Rogers v. Columbia/Hca of Central Louisiana, Inc.
| Decision Date | 09 June 1997 |
| Docket Number | Civil Action No. 96-2839. |
| Parties | Charles ROGERS, v. COLUMBIA/HCA OF CENTRAL LOUISIANA, INC., et al. |
| Court | U.S. District Court — Western District of Louisiana |
A. Sale Smith, David A. Johnson, Smith Farrar & Johnson, Ball, LA, for Charles Rogers MD, M.D.
Scott Holland Crawford, Crawford & Lewis, Baton Rouge, LA, Mary G. Erlingson, Matchett Verbois Futrell & Henchy, Baton Rouge, LA, for Columbia/HCA of Central Louisiana, Inc., Philip Lindsay, M.D., George Hovantanian, M.D., J. Michael Conerly, M.D., David Rayburn, M.D., John McCabe, M.D., Rapides Foundation.
Scott Holland Crawford, Crawford & Lewis, Baton Rouge, LA, for Central Louisiana Healthcare System Ltd. Partnership.
RULING
As the stay of this matter is lifted, we consider again the defendants' motion for summary judgment. This case requires the court to apply a maxim stated by the English philosopher John Donne: "I observe the physician with the same diligence as he the disease."1 We apply the federal Health Care Quality Improvement Act of 1986 (the "HCQIA"), 42 U.S.C. § 11101, et seq., which establishes immunity for physician peer review committee actions in qualifying circumstances.2 This suit is precisely the type that the HCQIA is intended to prevent. For the reasons that follow, the motion is GRANTED and the suit DISMISSED.
Plaintiff Charles Rogers ("Rogers"), a licensed physician specializing in the sub-specialty of bariatric surgery, seeks relief under seven counts arising from the one-year revocation of his bariatric surgery privileges at Rapides Regional Medical Center ("Rapides Regional"), a medical facility operated by defendants Columbia/HCA of Central Louisiana, Inc. and Central LA Healthcare Systems Limited Partnership (together "RRMC") in Alexandria, Louisiana. Named as defendants are RRMC and physicians Philip Lindsay, George Hovnatanian, J. Michael Conerly, David Rayburn, and John McCabe (collectively the "Doctor Defendants"). Each Doctor Defendant is a surgeon on the "Active Medical Staff" at Rapides Regional. The Doctor Defendants comprised a professional peer review committee that evaluated Rogers and recommended the revocation of his bariatric surgery privileges for one year. The Medical Executive Committee adopted the peer committee's recommendation.
The facts of this case, including the administrative remedies available to Rogers, were ably reported in our first consideration of the defendants' alternative motion to dismiss or for summary judgment. Rogers v. Columbia/HCA of Central Louisiana, Inc., 961 F.Supp. 960 (W.D.La.1997). We incorporate our prior ruling and repeat selected discussions solely for the ease of the reader.
In sum, Rogers asserts multiple antitrust violations of the Sherman Act (Counts One, Two, and Three), that La.Rev.Stat. Ann. § 13:3715.3 is unconstitutional (Count Four), violation of 42 U.S.C. § 1983 (Count Five), violation of the HCQIA, § 11111 (Count Six), and defamation (Count Seven). Rogers seeks injunctive, declaratory, and compensatory relief.
On 27 December 1996 we denied Rogers' request for a temporary restraining order or preliminary injunction. Defendants moved alternatively to dismiss or for summary judgment. On 19 February 1997 we ordered the action stayed pending Rogers' completion of available administrative remedies. The basis for our ruling was the doctrine of primary jurisdiction.
Pursuant to the administrative remedies available to Rogers under the Rapides Regional Medical Staff Bylaws (the "Bylaws"), an administrative hearing concerning the revocation of Rogers' bariatric surgery privileges was held on 5-6 February 1997. The "Fair Hearing Panel" (the "Panel") consisted of physicians Vanda Davidson, Gary Manuel, Robert Moore, Lance Templeton, and Renick Webb. The Panel, in a recommendation issued 21 February 1997, found that the actions by the Medical Executive Committee did have a basis in fact and the conclusions drawn were not capricious or arbitrary. Specifically, the Panel found that "[c]omplication rates were above acceptable rates for the community," and that Rogers "was naive in his assessment of patients for surgery and the clinical capabilities of the hospital's surgery and support facilities." The Panel also found that the recommendation of the Medical Executive Committee was arbitrary as to the length of time set for Rogers' suspension. The Panel recommended that Rogers' bariatric surgery privileges instead should be suspended until he completed at least four weeks of additional training in bariatric surgery. The Panel further recommended that reinstatement of Rogers' bariatric surgery privileges should be subject to: (1) establishment of patient selection criteria by a consulting bariatric specialist; (2) preoperative consultation by telephone with the consulting specialist until the Medical Executive Committee is confident of Rogers' skills and judgment: (3) critical clinical review of all bariatric surgeries; and (4) secession of reoperative elective surgery procedures until Rogers has established an acceptable complication rate in primary procedures.
The Medical Executive Committee on 6 March 1997 unanimously accepted the recommendations of the Panel. On 4 April 1997 Rogers voluntarily changed his status at Rapides Regional to "courtesy" status, as he had been elevated to the full medical staff at another hospital.
On 8 April 1997 we lilted the stay of this action. We now complete our consideration of defendants' motion. Defendants seek judgment in their favor and an award of attorneys' fees and costs pursuant to the HCQIA, § 11113.
We treat the defendants' alternative motion as one for summary judgment because matters outside the pleadings were presented to and not excluded by the court. Fed. R.Civ.P. 12(b); Washington v. Allstate Ins. Co. 901 F.2d 1281, 1284 (5th Cir.1990). Rogers' request for a continuance pursuant to Rule 56(f) of the federal Rules of Civil Procedure is denied because Rogers did not submit an affidavit in support of his request. Fed.R.Civ.P. 56(f). A further delay, moreover, is not justified.
Summary judgment is appropriate only if "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any," when viewed in the light most favorable to the non-movant, "show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249-50, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986). A dispute about a material fact is "genuine" if the evidence is such that a reasonable jury could return a verdict for the nonmoving party. Id. at 248, 106 S.Ct. at 2510. In making its determination, the court must draw all justifiable inferences in favor of the nonmoving party. Id. at 255, 106 S.Ct. at 2513-14. Once the moving party's has initially shown "that there is an absence of evidence to support the nonmoving party's case," Celotex Corp. v. Catrett, 477 U.S. 317, 325, 106 S.Ct. 2548, 2554, 91 L.Ed.2d 265 (1986), the nonmovant must come forward, after adequate time for discovery, with "specific facts" showing a genuine factual issue for trial. Fed. R.Civ.P. 56(e); Matsushita Elec. Ind. Co. v. Zenith Radio, 475 U.S. 574, 587, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986). "Conclusionary denials, improbable inferences, and legalistic argumentation" are not an adequate substitute for specific facts showing that there is a genuine issue for trial. S.E.C. v. Recile, 10 F.3d 1093, 1097 (5th Cir.1993).
HCQIA immunity is a question of law that the district court may determine on summary judgment. Bryan v. James E. Holmes Regional Medical Center, 33 F.3d 1318, 1332-33 (11th Cir.1994); Monroe v. AMI Hospitals of Texas, Inc., 877 F.Supp. 1022 (S.D.Tex.1994).
The HCQIA provides immunity for qualifying peer review actions. The principal issue in this case is whether the defendants are shielded because they complied with the dictates of the HCQIA.
If a "professional review action," as defined by § 11151(9), of a "professional review body" meets all the standards specified in § 11112(a), then the professional review body, any person acting as a member or staff to the body, any person under a contract or other formal agreement with the body, and any person who participates with or assists the body with respect to the action, "shall not be liable in damages under any law of the United States or of any State ... with respect to the action." § 11111(a)(1).
Defendants contend that Counts One, Two, Three (antitrust), and Seven (defamation) should be dismissed because their peer review actions are immunized by the HCQIA. Careful statutory analysis is required to determine if immunity applies.
As an initial matter, we find that all defendants fall within the scope of HCQIA immunity pursuant to § 11111(a)(1)(A-D) because each is defined in the statute under the term "professional review body." The term "professional review body" means "a health care entity and the governing body or any committee of a health care entity which conducts professional review activity, and includes any committee of the medical staff of such an entity when assisting the governing body in a professional review activity." § 11151(11).
There is no dispute that RRMC is a health care entity and that the Doctor Defendants were assisting RRMC in a professional review activity. Accordingly, if HCQIA immunity applies, it applies to all defendants.
We also find that defendants' actions at issue qualify as a "professional review action" within the statutory definition. "Professional review action" is defined in § 11151(9):
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