Filed 7/6/26 O’Hanlan v. Dignity Health Sequoia Hospital CA1/1
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
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IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
FIRST APPELLATE DISTRICT
DIVISION ONE
KATE O’HANLAN,
Plaintiff and Appellant,
v.
DIGNITY HEALTH SEQUOIA A171138
HOSPITAL et al.,
(San Mateo County
Defendants and Respondents.
Super. Ct. No. 23CIV00725)
Defendants and respondents Dignity Health Sequoia Hospital dba
Sequoia Hospital—Redwood City and Governing Board of Dignity Health
Sequoia Hospital dba Sequoia Hospital—Redwood City (collectively, Sequoia)
terminated the medical staff membership and clinical privileges of plaintiff
and appellant Kate O’Hanlan, a former gynecologic oncologist, after
summarily suspending her privileges while investigating her practice.
O’Hanlan appeals from a judgment denying her petition for writ of mandate
to compel Sequoia to set aside these actions. (Code Civ. Proc., § 1094.5.) We
affirm.
I. BACKGROUND
Our Legislature has adopted peer review as the mechanism to protect
Californians’ health and welfare by excluding from practice physicians who
1
provide substandard care or engage in professional misconduct. (Bus. & Prof.
Code, § 809, subds. (a)(6) & (b); see Natarajan v. Dignity Health (2021)
11 Cal.5th 1095, 1102–1103 (Natarajan).) Acute care hospitals like Sequoia
must adopt written bylaws that implement the peer review statute.
(Ellison v. Sequoia Health Services (2010) 183 Cal.App.4th 1486, 1494
(Ellison), citing Bus. & Prof. Code, § 809, subd. (a)(8) & Cal. Code Regs.,
tit. 22, § 70703, subd. (b).) Sequoia’s bylaws establish “a three-tier process” of
formal peer review to consider “disciplinary action or restriction of hospital
privileges.”1 (Ellison, supra, at pp. 1494–1495 [addressing prior version of
Sequoia’s bylaws].) Here, that process resulted in the challenged actions
against O’Hanlan, which ended her long career.
A. O’Hanlan’s Practice Brings Her to Sequoia
After medical school and residency, O’Hanlan obtained board
certifications in obstetrics and gynecology and in gynecologic oncology. She
taught and practiced medicine at a college in New York for four years and
then, beginning in 1990, at Stanford University. At Stanford, O’Hanlan
1 Under Sequoia’s bylaws, a medical executive committee, or the
president of the medical staff on its behalf, may investigate when reliable
information indicates a staff member acted in a manner reasonably likely to
harm patient safety or the delivery of quality patient care, violate
professional standards, or disrupt hospital operations. (Sequoia Hospital
Medical Staff Bylaws (May 3, 2017 rev.) art. VII, §§ 1–3 (Bylaws).) When the
investigation concludes, the medical executive committee must take
appropriate action, which may include summarily suspending a staff
member’s clinical privileges and/or recommending they be revoked. (Id., art.
VII, § 4.) A staff member may appeal to a hearing committee and receive a
hearing at which the medical executive committee must show by a
preponderance of the evidence that its action or recommendation is
“reasonable and warranted.” (Bylaws, art. VIII, §§ 2, 4, 6(c).) The staff
member may then appeal to Sequoia’s board of directors, which conducts
proceedings “in the nature of an appellate review” based upon the record of
the hearing. (Bylaws, art. VIII, § 7.)
2
began to focus on laparoscopic surgeries, ultimately performing “about 2300
laparoscopic hysterectomies and over 200 other laparoscopic minor surgeries”
during her career. While at Stanford, she also practiced at nearby Mills-
Peninsula Hospital to “increase [Stanford’s] referral base.”
In 2002, O’Hanlan wrongfully removed a woman’s ovaries without
permission. As she later testified, she “thought [she] remembered the
consent, and [she] didn’t.” She settled a resulting malpractice lawsuit “with
an extensive apology.” In the same year, O’Hanlan was reported to the
Medical Board of California after she obtained a substance for a patient who
was considering suicide. The Department of Justice investigated.
O’Hanlan’s license was revoked for 30 days, followed by a three-year period of
probation, and she resigned from Stanford as part of a settlement after
Stanford’s executive medical board recommended that her medical staff
membership be terminated.
Having disclosed what happened at Stanford, O’Hanlan applied for and
was granted medical staff privileges at Sequoia. She continued on at Mills-
Peninsula. But in 2004, she was summarily suspended from practice at
Mills-Peninsula after removing a woman’s fallopian tubes when not indicated
on her consent form. Pursuant to a settlement, O’Hanlan resigned from
Mills-Peninsula and the summary suspension was withdrawn.
In the years that followed, O’Hanlan established an impactful practice
at Sequoia, treating most of the gynecological oncology cases there.
B. O’Hanlan’s Practice at Sequoia Draws Attention
Dr. James Torosis served on Sequoia’s medical executive committee
beginning in 2012. In July 2016, he became the president of the medical staff
and chair of the medical executive committee, succeeding Dr. Mojdeh
Talebian. Dr. Torosis testified that during this time, medical staff in each
3
department conducted peer review of cases that were flagged for evaluation
in various ways (including through staff and patient complaints), and the
medical executive committee would review the departments’ work. Leading
up to his presidency, Dr. Torosis noticed “quite a few [peer review] cases,
surely by volume, that were . . . O’Hanlan’s”—roughly double the typical rate
of one or two cases per month. Some of these cases sounded “pretty
significant and serious.”
Among the more concerning cases was a February 2016 surgery in
which O’Hanlan removed a patient’s ovaries without consent (the Ovaries
Case). As O’Hanlan testified, during a required surgical “pause” or time-out
before operating, she did not read the patient’s consent form herself but
asked a nurse whether they were to remove the patient’s ovaries. The nurse
read from a different form completed when the surgery was initially
scheduled, which indicated the ovaries should be removed—but the patient
had later decided to keep her ovaries and O’Hanlan had updated her consent
form accordingly. The California Department of Public Health investigated
the matter and found it violated a World Health Organization safety
procedure adopted by Sequoia for a surgeon to lead the time-out instead of a
designated nurse. Dr. Torosis testified that as a result of the Ovaries Case,
Sequoia was fined by the Department of Public Health for the first time in its
history and changed its policies concerning surgical time-outs and the review
of consents. Still, O’Hanlan continued to “ha[ve] issues with consent,” for
example, “refus[ing]” to “redo [an] entire consent” to implement a change per
the new policy.
O’Hanlan’s practice also drew the attention of Dr. Anita Chandrasena,
Sequoia’s chief medical officer at the time Dr. Torosis’s presidency began. In
this role, Dr. Chandrasena served as a liaison between Sequoia’s medical
4
staff and its administration and oversaw its quality department. Dr.
Chandrasena testified that she and the quality department noticed a “pattern
of increasing complications and complaints” related to O’Hanlan’s practice
and raised the issue to Dr. Torosis and to the head of obstetrics and
gynecology. As Dr. Torosis testified, O’Hanlan performed both “difficult
oncology cases” with understandably “higher complication rate[s]” and many
outpatient procedures that were not reflected in certain quality department
metrics.2 Still, O’Hanlan experienced “many significant complications” even
in cases that did not involve cancer.
As Dr. Talebian handed off the medical staff presidency to Dr. Torosis,
she told him she had “ ‘tried to reach out to’ ” O’Hanlan to “talk to her and see
how we can help her” explain “why there are so many [of her] cases that fall
out [into peer review].” Dr. Talebian felt O’Hanlan had “rebuffed” her by
requesting “a lot of details, exactly what cases we’ve been talking about, even
though they were always reviewed and peer-reviewed.” Dr. Torosis called
O’Hanlan to arrange a meeting. As he memorialized in follow-up email,
during this call, O’Hanlan requested information about various performance
metrics, falsely claimed she was never told a case of hers had “ ‘fallen out’ ”
into peer review, and said she did not “ ‘need [to create] a black mark on [her]
file’ ” by meeting with Dr. Torosis. Dr. Torosis provided information in
2 O’Hanlan testified that she calculated her own complication rate
during the relevant period to be four percent, which gynecology literature
reflects is within the normal range. She faulted Dr. Chandrasena for failing
to “question[] . . . [the] discrepancy” between two “computer formula[ted]”
rates utilized by the quality department, a “MIDAS” rate that was 21 percent
for O’Hanlan during the relevant period and an “NSQIP” rate that was only
three percent. Dr. Chandrasena testified that the MIDAS rate “looks at
inpatients only,” and she discussed the “strengths and weaknesses of each
methodology for calculating complication rates” at length with the medical
executive committee.
5
response to O’Hanlan’s requests and asked her to review it so they could
schedule a meeting. Rather than agreeing to meet, O’Hanlan responded that
upon her inquiry, the quality department had “ ‘removed’ ” 12 of her cases
from the list flagged for review (which the department head denied), attached
a letter interpreting the metrics data she had requested, and asked Dr.
Torosis to “ ‘[l]et [her] know’ ” if they still “ ‘need[ed] to meet.’ ” She followed
this with emails requesting an apology from the quality department,
informing Dr. Torosis that he “ ‘should be outraged’ ” the matter was
“ ‘dump[ed] . . . on [his] lap,’ ” and repeatedly requesting the name of the
person “ ‘who told [Dr. Torosis] to call [her] for a meeting.’ ”
At this point, another troubling case occurred (the SLO Case). A
hysterectomy patient who had traveled from San Luis Obispo for her surgery
with O’Hanlan experienced postoperative bleeding in her abdomen.
O’Hanlan operated again and evacuated blood from the patient’s abdomen;
she did not identify a bleeding site. The next morning, O’Hanlan “just talked
to the patient and discharged her” without performing a blood test. About an
hour into the patient’s drive home, her husband called O’Hanlan and said his
wife was “ ‘not feeling well,’ ” was “ ‘diuretic[,] . . . sweaty[,]’ ” and had an
elevated heart rate. O’Hanlan responded that the patient was “ ‘probably
just having a panic attack.’ ” After two more hours of driving, the patient
experienced “a large amount of rectal bleeding” in a gas station bathroom.
When her husband called O’Hanlan, she told him to return to Sequoia. Dr.
Torosis testified, “you don’t need to be an advanced GYN/oncologist to know”
it was dangerous to “allow this patient to drive three hours while bleeding
where she could have died on the way without telling them to go to the
nearest hospital.”
6
Based on this and another concerning case of O’Hanlan’s that he
learned of at the time, Dr. Torosis asked the medical executive committee to
create an ad hoc committee to conduct a formal review of O’Hanlan’s practice.
C. Sequoia Investigates and Suspends O’Hanlan’s Privileges
In October 2016, the medical executive committee appointed an ad hoc
committee of three physicians to investigate O’Hanlan’s practice. The
committee met 18 times over the course of nearly a year, and its members
collectively reviewed all 28 of O’Hanlan’s cases that had been flagged for peer
review from 2014 to September 2016. The committee also obtained outside
review of seven cases by an independent expert, an associate professor and
director of gynecologic oncology at a major university medical center in
another state. The outside reviewer prepared a report, in which she
identified multiple deviations from the standard of care and several patterns
of concerning behavior by O’Hanlan in the cases she reviewed. The
committee considered its own and the expert’s analyses of O’Hanlan’s cases
and interviewed several members of Sequoia’s medical staff about her
practice, including O’Hanlan and another surgeon who frequently assisted
her.3
Meanwhile, another case of O’Hanlan’s drew attention (the Aorta
Case). As Dr. Torosis testified, a patient who previously had uterine cancer
3 During this process, the committee received a letter from O’Hanlan
with the subject line “Re: ‘They want my goat dead.’ ” In the letter,
O’Hanlan defended her practice, her professionalism, and her approach to
particular cases. She also described a “folk story” in which a man is granted
one wish after his goat dies and uses it to wish for his neighbor’s goat to die.
O’Hanlan used the story to illustrate her view that “[s]ome people, deprived
of success, instead of creating success for themselves, . . . find solace in
causing the failure of their peers.” She concluded her letter by “suggesti[ng]
to the Gyn department . . . that they grow their own skills,” characterizing a
recent quality assurance meeting as “an evidence-free, ethics-free kangaroo-
7
presented years later with abdominal pain, and imaging of her aorta raised
concern that the aorta was involved in recurrent cancer. O’Hanlan
informally consulted with a vascular surgeon, Dr. James Zimmerman, about
the possibility that she might need his help with the surgery. As O’Hanlan
performed the surgery with her usual assisting surgeon, “there was a hole or
rent placed in the aorta, and they had to . . . call Dr. Zimmerman,” who was
in the midst of another surgery. Dr. Zimmerman had to stabilize his own
patient and quickly go to O’Hanlan’s patient “to put in a vascular graft and
save the patient who could have bled.”
After the surgery, O’Hanlan dictated an “extremely peculiar” series of
operative reports that “weren’t consistent.” She originally dictated a report of
her own and another on behalf of her assisting surgeon, explaining later that
she intended “to try to have them as co-surgeons for billing purposes.” These
reports appeared to downplay the patient’s vascular injury or attribute it to
the assistant surgeon, and it was unusual and inappropriate to dictate a
report for another surgeon in the first place. When the assisting surgeon
rejected this approach, O’Hanlan “attempted to redact” the original reports
and dictated a third report that was more consistent with one Dr.
Zimmerman submitted in the interim. Dr. Torosis interviewed Dr.
Zimmerman about what happened, and Dr. Zimmerman expressed his view
that O’Hanlan failed to adequately prepare for him to assist with the surgery,
court,” and opining that “[t]his entire process suggests that having general
gynecologist’s [sic] review my cases is inappropriate, due to either their
unprofessionalism or their lack of knowledge.” A member of the ad hoc
committee later testified that while the committee had initially believed
“there might be some room for improvement” after meeting with O’Hanlan,
their conclusion changed based on this letter and the next case that we
discuss.
8
improperly documented what happened, and demonstrated other lapses in
judgment.
After learning about the Aorta Case, Dr. Torosis asked the medical
executive committee to consider summarily suspending O’Hanlan’s
privileges. The committee held a special meeting to consider the issue and
invited O’Hanlan to respond at a subsequent meeting. It decided to suspend
O’Hanlan’s privileges pending completion of the ongoing investigation into
her practice. The committee issued formal charges supporting its decision,
citing O’Hanlan’s failure to make appropriate arrangements for a vascular
surgeon to assist in the Aorta Case and her irregular documentation of that
surgery, as well as her rejection of all or most of the concerns raised by the ad
hoc committee and its outside expert and her characterization of the peer
review process as inappropriate. O’Hanlan requested a hearing, which the
parties agreed to defer until the ad hoc committee completed its
investigation.
D. O’Hanlan’s Privileges Are Terminated
The ad hoc committee provided its final report in September 2017. The
committee unanimously recommended that O’Hanlan’s medical staff
membership and clinical privileges be revoked. Its report detailed the
committee’s concerns with nine cases it had discussed with O’Hanlan,
including the Ovaries Case, SLO Case, and Aorta Case, and explained that
while her high complication rates indicated by various metrics had “partially
prompted” its investigation, the committee had decided to focus on actual
cases rather than analyzing the metrics.
The ad hoc committee summarized: “As we explored the many cases in
hand, we quickly noticed a pattern of negligence, lack of attention to details,
blame of others for her complications and bad outcomes, poor judgment,
9
unwillingness to include hospitalists and subspecialists early on, and
abrasive personality towards the medical staff.” The pattern continued
during the investigation, with “an additional 17 cases of complications”
arising after the investigation period ended. The committee noted that
O’Hanlan “did not show up for most of her cases that underwent peer review”
and when she did, “she attacked the presenters and outwardly attempted to
embarrass and discredit them,” making it “obvious that she thinks the
Obstetrics/Gynecology department is far too inferior to provide any kind of
comments on her cases.” The committee was thus “concerned” that O’Hanlan
was “unable to evolve and change to give us the confidence that she can
become a safer physician.”
As the ad hoc committee completed its investigation, Dr. Torosis
reviewed and made available to the medical executive committee documents
related to O’Hanlan’s practice at Stanford and Mills-Peninsula. He invited
O’Hanlan to discuss the ad hoc committee’s report with the medical executive
committee and informed her that issues related to her practice at Stanford
and Mills-Peninsula would also be discussed. O’Hanlan made a presentation
to the medical executive committee, which ultimately voted 10 to 6 to accept
the ad hoc committee’s recommendation that her medical staff membership
and privileges be revoked and her summary suspension continue. The
committee memorialized its decision in a letter to O’Hanlan.
O’Hanlan requested review of the medical executive committee’s
decision, and five physicians were appointed to a hearing committee (also
known as a judicial review committee). The medical executive committee
issued charges supporting its recommendations, incorporating the charges
underlying O’Hanlan’s summary suspension, the ad hoc committee’s report,
and its own conclusion that O’Hanlan “cannot be relied upon . . . to exercise
10
good clinical judgment and otherwise provide patient care that meets the
standards of quality required of physicians who practice at Sequoia.”
The hearing committee received evidence during 12 sessions held from
February to November of 2018. It heard testimony by Dr. Torosis, Dr.
Chandrasena, Dr. Zimmerman, and all three members of the ad hoc
committee, as well as O’Hanlan and the surgeon who often assisted her. Six
more physicians and one nurse testified on O’Hanlan’s behalf. The outside
expert retained by the ad hoc committee did not testify.
In January 2019, the hearing committee voted to uphold the medical
executive committee’s recommendations and issued findings and conclusions
in a written decision. The decision summarized the peer review proceedings
concerning O’Hanlan’s practice and analyzed the Ovaries Case, SLO Case,
and Aorta Case as “milestone” cases. It also assessed O’Hanlan’s
engagement with the quality improvement and peer review processes and her
arguments concerning different metrics Sequoia used in that context. The
decision set forth seven detailed findings, which we summarize:
(1) O’Hanlan’s “training, experience and skill in performing the physical and
mental act of surgery, especially laparoscopic surgery, is excellent-perhaps
even exceptional”; (2) her “inattention to important details, both
preoperatively and postoperatively, has exposed patients to an unreasonable
and unacceptable level of risk of serious injury”; (3) she “is especially
‘challenged’ when she needs to seriously consider the advice of peers” and
“adjust her practice patterns to applicable professional standards,” to the
degree that it would jeopardize “patient safety” for medical staff to make “a
‘leap of faith’ . . . by continuing her privileges in the hope that change would
occur”; (4) “[c]onsidering the information which was presented to the [medical
executive committee] . . . , and especially in view of [her] lack of veracity” in
11
documenting the Aorta Case, the summary suspension of O’Hanlan’s
privileges was reasonable and warranted; (5) continuing the summary
suspension was reasonable and warranted to avoid “expos[ing] future
patients to imminent danger”; (6) the preponderance of evidence presented to
the hearing committee supported its “unanimous conclusion and decision”
that O’Hanlan’s “medical staff membership and clinical privileges . . . should
be revoked”; and (7) the actions of the ad hoc committee, medical executive
committee, and other hospital staff “were fair and appropriate, both
substantively and procedurally.”
E. The Hearing Committee’s Decision Is Affirmed
O’Hanlan appealed the hearing committee’s decision to the appellate
review committee of Sequoia’s board of directors.4 In February 2020, that
committee denied her appeal, affirmed her summary suspension and its
continuation, and adopted the recommendation to revoke her medical staff
membership and clinical privileges. The appellate review committee found
all seven of the hearing committee’s findings were supported by substantial
evidence.
O’Hanlan filed a petition for writ of administrative mandate
challenging the appellate review committee’s decision. (Code Civ. Proc.,
§ 1094.5.) The superior court denied the petition.
4 We grant Sequioa’s unopposed motion to augment the record to
include the transcript of the proceedings before the appellate review
committee.
12
II. DISCUSSION
O’Hanlan claims Sequoia violated her right to a fair hearing and
aspects of its bylaws during peer review, and no substantial evidence
supports its findings against her.5 We reject these arguments.
A. Standard of Review
A hospital’s decision in a peer review proceeding may be judicially
reviewed by a petition for writ of administrative mandate. (Ellison, supra,
183 Cal.App.4th at p. 1495.) The writ shall issue “where ‘there was any
prejudicial abuse of discretion’ ” by the hospital, including “where the
petitioner has been denied ‘a fair trial’ ” or there were material, prejudicial
deviations from peer review bylaws. (El-Attar v. Hollywood Presbyterian
Medical Center (2013) 56 Cal.4th 976, 991 (El-Attar), italics omitted, quoting
Code Civ. Proc., § 1094.5, subd. (b); see Natarajan, supra, 11 Cal.5th at
pp. 1111–1112 [finding of prejudicial procedural error requires a new
hearing].) It will also issue where the hospital’s “ ‘findings are not supported
by substantial evidence in light of the whole record.’ (Code Civ. Proc.,
§ 1094.5, subds. (c) & (d).)” (Ellison, supra, at p. 1495.) We independently
5 Since the decisions at each level of the peer review proceedings were
consistent, and O’Hanlan does not claim the board of directors applied the
wrong standard to its decision, we collectively refer to the findings and
actions of the several investigative bodies against O’Hanlan as those of
Sequoia for simplicity’s sake. Ultimately, we review the board of directors’
final administrative decision rather than those that preceded it. (See Ellison,
supra, 183 Cal.App.4th at pp. 1495–1496 [where the hospital’s governing
body applied the correct standard to its own review, we ask whether
substantial evidence supported its decision].)
13
review these issues, giving no deference to the trial court’s ruling. (Id. at
pp. 1495–1496.)
B. Fair Procedure
“A physician facing peer review is not entitled to the same due process
protections as a criminal defendant.” (Ellison, supra, 183 Cal.App.4th at
p. 1498.) Rather, minimum protections are established by the peer review
statute, drawing from “ ‘the common law fair procedure doctrine that
preceded it.’ ” (Natarajan, supra, 11 Cal.5th at p. 1106.) The statute
“guarantees, among other things, a physician’s right to notice and a hearing
before . . . an unbiased panel, the right to call and confront witnesses and to
present evidence, and the right to a written decision by a trier of fact.” (El-
Attar, supra, 56 Cal.4th at p. 988; Bus. & Prof. Code, §§ 809.1, 809.2,
subd. (a), 809.3, subds. (a)(3), (4), 809.4, subd. (a)(1).) Hospital bylaws may
establish additional protections. (El-Attar, supra, at pp. 988–989.)
O’Hanlan claims that Dr. Torosis’s participation in the peer review
proceedings created an intolerable probability of bias against her under the
fair procedure doctrine. She argues that Dr. Torosis proceeded based on
“false information about [her] complication rates,” misrepresented her
willingness to meet with medical staff leadership, presented his findings on
the Aorta Case to the ad hoc committee “in the most negative light” without
speaking to her first, and was heavily involved in all stages of the
proceedings. O’Hanlan contends that these circumstances show Dr. Torosis
was “personally ‘embroiled’ ” in the peer review proceedings to an intolerable
degree, citing Mennig v. City Council (1978) 86 Cal.App.3d 341, 351 (Mennig).
O’Hanlan forfeited this argument by failing to raise it during the peer
review proceedings. (See Weinberg v. Cedars-Sinai Medical Center (2004)
119 Cal.App.4th 1098, 1115 [physician waived claim of bias based on chief of
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staff’s report to board of directors about medical executive committee’s
recommendation by failing to raise it to the board].) The argument also fails
on the merits. Despite O’Hanlan’s allegation that Dr. Torosis’s involvement
in the peer review proceedings was inappropriate, the peer review statute
“does not contemplate a strict separation between the medical staff and the
governing body as a prerequisite for a fair peer review system.” (El-Attar,
supra, 56 Cal.4th at p. 992.) O’Hanlan does not claim Dr. Torosis’s
involvement was other than what Sequoia’s bylaws and the peer review
statute provide for or show it was improper on its face. (See Weinberg, supra,
at p. 1115 [mere fact that chief of staff commented on medical executive
committee’s recommendation did not show bias].)
Moreover, O’Hanlan’s disagreement with Dr. Torosis’s analysis and
approach does not show he was “personally ‘embroiled’ ” in the proceedings.
(Mennig, supra, 86 Cal.App.3d, at p. 351.) In Mennig, after a civil service
commission largely rejected the testimony of members of the city council, the
members enacted a resolution to override the commission’s decision. Mennig
viewed this act of “vindication” as demonstrating “a degree of embroilment”
that created a “constitutionally intolerable” “ ‘probability of actual bias.’ ”
(Mennig, supra, at pp. 348–351.) Here, Dr. Torosis’s work never approached
conduct resembling the embroilment in Mennig. To the contrary, the
investigation and recommendations concerning O’Hanlan’s practice were
evaluated by a hearing committee, and later an appeal board, comprised of
staff members who—as required by statute and Sequoia’s bylaws—were
previously uninvolved in the investigation of O’Hanlan’s matters. (Bus. &
Prof. Code, §§ 809.2, subd. (a), 809.4) Dr. Torosis did not seek to override
those bodies like the city council members in Mennig and O’Hanlan does not
point to facts proving her conclusory statements that Dr. Torosis “staked his
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reputation” on a finding about her complication rates and “had every motive
to see [her] disciplined.”6
Next, O’Hanlan argues she was punished for exercising her rights to
defend herself in the peer review proceedings. She asserts without citation to
the record—and contrary to it—that her “defenses were never evaluated on
their merits”7 and were instead “unfairly characterized as evidence that she
was ‘unable to evolve’ into a safer physician.” While it is true that “a
physician may not be denied staff privileges merely because he or she is
argumentative or has difficulty getting along with [colleagues], when those
traits do not relate to the quality of medical care the physician is able to
provide,” Sequoia made specific findings that drew this connection in
O’Hanlan’s case. (Mileikowsky v. West Hills Hospital & Medical Center
(2009) 45 Cal.4th 1259, 1271, italics added.)
O’Hanlan further contends she was denied a fair hearing because she
was not afforded the opportunity to cross-examine the independent expert
witness, Dr. Julia Chapman, who submitted a report to the ad hoc committee.
But while the peer review statute and Sequoia’s bylaws establish a right to
cross-examine witnesses who testify at a peer review hearing (Bus. & Prof.
6 O’Hanlan also cites Nasha v. City of Los Angeles (2004)
125 Cal.App.4th 470, 477, 484 & fn. 8, which found an unacceptable
probability of bias due to a planning commissioner’s undisclosed authorship
of a newsletter article opposing a project whose approval the commission
later voted to overturn. O’Hanlan identifies no similar conduct by Dr.
Torosis, so this case does not support her position, either.
7 The hearing committee evaluated O’Hanlan’s criticism of Sequoia’s
application of certain quality metrics to her practice in detail, acknowledging
that her criticism was to some extent legitimate but finding it “largely missed
the point” because Sequoia’s findings and actions against O’Hanlan were
based on her lack of “quality of clinical decision-making, adequate attention
to detail, careful planning and honesty in documentation.”
16
Code, § 809.3, subd. (a)(3)), the report author did not testify. Our Supreme
Court has explained that “live adversarial questioning may be considered
essential in the context of a criminal trial” but “there is no absolute right to a
live hearing with cross-examination in administrative proceedings.”
(Boermeester v. Carry (2023) 15 Cal.5th 72, 93.) As for the report itself,
Sequioa’s bylaws permit consideration of any relevant hearsay evidence of
the type “on which responsible persons are accustomed to rely in the conduct
of serious affairs, regardless of the admissibility of such evidence in a court of
law.” (Bylaws, art. VIII, § 6.) O’Hanlan does not claim the report failed to
meet that standard or that she was denied other means to meet the report’s
contents. Indeed, O’Hanlan had been sent a copy of the report inviting her
comments. And, at the hearing, multiple witnesses, including O’Hanlan
herself, were questioned about Dr. Chapman and her report. Later, in her
brief to the appellate review committee, O’Hanlan did not object that she had
been denied a fair hearing on this basis, but instead used the fact that Dr.
Chapman did not testify (and was not cross-examined) to discredit her review
and conclusions.
Finally, O’Hanlan argues the cases that prompted her resignation from
Stanford and Mills-Peninsula should not have been considered during
Sequoia’s peer review proceedings because they were irrelevant and “[she]
was not given an adequate opportunity to address” them with the medical
executive committee. O’Hanlan urges that she disclosed these cases to
Sequoia and they long predated the proceedings at issue, but cites no
authority to show these circumstances made the cases irrelevant. To the
contrary, the prior cases—two of which involved issues with patient consent
similar to the Ovaries Case at Sequoia—clearly satisfied the broad standard
of relevance despite their age. (See Powell v. Bear Valley Community
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Hospital (2018) 22 Cal.App.5th 263, 267–269, 282 [case underlying revocation
of physician’s privileges at another hospital more than 10 years earlier was
relevant to ongoing risk of “adverse patient outcomes”].) And before the
medical executive committee met to consider the ad hoc committee’s
recommendations, Dr. Torosis notified O’Hanlan that it would consider this
history and specifically invited her comments in response.
In sum, O’Hanlan has not shown she was denied fair procedure during
peer review.
C. Substantial Evidence
That leaves O’Hanlan’s argument that there is no substantial evidence
in the record to support Sequoia’s actions against her. In applying the
substantial evidence standard to peer review decisions, we determine
whether the decision is supported “ ‘in the light of the whole record’ ” and
draw all reasonable inferences in support of the findings. (Cipriotti v. Board
of Directors (1983) 147 Cal.App.3d 144, 154.) It is not our role “to resolve
differences of medical judgment.” (Ibid.)
Initially, we agree with Sequoia that O’Hanlan has forfeited her
substantial evidence challenge by failing “to fairly summarize all of the facts
in the light most favorable to the judgment.” (Slone v. El Centro Regional
Medical Center (2024) 106 Cal.App.5th 1160, 1173–1174.) O’Hanlan’s
summary is severely lopsided: she does not meaningfully engage with the
major portion of the large administrative record that supports Sequoia’s
actions. (See id. at p. 1173 [“ ‘the burden to provide a fair summary of the
evidence “grows with the complexity of the record” ’ ”].) For example, she
summarizes the medical executive committee’s presentation to the hearing
committee—which occupied 8 of 12 sessions of the 9-month long proceedings
before that body—in a single paragraph that merely lists asserted flaws in
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the presentation rather than addressing its substance. This choice is
especially notable considering that Sequoia’s appellate review committee
pointed out O’Hanlan’s similar failure to discuss all the pertinent evidence in
her brief to that committee.
We have not attempted to provide a comprehensive summary of the
record evidence where O’Hanlan herself did not. But despite her forfeiture,
we have independently reviewed the record and find substantial evidence
supported Sequoia’s actions. Recognizing her surgical skill as “excellent-
perhaps even exceptional,” O’Hanlan’s peers also determined that her poor
judgment and oversights in specific cases, combined with her lack of
constructive engagement with the peer review process and inability or
unwillingness to adjust practice patterns to applicable professional
standards, presented an ongoing danger to patient safety. Ample record
evidence supports those conclusions. Neither O’Hanlan’s contrary evidence
and argument nor her criticisms of the processes and metrics that initially
drew attention to her practice supply a basis for us to overturn Sequoia’s
findings or its resulting actions against O’Hanlan.
III. DISPOSITION
The judgment is affirmed. Sequoia is entitled to its costs on appeal.
(Cal. Rules of Court, rule 8.278(a)(2).)
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_________________________
SMILEY, J.
WE CONCUR:
_________________________
HUMES, P. J.
_________________________
BANKE, J.
O’Hanlan v. Dignity Health Sequoia Hospital et al. / A171138
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