Recently, the Montana Supreme Court issued an opinion granting immunity under the Health Care Quality Improvement Act (“HCQIA”) to a Helena, Montana hospital (the “Hospital”) after a physician’s (the “Physician”) medical staff membership and clinical privileges were revoked following a peer review investigation that identified substandard patient care.
In Weiner v. St. Peter’s Health (“Weiner”), a peer review investigation revealed an array of concerning patterns related to an employed oncologist’s practice at the Hospital, including misdiagnosis, improper treatment and overprescription of narcotics. One referenced example included where a lung autopsy revealed the patient did not have lung cancer and the investigation concluded that the patient’s death was caused by chemotherapy meant to treat the nonexistent cancer. The Physician initially agreed to voluntarily refrain from practicing at the Hospital while medical staff leaders investigated the matter; however, based on information obtained during the investigation, the Physician’s clinical privileges were later summarily suspended and ultimately revoked following the conclusion of the investigation.
The Physician sued in Montana state court, asserting breach of contract claims based on his employment agreement and the Hospital bylaws, wrongful termination, tortious interference with business prospective business advantage, denial of due process and defamation, among other claims. The Montana Supreme Court affirmed the District Court’s decision, granting summary judgment to the Hospital finding that the Hospital was entitled to immunity from damages because it acted within the scope of its peer review obligations under HCQIA.
In reaching its decision, the Montana Supreme Court evaluated four actions taken by the Hospital and its peer review committees, which it determined, after applying a very literal standard and efficient analysis, to be professional review actions as defined by the HCQIA. Those actions included the initiation and extension of the Physician’s summary suspension. The Montana Supreme Court found that for each of these actions, the due process rights afforded to the Physician were fair under the circumstances. Those procedural rights either met the criteria for HCQIA’s safe harbor or were exempt under the so-called imminent harm exception. Consequently, the Montana Supreme Court concluded that the actions taken by the Hospital in connection with the suspension and revocation of the Physician’s privileges were objectively reasonable and that the Physician failed to rebut the statutory presumption of immunity.
Practical Takeaways
- Despite prior state court rulings that may have had a chilling effect on certain peer review activities, this unanimous Montana Supreme Court decision can be seen as an affirmation of the importance of established and clearly defined peer review mechanisms aimed at promoting quality care and patient safety.
- While the Weiner decision does not overturn any existing precedents in Montana, it underscores the need to maintain well-structured and informed peer review processes and reinforces the notion that even in more challenging legal environments, health care facilities that implement and adhere to fair, transparent peer review procedures will be afforded protection under HCQIA.
- Hospitals should thoroughly document all steps taken in peer review actions, as this may be crucial in demonstrating compliance with HCQIA standards and reinforcing the presumption of immunity.
If you have any questions about this topic or would like additional information, please contact:
- Brian Betner at (303) 802-1298 or bbetner@hallrender.com;
- Thomas Donohoe at (720) 308-5450 or tdonohoe@hallrender.com;
- Mayo Alao at (317) 977-1480 or malao@hallrender.com;
- Brian Sabey at (720) 282-2025 or bsabey@hallrender.com;
- Liliann Stoll at (202) 742-9672 or lstoll@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
