Dr. Frank Nemec, the hospital`s deputy chief of staff, also feared that Meyer`s treatment of Anguiano was a violation of COBRA, as it could be interpreted as a refusal to treat a needy patient. According to Wilson, Medicare had previously investigated the hospital for “patient dumping,” which was denying care to a destitute patient. This earlier investigation resulted from the allegedly poor treatment of a destitute patient by another hospital doctor who suffered a subdural hematoma and fainted in a casino shortly after being diagnosed with heat exhaustion and discharged from the hospital. According to Dr. Graham Wilson, chief of Meyer`s emergency unit and chairman of the hospital`s emergency services department, Meyer treated Anguiano for about seven minutes in total and gave him no follow-up instructions. Wilson went on to explain that security officials were so concerned about the “responsibility” for Anguiano`s release that they asked Meyer to reinstate Anguiano. Apparently, Meyer refused this request. I have to agree with the result of the majority opinion because HCQIA sets such a low threshold for granting immunity for what is called a hospital`s peer review. As long as hospitals ensure due process and provide a minimum basis for quality health care, legitimate or not, they are in principle exempt from liability. Unfortunately, this can leave hospitals and review committee members free to abuse the process for their own purposes, regardless of the quality of medical care. This is particularly likely, as most courts have noted that HCQIA`s legislative history precludes consideration of subjective motives or biases of peer review committees.
Meyer testified by affidavit that Anguiano had no significant complaints about his physical condition, except that he was hungry and thirsty. Meyer further explained that after giving Anguiano a complete physical exam, measuring her vital signs and measuring the oxygenation of her blood, she concluded that no further testing was necessary. Meyer then gave Anguiano crackers and juice and was escorted out of the hospital by security guards. After that, Meyer filed an infringement suit against the hospital, claiming its privileges had been suspended for fear of Consolidated Omnibus Budget Reconciliation Act (COBRA) investigations and potential lawsuits, rather than promoting quality patient care. The hospital dismissed Meyer`s complaint, arguing that the court lacked jurisdiction under state law to hear the lawsuit and that his actions were immune under the Health Care Quality Improvement Act (HCQIA). After a year of discovery, the district court dismissed Meyer`s lawsuit, ruling that the hospital`s decision to suspend Meyer`s privileges was appropriate under the circumstances and that the hospital`s actions were immune under HCQIA. This case stems from the Dr. Treatment by Susan Meyer of Adolph Anguiano, a homeless patient who died on the grounds of Columbia Sunrise Hospital and Medical Center (the “Hospital”) about two hours after Anguiano was treated and escorted him off the premises by hospital security. Due to Meyer`s allegedly inferior treatment of Anguiano, Meyer was suspended and then went through the fair hearing process set out in the hospital`s regulations.
After three separate peer review committees reviewed the circumstances of Anguiano`s treatment by Meyer, Meyer`s personal privileges were revoked for a period of twelve months. After a year of discovery, the hospital renewed its motion to dismiss and asked the court to consider it as a request for summary judgment because Meyer had filed an affidavit from his expert and submitted excerpts from the testimony. The affidavit of Meyer`s expert, Dr. Rosen, an expert in emergency medicine, concluded that Meyer`s dismissal could not have been done to promote quality health care, and therefore Meyer`s removal violates hospital regulations. However, prior to Wilson`s meeting with Meyer, Wilson had met with Rick Kilburn, the hospital`s chief operating officer, who informed him that there was no way for Meyer to continue working at the hospital. Kilburn discussed the possibility that Meyer`s care at Anguiano could lead to another COBRA 1 investigation or possibly a major trial. In addition, Wilson admitted in her testimony that Meyer would not be reinstated, no matter what happened in the fair hearing process, because he had lost confidence in her, and once “erratic behavior” like Meyer`s occurred, there was a possibility that it would happen again. 3. The hospital submits, in part, that that court does not have jurisdiction to review the decisions of private hospital authorities, relying on Lakeside Community Hospital v Levenson, 101 Nev. 777, 778, 710 P.2d 727, 728 (1985) (“The weight of the judicial authority of this country refuses judicial review of the decisions of the boards of directors of private hospitals, appointing or dismissing members of their medical staff.
To the extent Lakeside prohibited this court from considering whether a hospital`s board of directors acted unconstitutionally or beyond the HCQIA`s conditional immunity, we hereby expressly waive this measure. On January 9, 1996, Meyer filed a civil action against the hospital, alleging partial breach of contract and breach of the duty of good faith and loyalty. After that, the hospital dismissed Meyer`s complaint, arguing, among other things, that Meyer`s claims were excluded from the HCQIA. The district court ruled that it had jurisdiction over Meyer`s trial if it alleged a violation of hospital regulations. As a result, the district court ordered additional disclosure to determine whether Meyer had an actionable claim. Despite Wilson admitting that he would not reinstate Meyer, regardless of the Fair Hearing Panel`s recommendation, Wilson sent a letter to the hospital`s chief of staff requesting a fair and impartial review of Anguiano`s treatment by Meyer. Wilson`s letter identified five areas where there are concerns about this treatment: (1) No complaints documented by Anguianos have been addressed by diagnostic tests; (2) Meyer`s medical diagrams were non-medical and inferior; (3) Meyer did not give follow-up instructions; 4) a nurse told Wilson that security forces had asked to retake Anguiano because they feared “responsibility”; and (5) Meyer made no move to revive Anguiano after he was in the “complete code.” 2 However, other doctors felt that Anguiano by Meyer`s treatment was entirely up to standard. First, Wilson testified that Dr. Jerry Goldberg, another doctor at the hospital, insisted that Meyer had done nothing wrong. In addition, Gary Young, an expert in the field of emergency medicine, explained that Meyer acted within the standard of care because Anguiano was not in acute distress and was clinically stable when Meyer examined him. 6.
Without applying for cross-appeal and without attorneys` fees to the District Court, the hospital applies to that court for an award of attorneys` fees in accordance with Article 11113 of the HCQIA, which provides for attorneys` fees if the dispute relating to a claim was “frivolous, unreasonable, unfounded or in bad faith”. We do not come to the question of whether the lawyers` fees are reasonable, because this court does not have jurisdiction to hear the application. See Sierra Creek Ranch v. J.I. Case, 97 Nev. 457, 460, 634 P.2d 458, 460 (1981) (provided that the Court will not consider the issue of cross-appeal attorneys` fees); see also Montesano v Donrey Media Group, 99 Nev. 644, 650 n. 5, 668 P.2d 1081, 1085 n.
5 (1983) (stressing that the arguments put forward for the first time on appeal are not taken into account). On July 28, 1995, Anguiano, a thirty-four-year-old man, was found unconscious in the wet grass of a Las Vegas hotel. Shortly after, Anguiano was taken by ambulance to the hospital, where he was admitted to the emergency room at 8:03 a.m. and later examined by Meyer. Meyer further argues that the hospital did not act to promote quality health care because its decision to suspend its privileges was made based on the hospital`s fear of lawsuits and COBRA investigations. We therefore conclude that the hospital conducted a proper investigation to obtain the facts regarding Anguiano`s treatment by Meyer. In our review of the first HCQIA requirement, we also concluded that the peer review was conducted on the reasonable assumption that it was justified on the basis of these facts.
