Muzquiz v. W.A. Foote Memorial Hosp., Inc.

• Decision Date: 16 November 1995
• Docket Number: 94-1089 and 94-1420,Nos. 94-1088,s. 94-1088
• Citation: 70 F.3d 422
• Parties: 69 Fair Empl.Prac.Cas. (BNA) 540 Moses MUZQUIZ, Jr., M.D., Plaintiff-Appellant (94-1088), Cross-Appellee, Appellee, v. W.A. FOOTE MEMORIAL HOSPITAL, INC., Defendant-Appellee, Cross-Appellant (94-1089), Appellant (94-1420).
• Court: U.S. Court of Appeals — Sixth Circuit

Page 422

70 F.3d 422

69 Fair Empl.Prac.Cas. (BNA) 540

Moses MUZQUIZ, Jr., M.D., Plaintiff-Appellant (94-1088) Cross-Appellee, Appellee, v. W.A. FOOTE MEMORIAL HOSPITAL, INC., Defendant-Appellee Cross-Appellant (94-1089), Appellant (94-1420).

Nos. 94-1088, 94-1089 and 94-1420.

United States Court of Appeals Sixth Circuit.

Argued and Submitted May 18, 1995.

Decided Nov. 16, 1995.

Richard G. Brewer (briefed), Bloomfield Hills, MI, for Moses Muzquiz, Jr. M.D.

Gregory G. Drutchas, Susan Healy Zitterman (argued and briefed), Jeremiah J. Kenney, Brian R. Garves, Kitch, Drutchas, Wagner & Kenney, Detroit, MI, for W.A. Foote Memorial Hosp., Inc.

Before: JONES and NORRIS, Circuit Judges; DOWD, District Judge. ^*

NATHANIEL R. JONES, Circuit Judge.

Plaintiff Dr. Moses Muzquiz appeals the judgment for Defendant W.A. Foote Memorial Hospital, Inc. ("Hospital") in this action (No. 94-1088). The Hospital cross-appeals, arguing that this court should assess attorney fees and costs pursuant to the Health Care Quality Improvement Act ("HCQIA"), 42 U.S.C. Sec. 11113, for this appeal. (No. 94-1089). The Hospital also appeals the district court's post-judgment order denying its application for the imposition of costs and attorney fees under HCQIA against Dr. Muzquiz (No. 94-1420). These appeals and cross-appeal have been consolidated for consideration in this court. For the reasons that follow we affirm the decision of the district court, and we deny the Hospital's request for attorney fees and costs for this appeal.

I. Background

Dr. Muzquiz was born in Texas in 1932, is of Hispanic origin (Mexican-Indian), and graduated from a Mexican medical school in 1963. Dr. Muzquiz completed his residency in internal medicine/cardiology in 1968 and has performed invasive cardiology, including heart catheterizations, since that time.

In 1985, Dr. Muzquiz moved from Texas to Michigan and commenced a cardiology practice. From 1985-89, Dr. Muzquiz performed no cardiac catheterizations in Michigan, but did travel to Mexico for several weeks each year where he performed that procedure.

In January 1989, Dr. Muzquiz became a member of the provisional staff of Defendant Hospital, which is a not for profit institution. In late 1990, the Hospital was in the process of establishing a cardiac catheterization laboratory, which opened on January 1, 1991. ¹ In November 1990, Dr. Muzquiz, along with ten other cardiologists, applied for invasive cardiology privileges at the Hospital, which would become available upon the opening of the cardiac catheterization laboratory. Dr. Muzquiz was the only applicant of Mexican-Indian extraction, and he was also the oldest applicant. ²

At the time Muzquiz applied, the Hospital had adopted "Guidelines for Credentialling in Invasive Cardiology," that had been promulgated by the American College of Cardiology. As relevant to the instant case, the Guidelines state the following:

3. In addition to meeting the basic qualifications (above), a physician who seeks to independently perform invasive cardiology procedures shall meet the following specific requirements:

a. (i) Board certification

or

(ii) Active board candidacy

or

(iii) If a physician who completed his cardiovascular disease/cardiology fellowship training 4 or more years before ...

or

(iv) If a graduate of medical school prior to July 1, 1975,

--primary devotion for ten or more years to the practice of cardiology with at least 25% of the practice devoted to performance of invasive cardiology procedures;

--holding of diagnostic catheterization privileges in good standing at an institution with a recognized invasive cardiology program;

--certification by the Program Director(s) of the invasive cardiology program(s) where currently practices of: successful performance of at least 1,000 invasive cardiology procedures (at least 500 of which were as primary physician), invasive cardiology morbidity and mortality within generally accepted limits (actual figures must be stated) and the absence of any disciplinary action related to the delivery of medical services

b. A favorable review [of] medical charts and films of patients for whom the physician served as primary physician for diagnostic catheterizations in the past year selected at random. The number of charts, the manner of random selection, and the reviewers shall be determined by the Service Director. If there is an expense of such review, it shall be borne by the physician seeking privileges. A physician who is board certified or an active board candidate, or whose skills are known on a firsthand basis by the Service Director may be exempted from this requirement in the discretion of the Service Director.

c. A favorable recommendation and certification of successful performance of at least 200 diagnostic catheterization procedures in the 4 years immediately preceding application by the Program Director(s) of the institution(s) where he currently holds clinical privileges in invasive cardiology and/or served a cardiovascular disease/cardiology fellowship (in the preceding year).

J.A. at 768-70, 1021-23. ³ Having graduated from medical school in 1963, and having completed his residency in internal medicine/cardiology in 1968, Dr. Muzquiz, in addition to satisfying certain basic requirements not at issue in this case, had to satisfy requirements 3a(iv), b, & c, to qualify for invasive cardiology privileges.

The Hospital provides the following description of the general credentialling process at the hospital:

The credentialling process (whereby privileges are granted after an investigation by the hospital to ensure physician qualifications and competency), is statutorily mandated of hospitals and is conducted in order to ensure patient safety and the quality of care rendered in hospitals.

At Foote Hospital, as at most hospitals, the credentialling process for granting clinical privileges is established by the Medical Staff bylaws. The bylaws provide that a physician's application for privileges is submitted to the Medical Staff Coordinator who collects the initial documentation and evidence. The Coordinator then forwards the materials on to the Chairperson of the Department in which privileges are being sought (here the Department of Internal Medicine, of which Dr. Hurtado, who is of Hispanic descent, was Chair), to the Credentials Committee, and to the President of the Hospital (Mr. Paul Tejada, also of Hispanic descent).

Upon receipt and evaluation of all necessary information, the Internal Medicine Department (through the Internal Medicine Department's Executive Committee) and the Credentials Committee then make recommendations to the Medical Executive Committee, which is composed of the leadership of the Medical Staff. The Medical Executive Committee in turn then makes a recommendation to the Board of Trustees. Only the Board of Trustees has the power to make a final decision as to actually grant or deny privileges. Pursuant to the hospital bylaws, and as at all hospitals, the burden rests upon the physician applicant to obtain the required information for the credentialling process.

Hosp. Br. at 6-7 (references to the record omitted).

At the core of the instant dispute is the difficulty Dr. Muzquiz encountered in trying to meet requirement 3b. ⁴ Dr. Muzquiz had performed all of his recent cardiac catheterizations during his trips to Mexico. Consequently, to comply with requirement 3b, it was necessary to obtain the films and charts of the catheterizations he had performed in the past year from the hospital in Mexico. The Internal Medicine Executive Committee determined that ten films and charts needed to be reviewed. On September 18, 1991, already almost a year after Dr. Muzquiz had applied for catheterization privileges, Dr. Frank Morales, Administrator and CEO of the hospital in Mexico forwarded the English translation of ten patient charts. See J.A. at 1098-1124.

The Credentials Committee then sent all of Dr. Muzquiz's information to an outside consultant, Dr. Fierens, for a review and recommendation regarding Dr. Muzquiz's request for catheterization privileges. Dr. Fierens recommended review of properly authenticated catheterization films of Dr. Muzquiz's past four years experience prior to making a final assessment of Dr. Muzquiz's qualifications. J.A. at 1135-36.

On December 11, 1991, the Credentials Committee informed Dr. Muzquiz that they needed (1) a written explanation from Dr. Morales as to why the actual case logs and copies of the films corresponding to the ten translated charts sent were not available, and (2) copies of the actual medical records that had been translated. J.A. at 1141-42. Upon receipt and review of that documentation, the Committee was prepared to recommend Dr. Muzquiz for provisional cardiac catheterization privileges conditioned on a favorable evaluation of his first ten catheterization procedures. Id. In a letter dated December 31, 1991, Dr. Morales explained that the requested films were unavailable because the hospital followed a policy of giving the films to the patients at the time of discharge. J.A. at 1156. With respect to the original Spanish records of the charts, Dr. Morales explained that it was the policy of the hospital not to release the records. Id. He stated, however, that he had prepared the English translations himself, and that they were exact translations of the Spanish records. Id. The Credentials Committee determined that this was a satisfactory explanation and went forward with its recommendation.

On January 15, 1992, however, the Medical Executive Committee voted to reject the recommendation of the Credentials Committee with respect to the ten proctored cases, and instead recommended proctoring Muzquiz' first twenty-five cases. As noted in the minutes of that committee meeting,

[t]his recommendation is based on information from the Journal of the American College of Cardiology, November 1, 1991, Volume 18, Number 5, Page 1166:

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