Goodwich v. Sinai Hosp. of Baltimore, Inc.

• Decision Date: 01 September 1994
• Docket Number: No. 797,797
• Citation: 653 A.2d 541,103 Md.App. 341
• Parties: Kenneth GOODWICH v. The SINAI HOSPITAL OF BALTIMORE, INC. ,
• Court: Court of Special Appeals of Maryland

Page 341

103 Md.App. 341

653 A.2d 541

Kenneth GOODWICH v. The SINAI HOSPITAL OF BALTIMORE, INC.

No. 797, Sept. Term, 1994.

Court of Special Appeals of Maryland.

Feb. 9, 1995.

Reconsideration Denied March 6, 1995.

Angus R. Everton (Roy L. Mason and Mason, Ketterman & Morgan, on the brief), Baltimore, for appellant.

Michael J. Baxter (John R. Penhallegon and Smith, Somerville & Case, on the brief), Baltimore, for appellee.

Argued before WILNER, C.J., and CATHELL and HOLLANDER, JJ.

WILNER, Chief Judge.

Kenneth Goodwich sued Sinai Hospital in the Circuit Court for Baltimore City because the hospital placed certain restrictions on his privilege to practice medicine at the hospital. The court granted summary judgment in favor of the hospital on the ground that it enjoyed statutory immunity. Dr. Goodwich believes the court erred.

Dr. Goodwich is a licensed physician who specializes in obstetrics and gynecology but is not board certified in that specialty. ¹ In the mid-1970's, he was an intern and resident at Sinai; he joined the medical staff as an assistant attending physician in 1978. According to Sinai, Dr. Goodwich's "clinical practice patterns were subject to question by his peers on a wide variety of medical matters over the years." In 1988, the Chairman of the Obstetrics and Gynecology Department, Dr. Phillip Goldstein, met with Dr. Goodwich on several occasions regarding those concerns and suggested to him that he obtain second opinions from board certified obstetricians and gynecologists (OB/GYNs) for all high-risk obstetrical patients. Dr. Goodwich orally agreed.

That agreement was memorialized in two letters, one dated June 29, 1988 from Dr. Goldstein to Dr. Goodwich and one dated August 12, 1988 from Dr. Goodwich to Dr. Goldstein. Although Dr. Goodwich now claims that he was initially misled into thinking that the "second opinion" rule was applicable to all non-board certified OB/GYNs, there is nothing in the exchange of letters to so indicate. Dr. Goldstein, after noting one incident of a pre-eclamptic patient admitted to the obstetrical service without a senior consultation, suggested that it would be prudent, in the current litigious atmosphere, to have such a consultation for high-risk patients, and that it made sense to select a board certified OB/GYN to support Dr. Goodwich's therapeutic goals in the management of such patients. Dr. Goodwich responded that he agreed with that recommendation with respect to high-risk obstetrical patients.

Unfortunately, Dr. Goodwich failed to comply faithfully with his agreement. As a result, a second meeting took place in February, 1990, this time between Dr. Goldstein and Dr. Goodwich's attorney. At that meeting, the parties agreed that Dr. Goodwich would obtain second opinions from board certified OB/GYNs on "all of his high-risk patients." That agreement, which does not appear to have been restricted to obstetrical patients, was memorialized in a letter from the attorney to Dr. Goldstein dated February 26, 1990.

Due to continued noncompliance with the second opinion agreement and "more instances of questionable patient care," Dr. Goldstein requested the Director of Quality, Risk & Utilization Management at Sinai to investigate how often Dr. Goodwich failed to obtain second opinions. The investigation uncovered several instances of noncompliance as well as problems with Dr. Goodwich's management of various patients. Dr. Goldstein met with Dr. Goodwich again to discuss those matters. Dr. Goodwich, for a third time, agreed to obtain second opinions in high-risk obstetrical cases. Dr. Goldstein confirmed that agreement in a letter to Dr. Goodwich dated April 23, 1992. In that letter, Dr. Goldstein made clear what he thought had been clear from the beginning--that the second opinion must be in writing and posted in the patient's chart prior to surgery.

In June, 1992, after Dr. Goldstein left Sinai, Dr. W. Scott Taylor became acting Chief of the Obstetrics and Gynecology Department. In December, Dr. Taylor requested the Director of Quality, Risk & Utilization Management at Sinai to re-check Dr. Goodwich's compliance with the second opinion agreement.

By January, Sinai had appointed Dr. John L. Currie as Chief of the Obstetrics and Gynecology Department. On January 27, in response to Dr. Taylor's request, the Quality Assurance Committee reported to Dr. Currie that Dr. Goodwich had failed to obtain second opinions in 14 cases since his agreement with Dr. Goldstein in April, 1992. On January 28, Dr. Currie met with Dr. Goodwich and, again, Dr. Goodwich agreed to obtain second opinions on certain categories of high-risk obstetrical and gynecological cases. That same day, Dr. Currie sent a confirmation letter of the agreement to Dr. Goodwich requesting that he sign it. Dr. Goodwich did not sign the letter. On February 2, Dr. Currie met with Dr. Goodwich and his attorney. Again, Dr. Goodwich orally agreed to obtain second opinions, but no written agreement was signed.

In his January 28 letter, Dr. Currie informed Dr. Goodwich that his privileges had been extended to March 31, 1993 but that, "[i]n order to renew your privileges, I am requiring that you obtain written second opinions and direct supervision by Board certified obstetricians and gynecologists for the following OB/GYN procedures:

"Obstetrical: Operative vaginal deliveries (i.e. forceps, vacuum extraction)

Management of fetal distress

Cesarean deliveries

Breech deliveries

Disorders of pregnancy such as preeclampsia, etc.

Gynecological: All major abdominal procedures

Vaginal hysterectomy

Laparoscopy (i.e., when any surgical procedure other than visual diagnosis occurs)"

Dr. Currie warned that failure to obtain a second opinion and supervision "for all such cases at Sinai Hospital prior to March 31, 1993" would result in "further action against your privileges."

According to Sinai, Dr. Goodwich's continuing failure to obtain second opinions and some additional instances of questionable patient care prompted the hospital to abridge his privileges temporarily by making the obtention of second opinions in the categories of cases enumerated in the January 28 letter a mandatory condition of his privilege to practice medicine at Sinai. On February 26, 1993, Dr. Currie informed Dr. Goodwich in writing that, pursuant to Article IV, § 7C of the By-Laws, Rules, and Regulations of the Hospital's Medical Staff, his privileges were "temporarily abridged" in precisely the manner set forth in the January 28 letter. ² The notice also advised Dr. Goodwich that the Medical Executive Committee (MEC) would consider a permanent abridgement of his privileges on March 8 and informed him of the time and location of the meeting. Prior to the meeting, all interested parties were provided access to the list of specific patient cases under consideration and to all departmental files.

At the meeting on March 8, Dr. Currie discussed the abridgement and the reasons for it. Dr. Goodwich was permitted to make a statement on his own behalf and to answer questions from the MEC members. At the conclusion of the meeting, the MEC, after an hour-and-a-half deliberation, decided to abridge Dr. Goodwich's privileges for three months on the same terms as the temporary abridgement. The outcome of the meeting was reported to the Maryland State Board of Physician Quality Assurance and the National Practitioner Data Bank.

Subsequent to the meeting, Dr. Goodwich requested and received an evidentiary hearing before a three-physician panel to consider the reasonableness and necessity of the abridgement. Thereafter, Dr. Goodwich requested and received an administrative hearing before another three-physician panel. Both panels, as well as the hospital's Board of Trustees in a subsequent meeting, affirmed the MEC's decision.

During the above administrative appellate process, Dr. Goodwich sued Sinai and the MEC in the Circuit Court for Baltimore City for civil conspiracy, denial of procedural due process, breach of contract, intentional interference with contractual relations, and tortious interference with prospective economic benefit. ³ On May 12, the conspiracy and due process counts were dismissed. On January 13, 1994, Sinai filed a motion for summary judgment as to all remaining counts, claiming immunity under both Federal and State law. At a subsequent hearing, the motion was granted. On appeal, appellant contends that the court erred in granting summary judgment because there were genuine disputes of fact as to both Federal and State immunity and asks us to reverse the order. Finding no error with the court's decision, we decline to do so.

I. Federal Immunity.

The Health Care Quality Improvement Act of 1986 (HCQIA) was enacted in response to "[t]he increasing occurrence of medical malpractice and the need to improve the quality of medical care." 42 U.S.C. § 11101. The purpose of HCQIA is to "provide for effective peer review and interstate monitoring of incompetent physicians and to grant qualified immunity from damages for those who participate in peer review activities." Austin v. McNamara, 979 F.2d 728, 733 (9th Cir.1992). Thus, the statute provides that a professional review body is not liable for damages if the review action of that body was taken:

"(1) in the reasonable belief that the action was in the furtherance of quality health care,

(2) after a reasonable effort to obtain the facts of the matter,

(3) after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances, and

(4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph (3)."

42 U.S.C. § 11112(a).

Section 11112(a) further provides:

"A professional review action shall be presumed to have met the preceding standards necessary for the protection...