Brintley v. St. Mary Mercy Hosp.
| Decision Date | 16 November 2012 |
| Docket Number | No. 09–cv–14014.,09–cv–14014. |
| Citation | 904 F.Supp.2d 699 |
| Parties | LaCesha BRINTLEY, M.D., Plaintiff, v. ST. MARY MERCY HOSPITAL, Gilbert Roc, M.D., Louis Hallal, M.D., Tallal Zeni, M.D., and Asit Gokli, M.D., Defendants. |
| Court | U.S. District Court — Eastern District of Michigan |
OPINION TEXT STARTS HERE
Darryl K. Segars, Hatchett, Dewalt, Pontiac, MI, for Plaintiff.
David A. French, Martha R. Boonstra, Hall Render Killian Health and Lyman, PLLC, Troy, MI, for Defendants.
Plaintiff LaCesha Brintley, M.D. commenced this action on October 9, 2009 in this Court, asserting claims of race and gender discrimination under federal and state law, and state common law breach of contract and tort claims, against Defendants St. Mary Mercy Hospital (“SMMH”); Gilbert Roc, M.D., the Chair of SMMH's Department of Surgery; Asit Gokli, M.D., SMMH's Chief Medical Officer; Louis Hallal, M.D., Chair of SMMH's Surgical Quality Improvement Committee; and Tallal Zeni, M.D., the Director of Minimally Invasive Bariatric Surgery at SMMH. Plaintiff's various claims in this action arise from restrictions placed upon, and the ultimate suspension of, her medical staff privileges at SMMH, decisions made by SMMH's Medical Executive Committee and upheld by the St. Joseph Mercy Health System Board of Directors in August of 2009, following a lengthy peer review hearing and appeal process.
After an extended period of discovery, Defendants filed the instant Motion for Judgment on the Pleadings and/or Summary Judgment. Plaintiff has responded and Defendants have replied. Having thoroughly reviewed and considered the parties' briefs and supporting documents and the entire record of this matter, the Court has determined that the pertinent allegations and legal arguments are sufficiently addressed in these materials and that oral argument would not assist in the resolution of this motion. Accordingly, the Court will decide Defendants' motion “on the briefs.” See L.R. 7.1(f)(2). This Opinion and Order sets forth the Court's ruling.
Plaintiff LaCesha Brintley is an African–American medical doctor, board certified in general surgery. In October 2006, Dr. Brintley applied for medical staff privileges at St. Mary Mercy Hospital. During the application process, Dr. Asit Gokli, Vice President and Chief Medical Officer of SMMH, discovered that Foote Hospital in Jackson, where Dr. Brintley previously had privileges, had suspended her. He discovered that Dr. Brintley's privileges had been suspended at Foote because “there were a few patients that had excessive bleeding, and there were cholecystectomies where there were leaks.” [ See Gokli testimony, 1/22/09 Peer Review Hearing Transcript Vol. I, Plaintiffs' Ex. 42, p. 66.] 1 The Medical Executive Committee at Foote also had found that Dr. Brintley had communication issues, follow-up issues, and issues with working as a member of a surgical team. Id.
After discussing the matter with Dr. Roc, SMMH's Chief of the Department of Surgery, and Dr. John Dirani, then the Chief of Staff, Dr. Gokli contacted Dr. Brintley to give her an opportunity to explain the situation herself.
Dr. Brintley thereafter met with Dr. Gokli, Dr. Roc, and Dr. Dirani. According to Dr. Gokli, at this meeting:
... [Dr. Brintley] admitted that she could have done things differently. She had learned her lesson about communicating with the patients properly, working as a team member, and she also kind of explained that the complications were not out of the ordinary but it was jealousy on the part of the other physicians at Foote Hospital that had led to the MEC acting arbitrarily and capriciously in suspending her.
Based on that, after the meeting occurred—and also Dr. Brintley had assured us that this would not happen again and she had learned her lesson—Dr. Roc, Dr. Dirani, and myself, we deliberated for a pretty long time, and decided she was a young, bright—she came across as a bright young lady. She was—we thought she was very honest in communicating with us about what happened at Foote Hospital. She also mentioned to us that her salary there guarantee was way too high and when other surgeons found out what she was making there was professional jealousy that had led to all these things also.
So we decided that everybody deserves a second chance and based on the information, we would bring her into the hospital.
].
Based on the information presented by Dr. Brintley and the recommendation of Drs. Roc, Dirani, and Gokli, Dr. Brintley's application for medical staff privileges was approved by the SMMH Credentialing Committee, the Medical Executive Committee (“MEC”), and ultimately, the hospital Board.
Dr. Brintley's first year of privileges at SMMH was relatively uneventful. Although Dr. Gokli, as Chief Medical Officer, testified that he had received some anecdotal complaints that Dr. Brintley's patient care was not good, he did not initiate any action because these generally subjective complaints lacked specific information. Id. at 68–69. Concerns arose about Dr. Brintley's practice, however, when, on January 24, 2008, she performed a laparoscopic appendectomyon an otherwise healthy 22–year–old woman who presented at SMMH's emergency room the night before with acute appendicitis. Dr. Brintley was the surgeon taking emergency call that night.
Dr. Brintley commenced the appendectomy the next morning. She inserted a Verres needle and inflated the patient's abdomen. Then, using the “blind” introduction technique,2 she introduced a bladed trocar into the abdomen. [ See Brintley testimony, 3/14/09 Hrg. Tr., Plaintiff's Ex. 45, pp. 842–43.] However, she inserted the trocar in such a fashion that it severed two major blood vessels—the inferior vena cava and the iliac artery. Id. at 846, 849. The patient began to hemorrhage profusely. Dr. Brintley called for another surgeon to assist her. Fortunately, Dr. Jon Iljas, a vascular surgeon, was prepping for a surgical procedure in a nearby operating room, and he came to assist. Id. at 845–46. Once the vascular injuries were located and the patient stabilized,3 Dr. Iljas was able to repair the trauma. [ See Iljas Dep., Defendants' Ex. 12, pp. 14–17.]
After the surgery was completed, however, the patient's abdomen could not be immediately closed due to a risk of excessive swelling caused by the trauma. .] She was taken to the Intensive Care Unit and her family was told that she would have to return to surgery to close the abdomen. Id. When informed of the events, the patient's family refused to have Dr. Brintley continue to care for the patient. [1/22/09 Tr., Plaintiff's Ex. 42, pp. 70–71.] Dr. Roc, Chair of the Department of Surgery, took over the patient's care.
Dr. Roc subsequently met with Dr. Brintley to discuss the case and instructed her to stop using the Verres needle and the blind introduction of trocars for laparoscopic procedures. Id. at 247–48.4 He further requested that Dr. Brintley take herself off the emergency call list, which she did. Id. Then, on January 30, 2008, Dr. Roc met with Dr. Gokli and Dr. Roy Misirliyan, who was, at the time, the Chief of Staff and Vice–President of Medical Affairs. Though they viewed the January 24th surgical incident as an isolated event, because of the magnitude of the injury and other anecdotal concerns about Dr. Brintley's quality of care, they considered whether additional corrective action was warranted. Dr. Gokli reiterated his position that subjective information should never be acted upon. 1/22/09 Hrg. Tr., p. 72. Therefore, before taking any further corrective action, they determined that they should ask the hospital's Outcomes Department to conduct a comparison of Dr. Brintley's surgical complication rates to that of other surgeons at SMHH. Id. at 72–73.
Accordingly, they asked SMMH's Outcomes Department to conduct a comparison of complication rates of surgeons during the period of time that Dr. Brintley had been operating at SMMH, i.e., December 1, 2006 through January 31, 2008. Id.
Debbie Karabatakis, the manager of the Outcomes Department testified that she first needed to identify similar procedures to the appendectomy performed by Dr. Brintley to do the comparison. Because she is a statistician and not a doctor, she asked for clinical guidance from Dr. Gokli and from Dr. Mikkilineni, SMMH's Medical Director of Quality to do so. See Karabatakis Dep., Plaintiff's Ex. 53, p. 9. The doctors instructed her to focus on primary surgeons who performed appendectomies or cholecystectomies. Id. This meant that she did not include cases in which a principal surgeon conducted a different procedure on a patient and then a second surgeon came in and performed the appendectomy. Id. She testified that, using the hospital's ICD–9 procedure codes,5 she first identified all surgeons at SMMH who had performed an appendectomy or cholecystectomy during the period. Then, to have a statistically valid comparison, she compared Dr. Brintley's 104 such procedures to the other surgeons at SMMH who had performed 30 or more appendectomies or cholecystectomies during the period. Id. at 15.
The comparison was done at two levels. Ms. Karabatakis testified that first, all of the procedures were screened using computer logic to cull out those procedures with additional codes indicating potential complications. Id. at 17–18. This computer screening identified procedures with the following complications: (1) a laceration; (2) the patient received greater than four units of blood; (3) the patient returned to surgery within 30 days; and (4) the patient was transferred to another facility. Id. Then, the medical records of those procedures with potential complications were sent to the Performance Improvement Committee...
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