Demonstrating the broad scope of peer-review immunity under federal law for health care providers, a federal district court in South Carolina held on Oct. 25, 2012 that a hospital and other providers were entitled to summary judgment on various claims against them by a physician arising from termination of the physician’s privileges.
Among her claims, the physician in Hein-Munoz v. Aiken Regional Medical Centers, No. 1:10-cv-986, alleged that she was denied proper notice and hearing under the Health Care Quality Improvement Act (HCQIA), a federal statute that provides professional review bodies of hospitals and other health care entities civil liability immunity for taking quality-based adverse actions against physicians that comply with certain procedural protections for such physicians. While the court was skeptical about the adequacy of the procedures afforded to the physician, it concluded that the providers were nevertheless entitled to immunity under the HCQIA and that the physician’s other claims were subject to dismissal for a lack of supporting evidence.
The lawsuit arose from an incident involving a patient who delivered a stillborn fetus after receiving treatment from the physician in the hospital emergency department. After the incident, a medical executive committee first suspended the physician’s privileges and then later revoked them. On appeal, another committee upheld the decision, which was then adopted by the hospital’s board of governors and reported to the National Practitioner Data Bank, a centralized information system created by the HCQIA that compiles information about quality-based adverse actions taken by health care entities against physicians.
The physician later sued the hospital and other entities, alleging various claims about the inadequacy of the peer-review process, including a claim that she did not receive proper notice of the hospital’s basis for terminating her privileges. The court rejected all of these claims, however, on grounds that the HCQIA conferred the hospital and other entities with immunity from damages or that supporting evidence was absent. The court reached this conclusion despite being “disturbed” by discrepancies between the original reasons cited for terminating the physician’s privileges—concerns about patient care—and later reasons cited for the termination—the physician’s truthfulness. “It is evident that the peer review action against [the physician] was not perfect,” the court explained. “However, [the HCQIA] does not require perfection. Rather, the statute requires notices and hearing procedures that were fair under the circumstances.”