Goh v. Dep’t of the Air Force – April 2015 (Summary)

PEER REVIEW

Goh v. Dep’t of the Air Force, No. 1:14-cv-00315 LJO SKO (E.D. Cal. Apr. 8, 2015)

The United States District Court for the Eastern District of California affirmed the decision to restrict a physician’s clinical privileges to practice at an Air Force hospital holding that there was sufficient evidence to support the decision.

After the physician discharged a patient who was having a myocardial infarction from the emergency department without diagnosing the patient’s condition, the physician’s privileges were held in abeyance pending a review of his records. A review of 74 records confirmed that in 15 cases there were “significant discrepancies ranging from lack of adequate documentation to failure to meet standard of care.” Based on these findings, the Credentials Committee recommended supervision and medical record review for the next 360 patient interactions. The Credentials Committee then reviewed an additional 102 cases and found discrepancies in 22 cases and concluded that the physician failed to meet the standard of care in 13 of these cases.

The physician requested and was granted a hearing. The hearing committee found that the physician had failed to meet the standard of care in a number of cases. The review panel concluded that the physician failed to meet the standard of care in 22 out of 192 cases and that this was “egregious.” A final decision was made to restrict the physician’s privileges.

The physician sought review of the restriction arguing that the decision was arbitrary or capricious because there was no evidence of mismanagement or inappropriate care. Specifically, the physician asserted that it was unreasonable to find that his conduct fell below the standard of care because no patients suffered adverse outcomes. The physician also argued that the hospital’s documentation requirements were onerous given its paper records system.

The court affirmed the hospital’s decision to restrict the physician’s privileges finding that the decision was supported by sufficient evidence. The court explained that the physician’s argument – that there was no evidence that he failed to meet the standard of care because there were no injured patients – was contrary to common sense. According to the court, the physician’s argument “relies on the logical fallacy that simply because one never becomes aware of something necessarily means that the thing does not exist.” The court concluded that the hospital’s decision was supported by the evidence and reasonable because it based its decision on the review performed by four practicing physicians.

Furthermore, the court rejected the argument that the hospital’s documentation standard was onerous and required that the physician record “each of his impressions.” Rather, the hospital had been critical of the physician’s documentation because he failed to document that he had evaluated alternative etiologies and he failed to document his medical decision-making. Thus, there was substantial evidence to support the hospital’s decision to restrict the physician’s privileges.