Christy Leann Smith v. Leona M. Pratt, of The Estate of Stephen M. Pratt, M.D., and HCA Health Services of Tennessee, Inc. d/b/a Centennial Medical Center
Docket: M2008-01540-COA-R9-CV
Court: Court of Appeals of Tennessee; April 22, 2009; Tennessee; State Appellate Court
Christy Leann Smith filed a malpractice lawsuit against Dr. Stephen Pratt's estate and HCA Health Services of Tennessee, claiming negligence in granting Dr. Pratt surgical privileges at Centennial Medical Center. After undergoing several surgeries on November 20, 2003, Smith experienced severe complications, including deep vein thrombosis and a pulmonary embolism. Centennial sought summary judgment, asserting qualified immunity under Tenn. Code Ann. 63-6-219 for its credentialing decisions, which was initially denied by the trial court. The court concluded that granting immunity would undermine the statute's purpose of enabling the medical profession to regulate itself without fear of litigation. Centennial's request for an interlocutory appeal was approved, and the appellate court reviewed the case de novo, focusing on the legal interpretation of Tenn. Code Ann. 63-6-219, ultimately reversing the trial court's decision.
The action against Centennial is based on its peer review committee's recommendation to renew Dr. Pratt’s surgical privileges. Centennial seeks qualified immunity under Tenn. Code Ann. 63-6-219(d)(1), which provides immunity from liability to various entities and individuals involved in peer review processes for actions taken in good faith, without malice, and based on reasonably known or believed facts. This immunity extends to decisions related to alcohol or drug counseling for healthcare professionals and their family members. Courts must interpret the statute by ascertaining legislative intent from the language used, ensuring every word is given effect, and may consult legislative history for clarification if the statute is ambiguous. The statute indicates that any mentioned entities or individuals are immune from liability for damages resulting from peer review committee decisions made in accordance with specified conditions. Notably, the Tennessee Supreme Court has confirmed that hospitals qualify as "institutions" under this statute, reinforcing the legislative intent to include them within its immunity provisions.
The central issue is whether qualified immunity applies to hospitals when patients sue based on a peer review committee's credentialing decisions. Statutory language indicates that immunity is granted to "any patient, individual or organization" regarding committee decisions, suggesting that patients can sue without negating this immunity. Ms. Smith argues that this immunity contradicts the intent of the Peer Review Law, which aims to promote candid evaluations of medical professionals. However, the court disagrees, asserting that the immunity fosters honest peer reviews and does not undermine the law's intent, even if credentialing errors occur.
The legislative history supports this interpretation, as Representative Rogers noted the bill's purpose was to encourage doctors to report poor practices without fear of litigation. The law stipulates that immunity is contingent upon good faith and absence of malice in decision-making. Even if a physician commits malpractice, it does not imply negligence on the part of the hospital or committee in granting privileges, as established in prior cases. Ms. Smith's claims also fail to align with existing Tennessee case law, which historically emphasized hospitals' duties to select competent physicians but does not apply to the current statutory context. The cases she cites do not adequately support her position.
Under Tennessee law, health-care providers may be held liable for the negligence or malpractice of a physician they select if they fail to exercise due care in that selection, as established in Crumley. However, this principle originates from a case involving events prior to the 1975 amendment to the Peer Review Law, which does not apply to the current matter. The case Bryant v. McCord reaffirms the necessity for hospitals to select competent physicians but is not applicable here since it dealt with investigational devices rather than physician selection. Similarly, Wicks v. Vanderbilt Univ. rejected a negligent credentialing claim and did not focus on the hiring of competent employees, framing the issue instead as negligent supervision. In Edmonds v. Chamberlain Mem’l Hosp., the court ruled that a hospital is not liable for a physician's negligence unless the hospital knew or should have known of the physician's incompetence at the time of selection. This case noted that the hospital's qualified immunity under the Peer Review Law was not invoked because the physician was not reviewed by a peer committee. The court affirmed that this qualified immunity applies when hospitals make credentialing decisions based on peer review committee recommendations. Lastly, Ms. Smith argues that Centennial's interpretation of the statute violates the open courts provision of the Tennessee Constitution by potentially eliminating claims against hospitals for negligent credentialing. However, case law does not support her assertion that such elimination would infringe upon her rights under this provision.
In 1978, the Tennessee Supreme Court interpreted the state's constitutional section regarding open courts as a directive for the judiciary rather than a limitation on legislative authority. The court clarified that the constitutional guarantee for remedies applies only to legally defined injuries, allowing the legislature to define what constitutes an 'injury.' Legislative changes to legal rights or remedies must either provide reasonable substitutes or demonstrate a reasonable response to societal needs.
The court upheld a statute of limitations for medical malpractice actions, acknowledging a medical malpractice insurance crisis that led to rising premiums and a potential decrease in available physicians, thereby impacting healthcare quality. Such legislative actions were seen as necessary responses to these challenges.
The ruling confirmed the constitutionality of the qualified immunity defense under Tennessee Code Annotated 63-6-219(d)(1) for hospitals in cases involving credentialing decisions made by peer review committees. However, it did not address the specific application of Centennial’s qualified immunity, which requires further proof regarding the good faith of the credentialing decision. The court reaffirmed that outside the statute's scope, hospitals remain liable for the negligent acts of their agents and employees. Costs of the appeal have been assigned to the appellant, Christy Leann Smith.
