The New Mexico Supreme Court has ruled in favor of Albuquerque-based Lovelace Health System and its operator, Nashville, Tenn.-based Ardent Health Services, after a physician alleged the organizations conducted an unreasonable peer review process that led to the suspension of his privileges.
Plaintiff William K. Summers, MD, an internist and psychiatrist, was subject to a formal professional review in 2003 after two female patients reported separate incidents of him using sexually explicit and offensive language during consultations. Dr. Summers admitted to Patient A's complaints but denied those of Patient B, claiming neither the patient's complaints nor the notes provided by a medical caseworker detailing the complaints were credible.
During the investigation into the Patient B's complaints, the hospital did not interview Dr. Summers, contrary to the hospital's bylaws. Lovelace's medical executive committee suspended Dr. Summers' internal medicine privileges, placed his psychiatric privileges on probation for two years and reported his action to the National Practitioner Data Bank.
When Dr. Summer's appealed this decision, Lovelace held a two-day hearing with a professional review committee, which was made up of providers not in direct competition with Dr. Summers. Although the professional review committee concluded that some of the specific issues against Dr. Summers were "unfounded," they remained concerned with his general standards of care. Dr. Summers appealed that decision as well, and a hearing was held before the Board of Trustees Appellate Review Committee, which is comprised of hospital executives. That board recommended permanent suspension of Dr. Summers' privileges.
Dr. Summers filed suit in the Second Judicial District Court, claiming defamation and breach of contract. He also stated that Lovelace had acted in bad faith and conducted an unreasonable peer review process. The case made its way through the courts, who found the peer review process' reliance on caseworker notes — especially when Dr. Summers disputed the credibility of those notes — to be questionable. The Court of Appeals determined that Dr. Summers had met his burden and rebutted immunity of the 1986 Health Care Quality Improvement Act.
The HCQIA immunity protects hospitals and other healthcare organizations from damages if they participate in a professional peer review actions and meet four requirements. Under those requirements, the peer review must be conducted:
1. in the reasonable belief that the action was in the furtherance of quality care;
2. after a reasonable effort to obtain the facts of the matter;
3. after adequate notice and hearing procedures are afforded to the physician involved or after other procedures as fit to the physician under the circumstances;
4. 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 the third point.
The New Mexico Supreme Court held that the plaintiff did not successfully "rebut" HCQIA immunity and reversed the decision of the appellate court. It said the hospital committee's failure to interview Dr. Summers about the second patient's allegations was "not fatal." The court also said that, in order to challenge the reasonableness of the peer review, Dr. Summers "must point to specific and material facts demonstrating that the fact-finding efforts were unreasonable," according to the brief. The court said suspension of Dr. Summers' medical privileges was enacted "after a fact-finding process that involved a broad and thorough investigation." Thus, Dr. Summers will not be awarded damages from Lovelace and Ardent.
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Plaintiff William K. Summers, MD, an internist and psychiatrist, was subject to a formal professional review in 2003 after two female patients reported separate incidents of him using sexually explicit and offensive language during consultations. Dr. Summers admitted to Patient A's complaints but denied those of Patient B, claiming neither the patient's complaints nor the notes provided by a medical caseworker detailing the complaints were credible.
During the investigation into the Patient B's complaints, the hospital did not interview Dr. Summers, contrary to the hospital's bylaws. Lovelace's medical executive committee suspended Dr. Summers' internal medicine privileges, placed his psychiatric privileges on probation for two years and reported his action to the National Practitioner Data Bank.
When Dr. Summer's appealed this decision, Lovelace held a two-day hearing with a professional review committee, which was made up of providers not in direct competition with Dr. Summers. Although the professional review committee concluded that some of the specific issues against Dr. Summers were "unfounded," they remained concerned with his general standards of care. Dr. Summers appealed that decision as well, and a hearing was held before the Board of Trustees Appellate Review Committee, which is comprised of hospital executives. That board recommended permanent suspension of Dr. Summers' privileges.
Dr. Summers filed suit in the Second Judicial District Court, claiming defamation and breach of contract. He also stated that Lovelace had acted in bad faith and conducted an unreasonable peer review process. The case made its way through the courts, who found the peer review process' reliance on caseworker notes — especially when Dr. Summers disputed the credibility of those notes — to be questionable. The Court of Appeals determined that Dr. Summers had met his burden and rebutted immunity of the 1986 Health Care Quality Improvement Act.
The HCQIA immunity protects hospitals and other healthcare organizations from damages if they participate in a professional peer review actions and meet four requirements. Under those requirements, the peer review must be conducted:
1. in the reasonable belief that the action was in the furtherance of quality care;
2. after a reasonable effort to obtain the facts of the matter;
3. after adequate notice and hearing procedures are afforded to the physician involved or after other procedures as fit to the physician under the circumstances;
4. 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 the third point.
The New Mexico Supreme Court held that the plaintiff did not successfully "rebut" HCQIA immunity and reversed the decision of the appellate court. It said the hospital committee's failure to interview Dr. Summers about the second patient's allegations was "not fatal." The court also said that, in order to challenge the reasonableness of the peer review, Dr. Summers "must point to specific and material facts demonstrating that the fact-finding efforts were unreasonable," according to the brief. The court said suspension of Dr. Summers' medical privileges was enacted "after a fact-finding process that involved a broad and thorough investigation." Thus, Dr. Summers will not be awarded damages from Lovelace and Ardent.
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