June 18, 2019

Tenth Circuit: Hospital Immune Under Health Care Quality Improvement Act from Physician’s Claims; Record Insufficient to Support Physician’s Antitrust and Tort Claims

The Tenth Circuit Court of Appeals published its opinion in Cohlmia v. St. John Medical Center on Friday, September 7, 2012.

Plaintiff, Dr. George Cohlmia, a surgeon, performed two surgeries at St. John Medical Center (SJMC or hospital). One surgery resulted in death, the other in permanent disfigurement. After hospital review and formal hearing, SJMC suspended and ultimately terminated Dr. Cohlmia’s privileges. Before his initial suspension, Dr. Cohlmia explored opening a specialty heart hospital. The specialty heart hospital failed to attract any investors.

Dr. Cohlmia filed a complaint alleging violations of federal antitrust laws, violation of the Oklahoma state antitrust law, and tortious interference with a contract.

After discovery, SJMC moved for summary judgment on all claims, as well as its affirmative defense of immunity pursuant to the Health Care Quality Improvement Act (HCQIA). The district court granted all motions for summary judgment. Dr. Cohlmia appealed.

On appeal, Dr. Cohlmia challenged the district court’s grant of HCQIA immunity.  HCQIA provides immunity to hospitals or doctors who perform peer reviews or challenges to professional conduct where patient care is at issue. The entity or persons that undertake the professional review are immune as long as they substantially comply with a list of objective standards set forth in the Act. A professional review action is presumed to have met the standards for HCQIA immunity unless the presumption of regularity is rebutted by a preponderance of the evidence. The district court concluded that no reasonable jury could find that Dr. Cohlmia had overcome the presumption. The Tenth Circuit agreed.

Having found that the hospital’s actions fell within the grant of immunity by HCQIA, the Tenth Circuit next determined the scope of that immunity. HCQIA grants immunity only against a monetary damage award. In his complaint, the doctor also sought injunctive relief and reinstatement of his staff privileges. Therefore, the Tenth Circuit was required to review the merits of the doctor’s federal and state claims.

Federal Claims

First, the doctor claimed that his exclusion from the marketplace resulted in an antitrust injury. The Tenth Circuit agreed with the district court’s assessment of the record that there was no credible evidence from which to infer an antitrust injury.

Second, the doctor argued the hospital had a sufficient market share to show monopoly power in violation of federal antitrust laws. The Tenth Circuit agreed that the hospital’s market share of less than 20% was woefully short under any metric from which to infer market power.

Dr. Cohlmia’s final federal claim alleged the hospital conspired to block his specialty heart hospital.  The Tenth Circuit found the doctor’s claims speculative at best, and agreed with the district court that granting summary judgment to the hospital was proper on this claim.

State Claims

Under the Oklahoma Antitrust Reform Act, it is unlawful for any person to monopolize, attempt to monopolize, or conspire to monopolize any part of trade or commerce in a relevant market.  Because the record did not support that the hospital had monopoly power, the doctor’s state law claim failed for the same reason his federal antitrust claim failed.

The doctor further argued the district court erred in dismissing his tortious interference with contract claims: patient contracts and insurance contracts. Since the relationship between physician and patient is at-will, there is no contract, so that claim failed. As to insurance contracts, Dr. Cohlmia failed to provide evidence of economic damages with Blue Cross/Blue Shield.  Accordingly, this claim failed as well.

Dr. Cohlmia’s finally claimed that the hospital wrongfully interfered with his medical practice. Because Dr. Cohlmia’s expert report relied on economic projections that were speculative at best, the district court did not err in concluding that state law required more evidence to support a damage award.

Based on the foregoing, the Tenth Circuit AFFIRMED the district court’s grants of summary judgment.

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