Shahawy v. Harrison

• Decision Date: 27 June 1989
• Docket Number: No. 87-3408,87-3408
• Citation: 875 F.2d 1529
• Parties: , 1989-1 Trade Cases 68,644 Mahfouz El SHAHAWY, M.D., M.S., F.A.C.C. Individually and Mahfouz El Shahawy, M.D., P.A., a Florida Professional Association, Plaintiffs-Appellants, v. William T. HARRISON, Jr., Individually, F. Edwards Rushton, M.D., Individually, et al., Defendants-Appellees.
• Court: U.S. Court of Appeals — Eleventh Circuit

Page 1529

875 F.2d 1529

58 USLW 2041, 1989-1 Trade Cases 68,644

Mahfouz El SHAHAWY, M.D., M.S., F.A.C.C. Individually and Mahfouz El Shahawy, M.D., P.A., a Florida Professional Association, Plaintiffs-Appellants, v. William T. HARRISON, Jr., Individually, F. Edwards Rushton M.D., Individually, et al., Defendants-Appellees.

No. 87-3408.

United States Court of Appeals Eleventh Circuit.

June 27, 1989.

Bailey & Hunt, a Professional Ass'n, Jesse C. Jones, Stephen E. Nagin, Law Office of Stephen Nagin, Miami, Fla., for plaintiffs-appellants.

Mike Piscitelli, C. Lawrence Stagg, Dennis R. Ferguson, Stagg, Hardy & Yerrid, P.A., Tampa, Fla., James Burgess, Syprett, Meshad, Resnick & Lieb, Sarasota, Fla., for Sarasota County Hosp. Bd., Harrison, Bowman Matthews, Floyd, Rard, French and Tollerton.

Richard Garland, Dickinson, O'Riorden, Gibbons, Quale, Shields and Carlton, P.A., G. Hunter Gibbons, Claire Hamner, Sarasota, Fla., for Rushton, Carlson, Page, Sarkis, Silverstein, Stutz, Ronnuswamy, Natarajan, Mathews, Myers, Chidsey & Fleegler.

Donald W. Stanley, Marlow, Shofi, Smith, Hennen, Smith & Jenkins, Tampa, Fla., for David Bowman.

Mary Lau, Lau, Lane, Pieper & Asti, P.A., Tampa, Fla., for Delmastro.

Frank Strelec, Dart, Ford, Strelec, Spivey & Bennett, Sarasota, Fla., for C. Ted French.

Appeal from the United States District Court for the Middle District of Florida.

Before HATCHETT and EDMONDSON, Circuit Judges, and MARKEY ^*, Circuit Judge.

HATCHETT, Circuit Judge:

Antitrust, civil rights, and defamation rulings are reviewed in this case arising from a public hospital board's termination of a physician's medical staff membership and other privileges. We affirm in part and reverse in part.

I. FACTS

In November, 1982, appellants, Mahfouz El Shahawy and his medical association, brought this action against the Sarasota County Public Hospital Board, the hospital's medical review committee members, and physicians on the hospital's staff. The lawsuit resulted from the hospital board's denial of Shahawy's request for cardiac catheterization laboratory privileges, and alleged antitrust, civil rights, racketeering, and state common law violations. The district court dismissed Shahawy's original and amended complaints for failure to state federal claims for relief.

Shahawy appealed the district court's dismissal of his claims. In Shahawy v. Harrison, 778 F.2d 636 (11th Cir.1985), modified, 790 F.2d 75 (11th Cir.1986), we affirmed in part, reversed in part, and remanded the lawsuit for further consideration. In doing so, we held that Shahawy's antitrust counts sufficiently alleged that the appellees' business activities had a substantial impact on interstate commerce. Shahawy I, 778 F.2d at 641. In addition, because we found that Shahawy had no constitutionally protected property or liberty interest in cardiac catheterization laboratory privileges, we held that the district court properly dismissed Shahawy's civil rights counts. Shahawy I, 778 F.2d at 644. We also held that the district court had not abused its discretion by dismissing Shahawy's pendent state law claims. Shahawy I, 778 F.2d at 644.

Between the time of the district court's dismissal of Shahawy's original complaint and this court's ruling on appeal, the hospital board declined to renew Shahawy's medical staff privileges. Consequently, following remand, Shahawy amended his complaint to allege a denial of his constitutional rights based on the termination of his medical staff privileges, and renewed the antitrust, civil rights, RICO defamation, and state law claims.

As to the amended complaint, the district court granted the appellees' motions for summary judgment on the racketeering, section 1985, and antitrust claims (exclusion from catheterization laboratory counts). The district court denied the motions for summary judgment on Shahawy's section 1983 count based on the termination of his staff privileges. The district court also denied his state law claims for defamation and tortious interference with reasonable business expectations. Following trial, the district court directed a verdict in favor of all appellees on all counts.

On appeal, Dr. Shahawy contends that the district erred 1) by granting summary judgment in favor of the appellees on his antitrust claim; and 2) by granting the appellees' motions for directed verdicts on the civil rights and defamation claims.

II. CIVIL RIGHTS VIOLATIONS

Relying upon the medical staff bylaws, and Fla.Stat. Sec. 395.0115, Shahawy contends that he had a legitimate claim of entitlement to a continuation of medical staff privileges, and such entitlement could not be properly terminated or impaired without compliance with substantive and procedural due process. The appellees contend that the hospital board constitutes a quasi-judicial body, the members of which are entitled to absolute immunity. Alternatively, the appellees contend that Dr. Shahawy has been afforded the full panoply of procedural due process protections, and the district court properly granted a directed verdict in their favor.

We may reverse the district court's order only if we find "substantial evidence, evidence of such quality and weight that reasonable and fair-minded jurors in the exercise of impartial judgment might reach differing conclusions, [specifically conclusions] opposing the motion for directed verdict." Benson v. Coca-Cola Co., 795 F.2d 973, 975 (11th Cir.1986) (quoting Worsham v. A.H. Robins Co., 734 F.2d 676 (11th Cir.1984)). "A mere scintilla of evidence is insufficient to present a question for the jury; there must be a conflict in substantial evidence to create a jury question." Kaye v. Pawnee Constr. Co., 680 F.2d 1360 (11th Cir.1982).

As we stated in the prior appeal of this case when discussing Dr. Shahawy's civil rights claims based on the hospital board's denial of cardiac catheterization laboratory privileges, in order to have a federally-protected property interest,

[A] person clearly must have more than an abstract need or desire for it. He must have more than a unilateral expectation of it. He must, instead, have a legitimate claim of entitlement to it....

... Property interests, of course, are not created by the Constitution. Rather, they are created and their dimensions are defined by existing rules or understandings that stem from an independent source such as state law--rules or understandings that secure certain benefits and that support claims of entitlement to those benefits.

Shahawy I, 778 F.2d at 642 (quoting Board of Regents v. Roth, 408 U.S. 564, 577, 92 S.Ct. 2701, 2709, 33 L.Ed.2d 548 (1972)).

In Northeast Georgia Radiological Associates v. Tidwell, 670 F.2d 507 (5th Cir. Unit B 1982), we held that a physician had a constitutionally-protected property interest in medical staff privileges where, among other things, the medical staff's bylaws detailed an extensive procedure to be followed when corrective action against a medical staff physician was warranted. Tidwell, 670 F.2d at 511. Applying the same rationale here, we hold that Dr. Shahawy has a constitutionally-protected property interest in medical staff privileges. Here, as in Tidwell, the medical staff bylaws establish specific standards and procedures to be applied when considering the suspension, denial, or revocation of the staff privileges of any member. Our decision recognizing Dr. Shahawy's property interest is consistent with well-established precedent in this circuit which recognizes a physician's medical staff privileges as a property interest protected by the fourteenth amendment. See, e.g., Shaw v. Hospital Authority of Cobb County, 507 F.2d 625 (5th Cir.1975), aff'd on reh'g, 614 F.2d 946 (5th Cir.1980); Woodbury v. McKinnon, 447 F.2d 839 (5th Cir.1971); see also Palm Beach-Martin County Medical Center, Inc. v. Panaro, 431 So.2d 1023 (Fla.Dist.Ct.App.1983); Carida v. Holy Cross Hospital, Inc., 427 So.2d 803 (Fla.Dist.Ct.App.1983).

Having found a property interest, we now consider whether Dr. Shahawy was afforded procedural due process when medical staff privileges were terminated. It is settled that "the categories of substance and procedure are distinct." Cleveland Board of Education v. Loudermill, 470 U.S. 532, 541, 105 S.Ct. 1487, 1492, 84 L.Ed.2d 494 (1985). Although a state may elect not to confer a property interest in employment, "it may not constitutionally authorize the deprivation of such an interest, once conferred, without appropriate procedural safeguards." Arnett v. Kennedy, 416 U.S. 134, 167, 94 S.Ct. 1633, 1650, 40 L.Ed.2d 15 (1974) (Powell, J., concurring in part and concurring in result in part). In Tidwell, we stated that "[m]edical staff privileges embody such a valuable property interest that notice and hearing should be held prior to [their] termination or withdrawal, absent some extraordinary situation where a valid government or medical interest is at stake." Tidwell, 670 F.2d at 511.

A fundamental principle of procedural due process is that a person be given a pre-termination hearing prior to being deprived of any significant property interest. Boddie v. Connecticut, 401 U.S. 371, 379, 91 S.Ct. 780, 786, 28 L.Ed.2d 113 (1971). Although a pre-termination hearing is generally favored, the extensiveness of such a hearing depends upon a balancing of competing interests. Such interests as retaining gainful employment must be balanced against the governmental interest in the expeditious removal of unsatisfactory employees and the need to avoid erroneous termination decisions.

The record shows that Dr. Shahawy has been afforded the full panoply of due process protections. As the district court observed when granting the appellees' motions for directed verdicts:

As to the board hearing on October 1983 at which time the plaintiff's staff privileges were terminated, the Court finds that the plaintiff was given adequate notice of the proceeding and the matters to be considered, that the plaintiff...