Ming Wei Liu v. Bd. of Tr. of the Univ. of Alabama (Full Text)

[DO NOT PUBL ISH ]

IN THE UN ITED STATES COURT O F A PPEALS

FOR THE ELEVENTH C IRCU IT
________________________

N o . 09 -10011
N on -A rgum en t C a lendar
________________________

FILED
U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
MAY 19, 2009
THOMAS K. KAHN
CLERK

D . C . D ocke t N o . 07 -00381 -CV -AR -S

M ING WE I L IU ,

BOARD O F TRU STEES O F THE
UN IVERS ITY OF ALABAMA ,
ROBERT C . BOURGE ,

P la in tiff-A ppe llan t,

versus

D efendan ts-A ppe llees .

________________________

A ppea l from the U n ited S ta tes D istr ic t Cou rt
fo r the N o r thern D istr ic t o f A labam a
_________________________

(M ay 19 , 2009 )

B efo re CARNES , W ILSON and KRAV ITCH , C ircu it Judges .

PER CUR IAM :

A ppe llan t D r . M ing W e i L iu (“L iu”) cha llenges the d istric t cou r t’s g ran t o f

summ ary judgm en t in th is case .

I .

L iu is a card io log ist w ho , be tw een 1991 and 2001 , w as a tenu red A ssoc ia te

P ro fesso r o f M ed ic ine a t the U n iversity o f A labam a B irm ingham (“UAB ”) . In

2001 , fo r reasons no t re levan t to th is appeal, the d irec to r o f the D iv ision o f

C ard iovascu lar R esearch a t UAB D r . Rober t Bou rge (“Bou rge”) summarily

suspended L iu ’s c lin ica l p r iv ileges and institu ted a “peer rev iew ” investiga tion o f

L iu ’s c lin ica l p r iv ileges . U pon the adv ice o f counse l, L iu subm itted h is resigna tion

before the investiga tion w as comp leted . A s requ ired by the H ea lthcare Q uality

Imp rovem en t A c t o f 1986 (“HCQ IA ”), 42 U .S .C . § 11101 , e t seq ., UAB repo r ted

L iu ’s resigna tion du r ing the pendency o f an investiga tion to the N a tiona l

P rac titioner D a ta B ank (“N PDB ”) .

A f ter resign ing from h is position a t UAB , L iu app lied fo r a p ro fesso rsh ip a t

the U n iversity o f Sou thern C a lifo rn ia H osp ital (“U SC ”) . A s a par t o f h is

app lica tion fo r staff p r iv ileges, U SC asked L iu to request tha t UAB fo rw ard cer ta in

peer rev iew in fo rm a tion to U SC , so tha t it cou ld eva lua te the repo r t on the N PDB .

Instead o f send ing the requested peer rev iew in fo rm a tion , Bou rge sen t a

“recommenda tion le tter” to USC sta ting tha t L iu w as p laced on p roba tion and w as

be ing investigated because h is “perfo rm ed p rocedu res , p lanned p rocedures , cer ta in

aspec ts o f m ed ica l care , and h is hosp ita l char t docum en ta tion w ere no t w ith in the

standard o f care a t ou r institu tion .” U pon rece iv ing th is le tter , U SC aga in

requested add itiona l peer rev iew in fo rm a tion regard ing the cases Bou rge asser ted

w ere no t w ith in UAB ’s “standard o f care .” UAB invoked A labama sta te m ed ica l

peer rev iew p r iv ilege , A la . Code §§ 6 -5 -333 and 22 -21 -8 (“peer rev iew p r iv ilege”) ,

and refused to p rov ide the peer rev iew in fo rm a tion concern ing L iu to U SC .

B ecause it d id no t rece ive the requested peer rev iew in fo rm a tion , the U SC

creden tialing comm ittee den ied L iu ’s app lica tion fo r staff p r iv ileges as incomp lete .

A f ter being den ied staff p r iv ileges a t U SC , L iu w as even tua lly g ran ted c lin ica l

p r iv ileges a t severa l hosp ita ls in the Los A nge les , C a lifo rn ia area , w here he is

cu rren tly p rac tic ing m ed ic ine .

L iu comm enced th is case aga inst UAB and Bou rge seek ing , in ter a lia , a

dec lara to ry judgm en t and in junc tive re lief to requ ire UAB to prov ide the peer

rev iew in fo rm ation concern ing L iu to the creden tialing comm ittee o f USC . In

add ition to severa l sta te law c laim s , L iu asser ted tw o c la im s pu rsuan t to 42 U .S .C .

§ 1983 , a lleg ing tha t UAB ’s invoca tion o f the A labam a peer rev iew p r iv ilege to

refuse to p rov ide the peer rev iew in fo rm a tion to U SC (1 ) v io la ted the Sup rem acy

C lause o f the U n ited S ta tes Constitu tion by obstruc ting the “essen tia l pu rpose” o f

the HCQ IA and (2) v io la ted L iu ’s Fou r teen th Am endm en t r igh t to substan tive and

p rocedu ra l due p rocess and to equa l p ro tection by in terfer ing w ith h is r igh t to

pu rsue h is chosen p ro fession . U pon cross-mo tions fo r summ ary judgm en t, the

d istr ic t cou r t found , in ter a lia , tha t (1 ) UAB , as an instrum en tality o f the sta te o f

A labam a , is immune from su it under the E leven th Am endm en t; (2 ) Bou rge’s

refusa l to p rov ide the peer rev iew in fo rm a tion requested by U SC d id no t v io la te

the “essen tia l pu rpose” o f the HCQ IA ; and (3 ) because L iu is cu rren tly p rac tic ing

as a card io log ist and has no t show n tha t UAB /Bou rge’s conduc t has p reven ted h im

from emp loym en t as a p ro fesso r o f m ed icine w ith a ll emp loyers , L iu has no va lid

due p rocess c la im . A cco rd ing ly , the d istr ic t cou r t d ism issed a ll c la im s asser ted

aga inst UAB and d ism issed the federal cla im s asser ted aga inst Bou rge . Then ,

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because ju risd iction w as p rem ised upon federa l question and a ll o f the federa l

c la im s had been d ism issed , the d istr ict cour t declined to exerc ise ju r isd ic tion over

the sta te law c la im s and d ism issed them w ithou t p rejud ice .

L iu appea ls , cha lleng ing the d ism issa l o f h is federa l cla im s aga inst Bou rge .2

In his complaint, Liu also claimed federal jurisdiction on the basis of diversity of
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citizenship. The district court, however, found that Liu had not established the requisite amount
in controversy and that federal jurisdiction was only proper because Liu asserted federal claims.
Liu does not dispute this finding on appeal.

Liu does not appeal the district court’s determination that UAB is immune from suit
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under the Eleventh Amendment.

II .

“W e rev iew the d istr ic t cou r t’s g ran t o f summ ary judgm en t de novo ,

app lying the sam e lega l standards tha t bound the d istr ic t cou r t, and v iew ing a ll

fac ts and reasonab le in ferences in the ligh t most favo rab le to the nonmov ing

par ty .” C ruz v . Pub lix Super M arke ts , Inc ., 428 F .3d 1379 , 1382 (11 th C ir . 2005 )

(citation and quo ta tion om itted ). Summ ary judgm en t is app ropr ia te w hen “there is

no genu ine issue as to any m a ter ia l fac t and . . . the mov ing par ty is en titled to a

judgm en t as a m a tter o f law .” F ed . R . C iv . P . 56 (c) .

III.

L iu appea ls the g ran t o f summ ary judgm en t, asser ting tha t the d istr ic t cou r t

erred (1 ) by f ind ing tha t Bou rge’s refusa l to p rov ide the requested peer rev iew

info rm a tion d id no t v io late the Sup rem acy C lause as inconsisten t w ith the HCQ IA ;

and (2 ) by f ind ing that L iu had no t estab lished that h is constitu tiona lly p ro tec ted

“r igh t to pu rsue h is chosen pro fession” w as v io la ted . 3

Liu also argues that the district court erred in its “threshold conclusion” that the
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Alabama peer review privilege could be invoked to refuse to provide peer review information
properly requested by a hospital in another state. The district court, however, did not actually
reach this conclusion; rather, it considered whether the peer review privilege, as it was asserted
by Bourge, violated Liu’s constitutional rights. After finding that Bourge’s invocation of the
privilege to deny USC’s request for peer review information did not violate any of Liu’s
federally protected rights, the district court declined to exercise its supplemental jurisdiction
over the pending state law claims and therefore had no need to determine whether the state law
privilege was intended to be asserted in such a manner. See Pintando v. Miami-Dade Housing
Agency, 501 F.3d 1241, 1242 -1243 (11th Cir. 2007) (noting that a district court “may decline to
exercise supplemental jurisdiction over a claim if . . . the district court has dismissed all claims

R egard ing L iu ’s f irst assignm en t o f erro r , L iu argues tha t Bou rge’s

in terp re ta tion of the A labam a peer rev iew p r iv ilege “frustra tes” Cong ress’s in ten t

in enac ting the HCQ IA and tha t therefo re the p r iv ilege as app lied is

unconstitu tiona l as v io la tive of the Sup rem acy C lause. S ee W isconsin Pub lic

In terveno r v . M o r tier , 501 U .S . 597 , 604 -05 (1991 ) . W e d isag ree .

Cong ressiona l in ten t is the “u ltim a te touchstone” in a Sup rem acy C lause

case, M ed tron ic , Inc . v . Loh r , 518 U .S . 470 , 485 (1996 ) , and th is in ten t “governs

ou r de term ina tion o f w he ther federa l law preemp ts sta te law .” Boyes v . She ll O il

P rods . Co ., 199 F .3d 1260 , 1267 (11 th C ir . 2000 ) ; see Th is Tha t and O ther G if t and

Tobacco , Inc . v . Cobb Coun ty , G a ., 285 F .3d 1319 , 1322 (11 th C ir . 2002 ) . O n ly if

the app lica tion o f a sta te law “stands as an obstac le to the accomp lishm en t and

execu tion o f the fu ll pu rposes and ob jec tives o f Cong ress” w ill it be deem ed a

v io la tion o f the Sup rem acy C lause and therefo re p reemp ted by the federa l law .

S ee M o r tier , 501 U .S . a t 604 -05 (1991) .

Cong ress enac ted the HCQ IA to add ress the r ising p rob lem of m ed ica l

m a lp ractice and the ab ility o f incompe ten t doc to rs to move be tw een sta tes w ithou t

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hav ing the ir p r io r prac tice reco rds fo llow them and to crea te a p resump tive

over which it has original jurisdiction”). Our review therefore is limited to the district court’s
findings regarding the sufficiency of Liu’s constitutional claims.

To that end, it created the NPDB, a national registry which requires health care entities,
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inter alia, to report the following information upon accepting a physician’s surrender of clinical

immun ity from mone tary dam ages aw arded aga inst par tic ipan ts in the peer rev iew

p rocess . 42 U .S .C . §§ 11101 – 11111 . The A labam a sta tu tes a t issue , A la . Code

§§ 22 -21 -8 and 6 -5 -333 (d ), supp lem en t the HCQ IA by p rov id ing par ticipan ts in

the peer rev iew p rocess w ith an exp lic it p r iv ilege from d iscovery in the c iv il

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litiga tion con tex t. W e conclude tha t the in ten t o f bo th the federa l and sta te

sta tu tes , therefo re , is “to fac ilita te the frank exchange o f info rm a tion among

p ro fessiona ls conduc ting peer rev iew inqu iries w ithou t the fear o f rep r isa ls in c iv il

law su its .” B ryan v . Jam es E . H o lm es R eg ’l M ed . C tr ., 33 F .3d 1318 , 1322 (11 th

C ir . 1994 ) ( in terp re ting the HCQ IA ) ; accord Ex par te K ro thapa lli, 762 So . 2d 836 ,

838 (A la . 2000 ) (“In o rder to m ake m ean ing fu l peer rev iew possib le , the [A labam a

sta te] leg isla tu re p rov ided a guaran tee o f con f iden tia lity for the peer rev iew

p rocess . . . .”) (quo ting C ruger v . Love , 599 So . 2d 111 , 113 -14 (F la. 1992 )) ;

M arsha ll v . P lanz , 145 F . Supp . 2d 1258 , 1265 (M .D . A la . 2001 ) ; M cG ee v . B ruce

privileges while under an investigation: “the name of the physician involved; a description of the
acts or omissions or other reasons for the action or, if known, for the surrender; and such other
information respecting the circumstances of the action or surrender as the Secretary deems
appropriate.” 42 U.S.C. § 11133(a)(3). Liu does not allege that UAB’s report to the NPDB
failed to satisfy HCQIA’s statutory disclosure requirements.

“The plain language of Alabama’s two statutes, §§ 6-5-333 and 22-21-8 . . . declares as
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privileged ‘all information, interviews, reports, statements, or memoranda furnished to any
committee as defined in this section’ . . . and provides that ‘no person involved in preparation,
evaluation or review of accreditation, quality assurance or similar materials shall be permitted or
required to testify in any civil action as to any evidence or other matters produced or presented.’”
Ex parte Burch, 730 So. 2d 143, 149 (Ala. 1999) (finding testimony of a peer review committee
chairman privileged).

H osp . Sys ., 439 S .E .2d 257 , 259 -60 (S .C . 1993 ) (“The underlying pu rpose beh ind

the con f iden tia lity sta tu te is no t to fac ilita te the p rosecu tion o f c iv il ac tions , bu t to

p romo te comp le te cando r and open d iscussions among par tic ipan ts in the peer

rev iew p rocess .”) .

In th is case , how ever , Bou rge in terp re ted the sta te law p r iv ilege as ex tend ing

beyond the litiga tion con tex t and requ ir ing UAB to no t d isc lose to U SC ’s

creden tialing comm ittee the in fo rm a tion the UAB peer rev iew comm ittee had

ga thered du r ing its investiga tion o f L iu . W ithou t dec id ing w he ther the A labam a

leg isla tu re in tended for the peer rev iew p r iv ilege to be app lied in th is m anner , w e

conc lude tha t the peer rev iew pr iv ilege as app lied d id no t thw art Cong ress’s in ten t

in enac ting the HCQ IA and th is app lica tion o f the p r iv ilege is therefore no t

unconstitu tiona l under the Sup rem acy C lause . N o th ing in the HCQ IA m anda tes

tha t hea lth care en tities p rov ide peer rev iew in form a tion to creden tia ling au tho r ities

in o ther sta tes in excess o f the in fo rm a tion requ ired to be repo r ted to the NPDB .

Indeed , as sta ted above , Cong ress enac ted the HCQ IA “to fac ilita te the frank

exchange o f in fo rm a tion among p rofessiona ls conduc ting peer rev iew inqu ir ies”

and to ensu re tha t som e m in im a l amoun t o f in fo rm a tion regard ing a physic ian ’s

“p rev ious dam ag ing o r incompe ten t perfo rm ance” w ill fo llow the physic ian w hen

he o r she moves from sta te to sta te . Bou rge’s invoca tion o f the A labama peer

rev iew p r iv ilege to refuse to prov ide spec if ic requested de ta ils regard ing the

surrender o f L iu ’s c lin ica l p r iv ileges does no t con f lic t w ith e ither o f these goa ls o f

the HCQ IA . A s such , the A labam a sta tu tes a t issue , as app lied in th is case , do no t

v io la te the Sup rem acy C lause . 6

L iu also argues on appea l tha t Bou rge’s refusa l to p rov ide the peer rev iew

m a teria l and send ing o f the “recomm endation” le tter to U SC effec tive ly b lack listed

h im and p reven ted h im from pursu ing h is chosen p ro fession as a p rofesso r o f

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m ed ic ine . A cco rd ing ly, because the r igh t to fo llow a p ro fession free from

un reasonab le governm en t in terference is a p ro tec ted p roper ty r igh t, L iu asser ts that

he has p resen ted su ff ic ien t ev idence suppo r ting h is substan tive due p rocess c la im .

A gain , w e d isag ree .

The Sup rem e Cou r t has recogn ized tha t the liber ty componen t o f the

Fou r teen th Amendm en t’s D ue P rocess C lause inc ludes the r igh t to pu rsue a

p ro fession . S ee Conn v . G abber t, 526 U .S . 286 , 291 -92 (1999 ) (stating tha t there

is “som e genera lized due p rocess r igh t to choose one’s f ie ld o f p r iva te

emp loymen t”) . In recogn iz ing a v io la tion o f th is r igh t, how ever , the Cou r t has

This is not to say Liu is without legal recourse if Bourge in fact wrongfully invoked the
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privilege to deny Liu’s request for his peer review information; we only conclude that Liu has
identified no Supremacy Clause violation.

The parties dispute whether Liu’s “chosen profession” is as a cardiologist or as a
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professor of medicine. We reach the same conclusion regardless; therefore, we need not decide
this issue.

no ted tha t its cases “a ll deal w ith a comp le te p roh ib ition o f the r igh t to engage in a

ca lling , and no t [a] so r t o f b r ief in terrup tion .” Id . a t 292 (emphasis added ) . In

Board o f R egen ts v . Ro th , 408 U .S . 564 , 573 (1972 ) , fo r examp le , the Sup rem e

Cou r t found that an emp loyee’s due p rocess righ ts are tr iggered w here the sta te

emp loyer imposes “a stigm a o r o ther d isab ility tha t forec loses h is freedom to take

advan tage o f o ther emp loym en t oppo r tun ities .” (Emphasis added) . In C lemons v .

D ougherty Coun ty, G eo rg ia , 684 F .2d 1365 , 1371 (11 th C ir. 1982 ) , th is cou r t

reitera ted the standard fo r p rov ing a dep r iva tion o f the liberty in terest, sta ting tha t a

p la in tiff must estab lish tha t the sta te emp loyer m ade “stigm a tiz ing charges w h ich

forec lose h is freedom to take advan tage o f o ther emp loym en t oppor tun ities .” S ee

a lso Su llivan v . Schoo l Bd . of P ine llas Coun ty , 773 F .2d 1182 , 1187 (11 th C ir .

1985 ) (find ing tha t pub lished comm en ts regard ing pub lic emp loyee’s non -renew a l

d id no t imp lica te a liber ty in terest because they d id no t “forec lose [her] freedom to

take advan tage o f o ther emp loym en t oppo r tun ities”) ; P iro lo v . C ity o f C learw a ter ,

711 F .2d 1006 , 1011 (11 th C ir . 1983 ) (d ism issing a irpo r t operato r’s substan tive

due p rocess c la im w here o rd inances d id no t p reven t h im from con tinu ing h is

p ro fession “e ither a t ano ther loca tion o r under the restr ic tions imposed”) . A s such ,

to su rv ive summ ary judgm en t, a c la im an t must p resen t ev idence suggesting tha t a

governm en ta l act effec tive ly banned h im o r her from a p rofession . S ee C lemons ,

684 F .2d a t 1374 ; see a lso Borde lon v . Ch i. S ch . R efo rm Bd . o f T rs ., 233 F .3d 524 ,

531 (7 th C ir . 2000 ) (“I t is no t enough tha t the emp loyer’s stigm a tiz ing conduc t has

som e adverse effec t on the emp loyee’s job p rospec ts; instead , the emp loyee must

show tha t the stigm a tiz ing ac tions m ake it v ir tually impossib le fo r the emp loyee to

f ind new emp loym en t in h is chosen f ie ld .”) ; Engqu ist v . O regon D ep t. o f

A g ricu ltu re , 478 F .3d 985 , 996 -98 (9 th C ir . 2007 ) ( lim iting a substan tive due

p rocess occupationa l liber ty c la im “to ex trem e cases , such as a governm en t

b lack list, w h ich w hen c ircu la ted o r o therw ise pub licized to p rospec tive emp loyers

effec tive ly exc ludes the b lack listed ind iv idua l from h is occupa tion , much as if the

governm en t had yanked the license o f an ind iv idua l in an occupa tion tha t requ ires

licensu re”) ; see also O liv ier i v . Rod r iguez , 122 F .3d 406 , 408 (7 th C ir . 1997 )

(sam e) .

In th is case , it is und ispu ted tha t L iu has received staff p r iv ileges and is

cu rren tly p rac tic ing m ed ic ine w ith a t least one hosp ita l in C a lifo rn ia , desp ite the

a lleged ly stigm a tiz ing conduc t o f h is fo rm er pub lic emp loyer . Fu r thermo re ,

a lthough he w as den ied a p ro fesso rsh ip a t U SC , L iu has p resen ted no ev idence tha t

he w ou ld be unab le to secu re a sim ilar position w ith any o ther emp loyer . A s such ,

L iu has simp ly fa iled to show tha t a sta te agen t’s conduc t en tire ly fo rec losed h is

freedom to pu rsue emp loym en t in h is chosen f ie ld as e ither a card io log ist o r a

p ro fesso r o f m ed ic ine . A cco rd ing ly , w e conc lude tha t the d istr ic t cou rt p roper ly

g ran ted summ ary judgmen t on L iu ’s substan tive due p rocess c la im .

IV .

Fo r the reasons stated here in , w e A FF IRM the judgm en t o f the d istr ic t cou r t.