The U.S. Circuit Court of Appeals for the Fourth Circuit recently held that a hospital was immune from various federal and state claims under the Health Care Quality Improvement Act of 1986 (HCQIA) for suspending a physician's privileges without a hearing (Wahi v. Charleston Area Medical Center). In this case, Dr. Wahi, a cardiothoracic surgeon, had a long disciplinary history with Charleston Area Medical Center (CAMC), in West Virginia. After several temporary suspensions, CAMC chose to deny Dr. Wahi's request to reinstate his clinical privileges. CAMC alerted Dr. Wahi of his right to have a hearing but failed to schedule one. As required under law, the hospital reported Dr. Wahi's suspensions to the National Practitioner Data Bank, a clearinghouse established under HCQIA. As a result, Dr. Wahi brought an action in federal court alleging, among other things, antitrust, breach of contract and civil rights violations. The court noted that the HCQIA provides a "professional review body" with immunity from damages whenever a "professional review action" is taken:
- In the reasonable belief that the action was in the furtherance of quality health care;
- after a reasonable effort to obtain the facts of the matter;
- after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures that are fair to the physician under the circumstance; and
- in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph 3.
Under HCQIA, health care entities may also qualify for immunity from civil liability for certain disciplinary actions if they report information to the data bank.
After an extensive review of the HCQIA, the Fourth Circuit affirmed the district court's ruling and concluded that because CAMC's actions qualified as a professional review, the hospital was entitled to immunity under HCQIA, despite not having held a formal hearing. The court determined that CAMC satisfied the third prong of the immunity test by affording Dr. Wahi "other procedures" that were fair under the circumstances, such as providing a detailed letter regarding his rights and providing notice of the action and charges against him. Read the entire case here.