Sibley v. Lutheran Hosp. of Maryland, Inc.

• Decision Date: 31 March 1989
• Docket Number: No. 88-2802,88-2802
• Parties: Anthony Frank SIBLEY, M.D., Plaintiff-Appellant, v. LUTHERAN HOSPITAL OF MARYLAND, INC.; Duleep Pradhan, M.D., individually, and in his official capacity as Chairman, Department of Surgery, Lutheran Hospital of Maryland, Inc., Defendants-Appellees.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 479

871 F.2d 479

Anthony Frank SIBLEY, M.D., Plaintiff-Appellant, v. LUTHERAN HOSPITAL OF MARYLAND, INC.; Duleep Pradhan, M.D. individually, and in his official capacity as Chairman, Department of Surgery Lutheran Hospital of Maryland Inc., Defendants-Appellees.

No. 88-2802.

United States Court of Appeals Fourth Circuit.

Argued Nov. 1, 1988.

Decided March 31, 1989.

Lynn Suzanne Spradley (Paulson, Nace & Norwind, on brief), for plaintiff-appellant.

Daniel J. Moore (Semmes, Bowen & Semmes, on brief), for defendants-appellees.

Before WINTER, MURNAGHAN and SPROUSE, Circuit Judges.

PER CURIAM:

The district court granted summary judgment for Lutheran Hospital of Maryland, Inc. (Hospital) and Dr. Duleep Pradhan in this action filed against them by Dr. Anthony F. Sibley for defamation, negligent withholding and termination of hospital privileges, and intentional deprivation of hospital privileges. Summary judgment was granted for Dr. Pradhan, but denied to the Hospital with respect to plaintiff's tortious breach of contract cause of action. Pursuant to Fed.R.Civ.P. 54(b), the grant of summary judgment was made final.

Plaintiff appeals and we affirm.

Plaintiff's alleged causes of action all arose out of derogatory remarks made about him in the evaluation of his qualifications following his application for hospital privileges, delay on the part of the Hospital in taking final action on his application, and failure on the part of the Hospital to follow its own bylaws in denying him certain procedural rights.

In a concise opinion, the district court correctly determined that Dr. Pradhan was entitled to summary judgment on all of plaintiff's alleged causes of action, as was the Hospital, except with regard to plaintiff's claim of breach of contract or tortious breach of contract against the Hospital. See Sibley v. Lutheran Hospital of Maryland, 709 F.Supp. 657 (D.Md.1989). We are altogether satisfied with the opinion of the district court. We adopt it as our own statement as to why we affirm the judgment of the district court.

AFFIRMED.

MURNAGHAN, Circuit Judge, concurring:

Although I concur in the result reached by the majority, and acknowledge the thoroughness and quality of the opinion of the lower court, I feel the issues raised by this case are of tremendous importance and deserve further discussion.

In the medical doctors' intense interest in securing hospital privileges, which are terribly important if not altogether vital to their future professional success, some are turning to actions for defamation as a means to deter unfavorable comments on their activity. While they are entitled not to be maligned, they must accept that the public has a developed interest in the safe and efficient conduct of hospitals. Medical administrators must not be unduly constrained in accumulating professional comments on how safely and efficiently the hospital's affairs are being conducted.

It is with those thoughts in mind that I address Dr. Anthony Frank Sibley's suit for defamation against the Lutheran Hospital of Maryland and a member of its medical staff.

On August 6, 1984, Sibley, a resident of Washington, D.C., applied to the Lutheran Hospital of Maryland, located in Baltimore City, for full courtesy staff privileges in urology and full courtesy staff privileges, as well as temporary privileges, in emergency medicine (emergency room privileges). Sibley had graduated from medical school, served a one-year rotating internship and then completed a four-year residency in urology. He had already secured a temporary appointment in Lutheran Hospital's emergency room. At that time, Lutheran's division of urology, headed by Dr. Leslie Abramowitz, was one of several medical units within the department of surgery, headed by Dr. Duleep Pradhan. The division of emergency services fell under the department of ambulatory services, headed by Dr. Charles Shubin. The actual emergency room was managed and staffed on a contractual basis by the professional corporation of Dr. Reed Winston. ¹

Sibley's application contained a release stating in part:

I hereby release from liability all representatives of the hospital and its medical staff for their acts performed in good faith and without malice in connection with evaluating my application and my credentials and qualifications.

An applicant for full privileges in emergency medicine was required to possess certain qualifications; inter alia, a full program of training in surgery, medicine, family practice or emergency medicine, or three years experience in emergency room service. A "full program of training" is defined by Lutheran as the completion of a five-year residency program in one of the areas of specialization required for emergency room service.

Applications for full privileges at Lutheran were granted or denied by the Medical Executive Committee upon the recommendation of the Credentials Committee. Temporary privileges, on the other hand, did not need to be screened by the Credentials Committee nor meet all the required qualifications for full privileges. ² Applications for temporary privileges are approved by the department head and the chief medical affairs officer of the Hospital.

On October 25, 1984, Sibley met with Abramowitz concerning his application for privileges in urology. Abramowitz voiced his concern over Sibley's residence. Given the distance between Baltimore and Washington, Abramowitz was concerned about Sibley's ability to deal with problems and emergencies on a timely basis. ³ Sibley responded that if the situation called for it, such as a patient recovering from surgery, he could use as a temporary shelter the home of a friend. Abramowitz did not tell him the proposal was unsatisfactory or recommend he change his residence to get privileges. Abramowitz orally briefed Pradhan as to the interview shortly thereafter.

Abramowitz reported to Pradhan in a letter dated June 13, 1985 that he regarded Sibley as well-qualified, but noted his concern over Sibley's residence. ⁴ On July 22, 1985, Sibley informed Pradhan that he had acquired a Baltimore residence. On August 1, 1985, Pradhan sought further information, particularly as to whether the residence was permanent, which Sibley provided. At the subsequent meeting of the Credentials Committee, held on September 12, 1985, Sibley's application for privileges in urology was considered and approved.

Sibley's application for privileges in emergency medicine was considered at the same Credentials Committee meeting of September 12, 1985. The Committee determined Sibley did not meet the prescribed qualifications for full courtesy privileges in emergency medicine. At the meeting Pradhan reported two incidents of questionable patient care by Sibley. Pradhan made no representation to those attending the meeting as to the correctness of the information he was reporting.

First, Dr. Juan Arrisueno, head of the Hospital's surgical intensive care unit, had reported to Pradhan that a patient had appeared at the emergency room complaining of acute shortness of breath. Sibley inappropriately initiated intermittent positive pulse breathing therapy with the patient. It was subsequently discovered that the patient had a tension pneumothorax. A chest tube was then inserted and the patient was resuscitated. Pradhan reported the incident to Dr. Rafael Aybar, then Director of Medical Affairs at the Hospital, but took no further action.

The second incident, reported by Dr. Ashok Agrawal, involved a patient presented to the emergency room with a stab wound to the chest. ⁵ No X-ray was taken prior to the stitching of the chest wound. An X-ray was taken afterward, revealing fluid in the chest cavity necessitating evacuation.

The Credentials Committee recommended unfavorably on Sibley's application for emergency room privileges, which negative recommendation was adopted by the Medical Executive Committee. The Credentials Committee also voted to rescind Sibley's temporary emergency room privileges, which the Medical Executive Committee also approved.

Sibley was notified of the decision by a letter dated November 1, 1985. The notice was not sent by certified mail, did not state reasons for the Medical Executive Committee's action and did not advise Sibley of his right of appeal, all steps required by the Hospital bylaws.

On July 14, 1986, Sibley brought an action against Lutheran Hospital and Pradhan in the United States District Court for the District of Maryland, ⁶ seeking compensatory and punitive damages on four counts: defamation, negligent withholding and termination of hospital privileges, intentional deprivation of hospital privileges, and tortious breach of contract.

In count I, Sibley alleged Pradhan's statements to the Credentials Committee concerning the two incidents of patient mishandling were defamatory and that, because Pradhan acted with malice, he had lost any qualified privilege provided by statute or common law. In count II, Sibley alleged that the Hospital negligently violated its own bylaws by its manner of processing Sibley's application for privileges in urology and of terminating Sibley's temporary privileges in its emergency room. In count III, Sibley alleged Pradhan and the Hospital intentionally withheld the urology privileges and intentionally violated the Hospital bylaws by the manner in which the temporary emergency room privileges were revoked. In count IV, Sibley alleged the violation of the Hospital bylaws resulting in a breach of contract, and that the defendants' "acts and omissions were tortious in nature."

Following discovery the defendants moved for summary judgment on all counts. Accepting that the bylaws were an implied contract, the district court granted summary judgment to the defendants on all counts except the breach of contract claim against the Hospital. ⁷ The court also granted summary judgment denying Sibley's claims for punitive damages arising from the Hospital's...