Opinion ID: 2570384
Heading Depth: 2
Heading Rank: 3

Heading: Did the Hospital Fail to Substantially Follow the Bylaws?

Text: 1. Did the Hospital properly consider the various factors listed in the Bylaws as a basis for determining whether or not to grant medical staff privileges? One of the factors listed in the Bylaws as a basis for determining whether to grant medical staff privileges is the applicant's current competence and clinical judgment in the treatment of his patients. Another is pertinent information concerning clinical performance obtained from staff members, peers and other sources. Dr. Miller argues that the Hospital failed to give sufficient weight to these two factors. He also contends that he was not treated equally because he is the first physician to be denied medical staff privileges by the Hospital based upon his inability to work cooperatively with others. The weight to be given the various factors is entirely within the discretion of the Hospital and is not subject to judicial review. 2. Did the Hospital fail to substantially comply with the Bylaws by not providing Dr. Adcox's notes prior to the hearing? The Bylaws provided that an applicant can request a formal hearing before a Hearing Panel when the Medical Executive Committee recommends against granting him or her medical staff privileges. The Bylaws further provided: If pertinent, all patient records or information supporting the recommendation shall be identified. This statement may be amended or added to at any time, even during the hearing so long as material is relevant to the continued appointment or Clinical Privileges of the person requesting the hearing, who shall have sufficient time to study this additional information and rebut it. By letter dated December 1, 1999, Dr. Miller's counsel requested from the Hospital's counsel, If any of the hospital's witnesses are going to be giving testimony based on notes of conversations, I think we are entitled to see those notes, as are the hearing panel members. The Hospital's counsel responded by letter dated December 3, 1999, stating: In response to your December 1, 1999 letter, I do not have any objection to notes of members of the hospital staff being admitted into evidence at the hearing provided that such individual is called to testify and testifies from his or her notes. I do not have copies of such individual's notes nor does the medical staff office. Any such notes (and assuming such notes exist) would be maintained by the individual staff members who took notes. As a result, I would propose to deal with this at the time of the hearing and not try to provide the notes to the hearing panel in advance. By letter dated December 17, 1999, Dr. Miller's counsel again requested such notes, particularly any made by Dr. Adcox, in order to prepare a response. He stated that Dr. Miller needed to know the source of several allegations in order to respond. By letter dated December 28, 1999, the Hospital's counsel responded, The notes of individual physicians who participated in telephone interviews are not intended by me to be an exhibit at the hearing. Obviously, to the extent I call a witness who will testify from notes, you will be entitled to review those notes. Dr. Adcox was the first witness called to testify when the formal hearing before the Hearing Panel commenced on January 6, 2000. As chair of the Credentials Committee, he had between May 18 and 24, 1999, telephoned various physicians who had previously worked with Dr. Miller and had made notes of those telephone calls. When he was asked to testify regarding those conversations, he requested permission to review his personal notes. At that point, a copy of the notes was given to Dr. Miller's counsel. After Dr. Adcox testified to his telephone conversation with one physician, Dr. Miller's counsel objected to anything from the notes because they had not been provided to him prior to the hearing. The hearing officer ruled that Dr. Adcox could use the notes to refresh his memory, but he could not read from them or quote them. That was a discretionary ruling of the hearing officer that is not subject to judicial review. Dr. Miller also alleges that he could not adequately prepare for the hearing without the notes. He was notified before the hearing of the reason for the denial of his application for privileges and provided with the names of those persons from whom information had been obtained. The Bylaws did not require that the expected testimony of the various witnesses be disclosed prior to the hearing. They only require the exchange of a list of the names and addresses of witnesses that a party intends to call and a list of exhibits that the party intends to introduce at the hearing. The Hospital did not offer Dr. Adcox's notes as an exhibit. The Hospital did not fail to substantially comply with the procedures set forth in the Bylaws.