37 F.3d 1026 (4th Cir. 1994), 93-2477, Imperial v. Suburban Hosp. Ass'n, Inc.
|Citation:||37 F.3d 1026|
|Party Name:||Roland IMPERIAL, M.D., Plaintiff-Appellant, v. SUBURBAN HOSPITAL ASSOCIATION, INCORPORATED; Medical Staff of Suburban Hospital of Bethesda, Maryland; Dr. John S. Saia; Dr. Daniel Powers; Dr. John Lord; Dr. John S. Eng; Dr. Joel Schulman; Dr. Charles Tennen, Defendants-Appellees, and Suburban Hospital Board of Trustees, Defendant.|
|Case Date:||September 12, 1994|
|Court:||United States Courts of Appeals, Court of Appeals for the Fourth Circuit|
Argued May 11, 1994.
ARGUED: Barry Jay Rosenthal, Bromberg, Rosenthal & Siegel, Rockville, MD, for appellant. S. Allan Adelman, Godard, West & Adelman, P.C., Rockville, MD, for appellees. ON BRIEF: Kenneth S. Golden, Bromberg, Rosenthal & Siegel, Rockville, MD, for appellant.
Before NIEMEYER, Circuit Judge, PHILLIPS, Senior Circuit Judge, and ERWIN, Senior United States District Judge for the Middle District of North Carolina, sitting by designation.
Affirmed by published opinion. Judge NIEMEYER wrote the opinion, in which Senior Judge PHILLIPS and Senior District Judge ERWIN joined.
NIEMEYER, Circuit Judge:
When Roland Imperial, M.D., was denied reappointment to the medical staff at Suburban Hospital in Bethesda, Maryland, effective January 1, 1988, he filed this action against the Hospital and the doctors involved in its professional peer review activities. Imperial is an internist who was granted privileges to practice medicine at Suburban Hospital in 1977. Suburban Hospital denied Imperial's reappointment on the grounds that his professional activities did not meet the appropriate standards of care, finding deficiencies in record keeping, patient management, and work relationships with health care professionals at the Hospital. In his amended complaint, Imperial alleged, in four counts, that (1) the Hospital's proceedings to deny him reappointment to the medical staff were had in bad faith and denied him due process by not providing adequate notice of the reasons for the Hospital's actions; (2) the Hospital's action restrained trade and "created a monopoly" in violation of the Sherman Act; (3) the Hospital breached an implied contract to comply with its own bylaws; and (4) the defendants tortiously interfered with contractual relationships between Imperial and his patients. Imperial demanded $1 million in damages on each count and, on the first three counts, "restoration of [his] hospital privileges."
The defendants filed a motion for summary judgment, asserting immunities granted them under the Health Care Quality Improvement Act of 1986 (the "Health Care Improvement Act"), 42 U.S.C. Sec. 11101, et seq., and under its Maryland counterpart set forth in Maryland Health Occup. Code Ann. Sec. 14-501 and Maryland Cts. & Jud. Proc.Code Ann. Sec. 5-393. From the district court's order entering summary judgment in favor of the defendants, Imperial appeals, and finding no error, we affirm.
The Health Care Improvement Act was enacted in 1986 to improve the quality of medical care by restricting the ability of physicians who have been found to be incompetent from repeating this malpractice by moving from state to state without discovery of such finding. See 42 U.S.C. Sec. 11101; H.R.Rep. No. 903, 99th Cong.2d Sess. (1986), reprinted in 1986 U.S.C.C.A.N. 6384-6391. Toward this end, the Act establishes a national reporting system "to follow bad doctors from place to place," id. at 6385, and provides immunity from damages for persons participating in professional review activities. Under the national reporting system, insurance companies are required to report medical malpractice payments to the Secretary of Health and Human Services, 42 U.S.C. Sec. 11131; boards of medical examiners are required to report sanctions imposed against physicians, 42 U.S.C. Sec. 11132; and health care entities are required to report adverse professional review information, 42 U.S.C. Sec. 11133. The Act also imposes a duty on hospitals to obtain information reported about any physician who applies for hospital privileges or employment, and to update such information every two years after hospital privileges are granted. 42 U.S.C. Sec. 11135.
To assure that hospitals and doctors cooperate with the system and engage in meaningful professional review, Congress found it essential to provide qualified immunity from damages actions for hospitals, doctors, and others who participate in the professional review process. See 42 U.S.C. Sec. 11101; H.R.Rep. 903, at 6385. Thus, 42 U.S.C. Sec. 11101 provides that persons participating in professional review activities that meet the standards imposed by 42 U.S.C. Sec. 11112 "shall not be liable in damages under any law of the United States or of any State (or political subdivision thereof)" with respect to the person's participation in such activities. The immunity also extends to persons providing information to professional review bodies. 42 U.S.C. Sec. 11111(a)(2). The conditions for granting such immunity are set forth in 42 U.S.C. Sec. 11112. That section provides, in relevant part:
For purposes of the protection set forth in [Sec. 11111(a) ], a professional review action must be taken--
(1) in the reasonable belief that the action was in the furtherance of quality health care,
(2) after a reasonable effort to obtain the facts of the matter,
(3) after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances, and
(4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph (3).
The Health Care Improvement Act also provides that if a health care entity fails to participate in the national reporting system, the Secretary may, after conducting an investigation and hearing, publish the entity's name in the Federal Register. An entity whose name is so published may not receive the immunity provided by 42 U.S.C. Sec. 11111 for a three-year period. See 42 U.S.C. Sec. 11111(b).
Imperial contends that the defendants may not invoke the immunity granted by 42 U.S.C. Sec. 11111 on two grounds: (1) there is evidence establishing a factual dispute about whether defendants' actions were taken in the reasonable belief that they were in furtherance of quality health care, and (2) the defendants failed to follow the reporting requirements imposed by 42 U.S.C. Sec. 11133(a) and thereby lost their immunity by reason of Sec. 11111(b). He also contends that this immunity does not cover his claim for injunctive relief and that the Maryland immunity statute should not be imposed retroactively. We will address these points in order.
In support of his contention that immunity does not apply to the defendants' actions because their professional review action against him was not taken "in the reasonable belief that the action was in furtherance of quality health care," Imperial points
to the original memorandum of his department head, Dr. John S. Saia, the former chairman of medicine at Suburban Hospital, which initiated the proceedings with a recommendation against reappointment. Asserting it is "inconceivable" that the memorandum "could be deemed as being in furtherance of quality health care," Imperial points to the fact that the memorandum fails to note "formally" any deficiencies and fails to take into account a recent review of Imperial's patient care conducted by the Quality Assurance Committee of the Hospital, which showed that Imperial's patient care was, in Imperial's words, "for the most part" adequate and acceptable. Imperial also maintains that the other doctors reviewing his performance were not qualified to decide the medical issues because they did not practice in his field and, in any event, were biased against him.
From our review of the record, we conclude that the district court did not err in concluding as a matter of law that the defendants' actions were taken in the reasonable belief that they would further the quality of health care. The memorandum of Dr. Saia, on which Imperial so heavily relies, begins with a summary statement against reappointment of Imperial and the general reasons for such recommendation:
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