Courts don't require hospitals to tolerate unprofessional conduct

Dear Medical Staff Leader,

On July 11, 2003, Judge Sylvia H. Rambo (United States District Court, Middle District of Pennsylvania, Case No. 1:199-CV-1100) granted summary judgment to Lewistown Hospital in a case brought by Alan Gordon, MD. The case is a fascinating example of a medical staff's and hospital's attempt to control the unprofessional behavior of a physician through progressive discipline only to become embroiled in seemingly endless litigation. One of the most significant passages in Judge Rambo's nearly 100-page decision is a quote from the Third Circuit as follows:

"[W]e do not doubt that a hospital could exclude an applicant from staff privileges either because he is not medically qualified or because of unprofessional conduct, so long as the hospital applied the same standard to all applicants. This result does not skew our antitrust analysis. First, as to medical ability, restricting staff privileges to doctors who have achieved a specified level of medical ability falls within the scope of a hospital's 'public services' function . . . Applying the rule of reason analysis, it seems obvious that by restricting staff privileges to doctors who have achieved a predetermined level or medical competence, a hospital will enhance its reputation and the quality of medical care that it delivers. Thus such action is pro-competitive and, therefore, permissible under the rule of reason . . .

"The analysis for professional conduct is basically identical. The 'public service' function of a hospital is to provide for effective and efficient medical treatment for its patients. One factor in the effective and efficient running of a hospital is a medical staff that can work together and be courteous to patients and staff. Doctors who have a history of trouble in interpersonal relations can legitimately be excluded because, if admitted, they will reduce the effectiveness of the medical staff, thereby reducing the ability of the hospital to provide top-flight service. In sum, doctors who have trouble getting along with other people will reduce efficiency, thereby reducing the hospital's competitive position, and, therefore, exclusion of such doctors is pro-competitive and permissible under the rule of reason."

Judge Rambo then states that "if denying staff privileges to a physician based on unprofessional conduct is sufficient pro-competitive justification under the rule of reason, then placing reasonable conditions on a chronically disruptive physician's reappointment likewise serves the same pro-competitive ends. Because Dr. Gordon violated the Conditions of Reappointment, the hospital's decision to expel him similarly serves interests that are consistent with the Sherman Act."

The Judge then provides further enlightenment as she quotes from the Fourth Circuit:

"This case illustrates well the dilemma that hospitals face when they consider disciplining a physician by altering his admitting privileges. On the one hand, if the hospital failed to discipline a physician against whom documented complaints were legion, the efficiency of the entire institution could be affected and the hospital could even be exposing itself to malpractice liability. Yet, if the hospital takes corrective action, it and its medical staff face the prospect of a disgruntled physician bringing an antitrust suit against them.

"In our view, the antitrust laws were not intended to inhibit hospitals from promoting quality patient care through peer review . . . While we cannot say that no peer review decision would ever implicate the Sherman Act's concern for competition, this assuredly is not such a case. [The hospital] simply took measured steps to discipline an imperious physician. In taking these actions, [the hospital] and its medical staff have [not] violate . . . federal . . . law."

Readers can expect to hear more about this case, as it is a reminder that medical staff leaders need not fear the legal profession when they enforce reasonable rules of conduct in a consistent and even manner.

That's all for this week.

All the best,

Hugh Greeley