Stern v. Tarrant County Hosp. Dist.

• Decision Date: 06 June 1983
• Docket Number: Civ. A. No. 4-80-281-E.
• Citation: 565 F. Supp. 1440
• Parties: Paul A. STERN, et al. v. TARRANT COUNTY HOSPITAL DISTRICT, et al.
• Court: U.S. District Court — Northern District of Texas

565 F. Supp. 1440

Paul A. STERN, et al. v. TARRANT COUNTY HOSPITAL DISTRICT, et al.

Civ. A. No. 4-80-281-E.

United States District Court, N.D. Texas, Fort Worth Division.

June 6, 1983.

James A. Williams, Bailey, Williams, Westfall, Lee & Fowler, Dallas, Tex., for plaintiffs.

Frederick M. Schattman, Asst. Dist. Atty., Tarrant County, Fort Worth, Tex., for defendants.

Alan Wilson, Law, Snakard, Brown & Gambill, Fort Worth, Tex., for George J. Luibel.

MEMORANDUM OPINION AND ORDER

MAHON, District Judge.

Plaintiffs Paul A. Stern, Lee J. Walker, C. Raymond Olson, Joel Alter and W.R. Jenkins bring this action against Defendants Tarrant County Hospital District, John Peter Smith Hospital, Harold B. Daley, Bruce K. Jacobson, George J. Luibel, Robert L. McAfee, George H. Moore, Harry A. Noah, Tim Philpot, James C. Pollard, and Julius Truelson, alleging that the denial of Plaintiffs' applications for staff membership at John Peter Smith Hospital has denied to these plaintiffs their rights and privileges under the Fifth and Fourteenth Amendments to the Constitution of the United States pursuant to 42 U.S.C. § 1983, and has violated the antitrust laws found in the Sherman and Clayton Acts. 15 U.S.C. §§ 1-7, and 15 U.S.C. §§ 12-27. Trial was to the Court without a jury. Having carefully considered the evidence presented, the argument of counsel and the supporting briefs, the Court enters the following opinion which will address: (1) Plaintiffs' Constitutional Rights, (2) Applicable Standard, (3) Case Law Background, (4) Abstention, (5) Texas Medical Practice Act, (6) Reasonableness, (7) Findings of Fact, and (8) Conclusions of Law.

I. Plaintiffs' Constitutional Rights

All of the plaintiffs are physicians duly licensed by the Board of Medical Examiners of the State of Texas and all have had two or more years of post-doctoral training in a program accredited by the American Osteopathic Association. Defendants correctly assert that in order to sustain a suit under 42 U.S.C. § 1983, a plaintiff must show the Court some right, privilege, or immunity that he claims under the Constitution. Defendants are also correct in stating that a physician has no constitutional right to the staff privileges of a hospital merely because he is licensed to practice medicine. Hayman v. City of Galveston, et al., 273 U.S. 414, 416-17, 47 S.Ct. 363, 364, 71 L.Ed. 714 (1927); Daly v. Sprague, 675 F.2d 716, 727 (5th Cir.1982); Sosa v. Board of Managers of Val Verde Memorial Hospital, 437 F.2d 173, 175 (5th Cir.1971).

However, that does not end the Court's inquiry. The Fourteenth Amendment contains an "equal protection" clause that applies to any "state action" regardless of whether the state action affects specific rights which themselves rise to a constitutional level. For example, in Meredith v. Allen County War Memorial Hospital Com'n, 397 F.2d 33 (6th Cir.1968), involving the denial of reappointment of a physician to the hospital medical staff, the Court stated:

Defendants are correct in asserting that plaintiff has no constitutional right to practice his profession at a public facility ... The constitutional requirements of due process and equal protection, however, place limitations on the manner in which one can be excluded from such practice.

Meredith at 35.

Likewise, in a case brought by Chiropractors, the Fifth Circuit noted:

We are not called on at this time to say whether chiropractors should be admitted to practice in Louisiana, but the question is whether they are entitled to an opportunity to prove that the State's denial of their claimed right to practice an allegedly useful profession is so arbitrary and unreasonable as to amount to a denial of due process or of the equal protection of the laws under the Fourteenth Amendment.

England v. Louisiana State Board of Medical Examiners, 259 F.2d 626, 627 (5th Cir. 1958).

Similarly, in Foster v. Mobile County Hospital Board, 398 F.2d 227 (5th Cir.1968), the Fifth Circuit considered the denial of admission of plaintiffs to the medical staff of the county hospital and noted:

It is not disputed by appellees that the Mobile County Hospital Board, which was created by Act No. 46 of the Alabama Legislature, and which receives both state and federal funds, is a public institution. Its acts, therefore, are state acts subject to the provisions of the Fourteenth Amendment ....

That such state action demands equal treatment of members of the same class (i.e. physicians) is a fundamental requisite of equal protection rights.

Foster at 230.

There are numerous cases in which the absence of a constitutional right to practice medicine in a public hospital has not prevented the courts from considering the physician's equal protection claims. Plaintiffs in this case have presented a similar equal protection claim which this Court will consider.

II. Applicable Standard

In its consideration of Plaintiff's equal protection claims, the Court must determine the appropriate standard to apply. The Fifth Circuit has stated:

The proper degree of judicial "scrutiny," ... is a function of two variables: first the nature of the right affected; and second, the identity of the plaintiff. If the classification "interferes with the exercise of a fundamental right or operates to the peculiar disadvantage of a suspect class," ... "strict" judicial scrutiny is then the standard of review ... Otherwise, the question is whether the classification bears "a rational relation to a legitimate state interest."

Pappanastos v. Board of Trustees, Etc., 615 F.2d 219, 220-21 (5th Cir.1980).

Plaintiffs have not shown a "fundamental right" nor have they shown they are a "suspect class," and, thus, the Court will use the "rational relation" standard to judge the classification in this case.

The rational relation standard requires an examination of whether "any state of facts reasonably may be conceived to justify" the challenged classification. McGowan v. Maryland, 366 U.S. 420, 426, 81 S.Ct. 1101, 1105, 6 L.Ed.2d 393 (1961). The Fifth Circuit, in Foster, after noting that the actions of a county hospital board are state actions demanding equal treatment of all members of the same class (of physicians) explained that "any distinction between such members must be on a reasonable basis" and "the distinctions which are drawn must in some way relate to the purpose of the classification made." Foster at 230.

These are the guidelines the Court will follow in this case.

III. Case Law Background

An examination of the case law regarding osteopaths and their admission to practice in public and private hospitals must begin with Hayman v. City of Galveston, 273 U.S. 414, 47 S.Ct. 363, 71 L.Ed. 714 (1927) in which an osteopathic physician who was a resident of Texas brought suit to enjoin the enforcement of a regulation excluding osteopaths from practicing in a municipal hospital. The Supreme Court first held that a physician does not have a constitutional right to practice his profession in a hospital maintained by a state or a political subdivision (as already noted above). Hayman at 416-17, 47 S.Ct. at 364.

Next, the Supreme Court noted that there were "numerous systems or methods of treating diseases authorized to practice in Texas" and that in the management of a hospital, a choice among those methods of treatment would be inevitable. Hayman at 417, 47 S.Ct. at 364. The choice of excluding osteopaths was found to have a "basis in the exercise of the judgment of the state board," and thus, the Supreme Court stated it could not say that the regulation was either unreasonable or arbitrary. Hayman at 417, 47 S.Ct. at 364. Finally, the Supreme Court said that the provision of the Texas Constitution declaring that "no preference shall ever be given by law to any schools of medicine," Art. XVI, § 31, Texas Constitution, applied only to the admission to practice medicine in Texas and had nothing to do with the qualifications of those who were to be allowed to practice in state hospitals. Hayman at 418, 47 S.Ct. at 364.

At first glance, this case decided in 1927, would appear to definitively resolve all of the issues which are now before the Court over 50 years later. This Court, however, must always be mindful of the basic premise that our system of law is an evolving one, uniquely adaptable to the constantly evolving society and changing world in which we live. Therefore, the Court is compelled to examine all of the evidence presented in this case to determine if such a standard is unreasonable or arbitrary under the facts as they exist today, even though such a standard may have been reasonable under the facts as they existed over 50 years ago.

This Court, in its examination of the evidence has concluded that at least two basic changes regarding the practice of osteopathic medicine in Texas have taken place since Hayman was decided in 1927. First, the evidence before the Court shows that the obvious differences which once distinguished osteopathic physicians (D.O.'s) from allopathic physicians (M.D.'s) have virtually disappeared today.

It is undisputed that today there is no substantial difference between accredited medical schools conferring "Doctor of Medicine" degrees and "Doctor of Osteopathy" degrees except that students attending the medical school conferring the "Doctor of Osteopathy" degree are required to take several courses in manipulative therapy. The only remaining difference between D.O.'s and M.D.'s has been described simply as one of philosophy.

Second, the Texas Medical Practice Act, Tex.Rev.Civ.Stat. art. 4495b (Vernon Supp. 1982-83) hereinafter called "the Act" was passed by the Texas Legislature in 1981. This Act states, among other things, that "state agencies or political subdivisions shall not differentiate solely on the basis of the academic medical degree held by a person licensed under this Act." Subchapter A, Sec. 1.02(9) (Vernon Supp.1982-83). Such an act passed by the legislature would, at the...