What Physicians Need to Know About Clinical Privileges and Peer Review Actions From the Meyers Case
If you are a physician with hospital privileges or have ever been called a “disruptive physician” make sure you are familiar with Meyers v. Columbia/HCA Healthcare Corp., which was finally decided in 2003. In ruling on disruptive physician cases, courts almost always rely on Meyers, and it has been cited repeatedly in other disruptive physician cases to justify a hospital or medical staff’s peer review actions disciplining the physician.
In this case, Dr. Meyers, an orthopedic surgeon, received provisional medical staff privileges at a hospital. A year later, the credentials committee at his hospital, comprised of three board members, re-evaluated Dr. Meyers for advancement to active staff privileges. He was denied active staff privileges by the committee for reasons that included his alleged temper tantrums, condescending remarks towards women, refusal to speak to a member of his surgical team during surgical procedures, and several instances of throwing a scalpel during surgical procedures.
Dr. Meyers was granted a hearing by the hospital. The hospital’s bylaws provided for a fair hearing committee comprised of three members of the medical staff, who would have been Dr. Meyers’ peers. However, the fair hearing committee in Dr. Meyers’ case was different. It was comprised of a retired judge, an attorney, a bank president, an industrialist and a dentist. The fair hearing committee met eleven times and 35 witnesses testified during the course of the hearing. After the hearing, the fair hearing committee recommended not appointing Dr. Meyers. It cited his failure to meet the hospital’s ethical standards, as well as his inability to work cooperatively with others. This recommendation was adopted by the hospital’s governing board.
Dr. Meyers sued the hospital and the fair hearing participants. His claims included breach of contract, antitrust, violations of the Emergency Medical Treatment and Active Labor Act (EMTALA), tortious interference, and defamation.
The hospital moved for a summary judgment, claiming immunity under the Health Care Quality Improvement Act of 1986 (HCQIA), which provides immunity if a professional review action is taken under a combination of four circumstances: (1) in the reasonable belief that the action would further quality healthcare; (2) after a reasonable investigation; (3) with adequate notice and hearing procedures; and (4) the reasonable belief that the action was warranted by the facts and the process.
The trial court granted summary judgment in favor of the hospital and the hearing panel’s members. The court’s analysis of the summary judgment standard in the Meyers case for HCQIA has been relied upon regularly since this. Meyers indicated that the professional review actions that were followed satisfied the HCQIA’s immunity requirements. The district court’s action was later affirmed on appeal by the Sixth Circuit.
Because of Meyers, physicians have a much higher standard to overcome, in order to get a similar case before a jury. The physician must demonstrate 1) that a genuine issue of fact exists and 2) that a reasonable jury, viewing the facts in the best light for the plaintiff, might conclude that he has shown by a preponderance of the evidence that the actions of the hospital and committee are outside the scope of HCQIA.
In both Meyers and in subsequent cases, physicians have attempted to challenge this summary judgment standard by various legal arguments. One used is that the action taken against the physician was not “fair” because the hearing committee did not include a physician of the same specialty. Another is that the hearing panel did not include a physician, a “peer.” Therefore, how could it truly be “peer review.”
In Meyers, both the Sixth Circuit and the district court looked to the hospital’s medical staff bylaws which stated that medical staff members (other physicians) would be appointed to the fair hearing committee only “when feasible.” The hospital presented evidence that no medical staff member could serve on the committee at the time when the hearing was scheduled in Dr. Meyers’ case. Furthermore, the district court stated that the bylaws of a hospital concerning peer review actions are inconsequential, as long as the HCQIA’s fair hearing requirements are met. In the HCQIA, there is no requirement that a physician must serve on a fair hearing committee.
Meyers also provided grounds for justifying professional review actions based a physician’s “general behavior and ethical conduct.” Disruptive behavior is also enough to justify suspension or termination of privileges, because, according to the district court, “Quality patient care demands that doctors possess at least a reasonable ability to work with others.”
Although the Meyers case has been the precedent for disruptive physician cases since 2003, physicians must also be aware of The Joint Commission’s standard on disruptive behavior, issued in 2008. This standard affirms that disruptive behavior is enough to justify a hospital’s action against a physician, including termination. Physicians can now expect to see even more actions initiated by hospitals and their staffs against any physician deemed uncooperative or disruptive. You can read The Joint Commission’s sentinel alert on disruptive behavior here.
If you find yourself at the center of a peer review hearing due to reasons of disruptive behavior, make sure that you contact an experienced healthcare attorney to help you navigate the peer review process. See this article on clinical privileges and peer review hearings for more information or visit our website at www.TheHealthLawFirm.com.