Klinge v. Lutheran Charities Association of St. Louis

• Decision Date: 07 October 1975
• Docket Number: No. 74-1994,74-1994
• Citation: 523 F.2d 56
• Parties: Fred W. KLINGE, M. D., Appellant, v. LUTHERAN CHARITIES ASSOCIATION OF ST. LOUIS, a corporation, d/b/a Lutheran Medical Center, et al., Appellees.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 56

523 F.2d 56

Fred W. KLINGE, M. D., Appellant, v. LUTHERAN CHARITIES ASSOCIATION OF ST. LOUIS, a corporation d/b/a Lutheran Medical Center, et al., Appellees.

No. 74-1994.

United States Court of Appeals Eighth Circuit.

Submitted May 14, 1975.

Decided Aug. 4, 1975.

Rehearing and Rehearing En Banc Denied Oct. 7, 1975.

James J. Raymond, Clayton, Mo., for appellant.

Norris H. Allen, St. Louis, Mo., for appellees.

Before LAY, WEBSTER and HENLEY, Circuit Judges.

HENLEY, Circuit Judge.

This is an appeal from a summary judgment entered in favor of the defendants in subject case by the United States District Court for the Eastern District of Missouri. ¹ The suit arose from the fact that after the conclusion of rather protracted administrative proceedings that were conducted both before and after the commencement of the action, the plaintiff, Dr. Fred W. Klinge of St. Louis, Missouri, was removed from his position on the surgical staff of Lutheran Medical Center in the city just mentioned.

The Lutheran Medical Center, hereinafter at times called "Lutheran," is a not-for-profit hospital privately owned by the Lutheran Charities Association of St. Louis, a Missouri corporation.

Prior to 1972 plaintiff had been a member of the staff at Lutheran for a number of years. In 1972 he began having professional problems in connection with his surgical practice, and the hospital administration named a Special Medical Records Review Committee to review and appraise the work of the plaintiff. That Committee conducted studies of cases that plaintiff had handled and recommended that he be allowed to continue to practice only under certain restrictions. The plaintiff did so practice throughout 1973, but he was finally advised that as of mid-January, 1974 his staff privileges would be revoked and that he would not be permitted to engage in any surgery whatever at Lutheran.

Plaintiff commenced this action on January 16, 1974, naming the Hospital and three individual doctors occupying important positions in the Hospital administration as defendants. The complaint is in two counts. In the first count plaintiff alleges in substance that as a result of a conspiracy on the part of the individual defendants and other Hospital personnel he was deprived of his staff position in violation of both procedural and substantive due process of law guaranteed by the fourteenth amendment to the Constitution of the United States. It is alleged in that connection that the Hospital has received financial assistance under the Hill-Burton Act, 42 U.S.C. § 291 et seq., and that the actions taken against plaintiff were done under color of state law. In the second count it is alleged that plaintiff's loss of staff position resulted from a violation of the Hospital's own written rules, regulations and by-laws. With respect to that count plaintiff invoked the pendent jurisdiction of the court since there is no diversity of citizenship between him and the defendants. The complaint prays for appropriate injunctive relief and for an award of compensatory and punitive damages.

Plaintiff sought both a preliminary and final injunction, and a hearing was held on the application for temporary relief soon after the complaint was filed. The district court did not issue a temporary injunction but did order that plaintiff not be terminated at the Hospital until he had been afforded a hearing.

A full hearing was held. The hearing commenced on January 28, 1974 and was concluded on February 11. There were six sessions conducted by the hearing panel consisting of doctors who were members of the staff at Lutheran.

In advance of the hearing plaintiff was served with fifteen specific written charges of professional deficiencies or misconduct. He requested that he be supplied with copies of some 95 hospital documents and they were supplied. The hearings were presided over by an experienced attorney who acted largely as a parliamentarian; the proceedings were reported in shorthand, and the transcript of the hearings consists of some 500 pages. A substantial body of documentary evidence was also introduced.

The hearing panel sustained ten of the charges against the plaintiff, two of them being that plaintiff had failed to exercise the degree of care and skill that a reasonably careful and skilled surgeon would have exercised in the circumstances, and that he failed to possess the degree of care and skill ordinarily possessed by reasonably skilled surgeons. The district court found that "the evidence was overwhelming that plaintiff simply should not practice as a surgeon."

The findings of the panel were turned over to the President of the Hospital's medical staff, and a copy of them was supplied to plaintiff. In due course plaintiff was advised that the Board of Directors had adopted a resolution expelling plaintiff from the staff, but that the Board would hold a hearing in the matter on April 17; plaintiff was invited to appear at that hearing, but he did not do so. In the course of that hearing the medical records librarian testified that she was instructed on January 23 and 24 to make hospital records available to plaintiff for his review and for that of his attorney and a physician, and that she made available such records as were requested.

The Board adhered to its view that plaintiff should be dismissed from the staff, and the administrative proceedings having been completed, the defendants moved for summary judgment in the district court.

The district court found that plaintiff had been accorded procedural due process of law. Substantively, the district court found that the final administrative action taken against plaintiff was supported by substantial evidence and was proper. In coming to that conclusion the district court noted that it was not free to substitute its own judgment for that of the experts who had sat in judgment on plaintiff's qualifications to continue to practice surgery.

On the basis of its findings and conclusions the district court granted the motions of the defendants and entered a summary judgment dismissing the complaint and assessing costs against plaintiff including the expenses of the hearings that have been described. This appeal followed.

It is not disputed that Lutheran has participated substantially in the federal Hill-Burton program, which is administered through state agencies, and that Lutheran has substantial contract relations with the State of Missouri and the City of St. Louis. No claim is made that the action of the Hospital's Board of Directors in removing plaintiff from the staff was not state action which would give the court jurisdiction under 28 U.S.C. § 1343(3) read in connection with 42 U.S.C. § 1983. ²

The defendants concede that plaintiff had a federally protected right not to be removed from Lutheran's staff without due process of law.

More specifically, the defendants do not deny that plaintiff had a constitutional right not to be expelled from the staff without valid cause related to his professional capabilities and conduct, and that he had a right not to be removed without the procedural due process appropriate to an intra-institutional inquiry as to whether a hospital staff member should be removed on account of incompetence or negligence. Duffield v. Charleston Area Medical Center, Inc., 503 F.2d 512 (4th Cir. 1974), Affirming 361 F.Supp. 398 (S.D.W.Va.1973); Christhilf v. Annapolis Emergency Hospital Ass'n, Inc., 496 F.2d 174 (4th Cir. 1974); Woodbury v. McKinnon, 447 F.2d 839 (5th Cir. 1971); Citta v. Delaware Valley Hospital, 313 F.Supp. 301 (E.D.Pa.1970).

As to procedural due process, plaintiff was entitled to reasonable notice of the charges against him and a fair opportunity to be heard with respect to those charges before a panel of fair minded doctors. However, he was not entitled to a full blown judicial trial. Duffield v. Charleston Area Medical Center, Inc; Christhilf v. Annapolis Emergency Hospital; and Woodbury v. McKinnon, all Supra.

While plaintiff was entitled to judicial review of the administrative action that was finally taken against him, he was not entitled to a trial de novo as to his competency to remain on the staff at Lutheran. The judicial inquiry available to him was limited to a consideration of whether his ultimate removal from the staff involved deprivations of procedural or substantive rights guaranteed by the fourteenth amendment. In this connection we call attention to the following pertinent language appearing in Woodbury v. McKinnon, supra, 447 F.2d at 842-43:

Once having become a member of the hospital surgical staff Dr. Woodbury had a right to reappointment until the governing authorities determined after a hearing conforming to the minimum requirements of procedural due process that he did not meet the reasonable standards of the hospital. The decision resulting from the hearing must be untainted by irrelevant considerations and supported by sufficient evidence to free it from arbitrariness, capriciousness or unreasonableness. This is the extent to which Dr. Woodbury is entitled to substantive due process under the United States Constitution. Foster v. Mobile County Hospital Board, 398 F.2d 227 (5th Cir. 1968).

A doctor has no constitutional right to practice medicine in a public hospital. Hayman v. Galveston, 273 U.S. 414, 47 S.Ct. 363, 71 L.Ed. 714 (1927). However, there is no dispute that the operation of this hospital is state action and that it is required to meet the provisions of the Fourteenth Amendment in the admission of physicians to its staff. Foster v. Mobile County Hospital Board, supra; Birnbaum v. Trussell, 371 F.2d 672 (2d Cir. 1966); Meredith v. Allen County War Memorial Hospital Comm., 397 F.2d 33 (6th Cir. 1968); see Annot. 37 A.L.R.3d 645 (1971).

The Constitution, however, does not prevent the hospital from establishing standards for admission geared to the purpose of providing adequate hospital care. This court has recently...