Blaine v. N. Brevard Cnty. Hosp. Dist.

312 F. Supp. 3d 1295
CourtDistrict Court, M.D. Florida
DecidedJune 6, 2018
DocketCase No. 6:18–cv–487–Orl–37DCI
StatusPublished
Cited by4 cases

This text of 312 F. Supp. 3d 1295 (Blaine v. N. Brevard Cnty. Hosp. Dist.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blaine v. N. Brevard Cnty. Hosp. Dist., 312 F. Supp. 3d 1295 (M.D. Fla. 2018).

Opinion

ROY B. DALTON JR., United States District Judge

This case springs from a bitter dispute between a public hospital and a healthcare conglomerate over access to facilities, insurance, and doctors in Brevard County, Florida. Stuck in the middle of these dueling entities are Plaintiffs, seven oncologists employed by the healthcare conglomerate "Health First " who previously held medical privileges at the public hospital, Parrish Medical Center ("PMC ") operated by Defendant. (Doc. 1.) But PMC denied Plaintiffs' most recent applications for reappointment of their medical privileges ("Reappointment Applications ")-not based on quality of patient care, but because Plaintiffs and Health First failed to turn over patient data PMC requested. (See Doc. 33-2, pp. 64-77.) Since losing their medical privileges, Plaintiffs haven't been able to meet with their oncology patients at PMC, even in emergency situations where PMC was the closest facility for the patient. (See Docs. S-11, S-12, S-13.)

Against this backdrop, Plaintiffs filed suit, claiming that the process PMC employed to deny the Reappointment Applications-by not offering them sufficient notice and a pre-termination hearing before an impartial decisionmaker-contravened their constitutional rights to procedural due process and breached PMC's Bylaws. (Doc. 1.) Plaintiffs then moved for a preliminary injunction to: (1) reinstate their medical privileges; (2) set aside PMC's denial of the Reappointment Applications; and (3) prohibit PMC from taking further action to deprive them of their privileges or reporting them to the National Practitioner Data Bank or agency for non-clinical matters unrelated to patient welfare. (Doc. 5 ("PI Motion ").) Taking the PI Motion under advisement, the Court held a hearing on May 15, 2018 ("Hearing "). (Docs. 24, 39, 40.) This Order follows.

I. BACKGROUND

Plaintiffs are seven well-regarded oncologists with impeccable track records of *1298providing excellent patient care. (Doc. 1, ¶¶ 8, 9, 11.) PMC is a public hospital created to serve northern Brevard County, and is the only hospital located there. (Doc. 1, ¶¶ 3-4.) Seeking to extend their practice to encompass patients in this otherwise-inaccessible area, Plaintiffs applied for initial appointment to the medical staff, which PMC granted. (Id. ¶ 12.) PMC term limits these appointments to two years, but allows physicians to seek reappointment through a process outlined in its Bylaws. (See id. ¶ 19 (citing Doc. 1-2, § 6.4 (Bylaws Reappointment Process) ).) Since their initial appointment, Plaintiffs successfully obtained reappointment each time they applied-until now. (Id. ¶ 12.) Before turning to the process Plaintiffs received, the Court details the Bylaws' reappointment process.

A. PMC's Bylaws' Reappointment Process

Seeking reappointment entails a multi-step process thoroughly detailed in PMC's Bylaws. (See generally Doc. 1-2, §§ 6.4, 6.3-5-6.3-6.) To kick-start the process, the CEO reviews an application, which then goes to PMC's Credentials and Medical Ethics Committee ("CMEC ") followed by the Medical Executive Committee ("MEC "). (See id. ) The MEC "examine[s] the evidence of the character, professional competence, qualifications and ethical standing of the applicant" to determine whether "all the necessary qualifications" have been established and met. (Id. § 6.3-5(A)(2).) Upon review, the MEC "shall take" one of three actions on the application: (1) recommend approval; (2) recommend deferral for further consideration; or (3) issue an "adverse" recommendation, as defined in the Bylaws. (Id. §§ 6.3-5(B)(1)-(3).)

This is where the path forks. If the MEC issues a "favorable" recommendation, the application goes to the Board. (Id. § 6.3-6.) Like the MEC, the Board "shall take" one of three actions on the MEC's recommendation: (1) adopt it; (2) reject it; or (3) refer it back to the MEC for further consideration.1 (Id. §§ 6.3-6(A)-(C).) But if the MEC's recommendation is "adverse," the "applicant shall be entitled to ... procedural rights" (id. § 6.3-5(B)(3) ),2 that is, special notice and a hearing before an Ad Hoc Committee of the Medical Staff (id. § 9.2-1).3 Such hearing entails a panoply of procedural rights for the applicant, including having counsel present, calling witnesses, and cross-examination. (See id. § 9.2-4(E).) Depending on the outcome of the hearing, an applicant may seek appellate review in front of the Board, who renders a final, binding decision. (See id. §§ 9.3-1-9.3-2(A).)

Beyond a hearing, the Bylaws contemplate another process if a committee "receives or is considering initiating an adverse recommendation concerning a practitioner": an interview with that committee.4 (Id. § 9.1-1.) An interview is *1299"preliminary in nature." (Id. ) The practitioner is "informed of the general nature of the circumstances and may present relevant information thereto," but the interview "shall not constitute a hearing" and "shall not be conducted according to the procedural rules of hearings." (Id. ) From an interview, the MEC makes a recommendation about the practitioner to the CEO, who then confers with the practitioner and the MEC before resolving the application. (Id. §§ 9.1-2-9.1.3.)

So the key actors in reappointment are the MEC and the Board. For both, the Bylaws strictly circumscribe their universe of actions-but the Board retains ultimate authority over the decision to reappoint. (See id. § 6.3-6.)

B. Plaintiffs' Reappointment Process

With their terms set to expire on January 18, 2018, Plaintiffs submitted reappointment applications in advance, as usual. (See Doc. 1, ¶ 19; Doc. 33-1, ¶ 9.) In line with the Bylaws, PMC's CEO George Miktarian, Jr. ("Miktarian ") submitted the applications to the CMEC. (Doc. 33-1, ¶ 21.) On review, the CMEC transmitted the applications to the MEC. (Id. ¶ 22.) The MEC reviewed the applications and, on November 21, 2017, provided a favorable recommendation regarding Plaintiffs' reappointment to the Board ("Favorable Recommendation "). (Id. ¶ 23.) The Board considered the Favorable Recommendation at its meeting on December 4, 2017. (Id. ¶ 25; Doc. 33-2, pp. 2-4.) There, Miktarian spoke:

Mr. Mikitarian noted that PMC hosts the only cancer program in Brevard County accredited by the Commission on Cancer. The PMC cancer program relies on clinical data from both Physicians and Hospitals. For the first time, the program's accreditation is in jeopardy, due to a number of physicians as listed not submitting the needed clinical data to maintain accreditation. Mr. Mikitarian disseminated a memorandum documenting the attempts to retrieve the information, as well as a draft letter to each physician requesting the information yet again. Discussion ensued and the following motion was made by Mr. Jordan, seconded by Dr. Galfo and approved (8 ayes, 0 nays, 0 abstentions).

(Doc. 33-2, p.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
312 F. Supp. 3d 1295, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blaine-v-n-brevard-cnty-hosp-dist-flmd-2018.