Opinion ID: 2233405
Heading Depth: 1
Heading Rank: 6

Heading: McLEAY'S EVIDENCE TO REBUT PRESUMPTION

Text: We next address whether McLeay presented evidence to rebut the presumption that would make summary judgment inappropriate. One court described a factual challenge to the professional review action, stating that the facts would have to be `so obviously mistaken or inadequate as to make reliance on them unreasonable.' Meyers v. Columbia/HCA Healthcare Corp., 341 F.3d 461, 471 (6th Cir.2003). Also, when reaching the determination, the court looks at the totality of the process leading up to the professional review action. Joshi v. St. Luke's Episcopal, 142 S.W.3d 862 (Mo.App.2004). Although McLeay alleges that he was not afforded adequate notice and hearing, the record does not support that assertion. Nor is there a meaningful dispute about a reasonable effort to obtain facts in the matter. Thus, we focus on the reasonable belief that the action was in the furtherance of quality care. McLeay contends that the testimonies of Pantano and Mailliard show that he acted competently and thus raise an issue of material fact whether Bergan had a reasonable belief that it was acting in the furtherance of quality care. He also argues the record reflects very little evidence about the eight cases that led to the termination of his privileges. McLeay's argument falls short. Courts have overwhelmingly held that a physician's showing that the standard of care was met, or that the professional review board reached the wrong conclusion, does not meet the burden of overcoming the presumption of a reasonable belief that the hospital was furthering quality health care. See, Lee v. Trinity Lutheran Hosp., 408 F.3d 1064 (8th Cir.2005); Meyers, supra; Brader v. Allegheny General Hosp., 167 F.3d 832 (3d Cir.1999). The focus is on whether the hospital acted in a reasonable belief that it was furthering quality health care, with the information available to the professional review board when it acted, and if the reviewers would have reasonably concluded that their actions would restrict incompetent behavior or protect patients at that time. See, generally, id. Only one court has held that expert testimony about the standard of care could be used to rebut the presumption. Brown v. Presbyterian Healthcare Services, 101 F.3d 1324 (10th Cir.1996). There, the expert testified not only about the standard of care, but stated that the review panel reviewed only two charts before revoking privileges, which was unreasonably narrow at that time. Brown has been distinguished by other courts because of its unique facts that focus on the information available to the review board. See, e.g., Manzetti v. Mercy Hosp. of Pittsburgh, 741 A.2d 827 (Pa.Commw.1999). One court that distinguished Brown described it as follows: While Brown does discuss the use of expert testimony in evaluating issues of immunity under HCQIA, the decision in Brown centered upon the fact that Dr. [Arlene] Brown was able to produce significant evidence to support her allegations that information submitted by the defendants in her medical review process was false or misleading. Indeed, Dr. Brown produced evidence that the individuals who investigated her actions were involved in encouraging another doctor to move his practice so as to be in direct competition with her. In other words, the defendants in Brown had conspired to manufacture allegations of improper behavior by Dr. Brown so as to put Dr. Brown out of business. In this setting, Dr. Brown's expert concluded that the defendants were not acting to further quality health care. Neither were their actions reasonable under the facts of the case. It was for this reason that the federal district court in Brown refused to grant summary judgment on the basis of HCQIA immunity, a decision that was affirmed by the United States Court of Appeals for the Tenth Circuit. Meyer v. Sunrise Hosp., 117 Nev. 313, 324, 22 P.3d 1142, 1150 (2001). Instead of applying Brown, the Meyer court stated: Expert testimony is irrelevant to our consideration of immunity under HCQIA because we focus solely on the reasonableness of the peer reviewer's belief, not on whether the peer review action ultimately proved to be medically sound or actually furthered quality care. 117 Nev. at 323, 22 P.3d at 1149, citing Sugarbaker v. SSM Health Care, 190 F.3d 905 (8th Cir.1999), and Manzetti, supra . Although Brown allowed the use of expert testimony, that case also involved the use of experts to testify about the review process itself. Brown, supra . In cases involving the use of expert testimony after the fact to show that the standard of care was actually met, courts uniformly hold that the testimony will not rebut the presumption. See, e.g., Lee, supra ; Brader, supra; Mathews v. Lancaster General Hosp., 87 F.3d 624 (3d Cir.1996); Manzetti, supra . Here, Pantano's and Mailliard's testimonies cannot rebut the presumption. The presumption is focused on what the review board knew when it acted. Therefore, later expert testimony that McLeay acted appropriately in the cases reviewed cannot be used to rebut the presumption. Although the record is sparse on details of the eight cases reviewed, McLeay signed his agreement to the meeting minutes of the committee when it imposed monitoring. When the committee later imposed further restrictions, it reviewed the cases, including two reports from nursing staff on the floors, two reports from nursing staff in the surgery department, two reports from anesthesiologists, and a number of cases identified as having substandard care. In a letter, McLeay acknowledged that 1992 was an aberration of my surgical care and stated that he had his `wake-up call.' When McLeay's privileges were suspended, Bergan stated that it was troubled by the eight cases. In addition, Peetz testified that several cases were close together in time and that a suspension would not occur unless the review board believed that harm might come to patients. Finally, Feldhaus testified that he personally was concerned about one of the eight cases that were listed when McLeay's privileges were suspended. Although the evidence is not overwhelming as to the specific details of the cases reviewed, the record shows that a review was justified, and McLeay failed to present evidence to overcome the presumption to show that Bergan reasonably believed that it was acting in the furtherance of quality care. Accordingly, McLeay failed to meet his burden to present evidence that would allow a reasonable jury to conclude that Bergan's peer review process failed to meet the standards of the HCQIA.