ÿWPCh# …# V {Sa %´ 0 „ºw@> 4~ ’ ¡ 0È© 0Dq n­µ b {„j 0Jî 0T8 0^Œ 0hê 0rR U :Ä 0|þ 0†z 0 1u B 0d" D3† {„¹U 6= 0@sB)³DCÜ AMU*l/–pÅ.5Íc04>v~rvÓð AOÃ!Æ" 0DØ" D/# BK#˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ(+­Q$¡¡Ñ  ÑÔ€Xu“XXXÔX(\àÉ$¡¡Ñ  ÑÔ€XÝ÷XXXÔÔ€MÝ÷XXXÝ÷ÔÓîÓ ÏÐÑ ÒEÓÔ*vÕVÖ×TØÓ€R¦" ú ú, 3|xã(x(2bC$¤¤Ý ƒàÉ!ÝÑ  ÑÔ€X æXXXÔÔ€MŠìMXX æÔÓîÓÝ  Ýà  àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó«<þ6X9`("Courier 10cpiXXxþ6X@É“8Ç;X@(\6$¡¡Ñ  ÑÔ€X ÇXXXÔÔ€? ÇXXX ÇÔÓãñÓ2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô<Ô6X9`+"Courier 10cpi2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a) dP ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ'ÿÿdxd(\ä $¡¡Ñ  ÑÔ€X ÇXXXÔÔ€M ÇXXX ÇÔÓ-úÓ< Œ 9p`(Courier New("ÿÿ$££Ò  ÒÒ  Ò% Line 7 d....7Border 1dd€-/Cþÿ << Gÿÿ< Œ 9p`(Arial %Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€,ÔÑ  ÑÓîÓÝ  ÝÔ€1ÔÔ€1ÔÓ  ÓÔ YYY ÔFILEDÔ€1XÔÌÌò òJune€4,€1997ÌÌCecil€Crowson,€Jr.ÌÔ€1ôÔAppellate€Court€Clerkó ó fÝ ƒ!ÝÑ#€d#ÑÔ€,ÔÑ  ÑÓîÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  Ý›òòœParkwest›€Hospital€was€purchased€by€Fort€Sanders€Alliance€in€1990€andÏbecame€known€as€Fort€Sanders€œParkwest›€Medical€Center.€€We€hereafter€refer€toÏthe€hospital€as€"œParkwest›."œóóÌ $Ý ƒ!ÝÑ#€d#ÑÔ€,ÔÑ  ÑÓîÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝòòAs€discussed€below,€this€section€only€grants€immunity€when€such€actionsÏare€taken€in€good€faith€and€without€maliceóó.Ì ÃÝ ƒ!ÝÑ#€d#ÑÔ€,ÔÑ  ÑÓîÓÝ  Ýòòà àòòÚ  ÚÚ  Úóó"'Hospital'€means€any€institution,€place,€building€or€agencyÏrepresented€and€held€out€to€the€general€public€as€ready,€willing€and€able€toÏfurnish€care,€accommodations,€facilities€and€equipment€for€the€use,€inÏconnection€with€the€services€of€a€physician€or€dentist€.€.€."€T.C.A.€ðð€68„11„201(21)(A).óóÌ Ý ƒ!ÝÑ#€d#ÑÔ€,ÔÑ  ÑÓîÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝòòòòAlexander€v.€Memphis€Individual€Practice€Ass'n›óó,€870€S.W.2d€278€(Tenn.Ï1993).óóÌ *Ý ƒ!ÝÑ#€d#ÑÔ€,ÔÑ  ÑÓîÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝòòP.€Rosen,€òòMedical€Staff€Peer€Review:€Qualifying€the€Qualified€PrivilegeÏProvisionóó,€27€Loyola›€L.€Rev.€357€(1993).óó€€ÌPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'hStyl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  h HD: Geneva ÒÒ  h HD: Geneva Ò€-‚ƒCþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP PdÝ ƒ!ÝÔ . ÔÔ€,ÔÑ  ÑÓîÓÝ  ÝÔT€ÔÔT€(ÔÔT€ÔÑ ¸ ÑÑ Ü ÑÑ\R AØ'\ÑÑ  ÑÑ\R AØ'\ÑÑ7€ æXXdÈdÈ7ÑÓ ` Ü` A ¸ ™X ÓÙ€€ÙßR€02/A1-j|` @ `€€@ÿRß›Þ ÞÌà@ àIN€THE€COURT€OF€APPEALSÌÌÌÌÌÌÌÌEDWARD€J.€EYRING,€M.D.,€€€€€€€€€)à àKNOX€CIRCUITÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)à àC.A.€NO.€03A01„9607„CV„00240Ì€€€€€€€€€€Plaintiff„Appellant€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ìvs.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)à àHON.€WHEELER€A€ROSENBALMÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)à àJUDGEÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)ÌFORT€SANDERS€PARKWEST€MEDICAL€€€)à àAFFIRMED€AND€REMANDEDÌCENTER,€INC.,€and€FORT€SANDERS€€)ÌALLIANCE,€œINC.,€€€€€€€€€€€€€€€€€)›Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)ÌÓ  Ó€€€€€€€€€€œDefendants„Appellees€€)›ÌÓ  ÓÌÌÌÌœÓ  ÓJOHN€K.€KING€and€ALAN€PARKER,€Lewis,€King,€Krieg,€Waldrop€andÏCatron,€Knoxville€€€for€Appellant.›ÌÌÌœFOSTER€D.€ARNETT€and€RICK€POWERS,€Arnett,€Draper€and€Hagood,ÏKnoxville,€for€Appellees.›ÌÌÌÌÌÌœ›Ó$ÜÓà@ àòòO€P€I€N€I€O€NóóÌÌà€ àMcMurray,€œJ.Ì›Ìà àWe€are€primarily€called€upon€in€this€appeal€œto€decide›€whetherÏthe€Tennessee€Peer€Review€Law€of€1967€(T.C.A.€ðð€63„6„219)€(theÏLaw)€grants€immunity€to€hospitals€for€actions€taken€againstÏphysicians€upon€recommendations€of€peer€review€boards€orÏcommittees.€€For€reasons€hereinafter€stated,€we€believe€that€theÏlaw€was€intended€œto,›€and€œdoes,›€grant€hospitals€such€immunity.€€WeÏaffirm€the€judgment€of€the€trial€court.ÌÌà àThe€plaintiff/appellant,€Edward€J.€Eyring,€M.D.,€is€a€licensedÏphysician€in€the€State€of€Tennessee€and€a€Board€CertifiedÏOrthopedic€Surgeon.€€He€became€a€member€of€the€medical€staff€ofÏthe€defendant/appellee,€Fort€Sanders€Parkwest€Medical€Center€œin›Ï1974€(Parkwest).œ× ƒ3 ××  ×›€€In€July€1992,€Parkwest€terminated€hisÏprivileges.€€Dr.€Eyring€thereafter€œsued›€Parkwest€alleging€breachÏof€contract,€intentional€interference€in€contract,€intentionalÏinterference€in€an€existing€business€relationship,€intentionalÍinterference€in€a€prospective€business€expectancy,€and€intentionalÏdiscriminatory€interference€in€his€right€to€engage€in€hisÏprofession€at€the€hospital.ÌÌà àThe€Circuit€Court€for€Knox€County€granted€the€defendants€summaryÏjudgment,€holding€that€the€hospital€enjoyed€immunity€under€theÏimmunity€provision€of€the€law,€had€not€acted€in€bad€faith€nor€wasÏmotivated€by€malice,€and€had€not€violated€its€bylaws.€€PlaintiffÏappeals,€raising€the€following€issues:Ìœ›ÓîÓÌÒ  ÒÒ ° ÒÒ  ÒÒ  Òà0 àà àA.à àWhether€the€trial€court€erred€in€refusing€to€grantÏpartial€summary€judgment€to€Plaintiff/Appellant€underÏòòLewisburg€Community€Hospital€v.€Alfredsonóó,€805€S.W.2dÏ756€(Tenn.€1991)€on€the€issue€of€contract€liabilityÏbased€upon€Parkwest€Hospital's€violation€of€itsÏBylaws.ÌÌà0 àà àB.à àWhether€the€trial€court€erred€in€failing€to€holdÏthat€Defendants/Appellees€were€not€entitled€toÏimmunity€under€the€Health€Care€Quality€Improvement€ActÏof€1986,€42€U.S.C.€ðððð€11101.€òòet€seqóó.ÌÌà0 àà àC.à àWhether€the€trial€court€erred€in€granting€summaryÏjudgment€to€Defendants/Appellees€granting€it€immunityÏfrom€monetary€liability€under€the€Tennessee€PeerÏReview€Law,€T.C.A.€ðð€63„6„219.ÌÌà0 àà àD.à àWhether€the€Tennessee€Peer€Review€Law€immunityÏprovision,€T.C.A.€ðð€63„6„219(c)(1)€applies€toÏhospitals.ÌÌà0 àà àE.à àWhether€T.C.A.€ðð€63„6„219(c)€provides€immunity€forÏbreach€of€contract.ÌÌà0 àà àF.à àWhether€the€trial€court's€application€of€theÏTennessee€Peer€Review€Law€impermissibly€interferesÏwith€œpreexisting›€contract€rights.ÌÌà0 àà àG.à àWhether€Parkwest€failed€to€meet€its€burden€ofÏproving€that€its€actions€fall€within€the€standard€ofÏthe€Peer€Review€Law.ÌÌà0 àà àH.à àWhether€the€trial€court€erred€in€failing€to€holdÏthat€Parkwest€Hospital's€actions€were€not€made€in€goodÏfaith€but€occurred€under€circumstances€from€whichÏlegal€malice€should€be€inferred.ÌÌà0 àà àI.à àWhether€the€trial€court's€grant€of€summary€judgmentÏshould€be€reversed€because€Plaintiff/Appellant€wasÏdenied€an€adequate€opportunity€to€engage€in€discovery.ÌÌà0 àà àJ.à àWhether€the€Peer€Review€[Law]€should€be€nullifiedÏon€the€basis€of€the€doctrine€of€equitable€estoppel.ÌÌà0 àà àK.à àWhether€the€revocation€of€Plaintiff's€staffÏmembership€should€be€vacated€by€the€doctrines€of€òòResÏJudicataóó€and€Collateral€Estoppel.ÌÌÒ ° ÒÒ  ÒÒ ° ÒÒ ° Òœ›Ó$ÜÓÌà àAlthough€plaintiff€enumerates€eleven€issues,€we€are€primarilyÏconcerned€with€the€applicability€of€the€Tennessee€Peer€Review€Law,Ïtherefore,€we€will€discuss€the€issues€relating€to€it€first.ÌÌÓ  Óà àò òTHE€TENNESSEE€PEER€REVIEW€LAW€OF€1967ÌÌÓ  Óó óà àT.C.A.€ðð€63„6„219€was€enacted€in€1967,€and€is€quoted€in€itsÏentirety€as€follows:ÌÌœò ò›ÓîÓà8 àà àT.C.A.€ðð€63„6„219.€€€Legislative€policy€declarationÏð"ð€Medical€review€committees€ð"ð€Immunity€of€members€ð"ðÏConfidentiality€of€records€„„€Short€title.€„„€ó ó(a)(1)€InÏconjunction€with€the€applicable€policies€of€the€Health€CareÏQuality€Improvement€Act€of€1986€(42€U.S.C.€ðððð€11101„11152),€itÏis€the€stated€policy€of€Tennessee€to€encourage€committees€madeÏup€of€Tennessee's€licensed€physicians€to€candidly,Ïconscientiously,€and€objectively€evaluate€and€review€theirÏpeers'€professional€conduct,€competence,€and€ability€toÏpractice€medicine.€Tennessee€further€recognizes€thatÏconfidentiality€is€essential€both€to€effective€functioning€ofÏthese€peer€review€committees€and€to€continued€improvement€inÏthe€care€and€treatment€of€patients.ÌÌà8 àà à(2)€As€incentive€for€the€medical€profession€to€undertakeÏprofessional€review,€including€the€review€of€health€care€costs,Ïpeer€review€committees€must€be€protected€from€liability€forÏtheir€good€faith€efforts.€€To€this€end,€peer€review€committeesÏshould€be€granted€certain€immunities€relating€to€their€actionsÏundertaken€as€part€of€their€responsibility€to€review,Ïdiscipline,€and€educate€the€profession.€€In€instances€of€peerÏreview€committees€examining€the€appropriateness€of€physicians'Ïfees,€this€immunity€must€also€extend€to€restraint€of€tradeÏclaims€under€title€47,€chapter€25.ÌÌà8 à(b)€As€used€in€this€section,€"medical€review€committee"€orÏ"peer€review€committee"€means€any€committee€of€a€state€or€localÏprofessional€association€or€society,€including€impairedÏphysician€peer€review€committees,€programs,€malpractice€supportÏgroups€and€their€staff€personnel,€or€a€committee€of€anyÏlicensed€health€care€institution,€or€the€medical€staff€thereof,Ïor€any€committee€of€a€medical€care€foundation€or€healthÏmaintenance€organization,€preferred€provider€organization,Ïindividual€practice€association€or€similar€entity,€the€functionÏof€which,€or€one€(1)€of€the€functions€of€which,€is€to€evaluateÏand€improve€the€quality€of€health€care€rendered€by€providers€ofÏhealth€care€service€€to€improve€the€quality€of€health€careÏrendered€by€providers€of€health€care€service€to€provideÏintervention,€support,€or€rehabilitative€referrals€or€services,Ïor€to€determine€that€health€care€services€rendered€wereÏprofessionally€indicated,€or€were€performed€in€compliance€withÏthe€applicable€standard€of€care,€or€that€the€cost€of€healthÏcare€rendered€was€considered€reasonable€by€the€providers€ofÍprofessional€health€care€services€in€the€area€and€includes€aÏcommittee€functioning€as€a€utilization€review€committee€underÏthe€provisions€of€Public€Law€89„97€(42€U.S.C.€ðððð€1395œ„1395pp›)(Medicare€Law),€or€as€a€utilization€and€quality€controlÏpeer€review€organization€under€the€provisions€of€the€PeerÏReview€Improvement€Act€of€1982,€Public€Law€97„248,€ðððð€141„150,Ïor€a€similar€committee€or€a€committee€of€similar€purpose,€toÏevaluate€or€review€the€diagnosis€or€treatment€or€theÏperformance€or€rendition€of€medical€or€hospital€services€whichÏare€performed€under€public€medical€programs€of€either€state€orÏfederal€design.ÌÌà8 àà à(c)(1)€All€state€and€local€professional€associations€andÏsocieties€and€other€organizations,€institutions,€foundations,Ïentities€and€associated€committees€as€identified€in€subsectionÏ(b),€physicians,€surgeons,€registered€nurses,€hospitalÏadministrators€and€employees,€members€of€boards€of€directors€orÏtrustees€of€any€publicly€supported€or€privately€supportedÏhospital€or€other€such€provider€of€health€care,€any€personÏacting€as€a€staff€member€of€a€medical€review€committee,€anyÏperson€under€a€contract€or€other€formal€agreement€with€aÏmedical€review€committee,€any€person€who€participates€with€orÏassists€a€medical€review€committee€with€respect€to€itsÏfunctions,€or€any€other€individual€appointed€to€any€committee,Ïas€such€term€is€described€in€subsection€(b),€is€immune€fromÏliability€to€any€patient,€individual€or€organization€forÏfurnishing€information,€data,€reports€or€records€to€any€suchÏcommittee€or€for€damages€resulting€from€any€decision,€opinions,Ïactions€and€proceedings€rendered,€entered€or€acted€upon€by€suchÏcommittees€undertaken€or€performed€within€the€scope€or€functionÏof€the€duties€of€such€committees,€if€made€or€taken€in€goodÏfaith€and€without€malice€and€on€the€basis€of€facts€reasonablyÏknown€or€reasonably€believed€to€exist.ÌÌà8 àà à(2)€Notwithstanding€the€provisions€of€subdivision€(c)(1),Ïany€person€providing€information,€whether€as€a€witness€orÏotherwise,€to€a€medical€review€committee€regarding€theÏcompetence€or€professional€conduct€of€a€physician€is€immuneÏfrom€liability€to€any€person,€unless€such€information€is€falseÏand€the€person€providing€it€had€actual€knowledge€of€suchÏfalsity.ÌÌà8 àà à(3)€A€member€of€a€medical€review€committee,€or€personÏreporting€information€to€a€medical€review€committee,€isÏpresumed€to€have€acted€in€good€faith€and€without€malice.€€AnyÏperson€alleging€lack€of€good€faith€has€the€burden€of€provingÏbad€faith€and€malice.ÌÌà8 àà à(d)€All€information,€interviews,€incident€or€other€reports,Ïstatements,€memoranda€or€other€data€furnished€to€any€committeeÏas€defined€in€this€section,€and€any€findings,€conclusions€orÏrecommendations€resulting€from€the€proceedings€of€suchÏcommittee€are€declared€to€be€privileged.€€All€such€information,Ïin€any€form€whatsoever,€so€furnished€to,€or€generated€by,€aÏmedical€review€committee€shall€be€privileged€communicationÏsubject€to€the€laws€pertaining€to€the€attorney„clientÏprivilege.€€The€records€and€proceedings€of€any€such€committeesÏare€confidential€and€shall€be€used€by€such€committee,€and€theÏmembers€thereof€only€in€the€exercise€of€the€proper€functions€ofÏthe€committee,€and€shall€not€be€public€records€nor€be€availableÏfor€court€subpoena€or€for€discovery€proceedings.€€One€(1)Ïproper€function€of€such€committees€shall€include€advocacy€forÏphysicians€before€other€medical€peer€review€committees,€peerÏreview€organizations,€health€care€entities,€private€andÏgovernmental€insurance€carriers,€national€or€localÏaccreditation€bodies,€and€the€state€board€of€medical€examinersÏof€this€or€any€other€state.€€The€disclosure€of€confidential,Ïprivileged€peer€review€committee€information€to€such€entitiesÏduring€advocacy,€or€as€a€report€to€the€board€of€medicalÏexaminers€under€ðð€63„6„214(d),€or€to€the€affected€physicianÏunder€review€does€not€constitute€either€a€waiver€ofÏconfidentiality€or€privilege.€€Nothing€contained€herein€appliesÏto€records€made€in€the€regular€course€of€business€by€a€hospitalÏor€other€provider€of€health€care€and€information,€documents€orÏrecords€otherwise€available€from€original€sources€are€not€to€beÏconstrued€as€immune€from€discovery€or€use€in€any€civilÏproceedings€merely€because€they€were€presented€during€discoveryÏproceedings€of€such€committee.ÌÌà8 àà à(e)€This€section€shall€be€known€and€may€be€cited€as€theÏ"Tennessee€Peer€Review€Law€of€1967."€[Acts€1967,€ch.€348,€ðð€1;Ï1975,€ch.€117,€ðð€63„623;€Acts€1983,€ch.€344,€ðððð€1,€2;€1987€ch.Ï315,€ðð€1;€1988€ch.€609,€ðððð€1,2;€1990,€ch.€596,€ðð€1;€1992,€ch.Ï916,€ðð€1;€1992,€ch€916,€ðððð€1„47;€1993,€ch.€404,€ðð€13;€1994,€ch.Ï732,€ðððð€5,6.]ÌÌÌÌœÔ&  Ô›Ó$ÜÓÓ ` ܇X2È“X Óà àThe€Trial€Court€found€that€the€law€applied€to€Parkwest,Ïstating:ÌÌœ›ÓîÓÒ  ÒÒ ° ÒÒ  ÒÒ  Òà àAnd€so€it€appears€to€the€Court,€as€alreadyÏindicated,Ô'  Ô€that€so€long€as€the€committees€and€healthÏcare€providers€who€make€decisions€about€peer€review€areÏfree€of€bad€faith€and€malice,€and€there€are€facts€whichÏare€reasonably€known€or€reasonably€believed€to€exist,Ïthat€the€health€care€providers€making€decisions€aboutÏpeer€review€should€be€free€from€the€interference€andÏcontrol€of€Courts.ÌÌÌÒ ° ÒÒ  ÒÒ ° ÒÒ ° Òœ›Ó$ÜÓà àThe€court€further€found€that€Parkwest's€peer€review€committeeÏconcluded€€that€the€plaintiff€was€too€aggressive€in€the€practiceÏof€orthopedic€surgery,€and€exercised€poor€clinical€judgment€inÏselecting€patients€for€surgery.€€The€court€found€that€theÏplaintiff€had€failed€to€produce€sufficient€evidence€to€create€aÏgenuine€issue€of€material€fact€that€the€hospital€was€not€acting€inÏgood€faith€or€was€motivated€by€malice€in€making€its€decision€toÏrevoke€plaintiff's€privileges.ÌÌà àBefore€addressing€plaintiff's€issues€relating€to€the€peerÏreview€statute,€we€note€that€our€standard€of€review€in€consideringÏthe€propriety€of€summary€judgment€is€as€follows:ÌÌÒ  ÒÒ ° ÒÒ  ÒÒ  Òœ›ÓîÓà àThe€standards€governing€an€appellate€court's€reviewÏof€a€trial€court's€action€on€a€motion€for€summaryÏjudgment€are€well€settled.€€Since€our€inquiry€involvesÏpurely€a€question€of€law,€no€presumption€of€correctnessÏattaches€to€the€trial€court's€judgment,€and€our€task€isÏconfined€to€reviewing€the€record€to€determine€whetherÏthe€requirements€of€Tenn.€R.€Civ.€P.€56€have€been€met.€ÏòòCowden€v.€Sovran€Bank/Central€Southóó,€816€S.W.2d€741,€744Ï(Tenn.€1991).€€Tenn.€R.€Civ.€P.€56.03€provides€thatÏsummary€judgment€is€only€appropriate€where:€(1)€there€isÏno€genuine€issue€with€regard€to€the€material€factsÏrelevant€to€the€claim€or€defense€contained€in€theÏmotion,€òòByrd€v.€Hallóó,€847€S.W.2d€208,€210€(Tenn.€1993);Ïand€(2)€the€moving€party€is€entitled€to€a€judgment€as€aÏmater€of€law€on€the€undisputed€facts.€€òòAnderson€v.ÏStandard€Register€Coóó.,€857€S.W.2d€555,€559€(Tenn.€1993).€ÏThe€moving€party€has€the€burden€of€proving€that€itsÏmotion€satisfies€these€requirements.€€òòDownen€v.€AllstateÏIns.€Coóó.,€811€S.W.2d€523,€524€(Tenn.€1991).ÌÌà àThe€standards€governing€the€assessment€of€evidenceÏin€the€summary€judgment€context€are€also€wellÏestablished.€€Courts€must€view€the€evidence€in€the€lightÏmost€favorable€to€the€nonmoving€party€and€must€also€drawÏall€reasonable€inferences€in€the€nonmoving€party'sÏfavor.€€òòByrdóó,€847€S.W.2d€at€210„11.€€Courts€should€grantÏa€summary€judgment€only€when€both€the€facts€and€theÏconclusions€to€be€drawn€from€the€facts€permit€aÏreasonable€person€to€reach€only€one€conclusion.€€òòIdóó.ÌÌÒ ° ÒÒ  ÒÒ ° ÒÒ ° ÒòòCarvell€v.€Bottomsóó,€900€S.W.2d€23€(Tenn.€1995).ÌÌÌÌœ›Ó$ÜÓà àPlaintiff€argues€that€Parkwest€was€not€entitled€to€summaryÏjudgment€under€the€Peer€Review€Law€for€a€myriad€of€reasons.€€WeÏshall€first€address€the€question€of€whether€the€law€applies€toÏhospitals.€€Plaintiff€claims€that€the€plain€language€of€theÍstatute€does€not€include€hospitals,€and€that€including€hospitalsÏwould€be€in€derogation€of€the€intent€of€the€statute.€€òòSeeóó€òòMadisonÏLoan€&€Thrift€Co.€v.€Neffóó,€648€S.W.2d€655,€657€(Tenn.€œApp.›€1982)Ï("It€is€a€general€rule€that€no€intent€may€be€imputed€to€theÏlegislature€in€the€enactment€of€a€statute€other€than€such€as€isÏsupported€by€the€face€of€the€statute€itself.")€€Applying€this€ruleÏof€construction,€plaintiff€argues€that€since€the€term€"hospital"Ïdoes€not€appear€anywhere€within€the€statute's€immunity€provision,Ïit€is€improper€to€imply€that€hospitals€were€intended€by€theÏlegislature€to€be€included.ÌÌà àParkwest€counters€with€the€argument€that€the€language€of€theÏstatute€includes€hospitals.€€Specifically,€Parkwest€cites€twoÏsections€that,€in€its€opinion,€include€€hospitals.€€€T.C.A.€œðð€63„6„219(b)›€defines€a€medical€review€committee€or€peer€reviewÏcommittee€to€include€"a€committee€of€any€licensed€health€careÏinstitution."€Clearly,€this€would€include€the€peer€reviewÏcommittees€of€Parkwest€which€investigated€the€plaintiff.€€ParkwestÏthen€directs€our€attention€to€section€(c)(1)€of€the€law,€whichÏgrants€immunity€to€"[a]ll€state€and€local€professionalÏassociations€and€societies€and€other€organizations,€òòinstitutionsóó,Ïfoundations,€òòentitiesóó€and€associated€committees€as€identified€inÍsubsection€œ(b)€.€.€.€›€"× ƒ4 ××  ×€(emphasis€added).€€Parkwest€notes€that€aÏhospital€is€defined€as€an€institution€under€T.C.A.€ðð€68„11„201(21)(A).× ƒ5 ××  ×€€ÌÌà àWe€have€thoroughly€reviewed€the€Peer€Review€Law,€and€concurÏwith€the€trial€court's€conclusion€that€the€immunity€granted€doesÏextend€to€hospitals.€Our€decision€is€based€on€several€factors.€ÏFirst,€while€clearer€language€could€have€been€employed,€we€believeÏsection€(c)(1)€was€meant€to€include€hospitals€by€the€inclusion€ofÏthe€terms€"institutions"€and€"entities."€€Certainly€theÏlegislature€was€aware€of€its€use€of€the€term€institution€asÏreferring€to€a€hospital€in€T.C.A.€ðð€68„11„201(21)(A).€€However,Ïeven€more€persuasive€is€the€language€of€section€(b)€of€the€PeerÏReview€Law.€€That€section€defines€a€peer€review€or€medical€reviewÏcommittee€as€a€committee€of€a€licensed€health€€care€"institution."€ÏSection€(c)(1)€clearly€grants€immunity€to€all€"institutions"€asÏidentified€in€subsection€(b),€which€identifies€committees€ofÍvarious€medical€groups.€€€The€only€use€of€the€word€institution€inÏsubsection€(b)€is€in€reference€to€"licensed€health€careÏinstitutions,"€which,€as€previously€stated,€has€been€defined€byÏthe€legislature€to€mean€a€hospital.ÌÌà àSecond,€we€believe€it€would€be€contrary€to€the€intent€of€theÏlegislature€to€grant€immunity€to€medical/peer€review€committees,Ïbut€not€to€the€organizations€that€act€upon€their€recommendations.€ÏPlaintiff€argues€that€section€(c)(1)€only€includes€the€committeesÏof€such€groups.€€However,€the€language€of€the€section€specificallyÏidentifies€various€medical€providers,€òòandóó€associated€committees.€ÏWe€believe€this€language€grants€immunity€to€the€peer€reviewÏcommittees,€and€the€entities€from€which€such€committees€areÏformed.€The€Peer€Review€Law€is€intended€to€be€an€incentive€for€theÏmedical€profession€to€"undertake€professional€review."€€T.C.A.€ððÏ63„6„219(2).€€As€part€of€that€review,€the€Law€makes€it€theÏresponsibility€of€the€committee€to€"review,€òòdisciplineóó,€andÏeducate€the€profession."€€òòIdóó.€(emphasis€added).€€The€law€isÏsilent,€however,€as€to€the€various€means€such€committees€are€toÏuse€in€those€efforts.€Since€such€committees€are€charged€withÏdisciplining€physicians,€and€granted€immunity€for€those€acts,€itÏwould€seem€illogical€to€grant€immunity€to€a€committee€that€makes€aÍrecommendation€for€discipline,€but€not€to€the€hospital€forÏcarrying€out€such€recommendation.€œHere›€Parkwest€charged€its€reviewÏcommittees€with€investigating€and€recommending€appropriate€actionÏagainst€the€œplaintiff.€Parkwest›€followed€the€committee'sÏrecommendation.€œWe›€believe€that€public€policy€mandates€thatÏhospitals€œbe›€immune€from€liability€for€acting€upon€theÏrecommendation€of€a€peer€review€committee.€€To€hold€otherwiseÏwould€thwart€what€we€perceive€to€be€the€intention€of€theÏlegislature.€We€believe€this€decision€is€in€keeping€with€the€ruleÏof€statutory€construction€set€forth€in€òòMadison€Loan€&€Thriftóó,Ïòòsupraóó.€€We€are€not€imputing€an€intent€to€the€legislature'sÏactions.€€Rather,€we€are€reinforcing€the€intent€set€forth€by€theÏlegislature€to€encourage€the€self„discipline€of€the€medicalÏprofession.ÌÌà àFinally,€as€to€the€applicability€of€the€Peer€Review€Law,Ïplaintiff€maintains€that€the€Law€interferes€with€plaintiff's€pre„existing€contractual€rights,€and€was€not€meant€to€grant€immunityÏfor€breaches€of€contract.€€As€to€the€alleged€interference€withÏpreexisting€contractual€rights,€plaintiff€maintains€that€heÏentered€into€a€written€contract€with€Parkwest€in€the€form€of€theÏhospital's€bylaws€in€1974,€and€that€since€there€was€no€lapse€inÍthis€contractual€relationship,€the€1990€amendment€to€the€PeerÏReview€Law€that€we€have€determined€granted€immunity€to€hospitalsÏimpermissibly€interferes€with€his€contractual€relationship.€€WeÏdisagree.€€We€do€not€find€that€plaintiff€had€a€contractualÏrelationship€with€Parkwest€with€no€lapses€since€1974.€€We€findÏthat€Dr.€Eyring€had€privileges€at€Parkwest,€with€no€lapse€fromÏ1974€to€1992,€but€that€he€had€multiple€contracts€with€ParkwestÏduring€that€period.€ÌÌà àParkwest's€bylaws€provide€for€procedures€for€theÏreappointment€of€physicians€to€its€medical€staff€every€two€years.€ÏWe€believe,€as€did€the€trial€court,€that€each€successiveÏreappointment€was€a€separate,€distinct€contractual€relationshipÏfor€a€two„year€period,€not€a€continuous€contractual€relationshipÏas€plaintiff€asserts.€€Our€decision€is€supported€by€the€rules€ofÏthe€Board€for€Licensing€Health€Care€Facilities€of€the€TennesseeÏDepartment€of€Health€which€prohibit€a€hospital€from€appointing€aÏphysician€to€its€medical€staff€for€a€period€of€more€than€twoÏyears.€€Tenn.€œAdmin›.€œComp›.€ðð€1200„8„3„.02(1).€€If€Parkwest'sÏregulations€could€somehow€be€construed€as€guarantying€aÏphysician's€reappointment,€or€if€the€reappointment€procedure€wereÏconstrued€to€be€a€continuing€contractual€relationship€from€theÍtime€the€plaintiff€joined€the€hospital's€staff,€both€the€spirit,Ïletter€and€intent€of€the€Department€of€Health's€rules€would€beÏviolated.€€We€therefore€hold€that€the€Peer€Review€Law,€as€appliedÏto€this€physician,€did€not€interfere€with€a€preexistingÏcontractual€relationship.€€Having€reached€this€conclusion€andÏconcluding€that€plaintiff€has€failed€to€show€a€violation€ofÏParkwest's€bylaws,€which€we€will€hereinafter€discuss,€we€need€notÏreach€plaintiff's€contention€that€the€law€was€not€meant€to€provideÏimmunity€for€a€breach€of€contract.ÌÌò òÔ&  ÔÓ  ÓMALICEÌÌÓ  Óó óà àAs€we€have€stated,€the€immunity€granted€by€the€Peer€ReviewÏLawÔ'  Ô€is€a€qualified€one.€€Only€actions€that€are€taken€in€good€faithÏand€without€malice€and€on€the€basis€of€facts€reasonably€known€orÏreasonably€believed€to€exist€are€immune.€€T.C.A.€ðð€63„6„219(c)(1).€ÏA€1994€amendment€to€the€law€provided€that€"A€member€of€a€medicalÏreview€committee,€or€person€reporting€information€to€a€medicalÏreview€committee,€is€presumed€to€have€acted€in€good€faith€andÏwithout€malice.€€Any€person€alleging€lack€of€good€faith€has€theÏburden€of€proving€bad€faith€and€malice."€€T.C.A.€ðð€63„6„219(c)(3).€ÏThis€amendment€clearly€places€the€burden€on€the€party€alleging€badÍfaith€to€prove€such€action.€€However,€plaintiff€maintains€thatÏthis€provision€only€places€the€burden€on€the€complaining€party€ifÏit€is€alleging€bad€faith€on€the€part€of€the€committee,€not€on€theÏpart€of€the€hospital.€€Therefore,€since€he€œsued›€the€hospital€andÏnot€the€individual€members€of€the€Parkwest€committees€whoÏrecommended€revocation€of€his€privileges,€œhe€does€not€bear€this›Ïœburden.€€We€respectfully€disagree.ÌÌà àSubsequent€to€our€Supreme€Court's€decision€in€1993€that€afterÏfull€discovery€a€physician€had€failed€to€create€a€genuine€issueÏthat€a€medical€review€committee€had€acted€in€bad€faith€and€withÏmalice,€the€legislature€amended€the€Peer€Review€Law€to€create€theÏpresumption€of€good€faith.× ƒ6 ××  ×€€Clearly,€the€language€of€thatÏamendment€applies€to€members€of€medical€review€committees€andÏthose€people€reporting€information€to€such€committees.€€However,Ïas€we€have€stated,€we€believe€the€statute€applies€to€hospitalsÏwhen€acting€on€the€recommendation€of€medical€review€committees.€ÏThe€statute,€when€read€in€toto,€provides€immunity€for€theÏdiscipline€of€physicians€upon€the€evaluation€and€recommendation€ofÏmedical€review€committees.€€We€are€persuaded€that€to€disallowÍimmunity€to€the€hospital€would€have€a€chilling€effect€upon€theÏability€of€hospitals€to€evaluate,€discipline€or€withdrawÏprivileges€from€physicians€practicing€in€their€facility.€€StatedÏdifferently,€the€spirit€and€intent€of€the€Law€would€be€renderedÏineffective€if€hospitals€were€not€granted€immunity.€€While€theÏplaintiff€is€not€suing€the€individual€members€of€the€medicalÏreview€committees€of€Parkwest,€but€is€suing€the€hospital€directly,Ïwe€believe€that€the€law€nevertheless€applies€because€plaintiffððsÏbases€for€suing€the€hospital€spring€directly€from€the€actions€andÏrecommendations€of€the€review€committees.€€We€therefore€believeÏthat€such€presumption€of€good€faith€as€provided€for€by€T.C.A.€ððÏ63„6„219(c)(3)€remains€in€effect.€€The€language€of€the€amendmentÏdoes€not€state€that€it€applies€only€when€members€of€peer€reviewÏcommittees€are€sued,€nor€should€it,€given€public€policy€reasons.€ÏThe€statute,€as€we€have€stated,€applies€to€entities€acting€uponÏthe€recommendation€of€such€committees.€€There€is,€therefore,€noÏneed€to€expressly€attach€a€presumption€of€good€faith€to€theÏhospital€statutorily.€€It€is€the€action€of€the€committee,€not€theÏaction€of€the€hospital€in€relying€on€the€committee,€where€theÏpresumption€is€most€compelling.ÌÌÔ&  Ôà àHaving€reached€the€above€conclusion,€we€will€now€discussÏwhether€plaintiff€demonstrated€by€sufficient€countervailingÏevidence€to€establish€a€genuine€issue€of€fact€concerning€theÏallegations€that€Parkwest's€actions€were€not€made€in€goodÔ'  Ô€faithÏand€occurred€in€circumstances€from€which€legal€malice€should€beÏinferred.€Plaintiff€cites€a€law€review€article€discussingÏ"appropriate€factors€upon€which€malice€may€be€implied€or€inferred"Ïin€the€peer€review€process.× ƒ7 ××  ×›€€Plaintiff€cites€seven€factors€fromÏthe€article€that€indicate,€in€his€opinion,€that€legal€maliceÏshould€be€inferred.€€Those€seven€factors€are:ÌÌÒ  ÒÒ ° ÒÒ  ÒÒ  Òœ›ÓîÓà0 àà à1.à àMalice€may€be€inferred€when€the€complaintÏoriginates€and€is€pursued€outside€the€normalÏquality€assurance€procedure.ÌÌà0 àà à2.à àMalice€may€be€inferred€when€stale€charges€are€used.ÌÌà0 àà à3.à àMalice€may€be€inferred€by€the€manner€in€which€theÏadministration€handled€the€initial€complaints€„„Ïwas€the€doctor€considered€competent€until€provenÏincompetent;€or€was€he€summarily€terminated€fromÏthe€medical€staff.ÌÌà0 àà àœ4.›à àœLack›€of€due€process€is€a€circumstance€from€whichÏlegal€malice€may€be€inferred.ÌÌà0 àà à5.à àMalice€should€be€implied€when€a€physician€did€notÏhave€an€opportunity€to€be€meaningfully€heard€inÏresponse€to€the€allegations.ÌÌà0 àà à6.à àMalice€may€be€inferred€by€the€disparate€treatmentÏof€one€doctor€as€compared€to€the€doctor'sÏcolleagues.ÌÌà0 àà à7.à àMalice€may€be€inferred€when€the€severity€of€theÏhospital€disciplinary€action€is€disproportionate.ÌÌÌÒ ° ÒÒ  ÒÒ ° ÒÒ ° ÒÌœ›Ó$ÜÓ€à àWe€have€thoroughly€reviewed€plaintiff's€argument€and€theÏrecord,€and€conclude€that€there€was€insufficient€evidence€fromÏwhich€malice€could€have€been€inferred€under€the€Peer€Review€Law.€ÏWe€also€note€that€the€conditions€set€out€in€the€law€review€articleÏhave€not€been€established.€€As€we€have€previously€stated,€theÏburden€of€proof€for€œdemonstrating›€malice€rests€on€the€œplaintiff›Ïbecause€of€the€presumption€of€good€faith€embodied€in€the€statute.€ÏIn€order€to€overcome€the€presumption€of€good€faith€of€T.C.A.€ðð€63„6„219(c)(3),€we€believe€that€a€plaintiff€must€produce€more€thanÏthe€conclusory€evidence€that€the€plaintiff€has€submitted€inÏopposition€to€the€hospitalððs€motion€for€summary€judgment.€€TheÏTennessee€Peer€Review€Law€not€only€provides€immunity€for€actionsÏtaken€in€good€faith€by€peer€review€groups,€it€imposes€extremelyÏstringent€safeguards€in€limiting€discovery€and€in€requiringÏphysicians€to€overcome€a€strong€presumption€of€good€faith€on€theÍpart€of€review€groups.€€It€is€not€the€province€of€this€court€toÏsecond€guess€the€wisdom€of€the€legislature€in€enacting€theseÏrestrictions.€€We€cannot,€however,€escape€the€conclusion€that€theÏlegislature€intended€to€afford€peer€review€groups€the€utmostÏdiscretion€in€reviewing€the€medical€profession,€and€in€limitingÏthe€ability€to€question€that€review.€€Indeed,€because€of€theÏimportance€of€quality€review€of€the€medical€profession,€and€theÏunique€problems€associated€with€review€of€medical€competence€byÏnon„physicians,€we€believe€the€legislature€enacted€this€statute€toÏinsure€that€such€peer€review€would€be€free€from€judicialÏintervention€absent€clear€proof€of€an€egregious€injustice€duringÏthe€process.€€Plaintiff€has€not€demonstrated€such€conduct€in€hisÏcountervailing€evidence,€and€the€trial€court€was€correct€inÏrefusing€to€infer€legal€malice.ÌÌà àHaving€reached€this€conclusion,€we€believe€that€the€burden€ofÏproving€malice,€on€motion€for€summary€judgment,€requires€suchÏevidence,€accepted€as€true,€to€show€that€more€probably€then€not,Ïthe€committee€acted€maliciously.€€We€are€not€prepared€to€discussÏany€type€of€"minimal€requirements"€that€might€suffice.€€TheÏinquiry€must€necessarily€be€made€on€a€case€by€case€basis.€€In€thisÏcase€specifically,€we€note€that€the€plaintiff€was€present€at€theÍrevocation€hearing€of€the€Parkwest€Board€of€Directors,€and€wasÏallowed€to€present€proof€on€his€behalf.€€Certainly,€the€statuteÏallows€for€plaintiff€to€testify€to€inaccuracies€that€wereÏpresented€to€the€Board.€€However,€plaintiff€has€failed€toÏadequately€do€so€in€this€case.€€Plaintiff€œadmits›€that€his€practiceÏof€medicine€was€somewhat€œcontroversial,›€that€he€has€anÏ"aggressive"€approach€to€œsurgery,€and›€that€he€œis›€"willing€toÏattempt€the€difficult€surgical€cases€that€other€surgeons€oftenÏrefused€to€treat."€€This€admission€is€essentially€the€same€as€theÏlower€court's€finding€that€Parkwest€based€its€decision€on€theÏdetermination€that€plaintiff€was€too€aggressive€in€the€practice€ofÏmedicine,€and€had€used€poor€judgment€in€selecting€patients€forÏsurgery.€€Plaintiff€is€essentially€asking€the€courts€to€retry€theÏParkwest€hearing,€something€that€we,€as€non„physicians,€lack€theÏcapability€to€do.€€We€must€limit€our€inquiry€to€the€lawfulness€ofÏthe€procedure€employed€by€Parkwest.Ì€€Ìò òÓ  ÓHEALTH€CARE€QUALITY€IMPROVEMENT€ACTÌÓ  Óó óÌà àThe€plaintiff€also€contends€that€Parkwest€was€not€entitled€toÏimmunity€under€the€Health€Care€Quality€Improvement€Act€(HCQIA)€ofÍ1986,€codified€at€42€U.S.C.€ðððð€11101,€òòet€seqóó.€€The€Trial€CourtÏconcluded€that€the€Peer€Review€Law€applied€instead€of€the€HCQIA.€€ÌÌà àPlaintiff€contends€that€the€trial€court€was€in€error€byÏapplying€the€Peer€Review€Law€instead€of€the€HCQIA.€€PlaintiffÏargues€that€Parkwest€chose€to€place€itself€within€the€immunityÏprovisions€of€HCQIA,€but€did€not€comply€with€HCQIA€due€processÏrequirements€in€terminating€plaintiff's€hospital€privileges.€€ÌÌà àParkwest€argued€in€the€lower€court€that€it€was€immune€fromÏsuit€under€òòbothóó€the€Tennessee€Peer€Review€Law€and€the€HCQIA.€€TheÏtrial€court€granted€summary€judgment€to€Parkwest€based€solely€onÏthe€Peer€Review€œLaw.›€Thus,€whether€Parkwest€was€entitled€toÏsummary€judgment€under€HCQIA€is€a€moot€point.€€The€trial€court€didÏnot€reach€this€issue€and€we€have€concurred€with€the€trial€courtððsÏdecision€concerning€immunity€under€the€Peer€Review€Law.€€We€note,Ïparenthetically,€however,€that€HCQIA€does€not€impose€specificÏminimal€hearing€requirements€on€peer€review€committees€for€whichÏaggrieved€physicians€can€seek€redress.€€òòSeeóó€òòHancock€v.€Blue€Cross„Blue€Shield€of€Kansas,€Incóó.,€21€F.3d€373,€374€(œ10th›€Cir.€1994)Ï("Congress€did€not€intend€to€create€a€cause€of€action€for€theÏbenefit€of€physicians€to€enforce€provisions€of€the€HCQIA.")ÌÌò òÔ&  ÔÓ  ÓCONTRACTUAL€LIABILITYÌÌÓ  Óó óà àThe€Trial€Court€denied€plaintiff's€motion€for€partial€summaryÔ'  ÔÏjudgment€on€the€issue€of€contractual€liability.€€The€TennesseeÏSupreme€Court€held€in€òòœLewisburg›€Community€Hospital€v.€œAlfredson›óó,Ï805€S.W.2d€756€(1991),€that€a€hospital's€failure€to€follow€itsÏbylaws€is€subject€to€a€lawsuit,€because€the€bylaws€of€a€privateÏhospital€constitute€a€contract€with€a€physician€on€its€staff.€Ï"Like€any€other€legal€entity,€hospitals€are€capable€of€breachingÏcontracts,€committing€torts,€or€violating€other's€constitutionalÏrights.€€When€they€do,€they€are€no€less€subject€to€the€court'sÏjurisdiction€than€anyone€else."€€òòIdóó.€at€759€(citation€omitted).€ÏIndeed,€the€Board€for€Licensing€of€Health€Care€Facilities€of€theÏTennessee€Department€of€Health€requires€all€licensed€hospitals€toÏadopt€bylaws€setting€forth€the€due€process€procedures€forÏdepriving€a€physician€of€staff€membership€or€clinical€privileges.€ÏòòSeeóó€Tenn.€œAdmin›.€œComp›.€ðð€1200„8„3„.02(2)(a).ÌÌà àWith€the€foregoing€in€mind,€plaintiff€argues€that€the€trialÏcourt€erred€in€not€granting€its€motion€for€partial€summaryÏjudgment€on€the€issue€of€contractual€lability€based€on€Parkwest'sÍviolation€of€its€bylaws.€€Plaintiff€sets€forth€94€purportedÏviolations€of€its€bylaws,€which€we€list€in€Appendix€A€to€thisÏopinion.ÌÌà àParkwest€does€not€dispute€plaintiff's€position€that€aÏhospital€must€follow€its€bylaws€in€matters€involving€theÏcredentials€of€its€physicians.€€The€hospital€argues,€however,€thatÏit,€in€fact,€did€substantially€follow€its€bylaws.€€Parkwest€admitsÏthat€its€board€did€act€prematurely€on€the€Medical€ExecutiveÏCommittee's€adverse€recommendation,€but€that€it€immediatelyÏrescinded€such€action.€€Furthermore,€Parkwest€contends€thatÏplaintiff€was€in€no€way€prejudiced€by€such€action,€and€thatÏplaintiff€in€fact€made€no€such€allegation.ÌÌà àOther€than€listing€the€94€alleged€violations€set€forth€inÏappendix€to€this€opinion€(which€lack€adequate€references€to€theÏrecord€or€indication€of€how€plaintiff€was€harmed€by€eachÏviolation),€plaintiff€has€utterly€failed€to€identify€any€reasonÏwhy€summary€judgment€œwas€not›€appropriate€to€this€issue.€€Likewise,Ïhe€has€failed€to€direct€the€Court€to€instances€in€the€record€whereÏhe€was€harmed€by€any€specific€violation.€€It€is€not€incumbent€uponÏthis€Court€to€sift€through€the€record€in€order€to€find€proof€toÍsubstantiate€the€positions€of€the€parties.€€òòSeeóó€òòœRedbud›€Coop.€Corp.Ïv.€Claytonóó,€700€S.W.2d€551,€557€(Tenn.€œApp.›€1985).€€òòSee€alsoóó€òòœMabry›Ïv.€œMabry›óó,€an€unreported€opinion€of€this€Court€filed€at€KnoxvilleÏFebruary€14,€1992.€(1992€Tenn.€App.€LEXIS€130).€€However,€in€orderÏto€do€justice€and€avoid€further€litigation€expense,€if€possible,Ïwe€have€endeavored€to€search€through€the€record,€which€consists€ofÏmore€than€5,000€pages,€to€determine€if€there€are€undisputed€factsÏto€entitle€the€plaintiff€to€partial€summary€judgment€as€a€matterÏof€law.€€We€find€no€evidence€sufficient€to€overcome€the€trialÏcourt's€finding€that€there€was€not€a€sufficient€departure€ofÏParkwest's€bylaws€to€warrant€the€granting€of€partial€summaryÏjudgment€to€the€plaintiff.€€The€exhaustive€list€of€allegedÏviolations€plaintiff€presents€is€replete€with€repetitive,€self„serving€allegations€not€adequately€supported€by€specificÏreferences€to€the€bylaws€or€record.€€Plaintiffððs€argument€isÏsimply€not€supported€by€the€record.€We€€affirm€the€Trial€Court'sÏdecision€that€the€plaintiff€was€not€entitled€to€partial€summaryÏjudgment€on€the€issue€of€contractual€liability.Ìò òÔ&  ÔÓ  ÓDISCOVERYÌÓ  Óó óÌà àPlaintiff€also€raises€as€an€issue€whether€summary€judgmentÔ'  ÔÏshould€be€reversed€because€he€was€denied€an€adequate€opportunityÍto€engage€in€discovery.€€The€trial€court€first€ruled€thatÏplaintiff€would€be€entitled€to€discovery€insofar€as€necessary€toÏenable€plaintiff€to€inquire€as€to€whether€Parkwest's€actions€wereÏmade€in€good€faith€without€malice€and€upon€facts€reasonably€knownÏor€reasonably€believed€to€exist.€€However,€Parkwest's€attorneysÏobjected€during€the€discovery€process€on€the€basis€of€privilegeÏand€confidentiality€in€accordance€with€T.C.A.€ðð€63„6„219(d),€whichÏmakes€information€furnished€to€or€generated€by€a€medical€reviewÏcommittee€privileged,€subject€to€the€laws€pertaining€to€theÏattorney„client€privilege.€€The€court€then€ruled€that€plaintiffÏcould€not€engage€in€discovery€in€order€to€probe€the€actual€peerÏreview€process.€€Plaintiff€now€complains€that€without€suchÏdiscovery,€he€was€denied€access€to€the€"very€source€of€informationÏupon€which€to€substantiate€his€claim€that€the€process€used€byÏParkwest€involved€legal€malice,€and€that€the€decision€was€notÏbased€on€facts€reasonably€known€or€reasonably€believed€to€exist."€€ÌÌà àPlaintiff€argues€that€the€confidentiality€provision€of€T.C.A.Ïðð€63„6„219(d)€grants€an€exception€to€the€confidentiality€privilegeÏby€the€language€"subject€to€the€laws€pertaining€to€the€attorney„client€privilege."€€Plaintiff€then€directs€us€to€a€recentÏunreported€case€from€this€court,€holding€that€there€is€"anÍexception€when€the€activities€of€counsel€are€directly€at€issue."€ÏòòCannon,€et€al.,€v.€Garneróó,€opinion€filed€at€Nashville€on€DecemberÏ1,€1995.€€We€do€not€believe€that€òòCannonóó€applies.€€Contrary€toÏplaintiff's€assertion,€òòCannonóó€did€not€involve€the€application€ofÏthe€attorney„client€privilege,€but€was€a€case€involving€the€workÏproduct€rule.€€€Although€similar,€the€work€product€rule€isÏdistinct€from€and€broader€than€the€attorney„client€privilege.€€òòSeeóóÏòòœHickman›€v.€Tayloróó,€329€U.S.€495,€508,€67€S.€Ct.€385,€òòUnited€StatesÏv.€Noblesóó,€422€U.S.€225,€238,€€95€S.€Ct.€2160,€2169„70.€€The€workÏproduct€rule,€found€in€Rule€26.02(3),€T.R.C.P.,€provides€forÏdiscovery€upon€a€showing€that€the€party€seeking€discovery€has€aÏ"substantial€need€of€the€materials€in€the€preparation€of€his€caseÏand€that€he€is€unable€without€undue€hardship€to€obtain€theÏsubstantial€equivalent€of€the€materials€by€other€means."€€TheÏattorney„client€privilege€on€the€other€hand,€is€considered€to€beÏthe€privilege€worthy€of€the€greatest€protection.€€Neil€P.€Cohen,ÏDonald€F.€Paine€&€Sarah€Y.€œSheppeard›,€òòTennessee€Law€of€Evidenceóó,€ððÏ501.4€(2d€ed.,€1990).€€Communications€between€a€client€and€anÏattorney€are€privileged.€€T.C.A.€ðð€23„3„105.€€Unlike€the€workÏproduct€rule,€no€exception€applies€for€discovering€informationÏwithout€undue€hardship.€Given€this€important€distinction,Ïplaintiff's€argument€that€he€was€unable€to€discover€informationÍabout€the€peer€review€process€without€undue€hardship€must€fail.€ÏWe€hold€that€the€trial€court€was€correct€in€denying€plaintiff€theÏability€to€conduct€discovery€concerning€the€peer€review€process.ÌÌò òÓ  ÓEQUITABLE€ESTOPPELó óÌÓ  ÓÌà àThe€Plaintiff€next€argues€that€Parkwest€should€have€beenÏprecluded€from€revoking€plaintiff's€privileges€due€to€the€doctrineÏof€equitable€estoppel.€€Basically,€plaintiff€claims€that€ParkwestÏshould€not€have€been€allowed€to€revoke€plaintiff's€privilegesÏbecause€it€had€reappointed€him€to€the€medical€staff€in€1991Ïwithout€any€restrictions.€€Plaintiff€claims€that€he€detrimentallyÏrelied€on€his€reappointment€without€restrictions€and€wasÏirreparably€harmed€and€damaged€as€a€result€of€Parkwest'sÏsubsequent€change€of€position.€€Plaintiff€maintains€thatÏParkwest's€decision€to€revoke€his€privileges€was€based€on€23€ofÏplaintiff's€patient's€charts,€which€were€known€to€Parkwest€at€theÏtime€of€his€reappointment.€€We€find€this€position€to€be€withoutÏmerit.ÌÌà àThe€doctrine€of€equitable€estoppel€is€an€equitable€remedyÏthat€is€designed€to€prevent€inconsistency€and€fraud€from€resultingÍin€an€injury.€€When€a€person€has€been€mislead€by€the€untruthÏpropounded€by€another,€and€acted€to€his€detriment€in€reliance€uponÏthe€misrepresentation,€the€misleading€party€will€be€estopped€toÏshow€that€the€true€facts€are€contrary€to€those€he€firstÏpropounded.€€òòArthur€v.€Lake€œTanasi›€Village,€Incóó.,€590€S.W.2d€923Ï(Tenn.€1979),€òòœCorim›,€Inc.€v.€Sam€Blair€Co.,€Incóó.,€721€S.W.2d€256Ï(Tenn.€App.€1986),€òòDuke€v.€Hopperóó,€486€S.W.2d€744€(Tenn.€App.Ï1972).ÌÌà àSince€this€was€a€summary€judgment€action,€we€must€take€asÏtrue€plaintiff's€assertion€that€Parkwest's€conduct€in€revokingÏplaintiff's€privileges€was€inconsistent€with€his€earlierÏreappointment€without€restrictions.€€However,€equitable€estoppelÏdoes€not€apply€unless€plaintiff€detrimentally€relied€uponÏParkwest's€actions.€€œThis€the›€plaintiff€has€not€shown.€€œPlaintiff›Ïœstates›€that€"Plaintiff€detrimentally€relied€on€his€reappointmentÏwithout€restrictions€in€July€1991€and€he€was€irreparably€harmedÏand€damaged€as€a€result€of€Parkwest's€subsequent€change€ofÏposition."€€Such€cursory€and€conclusory€statements€do€not€provideÏsufficient€evidence€that€plaintiff€relied€upon€or€wasÏdetrimentally€harmed€as€a€result€of€Parkwest's€alleged€"change€ofÏposition."€€We€find€that€there€is€not€a€sufficient€basis€toÍwarrant€a€trial€on€this€issue.€€"Estoppel€is€not€favored€and€it€isÏthe€burden€of€the€party€seeking€to€invoke€the€estoppel€to€proveÏeach€and€every€element€of€an€estoppel."€€òòœBokor›€v.€Holderóó,€722ÏS.W.2d€676,€680€(Tenn.€App.€1986).ÌÌò òÔ&  ÔÓ  ÓRES€JUDICATA/COLLATERAL€ESTOPPELó óÌÌÓ  Óà àThe€plaintiff's€final€issue€concerns€the€application€of€òòresÔ'  ÔÏjudicataóó€and/or€collateral€estoppel.€Plaintiff€claims,€andÏParkwest€admits,€that€the€Board€of€Directors€took€action€on€theÏœrecommendation€of€the€peer€review€committee›€to€revoke€plaintiff'sÏprivileges€without€giving€plaintiff€a€chance€to€respond,€inÏviolation€of€Parkwest's€bylaws.€€The€Board's€action€was€laterÏrescinded,€and€a€hearing€took€place.€€Plaintiff€claims€that€thisÏsecond€hearing€should€not€have€occurred€because€it€subjected€himÏto€the€equivalent€of€"peer€review€double€jeopardy."€€ÌÌà àWe€believe€that€neither€the€doctrine€of€òòres€judicataóó€norÏcollateral€estoppel€have€any€application€to€this€case.€€€We€alsoÏnote€that€both€doctrines€apply€to€final€judgments,€and€we€feelÏthat€the€action€of€the€Parkwest€Board€in€rescinding€its€previousÏdecision€was€not€a€final€decision€on€its€part,€but€was€aÍcontinuation€of€the€original€proceeding€to€cure€a€proceduralÏdefect.ÌÌà àAs€to€double€jeopardy,€it€is€well„settled€law,€requiring€noÏœdiscussion,›€that€double€jeopardy€has€no€application€in€civil€casesÏinvolving€individuals€as€parties€as€opposed€œto›€state€œagencies.›€ÏThe€civil€counterpart€is€the€doctrine€of€òòres€judicataóó.ÌÌœ›ÓîÓà8 àà àThe€doctrine€of€òòres€judicataóó€is€that€an€existingÏfinal€judgment€rendered€upon€the€merits€by€a€court€ofÏcompetent€jurisdiction€is€conclusive€of€the€rights,Ïquestions€and€facts€in€issue€as€to€the€parties€and€theirÏprivies€in€the€same€action€in€other€judicial€tribunalsÏof€concurrent€jurisdiction.ÌÌòòPhillips€v.€œGMC›óó,€669€S.W.2d€665€(Tenn.€App.€1984).ÌÌœ›Ó$ÜÓÌà àThis€case€has€not€previously€been€disposed€of€on€its€meritsÏby€a€court€of€competent€jurisdiction,€hence,€the€doctrine€of€òòresÏjudicataóó€does€not€apply.ÌÌà àFor€the€reasons€set€forth€above,€the€judgment€of€the€trialÏcourt€is€affirmed€in€all€respects.€€Costs€of€appeal€are€taxed€toÏthe€plaintiff/appellant.ÌÌÌœ›ÓîÓà€ à______________________________Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Don€T.€McMurray,€JudgeÌÌÌÌCONCUR:ÌÌÌ___________________________________ÌHouston€M.€Goddard,€Presiding€Judgeà àÌÌÌ___________________________________ÌHerschel€P.€Franks,€œJudgeÌÇò òÔ€,&Ôà@ àAPPENDIX€AÌÌPlaintiff's€Allegations€of€Violations€of€the€Bylaws€of€ParkwestÏHospitalÌÌÓÓó óà0 àà à1.à àPlaintiff€was€not€given€notice€of€proposed€adverse€actionÏagainst€him€in€violation€of€the€Bylaws€prior€to€the€immediateÏtermination€and€revocation€of€his€clinical€privileges€by€theÏMEC€[Medical€Executive€Committee]€and€the€Parkwest€Board€onÏJanuary€24,€1992.ÌÌà0 àà à2.à àPlaintiff€was€not€given€an€opportunity€for€a€hearing€inÏviolation€of€the€Fair€Hearing€Plan€of€the€Bylaws€prior€to€theÏimmediate€termination€and€revocation€of€his€privileges€ofÏJanuary€24,€1992.ÌÌà0 àà àà0 àà à3.à àThe€Parkwest€Board€prematurely€and€improperly€acted€onÏJanuary€24,€1992,€on€the€MEC's€recommendation€absent€anyÏrecord€of€a€hearing€proceeding€pursuant€to€the€requirementsÏof€the€Fair€Hearing€Plan€of€the€Bylaws.ÌÌà0 àà à4.à àThere€was€no€report€or€written€document€evidencing€the€actionÏor€basis€upon€which€the€Parkwest€Board€undertookÏconsideration€of€the€recommendation€of€the€MEC€for€revocationÏand€termination€of€Plaintiff's€clinical€privileges€on€JanuaryÏ24,€1992,€in€violation€of€the€requirements€of€the€FairÏHearing€Plan€of€the€Bylaws.ÌÌà0 àà à5.à àAll€of€Plaintiff's€requests€for€minutes,€reports,€writingsÏwith€respect€to€the€action€taken€by€this€Board€on€January€24,Ï1992€or€the€basis€for€that€action€were€denied€and€refused.ÌÌà0 àà à6.à àThe€summary€suspension€of€a€physician€under€Article€8.2„1€ofÏthe€Bylaws€without€a€hearing€may€only€occur€when€he€exhibitsÏa€dependency€on€drugs€or€alcohol€or€because€the€safety€ofÏlife€of€a€patient€and€in€this€hospital€is€at€risk,€and€theÏaction€taken€against€Plaintiff,€which€was€the€equivalent€of€aÏsummary€suspension,€was€improper€and€unsubstantiated€and€inÏcomplete€violation€of€the€Bylaws€and€Fair€Hearing€Plan€of€theÏBylaws.ÌÌà0 àà à7.à àThe€Bylaws€require€that€a€recommendation€for€revocation€ofÏclinical€privileges€is€deemed€adverse€when€it€has€beenÏrecommended€by€the€MEC€and€that€a€practitioner€against€whomÍan€adverse€action€has€been€recommended€is€to€be€given€priorÏnotice€of€the€action€which€notice€is€to€include€theÏPractitioner's€right€to€a€hearing€pursuant€to€the€provisionsÏof€the€medical€staff€Bylaws€and€the€Fair€Hearing€Plan.€€ThisÏwas€not€done.€€Plaintiff€was€not€notified€until€after€the€MECÏand€Parkwest€Board€already€had€revoked€and€terminated€hisÏprivileges€and€staff€appointment€on€January€24,€1992.ÌÌà0 àà à8.à àPrior€to€the€action€which€was€taken€on€January€24,€1992,€theÏBy„Laws€and€Fair€Hearing€Plan€of€the€Bylaws€required€thatÏPlaintiff€be€given€notice€of€his€right€to€a€hearing€with€theÏsubsequent€right€to€appeal€the€decision€to€the€Board€ofÏTrustees€as€an€appellate€body.€€The€Parkwest€Board's€actionsÏof€January€24,€1992€violated€the€Bylaws€by€improperlyÏinvolving€the€Parkwest€Board€of€Directors€in€adverse€actionÏcontrary€to€Plaintiff's€right€to€a€prior€due€process€hearing.ÌÌà0 àà à9.à àThe€impartiality€of€the€MEC€and€the€Parkwest€Board€wasÏcompromised€by€virtue€of€its€premature€action€on€January€24,Ï1992,€because€of€a€failure€to€follow€the€requirements€of€theÏBylaws€and€Fair€Hearing€Plan€and€the€MEC€tainted€the€ParkwestÏBoard€with€undue€prejudicial€bias€which€rendered€itÏimpossible€for€Parkwest€or€its€Board€to€fairly€proceed€in€aÏsecond€decision€on€the€same€charges.€€All€of€the€subsequentÏcharges€against€Plaintiff€were€tainted€with€prejudicial€biasÏand€are€fatally€flawed€procedurally.ÌÌà0 àà à10.à àArticle€8.1„2€of€the€Bylaws€requires€that€all€requests€forÏcorrective€action€against€a€Practitioner€shall€be€in€writingÏand€submitted€to€the€MEC€at€the€commencement€of€any€attemptÏto€institute€corrective€action€against€Plaintiff,€andÏsupported€by€reference€to€the€specific€activities€or€conductÏwhich€constitute€the€ground€for€the€request.€€This€was€notÏdone.€€Both€the€initial€action€of€January€24,€1992,€and€theÏsubsequent€action,€violated€these€provisions€of€the€Bylaws.€ÏThere€never€was€a€request€for€corrective€action€which€met€theÏrequirements€of€the€Bylaws.ÌÌà0 àà à11.à àCorrective€action€sought€against€Plaintiff€was€not€initiatedÏby€the€MEC,€the€CEO€or€the€Parkwest€Board€as€required€byÏArticle€8.1„1€of€the€Bylaws.€€This€Article€delineates€theÏonly€parties€who€may€initiate€such€corrective€action.€ÏInstead€the€action,€culminating€in€revocation€of€theÏPlaintiff's€privileges,€was€initiated€by€an€Ad€Hoc€CommitteeÍfrom€the€Surgical€Patient€Care€Evaluation€Committee€which€wasÏnot€authorized,€and€is€not€a€party€authorized€under€theÏBylaws€to€initiate€such€charges.ÌÌà0 àà à12.à àNo€request€for€corrective€action€was€reported€to€the€Chief€ofÏSurgery€as€required€by€Article€8.1„3€of€the€Bylaws.ÌÌà0 àà à13.à àAs€required€by€Article€8.1„3€of€the€Bylaws,€there€was€noÏinvestigation€conducted€of€a€request€for€corrective€action€byÏthe€Chief€of€Surgery€and€since€there€was€no€request€forÏcorrective€action,€the€Chief€of€Surgery€could€not€haveÏappointed€an€Ad€Hoc€Committee€to€investigate€as€required€byÏArticle€8.1„3.ÌÌÓãñÓà0 àà à14.à àThe€Ad€Hoc€Committee€was€selected€prior€to€any€request€forÏcorrective€action€ever€being€made€against€Plaintiff,€and€inÏadvance€of€and€in€anticipation€of€the€committee€meeting€inÏwhich€the€decision€to€review€"trended€cases."€€There€is€noÏprovision€in€the€Bylaws€for€an€investigation€of€this€type,Ïabsent€a€request€for€corrective€action.ÌÌà0 àà à15.à àNo€report€of€the€Chief€of€Surgery€or€an€Ad€Hoc€CommitteeÏ(appointed€by€the€Chief€of€Surgery)€was€made€to€the€MECÏwithin€thirty€(30)€days€of€receipt€of€the€request€forÏcorrective€action€as€required€by€Article€8.1„3€of€the€BylawsÏabsent€which€no€corrective€action€is€timely€and€thus€violatesÏthe€Bylaws.ÌÌà0 àà à16.à àSince€the€Ad€Hoc€Committee€was€not€duly€appointed€and€did€notÏfile€any€report€within€thirty€(30)€days€of€receipt€of€aÏrequest€for€corrective€action,€the€MEC€did€not€have€authorityÏto€take€any€action€on€the€January€20,€1992,€report€of€theÏimproperly€constituted€AHC,€which€report€also€was€not€filedÏwithin€thirty€(30)€days€from€the€date€the€AHC€began€itsÏinvestigation€as€required€by€and€in€violation€of€Article€8.1„3€of€the€Bylaws.€€Any€adverse€action€against€Plaintiff€by€theÏMEC€based€upon€such€untimely€and€unauthorized€report€of€theÏAHC€was€in€violation€of€Article€8.1„4€of€the€Bylaws,€and€wasÏunauthorized.ÌÌà0 àà à17.à àArticle€2.1€of€the€Fair€Hearing€Plan€was€breached€andÏviolated€because€the€Hospital€and€medical€staff€failed€toÏconvene€the€May€16„17€hearing€within€the€thirty€(30)€day€timeÏlimit€from€the€date€that€Plaintiff€requested€a€hearing€onÏFebruary€14,€1992.ÌÌà0 àà à18.à àThe€letter€of€the€Parkwest€Board€of€Directors€to€PlaintiffÏdated€February€3,€1992,€which€revokes€the€action€of€theÏParkwest€Board€taken€on€January€24,€1992,€asserted€that€theÏMEC€was€acting€pursuant€to€Article€8.1„4(b)€of€the€Bylaws€inÏrecommending€revocation€of€Plaintiff's€privileges€on€JanuaryÏ23,€1992.€€Article€8.1„4(b)€of€the€Bylaws€was€violatedÏbecause€there€was€no€department€report€conforming€to€theÏrequirements€of€the€Bylaws€upon€which€the€MEC€could€haveÏproperly€acted.€€The€subsequent€adverse€action€of€the€MEC€wasÏin€violation€of€the€Bylaws€and€Fair€Hearing€Plan€of€theÏBylaws.ÌÌà0 àà à19.à àArticle€8.1„4€of€the€Bylaws€was€also€violated€because€theÏaction€taken€by€the€MEC€on€January€23,€1992€was€not€reportedÏin€writing€to€the€Surgery€Department€as€required.ÌÌà0 àà à20.à àThe€letter€of€the€Parkwest€Board€of€Directors€to€Plaintiff€ofÏFebruary€3,€1992,€improperly€invokes€provisions€requiringÏPlaintiff€to€exercise€his€procedural€rights€in€spite€of€theÏfact€that€the€Hospital€has€failed€to€comply€with€the€By„Laws.€ÏThe€letter€states€the€adverse€action€of€the€MEC€was€basedÏupon€"a€written€report€by€an€Ad€Hoc€Committee€appointed€byÏthe€Surgical€Patient€Care€Evaluation€Committee."€€There€wasÏno€corrective€action€request€upon€which€the€MEC€could,€orÏdid,€act.€€Insistence€that€Plaintiff€pursue€his€hearingÏremedies€was€therefore€in€violation€of€the€Bylaws€and€theÏFair€Hearing€Plan.€€The€action€rescinding€the€Board'sÏrevocation€vote€constituted€final€action€on€theÏrecommendation€or€[sic]€the€MEC.€€There€was€no€subsequentÏrecommendation€or€action€of€the€MEC.€€Continuation€of€theÏProcess€was€not€based€on€any€pending€recommendationÏconstituting€adverse€action€and€therefore€continuation€ofÏaction€against€Plaintiff€was€improper.ÌÌà0 àà à21.à àThe€Parkwest€Board€of€Directors'€revocation€on€February€3,Ï1992,€of€its€earlier€improper€adverse€action€of€January€24,Ï1992,€did€not€cure€the€violations€and€breaches€of€the€BylawsÏwhich€had€already€occurred,€nor€did€it€cure€the€damage€toÏPlaintiff's€practice€caused€by€the€previous€wrongful€andÏunlawful€summary€suspension€by€the€MEC€and€the€ParkwestÏBoard.ÌÌà0 àà à22.à àThe€five€member€Ad€Hoc€Committee€exceeded€the€scope€of€itsÏappointment€by€not€limiting€its€review€solely€to€allÏpreviously€"trended"€cases,€of€which€there€were€only€three.€ÏIf€the€Helen€Parker€case€were€included,€there€would€have€beenÏfour€such€cases.€€The€extension€of€their€review€to€all€casesÍwhich€had€been€identified€in€the€Quality€Assurance€process,Ïbut€not€"trended",€was€not€authorized.€€The€Ad€Hoc€CommitteeÏalso€had€no€authority€from€the€Department€of€Surgery€or€anyÏother€properly€constituted€body€to€bring€charges€or€makeÏrecommendations€for€sanctions€against€Plaintiff,€nor€wereÏthey€authorized€to€do€so€under€the€Bylaws.ÌÌà0 àà à23.à àPlaintiff's€right€to€be€treated€fairly€was€violated€by€denialÏof€his€request€for€minutes,€tapes,€or€other€documents€whichÏmemorialized€the€Ad€Hoc€Committee's€deliberations.ÌÌà0 àà à24.à àPlaintiff€was€not€furnished€a€copy€of€the€AHC's€January€20,Ï1992,€report€until€provided€by€the€hospital's€attorney€onÏApril€23,€1992.€€The€AHC€met€with€Plaintiff€only€once,€onÏJanuary€9,€1992,€at€which€time€only€three€cases€wereÏdiscussed,€two€of€which€they€advised€presented€no€problems.€ÏThe€report€adopted€eleven€(11)€days€later€and€presented€toÏthe€MEC€was€kept€secret€from€the€Plaintiff.€€The€action€ofÏthe€MEC€and€immediate€subsequent€action€of€the€Board€ofÏDirectors€occurred€without€Plaintiff€being€given€notice€asÏrequired,€nor€was€there€any€attempt€at€substantial€complianceÏwith€the€positive€requirements€of€the€Bylaws.ÌÌà0 àà à25.à àThe€alleged€notice€of€the€hearing€from€Parkwest's€attorney,Ïdated€March€26,€1992,€violates€the€Fair€Hearing€Plan€in€thatÏit€fails€to€contain€a€"concise€statement"€of€Plaintiff'sÏalleged€acts€or€omissions,€fails€to€contain€a€list€by€numberÏof€the€specific€or€representative€patient€records€andÏquestions€and/or€other€reasons€or€subject€matter€forming€theÏbasis€for€the€recommended€adverse€action€of€the€MEC€asÏrequired€by€Article€II€of€the€Fair€Hearing€Plan.ÌÌà0 àà à26.à àThe€hospital's€attorney€represented,€counseled,€advised,Ïcommunicated,€and€met€with€the€hospital€Administrator,Ïmembers€of€the€MEC€(the€charging€party),€the€Ad€Hoc€CommitteeÏ(the€prosecutors),€the€Hearing€Panel€(the€initial€decisionÏmakers),€and€the€Parkwest€Board€of€Directors€(the€decisionÏmakers€on€appeal).€€By€this€multiple€representation€by€theÏParkwest€attorneys,€of€which€Parkwest€was€aware,€ParkwestÏviolated€the€fundamentals€of€fairness€and€tainted€the€processÏwith€undue€bias€in€violation€of€the€articulated€purposes€ofÏthe€Bylaws€and€the€Fair€Hearing€Plan.ÌÌà0 àà à27.à àParkwest€reversed€its€earlier€representation€that€PlaintiffÏwould€be€allowed€to€be€represented€at€the€hearing€by€hisÏattorneys,€that€attorneys€must€be€involved€throughout€theÏproceeding€and€that€he€would€have€the€right€to€take€proof€ofÍwitnesses€by€deposition.€€Failure€to€permit€Plaintiff€toÏexercise€these€rights€after€initially€agreeing€to€themÏviolates€Sections€3.4€and€3.5€of€the€Fair€Hearing€Plan€andÏSection€8.2€of€the€Fair€Hearing€Plan.ÌÌà0 àà à28.à àIt€was€basically€unfair€and€a€violation€of€Plaintiff's€dueÏprocess€rights€to€prohibit€his€attorneys€even€to€be€on€siteÏat€the€Hospital€outside€of€the€hearing€room€so€that€he€couldÏconsult€with€them€after€he€was€denied€the€right€to€beÏrepresented€in€the€hearing€or€have€them€available€forÏconsultation€in€the€hearing.ÌÌà0 àà à29.à àPlaintiff€made€repeated€requests€that€the€Parkwest€medicalÏstaff€notify€him€of€patient€specific€charges€or€deficienciesÏwhich€never€was€properly€done€in€violation€of€Article€II€ofÏthe€Fair€Hearing€Plan€of€the€Bylaws.ÌÌà0 àà à30.à àParkwest€violated€the€notice€requirements€in€the€Bylaws€byÏattempting€to€add€an€additional€charge€regarding€anÏoccurrence€involving€an€incident€report€dated€March€20,€1992,Ïfor€determination€by€the€Hearing€Panel,€which€charge€had€notÏbeen€previously€presented€to€the€MEC.€€Such€action€alsoÏviolates€Sections€8.1„1,€8.1„2,€8.1„3,€8.1„4,€and€8.1„5€ofÏthe€Bylaws€and€the€Fair€Hearing€Plan.ÌÌà0 àà à31.à àParkwest€violated€Plaintiff's€rights€in€refusing€to€tellÏPlaintiff€who€or€what€witnesses€would€be€called€by€ParkwestÏto€testify.ÌÌà0 àà à32.à àParkwest€violated€Plaintiff's€rights€in€refusing€to€notifyÏPlaintiff€as€to€how€many€witnesses€would€be€called€byÏParkwest€to€testify.ÌÌà0 àà à33.à àParkwest€required€through€its€attorney€and€representativeÏthat€all€proof€at€the€hearing€be€restricted€to€live€witnessesÏin€violation€of€Article€3.5€of€the€Fair€Hearing€Plan€of€theÏBylaws€which€provided€that€"any€relevant€matter€upon€whichÏresponsible€persons€customarily€rely€in€the€conduct€ofÏserious€affairs€shall€be€admitted€regardless€of€admissibilityÏof€such€evidence€in€a€court€of€law."€€Under€the€Bylaws€anyÏform€of€written€or€recorded€material€was€to€be€admitted,Ïwhich€right€was€denied€to€Plaintiff.€€Certainly€the€hospitalÏutilized€medical€charts€and€other€written€data€containingÏobservations€and€opinions€of€various€people€without€requiringÏthem€to€be€present€to€testify.ÌÌà0 àà à34.à àOnce€attorneys€were€prohibited€from€participating€in€theÏhearing€process,€Parkwest€violated€this€ruling€by€ex€parteÏcontact€between€the€attorney€representing€the€hospital€andÏmembers€of€the€Hearing€Panel,€which€communication€or€contactÏoccurred€before€and€after€the€hearing.€€Ex€parte€contactÏlikewise€occurred€with€respect€to€the€Board€of€Directors.ÌÌà0 àà à35.à àParkwest€and€its€Medical€Executive€Committee€erred€andÏviolated€Plaintiff's€rights€and€violated€the€spirit€andÏintent€of€Section€2.3„3€of€the€Fair€Hearing€Plan€byÏappointing€orthopedic€surgeons€to€the€Ad€Hoc€Committee€whoÏwere€competitors€of€Plaintiff.ÌÌà0 àà à36.à àParkwest€and€its€Medical€Executive€Committee€violatedÏPlaintiff's€rights€and€violated€the€spirit€and€intent€ofÏSection€2.3„3€of€the€Fair€Hearing€Plan€by€allowing€orthopedicÏsurgeons€in€competition€with€Plaintiff€to€act€as€members€ofÏthe€Hearing€Panel.ÌÌà0 àà à37.à àParkwest€tainted€the€process€with€bias€and€conflict€andÏviolated€the€spirit€and€intent€of€Section€2.3„3€of€the€FairÏHearing€Plan€by€appointing€to€the€Hearing€Panel,€the€initialÏdecision€makers,€physicians€whose€practice€group€partnersÏwere€also€members€of€the€Ad€Hoc€Committee€which€was€theÏinvestigatory€and€prosecutorial€body.ÌÌà0 àà à38.à àParkwest€tainted€the€process€with€bias€and€conflict€ofÏinterest€and€violated€the€spirit€and€intent€of€Section€2.3„3Ïof€the€Fair€Hearing€Plan€by€appointing€physicians€to€act€asÏmembers€of€the€Hearing€Panel,€the€initial€decision€makers,Ïwhose€practice€group€partners€were€also€members€of€the€MEC,Ïthe€charging€body€whose€recommendation€initiated€theÏproceeding.ÌÌà0 àà à39.à àParkwest€failed€to€follow€the€confidentiality€requirementsÏexcept€to€assert€them€to€keep€information,€vital€toÏPlaintiff's€defense,€secret€and€unavailable€to€him€byÏasserting€that€the€documents€were€privileged.ÌÌà0 àà à40.à àParkwest€violated€the€spirit,€intent€and€provisions€ofÏSection€3.9€of€the€Fair€Hearing€Plan€by€failing€to€grantÏPlaintiff's€timely€request€for€postponement€of€the€hearingÏbased€upon€the€addition€of€the€23rd€patient€case€just€priorÏto€the€start€of€the€hearing.€€Parkwest€failed€to€give€theÏseven€day€required€notice€as€to€inclusion€of€this€patientÏcase.€€There€was€no€notice€given€as€to€this€patient€chart.€ÏTherefore,€the€30€day€notice€provision€of€HCQIA€was€violated.ÌÌà0 àà à41.à àParkwest€violated€the€spirit,€intent€and€provisions€ofÏSection€3.9€of€the€Fair€Hearing€Plan€by€failing€to€grantÏPlaintiff's€timely€request€for€postponement€of€the€hearingÏbased€upon€the€inclusion€of€new,€different€and€additionalÏcharges€first€identified€to€Plaintiff€in€the€19„page€summaryÏfiled€on€the€first€day€of€the€hearing.€€Neither€the€seven€dayÏnotice€required€by€the€Bylaws€nor€the€30€day€notice€requiredÏby€HCQIA€were€given.€€These€notice€requirements€wereÏviolated.ÌÌà0 àà à42.à àThe€hospital€used€medical€records€of€Medicaid€patientsÏagainst€Plaintiff€in€violation€of€T.C.A.€ðððð€10„7„504€andÏT.C.A.€ðð€68„11„305(c)€and€in€violation€of€the€patients'Ïspecific€refusal€to€grant€consent€for€the€use€of€theirÏrecords€in€any€adverse€action€against€Plaintiff.ÌÌà0 àà à43.à àParkwest€violated€Plaintiff's€rights€by€using€the€medicalÏrecords€and€charts€of€his€patients€against€him€after€thoseÏpatients€had€specifically€in€writing€withdrawn€their€consentÏfor€use€of€their€records€and€filed€written€objections€to€theÏuse€of€their€records€in€any€adverse€action€against€Plaintiff.€ÏLetters€from€14€patients€were€received€by€Parkwest€refusingÏto€grant€or€give€any€authority€to€the€hospital€to€use€thatÏpatient's€medical€records€for€any€purpose€to€take€adverseÏaction.€€The€use€of€these€patients'€records€without€theÏconsent€of€the€patients€and€contrary€to€the€patients'Ïobjections€was€a€violation€of€the€implied€condition€of€theÏcontract€between€Plaintiff€and€his€patient€that€noÏconfidential€information€gained€through€the€relationshipÏwould€be€released€without€the€patient's€permission.€€NeitherÏParkwest€not€the€MEC€had€authorization€from€any€of€the€22€orÏ23€patients€involved€in€the€focused€review€to€use€thoseÏpatients'€medical€records€in€any€proceeding€againstÏPlaintiff,€and€the€use€of€those€records€by€Parkwest€wasÏimproper€and€unauthorized.ÌÌà0 àà à44.à àParkwest€assisted,€encouraged,€and€allowed€the€AHC€to€goÏbeyond€its€instruction€and€its€presumed€authority€forÏexistence€when€the€AHC€reviewed€19€of€Plaintiff's€QualityÏAssurance€Charts€which€had€not€been€trended.€€The€AHC'sÏauthorization,€if€any,€to€conduct€an€investigation,€wasÏlimited€to€a€"focused€review"€of€"previously€trended"€cases.€ÏThe€AHC€violated€that€authorization.ÌÌà0 àà à45.à àThe€AHC€undertook€an€investigation€without€there€being€aÏrequest€for€corrective€action€in€writing,€as€required€toÍdetail€the€specific€activities€or€conduct€constituting€theÏgrounds€for€the€request,€as€required€by€Section€8.1„2€of€theÏBylaws.€€The€only€description€the€AHC€had€as€to€"the€matter"Ïto€be€investigated€was€to€review€"previously€trended"€cases;Ïtherefore,€the€review€actually€conducted€was€in€excess€of€theÏonly€notice€or€instruction€the€AHC€had€as€to€the€matter€to€beÏreviewed.€€The€AHC's€action€violated€the€spirit€and€intent€ofÏSection€8.1„3€of€the€Bylaws.ÌÌà0 àà à46.à àParkwest€violated€the€hearing€prerequisites€of€the€FairÏHearing€Plan€in€Article€II€by€adding€a€23rd€patient€chart,Ïthe€Helen€Parker€chart,€less€than€seven€(7)€days€prior€to€theÏdate€of€the€hearing€and€in€violation€of€the€seven€(7)€days'Ïnotice€requirement€to€Plaintiff€of€the€charges€against€him€asÏrequired€under€Article€II€of€the€Fair€Hearing€Plan€of€theÏBylaws.ÌÌà0 àà à47.à à€The€Chairman€of€the€Hearing€Panel€knew€that€no€adverseÏtrends€existed€in€these€three€trended€cases€reviewed€by€theÏAd€Hoc€Committee€and€that€no€adverse€action€would€have€beenÏwarranted€on€the€basis€of€those€three€trended€cases.ÌÌà0 àà à48.à àParkwest€violated€the€credentialling€process€andÏreappointment€review€process€of€the€Bylaws€by€advising€theÏAHC€or€the€MEC€or€the€Hearing€Panel€to€consider€matters€orÏincidents€relating€to€patient€charts€that€predatedÏPlaintiff's€last€appointment€to€the€medical€staff€on€July€31,Ï1991.ÌÌà0 àà à49.à àParkwest€violated€the€Fair€Hearing€Plan€and€theÏcredentialling€and€reappointment€provisions€of€the€Bylaws€byÏallowing€the€Quality€Assurance€coordinator,€the€AHC,€the€MEC,Ïor€the€Hearing€Panel€to€use€stale,€stockpiled€QualityÏAssurance€matters€and€medical€records€from€a€period€of€manyÏprior€years€and€then€utilize€them€in€a€"stacked€deck"€fashionÏagainst€Plaintiff€in€a€prearranged€plan€to€remove€his€staffÏappointment,€when€Plaintiff€had€been€investigated€(includingÏthe€time€period€for€all€of€the€23€charts)€and€reappointedÏwithout€any€restrictions€to€the€staff€during€that€period.€ÏThe€latest€reappointment€on€July€31,€1991€was€subsequent€toÏall€of€the€surgical€procedures€reviewed€by€the€Ad€HocÏCommittee.ÌÌà0 àà à50.à àParkwest€violated€the€fairness€provisions€of€the€Fair€HearingÏPlan€and€the€Quality€Assurance€provisions€of€the€Bylaws€andÏit€was€improper,€arbitrary€and€capricious€for€the€AHC€or€theÏMEC€to€claim€that€Plaintiff€deviated€from€establishedÍprocedures€or€used€obsolete€methods€when€no€medical€staff€orÏhospital€policy€ever€existed€which€established€the€properÏprocedure€to€be€used.ÌÌà0 àà à51.à àParkwest€violated€the€fairness€provisions€of€the€Fair€HearingÏPlan€and€Quality€Assurance€provisions€of€the€Bylaws€and€itÏwas€improper,€arbitrary€and€capricious€for€the€Ad€HocÏCommittee€or€the€Medical€Executive€Committee€to€allege€thatÏthe€use€of€a€hemovac€drain€in€a€knee€joint€is€poor€clinicalÏjudgment€when€no€hospital€policy€or€guidelines€existedÏprohibiting€the€use€of€such€drain,€and€when€in€fact€use€ofÏsuch€drain€is€commonplace€by€other€surgeons€in€this€Hospital.ÌÌà0 àà à52.à àParkwest€violated€the€fairness€provisions€of€the€Fair€HearingÏPlan€and€the€Quality€Assurance€provisions€of€the€Bylaws€andÏit€was€improper€and€error€for€the€Medical€Executive€CommitteeÏor€the€Ad€Hoc€Committee€to€assert€that€multiple€bilateralÏsimultaneous€procedures€performed€by€Plaintiff€were€improperÏwhen€the€hospital€had€no€policy€or€guidelines€with€respect€toÏsuch€multiple€simultaneous€procedures,€and€when€in€fact€suchÏmultiple€or€bilateral€procedures€routinely€were€performed€byÏother€surgeons€during€that€time€frame.ÌÌà0 àà à53.à àParkwest€violated€the€fairness€provisions€of€the€Fair€HearingÏPlan€and€the€due€process€requirements€of€HCQIA€and€the€spiritÏand€intent€of€providing€for€separations€of€functions€in€theÏhearing€process,€where€the€AHC,€the€MEC,€the€Hearing€PanelÏand€the€Parkwest€Board€of€Directors,€were€required€to€and€didÏutilize€one€representative€for€all€of€them.€€The€sameÏattorneys€served€as€spokesman,€representative€and€legalÏcounsel€for€all€of€these€committees€and€groups€in€addition€toÏserving€in€such€function€for€Parkwest€administration.€ÌÌà0 àà à54.à àThe€AHC€knew€that€the€normal€Quality€Assurance€process€hadÏnot€been€followed€with€regard€to€Plaintiff,€prior€to€the€peerÏreview€hearing.ÌÌà0 àà à55.à àParkwest€violated€the€medical€records€provisions€of€theÏBylaws€included€in€the€Rules€and€Regulations€at€Section€VI„8Ïand€the€spirit€and€intent€of€the€Fair€Hearing€Plan€byÏrequiring€Plaintiff€to€pay€25€cents€a€page€to€copy€and€haveÏlimited€access€to€the€medical€records€of€his€own€patients,Ïwhen€other€members€of€the€active€staff€had€free€access€toÏsuch€records.€€Plaintiff€was€refused€direct€access€to€theÏmedical€records€of€his€patients€and€could€only€see€theÏmedical€records€upon€prearrangement€through,€and€at€theÏoffice€of,€the€hospital's€attorney.ÌÌà0 àà à56.à àPrior€to€the€hearing,€the€hospital,€through€its€attorney,Ïadvised€Plaintiff€that€the€two€page€Ad€Hoc€Committee€reportÏwas€the€sole€source€of€the€charges€against€which€PlaintiffÏmust€defend.€€The€day€before€the€hearing,€Parkwest's€attorneyÏstated€again€in€Plaintiff's€presence€that€the€AHC€report€toÏbe€presented€the€next€day€was€two€pages€long.€€ParkwestÏdeliberately€mislead€Plaintiff€as€to€the€nature€of€theÏcharges€against€him.€€In€fact,€prior€to€the€hearing,€the€AdÏHoc€Committee€had€already€developed€a€19„page€summary€ofÏcharges€containing€numerous€new€charges€and€criticism,€andÏthese€new€charges€were€made€available€to€members€of€theÏHearing€Panel€prior€to€the€commencement€of€the€hearing€butÏwithout€providing€the€report€to€Plaintiff.€€Plaintiff€wasÏdenied€the€opportunity€to€review€charges€within€the€timeÏrequired€by€the€Fair€Hearing€Plan.€€Plaintiff€was€not€givenÏ30€days€nor€even€seven€days€prior€notice.€€Plaintiff€wasÏeffectively€denied€rights€granted€under€Section€2.1,€2.2,Ï3.4,€and€3.5€of€the€Fair€Hearing€Plan.ÌÌà0 àà à57.à àThe€new€charges€prepared€by€the€Ad€Hoc€Committee€were€neverÏapproved€or€authorized€by€the€MEC€and€the€use€of€theseÏadditional€charges€violated€the€corrective€action€provisionsÏof€the€Bylaws,€and€violated€the€Fair€Hearing€Plan€andÏviolated€the€other€process€provisions€of€HCQIA.ÌÌà0 àà à58.à àPrior€to€the€hearing€the€Hearing€Panel€was€provided€access€toÏevidence€to€be€presented€by€Parkwest€against€Plaintiff€andÏwas€given€an€opportunity€to€review€this€evidence€withoutÏPlaintiff's€knowledge€and€without€Plaintiff€being€granted€anÏopportunity€to€present€or€cross€examine€the€evidence€againstÏhim€in€violation€of€the€corrective€action€provisions€of€theÏBylaws€and€in€violation€of€the€Fair€Hearing€Plan.ÌÌà0 àà à59.à àDuring€the€peer€review€hearing,€the€Hearing€Panel€violatedÏthe€fairness€provisions€of€the€Fair€Hearing€Plan€when€itÏimproperly€refused€to€grant€Plaintiff€a€continuance€toÏprepare€proof€in€defense€of€the€23rd€chart€regarding€HelenÏParker€which€was€added€to€the€hearing€on€May€15,€1992,€on€theÏeve€of€the€commencement€of€the€hearing,€and€without€sevenÏdays'€notice€of€the€charges€as€required€by€the€Fair€HearingÏPlan€of€the€Bylaws.ÌÌà0 àà à60.à àThe€Hearing€Panel€violated€the€Fair€Hearing€Plan€of€theÏBylaws€and€violated€and€erred€in€making€findings€andÏconclusions€regarding€the€Helen€Parker,€the€23rd€chart,€sinceÏno€charges€and€no€description€of€claimed€deficienciesÍregarding€that€specific€case€were€made€prior€to€the€start€ofÏthe€hearing.€€The€notice€requirements€of€the€Bylaws€wasÏviolated€by€conducting€a€hearing€on€this€chart€without€sevenÏdays'€notice€as€required.ÌÌà0 àà à61.à àParkwest€violated€the€Fair€Hearing€Plan€of€the€Bylaws€and€theÏcorrective€action€provisions€of€the€Bylaws€in€allowing€the€AdÏHoc€Committee€to€make€new,€different€and€additional€chargesÏfrom€its€new€19„page€Case€Summary€report€which€was€neverÏgiven€to€Plaintiff€prior€to€the€hearing,€but€was€given€to€theÏhospital€and€to€the€Hearing€Panel€prior€to€the€hearing.ÌÌà0 àà à62.à àThe€Fair€Hearing€Plan€was€violated€by€terminating€Plaintiff'sÏprivileges€based€on€the€new€charges€contained€in€the€Ad€HocÏCommittee's€Case€Summary,€first€given€to€Plaintiff€on€theÏfirst€day€of€the€hearing.ÌÌà0 àà à63.à àArticle€II€of€the€Fair€Hearing€Plan€was€violated€by€failingÏto€give€notice€of€the€new€charges€in€the€AHC's€19„page€CaseÏSummary€report€at€least€seven€days€before€the€hearing.€ÏFailure€to€give€notice,€describing€the€nature€of€the€chargesÏ30€days€prior€to€the€hearing€violated€requirements€of€HCQIA.ÌÌà0 àà à64.à àArticle€3.5€of€the€Fair€Hearing€Plan€was€violated€by€refusingÏto€allow€Plaintiff€to€present€sworn€video€statements€from€hisÏpatients€and€other€witnesses.ÌÌà0 àà à65.à àThe€Fair€Hearing€Plan€was€violated€by€refusing€and€failing€toÏgive€Plaintiff€adequate€opportunity€to€read€or€review€the€19„page€AHC€Case€Summary€report€first€given€to€Plaintiff€at€theÏbeginning€of€the€hearing€or€to€allow€Plaintiff€anyÏopportunity€to€obtain€witnesses€and€proof€in€order€to€defendÏthe€new,€different€and€additional€charges€in€this€report.ÌÌà0 àà à66.à àThe€intra€hearing€use€of€medical€records€of€Medicaid€patientsÏwithout€their€prior€consent€was€a€violation€of€T.C.A.€ðð€10„7„504.ÌÌà0 àà à67.à àThe€Fair€Hearing€Plan€was€violated€by€not€advising€PlaintiffÏas€to€the€issues€or€charges€upon€which€information€was€soughtÏso€that€he€related€to€these€issues€or€charges.€€Rather€theÏHearing€Panel€just€sought€access€to€Plaintiff's€officeÏrecords€for€their€review€without€identifying€the€issueÏinvolved.€€Subsequent€to€the€hearing,€the€Hearing€Panel€firstÏidentified€issues€or€criticisms€allegedly€based€on€theirÏreview,€present€testimony€himself€from€his€office€records€orÏto€respond€directly€to€questions.ÌÌà0 àà à68.à àThe€fairness€provisions€of€the€Fair€Hearing€Plan€wereÏviolated€by€allowing€all€five€members€of€the€Ad€Hoc€CommitteeÏto€remain€in€the€hearing€room€at€the€same€table€toÏcollaborate€as€a€committee€of€five€against€Plaintiff€whenÏArticle€3.3€of€the€Fair€Hearing€Plan€only€allowed€the€MEC€toÏhave€one€individual€to€present€the€facts€in€support€of€theÏadverse€recommendation.ÌÌà0 àà à69.à àThe€fairness€provisions€of€the€Fair€Hearing€Plan€and€theÏcorrective€action€provisions€of€the€Bylaws€were€violated€byÏthe€Hearing€Panel€becoming€an€investigative€body€whichÏinitiated€new€charges€against€Plaintiff€which€had€not€beenÏpresented€to€the€MEC€nor,€in€some€instances,€discussed€orÏidentified€even€in€the€hearing.ÌÌà0 àà à70.à àThe€fairness€provisions€of€the€Fair€Hearing€Plan€wereÏviolated€by€allowing€members€of€the€Hearing€Panel€to€becomeÏwitnesses€who€testified€into€the€record€from€Dr.€Eyring'sÏrecords,€as€to€results€of€their€own€intra„hearingÏinvestigation.€€The€Hearing€Panel€members€did€not€submitÏthemselves€to€cross€examination.€€They€were€not€sworn€asÏwitnesses,€nor€were€they€called€to€give€proof.€€This€action,Ïand€the€further€action€of€members€o€[sic]€the€Hearing€PanelÏbeing€witnesses€as€to€findings€or€matters€first€identified€inÏtheir€report€subsequent€to€close€of€the€hearing,€deniedÏPlaintiff€rights€granted€under€Section€3.4€of€the€FairÏHearing€Plan.ÌÌà0 àà à71.à àThe€fairness€provisions€of€the€Fair€Hearing€Plan€and€theÏcorrective€action€provisions€of€the€Bylaws€were€violated€byÏmaking€findings€of€fact€and€conclusions€on€new€charges€whichÏwere€first€identified€solely€by€the€Hearing€Panel,€eitherÏduring€the€hearing€or€after€the€hearing€for€which€no€priorÏnotice€whatsoever€was€given€to€Plaintiff.€€This€violatedÏSections€3.4€and€3.5€of€the€Fair€Hearing€Plan€and€was€inÏderogation€of€their€function€under€3.7€of€the€Fair€HearingÏPlan.ÌÌà0 àà à72.à àThe€hospital€violated€the€HCQIA€by€refusing€to€identify€itsÏorthopedic€expert€witness€until€the€date€of€the€hearing.ÌÌà0 àà à73.à àThe€Hearing€Panel€violated€the€HCQIA€by€allowing€Dr.€Hornsby,Ïits€paid€orthopedic€expert€to€testify€as€an€expert€witness€onÏbehalf€of€the€MEC€in€violation€of€the€requirement€of€federalÏlaw€that€a€list€of€all€witnesses€to€testify€at€the€hearingÏmust€be€given€to€the€physician€30€days€before€the€hearing.ÌÌà0 àà à74.à àThe€Hearing€Panel€violated€the€HCQIA€by€allowing€any€membersÏof€the€Ad€Hoc€Committee€to€testify,€because€Plaintiff€was€notÏgiven€30€days'€notice€prior€to€the€hearing,€as€required€byÏHCQIA,€that€the€AHC€members€would€testify.ÌÌà0 àà à75.à àAfter€the€close€of€the€hearing€and€before€the€decision€of€theÏHearing€Panel,€the€Plaintiff€was€required€by€HCQIA€to€beÏnotified€of€his€right€to€submit€a€written€statement€to€theÏPanel.€€Plaintiff€was€not€advised€of€this€right€by€theÏHearing€Panel.€€This€right€was€violated.ÌÌà0 àà à76.à àThe€hearing€was€declared€adjourned€on€May€17,€1992,€and€theÏdecision€of€the€Hearing€Panel€dated€June€12,€1992,€was€notÏmade€within€14€days€as€required€by€Article€4.1€of€the€FairÏHearing€Plan.ÌÌà0 àà à77.à àThe€decision€of€the€Hearing€Panel€was€not€forwarded€to€theÏMedical€Executive€Committee€with€all€of€the€documentationÏconsidered€by€it€from€the€office€[of]€medical€records€ofÏPlaintiff€in€violation€of€Article€4.1€of€the€Fair€HearingÏPlan.ÌÌà0 àà à78.à àThe€Hearing€Panel€gave€no€notice€to€Plaintiff€that€it€wasÏconsidering€new€charges€or€issues€after€the€time€of€theÏadjournment€of€the€hearing,€which€charges€or€issues€wereÏnever€identified€either€prior€to€or€during€the€hearing€inÏviolation€of€Article€II€and€Article€3.11,€of€the€Fair€HearingÏPlan,€and€in€violation€of€the€Bylaws.ÌÌà0 àà à79.à àAfter€adjournment€of€the€hearing,€the€Hearing€Panel€continuedÏto€conduct€an€independent€investigation€identifying€newÏallegations€and€charges.€€These€new€and€different€allegationsÏwere€not€previously€made€to€the€MEC€in€January,€1992,€notÏmade€before€or€at€the€time€of€the€May€1992€hearing.ÌÌà0 àà à80.à àBy€identifying€new€charges€after€the€hearing€had€adjourned,ÏPlaintiff€was€denied€the€opportunity€to€present€any€oral€orÏwritten€evidence€upon€these€new€charges,€in€violation€of€theÏParkwest€Bylaws€and€Fair€Hearing€Plan.€€This€same€actionÏviolates€provisions€of€HCQIA.ÌÌà0 àà à81.à àThe€hospital,€acting€through€its€attorney,€notified€PlaintiffÏthat€attorneys€were€prohibited€from€being€allowed€in€anyÏmanner€to€participate€in€the€hearing€while€it€was€inÏprogress.€€Contrary€to€the€admonition€and€instructionsÏcontained€in€the€letter€of€Parkwest's€attorney€dated€May€14,Í1992,€to€the€hearing€officer,€ex€parte€contact€between€theÏhospital's€representative€and€Hearing€Panel€members€tookÏplace.€€In€the€letter€referred€to,€the€hospital'sÏrepresentative€said€that,€during€deliberation€orÏadjournments,€no€member€of€the€Hearing€Panel€should€have€exÏparte€contact€with€representatives€of€the€parties,€and€thatÏthe€parties€should€have€no€contact€with€the€Hearing€PanelÏconcerning€any€matters€at€issue.€€Ex€parte€contact€and€aÏmeeting€of€the€hospital's€representative€with€the€HearingÏPanel€occurred€before€the€hearing€took€place.€€There€were€atÏleast€two€instances€of€ex€parte€contact€with€the€HearingÏPanel€by€the€hospital's€representative€after€the€hearing€andÏbefore€the€Hearing€Panel's€decision.ÌÌà0 àà à82.à àOn€June€3,€1992,€as€a€consequence€of€a€letter€of€June€2,Ï1992,€from€the€hospital's€representative€to€the€Hearing€PanelÏChairman,€Plaintiff's€attorneys€wrote€to€the€hospital'sÏattorney€requesting€that€Parkwest€cease€from€communicatingÏand€advising€the€Hearing€Panel€to€refrain€from€any€other€typeÏof€advice€or€contact.€€By€letter€of€May€13,€1992,€Plaintiff'sÏattorneys€had€objected€to€an€ex€parte€contact€by€theÏhospital's€attorney„representative€with€Hearing€PanelÏmembers.€€Plaintiff€objected€to€the€hospital's€counselÏundertaking€to€assist€the€Hearing€Panel€or€having€contactÏwith€its€members.€€Despite€this,€ex€parte€contact€occurred.ÌÌà0 àà à83.à àOn€June€3,€1992,€the€hospital's€attorney„representative€sentÏto€the€Hearing€Panel€a€copy€of€an€inflammatory€and€self„serving€letter€addressed€to€Plaintiff's€attorneys,€which€wasÏhighly€prejudicial€to€Plaintiff's€interest.€€This€again€wasÏex€parte€contact.€€On€June€4,€1992€Plaintiff's€attorneysÏagain€wrote€to€the€hospital's€attorney,€(with€no€copy€to€theÏHearing€Panel),€requesting€that€he€cease€communications€withÏthe€Hearing€Panel€and€discontinue€attempts€which€might€wellÏinfluence€or€prejudice€their€decision.€€The€continuedÏcommunications€by€the€hospital's€designated€representativeÏwith€the€Hearing€Panel€were€very€prejudicial€to€Plaintiff€andÏwere€improper€and€in€violation€of€the€hospital's€ruling€toÏnot€allow€attorneys€to€participate€in€the€process,€and€inÏviolation€of€the€ruling€of€the€Presiding€Officer€thatÏattorneys€could€not€participate€in€the€process€hearing.ÌÌà0 àà à84.à àThe€Parkwest€Board€wrongfully€denied€Plaintiff,€and/or€hisÏattorney€an€opportunity€to€appear€before€the€Parkwest€BoardÏof€Directors.€€As€previously€discussed,€the€hospital'sÏrepresentative€engaged€in€ex€parte€contact€with€the€BoardÏduring€the€period€of€their€consideration€of€the€case.ÌÌà0 àà à85.à àThe€MEC€and€the€Parkwest€Board€of€Directors,€after€the€peerÏreview€hearing,€were€precluded€from€adopting€theÏrecommendations€of€the€Hearing€Panel€because€the€earlierÏrescission€of€the€termination€of€Plaintiff's€medical€staffÏmembership€and€privileges€represented€biased€action€on€thisÏrecommendation;€no€new€peer€review€action€could€occur€withoutÏthe€initiation€of€a€proper€request€for€corrective€action,€andÏsetting€forth€the€basis€for€recommended€action.€€The€JulyÏ1992€termination€of€Plaintiff's€medical€staff€privilegesÏviolated€the€corrective€action€and€reappointment€provisionsÏof€the€Bylaws.ÌÌà0 àà à86.à àThe€Board€of€Directors€did€not€act€on€any€properly€conductedÏrequest€for€corrective€action€but€adopted€the€unanimous€viewÏof€the€MEC€regarding€an€unauthorized€focused€review€inÏviolation€of€the€Bylaws.ÌÌà0 àà à87.à àIn€addition€to€violations€of€the€Bylaws€and€Fair€HearingÏPlan,€actions€of€Parkwest€violate€provisions€of€the€HealthÏCare€Quality€Improvement€Act€(HCQIA).€€The€AHC€as€aÏrepresentative€of€Parkwest€seeking€adverse€action€providedÏinformation€as€to€his€treatment€and€care€which€was€false€andÏknown€by€them€to€be€false.ÌÌà0 àà à88.à àThe€action€taken€in€this€case€was€not€taken€in€the€reasonableÏbelief€that€it€was€in€furtherance€of€quality€health€care,€norÏwas€it€taken€after€reasonable€effort€to€obtain€the€facts€ofÏthe€matter.€€There€was€no€showing€of€any€prior€counseling€asÏto€suggested€problems€in€Plaintiff's€practice;€his€history€atÏParkwest€revealed€that€all€prior€reviews€of€his€practiceÏconcluded€that€there€were€no€problems€with€his€patientÏtreatment€or€care.€€There€was€certainly€no€reasonable€effortÏto€obtain€the€facts€of€the€matter€when€charges,€criticisms€orÏissues€are€deliberately€and€actively€kept€from€him€so€as€toÏpreclude€his€opportunity€to€discuss€or€meaningfully€prepareÏand€present€evidence.ÌÌà0 àà à89.à àPlaintiff€was€not€given€adequate€notice€as€described€byÏHCQIA.€€He€was€not€given€notice€at€all€of€the€January€24,Ï1992€action;€thereafter€he€was€given€a€notice€as€set€out€inÏhis€affidavit.€€The€notice€to€be€given€under€HCQIA€was€toÏtell€him€of€proposed€action€and€the€reasons€for€the€proposedÏaction.€€This€was€violated€„„€HCQIA€granted€him€30€daysÏwithin€which€to€request€a€hearing€instead€of€the€14€days€setÏby€Parkwest's€Bylaws.€€The€Act€provides€that€a€requestedÏhearing€shall€not€be€less€than€30€days€after€the€date€ofÍnotice€and€that€notice€is€to€include€a€list€of€the€witnessesÏexpected€to€testify€on€behalf€of€the€review€body.€€This€wasÏviolated.€€Despite€Plaintiff's€request,€the€hospital€did€notÏprovide€such€information.€€The€hospital€did€advise€just€priorÏto€the€hearing€that€Dr.€Burns,€and€perhaps€others€of€the€AHCÏwould€testify.€€While€stating€on€May€15,€1992€that€theÏhospital€might€use€an€orthopedic€surgeon,€it€refused€toÏidentify€that€individual.ÌÌà0 àà à90.à àThe€requested€hearing€was€not€held€before€a€mutuallyÏacceptable€arbitrator,€or€a€hearing€officer€not€inÏcompetition€with€Plaintiff,€or€a€panel€of€individuals€not€inÏcompetition€with€him.€€The€make„up€of€the€hearing€panelÏtherefore€violated€the€provision€of€HCQIA.ÌÌà0 àà à91.à àUnder€HCQIA,€he€had€the€right€to€representation€by€anÏattorney€in€the€hearing.€€He€was€denied€that€right.€€HisÏright€to€call,€examine€and€cross„examine€witnesses€wasÏeffectively€precluded€by€the€active€and€deliberateÏwithholding€of€information€as€to€the€criticisms€to€beÏpresented.€€ÌÌà0 àà à92.à àThe€Bylaws€required€that€his€reappointment€was€to€beÏdetermined€on€the€basis€of€evaluation€of€his€professionalÏcompetence.€€The€hospital€was€to€collect€and€obtainÏinformation€deemed€pertinent€regarding€his€professionalÏactivities€and€conduct€in€the€hospital.€€Under€the€Bylaws,Ïthe€Chairman€was€to€review€the€information€and€make€aÏrecommendation€as€to€renewal€of€his€appointment€andÏprivileges.€€The€Credentials€and€Privileges€Committee€was€toÏreview€his€qualifications€and€òòall€other€pertinent€informationóóÏand€make€a€recommendation€as€to€renewal€of€his€appointmentÏand€privileges.€€The€MEC€also€was€to€review€òòall€otherÏrelevant€informationóó€and€make€its€recommendation.€€All€ofÏthese€committees€and€individuals€did€as€they€were€requiredÏwith€the€result€that€he€was€reappointed€routinely€for€years,Ïand€his€last€reappointment€was€in€July€1991.€€The€Bylaws€sayÏas€to€each€recommendation€described€above€that€it€".€.€.Ïshall€be€based€upon€such€appointee's€professionalÏperformance,€ability€and€clinical€judgment€in€the€treatmentÏof€patients,€his€or€her€discharges€of€staff€obligations,€hisÏor€her€compliance€with€staff€Bylaws,€rules€and€regulations,Ïhis€or€her€cooperation€with€other€staff€members€and€withÏpatients,€and€other€matters€bearing€out€his€or€her€abilityÏand€willingness€to€contribute€to€the€quality€of€patient€careÏpractices€in€the€hospital€that€are€optimally€achievable."€ÏBased€upon€that€standard,€he€was€reappointed€in€July,€1991.€ÍAll€of€the€patient€cases€complained€of€in€the€subsequentÏreview€had€occurred€prior€to€July,€1991.€€On€the€basis€ofÏquality€of€patient€care€he€was€determined€to€be€in€conformityÏwith€the€required€standard€of€care€and€treatment€at€Parkwest.€ÏThe€subsequent€peer€review€and€revocation€of€his€privilegesÏconflicted€and€was€inconsistent€with€the€review€of€hisÏqualifications€during€reappointment€to€the€medical€staff.ÌÌà0 àà à93.à àAs€to€all€these€patient€cases€involved€in€the€1991€peerÏreview,€Parkwest€violated€the€spirit€and€intent€of€the€FairÏHearing€Plan€by€claiming€that€he€deviated,€in€some€fashion,Ïfrom€established€procedures€when€there€was€no€policy€orÏprocedure€in€place€anywhere€his€privileges€had€been€renewedÏbased€upon€his€compliance€with€hospital€rules€and€regulationsÏand€his€professional€performance,€ability€and€clinicalÏjudgment.ÌÌà0 àà à94.à àThe€Quality€Assurance€review€processes€had€determined€thatÏeach€case€of€the€22€patients€reviewed€was€appropriate€withÏone€exception.€€Parkwest€violated€the€spirit€and€intent€ofÏthe€Fair€Hearing€Plan€by€subjecting€his€patient€care€toÏrepetitious€review€after€findings€demonstrating€appropriateÏcare.ÌÌÇÑ  ÑÑ7€Ý÷XXdÈXXdÈ7Ñà@ àIN€THE€COURT€OF€APPEALSÌÌÌÌÌÌÌÌEDWARD€J.€EYRING,€M.D.,€€€€€€€€€)à àKNOX€CIRCUITÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)à àC.A.€NO.€03A01„9607„CV„00240Ì€€€€€€€€€€Plaintiff„Appellant€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ìvs.€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)à àHON.€WHEELER€A€ROSENBALMÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)à àJUDGEÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)ÌFORT€SANDERS€PARKWEST€MEDICAL€€€)à àAFFIRMED€AND€REMANDEDÌCENTER,€INC.,€and€FORT€SANDERS€€)ÌALLIANCE,€INC.,€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€)Ì€€€€€€€€€€Defendants„Appellees€€)ÌÌÌ€Ìà@ àò òJUDGMENTó óÌÌÌÓÆãÓà àThis€appeal€came€on€to€be€heard€upon€the€record€from€theÏCircuit€Court€of€Knox€County,€briefs€and€argument€of€counsel.€ÏUpon€consideration€thereof,€this€Court€is€of€the€opinion€thatÏthere€was€no€reversible€error€in€the€trial€court.ÌÌà àThe€judgment€of€the€trial€court€is€affirmed€in€all€respects.€ÏCosts€of€appeal€are€taxed€to€the€plaintiff/appellant.ÌÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€PER€CURIAMÌÓ$ÜÓÓ  ÓÔ€,XÔ