Hourani v. Benson Hosp.

• Citation: 122 P.3d 6,211 Ariz. 427
• Decision Date: 27 September 2005
• Docket Number: No. 2 CA-CV 2004-0155.,2 CA-CV 2004-0155.
• Parties: Abdulkadir HOURANI, M.D., Plaintiff/Appellee, v. BENSON HOSPITAL, an Arizona nonprofit corporation, Defendant/Appellant.
• Court: Arizona Supreme Court

122 P.3d 6

211 Ariz. 427

Abdulkadir HOURANI, M.D., Plaintiff/Appellee, v. BENSON HOSPITAL, an Arizona nonprofit corporation, Defendant/Appellant.

No. 2 CA-CV 2004-0155.

Court of Appeals of Arizona, Division 2, Department A.

September 27, 2005.

COPYRIGHT MATERIAL OMITTED

Chandler & Udall, LLP, By Peter Akmajian and Michael J. Crawford, Tucson, for Plaintiff/Appellee.

Slutes, Sakrison & Hill, P.C., By Tom Slutes and Diana L. Kanon-Ustariz, Tucson, for Defendant/Appellant.

OPINION

HOWARD, Presiding Judge.

¶ 1 Appellant Benson Hospital challenges the superior court's grant of summary judgment in favor of appellee Abdulkadir Hourani in his appeal of the Hospital's suspension of his hospital privileges. The Hospital also argues that the court erred by denying its cross-motion for summary judgment. We affirm the court's denial of the Hospital's motion, but reverse the granting of Hourani's motion, finding that factual issues precluded summary judgment.

¶ 2 The procedural facts relevant to this appeal are undisputed. Abdulkadir Hourani is a board-certified, pulmonary critical-care specialist licensed to practice medicine in Arizona. From 2000 to 2002, he was employed by EmCare, Inc., which contracted with Benson Hospital to provide it emergency room physicians. In December 2000, the Hospital's Medical Staff Executive Committee began investigating the quality of Hourani's care at the Hospital and subsequently voted to recommend to the Governing Board that it revoke Hourani's privileges to practice medicine at the Hospital. The Executive Committee informed Hourani of its decision, and Hourani requested a hearing. After the hearing, the hearing officer issued a report, stating that, of the eight cases discussed in his report, "variances" had occurred in three of the cases in which "the care varie[d] from the norm that has been established in Emergency Medicine." However, the hearing officer made no official recommendation to revoke Hourani's hospital privileges, stating at the hearing that "it is up to the Medical Staff to decide whether privileges are revoked or not revoked." After considering the hearing officer's report, the Executive Committee remained in favor of recommending to the Governing Board that it revoke Hourani's privileges.

¶ 3 Hourani appealed the Executive Committee's recommendation to the Appellate Review Committee. After a hearing, the Appellate Review Committee adopted the Executive Committee's recommendation for revocation. The Governing Board subsequently accepted this recommendation and revoked Hourani's privileges to practice medicine at Benson Hospital. Hourani sought injunctive relief from the superior court, arguing that the Hospital's proceedings had denied him due process. Hourani moved for summary judgment, and the Hospital cross-moved for summary judgment. The superior court denied the Hospital's motion but granted Hourani's motion and ordered that his privileges be reinstated.

DENIAL OF SUMMARY JUDGMENT

¶ 4 Benson Hospital first argues that the superior court erred as a matter of law in denying its cross-motion for summary judgment, in which it had argued A.R.S. § 36-445.02(B) required the court to affirm a revocation of privileges that is based on substantial evidence. Although the denial of summary judgment is usually not an appealable order, Bothell v. Two Point Acres, Inc., 192 Ariz. 313, ¶ 7, 965 P.2d 47, 50 (App.1998), an appellate court may review a denial if it was based on a point of law. Strojnik v. Gen. Ins. Co. of Am., 201 Ariz. 430, ¶ 11, 36 P.3d 1200, 1203 (App.2001). Here, the court denied the Hospital's motion based on its interpretation of § 36-445.02(B). Furthermore, if we were to agree with the Hospital that we were required to uphold a decision supported by substantial evidence despite procedural errors, we would necessarily vacate the summary judgment in favor of Hourani without considering the procedural errors the superior court identified. We therefore address the Hospital's argument and review the denial de novo. See Strojnik, 201 Ariz. 430, ¶ 11, 36 P.3d at 1203.

¶ 5 Section 36-445, A.R.S., requires licensed hospitals to have their medical staffs evaluated through peer review. In order to "encourage full and frank discussions and decision-making" in a process that can be both time consuming and contentious, Scappatura v. Baptist Hospital, 120 Ariz. 204, 210, 584 P.2d 1195, 1201 (App.1978), the legislature granted immunity to physicians engaging in peer review under § 36-445.02(B) by limiting any legal remedy to injunctive relief, providing:

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 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. The review shall be limited to a review of the record. If the record shows that the denial, revocation, limitation or suspension of membership or privileges is supported by substantial evidence, no injunction shall issue. In such actions, the prevailing party shall be awarded taxable costs, but no other monetary relief shall be awarded.

¶ 6 The Hospital contended in its motion that the record contains substantial evidence supporting the revocation of Hourani's privileges; therefore, it argued, regardless of any procedural violations, § 36-445.02(B) requires that "no injunction shall issue" and the courts must uphold the Governing Board's decision.¹ Hourani countered that even if substantial evidence exists to support the Board's decision, § 36-445.02(B) entitles him to injunctive relief to remedy the Hospital's violation of its revocation procedures.

¶ 7 In interpreting a statute, our primary goal is to ascertain the legislature's intent. Ziemak v. Schnakenberg, 210 Ariz. 442, ¶ 14, 111 P.3d 1042, 1046 (App.2005). If the statute is clear and unambiguous, we apply the plain meaning of the statute. See id. When an ambiguity exists, however, we attempt to determine legislative intent by considering "the statute's context, subject matter, historical background, effects and consequences, and spirit and purpose." Zamora v. Reinstein, 185 Ariz. 272, 275, 915 P.2d 1227, 1230 (1996). In construing a statute, "`we consider the statutory scheme as a whole and presume that the legislature does not include statutory provisions which are redundant, void, inert, trivial, superfluous, or contradictory.'" Parrot v. DaimlerChrysler Corp., 210 Ariz. 143, ¶ 9, 108 P.3d 922, 924 (App.2005), quoting State v. McDermott, 208 Ariz. 332, ¶ 5, 93 P.3d 532, 534 (App.2004).

¶ 8 We find that language in § 36-445.02(B) could support either party's interpretation. The statute provides that a physician may file "an action for injunctive relief seeking to correct an erroneous decision or procedure." Id. However, it also states that an injunction shall not be issued if the decision "is supported by substantial evidence." Id. Because those provisions could be interpreted as inconsistent, the language is ambiguous, and we must look beyond the language of the statute to determine the intent of the legislature.

¶ 9 The Arizona legislature enacted the state's first statutorily mandated peer review requirement in 1971. 1971 Ariz. Sess. Laws, ch. 203, § 1. The statutes mandated peer review of physicians practicing in hospitals and provided immunity to those participating in the peer review process for decisions made "without malice and in good faith." Id. They did not specifically provide for any judicial review of a final peer review decision. In 1984, the legislature amended § 36-445.02 and removed all liability for those involved in peer review activities, added hospitals themselves to the immunity provision, and only permitted a plaintiff to seek injunctive relief for an erroneous decision or procedure occurring during the peer review process. 1984 Ariz. Sess. Laws, ch. 119, § 1; see Goodman v. Samaritan Health Sys., 195 Ariz. 502, ¶ 20, 990 P.2d 1061, 1066 (App.1999); Gilbert v. Bd. of Med. Exam'rs, 155 Ariz. 169, 178, 745 P.2d 617, 626 (App.1987).

¶ 10 After the statute was enacted but prior to the amendment of § 36-445.02 in 1984, this court espoused the general rule that the exclusion of a physician from staff privileges in a private hospital was not subject to judicial review. Peterson v. Tucson Gen. Hosp., Inc., 114 Ariz. 66, 69, 559 P.2d 186, 189 (App.1976). Even so, this court found that the prohibition against judicial review did not apply when "there is a contention that the hospital failed to conform to procedural requirements set forth in a hospital's constitution, bylaws, or rules and regulations." Id.; see also Holmes v. Hoemako Hosp., 117 Ariz. 403, 404, 573 P.2d 477, 478 (1977) (courts have authority to review both "procedural and substantive aspects" of suspension of a physician's privileges); Bock v. John C. Lincoln Hosp., 145 Ariz. 432, 433, 702 P.2d 253, 254 (App.1985) ("Since . . . the hospital breached its own procedural requirements, we have full authority to consider this case.").

¶ 11 In its 1984 revision, the legislature did not express any intent to limit a court's authority to review a decision based on a procedural defect; instead, the legislature appeared to codify the courts' opinions by amending the statute to permit aggrieved parties to file "an action for injunctive relief seeking to correct an erroneous decision or procedure." § 36-445.02(B). Furthermore, because we presume that the legislature did not include a provision that is "inert, trivial, [or] superfluous," Parrot, 210 Ariz. 143, ¶ 9, 108 P.3d at 924, we cannot find that the...