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ÝÔ_Ô€€This€patient€made€a€claim€over€the€treatment€he€received€to€the€wrong€kidney.€€This€claim€was€settled€out€ofÐ ° Ðcourt€with€Dr.€Peytonððs€malpractice€insurance€carrier€paying€$300,000€and€the€Hospital€paying€$150,000. !Ý ƒRû¸$ÝÓ  Óà  àòòÚ  Ú3Ú  ÚóóÔ€ô¤}ò»»ÔÝ  ÝÔ_Ô€At€the€beginning€of€the€hearing,€Dr.€Wilson€announced€that€Dr.€Ô_ÔPeytonÔ_Ô€had€treated€his€father€and€he€(i.e.,€Dr.Ð ° ÐWilson)€was€very€impressed€with€the€treatment€his€father€had€received.€€He€then€informed€counsel€he€may€be€biased€inÐ tÄ ÐDr.€Ô_ÔPeytonÔ_Ôððs€favor.€€Dr.€Wilson€was,€nevertheless,€allowed€to€remain€on€the€Panel.€ d LÝ ƒRû¸$ÝÓ  Óà  àòòÚ  Ú4Ú  ÚóóÔ€ô¤}ò»»ÔÝ  ÝÔ_Ô€€The€Hospital€also€proffered€testimony€from€other€health€care€providers€employed€by€the€Hospital.€€ThisÐ ° Ðtestimony€was€essentially€consistent€with€the€testimony€of€Harrell€and€Lamberson.(|3¿j$££Ý ƒ£ª!ÝÑ€.ÑÑ8€…»»dd8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó ^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3¿j$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€…»»dd8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKK cÝ ƒRû¸$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ô¤}ò»»ÔÝ  ÝÔ_Ô€€This€case€involves€a€partial€summary€judgment€made€appealable€under€Tenn.€R.€Civ.€P.€54.02.€€The€relevantÐ ° Ðportions€of€the€Act€provide€for€immunity€from€monetary€damages€but€do€not€prohibit€other€actions,€such€as€a€claim€forÐ tÄ Ðinjunctive€relief.€€Dr.€Peytonððs€request€for€injunctive€relief€arising€from€his€loss€of€hospital€privileges€has€not€been€ruledÐ 8ˆ Ðupon€by€the€Trial€Court.€€It€is€important€to€note€the€only€issues€on€appeal€involve€the€granting€of€partial€summaryÐ üL Ðjudgment.€€We€express€no€opinion€whatsoever€on€any€other€issues€yet€to€be€decided€by€the€Trial€Court,€such€as€whetherÐ À Ðor€not€Dr.€Peyton€is€entitled€to€injunctive€relief.Ý ƒ£ª!ÝÑ€.ÑÑ8€…»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÔ€¼…»»»ÔÑ8€WYXXdì»»d8ÑÑ  Ñà@ü ü ìàÔ‡îD…ÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@WW$ìàAT€KNOXVILLEÔ#†¼…»îîD #ԈРÖ& ÐÓ  ÓAugust€22,€2002€SessionÐ üL ÐÔ‡XWYX»¼…ÔÌò òÔ#†¼…»XXWYô#ÔRICHARD€R.€Ô_ÔPEYTONÔ_Ô,€M.D.€v.€JOHNSON€CITY€MEDICAL€CENTERÔ‡XWYX»¼…Ôó óÐ úJ ÐÌà@@½½ìàò òÔ#†¼…»XXWY#ÔÔ€XWYX»¼…ÔAppeal€from€the€Circuit€Court€for€Washington€CountyÐ ú J Ðà@@øøìàNo.€17248€€€€€€John€S.€Ô_ÔMcLellanÔ_Ô,€III,€Ô_ÔJudgeÐ æ 6 ÐFILED€OCTOBER€29,€Ô_Ô2002Ô_ÔÐ Ò " Ðà@@ìì*ìàßA€V) °°` dýFE<½ ` AßÐ ¾   ÐÌà@@TTìàNo.€E2001„02477„Ô_ÔCOAÔ_Ô„R3„CVÐ ¹  ÐÌßA€V) °°` dE<` AßÐ ‘á  Ðó óÓ  ÓÌIn€April€of€1994,€Johnson€City€Medical€Center€(the€ð ðHospitalðð)€summarily€suspended€the€hospitalÐ ŒÜ  Ðprivileges€of€Dr.€Richard€R.€Ô_ÔPeytonÔ_Ô€(ð ðDr.€Ô_ÔPeytonÔ_Ôðð).€€Dr.€Ô_ÔPeytonÔ_Ô€was€told€the€reason€for€this€actionÐ xÈ  Ðand€about€his€right€to€request€a€hearing.€€Dr.€Ô_ÔPeytonÔ_Ô€requested€a€hearing,€which€took€place€over€threeÐ d´ Ðdays€and€in€which€18€witnesses€testified.€€After€the€hearing,€the€decision€to€revoke€Dr.€Ô_ÔPeytonÔ_ÔððsÐ P  Ðhospital€privileges€was€upheld€by€the€hearing€panel.€€Dr.€Ô_ÔPeytonÔ_Ô€appealed€this€decision,€all€to€noÐ <Œ Ðavail,€through€the€Hospitalððs€internal€appeal€procedures.€€Dr.€Ô_ÔPeytonÔ_Ô€then€filed€suit€claiming€hisÐ (x Ðhospital€privileges€were€improperly€revoked€and€sought€injunctive€relief€and€monetary€damages€inÐ d Ðthe€amount€of€ten€million€dollars.€€The€Trial€Court€granted€the€Hospitalððs€motion€for€partial€summaryÐ P Ðjudgment€pursuant€to€the€federal€Health€Care€Quality€Improvement€Act€of€1986,€42€U.S.C.€ðð€11101,Ð ì< Ðòòet€seq.óó€€This€decision€effectively€prevented€Dr.€Ô_ÔPeytonÔ_Ô€from€receiving€any€monetary€damages.€€Dr.Ð Ø( ÐÔ_ÔPeytonÔ_Ô€appeals€the€granting€of€partial€summary€judgment.€€We€affirm.Ð Ä Ðò òÌà@µ µ ìàTenn.€R.€App.€P.€3€Appeal€as€of€Right;€Judgment€of€theˆÐ œì Ðà@û û ìàCircuit€Court€Affirmed;€Case€Remanded.ˆÐ ˆØ Ðó óòòÌD.€Michael€Ô_ÔSwineyÔ_Ô,€J.,€óódelivered€the€opinion€of€the€court,€in€which€òòHouston€M.€Ô_ÔGoddardÔ_Ô,€Ô_ÔP.J.Ô_Ô,óóÐ `° Ðand€òòHerschel€P.€Franks,€J.óó,€joined.Ð L œ ÐÌHowell€H.€Ô_ÔSherrodÔ_Ô,€Johnson€City,€Tennessee,€for€the€Appellant€Richard€R.€Ô_ÔPeytonÔ_Ô,€M.D.Ð $"t! ÐÌRonald€T.€Hill,€Knoxville,€Tennessee,€for€the€Appellee€Johnson€City€Medical€Center.Ð ü#L# ÐÌWilliam€B.€Ô_ÔHubbardÔ_Ô,€Robyn€E.€Smith,€William€L.€Penny,€Nashville,€Tennessee,€for€Amici€CuriaeÐ Ô%$!% ÐTennessee€Hospital€Association€and€Hospital€Alliance€of€Tennessee.Ð À&"& ÐÌAndrew€Ô_ÔYarnellÔ_Ô€Ô_ÔBeattyÔ_Ô,€Nashville,€Tennessee,€for€Amici€Curiae,€Tennessee€Medical€Association€andÐ ˜(è#( ÐAmerican€College€of€Radiology.Ð „)Ô$) ÐÌThomas€C.€Ô_ÔJesseeÔ_Ô,€Johnson€City,€Tennessee,€Andrew€L.€Ô_ÔSchlaflyÔ_Ô,€Far€Hills,€New€Jersey,€for€AmicusÐ \+¬&+ ÐCuriae€The€Association€of€American€Physicians€and€Surgeons.Ð H,˜', ÐÐ 4-„(-ýà ЇÓÓà@66'ìàò òOPINIONó óˆÐ ° ÐÓÓÌà  àà ` àThis€lawsuit€arises€out€of€the€Hospitalððs€permanent€revocation€of€Dr.€Ô_ÔPeytonÔ_ÔððsÐ tÄ Ðprivileges€to€practice€medicine€at€the€Hospital.€€€The€issues€on€appeal€surround€the€Trial€CourtððsÐ `° Ðgranting€of€partial€summary€judgment€to€the€Hospital€after€concluding€the€Hospital€was€immuneÐ L œ Ðfrom€monetary€damages€pursuant€to€the€federal€Health€Care€Quality€Improvement€Act€of€1986Ð 8 ˆ Ð(ð ðActðð),€42€U.S.C.€ðð€11101,€òòet€seq.óó׃b×Ý ƒQ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€This€Act€was€passed€in€an€attempt€to€address€severalÐ $ t ÐCongressional€findings€which€were:Ð  ` ÐÌà8  àà8` Ð Ð à(1)€€The€increasing€occurrence€of€medical€malpractice€and€the€needÐ è 8  Ðto€improve€the€quality€of€medical€care€have€become€nationwideÐ Ô$  Ðproblems€that€warrant€greater€efforts€than€those€that€can€beÐ À  Ðundertaken€by€any€individual€State.€Ð¬ü ` x` x ÐÌà8  àà8` Ð Ð à(2)€€There€is€a€national€need€to€restrict€the€ability€of€incompetentÐ „Ô  Ðphysicians€to€move€from€State€to€State€without€disclosure€orÐ pÀ Ðdiscovery€of€the€physician's€previous€damaging€or€incompetentÐ \¬ Ðperformance.ÐH˜` x` x ÐÌà8  àà8` Ð Ð à(3)€€This€nationwide€problem€can€be€remedied€through€effectiveÐ  p Ðprofessional€peer€review.€Ð \` x` x ÐÌà8  àà8` Ð Ð à(4)€€The€threat€of€private€money€damage€liability€under€Federal€laws,Ð ä4 Ðincluding€treble€damage€liability€under€Federal€antitrust€law,Ð Ð  Ðunreasonably€discourages€physicians€from€participating€in€effectiveÐ ¼  Ðprofessional€peer€review.€Ð¨ø` x` x ÐÌà8  àà8` Ð Ð à(5)€€There€is€an€overriding€national€need€to€provide€incentive€andÐ €Ð Ðprotection€for€physicians€engaging€in€effective€professional€peerÐ l¼ Ðreview.€ÐX ¨` x` x ÐÌ42€U.S.C.€ðð€11101.€Ð 0"€  ÐÌà  àà ` àThe€Act€creates€a€limitation€on€monetary€damages€for€professional€review€actions.€Ð $X" ÐAs€a€general€rule,€if€a€ð ðprofessional€review€actionðð€of€a€ð ðprofessional€review€bodyðð€meets€theÐ ô$D # Ðstandards€specified€in€42€U.S.C.€ðð€11112(a),€then€there€shall€be€no€monetary€liability€ð ðunder€any€lawÐ à%0!$ Ðof€the€United€States€or€of€any€State€(or€political€subdivision€thereof)€with€respect€to€theðð€professionalÐ ° Ðreview€action.׃P×Ý ƒQ#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×€€42€U.S.C.€ðð€11111(a)(1).€€This€immunity€from€monetary€liability€extends€to:€€€(a)Ð œì Ðthe€professional€review€body;€(b)€any€person€acting€as€a€member€or€staff€to€the€body;€(c)€any€personÐ ˆØ Ðunder€a€contract€or€other€formal€agreement€with€the€body;€and€(d)€any€person€who€participates€withÐ tÄ Ðor€assists€the€body€with€respect€to€the€action.€€42€U.S.C.€ðð€11111(a)(1)(A)€„€(D).€€To€be€immune€fromÐ `° Ðmonetary€liability,€a€professional€review€action€must€be€taken:€Ð L œ ÐÌà8  àà8` Ð Ð à(1)€€in€the€reasonable€belief€that€the€action€was€in€the€furtherance€ofÐ $ t Ðquality€health€care;Ð `` x` x ÐÌà8  àà8` Ð Ð à(2)€€after€a€reasonable€effort€to€obtain€the€facts€of€the€matter;Ðè 8 ` x` x ÐÌà8  àà8` Ð Ð à(3)€€after€adequate€notice€and€hearing€procedures€are€afforded€to€theÐ À  Ðphysician€involved€or€after€such€other€procedures€as€are€fair€to€theÐ ¬ü  Ðphysician€under€the€circumstances;€and€Ð˜è ` x` x ÐÌà8  àà8` Ð Ð à(4)€€in€the€reasonable€belief€that€the€action€was€warranted€by€the€factsÐ pÀ Ðknown€after€such€reasonable€effort€to€obtain€facts€and€after€meetingÐ \¬ Ðthe€requirement€of€paragraph€(3).€.€.€.€ÐH˜` x` x ÐÌ42€U.S.C.€ðð€11112(a).€€The€statute€further€provides€that€a€professional€review€action€shall€beÐ  p Ðð ðpresumedðð€to€have€met€the€preceding€standards€necessary€for€the€protection€set€out€in€42€U.S.C.€ððÐ  \ Ð11111(a),€unless€this€presumption€is€rebutted€by€a€preponderance€of€the€evidence.€€òòIdóó.€€Ð øH ÐÌà  àà ` àDr.€Ô_ÔPeytonÔ_Ô€first€learned€the€Hospital€had€suspended€his€medical€privileges€on€AprilÐ Ð  Ð29,€1994,€when€he€received€a€letter€informing€him€the€Hospitalððs€Executive€Committee€had€movedÐ ¼  Ðto€suspend€his€medical€privileges€immediately€for€disregarding€radiation€safety€procedures€andÐ ¨ø Ðpolicies,€providing€substandard€quality€of€care,€and€engaging€in€disruptive€behavior.€€Dr.€Ô_ÔPeytonÔ_Ô€wasÐ ”ä Ðinformed€that€before€this€action€became€final,€he€was€entitled€to€request€a€hearing€and€the€procedureÐ €Ð Ðfor€doing€so€was€detailed€in€the€letter.€€Dr.€Ô_ÔPeytonÔ_Ô€also€was€notified€of€his€rights€at€such€a€hearing,Ð l¼ Ðincluding,€òòinter€aliaóó,€his€right€to€counsel,€to€have€a€record€made€of€the€proceedings,€to€examine€andÐ X ¨ Ðcross„examine€witnesses,€and€to€present€relevant€evidence€regardless€of€its€admissibility€in€a€courtÐ D!” Ðof€law,€etc.€Ð 0"€  ÐÌà  àà ` àDr.€Ô_ÔPeytonÔ_Ô€requested€a€hearing,€which€took€place€on€June€15òòthóó€through€17òòthóó€of€1994.€Ð $X" Ðâ âThe€members€of€the€Fair€Hearing€Panel€were€Dr.€Boyce€Berry,€Dr.€Brent€Coyle,€Dr.€Don€Clemons,€Ð ô$D # ÐDr.€John€Wilson׃U×Ý ƒQ#ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×,€Dr.€Ricky€Mohon,€Mr.€Joe€Johns,€Mr.€Don€Jeanes,€and€Ms.€Marion€McKinney.€Ð ° ÐThe€Hospital€and€Dr.€Peyton€each€had€two€attorneys€present.Ð œì Ðâ âÌà  àà ` àThe€first€witness€was€Sandra€Elliott€(ð ðElliottðð),€the€Hospitalððs€Director€of€QualityÐ tÄ ÐImprovement€and€Resource€Management.€€Elliott€testified€to€five€incidents€of€noncompliance€withÐ `° ÐState€regulations€by€Dr.€Ô_ÔPeytonÔ_Ô€which€were€reported€to€the€State€by€the€Hospital€or€the€HospitalððsÐ L œ ÐCancer€Treatment€Center.€€Elliott€testified€Dr.€Ô_ÔPeytonÔ_Ô€in€one€of€these€incidents€was€the€chief€treatingÐ 8 ˆ Ðphysician€but€the€patient€received€follow„up€care€from€another€physician.€€In€the€other€four€cases,Ð $ t ÐDr.€Ô_ÔPeytonÔ_Ô€was€the€chief€treating€physician.€€Elliott€then€testified€to€the€various€incidents€which€hadÐ  ` Ðbeen€reported€to€the€State.€The€first€incident€involved€a€patient€of€Dr.€Peyton€with€kidney€cancer.€Ð ü L  ÐDr.€Ô_ÔPeytonÔ_Ô€administered€30€radiation€treatments€over€a€six€week€period€to€the€patientððs€left€kidney.€Ð è 8  ÐThe€cancer,€however,€involved€the€right€kidney.€€The€next€two€cases€concerned€patients€whoÐ Ô$  Ðreceived€Ô_ÔbrachytherapyÔ_Ô€treatment,€which€is€the€introduction€of€a€radioactive€source€into€the€body€toÐ À  Ðemanate€radiation€close€to€a€tumor.€€In€these€two€cases,€in€which€Dr.€Ô_ÔPeytonÔ_Ô€was€the€chief€treatingÐ ¬ü  Ðphysician,€the€radioactive€source€was€not€placed€in€the€appropriate€location,€resulting€in€the€twoÐ ˜è  Ðpatients€being€overexposed€to€radiation.€€The€fourth€incident€was€the€one€where€Dr.€Peyton€was€theÐ „Ô  Ðchief€treating€physician€but€really€concerned€another€doctor€who€administered€an€electron€ð ðrevÐ pÀ Ðboostðð€to€a€breast€cancer€patient.€€The€dosage€apparently€was€too€large€and€resulted€in€damage€to€theÐ \¬ Ðpatientððs€lung.€€The€fifth€incident€involved€Dr.€Ô_ÔPeytonÔ_Ô€improperly€securing€radioactive€materialsÐ H˜ Ðwhich€had€been€removed€from€a€patient,€which€the€Hospital€claims€resulted€in€the€patient€and€severalÐ 4„ Ðfamily€members€being€exposed€for€approximately€one€hour€to€a€radiation€level€high€enough€toÐ  p Ðrequire€the€incident€to€be€reported€to€the€State.€€This€incident€resulted€in€the€State€issuing€a€NoticeÐ  \ Ðof€Noncompliance€to€the€Hospital.€€Elliott€testified€the€summary€suspension€of€Dr.€Ô_ÔPeytonÔ_ÔððsÐ øH Ðprivileges,€in€her€opinion,€was€reasonable€and€necessary€in€order€to€reduce€the€substantial€likelihoodÐ ä4 Ðof€immediate€injury€or€damage€to€the€health€and€safety€of€patients.Ð Ð  Ðà  àà ` àà ¸ àà  àà h àà À àà  àà p àà È àà  àÌà  àà ` àMr.€William€Ô_ÔRougheadÔ_Ô€(ð ðÔ_ÔRougheadÔ_Ôðð)€also€testified.€€Ô_ÔRougheadÔ_Ô€is€a€medical€physicistÐ ¨ø Ðat€the€Hospital€and€earned€a€Masterððs€Degree€in€physics€in€1983.€€Ô_ÔRougheadÔ_Ô€testified€to€instancesÐ ”ä Ðinvolving€Ô_ÔmisadministrationÔ_Ô€of€radiation€which€he€attributed€to€Dr.€Ô_ÔPeytonÔ_Ô€and€involve€some€of€theÐ €Ð Ðsame€incidents€described€by€Elliott,€although€the€specifics€of€the€misadministration€were€testifiedÐ l¼ Ðto€in€much€more€detail€by€Ô_ÔRougheadÔ_Ô.€Ð X ¨ ÐÌà  àà ` àMs.€Diana€Ô_ÔHarrellÔ_Ô€(ð ðÔ_ÔHarrellÔ_Ôðð),€a€registered€nurse€who€worked€with€Dr.€Ô_ÔPeytonÔ_Ô,€alsoÐ 0"€  Ðtestified€to€problems€she€encountered€with€Dr.€Ô_ÔPeytonÔ_Ô.€€In€particular,€she€testified€Dr.€Ô_ÔPeytonÔ_Ô€had€aÐ #l! Ðð ðget€them€in,€get€them€outðð€philosophy€and€explained€the€problems€this€caused,€as€well€as€problemsÐ $X" Ðwith€Dr.€Ô_ÔPeytonÔ_Ô€not€properly€reviewing€patientsðð€medical€records.€€According€to€Ô_ÔHarrellÔ_Ô,€in€herÐ ô$D # Ðprofessional€judgment,€there€were€ð ðmany€frequent€times€when€the€attention€that€deserved€to€beÐ à%0!$ Ðafforded,€either€through€the€technical€staff,€the€professional€staff,€or€through€the€patient€themselves,Ð Ì&"% Ðwas€dispelledðð€by€Dr.€Ô_ÔPeytonÔ_Ô.€€In€her€opinion,€Dr.€Ô_ÔPeytonÔ_Ô€posed€an€immediate€danger€to€the€patients.€Ð ¸'#& ÐÔ_ÔAnnette€Ô_ÔLambersonÔ_Ô,€a€radiation€technologist,€also€testified€to€problems€she€encountered€with€Dr.Ð ° ÐÔ_ÔPeytonÔ_Ôððs€€practices,€including€beginning€treatment€without€all€of€the€required€information€and€hisÐ œì Ðlack€of€communication€with€the€staff.׃W×Ý ƒQ#ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×Ð ˆØ ÐÌà  àà ` àMr.€Dennis€Ô_ÔVonderfechtÔ_Ô€(ð ðÔ_ÔVonderfechtÔ_Ô),€the€Hospitalððs€Administrator€and€ChiefÐ `° ÐOperating€Officer€testified€the€reasons€Dr.€Ô_ÔPeytonÔ_Ô€was€summarily€suspended€involved€quality€of€careÐ L œ Ðissues,€his€lack€of€leadership,€and€his€poor€relationships€with€Hospital€employees.€€Ô_ÔVonderfechtÔ_ÔÐ 8 ˆ Ðdenied€Dr.€Ô_ÔPeytonÔ_Ôððs€opening€of€clinics€in€the€area€in€any€way€impacted€on€the€decision€to€summarilyÐ $ t Ðsuspend€Dr.€Ô_ÔPeytonÔ_Ôððs€staff€privileges.€€He€did,€however,€admit€Dr.€Ô_ÔPeytonÔ_Ôððs€opening€of€clinics€wasÐ  ` Ða€concern€of€the€Hospital.€€Ð ü L  ÐÌà  àà ` àDr.€Ô_ÔPeytonÔ_Ô€admitted€in€his€testimony€he€was€at€fault€when€he€treated€the€wrong€kidneyÐ Ô$  Ðof€one€of€his€patients.€€Dr.€Ô_ÔPeytonÔ_Ô€denied€any€improper€medical€treatment€on€his€part€with€regard€toÐ À  Ðthe€other€four€cases€at€issue.€€Several€physicians€were€called€on€behalf€of€Dr.€Ô_ÔPeytonÔ_Ô.€€TheseÐ ¬ü  Ðphysicians€reviewed€medical€records€and€other€information€prior€to€the€hearing.€€They€essentiallyÐ ˜è  Ðtestified€there€was€no€Ô_ÔmisadministrationÔ_Ô€of€radiation€to€two€of€the€patients€at€issue€or€the€impact€ofÐ „Ô  Ðthe€dosage€received,€if€it€was€incorrect,€was€minimal€or€nonexistent.€€The€accuracy€of€the€StateððsÐ pÀ ÐNotice€of€Noncompliance€was€challenged€by€one€or€more€of€these€physicians,€as€was€the€testimonyÐ \¬ Ðof€several€of€the€Hospitalððs€witnesses.€€In€rebuttal,€the€Hospital€called€a€radiation€oncologist€as€anÐ H˜ Ðexpert€witness.€€This€physician€testified€the€treatment€of€several€of€Dr.€Ô_ÔPeytonÔ_Ôððs€patients€fell€belowÐ 4„ Ðthe€acceptable€standard€of€care.€€All€in€all,€eighteen€witnesses€testified€at€the€three€day€hearing.Ð  p ÐÌà  àà ` àOn€June€24,€1994,€the€Chairman€of€the€Hearing€Committee,€Boyce€Berry,€M.D.,€sentÐ øH Ða€memorandum€to€Cameron€Perry€(ð ðPerryðð),€President€of€the€Hospitalððs€Board€of€Directors.€€ThisÐ ä4 Ðmemorandum€stated:Ð Ð  ÐÌà8  àà8` Ð Ð àAfter€hearing€testimony€from€eighteen€(18)€witnesses€over€a€periodÐ ¨ø Ðof€twenty€three€(23)€hours,€the€hearing€panel€concurs€with€theÐ ”ä ÐProfessional€Review€Board.€€The€vote€was€passed€by€large€majority,Ð €Ð Ðbut€not€unanimously.Ðl¼` x` x ÐÌà8  àà8` Ð Ð àThere€was€great€concern€expressed€regarding€Dr.€Ô_ÔPeytonÔ_Ôððs€stability.ÐD!”` x` x ÐÌà8  àà8` Ð Ð àThe€decision€of€the€panel€was€based€not€only€on€the€medicalÐ #l! Ðmanagement€of€the€five€cases€presented€but€on€the€lack€ofÐ $X" Ðmanagement€style€and€lack€of€compassion€and€team€approach.Ðô$D #` x` x ÐÌà8  àà8` Ð Ð àIt€was€further€decided€by€the€panel€that€the€evidence€presented€at€thisÐ Ì&"% Ðhearing€did€indicate€that€the€summary€suspension€was€necessary€toÐ ¸'#& Ðreduce€the€substantial€likelihood€of€immediate€injury€or€damage€to€theÐ ¤(ô#' Ðhealth€or€safety€of€patients,€employees€or€other€persons€present€in€theÐ ° Ðhospital.ð8ðМì` x` x ÐÌà  àà ` àOn€October€4,€1994,€Perry€issued€a€Written€Decision€of€the€Board€which€affirmed€theÐ tÄ Ðrecommendation€of€the€Hearing€Committee.€€The€Written€Decision€states€the€basis€for€the€decisionÐ `° Ðwas:Ð L œ ÐÌà8  àà8` Ð Ð àà ¸ à1.à  àThe€Hearing€Committee€comprised€of€seven€(7)Ð $ t Ðmembers,€four€(4)€of€which€were€physicians,€after€receiving€overÐ  ` Ðtwenty„three€(23)€hours€of€testimony€and€evidence,€including€that€ofÐ ü L  ÐDr.€Ô_ÔPeytonÔ_Ô€and€his€seven€(7)€other€witnesses,€including€several€expertÐ è 8  Ðwitnesses,€concluded€that€the€summary€suspension€of€Dr.€Ô_ÔPeytonÔ_Ô€wasÐ Ô$  Ðreasonable.€€This€committee€had€the€exclusive€opportunity€to€viewÐ À  Ðwitnesses€in€person;€consider€their€credibility€and€demeanor;€and€alsoÐ ¬ü  Ðask€any€questions€the€committee€members€felt€relevant€to€the€issues.€Ð ˜è  ÐHaving€this€opportunity,€it€is€clear€that€this€committeeððsÐ „Ô  Ðrecommendation€should€be€given€great€weight€in€any€review€of€same.ÐpÀ` x` x ÐÌà8  àà8` Ð Ð àà ¸ à2.à  àThe€actions€of€Dr.€Ô_ÔPeytonÔ_Ô,€as€set€forth€in€his€Notice€ofÐ H˜ ÐSummary€Suspension,€including€his€continual€pattern€of€same€and€hisÐ 4„ Ðunwillingness€to€modify€his€actions,€conduct€and€method€of€practice,Ð  p Ðclearly€presented€and€does€still€present€a€substantial€likelihood€ofÐ  \ Ðimmediate€injury€and/or€damage€to€the€health€and/or€safety€ofÐ øH Ðpatients,€employees€and/or€other€persons€present€in€the€Johnson€CityÐ ä4 ÐMedical€Center€Hospital.ÐÐ ` x` x ÐÌà  àà ` àDr.€Ô_ÔPeytonÔ_Ô€appealed€the€decision€of€the€Board€of€Directors€to€the€Appellate€ReviewÐ ¨ø ÐCommittee.€€On€June€12,€1995,€the€Chairman€of€the€Appellate€Review€Committee,€James€R.Ð ”ä ÐÔ_ÔKerriganÔ_Ô,€M.D.,€issued€a€memorandum€stating€the€Appellate€Review€Committee€concurred€in€theÐ €Ð Ðdecision€of€the€Board€of€Directors.€€This€decision€was€based€on€a€review€of€the€hearing€transcript€asÐ l¼ Ðwell€as€written€responses€and€oral€statements€by€the€parties.€€The€decision€of€the€Appellate€ReviewÐ X ¨ ÐCommittee€was€unanimous.€€This€memorandum€went€on€to€state:Ð D!” ÐÌà8  àà8` Ð Ð àThe€committee€agrees€that€Dr.€Ô_ÔPeytonÔ_Ôððs€case€has€received€fair€and€dueÐ #l! Ðlegal€process.ð8ð€€The€committee€believes€the€evidence€demonstratesÐ $X" Ðthat€Dr.€Ô_ÔPeytonÔ_Ôððs€clinical€practice€methods€confer€a€ð ðsubstantialÐ ô$D # Ðlikelihood€of€immediate€injury€or€damage€to€the€health€or€safety€ofÐ à%0!$ Ðany€patient,€employee,€or€other€person€present€in€this€hospitalðð.€Ð Ì&"% ÐTherefore,€summary€suspension€was€necessary€and€justifiable.€Ð ¸'#& ÐFurthermore,€the€committee€expresses€concern€about€the€failure€ofÐ ¤(ô#' ÐDr.€Ô_ÔPeytonÔ_Ô€to€demonstrate€attention€to€details€of€patient€careÐ )à$( Ðfollowing€the€L.C.€case.€€Ð|*Ì%)` x` x ÐÐ h+¸&* ÐÔ_Ôà  àà ` àOn€June€26,€1995,€a€Final€Decision€of€the€Board€was€rendered,€concurring€in€theÐ ° Ðprevious€recommendations.€Ð œì ÐÌà  àà ` àThis€lawsuit€was€filed€by€Dr.€Peyton€in€September€of€1995.€€Dr.€Peyton€is€a€licensedÐ tÄ Ðphysician€and€is€board€certified€in€radiation€oncology.€€From€February€1,€1987,€until€April€24,€1994,Ð `° ÐDr.€Peyton€maintained€membership€with€the€active€medical€staff€and€enjoyed€full€medical€privilegesÐ L œ Ðat€the€Hospital.€€On€or€about€April€29,€1994,€the€Hospitalððs€Board€of€Directors€or€ExecutiveÐ 8 ˆ ÐCommittee€summarily€suspended€his€medical€staff€membership€and€clinical€staff€privileges.€€Dr.Ð $ t ÐPeyton€claims,€òòinter€aliaóó,€that€his€suspension€was€not€in€accordance€with€the€Hospitalððs€bylaws.€Ð  ` ÐAccording€to€Dr.€Peyton,€the€reasons€given€by€the€Hospital€to€support€the€revocation€of€his€staffÐ ü L  Ðprivileges€(i.e.€disregarding€radiation€safety€procedure€and€policies,€providing€substandard€qualityÐ è 8  Ðof€care,€and€engaging€in€disruptive€behavior)€were€not€supported€by€the€evidence.€€Dr.€Peyton€soughtÐ Ô$  Ðcompensatory€and€punitive€damages€totaling€ten€million€dollars€as€well€as€injunctive€relief.Ð À  ÐÌà  àà ` àThe€Hospital€filed€a€motion€for€summary€with€supporting€affidavits.€€Perryððs€affidavitÐ ˜è  Ðstated€the€decision€of€the€Board€of€Directors€was€made:€ð ð(1)€in€the€reasonable€belief€that€the€actionÐ „Ô  Ðwas€in€furtherance€of€quality€health€care;€(2)€after€a€reasonable€effort€to€obtain€the€facts€of€the€matter;Ð pÀ Ð(3)€after€adequate€notice€and€hearing€procedures€were€afforded€to€Dr.€Peyton;€and€(4)€in€theÐ \¬ Ðreasonable€belief€that€the€action€was€warranted€by€the€facts€known€after€all€of€the€above.ðð€€Perry€alsoÐ H˜ Ðstated€the€action€was€taken€after€Dr.€Peyton€had€been€given€every€opportunity€to€correct€his€conductÐ 4„ Ðand€actions,€and€after€Dr.€Peyton€was€afforded€due€process€and€hearing€procedures€afforded€to€himÐ  p Ðunder€the€Hospitalððs€bylaws.€€Perry€then€detailed€the€hearing€procedures€and€appeals€afforded€to€Dr.Ð  \ ÐPeyton.€€The€Hospital€also€filed€the€affidavit€of€Vonderfecht,€which€was€similar€to€Perryððs€affidavit.Ð øH ÐÌà  àà ` àIn€the€memorandum€filed€in€support€of€the€motion€for€summary€judgment,€theÐ Ð  ÐHospital€detailed€the€problems€it€claimed€it€was€having€with€Peyton.€€In€this€memorandum,€theÐ ¼  ÐHospital€states:Ð ¨ø ÐÌà8  àà8` Ð Ð àà ¸ àThe€plaintiff€was€the€main,€and€often€only,€radiationÐ €Ð Ðoncologist€who€practiced€at€the€Hospitalððs€Cancer€Treatment€CenterÐ l¼ Ð(hereinafter€ð ðthe€CTCðð)€for€a€period€of€approximately€seven€(7)€yearsÐ X ¨ Ðprior€to€his€suspension.€€Throughout€his€tenure€at€the€CTC,€butÐ D!” Ðparticularly€throughout€the€last€year€prior€to€his€suspension,€theÐ 0"€  ÐPlaintiff€had€serious€interpersonal€problems€with€a€number€of€teamÐ #l! Ðmembers€associated€with€the€CTC.€€Additionally,€the€PlaintiffÐ $X" Ðexhibited€a€cavalier€attitude€toward€his€work€and€his€patients€whichÐ ô$D # Ðresulted€in€reporting€to€the€State€of€Tennessee€five€(5)€treatmentÐ à%0!$ Ðerrors€during€an€approximately€one€(1)€year€period.€€Further,€theÐ Ì&"% ÐPlaintiff€continued€a€pattern€of€disregard€for€the€rules€and€regulationsÐ ¸'#& Ðof€the€Hospital,€and€reflected€no€intention€to€change€any€of€hisÐ ¤(ô#' Ðbehavior€with€regard€to€any€of€the€above.Ð)à$(` x` x Ðâ âÐ |*Ì%) ÐThe€five€incidents€of€treatment€errors€were€described€in€the€memorandum.€€As€to€the€incident€whereÐ ° Ðâ âDr.€Peyton€treated€the€wrong€kidney,€the€Hospital€claimed€when€Dr.€Peyton€was€presented€with€thisÐ œì Ðinformation,€his€response€was:€ð ðThatððs€why€I€carry€malpractice€insurance.ðð€€The€memorandum€thenÐ ˆØ Ðwent€on€the€explain€several€other€problems€encountered€with€Dr.€Peytonððs€methods€of€practicingÐ tÄ Ðmedicine.€€Ð `° ÐÌÔ& œ Ôà  àà ` àWith€regard€to€Dr.€Peytonððs€claimed€inability€to€get€along€with€Hospital€employees,€Ð 8 ˆ Ða€Management€Audit€of€the€Cancer€Treatment€Center€had€been€prepared€in€July€of€1993€and€wasÐ $ t Ðmade€a€part€of€the€record.€€Fifteen€employees€were€interviewed€during€a€one€week€period.€€TheÐ  ` Ðsummary€and€employee€recommendations€contained€within€the€Audit€state€as€follows:Ð ü L  ÐÔ'œ8 èmÔÌà8  àà8` Ð Ð àThe€vast€majority€of€employees€in€the€Cancer€Treatment€Center€areÐ Ô$  Ðcurrently€at€odds€with€Dr.€Peyton.€€They€describe€the€doctor€asÐ À  Ðmoody,€explosive,€unpredictable,€pre„occupied,€arrogant,€andÐ ¬ü  Ðobsessively€controlling.€€Whereas€much€of€the€conflict€in€1989Ð ˜è  Ðcentered€upon€physician„to„physician€conflict,€employees€now€reportÐ „Ô  Ðincreased€anxiety,€paranoia,€and€chaos€as€a€result€of€Dr.€PeytonððsÐ pÀ Ðefforts€to€retain€control.€€Management€within€the€department€wasÐ \¬ Ðrarely€criticized€and€often€praised€during€the€interviews.ð8ð€€MostÐ H˜ Ðemployees€doubted€Dr.€Peytonððs€ability€or€willingness€to€change.€Ð 4„ ÐThese€employees€either€strongly€implied€or€directly€stated€that€theÐ  p Ðphysician€should€be€replaced.ð8ðÐ \` x` x ÐÌà  àà ` àDr.€Peyton€responded€to€the€motion€for€summary€judgment€and€also€filed€his€ownÐ ä4 Ðmotion€for€summary€judgment.€€In€his€response,€Dr.€Peyton€essentially€challenging€the€motivationÐ Ð  Ðof€the€Hospital€in€revoking€his€privileges.€€Dr.€Peyton€was€in€the€process€of€opening€cancer€treatmentÐ ¼  Ðcenters€in€Boone,€North€Carolina,€and€Morristown,€Tennessee.€€According€to€certain€exhibitsÐ ¨ø Ðattached€to€Dr.€Peytonððs€affidavit,€the€Hospital€estimated€the€ð ðannual€adverse€impactðð€upon€theÐ ”ä ÐHospitalððs€net€income€to€be€over€$900,000.00.€€The€Hospital€at€one€point€declined€an€invitation€byÐ €Ð ÐDr.€Peyton€to€be€a€part€of€this€process€and€join€a€joint€venture€establishing€these€cancer€treatmentÐ l¼ Ðcenters.€€Dr.€Peyton€also€claimed€the€Hospital€was€motivated€by€his€challenging€certain€HospitalÐ X ¨ Ðpolicies€and€complaining€about€over„billing€practices.€€Dr.€Peyton€argued€four€of€the€five€allegedÐ D!” Ðincidents€of€improper€care€set€forth€by€the€Hospital€were€so€trivial€they€could€not€ð ðreasonablyððÐ 0"€  Ðwarrant€permanent€suspension€of€his€privileges.€€Dr.€Peyton€further€asserted€the€incident€involvingÐ #l! Ðthe€patient€whose€wrong€kidney€was€treated€with€radiation€was€not€sufficient€to€warrant€permanentÐ $X" Ðrevocation€of€privileges.׃T×Ý ƒQ#ÃÝòòÚ  Ú5Ú  ÚóóÝ  Ý×  ×€€Dr.€Peyton€made€this€same€argument€with€respect€to€his€alleged€conductÐ ô$D # Ðwith€co„workers,€etc.€€In€his€response€to€the€Hospitalððs€motion€for€summary€judgment,€Dr.€PeytonÐ à%0!$ Ðconcluded:€ð ðAt€most,€a€reasonable€hospital€would€have€limited€only€certain€privileges,€subject€to€aÐ Ì&"% Ðplan€for€Dr.€Peyton€to€improve€in€those€areas€in€order€to€achieve€full€reinstatement€of€thoseÐ ¸'#& Ðprivileges.€€Therefore,€any€belief€by€the€Hospital€that€its€actions€furthered€quality€of€care€wereÐ ¤(ô#' Ðunreasonable.ðð€Dr.€Peyton€went€on€to€add€that€ð ðeven€if€the€evidence€is€viewed€in€the€òòleastóó€favorableÐ ° Ðlight€to€Dr.€Peyton€(which€is€not€the€standard€for€a€review€on€summary€judgment),€at€òòmostóó€a€partialÐ œì Ðsuspension€would€have€been€arguably€reasonable,€and€a€complete€suspension€totally€insupportable.ððÐ ˆØ ÐÌà  àà ` àThe€Trial€Court€granted€the€Hospital€summary€judgment€with€respect€to€any€claimÐ `° Ðfor€monetary€damages.€€In€doing€so,€the€Trial€Court€stated:Ð L œ ÐÌà8  àà8` Ð Ð àà ¸ àThe€Court€finds€that€the€peer€review€panel€which€conductedÐ $ t Ðthe€Fair€Review€Hearing€in€this€matter€did€meet€the€standardsÐ  ` Ðrequired€by€the€Health€Care€Quality€Improvement€Act€of€1986,€asÐ ü L  Ðamended,€to€qualify€for€immunity€from€damages.€€This€Court€shouldÐ è 8  Ðnot€substitute€its€judgment€for€the€peer€review€panel.ÐÔ$ ` x` x ÐÌà8  àà8` Ð Ð àà ¸ àTherefore,€this€Court€is€of€the€opinion€and€hereby€finds€andÐ ¬ü  Ðorders€that€Defendant€is€immune€from€the€monetary€damages€soughtÐ ˜è  Ðby€Plaintiff€and€therefore€Defendantððs€Renewed€Motion€for€PartialÐ „Ô  ÐSummary€Judgment€on€the€issue€of€monetary€damages€should€be,€andÐ pÀ Ðhereby€is,€granted.€€Accordingly,€judgment€is€hereby€entered€in€favorÐ \¬ Ðof€Defendant€on€the€issue€of€monetary€damages€sought€by€Plaintiff.ÐH˜` x` x ÐÌà@))%ìàò òòòDiscussionó óóóˆÐ  p ÐÌà  àà ` àAs€indicated€previously,€the€Act€includes€a€presumption€that€a€professional€reviewÐ øH Ðaction€has€met€the€four€prong€test€for€immunity€from€monetary€damages€set€forth€in€ðð€11112(a),Ð ä4 Ðunless€a€plaintiff€can€rebut€this€presumption€by€a€preponderance€of€the€evidence.€€The€standard€forÐ Ð  Ðreviewing€a€grant€of€summary€judgment€under€the€Act€is,€therefore,€ð ðunconventional:€€although€theÐ ¼  Ðdefendant€is€the€moving€party,€we€must€examine€the€record€to€determine€whether€the€plaintiffÐ ¨ø Ðððsatisfied€his€burden€of€producing€evidence€that€would€allow€a€reasonable€jury€to€conclude€that€theÐ ”ä ÐHospitalððs€peer€review€disciplinary€process€failed€to€meet€the€standards€of€HCQIA.ðððð€òòBrader€v.Ð €Ð ÐAllegheny€General€Hospitalóó,€167€F.3d€832,€839€(3d€Cir.€1999)(quoting€òòBryan€v.€James€E.€HolmesÐ l¼ ÐRegððl€Med.€Ctr.óó,€33€F.3d€1318,€1334€(11òòthóó€Cir.€1994)).€€We€must,€therefore,€determine€whether€Dr.Ð X ¨ ÐPeyton€has€met€his€burden€under€any€of€the€four€prongs€set€forth€in€Section€11112(a).€€At€this€pointÐ D!” Ðin€the€litigation,€neither€the€Trial€Court€nor€this€Court€need€decide€whether€the€action€taken€by€theÐ 0"€  ÐHospital€was€correct.€€That€issue€remains€to€be€decided€by€the€Trial€Court.€€òòSeeóó€òòImperial€v.€SuburbanÐ #l! ÐHosp.€Assððn,€Inc.óó,€37€F.3d€1026,€1030€(4òòthóó€Cir.€1994)(Even€if€the€plaintiff€can€show€an€incorrectÐ $X" Ðdecision€was€reached,€ð ðthat€does€not€meet€the€burden€of€contradicting€the€existence€of€a€reasonableÐ ô$D # Ðbelief€that€they€were€furthering€health€care€quality.€.€.€.€ðð).Ð à%0!$ ÐÌà  àà ` àFirst,€we€must€determine€whether€the€Trial€Court€correctly€held€the€professionalÐ ¸'#& Ðreview€action€was€taken€in€the€reasonable€belief€that€the€action€was€in€the€furtherance€of€qualityÐ ¤(ô#' Ðhealth€care.€€Dr.€Peyton€contends€he€has€raised€material€issues€of€fact€as€to€whether€the€Hospital€wasÐ )à$( Ðmotivated€by€something€other€than€a€reasonable€belief€that€its€actions€would€further€the€care€of€itsÐ |*Ì%) Ðpatients.€€Many€of€the€federal€courts€of€appeal€which€have€addressed€similar€arguments€under€theÐ h+¸&* ÐAct€have€adopted€an€objective€standard€of€reasonableness€in€this€context.€€òòSee€Brader€v.€AlleghenyÐ ° ÐGeneral€Hospitalóó,€167€F.3d€832,€840€(3d€Cir.€1999);€òòImperial€v.€Suburban€Hosp.€Assððn,€Inc.óó,€37€F.3dÐ œì Ð1026,€1030€(4òòthóó€Cir.€1994);€òòSmith€v.€Ricksóó,€31€F.3d€1478,€1485€(9òòthóó€Cir.€1994);€òòBryan€v.€James€E.Ð ˆØ ÐHolmes€Regððl€Med.€Ctr.óó,€33€F.3d€1318,€1335€(11òòthóó€Cir.€1994).€€Ð tÄ ÐÌà8  àà8` Ð Ð àTherefore,€the€good€or€bad€faith€of€the€reviewers€is€irrelevant.€€ð ðTheÐ L œ Ðreal€issue€is€the€sufficiency€of€the€basis€for€the€[Hospitalððs]€actions.ðð€Ð 8 ˆ ÐòòBryanóó,€33€F.3d€at€1335.€€The€ð ðreasonable€beliefðð€standard€articulatedÐ $ t Ðin€ðð€11112(a)(1)€will€be€satisfied€ð ðif€the€reviewers,€with€theÐ  ` Ðinformation€available€to€them€at€the€time€of€the€professional€reviewÐ ü L  Ðaction,€would€reasonably€have€concluded€that€their€actions€wouldÐ è 8  Ðrestrict€incompetent€behavior€or€would€protect€patients.ðð€€òòMathewsóó,Ð Ô$  Ð87€F.3d€at€635,€quoting€H.R.€Rep.€No.€903,€99òòthóó€Cong.,€2d€Sess.€10Ð À  Ð(1986)€ð8ð.Ьü ` x` x ÐÌòòBrader€v.€Allegheny€General€Hospitalóó,€167€F.3d€832,€840€(3d€Cir.€1999).€€We€agree€with€thisÐ „Ô  Ðposition.€€Thus,€Dr.€Peytonððs€claim€the€Hospital€acted€in€bad€faith€because€he€had€or€was€in€theÐ pÀ Ðprocess€of€opening€medical€clinics€which€would€reduce€the€Hospitalððs€gross€revenue€is€not€relevant.€Ð \¬ ÐòòSeeóó€òòMathews€v.€Lancaster€General€Hospitalóó,€87€F.3d€624,€634„35€(3d€Cir.€1996)(rejecting€asÐ H˜ Ðimmaterial€the€physicianððs€argument€the€Hospital€acted€in€bad€faith€because€it€was€in€directÐ 4„ Ðeconomic€competition€with€him).€€The€real€issue€as€to€the€first€of€the€four€prongs€is€the€sufficiencyÐ  p Ðof€the€basis€for€the€Hospitalððs€action.€€òòBryan€v.€James€E.€Holmes€Regional€Medical€Centeróó,€33€F.3dÐ  \ Ð1318,€1335€(11òòthóó€Cir.€1994),€òòcert€deniedóó,€514€U.S.€1019,€115€S.€Ct.€1363€(1995).Ð øH ÐÌà  àà ` àIn€the€present€case,€the€Hospital€had€significant€concerns€about€Dr.€Peytonððs€treatmentÐ Ð  Ðof€several€patients.€€In€fact,€his€treatment€of€one€patient€resulted€in€the€Hospitalððs€settling€a€claim€forÐ ¼  Ð$150,000.€€While€Dr.€Peyton€presented€evidence€that€his€treatment€of€four€of€the€patients€at€issue€wasÐ ¨ø Ðnot€improper,€there€also€was€abundant€proof€available€to€the€Hospital€to€make€it€think€otherwise.€Ð ”ä ÐFurthermore,€the€Hospital€was€concerned€about€Dr.€Peytonððs€ability€to€interact€with€the€employeesÐ €Ð Ðat€the€Hospital.€€Many€employees€of€the€hospital€had€been€interviewed€and€their€concerns€about€Dr.Ð l¼ ÐPeytonððs€personal€and€professional€skills€were€made€known.€€The€Hospital€undoubtedly€wasÐ X ¨ Ðconcerned€about€Dr.€Peyton€opening€clinics€which€would€reduce€its€revenue.€€This,€however,€doesÐ D!” Ðnot€negate€the€fact€there€were€problems€with€Dr.€Peytonððs€treatment€of€patients€and€his€ability€toÐ 0"€  Ðwork€with€Hospital€employees.€€Dr.€Peyton€has€not€presented€evidence€that€the€professional€reviewÐ #l! Ðaction€taken€by€the€Hospital€was€motivated€by€anything€other€than€a€reasonable€belief€that€the€actionÐ $X" Ðwould€further€quality€health€care.€€òòSeeóó€òòMathews€v.€Lancaster€General€Hospitalóó,€87€F.3d€624,€635€(3dÐ ô$D # ÐCir.€1996)€(ð ðDr.€Mathews€has€presented€evidence€that€defendants,€including€Lancaster€General€ð8ðÐ à%0!$ Ðwere€his€competitors.€But€he€has€not€presented€evidence€that€the€professional€review€action€takenÐ Ì&"% Ðby€Lancaster€General's€Board€was€motivated€by€anything€other€than€a€reasonable€belief€that€it€wouldÐ ¸'#& Ðfurther€quality€health€care.€As€the€district€court€concluded€after€carefully€reviewing€the€evidence,€Dr.Ð ¤(ô#' ÐMathews€has€failed€to€rebut€ðð€11112(a)'s€presumption€that€the€peer€reviewers'€action€met€the€standardÐ )à$( Ðfor€immunity€from€suit€for€monetary€damages€.ð8ððð).Ð |*Ì%) ÐÐ h+¸&* Ðà  àà ` àThe€second€prong€of€the€test€for€immunity€under€ðð€11112(a)€is€whether€the€action€wasÐ ° Ðtaken€after€a€reasonable€effort€to€obtain€the€facts€of€the€matter.€€The€relevant€inquiry€on€this€issue€isÐ œì Ðwhether€ð ðthe€totality€of€the€process€leading€up€to€the€Boardððs€ððprofessional€review€actionðð€ð8ðÐ ˆØ Ðevidenced€a€reasonable€effort€to€obtain€the€facts€of€the€matter.ðð€€òòSeeóó€òòMathews€v.€Lancaster€GeneralÐ tÄ ÐHospitalóó,€87€F.3d€624,€637€(3d€Cir.€1996).€€As€noted€previously,€the€Hospital€reported€five€incidentsÐ `° Ðto€the€State.€€Prior€to€the€reports€being€made,€at€least€some€factual€investigation€took€place.€€ManyÐ L œ Ðof€the€employees€of€the€Hospital€had€been€interviewed€and€had€expressed€concerns€over€Dr.€PeytonððsÐ 8 ˆ Ðpersonal€and€professional€skills.€€All€of€this€culminated€in€a€hearing€which€lasted€approximately€23Ð $ t Ðhours€where€eighteen€witnesses€testified.€€Many€of€the€witnesses€were€expert€witnesses.€€TheÐ  ` Ðmembers€of€the€Fair€Hearing€Panel,€many€of€whom€were€physicians,€were€active€during€the€hearingÐ ü L  Ðin€asking€questions€they€believed€needed€to€be€answered€in€order€to€make€a€determination.€€TheÐ è 8  Ðopinion€of€the€Fair€Hearing€Panel€was€appealed€by€Dr.€Peyton€to€the€Appellate€Review€Committee,Ð Ô$  Ðwhich€reviewed€the€transcript€of€the€hearing€as€well€as€written€responses€and€oral€statements€of€theÐ À  Ðparties.€€The€Appellate€Review€Committee€unanimously€concluded€Dr.€Peyton€posed€a€ð ðsubstantialÐ ¬ü  Ðlikelihood€of€immediate€injury€or€damage€to€the€health€or€safetyðð€of€patients.€€Based€on€the€eventsÐ ˜è  Ðprior€to,€during,€and€after€the€hearing,€we€believe€the€only€reasonable€conclusion€that€can€be€reachedÐ „Ô  Ðis€that€the€ð ðtotality€of€the€processðð€leading€up€to€the€professional€review€action€evidenced€aÐ pÀ Ðòòreasonableóó€effort€of€obtain€the€facts.€€The€Act€entitled€Dr.€Peyton€to€a€reasonable€investigation,€ð ðnotÐ \¬ Ða€perfect€investigation.ðð€€òòEgan€v.€Athol€Memorial€Hospitalóó,€971€F.€Supp.€37,€43€(D.€Mass.€1997).€Ð H˜ ÐÌà  àà ` àThe€third€prong€under€ðð€11112(a)€is€whether€the€professional€review€action€was€takenÐ  p Ðafter€adequate€notice€and€hearing€procedures€are€afforded€to€the€physician€involved€or€after€suchÐ  \ Ðother€procedures€as€are€fair€to€the€physician€under€the€circumstances.€€A€health€care€entity€will€beÐ øH Ðdeemed€to€have€satisfied€the€third€part€of€the€ðð11112(a)€test€if€it€follows€the€procedures€set€forth€inÐ ä4 Ððð€11112(b),€which€provides:Ð Ð  ÐÌà8  àà8` Ð Ð àAdequate€notice€and€hearing.€A€health€care€entity€is€deemed€to€haveÐ ¨ø Ðmet€the€adequate€notice€and€hearing€requirement€of€subsection€(a)(3)Ð ”ä Ðwith€respect€to€a€physician€if€the€following€conditions€are€met€(or€areÐ €Ð Ðwaived€voluntarily€by€the€physician):€Ðl¼` x` x ÐÌà8  àà8` Ð Ð à(1)€Notice€of€proposed€action.€The€physician€has€been€given€noticeÐ D!” Ðstatingð!ð€Ð0"€ ` x` x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(A)€(i)€that€a€professional€review€action€has€been€proposed€toÐ $X" Ðbe€taken€against€the€physician,€Ðô$D #¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(ii)€reasons€for€the€proposed€action,€ÐÌ&"%¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(B)€(i)€that€the€physician€has€the€right€to€request€a€hearing€onÐ ¤(ô#' Ðthe€proposed€action,€Ð)à$(¸ x¸ x Ðâ âÐ |*Ì%) Ðà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(ii)€any€time€limit€(of€not€less€than€30€days)€within€whichÐ ° Ðâ âto€request€such€a€hearing,€and€Ðœì¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(C)€a€summary€of€the€rights€in€the€hearing€under€paragraphÐ tÄ Ð(3).€Ð`°¸ x¸ x ÐÌà8  àà8` Ð Ð à(2)€Notice€of€hearing.€If€a€hearing€is€requested€on€a€timely€basis€underÐ 8 ˆ Ðparagraph€(1)(B),€the€physician€involved€must€be€given€notice€stating„€Ð$ t` x` x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(A)€the€place,€time,€and€date,€of€the€hearing,€which€date€shallÐ ü L  Ðnot€be€less€than€30€days€after€the€date€of€the€notice,€and€Ðè 8 ¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(B)€a€list€of€the€witnesses€(if€any)€expected€to€testify€at€theÐ À  Ðhearing€on€behalf€of€the€professional€review€body.€Ð¬ü ¸ x¸ x ÐÌà8  àà8` Ð Ð à(3)€Conduct€of€hearing€and€notice.€If€a€hearing€is€requested€on€aÐ „Ô  Ðtimely€basis€under€paragraph€(1)(b)„„€ÐpÀ` x` x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(A)€subject€to€subparagraph€(B),€the€hearing€shall€be€held€(asÐ H˜ Ðdetermined€by€the€health€care€entity)„„€Ð4„¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(i)€before€an€arbitrator€mutually€acceptable€to€the€physicianÐ  \ Ðand€the€health€care€entity,€ÐøH¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(ii)€before€a€hearing€officer€who€is€appointed€by€the€entityÐ Ð  Ðand€who€is€not€in€direct€economic€competition€with€theÐ ¼  Ðphysician€involved,€or€Ð¨ø¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(iii)€before€a€panel€of€individuals€who€are€appointed€by€theÐ €Ð Ðentity€and€are€not€in€direct€economic€competition€with€theÐ l¼ Ðphysician€involved;€ÐX ¨¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(B)€the€right€to€the€hearing€may€be€forfeited€if€the€physicianÐ 0"€  Ðfails,€without€good€cause,€to€appear;€Ð#l!¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà(C)€in€the€hearing€the€physician€involved€has€the€right„„€Ðô$D #¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(i)€to€representation€by€an€attorney€or€other€person€of€theÐ Ì&"% Ðphysician's€choice,€Ð¸'#&¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(ii)€to€have€a€record€made€of€the€proceedings,€copies€ofÐ )à$( Ðwhich€may€be€obtained€by€the€physician€upon€payment€of€anyÐ |*Ì%) Ðreasonable€charges€associated€with€the€preparation€thereof,€Ðh+¸&*¸ x¸ x Їà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(iii)€to€call,€examine,€and€cross„examine€witnesses,€Ð°¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(iv)€to€present€evidence€determined€to€be€relevant€by€theÐ ˆØ Ðhearing€officer,€regardless€of€its€admissibility€in€a€court€ofÐ tÄ Ðlaw,€and€Ð`°¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(v)€to€submit€a€written€statement€at€the€close€of€the€hearing;Ð 8 ˆ Ðand€Ð$ t¸ x¸ x ÐÌà8  àà8` Ð Ð à(D)€upon€completion€of€the€hearing,€the€physician€involved€has€theÐ ü L  Ðright„„€Ðè 8 ` x` x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(i)€to€receive€the€written€recommendation€of€the€arbitrator,Ð À  Ðofficer,€or€panel,€including€a€statement€of€the€basis€for€theÐ ¬ü  Ðrecommendations,€and€Ð˜è ¸ x¸ x ÐÌà8  àà8` Ð Ð àà0¸ ` x` xà€€€€(ii)€to€receive€a€written€decision€of€the€health€care€entity,Ð pÀ Ðincluding€a€statement€of€the€basis€for€the€decision.€Ð\¬¸ x¸ x ÐÌà8  àà8` Ð Ð àA€professional€review€body's€failure€to€meet€the€conditions€describedÐ 4„ Ðin€this€subsection€shall€not,€in€itself,€constitute€failure€to€meet€theÐ  p Ðstandards€of€subsection€(a)(3).€Ð \` x` x ÐÌ42€U.S.C.€ðð€11112(b).Ð ä4 ÐÌà  àà ` àDr.€Peyton€was€provided€with€notice€of€the€proposed€action€and€the€reasons€thereforÐ ¼  Ðon€April€24,€1994.€€He€was€informed€of€his€right€to€request€a€hearing€within€30€days,€which€he€did.€Ð ¨ø ÐDr.€Peyton€was€provided€a€summary€of€the€rights€he€would€have€at€the€hearing.€€Dr.€Peyton€obtainedÐ ”ä Ðcounsel€and€the€hearing€was€scheduled€at€a€time€when€all€parties€and€their€attorneys€could€be€present.€Ð €Ð ÐDr.€Peyton€acknowledges€he€was€provided€a€list€of€potential€witnesses€to€be€called€on€behalf€of€theÐ l¼ ÐHospital.€€At€the€hearing€and€thereafter,€Dr.€Peyton€was€provided€all€of€the€rights€set€forth€in€ððÐ X ¨ Ð11112(b)(3)(C)€and€(D).€€In€accordance€with€ðð€11112(b)(3)(A)(iii),€the€hearing€was€conducted€beforeÐ D!” Ða€panel€of€individuals€who€were€appointed€by€the€Hospital€and€who€were€not€in€direct€economicÐ 0"€  Ðcompetition€with€Dr.€Peyton.€€Ð #l! ÐÌà  àà ` àOn€appeal,€Dr.€Peyton€challenges€certain€aspects€of€the€hearing€by€pointing€out€whatÐ ô$D # Ðhe€considers€to€be€a€better€method€of€handling€certain€aspects€of€the€hearing.€€Whether€or€not€theÐ à%0!$ Ðhearing€could€have€been€conducted€in€a€better€way€is€not€relevant.€€The€Hospital€complied€with€theÐ Ì&"% Ðrequirements€of€the€statute€and€must,€therefore,€be€ð ðdeemedðð€to€have€met€the€third€prong€of€the€test.€Ð ¸'#& ÐEven€if€we€were€to€find€that€all€of€the€requirements€of€ðð€11112(b)€were€not€met,€we€neverthelessÐ ¤(ô#' Ðbelieve€Dr.€Peyton€was€provided€with€adequate€notice€and€hearing€procedures€as€were€fair€ð ðunderÐ )à$( Ðthe€circumstances.ðð€€òòSeeóó€òòSmith€v.€Ricksóó,€31€F.3d€1478,€1487€(9òòthóó€Cir.€1994)€(The€HospitalððsÐ |*Ì%) Ðð ðprocedures€either€fit€into€the€ðð€11112(b)(3)€ððsafe€harbor,ðð€or€are€so€close€to€the€ððsafe€harborðð€thatÐ h+¸&* Ðno€reasonable€jury€could€find€Dr.€Smith€rebutted€the€presumption€that€the€procedures€wereÐ ° Ðadequate.ðð).€Ð œì ÐÌà  àà ` àDr.€Peyton€also€takes€issue€with€the€fact€that€some€members€of€the€hearing€panel€wereÐ tÄ Ðnot€physicians.€€Pursuant€to€ðð€11112(b)(3)(A),€the€hearing€can€be€held€before€an€arbitrator,€a€hearingÐ `° Ðofficer,€or€a€panel€of€individuals€who€are€not€in€direct€competition€with€the€physician.€€We€find€noÐ L œ Ðrequirement€in€the€statute€that€the€ð ðindividualsðð€on€a€hearing€panel€be€physicians.€€Had€CongressÐ 8 ˆ Ðintended€that,€they€would€have€used€the€term€ð ðphysiciansðð€and€not€ð ðindividualsðð€in€the€statute.€€InÐ $ t ÐòòMeyers€v.€Logan€Memorial€Hospitalóó,€82€F.€Supp.2d€707€(W.D.€Ky.€2000),€the€United€States€DistrictÐ  ` ÐCourt€for€the€Western€District€of€Kentucky€reached€the€same€result,€stating:Ð ü L  ÐÌà8  àà8` Ð Ð àRegarding€the€members€of€the€Fair€Hearing€Committee,€Dr.€MeyersÐ Ô$  Ðcontends€that€the€laymen€comprising€the€Fair€Hearing€Committee€doÐ À  Ðnot€quality€for€immunity€because€the€purpose€of€the€HCQIA€"is€toÐ ¬ü  Ðencourage€physicians€to€participate€in€peer€review€by€granting€themÐ ˜è  Ðconditional€immunity."€€He€notes€that€although€the€Fair€HearingÐ „Ô  ÐCommittee€was€not€comprised€of€physicians,€its€members€seek€theÐ pÀ Ðprotection€of€the€HCQIA's€immunity.€€Nevertheless,€the€Court€canÐ \¬ Ðfind€no€provision€of€the€HCQIA€which€requires€the€professionalÐ H˜ Ðreview€process€to€be€conducted€by€physicians€only.€In€fact,€theÐ 4„ Ðlanguage€of€the€HCQIA€uses€the€word€"person"€rather€thanÐ  p Ð"physician"€to€describe€those€who€will€be€granted€immunity.€42Ð  \ ÐU.S.C.€ðð€11111(a)(1)(B)„(D).€€Furthermore,€under€the€HCQIA,€aÐ øH Ðhearing€may€be€conducted€by€an€arbitrator,€hearing€officer,€or€panelÐ ä4 Ðof€individuals,€which€contemplates€the€use€of€non„physicians€in€theÐ Ð  Ðprofessional€review€process.€Id.€ðððð€11112(b)(3)(A)(i)„(iii).€€Thus,€theÐ ¼  ÐCourt€concludes€that€each€of€the€Defendants€asserting€HCQIAÐ ¨ø Ðimmunity,€including€the€members€of€the€Fair€Hearing€Committee,€isÐ ”ä Ða€person€or€entity€entitled€to€summary€judgment€provided€that€all€ofÐ €Ð Ðthe€requirements€of€the€HCQIA€are€satisfied.€Ðl¼` x` x ÐÐ ÐòòMeyersóó,€82€F.€Supp.2d€at€713.Ð D!” ÐÌà  àà ` àDr.€Peyton€also€challenges€the€procedures€by€arguing€that€portions€of€the€HospitalððsÐ #l! Ðbylaws€were€not€followed.€€Whether€or€not€the€Hospital€followed€the€letter€of€its€bylaws€during€thisÐ $X" Ðprocess€is€not€germane€to€whether€or€not€the€Hospital€is€immune€from€damages€under€the€Act.€€TheÐ ô$D # Ðtest€is€whether€the€Hospitalððs€procedures€met€the€standards€set€forth€in€the€Act.€€ð ð[T]here€is€noÐ à%0!$ Ðstatutory€requirement€set€forth€in€the€HCQIA€that€a€peer€review€proceeding€must€be€conducted€inÐ Ì&"% Ðaccordance€with€.€.€.€a€hospitalððs€own€specific€internal€bylaws€or€procedures.ðð€€€òòMeyers€v.€LoganÐ ¸'#& ÐMemorial€Hospitalóó,€82€F.€Supp.2d€707,€715€(W.D.€Ky.€2000)(quoting€òòJohnson€v.€Greater€SoutheastÐ ¤(ô#' ÐCommunity€College€Hosp.€Corp.óó,€No.€CIV.A.€90„1992,€1996€U.S.€Dist.€LEXIS€9532€at€*14€(D.D.C.Ð )à$( ÐJune€24,€1996),€òòaffððd€without€published€opinionóó,€132€F.3d€1481€(D.C.€Cir.€1997)).Ð |*Ì%) ÐÐ h+¸&* Ðà  àà ` àThe€fourth€prong€of€the€test€is€whether€the€professional€review€action€was€taken€inÐ ° Ðthe€reasonable€belief€that€the€action€was€warranted€by€the€facts€known€after€such€reasonable€effortÐ œì Ðand€after€meeting€the€requirements€for€notice€and€the€hearing.€€Several€witnesses€testified€to€Dr.Ð ˆØ ÐPeytonððs€inability€to€get€along€with€many€of€the€Hospitalððs€staff€members,€which€is€certainly€aÐ tÄ Ðlegitimate€concern€of€the€Hospital.€€"Quality€patient€care€demands€that€doctors€possess€at€least€aÐ `° Ðreasonable€'ability€to€work€with€others.'"€€òòMeyers€v.€Logan€Memorial€Hospitalóó,€82€F.€Supp.2d€707,Ð L œ Ð714€(W.D.€Ky.€2000)(quoting€òòRooney€v.€Medical€Ctr.€Hospóó.,€1994€U.S.€Dist.€LEXIS€7420,€No.€C2„Ð 8 ˆ Ð91„1100€,€1994€WL€854372,€at€*3€(S.D.€Ohio€March€30,€1994)€and€òòEverhart€v.€Jefferson€ParishÐ $ t ÐHosp.óó,€757€F.2d€1567,€1573€(5th€Cir.€1985)).€€There€also€were€several€witnesses€who€testified€toÐ  ` Ðimproper€medical€care€rendered€by€Dr.€Peyton.€€Without€restating€all€of€the€evidence,€Dr.€PeytonÐ ü L  Ðsimply€failed€to€rebut€the€presumption€accorded€to€the€Hospital€under€the€Act€that€its€action€wasÐ è 8  Ðbased€on€a€reasonable€belief€that€the€action€was€warranted€by€the€facts€and€after€it€conducted€aÐ Ô$  Ðreasonable€investigation.€€Ð À  ÐÌà  àà ` àDr.€Peyton€argues€there€were€two€distinct€peer€review€actions€which€took€place€andÐ ˜è  Ðthe€Hospital€is,€therefore,€required€to€comply€with€the€standards€of€ðð€11112€for€each€particularÐ „Ô  Ðaction.€€More€specifically,€Dr.€Peyton€asserts€the€summary€suspension€was€a€peer€review€action,€andÐ pÀ Ðthe€subsequent€permanent€suspension€was€a€separate€and€distinct€peer€review€action.€€We€need€notÐ \¬ Ðdecide€whether€these€were€two€separate€peer€review€actions€or€whether€one€is€simply€a€continuationÐ H˜ Ðof€the€other.€€The€issue€can€be€resolved€by€looking€to€the€plain€language€of€ðð€11112(c)(2),€whichÐ 4„ Ðstates€that€for€purposes€of€ðð11111(a),€ð ðnothing€in€this€section€shall€be€construed€as€.€.€.€precludingÐ  p Ðan€immediate€suspension€or€restriction€of€clinical€privileges,€subject€to€subsequent€notice€andÐ  \ Ðhearing€or€other€adequate€procedures,€where€the€failure€to€take€such€an€action€may€result€in€anÐ øH Ðimminent€danger€to€the€health€of€an€individual.ðð€€This€is€exactly€what€happened€in€the€present€case.€Ð ä4 ÐDr.€Peytonððs€hospital€privileges€were€summarily€suspended,€and€he€was€thereafter€provided€with€theÐ Ð  Ðnecessary€protections€set€forth€in€the€statute.€€In€light€of€our€conclusion€above€that€the€revocation€ofÐ ¼  ÐDr.€Peytonððs€privileges€was€undertaken€in€a€reasonable€belief€ð ðthat€the€action€was€in€the€furtheranceÐ ¨ø Ðof€quality€health€careðð,€we€must€likewise€conclude€the€summary€suspension€which€occurred€on€AprilÐ ”ä Ð24,€1994,€was€taken€because€the€failure€to€do€so€may€have€resulted€in€an€imminent€danger€to€theÐ €Ð Ðhealth€of€an€individual.€€42€U.S.C.€ðð€11112(c)(2).Ð l¼ ÐÌà  àà ` àFinally,€we€will€discuss€briefly€Dr.€Peytonððs€argument€made€in€his€response€to€theÐ D!” ÐHospitalððs€motion€for€summary€judgment€that€ð ð[a]t€most,€a€reasonable€hospital€would€have€limitedÐ 0"€  Ðonly€certain€privileges,€subject€to€a€plan€for€Dr.€Peyton€to€improve€in€those€areas€in€order€to€achieveÐ #l! Ðfull€reinstatement€of€those€privileges.ðð€€It€appears€Dr.€Peyton€acknowledges€at€least€some€action€mayÐ $X" Ðhave€been€reasonable.€€If€some€action€would€have€been€reasonable€and€in€the€furtherance€of€qualityÐ ô$D # Ðhealth€care,€then€certainly€the€action€the€Hospital€took€would€likewise€be€in€furtherance€of€qualityÐ à%0!$ Ðhealth€care.€€Simply€because€Dr.€Peyton€disagrees€with€the€degree€of€action€taken€by€the€HospitalÐ Ì&"% Ðin€no€way€means€the€Hospitalððs€motivation€was€improper.€€Ð ¸'#& ÐÌà  àà ` àWe€affirm€the€judgment€of€the€Trial€Court€granting€the€Hospital€partial€summaryÐ )à$( Ðâ âjudgment€pursuant€to€the€federal€Health€Care€Quality€Improvement€Act€of€1986,€42€U.S.C.€ðð€11101,Ð |*Ì%) Ðòòet€seqóó.€€We€again€point€out€that€in€affirming€the€grant€of€partial€summary€judgment,€we€express€noÐ ° Ðopinion€on€any€remaining€claims€asserted€by€Dr.€Peyton.Ð œì Ðâ âÌà@  %ìàò òòòConclusionóóó óˆÐ tÄ ÐÌà  àà ` àThe€judgment€of€the€Trial€Court€granting€partial€summary€judgment€is€affirmed,€andÐ L œ Ðthis€cause€is€remanded€to€the€Trial€Court€for€such€further€proceedings€as€may€be€required,€consistentÐ 8 ˆ Ðwith€this€Opinion,€and€for€collection€of€the€costs€below.€€The€costs€on€appeal€are€assessed€againstÐ $ t Ðthe€Appellant,€Dr.€Richard€R.€Peyton,€and€his€surety.€€Ð  ` ÐÌÌÌÌÌÌà  àà ` àà ¸ àà  àà h àà À àà  à___________________________________€Ð „Ô  Ðà  àà ` àà ¸ àà  àà h àà À àà  àD.€MICHAEL€SWINEY,€JUDGEÐ pÀ Ð