Dallas, TX - A Texas judge has upheld an earlier ruling against the Presbyterian Hospital of Dallas and three of its cardiologists but reduced to $22.5 million the overall damage award originally granted to a fourth cardiologist, Dr Lawrence Poliner. A jury had earlier decided on the princely sum of $366 million for Poliner after finding in favor of his claims against Presbyterian Hospital and the three physicians on charges of breach of contract, defamation, business disparagement, tortious interference with a contract, and intentional infliction of emotional distress.

The defendants are appealing the decision to the United States Court of Appeals for the Fifth Circuit, the hospital announced today.

The case dates back to 1998, when Poliner's cath lab privileges were suspended after a hospital peer-review process concluded that he should voluntarily stop performing cardiac catheterizations due to concerns about his safety record and technique. But Poliner, who sued in 2000, challenged that the so-called peer-review process had been biased, since the panel conducting his review comprised cardiologists competing for patients and referrals at the same hospital. His original lawsuit named 10 physicians as defendants but was ultimately reduced to Dr James Knochel, internal medicine chair, Dr Charles Levin, head of the cardiac catheterization lab, and Dr John Harper, chief of cardiology.

Poliner, 60, a long-time cardiologist in the state of Texas, had first opened an office in the professional building at Presbyterian one year before his suspension. In his lawsuit he charged that, in doing so, he had fostered resentment among other cardiologists in the hospital.

The original August 2004 jury decision had found in favor of Poliner's claims and required $141 million to be paid by Knochel, $32 million each from Harper and Levin, and $161 million from the hospital itself. In appealing the court's decision, the hospital and defendants had sought to reduce the overall damage award to less than $1 million, but United States District Judge for the Northern District of Texas Jorge A Solis rejected their demands for a new trial and instead reduced the overall damage award to $22.54 million. This amount reflects noneconomic actual damages, lost earnings, punitive damages, and pre- and postjudgment interest, a hospital spokesperson confirmed.

In a press release, Poliner's lawyer for the appeal, Mike Lynn, said he and Poliner are "thrilled" by the judge's decision. "We believe that $22.54 million is a substantial damage award to compensate a victim of defamation from a conservative and thoughtful court. We expected the reduced award but feel that it was critical that the jury verdict vindicate Dr Poliner and through him the other doctors who have been abused by baseless peer reviews."

Contacted by heartwire, a spokesperson from Texas Health Resources (THR), of which Presbyterian Hospital is a member, said that the hospital system "believes it has strong legal positions in this matter and, more important, believes that protecting the integrity of physician peer review is crucial to improving quality and patient safety." THR announced it would be appealing the latest court decision. THR president and CEO Doug Hawthorne is quoted in a statement saying: "This is a matter of principle, not just of business practices. It goes to the heart of physicians' accountability and responsibility. On behalf of the physicians who practice on the medical staffs of THR hospitals, THR will take this as far as it needs to go to affirm the responsibility and accountability physicians have to one another and to their patients."

The Poliner case has put hospital peer-review processes in the spotlight and prompted a recent editorial in the summer 2006 issue of the Journal of American Physicians and Surgeons [1]. In it, editor-in-chief Dr Lawrence R Huntoon (Tucson, AZ) calls it "one of the most egregious cases of sham peer review in recent history."

As Huntoon details in his editorial, the American Association of Physicians and Surgeons (AAPS)—an organization composed primarily of private physicians and dedicated to "supporting the principles of the free market in medical practice"—actually filed a complaint with the Texas State Board of Medical Examiners in March 2006 against the three physicians who were the defendants in the Poliner case, alleging that "those who conduct or participate in sham peer review are engaging in unethical and/or professional misconduct," and that this should not be tolerated.

In response, the Texas Board stated that no investigation was filed because the actions the AAPS was complaining about "did not fall below the acceptable standard of care and did not rise to the level of a violation" of the Medical Practice Act.

"Therefore, at least in Texas, sham peer review appears to be officially within the accepted standard of care," Huntoon writes.