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Poliner decisions reversed

Credentialing Resource Center Connection, July 31, 2008

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Anne Roberts, CPMSM, CPCS, is the director of medical affairs at Children's Medical Center of Dallas, where she oversees the medical administration, graduate medical education, and medical staff services departments.

Dear credentialing colleague:

On July 23, 2008, U.S. Court of Appeals for the Fifth Circuit reviewed the case of Poliner vs. Texas Health Systems (Presbyterian Hospital of Dallas) and James Knochel, MD. The original case drew national attention when a jury awarded the defendant $366 million for defamation and punitive damages. A trial court later reduced that amount to approximately $33 million. Last week’s ruling overturned the jury and the trial court’s decisions and found in favor of Texas Health System, concluding that the physicians who advocated for Poliner’s suspension are protected under the Health Care Quality Improvement Act. As a result, Poliner will not receive any monetary award for damages.

If you are not familiar with the case, here is a summary: Poliner claimed that the hospital forced him to suspend practice of his clinical privileges (including cardiac catheterization and echocardiography privileges), failed to follow its bylaws, and damaged his reputation and career. Poliner sued the hospital and the physicians involved in the peer review committee that handled the investigation which led to the suspension of his privileges.

The court found that the defendants’ actions met the definition of a ‘professional review’ and reviewed the actions to determine if they met HCQIA’s four requirements for immunity (listed below), namely that a professional review action be taken:

1. In the reasonable belief that the action was in the furtherance of quality healthcare
2. After a reasonable effort to obtain the facts of the matter
3. After adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances
4. In the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph

The appellate court’s focus was on the information that the defendants had available to them at the time of the review and whether the action taken was reasonable and objective based on the facts available at that time. The Court of Appeals noted that HCQIA includes a presumption that a professional review action meets the standards for immunity, unless those standards are rebutted by a preponderance of the evidence. The Court of Appeals reversed the decision of the lower court after finding that Poliner had failed to rebut the presumption. The court also stressed that a hospital’s failure to follow or comply with its bylaws does not preclude the reviewer’s right to HCQIA protection and immunity from damages.

This ruling helps to reaffirm health care organizations faith in the peer review system and helps physicians to feel more comfortable participating in peer or quality reviews as HCQIA affords immunity when reviews meet the criteria outlined above.

Remember, clear, effective communication is the key to success!

That’s all for this week.

All the best,

Anne Roberts, CPMSM, CPCS

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