Pfenninger v. Exempla, Inc.
| Decision Date | 18 September 2000 |
| Docket Number | No. CIV. A. 99-WY-1883-CB.,CIV. A. 99-WY-1883-CB. |
| Citation | 116 F.Supp.2d 1184 |
| Parties | Mark W. PFENNINGER, M.D., and Womens Health Care Specialists, P.C., Plaintiffs, v. EXEMPLA, INC., Exempla Lutheran Medical Center, Exempla Medical Group of Colorado, Colorado Preferred Physicians Organization, Inc., Health Care Select, Inc., R. Douglas Hunter, M.D., and Phillip Burstein, M.D., Defendants. |
| Court | U.S. District Court — District of Colorado |
Brice A. Tondre, Tondre & Schumacher, PC, Denver, CO, for Plaintiff.
Frederick Y. Yu, Yu, Stromberg, Cleveland, OH, P.C., Denver, CO, Gregory Clayton Parham, Yu, Stromberg, Cleveland, OH, P.C., Wheat Ridge, John D. Shively, Christopher Beall, Faegre & Benson, Kathleen M. Shea, John O. Martin, P.C., Denver, CO, Patrick O'Rourke, Montgomery, Little and McGrew, Englewood, CO, for Defendants Exempla, Inc., Exempla Lutheran Medical Center, R. Douglas Hunter, M.D., Phillip Burstein, M.D. Colorado Preferred Physicans Organization, Inc., and Health Care Select, Inc. Francis Major, M.D. Westside Womens Care, Gayle Crawford, M.D., Bonita Kolrud, M.D. and Daniel Saunders, M.D.
Plaintiffs Mark W. Pfenninger, M.D. and Women's Health Care Specialists, P.C. bring this action against the above named Defendants alleging a per se violation of Section 1 of the Sherman Act, 15 U.S.C. § 1, violations of Dr. Pfenninger's due process and equal protection rights, defamation, and trade disparagement. Plaintiffs also allege tortious interference with contractual and business relations against Defendants Exempla, Inc., Exempla Lutheran Medical Center, and Drs. Hunter and Burstein. The Court exercises jurisdiction over this action pursuant to 28 U.S.C. §§ 1331, 1337, 1343, and 1367.
The matter is currently before the Court on the following motions: (1) Defendants Exempla, Inc., Exempla Lutheran Medical Center, Exempla Medical Group of Colorado, and Drs. Hunter and Burstein's (collectively referred to as "Exempla Defendants") motion to dismiss or for summary judgment, (2) Defendants Colorado Preferred Physicians Organization, Inc. and Health Care Select, Inc.'s motion to dismiss or for summary judgment, (3) Defendants Colorado Preferred Physicians Organization, Inc. and Health Care Select, Inc.'s motion for partial summary judgment on Plaintiffs' due process claim, and (4) Plaintiffs' cross-motion for summary judgment on their due process claim. Pursuant to the Court's Order of July 26, 2000, all motions have been converted to motions for summary judgment to be disposed of pursuant to Rule 56 of the Federal Rules of Civil Procedure, and the parties were given opportunity to supplement their motions and responses. Now, having considered the parties' briefs and oral arguments, and being fully advised in the premises, the Court hereby FINDS and ORDERS as follows:
Background
The following facts are undisputed unless otherwise indicated. Dr. Pfenninger practiced obstetrics and gynecology in the Denver metropolitan area from approximately 1965 to 1998. At all times relevant to this action, Dr. Pfenninger operated his practice through Women's Health Care Specialists, P.C., and held medical staff privileges at Exempla Lutheran Medical Center, where he conducted approximately seventy percent of his practice.
Defendants Colorado Preferred Physicians Organization, Inc. ("CPPO") and Health Care Select, Inc. ("HCS") are independent physician associations ("IPAs") that function as non-profit corporations whose members include licensed physicians and other health care providers. These organizations negotiate with health insurance carriers and other health care payor organizations to establish arrangements for their member physicians to be considered preferred providers by the payors. Dr. Pfenninger was a member of both CPPO and HCS until his memberships were suspended in or around April 1998.
Defendant Exempla, Inc. ("Exempla") is a non-profit heath organization that owns and operates various healthcare delivery facilities including Exempla Lutheran Medical Center ("Lutheran"). Exempla also employs a number of primary care physicians throughout the Denver metropolitan area, collectively referred to as Exempla Medical Group, Inc. At all times relevant to this action, Defendants Philip Burstein, M.D. and Robert Hunter, M.D. served as Vice President of Medical Affairs and Medical Staff President at Lutheran, respectively.
In October 1997, an ad hoc panel of the Lutheran Medical Staff Quality Improvement Committee ("MSQIC") reviewed one of Dr. Pfenninger's cases. Drs. Burstein and Hunter served on the ad hoc panel along with physicians Gayle Crawford, Robert Kongisberg, Ira Rifkin and Diane Stone. The MSQIC found that Dr. Pfenninger had performed a dilatation and curettage procedure ("D & C") in an examination room without benefit of proper monitoring equipment or an anesthesiologist. The MSQIC concluded that an examination room was an inappropriate location for a D & C and that Dr. Pfenninger's decision to perform the D & C under such circumstances "posed a great risk to the patient." The MSQIC informed Dr. Pfenninger of its determination and forwarded its concerns to the Credentials Committee. Dr. Burstein served on the Credentials Committee along with physicians Bruce Waring, Dave Wahl, Jennifer Caskey, Howard Netz, Barbara Gablehouse, and Jim Thompson. At the time, Dr. Thompson also served as President of CPPO, and as a member of HCS's Board of Directors. The Credentials Committee considered the matter and forwarded to the Medial Staff Executive Committee (the "Executive Committee," or, the "Committee") a recommendation that Dr. Pfenninger's medical staff privileges be suspended for twenty-nine days. Drs. Crawford and Hunter served as members of the Executive Committee along with physicians B. Abernathy, John Breckinridge, Robert Brown, Mark Conklin, James Hopfenbeck, P. Knott, C. Murphy, W. Saber, and C. Traut.
In February 1998, acting on the recommendation of the Credentials Committee, the Executive Committee reviewed Dr. Pfenninger's patient care history dating from 1977. The Committee also reviewed a summary of Dr. Pfenninger's actions in performing the D & C, which summary was presented by Dr. Crawford, then Chair of Lutheran's Ob/Gyn department, and a letter from Dr. Pfenninger regarding his conduct in that instance. The Executive Committee identified several concerns regarding Dr. Pfenninger's decision to perform the D & C under the prevailing circumstances, and noted a historical pattern of similar problems with Dr. Pfenninger's patient care. At the close of the session, the Committee voted to adopt the recommendation of the Credentials Committee and to further impose a one-year term of probation to follow the twenty-nine day suspension. Dr. Hunter informed Dr. Pfenninger of the Committee's decision via letter dated March 10, 1998. The letter summarized the Committee's findings and recommendations and informed Dr. Pfenninger of his right to challenge the recommendations under Lutheran's Fair Hearing Plan.
On April 1, 1998, Dr. Hunter sent a second letter informing Dr. Pfenninger that Lutheran Medical Staff had identified two recent, additional instances of perceived substandard care provided by Dr. Pfenninger. The letter accused Dr. Pfenninger of exercising "poor judgment" in undertaking "a procedure on a terminally ill patient that was beyond [his] capabilities." According to Dr. Hunter, Dr. Pfenninger (Id.)
With regard to the second case, the letter accused Dr. Pfenninger of acting "to hasten a delivery by using the vacuum and then a procto-episiotomy and forceps when delivering a 5 pound, 10 ounce baby." (Id.) Dr. Hunter judged the instance as one "in which [Dr. Pfenninger's] impatience resulted in a more aggressive than necessary surgical procedure (procto-episiotomy), a procedure that is painful and rarely indicated in modern day obstetrics." (Id.)
Viewing these additional cases of perceived substandard care in the context of both Dr. Pfenninger's previous patientcare problems, and Dr. Pfenninger's own medical condition (Dr. Pfenninger had undergone cancer surgery in September 1997), Dr. Hunter recommended a leave of absence, during which Dr. Pfenninger's medical privileges at the hospital would be suspended. Dr. Hunter informed Dr. Pfenninger that if he (Dr. Pfenninger) declined the leave of absence, the Executive Committee would summarily suspend all hospital privileges pending an appeal.
In response to Dr. Hunter's letter, Dr. Pfenninger requested a hearing before the Executive Committee. The Executive Committee granted Dr. Pfenninger's request and convened a hearing on April 2, 1998. Committee members present at the April 2, 1998 hearing were Drs. Hunter, Crawford, Breckinridge, Brown, and Hopfenbeck, and Drs. Dennis Clifford, Mark Conklin, Joseph Morgan, Vernon Ritzman, Malcolm Tarkanian, and Brian Ridge. Also present were Dr. Pfenninger, Dr. Pfenninger's attorney, and Dr. William Goddard. Dr. Hunter provided a chronology of events involving Dr. Pfenninger and reviewed the Committee's previous session and recommendation. Committee members reviewed Dr. Hunter's April 1, 1998 letter to Dr. Pfenninger and the medical charts of cases discussed in the letter. The Committee then heard testimony from Drs. Pfenninger and Goddard, and from Dr. Pfenninger's attorney. Dr. Goddard's testimony generally supported the view that Dr. Pfenninger's patient care met appropriate Ob/Gyn standards of care. Dr. Goddard specifically noted that while a...
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