Opinion ID: 200100
Heading Depth: 2
Heading Rank: 1

Heading: The HCQIA

Text: 17 When Congress passed the HCQIA in 1986, it was responding to a crisis in the monitoring of health care professionals. Although state licensing boards had long monitored the conduct and competence of their own health care workers, Congress found that [t]he increasing occurrence of medical malpractice and the need to improve the quality of medical care have become nationwide problems that warrant greater efforts than those that can be undertaken by any individual State. 42 U.S.C. § 11101(1). Finding that incompetent physicians find it all to[o] easy to move to different hospitals or states and continue their practices in these new locations, Congress mandated the creation of a national database that recorded incidents of malpractice and that was available for all health care entities to review when screening potential employees. H.R.Rep. No. 99-903, at 2, reprinted in 1986 U.S.C.C.A.N. 6384, 6385 (hereinafter H.R.Rep. No. 99-903). 3 Before passage of the HCQIA in 1986, threats of antitrust action and other lawsuits often deterred health care entities from conducting effective peer review. In order to encourage the type of peer review that would expose incompetent physicians, the HCQIA shields health care entities and individual physicians from liability for damages for actions performed in the course of monitoring the competence of health care personnel. 4 See Mathews v. Lancaster Gen. Hosp., 87 F.3d 624, 632 (3d Cir.1996) (describing legislative history of the HCQIA); Bryan v. James E. Holmes Reg'l Med. Ctr., 33 F.3d 1318, 1332 (11th Cir.1994) (listing Congressional motivations for passing the HCQIA). 18 The HCQIA mandates that a health care entity's review of the competence of a physician shall not result in its liability in damages under any law of the United States or of any State, if such a peer review meets all the standards specified in section 11112(a) of this title. 42 U.S.C. § 11111(a). In order for immunity to attach to a professional review action, it 19 must be taken — 20 (1) in the reasonable belief that the action was in the furtherance of quality health care, 21 (2) after a reasonable effort to obtain the facts of the matter, 22 (3) after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances, and (4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph (3). 23 42 U.S.C. § 11112(a). The HCQIA standards will be satisfied if the reviewers, with the information available to them at the time of the professional review action, would reasonably have concluded that their action would restrict incompetent behavior or would protect patients. H.R.Rep. No. 99-903 at 10, reprinted in 1986 U.S.C.C.A.N. 6384, 6392-93 (discussing the proper test to use in applying the first HCQIA standard). Adopting objective `reasonable belief' standard[s], the HCQIA advances the Congressional purpose of permitting a determination of immunity without extensive inquiry into the state of mind of peer reviewers. Id. at 12, reprinted in 1986 U.S.C.C.A.N. at 6394 (stating that these provisions [are designed to] allow defendants to file motions to resolve the issue of immunity in as expeditious a manner as possible). 24 Our sister circuits have uniformly applied all the sections of § 11112(a) as objective standards. See Mathews, 87 F.3d at 635 (collecting cases); Imperial v. Suburban Hosp. Ass'n, Inc., 37 F.3d 1026, 1030 (4th Cir.1994) (The standard is an objective one which looks to the totality of the circumstances.); Smith v. Ricks, 31 F.3d 1478, 1485 (9th Cir.1994) (the `reasonableness' requirements of § 11112(a) were intended to create an objective standard, rather than a subjective standard); Bryan, 33 F.3d at 1335 (The test is an objective one, so bad faith is immaterial. The real issue is the sufficiency of the basis for the [Hospital's] actions.); Austin, 979 F.2d 728, 734 (9th Cir.1992); but see id., 979 F.2d at 741 n. 3 (Pregerson, J., dissenting) (Evidence of motive and intent is relevant to show whether the defendants possessed a reasonable belief that [an adverse professional review action] was warranted by the facts known.). We apply these objective standards here.