Patel v. Midland Memorial Hosp. and Medical Center

• Decision Date: 10 July 2002
• Docket Number: No. 00-51265.,00-51265.
• Citation: 298 F.3d 333
• Parties: P.V. PATEL, M.D., individually; P.V. Patel, M.D., A Professional Association; The Heart Center; Echo Lab Incorporated; Associates of Midland Cardiovascular and Internal Medicine, A Professional Association, also known as Midland Cardiovascul, Plaintiffs-Appellants-Cross-Appellees, v. MIDLAND MEMORIAL HOSPITAL AND MEDICAL CENTER; et al., Defendants, Midland Memorial Hospital and Medical Center; Memorial Heart and Vascular Institute; Permian Cardiology Group; Stephen Brown, M.D.; Michael Miller, M.D.; Jay Mendez, M.D.; Donald Loveman, M.D.; Harold Rubin, Defendants-Appellees-Cross-Appellants.
• Court: U.S. Court of Appeals — Fifth Circuit

298 F.3d 333

P.V. PATEL, M.D., individually; P.V. Patel, M.D., A Professional Association; The Heart Center; Echo Lab Incorporated; Associates of Midland Cardiovascular and Internal Medicine, A Professional Association, also known as Midland Cardiovascul, Plaintiffs-Appellants-Cross-Appellees, v. MIDLAND MEMORIAL HOSPITAL AND MEDICAL CENTER; et al., Defendants Midland Memorial Hospital and Medical Center; Memorial Heart and Vascular Institute; Permian Cardiology Group; Stephen Brown, M.D.; Michael Miller, M.D.; Jay Mendez, M.D.; Donald Loveman, M.D.; Harold Rubin, Defendants-Appellees-Cross-Appellants.

No. 00-51265.

United States Court of Appeals, Fifth Circuit.

July 10, 2002.

Rehearing Denied August 6, 2002.

COPYRIGHT MATERIAL OMITTED

David W. Townend (argued), Brown, Brown, Chandler & Townend, Garland, TX, for Plaintiffs-Appellants-Cross-Appellees.

John L. Murchison, Jr. (argued), Alison L. Smith, Gwendolyn Johnson Samora, Vinson & Elkins, Houston, TX, Ted M. Kerr, Kerr & Ward, Midland, TX, for Midland Memorial Hosp. and Medical Center, Memorial Heart and Vascular Institute, Mendez, Loveman and Rubin.

Scott Patrick Stolley, George C. Chapman, Christopher Lee Barnes (argued), Thompson & Knight, Dallas, TX, for Permian Cardiology Group, Brown and Miller.

Appeals from the United States District Court for the Western District of Texas.

Before JONES, EMILIO M. GARZA and STEWART, Circuit Judges.

EMILIO M. GARZA, Circuit Judge:

P.V. Patel, M.D., ("Dr.Patel") filed suit in district court against Midland Memorial Hospital and several of its doctors (collectively "the Defendants") for claims arising out of the hospital's summary suspension of all of his clinical privileges in January 1999.¹ Specifically, Dr. Patel alleged that the Defendants, by participating in the suspension of his privileges: (1) denied him pre-suspension due process in violation of 42 U.S.C. § 1983 (2000); (2) engaged in racial discrimination in violation of 42 U.S.C. § 1981 (2000); (3) engaged in an illegal monopoly and attempted to monopolize in violation of 15 U.S.C. §§ 1 & 2 (2000) and TEX. BUS. & COM.CODE ANN. § 15.05 (Vernon 2001); and (4) engaged in conduct that constituted breach of contract, defamation, and interference with contractual relationships. The district court granted the Defendants' motion for summary judgment on all of Dr. Patel's claims. Dr. Patel now appeals on the ground that genuine issues of material fact exist with respect to all of his claims. The Defendants cross-appeal arguing that under the Health Care Quality Improvement Act of 1986 (HCQIA), 42 U.S.C. §§ 11101-11152 (2000), they are immune from all of Dr. Patel's claims, except for his civil rights claims, and are entitled to reasonable attorneys' fees.

I

Dr. Patel is a board-certified cardiologist who specializes in invasive and interventional cardiology.² He joined the staff of Midland Memorial Hospital ("Midland"), a public hospital, in 1982. While at Midland, he continuously expanded his practice by obtaining new clinical privileges and increasing the volume of procedures he performed. By the mid-1990s, he performed one of the highest numbers of cardiac interventions of the hospital staff. Dr. Patel also expanded his practice outside of Midland by maintaining a practice at Odessa Medical Center and opening his own cardiac cath labs and primary care clinics, at times competing with Midland and members of its staff. For fifteen years, Dr. Patel appears to have practiced successfully without any significant problems.

Two incidents in 1997 and 1998, however, drew the attention of Midland's Medical Executive Committee (MEC) to Dr. Patel's practice. In November 1997, the MEC investigated an altercation between Dr. Patel and a nurse in front of a patient just before a procedure. Questions were raised as to whether Dr. Patel properly secured the patient's consent to continue with the procedure and whether he waited for a new nurse to arrive before beginning the procedure. The MEC ultimately suspended Dr. Patel's clinical privileges for fourteen days and ordered him to undergo a behavioral evaluation.

Six months later, the MEC received its second complaint regarding Dr. Patel's practice. The chairman of Midland's Department of Radiology reported to the MEC that Dr. Patel had "an inordinate number of catastrophic outcomes" among his recent cases of noncardiac peripheral vascular interventions. The MEC directed an ad hoc committee of eight cardiology, vascular surgery, and radiology physicians to review Dr. Patel's problematic cases. After reviewing three cases handled by Dr. Patel in the preceding eight months, the committee reported several concerns to the MEC. Specifically, the committee cited concerns regarding Dr. Patel's technical performance of procedures, his intra-procedure decisionmaking, and the accuracy of his documentation. The MEC then met to discuss the cases and the committee's report, and voted unanimously to revoke Dr. Patel's noncardiac peripheral privileges. While a post-suspension hearing was pending, the MEC sought independent review of three of Dr. Patel's cases by two outside experts. Both confirmed that the revocation was appropriate.³

At the same meeting during which it revoked Dr. Patel's peripheral privileges, the MEC charged the Cardiovascular Committee with reviewing Dr. Patel's diagnostic and interventional cardiac procedures "to ensure that a similar pattern is not emerging." In response, Stephen Brown, M.D., Chair of the Cardiology Committee, reviewed the last six fatalities in cases handled by Dr. Patel. In a report made to John Foster, Jr., M.D., Chairman of the MEC,⁴ Dr. Brown noted several concerns with each of the cases and concluded that Dr. Patel's management of them warranted further investigation. He recommended sending the cases for outside review to avoid any issues of bias on the part of Dr. Patel's competitors. As a result, Dr. Foster sent ten of Dr. Patel's cardiology cases to Richard A. Lange, M.D., Director of the Cardiac Catheterization Laboratory at the University of Texas Southwestern Medical Center at Dallas, for outside review.

While Dr. Lange conducted his outside review, the Cardiovascular Committee continued its inside review. At its bi-monthly meeting to review the morbidity/mortality cases of cardiologists at the hospital, the Committee reviewed Dr. Patel's recent morbidity/mortality cases and noted a "high concentration of severe complications."⁵ The Committee then forwarded a report to Dr. Foster stating that Dr. Patel was "not operating in a safe fashion" while performing certain coronary procedures and that the situation was "very dangerous."⁶ The report again recommended outside review by an unbiased third party, and potentially a reevaluation of Dr. Patel's privileges depending on the outcome of that report.

Dr. Foster then requested that the Medical Control Committee (MCC)⁷ review the Cardiovascular Committee reports regarding Dr. Patel's cardiology cases. The MCC met to discuss the cases, but decided to wait for the results of Dr. Lange's review, which were expected within the week, before acting. One week later, Dr. Lange reported to Dr. Foster that six of the ten patients whose cases he reviewed died as a "direct result of an interventional procedure" that was performed by Dr. Patel: (a) without clear indication, (b) with poor technical skills, or (c) in coronary vessels poorly suited for the procedure. Dr. Lange also found problems in the cases that suggested poor medical judgment. Two days later, the MCC reviewed Dr. Lange's report and voted to recommend the suspension of all of Dr. Patel's privileges. Upon the MCC's request, the MEC met to consider the evidence and the recommendation for suspension. After deliberation, the MEC unanimously approved the MCC's recommendation that Dr. Patel's privileges be summarily suspended.⁸

Dr. Patel was notified of his suspension by letter. The MEC then informed him that he had a right to a post-suspension hearing under Midland's Fair Hearing Plan. Dr. Patel immediately requested a full due process hearing and the hospital offered to provide one two weeks later. Thereafter, an Ad Hoc Hearing Committee ("Hearing Committee") held ten meetings in which Dr. Patel and the hospital submitted documentary evidence and testified regarding the events leading up to the suspension and the hospital's continued concerns about the quality of Dr. Patel's practice. After hearing testimony from eight physicians and reviewing over 125 exhibits, the Hearing Committee ultimately concluded that Dr. Patel was not a danger to his patients. Instead, the Hearing Committee faulted Dr. Patel's inadequate documentation — including his failure to note on patients' records major complications that occurred during procedures — for the questionable appearance of his cases. As a result, the Hearing Committee recommended that Dr. Patel's clinical privileges be restored, but that he be placed on probation for six months to ensure that he prepare timely and accurate medical records for each of his patients at Midland. Although the Hearing Committee recommended restoration of his privileges, it also held that there were "reasonable grounds" for the action taken by the various doctors and hospital committees reviewing Dr. Patel's cases prior to the suspension. In addition, the Hearing Committee held that the participating doctors acted "in reasonable belief that such action was in furtherance of quality health care," and "in reasonable belief that [action] was warranted by the facts known after a reasonable effort to obtain the facts." Finally, the Hearing Committee held that Dr. Brown, Dr. Miller, and Dr. Lange — the authors of three of the reports reviewing Dr. Patel's cases — "acted at all times without malice, without fraudulent or wrongful intent, and without any ulterior or improper motive."⁹

After his privileges were restored, Dr. Patel filed suit against Midland, four of...