Bock v. John C. Lincoln Hosp., s. 1

• Decision Date: 29 January 1985
• Docket Number: Nos. 1,CA-CIV,s. 1
• Citation: 702 P.2d 253,145 Ariz. 432
• Parties: Henry BOCK, M.D., Plaintiff-Appellant, Cross-Appellee, v. JOHN C. LINCOLN HOSPITAL, an Arizona non-profit corporation, Defendant-Appellee, Cross-Appellant. 6786, 1 6789.
• Court: Arizona Court of Appeals

Page 253

702 P.2d 253

145 Ariz. 432

Henry BOCK, M.D., Plaintiff-Appellant, Cross-Appellee, v. JOHN C. LINCOLN HOSPITAL, an Arizona non-profit corporation, Defendant-Appellee, Cross-Appellant.

Nos. 1 CA-CIV 6786, 1 CA-CIV 6789.

Court of Appeals of Arizona Division 1, Department B.

Jan. 29, 1985.

Reconsideration Denied April 4, 1985.

Review Dismissed July 2, 1985.

Martori, Meyer, Hendricks & Victor, P.A. by Lawrence A. Hammond, Thomas H. Curzon, Phoenix, for plaintiff-appellant, cross-appellee.

Snell & Wilmer by Robert B. Hoffman, Richard K. Mahrle, Phoenix, for defendant-appellee, cross-appellant.

OPINION

KLEINSCHMIDT, Judge.

The appellant, Henry Bock, M.D., filed suit asking the trial court to enjoin John C. Lincoln Hospital from revoking his hospital privileges. The trial court found in favor of the hospital and this appeal ensued. The case presents a question as to whether the way the hospital applied its method for reviewing the doctor's qualifications complied with fundamental principles of fair procedure. We find that it did not.

Dr. Bock is licensed to practice medicine in Arizona. He specialized in internal medicine. He completed his residency in 1976 and opened an office in a building which he owns in north central Phoenix. The office is near John C. Lincoln Hospital. Many of the doctor's patients resided in the neighborhood of his office.

At about the same time that he began practice, Dr. Bock applied to the hospital for the privilege of admitting patients and serving as a consultant in internal medicine in the hospital's Department of Medicine. He received provisional privileges and began to admit patients. The hospital conditioned the doctor's privileges on a review of his first ten admissions by other doctors on the staff. A reviewing physician generally reads a patient's chart and writes a critique of the treating physician's performance in the form of an observation report. These observation reports are submitted to a departmental committee composed of doctors practicing in the same general field as the doctor whose work is under review. The committee recommends that full, unobserved privileges be granted or denied.

For reasons that are unclear, the hospital did not review Dr. Bock's first ten admissions. The doctor practiced for two years with provisional privileges before the observation reports, which were used to review his performance, were compiled. During that time he admitted over 100 patients to the hospital. A substantial portion of his hospital practice during that period was derived from consultations. In 1979, after a series of hearings, Bock's privileges were revoked. Thereafter, his consultations dropped from approximately seventy in 1977 to one or two by 1981.

The threshold question is whether the hospital's procedure for determining admitting privileges is subject to judicial review. The hospital contends that it is not. It concedes that the test of whether judicial review is appropriate is whether a refusal to allow privileges will seriously impair a doctor's ability to pursue his profession. This test is derived from Reiswig v. St. Joseph's Hospital & Medical Center, 130 Ariz. 164, 634 P.2d 976 (App.1981). In that case all that the doctor showed was that as the result of an alleged deficiency in education and experience she was excluded from a hospital training fellowship. Certainly, Dr. Bock has shown as serious an impairment to his career as did the plaintiff in Reiswig.

Even if the Reiswig criterion were not satisfied, we would still be justified in reviewing this case. The general rule, as stated in Peterson v. Tucson General Hospital, Inc., 114 Ariz. 66, 559 P.2d 186 (App.1976), to the effect that the exclusion of a doctor from staff privileges is ordinarily not subject to judicial review, does not apply "where there is a contention that the hospital failed to conform to procedural requirements set forth in a hospital's constitution, bylaws, or rules and regulations." 114 Ariz. at 69, 559 P.2d at 189. Since, as explained below, the hospital breached its own procedural requirements, we have full authority to consider this case.

We turn to the question of whether the hospital complied with fundamental principles of fair procedure. The procedures for observation of a doctor's work and review and appeal of staff privileges are found in the bylaws of the hospital corporation and the bylaws of the medical staff. A portion of the staff bylaws is referred to as the "Fair Hearing Plan". As respects Dr. Bock, the system worked as follows:

Following a review of the observation reports the Medical Committee recommended to Bock that he withdraw from the Department of Medicine. Bock declined and the committee voted to recommend that he not be given full privileges. Up to this point no notice or hearing is required by the bylaws and no participation by the doctor under review is contemplated.

The next stage is known as the "informal" or "preliminary" interview held before the Executive Committee. An adverse recommendation of the Medical Committee is sent to the Executive Committee, a body composed of physicians representing all of the disciplines and departments in the hospital. The bylaws require that the Medical Committee's recommendation be transmitted to the Executive Committee in writing along with all other documentation considered by the Medical Committee in connection with its recommendation. The affected physician is to be notified and "informed of the nature of the circumstances with reasonable particularity." He is to be allowed to meet with the Executive Committee and present information relevant to the circumstances which gave rise to the Medical Committee's recommendation.

On January 29, 1979, Dr. Bock received a letter from the hospital administrator advising him of the Medical Committee's adverse recommendation. With respect to the nature of the circumstances attending the recommendation the letter said:

The Medical Committee indicated the denial recommendation was based on the Committee's review of observed cases required of all new applicants for privileges in the Department of Medicine. Specific charts were Marie Esker (sic) # 5411038 and Gilbert Richardson, # 5385067.

The Executive Committee met one day after Dr. Bock received this letter. Bock objected to the short notice and what he felt was an inadequate explanation of the charges. At the meeting the discussion involved not only the two charts referred to in the letter but the treatment of one of those patients on the occasion of a different hospitalization. This case was not one that had been observed by another doctor and Bock had not reviewed the chart in preparation for the interview.

In response to Bock's questions, the doctor who was attending the Executive Committee meeting as a representative of the Medical Committee told Bock and the Executive Committee that all of the observation reports noted some deficiency in Bock's performance. The accusing doctor told the committee that Bock's charts had been found inadequate by a "multitude of observers" and that many examples in addition to the two charts referred to in the administrator's letter could be cited in support of his statement. At one point he remarked to Bock, "Maybe once, yes, but, Henry, this has been 2 years of repeated observation. There isn't one chart, there [are] 2 charts, 3 charts, 4 charts, 5 charts. They're all like this. They are all like this."

The observation reports, purportedly considered by the Medical Committee, were apparently not transmitted to the Executive Committee and were not in the room during the meeting of the Executive Committee. From all that appears from the record, the observation reports were never reviewed by the Executive Committee. Doctor Bock did not gain access to the reports until after he filed his lawsuit. There are a total of sixteen observation reports. In fact, only two of them are critical of Bock's performance.

The Executive Committee ratified the adverse recommendation of the Medical Committee. Bock was ultimately advised that the reason for the recommendation was that "the Executive Committee has determined that you have failed to demonstrate to the Medical Committee that you are qualified to practice as an Internal Medicine specialist." The letter went on to say that two specific charts, # 46921 and # 39048, were considered representative of Bock's deficiencies. These are not the same two charts referred to in the notice of the Executive Committee meeting provided to Dr. Bock.

Doctor Bock appealed the decision of the Executive Committee to the Judicial Review Committee. This committee consisted of a panel of four doctors. A fifth doctor attended as a representative of the Executive Committee. This was not the same physician who had represented the Medical Committee at the interview before the Executive Committee. At the hearing before the Judicial Review Panel, the Executive Committee's representative summarized the history of the case. He told the panel that a number of observers had made significant criticisms of Bock's work and "two charts were checked on the charts which received critical reviews for further evaluation and these two charts were the charts we're looking at Eskew and Richardson." These were discussed in some detail. No documentation was forwarded from the Executive Committee to the Judicial Review Committee. The Judicial Review Committee denied Bock's appeal because he had not demonstrated error in the facts presented by the Executive Committee.

The last step in the procedure was an appeal to the Appellate Review Committee, which was composed of five lay members of the hospital's board of directors. The same doctor who had represented the Executive Committee before the Judicial Review Committee appeared at the hearing before the Appellate Review Committee. This doctor again summarized the case. The Committee did not have before it the observation...