Court Opinion

ID: 9696088
Source: CourtListenerOpinion
Date Created: 2023-08-25 18:35:58.295331+00
Date Added: 2024-06-11T18:20:18.346473
License: Public Domain

Thomas Gallagher, Justice.
Action by plaintiff, Dr. O. E. Benell, for a declaratory judgment that a resolution adopted June 3, 1957, by the hospital commission of the Virginia Municipal Hospital, which is owned by defendant, city of Virginia, is invalid. The resolution is as follows:

“Any member of the active medical staff may be called in consultation by any other member of the hospital staff. The consultant will have access to all the hospital records affecting the patient in question, including laboratory reports, reports on tissues examined by the hospital Pathologist and X-rays taken under the supervision of the hospital Radiologist. After adequate examination of the patient and/or his hospital records, the consultant will enter his opinion on the hospital chart as to diagnosis and/or recommendations for treatment of the patient.

“The above would apply to the case of Dr. O. E. Benell. While Dr. Benell is a member of the active medical staff he may be called in consultation by another member of the staff. He may enter into the hospital charts his interpretation of X-rays taken under the supervision of the hospital Radiologist or he may be consulted for his opinion as to X-ray therapy for a patient. His opinion should be entered in the hospital chart.

“In consultation with the hospital Radiologist, a decision may be made as to the method of administration and dosage schedule for the X-ray therapy. At the request of the attending physician, the hospital Radiologist will then administer the X-ray therapy.
“Dr. Benell thus exercises a function of the consultant in Radiology *561by interpreting X-rays and recommending further diagnostic X-ray techniques or by making recommendations in regard to X-ray therapy. It is to be understood that no compensation is to be expected from the hospital for this consultation service.” (Italics supplied.)
The trial court determined that since the resolution was for the promotion of higher standards of medical practice in the hospital; and for placing of responsibility for all radiological procedures with the radiologist heading the radiology department, it was reasonable and in all respects valid.
On appeal from the judgment entered pursuant to the trial court’s order, plaintiff, a licensed physician and surgeon, and a qualified radiologist on the staff of the hospital, contends that the hospital, being a publicly supported institution, is required to make its equipment and the technical staff in its radiology department reasonably available to qualified radiologists on its active medical staff without the limitations and restrictions set forth in the resolution.
The Virginia Municipal Hospital is operated by the city of Virginia pursuant to the latter’s home rule charter. It includes a well-equipped and modem department of radiology and a technical staff is maintained in connection therewith. It operates under a charter commission consisting of five lay freeholders and voters appointed by the mayor subject to the approval of the city council. The commission is empowered by the charter to make rules relating to its own procedures and the administration, maintenance, and control of the hospital.
Plaintiff has specialized in the practice of radiology since 1947. Since December 23, 1949, he has been a member of the LenontPeterson Clinic at Virginia. On January 9, 1950, he was hired as a radiologist for the Virginia Municipal Hospital to act on a part-time basis. Payments for his services were made to the Lenont-Peterson Clinic by the hospital. A resolution terminating this arrangement as of November 1, 1955, was adopted by the commission September 19, 1955. At that time it appointed Dr. Abraham Alpert as a full-time hospital radiologist, and on June 3, 1957, adopted the resolution here challenged. Prior thereto, it had offered plaintiff the opportunity of serving as radiologist for the hospital if he would disassociate himself *562from the Lenont-Peterson Clinic and work out a suitable arrangement with Dr. Alpert. Plaintiff declined to disassociate himself from the clinic and thereafter requested that the hospital define his rights with respect to the radiology department, its staff, and equipment. The June 3, 1957, resolution followed this request, the commission giving as one of its reasons therefor its desire that the hospital radiology department be independent of any clinics and that its radiologist be responsible .solely to the hospital.
At the trial, testimony of experts was submitted with reference to the reasonableness of the resolution. Mr. Ray M. Amberg, Director of the University of Minnesota Hospitals, called by defendant, testified that in his opinion the resolution was reasonable since the commission was vested with responsibility for selecting a radiologist for all hospital patients and since any negligence on his part might make the hospital liable in damages. Dr. Abraham Alpert, called by plaintiff for cross-examination under the statute, testified that in his opinion it was necessary for the hospital radiologist to take charge of all radiological procedures and to exercise his independent judgment when it was needed so diagnosis and treatment of all hospital patients could be obtained as expeditiously as possible. Dr. Arthur M. Antonow, a member of the East Range Clinic and chief of staff of the hospital, testified that in his opinion the resolution was reasonable because of the responsibility of the hospital for X-ray, diagnosis, and therapeutic treatment; because better and more uniform standards by the technicians could thereby be provided; and because better team work and greater efficiency would be promoted by closed staff arrangements for radiology.
Experts called by plaintiff included Dr. E. N. Peterson of the LenontPeterson Clinic and Dr. Henry G. Moehring, a radiologist with a Duluth clinic. Both expressed the opinion that the resolution was unreasonable; that it would hamstring visiting consultants in administering radiation therapy where daily judgment must be exercised. Dr. Peterson testified that it would deprive a consulting doctor of his right to examine his patients; that it would require diagnosis based upon another’s findings; that it would deny the patient a free choice of physician and deny an *563attending physician the right to proper evidence required for diagnosis. Dr. Moehring testified that the radiologist should be present at almost all examinations, even where simple chest films are taken; that if the radiologist can see films shortly after exposure, he may find reason to expose additional films or to suggest study along lines not apparent upon physical examination. Plaintiff testified that the resolution barred his practice of radiology at defendant hospital in that it is not satisfactory for a radiologist to be required to look at films taken by another radiologist. He was corroborated by Dr. Peterson and Dr. Moehring as well as by Dr. Alpert.
It is our opinion that the challenged resolution constitutes an administrative act adopted by the hospital commission pursuant to Charter of City of Virginia, § 200-C,1 in furtherance of the administration, operation, maintenance, and control of the hospital, City of Duluth v. Cerveny, 218 Minn. 511, 16 N. W. (2d) 779, and that accordingly the function of this court is limited to a determination whether the commission’s action in adopting the resolution was arbitrary or unreasonable. State ex rel. McGinnis v. Police Civil Service Comm. 253 Minn. 62, 91 N. W. (2d) 154; Nelson v. Reid and Wackman, 228 Minn. 137, 36 N. W. (2d) 544; State ex rel. Ging v. Board of Education, 213 Minn. 550, 7 N. W. (2d) 544. In determining this question, of course, we may not substitute our judgment for that of the commission on matters relative to policy or good practice, which are *564purely administrative rather than legal in nature. State v. G. N. Ry. Co. 130 Minn. 57, 60, 153 N. W. 247, 248; Chicago, M. St. P. & P. R. Co. v. Foley Bros. Inc. 191 Minn. 335, 254 N. W. 435.
Basically, it is defendant’s position that the resolution follows a practice adopted by most hospitals and advocated by the American College of Radiologists calculated to best serve the interests of hospitals, patients, and medical staffs generally.2 Much other testimony was advanced in support of the reasonableness of the resolution, particularly as it related to the responsibility and liability of the hospital for negligence in connection with the operation of the equipment in its radiology department. Based upon all such factors, the trial court found that the conduct of the commission in adopting the resolution was not arbitrary or unreasonable, but purely administrative, and in furtherance of its endeavor to operate and maintain the hospital in an efficient manner.
Since there is ample evidence to sustain this finding, it must follow that even though this court might be of a contrary opinion as to what would be proper practice in the operation of hospital radiology departments, or in the administration of X-ray treatment and therapy, it would not be authorized to substitute its judgment in this respect. The question of good practice is purely administrative in nature and involves no legal principle. It would follow that the resolution challenged was in all respects reasonable and valid, and the trial court’s judgment in this respect should be affirmed. See, Hayman v. City of Galveston, 273 U. S. 414, 47 S. Ct. 363, 71 L. ed. 714; Green v. City of St. Petersburg, 154 Fla. 339, 17 So. (2d) 517; Selden v. City of *565Sterling, 316 Ill. App. 455, 45 N. E. (2d) 329; see, also, Hamilton County Hospital v. Andrews, 227 Ind. 217, 84 N. E. (2d) 469; Dade County v. Trombly (Fla. App.) 102 So. (2d) 394; Blackwell v. City of Pontiac (Mich. Cir. Ct.) No. C-29500, dated November 7, 1958.
Cases relied upon by plaintiff are distinguishable. Thus in Albert v. Gogebic County Public Hospital, 341 Mich. 344, 67 N. W. (2d) 244, the decision was based upon interpretation of Michigan statutes3 —Comp. Laws of Michigan 1948, §§ 331.154, 331.160, 331.163— governing the operation of public hospitals, which the court held contained no authority for the adoption of rules and regulations limiting the practice of medicine or surgery in such hospitals. In Findlay v. Board of Supervisors, 72 Ariz. 58, 230 P. (2d) 526, 24 A. L. R. (2d) 841, the court held invalid a rule requiring one doctor on a staff to assist another staff doctor on the theory that it involved an attempt to control the relationship between doctors rather than the administration of hospital facilities. The court there directed attention to the “axiomatic” rule that licensed physicians have no constitutional right to practice in a hospital maintained by state or political subdivision (Hayman v. City of Galveston, 273 U. S. 414, 47 S. Ct. 363, 71 L. ed. 714) and approved the principle that municipalities may prescribe regulations for physicians using hospital facilities, citing Green v. City of St. Petersburg, supra, and Selden v. City of Sterling, supra.
In the dissenting opinion it is suggested that under the resolution as above quoted the hospital commission here has invaded the right of an individual, particularly a recipient of old-age benefits, to select his physician, as well as the right of the physician to treat his patient in a public hospital; and that thereunder the hospital will be engaged in the practice of medicine through employed physicians and surgeons. *566We do not so construe the language of the resolution. Rather, it means merely that, before an attending physician reaches a decision as to the method and dosage schedule for X-ray therapy, consultation with the hospital radiologist is required; and that the latter will administer the therapy, but only at the request of the attending physician. The final decision with reference to the need, mode, method, and dosage schedule for such therapy is left to the patient’s physician.
Because of the nature of X-ray therapy and the technical equipment required therein, and the serious danger which may follow the incompetent administration thereof, most hospitals have adopted this procedure. A majority of physicians recognizing the advantages of special training in this field voluntarily refer their requirements therein to specialists with the necessary training, equipment, and facilities to achieve a safe and accurate result. The procedure outlined is but a phase of the steady advancement of specialization in various medical fields, designed to insure the safety of patients and to protect the hospital in the performance of its obligations to them. Nowhere does it violate the right of a patient — old-age pensioner or others — to select his own physician or compel the latter to yield to another’s decision in the treatment of such patient. Nowhere does it deny a qualified physician or surgeon the right4 to treat his patient in the hospital.
The judgment appealed from is, in all respects, affirmed.

Section 200-C provides in part: “Generally the commission shall have charge of the administration, maintenance and control of all hospitals now or hereafter owned by the City of Virginia * * *. The commission shall have power * * * to make rules relating to its own procedure and to the administration, maintenance and control of such hospitals.”
Section 200-D of the charter provides in part: “Subject to such limitations as may be prescribed by rules the Municipal Hospital shall be operated primarily as a general hospital, and the commission shall from time to time establish and provide for the collection of suitable charges for the use of the Municipal Hospital and its facilities. In fixing such charges and in all other business practices the commission shall have in mind this purpose: that the Municipal Hospital shall be self sustaining in so far as proper business practices can make it so.”

In his testimony, Dr. Moehring admitted that the views of the American College of Radiology were authoritatively expressed in its publication, A Guide for Conduct of Radiologists in Relationships with Institutions (1955), which states (p. 5): “The responsibility for all radiologic examinations and treatments in the hospital rests primarily on the radiologist who is head of the department. His findings and conclusions for all examinations should be communicated to* the patient’s physician and placed on the patient’s chart. Nothing in this provision precludes additional study and interpretation by other qualified attending and consulting physicians on the staff.”

By virtue of Public Acts of Michigan 1958, No. 105, approved April 14, 1958, § 331.163 of the above statutes was amended so that hospital boards may now adopt rules governing the operation of hospitals and may define the rights of physicians and surgeons in treating patients in hospitals. A subsequent decision, Blackwell v. City of Pontiac (Mich. Cir. Ct.) No. C-29500, dated November 7, 1958, cited with approval Green v. City of St. Petersburg, 154 Fla. 339, 17 So. (2d) 517, in which the Florida Supreme Court arrived at the same result as we do here.

As to whether this is a constitutional right, see Hayman v. City of Galveston, supra; Findlay v. Board of Supervisors, supra.