Head v. Lutheran General Hosp.

• Decision Date: 25 November 1987
• Docket Number: No. 86-2792,86-2792
• Citation: 516 N.E.2d 921,163 Ill.App.3d 682
• Parties: , 114 Ill.Dec. 766 Louis R. HEAD, M.D., Plaintiff-Appellant, v. LUTHERAN GENERAL HOSPITAL, a corporation, Defendant-Appellee.
• Court: United States Appellate Court of Illinois

Page 921

516 N.E.2d 921

163 Ill.App.3d 682, 114 Ill.Dec. 766

Louis R. HEAD, M.D., Plaintiff-Appellant, v. LUTHERAN GENERAL HOSPITAL, a corporation, Defendant-Appellee.

No. 86-2792.

Appellate Court of Illinois First District, Third Division.

Nov. 25, 1987.

Donald T. Morrison & Associates, P.C., Waukegan (Donald T. Morrison, of counsel), for plaintiff-appellant.

Cassiday, Schade & Gloor, Chicago (Rudolf G. Schade, Jr., Michael J. Gallagher and Judith A. Schieber, of counsel), for defendant-appellee.

Justice WHITE delivered the opinion of the court.

Plaintiff Dr. Louis Head sued defendant Lutheran General Hospital for wrongful termination of his staff privileges. In count I of his third amended complaint plaintiff alleged that defendant failed to follow its bylaws in the termination proceedings; in count II he alleged that the proceedings were fundamentally unfair; and in count III he alleged that the decision to terminate his privileges was arbitrary and capricious. The trial court directed a verdict for defendant on count I, dismissed count II, and entered judgment on the jury's verdict in favor of defendant on count III. Plaintiff appeals.

Plaintiff, a chest surgeon, joined defendant's courtesy staff in 1959. As a member of the courtesy staff he was permitted to admit patients to the hospital, but unlike members of the attending staff he was not required to attend staff meetings and he could not vote on hospital affairs. He also joined the courtesy staffs of several other hospitals in the area in order to have enough work to sustain his practice as a chest surgeon. In 1969 plaintiff became a member of defendant's provisional staff due to a change in defendant's bylaws, retaining the privileges he had as a member of the courtesy staff. Under defendant's bylaws the Credentials Committee made recommendations concerning reappointment for all of defendant's staff members each year. In October 1975, the Credentials Committee recommended reappointment of plaintiff, but it also voted to monitor his records on an ongoing basis.

In February 1976, plaintiff asked a nurse to contact Dr. Charles Staley, who chaired the division of surgery, for consultation regarding a patient in intensive care. Staley told the nurse he was not able to consult on the case. Plaintiff made a note in the patient's chart stating that Staley refused to see the patient. On February 20 1976, Staley wrote a letter to plaintiff objecting to the note in the patient's record, and asking plaintiff not to request any further consultations from him. Also on February 20, 1976, plaintiff received a letter from Dr. Morris Binder, who chaired the Credentials Committee, notifying plaintiff that the committee reviewed some "deficiencies" in plaintiff's records and decided to monitor his records on an ongoing basis. Plaintiff wrote an apology to Staley.

On April 6, 1976, plaintiff admitted D.S. into the hospital for surgery which was scheduled for April 8th. On April 9, Staley sent a memo to Binder in which he said that plaintiff had not seen D.S. for two weeks prior to his admission, and did not see him for two days after admission. The hospital scheduled the surgery for 3:30 p.m. on April 8, but Staley canceled the surgery when plaintiff failed to appear at the scheduled time. Plaintiff discharged D.S. from the hospital on April 9 without performing the surgery. Plaintiff sent a letter to the Utilization Review Committee explaining that he wanted to discourage D.S. from undergoing the cosmetic surgery he requested, since plaintiff did not believe that the potential advantages were worth the risk. When he was initially unable to dissuade D.S., he agreed to admit him to the hospital. Plaintiff wanted D.S. to spend an extra day in the hospital before surgery because he suspected that D.S. was under the influence of various drugs. On April 9 he effectively persuaded D.S. not to undergo the surgery.

On May 25, 1976, Staley sent plaintiff a letter in which he criticized plaintiff for beginning a surgery one half hour late on May 19, 1976. Staley sent Binder a copy of the letter.

Plaintiff met with Binder on May 27, 1976. Binder criticized plaintiff for failing to see his patients and write progress notes with adequate frequency. Plaintiff drafted a memo summarizing the meeting and he sent a copy to Binder. Plaintiff wrote that

the Credentials Committee evaluates each doctor on the staff in reference to his attendance at hospital meetings, * * * the number of times he sees [his] patient[s], and the number of times that he writes hospital record progress notes. * * * I told Dr. Binder that complying with these artificial guidelines for the measurement of quality of medical care [was] not consistent with my principles of practice and that the problem would certainly continue and would probably only be resolved by a decision of the Medical Staff or Board of Directors.

* * *

* * *

In my individual case I do think that there are possible solutions to the problem. One is to resign from the staff and the second is to be expelled from the staff. * * *

There is a third alternative which * * * is to change my status from that of courtesy staff to one of consulting staff. * * * It would require * * * referring [patients] to other physicians chosen by me as their primary admitting doctor[s].

On October 5, 1976, the Credentials Committee voted unanimously to recommend that the Board of Trustees not reappoint plaintiff. According to the bylaws, "In the event of an adverse Credentials Committee recommendation, the affected Member shall have the privilege of the floor at the meeting with the Attending Medical Staff which considers that recommendation." Plaintiff requested from Binder a written statement of the charges against him to help him prepare his statement to the staff. Plaintiff testified at trial that Binder told him he was to "give a general statement * * * about anything relative to the matter that [he] thought would be appropriate * * *," but Binder did not tell him the charges. Binder testified that he told plaintiff that the charges were the same as the matters they discussed at their meeting on May 27th, and he told plaintiff he had the privilege of responding to those charges at the Medical Staff meeting. He admitted that he did not supply a written list of charges.

At the staff meeting on November 16, 1976, plaintiff discussed in general terms his desire to remain on the staff. After the staff dismissed him from the meeting it voted to recommend that plaintiff not be reappointed. The bylaws provide:

Upon his receipt of notice of an adverse recommendation [by the Medical Staff] or upon his receipt of notice of an adverse decision [by the Board of Trustees], the affected Member shall have fifteen (15) days within which to deliver to the President a written request for a hearing before the Judicial Review Committee. * * * Under no circumstances shall a Member be entitled to more than one (1) hearing before the Judicial Review Committee each time reappointment is sought.

Plaintiff requested a hearing before the Judicial Review Committee (JRC) and a written statement of the charges. The written statement specified five charges against plaintiff which the JRC investigated in a five-hour hearing with plaintiff held on January 4, 1977. The JRC summarized its findings in a two page report, in which it stated that the most important charge was that plaintiff did not meet "accepted standards of medical care * * * with regard to frequency of patient visits." The JRC answered in its report:

The committee carefully considered each of the records cited in this charge. The committee was unable to find any written or unwritten requirement with regard to frequency of patient visits and, therefore, attempted to apply a standard of reasonableness as dictated by the quality of medical care expected from a member of the Medical Staff of Lutheran General Hospital. There were a total of 33 charts which were reviewed by several members of the Medical Staff. Of these 33 charts, 16 were found to be OK and 3 were missing discharge summaries when reviewed and since these were present on the charts, these records were not further considered. Almost all of the remaining charts were reviewed. In each case, Dr. Head reviewed the medical problem with the committee and pointed out that each case represented a long-term chronic illness and the need for therapy of a chronic type but necessary to be done in an acute care institution. In each case, Dr. Head asserted that his only failure was that of writing a progress note. In each case he maintained that there was at least daily telephone communication with the patient usually or a staff nurse occasionally to insure that there was no status change which would require a personal visit. The Medical Staff representative did not assert that any patient had been harmed by this procedure nor tha[t] any specific patient[']s hospital stay had been unnecessarily prolonged by this procedure. The committee did not express either approval nor disapproval of this approach to patient care, but attempted to apply both individually and collectively the above described standard. * * * [C]onsiderations of this charge probably formed the basis for each man's vote at the conclusion of the proceeding.

The JRC recommended that defendant reappoint plaintiff to the staff, thereby reversing the staff's recommendation.

According to the bylaws:

In the event of a recommendation, made by * * * the Judicial Review Committee * * * for:

a. The modification of an adverse recommendation, then the body which made the adverse recommendation shall vote again on the matter and forward its second recommendation to the Governing Body [i.e. the Board of Trustees] which shall, upon receipt, take final action thereon;

b. The upholding of an adverse recommendation in all respects, then the Governing Body shall upon receipt of the recommendation take final...