## Facts

- Dr. Nedunchezian Sithian, a vascular surgeon, held privileges at Staten Island University Hospital (SIUH).
- SIUH initiated outside review of Sithian’s cases after concerns about a high incidence of morbidity and mortality among his patients.
- An external reviewer identified serious quality-of-care issues.
- After further internal review, SIUH suspended Sithian from performing complex (“index”) vascular procedures.
- SIUH obtained an additional independent peer review from an outside vascular surgeon, who concluded Sithian’s care fell below accepted standards and recommended he not perform complex vascular procedures.
- At Sithian’s request, an ad hoc medical staff committee held a multi-day hearing and recommended conditional permission to operate only with mandatory consultation and another vascular surgeon present in the operating room.
- After receiving the outside reviewer’s written report, SIUH’s Medical Executive Committee unanimously recommended continuing the suspension until Sithian obtained retraining through an approved vascular surgery fellowship program.
- The New York State Public Health Council investigated and found no cause for Sithian’s complaint, concluding the hospital’s decision was based on patient care, welfare, competence, and institutional objectives.
- Sithian filed consolidated civil actions alleging defamation and related torts (including interference with economic interests) against SIUH and peer-review participants.
- Courts previously determined defendants were immune from damages under HCQIA and state peer-review immunity law; the HCQIA immunity ruling was affirmed on appeal.
- After immunity was affirmed, defendants sought statutory costs and attorneys’ fees under HCQIA’s fee-shifting provision.

## Issues

1. Whether defendants, having prevailed on HCQIA immunity for professional review actions, were entitled to reasonable attorneys’ fees and costs under 42 U.S.C. § 11113 because Sithian’s suits were frivolous, unreasonable, without foundation, or brought in bad faith.
2. Whether the record supported characterizing the defamation and related tort actions as retaliatory litigation against peer-review participants.

## Decision

- The court awarded defendants statutory costs and reasonable attorneys’ fees under 42 U.S.C. § 11113.
- The court treated the prior, appellate-affirmed HCQIA immunity determinations as settled and relied on the established record of quality-of-care concerns, independent review, hearing procedures, and state oversight.
- The court found Sithian’s lawsuits were frivolous and commenced in bad faith as retaliatory actions targeting peer-review participants.
- The court reviewed submitted time and billing materials and limited the award to reasonable fees and costs incurred defending the actions.

## Legal Principles

- HCQIA grants immunity from damages for professional review actions meeting statutory standards, including actions taken in the reasonable belief they further quality health care, after reasonable fact-gathering, with adequate notice and hearing (or fair procedures), and with a reasonable belief the action was warranted.
- Under 42 U.S.C. § 11113, a court may award a prevailing defendant in an HCQIA-covered action reasonable attorneys’ fees and costs when the plaintiff’s claim is frivolous, unreasonable, without foundation, or brought in bad faith.
- Fee shifting under HCQIA functions to deter retaliatory suits that would otherwise burden and chill participation in peer review even where immunity from damages applies.

## Conclusion

The court held that, after HCQIA immunity was established and affirmed, the physician’s defamation-based litigation constituted frivolous, bad-faith retaliation against peer-review participants, warranting an award of reasonable attorneys’ fees and costs under 42 U.S.C. § 11113.


Sithian v. Staten Island Univ. Hosp., 189 Misc. 2d 410 (Sup. Ct. Richmond Cnty. 2001)