NM Court Denies Hospital Immunity under HCQIA

A New Mexico appeals court upheld January 11 a lower court’s refusal to grant summary judgment to a hospital based on immunity under the Health Care Quality Improvement Act of 1986 (HCQIA).  According to the appeals court, the lower court correctly found a question existed on whether the peer review action at issue was taken “after a reasonable effort to obtain the facts of the matter” as required under the statute.

Health Lawyers Weekly
AHLA January 29, 2010 Vol. VIII Issue 4

New Mexico Appeals Court Denies Hospital Immunity Under HCQIA, Finding Question Exists Whether Peer Review Action Was Taken With A Reasonable Effort To Obtain Facts

Plaintiff William K. Summers, M.D. held privileges to practice psychiatric and internal medicine within the Lovelace Sandia Health System.

In 2005, Summers’ medical privileges were permanently suspended based on findings of a “pattern of using inappropriate sexually explicit language with . . . patients [that] could result in imminent danger . . . .”

Summers appealed to a Professional Review Committee and finally to an Appellate Review Committee, which both upheld the suspension.

Summers sued defendants Ardent Health Services, L.L.C. and Lovelace Health System, Inc. claiming defamation, breach of contract, prima facie tort, and tortious interference with prospective contracts.

Defendants moved for summary judgment arguing that the HCQIA provided a complete defense of immunity to the action.

Summary judgment was denied by the trial court, which found that “[a] genuine issue of material fact exists regarding the reasonableness of the efforts taken by Defendant[s] to obtain the facts of the matter during the professional review action.”

The appeals court granted defendants an interlocutory appeal.

Defendants argued the district court failed to consider the totality of the process leading up to Summers’ suspension, and instead focused too narrowly on the facts relating to one particular patient.

In addition, defendants argued the district court improperly re-weighed the evidence considered by the peer reviewers.

The appeals court was unconvinced by these arguments, noting instead that the suspension was effectively based on Summers’ interactions with two patients.

With regard to one patient, Summers admitted the conduct, the appeals court explained, but with respect to the other, Summers “called into question the reasonableness of the fact finding efforts relating to Patient B based on articulable concerns: that her allegation is based on notes taken by a case manager during a phone conversation, that neither the case manager nor Patient B was ever contacted or questioned regarding the incident, and that Dr. Summers vigorously disputed the allegation throughout the process.”

“Even viewing the totality of the fact finding process, where an outcome is based on only two allegations and doubt has been reasonably cast on the key fact giving rise to the disciplinary action, the total process and its result can be reasonably called into question,” the appeals court said.

Accordingly, the appeals court said, a “reasonable jury, viewing these facts in the best light for Dr. Summers, could conclude by a preponderance of the evidence that Defendants were unreasonable in their fact finding efforts” and thus were not entitled to immunity under the HCQIA.

Summers v. Ardent Health Servs., L.L.C., No. 28,605 (N.M Ct. App. Jan. 11, 2010).

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