Kunajukr v. Lawrence & Mem. Hosp., Inc. (Summary)

HCQIA IMMUNITY

Kunajukr v. Lawrence & Mem. Hosp., Inc., No. 3:05-CV-1813(JCH) (D. Conn. Jan. 12, 2009)

The United States District Court for Connecticut (“district court”) granted a motion for summary judgment in favor of a hospital who denied a doctor reappointment to its medical staff due to concerns about his practice.  The district court found that the hospital’s professional review activities, including investigations, deliberations, and recommendations that preceded and supported the decision, qualified for HCQIA immunity.

The court also rejected the doctor’s contention that the Board did not conduct a reasonable fact-gathering process, finding that the Hospital’s process complied with HCQIA, was fair to the physicians and was taken in the reasonable belief that the action was warranted by the known facts.

The district court also granted the hospitals motion for summary judgment on the physician’s breach of contract claim based on the employment contract that gave the hospital the right not to renew the doctor’s contract.

The district court also granted the hospital’s motion for summary judgment on several other claims, including defamation and breach of the Connecticut Unfair Trade Practices Act.  The defamation claim was solely based on publication about the doctor in the National Practitioners Data Bank, but the district court found this this involved the initiation and carrying out of the peer review process, which entitled the hospital to immunity under the HCQIA.  As for the breach of the Connecticut Unfair Trade Practices Act, the district court found that the hospital did not breach a contract with the doctor and was entitled to HCQIA immunity from actions challenging the peer review process.

The district court also granted the hospital’s motion for summary judgment on the doctor’s claim of discrimination on the basis of national origin, age, marital status, and ancestry, in violation of the Connecticut Fair Employment Practices Act and Title VII of the Civil Rights Act of 1964, finding that even if the doctor was qualified to perform his job, he presented no evidence of employment discrimination based on age or marital status.  The doctor relied on the hospital’s reference to his poor English speaking skills as a basis for race and national origin discrimination, but the reference occurred years before his termination or denial of privileges.

Finally, the district court granted the hospital’s motion for summary judgment on the claims of negligent infliction of emotional distress and intentional infliction of emotional distress, finding that nothing pertaining to the doctor’s termination rose to the level of outrageous conduct beyond all possible bounds of decency.

Rouben v. Parkview Hosp., Inc. (Summary)

PEER REVIEW

Rouben v. Parkview Hosp., Inc., No. 1:10-CV-397 (N.D. Ind. June 6, 2013)

The United States District Court for the Northern District of Indiana (“district court”) granted a hospital and one of its administrator’s (“administrator”) motion for summary judgment on several claims asserted by a previously privileged doctor (“doctor”), including defamation and tortious interference with a business relationship.  While the physician was employed by Parkview Hospital as a locum tenens physician, he was informed that several hospital employees alleged that he had made several inappropriate comments to them.  The physician denied these allegations.  The physician accepted employment with Gulfport and resigned his employment at Parkview before the allegations could be considered by a peer review committee.

At some point in time, Gulfport became aware that the physician had resigned his position, was also aware of the allegations that had been made against the physician, and withdrew its offer to employ the physician.

The physician denied any wrongdoing and sued Parkview under several theories, including defamation, tortious interference and breach of contract.

The physician’s defamation claim alleged that Parkview Hospital did not offer him the opportunity to appear before its peer review committee prior to disclosing information to his prospective new employer about complaints received about the doctor’s allegedly inappropriate behavior.  However, the hospital argued that it was entitled to immunity from defamation claims based on Indiana’s Peer Review Statute, which provides immunity during an initial investigation so long as the investigating hospital’s policies provide for such review.  The district court agreed and found that Indiana’s Peer Review Statutes guaranteed confidentiality of all proceedings of a peer review committee.  Also, the district court held that the release of liability that was included in the physician’s application for medical staff appointment provided the hospital with additional protection from the physician’s claims.

The doctor based his tortious interference with business relationship claim on the theory that the hospital disclosed the allegations against the doctor to his prospective employer in an attempt to interfere with his business relationship with the prospective employer.  However, the hospital’s administrator explained to the prospective employer, during a phone conversation and later in writing, that the doctor’s privileges were not terminated.  The district court then found that the doctor’s application with the prospective employer was incomplete because he failed to provide a valid Mississippi medical license, current certificate of insurance, and a professional reference.  Therefore, the district court granted the hospital’s motion for summary judgment on this claim as well.

Sadler Clinic Ass’n. v. Hart (Summary)

RESTRICTIVE COVENANT

Sadler Clinic Ass’n. v. Hart, No. 09-12-00086-CV (Tex. App. June 13, 2013)

Multiple physicians brought a declaratory action claim against a clinic that was located in Texas seeking to have the restrictive covenant in their employment contract that prohibited them from competing with the clinic while they were employed by the clinic and for 18 months thereafter within a 22-mile radius of the clinic to be declared unenforceable.  The agreement also contained a buyout clause that allowed the physicians to opt out of the noncompetition covenant if they did not wish to be bound by it. The lower court held that the buyout clause was ambiguous and did not contain a reasonable buyout clause, and so was unenforceable as a matter of law.

The appellate court reversed the lower court holding that the noncompetition clause in the physicians’ agreement was reasonable. The court stated that the clause was intended to protect certain confidential information that the physicians had access to during their time at the clinic. The appellate court then held that the trial court did not have the authority to determine the reasonable price of a buyout.  Rather, the statute provided that the proper remedy was binding arbitration to determine a reasonable buyout price.

The appellate court also declined to grant an extension to the restrictive covenant based on the amount of time the agreement was in litigation. The court stated that the noncompetition covenant contained its own tolling provision extending the restricted period during a breach. The maximum tolling period was already anticipated by the parties, so there was no reason for the court to address the issue.

Karkalas v. Dept. of State, Bureau of Prof’l and Occupational Affairs, State Bd. of Med. (Summary)

LICENSE

Karkalas v. Dept. of State, Bureau of Prof’l and Occupational Affairs, State Bd. of Med., No. 1932 C.D.2012 (Pa. Commw. Ct. June 11, 2013)

The Commonwealth Court of Pennsylvania (“commonwealth court”) affirmed the State Board of Medicine’s (“board”) order which required a physician to pay a $2,500 civil penalty and complete 10 hours of continuing education.

In this case, a physician filled prescription requests based on patient online questionnaires provided by a clearinghouse.  The clearinghouse maintained the patient’s health information. Although the physician had access to the records that were maintained by the clearinghouse while his agreement with the clearinghouse was in effect, the physician did not print or personally retain prescription records on patient questionnaires nor did he maintain in his office any records, files or even the patient names pertaining to the online prescriptions that he prescribed.  The physician was denied access to the clearinghouse’s records following the termination of his agreement with the clearinghouse.

The State Board of Medicine ruled that the physician’s failure to maintain medical records for patients for whom he wrote online prescriptions constituted unprofessional conduct.  The Board then imposed a $2,500 civil penalty and a requirement that the physician complete 10 hours of continuing education in the area of recordkeeping.  The physician sued the Board claiming that the Board of Medicine erred when it held that he violated the regulation.

The Pennsylvania Commonwealth Court upheld the Board of Medicine’s decision that the physician violated the Board’s regulation, which required that he “maintain” his patients’ medical records. While the regulation does not explicitly define “maintain,” the court determined that the board’s interpretation of the word as meaning have “access to and control over” is consistent with the regulation. Further, the court held that the regulation was consistent with the statute under which it was promulgated.

Talmadge v. Stamford Hosp. (Summary)

EMPLOYMENT DISCRIMINATION – ADA

Talmadge v. Stamford Hosp., No. 3:11-cv-01239-WWE (D. Conn. May 31, 2013)

An OR nurse was caught stealing narcotics while working.  The nurse was able to retain his license if he took a leave of absence and participated in a rehabilitation program.  That rehab program required him to sign an agreement that he would not have any access to narcotics or return to working as a nurse in an operating room, procedure room, or recovery room without the approval of the rehab program.

The nurse then applied to work at the defendant hospital.  After meeting with the nurse, the defendant hospital decided not to hire him.  The nurse filed suit against the defendant hospital in federal district court for the district of Connecticut claiming he was denied employment due to his past drug addiction in violation of the Americans with Disabilities Act (“ADA”).

The hospital argued that the nurse was not disabled within the meaning of the ADA.  While the court stated that it was “skeptical of whether plaintiff demonstrated that his addiction substantially limited one or more major life activities,” this issue was found to be moot since the nurse failed to show that he was a “qualified individual” under the ADA.

In order to establish a claim under the ADA, the nurse was required to show that he was otherwise qualified to perform the essential functions of the job with or without reasonable accommodation.  Since the nurse was not cleared to access narcotics or return to an operating room environment until after the defendant hospital’s employment start date, the court found that he was not qualified to perform the necessary duties of the job.  Further, the court held that no reasonable accommodation could have been made for an operating room nurse who could not work in an operating room.  The court also reasoned that subsequent communications between the two parties regarding reconsideration of the nurse’s initial application could not be considered as new applications for the position.  As such, the district court granted the defendant hospital’s motion for summary judgment.

Ramos v. Kewanee Hosp. (Summary)

BYLAWS/FAIR HEARING

Ramos v. Kewanee Hosp., No. 3-12-0001 (Ill. App. Ct. May 31, 2013)

The Appellate Court of Illinois denied a physician’s motion to overturn a jury verdict in favor of a hospital on the physician’s claims that his summary suspension was contrary to the bylaws.  The appeals court found that the hospital’s failure to give the physician a hearing within five days of his request, and within 15 days of the suspension, among other things, in accordance with the bylaws was not a material breach of the bylaws.  However, the appeals court did grant the physician’s motion for a new trial after finding that the trial court did not permit the physician to depose the individuals associated with generating the quality care report that led to the summary suspension.

Hepner v. Thomas Jefferson Univ. Hosps., Inc. (Summary)

AMERICANS WITH DISABILITIES ACT

Hepner v. Thomas Jefferson Univ. Hosps., Inc., No. 12-5443 (E.D. Pa. May 29, 2013)

The United States District Court for the Eastern District of Pennsylvania denied a hospital’s motion to dismiss a former employee’s complaint alleging that the hospital violated his rights under the Americans with Disabilities Act (“ADA”), among other things, after he suffered a work-related injury.

The district court found the employee suffered an injury sufficient to support a claim of disability under the ADA and dismissed the hospital’s motion to dismiss on that ground.  The district court found that the employee, by alleging that he was subjected to hostile treatment, involuntary medical leave, and termination close to the time he was injured, was adequate to show that the hospital regarded him as disabled and such perception caused adverse employment actions.

El-Attar v. Hollywood Presbyterian Med. Ctr. (Summary)

FAIR HEARING

El-Attar v. Hollywood Presbyterian Med. Ctr., No. S196830 (Cal. June 6, 2013)

The Supreme Court of California reversed and remanded a lower court’s decision that a hospital had deprived a physician of a right to a fair hearing and was entitled to a new hearing after his reappointment application was denied.

The physician submitted an application for reappointment and while the medical executive committee recommended that his application be approved, the hospital board denied the application, and the physician requested a fair hearing.  The medical executive committee concluded that since it did not recommend any adverse action, it was the responsibility of the board to appoint hearing panel members, and the physician filed a petition for an injunction stating that it was unlawful for the board to appoint the members and that, instead, the members were required to be appointed by the medical executive committee in accordance with the bylaws.  The petition was denied, and the hearing panel concluded that the board’s decision was reasonable, but that the panel would have pursued another resolution.  The board then terminated the physician from the medical staff.

A lower court then held that the bylaws precluded the medical executive committee from delegating to the board the ability to appoint the hearing panel members, and the case made its way to the supreme court.  The supreme court held that a violation of the hospital’s bylaws is not a material deviation that by itself deprived the physician of a fair hearing, and reasoned that the peer review statute provides that while the board must give deference to the determinations of the medical staff, it may take unilateral action if warranted, and that the lower court erred in concluding that the identity of the entity that appoints the hearing panel members is not determinative of whether the physician receives a fair hearing.

However, the supreme court did not hold that the physician actually received a fair hearing, but simply concluded that the lower court erred in holding that the medical executive committee’s delegation of the power to select the hearing panel members deprived the physician of a fair hearing.

Walker v. Univ. of Md. Med. Sys. Corp. (Summary)

AGE AND RACE DISCRIMINATION

Walker v. Univ. of Md. Med. Sys. Corp., No. CCB-12-3151 (D. Md. May 30, 2013)

The United States District Court for the District of Maryland granted a motion for summary judgment in favor of a hospital in this age and race discrimination case brought by a former nurse practitioner.

The hospital terminated the nurse practitioner for negligence after a newborn’s death, and the district court found that while the nurse practitioner could have established a claim for discrimination, she would have failed to rebut the hospital’s legitimate, nondiscriminatory reason for her termination, since the nurse practitioner was negligent in discontinuing life-sustaining medications for the newborn, among other things.

Iowa Med. Soc’y v. Iowa Bd. of Nursing (Summary)

BOARD OF NURSING REGULATIONS

Iowa Med. Soc’y v. Iowa Bd. of Nursing, No. 11-1977 (Iowa May 31, 2013)

The Supreme Court of Iowa reversed and remanded a decision of the district court which invalidated the Board of Nursing and Department of Health’s promulgation of certain regulations.

Physician associations brought suit against the nursing board and the health department for their endorsement of regulations that permitted advanced registered nurse practitioners (“ARNPs”) to supervise radiologic technologists using fluoroscopy machines.  The district court found that none of the material facts at issue in the suit were in dispute and concluded that the nursing board and health department regulations were invalid.

The supreme court held that the nursing board’s determination on supervision of fluoroscopy procedures by ARNPs was lawful, stating that the language of the state law allows the nursing board to interpret whether the medical and nursing professions have recognized a particular practice of nurses, and that, unless said practice is “irrational, illogical, or wholly unjustifiable,” the court should uphold the nursing board’s determination.  The supreme court then held that the practice of ARNPs supervising fluoroscopy procedures was not irrational, illogical, or wholly unjustifiable, and concluded that the district court erred by reversing the nursing board’s determination.