Last month, the Sixth Circuit Court of Appeals issued an unpublished opinion granting a health care maintenance organization statutory immunity under the Health Care Quality Improvement Act (“HCQIA”) after terminating a physician’s contract. In Moore v John Deere Health Care Plan, Inc., John Deere terminated the contract of Dr. Moore after receiving numerous quality of care complaints from patients who were treated at Moore’s clinics.
In reaching its decision, the court adopted a broad interpretation what constitutes a professional review action and what types of actions and decisions reflect upon a physician’s individual competence or professional conduct. The court held that Moore’s decision to staff his clinics with other practitioners and then fail to properly supervise them touched upon his professional conduct. Further, the court noted that the sheer number of complaints received by John Deere meant that the termination arguably improved patient care.
The Court also held that Moore failed to rebut the statutory presumption that John Deere was entitled to immunity. The court found that John Deere had sent Moore a letter notifying him of the review action and of the meeting by John Deere’s quality improvement committee. Moore was also provided with a copy of each of the complaints relied upon by John Deere in terminating the contract. Moore was also given an opportunity to present additional facts or dispute the facts relied on by John Deere through John Deere’s appeal process. While the hearing may have been conducted in a better way, the court still felt the procedures were adequate under the circumstances.
The decision is significant in that the court adopted a broad view of what constitutes a professional review action and what physician decisions reflects upon “individual competence and professional conduct.” It also provides additional insight into the type of notice and hearing procedure which should be followed in order to ensure immunity will be granted under the HCQIA. For questions or more information regarding this case or the HCQIA, contact Timothy Gutwald at tgutwald@wp.hallrender.com.
