Opinion ID: 500112
Heading Depth: 3
Heading Rank: 1

Heading: The Validity of the Administrative Process

Text: 18 Daly-Murphy contends that the peer review procedure established by the bylaws is invalid and in conflict with 38 U.S.C. Sec. 4110 (1982 & Supp. III 1985), which establishes a disciplinary procedure for general medical and surgical (GM & S) personnel in VA facilities. Appellees argue that the peer review is the first step of a three-step process which culminates in a section 4110 proceeding. According to the appellees, this process begins with a preliminary investigation or a peer review proceeding at the local level to determine whether to forward the case to VA headquarters in Washington, D.C. for possible action under section 4110. If this occurs, the second step consists of a Central Office Screening Committee (COSC) review to determine whether formal charges should be brought. Finally, if charges are brought, the individual may request a hearing before a section 4110 disciplinary board. 19 Under 38 U.S.C. Sec. 4115 (1982), the VA's Chief Medical Director has the authority to promulgate regulations necessary to the administration of the Department of Medicine.... These regulations are contained in the VA Personnel Manual and Department of Medicine and Surgery Supplements. The VA manual requires that hospitals meet or exceed Joint Committee of Accreditation of Hospitals (JCAH) standards; these standards, in turn, require that hospitals establish procedures, including peer review, for use in cases involving suspension of privileges. The Medical Center's bylaws, which provide for peer review followed by a final decision by the Medical Center Director, were established pursuant to the VA Manual requirement and the JCAH standards. The VA Manual also indicates that when a station head (here, Dr. Nelson, the Director of the Medical Center) requests the suspension of an employee, this request is to be referred to the COSC for screening, and to a disciplinary board if charges are brought against the individual. 20 The November 23, 1984 affidavit of Michael Sullivan, the Administrative Assistant to the Chief of Staff of the Medical Center, elaborated upon the procedure followed by the hospital, and attached as exhibits the bylaws and the only portions of the VA Manual in the record dealing with disciplinary actions. The complete manual is not contained in the record and, thus, we must rely upon the accuracy of these exhibits as being the applicable provisions of the VA Manual then in effect. The Sullivan affidavit states in paragraph 8: 21 The peer review procedures outlined in Articles VIII and IX of the Rules, Regulations and By-Laws are not disciplinary proceedings. They are the mechanism by which V.A. Medical Centers can perform investigations to determine whether to forward a particular case to the Veterans Administration in Washington, D.C. for possible institution of a letter of charges and a hearing pursuant to 38 U.S.C. Sec. 4110. To date, no disciplinary action has been taken against Dr. Murphy. She is still on full pay status. 22 This is substantiated by Article II, Section 2(4) of the bylaws, detailing the responsibilities of the medical staff. Section 2(4) provides that the staff has the responsibility [t]o recommend, consistent with established V.A. procedures, corrective actions with respect to practitioners and/or specified professional personnel, when warranted (emphasis added). It is further substantiated by Article VIII, Section 1(a), dealing with corrective actions, which states: 23 a. Whenever the activities or professional conduct of any practitioner or specified professional person with clinical/practice privileges are considered to be lower than the standards or aims of the medical staff, or are considered to be disruptive to the operations of the medical center, corrective action against such alleged individual[s] may be instituted. Such action will follow prescribed V.A. regulations relevant to disciplinary action, suspension or revocation. 24 (Emphasis added.) 25 These provisions are consistent with Chapter 8, Sections A.5.c(1) and (2) of the VA Manual, which state: 26 (1) The Medical Officer, highest in authority at the station, will assure that a thorough preliminary inquiry is conducted to obtain all of the facts prior to the official initiation of a request for proposed action, including those facts relating to the employee's view in the matter. When initiating proposed disciplinary action more severe than admonishment or reprimand, the station [head] will forward the preliminary inquiry and any pertinent comments of station officials to the Chief Medical Director for review. If the review shows that the appropriate disciplinary action should be reprimand or less, the Chief Medical Director may take the action or he may refer the matter, through the Area Medical Director, to the station [head] for action. 27 (2) When station heads request the removal, demotion, or suspension of an employee through preferment of charges, the request will be evaluated for the Chief Medical Director by a Central Office Screening Committee. The organizational structure of this committee will be similar in nature to that outlined for Disciplinary Boards in paragraph 3 of section C. The Chief Medical Director will appoint all members of the Screening Committee. No person may serve on both a Disciplinary Board and a Screening Committee in handling the same case. 28 Insofar as this bylaw procedure is utilized as the preliminary inquiry to obtain all of the facts prior to initiating the disciplinary action in accordance with 38 U.S.C. Sec. 4110 and the VA regulations promulgated thereunder, it is consistent with the statute and VA regulations. A temporary suspension while investigating the medical competence of a physician is a reasonable procedure in order to avoid endangering the lives or health of the patients. Thus, the temporary suspension of clinical privileges is a permissible step in the three-step process. A permanent suspension of clinical privileges would certainly fit within the definition of disciplinary action as contained in Chapter 8, Section A, 8A.03a. of the VA Manual attached to the Sullivan affidavit. That section states: A Disciplinary Action--Is a corrective measure or penalty action taken against an employee for cause involving inaptitude, inefficiency, or misconduct. These were, indeed, the nature of the charges against Daly-Murphy. Before any permanent disciplinary action can be taken against Daly-Murphy, the three-step process must be followed. 29 According to Chapter 8, Section A.4c of the VA Manual, only the VA Administrator has the authority to suspend, demote, or discharge employees. Field station heads such as Nelson may only request the suspension of an employee, and refer the matter to Washington for COSC screening. Id. at section A.5c(1). Because Daly-Murphy has remained on suspended-with-pay status during the pendancy of these proceedings, her suspension must be considered as temporary. This is consistent with the appellees' argument adopted by the district court that Daly-Murphy has no due process claim at this point because her administrative remedies have not been exhausted.