Levitt v. Iasis Healthcare Holdings Inc.

Citations: 2019 UT App 68; 442 P.3d 1211Docket: 20180260-CA

Court: Court of Appeals of Utah; May 2, 2019; Utah; State Appellate Court

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Jodie K. Levitt, a neurosurgeon, sued Salt Lake Regional Medical Center (SLRMC), Iasis Healthcare Holdings Inc., Alan Davis, and Wanda Updike after her privileges at SLRMC were temporarily suspended. The district court granted summary judgment in favor of the defendants, citing Utah's statutory care review immunity, which protects them from lawsuits unless bad faith or malice is proven. Levitt failed to provide evidence of such misconduct. 

In 2011, Levitt sought a two-year renewal of her medical staff appointment, receiving a "six-month conditional reappointment" due to pending peer reviews of her cases. SLRMC officials were unable to discuss the specifics of these cases, citing peer review privilege, though they did provide a list of cases under review. 

In January 2012, the SLRMC Credentials Committee reviewed several of Levitt’s cases, identifying concerns including multiple cerebrospinal fluid (CSF) leaks and three wrong-site surgeries. The Committee requested Levitt to submit written protocols for handling CSF leaks and ensuring correct site confirmation for surgeries, warning that further incidents could lead to termination of her privileges. The appellate court affirmed the summary judgment, agreeing that genuine disputes of material fact regarding the defendants' good faith were lacking.

On January 30, 2012, Levitt was informed that submitting written protocols by March 1 would lead to a three-month conditional reappointment, although her cases would still be under review by the Credentials Committee. After submitting the protocols on February 14, she met with CEO Davis and Updike, who expressed concerns over a recent incident and imposed a twenty-eight-day suspension of her surgical and medical privileges. A follow-up letter clarified that the suspension would last at least 14 days and that reinstatement was contingent on completing certain criteria, including a proctorship of several cases. Levitt requested a hearing regarding her suspension; however, Davis indicated that it would not be urgent and needed to be scheduled within the bylaws' 30-day window. He also noted that completing her proctored cases would prevent her suspension from being reported to the National Practitioner Data Bank. Levitt did not pursue the hearing and successfully completed the proctorship, leading to her reinstatement.

In 2016, Levitt sued the Defendants for breach of contract, breach of the implied covenant of good faith, tortious interference, and civil conspiracy, alleging that their actions aimed to harm her reputation and end her hospital membership. Defendants moved for summary judgment, claiming immunity under Utah’s Health Care Providers Immunity from Liability Act, which shields healthcare providers from liability in licensing and care review decisions absent clear evidence of bad faith or malice. They argued their actions were focused on patient protection and quality improvement. Levitt countered that genuine disputes existed regarding bad faith, citing her lack of prior notice for suspension, denial of a fair hearing, and the pressure of an arbitrary timeline for her proctorship. The district court granted summary judgment for the Defendants, finding no evidence of malice or bad faith, concluding that Levitt failed to rebut the presumption of good faith under Utah law.

Levitt appeals the district court's summary judgment in favor of the Defendants, arguing that there were genuine disputes over material facts. She claims that evidence could lead a reasonable jury to find clear and convincing proof of SLRMC’s bad faith and malice. The appellate review standard for summary judgment involves assessing the facts in the light most favorable to the nonmoving party, confirming that no genuine dispute exists and that the moving party is entitled to judgment as a matter of law.

Under Utah Code section 58-13-4, health care providers and their sponsoring organizations enjoy qualified immunity when acting in good faith and without malice during specific evaluations of health care quality. This presumption of immunity can only be rebutted by clear and convincing evidence of bad faith and malice, which Levitt attempts to establish. 

Levitt acknowledges the presumption of immunity but contends that the totality of circumstances surrounding the Defendants' conduct demonstrates bad faith and malice. The court concludes that Levitt has not produced sufficient evidence to counter the immunity, emphasizing that she must meet the clear and convincing standard at the summary judgment stage.

Levitt's arguments include claims that the Defendants’ refusal to disclose reasons for their decisions indicates bad faith, which the court rejects. The evidence shows that Defendants adequately communicated the rationale for their actions, including detailed explanations of concerns raised in peer reviews and prior discussions with Levitt regarding her cases. Consequently, the court finds no basis for the claims of bad faith or malice, upholding the Defendants' immunity as a matter of law.

Defendants acknowledged informing Levitt that they could not discuss her peer-reviewed cases, but this alone does not imply bad faith or malice. Citing *Everett v. St. Ansgar Hosp.*, the court noted that a lack of input in the peer review process does not inherently suggest malice. Defendants provided undisputed evidence that non-responsiveness was intended to protect peer review privilege. Levitt argues that this privilege is a post hoc justification for secrecy, yet fails to present evidence of ulterior motives, relying instead on vague allegations of a conspiracy to undermine her career. The court emphasized that such bare allegations are insufficient to establish bad faith or malice, referencing *Nelson v. Target Corp.*, which states that vague or speculative evidence does not preclude summary judgment. 

Levitt also claimed that communication delays regarding adverse decisions on her hospital privileges suggested bad faith. However, the court noted a lack of evidence explaining these delays, with Levitt's assertions deemed speculative. The court reiterated that reasonable inferences must be supported by evidence, and even with favorable interpretations, the delays did not meet the burden of proving bad faith or malice. 

Furthermore, Levitt contended that bad faith could be inferred from the denial of her request for a hearing as stipulated in the bylaws. However, evidence showed that after her suspension, Levitt was informed that a hearing would not occur immediately and that she needed to request one within the specified timeframe. She did not respond or seek further action, instead completing a proctorship that restored her privileges. The court found no support for her claim that her hearing request was maliciously denied.

Levitt's claims against the Defendants were rejected, as there was insufficient evidence to support allegations of malicious and wrongful conduct regarding her conditional reappointment and temporary suspension. The November 23 Letter indicated Levitt's reappointment was conditional due to peer reviews revealing issues, including multiple CSF leaks and three wrong-site surgeries. Additionally, her temporary suspension stemmed from an incident necessitating immediate action, while the proctorship requirement aimed to address identified clinical and procedural concerns. The evidence clearly demonstrated that the Defendants' actions were intended to enhance healthcare quality at SLRMC. Consequently, no reasonable jury could find clear and convincing evidence of bad faith or malice, leading to the conclusion that Defendants are immune from Levitt’s claims under Utah Code section 58-13-4. The district court's decision to grant summary judgment in favor of the Defendants was affirmed.