Opinion ID: 2260589
Heading Depth: 2
Heading Rank: 1

Heading: the legislature has granted health care providers immunity from claims for the negligent credentialing of physicians

Text: ¶ 20 Of the three grants of immunity St. Marks invokes in this case, the broadest is found at Utah Code section 58-13-5(7). This section states that (7) An individual who is a member of a hospital administration, board, committee, department, medical staff, or professional organization of health care providers ..., and any hospital, other health care entity, or professional organization conducting or sponsoring the review, [is] immune from liability arising from participation in a review of a health care provider's professional ethics, medical competence, moral turpitude, or substance abuse. [2] The reviews described by section 58-13-5(7) constitute precisely the sort of credentialing review for which Ms. Archuleta suggests liability can be imposed. Specifically, Ms. Archuleta describes the term negligent credentialing as a form of short-hand for the breach of a duty that arises when a hospital undertakes ... to render services to another which [it] should recognize as necessary for the protection of the other. [3] Ms. Archuleta does not claim that St. Mark's is liable under the doctrine of respondeat superior. That is, she does not contend that Dr. Halversen was an employee of the hospital for whose actions the hospital is vicariously liable. Rather, she claims that St. Mark's was independently negligent in permitting Dr. Halversen to use its facilities. [4] ¶ 21 In other words, her allegation of negligent credentialing is based on alleged shortcomings in the hospital's review of Dr. Halversen's qualifications to provide treatment. [5] This is exactly the kind of liability that the plain language of the statute addresses. Put differently, Ms. Archuleta seeks to hold St. Marks liable for harms that allegedly arose from participation in a review of a health care provider's ... medical competence. ¶ 22 Ms. Archuleta argues, and the majority concludes, that section 58-13-5(7) grants immunity only from suits brought by fellow professionals who were the subject of the credentialing review. But this statute simply does not contain this limitation. Section 58-13-5(7) broadly provides that individuals participat[ing] in a review of a health care provider's ... medical competence are immune from liability. Nothing in the plain language of 58-13-5(7) suggests that the scope of immunity granted is in any way dependent on who brings the suit. ¶ 23 The majority does not explain how this statutory language fails to reach the claims advanced by Ms. Archuleta. Rather, the majority concludes that this language does not apply to negligent credentialing claims because other portions of Utah Code section 58-13-5 apply only in the context of peer review. ¶ 24 In support of this argument, the majority refers to the other two grants of immunity contained in this section. One of these grants of immunity shields individuals who provide information to the Division of Professional Licensing (DOPL). [6] The other grant of immunity shields members of a DOPL board from suits based on decisions made or actions taken in response to information acquired by the board. [7] The majority states that, because of the nature of these grants of immunity, the entire section contemplates only immunity between a doctor whose credentials are under review and the suppliers of information and decision makers; [not] immunity between a patient and a hospital. [8] ¶ 25 In my view, this conclusion regarding the scope of subsection 58-13-5(7) simply does not follow from the majority's interpretation of subsections 58-13-5(6)(a) and (6)(b). First, the majority's analysis is based on an inference that is neither apparent from, nor commanded by, the words of the statute. Further, the majority's conclusion depends on an extrapolation that does not logically follow from that initial inference. The majority has isolated subsections (6)(a) and (6)(b) of section 58-13-5 and reasoned that, because physicians are the likely plaintiffs in the lawsuits contemplated by those subsections, they are necessarily the only plaintiffs whose suits are precluded by the section as a whole. But these subsections do not contain any language that might limit them in this way, so this inference is questionable. ¶ 26 Regardless of the flaws in this initial premise, I do not believe the next step in the majority's reasoning withstands scrutiny. Even if the grants of immunity in subsections (6)(a) and (6)(b) should apply only to suits brought by physicians, the grant of immunity relevant for purposes of this casethe immunity set forth in subsection (7)is directed at a different class of activity. Subsections (6)(a) and (6)(b) address the immunity enjoyed by DOPL board members and individuals who share information with a DOPL board. They grant immunity for furnishing information and for decisions made or actions taken. They simply do not address the immunity that protects hospitals from liability arising from participation in a review of a [physician's] medical competence. Instead, this immunity is set forth in subsection (7). And although subsection (7) is related to subsections (6)(a) and (6)(b), this fact does not require that limitations from one subsection be applied to another. That these different subsections address different sorts of lawsuits and different categories of potential defendants militates against such an assumption. ¶ 27 The legislature separated the immunity contained in subsection (7) from the immunity relevant to DOPL reviews set forth in subsection (6). It used different operative language to define its scope. It directed the grants of immunity at different classes of potential defendants and different categories of activity. Yet, regardless of these differences, the majority urges that, simply because subsections (6)(a) and (6)(b) apply only when physicians bring suit, subsection (7) must necessarily be interpreted to contain a similar limitation. In my opinion, this extrapolation is logically flawed and inconsistent with the broad language used in subsection (7). ¶ 28 Further, the lack of an express limitation on the scope of immunity is important because related statutes make it clear that similar limitationswhen the legislature intends to create themare made explicit. For instance, section 58-13-3(3) grants, to both hospitals and physicians, immunity that is explicitly limited to medical malpractice action[s]. Section 58-13-2.6(2)(a) grants similar immunity that is explicitly limited to civil damages resulting from assist[ing] governmental agencies with specific, enumerated health care activities. [9] And section 58-13-4(3), which grants immunity for decisions made by certain peer review committees, limits that immunity by explicitly excepting claims for liability incurred in providing professional care and treatment to any patient. ¶ 29 These sections make it clear that when the legislature has intended to confine the immunity it creates it has done so with statutory language limiting the scope of the immunity to specific causes of action and factual scenarios. The absence of any such language in section 58-13-5(7) is a strong indication that the legislature intended to impose no limitations other than those made explicit by the statutory language. This reinforces what is plainly stated in this sectionno liability may be imposed on a hospital because of its participation in a review of a physician's medical competence. ¶ 30 The majority limits these subsections to a narrow subset of potential liability in an attempt to construe these statutory provisions in harmony with other provisions in the same statute and with other statutes under the same and related chapters. [10] However, the purpose for employing this canon of construction is to produce a harmonious whole. [11] In general, I question the appropriateness of disregarding plain statutory language in an attempt to construct a harmonious whole. But in this case, I find it especially inapt because the majority's interpretation of the statute is inconsistent with other portions of the code. ¶ 31 First, although section 58-13-5 relates to liability arising from information sharing and review of a physician's competence, the other provisions in this chapter of the Utah Code set forth multiple grants of immunity related to other activities. Some create immunity from liability for providing charitable care while others create immunity from liability when providing certain emergency services. [12] Reading this chapter of the Utah Code as a whole, the only valid bases I can find for limiting the various kinds of immunity conferred are the bases contained in the text. For example, section 58-13-4 creates immunity for the work done by certain committees, and it contains an exception for suits regarding professional care and treatment. [13] Unlike in section 58-13-5, the use of an explicit exception indicates that the legislature specifically considered whether the immunity provided would preclude suits by patients and explicitly provided that it would not. Indeed, every other grant of immunity in this chapter clearly contemplates suits by patients. Under the majority's interpretation, only in section 58-13-5 is it necessary to infer such a limitation from language that is not included in the statute. Given the legislature's clear ability to craft these limitations when it so intends, I would not construe the statute in a way that makes it necessary to impose such a limitation in a section where the legislature did not do so. ¶ 32 Second, the majority's interpretation of section 58-13-5 is inconsistent with a legislative mandate that information provided to a peer review committee not be used in court proceedings. Specifically, section 26-25-3 provides that when information regarding patient treatment and care is provided to a peer review committee, that information is deemed to be a privileged communication[ ] that is not subject to discovery, use, or receipt in evidence in any legal proceeding of any kind or character. [14] Indeed, a violation of this restriction is a class B misdemeanor. [15] This sectionwhich erects potentially insurmountable barriers to judicial resolution of negligent credentialing claimsis at the very least inconsistent with the notion that section 58-13-5 preserves an exception, sub silentio, for claims of negligent credentialing. A much more harmonious reconciliation of these provisions recognizes that the need to use this sort of information in court proceedings is obviated by the grant of immunity contained in section 58-13-5(7). ¶ 33 Third, the majority's interpretation carries with it a troublesome corollary. Because it asserts that the immunity conferred in section 58-13-5 does not contemplate immunity from patient suits, its interpretation would not protect members of the DOPL board who make licensing decisions from suits by patients of the physicians who were licensed by the board. [16] Nor would it protect individuals who, in good faith, provide information to the DOPL board from such suits. Given the majority's proposition that the whole of section 58-13-5 applies only to suits by physicians, there is no apparent basis for construing subsection (6)(a) and (6)(b) to preclude patients from pursuing their claims against DOPL board members and individuals who share information with the DOPL board. In the absence of any statutory language indicating that the immunity in these sections applies only to suits by physicians, it is far more consistent to interpret each subsection to grant immunity to hospitals, DOPL board members, and DOPL informants, regardless of who brings the suit. Any other interpretation inserts into the statute exceptions that simply cannot be found in the statute's plain language.