Court Opinion

ID: 9722937
Source: CourtListenerOpinion
Date Created: 2023-08-26 09:56:22.870928+00
Date Added: 2024-06-11T18:24:42.703340
License: Public Domain

KANE, J., Concurring and Dissenting.
For reasons which shall appear, I agree that a remand to the trial court is appropriate. I cannot, however, subscribe to the conclusion that the questioned by-law is either unrea-. sonable per se or violative of “minimal common law standards of a fair *515procedure.” On the contrary, in my opinion the requirement of obtaining letters of reference from three members of the active staff is entirely reasonable and sensible, is rationally connected to the essential and critical purposes of a professional and ethical private hospital and does no violence whatever to standards of fair procedure. I therefore respectfully dissent.
The majority bootstraps its contrary conclusion by means of indulging in rank speculation, viz: “There is too great a danger that the necessary endorsements may be arbitrarily and discrimatorily withheld.” And later: “The by-law has the inherent grave danger that members of the active staff may seek to exclude certain applicants because they are of a certain race, religion, ancestry, because they have testified against them in malpractice suits, or simply because they do not like them;” (italics added).
There is absolutely no evidence whatever in this record to suggest that any such “inherent grave danger” has actually occurred, or that it is reasonably likely to occur. Indeed, plaintiff makes no allegation that his claimed inability to obtain the necessary recommendations is due to any such arbitrary or discriminatory motivation.
Bearing in mind that we are dealing with common law—not constitutional—standards of “fair procedure” (Pinsker v. Pacific Coast Society of Orthodontists (1974) 12 Cal.3d 541, 550, fn. 7 [116 Cal.Rptr. 245, 526 P.2d 253]), we should not allow our decision to be formulated by “due process” considerations which are not only inapplicable (Pinsker II, p. 550, fn. 7, supra) but, in my opinion, inappropriate to the situation and the parties at bench.
First of all there can be no dispute with the fact that a private hospital, the purpose of which is to insure that all patients admitted—or treated—receive the best possible care, is free to establish its own rules, regulations and qualifications for medical staff membership, so long as they are not unreasonable or applied in a discriminatory manner. Here, defendants’ own by-laws contained such an expression of purpose, and the trial court found that a rational connection exists between the endorsement of staff members and the insurance of professional and ethical qualifications of the physicians for the common good of the hospital and its patients. That finding, in my view, is conclusively persuasive.
*516At a time when the standards of professional conduct and service are subject to aggressive consumer assault and when hospitals and physicians are exposed to increasing horizons of liability—often predicated upon principles of vicarious or imputed liability—courts should not unduly interfere with the legitimate and ostensible good-faith efforts of private hospitals and physicians to protect themselves.
No enterprise is more important than one which undertakes the responsibility of rendering medical care to the sick, sore, lame, and disabled members of society. It seems to me to be patently elementary that in order to discharge such an onerous and awesome duty, the hospital should be clothed with broad discretionary authority to establish reasonable standards for staff admission.
The majority’s concern that the necessary endorsements may be withheld is premised on the erroneous assumption that an applicant such as appellant is left entirely without a remedy in the event he is unable to obtain the three letters of recommendation.
Thus, the majority asserts that “he was not given a fair opportunity to defend himself.” But the record shows without contradiction that the by-laws of defendants do provide for a hearing.1
Thus, article III, section 7 (a), in pertinent part provides: “In all cases in which any applicant has been denied membership, the applicant shall be notified promptly by registered or certified mail. He may, within 30 days of receipt of notice of such denial, request in writing a hearing by the Medical Advisory Board and such hearing shall be held within 60 days after receipt of the request.. .. Failure to request a hearing after the prescribed time constitutes a waiver of the applicant’s right to a hearing.”
Admittedly, defendants failed to give written notice that plaintiff was entitled to request a hearing. In my opinion it should have done so. At the same time, the concept of common law standards of fair procedure should not be traveled on a one-way street. Plaintiff makes no showing —not even an allegation—that he ever requested a hearing of any kind. In my opinion, he should have done so.
Although it may be argued that since the application here was *517“returned” rather than “denied,” that the hearing by-law quoted above does not apply, I find such a contention to be altogether technical, substituting form for substance. The gravamen of plaintiff’s dispute is (as was conceded at oral argument before this court) simply that plaintiff has been denied the right to staff privileges at defendant hospital. As can be seen from even a cursory reading of article III, section 7(a), the provision for a hearing is all inclusive and applies “In all cases . . .” (italics added).
In my view, the solution to the instant controversy is a simple one and the facts of this case do not warrant the far-reaching consequences of the majority’s holding, i.e., that a by-law requirement such as here contested is violative of minimal common law standards of fair procedure.
If, in fact, plaintiff’s inability to obtain the necessary three signatures of active staff members is due to some discriminatory factor, such evidence can be acquired and established in the hearing permitted by defendants’ by-laws. If plaintiff’s application is then denied, he has the clear right of judicial review (Kronen v. Pacific Coast Society of Orthodontists (1965) 237 Cal.App.2d 289 [46 Cal.Rptr. 808]).
In a further effort to support its position that the by-law provision is unlawful per se, the majority pose this question: “what if an applicant simply does not know three members of the staff...?”
The short answer is that he should take steps to get acquainted with those physicians. One would be hopelessly naive to conclude that this would be an onerous or unreasonable burden for a physician to bear. In the case at bench, for example, as the majority points out, plaintiff has been practicing in San Francisco since 1959, and did submit a large number of letters from other physicians. To suggest that Doctor Ascherman will be unable to comply with the by-law because he does not know—and cannot reasonably be expected to arrange to meet—the active staff members simply overlooks the realities and practicalities of professional life which are matters of such common knowledge that a court should not hesitate to acknowledge them promptly.
Finally, I do not believe that either Pinsker II or Ascherman v. San Francisco Medical Society (1974) 39 Cal.App.3d 623 [114 Cal.Rptr. 681] compel the conclusion that the by-law in question is unreasonable on its face.
*518Each of these cases is distinguishable from the case at bench. Pinsker II, for example, involved membership in a professional association, as contrasted with admission to hospital staff privileges. The core of the holding in Pinsker II, as I read it, is that Dr. Pinsker was denied membership (1) without being notified of the reason for the rejection and (2) without being given a fair hearing “to defend himself.” In the case at bench Dr. Ascherman was notified of the reason for his rejection. Thus, the only defect in the procedure below is the absence of a hearing neither requested by plaintiff nor offered by defendants.
Ascherman v. San Francisco Medical Society, supra, does not stand for the proposition that a hospital by-law requiring recommendation by active staff members is inherently violative of due process, or even of common law principles of fair procedure. In that case, the trial court instructed the jury that hospitals were not required to afford the plaintiff a hearing at all in connection with a denial of, or expulsion from, staff privileges. Needless to say, that is clearly contrary to established law. In addition, as I have pointed out before, not only is plaintiff entitled to such a hearing in this case by operation of law, but defendants’ own by-laws explicitly provide for it.
I would therefore reverse the judgment with directions to the trial court to issue an injunction ordering defendants to advise plaintiff of his right to request a hearing in accordance with article III, section 7 (a), of defendants’ by-laws and, upon receipt of a timely request for such hearing from plaintiff, to consider the matter pursuant to a fair procedure as described in Pinsker II.

In addition, and independently of the by-laws, appellant is now entitled to a hearing under the holding of Pinsker II, a case which the majority correctly notes was decided after the proceedings in the court below. It is clear to me, therefore, that respondent’s by-laws providing for a hearing procedure in all cases is simply an express recognition of the procedural right later articulated by the court in Pinsker II.