## Facts

- Dr. Linda Freilich held medical staff privileges at a hospital operated by Upper Chesapeake Health, Inc.
- After an extensive reappointment review, the hospital terminated her staff privileges.
- The dispute followed conflicts over dialysis quality-assurance practices, hospital policies, and resource allocation.
- Dr. Freilich sued in federal court against the hospital, its board and directors, and also named the United States and Maryland.
- She challenged the constitutionality of the Health Care Quality Improvement Act (HCQIA) (peer-review immunity) and Maryland physician credentialing statutes.
- She asserted claims under the Americans with Disabilities Act (ADA) and the Rehabilitation Act, largely alleging she was penalized for advocating for dialysis patients characterized as disabled.
- She also asserted multiple state-law claims tied to the termination of privileges.
- The district court dismissed the federal claims and declined to exercise supplemental jurisdiction over the state-law claims.

## Issues

1. Whether Dr. Freilich had Article III standing to bring constitutional challenges to HCQIA and Maryland credentialing statutes.
2. Whether the complaint stated actionable claims under the ADA (including Titles II and III) and the Rehabilitation Act based on alleged retaliation or association with disabled patients.
3. Whether HCQIA and Maryland credentialing statutes violated due process, equal protection, or other asserted constitutional limits.
4. Whether the district court properly declined supplemental jurisdiction over state-law claims after dismissing all federal claims.

## Decision

- The Fourth Circuit affirmed dismissal of the action.
- The court held Dr. Freilich lacked standing to pursue portions of her constitutional challenges where her alleged injuries were not sufficiently concrete, traceable, or within the statutes’ regulatory reach.
- The court held her ADA and Rehabilitation Act allegations failed to state a claim because they did not plausibly plead discrimination against her “by reason of” disability, and her theory largely sought to litigate patient-centered grievances through her privileging dispute.
- The court rejected the constitutional attacks on HCQIA and Maryland credentialing laws, finding the statutes served legitimate interests in peer review and patient safety and were not shown to be constitutionally defective on the pleaded facts.
- The court upheld the district court’s decision to dismiss or decline jurisdiction over the remaining state-law claims once the federal claims were eliminated.

## Legal Principles

- Federal courts require a concrete, particularized injury that is fairly traceable to the challenged provision and redressable by the requested relief; broad policy objections do not confer standing.
- ADA and Rehabilitation Act liability generally requires discrimination against the plaintiff because of disability (or within a statutorily recognized associational framework); a provider’s disagreement with hospital policy or peer-review outcomes is not converted into a disability claim absent facts fitting statutory elements.
- Statutes encouraging peer review and credentialing, including immunity schemes conditioned on specified procedures, are generally upheld where they rationally further patient safety and fair review and do not deprive a physician of constitutional protections on the facts pleaded.
- When federal claims are dismissed at an early stage, district courts may decline supplemental jurisdiction over related state-law claims under 28 U.S.C. § 1367(c).

## Conclusion

The court treated the termination of staff privileges as a credentialing dispute that could not be repackaged into federal constitutional or disability-rights litigation without standing and well-pleaded statutory elements, and it affirmed dismissal of the federal claims and the refusal to retain state-law claims.


Freilich v. Upper Chesapeake Health, Inc., 313 F.3d 205 (4th Cir. 2002)