Opinion ID: 2982261
Heading Depth: 2
Heading Rank: 2

Heading: Internal Hearing and Due Process

Text: According to Satgunam, the hearing conducted after the district court remanded this matter to the Governing Board in the preliminary injunction was constitutionally defective and deprived him of due process for two reasons: (1) the internal appeal was not heard and considered by a neutral decision maker, and (2) Satgunam’s counsel was not permitted to play a participatory role.
First, Satgunam claims that the district court erred in remanding to the Governing Board because it was not a neutral decision maker. He asserts that the individual Governing Board members were inherently biased because they are defendants in the underlying action, facing the prospect of liability for damages. Satgunam raises this issue for the first time on appeal. During the Injunction Hearing, the district court invited him to voice concerns about the Governing Board’s impartiality, and he declined to do so: THE COURT: . . . Do you have any concerns regarding the governing board in terms of their ability to fairly adjudicate an appeal which is consistent with due process? 8 MR. HERRON: In the abstract, no. With proper procedures and time and the due process required by the constitution, there’s nothing to think that group of individuals could not in the first instance render a fair opinion. Satgunam also did not introduce any impartiality contentions in his Emergency Motion to Modify Preliminary Injunction or his supporting brief. Generally, “an argument not raised before the district court is waived on appeal to this Court.” Scottsdale Ins. Co. v. Flowers, 513 F.3d 546, 552 (6th Cir. 2008). There are narrow exceptions to this rule that do not apply here; we have “rarely” exercised our discretion to depart from the rule, id., and we decline to do so here. See Overstreet v. Lexington-Fayette Urban Cnty. Gov’t, 305 F.3d 566, 578 (6th Cir. 2002) (holding that this Court “will not consider arguments raised for the first time on appeal unless our failure to consider the issue will result in a plain miscarriage of justice”). We find that Satgunam has waived his right to argue this claim on appeal, and in turn find no error.3
Next, Satgunam argues that the district court should have ordered that his counsel be afforded a participatory role in the second appeal hearing. We find that it was proper for the district court to decline to do so for two reasons: (1) Satgunam has presented no substantive proof rebutting HealthTeam’s findings, and (2) participatory counsel was not required under law. First, Satgunam provides no substantive proof of what he would present to rebut the Governing Board’s findings if afforded participatory counsel. In order to obtain a preliminary injunction, a plaintiff “must establish that he is likely to succeed on the merits, that he is likely to 3 Moreover, Satgunam fails to offer any support for his contention that the Governing Board was not impartial. Satgunam provides no assertion of actual bias or impropriety by any hearing member toward him. Instead, he relies on Governing Board members’ alleged incentive to affirm their decision. We do not presume such categorical biases merely because a person is named as a party litigant. Instead, a party claiming bias on the part of an administrative tribunal “must overcome a presumption of honesty and integrity in those serving as adjudicators” by looking at the “circumstances present in the case.” Withrow v. Larkin, 421 U.S. 35, 47, 58 (1975). 9 suffer irreparable harm in the absence of preliminary relief, that the balance of equities tips in his favor, and that an injunction is in the public interest.” Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 20 (2008) (citations omitted). When asked during oral argument before this court what evidence he would present through counsel to defend his handling of the three surgical cases at issue, Satgunam submitted nothing more than his counsel’s intention to “put in crossexamination of witnesses who testified at the second proceeding.” Oral Argument, Satgunam v. Michigan State University, et al., No. 13-1535 (6th Cir. Jan. 29, 2014), available at http://www.ca6.uscourts.gov/internet/court_audio/aud2.php?link=http://www.ca6.uscourts.gov/i nternet/court_audio/recent/01-30-2014 - Thursday/13-1535 Satgunam v Basson.mp3&name=131535 Satgunam v Basson. However, Satgunam does not suggest what evidence would be introduced on cross-examination to bolster his case, and admits that he has no more substantive proof to submit. Id. We also note that the most serious allegations against Satgunam, two fatalities attributed to surgical error, are documented in medical and court records and would not be subject to cross-examination. By not offering any substantive arguments to rebut the Governing Board’s findings, Satgunam did not establish a likelihood of success on the merits and in turn cannot demonstrate his entitlement to this extraordinary relief. Second, Satgunam admits that in declining to order participatory counsel, the district court complied with Circuit law articulated in Yashon v. Hunt, 825 F.2d 1016, 1026 (6th Cir. 1987) (finding no right to counsel at a post-deprivation hearing of a doctor denied surgical privileges). A panel of this Court may not overrule a previous panel's decision. Meeks v. Illinois Cent. Gulf R.R., 738 F.2d 748, 751 (6th Cir. 1984). The district court did not err in declining to order that Satgunam’s counsel be afforded a participatory role in the second appeal hearing. 10 C. Declining to Examine the Merits of the Governing Board Decision Satgunam claims that the district court abused its discretion in declining to review the merits of the Governing Board’s decision at the injunction proceeding. First, Satgunam argues that the district court determined that it could not review the merits of a healthcare entities’ staffing decision. The district court did not so hold. Rather, it acknowledged that under the right circumstances, courts can, should, and in fact do review the propriety of staffing decisions by healthcare entities. As the district court noted, “the real question . . . is whether this is a proper situation for such review.” The district court declined to review the substance of the Governing Board’s decision because it recognized that this case’s adjudicative posture militated against judicial review of the merits, not because it found itself unable to do so in all situations. Second, Satgunam posits that injunction proceedings are an apt forum for merits review. We do not agree. At the injunction hearing, the district court only had before it the procedural due process issues. Allowing Satgunam to bootstrap procedural claims into review of his record as a surgeon would have significantly expanded the matter and required the district court to resolve issues that had not been sufficiently argued or briefed. Finally, as noted above, Satgunam offers no substantive proof to rebut HealthTeam’s findings on the merits. As such, he has not shown his likelihood of success if the court were to review the merits of HealthTeam’s decision. We hold that the district court did not abuse its discretion by refusing to consider the merits during the injunction proceedings. D. Declining to Order Removal or Modification of the Data Bank Report Satgunam argues that the district court erred in declining to order removal or modification of MSU’s report to the Data Bank. For the reasons stated below, we disagree. 11 1. Authorization to Report First, Satgunam argues that the district court should have ordered removal of the data bank report. He asserts that HealthTeam lacked authorization to report him to the Data Bank because it failed to follow its own peer-review procedures. Satgunam’s argument proceeds as follows. Under the HCQIA, 42 U.S.C. § 11133(a), HealthTeam can only report Satgunam to the Data Bank if it is a “health care entity.” The HCQIA defines “health care entity” as “an entity… that provides health care services and that follows a formal peer review process for the purpose of furthering quality health care.” 42 U.S.C. § 11151(4)(A)(ii) (emphasis added). Department of Health and Human Services regulations in turn define “formal peer review process” as “the conduct of professional review activities through formally adopted written procedures which provide for adequate notice and an opportunity for a hearing.” 45 C.F.R. § 60.3. Thus, Satgunam claims, HealthTeam can only report him if it was acting through formally adopted written procedures. HealthTeam policy allows the Surgery Department’s Peer Review Committee to “evaluat[e] a single practitioner’s performance in a single case” only, and the Committee must perform that evaluation by comparing the case to “a generally recognized standard of care.” Satgunam argues that the Committee violated those limitations by comparing a number of his cases against a similar number of cases involving another MSU doctor. The HealthTeam was not acting “through” its formal procedures when it sanctioned him, concludes Satgunam, and so it lacked the power to report him to the Data Bank. The district court, however, declined to enter preliminary injunctive relief removing the report, finding that administrative exhaustion applied to the question of whether MSU is eligible to file its report with the Data Bank. We agree and find no error. 12 The HCQIA establishes procedures for administrative review of Data Bank reports. See 42 U.S.C. § 11136; 45 C.F.R. § 60.21. While the Act does not expressly require exhaustion, the general rule is that parties must “exhaust prescribed administrative remedies before seeking relief from the federal courts.” McCarthy v. Madigan, 503 U.S. 140, 144-45 (1992). In such situations, courts must weigh “the litigant’s interests in immediate judicial review” against “the government’s interests in . . . efficiency or administrative autonomy.” Id. at 146. “[S]ound judicial discretion governs” this determination. Id. at 144. The Supreme Court has listed three situations where the individual’s interests weigh against requiring exhaustion: (1) where “requiring resort to the administrative remedy may occasion undue prejudice to subsequent assertion of a court action”; (2) where the agency lacks power to grant effective relief; and (3) where the agency “is shown to be biased or has otherwise predetermined the issue before it.” Id. at 146-48. Satgunam does not allege that the Secretary of Health and Human Services (“Secretary”) is biased or that he would not be able to receive a fair hearing before the Department. Further, his ability to file suit in federal court would not have been prejudiced had he raised this claim to the Secretary in the first instance. Satgunam provides no compelling reason why he could not have pursued administrative review of the Data Bank reports. The question turns on whether the issue of eligibility to report is within the Department’s purview. The Secretary’s power to review Data Bank reports is limited. The relevant regulation, 45 C.F.R. § 60.21(a) (entitled “How to dispute the accuracy of National Practitioner Data Bank information”), provides that a physician may “dispute the accuracy of a report concerning himself,” but does not expressly cover challenges to reporting authorization. However, as the district court noted, the Secretary 13 apparently reads that language to provide for agency review of this issue, demonstrated by the language in the Data Bank Guidebook: The subject of a Medical Malpractice Payment Report (MMPR) or an Adverse Action Report (AAR) may dispute either the factual accuracy of the report or whether a report was submitted in accordance with the NPDB’s reporting requirements, including the eligibility of the entity to report the information to the NPDB. U.S. Dep’t of Health & Human Servs., National Practitioner Data Bank Guidebook F–2 (2001), available at http://www.npdb.hrsa.gov/resources/NPDBGuidebook.pdf. We find that administrative exhaustion applies here because the Secretary would be able to address Satgunam’s claim about MSU’s eligibility to file its Data Bank report. The district court appropriately refused to hear that claim until it was administratively exhausted, and did not abuse its discretion in declining to enter preliminary injunctive relief removing the report. 2. Modification of Report Second, Satgunam argues that the district court erred when it declined to order modification of MSU’s Data Bank report. He claims that, in light of the re-hearing decision, several aspects of the report are now inaccurate. The district court declined to enter preliminary injunctive relief modifying the report because it found that administrative exhaustion applies. We agree and find no error. Mirroring the analysis above, whether administrative exhaustion applies to Satgunam’s concerns about the content Data Bank reports depends on whether those issues are within the Secretary’s purview. Issues regarding the content and accuracy of Data Bank reports are clearly within the Secretary’s authority. See Leal v. Sec’y, U.S. Dep’t of Health & Human Servs., 620 F.3d 1280, 1284 (11th Cir. 2010) (“The Secretary reviews a report for factual accuracy deciding only if the report accurately describes the adverse action that was taken against the physician and 14 the reporting hospital’s explanation for the action, which is the hospital’s statement of what the physician did wrong.”); see also National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: Reporting on Adverse and Negative Actions, 75 Fed. Reg. 4656-01, 4671 (Jan. 28, 2010) (“We do not have the statutory authority to review the merits of adverse actions taken by reporting entities. We can only review (1) if the report is legally required or permitted to be filed, and (2) if the report accurately depicts the action taken and the reporter’s basis for the action.”). The district court appropriately refused to hear those claims until they were administratively exhausted, and did not abuse its discretion in declining to enter preliminary injunctive relief ordering modification of the report. Therefore, we affirm the district court on the basis that Satgunam has not established his likelihood of success or entitlement to additional due process under law and because administrative exhaustion applied to the issues of whether MSU is eligible to file its Data Bank report and the content and accuracy of that report.