Hongsathavij v. Queen of Angels/Hollywood Presbyterian Medical Center
| Decision Date | 02 March 1998 |
| Docket Number | No. B108122,B108122 |
| Citation | 62 Cal.App.4th 1123,73 Cal.Rptr.2d 695 |
| Court | California Court of Appeals Court of Appeals |
| Parties | , 98 Cal. Daily Op. Serv. 2434, 98 Daily Journal D.A.R. 3315 Siri HONGSATHAVIJ, Plaintiff and Appellant, v. QUEEN OF ANGELS/HOLLYWOOD PRESBYTERIAN MEDICAL CENTER et al., Defendants and Respondents. |
Henry R. Fenton and Douglas B. Schwab, Los Angeles, for Plaintiff and Appellant.
Catherine I. Hanson, San Francisco, and Christiana G. Macfarlane, as Amici Curiae on behalf of Plaintiff and Appellant.
Rushfeldt, Shelley & Drake, Randall L. Shelley, Christine T. Hoeffner and Dawn Cushman, Sherman Oaks, for Defendants and Respondents.
McDonough, Holland & Allen and Ann O'Connell, Sacramento, as Amici Curiae on behalf of Defendants and Respondents.
Appellant, Dr. Siri Hongsathavij, was a member of the medical staff of respondent, Queen of Angels/Hollywood Presbyterian Medical Center (the Medical Center). After Dr. Hongsathavij was removed from the Medical Center's emergency room "call panel" (which did not affect his staff privileges at the Medical Center), he had a court-ordered hearing before a hospital Judicial Review Committee (JRC), composed of peer physicians from the Medical Center staff. The JRC determined that there was insufficient basis to remove Dr. Hongsathavij from the panel and recommended his reinstatement. The Medical Center appealed the matter to its board of directors (acting as an Appeal Board), which determined that the JRC's findings lacked evidentiary support and that Dr. Hongsathavij was properly removed from the panel and should not be reinstated. Dr. Hongsathavij then filed a petition for a writ of mandate, complaining that the Appeal Board acted improperly. The superior court denied the petition, and we affirm.
From October 1990 through approximately January 1991, Dr. Hongsathavij was on the call panel of the Medical Center for OB/GYN physicians who served, among others, pregnant patients coming through the emergency room of the Medical Center. The call panel was a rotating list of doctors available to treat patients in the emergency room. Dr. Hongsathavij earned approximately $17,000 a month from the call panel alone. Los Angeles County (the County) had contracted with the Medical Center to provide obstetrical and newborn care for eligible County patients who could not be placed in a County hospital due to a lack of available space. The County also had contracted with Dr. Hongsathavij to provide prenatal, obstetrical and newborn services to patients whose care was then paid for by the County. Many but not all of the patients who entered the Medical Center's emergency room were County patients.
The Medical Center had only one call panel. There was no separate list of physicians on call to cover the emergency room for non-County patients, as distinguished from County patients. The call panel functioned so that physicians were always compensated. In 90 percent of the cases, payment came either from insurance, from the County (for County patients), or from retroactively authorized Medi-Cal payments. In the remaining 10 percent of cases, the Medical Center itself compensated the doctor at Medi-Cal rates. Physicians at the Medical Center, other than Dr. Hongsathavij, generally understood or agreed that their emergency room services entailed treatment of all walk-in patients, including both County and non-County patients. Many were expressly informed that they had to see non-County patients to participate on the call panel. Some physicians considered treatment of all patients to be a moral obligation and thought it ethically improper to determine payment status before delivering a baby. Others were initially reluctant to treat non-County emergency room walk-ins, but were told it was a requirement if they wanted to be on the call panel.
However, Dr. Hongsathavij viewed the call panel as a panel only for County patients and did not want to treat non-County patients in the emergency room. He was the only doctor on the call panel who refused to treat non-County patients. He asserted that he understood the call panel was only to service County patients (for which a physician needed no malpractice insurance, as he would be indemnified by the County), and that he thus was not obligated to provide treatment for walk-in deliveries (for which he would need his own malpractice insurance).
On January 23, 1991, a patient in premature labor arrived in the emergency room of the Medical Center. The patient was 29 years old, had no prenatal care, had active vaginal bleeding, and admitted a history of drug abuse during her first trimester of pregnancy. The emergency room doctor contacted Dr. Hongsathavij, who admitted the patient to the hospital and had her transferred from the emergency room to the labor and delivery floor. She was admitted to the labor and delivery floor, but Dr. Hongsathavij refused to treat the patient because he discovered she was not a County-referred patient.
After Dr. Hongsathavij refused to treat the patient, Medical Center Administrator Ronald Dahlgren requested Dr. Boyd Cooper to take the patient under his care. Dr. Cooper was at home and not then on call, but agreed to come to the Medical Center and treat the patient. Before Dr. Cooper accepted the patient, he contacted Dr. Hongsathavij and admonished him about his obligation to treat the patient. Dr. Hongsathavij told Dr. Cooper that he did not want to treat the patient because he did not have medical malpractice insurance. Dr. Cooper stated that he had to have insurance because he was on the hospital staff, and Dr. Hongsathavij replied, "Well, I'm still not going to take the patient." The Medical Center administrator also that day admonished Dr. Hongsathavij that he had to accept non-County patients. However, he still refused to care for that pregnant patient, and Dr. Cooper delivered her infant later the same day.
Dr. Hongsathavij was subsequently removed from the Medical Center's emergency call panel by the Medical Center's administrator. Dr. Hongsathavij filed a mandamus action in superior court seeking reinstatement. In June of 1993, the superior court granted the petition for a writ of mandate, ordered the Medical Center to reinstate Dr. Hongsathavij on what it termed "the County's admission and referral list," provided he otherwise qualified, and directed the Medical Center to conduct a hearing in accordance with the Medical Center's medical staff by-laws. 1
The Medical Center asked its medical staff's Medical Executive Committee (MEC) to conduct the court-mandated hearing, pursuant to the medical staff's bylaws. The MEC impaneled a JRC by appointing five physicians from its ranks, but it refused to issue notice of charges and thus declined to prosecute the case against Dr. Hongsathavij. To comply with the court-ordered hearing, the Medical Center's administrative risk management staff, on behalf of the Medical Center's governing body (i.e., its board of directors), assumed the task of issuing a notice of charges and representing the Medical Center at the hearing. 2
The six charges against Dr. Hongsathavij were as follows: (1) abandonment of a patient; (2) failure to evaluate and stabilize the patient, subjecting himself and the hospital to "COBRA" violations; 3 (3) failure to honor the terms of the agreement between the staff OB/GYN physicians and the hospital regarding emergency room coverage; (4) failure to inform the hospital that he did not want to service the emergency room patients; (5) failure to provide documentary proof of medical malpractice insurance to cover emergency room, non-County contract patient care; and (6) failure to comply with medical staff rules and regulations.
On the issue of Dr. Hongsathavij's acceptance and then abandonment of the patient, Dr. Hongsathavij acknowledged at the hearing that after talking with the emergency room physician, he accepted as a patient the pregnant woman in question and then had her transferred to labor and delivery. An emergency room doctor cannot admit patients to the hospital; only attending physicians admit patients. But for rare exceptions, the Medical Center does not transfer a patient from the emergency room to the labor and delivery floor (i.e., does not admit a patient) unless and until a physician with staff privileges accepts the patient into his care. According to Dr. Jacob Fookary, an emergency medicine specialist at the Medical Center, the standard of care and the standard of practice in the Medical Center was that once a patient is accepted by a physician, the patient becomes that physician's patient and is under that physician's care and responsibility.
According to Dr. Cooper, once Dr. Hongsathavij accepted the pregnant woman in question as a patient, Dr. Hongsathavij became responsible for her care. Even when a physician has made a mistake about the patient's identity, the physician's duty to treat the patient remains until another doctor has assumed responsibility for the patient. Dr. Cooper, as well as Dr. Hongsathavij's two expert witnesses--Dr. Louis Acosta (an emergency room physician) and Dr. William Hummer, agreed that the refusal to care for a patient whom a physician arranges to admit constitutes abandonment. Dr. Hummer concluded that the patient in question had not been abandoned. This conclusion was based on the assumption that Dr. Hongsathavij had not accepted the patient because he had not yet offered her any treatment and on the theory that Dr. Hongsathavij had no obligation to a patient he did not want to accept. Dr. Hummer, however, was unaware that Dr. Hongsathavij had previously acknowledged that he had in fact accepted the woman in question as a patient for treatment.
Dr. Acosta also acknowledged that, as indicated by the...
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