Walker v. Memorial Health Sys. of E. Tex. — Feb. 2017 (Summary)

NATIONAL PRACTITIONER DATA BANK

Walker v. Mem’l Health Sys. of E. Tex.
Civil Action No. 2:17-CV-00066-JRG (E.D. Tex. Feb. 8, 2017)

The United States District Court for the Eastern District of Texas granted a surgeon’s motion for a preliminary injunction against his hospital employer. After issues arose in conjunction with the surgeon’s treatment of two patients at the hospital, the hospital’s Medical Executive Committee (“MEC”) had recommended that the surgeon have a mandatory concurring proctoring requirement for five bowel surgery cases.

The Board ultimately adopted the MEC’s recommendation (that the surgeon be required to have five bowl surgery cases proctored at his expense), but failed to specify a timetable for the completion of the proctored cases.  Thirty days elapsed without the surgeon completing the five cases, so the hospital filed an adverse report to the National Practioner Data Bank (“NPDB”).  The report noted the proctoring requirement and stated that the basis for the action was “substandard or inadequate skill level.”  (The court noted in a footnote that a hearing committee composed of five physicians had recommended rejecting any adverse action.)

The surgeon filed an administrative dispute of the report and filed this action seeking immediate injunctive relief.  The court found that the surgeon established all of the necessary elements to entitle him to a preliminary injunction: a substantial likelihood of success on the merits of the claim; a substantial threat of irreparable injury or harm for which there is no adequate remedy at law; a threatened injury to the applicant outweighing any harm that the injunction might cause to the defendant; and that the injunction would not disserve the public interest.

The court declined to interpret NPDB reporting requirements in a way that would “discriminate against practitioners in rural communities.”  The court reasoned that it would be easier for a surgeon in a busy Dallas hospital to find a proctor and complete the set number of cases within 30 days, compared to a surgeon practicing in a rural area with fewer potential proctors.  The court also directed criticism at the hospital’s decision-making process, noting that it had access to competent legal counsel yet decided to adopt a proctoring requirement that was silent as to duration, without any explanation.

With respect to irreparable harm, the court noted that an adverse report on the NPDB that deems a surgeon to have “substandard or inadequate skill” is an “indelible stigma” and would be intrinsically harmful to the surgeon’s practice, professional reputation, and livelihood.  In addressing the balance of harm element, the court rejected the hospital’s claim that the injunction would force the hospital to violate federal law by not making the report, stating that any injunctive relief ordered by the court would compel the hospital to comply with federal law, not violate it.

Lastly, the court concluded that the preliminary injunction would not disserve the public’s interest, because Congress had already considered the competing interests of the public and medical practitioners when it drew the 30-day bright-line temporal standard.  The court found that proctoring sanctions against the surgeon were not reportable, and to hold otherwise would read the 30-day requirement out of the statute and applicable NPDB guidelines. Thus, the court granted the surgeon’s motion for preliminary injunctive relief.