689 N.E.2d 76 | Ohio Ct. App. | 1996
[EDITORS' NOTE: THIS PAGE CONTAINS HEADNOTES. HEADNOTES ARE NOT AN OFFICIAL PRODUCT OF THE COURT, THEREFORE THEY ARE NOT DISPLAYED.] *726 This appeal arises from the summary suspension of the medical staff privileges of plaintiff-appellant Michael A. Gureasko, M.D., from defendant-appellee Bethesda Hospital ("Bethesda" or "the hospital"). At the time of his suspension, Dr. Gureasko was a member of the Bethesda medical staff, specializing in psychiatry.
In order to address Dr. Gureasko's appeal, we must review his summary suspension, his fair hearing ("fairness hearing"), and the state tort claims he raised in the court of common pleas.
Following notification of his summary suspension, Dr. Gureasko requested a fairness hearing, which took place over a number of months. The fairness hearing concluded with the recommendation that Dr. Gureasko's privileges be restored with the condition that he attend monthly meetings with the Department Director for a year. In January 1994, the hospital board accepted this recommendation and restored Dr. Gureasko's privileges.
Subsequently, Dr. Gureasko filed suit against Bethesda and two members of its psychiatry department, Pamela Lockwood and Phillip Edelstein.2 His complaint alleged due process violations, tortious interference with his business relationships, *728 and defamation. He sought compensatory and punitive damages, and also requested that the occurrence of his summary suspension be expunged from his record. All defendants moved for summary judgment, which was granted by the trial court. This appeal ensued.
In his sole assignment of error, Dr. Gureasko argues that the trial court erred in granting summary judgment. The reasons why we disagree with this are complex, and involve an analysis of federal and state law.
"(1) in the reasonable belief that the action was in the furtherance of quality health care,
"(2) after a reasonable effort to obtain the facts of the matter,
"(3) after adequate notice and hearing procedures are afforded to the physicians involved or after such other procedures as are fair to the physician under the circumstances, and
"(4) in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph (3)." Section 11112(a), Title 42, U.S.Code.
Section 11111, Title 42, U.S. Code provides immunity to hospitals and doctors for damages allegedly arising from a professional review action as long as the standards for professional review actions set out in Section 11112, supra, are followed.3 *729
Additionally, the statute provides that a professional review action is presumed to have met the preceding standards unless the presumption is rebutted by a preponderance of the evidence. Section 11112(a), Title 42, U.S.Code.
HCQIA also provides immunity to those who provide information to professional review committees unless the information is false and the person providing it knows the information is false. Section 11111(a)(2), Title 42, U.S.Code.
Finally, while adequate notice and hearing procedures are required in professional review actions to maintain immunity, Section 11112, Title 42, U.S. Code specifically provides that nothing in the statute shall be construed as "precluding an immediate suspension or restriction of clinical privileges, subject to subsequent notice and hearing or other adequate procedures, where the failure to take such action may result in an imminent danger to the health of any individual." Section 11112(c)(2), Title 42, U.S.Code.
Additionally, under Bouquett, when hospital bylaws provide for summary suspension of a physician if such action "must be taken immediately in the best interest of patient care in the hospital," the term "best interest of patient care in the hospital" encompasses more than technical skills and professional competence of the physician. Id. at paragraph two of the syllabus. *730
Finally, R.C.
"No hospital * * * shall be liable in damages to any person for any acts, omissions, decisions, or other conduct within the scope of the functions of the [professional review] committee." R.C.
Under R.C.
The appellees contend that the suspension in this case was due to a health emergency, that the summary suspension was proper, and that they are entitled to immunity.
"The president, the director of a clinical department, the chief executive officer, or in his absence, his designee, or the chairman of the board shall each have the authority to summarily suspend all or any portion of the clinical privileges of a Medical Staff appointee or other individual whenever such action is in the best interest of patient care or safety or the continued effective operation of the *731 Hospital or whenever such individual has violated the bylaws, policies and regulations of the Hospital or Medical Staff."5
Nothing in HCQIA prevents the summary suspension of a doctor's privileges. The hospital's bylaws specifically provide for a summary suspension under specified circumstances.6 The suspension is clearly a part of the professional review process at Bethesda. Additionally, the use of a summary suspension as part of the professional review process is specifically approved by the Joint Committee on Accreditation of Hospitals.7
Under both federal and state law, the action of those implementing a summary suspension should be reviewed for reasonableness under the circumstances. The reasons for a summary suspension can ultimately be wrong; that is not the test of whether there has been a due process violation. Austin,supra,
Dr. Bath met with the ad hoc committee on May 24, 1993, and discussed the memoranda, patient reports, and information concerning thirteen cases handled by Dr. Gureasko. The ad hoc committee discussed the suspension of Dr. Gureasko's clinical privileges, but no adverse action was taken at that time. Instead, the committee decided that the information concerning Dr. Gureasko should be reviewed by the Medical Staff Patient Care Committee12 at its meeting on the following day.
The Medical Staff Patient Care Committee met on May 25, 1993, and recommended that Dr. Gureasko's privileges be suspended. The Executive Committee considered the information pertaining to Dr. Gureasko at a meeting on June 1, 1993.13 The committee voted unanimously to recommend that the Board of Trustees permanently revoke Dr. Gureasko's clinical privileges at Bethesda and that Dr. Gureasko's clinical privileges be suspended pending final action by the Board of Trustees. *734
On June 1 or 2, 1993, Dr. Gureasko received five letters from quality assurance signed by Dr. Lockwood, alleging problems with his treatment and care of patients.
On June 2, 1993, Dr. Gureasko was notified of the summary suspension and of the Executive Committee's recommendation that his privileges be permanently revoked by a letter personally delivered to Dr. Gureasko by Dr. Bath. The letter identified thirteen patients whose treatment served as the basis for the suspension and notified Dr. Gureasko of his right to have a hearing on the Executive Committee's recommendation if requested in writing within thirty days.
The record clearly supports the hospital's obligation under HCQIA that its actions were taken in the reasonable belief that they were in furtherance of quality health care and after a reasonable effort to obtain the facts of the matter. The suspension was followed by adequate procedures, including notice and a comprehensive hearing. Further, the committees which received this information from the original ad hoc committee through the fairness hearing were evaluating a fellow physician's qualifications in light of concerns over patient safety.14 Therefore, the hospital is immune from liability for any damages resulting from the suspension.
We thus hold that the hospital's summary suspension procedure provided sufficient due process to qualify the hospital for immunity under HCQIA as well as under state law. We further hold after a review of the entire record that Dr. Gureasko has failed to rebut the statutory presumption of immunity.15 The trial court was correct in granting summary judgment to the hospital.
However, while we do not agree with Dr. Gureasko that the fact of his summary suspension should be expunged from his record, we do agree that such a notation, without more, is unfair to him. This entire process is a continuum. At the beginning, when a summary suspension is invoked, the concern over patient safety and welfare is absolutely paramount. At the end of the process, when the fairness hearing has been completed, ending with a recommendation to *735 the Hospital Board of Trustees, the doctor's interest is paramount, and due process at this point requires that his record contain the complete story. Accordingly, we direct the hospital to annotate his record to show the ultimate disposition of the fairness hearing along with the fact of his summary suspension.
In Jacobs v. Frank (1991),
"Public policy concerns dictate that those who provide information to licensing boards pursuant to R.C.
In order to defeat this privilege, Dr. Gureasko had to produce clear and convincing evidence that Drs. Lockwood and Edelstein acted with actual malice. "In a qualified privilege case, `actual malice' is defined as acting with knowledge that the statements are false or acting with reckless disregard as to their truth or falsity." Id. at 116,
Dr. Gureasko has presented no evidence that Dr. Edelstein made any false derogatory statements about him. In his affidavit, Dr. Edelstein stated that he had no involvement in the events leading to Dr. Gureasko's suspension other than being in attendance at the May 24, 1993 meeting. He stated further that he did not say anything derogatory about Dr. Gureasko at the meeting and that he did not recommend Dr. Gureasko's suspension. His only other involvement in the professional review process was to submit a requested affidavit into evidence at the fairness hearing. The contents of this affidavit are privileged pursuant to R.C.
Dr. Gureasko presented no evidence creating a material issue of fact that Dr. Lockwood made malicious statements about him or that any statements were made without a reasonable belief that the information was warranted by the facts known to her. Dr. Lockwood presented an affidavit denying any malice and explaining the basis for her statements. Dr. Gureasko in his deposition admitted that he felt that Dr. Lockwood believed that her statements were true. The trial court was correct in granting summary judgment to Dr. Lockwood on all of Dr. Gureasko's claims against her stemming from her role in the professional review proceedings. Civ.R. 56; Dresher andTemple, supra.
Accordingly, the assignment of error is overruled, and the trial court's entry of summary judgment for all defendants is affirmed as modified.
Judgment affirmedas modified.
PAINTER and SHANNON, JJ., concur.
RAYMOND E. SHANNON, J., retired, of the First Appellate District, sitting by assignment.
Dr. Lockwood has been the director of the psychiatry department since January 1, 1993. Dr. Edelstein was the co-director of the psychiatry department during 1993. At that time, he was married to Dr. Lockwood.
"If a professional review action of a professional review body meets all the standards specified in section 11112(a) of this title * * *
"(A) the professional review body,
"(B) any person acting as a member or staff to the body,
"(C) any person under a contract or other formal agreement with the body, and
"(D) any person who participates with or assists the body with respect to the action,
"shall not be liable in damages under any law of the United States or of any State (or political subdivision thereof) with respect to the action. * * *"
"The individual who exercises his authority under Section 1 of this Part to suspend summarily a person appointed to the medical staff shall immediately report his action to the Chairman of the Credentials Committee or the Chairman of the Executive Committee, whichever committee (depending on the reason for the suspension) shall be appropriate to take further action in the matter. An investigation of the matter resulting in summary suspension shall be completed within 14 days of the suspension or reasons for the delay shall be transmitted to the Board so that it may consider whether the suspension should be lifted. At that point the Committee to which the matter has been referred shall take such further action as is required in the manner specified under Part C of this Article for the Credentials Committee and Part D of this Article for the Executive Committee. The summary suspension shall remain in force after the appropriate committee takes responsibility unless and until modified by that committee or the Chief Executive Officer, or until the matter that required the suspension is finally resolved."
"In the case of Patient 4, Dr. Gureasko apparently discharged the patient at a time when the patient was still expressing suicidal thoughts and Dr. Gureasko essentially challenged the patient to commit suicide. In the case of Patient 6, Dr. Gureasko radically changed the patient's medication the very first time Dr. Gureasko saw the patient. Dr. Gureasko made no apparent effort to understand the basis on which Patient 6's medications had been prescribed. Not long after this consultation with Dr. Gureasko, Patient 6 reported a suicide attempt. In the other case of Patient 1, Dr. Gureasko had allowed a patient of his to go into a condition seriously risking cardiac arrest because of his failure to ensure that physical examinations and laboratory tests were timely done."
Members of the Executive Committee include the Medical Staff officers, the directors of each of the hospital's clinical departments, the chair of the Patient Care Committee, and two members elected at large from among the Medical Staff members holding active and teaching privileges.
"No hospital * * * shall be liable in damages to any person for any acts, omissions, decisions, or other conduct within the scope of the functions of the committee:
"(A) A utilization review committee, quality assurance committee, or tissue committee of a hospital * * *;
"(B) A board or committee of a hospital * * * reviewing professional qualifications or activities of the hospital medical staff or applicants for admission to the medical staff[.]"