Christenson v. Mt. Carmel Health

• Decision Date: 28 June 1996
• Docket Number: No. 95APE11-1474,95APE11-1474
• Citation: 112 Ohio App.3d 161,678 N.E.2d 255
• Parties: CHRISTENSON, Appellant, v. MOUNT CARMEL HEALTH, Appellee.
• Court: Ohio Court of Appeals

Page 161

112 Ohio App.3d 161

678 N.E.2d 255

CHRISTENSON, Appellant, v. MOUNT CARMEL HEALTH, Appellee.

No. 95APE11-1474.

Court of Appeals of Ohio Tenth District, Franklin County.

Decided June 28, 1996.

Spater, Gittes, Schulte & Kolman, and Frederick M. Gittes, Columbus, for appellant.

Arter & Hadden, John P. Gartland and Donald A. Davies, Columbus, for appellee.

LAZARUS, Judge.

Plaintiff-appellant, Doranna Christenson, M.D., appeals from a judgment of the Franklin County Court of Common Pleas denying her request for injunctive and declaratory relief and dismissing her complaint.

This case concerns the denial of hospital staff privileges to a physician. For the reasons that follow, we hold that appellant was deprived of her right to a fair hearing when defendant-appellee, Mount Carmel Health (the "hospital"), departed from its own bylaws by failing to provide Dr. Christenson with information sufficient for her to respond to the allegations constituting the basis for the denial of hospital privileges.

Christenson brought suit under R.C. 3701.351 and the common law in the Franklin County Court of Common Pleas. ¹ She sought an injunction requiring that she be granted privileges at Mt. Carmel East Hospital and that the hospital be required to correct its report regarding the reason for its denial of privileges to her submitted to the National Practitioners Data Bank coded under a provision entitled "incompetency/malpractice/negligence." The case was submitted on stipulated facts, exhibits, affidavits, and trial briefs. Following oral argument, the trial court denied appellant's request for injunctive relief and dismissed appellant's complaint. Appellant timely appealed the judgment of the trial court and raises the following three assignments of error:

"1. The trial court erred in concluding that the defendant-appellee Mount Carmel Health ('Hospital') was not arbitrary, capricious or unreasonable when it denied staff privileges to the plaintiff-appellant Dr. Doranna Christenson ('Dr. Christenson') in light of the fact that the Hospital relied solely for its decision on incorrect, unreliable, or unsubstantiated factual allegations, particularly where reliable and competent evidence exists in the record refuting these allegations.

"2. The trial court erred in concluding that the Hospital gave Dr. Christenson adequate procedural due process in light of the facts that the Hospital (a) failed to follow its own procedures and (b) failed to provide Dr. Christenson with information sufficient for her to respond to the basis for denial of hospital privileges.

"3. The trial court erred in failing to apply the hybrid standard of review for determining if the Hospital's decision was arbitrary, capricious or unreasonable."

Christenson received her medical degree in 1977 from the University of Alabama. She spent the first two years of her residency in obstetrics and gynecology ("OB/GYN") at the University of South Alabama in Mobile, Alabama, and the last two years of her residency in Albany, New York. She practiced in New York and Hawaii before entering a maternal/fetal medicine program at the Ohio State University. Christenson was board-certified in OB/GYN in 1984.

From 1985 to 1990, Christenson served as the principal investigator on a research grant funded by the National Institute of Health. The terms of the grant precluded Christenson from practicing medicine during that period. Christenson resumed practicing medicine when she went to work for Principal Health Care in January 1990. She worked with Principal Health Care until her contract expired in June 1992. While with Principal Health Care, Christenson became involved in a contract dispute over compensation. The dispute involved Dr. Dennis Cebul, who is on the board of directors of Principal Health Care and is also the chairman of the OB/GYN department at Riverside Methodist Hospital.

Christenson applied for provisional staff status with Mt. Carmel East Hospital in its OB/GYN department in October 1991. The bylaws of the Medical Staff of the Hospital and the Fair Hearing Plan set forth detailed procedures which an applicant and the hospital are to follow in the review of an application for privileges. The bylaws contain multiple levels of review and provide for appellate review of adverse determinations. Among other requirements, Section 6.2-2(d) of the bylaws required that Christenson submit:

"The names of at least three practitioners not currently or about to become partners with the applicant in professional practice or personally related to him who have personal knowledge of the applicant's current clinical ability, ethical character, health status, ability to work cooperatively with others, and other qualifications for appointment and who will provide specific written comments on these matters upon request from Hospital or Medical Staff authorities. The named individuals must have acquired the requisite knowledge through recent observation of the applicant's professional performance over a reasonable period of time, at least one, must have had organizational responsibility for supervision of his performance (e.g., Department Chairman, Service Chief, Training Program Director) * * *."

Christenson submitted recommendations from twelve physicians, none of whom were from her group and practice at the time, namely, Riverside Methodist Hospital and Principal Health Care. Although the Hospital later characterized these recommendations as "stale" and "weak," the first three hospital committees that reviewed those same submissions approved her application. The hospital's medical staff of the Department of Obstetrics and Gynecology, the Clinical Council for Provisional Staff Privileges, and then the Central Credentials Committee all recommended her for privileges.

Problems first appeared when Dr. Robert Hallet, chairman of the OB/GYN Department at the hospital, received and reviewed Christenson's application in the early part of 1992. Hallet telephoned Dr. Cebul, the chairman of the OB/GYN Department at Riverside Methodist Hospital. Hallet expressed by way of affidavit that he trusts and respects Cebul, having known him for over twenty years, since Cebul's years as a resident. Hallet's affidavit further stated:

"I contacted Dr. Cebul by telephone to obtain information regarding the clinical and surgical competency and performance of Dr. Christenson. I then relayed this information to the Ad Hoc Hearing Committee." Affidavit of Robert Hallet, M.D. at paragraph 6.

At the next level of review, the Medical Executive Committee ("MEC"), pursuant to a request from Hallett, voted to defer Christenson's application. At the time the MEC voted to defer, it had no information before it different from that before the first three committees except the unspecified information from Hallet.

The hospital notified Dr. Christenson by telephone and letter that action on her application was being deferred. Dr. Daniel Weltner, then president of the medical staff, explained that the MEC wanted clarification of Christenson's staff status at Riverside Methodist Hospital, wanted to know whether her relationship with Principal Health Care (a.k.a. Provider Physicians, Inc.) would be maintained, and wanted information more current than contained in her application materials. In a telephone conversation, Weltner told Christenson that she should obtain five references of individuals who were knowledgeable about her skill and competence as evidenced by her work within the preceding three years. Weltner sent Christenson a new application. Both the first application and the new application requested "medical references from five practitioners who can attest to your competence and character or have been responsible for professional observation of your work within the past three years." (Emphasis sic.)

Christenson submitted the new application containing many of the same references and some additional references. On May 26, 1992, the MEC met again and voted to deny Christenson's application for privileges. The minutes of the MEC meeting do not reflect any discussion or concern regarding her references, but, rather, Hallet reiterated that he had concerns regarding clinical performance:

"As of a conversation today, Doctor Robert Hallet, Chairman of the Department of OB/GYN at Mount Carmel East has reaffirmed his desire to deny Dr. Christenson's application based on concerns regarding her clinical performance. Other unanswered considerations which remain are Doctor Christenson's denial of privileges at Riverside which are currently being appealed, her lack of an office after July 1st, and lack of evidence of malpractice insurance after July 1st.

"A motion was made to deny the request of Doranna Christenson, M.D. for Provisional Staff Privileges based on Section 3.2-2(a) of the Medical Staff Bylaws, Clinical Performance. The motion was seconded and passed." (Emphasis added.)

Christenson received notice of the MEC's decision by letter dated June 1, 1992. The letter notified her of her right to appeal to the Ad Hoc Hearing Committee of the Medical Staff and stated that she would be notified of the grounds for the decision. By letter dated June 25, 1992, the hospital informed Christenson of her hearing date and that her staff appointment had been denied "based on section 3.2-2 and 3.2-3(a) of the Medical Staff Bylaws, specifically section 3.2-2(a), which includes insufficient references, questions regarding your clinical ability and present professional status." ²

At no time prior to the hearing before the Ad Hoc Committee was Christenson informed of what questions or concerns the hospital had regarding her clinical ability. The parties stipulated that, from the time the MEC voted to recommend denial of Christenson's application, she was never informed of any specific act, omission, case, or record which demonstrated in any way any lack of clinical or surgical competency on her part.

...