Mid-Atlantic Health Law TOPICS

A New Jersey appeals court recently reversed a hospital’s termination of a doctor’s clinical privileges on the grounds that the hospital’s peer review committee applied the wrong standard. 

The court ruled that the hospital’s decision was improperly based on a finding that the doctor’s conduct “could” adversely affect patient care, instead of “probably would” affect patient care. Because the “could affect” standard encompasses mere possibilities as opposed to probable harm to patient care, the hospital’s termination of privileges did not meet the standard.

The Facts

The case of Nanavati v. Cape Regional Medical Center arose out of Cape Regional Medical Center’s failure to reappoint cardiologist Dr. Suketu Nanavati to the hospital staff and the termination of Dr. Nanavati’s clinical privileges. Dr. Nanavati had a history of being at odds with the hospital and had openly expressed disapproval of hospital policies and some staff.

The ongoing conflict led the hospital’s credentials committee to recommend denial of reappointment and the termination of Dr. Nanavati’s medical privileges. The recommendation was accepted by the hospital’s Executive Committee.

The Executive Committee found that Dr. Nanavati failed to prove that the recommendation was arbitrary, unreasonable or capricious because of a lack of evidence that his behavior “could” adversely affect the hospital’s ability to deliver quality care to patients. The Superior Court of New Jersey upheld the termination of Dr. Nanavati’s hospital privileges, and Dr. Nanavati appealed.

The Appeal

The appellate court reversed the lower court’s decision because the hospital’s decision was based on the wrong standard. To merit termination, a hospital should present “concrete evidence of specific instances of misbehavior” that causes so substantial a disruption that it “will probably have an adverse impact on patient care.”  

The hospital’s bylaws also provided that a physician can be disciplined for conduct that is “reasonably likely” to be disruptive to hospital operations or detrimental to patient care.  Because the hospital’s decision in this case was based on a finding only that Dr. Nanavati’s conduct “could” adversely affect patient care, instead of “probably would” affect patient care, the hospital applied the wrong standard, and made Dr. Nanavati’s burden of challenging the decision insurmountable.

Barry F. Rosen
410-576-4224 • brosen@gfrlaw.com