Dooley v. Barberton Citizens Hosp., 83-40

• Decision Date: 27 June 1984
• Docket Number: No. 83-40,83-40
• Citation: 465 N.E.2d 58,11 OBR 532,11 Ohio St.3d 216
• Parties: , 11 O.B.R. 532 DOOLEY, Appellant, v. BARBERTON CITIZENS HOSPITAL, Appellee.
• Court: Ohio Supreme Court

Page 216

11 Ohio St.3d 216

465 N.E.2d 58, 11 O.B.R. 532

DOOLEY, Appellant, v. BARBERTON CITIZENS HOSPITAL, Appellee.

No. 83-40.

Supreme Court of Ohio.

June 27, 1984.

Syllabus by the Court

R.C. 3701.351 prohibits a hospital from adopting standards for staff membership or clinical privileges that are not reasonably related to accepted measures of skill, education and competence.

Appellant, James L. Dooley, D.P.M., is a licensed podiatrist. On June 17, 1980 appellant filed a complaint against Barberton Citizens Hospital ("the hospital"), appellee, seeking a mandatory injunction ordering the hospital to grant him medical staff privileges as a doctor of podiatric medicine, and to allow him to perform those surgical procedures for which he is licensed under Ohio law. The complaint further sought damages, attorney fees and the cost of the action.

The hospital answered appellant's complaint on July 10, 1980. The answer averred that appellant had failed to state a claim upon which relief could be granted and, moreover, that the court had no subject matter jurisdiction.

Subsequently the cause proceeded to the court of common pleas where on March 18, 1982 judgment issued in favor of appellee. Thereafter, on review of appellant's three assignments of error, the court of appeals affirmed the court of common pleas and denied relief to appellant. This cause then came before us pursuant to the allowance of appellant's motion to certify the record. On May 17, 1983 the medical executive council of the hospital approved changes in the criteria for admission and practice of podiatrists with respect to the hospital staff privileges. The changes were approved by active medical staff on May 19, 1983, and by the board of trustees on May 23, 1983. The effect of these changes was to allow staff privileges to state licensed board certified or board eligible podiatrists, to allow minor soft tissue surgical procedures involving anesthesia and to allow the co-admission of a podiatrist's patients.

Appellee argued in a motion to dismiss filed June 3, 1983, that the effect of these changes was to render appellant's claims for injunctive relief moot. In response appellant claimed, inter alia, that his prayer for damages kept the suit alive.

This court overruled appellee's motion and the cause continues before us on the motion to certify the record.

Johnson & Helmuth, Taryn L. Stambaugh and R.J. Helmuth, Akron, for appellant.

Roetzel & Andress, K.R. Aughenbaugh and Jeffrey J. Casto, Akron, for appellee.

Beghson, Borkland, Margolis & Adler, Howard Adler, Edward J. Westbrook, Sinrod & Tash and Werner Strupp, Washington, D.C., urging reversal for amicus curiae, American Podiatry Ass'n.

Vorys, Sater, Seymour & Pease, James P. Friedt and Anne C. Griffin, Columbus, urging reversal for amicus curiae, Ohio Podiatry Ass'n.

Bricker & Eckler and Richard C. Pfeiffer, Jr., Columbus, urging affirmance for amicus curiae, Ohio Hosp. Ass'n.

LOCHER, Justice.

The issue before us is whether Barberton Citizens Hospital, through its by-laws, illegally discriminated against appellant, a licensed Doctor of Podiatric Medicine because of his practice as a podiatrist. For the reasons set forth below we find such discrimination had occurred. Accordingly we reverse the court of appeals and remand as hereinafter set forth.

This cause has witnessed a number of transformations in the hospital's by-laws. Because of the importance of the issues to be resolved it is necessary to examine the factual basis of this case with close attention to the hospital by-laws prior to May 23, 1983.

We cannot, however, resolve the questions, if any, raised by changes in the rules, constitution and by-laws of the hospital subsequent to the court of appeals' decision. Such questions necessarily involve findings of fact and conclusions of law that were not adequately raised in the instant appeal and were not fully and fairly argued before us. We are therefore compelled to leave such findings of fact and conclusions of law to the proper trial court forum should appellant decide to renew his suit with respect to the new rules.

I

At the time this suit commenced Barberton Citizens Hospital subjected podiatrists to the following limitations:

"RULES AND REGULATIONS PCOF THE MEDICAL AND DENTAL STAFF PCOF THE BARBERTON CITIZENS HOSPITAL

" * * *

"IV. Division of Surgery

" * * *

"Rules and Regulations of the Surgical Division:

" * * *

"8. Podiatry:

"1. Podiatrists granted privileges will be assigned to the Department of Orthopedics.

"2. Privileges may be extended to Board Certified or Board Eligible podiatrists who are licensed in the State of Ohio and who have completed at least two (2) years of post-graduate training in an approved residency program.

"3. Podiatrists granted privileges shall provide conservative care of the foot excluding surgical procedures with anesthesia.

"4. A podiatrist granted privileges may initiate with the concurrence of a physician member of the Medical Staff the procedure for admitting or discharging a patient. Admission of a podiatry patient shall be the dual responsibility of the podiatrist and the co-admitting physician of the Medical Staff. The co-admitting physician member of the Medical Staff shall be responsible for the care of any medical problem that may be present at the time of admission or that may arise during hospitalization. All podiatry patients shall receive the same basic medical appraisal as patients admitted for other services.

"CONSTITUTION AND BY-LAWS OF THE MEDICAL AND DENTAL STAFF OF THE BARBERTON CITIZENS HOSPITAL

" * * *

"Article V. Classification of the Medical Staff

" * * *

"Section 6. Limited Courtesy Staff

"A. The Limited Courtesy Staff shall consist of members of the podiatry profession eligible as herein provided for Staff membership who wish to attend private patients in the Hospital.

"B. Limited Courtesy Staff shall not be eligible to vote, to hold office and shall not advance to other staff membership classifications.

"C. Members of the Limited Courtesy Staff will not be required to rotate on the Emergency Department roster if such a roster is put in effect.

"D. Members of the Limited Courtesy Staff shall be invited and urged to attend the regular Staff meetings."

On May 23, 1983 the trustees voted and approved substantial changes in the rules and regulations, the effect of which is not before us today.

It should be noted that Dr. Dooley is a fully licensed Doctor of Podiatric Medicine by the State Medical Board of Ohio. He has practiced podiatry in Barberton, Ohio for more than twelve years. Dr. Dooley is board eligible with the American Board of Podiatric Surgery, has graduated from the four-year program at the Ohio College of Podiatric Medicine, and has had one year of residency training. Moreover, Dr. Dooley has been afforded full surgical privileges at Wayne General Hospital in Orrville, Ohio. Wayne General, however, is twenty to twenty-five miles from his office which creates difficulty in the treatment of patients. No evidence was presented to suggest Dr. Dooley is anything but an extremely competent and skilled podiatrist.

II

In 1978 Ohio enacted R.C. 3701.342 (137 Ohio Laws, Part II, 2639), renumbered R.C. 3701.351, which now states:

"(A) [Within one hundred eighty days of the effective date of this section,] [t]he governing body of every hospital shall set standards and procedures to be applied by the hospital and its medical staff in considering and acting upon applications for staff membership or professional privileges. These standards and procedures shall be available for public inspection.

"(B) The governing body of any hospital, in considering and acting upon applications for staff membership or professional privileges within the scope of the applicants' respective licensures, shall not discriminate against a qualified person solely on the basis of whether such person is certified to practice medicine or osteopathic medicine, or podiatry, or dentistry.

"(C) Any person may apply to the court of common pleas for temporary or permanent injunctions restraining a violation of division (A) or (B) of this section. This action is an additional remedy not dependent on the adequacy of the remedy at law." (Bracketed material in original R.C. 3701.342.) ¹

Prior to 1978, the rulings of the courts of this state left little doubt that hospitals were to be given substantial discretion in the promulgation of rules relating to staff privileges. See, e.g., Davidson v. Youngstown Hosp. Assn. (1969), 19 Ohio App.2d 246, 251, 250 N.E.2d 892 . The extent of discretion was contingent, of course, upon compliance with basic procedural due process constraints. Khan v. Suburban Community Hospital (1976), 45 Ohio St.2d 39, 340 N.E.2d 398 .

In the case before us we must consider legislation subsequent to earlier Ohio rulings governing hospital discretion with respect to staff privileges. Because R.C. 3701.351(B) is designed to remedially prevent discrimination against podiatry, we are compelled to construe the statute in a manner to reach the presumably intended just and reasonable result (R.C. 1.47) and to effectuate the legislative intent. Thus, while R.C. 3701.351 specifically recognizes the continued need for hospitals to exercise discretion in the selection of staff, we can no longer rely on such discretion where class-wide discrimination is extant as delineated in R.C. 3701.351(B). The test we must use is whether the rules and/or regulations of a hospital either overtly or implicitly discriminate against a specified classification (in this case the profession of podiatry). It is also important to note the exact words of R.C. 3701.351 which stipulate that "[t]he governing body of any hospital, in considering and acting upon applications for staff membership or professional privileges within the scope of the applicants' respective licensures, shall not discriminate against a qualified person * * *." (...