Asiryan v. Med. Staff of Glendale Adventist Med. Ctr.

• Docket Number: B316313,B317728
• Decision Date: 29 February 2024
• Citation: 319 Cal.Rptr.3d 456
• Parties: Vardui ASIRYAN, Plaintiff and Appellant, v. MEDICAL STAFF OF GLENDALE ADVENTIST MEDICAL CENTER, Defendant and Respondent. Vardui Asiryan, Plaintiff and Appellant, v. Glendale Adventist Medical Center et al., Defendants and Respondents.
• Court: California Court of Appeals

319 Cal.Rptr.3d 456

Vardui ASIRYAN, Plaintiff and Appellant,

v.MEDICAL STAFF OF GLENDALE ADVENTIST MEDICAL CENTER, Defendant and Respondent.

Vardui Asiryan, Plaintiff and Appellant,

v.Glendale Adventist Medical Center et al., Defendants and Respondents.

B316313

B317728

Court of Appeal, Second District, Division 1.

Filed February 29, 2024

APPEALS from the judgment and an order of the Superior Court of Los Angeles County, Richard L. Fruin, Jr., Judge.Affirmed (appeal No. B316313); affirmed in part and reversed in part with directions (appeal No. B317728).(Los Angeles County Super. Ct.No. 19STCV02196)

Fenton Law Group, Nicholas D. Jurkowitz and Dennis E. Lee for Plaintiff and Appellant.

Cole Pedroza, Kenneth R. Pedroza and Scott M. Klausner for Defendants and Respondents.

ROTHSCHILD, P. J.

PlaintiffVardui Asiryan is a licensed obstetrician and gynecologist who around November 2015 obtained medical staff privileges at defendant Glendale Adventist Medical Center dba Adventist Health Glendale (GAMC).Defendant Medical Staff of Glendale Adventist Medical Center (the Medical Staff)"is a separate legal entity, an incorporated association, which is required to be self-governing and independently responsible from [GAMC] for its own duties and for policing""physicians who are given staff privileges to admit patients and practice medicine [at GAMC]."(Hongsathavij v. Queen of Angels etc. Medical Center(1998)62 Cal. App.4th 1123, 1130, fn. 2, 73 Cal.Rptr.2d 695.)In October 2018, the Medical Staff suspended Asiryan’s privileges at GAMC without holding a hearing or giving Asiryan prior notice.Asiryan resigned those privileges the day she learned of the decision.

Asiryan sued GAMC and the Medical Staff (collectively, the defendants), alleging they failed to comply with statutory and common law procedural requirements in connection with suspending her privileges at GAMC.She further alleged that the Medical Staff lied to her regarding their obligations to report her suspension and resignation to the state licensing board, and that this violated the staffs statutory and common law notice obligations.

Asiryan appeals from a judgment in the Medical Staffs favor.She argues that the court reversibly erred when, based on its incorrect interpretation of the relevant case law and the Business and Professions Codesections addressing due process requirements for hospital peer review (seeBus. & Prof. Code, § 809 et seq.),¹the court(1) granted a motion for nonsuit on her claim under the common law doctrine of fair procedure and (2) rejected Asiryan’s proposed jury instructions.She further argues the court abused its discretion when it denied Asiryan’s request, made after trial had commenced, to amend her complaint.Finally, Asiryan also appeals from the court’s order awarding defendants attorney fees under section 809.9, the relevant attorney fees statute.She argues the court erred in concluding her peer review claims were without foundation and unreasonable for purposes of that section.

We hold that the trial court correctly concluded the code is the sole source of procedural protections in connection with hospital peer review, and that the common law doctrine of fair procedure does not supplant those protections with additional guarantees.Based on this interpretation, we conclude the court correctly granted the nonsuit on Asiryan’s common law peer review claims and correctly rejected her proposed jury instructions regarding peer review.We further hold that the court did not reversibly err in denying Asiryan leave to amend.For these reasons, we affirm the judgment.

We reach a different conclusion regarding Asiryan’s appeal from the order awarding attorney fees.Given the court’s rulings denying certain portions of defendants’ summary judgment and nonsuit motions as to the Medical Staff, we conclude a hypothetical reasonable attorney could have deemed Asiryan’s peer review claims against the Medical Staff tenable and reasonably decided to take them to trial.This same logic does not apply to the fees awarded to GAMC, because the court disposed of the claims against GAMC on summary judgment.We therefore reverse the court’s fee order to the extent it awards fees to the Medical Staff, but affirm the order as it applies to GAMC.

BACKGROUND

A.Legal Background: Code Sections Governing Hospital Peer Review and Related Reporting Requirements

"Under [California] law, a licensed hospital facility must have ‘a formally organized and self-governing medical staff responsible for "the adequacy and quality of the medical care rendered to patients in the hospital."(Cal. Code Regs., tit. 22, § 70703, subd. (a).)’(Arnett v. Dal Cielo(1996)14 Cal.4th 4, 10, 56 Cal.Rptr.2d 706, 923 P.2d 1 …, italics omitted;Oliver v. Board of Trustees(1986)181 Cal.App.3d 824, 826-827, 227 Cal.Rptr. 1 ….)The medical staff acts primarily through a number of peer review committees, which, along with other responsibilities, assess the performance of physicians currently on staff ….(Cal. Code Regs., tit. 22, § 70703, subds. (b) & (d).)"(Unnamed Physician v. Board of Trustees(2001)93 Cal.App.4th 607, 616, 113 Cal.Rptr.2d 309(Unnamed Physician).)

Several code sections address the efforts of such "peer review bod[ies,]" a term statutorily defined to include the "medical or professional staff of any health care facility or clinic"(§ 805, subd. (a)(1)(B)(i)), regarding the discipline and oversight of licensed physicians and other health care provider " ‘[l]ieentiate[s]’"(§ 805, subd. (a)(2)) affiliated with the facility or clinic.(See generally§§ 805-809.9.)The code defines "[p]eer review" in this context as, inter alia, the process of the staff reviewing "the basic qualifications, staff privileges, employment, medical outcomes, or professional conduct of licentiates" for disciplinary, investigatory, or quality improvement purposes.(§ 805, subd. (a)(1)(A)(i).)For case of reference, we will refer to these provisions of the code (§§ 805-809.9) as the California peer review statute.We briefly summarize the portions of this statute most relevant to the instant appeal.

A peer review body or the administration of the body’s affiliated hospital must file a " ‘805 report’ "(§ 805, subd. (a)(7)) to the "relevant [licensing] agency" regarding a licentiate when, "for a medical disciplinary cause or reason," it takes any of several actions outlined in the statute.(§ 805, subds. (b)(1)—(b)(3).)Specifically, a section 805 report is required when a licentiate’s "application for staff privileges or membership is denied or rejected"(§ 805, subd. (b)(1)), a licentiate’s "membership, staff privileges, or employment is terminated or revoked"(§ 805, subd. (b)(2)), or "[r]estrictions are imposed, or voluntarily accepted, on staff privileges, membership, or employment for a cumulative total of 30 days or more for any 12-month period"(§ 805, subd. (b)(3))."An 805 report shall also be filed within 15 days following the imposition of summary suspension of staff privileges, membership, or employment, if the summary suspension remains in effect for a period in excess of 14 days."(§ 805, subd. (e).)Finally, a section 805 report is also required when, "after receiving notice of a pending investigation initiated for a medical disciplinary cause or reason," a licentiate "[r]esigns or takes a leave of absence from membership, staff privileges, or employment."(§ 805, subd. (c) & (c)(1).)

The statute also sets forth certain notice and hearing rights for licentiates "who [are] the subject of a final proposed action of a peer review body for which a report is required to be filed under [s]ection 805."(§ 809.1, subd. (a);seeUnnamed Physician,supra., 93 Cal.App.4th at p. 616, 113 Cal.Rptr.2d 309.)Namely, section 809.1"entitle[s]" the subject licentiate "to written notice … [of] the ‘final proposed action’ "(§ 809.1, subd. (a)), which notice must also inform the licentiate that a section 805 report will be filed and that the "licentiate has the right to request a hearing on the final proposed action"(§ 809.1, subd. (b)(3)) and "[t]he time limit, within which to request such a hearing."(§ 809.1, subd. (b)(4);see§ 809.1, subd. (b) & (b)(1)-(4).)Further, "[i]f a hearing is requested on a timely basis, the peer review body [must comply with additional written notice requirements regarding the hearing]."(§ 809.1, subd. (c).)The statute also specifically guarantees several elements of due process be incorporated into such hear- ings, such as the right to call and confront witnesses and to present evidence, and the right to a written decision by a trier of fact.(See§§ 809.1, subds. (a) & (b),809.2, subd. (a),809.3, subds. (a)(3), (4) & (b)(1), (2), (3),809.4, subd. (a)(1);see alsoUnnamed Physician,supra, 93 Cal.App.4th at p. 617, 113 Cal.Rptr.2d 309["[t]he statutory scheme delegates to the private sector the responsibility to provide fairly conducted peer review in accordance with due process, including notice, discovery and hearing rights, all specified in the statute"];see also§§ 809-809.8.)"Notwithstanding [any of these procedural guarantees, however,] a peer review body may immediately suspend or restrict clinical privileges of a licentiate where the failure to take that action may result in an imminent danger to the health of any individual, provided that the licentiate is subsequently provided with the notice and hearing rights set forth in [s]ections 809.1 to 809.4, inclusive."(§ 809.5, subd. (a).)

B.Factual Background

1.Peer review efforts of the Medical Staff at GAMC regarding Asiryan before October 13, 2018

GAMC has in place procedures whereby anyone affiliated with GAMC (for example, nurses or medical assistants) may submit a report (referred to as a "RADAR" report) about perceived issues regarding a physician’s care.Rachel Van Houten, Director of Medical Staff Services, reviews the reports and forwards them to the appropriate person to be...