A recent ruling by the Tennessee Court of Appeals may leave the door open for a new interpretation of peer review protection legislation. The court ruled that hospitals—not just physicians—can be granted immunity in cases of physician negligence as long as the peer review decision was reached in good faith.
"This case strictly focuses on a Tennessee statute and the court recognized the constraints inherent in that statutory language. However, the premise of a peer review process is to objectively evaluate the conduct of a professional and make informed judgments," says Bruce D. Armon, Esq., attorney with Saul Ewing LLP in Philadelphia.
In most states, peer review laws provide confidentiality and legal immunity to those who participate in peer review—usually medical professionals who raise concerns about a colleague's ability to competently practice medicine or provide testimony during a peer review case.
"The idea is that protection will encourage better review," says Alice G. Gosfield, Esq., attorney with Alice G. Gosfield and Associates in Philadelphia.
In the case, the plaintiff, a patient, sued both a plastic surgeon practicing at Centennial Medical Center for malpractice and the hospital itself for negligent credentialing, claiming that the hospital should have revoked the physician's privileges because of a lack of competence.
In an appeal, the plaintiff asserts that Tennessee's statute regarding peer review is unconstitutional and argues that granting the hospital immunity when a patient sues over a credentialing decision is inconsistent with the original intent of the statute, which is to protect and encourage healthcare workers to participate in the peer review process.
At the center of the appeals case was the issue of interpreting the statute to determine whether hospitals are covered under qualified immunity when a patient sues. "The Tennessee statute is not a model of clarity," Gosfield says, adding that most peer review statutes are similarly unclear.
The split decision was written by Tennessee's Court of Appeals Judge Andy D. Bennett, who stated, "We hold that the qualified immunity defense under [the peer review protection law] is available when a patient sues a hospital for credentialing decisions made by a peer review committee." It also ruled that the statute is constitutional.
The concurring opinion recognizes the need to gather relevant facts to determine culpability for a hospital's peer review committee, and the decision underscores the importance of the peer review process, Armon explains.
However, the court did not hold that Centennial Medical Center was specifically immune. The case has been remanded back to the trial court to determine whether Centennial's credentialing decision was made in good faith.
According to Gosfield, the court is saying that the hospital itself cannot be liable unless the peer review was conducted with malice and not in good faith. "It's really a sideways view of peer review protection, and not really what the statutes were supposed to be about," she adds.