Cardio-Medical Assoc. v. Crozer-Chester Med. Ctr.
| Decision Date | 13 April 1982 |
| Docket Number | Civ. A. No. 81-3050. |
| Citation | 536 F. Supp. 1065 |
| Parties | CARDIO-MEDICAL ASSOCIATES, LTD. and Thomas J. McBride, M.D. and Paul T. Cass, M.D. and C. Richard Schott, M.D. and Michael B. Goodkin, M.D., Plaintiffs, v. CROZER-CHESTER MEDICAL CENTER and James H. Loucks, M.D. Michael C. Boyd, William J. Breece, John F. Cramp, Esquire, Daniel R. Curran, Mary E. Dale, Conrad A. Etzel, M.D., Jeremiah A. Hartley, Joseph R. Layton, Reverend David A. MacQueen, Peter L. Miller, William B. Mitchell, Jr., Clarence R. Moll, Ph.D., J. Harold Perrine, Malcolm B. Petrikin, Esquire, and Bertram M. Speare, individually and as members of the Crozer-Chester Medical Center Board of Directors, and James Clark, M.D., Chief of Department of Medicine of Crozer-Chester Medical Center, and Daniel J. Marino, M.D., R. David Mishalove, M.D., Joel A. Krackow, M.D., Adrian S. Weyn, M.D., Peter Lavine, M.D., Michael Yow, M.D., and Ancil Jones, M.D. c/a Cardiology Associates of Delaware County. |
| Court | U.S. District Court — Eastern District of Pennsylvania |
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Howard Richard and Lyn B. Schoenfeld of Richard, Brian, DiSanti & Hamilton, Media, Pa., for plaintiffs.
John W. Wellman, Steven G. Brown of Petrikin, Wellman, Damico & Carney, Media, Pa., H. Robert Halper, Hope S. Foster, Mary Susan Philp of O'Connor & Hannon, Washington, D. C., for CCMC and James Clark, M.D.
H. Robert Fiebach, Roberta D. Liebenberg of Wolf, Schorr & Solis-Cohen, Philadelphia, Pa., for Cardiology Associates of Delaware County.
TABLE OF CONTENTS
I. Preliminary Statement ....................................... 1069
II. Standards Under Which Defendants'
Motion Must be Decided ...................................... 1070
A. Rule 12(c) .............................................. 1070
B. Summary Disposition of Cases in Federal
Courts .................................................. 1070
1. Notice Pleading Policy ............................ 1070
2. Efficiency Policy .................................. 1071
3. Summary ............................................ 1072
III. Plaintiffs' Sherman Act Allegations ......................... 1072
A. Sections 1 and 2 of the Sherman Act ..................... 1073
1. Presence of Interstate Commerce .................... 1074
2. Substantial and Adverse Effect ..................... 1074
3. Nexus Requirement .................................. 1074
4. Conclusion ......................................... 1076
B. Standards for Reviewing Interstate Commerce
Allegations ............................................. 1078
C. Plaintiffs' Interstate Commerce Allegations ............. 1079
D. Sufficiency of Plaintiffs' Interstate Commerce
Allegations ............................................. 1080
1. Presence of Interstate Commerce .................... 1080
2. Substantial and Adverse Effect on
Interstate Commerce ................................ 1082
3. Nexus Between Defendants' Challenged
Activities and Interstate Commerce ................. 1083
4. Conclusion ......................................... 1084
E. Appropriate Relief ...................................... 1084
IV. Plaintiffs' Civil Rights Claims ............................. 1085
A. Section 1983 ............................................ 1086
1. Deprivation of a Federally Protected
Interest ........................................... 1086
2. Color of State Law ................................. 1087
B. Standards for Reviewing State Action Allegations ........ 1088
C. Plaintiffs' State Action Allegations .................... 1089
D. Sufficiency of Plaintiffs' State Action Allegations ..... 1090
1. Nexus Requirement .................................. 1091
2. Symbiotic Relationship ............................. 1091
a. Specific elements ............................. 1092
(i) Receipt of Hill-Burton funds ................ 1092
(ii) Governmental regulation ..................... 1093
(iii) Receipt of Medicare and Medicaid
funds ....................................... 1093
(iv) Tax-exempt status ........................... 1094
(v) Monopoly status ............................. 1094
b. Facts and circumstances test .................. 1096
E. Appropriate Relief ...................................... 1097
V. Conclusion .................................................. 1098
This action is one of a burgeoning number of cases brought by physicians who have been denied full or specialized staff privileges at a particular hospital. Cardio-Medical Associates, Ltd., and its four physician members, filed this complaint against Crozer-Chester Medical Center (hereinafter referred to as "CCMC"), members of the CCMC Board of Directors, the Chief of the Department of Medicine at CCMC, and several individual doctors practicing cardiology under the name of Cardiology Associates of Delaware County.
Plaintiffs allege in Count I of their complaint that the denial to them of the opportunity to perform certain specialized cardiology procedures1 at CCMC is the result of an unlawful conspiracy on the part of defendants which has restrained trade in violation of sections 1 and 2 of the Sherman Act. 15 U.S.C. §§ 1, 2. In Count II of their complaint, plaintiffs further allege that the denial of the opportunity to perform these specific cardiology procedures is a violation of their fourteenth amendment rights. This violation, plaintiffs allege, constitutes a deprivation of a constitutionally protected property interest within the meaning of section 1983. 42 U.S.C. § 1983. Further, plaintiffs allege that defendants acted under color of state law when they denied the individual plaintiff physicians the right to practice the specified procedures. Finally, plaintiffs allege, also in Count II of their complaint, that their fourteenth amendment procedural due process rights were violated by defendants' failure to afford them a hearing at any time during the period of their exclusion from the performance of the specified cardiology procedures.
On the basis of these allegations, plaintiffs seek a declaratory judgment and a permanent injunction compelling defendants to permit plaintiffs to perform the specified procedures from which they allegedly have been wrongfully excluded. Further, plaintiffs seek an award of damages for the injuries allegedly sustained as a result of the denial of the opportunity to perform these procedures.
Pursuant to rule 12(c) of the Federal Rules of Civil Procedure, defendant CCMC, the members of the CCMC Board of Directors, and James C. Clark, M.D. moved for judgment on the pleadings with respect to both Counts I and II of plaintiffs' complaint.2 Defendants assert that plaintiffs have (1) failed to state a claim for relief or establish that this court has subject matter jurisdiction under the antitrust laws and (2) failed to state a claim for relief or establish that this court has subject matter jurisdiction under the Constitution or section 1983.
For the reasons stated below, I grant defendants' motion for judgment on the pleadings as to both counts of plaintiffs' complaint and dismiss Count I without prejudice and Count II with prejudice. In deciding defendants' motion, I write at some length because of the increasing significance — to doctors, to hospitals, and to the federal courts — of this genre of cases. The large financial and administrative burdens imposed on hospital defendants and the courts as a result of the growing number of denial of hospital staff privileges cases, notwithstanding the infrequency with which plaintiffs prevail, is only one reason for this topic's current importance. Further, my analysis of the case law discloses no comprehensive discussion of the theories underlying and of the standards to be applied in deciding claims of this type. As a result, I write to explain fully my doubts that the ordinary denial of staff privileges claim states a federal cause of action in any case.
A motion for judgment on the pleadings may be used to assert the failure of plaintiffs to state a claim upon which relief can be granted or the lack of subject matter jurisdiction. Fed.R.Civ.P. 12(h)(2), (3). See C. Wright & A. Miller, Federal Practice and Procedure § 1368, at 688 (1969).
Motions for judgment on the pleadings should not be "lightly given." Moss v. School District of Norristown, 33 F.R.D. 518, 519 (E.D.Pa.1963). The applicable standard for ruling on a 12(c) motion has been summarized as follows in Professor Moore's treatise:
Under the orthodox rule, a motion for judgment on the pleadings must be sustained by the undisputed facts appearing in all the pleadings, supplemented by any facts of which the court will take judicial notice. For the purposes of the motion, all well-pleaded material allegations of the opposing party's pleading are to be taken as true, and all allegations of the moving party which have been denied are taken as false. Conclusions of law are not deemed admitted. Judgment on the pleadings may be granted only if, on the facts as so admitted, the moving party is clearly entitled to judgment.
2A J. Moore, Moore's Federal Practice ¶ 12.15, at 2343-44 (1981) (footnotes omitted). Accord, Huntt v. Government of Virgin Islands, 339 F.2d 309 (3d Cir. 1964); Can-Tex Industries v. Safeco Insurance Company of America, 460 F.Supp. 1022 (W....
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