Court Opinion

ID: 9947248
Source: CourtListenerOpinion
Date Created: 2024-03-04 14:16:47.72977+00
Date Added: 2024-06-11T14:26:17.785536
License: Public Domain

IN THE SUPERIOR COURT OF THE VIRGIN ISLANDS
                      DIVISION OF ST THOMAS AND ST JOHN

GLENDA WRENSFORD MD                                  )     CASE NO ST 2023 CV 00399
                                                     )
                             Plaintiff               )
       vs                                            )     ACTION FOR
                                   )                       TEMPORARY RESTRAINING
VIRGIN ISLANDS GOVERNMENT HOSPITAL )                       ORDER PRELIMINARY AND
AND HEALTH FACILITIES CORPORATION  )                       PERMANENT INJUNCTION
Including Roy Lester Schneider Hospital (RLS)        )     DAMAGES
CEO TINA COMMISSIONG CMO GEORGE                      )
ROSENBERG MD Medical Executive                       )     JURY TRIAL DEMANDED
Committee (MEC) Members DENITA                       )
BOSCHULTE MD YURI PETERKIN MD                        )
LEROY STERLING MD FRANK ODLUM MD                     )
JESSICA WILSON MD and                                )
TAI HUNT CEASAR MD                                   )
                                                     )
                             Defendants              )
                                                     )

                                   Cite as 2024 VI Super 12

                                MEMORANDUM OPINION

ﬁll    THIS MATTER is before the Court on Plamtiff’s Motion for Temporary Restraining

Order and Preliminary Injunction ﬁled November 10 2023 and amended on November 15, 2023

On November 17 2023 the Court granted a Temporary Restraining Order and enjoined the

Defendants from terminating Plaintiff‘s employment

$12    The Plaintiff‘s Motion for Preliminary Injunction came on for hearing on December 5, 6,

and 7 2023 and thereaﬁer the parties ﬁled written closing arguments Having heard evidence and

considered arguments from both parties the court will grant Plaintiff‘s Motion for a Preliminary

Injunction and will enjoin the Hospital from terminating Wrensford In addition, the court will

order that Defendants place Wrensford back on payroll pending a formal investigation
Wrensford v VI Govt Hospital and Health Facilities et 21
Case No ST 2023 CV 00399                                                     Cite as 2024 VI Super 12
Memorandum Opinion
Page 2 of 33

                                                 SYNOPSIS

1B      Plaintiff Glenda Wrensford a general surgeon at the Roy Lester Schneider Hospital

(RLSH), had her employment suspended and her hospital pnvileges revoked after she did not

participate in a formal investigation following a sentinel event at the hospital ‘ Wrensford ﬁled

suit for damages and injunctive relief seeking restoration of her hospital privileges, back pay, and

compensation for uncompensated sick leave The defendants are Virgin Islands Government

Hospitals and Health Facilities Corporation (VIGHHFC) including Roy Lester Schneider

Hospital the Chief Executive Ofﬁcer and Chief Medical Ofﬁcer of RLSH and members of the

Medical Executive Commxttee The issues are whether the medical staff bylaws empowered the

president of the medical staff to suspend and/or revoke Wrensford’s clinical privileges, whether

the Hospital bylaws empowered the chief medical ofﬁcer to suspend Wrensford whether

Wrensford was afforded due process before her hospital privileges were suspended and whether

Wrensford has a property interest in her employment and hospital privileges

                                                   FACTS2

1%      Plaintiff Glenda Wrensford MD ( Plaintiff or Wrensford ) is a board certiﬁed surgeon

licensed to practice in the U S Virgin Islands Wrensford has been employed with the Roy Lester

Schneider Regional Medical Center (“Hospital” or “RLSH") as a general surgeon for over ten

years Approximately six years ago she transitioned from a contract worker to a classiﬁed

employee (of the Government of the Virgm Islands) Prior to the events described herei;

| Hospital privileges and clinical prixilege: are used interchangeably
’ The following facts are gleaned from evidence introduced during the Preliminary Injunction Hearing whxeh took
place on December 5, 6, and 7, 2023 The following persons were called as witnesses during the hearing Dr Clayton
Wheatley Iermicah Paul Lewis Dr Glenda Wrensford Vonetta Winston Lisa Williams Norman Dr George
Rosenberg Dr Denim Boschulte Dr Frank Odlum TyshelCames Dr YuriPelerkin and Dr Samantha Targhi>
Wrensford v VI Govt Hospital and Health FaCIiltleS et a1
Case No ST 2023 CV 00399                                                 Cite as 2024 VI Super 12
Memorandum Opinion
Page 3 of 33

Wrensford had not been subject tn any disciplinary action, complaints, or ﬁndings of misconduct

and was in good standing

115     On May 4 2023 Wrensford was the general surgeon on call at RLS Hospital on a regular

rotation schedule At or around 1 00 a m , the Emergency Depanment( ED ) doctor on duty called

Wrensford to come in to treat two gunshot victims and asked Wrensford to insert a leﬁ chest tube

in one patient Wrensford immediately traveled to the hospital

116     As standard practice, a CAT scan image 0f the patient was produced to verify where the

chest tube placement was necessary Relying upon this infomation and the CAT scan images

Wrensford conﬁrmed that a chest tube placement was necessary on the left side of the patient

because blood was appearing on the leﬁ side A nurse said the patient had been shot on the right

side Wrensford looked at the CAT scan images and saw blood on the left and concluded that

despite being shot on the right, the bullet must have crossed over to the left since blood appeared

on the leﬁ side of the chest However when Wrensford placed the leﬁ chest tube in the patient

she observed that the patient was not producing the expected gush of blood but only minimal

blood Wrensford was concerned and reexamined the CAT scan images at which point she realized

that the CAT scan images were inverted              appaxently by a radiology technician This inverted

placement of the images was a Sentinel Event under the Joint Commission on Accreditation of

Healthcare Organizations standards and warranted review

117     Wrensford realized that the patient needed a chest tube on the right And she immediately

inserted a tube on the right chest Aﬂer Wrensford notiﬁed the emergency room doctor ofthe error

he reviewed the original CAT scan images again and concurred the images had been inverted

Wrensford documented this error and continued to tend to the patient
Wrenstord v VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                                      Cite as 2024 VI Super 12
Memorandum Opinion
Page 4 of 33

1T8      Wrensford subsequently requested that hospital staff obtain a portable connector to connect

the left chest and right chest tubes to evacuate the blood In the meantime Wrensford provided a

temporary form of suction to stabilize the patient The patient had other serious problems

including paralysis and needed to be stabilized as soon as possible so that he could be transported

off the island for timber medical treatment

1T9      Wrensford leﬂ the hospital around 4 00 a m and returned at approximately 9 00 a m Upon

her arrival, Wrensford observed that the tubes were still not connected to suction This failure to

carry out Wrensford s instructions was very concerning to her At 10 30 a m the tubes were still

not connected Wrensford stressed to the staff the importance of the tubing as the patient could

not be transferred off the island without it The daytime ER physician who had come on duty that

morning said she was unaware of the need for tubing but would ensure it was done Wrensford left

the hospital at approximately 10 45 a m

1110    At approximately 11 45 am or noon the ER physician called Wrensford to report the

presence of a bubble in the canister attached to the chest tube Wrensford directed her to check the

chest tube and Wrensford called Denita Boschulte MD President of the RLSH Medical Staff

(“Boschulte”)3, to report a delay and lack of urgency in the Emergency Department in attaching

the connector which was preventing the tube from suctioning The ChiefMedical Ofﬁcer George

Rosenberg MD( Rosenberg ) was out of the ofﬁce when the incident occurred Thus Wrensford

reported her concerns to Boschulte            as she was the acting Chief Medical Ofﬁcer during this

time The ER physician called Wrensford again and told Wrensford she needed to return to the

I The pleadings have various spellings ofthe sumame of the President ofthe Medical Staff But for purposes of
uniformity the court will only use the correct spelling Boschulte
Wrensford V VI Govt Hospital and Health Facilities et 31
Case No ST 2023 CV 00399                                                Cite as 2024 VI Super 12
Memorandum Opinion
Page 5 cf33

hospital because every time the hospital staff attempted to connect the left side suction the patient

 would scream out and holler in pain         Wrensford told the ER doctor that pain would be expected

but it would only last for 30 seconds and then the patient would be okay

ﬁll     At some point the ER physician contacted Yuri Peterkin MD ( Peterkin ) a radiologist

and the chief of radiology at RLSH to relay the same concerns she had expressed to Wrensford

Based on this phone call Peterkin recommended an additional CAT scan of the patient 5 chest to

help further identify the problem At approximately 4 00 p m Peterkin called Wrensford to read

her the report ofthe new CAT scan He said the images depicted fluid or substance in the lungs

and the leﬁ tube was in the left thoracic cav1ty and likely high

ll 12   Peterkin later received another call from the ER physician inquiring whether Wrensford

would be returning to the hospital Peterkin could not give a deﬁnitive answer as to whether

Wrensford would return

ﬁll:    When Wrensford did not immediately return to the hospital the ER called Frank Odlum,

MD ( Odlum ) the Chief of Surgery at RLSH and Wrenstm’d S immediate supervisor Odlum

estimates he was called at approximately 3 00 or 4 00 p m           and he arrived at the hospital at

approximately 5 30 p m aﬁer he was ﬁnished with his office patients (Jan his arrival Odlum

found the patient stable and not in any distress Odlum troubleshooted the patient and ensured that

everything was appropriately set up he moved the tubes from the portable suction and connected

them to wall suction Odlum described the patient as ﬁne and not suffering any discomfort Since

the contact with the patient was so minimal, Odlum did not record any of this in the patient chart
Wrensford V VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                                            Cite as 2024 VI Super 12
Memorandum Opinion
Page 5 of33

1H4      Unaware Odlum had been called to the hospital Wrensford returned to the hospital at

approximately 7 00 p m to check on the patient and observed the chest tubes had been properly

connected and suctioned

$5       The following day on May 5, 2023, several medical staff, including Wrensford, attended

a Rout Cause Analysis Meeting ( RCA ) to discuss the events of May 4 At least eight persons,

including Wrensford, attended the RCA Generally, an RCA is conducted shortly after a sentinel

event at the hospital A An RCA is a collaborative event that is typically conducted to help the

hospital staff prevent another similar event incorporate helpful solutions moving forward and is

not punitive or cast blame During the RCA, Wrensford explained the events of the previous day

However, the meeting, in Wrensford’s words and unrebutted, became a ‘ free for all ’ where at least

two attendees repeatedly yelled at Wrensford that she did not immediately return to the hospital

when called That action caused Wrensford to conclude that her concerns regarding the inverted

images the inability to timely locate the requested medical equipment and the failure to properly

connect the tubes were not being properly considered nor appropriately addressed 5

$116     Following the RCA on May 15 2023 Boschulte sent a formal letter to Wrensford to set

up a professional peer review meeting which is standard in the medical industry “ The letter

outlined that the Medical Executive Committee ( MEC ) determined that a collegial intervention

as permitted under the Medical Staffolaws Article VI Part A Sections 1 1 3 1 was appropriate

to address the placement of a chest tube on the incorrect side of a patient and to address

‘ A sentinel e\ em 15 an event so out of the norm that it warrants Ihe medical staffexaminmg the event and what steps
to take next to prevent n The parties stipulated that the placement of tubes on the wrong side of a patient is a sentinel

?‘sgtfonnal minute: were provided after the meetmg
5 Pl 5 Ex No 10
Wrensford v VI (3th Hospital and Health Facilities et 31
Case No ST 2023 CV 00399                                                  CHE as 2024 VI Super 12
Memorandum Opinion
Page 7 cm:

Wrensford s refusal to respond to the ED physician 5 request to re evaluate the patient after

expression of serious concems for the patient’s wellbeing 7

ﬁll 7   On the morning of May 22 2023 Wrensford Boschulte and Peterkin arrived to attend the

peer review meeting Wrensford inquired about having an administration employee present at the

meeting to keep minutes Boschulte and Peterkin responded that recording or keeping minutes is

not standard practice Upon hearing n0 minutes were going to be created, Wrensford inquired

whether anyone would be taking notes and producing minutes for the meeting Boschulte again

stated that no one would be present to take formal minute meeting notes However, Boschulte

offered Wrensford the opponunity to record the meeting on her phone and then produce formal

minutes from the recording Dr Wrensford declined this offer since it would not be ofﬁcial minutes

because she was aware that the results at a collegial intervention could be placed in a physician’s

personnel ﬁle Wrensford informed Boschulte and Peterkin she would only participate when

someone was present to take ofﬁcial minutes, and Wrensford leﬁ the meeting The gathering was

over in less than 2 minutes

108     Subsequently on or about June 2 2023 the Chief Medical Ofﬁcer ( CMO ) of the

hospital George Rosenberg MD and Odlum met with Wrensford as the CMO wanted to sit and

chat with Wrensford to hear her perspective about the events of May 4 so he could better

understand what had occurred Rosenberg was unaware an RCA meeting had already taken place

Wrensford described to Rosenberg the lopsided tenor of the RCA meeting And instead of a chat

with Rosenberg about the events of May 4 Wrensford expressed to him that she would prefer to

pull the patient’s record and chart and provide a written synopsis Rosenberg agreed, and

7 The meeting was originally scheduled for May 19 2023 but moved to May 22 2023
Wrensford v VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                              Cite as 2024 VI Super 12
Memorandum Opinion
Page 8 MM

Wrensford promised to submit her report the following Monday Rosenberg responded that he was

okay with a written Version and asked that Wrensford submit the report by midweek

1119    But on June 8 2023 Boschulte wrote to Wrensford, recapping the failure to conduct a

proper collegial meeting on May 22              noting concerns about Wrensford s ability to work

harmoniously with others and stated that aﬁer consultation with Rosenberg and Dr Olivacce

Chief of Nursing and in keeping with Wrensford 5 request for a more formal process, the MEC

had decided to initiate a formal investigation pursuant to Article VI, Part B, Section 2A of the

Medical Staff Bylaws 8 The letter also stated that a three person ad hoc investigating committee

would be appointed to conduct the formal investigation Boschulte 3 letter explained that under

the SRMC Medical Staff Bylaws one person is appointed by the MEC one person is appointed

by the Chief Medical Ofﬁcer (“CMO ’), and one person is appointed by the person being

investigated     in this case, Wrensford The Medical Bylaws provide that once all members are

appointed to the ad hoc committee, the investigating committee is expected to complete and issue

a report within thirty days           Pursuant to the Medical Staff Bylaws         the ﬁndings and

recommendations of the ad hoe committee are then sent to the Board through the CMO tor a ﬁnal

decision on whether to accept the committee s proposal ° Boschulte concluded the letter by giving

Wrensford a deadline of June 16, 2023, to submit a recommendation for a committee member

Wrensford testiﬁed that she was happy to receive this letter and the fomial investigation because

it would end the informality of meetings without minutes Given that the MEC was initiating a

8P1 EX 3
9 SRMC Medical Staff Bylaws Article VI Part B Section 4 Pl 5 Ex 3
Wrensford v VI Govt Hospital and Health Facllltles et 31
Case No ST 2023 CV 00399                                                      Cite as 2024 VI Super 12
Memorandum Opinion
Page 9 0f33

formal investigation and the letter said they had consulted with Rosenberg Wrensford believed

delivering the written report to Rosenberg was no longer necessary

$0      The portion of the Medical Staff Bylaws that provides for the formal investigation and a

three person ad hoc committee states that the ad hoc committee shall not include partners

associates or relatives or competitors of the Member being investigated, but it may include persons

not on the Medical Staff 10 Wrensford could not ﬁnd a professional to appoint to the ad hoc

committee who possessed similar subject matter knowledge and expedence in responding to

trauma in the emergency mom who was not her partner, associate, relative, or competitor On June

16 Wrensford emailed Boschulte communicating the difﬁculty Wrensford was experiencing in

appointing a member to the ad hoc committee by the requested deadline Wrenstord instead

requested that an external review be conducted to ensure a comprehensive objective analysis

Her request for an extemal review arose from concems that any internal investigation would not

be free ofbias

1121    Before the ad hoc committee was formed, Wrensford received a letter from Rosenberg

placing her on an eight week suspension '1 The letter stated that not having received Wrensford’s

report, Rosenberg was left with no choice but to base his evaluation on the accounts provided to

him by the other physicians and nurses who cared for the patient on May 4 The letter said that

Wrensford 5 failure to return to the hospital constituted patient abandonment and her lack of

responsiveness to the call for help from the ER physician was an abdication of her duty that

subjected her to discipline He concluded by saying that due to “your unacceptable patient care,

1" SRMC Medical Staffolaws Article VI Part3 Section 3(3) Pl Ex 3
“ Rosenberg 5 letter was dated June 16 and delivered on June 20, 2023 P1 Ex 10 The letter states the suspension
was approved by the Chief Executive Ofﬁcer ofRLSH
Wrensford v VI Govt Hospital and Health Facilities at 21
Case No ST 2023 CV 00399                                              Cite a: 2024 VI Super 12
Memorandum Opinion
Page 10 of 33

lack of collegiality and insubordination I am suspending you for a period of eight weeks without

pay ” The elght week suspension without pay began effective immediately and was set to end on

August 13, 2023 Through her union Wrensford ﬁled a union gnevance to challenge the

suspension as she had not received any advance notice that failure to submit a written report would

result in a suspension 1’

ﬁl22    The day aﬂer Wrensford received notice of an eight week suspension Boschulte emailed

Wrensford to follow up on Wrensford s duty to name a representatix e to the ad hoc committee and

extended the deadline to June 23, 2023, for Wrensford to name someone to the ad hoc committee

Boschulte further stated that if Wrensford failed to meet the deadline 21 member would be

appointed for her Boschulte clariﬁed that the investigation would not address Wrensford 5

technical abilities as a surgeon but would be limited to Wrensford 5 response to the hospital staff‘s

request for Wrensford to return to the emergency room Boschulte suggested Wrensford consider

someone in the surgical/teehnical ﬁeld, such as ophthalmology orthopedics or urology 0r one

from any other medical ﬁeld '3

1123    Wrensford replied to Boschulte by stating that her request for an external review still stands

because of bias concerns since she had already been suspended Wrensford did not appoint any

professional to the ad hoc committee by the June 23 deadline nor later But the MEC dtd not

appoint anyone to the committee on Wrensford s behalf Nor did the MEC formal investigation

occur as the MEC determined that the Medical Bylaws did not give the MEC the authority to

appoint a member to the ad hoc committee on Wrenstord s behalf

‘7 The grievance remains pending
u Plaintiff’s Ex N0 14
Wrensford V VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                                         Cite as 2024 V1 Super 12
Memorandum Opinion
Page 1 1 of 33

$124     On August 3 2023, Boschulte sent a formal letter to Wrensford to advise her the medical

staff denied the request for an external review because the Bylaws require a member ﬁrst be

appointed to the ad hoc committee, and then the ad hoc committee could initiate an external review

The letter further stated that because of Wrensford 5 failure to nominate a member to the ad hoc

committee, her hospital privileges were Voluntarily suspended pursuant to the Medical Staff

Bylaws Article VI, Part D, Section 3 14 Suspension of Wrensford’s hospital privileges meant that

she could not treat patients at the hospital 15 And Wrensford was thus unable to work at RLSH

$125     On September 14 2023 Rosenberg requested that Wrensford provide notice regarding the

date she intended to return to work “" She did not respond

ﬂ26      On October 2 2023 Rosenberg wrote to Wrensford stating that the delay in providing her

retum to work date was untenable and gave her seven days to return but two days to give notice of

her return date, failing which she would be subject to dismissal under Administrative Rules and

Regulations Section 10 6 Item 21 17 On October 3, 2023, Wrensford submitted a letter from her

physician which stated Wrensford was under his care unable to return to work at that time and

would be reevaluated on November 2 2023 Wrensford sent this letter to HR Dr Odlum and

several others, but she received no response to the letter

1127     On November 3, 2023, Wrensford’s physician sent a letter to RLS hospital stating she was

cleared to return to work on Monday November 6 2023 On November 14 the Chief Executive

N Plaintiff‘s Ex No 16
‘5 Wrensford was not paid during the suspension period, not even for sick leave after the suspenuon period had
expired Defendants contend that Wrensford did not complete the necessary leave slip for sick leave Ho“ ever the
sick leave Issue IS one of damages therefore, the court need not address it in this opinion determining ifpreliminary
injunction should be granted
‘5 P1 5 Ex 19
'7 Pl 5 Ex 20
Wrensford \ V1 Govt Hospital and Health Facilities et 31
Case No ST 2023 CV 00399                                             Cue as 2024 VI Super 12
Memorandum Opinion
Page 12 of33

Ofﬁcer for RLS Tina Comissiong Esq MFA ( Comissiong ) sent a letter to Wrensford stating

that she was scheduled to resume on call work as a general surgeen on November 20 2023 on the

condition that active medical staff privileges were in place Comissiong 5 letter further stated that

failure to have active medical staff priv11eges by the November 20 return date meant Wrensford’s

employment would be permanently terminated

1128    On November 17 2023 Boschulte wrote to Wrensford to advise her that her failure to

appoint a member to the ad hoe investigating committee resulted in her automatic resignation from

the Medical Staff ‘8 Before the deadline in Comissiong 5 letter lapsed, Wrensford ﬁled this lawsuit

on November 10 2023 seeking a Temporary Restraining Order Injunctive Relief and Damages

1129    The Court granted the Motion for TRO in part prohibiting the Hospital from terminating

Wrensford and an evidentiary hearing on the Motion for Preliminary Injunction was held on

December 5 6, and 7, 2023 Both parties requested an opportunity to ﬁle written closing arguments

and agreed to the extension of the temporary restraining order to accommodate that brieﬁng

schedule

                             STATUTORY STRUCTURE OF RLS HOSPITAL

                          AND ASSOCIATED BYLAWS AND REGULATIONS

1130    Defendant Virgin Islands Government Hospitals and Health Facilities Corporation

(VIGHHFC) is a public entity that has jurisdiction over the territory’s hospitals including RLSH

and all personnel and equlpment associated therewith V I C 19 § 245(a) and (c) VIGHHFC has

a duty to “maintain a system of personnel administration based on merit princip1es, equal

opportunity and treatment and scientiﬁc methods governing the appointment, promotion transfer

'3 Pl EX 2)
Wrensford V VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                                    C118 as 2024 VI Super 12
Memorandum Opinion
Page 13 of 33

layoff removal and discipline of hospital ofﬁcers and employees ’ 19 V I C § 245(e)(1) The

Chief Executive Ofﬁcer ofRLSH “shall appoint and remove all managerial personnel, health care

providers and all other professional and nonprofessional personnel subject to the provisions of

Title 3,      Section 530 relating to procedures for employee dismissals demotion: and suspensions

        19 V I C § 244a(a)(b) And Section 530 of Title 3 provides that before the Hospital can

dismiss, demote or suspend a regular employee the CEO must ﬁrst ﬁlmish the employee with a

written statement of the charges against the employee

$131       In addition, VIGHHFC has a duty to “comply with the laws, rules and regulations, and

procedures of the Government of the Virgin Islands as appIicable and most particularly with

respect to employees and abide by collective bargaining agreements applicable to the Govemment

employees subject to supervision by the corporation         19 V I C § 246(c) Further VIGI-IHFC shall

       have those powers and duties expressly provided by law and no others            19 V I C § 243

1132       The MedicaI Staff at RLS Hospital is organized under the St Thomas & St John District

Governing Board ofthe V I Govemment Hospitals and Health Facilities Corporation (“Board ’),'9

as authorized by 19 V I C §§ 244(c) and 245(c)(3)

1133       Three different sets ofolaws for RLS Hospital are implicated and discussed in the instant

case By Laws, Rules and Regulations of the St Thomas St John District Governing Board The

Virgin Islands Govemment Hospital and Health Facilities Corporation (P1 5 Ex 1) Human

Resource Department Administrative Policy and Procedure Manual (Pl 5 Ex 2) and Schneider

Regional Medical Center Medical Staffolaws (Pl 5 Ex 3)

" Pl 5 Ex 3 Page 5 Medical Staff Bylaws Preamble Pg 5      [T]he medical staffis a component of the hospital
corporation and must work with and 1.5 subjeu ta 1h; ulzzmme aulhomy 9/”th Board ofDWecmr:       ”) (alterauon
m ongsz) (emphasis added)
Wrensford v VI Govt Hospital and Health Facilities at 21
Case No ST 2023 CV 00399                                                Cite as 2024 VI Super 12
Memorandum Opinion
Page 14 of33

                                               DISCUSSION

       A Motion for Preliminary Injunction

1134      Virgin Islands Rule of Civil Procedure 65 provides the legal standard for a ruling on a

preliminary injunction When deciding whether to grant or deny a preliminary injunction, Virgin

Islands courts shall consider the fallowing four factors

          ( 1) whether the movant has shown a reasonable probability of success on the
          merits, (2) whether the movant will be irreparany injured by denial of the relief;
          (3) whether granting preliminary relief will result in e\ en greater harm to the
          nonmoving party; and (4) whether granting the preliminary relief will be in the
          public interest
Yusufv Hunted 59 V I 841 847 (V I 2013) (citing Petrus \ Queen Charlotte Hotel Corp 56

V1 548 554 (V I 2012) (quoting Iles \ tie Jongh 638 F 3d 169 172 (3d Cir 2011)) A

preliminary injunction is an extraordinary and drastic remedy and is never awarded as of right

but only ‘upon a clear showing that the plaintiffis entitled to such relief ’” Basszl v Klein, 75 V I

19 27 (V I Super Ct 2021) (citing Yusuf, 59 V I at 847 (quoting Mzmqfv Germ 553 U S 674

689 90 (2008))

1135      The courts shall apply a variation of the sliding scale test       when analyzing the four

preliminary injunction factors 3RC & Co v Boynes Trucking Sys 63 VI 544 553 (VI 2015)

(citing SBRMCOA LLC v Morehouse Real Estate luvs LLC 62 VI 168 186 (VI Super Ct

2015)) Under the sliding scale approach no single factor is dispositiVe 3RC & Ca               63 VI at

544
Wrensford V VI Govt Hospital and Health Facilities et 31
Case No ST 2023 CV 00399                                            Cite as 2024 VI Super 12
Memorandum Opinion
Page 15 0133

        1    Reasonable Probability DfSuccess 0n the Merits

1136    A reasonable probability of success on the merits is shown if a party demonstrates ‘ a

reasonable chance, or probability, of winning ” Yusuﬂ 59 V I at 849 (citing Singer Mgmt

Consultants Inc v Mtlgram 650 F 3d 223 229 (3d Cir 2011)) The movant 0f the preliminary

inj unction need only show that success on the merits is more likely than not rather than whether

it will actually prevail on the merits Id Although a jury will ultimately determine the factual

issues presented in the case," the Court shall make a ﬁnding of fact when considering a preliminary

injunction Bum! 75 VI at 28 (citing Yusuf 59 VI at 85;) The burden is on the movant to

provide evidence supporting each element of the cause of action Advanced Surgical v Cmtron,

2017 V1 Lexis 63 * 31 (VI Super Ct 2017) (citing Purine” \ Carter 621 F 2d 578 583 (3d

Cir 1980))
$137    Courts shall consider the movant s likelihood of success on the merits in conjunction with

the claim of injury 305511 75 V 1 at 28 (see 3RC & C0 63 V I at 555 (quoting Commonwealth

v Cmy of Suﬂolk 383 Mass 286 418 N E 2d 1234 1235 (1981)) In certain cases courts can

permit a preliminary injunctian if a moving party demonstrates a strong probability of success on

the merits even if the irreparable harm factor is less sound Balm] 75 V I 3128 29 By extension

a court may also conduct a similar evaluation if the risk of irreparable harm to moving party is

substantial and the likelihood ofsuccess on the merits may be weaker Id (citing 3RC & Ca 63

V I at 556 (citingD C v Greene 806 A 2d 216 223 (D C 2002))
Wrensford v VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                            Cite as 2024 VI Super 12
Memorandum Optmon
Page 16 of 33

        i         Violation of Hospital Bylaws

1138    Relying on the Board of Director Bylaws Wrensford argues that the President of the

Medical Staff did not have the authority to revoke Wrensford 5 hospital privileges as the MEC s

authority is limited by the Board 5 Bylaws Wrensford asserts that the President of the MEC acted

outside the scope of authority in revoking Wrensford 3 hospital privileges and terminating her

Medical Staff appointment Without ﬁrst making a recommendation to the Board

            The bylaws 0f the Hospital speciﬁcally state,

            While the Board shall delegate to the Medical Staff the authority to evaluate the
        professional competence ofits member physicians and dentist       It shall hold the Medzcal
        Staff responstblc for making recommendatzans to the Board concerning mum] staff
        appamtments reappamfmertts and the grammg curtailment suspension or revocatzon

        clzmcalprzvzlegcs ”
(alteration in original) (emphasis added) 70

1139    The Hospital 5 bylaws further state

            Refusal Termination or Suspension of Appointment to the Medical Staff or Privileges
        thereon Consistent with the foregoing provisions any appointment to the Medical Staff
        may be terminated and any clinical privileges accorded to members of the Medical Staff
        may be curtailed or revoked by the Board prior to the expirations of the period for which
        such appointment was made or such clinical privileges granted 7'

1T40    In addition Plaintiff argues that the bylaws do not provide for the voluntary suspension of

clinical pnvileges fur the failure to appoint someone t0 the ad hoe committee not even by the

 0 Article IV Section 501) P1 EX ! PageS
" Article XI Section 807) P1 Ex 1 Page 31
Wrensford v VI Govt Hospital and Health FaCIlltleS et al
Case No ST 2023 CV 00399                                             Cue as 2024 VI Super 12
Memorandum 0mm“
Page 17 of 33

Board In suspending Wrensford’s Clinical pnvileges, the President of the Medical Staff relied

upon Article VI Part D Section 3 0f the Medical Staff Bylaws That section provides

        “If at any time a Member fails to pmvide requested infomation pertaining to patient
        care issues, peer review activities, and/or qualiﬁcations for appointment or
        maintaining Clinical Privileges (including but not limited to information related to
        automatic relinquishment of privileges and/or physical or mental examination
        reports as speciﬁed elsewhere) pursuant to a fon‘nal request by the Credential
        Committee the MEC the Board any other committee engaged in peer review or
        the Chief Medical Ofﬁcer the Member 5 Clinical Privileges shall be deemed to be
        voluntarily suspended until the required information is provided to the satisfaction
        of the requesting party ’72
WI      However that section falls in a category that addresses failure to complete medical records

or utilize electronic medical records, loss of medical license, 1055 cf member’s DEA controlled

substance authorization, failure to comply with the medical malpractice insurance coverage, and

professional liability and/or a criminal conviction The court ﬁnds that nothing within Article IV,

Part D is pertinent to failing to name a member to an ad hoc committee as failing to name someone

to an ad hoc committee cannot be deemed a failure to provide requested information for any of the

identiﬁed subject matters

1142    The Hospital Bylaws do not grant the MEC or its president the authority to suspend the

physician 3 medical privileges for failing to name a person to the ad hoc committee Moreover,

the court ﬁnds that nothing within any ofthe Bylaws grants the president ofthe Medical Staff the

authority to suspend a physician’s clinical privileges

  Pl Ex 3 Page 34
Wrensford V VI Go»! Hospltal and Health Facilities et a1
Case No ST 2023 CV 00399                                                 Cue as 2024 VI Super 12
Memorandum 01mm“
Pa e 18 0t 33

1T4}    Wrensford 5 Notiﬁcation of Personnel Action ( NOPA ) was signed by RLSH 5 Chief

Executive Ofﬁcer, Chief Financial Ofﬁcer, and Director of Human Resources 73 In addition,

Wrensford 5 August 30 2013 employment offer was signed by both the Intenm Chief Executive

Ofﬁcer and the Chairperson of Schnieder Regional Medical Center Board of Tmstees 2‘ Finally

Wrensford s biennial re appointment to the medical staff was approved by the Chairperson of the

Hospital Board of Trustees, the Chairperson of the Credential Committee, and the Chairperson of

the Executive Committee 75 The language in the Bylaws coupled with the evidence relating to

Wrensford s      hiring    process     and     re appointment   credentialing   approval     leads   the

court to arrive at the conclusion that, similar to the hiring authority, the authority to revoke clinical

privileges and staff appointments is not within the control of the MEC President

1144    Although the Hospital began the formal investigatory process whereby a physician 5

privileges or staff appointment can be revoked, the MEC was only responsible for making a

recommendation to the Board tor a ﬁnal decision Based upon the foregoing Wrensford has

demonstrated a reasonable probability of success in her claim that the President of the MEC acted

without lawful authority in suspending Wrensford’s clinical privileges

1145    Moreover the Medical Staff Bylaws that provide for the ad hoc committee state the

committee should consist of three persons Thus, the reference to a three person committee was

not mandatory Therefore, when Wrensford did not name someone to the ad hoc committee, the

committee of two had the right to consider the matter and proceed in accordance with the bylaws

3 Pl 5 Ex 6
‘ Pl 5 Ex 5
5 Pl : Ex 30
Wrensford v VI Gen Hospital and Health Facilities et 31
Case No ST 2023 CV 00399                                               Cite as 2024 VI Super 12
Memorandum Opinion
Page 19 of 33

$6      The November 17 2023 letter from the president of the medical staff advising Wrensford

that her appointment on the Medical Staff was automatically suspended for failing to appoint

someone to the ad hoc committee“ was similarly issued without authority The letter cited

Medical Staff Bylaws Article VI Part D Section 2D which provides that at the conclusion of the

investigation the MEC has several different actions it may recommend, including the reduction or

restriction of clinical privileges or that clinical privileges be suspended for a term It also provides

that the MEC could recommend that medical staff appointment and/or clinical pnvileges be

revoked (emphasis added) 77 Those Medical Staff Bylaws also state that any recommendation by

the MEC that would entitle the member to request a hearing shall be forwarded t0 the CMO who

shall give notiﬁcation to the employee, and then the CMO shall forward the matter to the Board

with a recommendation and all supporting information 23 So, not only did the president of the

medical staff not have authority to voluntarily suspend, she did not have authority to automatically

suspend Wrensford’s clinical pnvileges 7"

1H7     The parties presented no evidence that even suggests the MEC made a recommendation to

the Board nor adxised the Board that Wrensford 5 hospital privileges were voluntarily suspended

and that Wrensford was deemed to have automatically resigned her appointment to the medical

staff Therefore Wrensford has demonstrated that she has a reasonable degree of success in her

claim that the MEC violated the Hospital Bylaws by independently suspending Wrensford’s

pnvileges and membership on the Medical Staff

5 Pl 3 EX 25
 7 Pl EX 3
7“ Medical Staff Bylaws Article VI Part B Section MC)
° Medical Staff Bylaws Article VI Part B Section 4(1))
Wrensford v VI Govt Hospital and Health Faculties et a1
Case No ST 2023 CV 00399                                             Cite as 2024 V1 Super 12
Memorandum Opinion
Page 20 0f 33

        ii       Due Process

1148    The Due Process Clause of the Fourteenth Amendment prohibits government interference

in an individual's property interests without due process of the law U S CONST amend XIV The

Due Process Clause is made applicable to the Virgin Islands pursuant to § 3 ofthe Revised Organic

Act Richards v People 53 V I 379 384 n 2 (V I 2010) (citing Revised Organic Act0f1954 §

3 48USC §1561)

1H9     In considering a procedural due process claim the plaintiffmust show (1) he was depnved

of an individual interest that is encompassed within the Fourteenth Amendment's protection oflife,

liberty or property and (2) the procedures available to him did not provide due process of law

[les 638 F 3d at 173 Defendants argue there is no constitutional guarantee of an established right

to continued employment However, detemining “whether an employee has a propeny right in

continued employment is a question of state [or territorial] law ” George: » Gav t of the VIrgm

Islands 2021 VI Super 841} * 16 17(citing Iles 638 F 3d at 173))

       A     Property [merext 171 Employment

1150    A regular government employee as deﬁned in Title 3 of the Virgin Islands Code has a

statutorily protected property interest in their employment Flemmg \ Cruz 62 V I 702, 715 (V 1

2015) and Title 3 V I C § § 530(a)(1) and 530(a)(2)(C) (See also [les 638 F 3d at 230) Therefore

Wrensford as a regular employee, has a protected property interest in her employment Title 3

V I C §§ 530(a)(1) and 530(a)(2)(C) 3" Virgin Islands law requires that before the head ofﬁcer of

any agency (including a hospital under the jurisdiction ofthe VIGHHFC) dismisses demotes or

‘0 None of Ihe panics dispute that Wrensford is a regular employee
Wrensford V VI Govt Hospital and Health Facilities et 31
Case No ST 2023 CV 00399                                                        Cite as 2024 VI Super 12
Memorandum Opinion
Page 21 of 33

suspends a regular employee of a department or agency, the head ofﬁcer (in this case, the CEO of

RLSH) shall fumish the employee with a written statement of the charges against her and the

employee has ten days to appeal Title 3 V I C § 530(a)(2)(C)                 In addition the Hospital bylaws

and Human Resources Manual specify that an employee is entitled to notice and a hearing before

they are tenninated 3‘ 32 This has not occurred 33 Therefore Wrensford is entitled to a preliminary
injunction enjoining the Hospital from tenninating her 34 In addition Wrensford’s last

reappointment to the Medical Staff occurred on August 6 2022 and is due to expire on August 5

2025 3’ This strengthens the ﬁnding that Wrensford has a property interest in her employment

3‘ Medical Staff Bylaws Anicle II Section I 1 1 l4         Prerogative Appointees to this Active Category may Be
lcrmmalcd by the Board upml 7860mmendazwn of the MEC and effective immediately there will be appropriate
attempts ofNotlﬁcatlon t0 the affected Active Staff Member This will be subject to any hearing at appeal rights set
forth elsewhere in these Bylaws and in the Medical Staff InVeingaIion Correcti\e Action Hearing and Appeal Plan
Policy (emphasis added) See him Article 11 Section 1 The Acti\e Category Qualiﬁcations Appointees to this
category must have Served on the Medical Staff for one (1) year and complied with the Minimum Utilization Criteria
Pl Ex 3

 7 Human Resources Departments Admini:trati\e Policy and Procedure Manual Secllon 10 2          Whenever
Suspension or a diccharge i: recommended the division head and the Human Resource Director shall promptly
conduct an investigative hearing and immediately after the hearing submlt reports of ﬁndings and recommendations
to the Chief Executive Ofﬁcers through the Human Resource Director The Chlef Executive Ofﬁcer shall make the
ﬁnal decision on disclplinary action against the employee The employee shall be furnished a letter specifying the
disciplinary action being taken and the reasons therefore Section 10 5(B) In the Case ofdischarge prior to a formal
notice of dismissal the Chief Executive Ofﬁcer or a designee will conduct a hearing of the charges Pl 5 Ex 2

3‘ Certainly Wremford received notice regarding the ad hoc Committee and she reﬁned to participate But that piece»
did not invoke her employment despite the obvious intertwining of her Clinlcal pnvlleges and employment

3“ Although Wrensford has not been terminated from her employment it is only the temporary re<lrainlng order that
saved her from that fate as the CEO issued a letter threatening lamination just a few days before the court entered
the temporary restraining order prohibiting the Hospital from terminating Wrensford Had the court not acted when it
did, Wrensford would have likely been terminated

3 Pl EX 30
Wrensford v VI Govt Hospital and Health Facilities et a1
Cage No ST 2023 CV 00399                                                        Cite as 2024 VI Super 12
Memorandum Opinion
Page 22 of 33

        B Progeny interest in clinical privileges

1151    Wrensford claims a property interest in her clinical pdvileges Wrensford testiﬁed that

since the suspension of her privileges, she has been unable to return to work on the general surgery

call rotation at RLSH and treat patients since the start ofher eight week suspension and revocation

of clinical privileges 36 Without her clinical privileges Wrensford is prohibited from treating

patients In fact the CEO 5 letter to Wrensford, warning her of potential termination stated                      As

you know, you are required to have active medical staff privileges in order to practice medicine as

a general surgeon at SRMC 37 As a result, Wrensford is unable to fulﬁll any ofherjob duties as

a general surgeon at RLSH without clinical or medical staffprivileges which clearly demonstrates

that Wrensford 3 hospital privileges are wholly interwoven with her employment at RLSH In

addition the Medical Staff and Hospital Bylaws require that the MEC adhere to a series of

procedural steps including making a recommendation to the Board prior to tennination of a

physician’s privileges 324 Since the Bylaws require a formal investigatory process and opportunity

for a hearing before the suspension of privileges, and Wrensford's clinical privileges are

interwoven with her employment the coun ﬁnds that Wrensford has a property interest in her

clinical privileges

                 a    Notice and Hearing

3” P1 5 Ex 17
37 P1 5 Ex 26
33 PI 5 Ex 3 (quoting Medical Staff Bylaw: Article VII Part A Initiation of Hearing (A)        [A] Medical Staff
Member shall be entitled to request a heanng whenex er one of the following recommendations has been made by
the MEC or the Chief Medical Ofﬁcer (3) Revocation ofMedical Stafprpointment (6) Suspension of Clinic
Privileges for more Ihan (14) fourteen days (other than precautionary suspension); see [1150 Article VI, Pan B
Imestigations)
Wrensford v VI Govt Hcepital and Health Facilities et 31
Case No ST 2023 CV 00399                                                      Cite as 2024 VI Super 12
Memorandum Opinion
Page 23 0B3

1152      The Due Process Clause requires that an individual receive proper notice and hearing

before depriving that individual of a protected interest Cleveland Board of Educatmn v

Loudermzll 470 U S 532 543 544 (1985) (citing Boddte v Connecticut 401 U S 371 379

(1971))
1153      Wrensford argues that the Hospital disregarded her due process protections by not

providing adequate notice and hearing The Hospital counters that Wrensford was given notice of

the charges against her several times through a series of communications reminding her to appoint

someone to the investigative committee In addition the Hospital argues that Wrensford had an

opportunity to be heard at the RCA the Collegial Intervention and by providing Rosenberg with

her wntten account of the May 4 events Thus, the Hospital asserts Wrensford had severa1

opportunities to explain her version of events, and particularly, the chance to explain why she did

not immediately return to the hospital on May 4 39

1154      The court agrees that Wrenstord received several notices requesting she appoint someone

to the ad hoc investigative committee But Boschulte failed to communicate to Wrensford that her

privileges would be suspended as a consequence of failing to assign someone to the investigative

committee In fact Boschulte communicated in wnting to Wrensford on June 21 2023 that her

failure to appoint someone to the investigatory committee would result in Boschulte appointing

someone on her behalf “0 In response Wrensford stated she was unsuccessful in ﬁnding someone

to qualify in reviewing her Case Bosehulte never appointed a person for Wrensford and testiﬁed

that she subsequently determined she had no authority under the Medical Staff Bylaws to appoint

3’ This court has no opinion on whether Wrensford had a duty to immediately remm lo the hospital when called on
the afternoon of May 4
‘0 Pl 5 EX 14
Wrensford V VI Govt Hospital and Health Facilities at al
Case No ST 2023 CV 00399                                                        Cite as 2024 VI Super 12
Memorandum Opimon
Page 24 of 33

someone to the committee on Wrensford s behalf Boschulte ﬁrst informed Wrensford in a phone

call conversation on August 2, 202) that her hospital privileges would be suspended if Wrensford

did not name someone to the ad hoc investigative committee The following day, Wrensford’s

hospital privileges were voluntanly suspended ’ However the court is not persuaded that one

phone call n'ses to the level of adequate notice under the Due Process Clause, paniculaxly because

it was provided only one day before Wrensford 3 clinical privileges were suspended Furthermore

even if the notice was sufﬁcient, the president of the medical staff had no authority to terminate

Wrensford’s clinical privileges

1155    The court ﬁnds that Boschulte was correct in determining that the ability to initiate an

outside formal investigation was dependent upon the formation of the ad hoc committee 4'

However the bylaws only state that the ad hoc committee should consist of three persons In other

words, the bylaws do not require a committee of three people Once Wrensford declined to

panicipate the committee had the right to proceed and refer the matter for an outside investigation

if it so desired There is no doubt that Wrensford's predicament is partially self inﬂicted by failing

to accept a phone recording at the attempted collegial intervention meeting on May 22, 2023,

demanding fomality, and then refusing to participate in a fomal investigation under the Medical

Staff bylaws to which she is bound Nonetheless nothing within the bylaws authonzed the

“ Article VI Part B provides Investigations Section 3(8) An oumde eon:ultant or agency may be used whenever
a determination is made by the Hagpzml and the tmesttgalmg committee that (l) the clinic expertise needed to
conduct the review is not available on the Medical Staff or (2) the Member under review 13 likely Io ratse or had
raised questions about the objectivity ofother Members on the Medical Staff (whether or not such questions have
merit), or (3) the Member: With the necessary clinical expeni:e on the Medical Staffvtould not be able to conduct a
reView without riak of allegations ofbias, even If such allegations are unfounded " (emphasis added) Pl ’3 Ex 3
Wrensford v VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                                           Cite as 2024 VI Super 12
Memorandum Opinion
Pa e 25 of 33

President of the Medical Staff to valuntan'ly suspend Wrensfords hospital privileges without

Board approval

1156      Mareover, the court received no evidence that Wrensford received any notice prior to

November 17, 2023, that she was going to be deemed to have automatically resigned her Medical

Staff appointment for not appointing a member to the investigative committee 4”

1157      Separately the court notes that Wrensford had notice and an opportunity but refused to

participate in the Collegial Intervention because no administrative person would be present to take

formal minutes But refusal to participate in a Collegial Intervention under the Medical Staff

Bylaws only permits the MEC to initiate a formal investigation not to suspend her hospital

P rivile g es ‘3 The court ﬁnds it understandable that Wrensford never p rovided a written re P on to

Rosenberg because Boschulte 5 June 8 2023 letter to Wrensford stated that after consultation

with Rosenberg a fomal investigation was being initiated A4 Certainly, this led Wrensford to

believe that Rosenberg was aware of the fomal investigation Why Rosenberg would still expect

a report from Wrensford is unknown But the court hastens to add that the parallel tracks of

sanctions associated with employment and sanctions associated with clinical privileges can

certainly be confusing for a member of the medical staff with clinical privileges especially since

clinical privileges are interwoven with employment, and Wrensford could not work without both 45

4‘ Pl 5 EX 25
4’ Pl 5 EX 3 (citing Medical Staff Bylaws Article VI Part B Section 1(a) and 2(a)) see also Pl 5 Ex 11
M Pl w Ex 1 l (quoting the June 8 2023, letter AS the MEC we have made sufﬁcient inquiry and have reviewed the
matter with [Rosenberg] (ICMO)         [a]s per your request for a more formal process and In recognition of the Bylaw.
       the MEC met for an executive sesuon on Friday May 26, 2023, and we have decided to Initiate a formal
invesligalion ) (alteration in original)
‘5 Despite the purported failure ofWrensford to tender her report to the Chief Medical Ofﬁcer there was no authonty
for the ChiefMedical Ofﬁcer to subject her to an eight “ eek suspension because she v» as entitled to a hearing pursuant
to Human Resources Department Administrative Policy and Procedural Manual Section 10 4(3) In addition the
maximum Suspensmn under the bylaws is 30 days under the Human Resources Department Administrative Policy
Wrensford V VI Govt Hospital and Health Facilities at al
Case No ST 2023 CV 00399                                                         Cite as 2024 VI Super 12
Memorandum Opinion
Page 25 of 33

1158      In addition, Boschulte suspended Wrensford’s clinical privileges without ﬁrst making a

recommendation to the Board as required by the Board of Director Bylaws 46 The MEC’s course

of action did not provide Wrensford with adequate notice or hearing before revoking her privileges

and Medical Staff appointment Depriving Wrensford of her property interest in clinical privileges

without proper notice and hearing violates the due process clause In doing so, the Court ﬁnds that

Wrensford has demonstrated a reasonable probability of success on the merits ofher denial of due

process claim

          2   Irreparable Harm

1159      Irreparable injury or ham is the “certain and imminent ham for which a monetary award

does not adequately compensate            Yum] 39 VI at 854 (citing WlSdOm Imp Sales Co ‘ Laban

Brewmg C0        339 F 3d 101 114 (2d Cir 2003)) While considering the pre1iminary injunction

factors, irreparable harm is the primary factor a moving party must demonstrate in order to

succeed on a motion for a preliminary injunction ” Basstl, 75 V 1 21129 (citing 3RC & Ca , 63 V I

at 554)
1160      To prove the irrepaxable ham factor Wrensford must show that monetary damages are

either difficult to ascertain or are inadequate ” Gourmet Gallery Crown Bay Inc v Crown Bay

Marina LP 68 V1 584 597 (VI 2018) (citing Yum] 59 V I at 854) (quoting Danzelson 479

F 2d at 1037) The moving party fails to establish the irreparable harm necessary to succeed on a

and ProceduralManual Section 10 4(A) P1 5 Ex 2 EV en the MedicalStaffolaws Article VI ParlD Section 5(A)
Pl 5 Ex 3 limits the suspension to 29 days

“ Article IV Section 501) Duties Powers and Restrictions ofindividua] Direclom and the Board While the Board
ahall delegate to the Medical Staff the authority to evaluale the professional competence of its member physician: and
dentist     It shall hold the Medical Smffrevpansiblefor makmg rewmmendatmns t0 the Board concerning initial
ataffappoinlmenls reappointments and the granting curtailment suspension orrevocationclinicalprivileges )P1 5
EX 1 (alteration in original) (emphasis added)
Wrensford V VI Gen Hospital and Health Facilities et 211
Case No ST 2023 CV 00399                                                          Cite as 2024 VI Super 12
Memorandum Opinion
Page 27 of 33

preliminary injunction if the loss is a matter ofsimple mathematic calculation                    1d (citing Yum]

59 V I at 854) (citations and internal quotatian marks omitted) Finally the irreparable ham] must

be imminent 1d

1161     Wrensford argues that terminating her employment at RLSH would severely impact her

ability to remain and practice in the Virgin Islands which has been her home for many years

Wrensford further claims that the report to the National Board conceming her loss of privileges

will result in reputational damage and signiﬁcantly limit her ability to ﬁnd employment outside

the Virgin Islands The Hospital points out it is statutorily required to report the revocation of

Wrensford s privileges and it argues Wrensford was given proper notice and hearing to address

the charges against her 47 In addition, the Hospital points out that Wrensford was offered the

opportunity to reapply for her privileges

1162     RLSH is the only hospital located on St Thomas If the court denies the motion for

preliminary injunction, Wrensford will be unable to practice her profession in the Virgin Islands

And the intangible cost of a non voluntary move offisland cannot be calculated Further any

effort by Wrensford to relocate and apply for positions outside the Virgin Islands is signiﬁcantly

complicated by the report to the National Board Wrensford s liberty interest may also be impacted

if certain hospitals refuse to hire Wrensford based on the National Board report generated by a

wrongful suspension of clinical privileges based upon Concems about Wrensford s ability to work

‘7 Although the Defendants make th|s argument the court notes that those arguments are more applicable to the
success on the merits element of a preliminary injunction ruling than the element ofirreparable ham Sec Defs s
Clo<ing Arg 15 16 Dr Boschulte testiﬁed that plaintiff Wremford was not barred from re applying for her
privilege: Additionally Plaintths clalm ofdaInage to her reputation based on the hmpital 5 Statutory ability to report
does nut constitute irreparable han'n because she was provided notice and opportunity to be heard regarding the charges
against her and repeatedly chose not to avail herself of the proceas
Wrensford V VI Govt Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                                Clte as 2024 VI Super 12
Memorandum Opinion
Page 28 of 33

harmoniously with others The court has no opinion on whether Wrensford had a duty to quickly

rerum t0 the hospital on the aﬁemoon of May 4 but notes that Odlum the Chief of Surgery and

Wrensford s supervisor completed his private ofﬁce duties before reporting to the hospital almost

1 5 hours after he was called His treatment of the patient was so insigniﬁcant that he did not record

his actions in the patient 3 chart Moreover Boschulte 5 letter ofMay 15 which advised Wrensford

of the Collegial Intervention, also stated        the Medical Executive Committee has met and it has

been determined that the clinical assessment of your competency should be performed by the Chief

of your Department ﬁrst before any further consideration for evaluation by the Medical Executive

Committee 4" Despite this acknowledgment by the MEC that the Chief of Wrensford s

Department       that being Odlum         would perform a clinical assessment the court received no

evidence that such a clinical assessment was perfumed This supports the ﬁnding for a preliminary

injunction since the loss of clinical privileges was not tied to any ﬁnding of a lack ofcompeteney

on Wrensford 5 part

1T6}    If the court were to deny the motion for preliminary injunction, a report to the National

Board will likely follow Nothing herein is meant to suggest that RLSH should always be

prevented from sending a negative report on a physician to the National Board Instead the court

ﬁnds that in this speciﬁc instance where Wrensford 5 clinical privileges were suspended without

proper notice and by an ofﬁcial who had no authority to do so, and the investigation was prompted

by a Concem about Wrensford s ability to work harmoniously with others and not a ﬁnding of

lack of competency necessitates a preliminary injunction

“ PI Ex 11
Wrensford V VI Govt Hospital and Health Facilities et al
Case No ST 2023 CV 00399                                                 Cite as 2024 VI Super 12
Memorandum Opinion
Page 29 of33

$4      The court ﬁnds that Wrensford’s inability to engage in her profession in the Virgin Islands

and the potential loss of her reputation without a proper basis for the suspension of clinical

privileges, are not campensable by monetary damages As such, Wrensford has successfully

demonstrated a risk of irreparable ham for which a monetary award would be inadequate

        3    Harm to the Nonmoving Party

1i65    Courts must also determine whether the nonmoving party will suffer any irreparable harm

if the preliminary injunction is issued in favor of the moving party Yusuf, 59 VI at 856 (Km

Pharms Inc \ Andrx Corp             369 F 3d 700 727 (3d Cir 2004) (quoting Optlczans Assn afAm

\ Indep Opttczans ofAm 920 F 2d 187 192 (3d Cir 1990)) In considering the harm to each

party the Court should aim to maintain the status quo which is deﬁned as             the last peaceable

noneontested status of the parties        Bassll 75 V I at 3l (citing Yzlszgf, 59 V I at 856 57 (ﬁnding

that a preliminary injunction maintained the status quo by assuring that the parties retained equal

control over their business pending trial»

1!66    Here, the harm to Wrensford, if the preliminary injunction is granted, far outweighs any

harm RLSH will face ifthe injunction is denied The Hospital contends that granting the injunction

Will force RLSH to reinstate Wrensford 5 Hospital privileges, increasing the possibility ofpatient

injury and exposing the Hospital to reputational damage The court is not persuaded by the

argiimem that Wrensford s actions or inactions on May 4 posed a signiﬁcant risk to patient safety

or the Hospital or caused any harm to the patient In fact, Wrensford’s supervisor, Odlum, testiﬁed

that the adjustment to the patient 5 tubes was so minimal that he did record it in the patient 5 chart

The court notes too that when Odlum was called to the Hospital he took the time to ﬁnish up

with his ofﬁce patients before going to the Hospital and arrived there approximately 1 5 hours after
Wrensford V VI Govt Hospital and Health Facilities et 31
Case No ST 2023 CV 00399                                             Cite as 2024 V1 Super 12
Memorandum Opinion
Page 30 of33

he was called Odlum testiﬁed that when he arrived at the Hospital, the patient was stable and not

in distress This leads the court to ﬁnd that the patient was not in imminent danger Testimony also

demonstrates that a series of missteps likely contributed to the call for Wrensford to return to the

hospital starting with the radiologist tech 3 inverted CAT scan (had the images not been inverted

Wrenstord wauld have placed the tubing on the correct side of the chest, and a second tube and

attachment to wall suction would not have become necessary), followed by failure of the staff t0

timely ﬁnd the necessary equipment to connect the tubes to the wall for suction Lastly, evidence

provided by both parties demonstrates that Wrensford s privileges were suspended not because of

any failure or omission in her treatment of the patient but because she did not appoint a member

to the ad hoc investigative committee None of the evidence heard during the evidentiary hearing

suggested that Wrensford 3 treatment of the patient was substandard As a result the court ﬁnds

the Hospital will not suffer greater harm, or any harm, if an injunction is granted in favor of

Wrensford

        4    Public Interest

$167    On the element of public interest Virgin Island courts should seek to prevent the parties

from halting ‘speciﬁe acts presumptively beneﬁtting the public     until the merits [can] be reached

and a determination made as to whatjustice require[s]       30ml 75 V I at 31 (Yusuf 59 V I at

858 (quoting Cam I Grp Inc v Amoco Chemzcals Corp 614 F 2d 351 358 (3d Cir 1980)) But

ifboth a likelihood of success on the merits and irreparable harm can be shown then the public
Wrensford v VI Govt Hospital and Health Facilities et al
Case No ST 2023 CV 00399                                                          Ctte as 2024 VI Super 12
Memorandum Opinion
Page 31 of 33

interest factor typically tends to favor the moving party as well 3RC & C0 63 V I at 557 (citing

mm 59 V 1 at 347) 49

$8       In this case the public interest factor favors Wrensford because she has demonstrated a

reasonable probability of success on the meats and irreparable harm The Hospital asserts that

Wrensford's conduct fell below an applicable standard of care and reinstating her would not be in

the public interest However nothing in the record demonstrates her skills particularly as a general

surgeon have fallen below a standard of care In fact Boschulte informed Wrensford that the

 investigation will not address your technical abilities as a surgeon 5" Testimony evidence

conceming the events of May 4 indicates that the patient 3 initial CAT scan was inverted From

the outset Wrensford had repeatedly requested medical devices to stabilize that patient before

transfer off island When Odlum, Wrensford’s supervisor, was called to the Hospital to tend to the

patient he found the patient stable and not in any distress Odlum 5 treatment of the patient was

so insigniﬁcant that he did not record it in the patient chart Moreover, the public has an interest

in requiring the Hospital to correctly follow the procedures outlined in the Hospital Bylaws befere

sanctioning a public employee Accordingly it's in the public's interest to grant the injunction and

encourage VIGHHFC and its hospitals to adhere to the laws of the Virgin Islands and the Hospital

Bylaws

“’ (quoting Amman Tel & Ttl Co \ ttmme & ConseneProgmm Inc 42 F 3d 1421 1427 n 8 (3d Ctr 1994))
tee 111:0 Mano s: Crypt Inc 62 v1 at 592 [WL] at *4 [the public interestweighed agairm inning the injunctton
where the mowng party failed to estabhah a llkellhuod of succesa and the mjuncuon would have nsked the 10:5 of
federal grant money), T117 Top Camtr Corp 60 V I at 727 28 (the public interest wetghed In favor of the injunction
where the dispute involved the award of a contract on a htghway project without following the proper procurement
proceea) Yuwf, 59 v1 ztt x57 59 (afﬁrming the Superior Court 5 ﬁndmg that the public interest weighed in favor of
the injuncllon when the moving party satisﬁed the other factors and the continued employment of600 Virgin Islanders
was at stake)

5n P] 5 Ex 14 The Investigation will not address your technical abilities as a surgeon It speciﬁcally will address the
altualion :urrounding your response to request made by staff to return to the emergency room ‘
Wtensford v VI Gnu Hospital and Health Facilities et a1
Case No ST 2023 CV 00399                                                          Cite as 2024 VI Super 12
Memorandum Opinion
Page 32 of 33

                                                 CONCLUSION

1169     Considering the evidence offered by the Plaintiff at the evidentiary heanng on Decembett

5 6 and 7 the court will grant Plaintiffs Motion for Preliminary Injunction The court weighed

the four factors using a Variation of the sliding scale method The court ﬁnds that the Plaintiff

demonstrated a reasonable probability of success on the ments of her claim for violation of the

Virgin Islands law and violation ofdue process The Plaintiff has also established that the ham to

her trade and protected interests is imminent Moreover the court is not persuaded that any

petential harm or risk to the Defendants by reinstating Plaintiff‘s privileges outweighs the harm to

Plaintiffifthe injunction were denied Finally the coutt ﬁnds that the public interest is served by

encouraging VIGHHFC and its hospitals to adhere to the procedures set forth in their Bylaws

1170     Based on the preceding analysis, the court will grant the motion for preliminary injunction

and enjoin Defendants from terminating Wrensford and enjoin Defendants from sending a negative

repott to the Joint Commission pending completion of the investigation 5' In addition the court

will also 1) order that the Hospital place Wrensford back on the payroll within twenty days and 2)

permit the Hospital to again initiate a formal investigation provided it does so within 60 days 57

’1 At some point Wrenstord asaerted that the Court should prevent the Hospital from continuing wtth a tonnaI
im esttgation But were the court to preclude any further mvesttgatton and <tmply restore Wtencford 5 clinical
pri\ileges and place her back on payruIl u mum preclude the hospital from doing Its intestigation and send a
Stgnal that the court ﬁnds that Wtensford s actions are above reproach That IS not the Intent here The court has no
opimon on whether Wtensford :hould have been a subject of a peer review or formal investtgatton But Medical
Staff |S :ubJeet to overstght by the Medical Executive Committee the CMO the CEO and the Board It would be a
grave error for this court to preclude them from petfon‘ning [heir dunes In addition batting further investigation
could set an improper precedent for other medical staff to potentially argue they <hould not be subjecl to formal
investigation

57 If the defendants reinitiate the formal investigation and Wrensford again declines to name a member to the ad hoc
committee the other two members of the commtttee shall proceed Mthout the third member And the committee
shall make a recommendation to the Board in accordance with the bylaws If the defendants do not re initiate a
formal investigation Withln SIXty days they would have waived the tight to do so
Wremford v VI Govt Hospital and Health Facilities et ai
Case No ST 2023 CV 00399                                             Cite as 2024 VI Super 12
Memorandum Opinion
Page 33 OH}

Since Wrensford’s clinical privileges were wrongfully suspended, the court is ofthe opinion that

she has demonstrated that she is entitled to have her clinical privileges immediately restored

However, the court will instead allow the defendants the discretion to decide if Wrensford’s

clinical privileges should be reinstated pending completion of the formal investigation But even

if the Hospital defers reinstatement ofthe clinical privileges Wrensford must be placed back on

payroll and receive all other beneﬁts associated with her employment, pending completion ofthe

formal investigation and ultimate Board action, if any

        An order consistent with this Memorandum Opinion shall immediately follow

DATED March             /     2024                        W224 /§ :
                                                             Kathleen Mackay
ATTEST                                                    Judge of the Superior Court
TAMARA CHARLES                                              0fthe Virgin Islands
Clerk ofthe Court

BY
   {or LATOYﬁ
        Court Clerk Supervisor 05 /0| / 41$