Williams v. Baptist Health

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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. Williams’s 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. Williams’s 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. Williams’s 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. Williams’s surgery cases after receiving complaints from unidentified persons. Dr. Gardner’s 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. Weeks’s 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 hospital’s 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 Committee’s 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. Williams’s staff appointment and clinical privileges. The committee therefore formally recommended termination and directed the immediate suspension of Dr. Williams’s clinical privileges pending further review. Mr. Weeks notified Dr. Williams of the Credentials Committee’s 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. Williams’s 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 Health’s decision to take corrective action. At Dr. Williams’s 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 Committee’s decision.

          Dr. Williams timely appealed the Hearing Committee’s 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 Committee’s 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 Committee’s decision "was a reasonable one in light of the Hospital’s 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. Williams’s 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. Williams’s 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. Williams’s] 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. Williams’s 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. Williams’s 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. Hearnsberger’s 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. Williams’s staff ...