Nanavati v. Burdette Tomlin Memorial Hosp.
| Decision Date | 16 June 1987 |
| Citation | 107 N.J. 240,526 A.2d 697 |
| Parties | Suketu H. NANAVATI, M.D., Plaintiff-Appellant, v. BURDETTE TOMLIN MEMORIAL HOSPITAL, a corporation of the State of New Jersey, Defendant-Respondent, and Marvin Podolnick, M.D., Carmen Alameno, M.D., Mary Ann Haflin, M.D., Melvin Hankin, M.D., H. Sezer Koknar, M.D., and Richard Renza, D.O., Executive Committee of the Medical Staff of the Burdette Tomlin Memorial Hospital, Defendants. |
| Court | New Jersey Supreme Court |
Gerald W. Eisenstat, Vineland, for plaintiff-appellant (Eisenstat, Gabage & Berman, attorneys; Gerald W. Eisenstat, Mitchell S. Berman, and Harry Furman, on the briefs).
Carl J. Valore, Northfield, for defendant-respondent (Valore, McAllister, Westmoreland, Gould, Vesper & Schwartz, attorneys; Carl J. Valore and Nina Wisznat Chase, on the brief).
Mary K. Brennan, Princeton, submitted a brief on behalf of amicus curiae, New Jersey Hosp. Ass'n (Brener, Wallack & Hill, attorneys).
The opinion of the Court was delivered by
This appeal arises out of the revocation of the staff privileges of Suketu H. Nanavati (Dr. Nanavati) as a cardiologist at Burdette Tomlin Memorial Hospital (the hospital). The Chancery Division found that the hospital had prejudged the matter, thereby depriving Dr. Nanavati of a fair hearing. After making independent findings of fact, the court permanently enjoined the revocation of Dr. Nanavati's privileges. In an unreported opinion, the Appellate Division affirmed the issuance of the injunction "without prejudice to the relodging of the charges against plaintiff." The court also determined that the trial court should not have made independent findings of fact and that the appropriate standard of review is whether the decision of the hospital was supported by sufficient credible evidence.
We granted Dr. Nanavati's petition for certification, 105 N.J. 512, 523 A.2d 158 (1986), and now modify and affirm the judgment of the Appellate Division by remanding the matter to the hospital with the understanding that within a reasonable time it may reinstitute the proceedings against Dr. Nanavati. The injunction is to remain in effect, pending the outcome of any such proceedings.
I
The background of this case is a dispute between Dr. Nanavati and Dr. Robert Sorensen, who at the time was the chief of cardiology, chairman of the Department of Medicine, and a member of the Board of Governors at the hospital. The dispute originated over the allocation of the reading of electrocardiograms (ECGs or EKGs), which, at $5 per reading, produced an annual income of approximately $75,000. Burdette Tomlin is the only hospital in Cape May County, and when he was granted staff privileges, Dr. Nanavati was the only board-certified cardiologist in the county. Before the arrival of Dr. Nanavati in 1979, Dr. Sorensen, an internist, enjoyed a virtual monopoly on reading ECGs. Dr. Nanavati was allowed to read ECGs one day each week, but when he requested an additional day, Dr. Sorensen rejected his request. The rejection stimulated Dr. Nanavati into criticizing Dr. Sorensen, who retaliated.
As the discord between the two doctors escalated, Dr. Nanavati allegedly committed a series of violations of the hospital's bylaws. On August 2, 1982, the medical staff executive committee "voted unanimously to act toward the revocation of Dr. Nanavati's medical staff privileges." That action marked the beginning of lengthy proceedings before the hospital authorities and before federal and state courts in this state.
Pursuant to the hospital bylaws, the chairman of the medical staff executive committee requested the hospital executive committee to take corrective action. The executive committee forwarded the request to the chief of the Department of Medicine, who appointed an ad hoc committee to investigate the matter. The charges against Dr. Nanavati were captioned as "Acts of Disruptive Behavior" and "Failure to Cooperate with Hospital Personnel Regarding the Use of Facilities Especially During the Summer Months and the Emergent Admissions Procedures."
Underlying these charges is the contention that Dr. Nanavati caused disruption in violation of a bylaw provision requiring a staff doctor to be of a temperament and disposition that will enable him to work in harmony with his colleagues on the Medical Staff; with the professional, technical, and other personnel in the hospital, and with the administration, accepting criticism without resentment and offering it in a spirit and manner that is constructive and devoid of offense and malice * * *.
The further allegation is that Dr. Nanavati violated a bylaw provision that a staff member "must enjoy the reputation of being an ethical and conscientious practitioner and must strictly abide by the Code of Ethics * * *." At no time has the hospital questioned Dr. Nanavati's technical competence.
On August 23, 1982, the ad hoc committee "found against Dr. Nanavati on all charges and specifications" and recommended as the only appropriate punishment "his discharge from the Medical Staff of Burdette Tomlin Memorial Hospital, together with the permanent deprivation of Burdette Memorial Hospital privileges." The executive committee of the medical staff affirmed that finding, and Dr. Nanavati appealed to an ad hoc committee of the medical staff, which unanimously found against him and recommended that he be dismissed from the staff of the hospital. In November, the hospital administrator advised Dr. Nanavati of the revocation of his staff privileges.
Dr. Nanavati immediately filed an action in the Chancery Division, which found that the proceedings had not been conducted in accordance with the hospital's bylaws, enjoined the revocation of Dr. Nanavati's privileges, and remanded the matter for further proceedings to be conducted in accordance with the hospital's bylaws. The Board of Governors thereupon appointed a hearing committee, which recommended on April 15, 1983, "that the action of the medical staff in dismissing Dr. Nanavati be affirmed." Two weeks later, on April 29, the Board affirmed the hearing committee's recommendation.
Meanwhile, on March 8, 1983, Dr. Nanavati instituted an action in the United States District Court for the District of New Jersey against the hospital, the executive committee of the medical staff (both of which filed counterclaims against him), and Dr. Sorensen, who initiated an independent action against Dr. Nanavati. The cases were consolidated for trial and resulted in the entry of a judgment on July 23, 1986, in favor of Dr. Nanavati on an anti-trust claim against the hospital in the amount of $350,000, which was trebled, pursuant to 15 U.S.C.A. § 15, for a total of $1,050,000. Dr. Sorensen recovered $100,000 compensatory damages and $300,000 punitive damages against Dr. Nanavati on a claim for tortious interference with prospective economic advantage, and $100,000 as compensatory damages and $500,000 as punitive damages on a defamation claim. Likewise, the hospital recovered $100,000 compensatory damages and $50,000 punitive damages against Dr. Nanavati on its defamation claim. In effect, the jury returned a verdict both for and against Dr. Nanavati in the amount of $1,050,000. Under Federal Rule Civil Procedure 50(b), however, the trial court entered judgment notwithstanding the verdict in favor of the hospital and the executive committee, the effect of which was to vacate the $1,050,000 judgment recovered by Dr. Nanavati. 645 F.Supp. 1217 (D.N.J.1986), appeal docketed, No. 86-5778 (3d Cir. Nov. 5, 1986) & No. 86-5819 (3d Cir. Nov. 20, 1986). As a result, Dr. Nanavati is obligated to the hospital and Dr. Sorensen in the amount of $1,050,000. The matter is now on appeal before the Third Circuit. Id.
Returning to the present action, the Chancery Division found in July 1983 that the hearing committee, without notice to Dr. Nanavati, had held ex parte hearings, which "violated fundamental fairness," and again remanded the matter to the hospital. The hearing committee again recommended revocation of Dr. Nanavati's staff privileges, and the Board again approved the recommendation. Once again the Chancery Division found that the proceedings were unfair. The Appellate Division affirmed the Chancery Division's finding that Dr. Nanavati had been deprived of a fair hearing, and the hospital did not cross-petition for relief from the Appellate Division's judgment. Hence, we accept the judgment of the lower courts that Dr. Nanavati has never had a fair hearing on the revocation of his privileges. Suffice it to state that a hearing cannot be fair if the hearing body prejudges the matter before the hearing begins.
After finding that the hospital proceedings were unfair, the Chancery Division independently reviewed the record by a preponderance-of-the-evidence standard. The court determined that Dr. Nanavati's staff privileges should not be revoked on the ground of disharmony, absent a showing of actual interference with patient care, and concluded that the record did not support any such showing. Consequently, the court issued a permanent injunction against revocation of his privileges.
Although the Appellate Division affirmed the trial court's finding that the hospital proceedings were invalid, it disagreed with other portions of the trial court's opinion and held that the trial court, in reviewing the revocation of hospital staff privileges, should not have made independent findings of fact, but should have determined whether the hospital's decision was supported by sufficient credible evidence. In addition, the Appellate Division ruled that mere disharmony, although an insufficient ground by itself, is a relevant consideration in revocation proceedings.
With specific reference to the charges against Dr. Nanavati, the Appellate Division stated:
Unfair criticism tending to break down nursing staff morale and discipline, inquiry to a patient as to why she...
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