In the closing days of its May term, the Illinois Supreme Court affirmed the Appellate Court’s decision in Valfer v. Evanston Northwestern Healthcare, adopting a broad construction of hospitals’ immunity in connection with peer review for purposes of renewing doctors’ credentials.

In 2002, the plaintiff, an obstetrician/gynecologist, applied for reappointment at the defendant hospital.  Hospital personnel conducted an initial review and then a second review of the plaintiff’s cases, and met with him twice to discuss concerns.  The division chief recommended to the hospital executive committee that plaintiff not be reappointed.  In the summer of 2002, the president and CEO of the defendant informed the plaintiff that the recommendation had been accepted.  In 2004, the hospital held a hearing on the matter, at which the plaintiff was represented by counsel, and allowed to present evidence and examine witnesses.  The hearing committee ultimately upheld the executive committee’s recommendation.  The plaintiff requested appellate review, and the appellate review committee upheld the recommendation against reappointment.  The hospital board affirmed that decision in March 2005, at which point the plaintiff’s nonreappointment became final and effective.

Plaintiff filed suit in 2007 against the hospital, seeking damages arising out of the hospital’s decision not to reappoint him.  By 2014, the plaintiff’s claims had been reduced to a breach of contract count.  The plaintiff moved for summary judgment, arguing that it was immune from liability pursuant to the Illinois Licensing Act and the federal Health Care Quality Improvement Act.

The trial court granted summary judgment, holding that the plaintiff was afforded adequate notice and hearing procedures, and that the hospital’s decision was based on patient safety concerns.  The Appellate Court affirmed, holding that the statutory exception for willful and wanton misconduct was limited to allegations of some type of physical harm to a person’s safety or the safety of others.

Before the Supreme Court, the plaintiff challenged that holding, arguing that the statutory exception for willful and wanton misconduct was intended to cover situations where the hospital allegedly did not follow its own bylaws.  In an opinion by Justice Thomas, the Supreme Court rejected plaintiff’s claim.

According to Section 10.2 of the Licensing Act, willful and wanton misconduct “means a course of action that shows actual or deliberate intention to harm or that, if not intentional, shows an utter indifference to or conscious disregard for a person’s own safety and the safety of others.”  (210 ILCS 85/10.2.)  The Court concluded that the phrase beginning with the words “utter indifference to or conscious disregard” was intended to explain the intention to harm intended by the legislature to trigger the exception.  The legislature’s reference to safety, according to the Court, “shows an intent that the harm contemplated is physical.”  Besides, the Court noted, a showing that the hospital had breached its own bylaws was necessary simply to show a breach of contract.  If breach of the bylaws was sufficient to eliminate the immunity, then the immunity would never block liability: the clause would be rendered a nullity.

The Court emphasized that its decision did not effectively give hospitals absolute immunity for their credentialing decisions, contrary to the plaintiff’s argument.  Injunctive and declaratory relief remained available notwithstanding the immunity.  Actions alleging physical harm were still eligible for damages awards.  Further, when the plaintiff alleges well-pleaded facts that the defendant acted for some reason other than “internal quality control . . . or the improving or benefiting of patient care and treatment,” the immunity wouldn’t apply in the first place.  Besides, the Court noted, the Illinois statute certainly did not trump the federal civil rights statutes.

The plaintiff argued that if the Appellate Court correctly interpreted the Licensing Act, the statute was unconstitutional as special legislation, and as a denial of plaintiffs’ right of access to the courts.  The Court held that plaintiff’s special legislation argument rested on the faulty premise that the Appellate Court’s construction of the Licensing Act amounted to absolute immunity for hospital staffing decisions.  As for the right of access claim, the Court reiterated that physicians had several remedies available, even in cases where the immunity still applied.

Image courtesy of Flickr by David Howard (no changes).