Babcock v. Saint Francis Medical Center
| Decision Date | 20 February 1996 |
| Docket Number | No. A-94-619,A-94-619 |
| Citation | 543 N.W.2d 749,4 Neb.App. 362 |
| Parties | Nita Katherine BABCOCK, Appellant, v. SAINT FRANCIS MEDICAL CENTER, a nonprofit corporation, and the medical staff of Saint Francis Medical Center, Grand Island, Nebraska, Appellees. |
| Court | Nebraska Court of Appeals |
Syllabus by the Court
1. Summary Judgment: Appeal and Error. To review a summary judgment, an appellate court views the evidence in the light most favorable to the party against whom the judgment is granted and gives such party the benefit of all reasonable inferences deducible from the evidence.
2. Summary Judgment. A summary judgment is proper only when the pleadings, depositions, admissions, stipulations, and affidavits in the record disclose that there is no genuine issue as to any material fact or as to the ultimate inferences that may be drawn from those facts and that the moving party is entitled to judgment as a matter of law.
3. Judgments: Appeal and Error. An appellate court has an obligation to reach conclusions on questions of law independent of the trial court's ruling.
4. Injunction: Equity. The purpose of an injunction is the restraint of actions which have not yet been taken. Remedy by injunction is generally preventative, prohibitory, or protective, and equity will not usually 5. Federal Acts: Physicians and Surgeons. One of the purposes of the federal Health Care Quality Improvement Act is to encourage physicians, without fear of litigation, to identify and discipline other physicians who are incompetent or who engage in unprofessional behavior.
issue an injunction when the act complained of has been committed and the injury has been done.
6. Federal Acts: Health Care Providers: Damages: Immunity. The federal Health Care Quality Improvement Act bestows limited immunity from lawsuits for money damages upon those who participate in professional peer reviews.
7. Federal Acts: Health Care Providers: Immunity: Intent. Immunity under the federal Health Care Quality Improvement Act is a question of law, and it was the intent of Congress that questions regarding immunity under the act be resolved during the early stages of litigation, such as upon a motion for summary judgment.
8. Federal Acts: Health Care Providers: Immunity: Presumptions. The federal Health Care Quality Improvement Act creates a rebuttable presumption that a professional review action met the requirements of the act necessary to qualify for immunity under the act.
9. Health Care Providers: Due Process. A private hospital's actions do not constitute state action and therefore are not subject to scrutiny by the courts for compliance with due process protection.
10. Governmental Subdivisions. State action exists only when it can be said that the state is responsible for the specific conduct of which the plaintiff complains.
11. Health Care Providers: Due Process. The decision of a private hospital to revoke, suspend, or limit the privileges of a physician or other member of the medical staff is subject to limited judicial review to ensure that the hospital substantially complied with its medical staff bylaws, as well as to ensure that the bylaws provide for basic notice and fair hearing procedures.
12. Health Care Providers: Contracts. A hospital's obligation to follow its own bylaws can stem from a contractual relationship between the hospital and physician.
13. Contracts. Construction of a written contract is a question of law for the court.
14. Health Care Providers: Due Process. Absent evidence of actual bias, the fact that a board or committee or some of its members might have earlier considered suspending a physician's privileges does not amount to an unfair hearing.
15. Health Care Providers: Evidence: Due Process. To the extent that courts examine the evidentiary basis for a hospital's decision to suspend privileges, such examination is in recognition that an inherent element of fair hearing procedures is that there be sufficient evidence to support the hospital's decision. Nonetheless, the decision of a hospital, whether private or public, concerning medical staff privileges is entitled to judicial deference.
Appeal from the District Court for Hall County: James Livingston, Judge. Affirmed.
Judy K. Hoffman, Omaha, and James H. Truell, Grand Island, for appellant.
Patrick G. Vipond, and James W. Ambrose II, of Kennedy, Holland, DeLacy & Svoboda, Omaha, for appellees.
Dr. Nita Katherine Babcock appeals the district court order granting summary judgment to Saint Francis Medical Center and the medical staff of Saint Francis, hereinafter collectively referred to as St. Francis or the hospital for convenience. Babcock's medical staff privileges as an anesthesiologist were suspended by St. Francis after concerns arose about Babcock's drinking. Babcock filed suit against St. Francis, asking for injunctive relief, reinstatement of her staff privileges, and damages. St. Francis moved for summary judgment, which was granted, and Babcock now appeals.
Babcock applied for staff privileges with St. Francis as an anesthesiologist. St. Francis' bylaws provide that all practitioners who apply for medical staff privileges shall be provided with an application, a copy of the bylaws, and rules and regulations pertaining to the staff. Under the bylaws, the application form is to include an acknowledgment and agreement that the applicant has received and read the bylaws and agrees to be bound by them.
The record does not contain a complete application form filled out by Babcock. Instead, it contains two pages from the application. On one page of the application form, Babcock acknowledged that she has had a "physical or mental health condition (to include, but not limited to, drug or alcohol abuse) that affects or is reasonably likely to affect your ability to perform professional or medical staff duties." The second page from the application in the record is an attachment made by Babcock in which she states, in further explanation of her admission to her physical or mental health condition:
In February of 1992, I was an inpatient at Hazelden Treatment Center for alcoholism for 30 days. Following inpatient treatment, I have continued outpatient counselling and frequently and regularly attend AA.... Since inpatient treatment I have not taken a sick day or vacation day, and have assumed regular call schedules and full-time physician duties.
The bylaws of the hospital state that the executive committee of the medical staff is empowered to review applications and make recommendations, including any special conditions to be attached to the offer of medical staff privileges, to the hospital board. The hospital board then makes a decision whether to adopt the recommendation of the executive committee. The bylaws provide that all initial appointments to the medical staff are provisional and for 1 year. The provisional appointees are supervised and observed by other members of the St. Francis medical staff during the provisional period.
Babcock's application for staff privileges led to an agreement dated July 12, 1993, made between Babcock and the hospital, in which she was required to meet certain conditions to be retained as a medical staff member with clinical privileges. The conditions include participation in aftercare to follow up on her inpatient treatment for alcoholism, verification of her aftercare participation, and random drug screenings. The agreement states that "[i]f at any time in the future, as a result of ongoing monitoring activities, it is deemed that the practitioner is not appropriately carrying responsibilities as a member of the medical staff, the practitioner may be subject to suspension or revocation of privileges."
Eleven days after the date of this agreement, a registered nurse and a fellow physician each reported smelling alcohol on Babcock's breath in the surgical preoperating room. The physician reported that "[h]er subsequent actions seemed to be uncoordinated." An ad hoc committee met with Babcock to notify her of the complaints against her and to allow her to take "appropriate action to resolve the concerns." As a result of this incident and executive committee action concerning the incident, Babcock then voluntarily took a leave of absence and was admitted to St. Francis' own inpatient alcoholism treatment program.
Upon her return to work, on September 7, 1993, Babcock and St. Francis entered into a second agreement which was substantially identical to the first agreement, save for the following provision: "If at any time in the future, as a result of ongoing monitoring activities or in the event of recurrence, it is deemed that the practitioner is not appropriately carrying responsibilities as a member of the medical staff, the practitioner will be subject to termination of privileges." (Emphasis supplied.)
One month later, Babcock was arrested for second-offense driving while intoxicated in York County. Accompanying Babcock in the car on October 7, 1993, was her 5-year-old son. Babcock was tested for blood alcohol content (BAC) upon her arrest and had a BAC of .25. Babcock was scheduled to provide anesthesia for a surgery at 7:30 a.m. on October 8, but did not show up, since she was in jail. An affidavit in the record of Dr On October 14, 1993, Dr. D.G. Wirth, president of the medical staff, notified Babcock that her privileges were temporarily suspended pending resolution of the criminal charge of driving while intoxicated. Under the hospital's bylaws, the president of the medical staff has the authority "whenever action must be taken immediately in the best interest of patient care in the hospital, to summarily suspend all or any portion of the clinical privileges of a practitioner." The bylaws provide that the practitioner may then request that a hearing before the executive committee of the medical staff be held to review the...
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