Opinion ID: 585038
Heading Depth: 4
Heading Rank: 4

Heading: Rapp's Report and the InterQual Study

Text: 56 Marrese argues that the defendants evinced malice by failing to implement any of Dr. George Rapp's suggestions made in his February 2, 1982 letter, such as hiring an outside national firm to conduct a comparison of standards. Instead, defendants retained InterQual and continued to argue for revocation at the Fair Hearing after admitting the deficiencies of the InterQual audit. By retaining InterQual, however, the defendants were attempting to implement Rapp's suggestions to some degree. While Rapp did not suggest InterQual specifically, he did recommend that a national firm be employed to conduct a review of Marrese's surgeries, and InterQual constitutes an national firm. The defendants did not adopt Rapp's proposal to set up a review by experts chosen by Marrese and the defendants. While that fact alone might suggest that the defendants wanted to keep Marrese from upsetting some conspiracy they were conducting to get rid of Marrese, its significance pales in light of the substantial evidence that the defendants made substantial efforts to be fair to Marrese. The defendants offered to allow a Fair Hearing panel of independent physicians from the University of Indiana, but Marrese declined. Furthermore, Marrese was permitted to present his own expert testimony at the Fair Hearing. In light of such obvious efforts to be fair, a reasonable trier of fact could not likely find malice based on speculation as to why the defendants chose to follow Rapp's suggestions as they did. 57 While the InterQual study contained inaccuracies 9 , Marrese does not suggest that any action on the part of the defendants caused the inaccuracies. The record indicates that the results of the InterQual audit spurred the action taken by the MSEC, but the record does not indicate that it was the sole evidence upon which the MSEC relied in revoking Marrese's privileges. Therefore, the subsequent decision not to present the defective InterQual study at the Fair Hearing while continuing to press for revocation of Marrese's privileges does not tend to establish that the defendants had an ulterior motive in proceeding against Marrese. On the contrary, it tends to show no more than that the defendants concluded they could show that Marrese did not meet the appropriate standard of care even without the InterQual study.