Ritten v. Lapeer Regional Medical Center
| Decision Date | 11 March 2009 |
| Docket Number | No. 07-10265.,07-10265. |
| Parties | Gary M. RITTEN, M.D., Plaintiff, v. LAPEER REGIONAL MEDICAL CENTER, McLaren Health Care Corporation, Barton P. Buxton, Darlene F. Daly, D.O., Lisa M. Allen, D.O., Jan Gromada, D.O., and Scott Mango, R.N., Defendants. |
| Court | U.S. District Court — Eastern District of Michigan |
Barry S. Fagan, Darcie R. Brault, Albert J. Dib, Dib, Fagan, Royal Oak, MI, Geoffrey N. Fieger, Jeffrey A. Danzig, Victor S. Valenti, Fieger, Fieger, Southfield, MI, for Plaintiff.
Carol L. Fossee, Payne, Broder, Bingham Farms, MI, Anthony G. Arnone, Kitch, Drutchas, Michael J. Lavoie, Butzel Long, Detroit, MI, for Defendants.
Plaintiff Gary M. Ritten, M.D. commenced this case in this Court on January 17, 2007, asserting a claim of retaliation under the federal Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. § 1395dd, against Defendant Lapeer Regional Medical Center ("LRMC") and its parent company, Defendant McLaren Health Care Corporation, and also asserting state-law claims of tortious interference, defamation, and breach of contract against Defendant LRMC and subsets of the individual Defendants—a group that includes Barton P. Buxton, the president and chief executive officer of LRMC; Scott Mango, R.N., the chief nursing officer for LRMC; and Darlene F. Daly, D.O., Lisa M. Allen, D.O., and Jan Gromada, D.O., three obstetricians who hold clinical privileges at LRMC.1 Each of Plaintiff's various claims arises from the suspension of his clinical privileges to treat patients at LRMC, a decision that was initially made by Defendant Buxton in September of 2005, and that was upheld by LRMC's Board of Trustees in September of 2006 following a lengthy hearing process. This Court's subject matter jurisdiction rests upon Plaintiff's assertion of a claim arising under federal law. See 28 U.S.C. §§ 1331, 1367(a).
Through a motion filed on February 27, 2008, Defendants now seek an award of summary judgment in their favor on all of Plaintiff's federal and state-law claims. First and foremost, Defendants contend that damages may not be awarded to Plaintiff under any of his several theories of liability, in light of the immunity conferred under the federal Health Care Quality Improvement Act ("HCQIA"), 42 U.S.C. § 11101 et seq., for decisions reached in a hospital's professional review process. In addition, Defendants argue that certain of Plaintiff's claims are legally deficient, and that Plaintiff has failed as a matter of law to provide sufficient evidentiary support for one or more required elements of each of his claims.
Defendants' motion has now been fully briefed by the parties,2 and the Court heard oral argument on this motion on December 5, 2008. Having thoroughly reviewed the parties' briefs, the accompanying exhibits, and the record as a whole, and having considered the arguments of counsel at the December 5 hearing, the Court now is prepared to rule on Defendants' motion. This Opinion and Order sets forth the Court's rulings on this motion.
Plaintiff Gary M. Ritten, M.D. is a board certified obstetrician/gynecologist (Ob/Gyn) who has been licensed to practice medicine in Michigan since 1988. He initially was granted medical staff privileges at the Defendant Lapeer Regional Medical Center ("LRMC") in 1999, and was reappointed to the medical staff in September of 2001 and again in September of 2003. This lawsuit arises from the summary suspension of Plaintiff's staff privileges in September of 2005, followed by a permanent suspension of these privileges in September of 2006.
Defendant LRMC is an acute care hospital located in the city of Lapeer, Michigan, and is a wholly owned subsidiary of Defendant McLaren Health Care Corporation. Defendant Barton P. Buxton has been the president and chief executive officer of LRMC since December of 2003. At all relevant times, the chief nursing officer at LRMC was Defendant Scott Mango, R.N. The remaining Defendants—Darlene F. Daly, D.O., Lisa M. Allen, D.O., and Jan Gromada, D.O.—are Ob/Gyns who, like Plaintiff, held staff privileges to treat patients at LRMC, and who allegedly took actions that contributed to the loss of Plaintiff's staff privileges.
Clinical staff privileges are granted at LRMC for two-year periods, and are renewed through a process known as "reappointment" or "recredentialing." This process begins with a review by the Medical Staff Credentials Committee of various materials, including information provided by the Quality Department. The Credentials Committee forwards its recommendation to the Medical Executive Committee, which in turn makes its recommendation to the Board of Trustees, the final authority on the matter.
As noted, Plaintiff's staff privileges had been renewed in September of 2001 and September of 2003, so he was due to go through the reappointment process in September of 2005. This process had been revised in the summer of 2005 with the arrival of a new Director of Quality, Jo Weth. Among other changes instituted by Weth and other administrative officials, including Defendant Buxton, it was determined that the Credentials Committee should be given additional historical data for each physician being considered for recredentialing. This additional data consisted of a "grid" that summarized all of the "occurrence" and "incident" reports that had been made about a given physician over the past five years.
Upon preparing these grids for Plaintiff and the other physicians (approximately 25 in number) who were scheduled for recredentialing in September of 2005, Weth discovered that Plaintiff was the subject of three times as many reports as any other physician under review.3 Weth further determined that the 88 reports about Plaintiff comprised 21.6 percent of the reports about all LRMC physicians (numbering approximately 200) over the past five years. In addition, Weth prepared a chart of "patient safety indicators" for each physician who was scheduled for recredentialing, and this chart revealed a trauma rate of 47.46 percent for Plaintiff when he delivered babies using a vacuum extractor, versus a national trauma rate of 21.9 percent and a trauma rate for other LRMC Ob/Gyns of 22.9 percent.
Approximately two weeks before these materials were to be presented to the Credentials Committee at its scheduled September 2, 2005 meeting, Weth, Buxton, and two other individuals—Judy Trotter, the manager of the Medical Staff Office, and Dr. Charles Franckowiak, the Chair of the Credentials Committee—met to ensure that all of the necessary information was ready for presentation at the forthcoming committee meeting. Upon seeing the reports for Plaintiff, Dr. Franckowiak expressed a desire to discuss these reports with Dr. Olan Dombroske, the Chair of the Quality Committee, and a meeting was convened among Dr. Franckowiak, Dr. Dombroske, Buxton, and Weth. Following this meeting, it was determined that an outside obstetrician should review the materials concerning Plaintiff. The physician Buxton chose for this task was Thomas Petroff, D.O., who worked at another hospital affiliated with Defendant McLaren, and who had served along with Buxton on a committee that addressed issues common to all McLaren affiliates.
Upon receiving the reports for Plaintiff, Dr. Petroff asked to review the medical records for roughly 90 of Plaintiff's patients. Dr. Petroff explained at his deposition that his review focused principally upon patients who had undergone vaginal deliveries of babies with instruments, including a vacuum extractor and forceps. Through this review, Dr. Petroff concluded that the trauma rate shown on the "patient safety indicators" report for Plaintiff was too high, and reflected errors in coding the procedures used on Plaintiff's patients.4 Nonetheless, Dr. Petroff's review disclosed a different concern—namely, that Plaintiff's rate of vacuum delivery appeared to be high, and that the medical records provided to Dr. Petroff failed to disclose Plaintiff's justification for this technique, which tended to pose more risk to the mother and baby. Thus, Dr. Petroff reported back to Buxton his concern that it was difficult to determine whether Plaintiff was adhering to a proper standard of care, in light of the lack of justification in the records Dr. Petroff had reviewed for Plaintiff's seemingly high use of vacuum deliveries. (See Defendants' Motion, Ex. 8, Petroff Dep. at 140.)5
On Friday, September 2, 2005, Buxton summarily suspended Plaintiff's privileges at LRMC. In a letter sent to Plaintiff that day, Buxton stated:
It has come to our attention that your obstetrical practice at Lapeer Regional Medical Center poses a substantial likelihood of immediate injury to the health of patients. Preliminary review of a large number of your cases demonstrated frequent deviation from patient safety indicators in your treatment of obstetrical patients and in your delivery of babies. In particular and without limitation, these deviations included numerous, unnecessary instrument-assisted deliveries.
(Plaintiff's Response, Ex. D-13, 9/2/2005 Letter.) Buxton testified that he spoke to Dr. Petroff before making this decision, and that he also had heard Dr. Petroff's concerns in a telephone conference call with Dr. Petroff and Dr. Franckowiak. (See Defendants' Motion, Ex. 4, Buxton Dep. at 231.)6 Yet, while Dr. Petroff confirmed at his deposition that he was in contact with Buxton in the days leading up to September 2 and had expressed a general concern about what he had learned to...
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