Sadler v. Dimensions Health Corp.

• Decision Date: 28 December 2001
• Docket Number: No. 1625,1625
• Citation: 141 Md. App. 715,787 A.2d 807
• Parties: Cynthia D. SADLER, et al., v. DIMENSIONS HEALTH CORPORATION, et al.
• Court: Court of Special Appeals of Maryland

787 A.2d 807

141 Md. App. 715

Cynthia D. SADLER, et al., v. DIMENSIONS HEALTH CORPORATION, et al.

No. 1625, Sept. Term, 2000.

Court of Special Appeals of Maryland.

December 28, 2001.

Laurence S. Kaye (Eric L. Siegel and Henrichsen, Siegel, P.L.L.C. on the brief), Washington, DC, for appellants.

Phillip R. Zuber (Sheila F. Flashman and Sasscer, Clagett & Bucher on the brief), Upper Marlboro, for appellees.

Argued before JAMES R. EYLER, KRAUSER and ROBERT L. KARWACKI, (Retired, specially assigned), JJ.

KARWACKI, Judge, Retired, specially assigned.

This appeal had its genesis in a decision by the Board of Directors of Prince George's Hospital Center ("the hospital") to refuse Cynthia D. Sadler, M.D., the appellant, privileges of admitting patients to the hospital. That decision was based upon a recommendation of an Ad Hoc Committee of the Medical Staff of the hospital ("the hearing committee").

Dr. Sadler and her corporation, Metropolitan Health Care Plus, Inc., filed suit in the Circuit Court for Prince George's County against multiple defendants¹ claiming damages for alleged breach of contract and several torts. Also sought was a declaratory judgment that Dr. Sadler's privileges at the hospital had been illegally terminated. The defendants moved to dismiss the seven count Complaint.² A hearing on those motions was held on April 4, 2000, at which time the trial court (James J. Lombardi, Jr.) granted the motions of the Hopkins defendants and Dr. Goldman; at that hearing Metropolitan withdrew its claims for breach of contract and breach of the covenant of good faith and fair dealing contained in Counts I and II of the Complaint. Also, the trial court agreed to consider certain materials outside of the Complaint in ruling on the motions to dismiss, thereby converting those motions into ones for summary judgment. See Maryland Rule 2-322(c). The trial court took the matter under advisement as to the balance of the appellants' claims. An amended complaint was filed on April 14, 2000, by the appellants. In it the appellants no longer pursued their claim against the Hopkins Defendants, again stated the same claims against Dr. Goldman, and restated their claims for declaratory relief in a Count 8. On June 2, 2000, the trial court rescheduled argument on the motion and directed the parties to brief the issue of the appropriate standard to be applied in ruling on the motion. After hearing further oral argument on July 28, 2000, the court entered judgment in favor of all remaining defendants. This appeal ensued.

The principal issue which we are called upon to resolve in this appeal is the proper standard by which the courts should review a decision of the board of directors of a privately owned hospital as to who should have staff privileges at the hospital. The appellate courts of this State have not heretofore addressed that question.

Background

Dr. Sadler, who specializes in obstetrics and gynecology (OB/GYN) applied for medical staff privileges in the hospital's department of OB/GYN on July 10, 1992. In that application, Dr. Sadler agreed to subject her "clinical performance to, and participate in, the hospital's quality assurance programs as the same shall from time-to-time be in effect." Pending receipt of further information on her application for medical staff privileges, she applied for and was granted temporary privileges on February 24, 1993.

In April, 1993, three incident reports concerning Dr. Sadler were filed. They involved her failure to respond to calls and initiate timely treatment, a broken humerus and permanent nerve injury following a birth, and a retained surgical sponge. The Patient Care Committee of the OB/GYN Department ("PCC")³ reviewed the reports and concluded that continued observation of Dr. Sadler's "pattern of practice" was warranted.

When Dr. Sadler's application for medical staff privileges came before the hospital's credentials committee, action was deferred so that additional information could be obtained on her activities at Laurel Regional Hospital, where she previously had privileges. On July 8, 1993, the chairman of the credentials committee learned that Dr. Sadler was responsible for 28% of the quality assurance reviews at that hospital during her tenure there. Furthermore, he learned that when Dr. Sadler was informed by Laurel Regional Hospital that she was going to be monitored for a period of several months, she did not apply for reappointment to its medical staff.

On November 1, 1993, Dr. Sadler was granted provisional privileges for two years at the hospital.⁴ Her provisional privileges were extended by the Board of Directors in November 1994.

From September 1994 to July 1995, the PCC was referred sixteen of Dr. Sadler's cases, seven of which were found to involve significant opportunities for improvement and four involved breaches of the standard of care. On October 24, 1995, at the request of Dr. Cox and Dr. Quraishi, members of the OB-GYN department, Dr. Sadler met with the Director of Risk Management of the hospital and reviewed her entire medical staff credential file, including her incident reports. The PCC met with Dr. Sadler in November 13, 1995, to review five cases. Three involved nonindicated or precipitous cesarean sections and two involved delayed responses to calls from the hospital staff. Following that review, the PCC recommended that Dr. Sadler consult with more senior practitioners for second opinions before performing cesarean sections. Dr. Quraishi, who had become the chair of the OB/GYN department, refused to rate Dr. Sadler satisfactory on the provisional evaluation of her for the period from November 1994 until April 1995, because of fourteen multiple risk management reports, five involved substantial opportunities for improvement and one involved a breach of standard of care. On August 12, 1996, Dr. Quraishi in the provisional evaluation of Dr. Sadler's performance for the period from April 1995 to October 1995, rated it as unsatisfactory.

On September 3, 1996, Dr. Quraishi, as chief of the OB/GYN department recommended to the credentials committee that Dr. Sadler's provisional status be extended for an additional six months and that her activities be "closely monitored." On October 22, 1996, the credentials committee recommended that Dr. Sadler's provisional status be extended for an additional six months with monitoring to be set by the Medical Executive Committee of the hospital ("MEC").

On November 11, 1996, the PCC met to review several of Dr. Sadler's cases. That committee discussed the cerclage⁵ procedures performed by Dr. Sadler and recommended that an Ad Hoc Committee review that performance.

The MEC, acting on the recommendation of the credentials committee, voted on November 12, 1996, to extend Dr. Sadler's provisional privileges for an additional six months due to "repeated peer review and risk management issues." An oversight committee for all departments of the medical staff also decided that day to recommend to the OB/GYN department that it retain the services of an outside consultant to review Dr. Sadler's patient care.

On December 2, 1996, certain members of the OB/GYN department met with Dr. Sadler to discuss the incident reports on her, her professional behavior and other departmental issues. At that meeting, Dr. Sadler was provided copies of all the incident reports. In reply, Dr. Sadler claimed that staff members were "out to get her" and questioned why she was being singled out. She also stated that there was a group of nurses who were against her.

Harold Fox, M.D., Professor and Chief of OB/GYN at Johns Hopkins Hospital, and George R. Huggins, M.D., Associate Director of OB/GYN at Johns Hopkins Hospital and Director at Bayview Hospital, were retained by the OB/GYN department of the hospital on April 4, 1997, to review charts of a broad spectrum of OB/GYN cases of Dr. Sadler and random charts of other members of the OB/GYN department of the hospital. Following that review, they concluded that there was "a significant opportunity for improvement in both documentation and patient management" by Dr. Sadler. They recommended in their report that Dr. Sadler be subjected to case-by-case premonitoring for surgical indications. At an emergency meeting on April 25, 1997, the MEC considered the report of Drs. Fox and Huggins, the cerclage review findings, a chronology of events, and the recommendations of the PCC and the credentials committee. Based upon that review, all members of the MEC (seventeen present), with the exception of Dr. Frederick Corder, voted not to extend Dr. Sadler's provisional privileges beyond July 27, 1997, and until that time to impose monitoring and proctoring.

Dr. Sadler was notified of the decision of the MEC on April 28, 1997, by a hand-delivered letter from Dr. David M. Goldman, the Vice President for Medical Affairs of the hospital. That letter also advised Dr. Sadler that since the action to terminate her privileges was an adverse action, she had a right to request a hearing pursuant to the provisions of the bylaws. Dr. Sadler exercised that right on May 10, 1997.

The Hearing

Article VII.A.1 of the Bylaws provides:

When any practitioner receives notice of a recommendation of the Executive Committee that, if ratified by the Board of Directors, will adversely affect his appointment to or status as a member of the Medical Staff or his right to exercise clinical privileges, he shall be entitled to a hearing before an ad hoc committee of the Medical Staff. If the recommendation of the Executive Committee following such hearing is still adverse to the affected practitioner, he shall then be entitled to an appellate review before the Board of Directors.

On May 22, 1997, Dr. Sadler was notified that a hearing would be held on June 24, 1997, before an Ad Hoc Committee ("the hearing committee") formed pursuant to the bylaws. When Dr. Sadler requested a postponement from that date, Dr. David...