Goodman v. SAMARITAN HEALTH SYSTEM
| Decision Date | 16 March 1999 |
| Docket Number | No. 1 CA-CV 97-0392.,1 CA-CV 97-0392. |
| Citation | 990 P.2d 1061,195 Ariz. 502 |
| Parties | Herbert D. GOODMAN, M.D., Plaintiff-Appellant, v. SAMARITAN HEALTH SYSTEM, dba Maryvale Samaritan Hospital, Defendant-Appellee. |
| Court | Arizona Court of Appeals |
Burch & Cracchiolo, P.A. by Bryan F. Murphy J., Brent Welker, Phoenix, Attorneys for Plaintiff-Appellant.
Lewis & Roca, LLP by Susan Freeman, Steve Labensky, Karen C. Owens, Phoenix, Attorneys for Defendant-Appellee.
Coppersmith & Gordon, P.L.C. by Andrew S. Gordon, Kristen B. Rosati, Phoenix, Attorneys for Amici Curiae.
¶ 1 Herbert D. Goodman, M.D., sued Samaritan Health System, d/b/a Maryvale Samaritan Hospital, alleging claims of negligent peer review and malicious prosecution. The trial court granted summary judgment in favor of Samaritan, finding that Samaritan was statutorily immune from these claims pursuant to Arizona Revised Statutes Annotated ("A.R.S.") section 36-445.02(B) (1993), the peer review immunity statute. Goodman now appeals that ruling. We granted permission to the Arizona Hospital and Healthcare Association and several other hospitals and medical centers to file a brief as Amici Curiae in favor of upholding the judgment. For the following reasons, we affirm the judgment.
¶ 2 Samaritan's Medical Staff Bylaws provide that a new physician applying for staff privileges in the Family Practice Department shall be appointed to the provisional staff for a twelve-month period. During this time, the applicant must complete ten supervised cases, in which physicians selected by the applicant look at the medical charts of the applicant's patients to review his documentation of patient history, physical examination, and treatment provided. If the applicant fails to complete these supervised case reviews within one year, he may receive one twelve-month extension.
¶ 3 Once the provisional process is completed, the applicant may then apply for a promotion to the courtesy or permanent staff. As part of the courtesy staff application process, the applicant consents to an investigation of his medical portfolio, as well as other relevant information regarding prior patient care.
¶ 4 Goodman applied for medical staff privileges at Samaritan in 1989 and was appointed to provisional staff in March 1990. After receiving a one-year extension, Goodman completed his mandatory supervised case reviews in 1991. In January 1992, Goodman submitted an application for appointment to courtesy staff and the required investigation of his medical portfolio and background was undertaken by an appointed committee.
¶ 5 Following completion of the investigation, the committee expressed concerns that: (1) Goodman had falsified information regarding his prior affiliation with two area hospitals; (2) the Arizona Board of Medical Examiners ("BOMEX") had censured Goodman for "unprofessional conduct" for misdiagnosing a patient and knowingly falsifying that patient's medical records; and (3) the audit of Goodman's supervised case reviews reflected concerns about his patient care and documentation. Goodman submitted a response to these concerns in which he explained the circumstances of his BOMEX censure and his failure to mention prior hospital affiliations. Primarily though, Goodman's response sought to refute the finding that his supervised case reviews reflected inadequate patient care and documentation.
¶ 6 In reply, the committee admitted that the audit of the case reviews "did contain a couple of misstatements" and accordingly arranged for Dr. Donald Mulvaney, the Director of the Family Practice Residency program at another Samaritan medical center, to independently review Goodman's supervised case reviews. Dr. Mulvaney concluded that two of the eleven patient charts did not meet the community standard of care. Consequently, he recommended that Samaritan deny Goodman courtesy staff privileges.
¶ 7 Notwithstanding Dr. Mulvaney's recommendation, the committee recommended that Goodman be elevated from provisional staff to courtesy staff conditioned upon the following: (1) completion of a mini-residency of at least six weeks' duration; (2) performance of ten additional supervised cases within one year; and (3) continued nonparticipation in on-call emergency-room duty. Goodman then submitted additional documents responding to both the case review audit and Dr. Mulvaney's conclusions. Among these was a letter from a UCLA medical professor indicating that Goodman's documentation in his patients' charts showed "no deviation from the standard of medical care," and that many of the reviewers' comments were "grossly inaccurate." Goodman submitted similar letters from a University of Arizona pharmacology professor and two other physicians.
¶ 8 The committee then changed its conditions to the following: (1) retrospective review of his next ten admissions; (2) improved documentation of medical histories and physicals; and (3) improved management decisions. Ultimately, in June 1993, Samaritan granted Goodman courtesy staff privileges on the sole condition that Goodman's next ten patients' charts be retrospectively reviewed. Goodman has since twice been reappointed to the courtesy staff, although Goodman has not yet satisfied this last condition. Goodman presently remains on courtesy staff.
¶ 9 In May 1994, Goodman filed a superior court complaint against Samaritan, alleging claims of negligent peer review and malicious prosecution and seeking damages consisting of attorneys' fees, expert witness fees, pain and suffering, and punitive damages. Samaritan moved for summary judgment, asserting that it was entitled to complete immunity pursuant to section 36-445.02(B). Goodman responded that the absolute immunity granted by this statute to peer review participants violated the anti-abrogation, due process, and privileges or immunities clauses of the Arizona Constitution. The trial court granted judgment for Samaritan on its immunity defense and dismissed all Goodman's claims. Goodman timely appealed.
¶ 10 Goodman asserts that the trial court erred in holding that the absolute immunity provision of section 36-445.02(B), as applied to Goodman's claims for negligent peer review and malicious prosecution, does not violate the anti-abrogation, due process, or privileges or immunities clauses of the Arizona Constitution. Samaritan raises the issue whether the qualified immunity for professional review actions provided by the federal Health Care Quality Improvement Act immunizes Samaritan from liability. See 42 U.S.C. § 11101, et seq.
¶ 11 It is sound judicial policy to avoid deciding a case on constitutional grounds if there are nonconstitutional grounds dispositive of the case. See Petolicchio v. Santa Cruz County Fair & Rodeo Association, 177 Ariz. 256, 259, 866 P.2d 1342, 1345 (1994)
. Both Samaritan and Amici assert this case can be resolved and the trial court affirmed by applying sections 11101 to 11115 of the Health Care Quality Improvement Act. 42 U.S.C. § 11101 et seq. (1994). Goodman argues that we should not address this issue because it was not presented to the trial court. Samaritan responds that although the trial court did not base its decision on the federal act, the issue was fairly and adequately presented below. Our review of the record leads us to conclude that Goodman is correct.
¶ 12 Samaritan first mentioned federal immunity in its reply to Goodman's response to Samaritan's separate motion to dismiss, a motion that is not part of this appeal. In that reply, Samaritan did discuss the purposes of federal immunity in the context of peer review proceedings. However, Samaritan did not provide any analysis to show that its conduct at issue here met the primary requirements for immunity imposed by the Act, namely that the conduct constituted a "professional review action" and met the four "safe harbor requirements." See 42 U.S.C. §§ 11151(9), 11112(a); see also Michael J. Baxter, A Potent Weapon: Federal Peer Review Immunity Under HCQIA, 64 Def. Couns. J. 364, 364-65 (1997). It is only when these requirements are met that statutory immunity attaches. See 42 U.S.C. § 11112(a).1
¶ 13 Samaritan's motion for summary judgment, which is the motion before us, stated merely that the Act provides protection similar to that provided by Arizona's statute, "immunizing peer review participants from liability so long as the medical staff follows procedures that meet minimal due process guidelines, which was done here." Again, no analysis tying the Act's provisions to the facts of this case was undertaken. On this state of the record, we conclude that the applicability of the Act was not properly before the trial court and is therefore not properly before us. See Campbell v. Warren, 151 Ariz. 207, 208, 726 P.2d 623, 624 (App.1986) (). Consequently, we must address the constitutional issues raised by Goodman.
¶ 14 We begin by setting forth the pertinent language of the statute:
No hospital or outpatient surgical center and no individual involved in carrying out review or disciplinary duties or functions of a hospital or center pursuant to § 36-445 [mandated peer review] may be liable in damages to any person who is denied the privilege to practice in a hospital or center or whose privileges are suspended, limited or revoked. The only legal action which may be maintained by a licensed health care provider based on the performance or nonperformance of such duties and functions is an action for injunctive relief seeking to correct an erroneous decision or procedure.
In reviewing Goodman's challenge to the constitutionality of this statute, we accord the statute a presumption of constitutionality, with a view to resolving any doubts in favor of its validity....
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