This is a series describing the ten important pro-immunity peer review cases where court have granted immunity to peer reviewers under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”).
No. 3: Mathews v. Lancaster General Hospital, 87 F.3d 624 (3rd Cir. 1996)
Dr. Mathews was an orthopedic surgeon with privileges at Lancaster General Hospital in Pennsylvania. He was scheduled as the assistant surgeon on a case that turned out poorly, but he was not present at the operation. The surgeon in charge, Dr. Kent punctured the patient’s esophagus with a high speed drill. He repaired the would but there were later unfortunate sequelae. The hospital peer review investigation of tDr. Kent led to a review of Dr. Mathews cases as well as there was an arrangement for the two surgeons to participate in each others surgeries. There followed an exhaustive review of Dr. Mathews cases by his colleagues at the hospital and by an independent outside reviewer, who found substantial deficiencies in many of Dr. Mathews’ cases.
On September 16, 1993, the Lancaster General Hospital Board of Directors voted to restrict Dr. Mathews' privileges to perform spine surgery as either primary or assisting surgeon. They also voted to require Dr. Mathews to obtain a second opinion or consultation before performing prosthetic joint surgery, arthroscopy, or hand or foot surgery for a period of 12 months. The Board notified Dr. Mathews of its decision by letter dated September 22, 1993 and informed him of his right to a fair hearing under Lancaster General Hospital Medical Staff Bylaws. On October 26, 1993, Dr. Mathews requested a hearing, and the Board subsequently voted to suspend the restrictions on his privileges until a hearing could be held. Before the hearing was scheduled, however, Dr. Mathews filed his suit alleging antitrust violations and various state law claims.
The trial court granted summary judgment in favor of the defendants based on HCQIA immunity. Dr. Mathews appealed the decision to the Third Circuit Court of Appeals, arguing that the Defendants were engaged in a conspiracy to restrain his trade and that the hospital and the orthopedic physicians participating in the investigation were competitors of his. The Court held that the mere participation by competitors in the investigation leading up to the peer review action did not run afoul of HCQIA. Even though the Act suggests that a hearing officer or individuals sitting on a hearing panel should not be in direct competition with the subject of a hearing, it poses no such restrictions on participants in other phases of the peer review process.
The Court concluded:
Dr. Wilson, the outside reviewer, concluded that Dr. Mathews had provided substandard care in spine surgery cases. The Board then placed restrictions on Dr. Mathews' privileges to conduct spine surgery. Because these restrictions were tailored to address the health care concerns raised by the reports of the Rothacker Committee and Dr. Wilson, we believe the evidence supports the conclusion that the restrictions were imposed based on a reasonable belief that they were warranted by the facts known . . . . While the conflicting expert reports raise an issue of fact as to the adequacy of care provided by Dr. Mathews, they do not rebut the presumption that the Board made its decision in the reasonable belief that it was warranted by the facts known.