341 F.3d 461 (6th Cir. 2003), 01-6190, Meyers v. Columbia/HCA Healthcare Corp.
|Citation:||341 F.3d 461|
|Party Name:||Meyers v. Columbia/HCA Healthcare Corp.|
|Case Date:||August 20, 2003|
|Court:||United States Courts of Appeals, Court of Appeals for the Sixth Circuit|
Argued: May 2, 2003.
[Copyrighted Material Omitted]
Tom Curtis (argued and briefed), Curtis & Kirkpatrick, Pasadena, CA, for Plaintiffs-Appellants/Cross-Appellees.
Charles J. Cronan IV (argued and briefed), Margaret R. Appenfelder (briefed), Stites & Harbison, Louisville, KY, John R. Grise, Kerrick, Grise & Stivers, Bowling Green, KY, for Defendants-Appellees/Cross-Appellants.
Before: CLAY and GIBBONS, Circuit Judges; CLELAND, District Judge. [*]
CLELAND, District Judge.
Plaintiffs-appellants Dr. Robert Meyers ("Meyers") and his wife, Dr. Mary Meyers, initiated this action against multiple defendants after the Board of Trustees of Logan Memorial Hospital denied Meyers' reappointment to the hospital's medical staff. The district court granted summary judgment in favor of defendants, finding that they were immune under the Health Care Quality Improvement Act ("HCQIA"), 42 U.S.C. § 11101 et seq. Defendants moved for an award of costs and attorney's fees under the HCQIA, and the district court denied their motion. Plaintiffs appeal the grant of summary judgment; defendants cross-appeal the denial of costs and fees. We affirm the judgment of the district court on both issues.
I. FACTS 1
On March 25, 1991, Meyers applied for medical staff privileges at Logan Memorial Hospital, Inc. ("LMH") in Russellville, Kentucky. Shortly thereafter, the Credentials Committee and the Medical Executive Committee ("MEC") approved Meyers for staff privileges. As a result, in September 1991, the LMH Board of Trustees ("Board") approved Meyers for appointment to the medical staff. Pursuant to the LMH Bylaws, all initial appointments to the medical staff were provisional for one year. At the end of that year the physician would be reevaluated to qualify for advancement from associate to active member status.
In the fall of 1992, the Credentials Committee began to evaluate Meyers for his advancement to active staff privileges. On April 12, 1993, the Credentials Committee, which Meyers argues was composed largely of his competitors, voted to deny him staff privileges. In its decision, the committee cited concerns about Meyers' history of moving from hospital to hospital following disputes with hospital staff, 2 his
failure to timely and fully disclose disciplinary and corrective action taken against him while working in Virginia, 3 and the quality of his patient care. At this point, pursuant to LMH Bylaws, the Credentials Committee was to notify Meyers of the general nature of its concerns and arrange a meeting with Meyers. The Credentials Committee did, on short notice, invite Meyers to a meeting. According to Fred Mudge, a member of the Board, this invitation did not comply with the Bylaws.
On June 3, 1993, the MEC, half of whose members were also members of the Credentials Committee, voted to accept the Credentials Committee decision and revoke Meyers' staff privileges. Neither of these committees, however, had the power to grant or deny privileges to Meyers. The MEC was to consider the recommendation from the Credentials Committee and make a recommendation to the Board, which had the ultimate authority to grant, deny, or terminate Meyers' privileges.
On January 24, 1994, the Board informed Meyers that it was assuming full responsibility for determining his reappointment and advancement to active staff because of his concerns with the manner in which the peer review process was being handled. Three members of the Board, acting as a Credentials Committee, conducted an independent review. This committee discussed concerns about Meyers' behavior and inability to get along with others in addition to questions about his surgical technique. The committee gave Meyers the opportunity to put forth additional information, but he maintained that there was none. The committee questioned Meyers about several incident reports concerning disruptive behavior, his history of problems at other hospitals, his failure to timely complete medical records, his hostility towards the operation room staff, reports of breaking the sterile field, and his failure to provide appropriate coverage for patients while he was out of town. Meyers acknowledged that he had a personality problem.
At the same time, the Kentucky Cabinet for Human Resources Drug Control Division was investigating Meyers' prescription practices pursuant to complaints from pharmacists and the Kentucky State Police about the volume of prescriptions he wrote for controlled substances. The investigation concluded that "Meyers may not have used good judgment in prescribing controlled substances to all of his patients." The Kentucky Board of Medical Licensure recommended that Meyers attend a University of Kentucky miniresidency course in prescribing controlled substances.
On March 18, 1994, this three-member committee of the Board voted to deny Meyers' appointment to active staff. The reasons cited for the committee's decision were Meyers' failure to satisfy requirements that he meet LMH's standard of care, abide by the ethics of the profession, work cooperatively with others, and timely complete medical records. The committee outlined Meyers' pattern of disruptive behavior which included, but was not limited
to, temper tantrums, repeated refusal to limit elective cases to time periods routinely reserved for him, attempted interference with the right of an attending physician to refer a patient to the surgeon of his choice or to transfer the patient, condescending remarks toward women, refusal to speak to a member of his surgical team during surgical procedures, and several instances of throwing a scalpel during surgery. The committee informed Meyers that "[t]his behavior can have an adverse effect on the quality of patient care by inhibiting the ability of hospital personnel to perform optimally, by making it difficult for the hospital to retain qualified personnel, and by interfering with the judgment of referring physicians." The committee further noted that Meyers' behavior "can also disrupt the efficient operation of the hospital and the smooth operation of the surgical department to the detriment of the medical staff, the hospital, and the community." As for his failure to timely complete medical records, the committee stated that "[d]elinquent medical records can put patients at risk by being inaccurate or incomplete if needed to assist in later diagnosis and treatment of a patient." As for quality of care, the committee noted that Meyers had failed to comply with LMH's policy of obtaining post-operative films and that he had demonstrated repeated instances of violating the sterile field.
At this point, the Board began proceedings under the Medical Staff Bylaws Fair Hearing Plan § 2.3-2 which provides that "[a] hearing occasioned by an adverse action of the Trustees pursuant to § 1.2(b) or (c) shall be conducted by a hearing committee appointed by the Chairman of the Trustees and composed of five persons. At least three Medical Staff members shall be included on this committee when feasible." The Fair Hearing Committee was composed of Bill Paxton, a retired court of appeals judge; Fred Greene, an attorney; Mike Robbins, a bank president; Thomas Luckett, an industrialist; and Paul Kerr, a licensed dentist. The Board notified Meyers and explained that it was not feasible to have members of the medical staff on the Fair Hearing Committee. This committee met on eleven occasions. Meyers was represented by counsel, given the opportunity to present witnesses, affidavits, and other documentary evidence, and given the right to confront, examine, and cross-examine witnesses presented by LMH.
In April 1995, the Fair Hearing Committee issued its report and recommendation that LMH not appoint Meyers to its staff because of his failure to meet LMH's ethical standards and his inability to work cooperatively with others. In May, the Board adopted and affirmed the Fair Hearing Committee's recommendation. The Board informed Meyers of its decision and his right to appeal. Meyers appealed the Board's decision and was again represented by counsel. On August 9, 1995, the Board informed Meyers of its vote to affirm the decision denying clinical privileges to Meyers. This was the Board's final decision and Meyers' privileges were revoked.
II. PROCEDURAL HISTORY
On August 22, 1995, Meyers brought suit in Kentucky state court (Logan Circuit Court) seeking a restraining order and a temporary and permanent injunction requiring LMH to reinstate his staff privileges and enjoining LMH from making a report to the National Practitioner Data Bank. The court granted the restraining order and temporary injunction in part but denied the motion for an injunction which would require LMH to reinstate Meyers' privileges.
On August 8, 1996, Meyers filed a second suit in Logan Circuit Court with numerous causes of action against thirty-four defendants. Defendants moved for summary judgment based on immunity pursuant to K.R.S. § 311.377(1). The court denied that motion.
On November 5, 1997, while the two suits were still pending in state court, Meyers filed suit in the United States District Court for the Western District of Kentucky. Following an order for a more definite statement, Meyers filed two amended complaints against twenty-two defendants, including hospital administrators, members of LMH's medical staff who engaged in investigation and credentialing activities, and members of the Board that took final action after hearing Meyers' appeal....
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