Brandner v. Providence Health & Services - Washington
384 P.3d 773
| Alaska | 2016Background
- Dr. Michael Brandner, a surgeon, was subject to an Alaska State Medical Board order to undergo psychiatric and medical evaluations in Oct. 2010; he completed the Menninger Clinic evaluation in Dec. 2010 and the State Board closed its investigation in Dec. 2010 (confirmation sent May 2011).
- Providence’s medical staff policy MS 980-150(D) required physicians to report within 30 days any "limitations, restrictions, or conditions" imposed by a state board; failure to report triggers "automatic termination" of hospital privileges.
- Brandner did not report the State Board order to Providence; Providence’s executive committee learned of the order from internal records and, without prior notice to Brandner, recommended automatic termination in June 2011; the Providence Board affirmed and Brandner’s privileges were effectively terminated June 17, 2011.
- Brandner received post-termination administrative procedures: a one-day hearing panel, an appellate review committee decision, and final Providence Board affirmation; the internal bodies upheld termination as consistent with the policy.
- Brandner sued in superior court alleging due process violations and other claims; the superior court upheld the substantive application of the policy but found no pre-termination due process violation and granted Providence HCQIA immunity for damages; Brandner appealed.
- The Alaska Supreme Court affirmed that the policy was not vague nor applied arbitrarily (so no reinstatement or post‑termination damages on that ground), reversed on the pre-termination notice/hearing issue (finding a due process violation), and held HCQIA did not immunize Providence for the pre‑termination deprivation; the case was remanded for damages proceedings limited to the pre-termination due process violation.
Issues
| Issue | Brandner's Argument | Providence's Argument | Held |
|---|---|---|---|
| Whether Brandner waived a right to pre-termination hearing by agreeing to hospital bylaws | No waiver; bylaws/authentication did not clearly and voluntarily relinquish constitutional right | Bylaws and MS 980-150(D) functionally waive pre-termination rights via automatic termination provision | No waiver — waiver must be clear and voluntary; Brandner did not knowingly waive pre-termination hearing right |
| Whether due process required notice and hearing before termination of hospital privileges | Pre-termination notice and hearing required absent emergency; deprivation occurred without such process | Post-termination full hearing and appeals satisfied due process; immediate termination permitted by policy for safety | Pre-termination notice/hearing was required; terminating without them violated due process (no emergency shown) |
| Whether MS 980-150(D) was unconstitutionally vague or applied arbitrarily | Policy ambiguous ("conditions" could be read differently); applied arbitrarily to justify termination | Policy sufficiently clear; reasonable interpretation that State Board order was a "condition"; panel application non‑arbitrary | Policy was not impermissibly vague nor arbitrarily applied to Brandner; substantive termination upheld |
| Whether Providence is immune under HCQIA for damages from the pre-termination deprivation | HCQIA immunity not available because §11112(a)(3) requires adequate notice and hearing before the professional review action | HCQIA immunity applies because Providence used full peer-review process and post-termination procedures are fair | HCQIA immunity does not apply to the pre-termination deprivation because Providence failed to afford the notice/hearing required under §11112(a)(3) prior to the termination action |
Key Cases Cited
- McMillan v. Anchorage Cmty. Hosp., 646 P.2d 857 (Alaska 1982) (pre-termination hearing required absent evidence of immediate threat to patient safety)
- Storrs v. Lutheran Hosps. & Homes Soc’y of Am., Inc., 609 P.2d 24 (Alaska 1980) (quasi-public hospitals must meet due process standards when denying staff privileges)
- Alyeska Pipeline Serv. Co. v. State, Dep’t of Envtl. Conservation, 145 P.3d 561 (Alaska 2006) (standard for de novo review of constitutional claims and waiver principles)
- Peper v. St. Mary’s Hosp. & Med. Ctr., 207 P.3d 881 (Colo. App. 2008) (hospital bylaws cannot substitute for HCQIA’s statutory notice and hearing requirements for immunity)
- Whitaker v. Houston Cty. Hosp. Auth., 613 S.E.2d 664 (Ga. App. 2005) (waiver of due process rights in context of hospital privileges can be upheld when there is an express contractual waiver)