Opinion ID: 1729272
Heading Depth: 2
Heading Rank: 3

Heading: Statutory Immunity for Hazelden

Text: ¶ 47 The first issue is whether Hazelden, a third-party addictionology center, is too removed from the peer review process initiated by Spooner to be eligible for immunity under Wis. Stat. § 146.37. ¶ 48 Dr. Rechsteiner asserts that Hazelden was not a part of the medical peer review process conducted by Spooner and should not be granted immunity from civil liability under Wis. Stat. § 146.37(1g). Dr. Rechsteiner contends that § 146.37(1g) provides immunity only to persons reviewing or evaluating the services of a health care provider, or the charges for those services, in connection with specifically organized programs, to improve the quality of health care. Dr. Rechsteiner reasons that Hazelden is not immune from his claim of medical negligence inasmuch as Hazelden did not evaluate the services he provided as a surgeon; it evaluated Dr. Rechsteiner personally to determine whether he had an alcohol dependency problem. This, Dr. Rechsteiner asserts, is not the type of evaluation covered by § 146.37(1g). ¶ 49 By contrast, Hazelden argues that the circuit court was correct in concluding that an outside agency enlisted by a hospital to assist with peer review is entitled to immunity under Wis. Stat. § 146.37. Hazelden notes that this court construed § 146.38 to apply to organizations other than a hospital review committee in Hofflander. Hazelden further asserts that Spooner needed to bring in an outside expert to assess the care that Dr. Rechsteiner was providing. Hazelden insists that the peer review statute does not apply solely to the technical quality of a physician's services because the legislature chose not to use such limiting language. ¶ 50 Dr. Rechsteiner bases his argument in part on Franzen v. Children's Hospital of Wisconsin, Inc., 169 Wis.2d 366, 485 N.W.2d 603 (Ct.App.1992), a case in which the court of appeals stated that if a review committee was formed for the purpose of monitoring a physician's handling of addictive drugs, the activity would be one step removed from the actual peer review. Id. at 393, 485 N.W.2d 603 (footnote omitted). Franzen involved an action for medical malpractice where the plaintiff sought, and was denied access through discovery, to the defendant physician's credentials file that was in the possession of his hospital. Id. at 373-74, 485 N.W.2d 603. The plaintiff's discovery request was denied by the circuit court on the ground that the file was generated in the course of peer review and therefore constituted privileged information protected from disclosure by Wis. Stat. § 146.38. Id. at 374, 485 N.W.2d 603. The court of appeals remanded the discovery issue to determine the nature of the committee that produced the credentials file to ascertain whether material generated was privileged under § 146.38. Id. at 393, 485 N.W.2d 603. ¶ 51 Franzen does not aid Dr. Rechsteiner's argument because that case turned on a determination of whether an ad hoc committee organized to review a physician's compliance with the conditions of his reinstatement, namely his handling of addictive drugs, was indeed acting to improve the quality of health care as contemplated by Wis. Stat. § 146.38. Id. at 392-93, 485 N.W.2d 603. Franzen is distinguishable because the question there involved the interpretation of the nature of a reviewing committee under § 146.38. Franzen, 169 Wis.2d at 377, 485 N.W.2d 603. As noted above, the statutory language of § 146.38 is similar to § 146.37; however, a 1985 amendment to § 146.37 extended statutory immunity to acts or omissions by peer review committees or hospital governing bodies. Mallow, 148 Wis.2d at 330, 434 N.W.2d 839. The immunity afforded to acts or omissions under § 146.37 appears to be more inclusive than the privilege from civil discovery under § 146.38. Mallow, 148 Wis.2d at 331, 434 N.W.2d 839. If Franzen had involved a question of civil immunity under § 146.37, the result might have been different. ¶ 52 In the case at hand, Dr. Rechsteiner acknowledges that Wis. Stat. § 146.37 would apply to Spooner Health System's review and evaluation of Rechsteiner's services. Realistically, however, a review of Dr. Rechsteiner and his services would be incomplete if it focused solely on past performance. The Spooner Board convened to review Dr. Rechsteiner's ability to perform as an on-call physician in light of the March 8, 2003, snowmobile incident. The Board's concern was understandably focused on the surgeon's future performance. The actions of a hospital governing body in reviewing the ability of a physician to perform services, especially a physician who is frequently on call 24 hours per day, qualify for the immunity contemplated by § 146.37(1g). See Mallow, 148 Wis.2d at 330, 434 N.W.2d 839. There is no dispute here that the Board was evaluating not only Dr. Rechsteiner's past performance but also his future ability to perform while on call. ¶ 53 Although Spooner qualifies for immunity under Wis. Stat. § 146.37, the question remains whether Hazelden's actions are also eligible for immunity. Dr. Rechsteiner asserts that Hazelden is one step removed from the peer review process. See Good Samaritan, 123 Wis.2d at 99, 365 N.W.2d 887; Franzen, 169 Wis.2d at 393, 485 N.W.2d 603. However, the record provides ample support for the conclusion that Hazelden was an integral part of a review or evaluation of the services of [a] health care provider[ ], as contemplated by § 146.37(1g). ¶ 54 The facts concerning Spooner's enlistment of Hazelden illustrate the point. After receiving a sheriff's incident report and learning that Dr. Rechsteiner's blood alcohol content was .06 percent during a time when he was on call for surgical coverage, the Spooner Board informed Dr. Rechsteiner that his actions warranted corrective action. The Board notified Dr. Rechsteiner by letter that under the Corrective Action Procedures and Fair Hearing Plan Addendum of Spooner's bylaws, a physician may request a voluntary leave of absence or face suspension of his clinical privileges until he successfully undergo[es] an assessment process through a recognized addictionology center skilled in evaluating impaired professionals, as selected by the Board. ¶ 55 According to the letter referencing Spooner's bylaws, a physician must successfully undergo an assessment process and demonstrate compliance with any follow-up recommendations issued as a result of that process and [must be] cleared to resume practice to the satisfaction of the Medical Staff and Board before the physician will be considered for reinstatement. In addition, the letter indicated that Spooner's bylaws require that a physician must authorize Spooner Health Systems to release information to the assessment program and authorize the assessment program to release its results, any recommendations made as a result of the assessment, and information on [his] compliance with any recommendations. ¶ 56 These requirements indicate that once the Board selected a recognized addictionology center  Hazelden  Dr. Rechsteiner was required to successfully undergo an assessment process unless he chose to take a voluntary leave of absence. The enlistment of Hazelden to evaluate Dr. Rechsteiner is analogous to the enlistment of the two reviewing surgeons to evaluate Dr. Limjoco. Limjoco, 169 Wis.2d at 711-12, 486 N.W.2d 567. However, Spooner did not have a recognized addictionology center in house. It had to look beyond its own staff. We would defeat the purpose of Wis. Stat. § 146.37 if we held that the participation of an outside entity  enlisted by a reviewing committee to perform an assessment of the abilities of a physician to perform effectively while on call  is not eligible for immunity simply because the outside entity is not part of a formal peer review program. See id. at 711-12, 486 N.W.2d 567. ¶ 57 Although the Board initiated the review process by meeting to consider the [sheriff's incident report] and determine what, if any, evaluation of Dr. Rechsteiner's conduct was necessary, the review process did not end there. The letter Spooner sent to Dr. Rechsteiner indicated that an addictionology center would be brought into the review process unless Dr. Rechsteiner chose to take a voluntary leave of absence. By deciding to accept and participate in the assessment option, Dr. Rechsteiner effectively approved the scope and length of the peer review process with Hazelden. Thus, Hazelden became an integral part of the ongoing medical services review, and its actions are eligible for immunity from civil liability under Wis. Stat. § 146.37. ¶ 58 Dr. Rechsteiner contends, however, that if Hazelden is eligible for immunity it lost that immunity by acts of medical negligence, namely, a misdiagnosis of his condition, resulting in damages. The court of appeals bought into this contention, in part, when it concluded that Wis. Stat. § 146.37 is not broad enough to immunize a medical malpractice claim. Rechsteiner, 303 Wis.2d 656, ¶ 26, 736 N.W.2d 219. Consequently, the court of appeals affirmed summary judgment to Hazelden on different grounds. See id., ¶ 28. It examined the standard for liability arising from misdiagnosis and cited authority for the proposition that [m]alpractice is actionable only if the wrong diagnosis is followed by the wrong treatment. Id. (citing Ehlinger v. Sipes, 148 Wis.2d 260, 265, 434 N.W.2d 825 (Ct.App. 1988), aff'd in part and remanded, 155 Wis.2d 1, 454 N.W.2d 754 (1990); McManus v. Donlin, 23 Wis.2d 289, 295, 127 N.W.2d 22 (1964)). ¶ 59 The court of appeals appears to have concluded that Wis. Stat. § 146.37 does not immunize medical negligence in any form during the peer review process. See Rechsteiner, 303 Wis.2d 656, ¶ 26, 736 N.W.2d 219. Our second question tests this conclusion: Does Hazelden's diagnosis of Dr. Rechsteiner during the medical peer review process qualify for immunity, under Wis. Stat. § 146.37, even if its diagnosis is deemed negligent? In answering this question, our task is merely to decide whether Hazelden's actions in this case are immune from civil liability under § 146.37. ¶ 60 Dr. Rechsteiner's complaint points to Hazelden's alleged negligence in diagnosis. He claims that a misdiagnosis  alcohol dependence instead of alcohol abuse  led to unnecessary treatment that cost him time, money, and reputation. ¶ 61 We conclude that Hazelden's diagnosis of Dr. Rechsteiner's condition was indistinguishable from Spooner's review, evaluation, and analysis of Dr. Rechsteiner's ability to perform as an on-call surgeon. In this case, diagnosis was the essence of the peer review process initiated by Spooner. [9] Even if we were to assume that Hazelden's diagnosis was negligent, it was immune because it was central to the peer review process. ¶ 62 We would seriously undermine the peer review process if we denied immunity to a good faith diagnosis on these facts, especially when that diagnosis did not make an existing medical condition worse. ¶ 63 Dr. Rechsteiner contends that Hazelden's alleged misdiagnosis led to unnecessary treatment that caused damages. This brings us to the third question: Does Hazelden's treatment of Dr. Rechsteiner, following its diagnosis of his medical condition, qualify for immunity under Wis. Stat. § 146.37? To the extent Dr. Rechsteiner's claim implicates treatment, we decline to examine or decide whether treatment related to the peer review process can qualify for immunity. ¶ 64 If the focus is shifted from diagnosis to treatment, Hazelden asserts that summary judgment was appropriate. Hazelden contends that Dr. Rechsteiner would have received the same treatment regardless of whether he received a diagnosis of alcohol dependence or a diagnosis of alcohol abuse. It claims that Dr. Rechsteiner failed to produce any competent evidence that its alleged misdiagnosis led to improper treatment. It reasons that Dr. Rechsteiner's claim must fail as a matter of law because he expressly agreed to follow Hazelden's treatment recommendations, whatever they might be. ¶ 65 Dr. Rechsteiner disputes Hazelden's contention that he would have received the same treatment regardless of diagnosis. He argues that Hazelden was simply trying to protect itself from liability by sending him a letter that stated that the treatment he received would have been the same if he had received a diagnosis of alcohol abuse rather than alcohol dependence. [10] ¶ 66 Dr. Rechsteiner claims that evidence from an expert in alcohol treatment, as well as information on Hazelden's own website, create a factual issue regarding the effect of Hazelden's misdiagnosis. Dr. Rechsteiner provided evidence from Scott Hansen, an AODA Supervisor from Luther Midelfort, who conducted an assessment of Dr. Rechsteiner after his assessment and treatment at Hazelden. In a letter to the Wisconsin Medical Society, Hansen stated that [i]n 28 years, I've never seen a patient [with] an Alcohol Abuse diagnosis require a 30-day inpatient program. With an Alcohol Abuse diagnosis, I usually recommend educational counseling sessions, at most. Dr. Rechsteiner also points to Hazelden's website, which describes the possibility of outpatient treatment services for appropriate candidates. ¶ 67 Here again, if we assume for analysis that Hazelden's diagnosis of alcohol dependence instead of alcohol abuse was negligent, Dr. Rechsteiner still failed to claim that his treatment was substandard or negligent or aggravated his medical condition. A misdiagnosis, in and of itself, is not, and cannot, be an actionable injury. . . . The actionable injury arises when the misdiagnosis causes a greater harm than existed at the time of the misdiagnosis. Paul v. Skemp, 2001 WI 42, ¶ 25, 242 Wis.2d 507, 625 N.W.2d 860. ¶ 68 In affirming summary judgment to Hazelden, the court of appeals emphasized that Hazelden submitted evidence that Hazelden would have given Dr. Rechsteiner the same 28 days of inpatient treatment regardless of whether he had been diagnosed with alcohol abuse or alcohol dependence. Rechsteiner, 303 Wis.2d 656, ¶ 27, 736 N.W.2d 219. As this case played out, there is no genuine issue of material fact as to whether Dr. Rechsteiner would have received inpatient treatment at Hazelden if he had been diagnosed with only alcohol abuse. ¶ 69 The letter from Scott Hansen, which stated that Hansen had never seen an individual with a correct diagnosis of alcohol abuse undergo the type of treatment provided by Hazelden, does not create a genuine issue of material fact about whether Hazelden failed to satisfy the standard of care with regard to treatment of Dr. Rechsteiner. The letter does not assert that there is a specific standard of care for all patients diagnosed with alcohol abuse. It does not rule out alternative methods of treatment, including inpatient treatment, for patients diagnosed with alcohol abuse. Moreover, as the court of appeals observed, the letter does not state how this patient in this case would be treated, only that he had never seen an alcohol abuse patient go through inpatient treatment. Rechsteiner, 303 Wis.2d 656, ¶ 28, 736 N.W.2d 219. Hansen's letter is speculative in the sense that it invites the court to second-guess Dr. Rechsteiner's treatment without established standards. See id. Because the evidence presented by Dr. Rechsteiner does not create a genuine issue of material fact regarding whether his treatment at Hazelden would have or should have differed with a diagnosis of alcohol abuse, his claim for medical negligence cannot survive summary judgment. ¶ 70 We emphasize that our holding regarding Hazelden is heavily influenced by the facts and circumstances of this case. Like the court of appeals, we are not prepared to say that the peer review statute will immunize medical negligence in all situations, irrespective of the circumstances. ¶ 71 We conclude that the record before us indicates that Hazelden is eligible for immunity under Wis. Stat. § 146.37 because it played an integral role in Spooner's medical peer review process. Hazelden's medical diagnosis of Dr. Rechsteiner is immune, even if its diagnosis is deemed negligent, because Hazelden's diagnosis was central to its requested evaluation. If Dr. Rechsteiner's complaint is viewed as focusing on Hazelden's treatment of Dr. Rechsteiner, as opposed to its diagnosis of Dr. Rechsteiner, the complaint cannot survive summary judgment.