Granger v. Christus Health Cent. La.

• Citation: 144 So.3d 736
• Decision Date: 30 August 2013
• Docket Number: No. 2012–C–1892.,2012–C–1892.
• Parties: Tommie M. GRANGER, M.D. v. CHRISTUS HEALTH CENTRAL LOUISIANA, et al.
• Court: Supreme Court of Louisiana

144 So.3d 736

Tommie M. GRANGER, M.D.
v.
CHRISTUS HEALTH CENTRAL LOUISIANA, et al.

No. 2012–C–1892.

Supreme Court of Louisiana.

June 28, 2013.
Rehearing Denied Aug. 30, 2013.

[144 So.3d 740]

Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, Roy Clifton Cheatwood, Esq., Donna DiMartino Fraiche, Esq., Aubrey Bernard Hirsch, Jr., Esq., Alexander McVoy McIntyre, Jr., Esq., New Orleans, LA, for Applicant.

Faircloth Law Group, LLC, Jimmy Roy Faircloth, Jr., Esq., Barbara Bell Melton, Esq., Alexandria, LA, for Respondent.

HUGHES, J.

We granted certiorari in this case to review a damage award of nearly $3 million in favor of a surgeon for alleged improprieties in peer review proceedings. At issue in this case are: the Health Care Quality Improvement Act of 1986 (“HCQIA”), 42 U.S.C.A. § 11101 et seq.; Louisiana's peer review immunity statute, LSA–R.S. 13:3715.3(C); and Louisiana contract and negligent misrepresentation laws. For the reasons assigned, we affirm in part, reverse in part, and vacate in part.

FACTS AND PROCEDURAL HISTORY

At all pertinent times, the plaintiff, Dr. Tommie M. Granger, was a board-certified cardiac surgeon practicing in Alexandria, Louisiana, having hospital privileges as a member of the medical staff at CHRISTUS St. Frances Cabrini Hospital (“Cabrini”), also located in Alexandria. Dr. Granger maintained his private practice through a limited liability medical company, Cardiovascular Surgery of Alexandria, L.L.C. (“CSA”), of which he was the sole shareholder. Dr. Granger was also, at the time, Medical Director for Cardiovascular Services at another local hospital, Rapides Regional Medical Center (“Rapides”).

On December 18, 2002, a patient of Dr. Granger's was hospitalized at Cabrini following a surgical procedure ¹ and suffered

[144 So.3d 741]

complications, which resulted in Dr. Granger being called back from Rapides to Cabrini to attend the patient.² While he was at Cabrini attending his patient, heated words were exchanged between Dr. Granger and certain Cabrini staff members, with Dr. Granger casting aspersions on the care given by the Cabrini nursing staff, allegedly within the hearing of the patient. After Dr. Granger performed an in-room procedure to alleviate a hematoma that had developed at the surgery site, he ordered the patient transferred to the intensive care unit, and then he left Cabrini to return to his Rapides surgical patient. Dr. Granger stated that, while driving back to Rapides, he telephoned Cabrini to reserve surgical facilities so that, later that day, he could perform exploratory surgery to determine the cause of the bleeding at the Cabrini patient's surgical site. However, the Cabrini patient's condition deteriorated prior to the completion of Dr. Granger's Rapides surgery, and Dr. Granger was called by Dr. Michael Finley (Cabrini's Chief Medical Executive (“CME”)) and informed that his Cabrini patient had developed uncontrolled bleeding, which needed

[144 So.3d 742]

immediate surgery. Unable to leave his Rapides patient during surgery, Dr. Granger contacted Dr. Phillip Lindsay, who agreed to perform the exploratory surgery on Dr. Granger's Cabrini patient to locate and repair the source of the bleeding.

Later in the day, an anesthesiologist assigned to participate in the coronary bypass surgery on Dr. Granger's Cabrini patient, scheduled for the following day, cancelled the bypass surgery. Dr. Granger disagreed with the cancellation and further heated discussions ensued relating to the patient's care.³

On December 19, 2002 and continuing through June of 2003, peer review proceedings were undertaken by Cabrini's Board of Directors (the “Board”), the Board's Executive Committee (“BEC”), and the Medical Executive Committee (“MEC”). Initially, Dr. Granger was immediately and summarily suspended for approximately twenty-one days while an investigation was conducted with respect to the care of Dr. Granger's Cabrini patient on December 18, 2002. On January 10, 2003, Dr. Granger's clinical privileges were restored, but a letter of reprimand was placed in his permanent Cabrini record. Although Dr. Granger requested that the letter of reprimand be removed from his record or that a hearing be granted on the summary suspension, his request was denied. Finding that the unprofessional behavior of Dr. Granger was a contributing factor that adversely affected patient care, the MEC made a recommendation and the BEC passed a resolution to place Dr. Granger on a six-month supervised probation and to require him to self-refer to the Physician's Health Foundation of Louisiana (“PHFL”) ⁴ for an anger management evaluation, failing which his medical staff membership and clinical privileges would be automatically revoked. Dr. Granger did not self-refer to the PHFL, and, ultimately, on July 30, 2003, the Board voted to ratify the BEC's resolution to automatically revoke Dr. Granger's medical staff membership and clinical privileges.

In the interim, on February 6, 2003, Dr. Granger filed suit in the district court seeking declaratory and injunctive relief on his asserted right to a hearing on the December 19, 2002 through January 9, 2003 summary suspension imposed by Cabrini. Named as defendants were: CHRISTUS Health Central Louisiana d/b/a CHRISTUS St. Francis Cabrini Hospital; CHRISTUS St. Francis Cabrini Hospital Medical Staff; and the Local Governing Board of CHRISTUS St. Frances Cabrini Hospital. Dr. Granger filed amendments to his petition, on June 24, 2003 and June 8, 2010, to assert additional claims for Cabrini's revocation of his clinical privileges, bad faith breach of contract under its “Bylaws of the Medical Staff” (2002 edition) (“Bylaws”), defamation, unfair and deceptive trade practices, negligent misrepresentation, fraud, and damages and attorney fees under LSA–R.S. 51:1409 of Louisiana's Unfair Trade Practices and Consumer Protection Act (“LUTPA”). A stipulation was subsequently entered into by the parties, stating: ⁵

[144 So.3d 743]

1) CHRISTUS St. Frances Cabrini Hospital will not distribute or disseminate the letters of April 7 and June 16, 2003, to any healthcare organization, entity, or insurer.

2) CHRISTUS St. Frances Cabrini Hospital will not take any further adverse action regarding Dr. Granger's former privileges at CHRISTUS St. Frances Cabrini Hospital. Dr. Granger will not reapply for medical staff privileges during the pendency of this action.

3) If questioned by any licensing or credentialing entity concerning the summary suspension of December 19, 2002 to January 10, 2003, CHRISTUS St. Frances Cabrini Hospital shall reply: “Dr. Granger was summarily suspended on December 19, 2002. An ad hoc committee investigated the incident. Dr. Granger was restored to full medical staff privileges on January 10, 2003.”

4) If questioned by any licensing or credentialing entity concerning Dr. Granger's medical staff status, CHRISTUS St. Frances Cabrini Hospital will reply: “Members of the medical staff are appointed for two-year terms. Dr. Granger's last appointment expired July 31, 2003. He did not apply for renewal of his former privileges in the Section of Surgery.”

5) The stipulation between the parties is irrevocable unless withdrawn or modified with prior court approval.

Thereafter, on September 10, 2007, the trial court rendered a partial summary judgment, ruling that Cabrini was immune from liability, pursuant to HCQIA, for “monetary damages” for the allegedly improper December 19, 2002 summary suspension of Dr. Granger's hospital privileges. The trial court declined to render summary judgment in favor of Cabrini to find HCQIA immunity as to Dr. Granger's remaining claims. Subsequent defense motions for partial summary judgment on the LUTPA, breach of contract, and defamation claims were denied in June of 2010.

A nine-day jury trial was held in June and July of 2010, during which the trial court dismissed Dr. Granger's claims for defamation and fraud sua sponte. After deliberations, the jury answered jury interrogatories as follows:

1. Do you find that Cabrini Hospital took peer review action, without malice and in the reasonable belief that such action was warranted by the known facts?

YES __ NO v

If you answer “YES” to this question, do not answer any more questions, sign this verdict form and return to the courtroom. If you answer “NO” to this question, go to question number 2.

2. Do you find that Cabrini Hospital's peer review action regarding Dr. Granger was taken in the reasonable belief that the action was in the furtherance of quality health care?

YES __ NO v

If you answer “YES” to this question, go to question number 3. If you answer “NO,” to this question, go to question number 6.

* * *

[144 So.3d 744]

6. Do you find by a preponderance of the evidence that Cabrini failed to substantially comply with the hospital's bylaws in the peer review proceeding?

YES v NO __

If you answer “YES” to this question, go to question number 7. If you answer “NO,” go to question number 8.

7. Do you find by a preponderance of the evidence that such conduct by Cabrini Hospital caused revocation of Dr. Granger's privilege[s] at Cabrini Hospital?

YES v NO __

After you answer this question go to question number 8.

8. Do you find by a preponderance of the evidence that Cabrini Hospital, in its peer review action, engaged in unfair or deceptive trade practice(s) against Dr. Granger?

YES v NO __

If you answer “YES” to this question, go to question number 9. If you answer “NO” to this question, go to question number 10.

9. Do you find by a preponderance of the evidence that such conduct caused Dr. Granger harm?

YES v NO __

After you answer this question, go to question number 10.

10. Do you find by a preponderance of the evidence that Cabrini Hospital, in its peer review action, made negligent misrepresentation(s) to or concerning Dr. Granger?

YES v NO __

If you answer “YES” to this question, go to question 11. If you answer “NO” to this question, go to question number 12.

11...