Crow v. Penrose-St. Francis Healthcare Sys.
| Citation | 169 P.3d 158 |
| Decision Date | 15 October 2007 |
| Docket Number | No. 06SA323.,06SA323. |
| Parties | In re Jimmie R. CROW, M.D., Plaintiff v. The PENROSE-ST. FRANCIS HEALTHCARE SYSTEM, d/b/a Penrose-St. Francis Health Services, Defendant. |
| Court | Supreme Court of Colorado |
Kennedy Childs & Fogg, P.C., John R. Mann Denver, Colorado, Attorneys for Amicus Curiae Colorado Hospital Association.
John W. Suthers, Attorney General, Donald D. Domenico, Solicitor General, Diana E. Black, Deputy Attorney General, Claudia Brett Goldin, First Assistant Attorney General, Sue Y. Kim, Assistant Attorney General, Denver, Colorado, Attorneys for Amici Curiae Colorado Board of Medical Examiners and Committee on Anticompetitive Conduct.
At issue here is a physician's ability to obtain judicial relief when his hospital staff privileges have been suspended pending completion of the peer review process. The Penrose-St. Francis Healthcare System ("the Hospital") asks this court to overturn a trial court ruling allowing Dr. Jimmie R. Crow to bring a civil action against the Hospital seeking injunctive relief and asserting common law claims arising out of the Hospital's peer review of Crow before that peer review process has been completed. The Hospital argues that Crow's claims are not ripe because he has failed to exhaust his administrative remedies of completing the peer review process. Exercising our original jurisdiction pursuant to C.A.R. 21, we issued a rule to show cause and now make that rule absolute.
We hold that pursuant to the Colorado Professional Review Act ("the CPRA"), sections 12-36.5-101 to -203, C.R.S. (2007), a physician must exhaust all peer review committee administrative remedies before seeking relief in court. This exhaustion requirement, found in subsections 12-36.5-106(7) and (8), applies even though the physician is seeking money damages for common law claims arising out of the process, rather than challenging the board's final decision. Because the Hospital's governing board has not rendered a final decision in his matter, Crow has not exhausted his available administrative remedies, and his case is not ripe for judicial review.
For over three years now, Crow and the Hospital have been locked in a dispute over the summary suspension and the potential termination of Crow's medical staff privileges at the Hospital. Because this case is in the pre-trial stage, our description of the relevant facts is based on the parties' allegations.
The dispute began in October 2004, when Crow was the on-call surgeon covering the Hospital's emergency room. According to the Hospital, Crow failed to properly treat a patient, J.C., in a timely manner, significantly increasing the patient's risk of morbidity or mortality. In fact, the patient died within two weeks. As a result, the Hospital began its peer review process, which involves other physicians critically examining Crow's care of the Hospital's patients. Under the CPRA, a hospital's peer review is authorized by the state Board of Medical Examiners ("BME") "to review and evaluate the quality and appropriateness of patient care." § 12-36.5-104(1). As relevant to this case, the peer review process may investigate and determine whether a physician "has provided substandard or inappropriate patient care." § 12-36.5-104(7)(a).
The Hospital's peer review procedure has five steps.1 First, the peer review committee2 for the physician's clinical department investigates and recommends an appropriate resolution of the matter to the Credentials Committee and the Medical Executive Committee. Second, the Credentials Committee, a hospital-wide peer review committee charged specifically with reviewing staff privileges issues, reviews the matter, and delivers its recommendation to the Medical Executive Committee. Next, the Medical Executive Committee, a peer review committee charged with representing and acting on behalf of the entire medical staff of the Hospital, receives the two previous committees' recommendations, and then conducts its own investigation of the matter before it makes a recommendation to the Hospital's governing board. If the physician appeals this recommendation, the fourth step is for the Hospital's governing board to appoint a panel to hold a hearing on the matter. The panel's hearing is on the record, and the doctor has a right to present evidence there and may be represented by counsel. After the hearing panel decides, the physician again has a right to appeal the decision, this time to an appellate review panel of the governing board. This fifth panel, made up of individuals who have not served on the previous committees, will hold a similar hearing on the record. After the appellate panel makes its recommendation, the Hospital's governing board makes its final decision on the matter. Based on the timeline for completing the individual steps, the peer review process is envisioned to take several months.
In this case, Crow's peer review process remains unfinished after three years. The first three steps of peer review were completed within six weeks. The surgical peer review committee, the Credentials Committee, and the Medical Executive Committee each met and recommended that Crow's staff privileges at the Hospital be terminated. The Medical Executive Committee's investigation also raised serious concerns about Crow's treatment of seven patients in addition to J.C.
The next step in the process would be an evidentiary hearing. However, a hearing panel has yet to be convened. The parties have different explanations for the delay. It is undisputed that the Hospital has contacted Crow eleven times to set up this hearing, and four times Crow has initially agreed to a scheduled hearing, but then cancelled it for various reasons. Crow counters that the Hospital must provide him with documentation on all the patients whose care is at issue before he is able to defend himself capably at a hearing. The Hospital asserts that Crow has no right to discovery as such, and that Crow can review the relevant medical records at the Hospital.
Shortly after the process began, Crow's privileges were summarily suspended pending the outcome of the peer review process. Crow did not exercise his right to appeal the summary suspension, and his staff privileges at the Hospital remain suspended. Pursuant to section 12-36.5-104(7)(f), the Hospital reported Crow's suspension to the BME, which then conducted its own investigation. Because the basis for the suspension was Crow's treatment of J.C., the first patient in question, the BME limited its investigation to Crow's handling of J.C., and did not address his care of the other seven patients at issue. In January 2006, the BME admonished Crow for his treatment of J.C., and warned him that "complaints disclosing any repetition of such practice may lead to commencement of formal disciplinary proceedings against your license to practice medicine." The BME has not yet investigated the seven other complaints against Crow to determine if the other cases constitute "repetition of such practice," because the BME is waiting to receive the Hospital's hearing panel's recommendation.
In April 2006, Crow sued the Hospital in El Paso County District Court, seeking injunctive relief and alleging breach of contract and tort claims arising from the summary suspension and the incomplete peer review process. Specifically, Crow alleges that in suspending and attempting to terminate his privileges, the Hospital breached its contractual obligations and implied covenants of good faith and fair dealing embodied in the Hospital's bylaws, was negligent in failing to follow its bylaws, and tortiously interfered with Crow's prospective business relations with potential patients, payors, and healthcare providers. Crow is seeking actual and consequential damages, as well as a permanent injunction preventing the Hospital from revoking, suspending, or otherwise limiting Crow's medical staff privileges because of his treatment of any of the patients at issue.3
The Hospital filed a motion to dismiss the complaint, arguing that the case in district court was not ripe. It contended that Crow must exhaust his available administrative remedies through the Hospital's peer review process before seeking judicial relief. The district court denied the Hospital's motion, as well as its later motion to reconsider. The Hospital then filed this petition for a rule to show cause pursuant to C.A.R. 21.
The main issue before this court today is one of ripeness. The Hospital contends that Crow must exhaust his administrative remedies through the peer review process before he can bring any claims arising out of the administrative proceedings in district court. Crow, on the other hand, maintains that the CPRA only requires exhaustion if one is challenging the board's final decision. He reasons that his claims are ripe because he is seeking money damages for common law tort and contract claims arising out of the process.
We reject Crow's argument. The terms of the statute, as well as applicable case precedent and persuasive policy reasons, lead us to conclude that common law claims arising out of the peer review procedure are subject to the exhaustion of administrative remedies...
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