• The Fourth Circuit Affirms Dismissal under the Health Care Quality Improvement Act
  • May 4, 2009
  • Law Firm: King & Spalding LLP - Atlanta Office
  • The Fourth Circuit Court of Appeals affirmed the dismissal of numerous state and federal claims brought against Charleston Area Medical Center, Inc. (CAMC) based, in part, upon the Health Care Quality Improvement Act (HCQIA) 42 U.S.C. § 11101, et seq. The physician sued CAMC for its suspension of the physician’s medical privileges after several practice-related deficiencies.

    The HCQIA provides immunity to a “professional review body” whenever such a body takes an action that in its reasonable belief was: (1) in furtherance of quality health care; (2) after a reasonable effort to obtain the facts, (3) after adequate notice and hearing to the affected party; and (4) with the belief that the action was warranted based upon the obtained facts and hearing. 42 U.S.C.A. § 11112(a). A professional review action is presumed to meet those standards unless the presumption is rebutted by a preponderance of the evidence. Id.

    The District Court in the Southern District of West Virginia granted CAMC’s motion for summary judgment based, in part, upon the HCQIA. The district court held that CAMC qualified for immunity even though CAMC never held a suspension hearing. The district court held that CAMC’s actions were objectively reasonable due to its many attempts to schedule a hearing which the physician avoided.

    On appeal, the physician argued that CAMC was not entitled to immunity under the HCQIA because 1) he was summarily suspended without notice or a hearing; and 2) HCQIA immunity does not protect against a claim for injunctive relief because the HCQIA only provides immunity from suits for damages. The physician also challenged the district court’s determination that CAMC was not a state actor and could not be sued for due process violations as well as the dismissal of his state law claims.

    With respect to the HCQIA requirements, the Fourth Circuit held that CAMC was entitled to immunity under the particular facts of the case. The court reasoned that the physician failed to rebut HCQIA’s presumption in favor of the “professional review body” and that CAMC’s actions were objectively reasonable when viewed in the totality of the circumstances. Similar to the district court, the Fourth Circuit’s analysis focused on the physician’s avoidance of the hearing, holding that the physician’s claims of lack of a hearing were disingenuous when the physician did all he could not to have a hearing.

    The court also rejected the physician’s other claims while recognizing that HCQIA only provides immunity from suits for damages. The Court affirmed the district court, and dismissed the other claims because the physician did not assert any viable claim under any of his alleged causes of action.