Eileen M. WAYNE, Appellant, v. GENESIS MEDICAL CENTER, an Iowa Not for Profit Corporation and a Successor by Merger with St. Luke‘s Hospital; St. Luke‘s Hospital; Douglas Wells; Kristen Wells; James K. McEnerney; William B. Hofmann; Daniel P. Congreve; A.R. Swearingen, Appellees.
No. 97-1432.
United States Court of Appeals, Eighth Circuit.
Submitted Jan. 5, 1998. Decided April 6, 1998.
1145
Ralрh D. Sauer and Jean Dickson Feeney, Davenport, IA, for Appellees.
Before WOLLMAN, LOKEN, and HANSEN, Circuit Judges.
PER CURIAM.
Eileen Wayne, M.D., appeals the district court‘s1 grant of summary judgment to the defendants in her action asserting violations of the Health Care Quality Improvement Act of 1986 (HCQIA),
I.
Viewed in the light most favorable to Wayne, the stipulated facts and documents submitted in support of the pаrties’ cross-motions for summary judgment reveal the following. In October 1992, Wayne was a
When Wayne‘s action was discovered, the incident was referred to the hospital‘s Surgery Service Committee for investigation; Wayne declined its invitation tо attend its meeting. Because the Surgical Service Committee concluded Wayne‘s removal of the medical records was a medical staff issue, the matter was referred to a meeting of the hospital‘s Medical Executive Committee (MEC), which included the physician defendants. Wayne was invited to participate, but again declined. The MEC decided to suspend Wayne‘s surgical privileges. After Wayne returned the missing records, MEC voted to lift Waynе‘s suspension.
In April 1993, Wayne applied for staff privileges at Mercy Hospital. In response to a request for clinical information regarding Wayne, one of the defendants wrote a letter to Mercy‘s Director of Medical Affairs, in which he stated, inter alia, that Wayne had had her privileges temporarily suspended “because of an incident of alteration of her own personal medical record,” but that “[t]his difficulty [had] been resolvеd.” See Appellant‘s Br. Add. at unnumbered page between pages 25 and 26. In a subsequent letter, the physician defendant clarified that his reference to “alteration” meant only that Wayne had removed certain pоrtions of her medical record from the hospital for a period of time.
Wayne claimed the defendants’ actions in summarily suspending her violated the HCQIA, because the suspension was not taken “in the reasonable bеlief that they were furthering the quality of health care” as required by the Act, and because the HCQIA specifies that hearing panels may not include members “in direct competition” with the physician being reviewed, see
Wayne and the defendants cross-moved for summary judgment. The district court granted the defendants’ motion and denied Wayne‘s motion. The court reasoned that the HCQIA did not create a private right of action for physicians, and that the statute gave the hospital—the only proper defendant—immunity from Wayne‘s contract claim. As to the invasion of privacy claim, the district court concluded that Wayne had failed to demоnstrate widespread publicity. The court concluded that the defamation claim failed because the letter was substantially true.
II.
We review de novo the grant of summary judgment, using the same standards as the district court and affirming where, viewing the evidence in the light most favorable to the plaintiff, there is no genuine issue of material fact and judgment is appropriate as a matter of law. See Davenport v. Riverview Gardens Sch. Dist., 30 F.3d 940, 944 (8th Cir.1994). We also review de novo the district court‘s interpretation of state law. See Canal Ins. Co. v. Ashmore, 126 F.3d 1083, 1085 (8th Cir.1997).
III.
A. Private Cause of Action Under the HCQIA
Although this court has not had the opportunity to examine whether the HCQIA provides a private cause of action to aggrieved physicians, we can find no bases in the express languаge of the HCQIA for concluding that it affords such a private cause of action. See
We conclude that none of these relevant factors weighs in favor of an implied cause of action. The HCQIA‘s grant of immunity to review boards strongly suggests that the Act was not enaсted to benefit the physician undergoing peer review. The remaining factors weigh against finding an implied cause of action as well, as it was clearly Congress‘s intent in enacting the HCQIA, to “improve the quality of medical cаre by encouraging physicians to identify and discipline other physicians who are incompetent or who engage in unprofessional behavior.” H.R.Rep. No. 99-903, at 2 (1986), reprinted in 1986 U.S.C.C.A.N. 6287, 6384. Nothing in HCQIA‘s explicit language or legislative history оtherwise signals an intent to create a cause of action for aggrieved physicians.
We thus join the Tenth and Eleventh Circuits in concluding that the HCQIA does not explicitly or implicitly afford aggrieved physicians a cause of action when a hospital fails to follow the HCQIA‘s prescribed peer review procedures. See Hancock v. Blue Cross-Blue Shield, Inc., 21 F.3d 373, 374-75 (10th Cir.1994) (HCQIA does not explicitly or implicitly create a private cause of action for physicians subjectеd to peer review; Congress did not intend to create cause of action for benefit of physicians); see also Bok v. Mutual Assurance, Inc., 119 F.3d 927, 928-29 (11th Cir.1997) (per curiam) (agreeing with Hancock that HCQIA does not create cause of action for physicians).
B. HCQIA Immunity
We agree with the district court that the HCQIA immunizes the hospital from Wayne‘s breach-of-contract сlaim. Under the HCQIA, professional review bodies are protected from damages suits under federal and state law for review actions taken:
- in the reasonable belief that the action was in the furtherance of quality health care,
- after a reasonable effort to obtain the facts of the matter,
- after adequate notice and hearing procedures are afforded to the physician involved or after such othеr procedures as are fair to the physician under the circumstances, and
- in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and аfter meeting the requirement of paragraph (3).
There is a presumption that these requirements have been met unless the presumption is rebutted by a preponderance of the evidence. See
Applying this standard to the facts of this case, we agree with the district court that Wayne failed to rebut the presumption of immunity. In response to the defendants’ summary judgment motion, Wayne made conclusory allegations that the defendants were “clearly unconcerned about quality health care regarding other practitioners” and that her conduct, rather than the defen-
We also conclude that Wayne‘s claim that two members of the MEC were ophthalmologists in direct economic competition with her is insufficient to rebut the presumption that the peer review process was fair under the circumstances. See Mathews, 87 F.3d at 634-38 (physician‘s allegations that some review members were competitors was insufficient to rebut presumption that actions met standard for immunity from suit). Section 11112(b)(3)(A)(ii), (iii), which prohibits a hearing officer or panel from including physicians in direct competition with the physician involved, is inapplicаble, as the MEC members were not acting as hearing officers. See Mathews, 87 F.3d at 636 (affirming district court‘s conclusion that HCQIA prohibits direct competitors from being hearing officers, and not from participating in other phases of peеr review process).
C. Remaining State Law Claims
As Wayne did not show the defendant physicians were involved in disseminating information about her surgery or that the defendants did more than discuss her removal of records in committee meetings (referring to her by number), we further conclude the district court properly granted judgment to the defendants on Wayne‘s invasion of privacy claim. See Restatement (Second) of Torts § 652D (1977) (tort requires publicity of matter highly offensive to reasonable person that is not legitimate concern to public); Stessman v. American Black Hawk Broad. Co., 416 N.W.2d 685, 686 (Iowa 1987) (observing that Iowa has adopted and applied principles of privacy invasion as found in Restatement). The defamation claim is likewise without merit, as Wayne did alter her medical record and was suspended. By removing the pages from her record, she rendered the record less complete than it was originally, and thereby caused an alteration to it. See Behr v. Meredith Corp., 414 N.W.2d 339, 342 (Iowa 1987) (Iowa сourts recognize substantial truth as defense to defamation; test is whether “plaintiff would have been exposed to any more opprobrium had the publication been free of error“).
IV.
We further conclude the district сourt did not abuse its discretion in denying Wayne‘s delinquent motion to amend her complaint, see Williams v. Little Rock Mun. Water Works, 21 F.3d 218, 224 (8th Cir.1994) (standard of review), or her
V.
Accordingly, we affirm the judgment of the district court, and we deny all pending motions as moot.