Barnett v. United States Air Force et al

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UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF OHIO
WESTERN DIVISION AT DAYTON
MAJOR SEAN BARNETT,
Plaintiff,
v.
DEFENSE HEALTH AGENCY,
Defendant.
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Case No. 3:25-cv-228
Judge Thomas M. Rose
Magistrate Judge Michael R. Merz
______________________________________________________________________________
ENTRY AND ORDER DENYING PLAINTIFF’S RENEWED MOTION FOR
PARTIAL SUMMARY JUDGMENT (DOC. NO 88), PLAINTIFF’S MOTION
FOR JUDGMENT ON THE ADMINISTRATIVE RECORD (DOC. NO. 96), AND
PLAINTIFF’S MOTION FOR CLARIFICATION AND REQUEST FOR
LIMITED REDACTION (DOC. NO. 100); GRANTING DEFENDANT’S
MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD (DOC.
NO. 97)
______________________________________________________________________________
The present matter, being brought pursuant to the Administrative Procedures Act, 5 U.S.C.
§ 701, et seq. (the “APA”), is currently before the Court for consideration of three dispositive
motions. 	Plaintiff Major Sean Barnett (“Barnett”), proceeding pro se, has submitted Plaintiff’s
Renewed Motion for Partial Summary Judgment (Doc. No. 88) and Plaintiff’s Motion for
Judgment on the Administrative Record (Doc. No. 96) (together, “Plaintiff’s Motions”), seeking
reversal of Defendant the Defense Health Agency’s (“DHA”) decision to revoke Barnett’s
privileges to practice medicine. 	On the other side, the DHA has filed Defendant’s Motion for
Judgment on the Administrative Record (“Defendant’s Motion” or “DHA’s Motion”) (Doc. No.
97), seeking to uphold the same privileging decision. 	Also pending is Plaintiff’s Motion for
Clarification and Request for Limited Redaction (Doc. No. 100), which the Court shall deny as a
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preliminary matter to its analysis below. 	In substance, for the reasons that follow, the Court
DENIES Plaintiff’s Motions and GRANTS DHA’s Motion (collectively, the “Motions”).
I. 	BACKGROUND 1
In summation, Barnett was, at all times relevant here, a board-certified nephrologist who
served his tour of duty with the Air Force in the Wright-Patterson Air Force Base 88th Medical
Group, at the Wright-Patterson Medical Center (“WPMC”). 	(See e.g., Doc. No. 90-9 at
DHA_4362.) In 2023, when DHA officials received allegations of Barnett’s professional
misconduct, clinical deficiencies, and lack of clinical competence, DHA summarily suspended
Barnett’s privileges to practice medicine at WPMC pending a quality assurance investigation. (See
Doc. No. 90-3 at DHA_0097.) What ensued over the next couple of years would ultimately see
Barnett’s privileges to practice medicine at WPMC revoked altogether. 	(See Doc. 90-9 at
DHA_4374.) He now wishes to have that final action reversed under the banner of the APA. (Doc.
No. 1 at PageID 4-6.)
To best detail the instant scenario, the Court would break Barnett’s story up into the
following parts: first, the Court takes a brief look at Barnett, as he appeared before the DHA;
second, the Court examines the DHA policy manual provided with the Administrative Record
(“Record”) (Doc. No. 90), as it is applicable to the adverse administrative action Barnett faced;
thirdly, with that context, the Court sets out the administrative processes Barnett was in-fact
subjected to by the DHA; and, finally, the Court confirms the procedural posture of the case.
a. 	Barnett
1 Due to the voluminosity of the Administrative Record, the Court shall refer to said record by citing the document
number appearing on the docket and the corresponding Bates-Stamped page number provided by DHA here. By way
of example, the Court will cite to the Administrative Record in the following manner: (Doc. No. XX at DHA_YYYY.)
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When the events of this case began to unfold, Barnett was an osteopathic physician who
was serving as a staff nephrologist at WPMC. (Doc. No. 90-3 at DHA_ 0109; 90-4 at DHA_0266-
0267.) After graduating from medical school in 2016, Barnett shaped his practice serving in the
Air Force. (See Doc. No. 90-4 at DHA_0266.) He completed an internal medicine residency at
WPMC in June 2019. 	(Id.) 	He then completed a fellowship in nephrology at the San Antonio
Uniformed Services Health Education Consortium in mid-2021. (Id.) As of April 2023, Barnett
was board-certified in both internal medicine and nephrology. (Id. at DHA_0257.)
Notwithstanding, 	Barnett’s 	credentials 	are 	somewhat 	blemished 	by 	a 	critical 	care
fellowship at The University of Texas Health Science Center at San Antonio, which he failed to
complete. (Id. at DHA_0266.) Barnett entered this critical care fellowship in July of 2021 and
was dismissed by March of 2022. (Id.) To specify, Barnett was dismissed from his critical care
fellowship based on findings that he had endangered patient safety and shown poor clinical
competence, and for behaving disruptively and unprofessionally. (Doc. No. 90-3 at DHA_0212.)
The University of Texas review panel found that Barnett was taking liberties with the care of other
providers’ patients and consulting on patient care matters that were outside the scope of his training
program. (Id.) Barnett challenged these findings to no avail. (See id. at DHA_0214-0223.)
In the months that followed, Barnett would return to WPMC. 	In June of 2022, a
supervising physician, identified in the Record as LTCOL 2, issued Barnett an initial letter of
counseling. (Doc. No. 90-4 at DHA_0347-0351.) Therein, LTCOL 2 acknowledged aspects of
Barnett’s then-budding career that created cause for concern, namely that Barnett: previously
failed to pass his nephrology boards; was dismissed from his critical care fellowship; received poor
marks in the areas of professionalism, professional judgment, competence, and skill; had received
counseling on his inappropriate use of social media while affiliating himself with the Air Force;
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and, was counseled and encouraged to seek mental health treatment for his self-described mental
health concerns. (Id. at DHA_0347.) LTCOL 2 concluded the initial counseling letter by advising
that “[t]he importance of making the appropriate changes in [Barnett’s] professional and personal
behaviors cannot be overstated. [Barnett’s] success or failure in the next 24 months hinges upon
[Barnett’s] chosen actions.” 	(Id. at DHA_0351.) 	On August 5, 2022, Barnett was placed on a
focused professional practice evaluation plan where he would be monitored and evaluated by a
preceptor. (Id. at DHA_0264.) He then completed that plan on October 12, 2022, without incident.
(Id. at DHA_0264-0265.)
But, as will be discussed in greater detail below, Barnett continued to create friction
amongst his colleagues, even if those colleagues appreciated some of Barnett’s underlying talents.
By May of 2023, Barnett became known for generally unprofessional conduct, flouting the
appropriate standard of care, interjecting with recommendations outside his area of expertise, and
treating patients he had not been consulted on to begin with. 	(See e.g., Doc. No. 90-3 at
DHA_0133-0139.) On balance though, Barnett’s colleagues did not doubt his intelligence, with
at least one commenting that Barnett “is gifted with a very creative mind, and he is in fact very
forward thinking.” (Id. at DHA_0162.)
b. 	The DHA Procedures Manual
Fundamentally, the DHA serves as the privileging authority for military medical facilities
like WPMC and has created procedures to ensure adequate clinical quality management at those
facilities. (See Doc. No. 90-2 at DHA_0001, DHA_0012.) The DHA has established a healthcare
risk management program, designed to:
(a) 	Advance safe, trusted, and effective healthcare[;]
(b) 	Promote a fair and just culture[;]
(c) 	Use risk data/trends to prioritize risks and strategic responses to those
risks[;]
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(d) 	Manage risks effectively[;]
(e) 	Use strategies to reduce financial losses to the government[;]
(f) 	Encourage organization and individual accountability[;]
(g) 	Optimize organizational preparedness and performance.
(Id. at DHA_0007-0008.)
In aid of these guiding principles, the DHA Procedures Manual, No. 6025.13, Vol. 3
(“DHA Manual” or, the “Manual”), contains several pertinent definitions. 	As a foundation,
“clinical privileges” refer to “[p]ermission granted by the [DHA] to provide medical and other
patient care services.” (Id. at DHA_0009.) The Manual broadly defines “clinical adverse action”
as “[a]ction invoked against a healthcare provider … with the result that the authority to practice
clinically is adversely affected.” 	(Id. at DHA_0008.) 	In particular, clinical adverse actions are
taken in response to “evidence of misconduct, impairment, incompetence,” or any other behavior
by a healthcare provider that could adversely affect patient safety. 	(Id.) 	The Manual further
defines “adverse privileging action,” as the “[d]enial, restriction, reduction, or revocation of
clinical privileges as a result of due process professional review action ….” (Id.) A healthcare
provider operating under the DHA’s privileging authority may have his clinical privileges
temporarily restricted or revoked entirely, as a result of peer review. 	(Id. at DHA_0013.)
Meanwhile, the Manual permits that a provider’s privileges to practice may be summarily
suspended “based on [a] determination by the [DHA] for concerns regarding suspected
misconduct, impairment, incompetence,” or any conduct adversely affecting patient safety. (Id.)
A summary suspension is defined as “[t]he temporary removal of all or a portion of a healthcare
provider’s privilege(s) … prior to the completion of due process procedures ….” (Id.)
If it appears that a given healthcare provider has engaged in misconduct or incompetence
that poses a substantial risk to patient safety, clinical adverse actions at facilities like WPMC
generally begin with the initiation of a quality assurance investigation (“QAI”) and a summary
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suspension of the provider’s privileges. 	(See id. at DHA_0029-0032.) 	When a provider’s
privileges are summarily suspended, “[t]he individual will be notified in writing on the day clinical
privilege(s)/practice were placed in summary suspension.” (Id. at DHA_0030.) The provider’s
privileges will then remain in summary suspension while a QAI is conducted. (Id. at DHA_0029.)
If the summary suspension of a provider’s privileges lasts longer than 30 days, the suspension
must be reported to the National Practitioners Database (“NPDB”). 	Otherwise, a QAI is to be
conducted by an unbiased peer of the provider under investigation and conducting the QAI is to
be the selected investigator’s sole duty until it is completed. 	(Id. at DHA_0032.) 	When the
investigator completes his report, he must provide an evidence-based recommendation to reinstate,
restrict, reduce, revoke, or deny the subject provider’s privileges to practice. (Id. at DHA_0034.)
The provider subject to QAI may subsequently submit a written statement in response to the
investigator’s report within 15 days, or longer if an extension is granted. (Id.)
The QAI report, evidence, and any provider statement are then forwarded to a credentials
committee, comprised of a panel of three privileged providers, with at least one being a peer to the
provider under review. 	(Id. at DHA_0035.) 	Once the committee considers the submitted
materials, the panel is obligated to provide a recommendation to the DHA for reinstatement,
revocation, or denial of the provider’s privileges. (Id. at DHA_0035-0036.)
By this framework, the DHA proceeds with another review of its own and renders a
proposed decision regarding the subject provider’s privileges. 	(Id. at DHA_00036.) 	The DHA
must notify the provider in writing of its proposed decision within 10 days after receiving the
record on review. (Id.) If the DHA decides to reinstate the provider’s privileges—with or without
monitoring and evaluation—the DHA’s proposed decision is in-fact final. (Id.) On the other hand,
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if the DHA proposes to restrict or revoke the provider’s privileges, the organization “must advise
the individual in writing of [his] right to a peer review hearing and appeal rights.” (Id.)
Upon receiving written notification, the subject provider may appeal the DHA’s proposed
action with respect to his clinical privileges within 30 calendar days. (Id. at DHA_0036-0037.)
Any peer review hearing must not be held earlier than 30 days after receipt of the DHA’s proposed
decision. (Id. at DHA_0038.) Written notice of a peer review hearing must be made to the subject
provider and that notice shall include information such as the date and time of the hearing, and the
names of any witnesses expected to testify. (Id.) The hearing itself is quasi-judicial, with three
unbiased peers serving as factual adjudicators, while the government’s legal counsel advises on
questions of law and procedure. (Id. at DHA_0040-0042.)
At the close of evidence, the peer review panel adjourns and deliberates off the record,
whereas the hearing itself is to be transcribed. (Id. at DHA_0042.) Like the credentials committee
involved earlier in the process, the peer review panel submits the record on appeal, along with a
recommendation, back to the DHA. 	(Id.) 	The privileging authority is accordingly tasked with
reviewing the panel’s recommendations regarding the subject provider’s clinical privileges. (Id.)
While the DHA is not technically bound by the peer review panel’s recommendations, the
privileging authority must justify its decision with rationale drawn from the peer review
proceedings. (Id. at DHA_0043.)
Finally, if a provider disagrees with the privileging authority’s decision, he may appeal
within 10 days and any final decision must be issued within 14 days thereafter. (Id.) A separate
report authority goes on to review the appeal and render a final decision respecting the provider’s
privileges. (Id. at DHA_0045-0046.) This report authority is further responsible for reporting the
final outcome of a clinical adverse action to the NPDB. (Id. at DHA_0046.)
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c. 	The Events of this Case
1) 	Barnett’s First Clinical Adverse Action
In May 2023, the DHA summarily suspended Barnett’s clinical privileges and initiated a
QAI into allegations of Barnett’s professional misconduct, clinical deficiencies, and lack of
clinical competence between December 2022 and May 2023. (See Doc. No. 90-3 at DHA_0097-
0101.) It appears from the Record that Barnett’s privileges were suspended on May 9, 2023. (Id.
at DHA_0097-0098.) Though, contrary to the DHA Manual’s required procedures, it seems that
Barnett was not notified of the suspension until May 17, 2023, when a QAI officer was selected to
investigate the allegations against Barnett. 	(Id. at DHA_0100-0104.) 	Nonetheless, by May 17,
2023, Barnett’s privileges were suspended and a QAI was underway.
The QAI officer, identified in the Record as LTCOL 3, reviewed various documents in the
course of their investigation. 	(See id. at DHA_0122-0123.) 	Among these documents were
memorandums, effectively serving as affidavits, written by Barnett’s colleagues to establish a
record of the allegations against him. (Id.) As early as March of 2023, Barnett’s colleagues were
complaining of Barnett’s “high risk behavior,” to include inappropriately taking the lead on
patients that were not his to treat and inaccurately documenting patient conditions in the medical
chart. (Id. at PageID 0167-0168.) This kind of high risk behavior ultimately led a sizable number
of Barnett’s colleagues to author memorandums of their own with similar observations about him.
The chief of medical staff at WPMC additionally interviewed those colleagues and produced a
cumulative memorandum reflecting the thrust of all the allegations against Barnett. 	(Id. at
DHA_0133-0139.) 	All told, Barnett’s colleagues accused him of: interfering with attending
physicians’ primary care of patients (Id. at DHA_0133-0134, DHA_0135-0137); reviewing the
charts of patients he was not consulted on (Id. at DHA_0134); prescribing risky treatments, an
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allegation Barnett purportedly admitted to out of confidence in his own skills (Id. at DHA_0135);
and, being aggressive and unprofessional with his colleagues when they did not take his
recommendations (Id. at DHA_0134-0135).
LTCOL 3 checked these allegations against medical records, emails and text messages
between Barnett and his colleagues, Barnett’s personnel files, and six witness interviews. (Id. at
DHA_0109.) 	On allegations of misconduct, the investigator considered seven instances where
Barnett was reviewing patient charts without authorization, making inappropriate chart notes, or
overstepping the bounds of his role as a consultant in a way that could disrupt patient care. (Id. at
DHA_0110-0113.) 	LTCOL 3 then concluded that there was an abundance of evidence Barnett
acted unprofessionally in these seven instances and tended to create an environment where
Barnett’s colleagues avoided consulting with him. 	(Id. at DHA_0119.) 	As for clinical
deficiencies, LTCOL 3 found evidence that Barnett did not always perfectly chart his treatments,
but generally he showed no signs that he was out of step clinically. 	(Id. at DHA_0113-0117,
DHA_0119-0120.) 	However, LTCOL 3 did report there was an abundance of evidence that
Barnett made high risk clinical recommendations, stating, “Maj[.] Barnett has repeatedly obviated
patient safety over the execution of his preferred treatment plan.” 	(Id. at DHA_120.) 	In one
instance, Barnett prescribed a treatment based on a single study and then failed to follow up with
the patient. (Id. at DHA_0117-0118.) This type of behavior was particularly concerning in light
of Barnett’s insistence upon using riskier treatments as a matter of course. 	(Id. at DHA_120,
DHA_0178-0179.) At the end of the QAI report LTCOL 3 recommended that Barnett’s privileges
to practice be reinstated with the implementation of a monitoring and evaluation plan. 	(Id. at
DHA_0121.)
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DHA provided Barnett with a redacted copy of the QAI report on July 20, 2023, and Barnett
responded on August 18, 2023, after receiving an extension of time to do so. (Doc. No. 90-5 at
DHA_2450, DHA_2453-55.) 	Barnett began his response by accepting responsibility for his
shortcomings as a professional communicator. 	(Id. at DHA_2455-56.) 	Outside of that though,
Barnett hotly contested any findings in the QAI related to his competence and clinical judgment.
(Id. at DHA_2456-63.) For example, refuting a claim that he inappropriately prescribed 3% saline
to patients, Barnett, based on his own clinical analysis, stated:
In my hands, 3% Saline is the best and most versatile [intravenous fluid], diuretic
(standalone diuretic), diuretic adjunct, Sodium treatment, and diagnostic tool. I
wish I call myself a 3% Wizard.
(Id. at DHA_2462.) Barnett concluded his personal statement by agreeing on the reinstatement of
his privileges, but objected to the implementation of a monitoring and evaluation plan because he
“believe[d] four months of this hell ha[d] been enough punishment already,” and he did not believe
monitoring and evaluation would be a fruitful use of time. (Id. at DHA_2463-64.) In addition to
his statement, Barnett retained private counsel to submit a legal memo on his behalf, essentially
arguing that Barnett had been prejudiced thus far by not being included in the QAI’s evidence
gathering process. (Id. at DHA_2467-69.)
The credentials committee convened on August 25, 2023, to consider the QAI report and
Barnett’s responses. 	(See id. at DHA_2472.) 	The committee found by a preponderance of the
evidence that Barnet had engaged in professional misconduct, tended to make high risk clinical
recommendations, 	and—despite 	LTCOL 	3’s 	finding 	to 	the 	contrary—exhibited 	clinical
deficiencies that could or did have an adverse effect on patient care. (Id. at DHA_2474-75.) At
that time, the credentials committee voted to recommend the revocation of Barnett’s clinical
privileges in total. (Id. at DHA_2475.)
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By procedure, a privileging official for the DHA, identified as COL 4, rendered a proposed
decision in Barnett’s case on September 20, 2023. (Id. at DHA_2477-78.) COL 4 considered the
recommendations made and Barnett’s personal statement. (Id.) Regarding the latter, COL 4 noted
the humility Barnett showed in accepting responsibility for his part in interpersonal conflicts and
decided to reinstate Barnett’s clinical privileges with monitoring and evaluation, as the QAI report
suggested. (Id.) A revision-to-action report was lodged with the NPDB for Barnett and, because
monitoring and evaluation is not technically adverse action under the DHA Manual, COL 4’s
decision marked the end of official administrative action for a brief time. (Id.)
2) 	Barnett’s Second Clinical Adverse Action
The DHA again summarily suspended Barnett’s privileges to practice at WPMC on
November 20, 2023. (Id. at DHA_2479-80.) This time, Barnett faced allegations of professional
misconduct during his period of monitoring and evaluation. 	(Id. at DHA_2479.) 	The DHA
identified the allegations against Barnett, “to include inappropriate conflict resolution” when his
colleagues and preceptors disagreed with him, communicating argumentatively and aggressively,
circumventing the on-call admitting team, attempting to coerce other providers into acquiescing to
Barnett’s treatment plans, and inaccurately documenting patient encounters. (Id.)
A QAI officer, identified as LTCOL 6, was assigned on December 1, 2023, after the
Thanksgiving holiday, and LTCOL 6 issued a corresponding QAI report on January 29, 2024. (Id.
at DHA_2496-97, DHA_2500-06.) 	Throughout this second QAI, LTCOL 6 reviewed two
particular events on which the allegations of misconduct against Barnett were based. (See id. at
DHA_2501-04.) The first involved an elderly outpatient who Barnett treated in his dialysis clinic,
and who Barnett believed needed to be admitted to WPMC’s intensive care unit after falling. (Id.
at DHA_2501-02.) 	Barnett tried twice, on November 3 and November 15, 2023, to have this
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patient admitted to the ICU and he was twice told to direct the patient to the emergency room for
appropriate care. 	(See id.) 	The second time, Barnett went around the admissions team that
originally rebuffed his request, stating the following in text messages to other colleagues:
I am trying really really hard to be flexible, but I am not getting the same sense
from the [internal medicine] teams. At all.
This is a bit ridiculous, if I have to file a [patient safety report] because I was
concerned about falls, my concerns were dismissed, and the patient fell… I will? I
am trying really hard to work with y’all. It is not being reciprocated.
(Id. at DHA_2551.) 	As for the second event, LTCOL 6 observed an instance where Barnett
received pushback on treating a patient with immunosuppressants. 	(Id. at DHA_2503.) 	When
Barnett’s preceptor disagreed with this course of action, Barnett responded:
[P]lease notify me if you … are going to give me an order to “not treat this patient
the way I believe is clinically appropriate, based on available evidence and
guidelines,” in which case I will discuss the order with you all, plead my case, and
if you still disagree I will turn the case over to you ….
(Id. at DHA_2536.) What is more, although this patient encounter occurred on November 8, 2023,
Barnett did not finish documenting the encounter and treatment plan until November 21, 2023,
when his privileges were already in summary suspension. 	(Id. at DHA_2503.) 	In addition,
LTCOL 6 considered Barnett’s history and his general reluctance to accept the conditions of
monitoring and evaluation that had been placed on him. (Id. at DHA_2502.) Specifically, Barnett
told his preceptors that they were handicapping his care because they did not see what he could
see and stated:
I do not feel comfortable with it and I do not like that it goes this way, every time.
I do not get to treat my patients my way, and neither of you will give me any leeway,
nor benefit of the doubt, even after what you have seen I am capable of? Okay, I
hate it, it is not the right answer for patients either. But you’re the bosses.
(Id. at DHA_2516.) 	In the end, LTCOL 6 recommended the revocation of Barnett’s clinical
privileges entirely. (Id. at DHA_2504-05.)
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The QAI, corresponding evidence, and Barnett’s response were all forwarded along in the
process, as contemplated by the DHA Manual, much the same as Barnett’s first clinical adverse
action at WPMC. (See Doc. No. 90-6 at DHA_2967-72, DHA_2974-75.) On April 19, 2024, the
DHA proposed to revoke Barnett’s clinical privileges, rather than reinstate them with some
modicum of monitoring and evaluation. 	(Id. at DHA_2974-75.) 	With this recommendation,
Barnett was further advised of his right to appeal the DHA’s proposed decision to a peer review
panel. (Id.)
Barnett promptly pursued an appeal of the DHA’s proposed decision on April 22, 2024.
(Id. at DHA_2981-82.) The peer review hearing did not begin until November 4, 2024, though,
due to scheduling conflicts with Barnett’s attorney and difficulty compiling an unbiased panel of
Barnett’s peers. 	(Id. at DHA_2983-98.) 	At any rate, when the DHA notified Barnett of his
November 4 hearing, the agency provided him with a list of witnesses who might be called to
testify and the documents relied on by LTCOL 6 in conducting the second QAI. 	(Id. at
DHA_2998-3001.)
The assigned peer review panel heard Barnett’s case over three days. (Doc. No. 90-6 at
DHA_3020-3130; Doc. No. 90-7 at DHA_3161-3376; Doc. No. 90-8 at DHA_3897-4138.) On
day one, Barnett and all other parties involved defined the scope of the proceedings that were about
to take place. 	(See generally Doc. No. 90-6 at DHA_3020-3130.) 	With the assistance of legal
counsel, Barnett lodged evidence of his own and objected to certain evidence and processes against
him. 	(See id. at DHA_3064-65, DHA_3072-75.) 	Of note, Barnett won an objection where he
sought the exclusion of evidence compiled against him during the first QAI, earlier in 2023. (See
id. at DHA_3094.) On the second day, the panel heard the testimony of Barnett’s colleagues and
preceptors. (See generally Doc. No. 90-7 at DHA_3161-3376.) In brief, those witnesses testified
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to the events reported in their memoranda, which were used to launch a QAI into Barnett’s conduct.
(Id.) Finally, on day three, Barnett took the stand to testify on his own behalf. (See generally Doc.
No. 90-8 at DHA_3897-4138.) Throughout his testimony, Barnett held steadfast that he had done
nothing wrong clinically and framed his interpersonal disputes as attempts to hamstring him. (See
id. at DHA_3928-29.) In this vein, Barnett did not necessarily refute the allegations against him,
as much as try to recharacterize them a bit from his perspective. (See id. at DHA_3986-88.) Still,
when questioned by the panel, Barnett confirmed such accusations as his failure to timely and
accurately document patient encounters in the medical chart. 	(See id. at DHA_4036-44.) 	In
closing, Barnett argued that the misconduct he was accused of was really the product of
miscommunication and a general disdain that Barnett’s colleagues had for him. (Doc. No. 9-9 at
DHA_4117-28.)
On December 2, 2024, the peer review panel issued its report, unanimously recommending
the revocation of Barnett’s clinical privileges at WPMC. 	(Id. at DHA_4196-4200.) 	The panel
reviewed the evidence before it and found that Barnett was aggressive and unprofessional in his
communications when others did not agree with him. 	(Id.) 	For example, the panel interpreted
Barnett’s text message indicating that he might file a patient safety report as a threat to his fellow
providers if they did not adopt his preferred treatment plan. 	(Id. at DHA_4197-98.) 	The panel
also found that Barnett had failed to properly document certain patient encounters. 	(Id. at
DHA_4198-99.) These events, and others like them in the record, justified revocation of Barnett’s
clinical privileges because:
While [Barnett] has been out of clinical practice, he has shown great efforts and
initiative working in Education and Training. While this is to be lauded, it does not
address the concern that he seems unable to acknowledge his role in [] interpersonal
difficulties nor provide evidence that he can own or resolve them appropriately. He
maintains an air of unearned confidence in the correctness of his decisions, despite
an inability to articulate his rationale in a professional or persuasive manner. By his
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own admission, [Barnett] believes it necessary to have an intermediary facilitate
communication with other healthcare professionals in order to prevent future
conflict …. We do not believe that he will be able to sustainably maintain an
independent 	practice 	of 	medicine 	without 	compromising 	patient 	safety,
professional relationships and medical staff responsibility …. No limitations short
of revocation would adequately address the foundational deficits we believe exist,
based on a preponderance of the evidence.
(Id. at DHA_4199.)
The DHA privileging authority adopted the peer review panel’s findings and decided to
revoke Barnett’s privileges on February 12, 2025, and that decision was upheld after Barnett again
appealed. 	(Id. at DHA_4263-76, 4356-59.) 	The final decision determined that Barnett had
received all of the process due to him under the DHA Manual and that the evidence adduced at
Barnett’s peer review hearing supported revocation. 	(Id.) Following a bit of back-and-forth
between Barnett and DHA officials, Barnett’s privileges were finally revoked, and that revocation
reported to the NPDB, on December 1, 2025. (Id. at DHA_4373-74.)
d. 	Procedural Posture
Dissatisfied with DHA’s administrative processes, Barnett filed his Complaint (Doc. No.
1) on July 7, 2025, before the DHA’s decision in this case became final. In the Complaint, Barnett
alleged causes of action under the APA related to the revocation of his clinical privileges and the
Air Force’s attempt to administratively separate Barnett from service. (Id. at PageID 6.) In ruling
on the government’s motion to dismiss (Doc. No. 39), the Court did away with Barnett’s claims
regarding administrative separation from the Air Force on January 20, 2026, as no final
administrative decision had been handed down on that issue. 	(See Doc. No. 77.) 	However, by
January 20, 2026, the DHA had issued a final administrative decision to revoke Barnett’s
privileges and the Court permitted Barnett’s APA claim to proceed along those lines. 	(Id. at
PageID 621.)
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The Court subsequently set a timeline for the DHA to file the Record in this case and for
the Parties to file their respective dispositive motions. 	(See Doc. No. 81.) 	The DHA filed the
Record on April 6, 2026 (Doc. No. 86), and later re-filed the Record on May 13, 2026 (Doc. No.
90), due to clerical errors made in the original filing on April 6. Barnett filed Plaintiff’s Motions
on April 30, 2026, and June 18, 2026, respectively. (See Doc. Nos. 88 & 96.) In turn, the DHA
filed Defendant’s Motion on June 18, 2026. All of these dispositive Motions have now been fully
briefed and are ripe for review and decision.
II. 	LEGAL STANDARD
Typically, the Court considers dispositive motions, like the ones at bar, pursuant to Fed. R.
Civ. P. 56, but “[u]nder the [APA], when a district court is reviewing final agency action, the usual
rules governing summary judgment do not apply.” 	Integrity Gymnastics & Pure Power
Cheerleading, LLC v. U.S. Citizenship & Immigr. Servs., 131 F. Supp. 3d 721, 725 (S.D. Ohio
2015) (citing City of Cleveland v. Ohio, 508 F.3d 827 (6th Cir. 2007); North Carolina Fisheries
Ass’n., Inc. v. Gutierrez, 518 F. Supp. 2d 62 (D.D.C. 2007)). The APA creates a right of judicial
review for “[a]gency action made reviewable by statute and final agency action for which there is
no other adequate remedy in a court ….” 5 U.S.C. § 704. Once an agency takes final action “[a]
preliminary, procedural, or intermediate agency action or ruling not directly reviewable is subject
to review of the final agency action.” Id.
Upon review of final agency action under the APA, “the reviewing court shall decide all
relevant questions of law, interpret constitutional and statutory provisions, and determine the
meaning or applicability of the terms of an agency action.” 5 U.S.C. § 706. Though, as relevant
to the instant action, a reviewing court shall only “hold unlawful and set aside agency action,
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findings, and conclusions found to be … arbitrary, capricious, an abuse of discretion, or otherwise
not in accordance with the law….” 5 U.S.C. § 706(2)(A).
“The scope of this review ‘is narrow,’ and reviewing courts must exercise appropriate
deference to agency decisionmaking and not substitute their own judgment for that of the agency.”
Food & Drug Admin. v. Wages & White Lion Invs., L.L.C., 604 U.S. 542, 567 (2025) (quoting
Motor Vehicle Mfrs. Assn. of United States, Inc. v. State Farm Mut. Automobile Ins. Co., 462 U.S.
29, 43 (1983)). An agency’s final “decision is entitled to a presumption of regularity.” Citizens
to Pres. Overton Park, Inc. v. Volpe, 401 U.S. 402, 415 (1971), abrogated on other grounds by
Califano v. Sanders, 430 U.S. 99 (1977). 	To that end, “[w]hen assessing whether an agency’s
action was arbitrary or capricious, a court simply ensures that an agency has acted within a zone
of reasonableness ….” Sierra Club v. United States Env’t. Prot. Agency, 161 F.4th 934, 942 (6th
Cir. 2025) (citing Fed. Commc’ns. Comm’n. v. Prometheus Radio Project, 592 U.S. 414, 423
(2021)) (internal quotation marks omitted).
In considering whether an agency has acted within a zone of reasonableness, the reviewing
court must question whether the agency “has reasonably considered the relevant issues and
reasonably explained [its] decision.” Id. (internal quotation marks omitted). In translation, “an
agency must provide a satisfactory explanation for the decision, including a rational connection
between the relevant facts and the decision made.” Sierra Club, 161 F.4th at 941-42 (citing Motor
Vehicle Mfrs., 463 U.S. at 43). “A court may not vacate an agency’s decision unless the agency
‘has relied on factors which Congress has not intended it to consider, entirely failed to consider an
important aspect of the problem, offered an explanation for its decision that runs counter to the
evidence before the agency, or is [highly] implausible[.]’” Id. (alterations in original). Perfection
is not required and courts “should ‘uphold a decision of less than ideal clarity if the agency’s path
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may reasonably be discerned.’” 	F.C.C. v. Fox Television Stations, Inc., 556 U.S. 502, 513-14
(2009) (quoting Bowman Transp., Inc. v. Arkansas-Best Freight Sys., Inc., 419 U.S. 281, 286
(1974)).
“An agency’s factual findings are reviewed under the substantial evidence standard.”
Integrity Gymnastics, 131 F. Supp. 3d at 726 (citing Steeltech, Ltd. v. United States E.P.A., 273
F.3d 652, 656-57 (6th Cir. 2001)) (internal quotation marks omitted). By this standard, a court’s
review is further limited “to determining whether the agency’s factual findings are supported by
substantial evidence on the record as a whole, not whether there was substantial evidence in the
record for a result other than that arrived at by the agency.” 	Id. 	When making any of the
determinations set forth in this section, “the court shall review the whole record or those parts of
it cited by a party, and due account shall be taken of the rule of prejudicial error.” 5 U.S.C. § 706.
III. 	ANALYSIS
Before getting to the heart of Barnett’s APA claim, the Court takes pause to address a
preliminary issue: the Court will deny Plaintiff’s Motion for Clarification and Request for Limited
Redaction (Doc. No. 100). With that motion, Barnett argues that the DHA inappropriately referred
to 	his 	mental 	health 	diagnoses 	of 	narcissistic 	personality 	disorder 	and 	attention 	deficit
hyperactivity disorder, when responding to Barnett’s prior motion to complete the administrative
record. (Id.) By a separate order, the Court has already denied Barnett’s motion to complete the
administrative record (Doc. No. 102), so his Motion for Clarification and for Limited Redaction is
now likely moot. 	Even if the motion cannot be considered moot, it is unfounded all the same.
When the DHA referred to Barnett’s diagnoses, it did so in response to Barnett’s assertion that the
Record contains information related to those diagnoses, but that the Record contains insufficient
material to fully review such information. 	(See Doc. No. 94 at PageID 6905.) 	In other words,
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Barnett opened the door to discussion about his mental health diagnoses. 	Indeed, a report
containing those diagnoses is attached to Barnett’s Complaint as well. (Doc. No. 1-2 at PageID
35-36.) It would be wholly unfair to allow Barnett to invoke certain facts to support his arguments
and then bar the DHA from responding in-kind. 	Thus, Plaintiff’s Motion for Clarification and
Request for Limited Redaction (Doc. No. 100) is DENIED.
More substantively, the Court finds it most appropriate to analyze Barnett’s APA claim
based on the clinical adverse actions he faced. 	Accordingly, the Court proceeds by first
considering Barnett’s APA claim in relation to the first administrative action he was subjected to,
which resulted in a reinstatement of clinical privileges with monitoring and evaluation, before
considering the administrative action that ended with the ultimate revocation of Barnett’s
privileges altogether.
a. 	Barnett’s First Clinical Adverse Action
1) 	Opening of the Quality Assurance Investigation
Throughout Plaintiff’s Motions, Barnett claims that the QAI initiated against him on May
17, 2023, was so defective as to offend his rights and violate the APA. 	To synthesize, Barnett
argues that the scope of this QAI expanded without justification and that he was denied the
opportunity to take part in forming the record underlying the QAI report, issued on July 20, 2023.
(See Doc. No. 96 at PageID 6947-48, 6951-52.)
Alas, Barnett’s contentions in this regard are unavailing. 	The APA creates a right of
judicial review for “person[s] suffering legal wrong because of agency action ….” 5 U.S.C § 702.
Under the APA, the phrase ‘legal wrong’ refers to the “invasion of a legally protected right.”
Paducah Junior Coll. v. Sec’y. of Health, Ed. & Welfare, 255 F. Supp. 147, 150 (W.D. Ky. 1966).
In this instance, no part of the QAI constituted an invasion of Barnett’s legally protected rights.
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Barnett does not have a protected interest in being free from QAI in his role as a physician. He
similarly does not have a right to shape the evidence compiled against him. Hence, the Court finds
that Barnett cannot rest his APA claim on objections to the DHA’s QAI process.
2) 	Summary Suspension
The Court turns next to a consideration of the summary suspension imposed upon Barnett
on May 9, 2023. While Barnett’s arguments on this front are not particularly coherent, the Court
can liberally construe Barnett’s filings to make out a couple of key positions. 	By one token,
Barnett submits that he was prejudiced by the DHA’s failure to provide him same-day notice of
his summary suspension on May 9. 	(See generally Doc. No. 88.) 	On the other hand, Barnett
claims that the procedural defects revolving around his summary suspension were so vast that the
Court cannot meaningfully determine whether the DHA’s decision to summarily suspend Barnett’s
privileges was arbitrary or capricious. 	(See generally Doc. No. 96.) 	The Court takes each of
Barnett’s assertions in turn.
i. 	Same-Day Notice and Procedural Due Process
Regarding notice, the Court finds that the DHA’s failure to provide Barnett with same-day
notice of his summary suspension on May 9, 2023, contrary to DHA Manual requirements, was
harmless error. Barnett decries this lack of same-day notice, arguing that it “deprived [him] of the
opportunity to meaningfully respond during the initial portion” of the QAI process. (Doc. No. 88
at PageID 5298.) 	Yet, pursuant to the DHA Manual, Barnett would not have been granted this
opportunity if he had been notified of his summary suspension on May 9, 2023. Barnett did not
acquire the right to offer a response in the clinical adverse action process until the QAI was
completed and a recommendation made. To be sure, Barnett took advantage of the opportunity
when he received a redacted version of his first QAI on July 20, 2023. As such, the Court finds
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that Barnett was not prejudiced by the DHA’s failure to notify him of his summary suspension
until May 17, 2023.
Beneath the surface of Barnett’s gripes about the QAI process is a much more salient
complaint that he was deprived of procedural due process when his clinical privileges were
summarily suspended without a hearing. The Court will liberally construe Barnett’s filings to raise
such an argument.
Even so, the Court finds that Barnett was not deprived of due process by virtue of his
summary suspension. At bottom, “the [APA] separately provides for setting aside agency action
that is unlawful …, which of course includes unconstitutional action.” Fox TV Stations, 556 U.S.
at 516 (internal citation and quotation marks omitted). 	Regarding procedural due process, the
Supreme Court has “consistently held that some form of hearing is required before an individual
is finally deprived of a property interest.” 	Mathews v. Eldridge, 424 U.S. 319, 333 (1976)
(collecting cases). 	Practically speaking then, to determine the applicability of procedural due
process, courts must first “identify a property or liberty interest entitled to due process
protections.” Brock v. Roadway Express, Inc., 481 U.S. 252, 260 (1987) (citing Cleveland Bd. of
Educ. v. Loudermill, 470 U.S. 532, 538-39 (1985); Bd. of Regents v. Roth, 408 U.S. 564 U.S. 576-
78 (1972)). “‘Once it is determined that due process applies, the question remains what process is
due.’” Brock, 481 U.S. at 261 (quoting Morrissey v. Brewer, 408 U.S. 471, 481 (1972)). In all,
“[t]he fundamental requirement of due process is the opportunity to be heard ‘at a meaningful time
and in a meaningful manner.’” Mathews, 424 U.S. at 333 (quoting Armstrong v. Manzo, 380 U.S.
545, 552 (1965)).
When an individual’s liberty interest is temporarily restricted pending review, as was
theoretically the case with Barnett’s summary suspension, whether the individual should be
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entitled to a predeprivation hearing “requires consideration of three distinct factors: [f]irst, the
private interest that will be affected by the official action; second, the risk of an erroneous
deprivation of such interest through the procedures used, and the probable value, if any, of
additional or substitute procedural safeguards; and finally, the [g]overnment’s interest, including
the function involved and the fiscal and administrative burdens that the additional or substitute
procedural requirements would entail.” Mathews, 424 U.S. at 335 (citing Goldberg v. Kelly, 397
U.S. 254, 263-71 (1970)).
Here, the Court assumes, without deciding, that Barnett had a protected property interest
in his privilege to practice medicine at WPMC, which was adversely affected by summary
suspension on May 9, 2023. 	The only question is whether Barnett was otherwise entitled to a
predeprivation hearing before the summary suspension of his privileges took effect.
The Court answers this question in the negative. In the way of private interest, the Court
notes that Barnett’s privileges to practice at WPMC were certainly adversely affected by summary
suspension. Nonetheless, the Court finds that summary suspension created little risk of erroneous
deprivation. By its very nature, the summary suspension of Barnett’s clinical privileges was only
temporary. If it were erroneous, the ensuing QAI would reveal as much and the DHA could swiftly
take corrective action. The risk of erroneous deprivation that did exist could have been alleviated
by affording Barnett an opportunity to be heard before summarily suspending his privileges. But,
to provide such a hearing would actively undermine WPMC’s “important interest in quickly
dealing with incompetence and debilitating personal frictions ….” 	Black v. Barberton Citizens
Hosp., 134 F.3d 1265, 1268 (6th Cir. 1985) (citations and internal quotation marks omitted).
Recall the DHA only suspended Barnett’s clinical privileges after receiving a barrage of credible
allegations that Barnett was behaving in a way that endangered patient safety. Surely, the DHA
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must have some leeway to suspend physicians without jumping through the hoops of an
administrative hearing if the agency believes the wellbeing of patients to be at stake.
Rather, Barnett was provided with a meaningful opportunity to be heard once the QAI was
completed. 	This too comports with due process because Barnett’s response to clinical adverse
action would have been most appropriately reviewed with the benefit of evidence collected during
the QAI. Brock, 481 U.S. at 266 (observing in dicta that “[t]o allow the employer and employee
an opportunity to test the credibility of opposing witnesses during … investigation would not
increase the reliability of the preliminary decision sufficiently to justify the additional delay”).
Otherwise, the DHA would have been left to conduct an administrative hearing on little more than
“he said/they said” dynamics. Thus, the summary suspension of Barnett’s clinical privileges on
May 9, 2023, did not run afoul of Barnett’s right to due process.
ii. 	Arbitrary and Capricious
The Court further finds that the DHA’s decision to summarily suspend Barnett’s clinical
privileges in May 2023 was neither arbitrary nor capricious. To start, the Court simply disagrees
with Barnett’s assessment of the Record. 	In accord with what the Court has previously stated,
Barnett’s litany of irrelevant questions regarding the Record are little more than thought exercises,
assuming that some information must be missing from the Record because Barnett personally
believes more should be in there. But, as should be made apparent by the extensive facts set forth
above, the Record contains ample material to conduct a meaningful review.
Moreover, the DHA’s decision to summarily suspend Barnett’s privileges was entirely
rational. By the time the DHA suspended Barnett’s clinical privileges in May of 2023, the agency
had received a critical mass of allegations against Barnett, dating back to at least March 2023.
Those allegations were not trivial, but called into question Barnett’s ability to practice safely and
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professionally. 	With the sheer number of complaints made to the DHA about Barnett—to say
nothing of Barnett’s checkered background—it makes sense that the agency would suspend his
privileges until it could get a handle on whether the allegations had merit. To be sure, this would
seem the best way to ensure patient safety. 	Therefore, the summary suspension of Barnett’s
clinical privileges on May 9, 2023, was not violative of the APA.
3) 	Reinstatement with Professional Monitoring and Evaluation
As a final note on Barnett’s first clinical adverse action in this matter, the Court finds that
Barnett’s APA challenge to the reinstatement of his privileges with monitoring and evaluation fails
for much the same reasons as his challenge to the QAI. To reinstate Barnett’s clinical privileges
is the opposite of injurious. 	Further, Barnett had no legally protected interest in practicing
medicine without monitoring and evaluation. 	Indeed, the DHA manual explicitly states that
monitoring and evaluation plans are not to be characterized as adverse actions in the first place.
The Court can see nothing in the Record to suggest that monitoring and evaluation somehow
limited Barnett’s clinical privileges in a legal sense. 	If anything, monitoring amounted to an
employee performance tool. 	Accordingly, the DHA’s choice to reinstate Barnett’s clinical
privileges with monitoring and evaluation did not offend the APA.
b. 	Barnett’s Second Clinical Adverse Action
With respect to the second clinical adverse action, which resulted in the revocation of
Barnett’s clinical privileges, Barnett is remarkably silent. 	He instead spends the entirety of
Plaintiff’s Motions arguing for the reversal of the first clinical adverse action he faced, beginning
in May 2023. Regardless, the Court finds that the DHA’s final decision to revoke Barnett’s clinical
privileges was neither arbitrary nor capricious.
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As detailed above, the Record establishes facts that place the DHA’s final decision within
a zone of reasonableness. Barnett himself testified that he did not always timely update medical
charts after having a patient encounter, despite the terms of his monitoring and evaluation plan
requiring that he complete all charting responsibilities on the same day as his patient encounters.
What is more, Barnett attested that he would continue to use higher-risk treatments like 3% saline
and immunosuppressants out of confidence—or perhaps hubris—in his own abilities. Finally, the
Record contains plenty of communications between Barnett and his colleagues to support the
notion that Barnett’s personality leads him to behave unprofessionally when things do not go his
way. Barnett was not bagging groceries, he was treating patients and he could reasonably be said
to have endangered their safety. When trying to run a medical facility, it was perfectly rational for
the DHA to find that Barnett’s behavior posed too great a risk to tolerate. 	As such, the Court
upholds the DHA’s final decision to revoke Barnett’s clinical privileges.
IV. 	CONCLUSION
Based on the foregoing, the Court hereby DENIES Plaintiff’s Renewed Motion for Partial
Summary Judgment (Doc. No 88), Plaintiff’s Motion for Judgment on the Administrative Record
(Doc. No. 96), and Plaintiff’s Motion for Clarification and Request for Limited Redaction (Doc.
No. 100). 	By contrast, the Court hereby GRANTS Defendant’s Motion for Judgment on the
Administrative Record (Doc. No. 97). 	Barnett’s Complaint (Doc. No. 1) is accordingly
DISMISSED and the Clerk is directed to TERMINATE this matter on the Court’s docket.
DONE and ORDERED in Dayton, Ohio, this Friday, August 14, 2026.
s/Thomas M. Rose
________________________________
THOMAS M. ROSE
UNITED STATES DISTRICT JUDGE
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