Antitrust / Medical Staff Privileges

Guide to: Bryan v. James E. Holmes Regional Medical Ctr., 33 F.3d 1318 (11th Cir. Fla. 1994)

Who are the parties?

How much money did defendant win?

Why did Congress pass the Health Care Quality Improvement Act

Why did Congress think peer review is important?

How does the act encourage peer review?

What is the baseline requirement for immunity?

What are the reporting requirements of the Act?

What is the purpose of these reports?

Why did these reporting requirements drive litigation?

What is the penalty for not comply with the reporting requirements?

How far does the immunity go?

Why such limited immunity?

Who gets the immunity?

What causes of action are not covered by the Act?

Does it include injunctive or declaratory relief?

What are the standards for proper review?

What type of presumption is created?

What is a "safe harbor?"

What is the difference between "good faith" and an objective standard?

Who was the defendant?

Was the doc competent?

Why did they terminate him?

How was the hospital organized?

Who promulgates the bylaws?

What are the bylaws?

What is the executive committee?

What is the state requirement?

How are investigations initiated?

Who recommends discipline?

What are the options?

Who does the executive committee make its recommendations to?

What are the physicians rights when a suspension or revocation is recommended?

What are the provisions for temporary suspension?

Can it be appealed?

What are the physicians rights for a less severe form of discipline?

Who is on the hearing panel?

What is the purpose of the hearing?

What are the procedural rights?

What is the role of the hearing officer?

What does the panel base its ruling on?

What is the burden of proof?

What comes after the hearing?

What are the grounds for appeal?

What comes next?

What happens if there is an adverse recommendation by the board review panel?

What is the appeal from the Board's decision?

What is the disciplinary history for Bryan?

How does this endanger patients?

Why was he such a pain?

Did he contest that he had a problem with his temper?

What did they do at first?

What did he do in 1985?

Did it do any good?

Was he warned?

What did the ad hoc committee recommend?

What triggered his first discipline?

What was his "joke"?

What was the next discipline?

What did Bryan do?

What makes you think the Ryon panel was more interested in the docs than the nurses and patients?

How as the incident report system changed?

What message does this change send?

What did the board decide?

What did Bryan agree to?

What did he do next?

What did the executive committee recommend?

What happened before his hearing?

What about patient care problems?

Sounds like a good case for a drug screen!

How did he explain hitting the nurses?

What about sending the wrong patient's to surgery?

What did the executive committee recommend?

Do you think this was unreasonable?

Was he able to continue to treat his patients?

How were the Chanda hearings conducted?

How did the hearing officer "overlawyer" them?

What was Bryan's defense?

What did the panel recommend?

Was Bryan able to contest that accuracy of the incident reports?

The Trial

What did he complain of?

What was the central allegation?

What claims were discarded at trial or on appeal?

What protection did the Florida law provide?

Why did Bryan claim for intentional fraud?

Why no SJ for immunity?

What claims was Bryan allowed to take to the jury?

What was the directed verdict at the close of Bryan's case?

What was left?

What did Bryan's experts say?

Do you agree with them?

What did Bryan claim were procedural flaws in the hearing?

Did the jury instructions deal with immunity?

What was the instruction in the contact claim?

What is wrong with this instruction?

How about the antitrust instruction?

Why did the court give such simplist instructions?

What did the jury find?

What was the hospital's first appeal point?

What did Bryan appeal?

Who is the factfinder for HCQUIA immunity?

Why was the judge made the factfinder?

When can the defendant get SJ on immunity even if there is still a chance that the plaintiff might be able to show that the action was improper?

What did the AMA urge?

How is immunity dealt with under sec. 1983?

What should the court do if the defendant is not entitled to immunity?

What if there are factual issues such as whether the bylaws were followed?

What is the standard for JNOV?

What must the court do?

What is the 9th circuit's standard for SJ for peer review immunity?

Who has the burden under this standard?

How was this applied to Bryan?

B. Is this a case for immunity?

The term "professional review action" is defined in HCQIA as follows:

What is a professional review action?

What is a health care entity?

What is the first standard?

What did the court consider in determining if this standard was met?

What is the second standard?

How did they determine the facts?

Third standard?

What are the safe harbors for hearing procedures?

What was Bryan's principle complaint against the procedure?

What was required?

Is it necessary to follow these procedures exactly?

Did Bryan object to these procedures?

What was the 4th standard?

What was the contest over the allegations?

What is the role of the courts in all procedural due process cases?

What did the court determine was the correct result?

So why did the jury give him all that money? - bad judge and instructions