Silverstein v. Gwinnett Hosp. Authority, Civ. A. No. C86-1413A.
| Decision Date | 30 October 1987 |
| Docket Number | Civ. A. No. C86-1413A. |
| Parties | Gary M. SILVERSTEIN, D.O., David J. Conaway, D.O., and Richard L. Lieberman, D.O. v. GWINNETT HOSPITAL AUTHORITY, Medical Staff of the Gwinnett Hospital System, Worth L. Thompson, Richard Sikes, Jeanine Gullett, Linda Burdine Price, Elwyn D. Carswell, Roy B. Payne, Sr., Ken O. Logue, B. Doug Etheridge and Lillian Webb. |
| Court | U.S. District Court — Northern District of Georgia |
Susan A. Cahoon, Kilpatrick & Cody, Atlanta, Ga., for plaintiffs.
Michael Ross, King & Spalding, Atlanta, Ga., Webb, Fowler & Tanner, Lawrenceville, Ga., Sidney Wheeler, Long, Weinberg, Ansley & Wheeler, Atlanta, Ga., for defendants.
The above-styled matter is before the court on two motions for summary judgment: one on behalf of all plaintiffs and one on behalf of all defendants. Also before the court is a motion filed by the American Osteopathic Association for leave to file a brief amicus curiae. The court grants this latter motion. Defendants' response to the motion incorporates a response to the substance of the amicus brief and thus there is no need for defendants to file any further response.
Each of the plaintiffs is an osteopathic physician (D.O.) licensed to practice medicine in the state of Georgia. The Gwinnett Hospital Authority (the "Hospital Authority") is a public corporation established pursuant to the Georgia Hospital Authorities Law, O.C.G.A. §§ 31-7-70 et seq. The Medical Staff of the Gwinnett Hospital System (the "Medical Staff") is an unincorporated association of physicians and dentists admitted to staff privileges in the Gwinnett Hospital System. The remaining nine defendants (the "Individual Defendants") are current or former members of the Hospital Authority.
Each of the plaintiffs has applied for and been denied admission to the Medical Staff. The ground for denial of each was failure to meet the "Basic Qualifications" for admission to the Medical Staff as set forth in Article III, Section 1 of the Bylaws Provisions, Rules and Regulations of the Medical Staff (the "Bylaws"). Approved by the Hospital Authority, Article III, Section 1 of the Bylaws provides in pertinent part as follows:
Plaintiffs allege that Subsection 2 discriminates against osteopathic physicians (D.O.'s) since the American Specialty Boards and the Accreditation Council for Graduate Medical Education (ACGME) are allopathic organizations.
D.O.'s and allopathic physicians (M.D.'s) are distinguished by their different medical training and philosophies. Osteopathy is a "system of therapy ... based on the theory that the body is capable of making its own remedies against disease and other toxic conditions when it is in its normal structural relationship and has favorable environmental conditions and adequate nutrition." Dorland's Illustrated Medical Dictionary 1107 (25th ed. 1974). Allopathy is "a term applied to that system of therapeutics in which diseases are treated by producing a condition incompatible with or antagonistic to the condition to be cured or alleviated." Id. at 59. Both D.O.'s and M.D.'s can be licensed to practice medicine in the state of Georgia. O.C.G.A. § 43-34-20(3).
Because of the differences in medical philosophies, there are differences in training for D.O.'s and M.D.'s. The emphasis in osteopathy on the relationship between structure and function requires osteopaths to have special skills in recognizing and correcting structural problems through manipulative therapy. To obtain their basic medical training, D.O.'s attend medical schools accredited by the American Osteopathic Association (AOA). M.D.'s, on the other hand attend schools accredited by the American Medical Association (AMA). Post-graduate training (internship and residency training) in osteopathy is obtained through AOA accredited programs and institutions, while such training in allopathy is obtained through ACGME accredited programs and institutions. The ACGME does not accredit the same programs or institutions that the AOA accredits with the exception of some post-graduate training programs sponsored by the United States Armed Services.
Following successful completion of post-graduate training, osteopaths are certified by the American Osteopathic Boards while allopaths are certified by American Specialty Boards. Persons with their basic medical education in osteopathy may obtain post-graduate training in ACGME accredited programs and become certified by an American Specialty Board. On the other hand, persons with their basic education in allopathic medicine, are not eligible to participate in AOA accredited post-graduate programs or to receive certification by any American Osteopathic Board.
Plaintiffs have all completed four years of osteopathic medical school and have completed the post-graduate work required for certification by their respective American Osteopathic Boards. Dr. Silverstein has been certified in ophthalmology by the American Osteopathic Board of Ophthalmology and Otolaryngology. Dr. Lieberman has been certified in otolaryngology/head and neck surgery and facial plastic surgery by the American Osteopathic Board of Ophthalmology and Otolaryngology. Dr. Conaway has been certified in orthopedic surgery by the American Osteopathic Board of Orthopedic Surgery.
Since none of these plaintiffs has received post-graduate training in a program approved by the ACGME or been certified by an American Specialty Board, they were all refused admission to the Medical Staff. Plaintiffs contend that the Bylaws pursuant to which they were denied admission to the Medical Staff are violative of the equal protection and due process clauses of both the Constitution of the United States and the Constitution of the State of Georgia. They also allege that the Bylaws violate Georgia's anti-discrimination statute, O.C. G.A. § 31-7-7(a). All plaintiffs and all defendants move for summary judgment on all claims.
There are no factual issues that would preclude the grant of summary judgment. Each of plaintiffs' claims in this case can be decided as a matter of law.
It is clear that the Bylaws treat physicians trained only in osteopathic medicine differently than those trained in allopathy. Since no fundamental right or suspect classification is implicated, the Bylaws in question must be presumed to be constitutional unless it appears that they are not rationally related to any legitimate state interest. City of New Orleans v. Dukes, 427 U.S. 297, 303, 96 S.Ct. 2513, 2516-17, 49 L.Ed.2d 511 (1976) (per curiam).
It is uncontroverted that there are differences between the medical philosophies and treatment strategies of M.D.'s and D.O.'s. Defendants assert that "in light of these differences between D.O.'s and M.D.'s, it is certainly rational for a hospital to treat the two groups differently in granting staff privileges, especially because hospitals are increasingly held accountable for the judgment and conduct of its medical staff." (Defendants' Brief in Support of their Motion for Summary Judgment at 25).
In support of their position defendants rely on a recent Fifth Circuit decision which is squarely on point. In Stern v. Tarrant County Hospital District, 778 F.2d 1052 (5th Cir.1985) (en banc), cert. denied, ___ U.S. ___, 106 S.Ct. 1957, 90 L.Ed.2d 365 (1986), the court held that the differences between the allopathic and osteopathic schools in their approach to medical treatment provides a rational basis for a public hospital to deny staff privileges to osteopaths who failed to meet the requirement of having two years of post-graduate training in a program accredited by the ACGME. Id. at 1061; see also Hayman v. City of Galveston, 273 U.S. 414, 47 S.Ct. 363, 71 L.Ed. 714 (1927) (); Berman v. Florida Medical Center, Inc., 600 F.2d 466 (5th Cir.1979) ().
While the court is not bound by the Fifth Circuit decision in Stern, that decision along with the Supreme Court decision in Hayman, and the former Fifth Circuit decision in Berman, compel this court to conclude that defendants' Bylaws are rationally related to legitimate governmental interests.
In an attempt to create a genuine issue of material fact requiring a trial, plaintiffs have presented the declarations of three D.O.'s each essentially concluding that the plaintiffs are as well qualified as physicians with allopathic training in their respective specialties. However, it remains uncontroverted that there are differences between the basic medical philosophies and treatment methods of osteopaths as opposed to allopaths and these differences alone are sufficient to justify the classification under attack. Stern, 778 F.2d at 1061.
Accordingly, the court grants defendants' motion for summary judgment on plaintiff's equal protection challenge under the Fourteenth Amendment to the United States Constitution. Plaintiffs' motion for summary judgment on this ground is...
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