Full opinion text
OPINION AND ORDER VAN ANTWERPEN, District Judge. These consolidated actions stem from a physician peer review proceeding which eventually led to a curtailment of plaintiffs surgical privileges at the defendant hospitals. The Complaints in both cases allege a conspiracy in restraint of trade in violation of section one of the Sherman Act, 15 U.S.C. § 1, as well as various state law claims. Currently before the court are all defendants’ motions for summary judgment. We have subject matter jurisdiction over the antitrust claims pursuant to 28 U.S.C. §§ 1331 and 1337, and 15 U.S.C. §§ 4, 15, and 26 and supplemental jurisdiction over the state claims pursuant to 28 U.S.C. § 1367. I. FACTUAL BACKGROUND No party disputes the following facts. A. The parties Plaintiff Robert S. Mathews, M.D. is an orthopedic surgeon who specializes in spine trauma and spine diseases. Since 1988, Dr. Mathews has been a corporate partner with another orthopedic surgeon, George M. Kent, M.D., who also performs spine surgery. Dr. Kent is not a party to this suit. Defendants Lancaster General Hospital (“LGH”) and Lancaster General Hospital Foundation (“LGH Foundation”) are nonprofit corporations which operate and support, respectively, a hospital in Lancaster, Pennsylvania. Defendants Columbia Hospital (“Columbia”) and Columbia Hospital Foundation, Inc. (“Columbia Foundation”) are non-profit corporations which operate and support, respectively, a hospital in Columbia, Pennsylvania. ■ The LGH Foundation is the parent organization of LGH, and the Columbia Foundation is the parent organization of Columbia. On February 28, 1994, the LGH Foundation and the Columbia Foundation entered into a “Membership Agreement” which resulted in an affiliation between the two hospitals. Dr. Mathews has had active staff privileges at LGH since 1973. His office at 554 North Duke Street is directly across the street from LGH. Dr. Mathews’ first association with Columbia occurred in April of 1992, when he was granted temporary privileges there in the Division of Surgery, Orthopedics. The six individual physician defendants, Drs. Rothacker, Westphal, Shertzer, Lyet, Argires, and Hoke, are four orthopedic surgeons, a neurosurgeon, and a radiologist, respectively. Drs. Shertzer and Argires are members of LGH’s Board of Directors (“the LGH Board”). Dr. Hoke is an ex-officio member of the LGH Board. Defendant Orthopedic Associates of Lancaster (“OAL”) is a professional corporation located in Lancaster, Pennsylvania. OAL is an orthopedic surgery group which practices at LGH. Drs. Rothacker, Westphal, and Shertzer practice with OAL and are shareholders of the corporation. B. The December 1989 incident and investigation The chain of events that eventually led to the filing of this lawsuit began on December 27, 1989. That morning, Dr. Kent was performing spinal surgery on a patient at LGH. Dr. Mathews was listed as co-surgeon for the operation. During the procedure, a high-speed drill slipped, causing damage to the patient’s esophagus. Dr. Kent attempted to repair the esophagus, but did not seek assistance or a consultation regarding the damage done. According to Dr. Kent, Dr. Mathews was not present in the room at the time of the incident, at least not until after the repair of the esophagal tear had been completed. Later that day, the patient experienced se--vere problems and had to undergo a second, emergency surgery to repair the tear. As a result of these complications, Dr. Kent was suspended for five days, and.an Ad Hoc Committee was appointed to investigate the incident. Defendant Hugh H. Hoke, Jr., M.D. was chosen to be the chairman of the committee, which consisted of several other physicians who are not parties to this action (“the Hoke Committee”). After a five-day investigation, the Hoke Committee concluded that Dr. Kent had acted inappropriately by virtue of his failure to seek a consultation once harm had been done to the patient’s esophagus. In a report dated January 4, 1990, the committee recommended that “a focused review of all Dr. Kent’s cases should be performed by the Quality Assurance Committee of the Department of Surgery for a period of six months.” The Hoke Committee’s report was forwarded to Dr. Kent on the same day it was issued. In response, by way of a letter dated January 5,1990, Dr. Kent made minor modifications to the report and indicated his agreement with the recommended corrective action, including the focused review of his cases. Although recognizing that plaintiff Dr. Mathews may not have been in the operating room during the events in question, in its report the Hoke Committee concluded that as co-surgeon, he bore “some responsibility for the incident.” On January 5, 1990, Mr. Michael Young, LGH’s Chief Executive Officer, wrote Dr. Mathews a letter informing him of this conclusion. C. LGH’s focused review of Dr. Kent’s cases In accordance with the Hoke Committee’s recommendation, a focused review of Dr. Kent’s cases was indeed performed. However, for reasons that are disputed, the review was not performed by the Quality Assurance Committee of the Department of Surgery as suggested in the report. Rather, it was performed by a second Ad Hoc Committee selected by defendant Department of Surgery Chairman Gerald W. Rothacker, Jr., M.D., ahd composed of himself and two other board certified orthopedic surgeons, defendants Thomas R. Westphal, M.D. and J. Paul Lyet, M.D. (“the Rothacker Committee”). The Rothacker Committee reviewed surgical cases covering a period from January 1990 to June 1990 and involving Dr. Kent as either the primary or assisting surgeon. The committee’s review encompassed 208 cases and took approximately two years, beginning sometime in March of 1990. At the end of the review, the committee concluded that 27 of the 208 cases evidenced a substandard level of care. During the course of its focused review of Dr. Kent, the Rothacker Committee discovered that the medical records in almost every case reviewed identified plaintiff Dr. Mathews as participating in the surgery in some capacity. In particular, it was discovered that 23 of the 27 cases which were found not to meet the standard of care involved spine surgery, and that Dr. Mathews was the primary surgeon in each of those cases. Dr. Rothacker reported the findings of the committee by way of a March 19, 1992 letter to then-President of the LGH Medical and Dental Staff Robert P. Johnson, M.D. and a report to the Executive Committee of the Medical and Dental Staff on April 6, 1992. The letter recommended that the 27 files rated substandard by the committee be sent to an outside agency for further review and stated that “[i]f this agency agrees that these cases were not managed in an acceptable fashion, a restriction of privileges would be indicated.” Attached to the letter was a list of the cases at issue, with comments as to each. Both Dr. Kent and Dr. Mathews were sent copies of Dr. Rothacker’s March 19th letter. Subsequently, in a letter dated April 30, 1992, Dr. Johnson wrote to Dr. Mathews, informing him that the review of Dr. Kent’s eases had included a review of his work and that the Medical and Dental Staff Executive Committee was going to have an outside consultant review the cases in question. Attached to this letter was a copy of the minutes of the April 6, 1992 meeting of the Executive Committee. The minutes also indicated that the review of Dr. Kent had involved a review of Dr. Mathews’ work, and stated that review by an outside review agency “may result in a recommendation regarding Dr. Mathews’ clinical privileges.” D. The independent review LGH retained the American Medico-Legal Foundation to select an independent consultant to review the cases deemed substandard by the Rothacker Committee. The Foundation chose Philip D. Wilson, Jr., M.D. of Cornell Medical College. Drs. Kent and Mathews were given an opportunity to submit to Dr. Wilson additional information regarding the medical files selected for review, and both submitted some supplementary materials. On March 18, 1993, after reviewing all the information submitted by LGH and Drs. Mathews and Kent, Dr. Wilson issued a report concluding that the quality of care rendered by Drs. Mathews and Kent was inadequate and below acceptable standards in several respects. Dr. Wilson recommended that both doctors’ privileges to perform spine surgery be restricted until they were able to “demonstrate a renewed and updated understanding of present day principles and practice of this type of surgery.” By letter of May 10, 1993 from LGH CEO Mr. Young, Dr. Mathews was informed of Dr. Wilson’s conclusions and furnished with a copy of his report. E. LGH’s restriction of Dr. Mathews’ privileges On July 29, 1993, Dr. Mathews sent LGH his 1994-95 staff privileges application. For reasons that remain in dispute, in his application Dr. .Mathews did not request privileges to perform spine surgery. Also, a letter accompanying the application and addressed to Dr. Hoke stated that “[v]oluntarily I plan to stop doing spinal surgery for medical reasons at Lancaster General Hospital.” On November 17, 1993, the LGH Board of Directors granted plaintiff’s 1994-95 privileges as requested, i.e., without spine surgery privileges.. Meanwhile however, on September 16, 1993, the LGH Board of Directors had voted to restrict the surgical privileges held by Dr. Mathews at that time. Specifically, the Board voted to suspend Dr. Mathews’ privileges to perform spine surgery as either a primary or assisting surgeon, and to require him to obtain a second opinion or consultation before performing prosthetic joint surgery, arthroscopy, or hand or foot surgery for a period of 12 months. The defendant physicians on the Board, Drs. Shertzer and Argires, abstained from voting. Defendant Dr. Hoke, an ex-officio member- of the Board, also did not vote. Dr. Mathews was notified of the Board’s decision by a letter from Mr. Young dated September 22, 1993. The letter also advised Mathews of the reasons for the proposed restrictions and of his right under the LGH Medical Staff Bylaws to a fair hearing regarding the proposed action. On October 26, 1993, Mathews made a timely request for such a. hearing. Subsequently, the Board voted not to impose any restrictions until the fair hearing could be held. The hearing had not yet been scheduled when the first of these two consolidated actions was filed on December 15, 1993, and to date no such hearing has taken place. F. Dr. Mathews’ staff privileges at Columbia Also during the period when the above events were taking place, plaintiff for the first time applied for surgical privileges at defendant Columbia. Effective April 22, 1992, Columbia granted Dr. Mathews “temporary privileges” there in the Division of Surgery, Orthopedics. These privileges were scheduled to expire on September 30,' 1992. Approximately two weeks before the expiration date, Columbia’s Board of Trustees approved the Medical Staffs recommendation that Dr. Mathews be granted “provisional courtesy privileges” in the Division of Surgery, Orthopedics. As set out in Columbia’s Bylaws, all initial appointments to the medical staff are “provisional” for a period of twelve months. On September 15, 1992, Mr. Robert Katana, president and CEO of Columbia Hospital, wrote to Dr. Mathews, informing him of the Board of Trustees’ decision. Near the end of the twelve month “provisional” period, on August 25, 1993, Columbia’s Credentials Committee recommended to Columbia’s Medical Executive Committee and its Board of Trustees that Dr. Mathews’ status change from “provisional courtesy privileges” to “courtesy privileges” in the Division of Surgery, Orthopedics. The Board of Trustees approved this change on September 13, 1993, and on September 16, 1993 Mr. Katana sent Dr. Mathews a letter informing him of the lifting of his provisional status. Meanwhile, Dr. Mathews had submitted a reappointment application to have his privileges renewed for the next year beginning January 1, 1994, as was normal procedure under Columbia’s Bylaws. Although Dr. Mathews submitted his reappointment application prior to the September 1, 1993 deadline, on September 24, 1993 Mr. Katana discovered that the application was not complete because it did not include a reappointment reference from LGH. Columbia requires all staff physicians to submit completed reappointment references from any other hospitals where they exercise privileges. Despite repeated efforts, Columbia was unable to obtain LGH’s completed reappointment reference from either Dr. Mathews’ office or directly from LGH. Accordingly; on November 10, 1993, Mr. Katana wrote to Dr. Mathews informing him that his reappoint-, ment application was incomplete and that his courtesy staff privileges would therefore automatically expire on December 31, 1993. Mr. Katana also informed Dr. Mathews that he could reapply for those privileges in accordance with the procedures set out in Columbia’s Bylaws. Dr. Mathews never submitted the reappointment reference from LGH, and his courtesy staff privileges at Columbia expired on December 31,1993. After that date, however, Columbia again granted Dr. Mathews “temporary privileges,” which he continues to exercise. G. Procedural history On December 15, 1993, ■ plaintiff filed an action against LGH, the LGH Foundation, Columbia, the Columbia Foundation, and the six individual doctors listed above. The Complaint was amended on September 9, 1994. Count I of the Verified Amended Complaint is an antitrust claim alleging a conspiracy in violation of section one of the Sherman Act, 15 U.S.C. § 1, and seeking treble damages and injunctive relief pursuant to sections four and sixteen of the Clayton Act, 15 U.S.C. §§ 15 & 26. Counts II through IV allege state law claims of breach of contract, intentional interference with contractual relations, and civil conspiracy. On August 1, 1994, plaintiff filed a second, two-count Complaint against OAL, alleging a violation of section one of the Sherman Act and a state law claim of intentional interference with contractual relations. This court consolidated the actions for pretrial purposes in an order dated November 18, 1994. All defendants moved for summary judgment in late 1994. On December 1,1994, the court denied defendants’ motions for administrative purposes in order to allow plaintiff an additional discovery period of 60 days which he had requested. After the 60-day period, each defendant renewed its motion for summary judgment, and plaintiff renewed its responses to those motions and submitted a supplementary memorandum addressing materials uncovered during the additional discovery period. It is these summary judgment motions which are currently before the court. II. STANDARD OF REVIEW Rule 56(c) of the Federal Rules of Civil Procedure provides for summary judgment where the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. “The party moving for summary judgment must demonstrate that, under the undisputed facts, the non-movant has failed to introduce evidence supporting a necessary element of his case.” In re Phillips Petroleum Sec. Litig., 881 F.2d 1236, 1243 (3d Cir.1989). To defeat summary judgment, the non-moving party must respond with facts of record that contradict the facts identified by the movant and may not rest on mere denials. See Celotex Corp. v. Catrett, 477 U.S. 317, 321 n. 3, 106 S.Ct. 2548, 2552 n. 3, 91 L.Ed.2d 265 (1986) (quoting Fed.R.Civ.P. 56(e)); see also First Nat’l Bank v. Lincoln Nat’l Life Ins. Co., 824 F.2d 277, 282 (3d Cir.1987). The non-moving party must demonstrate the existence of evidence that would support a jury finding in its favor. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248-49, 106 S.Ct. 2505, 2510-11, 91 L.Ed.2d 202 (1986). “A non-movant’s burden in defending against summary judgment in an antitrust case is no different than in any other case.” Big Apple BMW, Inc. v. BMW of North America, Inc., 974 F.2d 1358, 1363 (3d Cir.1992), cert. denied, - U.S. -, 113 S.Ct. 1262, 122 L.Ed.2d 659 (1993). III. DISCUSSION A. HCQIA Immunity Defendants, except for Columbia and Columbia Foundation, contend that they are entitled to immunity under the Health Care Quality Improvement Act (“the HCQIA” or “the Act”), 42 U.S.C. § 11101-11152 (West Supp.1994). The HCQIA is intended to “provide incentive and protection for physicians engaging in effective professional review” by immunizing them from money damages liability in connection with such proceedings. 42 U.S.C. §§ 11101(5), 11111. It was enacted in part as a response to Congress’ finding that “[t]he threat of private money damage liability— unreasonably discourages physicians from participating in effective professional peer review.” 42 U.S.C. § 11101(4). The Act “essentially immunizes peer review action from liability if the action was taken ‘in the reasonable belief that [it] was in furtherance of quality health care.’ § 11112(a).” Patrick v. Burget, 486 U.S. 94, 105 n. 8, 108 S.Ct. 1658, 1665 n. 8, 100 L.Ed.2d 83 (1988). More specifically, to qualify for immunity under the HCQIA, a “professional review action” must be taken: (1) in the reasonable belief that the action was in the 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 the facts and after meeting the requirements of paragraph (3). 42 U.S.C. § 11112(a). If a “professional review action” meets all of these standards, then any party covered by the Act “shall not be liable in damages ... with respect to the action.” Id. at § 11111(a)(1). 1. Which parties are covered by the HCQIA? We note that no party has addressed the issue of whether the defendants claiming immunity are persons or entities to whom the protections of HCQIA would extend, provided that the peer review process met the Act’s standards. The Act provides protection 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.” Id. at § 11151(11). “[A] hospital that is licensed to provide health care services by the State in which it is located” is considered a “health care entity.” Id. at 11151(4)(A)(i). Guided by these definitions, it is clear that LGH and the individual physician defendants all fall within the protected categories listed in section 11111(a)(1). As a “health care entity,” LGH is a “professional review body” covered under section 11111(a)(1)(A).' The individual doctors, as either members/staff of LGH, persons under contract or formal agreement with LGH, or persons who assisted in a peer review action, are covered under sections lllll(a)(l)(B)-(D). Defendants LGH Foundation and OAL, however, are not entities which are expressly mentioned in the Act. The term “health care entity,” while expressly including hospitals such as LGH, does not appear on its face to include parent organizations such as LGH Foundation. See 42 U.S.C. §§ 1395x(e)(l) & (7), 11151(4) & (5). Thus, unlike LGH, LGH Foundation' is not expressly included within the definition of a “professional review body” as stated in section 11111(a)(1)(A). Subsections (B) and (D) initially appear to encompass LGH Foundation and OAL — LGH Foundation has a contract or formal agreement with LGH, see § 11111(a)(1)(B), and OAL is alleged to have participated, through its agents, in LGH’s peer review of plaintiff, see § 11111(a)(1)(D) — however, both subsections on their fapes only mention “person[s].” Neither LGH Foundation nor OAL is a natural “person”; rather, both are corporate entities. However, Congress has clarified that, “[i]n determining the meaning of any Act of Congress, unless the context indicates otherwise— ... the words “person” and “whoever” include corporations, companies, associations, [and] firms ... as well as individuals.” 1 U.S.C.A. § 1. There is nothing in the context of the HCQIA which would lead us to conclude that corporations are not “persons” entitled to the broad protections of the Act. To the contrary, such a conclusion would utterly thwart the Act’s stated overall purpose of encouraging physicians and others to participate in effective physician peer review. See 42 U.S.C. §§ 11101(4), 11101(5), 11111. If a plaintiff can circumvent the HCQIA’s immunity provisions merely by naming as a defendant a parent corporation or a corporation in which a peer review participant is a shareholder, then corporate agents such as physicians or hospital boards would be deterred from meaningful participation in the peer review process. It makes little sense to provide immunity for an agent and deny it for the corporation on whose behalf the agent is acting. We think the term “person” is broader than that. We need not decide this issue, however, because we find that even if OAL and LGH Foundation are not directly covered by the HCQIA, principles of corporate liability mandate that they be granted summary judgment if LGH and the individual physician defendants who allegedly acted on behalf of OAL are found to be immune under the HCQIA. “Under Pennsylvania law, a corporation is a legal fiction that can act only by creating agency relationships with its officers, directors, employees, and others.” Richardson v. John F. Kennedy Memorial Hosp., 838 F.Supp. 979, 985 (E.D.Pa.1993) (citing Biller v. Ziegler, 406 Pa.Super. 1, 593 A.2d 436, 439 (1991)). See also Daniel Adams Assocs. v. Rimbach Publishing Co., 360 Pa.Super. 72, 79, 519 A.2d 997, 1000 (1987), allocatur denied, 517 Pa. 597, 535 A.2d 1056 and 517 Pa. 599, 535 A.2d 1057 (1987). The Complaints reveal that the alleged liability of OAL is based solely on the actions of the three OAL agents who are named individually as defendants, Drs. Ro-thacker, Westphal and Shertzer. Similarly, the alleged liability of LGH Foundation is based solely on the actions of its subsidiary corporation, LGH. Neither OAL nor LGH Foundation is alleged to have acted in any other way except through these agents. Thus, the sole basis of recovery against OAL and LGH Foundation is that they are vicariously liable for the actions of the named defendants. As defendant OAL correctly points out, a claim of vicarious liability depends upon the life of the claim from which it derives. “Termination of the claim against the agent extinguishes the derivative claim against the principal.” See Mamalis v. Atlas Van Lines, Inc., 364 Pa.Super. 360, 528 A.2d 198, 200 (1987), aff'd, 522 Pa. 214, 560 A.2d 1380 (1989). Accordingly, if the agents of LGH Foundation and OAL are entitled to immunity from damages under the HCQIA, then LGH Foundation and OAL themselves would also be entitled to summary judgment on the issue of damage liability. Thus, we conclude that each of the defendants asserting HCQIA immunity is a person or entity entitled to summary judgment provided that all the requirements of the Act are met. 2. How many “professional review actions”? As a second preliminary matter, we must decide which of the actions leading up to this suit constitutes a “professional review action.” Defendants contend that only the Board’s September 16, 1993 vote to restrict plaintiff’s surgery privileges is a “professional review action.” They argue that in order for immunity to attach, only this action must meet the four standards set out in section 11112(a). Plaintiff, while agreeing that the Board’s vote is a “professional review action,” argues that there are as many as four additional “professional review actions,” each of which must individually meet the requirements of section 11112(a): 1) the Hoke Committee’s review of the initial surgical incident involving Dr. Kent, 2) the Rothacker Committee’s six-month review of Dr. Kent’s cases, 3) the Rothacker Committee’s March 19, 1992 letter recommending an outside review, and 4) the “action of [LGH] that resulted in the May 10, 1993 letter” informing plaintiff of the outside reviewer’s conclusions. See Plaintiffs 2/13/95 Brief at 7-8. Defendants counter that these four additional acts are merely investigatory “professional review activity” leading up to a single “professional review action,” i.e., the Board’s vote. The Third Circuit has not yet addressed the distinction between “professional review activity” and “professional review action” under the HCQIA. Defendants therefore rely upon two Ninth Circuit cases to support their characterization of the instant events as a number of “professional review activities” culminating in one “professional review action.” See Fobbs v. Holy Cross Health Sys. Corp., 29 F.3d 1439 (9th Cir.1994), aff'g 789 F.Supp. 1054 (E.D.Cal.1992), cert. denied, — U.S. -, 115 S.Ct. 936, 130 L.Ed.2d 881 (1995); Austin v. McNamara, 979 F.2d 728 (9th Cir.1992). Defendants also point out that at least one district court in our Circuit has tacitly followed the approach they suggest. See Farr v. Healtheast, Inc., No. 91-6960, 1993 WL 220680 (E.D.Pa. June 9, 1993) (nearly 21 month ongoing peer review investigation culminating in revocation of privileges analyzed as if one professional review action for purposes of HCQIA immunity). Plaintiff bases his interpretation primarily on the wording of the statutory definition of “professional review action.” Section 11151 of the HCQIA provides in relevant part: (9) The term “professional review action” means an action or recommendation of 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 ..., and which affects (or may affect) adversely the clinical privileges ... of the physician. Such term ... also includes professional review activities relating to a professional review action.... 42 U.S.C. § 11151. Plaintiff argues that because each of the five acts he enumerates is an “action or recommendation of a professional review body ... which ... may affect adversely the clinical privileges ... of the physician,” each must be considered an individual “professional review action.” In support of this position, he cites Manion v. Evans, No. 3:89CV7436, 1991 WL 575715 (N.D.Ohio July 8, 1991), appeal dismissed, 986 F.2d 1036 (6th Cir.), cert. denied, — U.S. -, 114 S.Ct. 71, 126 L.Ed.2d 40 (1993), as well as a case cited by defendants, Austin v. McNamara, supra. While plaintiffs interpretation might be plausible given the literal wording of one part of the statute, we find that it does not reflect the overall construction and purposes of the HCQIA. Plaintiff relies on the definition of “professional review action” to the exclusion of all other provisions of the Act. Perhaps most notably, plaintiff can provide no clue as to exactly what types of acts should be considered “professional review activity.” Instead, he appears to subsume every act connected to the peer review process into the category of “professional review action.” This is an absurd result. When the definitions of both terms are read in the context of the statute as a whole, defendants’ scheme of a series of “professional review activities” leading up to a final “professional review action” must prevail. The Act defines “professional review activity” as follows: (10) The term “professional review activity” means an' activity of a health care entity with respect to an individual physician— (A) to determine whether the physician may have clinical privileges with respect to, or membership in, the entity, (B) to determine the scope or conditions of such privileges or membership, or (C) to change or modify such privileges or membership. 42 U.S.C. § 11151(10). As outlined above, a “professional review action ... affects (or may affect) adversely [a physician’s] clinical privileges” and occurs “in the conduct of professional review activity.” § 11151(9). An “action” may be taken only after “a reasonable effort to obtain the facts of the matter,” § 11112(a)(2), and “in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts.” § 11112(a)(4). Reading all of these statutory provisions together, we must agree with defendants that, as applied in the context of a privileges restriction, the term “professional review activity” refers to preliminary investigative measures taken in “a reasonable effort to obtain the facts” relevant to a possible change in a physician’s privileges, while the term “professional review action” refers to the decision that results from a review of the facts obtained. See Fobbs v. Holy Cross Health Sys. Corp., 789 F.Supp. at 1065 (“[P]rofessional review activity means the investigative process during and/or upon which a professional review action, i.e., a decision, is made.”). This conclusion finds support in both the language and the construction of the statute. To begin with, there must be some distinction between “professional review activity” and “professional review action” or Congress would not have used two separate terms to refer to deeds done in connection with the peer review process. Our reading of the statute assigns a meaning to each term, rendering neither superfluous, and fits each type of act into a comprehensive, workable scheme. By contrast, the reading suggested by plaintiff ignores the term “professional review activity” and, as an example will show, is unworkable when viewed in conjunction with other statutory provisions. If, as plaintiff argues, an investigative measure such as the initial Hoke Committee investigation were considered a “professional review action,” then, under sections 11112(a)(2) and (4), it could not be undertaken until after there had been both a reasonable effort to obtain the facts of the matter and a determination that the investigation was warranted by the facts known after that reasonable effort. In other words, plaintiff’s construction of the Act would require the Hoke Committee, or any such investigative body, to make a reasonable effort to obtain the facts before undertaking its effort to obtain the facts. This simply makes no sense — the investigation is the effort to obtain the facts. As this example illustrates, “[i]t [is] impossible to apply the § 11112(a) standard to acts which are encompassed within the standard.” See Fobbs v. Holy Cross Health Sys. Corp., 789 F.Supp. at 1065 (concluding that this approach would be “nonsensical” and that the standard of section 11112(a) “is intended to apply to discrete decisions, not to an ongoing course of conduct”). The approach we adopt, avoids this conundrum. It treats efforts to obtain the facts as “professional review activity,” which is not separately subject to the strictures of section 11112(a). A decision, or “professional review action,” is evaluated under section 11112(a) to determine whether the “professional review activity” preceding it amounts to a “reasonable” effort to obtain the facts and provides “reasonable” substantive justification for the decision made:'-'- This interpretation conforms not just to the language and construction of the Act, but to its purposes as well. Section 11112(a)(8) requires that a “professional review action” be taken only after the physician involved is afforded adequate notice and hearing procedures. Under plaintiffs interpretation, such notice and hearing would be required after each step of an ongoing investigative process. In the instant ease, as many as five separate notice and hearing procedures would have been required. Given that one of the Act’s stated purposes is to provide incentive for physicians and others to participate in peer review, we do not think Congress could have intended such an involved result. See 42 U.S.C. § 11101(5). “[I]t would be a nearly insurmountable chore for these defendants, or any defendants, to attempt to prove HCQIA immunity for each aspect of their entire course of conduct in response to a plaintiffs general allegations of misconduct. Such a duty would reduce the efficaciousness of the HCQIA and defeat Congress’ stated purpose in promulgating it.” Fobbs v. Holy Cross Health Sys. Corp., 789 F.Supp. at 1065. Thus, the underlying purposes of the HCQIA also weigh in favor of our holding that the Act’s standards apply to decisions, not the ongoing course of investigative conduct which provides the basis for those decisions. Finally, we note that even the cases cited by plaintiff do not support the approach he suggests. Although both Austin v. McNamara and Manion v. Evans illustrate that a given course of conduct may include more than one “professional review action,” neither suggests that investigative activity is encompassed by that term. In both cases, the courts concluded that an initial suspension of the plaintiffs privileges and a subsequent hearing to review that decision were two separate “professional review actions.” See Austin v. McNamara, 731 F.Supp. 934, 939 (C.D.Cal.1990); Manion v. Evans, 1991 WL 575715, at *7-*8. The Austin court went on to analyze each “action” individually to determine whether it met the requirements of section 11112(a). Neither court, however, held that any investigative activity constituted “professional review action.” In fact, the Austin court held exactly the opposite. It concluded that a “[professional review] ‘action’ can only be taken after professional review activity to determine the facts_ [T]he responsible body ‘commences’ an action when it begins to take an action — after it reviews the results of the required investigation.” Austin v. McNamara, 979 F.2d at 737. Thus, Austin squarely supports defendants’ position, not plaintiffs. In fact, activities nearly identical to those at issue in this case were considered by the Austin court to constitute “professional review activity.” These included: a review of the plaintiff doctor’s eases by another hospital doctor, followed by a report to a Surgical Audit Committee identifying alleged deficiencies; an external review by two neurosurgeons who “expressed reservations and recommended further monitoring”; an Ad Hoc Committee discussion of plaintiffs work which led to a recommendation that a six-month review be performed; and the subsequent six-month review itself. See 979 F.2d at 731-32, 737. In sum, we find that neither the available caselaw nor the language, construction, or purposes of the Act support the approach suggested by plaintiff. Thus, we agree with the Fobbs court that “[t]he HCQIA does not require that a professional review body’s entire course of investigative conduct meet particular standards in order for it to be immune from liability in its ultimate decision.” 789 F.Supp. at 1065. Accordingly, we hold that only the LGH Board’s September 16, 1993 vote to restrict Dr. Mathews’ surgical privileges is a “professional review action.” The other actions enumerated by plaintiff constitute “professional review activity” and as such are not subject to separate scrutiny under section 11112(a). 3. Objective or subjective standard? As a final preliminary matter, we. must decide whether the reasonableness requirements of section 11112(a) create an objective or subjective standard for reviewing a professional review action. Although the Third Circuit has yet to address this issue, every other Circuit which has considered it has concluded that the legislative history of ■ the Act mandates an objective standard. See Imperial v. Suburban Hasp. Ass’n, 37 F.3d 1026, 1030 (4th Cir.1994) (“The standard is an objective one which looks to the totality of the circumstances.”); Bryan v. James E. Holmes Regional Medical Ctr., 33 F.3d 1318, 1323 (11th Cir.1994), cert. denied, — U.S. -, 115 S.Ct. 1363, 131 L.Ed.2d 220 (1995); Smith v. Ricks, 31 F.3d 1478, 1485 (9th Cir.1994), cert. denied, — U.S.-, 115 S.Ct. 1400, 131 L.Ed.2d 287 (1995) (“[T]he ‘reasonableness’ requirements of § 11112(a) were intended to create an objective standard, rather than a subjective standard.... ”); Austin v. McNamara, 979 F.2d at 734. As most "of these courts have noted, the House report on § 11112(a) states: Initially, the Committee considered a ‘good faith’ standard for professional review actions. In response to concerns that ‘good faith’ might be misinterpreted as requiring only a test of the subjective state of mind of the physicians conducting the professional review action, the Committee changed to a more objective ‘reasonable belief standard. The Committee intends that this test will be satisfied if the reviewers, with the information available to them at the time of the professional review action, would reasonably have concluded that their actions would restrict incompetent behavior or would protect patients. H.R.Rep. No. 903 99th Cong., 2d Sess. 10 reprinted in 1986 U.S.C.C.A.N. 6287, 6384, 6392-93. Given this clear statement of Congressional intent and the weight of authority from other Circuits, we too conclude that the reasonableness requirements of § 11112(a) are intended to create an objective standard, rather than a subjective or good faith standard. Thus, the issue we must address is, whether “physicians in the defendants’ position would reasonably have believed that their action was warranted by - the faets.” Smith v. Ricks, 31 F.3d at 1485. 4. Were the requirements of § 11112(a) met? We now turn to the question of whether the Board’s vote to restrict plaintiffs privileges satisfies the substantive and procedural requirements set out in section 11112(a). A professional review action is presumed to meet the requirements “unless the presumption is rebutted by a preponderance of the evidence.” 42 U.S.C. § 11112(a). On summary judgment, this presumption yields a “somewhat unusual” standard of review. See Austin v. McNamara, 979 F.2d at 734. The court must ask: Might a reasonable jury, viewing the facts in the light most favorable to the plaintiff, conclude that he has overcome, by a preponderance of the evidence, the presumption that the defendants’ actions fall within the scope of section 11112(a)? See id.; Bryan v. James E. Holmes Regional Medical Ctr., 33 F.3d at 1333 (“In a sense, the presumption language in HCQIA means that the plaintiff bears the burden of proving that the peer review process'was not reasonable.”). a. § 11112(a)(1) We find that plaintiff has not provided or pointed to any evidence from which a jury could reasonably conclude that he has overcome the presumption that the Board’s proposed restrictions on Dr. Mathews’ privileges were taken “in the reasonable belief that the action was in furtherance of quality health care.” The undisputed evidence shows that, in making its decision, the Board relied on the findings of the Rothacker Committee and the independent expert Dr. Wilson, as reported to the Board by LGH CEO Mr. Young and defendant Dr. Hoke. The Rothacker Committee report represents the conclusion of a committee of three board certified orthopedic surgeons that 23 of Dr. Mathews cases during a six-month period did not meet the appropriate standard of care. These findings were confirmed by those of the independent expert, Dr. Wilson of Cornell Medical College. Dr. Wilson was selected by the American Medico-Legal Foundation, an independent organization. He is a board certified orthopedic surgeon who has practiced and taught in the field of orthopedic surgery for over 40 years. After reviewing the cases identified by the Rothacker Committee, Dr. Wilson submitted a detailed report in which he concluded that the pattern and trend of care reflected were “substandard” in fourteen separate respects, which he enumerated. The reasons listed are all grounded in legitimate health care quality concerns including, for example, “incredibly, poor documentation of patient workups,” “failure to use alternative imaging techniques” and “lack of judgement [sic] in applying extensive lumbar surgical decompres-sions and fusions to patients irrespective of age and type of condition.” See Imperial v. Suburban Hasp. Ass’n, 37 F.3d at 1029 (de--fendants acted in furtherance of quality health care where “throughout the proceedings every doctor’s opinion about [plaintiff] related to the issue of health care quality”). Dr. Wilson recommended, inter alia, that the privileges of Drs. Mathews and Kent to perform spine surgery be restricted until they were able to “demonstrate a renewed and updated understanding of present day principles and practice of this type of surgery.” The restrictions voted on by the Board appear tailored to meet the concerns raised by Dr. Wilson’s report. Thus, in addition to the statutory presumption in favor of defendants, the evidentiary record in this case provides ample support for the conclusion that the Board’s action was taken in a reasonable belief that it would further quality health care. Dr. Mathews argues at length that participants in the peer review process were motivated by a desire to eliminate him as a competitor, rather than by legitimate health care concerns. For a number of reasons, we find this argument insufficient to overcome the presumption of compliance with the Act. First, we agree with those courts which have found that since the test of section 11112(a) is an objective one, assertions of bad faith or anticompetitive motive are irrelevant to the question of whether a decision was taken in a reasonable belief that it would further quality health care. Instead, the court must consider the adequacy of the basis for the decision made. See Bryan v. James E. Holmes Regional Medical Ctr., 33 F.3d at 1335; Austin v. McNamara, 979 F.2d at 734 (“[Assertions of hostility ... are irrelevant to the- reasonableness standards of § 11112(a). The test is an objective one, so bad faith is immaterial. The real issue is the sufficiency of the basis for the defendants’ actions.”); Crosby v. Hos pital Authority, 873 F.Supp. 1568 (M.D.Ga. 1995) (presumption of compliance with Act not rebutted by physician’s allegation that direct economic competitors on review board had anticompetitive motive); Monroe v. AMI Hosp. of Texas, No. H-93-620, 1994 WL 757527, at *5 (S.D.Tex. Oct. 31, 1994) (physician’s allegation that peer review by competitors was motivated by anticompetitive considerations insufficient to overcome presumption of compliance with Act). Moreover, even if subjective motivations were relevant to the section 11112(a) inquiry, Dr. Mathews has produced no evidence that anticompetitive considerations actually entered into the Board’s decisionmaking process. See Bryan v. James E. Holmes Regional Medical Ctr., 33 F.3d at 1335 (fact that plaintiff introduced no evidence that alleged personal animosity of board and executive committee members determined the outcome of the peer review process weighed against finding that presumption had been overcome); Imperial v. Suburban Hosp., 37 F.3d at 1029 (although plaintiff claimed peer review participants were biased against him, court found that defendants were entitled to HCQIA immunity, stating that “[njowhere in the record can we find any suggestion that any issue, other than a legitimate health care concern, was presented or considered”). There is no evidence that the reports contained or that the Board considered any supporting evidence that was not related to the quality of health care. Rather, Dr. Mathews appears to base his argument solely on his allegation that the defendants were his competitors and stood to gain by eliminating him from the market. Mere participation by plaintiffs competitors in the Hoke or Rothaeker Committee investigations or the Board’s vote, however, does not run afoul of the HCQIA. Although the Act suggests that a hearing officer or individuals sitting on a hearing panel should not be in direct competition with the physician who is the subject of the hearing, see § 11112(b)(3)(A)(ii) & (in), it imposes no such requirement on participants in other phases of the peer review process. To the extent plaintiff is attempting to suggest that it was not reasonable for the Board to rely on the Rothaeker report because it was generated by orthopedic surgeons who are plaintiffs competitors, this contention is negated by the fact that the committee’s findings were confirmed by Dr. Wilson, who is not in any way in competition with Dr. Mathews. Moreover, we note that although the HCQIA does not require it, the physician members of the Board, defendant Drs. Hoke, Argires, and Shertzer, abstained from voting on the privilege restriction. Thus, plaintiffs arguments concerning his competitors’ participation in the peer review process cannot serve to rebut the presumption in favor of defendants. Further, we find that the cases cited by plaintiff in support of his position are inappo-site. For example, plaintiff cites Manion v. Evans, No. 3:89CV7436, 1991 WL 575715 (N.D.Ohio July 8, 1991), for the proposition that his evidence of a possible economic motivation on the part of Dr. Rothaeker precludes a grant of summary judgment to defendants. The portion of Manion cited by plaintiff, however, deals with a provision of the Act which provides that HCQIA immunity does not extend to persons who knowingly provide false information to a professional review body. See id. at *13; 42 U.S.C. § 11111(a)(2). There has been no allegation, nor is there any evidence, that Dr. Rothaeker knowingly provided false information during the peer review process, and this section of the Act is not at issue in this case. Swarthmore Radiation Oncology, Inc. v. Lapes, 1993 WL 517722 (E.D.Pa.1993), and Pagano v. Oroville Hosp., 145 F.R.D. 683, 694 (E.D.Cal.1993) are similarly irrelevant to the present inquiry. They address the question of whether the HCQIA creates a federal statutory peer review privilege allowing defendants to avoid producing certain materials requested in discovery. Williamson v. Sacred Heart Hosp., No. 89-30084-RV, 1993 WL 543002 (N.D.Fla. May 28, 1993), aff'd, 41 F.3d 667 (11th Cir.1994), also provides little guidance in that it contains no discussion of the court’s basis for denying summary judgment on the issue of HCQIA. Finally, plaintiff relies heavily on Islami v. Covenant Medical Center, Inc., 822 F.Supp. 1361 (N.D.Iowa 1992). Although plaintiff correctly points out that Islami involves factual circumstances which are in some ways similar to those in the case at bar, the court held only that the defendants were not entitled to summary judgment because a factual issue existed as to whether they had afforded the plaintiff adequate notice and hearing procedures. The court did not address the bearing of the facts of the case on the issue of whether defendants had acted in the reasonable belief that their actions were in furtherance of quality health care. Moreover, we note that, in support of his HCQIA argument, plaintiff has twice quoted a lengthy passage from Islami which has nothing to do with the HCQIA,' but rather deals with the question of whether, for purposes of Sherman Act liability, the defendants were incapable of conspiracy as a matter of law. Plaintiff has also submitted the expert report of Dr. J. Leonard Goldner, which questions the validity of the methodology used and the conclusions reached by Dr. Wilson. This too, is insufficient to overcome the presumption that defendants’ actions were taken in the reasonable belief that they were in furtherance of quality health care. The report does indicate that a difference of opinion exists as to the propriety of Dr. Mathews medical practices. However, [The] HCQIA clearly grants broad discretion with regard to staff privileges decisions .... [T]he role of federal courts ‘on review of such actions is not to substitute our judgment for that of the hospital’s governing board or to reweigh the evidence regarding the renewal or termination of medical staff privileges.’ Bryan v. James E. Holmes Regional Medical Ctr., 33 F.3d at 1337 (quoting Shahawy v. Harrison, 875 F.2d 1529, 1533 (11th Cir. 1989)). Viewed in the light most favorable to plaintiff, Dr. Goldner’s report may provide a reasonable basis for a jury to conclude that Dr. Mathews rendered acceptable care. This, however, is a different question than whether defendants formed a reasonable belief that their actions were in furtherance of quality health care. The fact that a jury could possibly form a different conclusion as to whether the privilege restrictions were warranted is insufficient basis for a finding that the Board’s opposite conclusion was unreasonable. Even viewed in the light most favorable to plaintiff, nothing in Dr. Goldner’s report tends to suggest that Dr. Wilson’s report, upon which the Board relied, was so obviously inadequate or inaccurate that it would have been unreasonable to rely on it as the basis for a belief that restrictions on Dr. Mathews’ privileges would further quality health care. See Imperial v. Suburban Hosp. Ass’n, 37 F.3d at 1030 (“[E]ven if [plaintiff] could show that these doctors reached an incorrect conclusion on a particular medical issue because of a lack of understanding, that does not meet the burden of contradicting the existence of a reasonable belief that they were furthering health care quality....”); Austin v. McNamara, 979 F.2d at 735 (noting that ultimate reasonableness of doctor’s suspension was a “different question” than the issue of whether the defendants “acted in the ‘reasonable belief that the [suspension] was warranted by the facts known....’). Cf Willman v. Heartland Hosp. East, 34 F.3d 605, 611 (8th Cir.1994), cert. denied, — U.S.-, 115 S.Ct. 1361, 131 L.Ed.2d 218 (1995) (“Although the record contains evidence from physicians to the effect that in their opinion [plaintiff] had provided acceptable care, we nevertheless conclude that it would not have been unreasonable for [plaintiffs] peer reviewers to have doubts about the quality of [plaintiffs] patient care.”). Thus, Dr. Goldner’s report cannot serve as a basis for overcoming the presumption that defendants acted in the reasonable belief that their recommendation was in furtherance of quality health care, b. § 11112(a)(2) We also find that plaintiff cannot overcome the presumption that the Board’s recommendation was made “after a reasonable effort to obtain the facts of the matter.” 42 U.S.C. § 11112(a)(2). The undisputed facts of this case show that Dr. Mathews’ standard of care was originally drawn into question when the Rothacker Committee’s review of Dr. Kent’s work necessarily encompassed many of his cases and raised concerns as to the quality of care provided by both physicians. The reviewing committee was composed of three board certified orthopedic surgeons, the same specialty as practiced by Dr. Mathews. The initial review took more than two years to complete and encompassed 208 cases, representing six months worth of patient care. The Committee concluded that 27 of the 208 cases did not meet the standard of care. LGH did not rely solely on this report, however, as the basis for its privilege restriction recommendation. Rather, the hospital retained an outside organization, the American Medico-Legal Foundation, to select an independent professional to review the Ro-thacker Committee’s findings. This additional step was not required under the LGH Bylaws. Dr. Mathews was informed of-the Rothacker Committee’s conclusions and of the fact that an outside reviewer would be retained. He was given the opportunity to, and did, submit additional materials to the outside reviewer, Dr. Wilson. Dr. Wilson essentially confirmed the earlier findings of the Rothacker Committee. Thus, we find that in addition to the statutory presumption in favor of defendants, there is significant evidence indicating that defendants took action only after a reasonable effort to obtain the facts. In opposition, plaintiff asserts that the LGH Board made its recommendation “without doing any independent investigation of its own.” Plaintiff claims that the Board should have considered other available materials, such as reports of the LGH quality assurance program and the LGH Utilization Management Committee. We do not think this argument can overcome the presumption that the Board made a reasonable effort to obtain the facts. The Board based its recommendation on facts surrounding 27 eases in a six-month period that were found not to meet the standard of care. They did not act on the basis of one opinion regarding this group of cases, but waited until a second, independent, confirming opinion could be obtained. The materials which plaintiff would have had the Board consider are not specifically directed to the 27 cases upon which the Board’s recommendation was based, nor are they directed exclusively to the six-month period at issue. Rather, they are based largely on aspects of Dr. Mathews’ practice other than those upon which the Board based its recommendation. We find nothing in the Act which suggests that a reasonable effort to obtain the facts must include an evaluation of facets of a physician’s practice other than those upon which a professional review action is based. That Dr. Mathews may have been up to par in other aspects of his practice does not change the fact that 27 of his cases fell below the standard of care. See Imperial v. Suburban Hosp. Ass’n, 37 F.3d at 1029-30 (failure to take into account recent Quality Assurance Committee review which concluded that plaintiffs care was “for the most part” adequate and acceptable did not preclude finding of HCQIA immunity); cf. Smith v. Ricks, 31 F.3d at 1486 (fact that plaintiff was not permitted to introduce evidence that other physicians were more incompetent than he was did not indicate that hospital 'had failed to undertake reasonable effort to obtain facts). The Act imposes no duty to investigate a physician’s entire range of conduct before taking a professional review action. Accordingly, the evidence cited by plaintiff cannot be sufficient to overcome the presumption in favor of defendants, c. § 11112(a)(3) Section 11112(a)(3) requires that a professional review action be taken only after “adequate notice and hearing procedures are afforded to the physician involved.” Section 11112(b) of the Act sets out specific “safe harbor” procedures which, if followed, will satisfy the notice and hearing requirements of subsection 11112(a)(3). Section 11112(b) also provides, however, that “[a] professional review body’s failure to meet the conditions described in this subsection shall not, in itself, constitute failure to meet the standards of subsection (a)(3) of this section.” Rather, “[t]he ultimate inquiry is whether the notice and hearing procedures were adequate.” Smith v. Ricks, 31 F.3d at 1486 (citing Fobbs v. Holy Cross Health Sys. Corp., 789 F.Supp. at 1068). Here, the undisputed facts show that Dr. Mathews was informed of the conclusions of the Rothacker Committee at the same time those conclusions were reported to the LGH Medical and Dental Staff. He was sent a copy of Dr. Rothacker’s March 19, 1992 letter to then-President of the LGH Medical and Dental Staff, Robert P. Johnson, M.D., which contained the committee’s conclusions. The letter also contained the Committee’s recommendation that the matter be referred to an outside reviewer. On April 30, 1992, Dr. Mathews was informed by way of a letter from Dr. Johnson that the matter would indeed be referred to an outside consultant. The Executive Committee minutes enclosed with this letter indicated that the outside review “may result in a recommendation regarding Dr. Mathews’ clinical privileges.” Dr. Mathews was sent copies of the LGH charts for every ease in question. He was given the opportunity to, and did, submit additional materials for Dr. Wilson’s consideration. By way of a May 10, 1993 letter, Dr. Mathews was informed of Dr. Wilson’s conclusions and provided with a copy of his March 18, 1993 report. He was informed that LGH was considering privilege restrictions and that unless he accepted those restrictions voluntarily, the matter would be referred to the LGH Medical and Dental Staff Executive Committee for its recommendation and then to the LGH Board for its decision. Dr. Mathews was invited to discuss the recommended restrictions informally before responding, which he did. We note that during these preliminary investigative stages, no “professional review action” triggering the protections of section 11112(a) had yet taken place. Thus, the notices and opportunities for input afforded plaintiff up until this point were actually above and beyond those required by the Act. Although Dr. Mathews was not present at the September 16,1993 meeting at which the Board voted to restrict his privileges, he was informed of the Board’s proposed action and the reasons supporting it by way of a September 22,1993 letter from Mr. Young. The letter also informed him of his right to request a hearing to review the Board’s decision, the time limit for doing so, and a summary of the rights he would be afforded. The letter stated specifically that at the hearing, Dr. Mathews would be entitled to all of the procedural safeguards set out in the HCQIA. Thus, the September 16, 1993 letter conformed exactly with the requirements of section 11112(b)(1) for a “Notice of Proposed Action.” After Dr. Mathews requested a hearing, the Board voted to suspend the proposed restrictions pending the outcome of the hearing. The hearing was never held, however, as it had not yet been scheduled at the time this lawsuit was filed. Although the fact that a hearing has not been held means that defendants cannot satisfy all of the requirements set out in section 11112(b), no facts have been presented which would in any way suggest that LGH did not intend to afford plaintiff all procedures to which he was entitled by both that section and the LGH Bylaws. We do not think that a plaintiff may strip a defendant of. the protections of the Act merely by failing to complete the entire scope of review procedures available to him. Up to the point at which the process was terminated, defendants complied in every way with the “safe harbor” provisions of the Act. Under these circumstances, we find that Dr. Mathews was afforded adequate notice and opportunity to be heard. See Smith v. Ricks, 31 F.3d at 1486. In support of his claim that the procedural requirements of the Act have not been fulfilled, plaintiff argues that the Rothacker Committee investigation of him, as opposed to Dr. Kent, was not properly authorized and that he was not provided with appropriate notice and an opportunity to be heard prior to the issuance of the Committee’s report. We have already decided, however, that the Rothacker Committee investigation, as a preliminary, investigative “professional review activity,” need not separately meet the notice and hearing requirements of section 11112(a). Thus, these allegations cannot serve as a basis for rebutting the presumption of compliance with the Act. d. § 11112(a)(4) Lastly, we hold that the proposed restrictions were warranted by the facts uncovered during the investigation. The restrictions related only to areas in which Dr. Mathews’ standard of care had been found to be deficient. They appear designed to address the specific concerns raised by the cases reviewed. Our above dis