10 CRITICAL PRO IMMUNITY PEER REVIEW CASES: Number 10

 

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. 10: Reyes v. Wilson Memorial Hospital, 102 F Supp. 2d 798 (S.D. Ohio, 1998).

Dr. Reyes was a board certified internist who did not get along with his colleagues at the hospital. Having been summarily suspended in a peer review process, he sued the hospital for antitrust violations and and state law torts, to which the defendants raised the issue of immunity. According to an affidavit filed by Dr. Reyes in opposition to a motion for summary judgment,  he suffered the resentment of his fellow doctors because of the effect his method of practice had on the income of the Defendants. Plaintiff occasionally referred patients to hospitals other than Wilson Memorial and to doctors other than those named as Defendants. Dr. Reyes' practice of referring patients to other hospitals and to other doctors caused the Defendants to suffer a loss of income . 

 

Dr. Reyes also performed minor surgeries and diagnostic tests in his own office, rather than referring his patients to surgeons at Wilson Memorial or having their tests performed there. These practices earned him the enmity of his fellow doctors at the hospital. One of the defendants warned him on several occasions to stop these practices  Dr. Reyes believed that the Defendants' professional review actions were taken because of his refusal to move to a new medical office building, his practice of making referrals out of the Sidney area, and the fact that he had a successful practice. Dr. Reyes claimed that he  lost many patients and contracts as a result of his suspension. The trial court responded:

 

As the previous section makes clear, a plaintiff bears the crucial burden of producing evidence which could negate the statutory presumption that an eligible entity has acted in accordance with section 11112(a). The courts which have addressed the issue of immunity under the HCQIA have been unanimous in holding that a plaintiff cannot prove the "unreasonableness" of a defendant's actions by introducing evidence suggesting that a defendant acted in "bad faith." Rather, the courts have held that such evidence is irrelevant. A defendant's actions must be judged on an objective basis. 

 

The Court, in granting the defendants’ motion for summary judgment, held that a plaintiff, to prevail on a motion for summary judgment by the defendants must demonstrate that there exists a triable issue as to whether the result reached by the peer review board was based on a "reasonable belief" that it "was in the furtherance of quality health care." The court held that the reasons for a summary suspension can ultimately be wrong; that is not the test of whether there has been a violation. There must be a genuine issue of fact concerns the reasonableness of the defendants belief.