Federal court sides with physician in hospital suspension lawsuit involving physical altercation with colleague

This material originally appeared in the September 19, 2008, issue of Health Lawyers Weekly, a publication of the American Health Lawyers Association (www.healthlawyers.org).

A physician who sued a hospital that summarily suspended his privileges had met his burden of showing the hospital was not entitled to summary judgment based on immunity afforded by federal and state peer review protections, a federal trial court in Tennessee ruled September 8.

Dr. Alexander Stratienko, a physician at Erlanger Hospital in Chattanooga, Tennessee, was involved in a physical altercation at the hospital with another physician, Dr. Stephen Monroe.

Before the altercation, Stratienko had questioned Monroe’s qualifications to serve on a committee that credentialed physicians to place carotid stents. Monroe confronted Stratienko who said he moved Monroe aside so he could exit the room they were in.

Following this incident, the Chattanooga-Hamilton County Hospital Authority, which owns and operates the hospital, suspended Stratienko’s privileges for 30 days.

Stratienko sought and obtained a temporary restraining order (TRO) in state court prohibiting the Hospital Authority from suspending his hospital privileges pending the outcome of the lawsuit. The TRO eventually led to a preliminary injunction.

Defendants, the Hospital Authority and another physician, moved for summary judgment, arguing they were immune from damages under the Health Care Quality Improvement Act (HCQIA) and the Tennessee Peer Review Law. Defendants also sought to dissolve the preliminary injunction, arguing the court should defer to the peer review process and that judicial intervention was premature.

The U.S. District Court for the Eastern District of Tennessee denied both motions.

The court agreed that HCQIA was implicated because Stratienko’s summary suspension constituted a “professional review action,” but concluded that it could not dismiss the action based on HCQIA immunity in the context of summary judgment.

Viewing the evidence in the light most favorable to Stratienko, a reasonable jury could find defendants did not act reasonably in summarily suspending him, the court explained.

In reaching its conclusion that the hospital was not entitled to HCQIA immunity at this stage of the litigation, the court relied on a number of factors, including that the summary suspension occurred a little more than an hour after the incident occurred, that the evidence potentially indicated defendants failed to make “a reasonable effort to obtain the facts of the matter,” and that a jury could find it unreasonable to suspend a physician’s clinical privileges for an altercation without first informing or questioning the physician.

The court likewise found immunity under the Tennessee Peer Review Law unavailable as a basis for granting defendants summary judgment. Under the state peer review law, the party opposing immunity has the burden of showing bad faith or malice.

Reviewing relevant factors in this determination set forth by Tennessee courts, the federal district court found “some, even though not great, evidence to infer malice.”

Drawing reasonable inferences in the light most favorable to Stratienko, a reasonable jury could find some indications of malice or bad faith, including defendants’ decision to suspend Stratienko shortly after the incident without any prior investigation or discussion with him; without affording him notice and a hearing; and without action to determine whether Monroe should also be suspended as a threat to hospital operations.

Next, the court denied defendants’ motion to dissolve the preliminary injunction.

The court concluded deference to the hospital’s determination of whether a physician should enjoy clinical privileges was not implicated here because there was no indication Stratienko posed any risk of harm to patients and evidence existed that his suspension was decided without adequate investigation, a meaningful opportunity for him to refute the charges, and a clear justification for action as serious as a 30-day suspension of clinical privileges.

The court also rejected defendants’ contention that the peer review process should be fully completed before judicial intervention.

“The Court is not limited to considering only a final act of suspension, but can consider any professional review action within the relevant ‘professional review activity,’ which includes modification of a physician’s clinical privileges.”

The summary suspension of Stratienko’s privileges was not a “threatened” injury, as defendants contended, but rather included loss of wages, tarnishing of reputation, and disruption of patient services, the court noted.

Finally, the court clarified that the preliminary injunction did not prevent defendants from continuing with the peer review process, but rather precluded them from implementing the summary suspension while they did so.

Stratienko v.Chattanooga-HamiltonCounty Hosp.Auth., No. 1-07-CV-258 (E.D. Tenn. Sept. 8, 2008).