Dr. Sues Hospital for Negligent Peer Review.
ISSUE: Do physicians sue hospitals regarding peer review?
CASE FACTS: Dr. Herbert Goodman applied for medical staff privileges at Maryvale Samaritan Hospital in 1989. He was appointed to the provisional staff in March 1990. After receiving a one-year extension, Dr. Goodman completed his mandatory supervised case reviews in 1991. In January 1992, he submitted an application for appointment to the courtesy staff. The requested investigation of his medical portfolio and background was undertaken by an appointed committee. Following completion of the investigation, the committee expressed concerns that (1) Dr. Goodman had "falsified information" regarding his prior affiliation with two area hospitals, (2) the Arizona Board of Medical Examiners (BOMEX) had censured him for "unprofessional conduct" for misdiagnosing a patient and knowingly falsifying the patient's medical records; and (3) the audit of his supervised case reviews reflected concerns about his patient care and documentation. Dr. Goodman submitted a response to these concerns in which he explained the circumstances of his BOMEX censure and his failure to mention prior hospital affiliations. The committee arranged for Dr. Donald Mulvaney, the Director of the Family Practice Residency program at another Samaritan medical center to independently review Dr. Goodman's supervised case reviews. Dr. Mulvaney concluded that two of the eleven patient charts did not meet the applicable standard of care. He recommended that the hospital deny Dr. Goodman courtesy staff privileges. Notwithstanding Dr. Mulvaney's recommendation, the committee recommended that Dr. Goodman be elevated from provisional to courtesy staff conditioned upon the following: (1) completion of a mini-residency of at least six weeks duration; (2) performance of ten additional supervised cases within one year, and (3) continued nonparticipation in on-call emergency-room duty. Dr. Goodman then submitted documents responding to both the case review audit and Dr. Mulvaney's conclusions. A letter from a UCLA medical professor indicated that Dr. Goodman's documentation in his patient's charts showed "no deviation from the standard of medical care and that many of the reviewers' comments were grossly inaccurate." In 1993, the hospital granted courtesy staff privileges on the condition that the next ten cases be retrospectively reviewed. In May, 1994, Dr. Goodman filed suit against the hospital for negligent peer review and malicious prosecution. The Superior Court, Maricopa County, granted summary judgment for the hospital. The physician appealed.
COURT'S OPINION: The Court of Appeals of Arizona affirmed the judgment of the lower court. The Court held, inter alia, that granting absolute immunity, except for malice, to medical peer review participants did not violate the state constitution or laws. The context with which the court was operating was that of a peer review of a health care provider that determines the provider's entitlement to work in a hospital setting. Statutorily mandated peer review, as we know it today, did not exist in Arizona until 1971, when the legislature first entered the field. In that year, the legislature enacted a law which mandated peer review of physicians practicing in hospitals, and provided immunity from liability for civil damages or any other legal action for decisions made by those participating in the process "without malice and in good faith." The effect of the law was to create a claim for monetary damages in favor of a reviewee against a reviewer, including the hospital if it could be proved that the reviewer acted with malice and in bad faith in the peer review process. The court concluded that even before the legislation was passed there was no common law right to damages in such cases
LEGAL COMMENTARY: The court focused on the public policy considerations which spawned the exemptions from liability for good faith reporting under peer review laws. It is for the purposes of reducing morbidity and mortality and for the improvement of the care of patients. Militating against effective peer review is the fact that it "is not only time consuming, unpaid work, it is also likely to generate bad feelings and result in unpopularity. "If lawsuits by unhappy reviewees can easily follow any decisions ... then the peer review process will become an empty formality, if undertaken at all." If effective peer review is to be achieved, and the public policy goal realized peer reviewers and their hospitals must have some protection against money damage claims. The court concluded that Dr. Goodman's argument falters on its initial assumption that he has a right to sue. The court found that Dr. Goodman had no fundamental right to sue in this context. Where no fundamental right is at stake, the court reviews the case under a rational basis test. That test required that the court uphold the law if it serves a legitimate state interest and rationally furthers that interest. It appears that despite the extraordinary information the peer review committee had relative to falsification of records, including Board censure, it was extremely patient in affording Dr. Goodman an opportunity to obtain and keep privileges.
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|Author:||Tammelleo, A. David|
|Publication:||Hospital Law's Regan Report|
|Article Type:||Brief Article|
|Date:||Apr 1, 2000|
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