Case Name: Harry REIFF, Psy. D., v. NORTHEAST FLORIDA STATE HOSPITAL, Appellee
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 1998-05-27
Citations: 710 So. 2d 1030
Docket Number: No. 97-377
Parties: Harry REIFF, Psy. D., v. NORTHEAST FLORIDA STATE HOSPITAL, Appellee.
Judges: DAVIS, J., concurs.
Reporter: Southern Reporter, Second Series
Volume: 710
Pages: 1030–1036

Head Matter:
Harry REIFF, Psy. D., v. NORTHEAST FLORIDA STATE HOSPITAL, Appellee.
No. 97-377.
District Court of Appeal of Florida, First District.
May 27, 1998.
M. Christopher Bryant and Kenneth G. Oertel of Oertel, Hoffman, Fernandez & Cole, P.A., Tallahassee, for Appellant.
Dennis M. Flath, Northeast Florida State Hospital, MaeClenny, for Appellee.

Opinion:
ERVIN, Judge.
Dr. Harry Reiff, a licensed psychologist and Director of Psychological Services at Northeast Florida State Hospital (NEFSH), appeals a final administrative order which dismissed his rule challenge to certain bylaws approved by the Professional Staff Organization (PSO) of NEFSH. Dr. Reiff argued that the bylaws met the definition of rule, as provided in section 120.52(16), Florida Statutes (1995); hence they were invalid in that they had not been formally adopted. We agree and reverse.
In addition, Dr. Reiff alleged in his petition that the bylaws violate section 395.0191, Florida Statutes (1995), because they exclude licensed psychologists from obtaining certain clinical privileges and rights of staff membership that they are otherwise authorized to perform under the licensing laws of chapter 490. Section 395.0191(1) prohibits licensed hospitals from discriminating against licensed health care professionals, including psychologists, when awarding clinical privileges. Because we conclude that NEFSH should have promulgated the bylaws as a rule, we do not decide whether they are discriminatory.
NEFSH is a treatment hospital for the mentally ill, most of whom are involuntarily committed under the Baker Act and some of whom are admitted as forensic patients. The PSO bylaws, applicable only to NEFSH employees, establish the privileges available to licensed health care professionals at the hospital and include privilege request forms enumerating the various privileges permitted.
Under the bylaws, only NEFSH physicians are privileged to engage in admission and discharge from the hospital, hospital policy-making, authorization of outside clinical procedures, treatment of life-threatening emergencies, and participation in emergency drills. Patients are admitted by court order, but there is an internal admitting procedure — the process of beginning the evaluation, diagnosis, and treatment of each patient — which is the exclusive province of physicians, including psychiatrists, but not psychologists. Only physicians, including psychiatrists, may be assigned as attending professionals to determine care and enter treatment orders in the patients' records. In addition, each patient is monitored by a core treatment team, which consists of a psychiatrist, nurse, social worker and mental health professional, but, once again, not a psychologist. Only a psychiatrist or other medical doctor may enter an order recommending discharge of a patient to the hospital administrator. Florida law authorizes psychologists to perform each of the responsibilities enumerated above that the PSO bylaws permit only physicians/psyehiatrists to perform.
Following the rule-challenge proceeding, the administrative law judge (ALJ) determined that Dr. Reiff did not have standing to challenge the PSO bylaws. In so ruling, the ALJ recognized that an expansion of privileges might have an impact on Dr. Reiffs right to seek a raise in salary, which Dr. Reiff testified was a possibility if he were given attending status, or might enhance his level of professional knowledge and expertise, but the ALJ rejected these as reasons to find standing. Although the bylaws limit the range of activities that Florida law permits psychologists to perform, the ALJ also concluded that this did not deprive Dr. Reiff of a property right that would constitute an injury in fact. Finally, the ALJ concluded that the limitations on psychologists' privileges are premised upon the hospital's reasonable needs; thus, they did not violate section 395.0191(1) by discriminating against psychologists as a class. Accordingly, he concluded that Dr. Reiff was not injured in fact by the hospital's right to "exercise discretion in creating job requirements by class of health care providers."
Even assuming that Dr. Reiff had established standing, the ALJ next decided that although the governing body of the hospital is an "agency" and the PSO bylaws meet the definition of "rule," as provided in section 120.52(16), Florida Statutes (1995), the bylaws constitute internal management memo-randa under subsection (16)(a) thereof, and thus are exempt from rulemaking. First, he determined that they do not affect any plan or procedure important to the public, because the issue of right to treatment is addressed by statute, whereas the bylaws in question simply detail who delivers care to the patients at NEFSH. Next, he stated that the bylaws do not affect Dr. Reiff s private interests, because they apply to classes of employees, that is, psychologists, rather than any one psychologist in particular.
We are unable to agree with any of the ALJ's holdings. In regard to the ALJ's conclusion that Dr. Reiff lacked standing, we note that a showing of an adverse effect on an economic benefit has never been considered the litmus test by which standing is determined. For example, in Coalition of Mental Health Professions v. Department of Professional Regulation, 546 So.2d 27 (Fla. 1st DCA 1989), the Coalition was denied standing to intervene in a proceeding challenging the validity of rules regulating the Coalition's members. This court stated: "The fact that [the Coalition's] members will be regulated by the proposed rules is alone sufficient to establish that their substantial interests will be affected and there is no need for further factual elaboration of how each member will be personally affected." Id. at 28. In a comparable manner, the PSO bylaws establish the clinical privileges which Dr. Reiff may exercise; thus, he is substantially affected by their implementation.
The ALJ next decided that the bylaws did not meet the definition of rule, as provided in section 120.52(16)(a). It is important to observe that the ALJ initially examined the criteria outlined under the first paragraph of section 120.52(16), and determined that the bylaws comply with the general definition of rule in that they create rights and require compliance, and have the consistent effect of law. Consequently, he concluded that the bylaws in question were self-executing, and, as such, they could not be administered through the discretion of the Medical Executive Director. The ALJ then decided that the memoranda exception of subsection (16)(a) applied. From our reading of the plain language the legislature used in creating the exception, proof of its application is established in either of two ways: by showing that the memorandum does not affect the private interests of a person, or that it does not affect the interests of the public. In our judgment, NEFSH presented insufficient evidence as to either prong.
Turning first to the ALJ's determination that the internal management memorandum exception applied because Dr. Reiffs "private interests" were not affected by the bylaws' operation as to him, the ALJ essentially reached the same conclusion as he had in deciding that Dr. Reiff lacked standing to challenge the agency's policy statements as rules. The ALJ noted that the limitations created by the bylaws were designed to affect the class of psychologists as a whole, not the private interests of any individual psychologist, such as Dr. Reiff. We decline to accept such analysis for the same reason that we rejected the ALJ's conclusion in regard to the standing issue. As we previously observed, the bylaws purport to regulate Dr. Reiffs exercise of his profession by limiting the clinical privileges which he otherwise had a legal right to perform, thereby diminishing the scope of professional duties which he was qualified to carry out by law.
Additionally, we see very little difference between the facts in the present case and those in Florida State University v. Dann, 400 So.2d 1304 (Fla. 1st DCA 1981). There, this court held that the university's document setting forth procedures for awarding its employees merit raises and other increases was invalid because it had not been promulgated as a rule, and that the internal management memorandum exception did not apply. In affirming the decision that the exception was inapplicable, we approved the following language from the order striking down the agency's policy statement: '"Although the procedure is for use internally within the University, it affects the private interest of each faculty member in the salary he or she receives for services performed for the University.'" Id. at 1305. Similarly, in the present case, the private interests of each psychologist NEFSH employs are affected by the restrictions placed on him or her to practice psychology within the confines of the hospital, a valuable property right possessed by all licensed psychologists. Cf. Florida Med. Ass'n v. Department of Prof'l Reg., 426 So.2d 1112, 1116 (Fla. 1st DCA 1983).
In next determining that the public interest was not affected by the operation of the bylaws, the ALJ emphasized the fact that the bylaws have no application outside the agency which issued them. We have found no cases that have adopted such reasoning in assessing whether an agency's policy statement comes within the internal management memoranda exception. The few cases applying the exception have done so on different grounds. For example, this court held that guidelines of the Department of Highway Safety and Motor Vehicles, which prescribed standards of physical fitness for highway patrol officers, were exempt from the strictures of rulemaking because they were not self-executing, in that they were subject to the discretion of the supervising officer. See Department of Highway Safety & Motor Vehicles v. Florida Police Benevolent Ass'n, 400 So.2d 1302 (Fla. 1st DCA 1981). Obviously, the court's discussion of the exception was immaterial to its decision in that the agency's policy statements never met the statutory definition of rule.
Thus, we have found no case to date that supports the ALJ's restrictive interpretation of the internal management memoranda exception, i.e., that no public interest is implicated because the bylaws have no effect outside the agency which issued them. Even if such were a relevant consideration, the legislature has already announced a public interest in the establishment of clinical privileges by licensed facilities, because the statute prohibits such facilities from discriminating against certain classes of health care providers, such as psychologists, in the practice of their profession. Section 395.0191(1), Florida Statutes (1995), provides:
No licensed facility, in considering and acting upon an application for staff membership or clinical privileges, shall deny the application of a qualified doctor of medicine licensed under chapter 458, a doctor of osteopathy licensed under chapter 459, a doctor of dentistry licensed under chapter 466, a doctor of podiatry licensed under chapter 461, or a psychologist licensed under chapter 190 for such staff membership or clinical privileges within the scope of his or her respective licensure solely because the applicant is licensed under any of such chapters.
(Emphasis added.)
Section 395.0191(1), adding the provision banning discriminatory practices against the class of psychologists, was included within part I of Chapter 92-289, section 11, of the Laws of Florida. The legislative purpose behind the creation of the act was expressed in the following terms:
It is the intent of the Legislature to provide for the protection of public health and safety in the establishment, construction, maintenance, and operation of hospitals and ambulatory surgical centers by providing for licensure of same and for the development, establishment, and enforcement of minimum standards with respect thereto.
§ 395.001, Fla. Stat. (1995).
Thus, in order to implement the declared legislative intent of protecting the public health and safety in the maintenance and operation of hospitals, the Florida Legislature, among other enactments, expressly forbade licensed hospitals from denying clinical privileges to certain classes of health care providers solely because of their professional status. Consequently, in deciding whether a public interest was affected by the issuance of the internal management memoranda at bar, we need look no further than the language of section 395.019(1), on which Dr. Reiff relied in his administrative challenge. As we have recognized in numerous decisions, such as Florida League of Cities, Inc. v. Department of Environmental Regulation, 603 So.2d 1363, 1370 (Fla. 1st DCA 1992); Bowling v. Department of Insurance, 394 So.2d 165, 171 (Fla. 1st DCA 1981); and Balino v. Department of Health & Rehabilitative Services, 362 So.2d 21, 24 (Fla. 1st DCA 1978), evidence "appropriate in form" may differ from one proceeding to another depending on the "nature of the issues involved." Therefore, in the case at bar, the legislature has itself supplied the evidence relating to a public interest, appropriate in form to the nature of the issues involved.
REVERSED.
DAVIS, J., concurs.
BENTON, J., dissents with opinion.
. Forensic patients may be discharged only by court order, and the court takes into consideration the report and, occasionally, the testimony of hospital psychologists.
. Or section 120.52(15), Fla. Stat. (Supp.1996).
. Section 120.52(16)(a) states:
"Rule" means each agency statement of general applicability that implements, interprets, or prescribes law or policy or describes the organization, procedure, or practice requirements of an agency and includes any form which imposes any requirement or solicits any information not specifically required by statute or by an existing rule. The term also includes the amendment or repeal of a rule. The term does not include:
(a) Internal management memoranda which do not affect either the private interests of any person or any plan or procedure important to the public and which have no application outside the agency issuing the memorandum.
.It appears from our reading of the statute that once a challenger, such as Dr. Reiff, presents sufficient proof showing that the agency's statement complied with the general definition of a rule, as found by the ALJ, the burden of producing evidence establishing that the exception applies is then placed on the agency. See § 90.302(1), Fla. Stat. (1995).
. Indeed, such a narrow construction appears contrary to the recent legislative declaration that rulemaking is the preferred means of issuing agency statements, and that such procedure "is not a matter of agency discretion." § 120.54(1), Fla. Stat. (Supp.1996).