In 2006, a federal district court let stand a verdict for $33 million in favor of Dr. Lawrence Poliner, a cardiologist who sued Presbyterian Hospital of Dallas and several hospital physicians after they suspended his hospital privileges for five months following a review of his work.
Nurses and other doctors were concerned about Poliner’s surgical skills, so the hospital convened a panel of physicians to assess his work.
Hospitals and other health care facilities commonly use such peer-review panels to assess the quality of care a doctor provides.
They are widely viewed as one of the most effective ways to protect patients from incompetent physicians. To ensure the integrity of the peer-review process, the federal Health Care Quality Improvement Act (HCQIA) provides panel participants with immunity from being sued for money damages by doctors who disagree with their decisions.
When the hospital’s peer-review panel found Poliner lacking, it pulled his privileges and he sued.
A district court jury sided with Poliner and levied damages against the doctors who served on the peer-review panel.
In a highly anticipated decision, the 5th Circuit Court of Appeals has overruled that verdict, holding that the hospital and individuals involved in the peer-review process are indeed protected from money damages.
The 5th Circuit’s decision was based on a detailed analysis of the application of HCQIA to the facts in this case.
Congress passed the HCQIA to “improve the quality of medical care” by granting limited immunity from lawsuits for money damages to participants in professional peer-review actions.
In order for that immunity to apply, a “professional review action” must be 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 hearing procedures are afforded
- In the reasonable belief that the action was warranted by the facts known after a reasonable effort to obtain those facts.
The act presumes that a peer-review action meets those standards, unless that presumption is rebutted “by a preponderance of the evidence.”
The court then analyzed the hospital’s peer-review procedures under those criteria, and found that the participants were protected against monetary damages.
According to the court, Poliner failed to rebut the statutory presumption that the peer-review actions taken were compliant with HCQIA. Because the defendants were therefore immune from money damages under that act, the appeals court reversed the district court’s judgment. (Poliner v. Texas Health Systems, 5th Cir., No. 0-11235, 2008)