Summary
The Alaska Supreme Court held that Providence violated Dr. Michael Brandner’s procedural due process rights by terminating his hospital privileges without a pre-termination opportunity to be heard. The court concluded that the circumstances did not establish an emergency or realistic and recognizable threat to patient care requiring immediate termination. It affirmed the ruling that Providence’s substantive application of its reporting policy did not violate due process and remanded the pre-termination hearing and damages-immunity issues for further proceedings.
Topics
Practice areas
Questions Presented
- Whether Providence violated Dr. Brandner's procedural due process rights by terminating his hospital privileges without a pre-termination opportunity to be heard.
- Whether Providence's self-reporting policy was impermissibly vague or was applied arbitrarily and capriciously, thereby violating substantive due process.
- Whether Providence was entitled to damages immunity under HCQIA despite terminating Dr. Brandner's privileges without providing an opportunity to be heard before the termination.
Holdings
- Providence violated Dr. Brandner's procedural due process rights by terminating his hospital privileges without any pre-termination opportunity to be heard. A post-termination hearing did not cure the failure to provide pre-termination process because no emergency or realistic and recognizable threat to patient care justified summary action.
- Providence policy MS 980-150(D) was not impermissibly vague or ambiguous as applied to Dr. Brandner or on its face, and Providence did not apply it arbitrarily or capriciously. The termination therefore did not violate substantive due process, and Dr. Brandner was not entitled to reinstatement or damages based on the post-termination hearing claim.
- Providence was not entitled to HCQIA damages immunity for terminating Dr. Brandner's hospital privileges without an opportunity to be heard. The post-termination hearing and appeal did not satisfy HCQIA's requirement that the professional review action occur after adequate notice and hearing procedures or other procedures fair to the physician under the circumstances.
Key quotations
“We therefore disagree with the superior court’s determination that the connection between Dr. Brandner’s “dishonesty” and patient safety was sufficient to override Dr. Brandner’s due process right, and we conclude that Providence violated Dr. Brandner’s right to due process by terminating his hospital privileges without a pretermination opportunity to be heard.” (-15)
“And although appeal hearings took place after the actual termination of Dr. Brandner’s privileges, these procedures are insufficient to satisfy § 11112(a)(3)’s requirement that adequate hearing procedures must be afforded to the physician before the professional review action is taken.” (-25)
“We therefore reverse the superior court’s conclusion that HCQIA immunity applies to the due process violation arising from terminating Dr. Brandner’s hospital privileges without an opportunity to be heard.” (-32)
Factual background
Dr. Brandner held surgical privileges at Providence and returned from medical leave in 2010. The Alaska State Medical Board ordered him to undergo psychiatric and medical evaluations concerning his fitness to practice, and he completed the evaluations without the Board imposing further discipline. Providence policy required physicians to report limitations, restrictions, or conditions imposed by a state board and stated that violations would result in automatic termination. Dr. Brandner did not report the Board's order, and Providence terminated his privileges before providing the post-termination hearing and appeal procedures available under its policies.
Procedural history
Providence terminated Dr. Brandner's hospital privileges without providing an opportunity to be heard beforehand, although it later provided a fair-hearing panel proceeding and appellate review. Dr. Brandner sued Providence and others for, among other things, due process violations and sought reinstatement and damages. The superior court concluded that the termination procedures did not violate due process and that Providence was immune from damages under HCQIA. The Alaska Supreme Court affirmed the ruling concerning the substantive standard used to terminate the privileges, reversed the ruling concerning the lack of a pre-termination opportunity to be heard and Providence's HCQIA damages immunity as to that claim, and remanded.
Remand instructions
Remand to the superior court for further proceedings on Dr. Brandner's damages claim arising from the due process violation caused by terminating his hospital privileges without a pre-termination opportunity to be heard. The superior court's decision rejecting the substantive due process challenge to the policy was affirmed.