Kentuckyone Health, Inc. v. Benjamin Reid Jr M.D.
2016 SC 000321
| Ky. | Jul 10, 2017Background
- Dr. Benjamin Reid, a general surgeon, was a long‑time medical staff member at Jewish Hospital & St. Mary’s (operated by KentuckyOne Health).
- Beginning Jan. 31, 2013, Reid’s cases were subject to a focus review; on Feb. 27, 2013 the Medical Executive Committee allegedly told Reid his surgical/endoscopy privileges would require a board‑certified surgeon or gastroenterologist to accompany him in the OR.
- A committee letter recommended that a board‑certified surgeon/gastroenterologist accompany Reid for all future procedures; Reid performed no further surgeries at the hospital after Feb. 2013 and his staff membership later lapsed.
- Reid sued the Hospital (Jan. 31, 2014) for breach of contract, intentional infliction of emotional distress, tortious interference, and slander; the Hospital answered and later moved for judgment on the pleadings under CR 12.03, asserting HCQIA immunity (42 U.S.C. §§ 11101 et seq.).
- The Jefferson Circuit Court granted judgment on the pleadings for the Hospital; the Court of Appeals reversed, concluding the Hospital’s action was a "professional review action" that could adversely affect Reid’s clinical privileges and remanded to determine HCQIA immunity.
- The Kentucky Supreme Court vacated both lower court decisions and remanded for further proceedings, holding the trial court erred by converting the motion into a judgment on the pleadings (matters outside the pleadings were considered) and the record was insufficient to determine whether the conduct was a protected HCQIA "professional review action."
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether judgment on the pleadings (CR 12.03) was proper | Reid argued pleadings and disputes precluded judgment; factual development required | Hospital argued pleadings plus later submitted facts established immunity and entitlement to judgment | Court: Trial court erred; matters outside pleadings were considered so CR 12.03 treatment was improper and summary‑judgment treatment would be required; remand for development of record |
| Whether the Hospital’s conduct constituted an HCQIA "professional review action" (vs. mere "activities") | Reid contended the action did not satisfy elements of a protected professional review action and record lacked notice/hearing required for immunity | Hospital argued the committee’s recommendation effectively restricted Reid’s privileges and fit HCQIA definitions, entitling it to immunity | Court: Record insufficient to resolve whether HCQIA "professional review action" occurred; Court of Appeals erred in deciding it did; remand for factual development |
| Whether HCQIA immunity applied as a matter of law | Reid argued immunity prerequisites (e.g., proper procedural safeguards) were not shown and immunity was rebuttable | Hospital argued immunity attached because actions related to professional review and no outside‑scope conduct alleged | Court: Could not determine on the present record; immunity question must be addressed after fuller factual development |
| Whether complaint satisfied CR 8.01 and gave fair notice | Reid asserted his complaint met Rule 8 notice‑pleading requirements | Hospital relied on answer and later submissions to press immunity defense | Court: Complaint satisfied CR 8.01 but pleadings lacked well‑pleaded factual detail to support judgment on pleadings; more factual development required |
Key Cases Cited
- City of Pioneer Village v. Bullitt County ex rel. Bullitt Fiscal Court, 104 S.W.3d 757 (Ky. 2003) (explains purpose and standard for CR 12.03 judgment on the pleadings)
- Grand Aerie Fraternal Order of Eagles v. Carneyhan, 169 S.W.3d 840 (Ky. 2005) (pleading standard: fair notice under CR 8.01 suffices)
- Archer v. Citizens Fidelity Bank & Trust Co., 365 S.W.2d 727 (Ky. 1963) (pleadings admitted for purposes of motion on the pleadings)
- Spencer v. Woods, 282 S.W.2d 851 (Ky. 1955) (motion appropriate only when nonmoving party cannot prove any set of facts entitling relief)
- Underwood v. Underwood, 999 S.W.2d 716 (Ky. App. 1999) (illustrates circumstances proper for judgment on the pleadings)