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APPEAL
FROM THE PULASKI COUNTY CIRCUIT COURT, SIXTH DIVISION [NO.
60CV-14-808], HONORABLE TIMOTHY DAVIS FOX, JUDGE
Andre
K. Valley; and George W. McGriff & Associates, by: George W.
McGriff, pro hac vice, for appellant.
Mitchell,
Williams, Selig, Gates & Woodyard, P.L.L.C., Little Rock, by:
Byron Freeland and Megan D. Hargraves, for separate appellee
Baptist Health d/b/a/ Baptist Health Medical Center.
Anderson,
Murphy & Hopkins, L.L.P., Little Rock, by: Jason J. Campbell,
for separate appellee John E. Hearnsberger, M.D.
OPINION
LARRY
D. VAUGHT, Judge
The
appellant, Dr. Victor Williams, is an African American
surgeon who had a staff appointment and clinical privileges
at Baptist Health Medical Center (Baptist Health) in Little
Rock from 2003 until the hospital terminated their
relationship on April 14, 2011. The termination followed an
internal peer-review process that found Dr. Williams provided
substandard care in four of his surgical cases. As required
by state and federal law, Baptist Health reported its adverse
action to the Arkansas State Medical Board, which prepared to
take action regarding Dr. Williamss medical license in 2014.
Dr.
Williams subsequently sued Baptist Health, the hospital
administrator, and several doctors who served on the
peer-review committees, the Arkansas State Medical Board
(Board), and Dr. John Hearnsberger, individually and as
chairman of the Board. The complaint sought monetary damages
and injunctive relief based on thirteen causes of action
alleging defamation, tortious interference with contracts,
violations of the Arkansas Constitution, and violations of
the Arkansas Civil Rights Act, including discrimination under
Arkansas Code Annotated section 16-123-107 and retaliation
under Arkansas Code Annotated section 16-123-108. The
complaint also alleged that Baptist Health failed to follow
its own bylaws when it terminated Dr. Williamss staff
membership and clinical privileges.
The
circuit court granted summary judgment on the claims against
Dr. Hearnsberger.
The
circuit court also granted summary judgment to Baptist Health
and the individual Baptist Health appellees on all but one
claim alleging that the hospital failed to follow its bylaws.
The circuit court heard testimony on that claim over the
course of a three-day bench trial in February 2017, and it
entered findings of fact and conclusions of law on April 21,
2017, that dismissed the claim with prejudice.
Dr.
Williams now appeals, arguing that the circuit court erred in
several respects. We affirm the order granting summary
judgment to Dr. Hearnsberger. We also
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affirm the judgments in favor of the Baptist Health appellees
on the six constitutional claims, the defamation claim, the
retaliation claim, and the claim alleging that Baptist Health
failed to follow its own bylaws during the peer-review
process. We reverse the judgment in favor of the Baptist
Health appellees on the discrimination and
tortious-interference claims, however, because we agree that
the circuit court abused its discretion when it denied Dr.
Williamss motions to compel discovery of peer-review records
regarding other physicians at Baptist Health.
I.
Facts and Procedural History
Dr.
Williams obtained his license to practice medicine in
Arkansas in 1999 and was board-certified to practice general,
cardiothoracic, and vascular surgery. He became a member of
the medical staff at Baptist Health in November 2003.
In
January or February 2010, Dr. Guy Gardner, the chief medical
officer at Baptist Health, reviewed several of Dr. Williamss
surgery cases after receiving complaints from unidentified
persons. Dr. Gardners review caused him to be concerned
about the standard of care that Dr. Williams had rendered in
a handful of his cases, and he reported his concerns to
Douglas Weeks, the administrator of the hospital, and to Dr.
Tim Burson, the chief of surgery.
On
February 5, 2010, Mr. Weeks and Dr. Burson met with Dr.
Williams in Mr. Weekss office at Baptist Health. According
to Mr. Weeks, the purpose of the meeting was to inform Dr.
Williams "of the seriousness of the information that Dr.
Guy Gardner had obtained" and to explain that the cases
would be subject to internal peer review that "could
have serious implications" for his clinical privileges
at the hospital. Mr. Weeks wanted Dr. Williams to
"understand all of his options," including
voluntary resignation of his staff appointment, "which
would enable him to not have to report [an involuntary loss
of privileges] to the National Practitioner Databank."
Dr.
Williams declined to voluntarily resign his appointment, and
the hospitals peer-review process began. The Surgery Control
Committee discussed the surgical cases that Dr. Gardner
identified at one of its regular meetings on March 11, 2010.
Afterward, Dr. Burson, as chairman of the Surgery Control
Committee, wrote a letter to Dr. Williams explaining that the
committee had reviewed eleven of his cases and identified
suspected deviations from the standard of care in five of
them. The letter identified the five cases under
investigation and advised Dr. Williams that the committee
scheduled the cases for discussion with him on April 5, 2010.
The
Surgery Control Committee met with Dr. Williams on April
12.[1] The committee members in attendance
included appellees Dr. Scott Marotti, Dr. Robert Moffett, Dr.
Frederick Meadors, Dr. Robert Casali, and Dr. Burson. The
committee gave Dr. Williams the opportunity to answer
questions and explain his treatment of each of the patients.
At the conclusion of the meeting, the committee found that
Dr. Williams was unable to address significant concerns about
the quality of care in each case. The committee noted, in
particular, that Dr. Williams appeared unwilling to
acknowledge or take responsibility for the substandard care
that he rendered in each instance.
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Consequently, on April 16, Dr. Burson wrote a letter to the
Professional Staff Credentials Committee (Credentials
Committee) to request that it investigate the five cases
under review and take appropriate corrective action. Dr.
Susan Keathley, the chair of the Credentials Committee,
dispatched a letter to Dr. Williams later that day to notify
him of the Surgery Control Committees request and to inform
him that the Credentials Committee would meet on April 21, to
review and discuss the cases at issue. Dr. Keathley advised
Dr. Williams to be prepared to address several concerns
related to the five cases, including preoperative judgment;
medical decision-making; technical ability; ability to
recognize postoperative complications; lack of timely
follow-up; documentation; and "unwillingness to
acknowledge identified issues or take responsibility."
The letter also informed Dr. Williams that these issues could
result in suspension or termination of his staff appointment
and clinical privileges at Baptist Health Medical Center and
all other Baptist Health facilities.
The
Credentials Committee met with Dr. Williams on April 21. The
committee members in attendance included appellees Dr. Susan
Keathley and Dr. Everett Tucker. Following the meeting, the
Credentials Committee issued a report and recommendation that
found Dr. Williams had deviated from the standard of care in
four of the five cases and that there was sufficient evidence
to warrant termination of Dr. Williamss staff appointment
and clinical privileges. The committee therefore formally
recommended termination and directed the immediate suspension
of Dr. Williamss clinical privileges pending further review.
Mr. Weeks notified Dr. Williams of the Credentials
Committees action by a letter dated April 21.
On May
25, Dr. Williams, through counsel, appealed the suspension
and recommended termination to the Hearing Committee of the
Professional Staff of Baptist Health Medical Center (Hearing
Committee), which is composed of the chief (or vice chief) of
each clinical department in the hospital. While that
administrative appeal was pending, Baptist Health reported
the suspension of Dr. Williamss clinical privileges to the
National Practitioner Databank and the Board.[2] The Board
voted to investigate the matter, requested that Dr. Williams
appear, and obtained the medical records of the patients
involved in Baptist Healths decision to take corrective
action. At Dr. Williamss request, however, the Board
postponed further proceedings to allow Dr. Williams to pursue
an administrative appeal with Baptist Health and to allow him
to participate in a physician education and assessment
program.
On
February 28, 2011, the Hearing Committee conducted a
five-hour hearing and heard testimony from witnesses on
behalf of Dr. Williams and the Credentials Committee. The
following day, the Hearing Committee issued its report and
recommendations affirming the Credentials Committees
decision.
Dr.
Williams timely appealed the Hearing Committees decision to
the Board of Trustees Appellate Review Committee (Appellate
Review Committee) on March 24, 2011. After reviewing the
hearing record and written statements from both parties, the
Appellate Review Committee affirmed the Hearing Committees
report and recommendations on April 12, 2011.
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The Appellate Review Committee found, in particular, that the
staff bylaws had been followed during the peer-review
process; that the decision of the Hearing Committee was based
on substantial evidence; and that the Hearing Committees
decision "was a reasonable one in light of the
Hospitals duty to the public." Mr. Weeks notified Dr.
Williams in writing on April 14, 2011, that his clinical
privileges had been terminated.
The
proceedings before the Board resumed on June 8, 2012, when
the Board accepted Dr. Williamss offer to attend a
physician-assessment program in lieu of rendering a
disciplinary decision. The Board later determined that Dr.
Williams did not comply with the requirements of the
assessment program, however, and it ultimately voted to
revoke his license on April 3, 2014.[3]
On
February 25, 2014, shortly before the Board voted to revoke
Dr. Williamss license, Dr. Williams filed a complaint in the
Pulaski County Circuit Court for damages and injunctive
relief against Baptist Health; Douglas Weeks, in his
individual and official capacity as the hospital
administrator; several doctors individually and in their
official capacities as members of the peer review committees
at Baptist Health; the Arkansas State Medical Board; and Dr.
John Hearnsberger individually and in his official capacity
as chairman of the Board. The complaint generally alleged
that all the defendants acted "jointly, maliciously and
in concert" to "drive [Dr. Williams] out of the
practice of medicine in Little Rock, North Little Rock, and
Pulaski County ... because of his race ... and [to eliminate]
economic competition."
Regarding the Baptist Health appellees in particular, Dr.
Williams alleged that they "reviewed or caused to be
reviewed medical records of [Dr. Williamss] patients in the
hope of finding something that could be used to justify
suspension, revocation, or denial of [his] medical staff
privileges[.]" Dr. Williams alleged that he was not
afforded a fair procedure during the peer-review process at
Baptist Health and, because of his race, was treated more
harshly than similarly situated white doctors whose cases
were also subjected to internal peer review. Regarding the
Board and Dr. Hearnsberger, the complaint alleged that Dr.
Hearnsberger had a conflict of interest that caused him to be
biased in favor of taking adverse action against Dr. Williams
and that the alleged bias tainted other members of the Board.
Based
on these and other alleged facts, the complaint asserted
thirteen claims for relief, including six counts alleging
that Dr. Hearnsberger and the Baptist Health appellees had
violated several provisions in the Arkansas Constitution. The
complaint further alleged that the termination of Dr.
Williamss staff appointment and clinical privileges was
retaliatory and racially discriminatory in violation of his
rights under the Arkansas Civil Rights Act and that the
Baptist Health appellees were liable for defamation in
connection with the report that the hospital made to the
National Practitioner Databank. The complaint also alleged
two counts of tortious interference with contract, asserting
that the appellees adverse actions interfered with Dr.
Williamss contracts with referral physicians, insurance
companies, other hospitals, and his patients. Finally, the
complaint alleged that the Baptist
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Heath appellees failed to comply with the medical-staff
bylaws when they terminated his staff appointment and
clinical privileges.
The
circuit court granted Dr. Hearnsbergers motion for summary
judgment and dismissed him from the lawsuit in his individual
capacity in an order entered on December 8,
2014.[4] The Baptist Health appellees, in three
separate motions, successfully moved for summary judgment on
all but one of the claims in the complaint. The circuit
court, interpreting the bylaws claim to be a "due
process type claim," determined that there were genuine
issues of material fact regarding whether Baptist Health
substantially complied with the procedure in its bylaws when
it terminated Dr. Williamss staff ...