co l l ect ed wi t n es s

s t at em en t s ad d res si n g t h e i s s u es i n v o l v i n g Dr. Ko l b

, t h e co m m it t ee’ s p o s t s us p en s i o n

effo rt s t o co n ti n u e d o cu m en t i n g t h e s t aff’ s co m pl ai n t s d o es no t m ak e i t s

p res u s p en s i o n effo rt s u n reas o n ab l e, p art i cu l arl y i n t h i s cas e, s i n ce Dr. Ko l b h ers el f

ad m i t t ed t h e p ri m ary al l eg at i o ns b efo re t h e s u s p en si o n

. W e fi n d

, t h erefo re, t h at Dr.

Ko l b fai l ed t o p o i nt t o ev i d en ce i n t h e reco rd s u ffi ci en t t o p erm i t a ju ry t o fi n d t h at

s h e h as o v erco m e, b y a prep o n d eran ce o f t h e ev i den ce, t h e p res u m p t i o n t h at t h e

h o s p it al s u m

m ari ly s u sp en d ed h er cl i n i cal p ri v i l eg es o nl y “ aft er a reas o n ab l e effo rt

t o o b t ai n t h e fact s o f t h e m at t er.” 4 2 USC § 1 1 1 1 2 (a) (2 ). See Pa t t o n

, 2 6 0 Ga. Ap p.

at 2 0 7 (1 ) (c) (i i ); Da ven

p o r t , 2 4 7 Ga. Ap p. at 1 8 5 (1 ) (b )

.

18Acco rd i ng l y , we affi rm t h e t ri al co u rt ’ s g ran t o f s u m m ary ju d g m en t

.

Ju d g men t a f f i r m ed . Ba r nes , P. J., a n d

Mer ci er , J., co n cu r

.

19