Boucvalt v. Board of Com'rs of Hosp. Service Dist. No. 1, Iberia Parish

Decision Date27 August 1986
Docket NumberNo. 85-4670,85-4670
Citation798 F.2d 722
PartiesRoy P. BOUCVALT, M.D., Plaintiff-Appellee, Cross-Appellant, v. BOARD OF COMMISSIONERS OF HOSPITAL SERVICE DISTRICT NO. 1, IBERIA PARISH, et al., Defendants-Appellants, Cross-Appellees.
CourtU.S. Court of Appeals — Fifth Circuit

Eric W. Springer, Horty, Springer & Mattern, James C. McManus, Pittsburg, Pa., Roy, Forrest & Lopresto, Leon E. Roy, Jr., New Iberia, La., for defendants-appellants, cross-appellees.

R. James Kellogg, New Orleans, La., for plaintiff-appellee, cross-appellant.

Appeals from the United States District Court for the Western District of Louisiana.

Before CLARK, Chief Judge, RUBIN, and GARZA, Circuit Judges.

CLARK, Chief Judge:

Roy P. Boucvalt brought this action under 42 U.S.C. Sec. 1983 against Donald Hebert, Executive Director of Iberia General Hospital (IGH), and the Board of Commissioners (the Board) of Iberia Parish Hospital Service District No. 1 (the district). Dr. Boucvalt sought damages and injunctive relief for violations of his rights under the First and Fourteenth Amendments to the United States Constitution. He also asserted pendent state law claims for breach of contract and intentional infliction of mental distress. The district court found for defendants on all claims except breach and awarded Boucvalt $287,785.00 in compensatory damages. Defendants appeal from the judgment against them. Boucvalt cross appeals, arguing that the district court erred in finding that he was not deprived of his procedural due process rights in the termination of his contract and in the issuance of a reprimand to him. He seeks to have the reprimand vacated and to be awarded attorney fees under 42 U.S.C. Sec. 1988. We affirm the district court on all issues.

I

Construed most favorably to the findings of the district court, the record discloses the following facts. Boucvalt and Robert Miller, both anesthesiologists, entered into a contract on March 3, 1980 with the district to provide anesthesia services to IGH through June 30, 1983. In April 1981, Miller assigned his portion of the contract to Boucvalt in writing and terminated his relationship with IGH.

In May 1981, Donald Hebert became Executive Director of IGH. Hebert wanted to renegotiate the anesthesia contract because he felt that the compensation being received by the anesthesiologists was too high. Hebert sent a letter to Boucvalt stating that failure to reapply for staff privileges at IGH automatically terminated the contract and proposing that a new contract be negotiated. Boucvalt, however, maintained that the original contract remained effective.

In response, Hebert conceded that the anesthesia contract remained in effect. He also informed Boucvalt that commencing January 1, 1982, Boucvalt would be directly accountable to the Executive Director. Prior to that time, according to Hebert, Boucvalt had not been directly accountable to the Executive Director.

Section 11 of the anesthesia contract provided:

It is agreed that both the Administrator and the Anesthesiologists shall determine questions of policy. No departmental directives shall emanate unless approved by both the Administrator and the Anesthesiologists.

However, the Organizational Chart of the Department of Anesthesiology showed that the chief anesthesiologist was subordinate and accountable to the Executive Director.

In addition to his general positions on compensation and accountability, Hebert had a number of specific concerns about Boucvalt's performance, which he communicated to him in the December 1981 to January 1982 period. In one incident, Boucvalt and an attending physician disagreed about the appropriate type of tracheal tube to be utilized in children during surgical procedures. Hebert instructed Boucvalt that it was the attending physician's decision and that he was not to dispute the physician's choice. In other communications, Hebert questioned the adequacy of Boucvalt's insurance coverage and whether he had properly documented all pre-anesthesia visits of patients.

On April 21, 1982, Boucvalt's counsel advised the Board that Boucvalt felt that the situation created by Hebert's criticisms was intolerable. The attorney listed five proposals to satisfy Boucvalt's grievances. Proposal 3 was that:

[Boucvalt] be placed under the control and authority of the Hospital Board of Commissioners and not answerable to Mr. Hebert for matters concerning his employment with the hospital and the Anesthesia Department.

In reply, the Secretary of the Board informed Boucvalt that the Board had rejected all five of his proposals. The reply also stated that Boucvalt was under contract and was considered answerable to the Executive Director.

Another incident occurred around this time. Dr. James Falterman filed a complaint against Boucvalt with the Medical Staff Executive Committee. The Committee sent a letter to Boucvalt informing him of the complaint and asking him to attend a meeting two days later to discuss the complaint. The letter did not specify the nature of the complaint or the names of the patients involved.

At the beginning of the Executive Committee meeting, Boucvalt was told that it was customary for the accused physician to leave the room while the complaining physician voiced his complaint. Boucvalt then left the room. Upon his return, he was informed that he was accused of having departed the operating room during five operations over the past five months. Boucvalt explained that his behavior had been proper because he had been in an adjoining suite where he could maintain visual contact with the certified nurse anesthetist at all times during the operation. Nonetheless, Boucvalt was subsequently reprimanded by a letter from the Executive Committee for his absence during most of one particular operation performed by Falterman.

Boucvalt's attorney requested the Board to rescind the Executive Committee's reprimand because it was issued in violation of due process. The Board, however, refused to consider this request because established procedure required Boucvalt to seek reconsideration directly from the Executive Committee. The Board advised Boucvalt that it also felt that the reprimand was carried out with due process.

Meanwhile, the Board of Commissioners requested Boucvalt's attendance at its meeting on June 24. The principal concern of the Board was Proposal 3 of the letter sent by Boucvalt's counsel to the Board. During the June 24 meeting several Board members expressed to Boucvalt the view that he, like other physicians, was answerable to the Executive Director. Boucvalt, however, maintained that, under his contract, policy setting was a joint responsibility of the Executive Director and the anesthesiologist and that therefore he was not required to take directions from Hebert. The meeting concluded with these conflicting positions articulated but unresolved.

Following this meeting another dispute arose between Hebert and Boucvalt. Hebert stated that the Joint Commission on Accreditation of Hospitals (the Commission) guidelines required Boucvalt to provide continuing education sessions for nurse anesthetists. Boucvalt refused to accept Hebert's position and maintained that such sessions were not necessary.

Boucvalt attended a July Board meeting, at which he stated that he could only remain at IGH if all five proposals in the April 21 letter were met. After this meeting, the Chairman of the Board sent a letter to Boucvalt requesting confirmation of Boucvalt's categorical refusal to be accountable to the Executive Director. Boucvalt responded by stating that he had "never categorically refused to be accountable to the Chief Executive Officer of Iberia General Hospital except in the context" of Proposal 3.

On July 26 the Board informed Boucvalt that it was terminating the anesthesia contract on the ground that his refusal to be accountable to the Executive Director rendered the contract impossible to perform. Upon receiving this letter, Boucvalt withdrew from medical staff membership at IGH and sought employment elsewhere. He accepted a position in Rocks Springs, Wyoming and commenced work in November.

II

Defendants argue that Boucvalt's refusal to be accountable to the Executive Director justified the termination of the anesthesia contract because the refusal constituted an active breach of the contract which relieved the Board of its obligations under the contract, Andrew Development Corp. v. West Esplanade Corp., 347 So.2d 210, 212-13 (La.1977), and rendered the contract impossible to perform. This theory can be sustained only if the refusal to be so accountable was in fact a breach of contract under Louisiana law.

A preliminary question concerns the standard of review to be followed. The district court found that the refusal to be accountable was not a breach of contract because it was justified by Section 11 of the contract. However, the court did not indicate whether it found the language of Section 11 clear and unambiguous, in which case its interpretation is reviewed as a matter of law, or whether it relied on extrinsic evidence in interpreting Section 11, in which case its interpretation is reviewed under the "clearly erroneous" standard. Makofsky v. Cunningham, 576 F.2d 1223, 1229 n. 7 (5th Cir.1978). Since the court did not cite any extrinsic evidence in support of its interpretation, however, it appears that it found the language of Section 11 clear and unambiguous.

Section 11 states that policy is to be made by both the Administrator (i.e., the Executive Director) and the anesthesiologists and that "[n]o departmental directives shall emanate unless approved by both the Administrator and the Anesthesiologists." This language clearly means that the Executive Director cannot make policy or issue directives relating to the anesthesia department without the approval of the anesthesiologists. The anesthesiologists are not required to accede to the instructions or demands of...

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