louisiana peer review

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97 So.3d 604, 2011-85 (La.App. 3 Cir. 7/20/12)(Cite as: 97 So.3d 604, 2011-85 (La.App. 3 Cir. 7/20/12))

Court of Appeal of Louisiana,Third Circuit.

Tommie M. GRANGER, M.D.v.

CHRISTUS HEALTH CENTRAL LOUISIANA,et al.

No. 1185.July 20, 2012.

Background: Staff physician brought ac-tion against hospital alleging, inter alia,claims of negligent misrepresentation,fraud, and tortious interference with acontract. After granting a partial summary

judgment in favor of hospital and subse-quently dismissing physician's claims fordefamation and fraud, the Ninth JudicialDistrict Court, Parish of Rapides, No.211,938,George C. Metoyer, Jr., J., entered

judgment on jury verdict finding that hos-pital had made negligent misrepresenta-tions in its peer review action and conclud-ing that physician had suffered$2,900,000.00 in lost past income and$1,000,000.00 in general damages. Physi-cian and hospital appealed.

Holdings: The Court of Appeal, Peters, J.,held that:(1) hospital was not entitled to immunityunder the Health Care Quality ImmunityAct (HCQIA) and related state statute;(2) trial court did not abuse its discretionin allowing neurologist to testify as an ex-pert in peer review;(3) evidence supported finding that hospi-tal breached its contract with physician;(4) Louisiana Unfair Trade Practices andConsumer Protection Act (LUTPA) did notafford physician a remedy on the facts;(5) jury's determination that hospital negli-gently misrepresented its actions was notmanifestly erroneous;(6) physician failed to establish defama-tion and fraud claims against hospital; and(7) record did not support a $1,000,000.00general-damage award.

Affirmed as amended.

Thibodeaux, C.J., dissented and as-

signed written reasons.

West Headnotes

[1] Health 198H 274

198H Health 198HI Regulation in General 198HI(C) Institutions and Facilities 198Hk268 Staff Privileges andPeer Review 198Hk274k. Liability or im-

munity. Most Cited Cases

Hospital was not entitled to immunityunder the Health Care Quality ImmunityAct (HCQIA) and related state statute, inaction brought by staff physician againsthospital alleging, inter alia, claims of negli-gent misrepresentation, fraud, and tor-tious interference with a contract; peer re-view expert asserted that because of thepotential effect any disciplinary actionmight have on an individual physician, itwas extremely important that the peer re-

view agency follow the reasonablenessand notice requirements set forth in HC-QIA and its own internal rules and regula-tions, and according to expert, in the caseof physician, hospital did neither, and ex-pert also testified that the intent of the ini-tial summary suspension was suspectgiven the fact that it was purportedly im-posed because of the possibility of immi-nent danger to physician's patient, yet, as-suming physician needed direction on hisfailures in this regard, he received none,but instead, he was simply placed on sum-

mary suspension for 21 days and readmit-ted to full privileges without any remedialor corrective action being taken to correctthe behavior giving rise to the suspension.Health Care Quality Improvement Act of1986, 412(a), 42 U.S.C.A. 11112(a);LSAR.S. 13:3715.3(C).

2012 Thomson Reuters. No Claim to Orig. US Gov. Works.
http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=PROFILER-WLD&DocName=0176700001&FindType=hhttp://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=PROFILER-WLD&DocName=0138938401&FindType=hhttp://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=PROFILER-WLD&DocName=0153067001&FindType=hhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198Hhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198HIhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198HI(C)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198Hk268http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198Hk274http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198Hk274http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=198Hk274http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=1000546&DocName=42USCAS11112&FindType=L&ReferencePositionType=T&ReferencePosition=SP_8b3b0000958a4http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=1000011&DocName=LARS13%3A3715.3&FindType=Lhttp://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=PROFILER-WLD&DocName=0138938401&FindType=hhttp://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=PROFILER-WLD&DocName=0153067001&FindType=hhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198Hhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198HIhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198HI(C)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198Hk268http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=198Hk274http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=198Hk274http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=1000546&DocName=42USCAS11112&FindType=L&ReferencePositionType=T&ReferencePosition=SP_8b3b0000958a4http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=1000011&DocName=LARS13%3A3715.3&FindType=Lhttp://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=PROFILER-WLD&DocName=0176700001&FindType=h


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[2] Health 198H 274

198H Health 198HI Regulation in General

198HI(C) Institutions and Facilities 198Hk268 Staff Privileges andPeer Review 198Hk274k. Liability or im-munity. Most Cited Cases

Purpose of the Health Care Quality Im-munity Act (HCQIA) is to provide protec-tions for peer review of physicians' ac-tions, in an effort to reduce medical mal-practice, to improve the quality of medicalcare, and to prevent incompetent physi-cians' movements from state to statewithout disclosure of previous incompe-tent performance. Health Care Quality Im-provement Act of 1986, 402, 42 U.S.C.A. 11101.

[3] Health 198H 274

198H Health 198HI Regulation in General 198HI(C) Institutions and Facilities 198Hk268 Staff Privileges andPeer Review

198Hk274k. Liability or im-munity. Most Cited Cases

The Health Care Quality Immunity Act(HCQIA) was designed to promote thefrank exchange of information among pro-fessionals conducting peer review in-quiries without the fear of reprisals in civillawsuits. Health Care Quality ImprovementAct of 1986, 402, 42 U.S.C.A. 11101.

[4] Health 198H 274

198H Health 198HI Regulation in General 198HI(C) Institutions and Facilities 198Hk268 Staff Privileges andPeer Review 198Hk274k. Liability or im-munity. Most Cited Cases

Under the Health Care Quality Immu-nity Act (HCQIA), regardless of whetherthe disposition in a peer review action is

ultimately supported by the surroundingevidence, the agency responsible for thedisposition is insulated from liability aris-ing from that review if it complied with thereasonableness and notice requirementsof the Act; that is to say, HCQIA does notconfer absolute immunity to a peer reviewcommittee, but grants immunity onlywhen the statutory requirements are met.Health Care Quality Improvement Act of1986, 412(c), 42 U.S.C.A. 11112(c).

[5] Evidence 157 540

157 Evidence 157XII Opinion Evidence 157XII(C) Competency of Experts 157k540 k. Conduct of business,custom, or usage. Most Cited Cases

Trial court did not abuse its discretionin allowing neurologist to testify as an ex-pert in peer review, in action brought bystaff physician against hospital alleging,inter alia, claims of negligent misrepresen-

tation, fraud, and tortious interferencewith a contract; neurologist was a memberof the Board of Directors of the Associa-tion of American Physicians and Surgeonsand served on its Committee to CombatSham Peer Review, he was editor-in-chiefof the Association of American Physiciansand Surgeons' peer review medical jour-nal, and he had published numerous pa-pers and given many lectures on peer re-view. LSAC.E. art. 702.

[6] Appeal and Error 30 970(2)

30 Appeal and Error 30XVI Review 30XVI(H) Discretion of Lower Court 30k970 Reception of Evidence 30k970(2) k. Rulings on ad-missibility of evidence in general. MostCited Cases
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A trial court's determination ofwhether an expert meets applicable quali-fications and whether he or she is compe-

tent to testify in a specialized area is sub-ject to the abuse of discretion standard ofreview. LSAC.E. art. 702.

[7] Appeal and Error 30 1067

30 Appeal and Error 30XVI Review 30XVI(J) Harmless Error 30XVI(J)18 Instructions 30k1067 k. Failure or refusalto charge. Most Cited Cases

Any error from not including a jury in-struction stating that no damages couldbe awarded for hospital's initial summarysuspension of staff physician's clinicalprivileges was harmless, in action broughtby physician against hospital alleging, in-ter alia, claims of negligent misrepresenta-tion, fraud, and tortious interference witha contract; in opening statement, physi-cian's counsel admonished the jury that itcould not decide the appropriateness ofthe summary suspension, and in its clos-

ing statement hospital's counsel admon-ished the jury, without objection, that itcould not award damages for the sum-mary suspension.

[8] Health 198H 269

198H Health 198HI Regulation in General 198HI(C) Institutions and Facilities 198Hk268 Staff Privileges andPeer Review 198Hk269 k. In general.

Most Cited Cases

A contractual relationship existed be-tween hospital and staff physician, for pur-poses of breach of contract claim broughtby physician against hospital; hospital pro-vided physician care to its patientsthrough its medical staff, in exchange for

staff privileges, the physician must agreeto abide by certain specific terms of ethi-cal and religious behavior particular to aCatholic-run hospital, Bylaws controlled

the application process, and this processeffected the four elements necessary toform a contract. LSAC.C. art. 1906.

[9] Health 198H 273

198H Health 198HI Regulation in General 198HI(C) Institutions and Facilities 198Hk268 Staff Privileges andPeer Review 198Hk273 k. Suspension ortermination of privileges; discipline. MostCited Cases

Evidence supported finding that hospi-tal breached its contract with staff physi-cian; hospital provided physician care toits patients through its medical staff, By-laws controlled the application process,this process effected the four elementsnecessary to form a contract, it was im-plicit that hospital would provide a staffphysician the procedural protections af-forded under the Bylaws, peer review ex-pert asserted that because of the potentialeffect any disciplinary action might haveon an individual physician, it was ex-tremely important that the peer reviewagency follow the reasonableness and no-tice requirements set forth in its own inter-nal rules and regulations, and according toexpert, in the case of physician, hospitaldid not.

[10] Contracts 95 1

95 Contracts

95I Requisites and Validity 95I(A) Nature and Essentials inGeneral 95k1 k. Nature and grounds ofcontractual obligation. Most Cited Cases

Four elements are required for forma-tion of a contract: capacity, consent, cer-

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tain object, and lawful cause.

[11] Antitrust and Trade Regulation

29T 272

29T Antitrust and Trade Regulation 29TIII Statutory Unfair Trade Practicesand Consumer Protection 29TIII(D) Particular Relationships 29Tk272 k. Other particular rela-tionships. Most Cited Cases

Even assuming staff physician hadstanding to bring a Louisiana Unfair TradePractices and Consumer Protection Act(LUTPA) claim against hospital, LUTPA did

not afford physician a remedy on the factsin the case; peer review action under scru-tiny in the litigation was nothing morethan a disciplinary action authorized bythe Bylaws that both the hospital andphysician agreed to be bound by, and thefact that an underlying aspect of the disci-plinary procedure may have been physi-cian's perceived disloyalty to hospital didnot constitute an unfair trade practice un-der LUTPA. LSAR.S. 51:1401 et seq.

[12] Fraud 184 58(1)

184 Fraud 184IIActions 184II(D) Evidence 184k58 Weight and Sufficiency 184k58(1) k. In general.Most Cited Cases

Jury's determination that hospital neg-ligently misrepresented its actions duringstaff physician's disciplinary proceedingswas not manifestly erroneous; record con-tained a picture of an investigative

process by all those involved on behalf ofhospital which ignored its own rules andregulations as set forth in its Bylaws,seemed to stonewall any efforts by physi-cian to provoke a hearing to air the com-plaints and give him an opportunity to de-fend himself, involved the transmission ofcorrespondence to physician concerning

resolutions passed and actions taken bythe Medical Executive Committee, BoardExecutive Committee, and Board of Direc-tors which inaccurately depicted those

resolutions, and ultimately placed physi-cian in a position of having to allow hisstaff privileges to lapse or risk being re-

jected. LSAC.C. arts. 2315, 2316.

[13] Fraud 184 13(3)

184 Fraud 184I Deception Constituting Fraud,and Liability Therefor 184k8 Fraudulent Representations 184k13 Falsity and Knowledge

Thereof 184k13(3) k. Statementsrecklessly made; negligent misrepresenta-tion.Most Cited Cases

To recover under a theory of negligentmisrepresentation, there must be a legalduty on the part of the defendant to sup-ply correct information, there must be abreach of that duty, and the breach musthave caused plaintiff damage. LSAC.C.arts. 2315,2316.

[14] Negligence 272 1692

272 Negligence 272XVIII Actions 272XVIII(D) Questions for Jury andDirected Verdicts 272k1692 k. Duty as question offact or law generally. Most Cited Cases

Whether the defendant owes a duty isa question of law.

[15] Trial 388 168

388 Trial 388VI Taking Case or Question from

Jury 388VI(D) Direction of Verdict 388k167 Nature and Grounds 388k168 k. In general. Most
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Page 5


Cited Cases

A directed verdict is the proper proce-dural device to foreclose a jury's decision

on an issue after the close of evidence.LSAC.C.P. art. 1810.

[16] Trial 388 168

388 Trial 388VI Taking Case or Question from

Jury 388VI(D) Direction of Verdict 388k167 Nature and Grounds 388k168 k. In general. MostCited Cases

A trial court may not grant a directedverdict on its own motion but must do soon the motion of one of the litigants.

[17] Fraud 184 64(1)

184 Fraud 184IIActions 184II(F) Trial 184k64 Questions for Jury 184k64(1) k. In general.Most Cited Cases

Libel and Slander 237 123(1)

237 Libel and Slander 237IV Actions 237IV(E) Trial, Judgment, and Re-view 237k123 Questions for Jury 237k123(1) k. In general.Most Cited Cases

Trial court erred in striking staff physi-

cian's defamation and fraud claims againsthospital after the close of the evidence,without any motion from hospital; issuesshould have been submitted to the jury.

[18] Libel and Slander 237 112(1)

237 Libel and Slander

237IV Actions 237IV(C) Evidence 237k112 Weight and Sufficiency 237k112(1) k. In general.

Most Cited Cases

Staff physician failed to establishdefamation claim against hospital; al-though physician asserted at trial that hissuspension and hospital's subsequent in-vestigation harmed his reputation in thecommunity, he did not introduce any evi-dence showing how hospital had publishedany defamatory statements about him.

[19] Libel and Slander 237 1

237 Libel and Slander 237I Words and Acts Actionable, andLiability Therefor 237k1 k. Nature and elements ofdefamation in general. Most Cited Cases

There are four elements a plaintiff isrequired to prove in order to be successfulin a defamation case: (1) a false anddefamatory statement concerning an-other; (2) an unprivileged publication to athird party; (3) fault on the part of the

publisher; and (4) resulting injury.

[20] Fraud 184 27

184 Fraud 184I Deception Constituting Fraud,and Liability Therefor 184k27 k. Fraudulent representa-tions or concealment as to particular facts.Most Cited Cases

Staff physician failed to establish fraudclaim against hospital; there was no evi-

dence that any representative of hospitalmisrepresented the truth in the disci-plinary investigation of physician, therewas no evidence that hospital's Chief Med-ical Officer suppressed the truth when hereported to the Medical Executive Commit-tee, and once the initial meeting with theMedical Executive Committee terminated,

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westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=237k112http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=237k112(1)http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=237k112(1)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=237http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=237Ihttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=237k1http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=237k1http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=184http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=184Ihttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=184k27http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=184k27


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the future events could best be describedas negligent in nature.

[21] Damages 115 96

115 Damages 115VI Measure of Damages 115VI(A) Injuries to the Person 115k96 k. Discretion as toamount of damages. Most Cited Cases

Damages 115 104

115 Damages 115VI Measure of Damages 115VI(B) Injuries to Property

115k104 k. Discretion as toamount of damages. Most Cited Cases

Damages 115 119

115 Damages 115VI Measure of Damages 115VI(C) Breach of Contract 115k119 k. Discretion as toamount of damages. Most Cited Cases

A judge or jury is given great discretionin its assessment of quantum, both gen-eral and special damages.


30 Appeal and Error 30XVI Review 30XVI(I) Questions of Fact, Ver-dicts, and Findings 30XVI(I)2 Verdicts 30k1004 Amount of Recov-ery 30k1004(1) k. In general.

Most Cited Cases

The role of an appellate court in re-viewing a general damages award, onewhich may not be fixed with pecuniary ex-actitude, is not to decide what it considersto be an appropriate award, but rather toreview the exercise of discretion by the

trier of fact.


30 Appeal and Error 30XVI Review 30XVI(I) Questions of Fact, Ver-dicts, and Findings 30XVI(I)2 Verdicts 30k1004 Amount of Recov-ery 30k1004(1) k. In general.Most Cited Cases

Appeal and Error 30 1151(2)

30 Appeal and Error 30XVII Determination and Dispositionof Cause 30XVII(C) Modification 30k1151 Modification as toAmount of Recovery 30k1151(2) k. Reducingamount of recovery. Most Cited Cases

Appeal and Error 30 1151(3)

30 Appeal and Error 30XVII Determination and Disposition

of Cause 30XVII(C) Modification 30k1151 Modification as toAmount of Recovery 30k1151(3) k. Increasingamount of recovery. Most Cited Cases

Before an appellate court can disturban award made by a factfinder, the recordmust clearly reveal that the trier of factabused its discretion in making its award;only after making the finding that therecord supports that the lower court

abused its much discretion can the appel-late court disturb the award, and then onlyto the extent of lowering it or raising it tothe highest or lowest point which is rea-sonably within the discretion afforded thatcourt.
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aw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVIhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVI(I)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVI(I)2http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1004http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1004(1)http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=30k1004(1)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVIhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVI(I)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVI(I)2http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1004http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1004(1)http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=30k1004(1)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVIIhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVII(C)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1151http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1151(2)http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=30k1151(2)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVIIhttp://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30XVII(C)http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1151http://www.westlaw.com/KeyNumber/Default.wl?rs=dfa1.0&vr=2.0&CMD=KEY&DocName=30k1151(3)http://www.westlaw.com/Digest/Default.wl?rs=dfa1.0&vr=2.0&CMD=MCC&DocName=30k1151(3)


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Page 7


[24] Damages 115 5

115 Damages 115INature and Grounds in General

115k5 k. General and special dam-age. Most Cited Cases

Damages 115 37

115 Damages 115III Grounds and Subjects of Com-pensatory Damages 115III(A) Direct or Remote, Contin-gent, or Prospective Consequences orLosses 115III(A)1 In General

115k35 Pecuniary Losses 115k37 k. Loss of earn-ings or services.Most Cited Cases

Damages 115 43

115 Damages 115III Grounds and Subjects of Com-pensatory Damages 115III(A) Direct or Remote, Contin-gent, or Prospective Consequences orLosses 115III(A)1 In General

115k41 Expenses 115k43 k. Medical treat-ment and care of person injured. MostCited Cases

Special damages are those whichhave a ready market value, such that theamount of damages theoretically may bedetermined with relative certainty, includ-ing medical expenses and lost wages.


30 Appeal and Error 30XVI Review 30XVI(I) Questions of Fact, Ver-dicts, and Findings 30XVI(I)2 Verdicts 30k1004 Amount of Recov-ery

30k1004(6) ParticularCases and Items 30k1004(8) k. Per-sonal injuries.Most Cited Cases

In reviewing a special damage award,an appellate court must satisfy a two-stepprocess based on the record as a whole:there must be no reasonable factual basisfor the trial court's conclusions, and thefactual finding must be clearly wrong.

[26] Damages 115 57.15

115 Damages 115III Grounds and Subjects of Com-

pensatory Damages 115III(A) Direct or Remote, Contin-gent, or Prospective Consequences orLosses 115III(A)2 Mental Suffering andEmotional Distress 115k57.13 Negligent Inflic-tion of Emotional Distress 115k57.15 k. Nature ofconduct. Most Cited Cases

General damages, including damagesfor embarrassment, humiliation, mental

anguish, and worry, may be recovered fornegligent misrepresentation. LSAC.C. art.2315.


30 Appeal and Error 30XVII Determination and Dispositionof Cause 30XVII(C) Modification 30k1151 Modification as toAmount of Recovery 30k1151(2) k. Reducing

amount of recovery. Most Cited Cases

Fraud 184 62

184 Fraud 184IIActions 184II(E) Damages

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184k62 k. Amount awarded.Most Cited Cases

Record did not support a

$1,000,000.00 general-damages award tostaff physician with regard to negligentmisrepresentation claim against hospital,and thus, appellate court would reducethe general damage award to$100,000.00.

*608 Roy C. Cheatwood, Donna D.Fraiche, Aubrey B. Hirsch, Jr., Baker,Donelson, Bearman, Caldwell & Berkowitz,New Orleans, LA, forDefendant/Appellant/Appellee, ChristusHealth Central Louisiana d/b/a Christus St.Frances Cabrini Hospital.

Jimmy R. Faircloth, Jr., Barbara Bell Melton,Leah M. Penny, The Faircloth Law Group,LLC, Alexandria, LA, for *609 Plaintiff/Ap-pellee/Appellant, Tommie M. Granger,M.D.

Court composed of ULYSSES GENETHIBODEAUX, Chief Judge, and SYLVIA R.COOKS, OSWALD A. DECUIR, JIMMIE C.PETERS, and SHANNON J. GREMILLION,

Judges.

PETERS, J.**1 Both the plaintiff, Dr. Tommie M.

Granger, and the defendant, ChristusHealth Central Louisiana, appeal a trialcourt judgment based on a jury damageaward of $3,900,000.00 to Dr. Granger.For the following reasons, we amend thetrial court judgment to reverse the jury'sfinding of a violation of the Louisiana Un-fair Trade Practices and Consumer Protec-tion Act, amend the general damages

award by reducing it to $100,000.00, andamend the special damage award by re-ducing it to $2,894,000.00. We affirm thetrial court judgment in all other respects.

DISCUSSION OF THE RECORDPreIncident History

Resolution of the issues raised in the

appeal now before this court involves ananalysis of the professional relationshipexisting between a hospital and one of itsstaff physicians. This particular case is

fact-intensive and involves the interpreta-tion of the hospital's written proceduresversus the procedure actually used to dis-cipline Dr. Granger. In large part, it in-volves a determination of the due processrights owed a physician when the hospitalchooses to effect its discipline procedureagainst that physician.

Christus Health Central Louisiana is apublic health provider doing business asChristus St. Frances Cabrini Hospital inAlexandria, Louisiana. For the purpose of

clarity in this opinion, we will refer to thedefendant, hereinafter, as Cabrini Hospi-tal. The rights, privileges, and responsibili-ties of the physicians associated withCabrini Hospital are governed by a set ofwritten rules, entitled BYLAWS OF THEMEDICAL STAFF (Bylaws), containing sev-enteen articles, with sections and subsec-tions to each article. Unless otherwisespecifically stated, reference herein to anArticle will be a reference to an article inthe Bylaws.

**2 The general definitions applicableto the hospital/physician relationship arefound in Article I. Article I, Section 2 de-fines the medical staff of the hospital asincluding all medical, osteopathic, dental,oral surgery and podiatric physicians hold-ing unlimited licenses from the appropri-ate Louisiana State licensure board whoare privileged to attend patients in theHospital. Article I, Section 3 recognizesthe governing board of the hospital as theultimate authority in hospital/physician is-sues. In the case of Cabrini Hospital, this

governing board is its Board of Directors.Article II establishes five categories ofmedical staff membership at Cabrini Hos-pital: active, associate, courtesy, hon-orary, and affiliate. One of the permanentcommittees created by Article XI, Section5(1), and recognized in Article I, Section 4as the executive committee of the medical
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Page 9


staff, is the Medical Executive Committee.The actions of this Medical Executive Com-mittee in relation to this litigation are criti-cal to the analysis herein.

Articles II through VI provide a detailedprocess whereby a physician receives hos-pital privileges as a member of the medi-cal staff so that he or she may treat pa-tients at the hospital. Article VI providesthat reappointment to the medical staff isnot automatic and that reappointment isfor a maximum period of two years. Fur-thermore, Article VII provides a detailedprocess by which a physician's hospitalprivileges can be suspended or termi-nated.

*610 The plaintiff in this litigation, Dr.Granger, is an Alexandria, Louisiana car-diovascular surgeon who had originally ac-quired hospital privileges as a member ofthe active Medical Staff at Cabrini Hospitalin 1996. He renewed his hospital privi-leges at Cabrini Hospital without any diffi-culty each time it was necessary between1996 and the December 2002 incident giv-ing rise to this **3 litigation. In Decemberof 2002, he was in good standing withCabrini Hospital, and his hospital privi-

leges were not subject to renewal untilJuly 30, 2003.

From a personality standpoint, Dr.Granger could best be described as an in-tense individual who was sometimes diffi-cult to work with. According to Dr. John Si-moneaux, a Pineville, Louisiana psycholo-gist who examined Dr. Granger on March7, 2000, in relation to a child custody mat-ter and was one of the many professionalswho testified at trial, Dr. Granger is a pas-sive-aggressive individual who has a ten-

dency to be irritable, sullen, argumenta-tive, and obnoxious.

When he first acquired Cabrini Hospitalprivileges, Dr. Granger was associatedwith MacArthur Surgical Clinic (SurgicalClinic) in Alexandria and remained so until

he left the Surgical Clinic in mid2002. Ac-cording to Dr. James Driscoll Knoepp, acardiovascular surgeon associated withthe Surgical Clinic during the same time

period as Dr. Granger, there were mo-ments of friction between Dr. Granger andthe other physicians with whom heworked.

Dr. Knoepp testified that in June of2001, the Surgical Clinic partners causedDr. Granger to undergo a psychologicalevaluation based on complaints fromsome of the clinic's professional staff. Dr.Knoepp also testified that a November 16,2001 incident at Rapides Regional MedicalCenter (Rapides Regional), another health

care provider in Alexandria, resulted in Dr.Granger taking a voluntary leave of ab-sence from that hospital and undergoing aphysical examination, a neurological ex-amination, and a psychiatric examination.

The Surgical Clinic suspended Dr.Granger's privileges during the leave ofabsence, then reinstated them when hereturned to Rapides Regional.

Dr. Knoepp also testified that on May9, 2002, the physicians at the SurgicalClinic caused a letter to be sent to Dr.

Granger instructing him to enroll for a **4comprehensive assessment with thePhysicians' Health Foundation of Louisiana(Physicians' Health Foundation).FN1 Dr.Knoepp explained that this action was pre-cipitated in part by an internal disputeconcerning the finances of the SurgicalClinic and Dr. Granger's unwillingness tocooperate with the other physicians in ad-dressing this dispute. Dr. Granger refusedto undergo a fourth psychological evalua-tion in just over two years and left the Sur-gical Center. Still, Dr. Knoepp testified that

he was personally satisfied with the out-come of the June 2001 mandated psycho-logical evaluation and, given his close per-sonal relationship with Dr. Granger, hetook no part in the investigations ulti-mately giving rise to this litigation.

FN1. The Physicians' Health Foun-



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dation offers confidential assis-tance to physicians who are suffer-ing from substance abuse, depres-sion, anxiety, or other disruptive

behavioral patterns.

Dr. Granger did not necessarily dis-agree with Dr. Simoneaux's description ofhis intense nature. He testified at trial thatthe June 2001 referral arose because, atthat time, he was involved in a heated di-vorce and custody matter. He compliedwith his former partners' mandate be-cause he understood that they were con-cerned his marital difficulties were sub-

jecting him to excess stress that might im-pact his *611 practice. According to Dr.

Granger, he underwent a two-day evalua-tion and the psychologist found him to befree of any psychiatric, substance abuse,or personality problems.

With regard to the incident at RapidesRegional referred to by Dr. Knoepp, Dr.Granger testified that he agreed to obtaina general physical examination and to beexamined by a neurologist and a psychia-trist of the hospital's choice. Again, thesubsequent tests revealed no problemsthat would affect his ability to perform his

professional duties.

**5 Although he had no difficulty inrenewing his hospital privileges at CabriniHospital between 1996 and December of2002, Dr. Granger's intense personalitycaused his relationship with Cabrini Hospi-tal during that period to sometimes beless than smooth. According to Dr. MichaelFinley, Cabrini Hospital's Chief Medical Of-ficer FN2 from May of 2001 through May of2003, Dr. Granger was constantly criticalof the Cabrini Hospital nursing staff and

equipment and often made unsolicitedsuggestions concerning the improvementof patient care. Dr. Granger confirmed Dr.Finley's assertions on this point and ac-knowledged that he had difficulties overthe years with Cabrini Hospital's equip-ment as well as the personnel assigned tohis patients.

FN2. Despite holding the position ofChief Medical Officer, Dr. Finleyhad no medical license to practice

in Louisiana and, obviously, had nohospital privileges at Cabrini Hospi-tal.

In mid2002, and while still maintain-ing privileges at Cabrini Hospital, Dr.Granger accepted the position of MedicalDirector for Cardiovascular Services atRapides Regional. Even before assumingthis position at Rapides Regional, Dr.Granger had begun referring his high-riskpatients to that facility for surgical proce-dures and treatment. Dr. Finley testifiedthat Dr. Granger's activities in referringpotential Cabrini Hospital patients to anyother hospital was not only unacceptableto him, but that Stephen Frances Wright,Cabrini Hospital's Chief Executive Officer,had expressed his frustration to Dr. Finleyconcerning Cabrini Hospital's loss of pa-tients by Dr. Granger's referral elsewhere.

Incident HistoryWith that general background, we turn

to the incident that gave rise to this litiga-tion. On December 18, 2002, one of Dr.Granger's patients at Cabrini **6 Hospital,an almost ninety-year-old male, had un-dergone a carotid endarterectomy FN3 andwas awaiting open-heart surgery involvinga bypass procedure that was scheduledfor the next day. Shortly before 4:00 a.m.on December 18, Amy McKithen, one ofthe nurses at the hospital, telephoned Dr.Granger and reported that the patient washaving difficulty urinating and that therewas drainage at the site of the surgical in-tervention in the neck. Dr. Granger testi-fied that he authorized the nurse to insert

a Foley catheter to resolve the urinaryproblem, instructed her to let the incisionsite drain, and instructed her to call him ifthe patient began experiencing any respi-ratory problems.

FN3. This procedure involved a sur-
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gical intervention in the neck de-signed to maximize the blood flowthrough the carotid artery duringthe patient's scheduled bypass

surgery.

Kimberly Renee Fannin Trissler,FN4 an-other nurse-employee of Cabrini Hospital,relieved Ms. McKithen at 7:00 a.m. on De-cember 18. She testified at trial that Ms.McKithen related her conversation with Dr.Granger to her before leaving work. WhenMs. Trissler reviewed the *612 patient'schart at 7:30 a.m., she found no notationof respiratory distress, and the only nota-tion concerning the incision site in theneck was that it was swollen and bruised.

In fact, the patient's chart contained no in-dication that there had been drainagefrom that incision during the night. Ms.

Trissler observed no additional swelling inthe patient's neck area from 10:00 a.m.until 1:00 p.m. and, when she removedthe dressing to clean and air the wound at1:00 p.m., there was still no evidence ofdistress. However, according to Ms.

Trissler, things took a turn for the worse at2:00 p.m., when the patient began to com-plain of shortness of breath despite anoxygen level that appeared to be within

normal limits.

FN4. Ms. Trissler is referred tothroughout the record as Ms. Fan-nin. However, when she testified,she identified herself as Ms.

Trissler.

**7 At approximately 2:30 p.m., Ms.Trissler decided to call Dr. Granger and re-port the respiratory problem. However, be-fore she made the telephone call, she ob-served Dr. Robert Freedman, an Alexan-

dria, Louisiana cardiologist, standing atthe nurses' station. Instead of telephoningDr. Granger, she asked him to examinethe patient.

Dr. Freedman was the patient's cardi-ologist and had referred him to Dr.

Granger for surgery. When he examinedthe patient, Dr. Freedman observed thatthe patient had developed a largehematoma FN5 at the incision point in his

neck but was not in respiratory distress.Concluding that there existed a potentialfor significant complications if the pa-tient's problems were not addressed im-mediately, Dr. Freedman instructed Ms.

Trissler to telephone Dr. Granger. WhenMs. Trissler expressed concern over Dr.Granger's reaction if she were to tele-phone him, Dr. Freedman volunteered tomake the call. Dr. Freedman testified thatwhen he telephoned Dr. Granger and in-formed him of the developments with thepatient, Dr. Granger responded by stating

that he would come to Cabrini Hospital im-mediately.

FN5. An area of accumulated bloodunder the skin and muscular tissue.

Dr. Granger testified that when he re-ceived Dr. Freedman's telephone call, hehad just completed one coronary bypasssurgical procedure at Rapides Regionaland was in the final steps of scrubbing upto begin a second surgical procedure onanother patient who was already under

anesthesia. Initially, after receiving Dr.Freedman's call, Dr. Granger telephonedCabrini Hospital to see if anyone wasavailable in the operating room to takecare of the problem, but when he found noone available, he left his already-anaes-thetized patient and drove to Cabrini Hos-pital.

**8 Ms. Trissler testified that after Dr.Freedman made the telephone call to Dr.Granger, he instructed the nurses to makesure the documentation was in order be-

fore Dr. Granger's arrival because other-wise, it won't be pretty. She testifiedthat Dr. Granger walked onto the hall asshe walked out of the patient's room, andshe heard him slam the door from thestairway. She asserted that Dr. Grangerwas angrybitching and complainingand griping and cussing. According to Ms.

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Trissler, Dr. Granger commented aboutthe patient he had waiting at Rapides Re-gional and suggested that the nurses atCabrini Hospital were incompetent and

stupid. She then left to retrieve a surgicaltray for the doctor.

When Ms. Trissler returned to the pa-tient's room, Dr. Granger was already inthe process of removing a blood clot fromthe patient's neck with his fingers. Shesuggested that Dr. Granger was still com-plaining of incompetent nursing care, butshe toned him out. She did observe thatthe patient was awake and alert duringthe *613 procedure. According to Ms.

Trissler, the patient's incision was still ooz-

ing blood when she assisted in movinghim to the Intensive Care Unit (ICU) of thehospital. Ms. Trissler acknowledged at trialthat this was the only unprofessional en-counter she ever experienced with Dr.Granger.

Evelyn Lacombe was another nurseworking the floor on the afternoon of De-cember 18, 2002. She was not assigned tomonitor Dr. Granger's patient, but hadseen him at mid-morning and observed nodistress. She testified that while she would

have had no problem placing the tele-phone call to Dr. Granger pursuant to Dr.Freedman's instruction, she was awarethat Dr. Granger had a propensity to inter-act angrily with people. She also noted inher testimony that Dr. Freedman admon-ished the staff to make sure the patient'sfile was properly documented before Dr.Granger's arrival.

**9 Ms. Lacombe testified that

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