Smith v. Our Lady of the Lake Hosp., Inc.

• Decision Date: 05 July 1994
• Citation: 639 So.2d 730
• Parties: 93-2512 La
• Court: Louisiana Supreme Court

Page 730

639 So.2d 730

93-2512 La. 7/5/94

Prentiss E. SMITH, M.D. v. OUR LADY OF THE LAKE HOSPITAL, INC., d/b/a Our Lady of the

Lake Regional Medical Center, Kenneth C. Cranor, M.D., A.

Foster Sanders, M.D., Donald R. Cowick, M.D., W. Howard

Kisner, M.D., M.J. Rathbone, Jr., M.D., Louis P. Laville,

Jr., M.D., B. Eugene Berry, M.D., W. Redfield Bryan, M.D.,

Mr. Sidney Duplessis, Mr. W.H. LeBlanc, Jr., Mr. Roland

Toups, Mr. Robert Davidge, and Others Whose Identities

and/or Roles Are Unknown to Plaintiff at This Time.

No. 93-C-2512.

Supreme Court of Louisiana.

July 5, 1994.

Rehearing Denied Sept. 15, 1994.

Statement Concurring in Denial of Rehearing Sept. 15, 1994.

Thomas MacDougall Womack, Durrett, Hardin, Hunter, Dameron & Fritchie, Tom F. Phillips, Lloyd Joseph Lunceford, Taylor, Porter, Brooks & Phillips, Leon Gary, Jr., Gary, Field, Landry & Bradford, Baton Rouge, for applicant.

Kevin Patrick Monahan, Baton Rouge, for respondent.

Robert L. Roland, Randall Louis Champagne, Baton Rouge, for amicus curiae LA Hosp. Ass'n.

Thomas M. Hayes, Jr., Bruce McKamy Mintz, Monroe, for amicus curiae St. Francis Medical Center.

Donna Guinn Klein, Monica Ann Frois, New Orleans, for amicus curiae St. Francis Cabrini Hosp. of Alexandria, St. Patrick Hosp. of Lake Charles and Schumpert Medical Center of Alexandria.

Harmon F. Roy, Philip E. Roberts, Lafayette, for amicus curiae Our Lady of Lourdes Regional Medical Center.

Peter J. Butler, Donna Di Martino Fraiche, New Orleans, for amicus curiae American Hosp. Ass'n.

Charles Fenner Gay, Jr., Cristina Romig Wheat, Ralph H. Wall, New Orleans, for amicus curiae Alton Ochsner Medical Foundation.

[93-2512 La. 1] HALL, Justice. ^*

This suit arises out of a hospital's termination of a cardiovascular surgeon's staff privileges for incompetence and unprofessional misconduct. The surgeon, Dr. Prentiss E. Smith, sued the hospital, Our Lady of the Lake Hospital, Inc., d/b/a Our Lady of the Lake Regional Medical Center ("OLOL"); various members of the hospital's executive committee and board of trustees; his chief competitor, Dr. B. Eugene Berry; Dr. Berry's professional corporation, CVT Surgical Center, A Medical Corporation ("CVT"); and Dr. Berry's two partners, Drs. David Davis and Carlton Sheely. Dr. Smith's petition asserted numerous causes of action, including breach of contract, defamation and antitrust violations. The trial court dismissed this suit on summary judgment, finding all the defendants entitled to immunity from liability under LSA-R.S. 13:3715.3(C), ¹ which grants peer review committee members qualified immunity. The court of appeal reversed, finding material factual issues as to whether the [93-2512 La. 2] qualifications for invoking the immunity were met here, i.e., whether the committee members' action or recommendation was taken "without malice" and "in the reasonable belief that such action or recommendation [was] warranted by the facts known to [them]." On defendants' application, we granted certiorari to determine whether summary judgment was appropriate in this case. 93-C-2512 (La. 2/25/94); 632 So.2d 768.

I.

The long history giving rise to this litigation must be fully recounted to facilitate a detailed and complete resolution of the issues presently before this court. The depositions, affidavits and other supporting documents in the record reveal that the details of the lengthy peer review process underlying this litigation are essentially undisputed.

In 1969, Dr. Prentiss Smith was granted staff privileges as a cardiovascular surgeon at OLOL. Thereafter, Dr. Smith became the subject of two separate peer review inquires. ² The first inquiry was initiated in 1982 when the recovery room nurses filed a series of incident reports regarding Dr. Smith's alleged medically improper, personally abusive and offensive conduct. Responding to these complaints, the OLOL Executive Committee established an Ad Hoc Investigating Committee. After reviewing the complaints, the Ad Hoc Committee recommended that Dr. Smith be given two months to resolve his conflicts with the recovery room nurses or his staff privileges would be terminated.

On September 27, 1982, the Executive Committee reviewed the Ad Hoc Committee's recommendation and resolved as follows: (i) that Dr. Smith's behavior was "at times, unprofessional and below the standards appropriate for the Medical-Dental Staff and, for that reason, that Dr. Smith be formally reprimanded and placed on one year of probation;" (ii) that "any incidents of a similar nature will be considered by the same Ad Hoc Committee during the probation ... and, if necessary, they may make additional recommendations to the Executive Committee which could include reduction, suspension, or revocation of clinical privileges;" and (iii) that the Executive Committee "include an abbreviated portion of this matter in the minutes of the Medical Staff Executive Committee which are circulated to the Staff." On October 6, 1982, the Executive Committee informed Dr. Smith in writing of the above resolutions.

[93-2512 La. 3] On June 23, 1983, Mr. Robert Davidge, the OLOL Executive Director, sent a letter to Dr. Cranor, the Chief of Staff, regarding additional incident reports of a similar nature that the recovery room nurses had filed. In his letter, Mr. Davidge described Dr. Smith's behavior in the recovery room as "humiliating and intimidating to our personnel" and stated that it "appeared to be vindicative reprisals for their earlier report on his aberrant behavior." At a June 27, 1983, Executive Committee meeting, Dr. Cranor read Mr. Davidge's letter. On July 1, 1983, the Executive Committee reconvened its prior Ad Hoc Committee to review the additional complaints. After meeting on July 18, 1983, and August 1, 1983, the Ad Hoc Committee recommended that Dr. Smith be given two months from the time of notification by the Executive Committee to resolve the existing "problems" between himself and the recovery room nurses and that if, at the end of that two-month period, "the situation has not sufficiently improved, his privileges will be suspended."

On August 22, 1983, the Executive Committee met and adopted the Ad Hoc Committee's recommendation. On August 25, 1983, Dr. Cranor wrote Dr. Smith, informing him that the Executive Committee had resolved that his relations with the recovery room staff would be "observed closely for a period of two months, at which time the then current situation will be evaluated and acted upon as seems appropriate." ³ On December 9, 1983, Dr. Cranor wrote Dr. Smith again and informed him that the Executive Committee, on the basis of its Ad Hoc Committee's report, resolved that he "continue on a probationary status, without limitation of privileges for one year on the condition that [he be] able to work within the guidelines of the Medical Staff."

During the pendency of these probation periods, a "blind" survey (i.e., using physician code numbers rather than physician names) of the mortality rates for patients undergoing three cardiovascular surgical procedures--coronary artery bypass surgery, valve surgery and carotid endarterectomy surgery--was conducted. As part of this survey, Dr. Berry was asked by the Executive Committee, particularly by Drs. Laville and Cranor, to prepare a report on the [93-2512 La. 4] mortality rates for these selected procedures. ⁴ At a February 14, 1984 meeting of the Surgical/Dental Chief of Services, Dr. Berry presented his report. The report listed eight doctors by code number, breaking down the number of deaths per operation for each of the three surgical procedures for each doctor and totalling for each procedure all eight doctors' numbers with accompanying mortality percentages. Dr. Berry's report also specified with regard to doctor number 73601, which was disclosed to be Dr. Smith, a separate mortality percentage for each of the three surgical procedures and a separate mortality total for all the doctors excluding doctor number 73601. ⁵ Because Dr. Smith's mortality percentages were relatively higher than the other doctors' combined percentages, the members of the Surgical/Dental Chief of Services Committee determined that further investigation was required into the matter. These mortality statistics thus were the impetus for the second peer review inquiry against Dr. Smith.

On February 17, 1984, Dr. Sanders, Chief of Staff, approached Dr. Smith at OLOL and declared that his privileges would be summarily suspended if he did not agree to cease acting as primary surgeon in performing any of the three surgical procedures referenced in the mortality report; Dr. Sanders gave as the reason that Dr. Smith's mortality rates were "unacceptably high." Dr. Smith agreed, and Dr. Sanders confirmed that agreement in writing.

On February 20, 1984, the Executive Committee met to consider the curtailment of Dr. Smith's surgical privileges. The minutes of that meeting reflect that Dr. Smith attributed the statistical results to the fact that he had more "poor risk" and "salvage" cases. The minutes further reflect that a complete in-house evaluation of the surgical results of the entire OLOL open heart program since its inception in 1980 would be undertaken. The minutes still further [93-2512 La. 5] reflect that Dr. Smith's voluntary suspension be continued for two weeks pending further investigation. Dr. Sanders communicated that resolution to Dr. Smith in writing.

On March 5, 1984, the Executive Committee met again. After reviewing more extensive statistics, ⁶ the Executive Committee resolved that: (i) Dr. Smith be requested to continue his "voluntary abstention from the above three procedures as the primary surgeon or assistant, until a thorough study can be done by the Society of Thoracic Surgeons;" and (ii) if he did not agree to the "voluntary suspension, then his privileges should be suspended." On March 7, 1984, Dr. Sanders communicated that resolution to Dr. Smith in writing,...