Pennsylvania Supreme Court Upholds More Stringent Standard For Grant Of Immunity Under Federal Health Care Quality Improvement Act

The Pennsylvania Supreme Court's recent decision not to reconsider a lower court ruling that a hospital was not entitled to immunity under the federal Health Care Quality Improvement Act of 1986 ("HCQIA") could have important implications for entities seeking protection under this Act.

HCQIA was enacted, in part, to encourage candid and critical peer review of physicians without fear of creating a damaging record for potential malpractice lawsuits or a floodgate of employment, tort or contractual actions by the physician whose conduct is being reviewed. To achieve this, the HCQIA provides healthcare employers with immunity from adverse actions taken as a result of professional peer reviews. A professional review action subject to immunity must, however, meet certain standards. Notably, the healthcare employer must establish that the peer review action was taken:

In the reasonable belief that the action was in furtherance of quality health care; After a reasonable effort to obtain the facts of the matter; After adequate notice and a hearing that was fair to the physician under the circumstances; and In the reasonable belief that the action was warranted by the facts known after such reasonable efforts to obtain facts and after the hearing specified above. Courts uniformly recognize that addressing disruptive physician behavior is "in furtherance of quality health care."

In Babb v. Centre Community Hospital, the plaintiff doctor sued his health clinic employer for, among other claims, wrongful termination, breach of contract and defamation. The clinic, in turn, claimed it was immune from the lawsuit under the HCQIA because a peer review committee concluded that the plaintiff "had been unable to work cooperatively and effectively with his colleagues and office staff" as well as - based on a review of medical charts - failed to properly diagnose patients. The committee concluded that such conduct adversely impacted the quality of his patient care, thus justifying his termination. The doctor, however, claimed that he presented sufficient expert evidence showing that the alleged medical deficiencies "were pretextual, retaliatory, and trivial."

The trial court judge, in line with past precedent, determined that immunity was available under HCQIA as a matter of law if there was any evidence to support the finding that the plaintiff's termination was based upon improper patient care. Specifically, the court stated:

there are no genuine issues of...

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