Cardiology v. Wright

204 S.W.3d 676, 2006 Mo. App. LEXIS 1632, 2006 WL 3068967
CourtMissouri Court of Appeals
DecidedOctober 31, 2006
DocketNo. ED 87226
StatusPublished
Cited by3 cases

This text of 204 S.W.3d 676 (Cardiology v. Wright) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cardiology v. Wright, 204 S.W.3d 676, 2006 Mo. App. LEXIS 1632, 2006 WL 3068967 (Mo. Ct. App. 2006).

Opinion

PATRICIA L. COHEN, Judge.

Gateway Cardiology, P.C., Nizar Assi, M.D. and Bassam Al-Joundi, M.D. (Plaintiffs) appeal from the trial court’s grant of summary judgment in favor of William Wright, M.D. on Count III of Plaintiffs’ third amended petition.1 In Count III, Plaintiffs alleged that Dr. Wright’s claim that Dr. Assi conducted medically unnecessary procedures constituted an accusation of billing fraud resulting in the impairment of Plaintiffs’ business relationships and consequent loss of business and business [678]*678expectancies. As grounds for summary judgment, the trial court concluded that the Health Care Quality Improvement Act (HCQIA), 42 U.S.C. Section 11101, et seq. provided Dr. Wright with immunity.2 On appeal, Plaintiffs challenge the trial court’s grant of immunity. We affirm.

Factual Background

Drs. Assi and Al-Joundi are interven-tional cardiologists who, with another cardiologist, formed Gateway Cardiology, P.C. in 1994. Dr. Wright is also an interven-tional cardiologist and practices with the Cardiology Consultants of St. Louis, P.C. Drs. Assi and Al-Joundi, as well as Dr. Wright, focus their practices in south St. Louis County and, more specifically, at St. Anthony’s Medical Center, where both physician groups maintain offices.

In 1998, Dr. Wright assumed the position of director of St. Anthony’s Cardiac Catheterization Laboratory (Cath Lab). Dr. Wright’s duties included overseeing the professional competence of physicians providing care in the Cath Lab. In October 2003, St. Anthony’s approached Dr. Al-Joundi about replacing Dr. Wright as Director of the Cath Lab at the end of Dr. Wright’s term. Subsequent to this discussion, St. Anthony’s sent Dr. Al-Joundi, as well as Dr. Wright, a proposal identifying Dr. Al-Joundi as Dr. Wright’s successor. Shortly thereafter, St. Anthony’s forwarded an agreement to Drs. Al-Joundi and Wright in which Dr. Al-Joundi was identified as Dr. Wright’s successor.

In January 2004, Dr. Wright sent correspondence to Thomas Rockers, St. Anthony’s President and CEO, advising Mr. Rockers that Dr. Wright could not “in good conscience” agree to Dr. Al-Joundi’s appointment as Director of the Cath Lab. In support of his opposition, Dr. Wright detailed several matters including: (1) St. Anthony’s 1999 denial of active staff status to Drs. Al-Joundi and Assi (2) St. Anthony’s receipt of a “threatening letter” from Drs. Al-Joundi and Assi’s attorney after St. Anthony’s denied them active staff status and (3) Dr. Wright’s concern about numerous cases in which procedures were performed without the proper hospital privileges or patient consents. Dr. Wright concluded his letter with the statement that he had brought his concern about these cases to the attention of Dr. Gibson, chair of the Cardiovascular Care Review Committee (CCRC) and Dr. Sewall, chief of the cardiology section, and that they, along with Dr. Curtin, director of the Department of Medicine and Mr. Cardenas, St. Anthony’s compliance officer and legal counsel, planned to meet on January 14, 2004 to review Dr. Wright’s concerns.3

Following the January 14 meeting, Dr. Curtin informed Dr. Assi by telephone and confirmatory letter that Drs. Sewall, Wright and Gibson had arranged a meeting to which Dr. Assi, and any cardiologist he wished to accompany him, were invited to discuss procedures performed on five of Dr. Assi’s patients. In two separate follow-up letters, Dr. Curtin: (1) advised Dr. Assi that “the only issue to be discussed was ‘medical necessity’ for performing the procedures in question,” and (2) identified the specific patients and the medical procedures the doctors intended to review.

Around the same time as Dr. Curtin’s letter to Dr. Assi, Dr. Wright forwarded an extensive memorandum to Mr. Cardenas and Dr. Curtin in which he outlined, in [679]*679detail, his concerns about specific procedures performed primarily by Dr. Assi. The bulk of the information was intended to support Dr. Wright’s conclusion that Dr. Assi performed procedures that were medically unnecessary. Dr. Wright referred to fraud twice in the memorandum. At one point, Dr. Wright noted that “Mr. Cardenas was to inform [Dr. Assi] that St. Anthony’s would be refunding the receipts on these fraudulent cases and notifying the payers.” At another point, Dr. Wright identified a particular patient who had two procedures on consecutive days and stated “it is fraudulent to subject the patient to two separate procedures, which you can bill for separately, as to performing them on the same day.”

The Ad Hoc Committee, absent Dr. Wright, met with Dr. Assi on February 2, 2004. Dr. Wright did not attend the meeting at Dr. Assi’s request. Following the meeting, Dr. Curtin related his, Dr. Se-wall, and Dr. Gibson’s conclusions to Dr. Assi in a February 6 letter, stating:

Dear Dr. Assi,
Thank you for meeting with Dr[.] Se-wall, Dr[.] Gibson and me on February 2 to discuss the cases we were concerned about. Following that meeting, I have met and had further discussion with Drs[.] Sewall and Gibson, and Drs[.] Se-wall, Gibson and I have discussed our findings with Dr[.] Wright and John McGuire, CFO at St. Anthony’s. We have concluded that none of the procedures performed were medically unnecessary. Some of them, however, fall outside the typical practice pattern for IVRT. We would therefore request that you amend the reports on [Patients A, B, and C] to include the justifications for the procedures that you discussed with us on February 2. We would also ask that in the future you fully document the indications for IVRT. These eases will be referred to the Cardiology Care Review Committee as well. Thank you for your cooperation.

In response, Dr. Assi sent a detailed letter explaining his approach to each patient’s treatment. He also communicated general information relating to the procedures at issue, including guidelines from the American College of Cardiology. In addition, Dr. Assi provided an opinion from a recognized expert in interventional cardiology opining that the treatment provided the patients was not unnecessary.

Following the Ad Hoc Committee’s determination that “none of the procedures performed were medically unnecessary,” Dr. Wright forwarded a letter to Mr. Cardenas stating that “it was decided there was not a consensus that [Drs. Assi and Al-Joundi’s] cases did not meet medical necessity....” Dr. Wright also informed Mr. Cardenas that the cases under discussion were to be forwarded to St. Anthony’s CCRC. In a subsequent memorandum to the CCRC, Dr. Wright referred for review fifteen cases in which procedures had been performed by either Drs. Assi or Al-Joundi.

On April 7, the CCRC, which consisted of sixteen members, including Drs. Wright and Al-Joundi, met and reviewed one of Dr. Assi’s cases.4 Following the meeting, Dr. Gibson sent a memorandum to Dr. Assi noting that the review was for “treatment concerns.” After disclosing to Dr. Assi the substance of the records the CCRC reviewed as well as the CCRC’s conclusions, Dr. Gibson requested “data to support why this candidate was an appropriate candidate for [the procedure in question].”

[680]*680On July 14, the CCRC again met and discussed the case previously considered at the April 7 meeting.

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204 S.W.3d 676, 2006 Mo. App. LEXIS 1632, 2006 WL 3068967, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cardiology-v-wright-moctapp-2006.