Opinion ID: 720639
Heading Depth: 2
Heading Rank: 1

Heading: Professional Review Actions under the Act

Text: 37 Dr. Mathews argues Lancaster General and defendant physicians conducted at least two professional review actions relating to him: first, the March 19, 1992 letter of Dr. Rothacker on behalf of the Rothacker Committee recommending a focused review of his cases and a possible restriction of his privileges, 5 and second, the September 16, 1993 vote by the Lancaster General Hospital Board of Directors to revoke his spine privileges. 6 The Act defines a professional review action as: 38 an action or recommendation of a professional review body which is taken or made in the conduct of professional review activity ... which affects (or may affect) adversely the clinical privileges, or membership in a professional society, of a physician. Such term ... also includes professional review activities relating to a professional review action. 7 39 42 U.S.C. § 11151(9). Dr. Mathews contends that Dr. Rothacker's March 19, 1992 letter constituted a professional review action because it made a recommendation that had the potential to adversely affect his clinical privileges. He argues the district court erred by not treating the Rothacker Committee's letter as a professional review action and not assessing it for compliance with the fairness and procedural standards outlined in 42 U.S.C. § 11112(a). 40 The district court, reading the definitions of professional review action and professional review activity together, concluded that the term 'professional review activity' refers to preliminary investigative measures taken in a 'reasonable effort to obtain the facts' relevant to a possible change in a physician's privileges, while the term 'professional review action' refers to the decision that results from a review of the facts obtained. See Opinion and Order, 883 F.Supp. at 1027. It concluded Dr. Rothacker's letter was a part of the preliminary investigative process and therefore not a professional review action. We agree with the district court's analysis. 41 The definition of professional review action encompasses decisions or recommendations by peer review bodies that directly curtail a physician's clinical privileges or impose some lesser sanction that may eventually affect a physician's privileges. Professional review actions do not include a decision or recommendation to monitor the standard of care provided by a physician or factfinding to ascertain whether a physician has provided adequate care. These are professional review activities. See Fobbs v. Holy Cross Health Sys. Corp., 789 F.Supp. 1054, 1065 (E.D.Cal.1992) ([P]rofessional review activity means the investigative process during and/or upon which a professional review action, i.e., a decision, is made.), aff'd, 29 F.3d 1439 (9th Cir.1994), cert. denied, --- U.S. ----, 115 S.Ct. 936, 130 L.Ed.2d 881 (1995). We believe Dr. Rothacker's March 12, 1992 letter was a part of ongoing professional review activities. It did not constitute a decision to restrict Dr. Mathews' privileges, nor did it recommend that Dr. Mathews' privileges be restricted immediately. In fact, the letter did not impose any penalty. Instead, it recommended further investigation and review by an outside agency before any limitations were placed on Dr. Mathews' privileges. No professional review action occurred here until the Board's September 16, 1993 vote to suspend Dr. Mathews' privileges. See Austin v. McNamara, 979 F.2d at 736 (no 'action' was taken in this case until ... the first occasion when [plaintiff's] clinical privileges were adversely affected. Prior to that time, he had been monitored and reviewed, but no professional review body had limited his clinical privileges or adopted a recommendation that they be limited.). Because Dr. Rothacker's March 19, 1992 letter was not a professional review action, the district court correctly held it did not have to meet the standards set forth in 42 U.S.C. § 11112(a).