Illinois Psychological Ass'n v. Falk
| Decision Date | 26 June 1986 |
| Docket Number | No. 86 C 2514.,86 C 2514. |
| Citation | 638 F. Supp. 876 |
| Parties | ILLINOIS PSYCHOLOGICAL ASSOCIATION, Dr. Jean J. Rossi, and Dr. John R. Day, Plaintiffs, v. Marshall FALK, Alex Spadoni, Bernard Turnock, Robert Schinderle, Dave McConkey, Jim Malloy, Ann Kiley, Martha Fritz, Dale Smith, Daniel Michalec, Lester Dugas, Ed Siebert, Christopher Cohen, Edward Duffy, the Illinois Department of Public Health, and the Hospital Licensing Board, Defendants. |
| Court | U.S. District Court — Northern District of Illinois |
Michael R. Levinson, Mark A. Orloff, Levinson & Orloff, Chicago, Ill., for plaintiffs.
Colleen McLaughlin, Atty. Gen. of Illinois, Chicago, Ill., for defendants.
Plaintiffs allege that the Illinois Department of Public Health (IDPH) has erroneously interpreted a state regulation to exclude psychologists from membership on hospital medical staffs, and unlawfully amended that regulation to conform it to this interpretation. Plaintiffs, the professional association of Illinois psychologists and two individual psychologists who are members of hospital medical staffs in Illinois, contend that this conduct infringes their rights under the Due Process and Equal Protection clauses of the Fourteenth Amendment, and violates the Illinois Administrative Procedure Act, Ill.Rev.Stat. ch. 127, ¶ 1001 et seq.
The case comes before the court on plaintiffs' motion for a preliminary injunction. Plaintiffs seek to bar defendants from enforcing the regulation as interpreted, and from filing with the Illinois Secretary of State a "clarifying amendment" to that regulation allegedly adopted in violation of the Illinois Administrative Procedure Act. The court has considered the pleadings and memoranda, documentary evidence, and several days of testimony and argument.
Membership on a hospital's medical staff is significant because only persons on the medical staff may admit patients, order medical treatment, and vote on hospital policies. 77 Ill.Admin.Code §§ 250.310; 250.320; 250.330. Since 1976, § 250.150 of the Hospital Licensing Requirements, promulgated by the IDPH with the approval of the Hospital Licensing Board (HLB), has defined medical staff as:
An organized body composed of individuals granted the privilege by the governing authority of the hospital to practice in the hospital. Any of the following who are granted practice privileges by a hospital shall be placed on the hospital's Medical Staff: persons who are graduates of a college or school approved or recognized by the Illinois Department of Registration and Education, and who are currently licensed by the Department as a Doctor of Medicine, M.D.; Doctor of Osteopath, D.O.; Doctor of Dental Surgery, D.D.S.; or Doctor of Podiatric Medicine, D.P.M.
On July 29, 1985, IDPH director Dr. Bernard Turnock informed HLB members by letter that, "after careful review of the Requirements, minutes of the Hospital Licensing Board meetings, and memoranda prepared by the Department's legal staff addressing the issue," he had concluded that § 250.150 limits medical staff membership to physicians (including medical doctors and osteopaths), dentists, and podiatrists. Dr. Turnock's letter to the HLB, attached to the court's opinion as Appendix A, also proposed amending § 250.150 to clarify its language consistent with this conclusion. Two days later, the HLB voted to concur with Dr. Turnock's interpretation.
The IDPH subsequently adopted the proposed clarifying amendment. It did so in the course of a rulemaking proceeding already underway when Dr. Turnock issued his interpretation of § 250.150. Nothing in the notice of rulemaking that initiated this proceeding on June 25, 1985 indicated that the IDPH planned to alter the categories of practitioners permitted to serve on hospital medical staffs, or to adopt Dr. Turnock's forthcoming proposal to amend § 250.150. Of the two responses received to the notice of rulemaking, neither addressed the issue of whether medical staff membership is or should be limited to physicians, dentists, and podiatrists.
The IDPH has not enforced Dr. Turnock's interpretation of § 250.150 in the year following its announcement. Instead, the IDPH plans to implement the clarifying amendment beginning June 27, 1986. If for any reason it is precluded from enforcing that amendment, however, the IDPH will on the same date begin enforcing Dr. Turnock's interpretation of the existing language of § 250.150. As of June 27, therefore, hospitals will be required to remove psychologists from medical staffs or risk revocation of their licenses.
Plaintiffs filed this three-count action for damages and preliminary and permanent injunctive relief on April 11, 1986. Count I alleges that enforcement of Dr. Turnock's interpretation of § 250.150 would abridge plaintiffs' liberty and property interests under the Due Process and Equal Protection clauses. Count II alleges a violation of plaintiffs' procedural due process rights arising from the interpretation and amendment of § 250.150 without notice and hearing. Finally, Count III, a pendent claim, alleges that adoption of the clarifying amendment violated the Illinois Administrative Procedure Act.
The parties' evidence and arguments dealt primarily with whether the existing language of § 250.150 is ambiguous in light of its origin, context, and application, and whether Dr. Turnock's interpretation of that language is correct. That focus is understandable in light of the fact that psychologists' eligibility for medical staff membership can only be assured at this juncture by an injunction against enforcement of Dr. Turnock's interpretation of the existing language. An injunction that merely prohibited the IDPH from promulgating the clarifying amendment, while leaving it free to interpret the existing language to exclude psychologists from medical staffs, would be of little benefit to plaintiffs. The following findings of fact summarize the evidence relevant to plaintiffs' constitutional claims:
1. The plain language of § 250.150 is not conclusive as to whether psychologists may serve on hospital medical staffs. The statement that "any of the following who are granted practice privileges shall be placed on the hospital's medical staff ..." appears to leave open the possibility that, so long as a practitioner is not a physician, dentist, or podiatrist who has been granted practice privileges, the hospital has discretion to include that practitioner on its medical staff. The language does not expressly grant this discretion, however, and it is possible to interpret the list of practitioners as an exclusive one.
2. The origins of the present language in § 250.150 contain conflicting evidence as to the exclusivity of the list of practitioners in that section. Prior to 1976, the Hospital Licensing Requirements defined medical staff as "composed only of physicians and dentists...." Elimination of the word "only" in the amended language suggests the drafters may have intended to eliminate the exclusivity of medical staff membership.
Minutes of HLB meetings leading up to the adoption of that amendment, however, indicate that the HLB's primary concern in amending the Requirements was to end the routine exclusion of podiatrists and osteopaths from medical staffs. The minutes offer little or no support for the proposition that the HLB intended to open medical staff membership to every practitioner authorized to practice within a hospital.
3. The regulatory and statutory context of § 250.150 offers evidence supporting each party's interpretation of the definition of medical staff. A comprehensive review of the statutes and regulations cited by the parties is unnecessary here, but several examples are in order. The Illinois Mental Health and Developmental Disabilities Code permits psychologists to serve as facilities directors of mental health facilities, Ill.Rev.Stat. ch. 91 ½, § 1-104, and authorizes facilities directors to admit patients, id. at § 3-300, and supervise treatment, id. at § 1-104. Both of these functions are ones that the Hospital Licensing Requirements permit only medical staff members to perform, which suggests that the Legislature might not intend to exclude psychologists from hospital medical staffs.
On the other hand, § 250.320 of the Hospital Licensing Requirements provides that patients admitted by dentists and podiatrists "shall be under the care of both the admitting medical staff member and a physician who is also a medical staff member." No such requirement exists for psychologists. Because psychologists lack the medical training of either dentists or podiatrists, it seems reasonable to infer that the drafters of § 250.320 would have imposed a similar co-admission requirement on psychologists if they intended psychologists to have any admitting privileges whatsoever.
In a similar vein, § 250.310(b) provides that "regardless of any other categories (divisions of the medical staff) having privileges in the hospital, there shall be an active staff which must include physicians and may also include dentists and podiatrists, properly organized, which shall perform all the organizational duties pertaining to the medical staff." This section does not give hospitals the discretion to include practitioners other than physicians, dentists, and podiatrists on the active staff, despite the relatively non-technical nature of the active staff's quality control and policy-making duties. This arguably supports the view that medical staff membership is limited to physicians, dentists, and podiatrists.
4. Since 1976, the IDPH has sporadically enforced § 250.150 to require hospitals to exclude practitioners other than physicians, dentists, and podiatrists from their medical staffs. On at least four occasions the IDPH informed hospitals that the presence on their medical staffs of practitioners other than physicians, dentists, and podiatrists violated § 250.150. One of...
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...Roth. Immediately after entering into the AJO, both sides hotly disputed its proper interpretation. See generally, Illinois Psychological Ass'n v. Falk, 638 F.Supp. 876, 882, aff'd 818 F.2d 1337 (7th Cir.1987). And when, in November 1980, the Village decided to stop issuing building permits......
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