Garib-Bazain v. Hospital Espaol Auxilio Mutuo, Inc.

Citations: 773 F. Supp. 2d 248; 2011 WL 1118578Docket: Civil No. 10-1290 (FAB)

Court: District Court, D. Puerto Rico; March 25, 2011; Federal District Court

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The Court grants Dr. Jorge Garib-Bazain’s motion for remand following his request for medical privileges at Auxilio Mutuo Hospital, which was denied by the hospital’s Executive Committee. Dr. Garib, a medical doctor specializing in Internal Medicine and Infectious Diseases, had his medical license revoked in 2004 after a federal conviction for conspiracy to defraud the United States and for false statements to a grand jury. Although his medical license was reinstated in January 2009, his request for privileges was denied due to several factors: unauthorized access to pathology reports in 1995, a concealed incident involving a firearm during his residency, undermined credibility due to his federal conviction, and additional undisclosed matters.

Dr. Garib's denial of privileges was followed by his request for an evidentiary hearing, which the Executive Committee denied, stating he did not properly deny the allegations against him per hospital Bylaws. Consequently, the allegations were deemed admitted. His request for reconsideration was denied, and the Executive Committee's adverse recommendation was later upheld by Auxilio Mutuo's Board of Directors on March 19, 2010. The Board allowed for a new hearing but limited it to new allegations, excluding those already admitted, and informed Dr. Garib that certain requested documents were now available.

On March 25, 2010, Dr. Garib filed a lawsuit against several defendants, including Hospital Español Auxilio Mutuo, Inc., Sociedad Española de Auxilio Mutuo y Beneficiencia de Puerto Rico, Inc., Dr. Jose A. Isado-Zardon, and his conjugal partnership. The case, numbered KPE10-1201 in the Puerto Rico Court of First Instance, San Juan Superior Division, alleges that the defendants acted contrary to the hospital's Bylaws while reviewing Dr. Garib's privileges, claimed the Bylaws were illegal, and asserted that his rights were violated, resulting in damages. Under the Health Care Quality Improvement Act of 1986 (HCQIA), hospitals are required to report adverse decisions regarding physician privileges to the National Practitioner’s Data Bank. In response to an adverse decision against him, Dr. Garib sought remedies including a declaratory judgment, a temporary restraining order, a preliminary injunction, and a permanent injunction, along with a demand for an evidentiary hearing. On April 7, 2010, the defendants removed the case to federal court, claiming original federal question jurisdiction based on the HCQIA and supplemental jurisdiction for related Puerto Rico law claims. Dr. Garib subsequently filed a motion to remand the case back to the Puerto Rico court, seeking sanctions against the defendants for delaying the injunction hearing and requesting a temporary restraining order to prevent the reporting of the adverse decision. The defendants opposed the remand, asserting that the case presented a substantial federal question, despite the absence of a federal cause of action in the complaint.

Defendants asserted that the Supreme Court of Puerto Rico has not interpreted the Health Care Quality Improvement Act (HCQIA), suggesting that federal courts are better suited for such matters. In response, Plaintiffs noted that the Puerto Rico Court of Appeals has previously addressed issues of immunity and hospital Bylaws under HCQIA. 

Federal courts hold limited jurisdiction, requiring a question of federal law or diversity of citizenship with an amount exceeding $75,000 for a case to be maintained. The burden of proof lies with the party invoking federal jurisdiction, and cases may only be removed from state court if they would qualify for federal jurisdiction if filed there initially. The removal statute is interpreted strictly, favoring remand in cases of uncertainty.

Plaintiffs moved to remand, arguing a lack of subject-matter jurisdiction, while Defendants claimed federal question jurisdiction for removal. Defendants are required to make a "colorable" showing of federal jurisdiction. Federal question jurisdiction exists if the action arises under U.S. law. The determination follows the well-pleaded complaint rule, focusing solely on the allegations in the complaint and not on potential defenses. A federally created right must be evident in the complaint and integral to the cause of action. A state law claim can also arise under federal law if it necessitates interpreting federal law, provided that it raises a substantial federal issue that is disputed and will not disrupt the balance of state and federal judicial responsibilities. The “substantial federal question” doctrine includes three components: the state-law claim must raise a federal issue, the issue must be genuinely disputed and significant, and exercising jurisdiction should maintain the balance of judicial responsibilities as established by Congress.

Defendants acknowledge that the plaintiff's complaint does not arise under federal law, as the Health Care Quality Improvement Act (HCQIA) does not grant a private federal cause of action. They claim, however, that the Court has subject-matter jurisdiction based on the "substantial federal question" doctrine, which the Court rejects. The HCQIA, enacted in 1986 to address health care professional monitoring, aims to incentivize peer review to reduce malpractice occurrences. While it offers immunity from damages to those conducting peer reviews, it does not create a private cause of action for physicians involved in the review process. The HCQIA's provisions may be relevant if defendants assert immunity as a defense, but federal jurisdiction cannot be based on anticipated defenses. The Court determines that for jurisdiction to exist, the HCQIA must be essential to the plaintiff's claims. Since the plaintiff's allegations—regarding violations of bylaws and rights—do not necessitate interpretation of the HCQIA, which would only serve as a defense for the defendants, the Court concludes it lacks subject-matter jurisdiction and remands the case to Puerto Rico’s Court of First Instance.

The Court has granted the plaintiff's motion for remand, resulting in the plaintiff's complaint being sent back to the Puerto Rico Court of First Instance, San Juan Superior Division. The judgment will reflect this decision. The plaintiff's petition for a temporary restraining order has been deemed moot, and the request for sanctions has been denied. Myrgia Palacios, a law student, assisted in preparing the Opinion and Order. 

Dr. Garib renewed his petition for an injunction hearing, but defendants indicated that Auxilio Mutuo had made a final determination regarding Dr. Garib's request for privileges, reporting the adverse decision to the Data Bank as mandated by the Health Care Quality Improvement Act (HCQIA). Consequently, Dr. Garib's request for an injunction hearing became moot. 

Dr. Garib subsequently sought another preliminary injunction to compel defendants to retract their notice from the Data Bank, which the defendants opposed. The First Circuit has acknowledged that the rise in medical malpractice necessitates a national effort to improve healthcare quality, leading to the establishment of a national database to record malpractice incidents, allowing healthcare entities to conduct thorough screenings of potential employees. 

To benefit from immunity under the HCQIA, a professional review action must be conducted in good faith to improve healthcare quality, after reasonable fact-finding efforts, and with proper notice and hearing procedures afforded to the physician involved.