Immunity for Peer Review under HCQIA Upheld

A really good decision interpreting the immunity afforded health care providers performing peer review is Wahi v. Charleston Area Medical Center, Slip Op. No. 06-2162 (4th Cir. April 10, 2009). The Fourth Circuit affirmed summary judgment as to various claims made by the plaintiff, a cardiothoracic surgeon, arising from the suspension of his privileges at a Charleston hospital, CAMC. The opinion is a resounding affirmation of the immunity afforded hospitals under the Health Care Quality Improvement Act (HCQUIA), 42 U.S.C.A. § 11101, et seq. (West 2005).

Reviewing the four factor test for immunity in 42 U.S.C.A. § 11112(a) (West 2005), the Court found plaintiff waived his claims as to the first, second, and fourth requirements and rejected the argument that the hospital’s failure to hold a hearing denied it protection under the plain language of HCQIA’s “safe harbor” provisions. Moreover, the Court found a hearing did not occur, but found plaintiff “failed to rebut the presumption that [the hospital’s] actions satisfied the statutory requirement when the totality of the circumstances are viewed in an objectively reasonable manner.”

Finding the hospital’s “path to immunity in this case is not a recommended model, it must be evaluated considering all the events which transpired, not just those Wahi views as favorable to him,” the Court affirmed summary judgment, upholding the immunity.

Wahi demonstrates the importance of documenting interactions with physicians, and providing full information and an opportunity to respond during the peer review process. During the litigation, it shows this evidence is important to prove the totality of the circumstances. Even where a proceeding doesn’t quite follow the bylaws, it can still qualify for HCQIA immunity.

Nice work on this case by my pal, Rick Jones, of Flaherty Sensabaugh & Bonasso in Charleston, WV.