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Chand v. Patla

August 06, 2003

SURESH CHAND, M.D., PLAINTIFF-APPELLEE,
v.
ANN PATLA, DIRECTOR OF PUBLIC AID, AND THE DEPARTMENT OF PUBLIC AID, DEFENDANTS-APPELLANTS.



Appeal from the Circuit Court of Madison County. No. 99-MR-301 Honorable Daniel J. Stack, Judge, presiding.

The opinion of the court was delivered by: Presiding Justice Hopkins

PUBLISHED

The plaintiff, Suresh Chand, M.D., filed a complaint in the circuit court of Madison County for judicial review of the administrative action of the Illinois Department of Public Aid (the Department) terminating his eligibility as a vendor of medical services. The circuit court reversed the Department's decision to terminate the plaintiff from eligibility to participate in the State's medical assistance program and ordered the Department to pay the plaintiff $42,650 in attorney fees.

On appeal, the Department asserts that the case is moot, that the circuit court improperly awarded attorney fees, and that the plaintiff's failure to answer a questionnaire or provide copies of his professional licenses was a sufficient, alternative basis upon which to affirm the Department's determination. We affirm in part and reverse in part.

FACTS

In a letter dated February 9, 1998, and again in a letter dated March 16, 1998, the Department, through the Bureau of Medical Quality Assurance (the Bureau), indicated that the plaintiff had "been selected for peer review *** to determine [the plaintiff's] compliance with Department policies." The Bureau requested that the plaintiff produce the medical charts of 15 patients and attached a list of the 15 patients with their recipient identification numbers. The Bureau requested the patient records "in their entirety[,] including the initial visit, all progress notes, operative reports, consultation reports, hospitalization records[,] *** and diagnostic services." The Bureau also enclosed a physician's information questionnaire and requested that the plaintiff return the questionnaire within two weeks, along with copies of his current license, Illinois controlled substance license, Drug Enforcement Agency certificate, and continuing education certificates for the previous three years.

On February 23 and March 30, 1998, the plaintiff's attorney responded to the Department's request, stating that because the Department had failed to comply with the Mental Health and Developmental Disabilities Confidentiality Act (the Confidentiality Act) (740 ILCS 110/1 et seq. (West 2000)), the plaintiff would not honor the Department's request.

On May 22, 1998, the Department commenced an administrative proceeding seeking to terminate the plaintiff's eligibility to participate in the State's medical assistance program, which provides medical care to the State's public aid recipients. The administrative law judge (ALJ) heard evidence and argument on October 27 and 28, 1998; February 5 and 22, 1999; and March 8 and March 22, 1999.

Marilyn Harvatin, a health facilities surveillance nurse with the Bureau's peer review unit, testified that she participated in the Bureau's request for the recipient records, the physician questionnaire, and copies of professional licenses for the peer review committee. Harvatin asserted that the purpose of the peer review was to determine whether the plaintiff was in compliance with the Department's policies and whether recipients of the medical assistance program were receiving quality care. Harvatin testified that she did not contact or attempt to acquire authorizations from the 15 recipients whose medical records the Bureau requested. Harvatin explained that when a recipient signs up with the program, the recipient understands that the recipient's records might be reviewed.

Harvatin stated that the physician's questionnaire was essential to the peer review process. The questionnaire requested information regarding the provider's age, education, certification, licensing, and practice, i.e., how many offices and employees the provider has; whether the provider has an interest in a pharmacy, transportation company, or long-term care company; how many patients the provider treats; and whether the provider has a laboratory.

On April 23, 1999, the ALJ recommended that the plaintiff's eligibility to participate in the medical assistance program be terminated. The ALJ held that the plaintiff wrongfully refused to produce copies of the medical records. The ALJ determined that the plaintiff was permitted under the Confidentiality Act to supply the records to the Department because doing so was pursuant to a peer review of his work, a specific exception to the disclosure requirements under the Confidentiality Act (740 ILCS 110/9 (West 2000)). The ALJ further determined that the Confidentiality Act required the plaintiff, as the medical provider, to inform his patients that he was disclosing their records to the Bureau.

The ALJ held that the plaintiff also wrongfully refused to produce his professional documents and the physician's information questionnaire. The ALJ held that the information sought in the questionnaire was current and updated information to ensure an accurate basis on which to conduct a peer review. The ALJ rejected the plaintiff's claims that no specific rules or handbook policies required him to provide such information, that the Department already had the information, or that the plaintiff was being harassed by the Bureau. The ALJ determined that the plaintiff violated sections 140.12(f) and 140.16(a)(1) and (a)(4) of the Department's regulations, as well as paragraph four of the plaintiff's provider agreement.

On June 9, 1999, the director adopted the ALJ's recommended decision and terminated the plaintiff's eligibility to participate in the medical assistance program.

On June 17, 1999, the plaintiff sought administrative review in the circuit court. He alleged that the Department's decision was incorrect because the files that he refused to provide the Department were protected under the Confidentiality Act and that the Department failed to follow the procedures outlined in the Confidentiality Act.

On April 7, 2000, the circuit court continued the proceedings for three months, noting that a separate appeal was pending in the appellate court between the Department and the plaintiff, and that it concerned issues raised in the present case. In the separate appeal, this court, on April 26, 2000, affirmed the Department's termination of the plaintiff's eligibility to participate as a vendor in the medical assistance program because the plaintiff had provided medical goods and services to public aid patients that placed them at risk of harm and that were of a grossly inferior quality. Chand v. Wright, No. 5-98-0691 (2000) (unpublished order under Supreme Court Rule 23 (166 Ill. 2d R. 23)). On October 4, 2000, the Illinois Supreme Court denied the plaintiff's petition for leave to appeal. Chand v. Wright, 191 Ill. 2d 527 (2000).

In its November 20, 2000, order, the circuit court held that, despite the separate appeal terminating the plaintiff's eligibility, the present cause was not moot and that the Department's decision was not against the manifest weight of the evidence but that the Department's regulatory requirement to provide psychiatric records of patients without their consent violates the Confidentiality Act. The circuit court also held that the plaintiff's failure to complete the questionnaire did not ...


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