Koefoot v. American College of Surgeons, 81 C 4333.
| Decision Date | 25 July 1988 |
| Docket Number | No. 81 C 4333.,81 C 4333. |
| Citation | 692 F. Supp. 843 |
| Parties | Robert R. KOEFOOT, M.D., Richard G. Hanisch, M.D., M.D. Mathews, M.D., and Board of Trustees of Howard County Community Hospital, Plaintiffs, v. AMERICAN COLLEGE OF SURGEONS, Dr. C. Rollins Hanlon, and Dr. Frank Padberg, Defendants. |
| Court | U.S. District Court — Northern District of Illinois |
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William J. Sneckenberg, Jonathan D. Moses, William J. Sneckenberg & Associates, Ltd., Chicago, Ill., for plaintiffs.
John J. Cassidy, Jr., Douglas J. Polk, Susan G. Feingold, Vedder, Price, Kaufman & Kammholz, Chicago, Ill., for defendants.
This opinion follows a trial to the Court of the plaintiffs' claims against the defendants pursuant to the Illinois common law governing membership rights in voluntary associations. In a Memorandum Opinion and Order dated December 30, 1986, the Court bifurcated the plaintiffs' claims against the defendants into two segments: segment one was a trial of the plaintiffs' antitrust claims to a Jury and segment two was a bench trial to the Court of the plaintiffs' state law membership rights claims. By stipulation filed on December 31, 1986, the parties agreed that there were no disputed issues of fact for jury consideration common to both segments one and two of the trial. On March 5, 1987, the Jury returned a not guilty verdict in the antitrust segment of the trial.
This opinion contains the Court's findings of fact and conclusions of law with respect to segment two of the trial — the trial to the Court of the plaintiffs' membership rights claims. Other published opinions of the Court, all concerning pretrial matters, are found at 610 F.Supp. 1298 (N.D.Ill.1985) and at 652 F.Supp. 882 (N.D. Ill.1986).
1. Plaintiff Robert R. Koefoot, M.D., is a general surgeon residing in Grand Island, Nebraska. Grand Island is a city of 35,000 people located in central Nebraska. Dr. Koefoot has been licensed by the State of Nebraska continuously since 1947 and by the State of Minnesota since 1948. He practices surgery at three hospitals in Grand Island: Lutheran Memorial Hospital, St. Francis Hospital and the Veteran's Administration Hospital. Dr. Koefoot also practices surgery at Howard County Community Hospital in St. Paul, Nebraska.
2. Plaintiff Richard G. Hanisch, M.D., is a general medical practitioner engaged in a solo practice in St. Paul, Nebraska. He is licensed by the State of Nebraska and permitted by law to provide all types of medical care, including surgery. St. Paul is a community of 2,000 people located twenty miles north of Grand Island. Dr. Hanisch routinely refers his patients requiring general surgery to Dr. Koefoot unless the patients express a contrary preference.
3. Plaintiff M. D. Mathews, M.D., is also a general medical practitioner engaged in a solo practice in St. Paul, Nebraska. He is licensed by the State of Nebraska and permitted by law to provide all types of medical care, including surgery. Like Dr. Hanisch, Dr. Mathews routinely refers his patients requiring general surgery to Dr. Koefoot unless the patients express a contrary preference.
4. Drs. Hanisch and Mathews are the only physicians residing in St. Paul. Dr. Koefoot has worked with Drs. Hanisch and Mathews for many years and has confidence in their ability to assist at surgery and to care for surgical patients postoperatively.
5. Plaintiff Board of Trustees of Howard County Community Hospital is the governing body of Howard County Community Hospital, a not-for-profit corporation organized under Nebraska law. The hospital is a 36 bed acute care hospital located in St. Paul, Nebraska. The hospital is licensed by the State of Nebraska and approved for participation in the Medicare program. Drs. Hanisch, Mathews, and Koefoot are members of the medical staff of the hospital. Since 1970, twenty-one different surgeons have performed surgery at the hospital. The hospital has no requirement that surgeons on its medical staff be Fellows of the American College of Surgeons.
6. Dr. Koefoot has operated at Howard County Community Hospital continuously and on a regular basis since it opened in the mid-1950's. At the conclusion of the operations he performs at Howard County Community Hospital, Dr. Koefoot examines the patient in the recovery room and leaves instructions for the patient's postoperative care. Dr. Koefoot does not see these surgical patients postoperatively unless he is in the community to see other patients, or Drs. Hanisch or Mathews believes it is necessary, but he always remains available for consultation with Drs. Hanisch and Mathews by telephone. Dr. Koefoot expects Drs. Hanisch and Mathews to notify him of any complications that may develop.
7. Both Drs. Hanisch and Mathews have frequent occasion to refer patients to Dr. Koefoot who are subsequently operated upon at one of the Grand Island hospitals where Dr. Koefoot has operating privileges. These patients are operated upon in Grand Island either because their condition requires facilities not available at Howard County Community Hospital or because the patients desire to be hospitalized in Grand Island. Following surgery in Grand Island, Dr. Koefoot manages the postoperative course of his surgical patients by seeing them at least once daily. Dr. Koefoot sees patients hospitalized in Grand Island as often as necessary depending on the situation.
8. Defendant American College of Surgeons (hereinafter "ACS" or "College") is a not-for-profit corporation organized under Illinois law with its principal place of business in Chicago, Illinois. The ACS is a professional association of surgeons and calls its members Fellows.
9. Defendant C. Rollins Hanlon, M.D. was the Director and Chief Executive Officer of the ACS from October of 1969 through October of 1986. As Director, Dr. Hanlon was the ACS's ranking staff member. Dr. Hanlon is an Illinois resident.
10. Defendant Frank Padberg, M.D. is the Director of the Fellowship and Graduate Education Departments of the ACS. Dr. Padberg has responsibility for membership matters and serves as Secretary to the Central Judiciary Committee of the ACS, the body with general supervision and direction of disciplinary matters. Dr. Padberg is an Illinois resident.
11. The ACS was founded in 1913. The policymaking body of the ACS is its nineteen member Board of Regents which functions essentially as a board of directors.
12. The ACS is the preeminent organization of surgical specialists in the world. It has approximately 50,000 members in the United States and Canada. Another 8,000 persons, approximately, are in its candidate group. It is the only surgical specialty organization available to the general surgeon. The ACS is more influential than most other medical organizations, and people around the world look to it for leadership in medical matters. It is a mark of prestige within the medical profession to be a member of the ACS, as well as an assurance to the public that a surgeon is well qualified in his or her field. Many hospitals require either certification by a surgical specialty board or membership in the ACS for hospital operating privileges.
13. The ACS engages in numerous scientific and educational activities. It is involved in the process of hospital accreditation through its membership in the Joint Commission on Accreditation of Hospitals. Certification by an American surgical specialty board and Fellowship in the ACS are widely regarded as comprising the hallmark of a surgeon. In many hospitals ACS membership is considered a significant factor when application is made for hospital staff privileges. Likewise, disciplinary action taken by the ACS against a member can be detrimental to a surgeon seeking hospital privileges.
14. The ACS has promulgated and set standards for the medical education and training of surgeons. The ACS interacts with numerous other medical organizations, including the American Medical Association, in attempting to shape and direct medical-surgical training and practice in the United States.
15. The ACS engages in advertising and in the distribution of public service announcements which is intended to, and does, enhance the public perception of its members. It publishes a yearbook listing its members which is used for referral purposes.
16. Dr. Koefoot graduated from the medical school at the University of Nebraska in 1947. He did a rotating internship at the Charles T. Miller Hospital in St. Paul, Minnesota. He did a general surgical residence at the Charles T. Miller Hospital and the University of Minnesota which he completed in 1952. Dr. Koefoot is not certified by a surgical specialty board, although, as of 1952, he was eligible for board certification in general surgery.
17. Fellows of the ACS voluntarily agree to conform their surgical practices to the principles, declarations, and bylaws of the ACS by signing a Fellowship Pledge upon application for Fellowship.
18. On June 15, 1954, Dr. Koefoot signed an application for Fellowship in the ACS. By so doing, he agreed to abide by the bylaws of the ACS and by such rules and regulations as may be enacted from time to time, and he subscribed to the Fellowship pledge and declaration as follows:
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