Archuleta v. St. Mark's Hospital

DURHAM, Chief Justice:

INTRODUCTION

1 In this case, the district court improperly dismissed Tina Archuleta's negligent credentialing claim against St. Mark's Hospital on statutory grounds. We agree with Ms. Archuleta's argument on direct appeal that the plain language of Utah Code sections 58-13-5(7), 58-138-4, and 26-25-1 does not bar negligent credentialing claims brought by patients against health care providers. We reverse the district court's dismissal of Ms. Archuleta's negligent credentialing claim and remand for further proceedings consistent with this opinion.

BACKGROUND

T2 On August 4, 2005, Dr. R. Chad Hal-versen performed a laparotomy surgery on Ms. Archuleta at St. Mark's Hospital. Less than two days after being discharged from St. Mark's Hospital, Ms. Archuleta was admitted to McKay Dee Hospital complaining of severe pain and complications from the surgery. Over the course of the next year, physicians performed over six additional corrective surgeries on her.

13 Subsequently, Ms. Archuleta brought suit against Dr. Halversen and St. Mark's Hospital, among other defendants. In her First Amended Complaint, she asserted that St. Mark's Hospital "failed to seek consult when appropriate, inadequately trained healthcare provider employees, negligently credentialed ... [Dr.] Halversen and generally fell below the standard of care with regard to Plaintiff Tina Archuleta" St. Mark's Hospital moved to dismiss the negligent credentialing portion of the complaint, asserting that Utah does not recognize a cause of action for negligent credentialing.

T4 The district court determined that Utah Code sections 58-13-5(7), 58-13-4, and 26-25-1 each independently barred a negligent credentialing cause of action. Accordingly, the court dismissed Ms. Archuleta's negligent credentialing claim. We have jurisdiction to review the district court's dismissal pursuant to Utah Code section T8A-3-102(8)(j) (2008), to review the district.

STANDARD OF REVIEW

T5 "[Thhe purpose of a rule 12(b)(6) motion is to challenge the formal sufficiency of the claim for relief, not to establish the facts or resolve the merits of a case." Whipple v. Am. Fork Irrigation Co., 910 P.2d 1218, 1220 (Utah 1996). Accordingly, a "12(b)(6) dismissal is a conclusion of law" that "we review for correctness." Id. "Also, 'a matter of statutory interpretation is a question of law that we review on appeal for correctness." ABCO Enters. v. Utah State Tax Comm'n, 2009 UT 36, ¶ 7, 211 P.3d 382 (quoting MacFarlane v. Utah State Tax Comm'n, 2006 UT 25, ¶ 9, 134 P.3d 1116) (alterations omitted).

ANALYSIS

T6 Because the district court dismissed Ms. Archuleta's negligent credentialing claim on statutory grounds, we examine the three statutes on which the district court based its decision. Since we determine that the plain language of the statutes does not bar the negligent credentialing claim, we need not address Ms. Archuleta's constitutional arguments. We also discuss our reasoning for recognizing a negligent credentialing cause of action in Utah.

I. THE PLAIN LANGUAGE OF UTAH CODE SECTION 58-135 DOES NOT BAR NEGLIGENT CREDENTIALING CLAIMS

T7 The plain language of Utah Code section 58-18-65 is clear. Read as a whole and in harmony with related provisions and chapters, it shows that the legislature did not intend to immunize hospitals from negligent credentialing claims brought by patients.

T8 When faced with a question of statutory interpretation, "'our primary goal is to evince the true intent and purpose of the Legislature" Duke v. Graham, 2007 UT 31, ¶ 16, 158 P.3d 540 (quoting State v. Martinez, 2002 UT 80, ¶ 8, 52 P.3d 1276). We do so by looking at the "best evidence of legislative intent, namely, the plain language of the statute itself." Id. (internal quotation marks omitted). As part of this "well-worn canon[ ] of statutory construction," we must read the plain language of the statute "as a whole." Id. (internal quotation marks omitted). Under this "whole statute" interpretation, State v. Maestas, 2002 UT 123, ¶ 54, 63 P.3d 621, we construe provisions "in harmony with other provisions in the same statute and 'with other statutes under the same and related chapters'" State v. Schofield, 2002 UT 132, ¶ 8, 63 P.3d 667 (quoting Lyon v. Burton, 2000 UT 19, ¶ 17, 5 P.3d 616). "We do so because 'a] statute is passed as a whole and not in parts or sections and is animated by one general purpose and intent. Consequently, each part or section should be construed in connection with every other part or section so as to produce a harmonious whole" Sill v. Hart, 2007 UT 45, ¶ 7, 162 P.3d 1099 (quoting Maestas, 2002 UT 123, ¶ 54, 63 P.3d 621).

T 9 Section 58-18-5 addresses the dissemination of health care information. The statute compels a health care facility to report certain events-such as termination of employment or restrictions of privileges for cause, violations of professional standards or ethics, and findings of incompetency-that affect a licensed health care provider's practice or status. See Utah Code Ann. § 58-13-5(8)(a) to (h) (2007). To foster the dissemination of this information, the legislature grants three types of immunity. The first type is found in subsection 6(a), which provides, "[alny person or organization furnishing information in accordance with this section in response to the request of the [Division of Occupational and Professional Licensing] or a board, or voluntarily, is immune from liability with respect to information provided in good faith and without malice...." Id. § 58-18-5(6)(a). The second type is found in subsection 6(b), which reads, "[the members of the board are immune from liability for any decisions made or actions taken in response to information acquired by the board if those decisions or actions are made in good faith and without malice...." Id. § 58-18-5(6)(b). The third type exists under subsection 7, the subsection at issue in this case. Subsection 7 states,

[ain individual who is a member of a hospital administration, board, committee, department, medical staff, or professional organization of health care providers is, and any hospital, other health care entity, or professional organization conducting or sponsoring the review, immune from lHiability arising from participation in a review of a health care provider's professional ethics, medical competence, moral turpitude, or substance abuse.

Id. § 58-18-5(7).

£10 By its purpose and plain language, section 58-18-5 is a peer review statute. Indeed, this court has previously concluded that the plain language of similar statutes "indicates that their purpose is to protect health care providers who furnish information regarding the quality of health care rendered by any individual or facility." Rees v. Intermountain Health Care, Inc., 808 P.2d 1069, 1078 (Utah 1991). Likewise, under the plain language of the statute, the legislature intended to immunize three classes of individuals from negligent credentialing claims brought by licensed health care providers ie., doctors. Subsection 6(a) provides immunity to those who furnish the information, subsection 6(b) shields those who make decisions in response to the information, and subsection 7 immunizes those who organize or sponsor the review of the information. This limited immunity is guaranteed so long as the acts are done without malice. See UCS 58-13-5. In short, the immunity contemplated under the statute operates between a doctor whose credentials are under review and the suppliers of information and decision makers; it does not contemplate immunity between a patient and a hospital.¹

II. THE PLAIN LANGUAGE OF UTAH CODE SECTION 58-18-4 DOES NOT BAR NEGLIGENT CREDENTIALING CLAIMS

111 Utah Code section 58-18-4 grants immunity to health care providers that sponsor or make decisions regarding the proper use of facilities, the quality and cost of health care, ethical standards, or performance of services. See Utah Code Ann. § 58-13-4(2) (2007). The legislature, however, expressly excepted patients' claims regarding care. "This section does not relieve any health care provider from liability incurred in providing professional care and treatment to any patient." Id. § 58-18-4(8).

1 12 In its effort to discount the import of this exception, St. Mark's Hospital argues that "St. Mark's is not sued ... for 'providing professional care and treatment'.... Instead, St. Mark's is sued for its credentialing decisions with regard to Dr. Halversen prior to the time that Dr. Halversen provided the 'professional care and treatment about which Plaintiff complains...." We reject this distinction. The credentialing determination is a decision regarding a doctor's fitness to provide patient care-and is clearly covered by the language of the exception that protects patients' claims regarding provision of that care. Ms. Archuleta's negligent credentialing claim is for alleged shortcomings in St. Mark's Hospital's review of Dr. Halver-sen's qualifications to provide treatment. Moreover, a negligent credentialing claim is not solely based on the qualifications of a health practitioner to provide treatment. The claim must also assert the element of damages. These damages arise from improper or substandard care. Claims of negligent credentialing and care, in the patient context, are thus not mutually exclusive.

13 Any argument that the exception provided in 58-18-4(8) should only apply to situations enumerated in that same section is also unavailing. This contention ignores the overlapping territory between St. Mark's Hospital's proposed broad reading of section 58-13-5 immunity and situations enumerated in section 58-13-4, which include: committee evaluations and determinations regarding the quality of health care; whether provided health care was necessary, appropriate or properly performed; ethical standards review; the diagnosis and treatment of patients within the state; ete. Subsection 58-13-4(8) indicates the legislature's intent to protect a patient's ability to recover damages from health care providers, despite the immunities provided. In discounting section 58-18-4(8), St. Mark's Hospital's reading would give the exception no effect. This is contrary to basic rules of statutory interpretation. See State v. Jeffries 2009 UT 57, ¶ 9, 217 P.3d 265 ("Statute[s] should be construed ... so that no part [or provision] will be inoperative or superfluous, void or insignificant, and so that one section will not destroy another." (internal quotation marks omitted)).

III THE PLAIN LANGUAGE OF UTAH CODE SECTION 26-25-14 DOES NOT BAR NEGLIGENT CREDENTIALING CLAIMS

114 Finally, Utah Code section 26-25-1 bolsters this plain language reading of limited immunity. Section 26-25-1, similar to sections 58-13-4 and 58-18-5, grants immunity for "(a) providing information or material authorized in this section; (b) releasing or publishing findings and conclusions of groups referred to in this section to advance health research and health education; or (c) releasing or publishing a summary of these studies in accordance with this chapter." Utah Code Ann. § 26-25-1(5) (2007). We have noted,

The purpose of th{is] statute[ ] is to improve medical care by allowing health-care personnel to reduce "morbidity or mortality" and to provide information to evaluate and improve "hospital and health care." Without the privilege, personnel might be reluctant to give such information, and the accuracy of the information and the effectiveness of the studies would diminish greatly.

Benson v. I.H.C. Hosps., Inc., 866 P.2d 537, 539 (Utah 1993).² Again, under the plain language of this section, the legislature's grant of immunity relates to the dissemination of information, not to patient care. Indeed, as the court of appeals recognized, "the [statute] was never intended to shield hospitals from potential liability or to provide hospitals protection from medical malpractice claims." Cannon v, Salt Lake Reg'l Med. Ctr., Inc., 2005 UT App 352, ¶ 23, 121 P.3d 74.

IV. NEGLIGENT CREDENTIALING IS A VALID CLAIM IN UTAH

115 A "substantial majority of the other common law states" recognize negligent credentialing as a viable claim. Larson v. Wasemiller, 738 NW.2d 300, 306-309 (Minn.2007) (surveying states that have adopted negligent credentialing claims and the legal basis for the cause of action). We agree with the analysis that negligent cere-dentialing is "simply the application of broad common law principles of negligence," id. at 307, and is a natural extension of torts such as negligent hiring. Id. at 308. There are strong policy reasons for recognizing the cause of action, including the foreseeability of harm to patients where hospitals fail to properly investigate a doctor's qualifications, see Johnson v. Misericordia Cmty. Hosp., 99 Wis.2d 708, 301 N.W.2d 156, 164 (1981), and the " 'superior position [of hospitals] to monitor and control physician performance." Domingo v. Doe, 985 F.Supp. 1241, 1245 (D.Haw.1997) (quoting Pedroza v. Bryant, 101 Wash.2d 226, 677 P.2d 166, 169 (1984)). We therefore formally recognize negligent credentialing as a valid common-law cause of action in Utah.

CONCLUSION

16 A comprehensive reading of section 58-13-5's language, in harmony with sections 58-13-4 and 26-25-1, demonstrates that the legislature did not intend to immunize negligent credentialing claims brought by patients. We also expressly hold that negligent credentialing is a valid common-law cause of action in Utah. We therefore reverse the district court's dismissal of the negligent credentialing claim and remand to the district court for further proceedings consistent with this opinion.

1 17 Justice PARRISH and Justice NEHRING concur in Chief Justice DURHAM's opinion.

1 . Utah Code section 26-25-3 (2007) provides that "(alll information, interviews, reports, statements, memoranda, or other data furnished by reason of this chapter, and any findings or conclusions resulting from those studies are privileged communications and are not subject to discovery, use, or receipt in evidence in any legal proceeding of any kind or character." While this provision prevents a patient from introducing this type of evidence in a negligent credentialing suit, there may still be a question of fact whether hospital administrators reasonably relied on the determination of the credentialing committee given independently available information.

2 . This case was interpreting a previous version of the statute, but the purpose remains the same.