Opinion ID: 2623312
Heading Depth: 1
Heading Rank: 5

Heading: In furtherance of quality health care

Text: The first requisite is satisfied provided that 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. Bryan, 33 F.3d at 1334-35 (citing H.R.Rep. No. 99-903, at 10, reprinted in 1986 U.S.C.C.A.N. at 6393). In making this evaluation, the Court must not reweigh the evidence or substitute its own judgment for that of the peer review committee. Egan, 971 F.Supp. at 44 (citing Bryan, 33 F.3d at 1337). Further, because the reasonableness standard is objective, rather than subjective, the peer reviewer's subjective bias or bad faith is irrelevant. See Bryan, 33 F.3d at 1335; Austin, 979 F.2d at 734. In the instant matter, Meyer argues that there is a triable issue of material fact concerning whether the peer review committee based its action on a reasonable belief that it was acting in furtherance of quality health care because: (1) Dr. Rosen, Meyer's medical expert, stated by affidavit that the hospital's decision was not based in furtherance of quality care or on any medical reason; and (2) there was evidence in the record that Meyer was terminated because of the hospital's concern over bad publicity, lawsuits, and COBRA investigations. We will address each of these arguments in turn.
With respect to expert testimony, we agree with the majority of jurisdictions that such testimony is irrelevant to our consideration of whether a peer review committee believed it was furthering quality health care in terminating a physician. See Sugarbaker v. SSM Health Care, 190 F.3d 905, 914 (8th Cir.1999); Mathews v. Lancaster Gen. Hosp., 87 F.3d 624, 636 (3d Cir.1996); Imperial v. Suburban Hosp. Ass'n, Inc., 37 F.3d 1026, 1030 (4th Cir.1994); Egan, 971 F.Supp. at 43. Expert testimony is irrelevant to our consideration of immunity under HCQIA because we focus solely on the reasonableness of the peer reviewer's belief, not on whether the peer review action ultimately proved to be medically sound or actually furthered quality care. See Sugarbaker, 190 F.3d at 914; see also Manzetti v. Mercy Hosp., 741 A.2d 827, 834 (Pa.Commw.Ct.1999) (Even an incorrect decision to suspend a physician will not disqualify the peer review body from immunity provided the requisites of section 11112(a) are satisfied.). Therefore, Meyer's proffer of expert testimony stating that the peer review action taken was not warranted and did not further quality care does not create a triable issue of material fact because it does not bear on the relevant issue for our considerationnamely, whether the peer review committee acted with a reasonable belief that its action was warranted by the facts known after a reasonable investigation. Meyer relies heavily on Brown v. Presbyterian Healthcare Services, 101 F.3d 1324 (10th Cir.1996). While Brown does discuss the use of expert testimony in evaluating issues of immunity under HCQIA, the decision in Brown centered upon the fact that Dr. Brown was able to produce significant evidence to support her allegations that information submitted by the defendants in her medical review process was false or misleading. Indeed, Dr. Brown produced evidence that the individuals who investigated her actions were involved in encouraging another doctor to move his practice so as to be in direct competition with her. In other words, the defendants in Brown had conspired to manufacture allegations of improper behavior by Dr. Brown so as to put Dr. Brown out of business. In this setting, Dr. Brown's expert concluded that the defendants were not acting to further quality health care. Neither were their actions reasonable under the facts of the case. It was for this reason that the federal district court in Brown refused to grant summary judgment on the basis of HCQIA immunity, a decision that was affirmed by the United States Court of Appeals for the Tenth Circuit. Such facts do not exist here. There is no evidence or allegation that the doctors who evaluated Meyer's performance in treating Anguiano were manufacturing or exaggerating facts to support disciplinary sanctions. The Fair Hearing Committee found that Meyer's suspension was warranted because her care of Anguiano was substandard. Given this finding, the Medical Executive Committee and the Appellate Review Committee had an objective basis for concluding that Meyer's privileges at the hospital should be suspended for a period of twelve months. The fact that the FHC recommended reinstating Meyer's privileges because this was a first offense and she did not act out of malice is irrelevant to the issue of immunity under HCQIA. The issue is not whether doctors can disagree over the severity of the disciplinary action, or whether a judge or jury believes the penalty was too harsh. This decision, if supported by objective evidence, is within the discretion of a professional review committee under the HCQIA. This is precisely why the United States Courts of Appeal for the Third, Fourth, Ninth and Eleventh Circuits have concluded that issues of immunity should generally be decided by the court through the use of summary judgment motions. See generally, Mathews v. Lancaster General Hospital, 87 F.3d 624 (3d Cir.1996); Imperial v. Suburban Hospital Association, Inc., 37 F.3d 1026 (4th Cir.1994); Bryan v. James E. Holmes Regional Medical Center, 33 F.3d 1318 (11th Cir.1994); Austin v. McNamara, 979 F.2d 728 (9th Cir.1992). Absent evidence that an evaluation was misleading, false or otherwise defective, a dispute between experts over the standard of care or the decision to impose discipline is insufficient to overcome the presumption that individuals acting pursuant to HCQIA standards are entitled to immunity from monetary damages under the Act. In the present matter, we are confident that the peer review committee acted with a reasonable belief that they were furthering quality care. We cannot say that these physicians did not reasonably believe that they were furthering quality care in suspending Meyer because their review focused on Meyer's alleged substandard treatment of Anguiano, a patient who allegedly died of pnuemonia less than two hours after Meyer treated and released him. Accordingly, because HCQIA provides that the peer review action need not be correct, if it is taken with a reasonable belief that it was made in furtherance of quality care, we conclude that Meyer's expert testimony was not sufficient to overcome the presumption that the hospital acted with the reasonable belief that it was furthering quality care.
Meyer further argues that the hospital did not act in furtherance of quality health care because its decision to suspend her privileges was made based on the hospital's fear of lawsuits and COBRA investigations. Similar allegations have been made by other physicians trying to overcome the presumption of qualified immunity under HCQIA. In Mathews, 87 F.3d at 634-35, a physician claimed that his privileges were suspended because some of the members of the peer review committee were the doctor's economic competitors. The Mathews court rejected the physician's claim about subjective bias, reasoning that Congress had explicitly disaffirmed a subjective good faith standard for reviewing HCQIA immunity, and instead opted for an objective reasonable belief criteria. [5] See id. at 635 (citing the House Committee on Energy and Commerce Report on the HCQIA, H.R.Rep. No. 99-903 at 10 (1986), reprinted in 1986 U.S.C.C.A.N. at 6392-93 (omitting a good faith standard out of concern that it would be misinterpreted)). Similarly, in Egan, the court rejected a physician's allegations that the peer review committee's decision was based on economic motives because there was no evidence to show that anyone exaggerated or manufactured complaints against the doctor. 971 F.Supp. at 44. Like the physicians in Mathews and Egan, Meyer has failed to provide any evidence that the peer review committee's decision was based on anything other than Meyer's treatment of Anguiano. Although Meyer notes that Wilson and Kilburn were concerned about potential COBRA violations and potential lawsuits, these concerns related to quality health care. Indeed, the purpose behind the COBRA regulatory scheme is to ensure quality health care and prevent discrimination against homeless patients or those patients who cannot afford to pay for treatment. The hospital had already been sanctioned for refusing to properly treat indigents. The peer review professionals were then faced with the findings of the FHC that Meyer's treatment of Aguiano was substandard and facts from which an objective observer could conclude that Meyer failed to treat Aguiano's complaints seriously because of his homeless condition and general appearance. If a doctor's personal attitude towards a homeless patient affects his or her professional judgment, this is an issue of quality health care. There is objective evidence to support a conclusion that this is precisely what happened with Meyer. While we agree that the hospital could have imposed a lesser sanction, they are not required to do so under HCQIA. Because there was a reasonable evidentiary basis for the committee's decision in this matter, Meyer's allegations concerning the subjective beliefs of Wilson and Kilburn are insufficient to overcome the presumption of reasonableness. Accordingly, we conclude that Meyer has failed to proffer relevant evidence that would overcome the presumption that the hospital acted in furtherance of quality health care.