Leonard v. Board of Directors, Prowers County Hosp. Dist., 81CA0428

• Decision Date: 03 November 1983
• Docket Number: No. 81CA0428,81CA0428
• Citation: 673 P.2d 1019
• Parties: Hiram J. LEONARD, M.D., Plaintiff-Appellant, v. BOARD OF DIRECTORS, PROWERS COUNTY HOSPITAL DISTRICT, Prowers and Baca Counties, Colorado and Chester G. Cruikshank, William J. Grasmick, Ileta F. Pierson, Miles A. Vana, and Gary W. Oxley, individually and as purported and acting members of said Board of Directors, and Murry A. Carter, individually and as Chief Executive Officer of said Hospital District and a/k/a Administrator of the Prowers Medical Center and Anthony J. Dicola, individually and as attorney for said Hospital District, Defendants-Appellees. . III
• Court: Colorado Court of Appeals

Page 1019

673 P.2d 1019

Hiram J. LEONARD, M.D., Plaintiff-Appellant, v. BOARD OF DIRECTORS, PROWERS COUNTY HOSPITAL DISTRICT,

Prowers and Baca Counties, Colorado and Chester G.

Cruikshank, William J. Grasmick, Ileta F. Pierson, Miles A.

Vana, and Gary W. Oxley, individually and as purported and

acting members of said Board of Directors, and Murry A.

Carter, individually and as Chief Executive Officer of said

Hospital District and a/k/a Administrator of the Prowers

Medical Center and Anthony J. Dicola, individually and as

attorney for said Hospital District, Defendants-Appellees.

No. 81CA0428.

Colorado Court of Appeals,

Div. III.

Nov. 3, 1983.

Hiram J. Leonard, M.D., pro se.

Holme Roberts & Owen, P.C., Richard L. Schrepferman, John R. Webb, Denver, for defendants-appellees.

BERMAN, Judge.

The defendant Board of Directors of Prowers County Hospital District, a hospital district created under § 32-5-201, et seq., C.R.S.1973, took final action terminating the staff privileges of plaintiff, Hiram J. Leonard, on December 16, 1980. Plaintiff sought review in the district court pursuant to C.R.C.P. 106(a)(4). The district court affirmed the defendant's actions. On plaintiff's appeal of the district court's ruling, we affirm.

Plaintiff is a physician and surgeon duly licensed by the State of Colorado, practicing in Lamar, Colorado. He has been a member of the medical staff of Prowers County Hospital District, also known as Prowers Medical Center, since 1974.

In January of 1980, four of the five hospital board members voted to renew plaintiff's medical staff membership for the calendar year 1980. About one month later, the board requested plaintiff to remain after a regular meeting to discuss with them a certain medical procedure involving possible malpractice performed by plaintiff on February 12, 1980. Plaintiff refused.

After having received several letters from the hospital board and its attorney requesting more open communications, plaintiff wrote the hospital board a letter characterizing the board's request for information as a "kangaroo court proceeding." In addition, plaintiff sent a written memorandum to the board's attorney advising him to contact plaintiff's attorney if he wished any further information. This memorandum depicted a set of lips on the posterior of a nude figure. The letter and memorandum described were the key events which led the board, following its 1980 renewal of plaintiff's staff membership, to change its position and commence proceedings against plaintiff to terminate his staff privileges.

In March 1980, the hospital board requested the executive committee of the medical staff to take corrective action against plaintiff. The executive committee met, studied the charges, discussed them with plaintiff, and then among themselves voted that the appropriate corrective action was to send a letter of reprimand to plaintiff. The executive committee then issued the written reprimand.

In April of 1980 the hospital board voted to reject the executive committee's corrective action against plaintiff. They voted instead to revoke permanently plaintiff's privileges and remove him from the medical staff.

Pursuant to plaintiff's request, and in accordance with the bylaws, the hospital board appointed a seven member hearing committee to conduct an evidentiary hearing concerning the charges against plaintiff which were the subject of the board's request for corrective action and concerning two new charges of misconduct against plaintiff of which charges the board advised plaintiff by letter in June 1980. The committee held its evidentiary hearings and submitted its written report to the hospital board, finding that the board's decision to revoke plaintiff's clinical privileges at Prowers Medical Center was correct.

In November of 1980, pursuant to Article VIII, Section 6.5 of the hospital bylaws, which provides that the board itself may act as appellate review committee, the board conducted an appellate review and made a decision that its previous decision should be affirmed. In early December, pursuant to Article VIII, Section 6.8 of the bylaws, a joint conference committee composed half of board members and half of medical staff voted to affirm the hospital board's decision.

In mid-December 1980, following receipt of the joint conference committee recommendation, the board made its final decision and findings permanently revoking plaintiff's hospital privileges. The district court's affirmance of this action followed.

I.

Plaintiff argues first that the hospital board was not empowered under hospital bylaw Article III, Section 3.1, to revoke his clinical privileges. That section of the bylaws provides in pertinent part:

"The Governing Body shall act on appointments, reappointments, or revocation of appointments, only after there has been a recommendation from the Medical Staff and Chief Executive Officer as provided in these Bylaws ...." Prowers County Hospital District Bylaws, Art. III, Section 3.1 (emphasis added).

The record shows that in March of 1980, the Medical Executive Committee (MEC) acted on the board's request to take corrective action. The MEC issued a written reprimand to plaintiff, thus, implicitly "recommending" non-suspension of plaintiff's privileges. The fact that the board voted in April 1980 to reject the committee's recommendation and to proceed instead to terminate plaintiff's hospital privileges does not negate the fact that there was a recommendation from the MEC as required by the bylaws. There is no provision in the bylaws which expressly constrains the hospital board to act in accord with the MEC's recommendation.

Support for the fact that the board was empowered to terminate plaintiff's privileges is found in Article VIII, Section 1.2, Section 4.2 and Section 7.1 of the bylaws. Prowers County Hospital District Bylaws, Art. VIII, Section 1.2, provides:

"When any practitioner receives notice of a decision by the Governing Body that will affect his appointment to or status as a member of the Medical Staff or his exercise of clinical privileges, and such decision is not based on a prior adverse recommendation by the Executive Committee of the Medical Staff with respect to which he was entitled to a hearing, and appellate review, he shall be entitled to a hearing by a committee appointed by the Governing Body, and if such hearing does not result in a favorable recommendation, to an appellate review by the Governing Body, before the Governing Body makes a final decision on the matter." (emphasis added)

The trial court found, and we agree, that this section precisely outlines the course of proceedings against plaintiff: (1) hospital board action (April 16, 1980); (2) not based on a prior adverse recommendation of the MEC; (3) to which no hearing rights had previously attached; (4) hearing by committee appointed by the board yielding unfavorable recommendation (June 1980); (5) appellate review by the board (November 1980); (6) board's final decision in the matter (December 1980).

Plaintiff's suggested interpretation of the bylaws, that staff privileges can be terminated only upon the MEC's recommendation of termination, would render Section 1.2 of the bylaws superfluous. Such a construction is unacceptable because it contravenes the well-established rule of construction that all provisions of a statute or regulation are intended to be effective. See Flower v. People, 658 P.2d 266 (Colo.1983).

In addition to authority granted by the bylaws, the hospital board is empowered under § 32-5-206(1)(b) and (o ), C.R.S.1973, "[t]o have and exercise all rights and powers necessary or incidental to ..." establishing, maintaining and operating the hospital. Thus, by statute, the hospital board is vested with ultimate responsibility for governing the hospital. See also North Valley Hospital, Inc. v. Kauffman, 169 Mont. 70, 544 P.2d 1219, 1224 (1976). Accordingly, under both hospital bylaws and Colorado statutes, the hospital board had both the power and the authority to terminate plaintiff's hospital privileges.

II.

Plaintiff next argues that the district court abused its discretion in concluding that neither the hospital board nor its hearing committee was disqualified by reason of bias and prejudice. Again, we disagree.

Initially, we note that there is a legal presumption of regularity and validity with which the acts of an administrative body are clothed in carrying out its responsibilities. Public Utilities Commission v. District Court, 163 Colo. 462, 431 P.2d 773 (1967). Due consideration must be accorded this presumption that an administrative body has acted fairly, with proper motives, upon valid reasons and not arbitrarily. Colorado Civil Rights Commission v. Colorado, 30 Colo.App. 10, 488 P.2d 83 (1971).

The trial court found that:

"Because only the defendant hospital board has the statutory power to revoke hospital privileges, the policy favoring an unprejudiced tribunal must yield, under the so-called 'rule of necessity' to allow action by the only body empowered to act in the matter."

We agree that the rule of necessity controls.

Although we find no Colorado case which specifically addresses the rule of necessity, § 24-4-101, et seq., C.R.S.1973 (1982 Repl.Vol. 10) indicates that disqualification for bias will not be allowed to thwart administrative decision making. Section 24-4-105(3) provides that to avoid bias or an appearance of bias an entire agency or member thereof may withdraw, "unless ... withdrawal makes it impossible for the agency to render a decision." Section 24-4-105(3), C.R.S.1973 (1982 Repl.Vol. 10) (emphasis added).

Here, the withdrawal of the hospital board members for reason of alleged bias would make it impossible to decide the question of plaintiff's medical staff privileges since the board is the only body empowered under the bylaws to make such decision. As the court stated in Duffield v. Charleston Area Medical Center, Inc., 503...