Goodwich v. Sinai Hosp. of Baltimore, Inc.

• Decision Date: 06 August 1996
• Docket Number: S,No. 66,66
• Citation: 680 A.2d 1067,343 Md. 185
• Parties: Kenneth GOODWICH, v. SINAI HOSPITAL OF BALTIMORE, INC. ept. Term 1995.
• Court: Maryland Court of Appeals

Page 185

343 Md. 185

680 A.2d 1067

Kenneth GOODWICH, v. SINAI HOSPITAL OF BALTIMORE, INC.

No. 66, Sept. Term 1995.

Court of Appeals of Maryland.

Aug. 6, 1996.

Angus R. Everton (Roy L. Mason, Diane S. Deros, Susan Marie Reiners, Mason, Ketterman & Morgan, on brief), Baltimore, for petitioner.

Michael J. Baxter (John R. Penhallegon, David J. McManus, Jr., Smith, Somerville & Case, L.L.C., on brief), Baltimore, for respondent.

Jerome G. Geraghty, Francine R. Strauss, Blades & Rosenfeld, P.A., Baltimore, for amicus curiae The Maryland Hosp. Ass'n, Inc.

Argued before MURPHY, C.J., and ELDRIDGE, RODOWSKY, CHASANOW, KARWACKI, BELL and RAKER, JJ.

BELL, Judge.

This case presents for our review the issue of whether summary judgment was properly granted in favor of the respondent, Sinai Hospital of Baltimore, Inc. ("Sinai"), based upon the immunity provided by the Health Care Quality Improvement Act of 1986 ("HCQIA" or "the Act"), 42 U.S.C. §§ 11101-11152 (1994). The petitioner, Kenneth Goodwich ("Dr. Goodwich"), sued Sinai in the Circuit Court for Baltimore City because it restricted his privileges to practice medicine in the hospital. The court granted Sinai's motion for summary judgment on the ground that it was statutorily immune from suit. On appeal, the Court of Special Appeals affirmed the judgment of the circuit court. Goodwich v. Sinai Hospital, 103 Md.App. 341, 653 A.2d 541 (1995). At the petitioner's request, we issued the writ of certiorari. We shall affirm the judgment of the Court of Special Appeals.

I.

The professional relationship between Dr. Goodwich and Sinai, which is at the heart of this appeal, began in 1974, when Dr. Goodwich interned at the hospital. From 1975 to 1978, he served as a resident in the Obstetrics and Gynecology Department. Upon completion of his residency, Dr. Goodwich joined the hospital staff as an assistant attending physician.

On June 29, 1988, after several years of discussion and correspondence with Dr. Goodwich regarding patient care issues, ¹ Dr. Phillip Goldstein, the Chairman of the Obstetrics and Gynecology Department, sent Dr. Goodwich a letter, noting yet another patient care issue and suggesting that "in the litigious atmosphere of 1988" it would be prudent for him to obtain second opinions from board certified obstetricians and gynecologists ("OB-GYNs") for all "high risk [obstetrical] patients." ² Dr. Goodwich agreed with Dr. Goldstein's recommendation and so informed him by a letter dated August 12, 1988.

Over time, however, Dr. Goodwich failed to obtain second opinions as he had agreed to do. Thus, in a letter dated January 22, 1990, Dr. Goldstein wrote to Dr. Goodwich advising him of his failure to abide by his second opinion agreement. He also addressed three issues involving patient care. The letter concluded by advising Dr. Goodwich that a written second opinion by a board certified OB-GYN for all patients who were "high risk by the criteria of Calvin Hobel" ³ was required to be obtained and that, unless Dr. Goodwich complied voluntarily, Dr Goldstein would "present [a] recommendation for abridgement of [Dr. Goodwich's] privileges to the Medical Executive Committee on May 1, 1990." This prompted a February 1990 meeting between Dr. Goldstein and Dr. Goodwich's attorney. In that meeting it was agreed that Dr. Goldstein would not seek abridgement of Dr. Goodwich's privileges, provided that Dr. Goodwich obtained second opinions on all of his high risk patients. This agreement was memorialized in a letter dated February 26, 1990 from Dr. Goodwich's attorney to Dr. Goldstein.

Nevertheless, Dr. Goodwich's violation of the second opinion agreement continued, as did the instances in which his patient care was questioned. ⁴ Consequently, Dr. Goldstein asked the Director of Quality, Risk & Utilization Management at Sinai to examine Dr. Goodwich's compliance with the second opinion requirement. That information, provided to Dr. Goldstein on December 2, 1991, revealed Dr. Goodwich's failure to obtain second opinions for several high risk patients. It also revealed additional problems with Dr. Goodwich's patient management methods. ⁵ Dr. Goldstein, therefore, met with Dr. Goodwich to discuss these issues. Once again, Dr. Goodwich agreed to obtain second opinions in high risk obstetrical cases. Dr. Goldstein confirmed the agreement in an April 23, 1992 letter to Dr. Goodwich. In the letter, Dr. Goldstein also reemphasized that the required second opinion had to be in writing and posted in the patient's chart prior to surgery.

In June 1992, Dr. W. Scott Taylor, who was then acting Chief of the Obstetrics and Gynecology Department, Dr. Goldstein having left Sinai to accept a position at another hospital, wrote to Dr. Goodwich concerning two patient care issues. ⁶ In December 1992, Dr. Taylor asked Sinai's Director of Quality, Risk & Utilization Management, once again, to review Dr. Goodwich's compliance with the second opinion requirement.

Responding to Dr. Taylor's request, the Quality Assurance Committee, on January 27, 1993, reported to Dr. John L. Currie, who had earlier been appointed Chief of the Obstetrics and Gynecology Department, that since April 1992, the date when the second opinion agreement was reaffirmed for the third time, Dr. Goodwich had not obtained second opinions in 8 obstetrical cases. On January 28, Dr. Currie met with Dr. Goodwich to discuss this matter. At that time, Dr. Goodwich again agreed to obtain second opinions in high risk obstetrical cases. On that same date, Dr. Currie sent Dr. Goodwich a letter confirming the latest agreement and advising him that his privileges had been extended to March 31, 1993, but that renewal was dependent upon his obtaining written second opinions and direct supervision by board certified OB-GYNs for certain obstetrical and gynecological procedures. ⁷ Dr. Currie also advised Dr. Goodwich that his failure to obtain the second opinions for those specified procedures would result in further action against his privileges. Although he was requested to acknowledge his agreement with its contents by signing the letter, Dr. Goodwich declined to do so. On February 2, however, Dr. Goodwich and his attorney met with Dr. Currie, at which time Dr. Goodwich verbally agreed to the second opinion requirement.

When subsequently faced with yet another failure by Dr. Goodwich to obtain a second opinion, as well as further patient care concerns, ⁸ Sinai, consistent with the January 28 letter, responded by temporarily abridging his privileges. This abridgement was memorialized in a letter from Dr. Currie to Dr. Goodwich dated February 26, 1993. In the letter, Dr. Currie informed Dr. Goodwich that this action was taken pursuant to Article IV, § 7C of the By-Laws, Rules and Regulations of the Medical Staff of Sinai Hospital. ⁹ The letter also informed Dr. Goodwich that the Medical Executive Committee ("MEC") would consider permanent abridgement of his privileges on March 8. It also provided him with the time and location of the meeting and advised him of his right to attend.

Prior to the MEC meeting, Dr. Goodwich's counsel was provided with a list of the specific cases under consideration and, in addition, the hospital's medical records for each patient were made available for his inspection. During the meeting, at which Dr. Goodwich, represented by counsel, was present, Dr. Currie discussed the proposed abridgement with the Committee members and the reasons for it. After allowing Dr. Goodwich to make a statement and to respond to questions from its members, the MEC voted to abridge Dr. Goodwich's privileges for a period of three months, beginning March 8, 1993, on the same terms and conditions as the prior temporary abridgement. ¹⁰ The change in Dr. Goodwich's privileges was reported to the Maryland State Board of Physician Quality Assurance and the National Practitioner Data Bank. ¹¹

After the meeting, Dr. Goodwich requested, and received, before a panel of three physicians, an evidentiary hearing to consider the reasonableness of the MEC's decision. He subsequently requested, and received, an administrative hearing before another three-physician panel. Both panels affirmed the decision of the MEC, as did Sinai's Board of Trustees at a subsequent meeting.

Within four days after and based upon the March 8 abridgement, Dr. Goodwich filed suit against Sinai and the MEC ¹² in the Circuit Court for Baltimore City, alleging civil conspiracy, denial of procedural due process, breach of contract, intentional interference with contractual relations, and tortious interference with prospective economic benefit. On May 12, 1993, by stipulation of dismissal, the MEC was dismissed from the suit as were the civil conspiracy and due process counts. On January 17, 1994, Sinai filed a motion for summary judgment as to all remaining counts, claiming immunity under the HCQIA and state law. The hospital attached to the motion its correspondence with Dr. Goodwich over the years, hearing transcripts, as well as various other exhibits, including Supplemental Exhibit 25, which it identified as his credentialing file. After a hearing on the matter, the motion was granted. ¹³

Dr. Goodwich appealed to the Court of Special Appeals. That court, as previously noted, affirmed the judgment of the circuit court. Goodwich v. Sinai Hospital, supra, 103 Md.App. at 355, 653 A.2d at 548. The intermediate appellate court concluded that the hospital acted reasonably as the HCQIA requires and, therefore, was entitled to the immunity it provides. It further held that, because Sinai was immune from damages under federal law, it was unnecessary to reach the question of state law immunity. As we have also already noted, we granted Dr. Goodwich's petition for the writ of certiorari.

II.

A.

Congress enacted the HCQIA in 1986 for the express purpose of " 'improv[ing] the quality of medical care by encouraging physicians to identify and discipline other...