Smigaj v. Yakima Valley Memorial Hospital Ass'n
165 Wash. App. 837
| Wash. Ct. App. | 2012Background
- PQAC recommended suspension of Smigaj’s hospital privileges; MEC reinstated with external review for three months, non-retroactive.
- Smigaj filed suit challenging the suspension; court granted Memorial summary judgment on immunity and other claims; defamation claim remained.
- HCQIA/RCW 7.71.020 provides immunity for professional review actions based on competence/conduct; RCW 7.71.030 limits remedies for non-related actions.
- Trial court held HCQIA immunity applied and dismissed most claims; awarded Memorial substantial attorney fees.
- On appeal, court held HCQIA applies, Smigaj rebutted two immunity elements (investigation and fair process), and remanded for trial; defamation claim related to Group Health letter upheld as damages not shown; attorney fee award reversed.
- External review of JA, WC, LH cases found four major deviations; Imminent danger/notice/fair process evaluated under HCQIA standards.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether HCQIA immunity applies | Memorial failed elements; immunity not applicable | Immunity applies if four elements satisfied | HCQIA applies; genuine immunity questions for trial |
| Whether Smigaj rebutted elements 2 (investigation) and 3 (fair process) | Investigation and notice were inadequate; not reasonable | Process reasonable; relied on external reviews | Smigaj may rebut elements 2 and 3; questions for trial |
| Whether the procedure violated fair notice/process requirements | Informal process deprived notice and hearing | Informal procedures permissible under HCQIA | Procedural safeguards were lacking; not fair under circumstances |
| Whether damages/claims related to HCQIA immunity were properly dismissed | All non-defamation claims barred by immunity | Immunity bars damages; other claims may proceed | Damages claims subject to HCQIA preclusion; some claims survive remand |
Key Cases Cited
- Cowell v. Good Samaritan Cmty. Health Care, Inc., 153 Wn. App. 911 (Wash. App. 2009) (HCQIA immunity presumption; burden to rebut elements)
- Morgan v. PeaceHealth, Inc., 101 Wn. App. 750 (Wash. App. 2000) (immunity analysis; not perfect investigation)
- Perry v. Rado, 155 Wn. App. 626 (Wash. App. 2010) (reasonable notice/hearing; cooperation with investigation)
- Gabaldoni v. Wash. County Hosp. Ass’n, 250 F.3d 255 (4th Cir. 2001) (announcement of change in status is part of professional review action)
- Poliner v. Tex. Health Sys., 537 F.3d 368 (5th Cir. 2008) (thorough investigation required; not perfect)