Manzetti v. Mercy Hosp. of Pittsburgh

Citation776 A.2d 938,565 Pa. 471
CourtUnited States State Supreme Court of Pennsylvania
Decision Date18 July 2001
PartiesGene W. MANZETTI, M.D. & Gene W. Manzetti, M.D., P.C., Appellants, v. The MERCY HOSPITAL OF PITTSBURGH, Edward T. Wenzke, Dr. Ronald V. Pellegrini, Dr. Ross F. DiMarco, Jr., Dr. Dennis Manning, Dr. Howard A. Zaren, Dr. William Hetrick, Dr. Joann V. Narduzzi, Dr. Mitchell Massie, Dr. Robert H. Boretsky, Dr. Chester A. Phillips, III, Dr. Richard J. Kuwik, Dr. Patrick J. Vlahos, Dr. Daniel R. Sullivan, Dr. Christopher A. Troianos, Dr. Mark Stypula and Dr. Donna M. Lucas, Appellees.

Peter Matthews Wright, Pittsburgh, James Gregory Cirilano, McKees Rocks, for Gene W. Manzetti, M.D.

Eric W. Springer, Barbara Blackmond, Pittsburgh, for The Mercy Hospital of Pittsburgh, et al.

Before FLAHERTY, C.J., ZAPPALA, CAPPY, CASTILLE, SAYLOR, JJ.

OPINION

CAPPY, Justice.

We granted allocatur to determine whether the trial court correctly granted partial summary judgment in the instant matter on the basis that the immunity provisions of the Health Care Quality Improvement Act of 1986 ("HCQIA"), 42 U.S.C. §§ 11101 et seq. bar recovery of monetary damages for claims arising out of a peer review process. For the foregoing reasons, we affirm.

Dr. Gene Manzetti ("Manzetti") is a cardiac surgeon. From July of 1979 until February 11, 1994, he was privileged to perform all types of open-heart and vascular surgical procedures offered at Mercy Hospital of Pittsburgh ("Mercy").

In August of 1993, Dr. Mitchell Massie ("Massie") approached Dr. Ronald Pellegrini ("Pellegrini") with concerns about Manzetti's surgical skills. At that time, Massie was a surgical resident at Mercy while Pellegrini was the Chief of the Division of Cardiac Surgery. Massie confided to Pellegrini that he found Manzetti's surgical skills to be so poor that he had ethical and moral problems about operating with Manzetti. Massie specifically referenced the high number of complications occurring among open-heart patients who were under Manzetti's care.

In early January of 1994, Pellegrini was approached by Dr. Ross DiMarco ("DiMarco"), a cardiac surgeon, regarding a call he had received from Manzetti. Manzetti had telephoned DiMarco after one of Manzetti's patients had died and requested that DiMarco give him reassurance that he was a good surgeon. DiMarco described Manzetti as being emotionally distraught over the patient's death.

On January 15, 1994, Pellegrini orally requested that Manzetti voluntarily agree to cease performing open-heart surgeries so that no formal restrictions of Manzetti's privileges need be imposed. Manzetti did not accede to this request. Within the following two weeks, he performed two additional open-heart surgeries. The first was uneventful. The second, however, was fraught with serious intraoperative complications. Even though serious problems arose during this surgery, Manzetti noted on that patient's chart that the operative course was uncomplicated.

On February 4, 1994, Pellegrini wrote a letter to Manzetti in which he informed Manzetti that his privileges to perform open-heart surgery at Mercy were suspended effective February 14, 1994.

Manzetti immediately objected to Pellegrini's letter. On February 11, 1994, three days before the effective date of the suspension listed in Pellegrini's February 4, 1994 letter, Mercy's Medical Executive Committee ("MEC") held a meeting to consider suspending Manzetti's privileges to perform open-heart surgery. Later that same day, the MEC suspended Manzetti's cardio-thoracic surgery privileges. It also decided to conduct a further investigation of Manzetti and reconvene on February 24, 1994.

During this investigation, the MEC examined the medical records of more than a score of Manzetti's open-heart patients. It also conducted interviews with eight anesthesiologists who had worked with Manzetti during open-heart surgeries. Finally, Drs. William Hetrick ("Hetrick") and Dennis Manning ("Manning"), two members of the MEC, presented a statistical report. This report ("Hetrick and Manning statistical study") showed that Manzetti's open-heart surgery patients had a higher complication and mortality rate than open-heart surgery patients of other physicians at Mercy. Upon reconvening on February 24, 1994, the MEC voted unanimously to continue Manzetti's suspension.

Subsequently, Manzetti requested and was granted a hearing before a panel of three physicians (the "hearing panel"). Hearings were held on May 14, October 25 and October 26, 1994. The MEC presented the testimony of several cardiac surgeons. These surgeons testified as to incompetence on Manzetti's part during surgery as well as Manzetti's inability to respond appropriately to stress. Eight anesthesiologists who worked with Manzetti during his performance of open-heart surgery also testified. Each of these anesthesiologists testified that they found Manzetti's performance of this type of surgery to be subpar. In fact, each testified that if they heard that friend was going to have open-heart surgery performed on them by Manzetti, they would urge that friend to find another cardiac surgeon.

The MEC also established that for more than ten years preceding the suspension of Manzetti's open-heart surgery privileges, Manzetti performed only twenty to twenty-five open-heart surgeries a year. This volume was far lower than the one hundred open-heart surgeries that the Society of Thoracic Surgeons and other professional groups recommend a cardiac surgeon to perform each year in order to maintain a minimal level of competency. The MEC also introduced the Hetrick and Manning statistical study to show that Manzetti's open-heart patients had a higher complication and mortality rate than patients of other physicians. Finally, the MEC introduced evidence that Manzetti would fail to document complications in the charts of his patients.

Manzetti, who was represented by counsel, presented several witnesses in his defense. He introduced the expert testimony of two statisticians. The statisticians attacked the Hetrick and Manning statistical study. They asserted that Hetrick and Manning did not gather data in a fashion that a professional statistician would approve, and thus did not account for variables that could affect the results. In addition, Manzetti presented the testimony of three other physicians and the manager of Mercy's Quality Management Department; Manzetti also testified on his own behalf.

On December 5, 1994, the hearing panel issued a recommendation in favor of the MEC. The hearing panel explicitly stated that it gave "no credence" to the Hetrick and Manning statistical study. Report and Recommendation of the Hearing Panel, dated 12/05/1994, at 13. In recommending that Manzetti's privileges be suspended, the hearing panel focused on the fact that for more than a decade, Manzetti's volume in performing open-heart surgeries had been far below the number recommended to maintain competence in performing this procedure. Furthermore, the hearing panel found it disturbing that Manzetti failed to document complications experienced by his patients. The hearing panel also concluded that the poor relationships between Manzetti and the technicians and other physicians had a deleterious effect on patient care. The hearing panel thought it particularly striking—and troubling—that each of the anesthesiologists would urge a friend to go elsewhere if that friend were contemplating having Manzetti perform open heart surgery on him. Manzetti appealed the hearing panel's decision to a review panel. This review panel was comprised of two physicians and one attorney. On February 15, 1995, after hearing argument, the review panel recommended that Mercy's Board of Trustees ("Board of Trustees") uphold Manzetti's suspension. The review panel also recommended that Manzetti be given a provisional open-heart surgery privilege for one year subject to various conditions; these conditions included the requirement that Manzetti at all times must be assisted by a board certified surgeon and that Manzetti bring his volume of open-heart surgery cases to the recommended level of more than one hundred per year. The review panel noted that it recommended this provisional privilege only to the extent that the medical staff would agree to it.

On March 10, 1995, the Board of Trustees issued a resolution upholding Manzetti's suspension. The Board of Trustees rejected, however, the review panel's recommendation that Manzetti be granted provisional open-heart surgery privileges as it was not in the best interests of future patients. The Board of Trustees reasoned that the monitoring process was unlikely to bring about an improvement in Manzetti's skills as he had shown himself to be resistant to taking constructive criticism. The Board of Trustees also found it extremely unlikely that in one year, Manzetti would be able to build the volume of his open-heart surgeries to the required level as he had been unable to do so in any of the years in the preceding decade.

On February 2, 1995, prior to the issuance of the review panel's report, Manzetti and his professional corporation (collectively, "Appellants") commenced the instant action naming Mercy, the president of Mercy, and the physicians who were the members of the MEC as defendants (collectively, "Appellees"). The complaint contained ninety-nine counts, including breach of contract and defamation claims. Appellants requested both monetary and injunctive relief; all of the claims for monetary relief arose out of Appellees' participation in the peer review process.

After discovery commenced, Appellees moved for summary judgment. Appellees contended that the immunity provisions of the HCQIA precluded them from being held liable for monetary damages as all of Appellants' claims arose out of the peer review process. On November 12, 1996, the trial court granted partial summary judgment in favor of Appellees, and dismissed all...

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