Opinion ID: 1060738
Heading Depth: 1
Heading Rank: 4

Heading: Action Against Eyring

Text: The corrective action against Eyring was initiated by the Surgical Patient Care Evaluation Committee (Surgical Evaluation Committee), of which Eyring was a member. After Helen Parker died at Parkwest while under Eyring's care, the Surgical Evaluation Committee had its regular meeting and discussed the Helen Parker chart as a part of its regular agenda. Eyring was present during the discussion. The Surgical Evaluation Committee questioned Eyring's judgment in choosing to perform knee surgery on Helen Parker, who was a poor candidate for surgery because of numerous risk factors in her case, including extreme obesity. The Surgical Evaluation Committee recommended that the Helen Parker chart be trended, a term referring to the process by which Parkwest performs quality assurance. [1] The Surgical Evaluation Committee voted to appoint a five-member Ad Hoc Committee to conduct an in-depth focused review of all of Eyring's cases trended during the past two years, which totaled twenty-three charts including the Helen Parker chart. Both the Department of Surgery and the Medical Executive Committee approved the Surgical Evaluation Committee's recommendations, and the Ad Hoc Committee began its focused review of Eyring's trended cases. More than thirty days later, the Ad Hoc Committee submitted to the Medical Executive Committee a two-page report, in which it unanimously concluded that Eyring had deviated from the standard of care and recommended strong sanctions up to and including suspension. Based upon the Ad Hoc Committee's report, the Medical Executive Committee unanimously voted to recommend to the Board the revocation of Eyring's clinical privileges and medical staff appointment. Instead of providing Eyring notice of the Medical Executive Committee's adverse action, the Board met and unanimously voted to accept the Medical Executive Committee's recommendation and to immediately terminate Eyring's medical staff appointment. The Board notified Eyring of its action, that this action constituted adverse action, and that he was entitled to procedural rights contained in the Bylaws. However, shortly after terminating his appointment and privileges, the Board apparently realized that it had made a procedural mistake and reinstated Eyring's appointment and privileges. The Board informed Eyring that the Medical Executive Committee's original recommendation to revoke his privileges and appointment was still in effect and that he was entitled to request a hearing in accordance with the Bylaws. Approximately forty days after Eyring's request for a hearing, Parkwest provided him notice which suggested that the hearing would be held sometime the following month subject to the parties' agreement. This letter provided Eyring with the concise statement of his alleged acts, informing him that the Ad Hoc Committee found fault with him for three main reasons: 1) he had a high post-operative infection rate because [n]ine (9) cases of twenty-two (22) cases which were the subject of the focused review were definitely infected; 2) he demonstrated poor surgical technique; and 3) he exhibited poor clinical judgment. Prior to the hearing, Eyring requested voluminous materials from Parkwest including both photocopies of the patients' charts reviewed and charts of specified patients. He also requested various other peer review documents. Though Parkwest provided a copy of the Ad Hoc Committee's two-page report, a list of patients whose charts were reviewed, and charts of specific patients as requested, Parkwest claimed that documents and materials of the Ad Hoc Committee and the Medical Executive Committee were protected by a privilege pursuant to the Peer Review Law, Tenn.Code Ann. § 63-6-219. Pursuant to the Bylaws, the hearing was conducted before a Hearing Committee selected by Parkwest. The Hearing Committee was comprised of five physician members. Eyring, represented by a member of the medical staff in good standing, voir dired each member of the Hearing Committee extensively, presented proof, and cross-examined witnesses. An representative for the Ad Hoc Committee read into evidence a seventeen-page Ad Hoc Committee report, a copy of which Eyring had never seen, which explained the reasons for the Ad Hoc Committee's adverse recommendation. Though the Hearing Committee did not agree with all findings of the Ad Hoc Committee, by a four-to-one vote, it issued a report to the Medical Executive Committee in which it agreed with the Ad Hoc Committee's final recommendation to suspend Eyring's clinical privileges and staff appointment. [2] The Medical Executive Committee then suspended Eyring's clinical privileges and staff appointment. Eyring then, as provided by the Bylaws, requested appellate review, which Parkwest scheduled to occur approximately eleven days from his request. The Appellate Review Committee's report agreed that the conclusions of the Hearing Committee were supported by the evidence and that Eyring had received a fair hearing. The Appellate Review Committee unanimously recommended that the Board affirm the Medical Executive Committee's recommendation. The Board affirmed the recommendation by a unanimous vote. Consequently, the Board revoked Eyring's clinical privileges and medical staff membership. Eyring filed suit against Parkwest in the circuit court for an aggregate of $600,000,000.00 in compensatory and punitive damages alleging breach of contract, intentional interference in contract, intentional interference in an existing business relationship, intentional interference in a prospective business expectancy, and intentional discriminatory interference in his right to engage in his profession at the hospital. Parkwest filed a Motion for Partial Summary Judgment against Eyring's claims for damages based upon the qualified immunities granted by the Federal Health Care Quality Improvement Act, 42 U.S.C. §§ 11101, et seq. (HCQIA), [3] and by the Tennessee Peer Review Law, Tenn.Code Ann. § 63-6-219. In response, Eyring moved for discovery. Over Parkwest's objection, the trial court initially permitted discovery of peer review participants for the limited purpose of allowing Eyring an opportunity to discover the committee members' good faith, malice, and whether they acted on the basis of facts reasonably known or believed to exist. The trial court, however, eventually sustained Parkwest's objections that Eyring was seeking privileged information about the peer review committees' deliberative processes and granted Parkwest's motion for summary judgment. The Court of Appeals affirmed the trial court's grant of summary judgment to the defendants, holding that the Tennessee Peer Review Law includes hospitals in those parties entitled to qualified immunity from liability for damages; that there was no genuine issue of material fact regarding whether the hospital's actions were taken in good faith and without malice and on the basis of facts reasonably known or reasonably believed to exist; and that the Peer Review Law grants the hospital a privilege barring discovery of the peer review process. We granted Eyring's application for permission to appeal.