CAN YOU SUE ORGANIZED MEDICAL STAFF AT A HOSPITAL?
The short answer is “yes”. Medical staff is a phrase that is generally applied to all doctors and allied professionals at a hospital. But in the legal world, organized medical staff is an entity that has a key role in a hospital structure. Under certain circumstances, including situations where medical staff fails to carry out its duties or unfairly targets a physician, you can sue the organized medical staff at a hospital [1], [2].
What is Medical Staff?
The term "medical staff" includes individual doctors and physicians [3]. The organized medical staff in an accredited hospital is tasked with the responsibility for the quality of in-hospital medical care [7], [8]. They evaluate the qualifications of applicants and holders of staff privileges, recommend appointment, reappointment, curtailment, and exclusion from staff privileges, and provide peer group methods for reviewing basic medical, surgical, and obstetrical functions [5].
The medical staff operates under bylaws approved by the hospital's governing body, which detail the responsibilities of the medical staff for the quality of medical care provided to patients by the hospital [2], [4], [6], [8], [9]. If a hospital contravenes these bylaws, an aggrieved physician may sue for breach of contract [10], [11].
Intertwined Responsibilities – For Example, a Hospital Can Be Sued for a Doctor’s Negligence
In some cases, a hospital can be held liable for alleged malpractice by a doctor given staff privileges by the hospital. This liability can arise from the hospital's failure to ensure the competence of its medical staff through selection and review, thereby creating an unreasonable risk of harm to its patients [12], [13]. The Elam case details the rule for this.
However, there are limitations to consider. Before suing for damages resulting from expulsion or exclusion from a hospital's medical staff, a physician must exhaust all administrative and judicial avenues of review of the exclusionary decision [14]. It is also important to note that the Business and Professions Code section 2282 does not create a liability giving rise to any cause of action, except to support disciplinary proceedings by BMQA [11].
Furthermore, the 2007 amendment to section 1278.5, which authorizes whistleblower suits by hospital staff physicians, does not procedurally limit the right to sue even when a forbidden retaliatory action was taken through medical peer review proceedings [14]. However, the case of Anton v. San Antonio Community Hosp., which discusses disciplinary actions taken by committees of the medical staff, was superseded by statute as stated in Fahlen v. Sutter Central Valley Hospitals. In other words, this is a truly amorphous and every changing legal landscape.
Remember too that there are major protections preventing civil damages against a professional staff of a licensed hospital if they are acting within the scope of the functions of the committee formed to maintain the professional standards of the society established by its bylaws [9].
Cases, statutes, and regulations
1. Roseville Community Hospital v. Superior Court
Court of Appeal, Third District, California. • June 17, 1977 • 70 Cal.App.3d 809 • 139 Cal.Rptr. 170
"…A pathologists' partnership brought an action against a hospital, alleging that a controversy existed over rights and duties under an arbitration award and breach of that award. After the trial court ordered the hospital to turn over to plaintiff certain records of regular and special meetings of the executive committee of the hospital's medical staff, the hospital sought, by writ of prohibition, to have such order set aside. The Court of Appeal, Regan, Acting P.J., held that disclosure of the medical staff records was required under the 'staff privileges' exception to the statute making medical staff proceedings immune from discovery. Writ denied.…"
2. 42 CFR § 482.22 Condition of participation: Medical staff.
"…The hospital must have an organized medical staff that operates under bylaws approved by the governing body, and which is responsible for the quality of medical care provided to patients by the hospital.…"
3. Armin v. Riverside Community Hospital
Court of Appeal, Fourth District, Division 3, California. • November 16, 2016 • 5 Cal.App.5th 810 • 210 Cal.Rptr.3d 388
"…The phrase medical staff is thus a uniplural entity, like church or team or jury. Since the words certainly include doctors (the way the word jury includes its individual members), Armin argues that section 1278.5's definition of "facility" allows him to sue the individual members of a hospital's medical staff.…"
4. West Covina Hospital v. Superior Court
Supreme Court of California, In Bank. • May 29, 1986 • 41 Cal.3d 846 • 718 P.2d 119
"…In Matchett, the court stated: "In an accredited hospital, the organized medical staff is responsible to the hospital governing body for the quality of in-hospital medical care; it evaluates the qualifications of applicants and holders of staff privileges; it recommends appointment, reappointment, curtailment and exclusion from staff privileges; it provides peer group methods for reviewing basic medical, surgical and obstetrical functions. (Citations.) When medical staff committees bear delegated responsibility for the competence of staff practitioners, the quality of inhospital medical care depends heavily upon the committee members' frankness in evaluating their associates' medical skills and their objectivity in regulating staff privileges. Although composed of volunteer professionals, these committees are affected with a strong element of public interest.…"
5. Santa Rosa Memorial Hospital v. Superior Court
Court of Appeal, First District, Division 2, California. • November 21, 1985 • 174 Cal.App.3d 711 • 220 Cal.Rptr. 236
"…The California Supreme Court has not heretofore construed the scope of section 1157. The earliest Court of Appeal decision involving the application of section 1157, which was enacted in 1968, is Matchett v. Superior Court (1974) 40 Cal.App.3d 623, 115 Cal.Rptr. 317, which discussed the statute's purpose as follows: "In an accredited hospital, the organized medical staff is responsible to the hospital governing body for the quality of in-hospital medical care; it evaluates the qualifications of applicants and holders of staff privileges; it recommends appointment, reappointment, curtailment and exclusion from staff privileges; it provides peer group methods for reviewing basic medical, surgical and obstetrical functions. (Accreditation Manual: Governing Body and Management, p. 6; Medical Staff, pp. 5-7; Medical Record Services, p. 3) When medical staff committees bear delegated responsibility for the competence of staff practitioners, the quality of in-hospital medical care depends heavily upon the committee members' frankness in evaluating their associates' medical skills and their objectivity in regulating staff privileges. Although composed of volunteer professionals, these committees are affected with a strong element of public interest. (P ) California law recognizes this public interest by endowing the practitioner-members of hospital staff committees with a measure of immunity from damage claims arising from committee activities. (Civ.Code, S 43.7; Ascherman v. San Francisco Medical Society (1974) 39 Cal.App.3d 623 (114 Cal.Rptr. 681).)
Evidence Code section 1157 expresses a legislative judgment that the public interest in medical staff candor extends beyond damage immunity and requires a degree of confidentiality. It was enacted in 1968 in apparent response to this court's decision in Kenney v. Superior Court 1967) 255 Cal.App.2d 106 (63 Cal.Rptr. 84). There we sustained a malpractice plaintiff's claim to discovery of hospital staff records which might reveal information bearing upon the competence of the defendant doctor. In Kenney only the doctor was a defendant, not the hospital. Nevertheless, a public policy question was raised by malpractice plaintiffs' access to medical files revealing committee investigations and appraisals of their peers. Section 1157 was enacted upon the theory that external access to peer investigations conducted by staff committees stifles candor and inhibits objectivity. It evinces a legislative judgment that the quality of in-hospital medical practice will be elevated by armoring staff inquiries with a measure of confidentiality." (Fn. omitted.) (Matchett v. Superior Court, supra, 40 Cal.App.3d 623, 628-629, 115 Cal.Rptr. 317.)…"
"…Hospital cannot receive benefit of West's Ann.Cal.Evid.Code S 1157, providing that proceedings and records of organized medical staff committees are not subject to discovery, if it refuses to bear associated burden of demonstrating why information claimed to be immune should be deemed record or proceeding of medical staff committee.…"
6. Brown v. Superior Court
Court of Appeal, Second District, Division 3, California. • May 21, 1985 • 168 Cal.App.3d 489 • 214 Cal.Rptr. 266
"…In reaching that conclusion, the court in Matchett explored the statute's objective: "In an accredited hospital, the organized medical staff is responsible to the hospital governing body for the quality of in-hospital medical care; it evaluates the qualifications of applicants and holders of staff privileges; it recommends appointment, reappointment, curtailment and exclusion from staff privileges; it provides peer group methods for reviewing basic medical, surgical and obstetrical functions. (Citations.) When medical staff committees bear delegated responsibility for the competence of staff practitioners, the quality of in-hospital medical care depends heavily upon the committee members' frankness in evaluating their associates' medical skills and their objectivity in regulating staff privileges. Although composed of volunteer professionals, these committees are affected with a strong element of public interest.…"
7. Doe v. Pasadena Hospital Association, Ltd.
United States District Court, C.D. California. • June 07, 2021 • Not Reported in Fed. Supp. • 2021 WL 4557221
"…An "organized medical staff" entity (composed of health care professionals)-here, Defendant The Medical Staffhas responsibility for providing medical services, and is responsible to the governing body for the adequacy and quality of the medical care rendered to patients in the hospital.…"
8. Smith v. Selma Community Hospital
Court of Appeal, Fifth District, California. • July 21, 2008 • 164 Cal.App.4th 1478 • 80 Cal.Rptr.3d 745
"…Organization of Hospitals and Medical Staff. Every acute care hospital must have "an organized medical staff responsible to the governing body for the adequacy and quality of the medical care rendered to patients in the hospital." (Cal.Code Regs., tit. 22, S 70703, subd. (a).) As a result, hospitals and medical staffs are separate legal entities. (Medical Staff of Doctors Medical Center in Modesto v. Kamil (2005) 132 Cal.App.4th 679, 685, 33
Cal.Rptr.3d 853.) Generally, medical staffs are organized as unincorporated associations. (Ibid.)…"
9. CC § 43.7. Immunity from liability; mental health professional quality assurance committees; professional societies, members or staff; peer review or insurance underwriting committees; hospital governing board
"…(b) There shall be no monetary liability on the part of, and no cause of action for damages shall arise against, any professional society, any member of a duly appointed committee of a medical specialty society, or any member of a duly appointed committee of a state or local professional society, or duly appointed member of a committee of a professional staff of a licensed hospital (provided the professional staff operates pursuant to written bylaws that have been approved by the governing board of the hospital), for any act or proceeding undertaken or performed within the scope of the functions of the committee which is formed to maintain the professional standards of the society established by its bylaws, or any member of any peer review committee whose purpose is to review the quality of medical, dental, dietetic, chiropractic, optometric, acupuncture, psychotherapy, midwifery, or veterinary services rendered by physicians and surgeons, dentists, dental hygienists, podiatrists, registered dietitians, chiropractors, optometrists, acupuncturists, veterinarians, marriage and family therapists, professional clinical counselors, licensed midwives, or psychologists, which committee is composed chiefly of physicians and surgeons, dentists, dental hygienists, podiatrists, registered dietitians, chiropractors, optometrists, acupuncturists, veterinarians, marriage and family therapists, professional clinical counselors, licensed midwives or psychologists for any act or proceeding undertaken or performed in reviewing the quality of medical, dental, dietetic, chiropractic, optometric, acupuncture, psychotherapy, midwifery, or veterinary services rendered by physicians and surgeons, dentists, dental hygienists, podiatrists, registered dietitians, chiropractors, optometrists, acupuncturists, veterinarians, marriage and family therapists, professional clinical counselors, midwifery, or psychologists or any member of the governing board of a hospital in reviewing the quality of medical services rendered by members of the staff if the professional society, committee, or board member acts without malice, has made a reasonable effort to obtain the facts of the matter as to which he, she, or it acts, and acts in reasonable belief that the action taken by him, her, or it is warrant…"
10. O'Byrne v. Santa Monica-UCLA Medical Center
Court of Appeal, Second District, Division 1, California. • December 20, 2001 • 94 Cal.App.4th 797 • 114 Cal.Rptr.2d 575
"…The Janda court noted that although there was a split of authority, a common theme underlay the cases. "The courts acknowledge that the bylaws govern the relationship between the hospital and its medical staff, and each party is required to perform in accordance with the terms of the bylaws. Consequently, an aggrieved physician can enjoin a hospital from contravening the terms and provisions of the bylaws." (Janda v. Madera Community Hosp., supra, 16 F.Supp.2d at p. 1186.) The question to be decided was whether, under California law, the aggrieved physician could sue for breach of contract as well. (Ibid)"
Federal or State Court?
Do you sue in federal court or state court? Many jurisdictional issues will drive this question. SLAPP statutes may or may not apply and federal juries must be unanimous while state juries are usually a super majority (e.g. California 9 out of 12)
In California the application of Evidence Code section 1157 is critical.
Evidence Code Section 1157 is NOT a privilege but it is an exemption from discovery for proceedings and records of certain organized committees. These committees are responsible for evaluating and improving the quality of care. Here are the key points:
Section 1157 applies to the following organized committees:
Medical, medical-dental, podiatric, registered dietitian, psychological, marriage and family therapist, licensed clinical social worker, professional clinical counselor, pharmacist, or veterinary staffs in hospitals-
- Peer review bodies defined in Section 805 of the Business and Professions Code.
Evidence Code § 1157, does not apply in federal court proceedings (Leon v. County of San Diego, 202 F.R.D. 631 (2001)) and (Burrows v. Redbud Community Hospital District 187 F.R.D. 606 (1998)) Federal Rule of Evidence 501 indicates that in federal question cases, privileges are governed by principles of federal common law unless a federal statute or the U.S. Constitution provides otherwise. See: Leon v. County of San Diego, 202 F.R.D. 631 (2001))
1157 almost always favors the large hospitals or medical groups and interferes with the ability of the individual physician or patient to sue. Hence, federal court is often the chosen jurisdiction.