Opinion ID: 336380
Heading Depth: 1
Heading Rank: 4

Heading: The Process Which is Due.

Text: 28 Recently the Supreme Court has enunciated the factors which are to be balanced in determining the process which is appropriate to protect a property interest. Mathews v. Eldridge, --- U.S. ----, 96 S.Ct. 893, 96 S.Ct. 893, 47 L.Ed.2d 18, 44 U.S.L.W. 4224 (1976). The court held that such a determination: 29 . . . generally requires consideration of three distinct factors: first, the private interest that will be affected by the official action; second, the risk of an erroneous deprivation of (a property) interest through the procedures used, and the probable value, if any, of additional or substitute procedural safeguards; and finally, the government's interest, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail. Id. at ----, 96 S.Ct. at 893, 47 L.Ed.2d at 33, 44 U.S.L.W. at 4229. 30 We will discuss each of these factors in the context of Dr. Stretten's situation at Wadsworth VA Hospital. The balance among these factors must be used to determine both the extent and the timing of the procedures necessary to protect Dr. Stretten's property interest in his position as a resident pathologist. 31 Dr. Stretten's interests in keeping his position are to maintain his income, to complete the residency phase of his medical education, and to protect his professional reputation. Dismissal obviously would damage the first two interests, and the imputation of incompetence would damage the third. 32 The Hospital's interest is somewhat more complex. Like any government agency it has a strong interest in being able to deal quickly and inexpensively with personnel matters in order to promote efficiency and economy in administration. But because the government agency here is a hospital and plaintiff Stretten is a professional, the employer's interest is more particularized than in the ordinary case. As a hospital the employer has a special interest in protecting its patients from treatment by one who is professionally incompetent. The survival of patients often depends upon the presence of competent physicians. The interest of the hospital in enlarging the prospects of survival of patients weighs in favor of due process procedures which will minimize the risk of the continued employment of an incompetent doctor, so long as these procedures are consistent with notions of fundamental fairness. 17 In a sense this is the reverse side of the Goldberg v. Kelly, 397 U.S. 254, 90 S.Ct. 1011, 25 L.Ed.2d 287 (1970), coin. In Goldberg the danger of lack of survival was borne by the plaintiff whose rights were terminated while here the risk is borne by the patients entrusted to the defendant's care. 33 The Hospital's interest is unusual in another respect. Dr. Stretten is a professional whose position requires that he work in close coordination with other medical personnel. A hospital staff is highly interdependent, both in the sense that one doctor depends upon the professional skill of other doctors and in the sense that the collegial nature of the body makes tolerable working relationships an absolute prerequisite to effective staff performance. The necessity for a healthy working relationship is a function of the nature of the work to be done. Incompatible workers on farms, ranches, or in certain types of factories can function reasonably well although even there it is doubtful that full efficiency is achieved. Effective performance by physicians on the staff of a hospital, whose tasks require a high degree of cooperation, concentration, creativity, and the constant exercise of professional judgment, requires a greater degree of compatibility. The Hospital must recognize this necessity. This enhances its interest in quickly dealing with incompetence and debilitating personal frictions. In emphasizing the hospital's and thus the state's interest in harmony, we hasten to assert that we are not drawing the line between professionals and non-professionals for this purpose. In fact, we believe there is no clear line, rather only a continuum along which the state's interest in expeditious settlement of such problems attenuates. 34 The final factor mentioned by the court in Mathews was the risk of an erroneous decision prejudicial to the plaintiff under the procedures employed and the probable reduction of error which might result from a more elaborate or differently timed set of procedures. In Dr. Stretten's case, staff physicians submitted written evaluations of his technical competence and his ability to get along with his colleagues to the Resident Review Board. These opinions from experienced professionals in Stretten's field were based on months of close contact. With respect to the evaluations of his competence, it is improbable that an adversary procedure would enable a resident to undermine well-formulated opinions against him. Even so, the more important, and perhaps decisive, factor is the perceived inability of Stretten to cooperate effectively with his colleagues. The collective opinion that a resident is excessively abrasive would destroy the proper operation of a collegial, functionally-integrated group. The decision-maker may give great weight to the group's opinion on this point. 18 Significantly, this perception is not easily shaken by cross-examination. 19 The procedural implications of these considerations is that a full adversary hearing is unlikely to be more useful than less elaborate procedures in revealing any flaws that would undermine the case against a terminated resident. 35 The ultimate decision-maker must have wide discretion in considering the evidence against a resident. This includes the power to attach great value to the considered opinions of the resident's colleagues. It is bound, however, not to act in bad faith or arbitrarily and capriciously. The resident's interest is important enough that he should have notice of his deficiencies, should have an opportunity to examine the evidence against him, and should be allowed to present his side of the story to the decision-maker. These procedures will insure that all relevant data are before the decision-maker and will allow the terminated resident and any reviewing court to judge whether the decision-maker acted in bad faith or arbitrarily and capriciously. A termination procedure effective for these purposes was followed in this case. We hold that due process does not require a full adversary hearing either before or after termination. 36 The only remaining question is whether the protection of Dr. Stretten's interest requires that these procedures occur prior to termination. In a case where the decision to terminate is made long before the termination date, as was true here, we see no interest of the state which is furthered by delaying the resident physician's right to examine the evidence and tell an opposing version of the story until after termination. Following such procedures prior to termination may do much, in case error is exposed, to vindicate a resident's interest in his salary, reputation as a competent professional, and his interest in uninterrupted training. 20 In this case, however, the lower court's temporary restraining order and preliminary injunction had the practical effect of making the November 7 staff meeting a pre-termination hearing. 37 We hold that Dr. Stretten's property interest was adequately protected and hence the decision on the merits of the trial court is reversed and the case dismissed. The injunction preventing termination is dissolved. 38 REVERSED.