O'Hanlan v. Dignity Health Sequoia Hospital CA1/1 filed 7/6/26

Filed 7/6/26O’Hanlan v. Dignity Health Sequoia Hospital CA1/1
NOT TO BE PUBLISHED IN OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

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 HOSPITAL et al.,
Defendants and Respondents.

A171138

(San Mateo County
Super. Ct. No. 23CIV00725)

Defendants and respondentsDignity 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 privilegeswhile 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 mechanismto protect Californians’ health and welfare by excluding from practice physicianswho provide substandard care or engage in professional misconduct. (Bus. & Prof. Code, §809, subds.(a)(6) & (b); see Natarajanv. Dignity Health (2021) 11Cal.5th 1095, 1102–1103 (Natarajan).) Acute care hospitalslike Sequoia must adopt written bylaws that implement the peer review statute. (Ellisonv. Sequoia Health Services (2010) 183Cal.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.” (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 PracticeBrings 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 began to focus on laparoscopic surgeries, ultimately performing “about 2300laparoscopichysterectomies and over 200 otherlaparoscopic minor surgeries” during her career. Whileat Stanford, she also practiced at nearby Mills-Peninsula Hospitalto “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 settlementafter Stanford’s executive medical board recommended that her medical staff membership be terminated.
Having disclosed what happened at Stanford, O’Hanlanapplied 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-Peninsulaafter 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, hebecame 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 department conducted peer review of cases that were flagged for evaluationin various ways (including through staff and patient complaints), and the medical executive committeewouldreview the departments’ work.Leading up tohis 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“prettysignificant and serious.”
Among the more concerning caseswas 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 removethe 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. Chandrasenaserved as a liaison between Sequoia’s medical staff and itsadministration and oversawits 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. Still, O’Hanlan experienced “many significant complications” even in cases that did not involve cancer.
As Dr. Talebianhanded 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 thoughthey 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 providedinformation in response to O’Hanlan’s requests and asked her to review itso they could schedule a meeting. Rather than agreeing to meet, O’Hanlanresponded thatupon 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 emailsrequesting 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 panicattack.’” 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 thispatient to drive three hours while bleeding where shecould have died on the way without telling them to go tothe nearest hospital.”
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 adhoc 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 committeeappointed an ad hoc committee of threephysicians to investigate O’Hanlan’s practice. The committee met 18 times over the course of nearly a year, and its members collectively reviewed all28 of O’Hanlan’scases 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’sanalyses 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.
Meanwhile, another case ofO’Hanlan’s drew attention (the Aorta Case). As Dr. Torosis testified, a patient who previously had uterine cancer 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.AsO’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 wasunusual and inappropriate to dictate a report for another surgeonin the first place. When theassisting 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, 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 issueand 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,unwillingness to include hospitalists and subspecialists early on, andabrasive 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 notshow up for most of her cases that underwent peer review” and when she did, “she attacked the presenters and outwardlyattempted to embarrass and discredit them,” making it “obvious that she thinks theObstetrics/Gynecology department is far too inferior to provide any kind of comments onher cases.” The committee was thus “concerned”that O’Hanlan was“unable to evolve and change to give us the confidence that she can become asafer 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, whichultimately 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 committeememorializedits 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 good clinicaljudgment andotherwise provide patient care that meets the standards of qualityrequired of physicians who practice at Sequoia.”
The hearing committeereceived evidence during 12 sessions held from February to November of 2018. It heard testimony by Dr. Torosis, Dr. Chandrasena, Dr. Zimmerman, and all three membersof the ad hoc committee, as well as O’Hanlan and the surgeon who often assisted her. Sixmore 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 upholdthe medical executive committee’srecommendations 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 inperforming the physical and mental act of surgery, especially laparoscopic surgery,is excellent-perhaps even exceptional”; (2)her “inattention to important details, bothpreoperatively and postoperatively, has exposed patients to an unreasonable andunacceptable level of risk of serious injury”; (3)she “is especially ‘challenged’ when she needs to seriouslyconsider the advice of peers” and “adjusther 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 inthe hope that change would occur”; (4)“[c]onsidering the information which was presentedto the [medical executive committee]. . . , and especially in view of[her] lack of veracity”in documenting the Aorta Case, the summary suspension of O’Hanlan’s privileges was reasonable and warranted; (5)continuing the summary suspension was reasonable and warrantedto avoid “expos[ing] future patients to imminent danger”; (6)the preponderance of evidence presented to the hearing committee supported its “unanimous conclusion anddecision”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 andprocedurally.”
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. In February 2020, that committee denied her appeal, affirmedher 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.
II. DISCUSSION
O’Hanlan claimsSequoia violated her right to a fair hearing and aspects of its bylaws during peer review, and no substantial evidence supports its findings against her.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, 183Cal.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-Attarv. Hollywood Presbyterian Medical Center(2013) 56Cal.4th 976, 991 (El-Attar), italics omitted, quoting Code Civ. Proc., § 1094.5, subd.(b); see Natarajan, supra, 11Cal.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 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, 183Cal.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, 11Cal.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, 56Cal.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 thatDr. Torosisproceeded 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,andwas 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 Mennigv. City Council (1978) 86Cal.App.3d 341, 351 (Mennig).
O’Hanlan forfeited this argumentby failing to raise it during the peer review proceedings. (See Weinbergv. Cedars-Sinai Medical Center (2004) 119Cal.App.4th 1098, 1115 [physician waived claim of bias based on chief of 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 proceedingswas 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, 56Cal.4th at p.992.) O’Hanlan does not claim Dr. Torosis’s involvement was other than what Sequoia’s bylaws and the peer review statuteprovide 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’sdisagreementwith 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 membersenacted a resolution to override the commission’s decision. Mennig viewed thisact of “vindication” asdemonstrating “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 practicewereevaluated by ahearing committee, and later an appeal board, comprised of staff members who—as required by statute and Sequoia’s bylaws—were previously uninvolvedin 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 Mennigand O’Hanlan does not point to facts proving her conclusory statements that Dr. Torosis“staked his reputation” on afinding about her complication rates and “had every motive to see [her] disciplined.”
Next, O’Hanlan arguesshe was punished for exercising her rights todefend 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” 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,”Sequoiamade specific findings that drew this connection in O’Hanlan’s case. (Mileikowskyv. West Hills Hospital & Medical Center (2009) 45Cal.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. 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.” (Boermeesterv. Carry (2023) 15Cal.5th 72, 93.)As for thereport itself, Sequioa’s bylaws permit consideration of any relevant hearsay evidence of the type “on which responsiblepersons are accustomed to rely in the conduct of serious affairs, regardless of theadmissibility of such evidence in a court of law.” (Bylaws, art. VIII, § 6.) O’Hanlan does not claim the report failed to meet thatstandard 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’Hanlandid 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 herreview and conclusions.
Finally, O’Hanlanargues the cases that prompted her resignationfrom 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 proceedingsat 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 consentsimilar to the Ovaries Case at Sequoia—clearly satisfiedthe broad standard of relevance despite their age. (See Powellv. Bear Valley Community Hospital (2018) 22Cal.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. (Cipriottiv. Board of Directors (1983) 147Cal.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.” (Slonev. El Centro Regional Medical Center (2024) 106Cal.App.5th 1160, 1173–1174.) O’Hanlan’s summary is severely lopsided: she does not meaningfully engage withthe major portionof 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 occupied8 of 12 sessions of the 9-month long proceedings before that body—in a single paragraph that merely lists asserted flaws in 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 alsodetermined 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’scontrary evidence and argument nor her criticisms of the processes and metrics that initially drew attention to her practicesupply 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, rule8.278(a)(2).)

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SMILEY, J.

WE CONCUR:

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HUMES, P.J.

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BANKE, J.

O’Hanlan v. Dignity Health Sequoia Hospital et al. / A171138