Anton v. San Antonio Community Hosp.

CourtUnited States State Supreme Court (California)
Writing for the CourtTOBRINER; CLARK
Citation19 Cal.3d 802,140 Cal.Rptr. 442,567 P.2d 1162
Parties, 567 P.2d 1162 Achilles P. ANTON, Plaintiff and Appellant, v. SAN ANTONIO COMMUNITY HOSPITAL, Defendant and Respondent; BOARD OF TRUSTEES OF SAN ANTONIO COMMUNITY HOSPITAL, Real Party in Interest and Respondent. L.A. 30624.
Decision Date31 August 1977
[567 P.2d 1164] Arthur J. Jaffee, Pomona, for plaintiff and appellant

Musick, Peeler & Garrett and Joseph A. Saunders, Los Angeles, for defendant and respondent and for real party in interest and respondent.

SULLIVAN, * Justice.

Plaintiff Achilles P. Anton, a licensed physician and surgeon, appeals from a judgment denying his petition for a writ of mandate sought under Code of Civil Procedure section 1085 to compel defendant San Antonio Community Hospital, a private, nonprofit hospital corporation, to reinstate his hospital rights and privileges and reappoint him to the medical staff.

The cause was submitted on an agreed statement of facts, which on stipulation of the parties was to be treated as defendant's answer to the petition. The underlying facts, as they appeared in the agreed statement, were in substance as follows:

[19 Cal.3d 809] 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. 1 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.

In October 1973 the medical staff commenced an investigation of plaintiff's hospital medical practices. A committee report made in the same month indicated, inter alia, that 'there is evidence of poor medical judgment and overutilization of the hospital. Many of these patients did not appear to need actual hospital care, multiple tests were performed without medical indication, and there were several questionable industrial cases.' The matter was referred to a second committee which reported, following a review of eight consecutive admissions by plaintiff Anton, that the charts reviewed were 'found to be lacking in several areas, both in regard to over and underutilization as well as continued lack of completeness of histories and physicals . . ..' It was recommended that appropriate action be taken in accordance with medical staff bylaws.

In December 1973 the hospital's board of directors, having been advised of the foregoing recommendation, met for the purpose of reappointing staff members for the year 1974. After some discussion it was determined that all staff members with the exception of plaintiff should be reappointed and that action on plaintiff's reappointment should be tabled until the January meeting of the board.

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 'on the basis of his failure to document proper care of his patients by failure to [19 Cal.3d 810] complete the histories and physical examinations in accordance with the Rules and Regulations of the

[567 P.2d 1165] Medical Staff Bylaws. Dr. Anton to be notified by certified mail of his suspension and informed that he may request a preliminary hearing before this committee in accordance with Article III, section 8, of the Medical Staff Bylaws.' 2 The indicated notification was sent, and a preliminary hearing was requested and held, resulting in the upholding of the suspension of hospital privileges

In February 1974 plaintiff requested a formal hearing on the matter of his suspension (see fn. 2, Ante), and by letter dated February 11 he was notified that a judicial review committee had been appointed in accordance with the bylaws 'to meet with you on March 5 to consider your non-reappointment to the medical staff 3 and the recommendation of the Executive and Credentials Committees regarding suspension of all hospital privileges.' The letter went on to state: 'The charges on which the recommendation for suspension was based include failure to demonstrate a continued satisfactory level of professional care and judgment as follows:

'(1) Your lack of cooperation and repeated violations of the Rules and Regulations of the Medical Staff Bylaws relative to the completion of histories and physical examinations within the required period, as evidenced by the following records: (Citation by number of 54 hospital records.)

'(2) Repeated violations of the Rules and Regulations of the Medical Staff Bylaws relative to the completion of hospital records in general, as evidenced by the following records: (Citation by number of 14 hospital records.)

[19 Cal.3d 811] '(3) Failure to visit hospitalized patients on a timely basis, as evidenced by the following records: (Citation by number of four hospital records.)

'(4) Over utilization of hospital facilities and services, as evidenced by the following records: (Citation by number of 10 hospital records.)'

At its regular meeting of February 25, 1974, (see fn. 2, Ante)--which occurred subsequent to plaintiff's receipt of the above letter--the hospital board of directors approved a revised set of medical staff bylaws, 4 which differed in several respects from the theretofore existing (1968) bylaws and, according to the agreed statement of facts, 5 were based upon a document entitled 'Guidelines for the Formulation of Medical Staff Bylaws, Rules and Regulations,' published in 1971 by the Joint Commission on Accreditation of Hospitals, the national organization by which the hospital was accredited.

[567 P.2d 1166] 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. A court reporter was present and transcribed all proceedings. An attorney appointed for the purpose by the board of directors presided over the hearing as hearing officer, but neither plaintiff nor the medical staff was represented by counsel; plaintiff was assisted in the proceedings by a member of the medical staff and the staff itself was represented by two other members. The hearing was conducted under the revised bylaws over plaintiff's objection. At its conclusion the judicial review committee, after deliberating in the presence of the hearing officer and the two alternates, 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. In its formal report and recommendation the committee cited as reasons for its decision the four charges which had been set forth in the letter of February 11, finding each of the charges to be true.

[19 Cal.3d 812] On March 25, 1974, plaintiff made a written request for an appellate review of the judicial review committee decision as authorized by the 1968 medical staff bylaws. He was thereupon notified by letter that on April 24 an appellate review hearing would take place before the board of directors, as authorized by the revised (1974) bylaws.

On the appointed date plaintiff appeared with his attorney at the hearing. Also present were the members of the board of directors and their attorney. No one appeared on behalf of the medical staff or any of its committees. After introducing himself plaintiff's counsel stated that plaintiff would answer any questions that the board would care to put to him, but the attorney for the board pointed out that under the revised bylaws it was incumbent upon plaintiff to show either that the procedures required by the bylaws had not been complied with or that the decision of the judicial review committee was not supported by substantial evidence. 6 Thereupon plaintiff's attorney orally advanced five alleged errors and improprieties in the previous proceedings: (1) that the judicial review committee hearing was improperly conducted under the 1974 bylaws and should have been conducted under the 1968 bylaws; (2) that the disciplinary action taken was unduly harsh; (3) that none of the allegations made at the hearing were valid except that which related to the failure to complete history and physical examination records in a timely manner; (4) that the judicial review committee had erroneously refused to review selected medical records which he had brought to the hearing from his own office; and (5) that plaintiff was never able to present an adequate defense. Counsel concluded by stating that the committee hearing had contained other flaws as well, but that he would not undertake to enumerate them at that time. To this the board's attorney responded that counsel should call the attention of the board to each alleged prejudicial impropriety in order that plaintiff might claim exhaustion of his intraorganizational remedies should he subsequently wish to do so. Counsel, however, again declined to further enumerate the claimed errors or to become more specific regarding alleged prejudice, stating that the hearing in progress was not the appropriate forum for so doing. Plaintiff and his counsel were thereupon excused from the hearing.

On May 13, 1974, the board of directors, after reconvening to continue their deliberations, resolved to 'sustain the decision of the Judicial [19 Cal.3d 813] Review Committee in regard to the medical staff membership of Dr. An

[567 P.2d 1167] ton.' Plaintiff was notified of the decision, and this action in mandate followed

Following argument by the parties at the hearing on the order to show cause, the trial court issued a notice of intended decision in which it determined, inter alia: (1) that plaintiff was not entitled to a trial de...

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