Lee v. Chesterfield General Hosp., Inc.

• Decision Date: 23 January 1986
• Docket Number: No. 0696,0696
• Citation: 344 S.E.2d 379,289 S.C. 6
• Parties: James W. LEE, Jr., Respondent, v. CHESTERFIELD GENERAL HOSPITAL, INC. and James Madory, Appellants. Joseph K. NEWSOM, M.D., Respondent, v. CHESTERFIELD GENERAL HOSPITAL, INC. and James Madory, Appellants. JOSEPH K. NEWSOM, M.D., P.A., Respondent, v. CHESTERFIELD GENERAL HOSPITAL, INC. and James Madory, Appellants. . Heard
• Court: South Carolina Court of Appeals

Page 379

344 S.E.2d 379

289 S.C. 6

James W. LEE, Jr., Respondent, v. CHESTERFIELD GENERAL HOSPITAL, INC. and James Madory, Appellants.

Joseph K. NEWSOM, M.D., Respondent, v. CHESTERFIELD GENERAL HOSPITAL, INC. and James Madory, Appellants.

JOSEPH K. NEWSOM, M.D., P.A., Respondent, v. CHESTERFIELD GENERAL HOSPITAL, INC. and James Madory, Appellants.

No. 0696.

Court of Appeals of South Carolina.

Heard Jan. 23, 1986.

Decided May 5, 1986.

William P. Griggs, of Griggs & Spruill, Cheraw, and G. Trenholm Walker, of Wise & Cole, Charleston, for appellants.

James R. Gilreath, Greenville, and James E. Redfearn, Chesterfield, for respondents.

BELL, Judge:

These actions arise from the refusal of Chesterfield General Hospital to permit James W. Lee, Jr., to perform certain medical procedures upon patients in the Hospital. Lee is a licensed physician's assistant employed by the professional association of Joseph K. Newsom, M.D. He enjoys staff privileges as a physician's assistant at the Hospital. Lee, Dr. Newsom individually, and Newsom's professional association commenced identical tort suits against the Hospital and its administrator alleging a conspiracy to injure the plaintiffs in their trade. The Hospital demurred to all three suits on the ground that they failed to state a cause of action. The cases were consolidated for a hearing on the demurrers. The circuit court held the complaints stated a cause of action for conspiracy and overruled the demurrers. The Hospital appeals. We affirm.

In considering a demurrer, the complaint must be liberally construed in favor of the pleader and sustained if the facts alleged and the inferences reasonably deducible therefrom entitle the plaintiff to relief on any theory of the case. Christiansen v. Campbell, 285 S.C. 164, 328 S.E.2d 351 (Ct.App.1985). We agree with the circuit court that the complaints in these cases "are extremely prolix and contain much irrelevant, redundant, and evidentiary matter." Despite considerable defects in draftsmanship, however, we hold the complaints are sufficient to withstand a demurrer for failure to state a cause of action.

According to the allegations of the complaints, Lee is a certified physician's assistant duly licensed by the State Board of Medical Examiners to perform a wide range of medical procedures under the supervision of a licensed physician. Newsom is a physician licensed to practice in South Carolina. Newsom's professional association employs Lee to assist Newsom in his medical practice in Chesterfield County. Both Newsom and Lee have been granted staff privileges by the Chesterfield General Hospital for a number of years.

In October 1982, pursuant to a notice from James Madory, the hospital administrator, Lee applied for reappointment to the Hospital's staff for the ensuing year. In his application, Lee sought approval to perform a long list of medical procedures on patients in the Hospital. These included procedures the Hospital had previously approved as well as a number of new procedures. Lee is licensed by the State Board of Medical Examiners to perform all the procedures in question.

In January 1983, the Credentials Committee of the Hospital reviewed Lee's application for reappointment. The Committee recommended Lee for staff privileges as a physician's assistant. However, it refused to approve some of the procedures Lee wished to be able to perform.

In February 1983, the Board of Trustees of the Hospital, acting on the recommendation of the Credentials Committee, granted Lee staff privileges as a physician's assistant subject to stated guidelines which restricted the tests and procedures he would be able to perform in the Hospital. The guidelines prohibited Lee from performing some of the procedures he had requested in his application and permitted him to perform certain other procedures only when Newsom was physically present and supervising Lee.

The complaints allege the restrictions in question were imposed on Lee as part of a conspiracy between Madory, the Hospital, and other members of the medical staff of the Hospital. The alleged purpose or object of the conspiracy is "to dominate the practice of medicine by licensed physicians in Chesterfield County" and "to restrain and eliminate, for their own financial advantage and professional enhancement, the element of fair competition" in the practice of medicine in Chesterfield County. The complaints allege that as a result of the conspiracy, Lee, Newsom, and Newsom's professional association have suffered damages, including mental anguish, loss of professional reputation, and loss of trade.

I.

The Hospital first argues the demurrers should have been sustained because internal rules governing the practice of a physician's assistant in a private hospital are not subject to judicial review.

We agree that a private hospital is free, in the absence of controlling legislation or regulatory provisions, to decide the nature and extent of medical practice permitted to persons it grants staff privileges. Ordinarily, such decisions involve matters of expert medical judgment not subject to judicial review. See Gowan v. St. Francis Community Hospital, 275 S.C. 203, 268 S.E.2d 580 (1980), cert. denied, 449 U.S. 1062, 101 S.Ct. 786, 66 L.Ed.2d 605 (1980); Hoffman v. Garden City Hospital-Osteopathic, 115 Mich.App. 773, 321 N.W.2d 810 (1982). A medical professional has no right, simply because he is licensed by state authority to perform certain procedures, to claim unrestricted staff privileges in a hospital. See Yeargin v. Hamilton Memorial Hospital, 225 Ga. 661, 171 S.E.2d 136 (1969), cert. denied, 397 U.S. 963, 90 S.Ct. 997, 25 L.Ed.2d 255 (1970). Within the confines of the law, a hospital may set professional standards for staff according to its own conception of good medical practice.

These principles are not dispositive of the present cases, however. In ruling on the demurrers, the circuit court did not conduct a judicial review of internal hospital rules. The question to be decided is not whether the rules are valid or reasonable or medically sound, but whether the rules were imposed in furtherance of a conspiracy, the primary purpose of which was to injure the plaintiffs. If the complaints, liberally construed, allege such a conspiracy, it is irrelevant that the Hospital has the legal right to restrict staff privileges and that its rules are not subject to judicial review.

II.

The Hospital also argues that the complaints fail to state a cause of action because they do not allege any unlawful act by the defendants.

This argument confuses the elements of civil conspiracy with those of criminal conspiracy. A criminal conspiracy consists of "a combination between two or more persons for the purpose of accomplishing a criminal or unlawful object or an object neither criminal nor unlawful by criminal or unlawful means." State v. Hightower, 221 S.C. 91, 96, 69 S.E.2d 363, 365 (1952), quoting State v. Davis, 88 S.C. 229, 70 S.E. 811 (1911); see also, Mulcahy v. Regina (1868) L.R. 3 H.L. 306, 317 ("A conspiracy consists ... in the agreement of two or more to do an unlawful act, or to do a lawful act by unlawful means"). To establish a criminal conspiracy it is not necessary to prove an overt act. The gist of the crime is the unlawful combination. The crime is then complete, even though nothing further is done. State v. Ferguson, 221 S.C. 300, 70 S.E.2d 355 (1952), cert. denied, 344 U.S. 830, 73 S.Ct. 35, 97 L.Ed. 646 (1952); Todd v. South Carolina Farm Bureau Mutual Ins. Co., 276 S.C. 284, 278 S.E.2d 607 (1981).

A civil conspiracy, on the other hand, consists of three elements: (1) a combination of two or more persons, (2) for the purpose of injuring the plaintiff, (3) which causes him special damage. Charles v. Texas Co. (Charles I), 192 S.C. 82, 5 S.E.2d 464 (1939); Crofter Hand Woven Harris Tweed Co. v. Veitch (Crofters' Case) [1942] A.C. 435; Quinn v. Leathem [1901] A.C. 495; Hutton v. Watters, 132 Tenn. 527, 179 S.W. 134 (1915); cf., Pratt v. British Medical Association [1919] 1 K.B. 244; Thompson v. British Medical Association [1924] A.C. 764. The gravamen of the tort is the damage resulting to the plaintiff from an overt act done pursuant to the combination, not the agreement or combination per se. Todd v. South Carolina Farm Bureau Mutual Ins. Co., supra; see also Charles v. Texas Co. (Charles II), 199 S.C. 156, 18 S.E.2d 719 (1942). A civil conspiracy may, of course, be furthered by an unlawful act. See, e.g., Charles v. Texas Co. (Charles II), supra (slander, adulterating gasoline, etc.). However, an unlawful act is not a necessary element of the tort. An action for conspiracy may lie even though no unlawful means are used and no independently unlawful acts are committed.

In Charles v. Texas Co. (Charles I), supra, the plaintiff, a distributor of petroleum products, brought an action for conspiracy against the Texas Company, one Ezelle, a zone manager for the company, and Lynch, the plaintiff's former business partner in the petroleum trade. Charles alleged the defendants, from motives of "envy, ill will, spite and malice," entered into a combination, scheme and conspiracy with the purpose, design and intent of wrecking his business. In furtherance of the conspiracy, Lynch had first dissolved their former partnership to force Charles out of the petroleum trade. When Charles set up a competing distributorship, the defendants then engaged in a course of unfair competition to ruin his business. Among other things, Charles alleged that the defendants sold petroleum products and filling station equipment to his customers at below market price to induce them to discontinue the use and sale of Charles's products.

The defendants moved to strike these allegations from the complaint, arguing that Lynch had a legal right to dissolve the partnership and that they had a right to sell their petroleum products to whom they chose at any price they saw fit. Since...