Oksanen v. Page Memorial Hosp.
| Citation | 912 F.2d 73 |
| Decision Date | 30 September 1990 |
| Docket Number | No. 89-1768,89-1768 |
| Parties | 1990-2 Trade Cases 69,138 Owen D. OKSANEN, M.D., Plaintiff-Appellant, v. PAGE MEMORIAL HOSPITAL; J.R. Holsinger, M.D.; Romulo Ancheta, M.D.; Fang S. Horng, M.D.; James G. Dale, M.D., Defendants-Appellees. |
| Court | United States Courts of Appeals. United States Court of Appeals (4th Circuit) |
Edward B. Lowry, argued (Robert W. Jackson, on brief), Michie, Hamlett, Lowry, Rasmussen & Tweel, P.C., Charlottesville, Va. and (Sheldon Braiterman, on brief), Baltimore, Md., for plaintiff-appellant.
Gregory Thomas St. Ours, argued (Phillip C. Stone, Wharton, Aldhizer & Weaver, Harrisonburg, Va., Stephen L. Altman, Donahue, Ehrmantraut & Montedonico, Fairfax, Va., Roy V. Wolfe, III, Julias, Blatt & Blatt, Harrisonburg, Va., Norman F. Slenker, Slenker, Brandt, Jennings & Johnston, Fairfax, Va., Edward M. Burns, II, Poindexter, Burns & Marks, Waynesboro, Va., Lynn Fleming, Crews & Hancock, Richmond, Va., and Mary S. Meade, Meade & Associates, P.C., Vienna, Va., on brief), for defendants-appellees.
Before MURNAGHAN, Circuit Judge, BUTZNER, Senior Circuit Judge, and KAUFMAN, Senior United States District Judge for the District of Maryland, sitting by designation.
Dr. Owen D. Oksanen appeals the order of the district court granting summary judgment with regard to Oksanen's federal antitrust and pendent state claims. For the reasons stated below, we reverse that order and remand to permit Dr. Oksanen additional discovery, and for whatever trial opportunity to which he may, after such discovery, be entitled.
After finishing a three-year residency at the University of Virginia Hospital in 1978, Dr. Oksanen moved to Luray (Page County), Virginia, to practice family medicine. Upon arrival, Oksanen rejected an offer to practice in the office of defendant Dr. J.R. Holsinger (another general practitioner), preferring instead to open his own office as a sole practitioner. After a probationary period of one year, Dr. Oksanen applied for full medical privileges at Page Memorial Hospital (Page Memorial), a small (54 beds) community hospital which constitutes the only hospital in Page County. Although Dr. Holsinger opposed Oksanen's application, the appellant received the support of defendants Dr. Fang S. Horng and Dr. Romulo Ancheta, two Page Memorial surgeons, and at least one other of Page Memorial's five-physician staff and his application for full medical privileges was approved.
Soon after Oksanen began practicing at Page Memorial, the administration began receiving complaints about his behavior. From 1979 to 1983, the record reveals a lengthy list of claims of abusive conduct toward nurses, laboratory staff, and administrative personnel. 1 At the same time, Dr. Oksanen's complaints regarding his physician colleagues grew. In his affidavit, Oksanen stated that because of his deep concern over the quality of care at Page Memorial, he began referring many patients to the University of Virginia Hospital and other facilities which, in his opinion, provided a "better quality of specialized medical service." According to Dr. Oksanen, "the principal problems with medical care concerned the failure of Drs. Horng and Ancheta to realize their own limitations as to what surgery should be handled by them and what surgery required better facilities and surgeon[s]...."
In May 1983, with relations between Dr. Oksanen and the nursing staff worsening, 2 hospital administrator John Berry asked the medical staff, which consisted of all the individual defendants except newly arrived general practitioner Dr. James G. Dale, to investigate Oksanen's conduct and take any necessary "corrective action." The medical staff concluded that no disciplinary action was necessary. In July 1983, however, Dr. Oksanen engaged in two incidents which further antagonized the medical staff and the hospital Board of Trustees (Board). First, the appellant, in reaction to a letter sent by Board President T.C. Berrey to all physicians, told the Board that its attempt to create a more hospitable environment was "demeaning and insulting." Oksanen added that he was "not sure that the collection of individuals that make up the hospital Board have sufficient background, training or what have you to function appropriately in reviewing the activities of physicians." Second, Dr. Oksanen got into a public shouting match with Dr Horng after Oksanen told one of Horng's patients that a prescribed medication was potentially life-threatening.
At its next meeting, the Board, in response to the suggestions of Dr. Ancheta (Chief of the Medical Staff) and Administrator Berry, strongly recommended that the Medical Staff take corrective action. After reviewing testimony from 19 witnesses regarding the appellant's behavior, the Executive Committee of the Medical Staff voted 3-1 (with Dr. Oksanen the only dissenter) to revoke Dr. Oksanen's staff privileges. The Board of Trustees, after considering the protests of Dr. Oksanen and his lawyer, voted 9-2 to suspend Oksanen's privileges for three months (until December 31, 1983), to be followed by a one-year probationary period.
In the wake of Oksanen's suspension, a group called the Concerned Citizens mounted a campaign which resulted in the election of four members to the Board, ousting Dr. Holsinger in the process. Those events, along with newspaper statements made by Dr. Oksanen about the poor quality of surgical care at Page Memorial, did not ease Dr. Oksanen's return to practice in January 1984. After Oksanen was again practicing at Page Memorial, several physicians "embarked," according to the appellant, on a course of selective enforcement of the hospital's regulations, such as refusing to provide emergency room coverage for Oksanen's patients. Additionally, the other doctors refused to cover for Oksanen during his absences or name the appellant to any hospital committees. With complaints about Dr. Oksanen rising again, the Board of Trustees voted in May 1984 to request the medical staff to take further corrective action against him. The Executive Committee of the Medical Staff met on June 22, 1984, and voted to recommend to the Board that Oksanen's staff privileges be revoked permanently. Five days later, Dr. Oksanen resigned from the Page Memorial medical staff.
After his resignation, Dr. Oksanen claimed that the Page Memorial staff refused his patients access to ancillary services and diverted his patients to other physicians. 3 However, Oksanen continued to practice medicine in Virginia through 1984 and subsequently was reprimanded, in accordance with a consent decree by the Virginia Board of Medicine, for practicing medicine with a suspended license, for negligence in the death of a patient, and for unprofessional conduct. Thereafter, Dr. Oksanen's practice suffered greatly and, after working in a series of part-time physician arrangements, he finally settled in Florida.
On June 13, 1988, Dr. Oksanen filed a complaint in the court below against Page Memorial and Drs. Holsinger, Ancheta, Horng, and Dale, setting forth antitrust claims under Sections 1 & 2 of the Sherman Act, 15 U.S.C. Secs. 1, 2, and asserting pendent state claims under the Virginia Antitrust Act, and also for civil conspiracy, tortious interference with contract, and defamation. 4 In essence, Dr. Oksanen claimed that the defendants collectively forced him from practice and conspired to restrain competition in, and monopolize, the practice of medicine in Page County. This was done, according to Oksanen, because the defendant physicians felt professionally and economically threatened by the brash "new kid on the block."
The defendants then filed motions to dismiss and/or for summary judgment, and the district court calendared those motions for oral argument on November 7, 1988. Between June and November 1988, both parties submitted affidavits, transcripts of hospital disciplinary meetings, and correspondence in support of their respective positions. Dr. Oksanen also responded to interrogatories submitted by Drs. Dale and Horng. Dr. Oksanen served his own deposition requests, interrogatories, and production of documents requests on the individual defendants on October 20, 1988. Those discovery requests were never answered, however, because the district court stayed all discovery at the oral argument on November 7, pending a decision on the defendants' motions.
Although discovery had been stayed since the previous November, the district court granted summary judgment in favor of all defendants on June 16, 1989. The district court found that the documentary exhibits and correspondence were insufficient to establish the required concerted action under section 1 of the Sherman Act. Instead, the court concluded that "the recurring litany of complaints concerning [Oksanen] provides ample evidence that the individual defendants were not conspiring to restrain trade or to injure Dr. Oksanen...." Regarding the Sherman section 2 claim, the district court concluded that the "various actions" taken against Oksanen "do not suggest the willful maintenance of monopoly power," but were instead "motivated by professional concerns over the impact of Dr. Oksanen's behavior on hospital morale and, ultimately, on patient care." Finally, the district court dismissed the pendent state claims for essentially the same reasons. This appeal followed. We conclude that a remand is required.
Section 1 of the Sherman Act requires proof of a "contract, combination ..., or conspiracy, in restraint of trade." 15 U.S.C. Sec. 1 (1982). "Concerted action is the essence of a Section 1 claim." Terry's Floor Fashions, Inc. v. Burlington Industries, Inc., 763 F.2d 604, 610 (4th Cir.1985). Here, the alleged conspiracy occurred among the Board members and administrative staff of Page Memorial and its medical staff, all of whom participated in the peer review...
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