Michigan Court Finds That “How a Doctor Interacts with Staff May Serve as the Basis for a Reasonable Belief that the Quality of Health Care is Being Affected”: A Summary of El-Khalil v. Oakwood Healthcare, Inc.
Dr. Ali El-Khalil was an independent podiatrist, who maintained privileges at several hospitals in Michigan owned by Oakwood Healthcare, Inc.1 In 2014, Dr. El-Khalil sued Oakwood Healthcare, Inc. and two physicians, alleging racial discrimination on the basis of his Arabic ethnicity in violation of the Elliott-Larsen Civil Rights Act (“ELCRA”), tortious interference with an advantageous business relationship, and defamation.2 Dr. El-Khalil claimed the physicians made false allegations against him because he asserted that other physicians were incompetent and engaged in criminal activity.3
Dr. Eli-Khalil also claimed that, in response to his allegations, Oakwood Hospital–Dearborn initiated administrative proceedings against him.4 After proceeding through peer review, Dr. El-Khalil was required to attend an anger-management program.5
Dr. El-Khalil successfully completed the program but asserted that the peer-review process and the resulting actions against him were malicious and made in bad faith.6 The trial court found that Oakwood Healthcare, Inc. and individual defendants were statutorily immune from liability and that Dr. El-Khalil had failed to state a discrimination claim under ELCRA.7 The case was dismissed on May 4, 2015.8
After the dismissal, the Vice Chief of Staff at Oakwood Hospital-Dearborn informed Dr. El-Khalil that the Medical Staff Peer Review Committee reviewed complaints from his colleagues regarding his behavior.9 Approximately one month later, the Oakwood Hospital-Dearborn denied Dr. El-Khalil’s reappointment application for clinical privileges on the basis of the complaints against him.10 Two other hospitals owned by Oakwood Healthcare, Inc. – Oakwood Dearborn, Oakwood Hospital– Southshore and Oakwood Hospital– Wayne – similarly denied Dr. El-Khalil’s reappointment application.11
In late June 2015, Dr. El-Khalil filed a second action, alleging breach of contract and unlawful retaliation in violation of the ELCRA as a result of his 2014 lawsuit. He alleged that his privileges at Oakwood Hospital– Southshore and Oakwood Hospital– Dearborn (“Defendants”) were not due to expire until November 2015 and that they had been suspended without proper procedures and notice.12 Defendants moved for summary disposition and claimed immunity under the Healthcare Quality Improvement Act and Michigan’s healthcare peer-review statute and that Dr. El-Khalil’s lawsuit failed to state a claim upon which relief could be granted.13 The trial court granted Defendants’ motion without specifying which statute or rule supported its decision.14 After the trial court’s order, the case embarked on a long procedural journey. Dr. El-Khalil appealed the trial court’s ruling, which was affirmed by the Michigan Court of Appeals.15 The Michigan Supreme Court then vacated the Court of Appeals’ opinion and remanded it for review against the procedural standards for immunity and release and failure to state a claim.16 Once again, the Court of Appeals held that the trial court’s dismissal was appropriate based on Dr. El-Khalil’s failure to state a claim and consequently declined to address whether dismissal was appropriate based on the grounds of immunity and release.17
Dr. El-Khalil appealed again, this time requesting that the Michigan Supreme Court review the Court of Appeals’ decision on the basis that, while the Court of Appeals dismissed the case for failure to state a claim, it had actually performed an analysis for summary judgment, which carries a higher burden for him, the plaintiff.18 The Michigan Supreme Court agreed. The Court held that the Court of Appeals erred in dismissing Dr. El-Khalil’s allegations for failure to present sufficient evidence of his claims, because at this stage in the litigation, he was only required to properly allege his claims.19 As a result, the Michigan Supreme Court reversed the decision of the Court of Appeals and remanded the case for consideration of Dr. El-Khalil’s claims.20
Finally, on November 14, 2019, the Court of Appeals re-reviewed the trial court’s ruling, finding that dismissal was appropriate on the grounds of immunity and release.21 While Dr. El-Khalil originally alleged that his privileges had been suspended without proper procedures and notice, he abandoned that claim. Instead, he alleged that Defendants breached the Medical Staff Bylaws by denying him privileges for reasons other than those related to the efficient delivery of quality patient care and professional ability and judgment.22 Article II, Section 2, Subsection C of Oakwood Healthcare’s Medical Staff Bylaws provided that membership or particular clinical privileges would not be denied “on the basis of any criteria unrelated to the efficient delivery of quality patient care in the hospital, to professional ability and judgment, or to the community need.”23 In response, Defendants argued they were immune from liability because Dr. El-Khalil’s application for privileges included a release of the defendant hospitals and employees, among others, from liability for statements made or actions taken in good faith and without malice in connection with consideration of applications for privileges.24 Dr. ElKhalil then argued that Defendants’ actions were malicious and not made in good faith.25 The Court of Appeals rejected Dr. El-Khalil’s argument, writing, “[H]ow a doctor interacts with staff may serve as the basis for a reasonable belief that the quality of health care is being affected, regardless of his or her record as a doctor in general.”26
Dr. El-Khalil submitted evidence in support of his claim. The evidence included (1) a letter from the Medical Staff Peer Review Committee stating he had failed to comply with the requirements of a focused physician practice evaluation; (2) numerous e-mails, text messages, and letters from colleagues, alleging unprofessional and threatening behavior; and (3) a memorandum from a Medical Senior Staff Coordinator, stating that Dr. El-Khalil had been the subject of disciplinary action due to his behavior.27 This evidence actually supported Defendants’ contention that Dr. El-Khalil was denied hospital privileges because of his threatening behavior. Ultimately, the Court of Appeals declined to accept Dr. El-Khalil’s allegations as true and dismissed them on the basis that Defendants were entitled to immunity under the terms of its Medical Staff Bylaws as well as state and federal laws providing immunity to individuals and entities engaged in professional review activities.28
1 El-Khalil v. Oakwood Healthcare, Inc., 504 Mich. 152, 155 (2019).
6 Id. at 155-156.
7 El-Khalil v. Oakwood Health Care, Inc., No. 329986, 2017 WL 1244207 (Mich. Ct. App. April 4, 2017) at *1.
8 El-Khalil v. Oakwood Health Care Systems, Inc., unpublished Order of the Third Judicial Circuit of Michigan, entered May 4, 2015 (Docket No. 14-010667-NO).
9 El-Khalil, 504 Mich. at 156.
12 Id. at 157.
15 Id. at 159.
19 Id.at 162 and 165-166.
20 Id.at 166.
21 El-Khalil v. Oakwood Health Care Inc., No. 329986, 2019 WL 6045564 (Mich. Ct. App. November 14, 2019) at *2.
23 Id. at *3.
27 Id. at *4.
28 Id. at *6-7.