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Greensfelder team successfully defeats appeal in medical staff privileging case

January 30, 2017

Greensfelder Officers John Petite & Kathy ButlerJohn Petite and Kathy Butler led a firm team that recently scored a big win for one of Greensfelder’s hospital clients, successfully defending a lawsuit by a physician complaining that the hospital failed to substantially comply with its medical staff bylaws when it revoked his clinical privileges and medical staff membership. The Missouri Court of Appeals on Jan. 24, 2017, affirmed the judgment in favor of the hospital.

In the lawsuit, Antoine Adem, M.D. v. Des Peres Hospital, Inc., Adem claimed that Des Peres Hospital, a Tenet Healthcare Corporation facility, failed to follow its medical staff bylaws during the process that resulted in the hospital revoking his privileges. Adem sought a preliminary injunction to prohibit the hospital from reporting the revocation to the National Practitioner Data Bank (NPDB) and the Missouri physician licensing board, as required by federal and state law, respectively. Adem also sought a permanent injunction vacating the revocation and compelling the hospital to engage in a new process in compliance with the medical staff bylaws. After a daylong evidentiary hearing on the motion for preliminary injunction, the Circuit Court of St. Louis County, Missouri, granted the hospital’s motion to dismiss, denied Adem’s motion for a preliminary injunction, and entered judgment in the hospital’s favor on all of Adem’s claims.

Adem appealed from that judgment, and the Missouri Court of Appeals affirmed the judgment in favor of the hospital, holding that the hospital substantially complied with its medical staff bylaws when revoking Adem’s privileges. In so holding, the Court of Appeals not only reaffirmed Missouri’s rule of non-review, which prohibits courts from second-guessing the merits of a private hospital’s staffing decisions, but also expanded it to preclude a court from questioning the qualifications and composition of hospital peer review committees. The court also interpreted the hospital’s bylaws to allow physicians who had an employment relationship with the hospital or its affiliates to serve on peer review committees, rejecting Adem’s claim that such physicians are inherently biased in favor of the hospital. The appellate opinion can be found here. 

Greensfelder lawyers Ben Griffith and Ronnie White also contributed to the win. To read a Law360 article on this important decision, click here.

Petite argued the appeal before the Court of Appeals. As part of his practice — which includes intellectual property litigation and counseling and assisting clients, particularly in the petroleum marketing sector, in an array of litigation, trade regulation, franchise, contractual and transactional matters — Petite regularly defends hospitals and other health care providers in medical staff privileges litigation that implicates federal and state antitrust law, as well as state contract and tort law. His work has yielded significant published state and federal court decisions under the federal Health Care Quality Improvement Act of 1986 (HCQIA), which immunizes certain peer review actions from damages liability, and Missouri’s and Illinois’ rule of non-review, and with respect to the enforceability of medical staff bylaws under state law. Petite’s work in this area has yielded the following important published judicial decisions: 

  • Johnson v. SSM Health Care St. Louis,2013 U.S. Dist. LEXIS 12412 (E.D. Mo. January 30, 2013), aff’d, 583 Fed. Appx. 591 (8th Cir. 2014) (affirming summary judgment and holding the peer review action and NPDB report were immunized under HCQIA); 
  • Misischia v. St. John’s Mercy Medical Center, 30 S.W.3d 848 (Mo. Ct. App. 2000) (affirming summary judgment under HCQIA, holding malicious prosecution claim cannot be based on peer review proceedings and invoking rule of non-review to reject tortious interference claim); 
  • Sugarbaker v. SSM Health Care, 187 F.3d 853 (8th Cir. 1999) (affirming summary judgment under HCQIA);
  • Sugarbaker v. SSM Health Care, 946 S.W.2d 280 (Mo. Ct. App. 1997) (rejecting claim to enjoin filing of NPDB report);
  • Murfin v. St. Mary's Hosp., 2016 IL App (5th) 140136-U (Ill. App. Ct. 5th Dist. 2016) (rejecting claim for injunctive relief alleging that hospital violated its bylaws and the Illinois Hospital Licensing Act when revoking physician’s privileges and affirming summary judgment that hospital immune from damages under HCQIA); and
  • Zipper v. Health Midwest, 978 S.W.2d 398 (Mo. Ct. App. 1998) (authored amicus brief that shaped court’s opinion that medical staff bylaws do not form an enforceable contract).

In her health care practice, Butler assists health care providers with the full array of issues they confront in their daily hospital operations. She provides counseling on interpreting and complying with regulations, including federal and state fraud and abuse laws, federal Stark Law and legal requirements for tax-exempt entities. She counsels on compliance plans, internal regulatory reviews and external regulatory investigations and works with institutional and individual clients on physician practice acquisitions and other physician integration strategies. In addition, she provides advice on the development of hospital and hospital-system policies and professional service contracts. She has extensive experience in medical staff credentialing, governance and disciplinary matters, impaired health professional issues, risk management issues, patient rights issues and bio-ethical issues. In that regard, she regularly counsels clients in dealing with physicians adversely affected by medical staff privileging decisions, including best practices for hearings under medical staff bylaws and the reporting to government authorities when a hospital restricts a physician’s privileges. 

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