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. 9: Sugarbaker v. SSM Health Care, d/b/a St. Mary’s Health Center, 190 F. 3rd 905 (8th Cir. 1999)
Dr. Sugarbaker was general surgeon practicing in Jefferson City, Missouri in 1995. A member of the medical staff raised concerns about his surgical technique and timing and he received a precautionary suspension of his privileges when he refused to refrain from practice voluntarily. His performance was reviewed by a number of committees and although the executive committee sought to permanently terminate him, other committees opted for restrictions and monitoring. He eventually lost all of his privileges in 1999 when he refused to abide by the conditions imposed on him.
Dr. Sugarbaker filed a federal anti-trust claim and ancillary state claims essentially asserting that he was the victim of a conspiracy to control the medical services market in Jefferson City. The trial court ultimately dismissed his claim after finding HCQIA immunity applied and Dr. Sugarbaker appealed to the federal 8th Circuit Court of Appeals. He asserted that the Defendants were acting in bad faith, that they engaged in procedural errors and that the Defendants kept moving the goal posts on the allegations of inferior performance after he effectively responded to each concern. The Court responded:
We agree with the views of our sister circuits and now hold that bad faith on the part of the reviews is irrelevant to the objective inquiry under [HCQIA].
Dr. Sugarbaker also objected to the “shared counsel” between the Appellate Review Committee and the Executive Committee reviewing his performance and to two general surgeons [competitors] serving on one of the committees. The court ruled that he failed to preserve these complaints by contemporaneous objection. Regarding the shifting concerns the court held:
Dr. Sugarbaker contends that he was depreived of a “fail hearing due to the continually changing charges brought against him.” . . . We disagree. The fact that the peer reviewer’s concerns shifted as the investigation continued doe snot alone undermine the fairness of the procedures employed. During each phase of the peer review process. St. Marys notified Dr. Sugarbaker of his procedural rights under the hospital’s bylaws. Before each hearing, St. Marys notified Dr. Sugarbaker of its concerns.
Finally, Dr. Sugarbaker contends that he is at least entitled to injunctive relief but the court, noting that he failed to file a motion for injunctive relief, determined that he had abandoned it.