Oliver v. Board of Trustees

Citation227 Cal.Rptr. 1,181 Cal.App.3d 824
CourtCalifornia Court of Appeals
Decision Date16 January 1986
PartiesAnthony D. OLIVER, M.D., Petitioner and Appellant, v. BOARD OF TRUSTEES OF EISENHOWER MEDICAL CENTER, Respondent. E001631.

Beam, DiCaro, D'Antony, Stafford & Brobeck, Daniel R. Sullivan and Timothy J. Stafford, Santa Ana, for petitioner and appellant.

Weissburg and Aronson, Inc., Albert C. Mour, Lloyd A. Bookman and Craig T. Cuden, Los Angeles, for respondent.

KAUFMAN, Acting Presiding Justice.

Anthony D. Oliver, M.D. (petitioner or Dr. Oliver) appeals from a judgment denying his petition for a writ of mandate to compel the Board of Trustees of Eisenhower Medical Center (EMC) to set aside its order denying his application for membership to the Consulting Medical Staff of EMC and to reconsider his application.

Introduction

EMC is a private, nonprofit hospital in Coachella Valley. State licensing law vests final authority and responsibility for an acute care hospital such as EMC in the hospital's governing body. (Cal.Admin.Code, tit. 22, § 70035.) Every hospital in California must have an "organized medical staff responsible to the governing body for the adequacy and quality of the medical care rendered to patients in the hospital." (Cal.Admin.Code, tit. 22, § 70703(a).) The governing body is responsible for the appointment and reappointment of members to the hospital's medical staff (Cal.Admin.Code, tit. 22, § 70701(a)(1)(B)) and for assuring that the medical staff establishes controls designed to insure the maintenance of high standards of professional and ethical practices at the hospital (Cal.Admin.Code, tit. 22, § 70701(a)(7)). The medical staff must establish bylaws which provide formal procedures for "the evaluation of staff applications and credentials, appointments, reappointments, assignment of clinical privileges, appeals mechanisms and such other subjects or conditions which the medical staff and governing body deem appropriate." (Cal.Admin.Code, tit. 22, § 70703(b).) While the actions of private hospitals do not constitute "state action" triggering the constitutional guarantees of due process (Anton v. San Antonio Community Hospital (1982) 132 Cal.App.3d 638, 653-654, 183 Cal.Rptr. 423), hospitals are required when considering an application for staff membership to afford the applicant certain minimal requirements of "fair procedure." (Id.; see also Ezekial v. Winkley (1977) 20 Cal.3d 267, 278-279, 142 Cal.Rptr. 418, 572 P.2d 32; Lewin v. St. Joseph Hospital of Orange (1978) 82 Cal.App.3d 368, 385, 146 Cal.Rptr. 892; Ascherman v. San Francisco Medical Society (1974) 39 Cal.App.3d 623, 649, 114 Cal.Rptr. 681.)

There are five categories of medical staff membership at EMC: Active, Associate, Courtesy, Consulting, and Honorary.

The Honorary Staff is comprised of practitioners of outstanding reputation who are not active at EMC or hold emeritus positions.

Members of the Active Staff consist of "physicians, dentists and podiatrists who regularly utilize the hospital facilities, who are located close enough to the hospital to provide continuous care for their patients, who assume all the functions and responsibilities of membership on the Active Medical Staff, including, where appropriate, emergency service care and consultation assignments."

The Associate Staff "is the entry level for applicants who are being considered for advancement to the Active Medical Staff," and members must meet the same basic qualifications as Active Staff members.

The Courtesy Staff consists of "physicians, dentists, and podiatrists qualified for staff membership, but who only occasionally utilize the hospital facilities."

Members of the Active, Associate and Courtesy Staffs have various administrative responsibilities, including service on committees, attendance at medical staff meetings, and payment of annual dues. In addition, these staff members must provide emergency service care. Lastly, members of these categories of the staff have admitting privileges, and they provide the vast majority of medical services furnished at the hospital.

In contrast, the Consulting Staff is limited to "those physicians, dentists and podiatrists of widely renowned professional ability and reputation in the area of their specialty or whose specialty is not represented on the staff at the time of appointment...." Members of the Consulting Staff "may provide consultative services to other members of the staff." Consulting Staff members, however, do not have admitting privileges, nor are they required to pay medical staff dues or attend staff or departmental meetings.

Petitioner purports to be an expert in neurology, neurosurgery and psychiatry, particularly forensic psychiatry. He practices in Riverside and does not maintain an office in the Coachella Valley. He is on the Active Staff at Riverside Hospital and maintains staff privileges at Parkview Community Hospital in Riverside.

Petitioner applied for Consulting Staff membership at EMC and in due course his application was denied. EMC's internal review of petitioner's application included an investigation by the medical staff Credentials Committee, a review by the Executive Committee, a formal hearing before a Judicial Review Committee of five physicians on EMC's medical staff, and appellate review by the Board of Trustees. Denial of petitioner's application was recommended at each step of the review process. Upon completion of the hospital's review, petitioner challenged the Board's decision by filing a petition for writ of mandate in the Superior Court of Riverside County. The trial court conducted a hearing and upheld the Board's decision to deny petitioner's application for privileges.

Contentions on Appeal

On appeal, petitioner raises three principal arguments: (1) EMC did not proceed in the manner required by law because the membership standard applied to Consulting Staff membership is not rationally related to providing high quality medical care; (2) the findings of the Board are not supported by sutstantial evidence on the whole record; and (3) the medical staff did not offer evidence to support the Board's findings. Petitioner's contentions are not meritorious.

Facts

On May 7, 1982, petitioner applied for medical staff membership at EMC. Following a review by the Credentials Committee, the application was referred to the Executive Committee for consideration. The Executive Committee initially processed the application as one for Associate Staff membership and denied the application because, inter alia, it was determined that petitioner did not satisfy article IV, sections 1.A and 1.B, of the medical staff bylaws (bylaws), 1 which require members of the Associate Staff to limit their practice to the Coachella Valley on a full-time basis.

Petitioner requested and was granted a hearing before the Judicial Review Committee. At the hearing, it became apparent that petitioner intended to apply for Consulting rather than Associate Staff membership. The application therefore was remanded to the Credentials Committee for further recommendation.

Following review and recommendation by the Credentials Committee, the Executive Committee recommended denial of petitioner's application for privileges. Petitioner was advised of that recommendation by letter of March 15, 1983, which stated that petitioner had shown: "... No evidence of nationally or internationally renowned professional ability and reputation in the area of [his] specialty, and [his] qualifications are not considered unique in that they are already represented on the EMC Medical Staff."

At petitioner's request, and pursuant to the bylaws, a hearing was scheduled before the Judicial Review Committee. 2 On June 21, 1983, the Committee met, reviewed the matter, heard oral testimony and argument, and voted unanimously to affirm the Executive Committee's recommendation. The Judicial Review Committee found, inter alia:

"4. There is no evidentiary support for Dr. Oliver's contention that he has 'widely renowned professional ability and reputation' in the field of Psychiatry. To the extent that Dr. Oliver has any demonstrable renown or reputation, it is as to Forensic Psychiatry and is confined to Riverside County.

"5. There is no Department of Forensic Psychiatry at EMC and it is unlikely that Dr. Oliver's expertise in that field would be of any significant value to Staff Physicians at EMC."

Petitioner then requested review of the Judicial Review Committee's decision by the Appellate Review Committee of the Board of Trustees. The Appellate Review Committee considered the matter and affirmed the Judicial Review Committee's decision. On September 29, 1983, petitioner was advised of the hospital's decision to reject his application for staff membership.

Discussion
1. Rationally Related Standard

Article IV, section 1, subsection D, of the Medical Staff Bylaws of EMC provides in relevant part: "The Consulting Medical Staff shall consist of those physicians, dentists, and podiatrists of widely renowned professional ability and reputation in the area of their specialty or whose specialty is not represented on the staff at the time of appointment...."

In urging that this standard is not rationally related to the hospital's providing high quality medical care, petitioner urges, in essence, that the standard does not relate to physician competence and asserts that all competent physicians must be admitted to the medical staff. For these propositions he cites Miller v. Eisenhower Medical Center (1980) 27 Cal.3d 614, 631-632, 166 Cal.Rptr. 826, 614 P.2d 258, where in analyzing a particular requirement for medical staff admission, the court stated in pertinent part: "The bylaw provision here before us, as we have indicated, must be read to preclude the rejection of an otherwise qualified physician from medical staff membership unless it can be shown that he manifests an inability to 'work with others' in the...

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