Chalal v. Northwest Med. Center, Inc.
| Decision Date | 31 March 2000 |
| Docket Number | No. CV 098-B-2687-NW.,CV 098-B-2687-NW. |
| Parties | Richard L. CHALAL, M.D. Plaintiff, v. NORTHWEST MEDICAL CENTER, INC., Defendant. |
| Court | U.S. District Court — Northern District of Alabama |
Lindsey Mussleman Davis, Holt Mussleman & Holt, Florence, AL, K Rick Alvis, Alvis & Willingham LLP, Birmingham, AL, for Richard L Chalal, plaintiff.
Stephen A Rowe, Laurence J McDuff, Lange Simpson Robinson & Somerville, Birmingham, AL, for Columbia Northwest Medical Center Inc, a corporation, defendant.
This case presents claims by Richard L. Chalal ("Dr. Chalal" or "plaintiff") against Northwest Medical Center, Inc. ("the Hospital" or "defendant") arising from the Hospital's termination of the plaintiff's medical staff privileges. Currently before the court is defendant's Motion for Summary Judgment,1 which is based primarily on the Health Care Quality Improvement Act of 1986 ("HCQIA"), 42 U.S.C. §§ 11101 through 11152. Upon consideration of the record, the submissions of the parties, the argument of counsel, and the relevant law, the court is of the opinion that defendant's Motion for Summary Judgment is due to be granted.
The facts of this case are largely undisputed. Defendant Northwest Medical Center, Inc. operated a hospital located in Russellville, Alabama.2 (Deposition of Christine Stewart ("Stewart Dep.") at 153-54, submitted with Pl.'s Second Evid. Sub. in Resp. to Def.'s Mot. for Summ. J. and Pl.'s Opp. Thereto.) In 1995, the Hospital recruited Plaintiff Richard L. Chalal, M.D., a physician specializing in internal medicine, to relocate his practice from Florida and become a member of the Hospital's medical staff. (Deposition of Richard L. Chalal ("Chalal Dep." or "DX1") at 6, 90-92, Ex. 1 of Def.'s Evid. Sub. in Supp. of Mot. for Summ. J.;3 Recruiting Agreement and Recruiting Agreement Addendum —Relocation, attached as Ex. 7 to Chalal Dep.) Dr. Chalal and the Hospital entered into a Recruiting Agreement and a Professional Services Agreement, both of which were contingent upon Dr. Chalal maintaining privileges on the Hospital's medical staff. (Recruiting Agreement, attached as Ex. 7 to Chalal Dep.; Professional Services Agreement, attached as Ex. 8 to Chalal Dep.)
Dr. Chalal applied for staff privileges and was initially appointed to the Hospital's medical staff as a provisional member beginning October 2, 1995. (Chalal Dep. at 11, 90-92.) The Hospital's medical staff is governed by Medical Staff Bylaws ("the Bylaws"), which provide that all initial appointments to the medical staff shall be "provisional" for at least twelve months. (DX4, Med. Staff Bylaws ("the Bylaws") at 12, Art. IV, Sec. 2, ¶ H.) The Bylaws require that the chairman of the medical section to which a provisional member is assigned observe and evaluate the new member's professional and clinical performance. (Id.) To this end, the Bylaws state that a "proctorship" or other supervision during the provisional period is not considered an adverse action of the medical staff. (Id. at 23, Art. VI, Sec. 6, ¶ A.) At the conclusion of the provisional period, the Bylaws require the medical staff to determine whether to advance the physician from provisional status to "active" status. (Id.)
During Dr. Chalal's provisional year, a number of clinical incidents occurred which caused members of the medical staff to question Dr. Chalal's competency as a physician. (Letter to Dr. Chalal, attached as Ex. 2 to Chalal Dep.; Summary listing of incidents attached to Def.'s Reply in Supp. of Mot. for Summ. J.) In March of 1996, and again in May of 1996, the medical staff conducted peer review meetings to review certain incidents in which Dr. Chalal's patients suffered poor outcomes.4 (See Letter to Dr. Chalal, attached as Ex. 4 to Chalal Dep.; Memorandum to Dr. Chalal, attached as Ex. 5 to Chalal Dep.; Letter to Dr. Chalal, attached as Ex. 6 to Chalal Dep.) After the second peer review meeting, the medical staff elected to place Dr. Chalal on a proctorship, which did not limit his staff privileges, but required Dr. Chalal to have his hospital admissions reviewed by another member of the medical staff. (Letter to Dr. Chalal, attached as Ex. 6 to Chalal Dep.; Chalal Dep. at 92-94.)
As his one-year provisional period came to an end, Dr. Chalal applied for advancement to active staff membership. (Chalal Dep. at 90-92.) Pursuant to the procedure outlined in the Bylaws, Dr. Chalal's application was first reviewed by the medical staff's Executive Committee, whose function was to make a recommendation to the Hospital's Board of Trustees. (Bylaws at 9-12, Art. IV, Sec. 1-3; Bylaws at 50-51, Art. XIII, Sec. 1, ¶ B.) The Executive Committee met on September 26, 1996, and again on October 8, 1996, and recommended that Dr. Chalal's application be denied based on the clinical incidents which had occurred during Dr. Chalal's first year. (Letter to Dr. Chalal, attached as Ex. 3 to Chalal Dep.; Letter to Dr. Chalal, attached as Ex. 14 to Chalal Dep.) On October 9, 1996, the Hospital's Chief Executive Officer, Christine Stewart, informed Dr. Chalal in writing of the adverse recommendation, stating that the Executive Committee based its decision in part on "the aggregate (and excessive) number of `incidents' concerning clinical care and competency reported during the first year of your staff membership...." (Ex. 14 attached to Chalal Dep.) The Hospital CEO also informed Dr. Chalal that, pursuant to the Bylaws, he was entitled to request a hearing. (Id.)
Dr. Chalal requested a hearing, and a Hearing Committee was appointed to review the adverse recommendation of the Executive Committee. (Chalal Dep. at 18-19, 29; Letter to Dr. Chalal attached as Ex. 2 to Chalal Dep.) As provided by the Bylaws, the Hearing Committee was composed of five physicians on active staff who were not members of either the Executive Committee or the Hospital's Board of Trustees. (Chalal Dep. at 29; Bylaws at 30, Art. III, Sec. 5.) By letter dated October 24, 1996, approximately seven weeks prior to the hearing, the Hospital CEO provided Dr. Chalal with a summary of the incidents giving rise to the Executive Committee's adverse recommendation, specifying the particular patient charts and witnesses involved. (Chalal Dep. at 18-19, 32; Ex. 2 attached to Chalal Dep.)
The Hearing Committee convened on December 18, 1996. (DX2, Transcript of Hearing ("Hearing Transcript") at 1.) The hearing lasted three hours, documented in a 140-page transcript. (Hearing Transcript at 1-140.) During the hearing, the five Hearing Committee physicians and Dr. Chalal engaged in a thorough case review of each clinical incident outlined in the summary chart. (Id.) The Hearing Committee physicians reviewed the actual patient charts involved in the cases at issue, to which Dr. Chalal had been given full access in order to prepare for the hearing. (Id.; Chalal Dep. at 32.) No witnesses were called by either Dr. Chalal or the Executive Committee, and neither party was represented by an attorney. (Chalal Dep. at 26-28, 31-32; Hearing Transcript at 1-140.) However, the hearing transcript reflects that the Hearing Committee conducted an exhaustive professional review of the clinical incidents, allowing Dr. Chalal to present as much information or explanation regarding the incidents as he desired. (Hearing Transcript at 1-140.)
The Hearing Committee concurred with the adverse recommendation by the Executive Committee. (Report of Hearing Committee, attached as Ex. 13 to Chalal Dep.) The Hearing Committee issued a written recommendation stating, "after careful review of the specific cases and incidents involving Dr. Chalal submitted by the Medical Executive Committee during the Hearing, the Hearing Committee in good faith finds that these specific cases and incidents demonstrate that Dr. Chalal's level of clinical care and competency is unacceptable." (Id.) Dr. Chalal received a copy of the Hearing Committee's written adverse recommendation. (Id.)
On December 20, 1996, Dr. Chalal's application came before the Hospital's Board of Trustees, along with the adverse recommendations of the Executive Committee and the Hearing Committee. (Letter to Dr. Chalal and Hand Delivery Receipt, attached as Ex. 12 to Chalal Dep.) The Board of Trustees voted to adopt the adverse recommendations of the respective medical staff committees. (Id.) Accordingly, Dr. Chalal's hospital privileges were terminated, effective immediately. (Id.) The Hospital CEO gave Dr. Chalal written notice that his staff privileges had been terminated and informed him of his right to appellate review, as provided by the Bylaws. (Id.) The Hospital CEO subsequently notified Dr. Chalal that his Professional Services Agreement was terminated as a result of Dr. Chalal's loss of staff privileges. (Affidavit of Christine Stewart, ("Stewart Aff.") at ¶ 5, attached to def.'s Supp. Evid. Sub. in Supp. of Amended Mot. for Summ. J.) As required by the Health Care Quality Improvement Act, 42 U.S.C. § 11133, and Alabama state law, Ala.Code § 34-24-59, the Hospital reported the termination of Dr. Chalal's staff privileges to the Alabama State Board of Medical Examiners for inclusion in the National Practitioner Data Bank.5 (Stewart Dep. at 50-55.)
Dr. Chalal noticed an appeal of the decision in accordance with the Bylaws, and an Appellate Review Committee made up of three additional physicians was appointed to review the adverse decision. (Letter to Board of Trustees, DX3; Bylaws at 32-34, Art. VIII, Sec. 7, ¶¶ A-J.) After a review of the record and consideration of Dr. Chalal's written submission, on January 23, 1997, the Appellate Review Committee affirmed the Board of Trustees's decision. (Id.; DX3)
During this same time period, Dr. Chalal also applied for medical staff...
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