Opinion ID: 1781931
Heading Depth: 1
Heading Rank: 6

Heading: Definitional Basis for Statutory Qualifications on Immunity:

Text: As noted, the same factors that render the conditional privilege inapposite render the qualified immunity under LSA-R.S. 13:3715.3(C) inapposite. Recapping, the conditional privilege is abused, and thus inapposite, when statements are made with malice, without a reasonable basis for believing them to be true or on a subject matter outside the common interest or duty. Soentgen v. Quain & Ramstad Clinic, P.C., 467 N.W.2d 73, 79 (N.D.1991). Tracking almost verbatim these grounds for finding an abuse of the conditional privilege, LSA-R.S. 13:3715.3(C) qualifies the immunity from liability by providing that it applies only when the committee member's action or recommendation is taken without malice, in the reasonable belief that such action or recommendation is warranted by the facts known to him, and within the scope of the functions of such committee. LSA-R.S. 13:3715.3(C). Before looking to the jurisprudence construing the conditional privilege for guidance in defining these statutory qualifications on the immunity, we find it necessary to resolve an issue of statutory construction that overlaps with this definitional issue. The overlapping issue is whether the two statutory qualificationswithout malice and in the reasonable belief that such action or recommendation is warranted by the facts known to [the committee member]impose an integrated, one-prong standard, as Defendants contend, or a two-prong standard, as Dr. Smith contends. Classifying the qualifications as imposing a two-prong standard, the court of appeal relied on the plain language of LSA-R.S. 13:3715.3(C), which uses the conjunctive word and, and reasoned that [h]ad the legislature of this state envisioned that there is but one criteria for the application of the qualified immunity, the language of the statute would have clearly reflected this intent. Smith v. Our Lady of the Lake Hospital, Inc., 624 So.2d 1239, 1249 (La.App. 1st Cir.1993). Resolution of this issue does not depend on an interpretation of whether the word and is disjunctive or conjunctive. The two statutory qualifications on the immunity must be read together and surely are not separate and distinct. Our finding is based on the synonymous construction we give the two statutory qualificationswithout malice and in the reasonable belief that such action or recommendation is warranted by the facts known to [the committee member]. More particularly, we construe both these qualifications to mean good faith. Given that construction, we thus use the short-hand expression good faith throughout the remainder of the opinion when referring to the reasonable belief qualification. Our construction of LSA-R.S. 13:3715.3(C) as imposing an integrated, good faith standard is bolstered by the jurisprudence construing similar qualified immunity provisions. The courts have recognized that the same legal standard that applies to statutes having an express lack of malice requirement also applies to statutes having only a good faith requirement. Harris v. Bellin Memorial Hospital, 13 F.3d 1082, 1087 (7th Cir.1994) (citing Qasem v. Kozarek, 716 F.2d 1172, 1176-77 (7th Cir.1983)). Simply put, the courts have recognized that, in this context, good faithreasonable beliefis simply the flip-side of malice. Our construction of LSA-R.S. 13:3715.3(C) as imposing an integrated, good faith standard is based on the jurisprudence defining these qualifying terms without malice and good faith as synonymous in the conditional privilege context. In that context, courts have held that [g]ood faith or lack of malice does not mean lack of hostility or ill feeling. Rouly v. Enserch Corp., 835 F.2d 1127, 1130 (5th Cir.1988). Instead, courts have held that `good faith' means having reasonable grounds for believing that the statement is correct, but proof of ultimate truth is not necessarily required. Hines v. Arkansas Louisiana Gas Co., 613 So.2d 646, 656 (La.App. 2d Cir.), writ denied, 617 So.2d 932 (La.1993). `Only when lack of such reasonable grounds is found can it be said that the person uttering the statement is actuated by malice or ill will.' Clements v. Ryan, 382 So.2d 279, 282 (La.App. 4th Cir.1980) (quoting Ward v. Sears, Roebuck & Co., 339 So.2d 1255, 1261 (La.App. 1st Cir.1976)). [18] Another definitional approach is to avoid altogether attempting to define the overused term malice. Under this approach, the conditional privilege is abused if [the actor] does not act for the purpose of protecting the interest for the protection of which the privilege is given. Restatement (Second) of Torts § 603; Prosser & Keeton on Torts, supra at § 115, p. 834 (privilege is lost if the publication is not made primarily for the purpose of furthering the interest which is entitled to protection). Both of these approaches have been employed by courts in defining malice and lack of good faith in the context of qualified peer review immunity statutes similar to LSA-R.S. 13:3715.3(C). Employing the latter approach of focusing on whether the motivating purpose was something other than that for which the privilege was intended to protect, courts have defined malice or lack of good faith to mean a primary purpose other than the safeguarding of patients. Scappatura v. Baptist Hospital of Phoenix, 120 Ariz. 204, 584 P.2d 1195, 1201 (App.1978) (emphasis in original); Gilbert v. Board of Medical Examiners of State of Arizona, 155 Ariz. 169, 745 P.2d 617, 626 (App.1987); Cooper v. Delaware Valley Medical Center, 428 Pa.Super. 1, 630 A.2d 1, 10 (1993), appeal granted, 639 A.2d 28 (Pa.1994); Harris v. Bellin Memorial Hospital, 13 F.3d 1082, 1090 (7th Cir.1994). Employing the former approach and tailoring the definition to fit the qualified immunity provision, courts have found that lack of malice or good faith can be proven by establishing a reasonable basis for the conduct. See Maewal v. Adventist Health Systems/Sunbelt, Inc., 868 S.W.2d 886, 893 (Tex.App.Fort Worth 1993) (defining malice in Texas peer review immunity provision as knowledge that an allegation is false or with reckless disregard for whether the allegation is false). Formulating an integrated standard for LSA-R.S. 13:3715.3(C), we find that lack of malice and good faith exists in this context when the defendants-peer review committee members are shown to have a reasonable basis for their action or recommendation made in the course of the peer review process. We note that our formulation is consistent with that set forth in the federal HCQIA counterpart provision. Under the federal HCQIA, the standard is primarily one of objective reasonableness to be determined by reviewing the sufficiency of the basis for the defendants' actions. Austin v. McNamara, 979 F.2d 728, 734 (9th Cir.1992); Smith v. Ricks, 798 F.Supp. 605, 610 (N.D.Cal.1992) (requiring review be conducted with reasonable belief that the action was in furtherance of quality health care); Fobbs v. Holy Cross Health System Corp., 789 F.Supp. 1054, 1069 (E.D.Cal.1992) (requiring defendants act with objectively reasonable belief that their decision was warranted). Citing the legislative history, the Austin court points out that this standard of objective reasonableness was adopted by Congress so as to avoid the misinterpretation that might have resulted from requiring inquiry only into the subjective good faith of the peer review committee members. 979 F.2d at 734. Moreover, the legislative history reflects that the objective reasonableness standard will be met ` if the reviewers, with the information available to them at the time of the professional review action, would reasonably have concluded that their actions would restrict incompetent behavior or would protect patients. ' Id. (emphasis in original); see generally R. Adler, Stalking the Rogue Physician: An Analysis of the Health Care Quality Improvement Act, 28 Am.Bus.L.J. 683, 720 n. 181 (1991). Nonetheless, we note that the qualifying provisions of both the state statutes and the federal HCQIA have been recognized to involve, at least in part, an element of subjective intent. See J. Blumstein & F. Sloan, Antitrust and Hospital Peer Review, 51 J. Law & Contemp. Probs. 7, 83 n. 598 (1988) (noting HCQIA reasonable belief standard is designed to embrace both a subjective and an objective good faith test); Harris, 13 F.3d at 1087 (citing Campbell, 252 N.W.2d at 586-87; Gilbert, 745 P.2d at 626; Scappatura, 584 P.2d at 1201). As the court in Harris put it, good faith and malice involve, at least in part, a subjective inquiry. 13 F.3d at 1087. Summing up, we construe LSA-R.S. 13:3715.3(C) as creating an affirmative defense to civil liability for peer review committee member's actions taken in good faith and without malice. In determining the applicability of the qualified immunity, a court must engage in a two-step analysis. First, the court must determine whether the defendants are peer review committee members whose actions on which liability is premised were undertaken as part of the peer review process. Second, if so, it must be determined whether there was an abuse of that process. As to the latter determination, while it generally involves a factual issue for the jury, it may be made at the summary judgment stage provided the requisite lack of a material factual issue is shown and reasonable persons could not differ. Lastly, the burden of establishing the lack of good faith or the presence of malice is on the plaintiff-physician.