Ryals v. St. Mary-Corwin Regional Medical Center

SUPREME COURT, STATE OF COLORADO

No. 99SC137

[Announcement Date]September 18, 2000



JARVIS D. RYALS, M.D., Petitioner,

v.


ST. MARY-CORWIN REGIONAL MEDICAL CENTER,


a Colorado not-for-profit corporation;


PUEBLO RADIOLOGICAL GROUP, P.C., a Colorado


professional corporation; MICHAEL E. BALL,


M.D., individually and as President of


Pueblo Radiological Group, P.C.; LYNN PHELPS,


M.D.; MARK FORTE, M.D.; MARC JOHNSON, M.D.;


GARY LAMONTE, M.D.; MARK MOUNTFORD, M.D.;


STAN W. JONAS, individually and in his


capacity as Interim Chief Executive Officer


of St. Mary-Corwin Regional Medical Center;


WALTER SACKETT, individually and in his


capacity as the Chief Executive Officer of


St. Mary-Corwin Regional Medical Center,

Respondents.




 


Certiorari to the Colorado Court of Appeals


EN BANC JUDGEMENT REVERSED


AND CASE REMANDED


 





    Caplan and Earnest LLC


    Sharon E. Caulfield


    Sarah E. Meshak


    Boulder, Colorado


    Attorneys for Petitioner


    Kennedy & Christopher, P.C.


    John R. Mann


    Daniel R. McCune


    Dean A. McConnell


    Denver, Colorado


    Attorneys for Respondents St. Mary-Corwin Regional Medical


    Center, Stan W. Jonas and Walter Sackett


     


    Hogan & Hartson L.L.P.


    Kathryn Webb Bradley


    John W. Cook


    H. Thomas Coghill


    Denver, Colorado


    Attorneys for Respondents Pueblo Radiological Group, P.C.;


    Michael E. Ball, M.D.; Lynn Phelps, M.D.; Mark Forte, M.D.;


    Marc Johnson, M.D.; Gary LaMonte, M.D. and Mark Mountford,


    M.D.


     


    Montgomery Little & McGrew, P.C.


    Robert N. Spencer


    Englewood, Colorado


    Amicus Curiae for Colorado Medical Society


     


    Ken Salazar, Attorney General


    Richard H. Forman, First Assistant Attorney General


    Business and Licensing Section


    Denver, Colorado


    Amicus Curiae for Committee on Anticompetitive Conduct


     


    JUSTICE KOURLIS delivered the Opinion of the Court.


    JUSTICE BENDER does not participate.


    This case deals with the question of whether a physician is required to file
    a claim against a hospital that has denied him privileges with the Committee on
    Anticompetitive Conduct (CAC) rather than with the court. We hold that if the
    denial of privileges does not arise out of professional review committee
    activity at the hospital, then the physician need not seek review before the
    CAC. In this case, St. Mary-Corwin Regional Hospital (the Hospital) denied Dr.
    Jarvis D. Ryals, a neurologist, privileges to read MRIs at the Hospital based on
    a long-standing exclusive contract between the Hospital and a group of
    radiologists. Ryals filed suit claiming that the Hospital had engaged in
    anticompetitive conduct. The trial court dismissed his suit, holding that Ryals
    was first required to exhaust his administrative remedies with the CAC. The
    court of appeals affirmed. See Ryals v. St. Mary-Corwin Reg?l Med.
    Ctr.
    , 987 P.2d 865 (Colo. App. 1999).


    We reverse. We hold, based on the plain language of the Colorado Professional
    Review Act (CPRA) and the statutory scheme as a whole, that the CAC has
    jurisdiction only over those claims of anticompetitive conduct that arise out of
    professional review committee activity. Professional review committees assess
    physician qualifications, physician conduct, and the quality and appropriateness
    of patient care. In this case, the Hospital did not engage in any professional
    review committee activity in denying Ryals?s privileges. Rather, the Hospital
    made a business decision unrelated to Ryals?s qualifications or conduct. If that
    decision has antitrust implications, then Ryals?s claims against the Hospital
    and other Defendants were anticompetitive conduct claims arising independently
    of a peer review process. Therefore, Ryals was not required to file his claims
    with the CAC before seeking a remedy in district court.


    I.


    St. Mary-Corwin RegionalThe Hospital(the Hospital) has employed Dr. Ryals as
    a licensed neurologist since 1976. Prior to 1995, the Hospital did not own an
    MRI scanner, and Ryals interpreted MRI scans for the Hospital?s patients outside
    of the Hospital at Southern Colorado MRI, Ltd. (SCMRI). Ryals, the Hospital, and
    Pueblo Radiological Group (PRG) were joint partners in SCMRI. In December 1995,
    SCMRI closed. Shortly thereafter, the Hospital obtained its own MRI machines to
    read MRIs “in-house.”


    Because Ryals did not have privileges to read MRIs at the Hospital, Ryals
    began to make inquires regarding obtaining privileges. After several informal
    inquiries with the Hospital staff, Ryals submitted a request for privileges to
    the Hospital?s Medical Qualifications Committee on February 1, 1996. PRG had a
    long-standing exclusive contract with the Hospital to perform radiology services
    at the Hospital. The Medical Qualifications Committee decided that this
    exclusive contract prevented other doctors from reading MRIs. Ryals wrote PRG on
    February 6, 1996 requesting PRG to renegotiate their exclusive contract with the
    Hospital so as to permit him to read MRIs. PRG declined.


    Ryals submitted a second request to the Medical Qualifications Committee,
    which the Committee again denied at its meeting on March 1, 1996. The Committee
    found that although Ryals was qualified to read MRIs, he was not eligible to do
    so because of PRG?s exclusive contract. The Hospital?s acting chief executive
    officer, Stan Jonas, wrote Ryals on March 4, 1996 to inform him of the
    Committee?s decision to deny his request. On March 12, 1996, the Hospital
    Governing Board then passed a resolution affirming its exclusive contract with
    PRG. The resolution did not specifically address Ryals?s requests for
    privileges. Ryals did not receive a copy of the resolution until May 29, 1996
    when he requested a copy of the exclusive contract from the Hospital.


    Ryals then filed suit against St. Mary-Corwin Hospital, Hospital officers,
    and PRG in district court claiming three antitrust violations, breach of
    contract, promissory estoppel, tortious interference with contractual and
    prospective contractual relations, and outrageous conduct. The defendants moved
    to dismiss the complaint alleging that Ryals failed to exhaust his
    administrative remedies by first filing his complaint with the Colorado
    Committee on Anticompetitive Conduct (CAC). The trial court agreed and granted
    the motion without an evidentiary hearing.


    The court of appeals affirmed the trial court?s decision, holding that Ryals
    must first present his claims to the CAC. See Ryals, 987 at 869.
    The court of appeals held that the CAC had jurisdiction because the Hospital?s
    denial constituted a professional review activity within the parameters of the
    CAC?s enabling legislation. See id. The court reached this
    conclusion by reasoning that the Hospital?s Medical Qualifications Committee and
    the governing board operated pursuant to valid written bylaws, and therefore,
    they constituted professional review committees for the purpose of the CPRA.
    See id. The court further held that the Hospital?s actions, taken
    as a whole, could constitute final action and appropriate notice of the denial
    of privileges to Ryals in these circumstances. See id. at 868. The
    court also held that the


    CAC?s jurisdiction extended to Ryals?s common law claims. See


    id. at 870. We granted certiorari.1


    II.


    Maintaining standards of patient care is of preeminent importance in a
    hospital. In service of that goal, hospitals rely upon peer review processes to
    oversee physician conduct and promote appropriate patient care. During the peer
    review process, a peer review committee may be critical of the physician, and
    may issue a corrective action or sanction. See Fredrick Yu, The
    Committee on Anticompetitive Conduct: New Agency on the Block
    , 21 Colo.
    Lawyer 31, 31 (1992). However, a peer review committee is necessarily composed
    of peers who may be competitors of the physician being reviewed. Accordingly,
    when a peer review committee issues an adverse decision, it is possible that the
    committee?s decision was based not on a deficiency in the physician?s
    performance, but rather on a desire to remove the physician from competition.
    See id. This possibility raises antitrust liability concerns.


    In 1988, the Supreme Court ruled that a hospital?s peer review committee was
    not immune from federal antitrust liability because the state did not actively
    supervise the committee. See Patrick v. Burget, 486 U.S. 94, 100
    (1998). Because the committee did not qualify for immunity, the individual
    members of the peer review committee could be subject to suit for violating
    federal antitrust laws. See id. at 102. In order to qualify for
    state action immunity,2 the Supreme Court held that a state must
    actively supervise the private peer review committee?s activities so that the
    state exercises “ultimate control over the challenged anticompetitive conduct.”
    Id. at 101.


    In order to assure the continuation of the peer review process, many states,
    including Colorado, reacted to Patrick by enacting legislation to
    establish the requisite level of state supervision. The Colorado Professional
    Review Act (CPRA), was Colorado?s answer to the dilemma. See ??
    12-36.5-101 to ?106, 4 C.R.S. (1999). It allows private entities to establish
    professional review committees that operate as an arm of Colorado?s Board of
    Medical Examiners. See ? 12-36.5-103(3)(a), 4 C.R.S. (1999). In the
    enabling legislation, the General Assembly observed that the Board of Medical
    Examiners could not feasibly assume responsibility over every single allegation
    that a physician?s conduct deviated from a professional standard of care.
    See ? 12-36.5-103(1). The legislature, therefore, intended to employ
    professional review committees to assist the Board in reviewing “in good faith
    the professional conduct of physicians, including the quality and
    appropriateness of patient care.” ? 12-36.5-103(2).


    A hospital may establish a professional review committee as long as the
    committee operates pursuant to written bylaws, which are approved by the
    hospital?s governing board. See ? 12-36.5-104(4), 4 C.R.S. (1999).
    Professional review committees are charged with investigating the qualifications
    of a licensed physician or “the quality or appropriateness of patient care
    rendered by or the professional conduct” of any licensed physician. ?
    12-36.5-104(6)(a)(II); see also ? 12-36.5-104(1) (stating that a
    professional review committee may be established “to review and evaluate the
    quality and appropriateness of patient care provided by and the professional
    conduct of any physician”). To assist the committees in carrying out these
    functions, the legislature expressly provided that the committees would be
    granted immunity from liability for their activities, as long as the committees?
    actions were taken in good faith. See ? 12-36.5-105(1), 4 C.R.S.
    (1999).


    If the professional review committee makes an adverse finding against a
    physician, the physician may appeal to the entity?s governing board. The
    governing board then reviews the committee?s work and takes final action on the
    recommendation of the professional review committee. See ?
    12-36.5-104(7)-(8). The CPRA defines a governing board as any board authorized
    to take action “regarding the recommendations of any authorized professional
    review committee.” ? 12-36.5-102(2), 4 C.R.S. (1999).


    If a physician believes that a decision made by a peer review committee or a
    governing board stems from anticompetitive motivations, the physician may appeal
    the committee?s decision to the Committee on Anticompetitive Conduct (CAC).
    See ? 12-36.5-106, 4 C.R.S. (1999). The CAC is a state board comprised of
    four licensed physicians and one attorney with expertise in the area of
    antitrust. See ? 12-36.5-106(2). In order to appeal to the CAC, the
    physician must have been “the subject of a final action by a governing board,
    which action results in the denial, termination, or restriction of privileges at
    or membership in or participation in an organization, and who believes that such
    action resulted from unreasonable anticompetitive conduct.” ? 12-36.5-106(7).
    The CPRA makes the CAC the “sole and exclusive remedy” for physicians believing
    their adverse peer review decisions were the result of anticompetitive
    motivations. Id. “Failure to exhaust this administrative remedy . . .
    shall preclude the right of de novo review on the merits of the issue of
    unreasonable anticompetitive conduct.” Id.


    The CPRA limits the CAC?s jurisdiction to “the sole issue of whether such
    final board action resulted from unreasonable anticompetitive conduct.”
    Id. The CAC may hold a hearing to review the record and take evidence
    solely on the issue of anticompetitive conduct, “except when, in the discretion
    of the committee, the interests of a fair hearing demand otherwise.” ?
    12-36.5-106(9)(f).


    If the CAC finds that the final action of the governing board resulted from
    anticompetitive conduct, then the CAC may issue an order disapproving, setting
    aside, or modifying the final action. See ? 12-36.5-106(9)(k). The CAC is
    not authorized to award money damages or grant any other equitable remedies.
    Following the CAC?s final determination, the party may challenge the action of
    the governing board, rather than the CAC?s review of the action, in district
    court. See ? 12-36.5-106(10)(b).


    III.


    With that background, we now turn to the first question on certiorari: to
    wit, whether Ryals was required to present his claims to the CAC before seeking
    a remedy in district court. We conclude that the CAC?s jurisdiction is limited
    to those claims arising out of professional review committee activity as defined
    in the CPRA. Because Ryals?s claims did not arise from a professional review
    committee activity, the CAC lacked jurisdiction, and Ryals was not required to
    exhaust his administrative remedies with the CAC.


    The question of the scope of the CAC?s jurisdiction is a matter of statutory
    interpretation. This is a question of law, and therefore, we review the case de
    novo. See Fogg v. Macaluso, 892 P.2d 271, 273 (Colo. 1995).


    A.


    We recognize that general logic would lead to the conclusion that since Ryals
    alleged anticompetitive conduct claims and the General Assembly created the CAC
    to deal with claims of anticompetitive conduct, then a fortiori, the CAC should
    have heard this case. However, upon closer examination of the applicable
    legislation, we conclude that the CAC was not intended to be the repository of
    all claims of anticompetitive conduct between a physician and a hospital.
    Rather, the General Assembly limited the CAC?s jurisdiction to issues of
    physician qualification, professional conduct, and quality of patient care,
    arising out of qualified professional review committee activities. See ?
    12-36.5-104(8). Qualified professional review committees are in turn limited to
    issues of physician qualifications, quality of patient care, and professional
    conduct. See ?? 12-36.5-104(1), -104(6)(a). As a result, the CAC?s
    jurisdiction encompasses only antitrust allegations arising out of adverse
    decisions regarding physician competency.


    The sections of the CPRA cross reference each other, and reinforce the
    conclusion that the scope of CAC?s authority is limited to anticompetitive
    claims arising out of peer review activities assessing physician competence. For
    example, professional review committees are defined as committees authorized to
    review professional conduct and the quality and appropriateness of patient care.
    See ? 12-36.5-102(3). In addition, professional review committees act as
    extensions of the Board of Medical Examiners to evaluate physician competence.
    See ? 12-36.5-103(1). The overall purpose of the CPRA, which includes the
    establishment of the CAC, is to protect the public from unprofessional conduct,
    not from anticompetitive conduct. See id. (stating that the Board
    of Medical Examiners cannot assess every alleged deviation from the quality
    standards, professional conduct standards, or appropriate care standards);
    see also ? 12-36.5-101(2), 4 C.R.S. (1999) (providing in the legislative
    declaration that the purpose of the CPRA is to protect members of the public who
    lack the knowledge, experience, or education to properly evaluate the quality of
    medical practice or professional conduct of physicians).


    In addition, the CPRA contemplates that the CAC will not have jurisdiction
    over all claims. The statute expressly authorizes physicians to pursue judicial
    remedies for claims outside the CAC?s jurisdiction. See ? 12-36.5-106(8)
    (“Nothing in this article shall preclude a physician or health care provider
    otherwise aggrieved by the final action of a governing board from seeking other
    remedies available to them by law, except as provided in subsection (7)”). We
    read that provision to state, in part, that claims not arising from professional
    review committee activity may be litigated in district court. This would include
    claims that are antitrust allegations separate from any peer review process.


    A reading of a limited role for the CAC is further supported by the CAC?s
    limited ability to provide remedies for an aggrieved physician. The CAC may only
    disapprove, set aside, or modify a governing board?s decision. See ?
    12-36.5-106(9)(k). The agency has no authority to provide economic damages or
    other remedies at law. The agency?s ability to conduct hearings and accept
    evidence is likewise limited. See ? 12-36.5-106(9)(h).


    Other sections of the CPRA also reflect an understanding that the CAC?s role
    is expressly limited. Part Two of the CPRA is intended to conform the CPRA to
    federal law and regulations. That part defines “professional review action” as
    “an action or recommendation of a professional review body . . . which is based
    on the competence or professional conduct of an individual physician, which
    conduct affects or may affect adversely the clinical privileges of or membership
    in a professional society of the physician.” ? 12-36.5-203(3)(a), 4 C.R.S.
    (1999).3 Part Two specifically excludes some activities from the
    professional competence or conduct of a physician, including the physician?s
    competitive acts to retain business, the physician?s association with a
    particular group of professionals, or any other matter not relating to the
    competence or professional conduct of the


    physician. See id.4 These provisions focus
    professional review activities on the abilities and qualifications of
    physicians, rather than general hospital oversight or management.


    The CAC?s regulations similarly limit the scope of the CAC?s jurisdiction.
    The regulations provide the CAC with jurisdiction over the final action of a
    governing board involving “at least one of the following subjects:
    qualifications of a member physician; quality of patient care; appropriateness
    of patient care; or the professional conduct of a member physician.” 3 CCR
    713-13, Rule 6(a)(1)(C). We normally will defer to an agency?s own
    interpretation of its statutory mandate. See Northern Colo. Med. Ctr.,
    Inc. v. Committee on Anticompetitive Conduct
    , 914 P.2d 902, 907 (Colo.
    1996). The agency regulations indicate that peer review procedures are designed
    to address deviations from accepted standards by a physician, rather than a
    hospital?s business decisions or general policies to promote patient care. The
    regulations do not provide the CAC with jurisdiction over antitrust allegations
    as a category in and of themselves.


    B.


    Although we need not resort to legislative history, we note that the
    legislative history of the CPRA indicates that the General Assembly created the
    CAC in order to further the intended purpose of protecting peer review
    committees from antitrust liability, while still providing a limited remedy to
    physicians injured by anticompetitive decisions of a peer review committee.
    During committee debate, Representative Tim Foster stated:




        “[m]ainlyMainly what [the CAC] are charged with doing is reviewing any
        appeals geared solely for issues of anticompetitive behavior by the peer
        review committee. They?re not intended to be an appellate board which
        reviews any sort of admonition or other actions taken by the peer review
        committee, but to look at what the peer review committee has done in the
        context of the anticompetitive and antitrust. [sic]”antitrust [sic].


    Hearings on S.B. 89-122 Before the Health, Env?t, Welfare and Insts. Comm.,
    57th Legis. 1st Sess. (Colo. 1989) (statement of Representative Foster). The
    legislation?s sponsor, Dottie Wham, explained that the bill was a response to
    the Supreme Court?s decision in Patrick, and that because of
    Patrick, “it has been very difficult to get physicians to serve on peer
    review. And, because that process is of great importance to us in assuring
    quality of care and appropriateness of care,” the bill would offer antitrust
    protections. Id. (statement of Senator Wham).


    As a result, we find that the General Assembly did not intend for the CAC?s
    jurisdiction to encompass review of a hospital?s denial of privileges that is
    unrelated to professional conduct. Courts cannot expand authority of an
    administrative agency beyond the statute?s authorization. This is especially
    true when a statute derogates the common law. See Brooke v. Restaurant
    Servs., Inc.
    , 906 P.2d 66, 68 (Colo. 1995). A statute may modify or restrict
    a common law right “only to the extent embraced by the statute, which may not be
    enlarged by construction, nor its application extended beyond its specific
    terms.” Farmers Group, Inc. v. Williams, 805 P.2d 419, 423 (Colo.
    1991)(quoting Robinson v. Kerr, 144 Colo. 48, 52, 355 P.2d 117, 119-20
    (1960).


    As the CAC points out in its amicus brief, this court should exercise caution
    in broadly construing the CAC?s jurisdiction. Were we to expand the breadth of
    the CAC?s authority, we simultaneously would expand the scope of state action
    immunity established by the CPRA. The General Assembly has not suggested that
    either the State or the CAC should exercise supervision over a governing board?s
    decisions regarding either economic efficiencies or general policy directives
    regarding patient care. To construe the CPRA broadly in these circumstances
    would move beyond the General Assembly?s stated purpose. See, e.g.,
    Common Sense Alliance v. Davidson, 995 P.2d 748, 753 (Colo. 2000)
    (stating that courts should exercise caution to refrain from adding language to
    a statute).


    C.


    We turn then to the facts of this case. The outcome of this case hinges on
    whether the Hospital?s denial of privileges was a decision regarding Ryals?s
    competency that could fall within the rubric of professional review activities.
    The trial court granted Defendants? motion to dismiss and found that Ryals was
    required to file his claim with the CAC. However, the trial judge did not make
    any findings of fact as to the nature of the Hospital?s actions. We, therefore,
    review the record de novo.


    PRG argues that the governing board?s resolution in this case was an effort
    to improve patient care, and thus, the governing board acted as a professional
    review committee. We disagree and conclude that the Hospital?s actions are
    properly characterized as business decisions.


    The Hospital?s March 4, 1996 letter to Ryals informed him of the Medical
    Qualification Committee?s decision to deny his privileges based on the
    Hospital?s exclusive contract with PRG. The letter indicated that the reasons
    for the exclusive contract were “(a) to provide prompt and reliable coverage by
    qualified physician specialists to meet and satisfy [the Hospital?s] patient
    needs for diagnostic imaging services, (b) to develop on-going quality
    assessment and continuous quality improvement programs . . . (c) to enhance the
    effective and cost-effective administration of [the Hospital?s] diagnostic
    imaging department.” Nothing in the record indicates that the Committee?s
    decision was made as a part of a peer review process to assess Ryals?s
    performance or credentials. Although the Committee couched the exclusive
    contract in terms of general concerns for patient care, its denial of privileges
    was based on the exclusive contract, and not on Ryals?s competence or conduct as
    a physician.


    The Hospital?s governing board affirmed the exclusive contract on the grounds
    that such contracts:




        (a) arrange for and provide prompt and reliable coverage by qualified
        physician specialists to meet and satisfy Hospital?s patient needs . . . (b)
        develop and implement timely and on-going quality assessment and continuous
        quality improvement programs . . . (c) enhance the efficient and
        cost-effective administration and management of Hospital . . . (d)
        coordinate and develop comprehensive and efficient educational
        programs.


    The Hospital?s governing board resolution similarly concerned the PRG
    exclusive contract and not Ryals?s privileges. The resolution did not reference
    Ryals or his professional competence. Most importantly, the governing board
    resolution does not indicate that it was a review of an adverse professional
    review committee action. As we have explained, we read CPRA to provide that only
    the final action of a governing board relating to professional review committee
    activities may be appealed to the CAC.


    Because the Hospital did not engage in a professional review committee
    activity with regard to Ryals?s privileges, the CAC does not have jurisdiction
    over his anticompetitive conduct claims. Because Ryals was not required to file
    his claims with the CAC, no state administrative remedy existed for him to
    exhaust. Therefore, we conclude that the trial court and the court of appeals
    erred in their decisions to dismiss Ryals?s complaint for lack of subject matter
    jurisdiction.


    IV.


    On appeal to this court, Ryals also contested the court of appeals?
    determination that the actions of the Hospital constituted a final action for
    purposes of the CPRA. Because we find that the CAC is without jurisdiction over
    Ryals?s claims, we need not determine whether there was a triggering final
    action in this case.


    Similarly, the third issue on which we granted certiorari was whether the
    CAC?s jurisdiction extended to Ryals?s common law claims. It is unnecessary for
    us to resolve this issue, as we determine that Ryals need not seek relief for
    any of his claims with the CAC before filing his claims in district court.


    V.


    We reject a broad reading of the CAC?s jurisdiction. After considering the
    plain language of the statute, the structure of the CPRA as a whole, and the
    legislative history, we conclude that the CAC?s jurisdiction is limited to
    claims of anticompetitive conduct arising from professional review activities
    that focus on a physician?s qualification or conduct or on the quality of
    patient care. Because the Hospital?s actions with regard to Ryals were not
    professional review committee activities as defined in the statute, we hold that
    the CAC was without jurisdiction over Ryals?s claims. Accordingly, we reverse.


    reverse the judgment of the court of appeals, and remand the case to that
    court to return it to the district court for further proceedings consistent with
    this opinion.


    JUSTICE BENDER does not participate.


    We granted certiorari on the following issues:


    (1) Whether the court of appeals erred in holding that denial of Ryals?s
    request for privileges to read MRI scans was a professional review activity
    subject to review by the Committee on Anticompetitive Conduct where the denial
    was based solely on the hospital?s exclusive contract and not on Ryals?s
    qualifications, professional conduct or quality of care.


    (2) Whether the court of appeals erred in holding that a resolution of the
    hospital?s governing board affirming an exclusive contract for imaging services
    constituted the board?s final action denying Ryals?s request for privileges
    where the resolution did not reference Ryals and was not provided to Ryals until
    two months after Ryals?s request for privileges was denied.


    (3) Whether the court of appeals erred in holding that Ryals was required to
    pursue his common law tort, contract and equitable claims before the Committee
    on Anticompetitive Conduct.


    2 In the Health Care Quality Improvement Act of 1986 (HCQIA), Congress
    provided some antitrust immunity for peer review action taken “in the reasonable
    belief that [it] was taken in the furtherance of quality health care.”
    See 42 U.S.C. ? 11112(a)(1) (2000). States are free to immunize other
    peer review actions that do not meet the federal standard. See
    Patrick, 486 U.S. at 105-06. The CPRA in part duplicates the immunity
    provided by the HCQIA. See Northern Colo. Med. Ctr., Inc. v. Committee
    on Anticompetitive Conduct
    , 914 P.2d 902, 906 (Colo. 1996).


    3 Part Two of the CPRA states that its provisions are intended to
    complement the provisions of Part One. See ? 12-36.5-201, 4 C.R.S.
    (1999). To the extent that the parts conflict, the provisions of Part One should
    prevail. See id. Although the definition of professional review
    activity focuses more closely on the conduct of an individual physician, we find
    that the thrust of both parts is substantially the same, and that the parts may
    be read harmoniously.


    4 The HCQIA similarly defines professional review activities to exclude
    actions based on a physician?s association with a professional society or a
    particular class of health care professionals or “any other matter that does not
    relate to the competence or professional conduct of the physician.” 42 U.S.C. ?
    11151(9) (2000).