Klinge v. Lutheran Medical Center of St. Louis

• Decision Date: 26 November 1974
• Docket Number: No. 35728,35728
• Citation: 518 S.W.2d 157
• Parties: Fred W. KLINGE, M.D., Plaintiff-Appellant, v. The LUTHERAN MEDICAL CENTER OF ST. LOUIS, etc., Defendant-Respondent. . Louis District, Division Three
• Court: Missouri Court of Appeals

Page 157

518 S.W.2d 157

Fred W. KLINGE, M.D., Plaintiff-Appellant, v. The LUTHERAN MEDICAL CENTER OF ST. LOUIS, etc., Defendant-Respondent.

No. 35728.

Missouri Court of Appeals, St. Louis District, Division Three.

Nov. 26, 1974.

Motion for Rehearing or Transfer Denied Jan. 14, 1975.

James J. Raymond, Clayton, for plaintiff-appellant.

Anderson, Gilbert, Wolfort, Allen & Bierman, Robert G. Burridge, Karl E. Holderle, Jr., St. Louis, for defendant-respondent.

SIMEONE, Presiding Judge.

This is an appeal by plaintiff-appellant Fred W. Klinge, M.D., from a judgment entered on September 10, 1973, by the circuit court of the City of St. Louis which dismissed an injunction suit seeking to restrain defendant-respondent Lutheran Medical Center of St. Louis and its agents from examining the hospital records of plaintiff's patients for the purpose of determining the qualifications of plaintiff. For reasons hereinafter stated, we affirm the judgment.

Dr. Klinge is a physician, having graduated from a well-known medical school in 1942. After serving as an intern and a period of residency, he served in the U.S. Army Medical Corps. He spent four years in residency surgery, has written several medical articles, engaged in teaching, and was 'Board certified.' His recognized field of specialization was surgery. He has been a member of the staff of several hospitals and was on the staff of Lutheran Hospital since 1956. Since 1972 he restricted his practice to Lutheran Hospital. Originally, Dr. Klinge was a member of the courtesy staff and was advanced to active staff in 1957 or 1958. In 1970, he was advanced to consulting staff. In 1973, he was president-elect for the medical staff of Lutheran Hospital.

Lutheran Midical Center of St. Louis was incorporated under the official name Lutheran Charities Association of St. Louis in 1863. ¹ It is accredited by the Joint Commission on Accreditation of Hospitals, the national accreditation organization of hospitals which makes accreditation surveys. ² According to the testimony of Hilmer M. Lohmann, Vice President of the Lutheran Medical Center, when a hospital is accredited, a committee of the Joint Commission is sent to the hospital personally to look over the manner in which the hospital is run. The committee checks the records of the patients, the procedures and quality of medical care.

The Accreditation Manual for Hospitals of the Joint Commission (hereafter Manual) was introduced into evidence by the respondent hospital over objection. The Manual contains certain standards. Standard III requires that 'The medical staff must establish a procedure to ensure a fair evaluation of the qualifications and the competence of each applicant for appointment, and for periodic reappointment to the medical staff. Whatever th procedure, it should be objective, impartial and fair, broad enough to recognize professional excellence and strict enough to safeguard patients.' Manual at 42. ³ Standard IV requires the medical staff to participate in the maintenance of high professional standards and in the continuous study and evaluation of the factors that relate to patient care. Standard V requires medical staff meetings to review clinical work.

The hospital is governed by the Missouri Hospital Licensing Law, ⁴ and Regulations and Codes promulgated by the Missouri Division of Health (1960 Revised). Section II, subsection B8 of the Regulations and Codes provides, '. . . Records (hospital records and reports) may be removed from the record room only upon order of the administrator by duly qualified persons for purposes of study or research. Patient records are the property of the institution and shall not be removed from the hospital premises except by court order.' Regulations and Codes at 80. The Rules also require that although the administrator of the hospital has no control over the professional staff, he is 'required to bring to the attention of the president or chief of the professional staff any failure by members of that staff to conform with established hospital policies regarding administrative matters, professional standards and the maintenance of adequate clinical records.' Rules at 78.

Section IV, subsection A8 provides, 'The staff analyzes at regular intervals . . . and patients' records are available as the basis for such analysis and review.' Rules at 89.

The hospital also participates in the Federal Health Insurance for the Aged (Medicare) program. ⁵ Pursuant to the act, the Social Security Administration has promulgated certain federal regulations. CFR, Title 20, ch. III, Part 405, Subpart J sets forth certain conditions for participating hospitals. ⁶ The regulations were admitted into evidence over objection. The federal code requires that the medical records committee (or its equivalent) supervise the maintenance of medical records, and on the basis of documented evidence the committee 'reviews and evaluates the quality of medical care given the patient.' § 405.1023(n). ⁷

The By-laws, Rules and Regulations of the Medical Staff ⁸ of Lutheran Hospital, introduced over objection, establish various standing and special committees of the hospital. Among the committees established by the by-laws is the executive committee. ⁹ The executive committee is responsible for the investigation and disposition of cases of alleged deficiency or misconduct in accordance with Rules and Regulations. Other committees exercising certain functions at the hospital include: (1) the Medical Records Committee (a standing committee which maintains continuous supervision over the medical records and evaluates the quality of medical care given the patient and which considers the adequacy of the patient records regarding histories, examinations, etc.); (2) the Tissue Committee (a standing committee which reviews tissues removed by surgery on a monthly basis); (3) the Utilization Committee (which determines whether hospital facilities have been over or under utilized); and (4) the Surgical Section Committee (which meets monthly and reviews all complications and deaths.)

The Rules and Regulations of the Medical Staff provide in part that when dealing with staff deficiencies and misconduct the Executive Committee and Joint Conference Committee ¹⁰ of the medical staff shall follow a prescribed procedure including a formal hearing before certain committees or the Board of Directors of the hospital. Curtailment of privileges, suspension or dismissal may result.

In February, 1972, the Executive Committee of the hospital staff appointed a special medical records review committee to study and review the surgical records of Dr. Klinge because of the 'mounting concern over Dr. Klinge's performance in the operating room.' Dr. Cesar A. Gomez was appointed chairman of the special committee. That special committee reviewed the surgical records of Dr. Klinge for the five years prior to January 23, 1973, and found certain deficiencies. Dr. Gomez on January 23, 1973, wrote to the then president of the staff, Dr. Melvin A. Allen and informed Dr. Allen that the special committee had reviewed the records and that it found certain deficiencies and that in the opinion of the committee the 'present situation is unacceptable,' and 'corrective action should be instituted.'

On July 6, 1973, the new president of the staff, Dr. Herluf G. Lund, wrote to Dr. Klinge informing him that 'there will be a combined meeting of the Executive Committee, the Joint Conference Committee and Special Medical Records Review Committee' on July 11, 1973. This meeting 'is to review your surgical records. . . .' Dr. Klinge was invited to be present and to have a physician assist him. Dr. Klinge was informed that the committees will review and study the records which the special committee found to have certain deficiencies. The letter concluded that it would be the responsibility of the Executive Committee and Joint Conference Committee to make recommendations to the administration and Board of Directors as to whether Dr. Klinge's privileges 'will be temporarily curtailed or suspended, or that no action is necessary in your case' all in accordance with the By-laws, Rules and Regulations, § 24.

The meeting was never held, for on July 11, Dr. Klinge filed, in the circuit court of the City of St. Louis, his petition for injunction. The petition recited that (1) he was authorized to practice medicine, (2) the by-laws, rules and regulations of the hospital established various committees, (3) during the hospitalization of his patients records of medical care, treatment and surgical procedures were kept, (4) the hospital, its board of directors and employees 'embarked on a course of conduct' for the purpose of suspending or totally withdrawing all or part of his medical privileges, (5) the hospital and its employees have 'examined, copied, duplicated or otherwise obtained information from . . . the records kept and maintained . . . regarding the medical care, treatment and surgical procedures . . . performed by Plaintiff and such other private physicians . . . throughout the past five (5) years, prior to January 23, 1973, all without the consent or waiver of any of said patients, and all in violation of § 491.060(5), V.A.M.S.' He alleged that a meeting was scheduled that date for the purpose of reviewing the information 'so illegally obtained,' from the records. He prayed therefore for a restraining order enjoining the hospital, the Board of Directors, employees who are members of the Executive Committee and Joint Conference Committee from (1) examining, without the consent or waiver of the patients any information from the contents of the records for the purpose of evaluating his competency 'or any other private physician' and (2) using any such information at the schedule hearing or any other time for the purpose of 'determining whether to recommend . . . a curtailment, suspension, withdrawal' of his medical or clinical privileges. The trial...