The Healthcare Quality Improvement Act of 1986 ("HCQIA") is a federal law enacted to establish a national tracking system of healthcare practitioners with a history of medical malpractice payments or adverse actions. A significant provision of the law provides immunity from civil money damages for those who participate in hospital peer review process, including members of the medical staff. In June 2013, the Louisiana Supreme Court, determined that a hospital was not eligible for HCQIA immunity, and therefore subject to damages, because it failed to provide adequate due process during a peer review activity and failed to follow its medical staff bylaws.
The situation is a familiar one: a surgeon, an adverse event, a heated exchange of blame between the surgeon and the nursing staff, and a hospital too eager to see the surgeon go.
The essential facts are equally familiar: a patient was injured, the treating surgeon was temporarily suspended (without fair notice or fair hearing) and ordered to attend anger management courses. When the surgeon did not attend the courses, his medical staff privileges were terminated and he was not afforded a post-suspension/termination hearing (as provided for in the medical staff bylaws).
The case, Granger v. CHRISTUS Health Central Louisiana d/b/a CHRISTUS St. Francis Cabrini has national significance for two reasons.
First, the case comprehensively examines the federal HCQIA immunity provisions and essentially determines that any adverse credentialing result qualifies as a Professional Review Action versus a mere Professional Review Activity. The distinction is important because Professional Review Actions must meet federal requirements to qualify for HCQIA immunity.
Second, Granger further shifts the balance of case law in favor of the proposition that medical staff bylaws are a contract; the position embraced by Florida courts for more than thirty years.
Accordingly, all hospitals and their medical staffs are on notice that failure to: (1) provide adequate due process; and (2) comply with the hospital's medical staff bylaws during the peer review process, can limit HCQIA immunity and expose the hospital to a significant adverse judgment.