Florida case puts medical staff self-governance under fire

Contributing Writer
AMA Wire
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After a hospital medical staff renewed a physician’s privileges, trustees at the Florida hospital moved to push out the 15-year veteran by refusing the renew his privileges because they claimed their own investigation found deficiencies in his patient care and that he exhibited “disruptive behavior.”

The physician sued the hospital, asking that his privileges be renewed because he and the hospital were bound by the medical staff bylaws, under which he was found suitable for recredentialing. The doctor—Anil Desai, MD—also maintains the fair hearing procedure the hospital offered was not contemplated under the medical staff bylaws and he, consequently, was not obligated to accept the hearing.

Now, in a case that will have an impact on medical staff self-governance, the Florida Supreme Court will decide whether the physician has to accept the trustee’s hearing. In such a hearing, the physician would have to defend himself against the hospital’s claims—claims that medical staff recredentialing committee and the medical executive committee members reconsidered after the hospital’s accusations and found them factually unconvincing. 

The Litigation Center of the American Medical Association and State Medical Societies in March joined with the Florida Medical Association in filing a friend-of-the-court brief with the state’s high court in the case, Desai v. Lawnwood Medical Center. The Litigation Center brief argues that Lawnwood Medical Center violated Dr. Desai’s contractual rights and Florida law by refusing to renew his staff privileges without following the peer-review procedures outlined in the medical staff bylaws.

The brief further argues that hospital trustees based their decision to not renew Dr. Desai’s privileges on its “personal animus” against Dr. Desai and not his medical competence or out of concern for patients’ welfare. Dr. Desai had been involved in an unrelated lawsuit with the hospital and he had criticized the hospital for how it handled pathology slides, a method that caused slides to become contaminated, court records show.

“It wanted to make an example of him to demonstrate that physicians on the medical staff who might wish to challenge hospital procedures could not rely on the medical staff bylaws (which one of its executives called ‘trash’) for protection. The same executive said ‘the bylaws would not last long, nor would those who made them,’ ” the brief states.

The brief concludes that Florida courts have “repeatedly held”—and the Florida Legislature has mandated that—“medical staff bylaws are not trash.”

“Accused physicians have a right to be reviewed by their peers, under fair procedure,” the amicus brief argues, urging the high court to overturn two lower court decisions.

Hospital’s proposed hearing unfair

A Florida trial court dismissed Dr. Desai’s lawsuit because it said by not accepting the hearing the hospital offered under its Fair Hearing and Appellate Review Procedures (FHARP), the physician had not exhausted the administrative remedies available. The Florida District Court of Appeal—where the Litigation Center also filed an amicus brief—upheld the trial court decision.

The Litigation Center brief maintains that Dr. Desai was not required to accept the procedures specified in FHARP.

“For one thing, such a requirement would violate the principle of enforceability of medical staff bylaws, a principle repeatedly recognized by the Florida Courts,” the brief says. “For another, such a requirement would violate the Florida statutes and regulations that mandate that medical staff peer review must be conducted before (not after) disciplinary action is taken against a physician, by a physician’s peers, other physicians on the medical staff, rather than by laymen and under a fundamentally fair procedure.”

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Jul 13, 2018
In addition to a decision potentially raising medical liability insurance rates, a Connecticut high-court case could affect patient confidentiality and privacy.