New Jersey court dismisses physician's claims

This week of medical staff leadership coverage begins with a New Jersey court case that illustrates how following procedures regarding professional review actions can help ensure HCQIA immunity.

In the case, Neelu Pal, MD, sued Jersey City Medical Center, its medical-dental staff, and the chair of its credentials committee, claiming of breach of contract, defamation, and conspiracy to violate her civil rights based on gender and national origin, after her application for surgical privileges was denied.

Pal had applied for membership to the medical staff of JCMC in March 2009, and identified three professional references on her application. The evaluation form asked the references to rate her general competencies in six areas as poor, fair, food or excellent. Pal’s first two references ranked her competencies as good and selected the “recommended highly and without reservations” option on the form. The third reference declined to comment because he felt he could not provide a satisfactory evaluation because Pal only rotated through his hospital while serving her general surgery residency.

Evaluation forms were also sent to practitioners at Pal’s residency and fellowship programs. Two of Pal’s former program directors selected the “recommended with some reservations” option. One further added that he did not want to be contacted for additional information about Pal. A third program director from Pal’s bariatric surgery fellowship program at New York University Medical Center declined to fill out the evaluation but offered to speak to the department chair at JCMC.

On her JCMC application, Pal disclosed that she was dismissed from her NYU fellowship program due to a controversy related to her raising quality-of-care issues and contacting patients without permission in connection with her concerns.

Nathaniel Holmes, MD, JCMC’s credentials committee chair, met with Pal about her application on June 4, 2009. Following the meeting, Pal declined to withdraw her application for privileges. Holmes then spoke to the NYU program director regarding her termination. The NYU program director said when Pal was a fellow at NYU she made anonymous calls to the attending surgeon’s patients and their families, warning them that their surgeries at NYU were dangerous. Pal confirmed to NYU that she had made these calls. She was terminated from the NYU bariatric surgery program for this behavior.

Holmes also spoke to one of Pal’s former program directors at the University of Medicine and Dentistry of New Jersey, who confirmed that Pal had complained about discriminatory comments directed toward her but an investigation found the allegations were unsubstantiated. Pal was asked to resign when she refused to retract her complaint.

Holmes and Pal met a second time on August 6, 2009. Ultimately, Pal chose to proceed with the process. Her application was presented to the credentials committee, and Holmes recommended against her appointment. The medical executive committee subsequently recommended the same to JCMC’s board of trustees. Pal was then informed that her application was denied but that she had the right to appeal.

Pal filed an appeal and a fair hearing committee affirmed the denial, citing sufficient evidence to deny her application based on substandard and unacceptable references. Pal appealed to the appellate review committee, which affirmed the previous decisions. Pal then filed suit.

The U.S. District Court for the District of New Jersey dismissed her case, ruling that the Health Care Quality Information Act of 1985 (HCQIA) barred the physician’s breach of contract and defamation claims, and that there was no evidence of a discriminatory conspiracy to deny her application.

In its motion for summary judgment, JCMC argued that Pal’s breach of contract and defamation claims were barred by HCQIA immunity. The Court ruled that the actions taken by Holmes, members of JCMC’s medical staff and credentialing committees and board of trustees fell within the scope of professional review.

The Court ruled that the professional review actions met the criterion for HCQIA immunity because they were done in furtherance of quality healthcare, after a reasonable effort was made to obtain facts, and after adequate notice and hearing procedures were afforded to Pal. The Court granted summary judgment to JCMC regarding the breach of contract and defamation claims based on HCQIA immunity.

The Court also held there was no evidence to support Pal’s claim of a conspiracy to violate her civil rights based on her gender and national origin. The Court ruled that the evidence showed her application was denied due to unfavorable references and not because of her gender, national origin, or complaints she made while at UMDNJ.

Source: Credentialing and Peer Review Legal Insider, January 2015