Anton v. San Antonio Community Hospital

CourtCalifornia Court of Appeals
Citation132 Cal.App.3d 638,183 Cal.Rptr. 423
PartiesAchilles P. ANTON, M. D., Plaintiff and Appellant, v. SAN ANTONIO COMMUNITY HOSPITAL, etc., et al., Respondents. Civ. 25726.
Decision Date07 June 1982

KAUFMAN, Associate Justice.

Achilles P. Anton (plaintiff) appeals from a judgment denying his petition for a peremptory writ of mandate to compel San Antonio Community Hospital (Hospital) to reinstate him to membership on Hospital's medical staff.

This case has been before us before and has been the subject of a decision of the California Supreme Court, Anton v. San Antonio Community Hosp. (1977) 19 Cal.3d 802, 140 Cal.Rptr. 442, 567 P.2d 1162 (hereinafter Anton I ). The background facts are extensively set forth in that decision, and for convenience portions are repeated here.

"For 13 years preceding the events here in question plaintiff had been a member of defendant hospital's medical staff--an unincorporated association organized under the auspices of the hospital's board of directors as required by section 2392.5 of the Business and Professions Code. [Fn. omitted.] During that period, however, he had been the subject of several corrective and/or disciplinary actions taken by committees of the medical staff relative to his failure to complete hospital medical records." (Anton I, supra, 19 Cal.3d at p. 809, 140 Cal.Rptr. 442, 567 P.2d 1162.)

In December 1973, as a result of an investigation of plaintiff's hospital practices, plaintiff's application for annual reappointment was not granted along with those of all other members of the medical staff. In January 1974, at a special joint meeting of the executive and credentials committees of the medical staff it was resolved that plaintiff's hospital privileges should be summarily suspended. Plaintiff requested a preliminary hearing to which he was entitled under the bylaws. A hearing was held and the suspension of plaintiff's hospital privileges was upheld.

In February 1974, plaintiff requested a formal hearing and a judicial review committee was appointed in accordance with the bylaws. Plaintiff was advised by letter of the charges on which the recommendation for suspension was based. 1 On March 5, 1974, the formal hearing was commenced before the judicial review committee, which had been appointed by the executive committee and consisted of five members and two alternates, all of whom were members of the medical staff. At the conclusion of the hearing the committee recommended to the medical staff and board of directors that plaintiff's hospital privileges be suspended and that he not be reappointed to the medical staff, citing the four charges set forth in the letter earlier sent to plaintiff (see fn. 1, ante).

Plaintiff then requested an appellate review of the judicial review committee decision. He was notified that an appellate review hearing would take place before the board of directors in accordance with the medical staff bylaws as revised. On May 13, 1974, at the conclusion of the appellate review proceedings, the board of directors resolved to sustain the decision of the judicial review committee.

On June 5, 1974, plaintiff filed a petition for writ of mandate to compel his reinstatement to medical staff membership. The petition alleged numerous fair procedure violations and challenged the sufficiency of the evidence to support Hospital's not reappointing him to the medical staff. Trial was held on an agreed statement of facts submitted by the parties, and the trial court, utilizing a substantial evidence standard of review, determined that the procedures followed accorded with law and that substantial evidence supported the determination made by the board of directors. Accordingly, judgment was entered denying issuance of a peremptory writ of mandate.

Plaintiff appealed to this court contending that the correct standard of review in the trial court was the independent judgment standard and that the proceedings before hospital's several committees and board of directors did not afford him the fair procedure to which he was entitled. We affirmed the judgment.

The California Supreme Court granted hearing and in its decision in Anton I held that plaintiff's application for reappointment to Hospital's medical staff involved a vested and fundamental right and that pursuant to Code of Civil Procedure section 1094.5, subdivision (c), 2 the trial court erred in not exercising its independent judgment in reviewing the factual basis for the decision of Hospital's board of directors. However, the Supreme Court rejected all of plaintiff's claims that he was not accorded fair procedure and held that the procedures followed by Hospital did afford plaintiff the fair procedure required by law. (19 Cal.3d at p. 825, 140 Cal.Rptr. 442, 567 P.2d 1162, et seq.) The judgment was reversed and the cause remanded to the trial court for further proceedings consistent with the opinion. The decision issued August 31, 1977.

After remand but before retrial, the Legislature, on September 30, 1978, amended section 1094.5 effective January 1, 1979. Along with several minor changes not relevant here, the 1978 amendment added subdivision (d), which reads in pertinent part: "(d) Notwithstanding the provisions of subdivision (c) [see fn. 1, ante], in cases arising from private hospital boards, abuse of discretion is established if the court determines that the findings are not supported by substantial evidence in the light of the whole record." 3

After a number of continuances, retrial commenced on June 13, 1980. On March 24, 1981, the court entered judgment denying the writ. In its findings and conclusions, the court determined that the proceedings before the hospital board satisfied "minimal requisites of fair procedure"; that no new evidence going to the merits of plaintiff's case could be presented because the parties had stipulated to an agreed statement of facts and because plaintiff had failed to show good cause; that subdivision (d) of section 1094.5 was applicable and mandated review by the substantial evidence standard; that defendant was a private hospital within the meaning of the statute; that substantial evidence supported defendant's decision not to reinstate plaintiff to the hospital medical staff; that the Legislature had a rational basis for distinguishing between private and public hospitals; and that section 1094.5, as amended, was otherwise constitutional.

Plaintiff has again appealed contending inter alia that the trial court erred in reviewing Hospital's determination on the basis of the substantial evidence standard prescribed in section 1094.5, subdivision (d), and in refusing to receive additional evidence and that the original hearings before the several committees did not accord with fair procedure because the members of the committees were members of the same medical staff as the physicians who complained of his conduct. We have concluded that plaintiff's contentions are not meritorious. Accordingly, the judgment will be affirmed.

Discussion of Contentions and Issues Court's Declination to Receive Additional Evidence

On retrial the court denied plaintiff's requests to take additional evidence. The court was quite right.

Plaintiff points to footnote 24 in the Anton I decision where the court stated: "Because significant portions of the administrative proceedings here subject to review took place before a panel of medical doctors exercising professional judgment on matters of proper medical technique and practice, the trial court may find the record of those proceedings inadequate for the purpose of informed judicial review. If so the trial court, prior to undertaking its deliberations, may wish to remand the matter to the administrative body for further proceedings directed to the preparation of an adequate record. [Citations.]" (19 Cal.3d at p. 825, 140 Cal.Rptr. 442, 567 P.2d 1162.) However, so far as we are advised, plaintiff never requested that the matter be remanded to Hospital's board of directors for the taking of additional evidence; he requested that the trial court receive the evidence.

Section 1094.5, subdivision (e), provides: "Where the court finds there is relevant evidence which, in the exercise of reasonable diligence, could not have been produced or which was improperly excluded at the hearing before respondent, it may enter judgment as provided in subdivision (f) of this section remanding the case to be reconsidered in the light of such evidence; or, in cases in which the court is authorized by law to exercise its independent judgment on the evidence, the court may admit such evidence at the hearing on the writ without remanding the case." Plaintiff contends this is a case in which the trial court was authorized by law to exercise its independent judgment and urges that the court should have received additional evidence. However, the trial court found the additional evidence could with reasonable diligence have been produced at the Hospital hearings. Moreover, as later discussed, we have concluded that the trial court properly reviewed Hospital's determination under the substantial evidence standard.

The trial court's finding and our conclusion as to the proper standard of review in the trial court also dispose of plaintiff's contention the parties contemplated that further evidence would be received in the trial court if it should be determined that plaintiff was entitled to a "trial de novo" in the superior court.

Lack of Fair Procedure in the Hospital Hearings

In Anton I the court rejected as unmeritorious all of plaintiff's contentions that the procedures followed in the original proceedings denied him the "minimal requisites of fair procedure required by established common law...

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