781 F. Supp. 2d 1221
N.D. Okla.2011Background
- Wittenberg is a Oklahoma physician; OHCA administers Oklahoma's Medicaid program and contracts with physicians like Wittenberg for services to Medicaid children.
- APS, a private organization, contracts with OHCA to perform quality controls and grievance/appeals and peer review for Medicaid providers.
- Coniglione (retrospective review coordinator) and Sorrells (APS executive director) oversee APS’s review processes.
- APS issued records requests and written concerns in 2007; MEIC met Aug 30, 2007 to address deficiencies alleged in Wittenberg’s charts and care.
- OHCA subsequently terminated Wittenberg’s contract in 2008 after CAP discussions; Wittenberg challenged the process via §1983 and tortious interference claims against APS defendants.
- APS moved to dismiss under Rule 12(b)(6) arguing absolute immunity and other defenses; the court treated the motion as a 12(b)(6) motion and granted it in part.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether APS defendants have absolute immunity for their review functions | Wittenberg asserts no adequate safeguards and seeks to pierce immunity | APS argues quasi-judicial functions are immune | Yes; APS defendants entitled to absolute immunity for their quasi-judicial review actions |
| Whether § 1320c-6(b) abrogates the immunity | Congress intended to abrogate immunity with § 1320c-6(b) | No clear evidence of abrogation; statute does not apply to bar immunity | No abrogation; §1320c-6(b) does not remove immunity |
| Whether APS is a state actor for §1983 purposes | APS participation in review makes it state actor | APS functions privately under federal Medicaid framework | Court did not reach state-action issue after immunity barred the claims |
| Whether Wittenberg’s due process and tortious interference claims survive if immunity applies | Claims should proceed absent immunity | Immunity bars the claims | Dismissed due to absolute immunity on quasi-judicial functions |
Key Cases Cited
- Kwoun v. Southeast Missouri Professional Standards Review Organization, 811 F.2d 401 (8th Cir. 1987) (extent of immunity for peer review groups under federal program)
- Moore v. Gunnison Valley Hosp., 310 F.3d 1315 (10th Cir. 2002) (prosound factors for absolute immunity; distinction from Moore requires safeguards)
- Ostrzenski v. Seigel, 177 F.3d 245 (4th Cir. 1999) (peer review analogies; absolute immunity for certain review roles)
- Cleavinger v. Saxner, 474 U.S. 193 (1985) (factors to determine if actions are judicial/prosecutorial in nature)
- Stein v. Disciplinary Bd. of Supreme Court of New Mexico, 520 F.3d 1183 (10th Cir. 2008) (functional approach to absolute immunity; scope depends on function)
- Butz v. Economou, 438 U.S. 478 (1985) (policies informing immunity and corrective mechanisms)
- Ellis v. Univ. of Kan. Med. Ctr., 163 F.3d 1186 (10th Cir. 1998) (necessity of clear abrogation for immunity defeat)
- Houghton ex rel. Houghton v. Reinertson, 382 F.3d 1162 (10th Cir. 2004) (Medicaid quality control context; federal-state framework)