N O T FO R PUB L ICAT IO N UNITED STATES C OUR T OF APPEALS FOR THE NINTH C IR C UIT
PAC IFIC R

ADIATION ONC OLOGY, LLC , a Ha wa i ’ i lim ite d lia

bility c orporation; PRO ASSOC IATES, LLC , a Hawa i’ i lim ite d lia

bility c om pa ny ; JOHN LEDERER , M .D., individua lly and a s m an a g e r of the LLC ’ s a

ppe aring for the Pa c ific R a diation Onc ology Phy sic ia ns; LAETON PANG, M .D.; EVA B IENIEK, M .D.; VINC ENT B R OW N, M .D.; PAUL DEM ARE, M .D.; THANH HUYNH, M .D., Plaintiffs - Appe lle e s,
v. THE QUEEN’ S M EDIC AL C ENTER , a Hawa i’ i non-profit c orporation; QUEEN’ S DEVELOPM ENT C ORP., a Ha wa i’ i for profit c orporat i on; NOR

EEN D.S.W
. M OKUAU; W ILLIAM G. OB ANA, M .D.; ART HUR

A. USHIJIM A; M ARK H. YAM AKAWA; PAULA YOSHIOKA; SHARLENE K. TSUDA; R IC HARD C
. KEENE; C LINTON YEE; NALEEN M
. ANDR ADE, M .D.; ER

NEST H. FUKEDA, Jr.; R OB B OHTANI, M .D.; NEIL J. HANNAHS; C HR ISTINE M
. No. 12-15624 D.C . No. 1:12-c v-00064-LEKKSC
M EM O R ANDUM * 

# FIL ED

FEB 24 2014 M OLLY C. DW Y ER, CLERK U

. S

. CO URT O F APPEALS

* This disposition is not a ppropria te for public at ion a

nd is not pre c e de nt e xc e pt a s provide d

by 9th C ir. R . 36-3.GAYAGAS; PETER K. HANASHIR O;

R OB ER T K. NOB RIGA; ERIC K. YEAM AN; JULIA C . W O; C AR O LINE W ARD ODA; PETER

HALFOR

D, M .D.; B ARR Y W EINM AN, individually and in the ir c a pa c itie s a s Offic e rs a

n d Truste e s of Que e n’ s M e dic a l C e nte r, De fe nda

nts - Appe lla

nts. Appe a l from

the Unite d

Stat e s Distric t C ourt for the Distric t of Ha

wa ii Le slie E . Koba

y a shi, Distric t Judge , Pre siding Argue d a nd Subm itte d Oc tobe r 15, 2012 Honolulu, Ha

wa ii B e fore : REINHAR

DT, THOM AS, and PAEZ, C irc uit Judge s. The pla intiffs in this c a se are a group of ra diat ion onc o logists who ha d the i r privile ge s to pe rform

c e rta in m e dic a l proc e dure s at the Que e n ’ s M e dic a l C e nte r
re voke d whe n the M e dic a l C e nte r de c i de d to m ove to a n e m ploy m e nt-ba se d
m ode l, pe rm itting only

e m ploy e e s to useits ra diation onc ology fa c i litie s . The M e d ic a l C e nte r a

ppe a ls the distric t c ourt’ s orde r granting a pa rtia l pre l im ina

ry injunc tion tha

t pe rm its pla intiff Dr. John Le de re r, M .D. to pe rform c e rta i n proc e d ure s at the M e dic a l C e nte r’ s fa c ilitie s. W e a ffirm
. Fe de ra l jurisdic tion e x ists be c a use pla intiffs a l le ge a

Fourte e nth Am e ndm e n t
c la im a ga inst theM e d ic a l C e nte r. Although it is unc e rta in whe t he r the M e dic a l 2C e nte r qua lifie s a s a s tate a c tor for purpose s of this c la im , the que stion is not “ so

insubsta n tia l, im pla usible , fore c lose d by

prior de c isions of this C o urt, or othe rwise
c om ple t e ly de void of m e rit a s not to involve a fe de ra l c ontrove rsy .” One ida Indian N ation of N .Y. v . C nty
. of One ida , 414 U.S. 661, 666 (1974). The distric t c ourt did not a buse its disc re tion in gra

nting a pa rtia l pre l im ina ry injunc tion. Se e Pime nte l v . Dre y f us , 670 F.3d 1096, 1105 (9th C ir. 2012) (sta ting tha t re vie wof a

distric t c o urt’ s grant of a pre lim ina

ry injunc tion is for a b use of disc re tion). Unde r the gove rning W inte r sta nda rd, pla intiffs m

ust show tha t the y are “ like ly

to suc c e e d on the m e rits, tha t [the y are ] like ly

to suffe r irre pa ra ble ha rm in the a bse n c e of pre lim ina

ry re lie f, tha

t the ba l anc e of e q

uitie s tips in [the ir] favor, a

nd tha t a n injunc tion is in the

public inte re st.” W

inte r v . N atural Re s. De f. C ounc il, Inc

. , 555 U.S. 7, 20 (2008). The distric t c ourt c o rre c tly de te rm ine d tha

t pla intiffs we re like l y to suc c e e d on the ir due proc e ss c la im unde r Silv e r v . C

astle Me morial Hospital

, 497 P.2d 564 (Haw. 1972). 1 Silv e r e xpla i ne d tha t a priva te hospita l’ s de c ision to re fuse to e xte nd sta ff privile ge s to a

lic e nse d doc tor without prope r proc e dura l due proc e s s c ould

1 B e c a use we c onc lude tha

t the distric t c ourt did not a buse its disc re tion by finding a like lihood of suc c e ss on pla intiffs’ due proc e ss c la im unde r the sta

te c onstitution, we ne e d not re a c h its ruling tha t pla intiffs a

re a lso like ly

to suc c e e d on the ir unfa ir c om

pe tition c la im
. 3viola

te the Hawa ii C onstitution if tha t hospita l we re “ qua si-public .” Id. at 569-70. A priva te hospita l is “ qua si-public ” if it re c e ive s “ m o re tha n nom ina l gove rnm e nta l involve m e nt in theform

of funding.” Id. at

570. W e ta

ke judic ia l notic e of the fa c t that Ha wa ii ha s a ppropria te d the M e dic a l C e nte r $1.5 m illion to ope rate an orga

n transpla n t c e nte r. B a se d on the gove rnm e n t funding a s we ll a s the hospita l’ s historic a l tie s to the sta

t e , se e Hitev . TheQue e n’s Hospital , 36 Ha w. 250 (1942), it is like ly tha t pla intiffs will suc c e e d on the ir c la im tha t the M e dic a l C e nte r qua lifie s
a s “ qua si-public .” M ore ove r, the distric t c ourt pointe d to e vide nc e tha t the M e d ic a l C e nte r ba se d its de c i sion to re voke pla intiffs’ privile g e s, at le a st in pa rt, on “ c onc e rns a

bout thePR O phy sic ia

n s’ c om pe te nc e or qua lific ations.”The
re voc ation of privile ge s on the ba sis of “ profe ssiona l c om

pe t e nc e or c o n duc t” trigge rs due proc e ss rights under the M e dic a l C e nte r’ s by la ws, a nd, thus, plaintiffs
are l ike ly to suc c e e d on the ir c la im for de n ia l of due proc e ss unde r Silv e r . Turning to irre

p ara b l e ha rm , the distric t

c o urt did not a

buse its disc re tion by finding tha

t Le de re r is like ly

to suffe r irre pa

ra ble ha rm a s to two groups of pa tie n ts who would not be

a ble to re c e ive c e rta in ne e d e d proc e dure s unde r Le de re r’ s c are unle ss he c ould c ontinue to e x e rc ise privile ge s at the M e dic a l C e nte r. The distric t
c ourt found tha

t without a pre lim ina

ry injunc t ion, Le de re r would suffe r irre pa ra ble ha rm to re lationships with pa

tie nts a n d re fe rring phy sic ia

ns will be“ de prive d of 4the o pportunity to c om pe t e for [] pote ntia l pa

tie n ts” and “ will losec om p e titive ground in the

industry .” The s e ha

rm s a re irre pa ra ble be c a use the y c a nnot be
re m e die d by

m one y dam a ge s. Se eL.A. Me m’l C o l ise um C ommc ’n v . N

at’l Football Le ague , 634 F.2d 1197, 1202 (9th C ir.1980). Fina lly , the distric t c ourt did not a buse its disc re tion by

de te rm ining tha

t the b a la nc e of e quitie s a

nd the public inte re st fa

vor a pre lim ina

ry injunc tion be c a use c an c e r pat i e nts would be de nie d a c c e ss to Le de re r’ s le v e l of e xpe rtise for
c e rta in proc e dure s if the M e dic a l C e nte r we re not pre lim ina rily e njoine d. The distric t c o urt’ s pre lim ina

ry injunc tion is na

rrowly ta ilore d

to a void theha

rm tha t would re sult if Le de re r c ould not a c c e ss the M e d ic a l C e nte r’ s fa c ilitie s. The gran ting of this na

rrow pre lim ina

ry injunc tion wa s not a

n a buse of disc re tion.
AFFIRM E D.

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