Opinion ID: 2570384
Heading Depth: 2
Heading Rank: 2

Heading: Did the Procedures Set Forth in the Bylaws Afford Dr. Miller Due Process?

Text: Idaho Code § 39-1395 mandates that hospitals have a process for considering applications for medical staff membership and privileges that affords each applicant due process. Due process is a flexible concept, Bradbury v. Idaho Judicial Council, 136 Idaho 63, 28 P.3d 1006 (2001), and the legislature has not specified what process it considers due in this circumstance. A common definition of procedural due process is the opportunity upon reasonable notice for a fair hearing before an impartial tribunal. See Id.; Aberdeen-Springfield Canal Co. v. Peiper, 133 Idaho 82, 982 P.2d 917 (1999); Yellowstone Pipe Line Co. v. Drummond, 77 Idaho 36, 287 P.2d 288 (1955); Abrams v. Jones, Comm'r of Dept. of Law Enforcement, 35 Idaho 532, 207 P. 724 (1922). Implicit in the requirement of a fair hearing is an understandable standard against which the applicant's qualifications can be judged, Dupont v. Idaho State Bd. of Land Comm'rs, 134 Idaho 618, 7 P.3d 1095 (2000), although the specificity required here would not be as great as is required for criminal statutes. Dr. Miller argues that the Bylaws deprived him of due process [4] in several respects. 1. Did the Bylaws provide an understandable standard? Dr. Miller argues that the Bylaws did not provide a clear, ascertainable standard against which his conduct could be measured. The two standards that he challenges are his or her cooperation with other members, patients and hospital employees and his or her disruption, if any, of hospital operations. He argues that such standards are too vague unless they are tied to patient care or safety. These two factors were included in a list ending with the statement, and other matters bearing on his or her ability and willingness to contribute to high quality patient care practices in the Hospital. This phrase could be read as indicating that the preceding factors were understood as bearing on the applicant's ability and willingness to contribute to high quality patient care practices. The Hospital appears to have so interpreted the two challenged factors. In its report, the Credentials Committee stated, The primary concerns are related to disruptive behavior, possible creation of a hostile work environment and concerns that disruptive behavior has interfered with clinical decision making/medical care. When initially recommending that Dr. Miller's application for privileges be denied, the Medical Executive Committee stated, The primary concerns relate to disruptive behavior, possible creation of a hostile work environment and concerns that the disruptive behavior has interfered with clinical decision making/medical care in the past. Dr. Miller's application was then considered by the Ad Hoc Review Committee, which also linked its negative recommendation to patient care. In its report, it concluded: The Committee believes that Dr. Miller has demonstrated disruptive behavior at all prior locations of practice. This included behavior that was contentious, threatening, unreachable, insulting and at times litigious. His inability to get along with others or to rely on others for assistance and advice often resulted in poor surgical judgment and decisions. His behavior has high potential to disrupt the medical, nursing and support staff which could lead to difficulty in these individuals to perform their respective jobs effectively. We believe that his behavior holds a significant threat to patient care at Saint Alphonsus. Dr. Miller then had a formal hearing before the Hearing Panel. It also linked its adverse recommendation to patient care. It summarized its recommendation as follows: In four different locations in approximately seven years, the Applicant has repeatedly had significant and perhaps serious problems. There appears to be a consistent inability to evaluate with insight the dynamics of his professional environment. The Panel recognizes and appreciates the positive endorsements from a variety of sources, but these endorsements are not so persuasive as to negate the findings of the Committees. In his relatively short professional life, the Applicant has demonstrated an inability to work cooperatively with others; and the Panel believes there is a likelihood that such inability would cause problems with patient care at St. Alphonsus. The Appellate Review Panel then considered the application and recommended that the Board accept the report and recommendation of the Hearing Panel. The Board did so, and made the specific finding that Dr. Miller failed to demonstrate his ability to work with others; and that the ability to work with others is an important qualification that would likely impact patient care. Thus, throughout the process, the various recommendations to deny Dr. Miller's application for medical staff privileges and the final determination to deny that application were all tied to patient care. He was on notice from the initial recommendation of the Credentials Committee through the various levels of review that the primary issue was the concern that his inability to work cooperatively with others could adversely impact patient care. The challenged factors in the Bylaws for evaluating applications were not so vague as to deny Dr. Miller due process as required by Idaho Code § 39-1395. 2. Did Dr. Miller have an impartial tribunal? The Bylaws provide that any member of the medical staff who is appointed to serve on the Hearing Panel cannot have actively participated in the consideration of the matter at any previous level. In compliance with this provision, Ms. Bruce appointed three retired physicians to serve on the Hearing Panel. The Bylaws do not prohibit, however, a physician who is in direct economic competition with an applicant from serving on the Hearing Panel. In this case, however, the three members of the Hearing Panel were all retired, so none of them was an economic competitor of Dr. Miller. Dr. Miller contends that Dr. Austin Cushman, one of the members of the Credentials Committee, was a general surgeon who was in direct economic competition with Dr. Miller and that he had allegedly made negative comments about Dr. Miller's employer Primary Health, Inc. Dr. Miller alleges that Dr. Cushman, should therefore not have served on the Credentials Committee when Dr. Miller's application for privileges was being considered. The due process hearing to which Dr. Miller was entitled was, under the Bylaws, the hearing before the Hearing Panel. The various levels of review prior to that hearing are not required in order to provide procedural due process. Dr. Miller has not presented any argument or authority supporting the proposition that such other levels of review, if provided, must comport with due process. Under the facts of this case, we need not address that issue. The vote of the Credentials Committee was unanimous, and the district court found that Dr. Cushman did not express any opinion at any time to the Credentials Committee as to whether Dr. Miller's application for privileges should be granted. Dr. Cushman did not attempt to exert any influence over the Credentials Committee's decision. Thus, even if Dr. Cushman's service on the Credentials Committee violated the statutory right to due process provided by Idaho Code § 39-1395, any such violation was harmless. Dr. Miller also points out that some members of the Credentials Committee also served on and participated in the decision of the Medical Executive Committee, that a physician who served on the Ad Hoc Review Committee also participated in the final action of the Medical Executive Committee, and that Ms. Bruce provided information to the Credentials Committee and the Board and participated in the meeting of the Medical Executive Committee where it voted to recommend against approving Dr. Miller's request for medical staff privileges. Dr. Miller does not argue, however, that any of this conduct violated either the procedural due process required by Idaho Code § 39-1395 or the Bylaws. Dr. Miller also argues that various members of the medical staff who participated in reviewing his request for medical staff privileges were motivated by bias against his employer Primary Health, Inc. The district court found to the contrary, and that finding is supported by substantial and competent evidence.