and that's how physicians review themselves to do peer review to determine whether or not they're competent to practice medicine now you know why we have a rule is known as a  rule limited review sometimes it's misstated this rule of non review but courts are allowed to get into this matter if in fact the medical staff bylaws or not follow orders but fundamental unfairness in an issue this basically is a fun fundamental fairness issue it involves the physician they keep wanting a hospital who had his stack privileges revo now that the suspension is left a scarlet letter on his physician's hair just like a stamp tattooed in the following for the rest of his career now you're going to hear a little bit about a report similar or which is of which was a report that the hospital used as a basis for issuing the summer suspension the similar report was an unsigned document drafted by a nurse that was purported to be the findings of the same room physician but what we don't half know who we are allowed to carry out was any discovery as to whether or not those were the actual opinions of the physician or whether the physician even actually held those opinions that were used in the same report there are three cases relevant to this issue the athens supreme court case that talks about fundamental in this court's unpublished opinion survey which and then there's the locators and all of those cases talk about fundamental fairness but under the bylaws in this particular case the medical step bylaws are really the contract with how peer review happens the only avenue where the hospital could impose a summary suspension and that's an immediate suspension where you don't have any right to anything to just go in and say you're done but done your stuff and now we have to give you a hearing for that as opposed to a non summary suspension work this is the imposition doesn't start until you've you've had your right of a hearing the summary suspicion is the meat the only thing in the bylaws that go allows a summary suspension is if a physician poses imminent danger to a patient or someone on the staff fourth district case that i argued and i law was that the premis in lho was that of course the claim of imminent danger must be they sought out an opinion from the simmer report and there was an original several report the similar report was a peer review report that was drafted by this nurse and it came back and it came back showing no evidence of imminent danger or imminent threat now this this original report off or report on was hidden from the physician it was went out to get what she needed and that was the magical thing to hang your hat on to impose a summer suspension now the un the physician has a right to a fair hearing  in that physician requested it and really there isn't any debate in this issue that the bylaws were follow they say for example that the physician had a right to a file on a fair hearing within five days of his request that didn't physician had a right to a fair hearing within fifteen days of the suspension that didn't happen i would be wasting your time here if we're just talking about little technical violations that i view like  sixteen pages of material now you can timely request but the doc eight hundred sixteen pages of materials in front of the doorstep and said here here you are i go prepare for your fair hearing that show that the process was unfair now requested the fair hearing we held a fair hearing and that's where the hospital and in the physical involved physician and everybody agrees on a panel of and chose to disregard it and what they did is they said we'll tell you what we're going to restrict your privileges and they came up with this plan will will will will allow you to come back we've already suspended your privileges and that's reportable under the national practitioner databank but and we'll continue that but if you agree to this and this and this will give you your privileges back and they hang their hat on that that they say well we review process at the hospital not that the hospital the physician we request an appellate review panel i think it's important in this is really under the act in talks about can the entity can there be unfairness in the process when this case the hospital asked the physicians in the hospital bring charges against the doctor and they reviewed it and then they found no basis no no basis at all what happened dia's the hospital reduced and prosecutes the charges regardless of what the hospital physicians indicated they were the prosecuting entity when they got the favorable report back from the air here pam panel that they approved they disregarded that and then when they went to the pill review they were appealing to the very body the same people that issued the decision against him in the first place and i argue that process is fundamentally unfair and we talk about fundamental fairness a you know you know if i lose at the trial court up i wouldn't i wouldn't expect to come up here and find a trial court judge sitting here ruling on whether or not he issued the correct decision  we have to have some independence here you know the some of the things that that i view wrong with this is and i understand that there's a presumption under the law that in ministering the bodies will act in good fa but i think we says officially shown that good faith wasn't used in this for example the by laws prohibit the prosecuting in a thesis the representatives of of the physician or the representatives the hospital representatives can't participate in those deliberations while i wasn't invited to pull it participate i represented not the room but the hospital's representative mark brewer's was and he got back in closed door and we don't know what happened of course because there's no appellate record or there's no transcript of those appellate review process the process is fundamentally unfair they don't they don't deny that that occurred they're just saying that there's no proof that he intervened in a way that affected the ultimate denial of a reversal of the pelt review more all of these things to me see if you asked we've got that portions of the cyril report could come in and probably one of the biggest things that i see wrong with this is a process where you can have a nurse summarize the position the judge did not allow us at that probable to to depose the alleged offerer author of this report that just did not allow us to know that i'm clear on that when he did  denied he struck the struck the subpoena and we were not allowed to post the reviewing physician we were not allowed to depose the nurse who drafted the  report and presumably the second report that was used against him so what we were finding was a piece of paper that we couldn't cross exam i have to touch on science case i voluntarily dismissed there never been one allegation that there was a to nineteen violation or any discovery of use and i exercise our right to refile under saddle science and request a jury trial they had requested in the first case damages of twenty two thousand dollars the court took it under advisement but then signed an order saying you get one hundred thirty six add they used all that stuff all the depositions and whatnot in preparation for the second case but it was route is just a pamphlet now obviously the lower court was mad they were up sat there was this argument about we've gotten to this point did and it's going to inconvenience everybody and as they kill one person john your case as a it's i'm sorry but that sometimes happens but as long as the defended had a right to  is not supported any war in the law and it opens a whole big can of worms i think i'm about out of time five appreciate your time  issues for trial in a summer suspension pace whether the hospital substantially comply with medical staff bylaws or whether the physician can demonstrate fundamental unfairness in the process and resulting pre reason it was issued a limited see whether the bylaws were substantially complied with as it was by state law the hospital must adopt medical staff by laws that govern the relationship between the hospital and the  s provided the jury found in favor of the hospital on most issues likewise even assuming there was some fundamental fairness it was also the point of order to demonstrate some result in practice there was none corporate context that is if there is sufficient evidence presented to the board of the hospital in this case they properly deliberated they acted in good faith and they reviewed appropriate information that decision is not second guess voluntary dismissal was properly granted by the trial so the issue is not awarded costs and expenses and as you know or has very little discretion when ruling on a motion for voluntary dismissal th being sad that does not mean the court cannot have consequences to the execution or exercise a back right and that's what these cases we've cited stamford right and become but those happen in the first case right that you want to voluntarily do recognize it is important and inconvenience on the defendant any granted back burning inconvenience is not relevant to the decision or the determination whether he can exercise the right to voluntarily dismiss what it is unfettered right before trial or hearing is begun we made the argument back in january two thousand and eleven that it shouldn't be allowed to voluntarily dismiss because we had a five day preliminary injunction hearing which you for sure wasn't hearing or he meanwhile judge first enters an order shall cross against the husband for failure to pay maintenance of the husband voluntarily dismisses that proceeding goes off and we file that before another judge it's then sent back to the judge er any danger we propose to show the jury that the fair hearing panel found that the judge barred all of back the judge barnes specifically any testimony from us about imminent that's correct that's correct in a nutshell and you know that you know they said well what would it matter who we were never even given a copy data rich you know report so we never the report and that's were we said that's fundamentally unfair you can't allow the this presumption or the implication that there isn't a bad report out there and then i have not allowed us to depose that the authors or to rebuff that and and it doesn't show up because the judge refused to allow that in and and also refused to allow us to to present any evidence that that remember i've got to say i don't remember he borrowed i know that but there's there's abundant testimony about it but but but at the same kinds of court wouldn't allow us to even say what the difference was the