ROBERT H. MEYERS, M.D., Individually v. Columbia/hca Healthcare Corporation

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RECOMMENDED FOR FULL-TEXT PUBLICATION
Pursuant to Sixth Circuit Rule 206
ELECTRONIC CITATION: 2003 FED App. 0298P (6th Cir.)
File Name: 03a0298p.06
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
_________________
ROBERT H. MEYERS, M.D.,
Individually and as a
Partnership; MARY MEYERS,
M.D., Individually and as a
Partnership,
Plaintiffs-Appellants/
Cross-Appellees,
v.
COLUMBIA/HCA
HEALTHCARE CORPORATION,
et al.,
Defendants-Appellees/
Cross-Appellants.
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Nos. 01-6190/6217
Appeal from the United States District Court
for the Western District of Kentucky at Bowling Green.
No. 97-00219—Joseph H. McKinley, Jr., District Judge.
Argued: May 2, 2003
Decided and Filed: August 20, 2003
2 Meyers, et al. v. Columbia/HCA
Healthcare Corp., et al.
Nos. 01-6190/6217
*The Honorable Robert H. Cleland, United States District Judge for
the Eastern District of Michigan, sitting by designation.
Before: CLAY and GIBBONS, Circuit Judges;
CLELAND, District Judge.*
_________________
COUNSEL
ARGUED: Tom Curtis, CURTIS & KIRKPATRICK,
Pasadena, California, for Appellants. Charles J. Cronan IV,
STITES & HARBISON, Louisville, Kentucky, for Appellees.
ON BRIEF: Tom Curtis, CURTIS & KIRKPATRICK,
Pasadena, California, for Appellants. Charles J. Cronan IV,
Margaret R. Appenfelder, STITES & HARBISON,
Louisville, Kentucky, for Appellees.
_________________
OPINION
_________________
CLELAND, District Judge. Plaintiffs-appellants Dr.
Robert Meyers (“Meyers”) and his wife, Dr. Mary Meyers,
initiated this action against multiple defendants after the
Board of Trustees of Logan Memorial Hospital denied
Meyers’ reappointment to the hospital’s medical staff. The
district court granted summary judgment in favor of
defendants, finding that they were immune under the Health
Care Quality Improvement Act (“HCQIA”), 42 U.S.C.
§ 11101 et seq. Defendants moved for an award of costs and
attorney’s fees under the HCQIA, and the district court denied
their motion. Plaintiffs appeal the grant of summary
judgment; defendants cross-appeal the denial of costs and
fees. We affirm the judgment of the district court on both
issues.

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1W e find the district court’s statement of facts to be accurate, and
accordingly adopt it as our own.
2Meyers had p rivileges from 1 981 -82 at The M emo rial Ho spital in
No rth Conway, New H ampshire, but maintains that he was forced to leave
due to “po litical dynamics” upon establishing his “large, successful
practice.” Meyers then wo rked as a trauma surgeon from 198 3-84 in Fort
Bragg, North Carolina. From 1984-88 , Meyers practiced in Spruce Pine,
No rth Carolina until he got “burned out.” In 1988, Meyers moved to
W ytheville, Virginia, and practiced at W ythe County Community
Hospital (“WCCH”). He was suspended from WCCH in July 1989.
Meyers was later reinstated to the WCC H staff but took a leave of absence
and voluntarily left the hospital. Meyers then obtained provisional
privileges in 1990 at Clark Regional Medical Center (“CRMC”) in
W inchester, Kentucky. Meyers alleges that he left CRM C because his
plan to reestablish the practice of a departed orthopedic surgeon was
I. FACTS 1
On March 25, 1991, Meyers applied for medical staff
privileges at Logan Memorial Hospital, Inc. (“LMH”) in
Russellville, Kentucky. Shortly thereafter, the Credentials
Committee and the Medical Executive Committee (“MEC”)
approved Meyers for staff privileges. As a result, in
September 1991, the LMH Board of Trustees (“Board”)
approved Meyers for appointment to the medical staff.
Pursuant to the LMH Bylaws, all initial appointments to the
medical staff were provisional for one year. At the end of that
year the physician would be reevaluated to qualify for
advancement from associate to active member status.
In the fall of 1992, the Credentials Committee began to
evaluate Meyers for his advancement to active staff
privileges. On April 12, 1993, the Credentials Committee,
which Meyers argues was composed largely of his
competitors, voted to deny him staff privileges. In its
decision, the committee cited concerns about Meyers’ history
of moving from hospital to hospital following disputes with
hospital staff,2 his failure to timely and fully disclose
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sabotaged by a group of Lexington physicians. On the other hand, a letter
from CRMC’s administrator suggests that M eyers left because he did not
work harmoniously with other members of the hospital staff. The
administrator also no ted that he did not maintain m edica l records in
accord ance with staff rules and regulations.
3Meyers was censured and p laced under a corrective action plan
(“CAP”) by the Medical Society of Virginia Review Organization
(“MSVR O”) for failure to keep sufficient medica l records. Meyers argues
that he completed the CAP and his license was in no way affected by the
MSVRO. Defendants maintain that he failed to disclose this information
by answering “no” to the following questions on his initial application:
“Has your license to practice medicine in any jurisdiction ever been
limited, suspended or revoked?” and “Have you ever been denied
mem bership or renewal thereof, or been subject to disc iplinary action in
any medical organization?”
disciplinary and corrective action taken against him while
working in Virginia,3 and the quality of his patient care. At
this point, pursuant to LMH Bylaws, the Credentials
Committee was to notify Meyers of the general nature of its
concerns and arrange a meeting with Meyers. The
Credentials Committee did, on short notice, invite Meyers to
a meeting. According to Fred Mudge, a member of the
Board, this invitation did not comply with the Bylaws.
On June 3, 1993, the MEC, half of whose members were
also members of the Credentials Committee, voted to accept
the Credentials Committee decision and revoke Meyers’ staff
privileges. Neither of these committees, however, had the
power to grant or deny privileges to Meyers. The MEC was
to consider the recommendation from the Credentials
Committee and make a recommendation to the Board, which
had the ultimate authority to grant, deny, or terminate
Meyers’ privileges.
On January 24, 1994, the Board informed Meyers that it
was assuming full responsibility for determining his
reappointment and advancement to active staff because of his

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concerns with the manner in which the peer review process
was being handled. Three members of the Board, acting as a
Credentials Committee, conducted an independent review.
This committee discussed concerns about Meyers’ behavior
and inability to get along with others in addition to questions
about his surgical technique. The committee gave Meyers the
opportunity to put forth additional information, but he
maintained that there was none. The committee questioned
Meyers about several incident reports concerning disruptive
behavior, his history of problems at other hospitals, his failure
to timely complete medical records, his hostility towards the
operation room staff, reports of breaking the sterile field, and
his failure to provide appropriate coverage for patients while
he was out of town. Meyers acknowledged that he had a
personality problem.
At the same time, the Kentucky Cabinet for Human
Resources Drug Control Division was investigating Meyers’
prescription practices pursuant to complaints from
pharmacists and the Kentucky State Police about the volume
of prescriptions he wrote for controlled substances. The
investigation concluded that “Meyers may not have used good
judgment in prescribing controlled substances to all of his
patients.” The Kentucky Board of Medical Licensure
recommended that Meyers attend a University of Kentucky
miniresidency course in prescribing controlled substances.
On March 18, 1994, this three-member committee of the
Board voted to deny Meyers’ appointment to active staff. The
reasons cited for the committee’s decision were Meyers’
failure to satisfy requirements that he meet LMH’s standard
of care, abide by the ethics of the profession, work
cooperatively with others, and timely complete medical
records. The committee outlined Meyers’ pattern of
disruptive behavior which included, but was not limited to,
temper tantrums, repeated refusal to limit elective cases to
time periods routinely reserved for him, attempted
interference with the right of an attending physician to refer
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a patient to the surgeon of his choice or to transfer the patient,
condescending remarks toward women, refusal to speak to a
member of his surgical team during surgical procedures, and
several instances of throwing a scalpel during surgery. The
committee informed Meyers that “[t]his behavior can have an
adverse effect on the quality of patient care by inhibiting the
ability of hospital personnel to perform optimally, by making
it difficult for the hospital to retain qualified personnel, and
by interfering with the judgment of referring physicians.”
The committee further noted that Meyers’ behavior “can also
disrupt the efficient operation of the hospital and the smooth
operation of the surgical department to the detriment of the
medical staff, the hospital, and the community.” As for his
failure to timely complete medical records, the committee
stated that “[d]elinquent medical records can put patients at
risk by being inaccurate or incomplete if needed to assist in
later diagnosis and treatment of a patient.” As for quality of
care, the committee noted that Meyers had failed to comply
with LMH’s policy of obtaining post-operative films and that
he had demonstrated repeated instances of violating the sterile
field.
At this point, the Board began proceedings under the
Medical Staff Bylaws Fair Hearing Plan § 2.3-2 which
provides that “[a] hearing occasioned by an adverse action of
the Trustees pursuant to § 1.2(b) or (c) shall be conducted by
a hearing committee appointed by the Chairman of the
Trustees and composed of five persons. At least three
Medical Staff members shall be included on this committee
when feasible.” The Fair Hearing Committee was composed
of Bill Paxton, a retired court of appeals judge; Fred Greene,
an attorney; Mike Robbins, a bank president; Thomas
Luckett, an industrialist; and Paul Kerr, a licensed dentist.
The Board notified Meyers and explained that it was not
feasible to have members of the medical staff on the Fair
Hearing Committee. This committee met on eleven
occasions. Meyers was represented by counsel, given the
opportunity to present witnesses, affidavits, and other

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documentary evidence, and given the right to confront,
examine, and cross-examine witnesses presented by LMH.
In April 1995, the Fair Hearing Committee issued its report
and recommendation that LMH not appoint Meyers to its staff
because of his failure to meet LMH’s ethical standards and
his inability to work cooperatively with others. In May, the
Board adopted and affirmed the Fair Hearing Committee’s
recommendation. The Board informed Meyers of its decision
and his right to appeal. Meyers appealed the Board’s decision
and was again represented by counsel. On August 9, 1995,
the Board informed Meyers of its vote to affirm the decision
denying clinical privileges to Meyers. This was the Board’s
final decision and Meyers’ privileges were revoked.
II. PROCEDURAL HISTORY
On August 22, 1995, Meyers brought suit in Kentucky state
court (Logan Circuit Court) seeking a restraining order and a
temporary and permanent injunction requiring LMH to
reinstate his staff privileges and enjoining LMH from making
a report to the National Practitioner Data Bank. The court
granted the restraining order and temporary injunction in part
but denied the motion for an injunction which would require
LMH to reinstate Meyers’ privileges.
On August 8, 1996, Meyers filed a second suit in Logan
Circuit Court with numerous causes of action against thirty-
four defendants. Defendants moved for summary judgment
based on immunity pursuant to K.R.S. § 311.377(1). The
court denied that motion.
On November 5, 1997, while the two suits were still
pending in state court, Meyers filed suit in the United States
District Court for the Western District of Kentucky.
Following an order for a more definite statement, Meyers
filed two amended complaints against twenty-two defendants,
including hospital administrators, members of LMH’s
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medical staff who engaged in investigation and credentialing
activities, and members of the Board that took final action
after hearing Meyers’ appeal. The complaints alleged breach
of contract, violations of federal antitrust laws, violations of
the Emergency Medical Treatment and Active Labor Act,
breach of the covenant of good faith and fair dealing, tortious
interference with economic advantage, and defamation. On
January 27, 2000, the district court entered an order granting
summary judgment in favor of Defendants on the basis of
HCQIA immunity. Plaintiffs’ motion to alter, amend, and
vacate the order was denied on May 25, 2000.
The parties then entered into a stipulation of dismissal,
which was entered by the district court on March 23, 2001.
In the stipulation, the parties agreed that upon a ruling by the
district court on a motion for costs and fees (filed by the
defendants on April 6, 2001), the case would be deemed
concluded and the ruling on the motion for costs and fees
would constitute a final judgment for the purpose of
determining the time in which to file appeals.
On August 14, 2001, the district court entered an order
denying Defendants’ motion for costs and fees. Plaintiffs and
Defendants filed timely notices of appeal.
III. STANDARDS OF REVIEW
A district court must grant a motion for summary judgment
if it finds that the “pleadings, depositions, answers to
interrogatories, and admissions on file together with the
affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to judgment
as a matter of law.” Fed. R. Civ. P. 56(c). The moving
party bears the initial burden of specifying the basis for its
motion and of identifying that portion of the record which
demonstrates the absence of a genuine issue of material fact.
Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). The non-
moving party must then produce specific evidence that

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4The HCQIA defines “professiona l review action” as:
an action or recomm endation o f a professional review body
which is taken or made in the conduct of professional review
activity, which is based on the competence or professional
conduct of an individual physician (which conduct affects or
demonstrates there is a genuine issue of fact for trial.
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48
(1986). “The mere existence of a scintilla of evidence in
support of the plaintiff’s position will be insufficient; there
must be evidence on which the jury could reasonably find for
the plaintiff.” Id. at 252. The court must view the evidence
in the light most favorable to the non-moving party.
Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S.
574, 587 (1986). On appeal, this court reviews an order
granting summary judgment de novo. Williams v. Mehra, 186
F.3d 685, 689 (6th Cir. 1999). The appellate court uses the
same legal standard as used by the district court to determine
whether summary judgment is appropriate. Id.
The district court’s denial of Defendants’ request for
attorney’s fees is reviewed for abuse of discretion. Muzquiz
v. W.A. Foote Memorial Hosp., Inc., 70 F.3d 422, 432 (6th
Cir. 1995).
IV. DISCUSSION
A. The district court’s grant of summary judgment in
favor of Defendants on the basis of HCQIA immunity
was proper.
The HCQIA was passed in 1986 to provide for effective
peer review and interstate monitoring of incompetent
physicians, and to grant qualified immunity from damages for
those who participate in peer review activities. Austin v.
McNamara, 979 F.2d 728, 733 (9th Cir. 1992); 42 U.S.C.
§ 11101. If a “professional review action”4 satisfies certain
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could affect adversely the health or welfare of a patient or
patients), and which affects (or may affect) adversely the clinical
privileges, or memb ership in a pro fessiona l society, of the
physician.
42 U.S.C. § 1 115 1(9). “Pro fessiona l review activity,” in turn, is defined
as “an activity of a health care en tity with respect to an individual
physician
(A) to determine whether the p hysician may have clinical
privileges with respect to, or memb ership in, the entity;
(B) to determine the sco pe or conditions of such privileges or
membership; or
(C) to change or modify such privileges or membership.
Id. § 1115 1(10).
reasonableness requirements, then those persons participating
in the review “shall not be liable in damages under any law of
the United States or of any State . . . with respect to the
action.” 42 U.S.C. § 11111(a)(1).
Specifically, persons participating in a professional review
action are entitled to immunity if the action is taken:
(1) in the reasonable belief that the action was in
furtherance of quality health care;
(2) after a reasonable effort to obtain the facts of the
matter;
(3) after adequate notice and hearing procedures are
afforded to the physician involved or after such
other procedures as are fair to the physician under
the circumstances; and
(4) in the reasonable belief that the action was
warranted by the facts known after such reasonable
effort to obtain facts and after meeting the
requirement of paragraph (3).

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42 U.S.C. § 11112(a). Once the preceding standards are met,
the HCQIA offers immunity to:
(A) the professional review body,
(B) any person acting as a member or staff to the body,
(C) any person under a contract or other formal
agreement with the body, and
(D) any person who participates with or assists the body
with respect to the action.
42 U.S.C. § 11111(a)(1).
The term “professional review body” includes a “health
care entity and the governing body or any committee of a
health care entity which conducts professional review
activity.” 42 U.S.C. § 11151(11). The district court correctly
found that Defendants all fall within the protected categories
listed in § 11111(a)(1). LMH is a health care entity and a
professional review body. The individual doctors are covered
under (B)-(D) as staff members of LMH, persons under a
contract with LMH, or persons who participate with or assist
the body with respect to the professional review action.
The HCQIA creates a rebuttable presumption of immunity,
forcing the plaintiff to prove that the defendant’s actions did
not comply with the relevant standards. Id. § 11112(a) (“A
professional review action shall be presumed to have met the
preceding standards necessary for the protection set out in
section 11111(a) of this title unless the presumption is
rebutted by a preponderance of the evidence.”). As the
district court explained, this rebuttable presumption “creates
an unusual summary judgment standard” that can be stated as
follows: “Might a reasonable jury, viewing the facts in the
best light for [the plaintiff], conclude that he has shown, by a
preponderance of the evidence, that the defendants’ actions
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are outside the scope of § 11112(a)?” Bryan v. James E.
Holmes Reg’l Med. Ctr., 33 F.3d 1318, 1333 (11th Cir. 1994)
(quoting Austin v. McNamara, 979 F.2d 728, 734 (9th Cir.
1992)). The plaintiff has the burden of overcoming the
presumption of immunity by showing that the review process
was not reasonable. Id. Meyers argues that Defendants can
meet none of the elements for establishing statutory
immunity. However, as the district court found, he failed to
raise a genuine issue of material fact as to any element.
Therefore, we will affirm the grant of summary judgment.
1. The Board’s Action Was Taken in the Reasonable
Belief that It Was in Furtherance of Quality Health
Care
The “reasonable belief” standard of the HCQIA is satisfied
if “the reviewers, with the information available to them at the
time of the professional review action, would reasonably have
concluded that their action would restrict incompetent
behavior or would protect patients.” Bryan, 33 F.3d at 1323
(citing H.R. REP. NO. 903, at 10, reprinted in 1986
U.S.C.C.A.N. at 6392-93). It is an objective standard, rather
than a subjective good faith requirement. Id. (citing Austin,
979 F.2d at 734). The Act does not require that the
professional review result in actual improvement in the
quality of health care, but only that it was undertaken in the
reasonable belief that quality health care was being furthered.
Imperial v. Suburban Hosp. Ass'n, Inc., 37 F.3d 1026, 1030
(4th Cir. 1994).
Meyers contends that a reasonable jury could find that this
element was not satisfied because: (1) eight members of the
medical staff testified on behalf of Meyers and no member
testified against him; (2) two independent reviewers gave
favorable reviews of Meyers; (3) two psychologists who
examined Meyers recommended that he receive his
privileges; and (4) although some nurses testified as to

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5Meyers argues that genuine issues of fact exist regarding the
veracity of the underlying allegations against him. Our review, however,
is not directed at whether each of the complaints were undisputedly true,
but whethe r Defendants acted reasonably in considering and relying upon
them. In this case, in view of the volume of incidents and the seriousness
of the complaints, there is no genuine issue with respect to the
reasonab leness of Defendants’ belief that their action was taken in the
furtherance o f quality health care.
disruptive incidents, each of them testified that they could still
work with Meyers.
However, the evidence conclusively demonstrates that both
the Board’s decision and the Fair Hearing Committee’s
decision were made in the reasonable belief that they were
furthering quality health care, and no reasonable jury could
find otherwise. Among other evidence, the Fair Hearing
Committee heard testimony about twenty-two incident reports
involving Meyers which documented loss of temper during
surgery, breaking the sterile field, failure to take and
document histories before patients were sedated for surgery,
and other problems.5 This evidence was also considered by
the Board. The Fair Hearing Committee noted that its
decision was based on Meyers’ temper tantrums, his use of
coercive tactics, delinquent medical records, his inability to
work with others, and unethical conduct. As the district court
held, these reasons are in furtherance of quality health care,
despite the fact that no patients were actually injured.
“Quality health care” is not limited to clinical competence,
but includes matters of general behavior and ethical conduct.
See Bryan, 33 F.3d at 1334-35 (finding that the termination of
physician’s privileges was “taken in reasonable belief that the
action was in furtherance of quality health care” where
physician had “exhibited a pattern of unprofessional conduct
over a period of many years,” “was disruptive,” and
“interfered with the important work of other employees”);
Everhart v. Jefferson Parish Hosp. Dist. No. 2., 757 F.2d
1567, 1573 (5th Cir. 1985) (“[Q]uality patient care demands
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that doctors possess at least a reasonable ‘ability to work with
others.’”). Meyers failed to present evidence that the action
against him was not taken in the reasonable belief that it
furthered quality health care.
2. The Board’s Action Was Taken After a Reasonable
Effort to Obtain the Facts of the Matter
Similarly, Meyers failed to raise any genuine issue of fact
with respect to the second element of HCQIA immunity. The
inquiry is whether the “totality of the process” leading up to
the professional review action evinced a reasonable effort to
obtain the facts of the matter. Mathews v. Lancaster Gen.
Hosp., 87 F.3d 624, 637 (3d Cir. 1996). In this case, there
was an exhaustive review process. As the district court noted,
Meyers was reviewed by both the Credentials Committee and
the MEC, as well as by a committee of three Board members
who conducted an independent investigation. This three-
person committee questioned Meyers and gave him an
opportunity to provide them with additional information. It
then made a recommendation to the Board, which voted to
deny Meyers’ appointment to the active staff. Thereafter, the
Fair Hearing Committee met on eleven occasions and heard
testimony from thirty-five witnesses. Meyers was represented
by counsel, given the opportunity to present witnesses,
affidavits, and other documentary evidence, and given the
right to confront, examine, and cross-examine witnesses
presented by LMH. Meyers disputes that a “reasonable
inquiry” occurred, but his argument is limited to conclusory
statements attacking individual items of evidence considered
by the reviewers. He fails, however, to raise a genuine issue
to rebut the presumption that the professional review action
was taken after a “reasonable effort to obtain the facts.”

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3. Meyers Received Adequate Notice and Hearing
Procedures
The third element of the HCQIA immunity test is whether
adequate notice and hearing procedures were afforded to the
physician involved. 42 U.S.C. § 11112(a)(3). Meyers raises
the same argument on appeal that he presented to the district
court. He argues that a reasonable jury could conclude that
LMH did not provide adequate notice and procedures because
it did not comply with its own bylaws.
This argument fails for two reasons. First, Meyers failed to
show that LMH violated its bylaws. Second, even assuming
LMH did violate the bylaws, the notice and procedures
provided complied with the HCQIA’s statutory “safe harbor,”
as described below.
First, the Board was proceeding under the Medical Staff
Bylaws Fair Hearing Plan § 2.3-2 which provides that “[a]
hearing occasioned by an adverse action of the Trustees
pursuant to § 1.2(b) or (c) shall be conducted by a hearing
committee appointed by the Chairman of the Trustees and
composed of five persons. At least three Medical Staff
members shall be included on this committee when feasible.”
(Emphasis added.) Claudia Dickerson, counsel for LMH,
explained in letters to Meyers’ counsel dated June 27 and
July 1, 1994, that it was not feasible to appoint members of
the medical staff to the Fair Hearing Committee because some
were working too many hours to devote adequate time to the
Committee, some had been involved previously in Meyers’
peer review or incidents under review, and some were,
themselves, possible subjects of future peer review. Meyers
disputes this fact by saying that he located four members of
the medical staff who had not been asked to serve on the
Committee. However, this evidence alone cannot show that
LMH violated its bylaws.
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In any event, the HCQIA sets out specific “safe harbor”
procedures, which satisfy the “notice and hearing procedures”
requirement of § 11112(a)(3). This requirement is met if the
hospital has provided, or the physician has voluntarily
waived, the following:
1. The physician has been given notice stating that a
professional review action has been proposed to be
taken against the physician, reasons for the proposed
action, that the physician has the right to request a
hearing on the proposed action, any time limit (of
not less than 30 days) within which to request such
a hearing, and a summary of the rights in the hearing
. . . .
2. If a hearing is requested on a timely basis . . . , the
physician involved must be given notice stating the
place, time, and date, of the hearing, which date
shall not be less than 30 days after the date of the
notice, and a list of the witnesses (if any) expected
to testify at the hearing on behalf of the professional
review body.
3. If a hearing is requested on a timely basis . . . , the
hearing shall be held (as determined by the health
care entity) before an arbitrator mutually acceptable
to the physician and the health care entity, before a
hearing officer who is appointed by the entity and
who is not in direct economic competition with the
physician involved, or before a panel of individuals
who are appointed by the entity and are not in direct
economic competition with the physician involved.
4. [I]n the hearing the physician involved has the right
to representation by an attorney or other person of
the physician’s choice, to have a record made of the
proceedings, copies of which may be obtained by
the physician upon payment of any reasonable

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6W e also note that § 11112 (b) also provides that a failure to meet the
“safe harbor” provisions outline d above does “not, in itself, co nstitute
failure to meet the [adequate notice and hearing] standards of subsection
(a)(3) of this section.” 42 U.S.C. § 11 112(b).
charges associated with the preparation thereof, to
call, examine, and cross-examine witnesses, to
present evidence determined to be relevant by the
hearing officer, regardless of its admissibility in a
court of law, and to submit a written statement at the
close of the hearing; and upon completion of the
hearing, the physician involved has the right to
receive the written recommendation of the arbitrator,
officer, or panel, including a statement of the basis
for the recommendations, and to receive a written
decision of the health care entity, including a
statement of the basis for the decision.
42 U.S.C. § 11112(b).6 The district court correctly found that
no reasonable jury could find that Meyers did not receive
adequate notice or the other requirements of § 11112(b) were
not met. Meyers himself admitted under oath that he received
each of the HCQIA’s notice and hearing requirements (which
had been outlined in a letter to him). Accordingly, his
argument that notice was insufficient fails.
4. The Board’s Action Was Taken in the Reasonable
Belief That the Action Was Warranted by the Facts
The district court also held that no reasonable jury could
find that the Board did not take the action in the reasonable
belief that it was warranted by the facts. “Our analysis under
§ 11112(a)(4) closely tracks our analysis under
§ 11112(a)(1).” Gabaldoni v. Washington County Hosp.
Ass'n, 250 F.3d 255, 263 n.7 (4th Cir. 2001) (quoting
Sugarbaker v. SSM Health Care, 190 F.3d 905, 916 (8th Cir.
1999)); Brader v. Allegheny Gen. Hosp., 167 F.3d 832, 843
18 Meyers, et al. v. Columbia/HCA
Healthcare Corp., et al.
Nos. 01-6190/6217
7See also supra note 5.
(3d Cir. 1999). While Meyers challenges certain of the
underlying facts upon which Defendants relied, he has not
shown that the facts were “so obviously mistaken or
inadequate as to make reliance on them unreasonable.”
Mathews, 87 F.3d at 638. Moreover, “a plaintiff’s showing
‘that [the] doctors reached an incorrect conclusion on a
particular medical issue because of a lack of understanding’
does not ‘meet the burden of contradicting the existence of a
reasonable belief that they were furthering health care quality
in participating in the peer review process.’” Brader, 167
F.3d at 843 (quoting Imperial, 37 F.3d at 1030).7 In view of
the Board’s well-supported findings that Meyers had failed to
meet LMH’s ethical standards and that he was unable to work
cooperatively with others, there is no genuine issue as to
whether the Board’s action was taken in the reasonable belief
that it was warranted by the facts.
5. Meyers’ Legislative History Argument
Meyers makes one additional argument, contending that
“the District Court erred in granting immunity under the Act
where the review was conducted entirely by nonmedical
personnel because such does not constitute ‘peer review.’”
Appellants’ Brief at 31.) Although “peer review” is not
defined in the Act, it has been described as “the process by
which physicians and hospitals evaluate and discipline staff
doctors.” Bryan, 33 F.3d at 1321. Bryan explained peer
review as the entire system of handling physician disciplinary
actions, from promulgation of bylaws to medical staff
recommendation to final Board action. Id. at 1324.
Accordingly, the process at issue was “peer review.”
Meyers also claims that “the Act does not give immunity to
persons, other than physicians and medical personnel,
performing peer reviews of physicians.” Appellants’ Brief at

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Nos. 01-6190/6217 Meyers, et al. v. Columbia/HCA
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32.) As Defendants point out, the point is moot because none
of the non-physician reviewers is a defendant in this action.
(Appellees’ Brief at 55.) Even so, Meyers devotes twenty-
five pages of his appellate brief to this argument, including
extensive discussion of legislative history that he argues
indicates the purpose of the Act is to provide immunity for
physicians participating in peer review, and not for others
involved in the review process. He argues that
the disputed section of the Act states that “(A) the
professional review body, (B) any person acting as a
member or staff to the body, (C) any person under a
contract or other formal agreement with the body, and
(D) any person who participates with or assists the body
with respect to the action, shall not be liable in damages
. . . .” 42 U.S.C. § 11111(a)(1)(A)-(D) . . . The Act is
ambiguous in defining to whom it grants immunity. The
word “person” in the Act is never defined, even though
the Act defines many other words used.
(Id. at 34-35.) Meyers thus implies that, because the review
was not conducted by physicians, the review was not a
“professional review action” and thus the HCQIA does not
apply.
We disagree and find that the statutory language is not
ambiguous as to who is entitled to immunity or as to what
actions are covered. It is clear that every “person” who
participates in a professional review action is entitled to
immunity. 42 U.S.C. § 11111(a)(1). Meyers argues that the
word “person” should be read as “physician,” but there is no
support for this assertion. Where the language of the statute
is not ambiguous, it is unnecessary to resort to legislative
history. See, e.g., Garcia v. United States, 469 U.S. 70, 76
n.3. In any event, Meyers’ legislative history discussion is
limited to statements made about the general purpose of the
Act, rather than the specific provision at issue. Accordingly,
his argument fails. Had Congress wished to specify that
20 Meyers, et al. v. Columbia/HCA
Healthcare Corp., et al.
Nos. 01-6190/6217
immunity was only intended for physicians, it could have
done so. In its order granting Defendants’ summary judgment
motion, the district court stated that it could
find no provision of the HCQIA which requires the
professional review process to be conducted by
physicians only. In fact, the language of the HCQIA
uses the word “person” rather than “physician” to
describe those who will be granted immunity. 42 U.S.C.
§§ 11111(a)(1)(B)-(D). Furthermore, under the HCQIA,
a hearing may be conducted by an arbitrator, hearing
officer, or panel of individuals, which contemplates the
use of non-physicians in the professional review process.
Id. § 11112(b)(3)(A)(I)-(iii).
(J.A. at 11 (emphasis added).) The district court’s reasoning
was correct, and we hold that the action in this case was a
professional review action giving rise to HCQIA immunity
for the persons involved.
B. Cross-Appeal: The District Court Did Not Abuse Its
Discretion in Declining to Award Attorney’s Fees
Finally, Defendants contend that the district court erred in
denying their motion for costs and attorney’s fees. The
following provision of the HCQIA provides for fee-shifting:
In any suit brought against a defendant, to the extent that
a defendant has met the standards set forth under section
11112(a) of this title and the defendant substantially
prevails, the court shall, at the conclusion of the action,
award to a substantially prevailing party defending
against any such claim the cost of the suit attributable to
such claim, including a reasonable attorney’s fee, if the
claim, or the claimant’s conduct during the litigation of
the claim, was frivolous, unreasonable, without
foundation, or in bad faith.

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Nos. 01-6190/6217 Meyers, et al. v. Columbia/HCA
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42 U.S.C. § 11113. Thus, a defendant should receive an
award of costs and fees when (1) the defendants are among
the persons covered by the HCQIA, (2) the standards set forth
in § 11112(a) were followed, (3) the defendants substantially
prevailed, and (4) the plaintiffs’ claim or conduct during the
litigation was frivolous, unreasonable, without foundation, or
in bad faith. Defendants in this case clearly satisfied the first
three factors. Whether a party’s claim or conduct is frivolous,
unreasonable, or without foundation is a question committed
to the sound discretion of the district court. Johnson v. Nyack
Hosp., 964 F.2d 116, 123 (2d Cir. 1992) (citing
Christiansburg Garment Co. v. EEOC, 434 U.S. 412, 421
(1978)).
Examining the facts, the district court found that the fourth
factor was not satisfied because plaintiffs’ claims and conduct
were not frivolous, unreasonable, without foundation, or in
bad faith. In its order denying Defendants’ motion for costs
and fees, the court stated that:
it was not unreasonable, frivolous, without foundation, or
in bad faith for plaintiffs to oppose the LMH Defendants’
position on HCQIA immunity. Plaintiffs had valid
questions concerning the manner in which the LMH
Defendants conducted the professional review of
Dr. Robert Meyers and chose to resolve those issues in
this Court. As stated above, the fact that Plaintiff did not
prevail in no way indicates that Plaintiffs’ claims were
unreasonable, frivolous, without foundation, or in bad
faith.
(J.A. at 265.) Furthermore, because the HCQIA immunity
issue decided the case, the district court never determined
whether plaintiffs had sufficient evidence to reach a jury on
their claims related to antitrust, COBRA, EMTALA, breach
of covenant of good faith and fair dealing, or defamation. As
such, the district court could not say that those claims lacked
foundation.
22 Meyers, et al. v. Columbia/HCA
Healthcare Corp., et al.
Nos. 01-6190/6217
Defendants/cross-appellants contend that the district court
erred by considering only the foundation of Meyers’ claims
without considering his “abusive” conduct. They seek $2,349
in costs and $215,031 in attorney’s fees. Specifically, cross-
appellants argue that Meyers’ filing suit in federal court while
his two state court suits were pending was a “relentless
pursuit” that “was a continuation of harassing behavior
demonstrated at [LMH] and other hospitals.” (Appellees’
Brief at 68.) Meyers’ behavior at other hospitals is not a
proper consideration in the attorney’s fees question. The fact
that he filed two actions in state court before filing the action
in federal court is relevant, but not determinative of the
attorney’s fees issue. As Meyers points out, there is “no
evidence whatever on the litigation strategy question as to
why the federal action was pursued instead of the state
action.” (Appellants’ Reply Brief at 53.) The district court
was very familiar with plaintiffs’ claims and conduct, having
presided over the case for nearly four years. It correctly
stated and applied the standard for granting attorney’s fees.
Even if we may have decided the attorney’s fees issue
differently if reviewing de novo, Defendants fail to
demonstrate that the district court abused its discretion by
denying attorney’s fees in this case.
V. CONCLUSION
For the foregoing reasons, we affirm the district court’s
grant of summary judgment and its denial of costs and fees.

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