Fort Sanders Regional Medical Center v. American Anesthesiology of Tennessee, P.C.

CourtCourt of Appeals of Tennessee
DecidedNovember 13, 2024
DocketE2023-01340-COA-R3-CV
StatusPublished

This text of Fort Sanders Regional Medical Center v. American Anesthesiology of Tennessee, P.C. (Fort Sanders Regional Medical Center v. American Anesthesiology of Tennessee, P.C.) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fort Sanders Regional Medical Center v. American Anesthesiology of Tennessee, P.C., (Tenn. Ct. App. 2024).

Opinion

11/13/2024 IN THE COURT OF APPEALS OF TENNESSEE AT KNOXVILLE May 15, 2024 Session

FORT SANDERS REGIONAL MEDICAL CENTER, ET AL. V. AMERICAN ANESTHESIOLOGY OF TENNESSEE, P.C.

Appeal from the Chancery Court for Knox County No. 207036-2 Richard B. Armstrong, Chancellor ___________________________________

No. E2023-01340-COA-R3-CV ___________________________________

This is a declaratory judgment action concerning the enforceability of covenants not to compete in the medical field. The trial court held the covenants unenforceable as applied to the plaintiff clinicians who provide anesthesia services at local hospitals in Tennessee. We affirm.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Chancery Court Affirmed; Case Remanded

JOHN W. MCCLARTY, J., delivered the opinion of the court, in which D. MICHAEL SWINEY, C.J. and KRISTI M. DAVIS, J., joined.

Luther White, Jr. and Jill Dalrymple, Nashville, Tennessee, for the appellant, American Anesthesiology of Tennessee, P.C.

W. Edward Shipe and Avery C. Lovingfoss, Knoxville, Tennessee, for the appellees, Fort Sanders Regional Medical Center and Parkwest Medical Center.

Nathan L. Kinard and Justin L. Furrow, Chattanooga, Tennessee, for the appellees, Gregory Hagopian and CRNA Intervenors.

J. Chadwick Hatmaker and John M. Lawhorn, Knoxville, Tennessee, for the appellees, Michael Baird, M.D. and the Physician and Chief CRNA Intervenors. OPINION

I. BACKGROUND

American Anesthesiology of Tennessee, P.C. (“AATN”)1 is the medical service provider of anesthesia services for Fort Sanders Regional Medical Center and Parkwest Medical Center (collectively “the Hospitals”), as well as other cities in Tennessee. AATN is a clinical affiliate of NAPA Management Services Corporation (“NMSC”),2 which is an anesthesia management company that provides back-office administrative and operational support to AATN. NMSC is responsible for, inter alia, assisting AATN in its recruitment of clinicians, billing patients and clients, and privileging and credentialing providers.

There is no contract between AATN and the Hospitals. However, anesthesia services at the Hospitals are solely provided by AATN’s 20 anesthesiologists and 93 Certified Registered Nurse Anesthetists (“CRNA”) (collectively “Clinicians”). The patients at the Hospitals are then billed by NMSC for AATN’s services.

AATN maintains employment agreements with its Clinicians in which AATN has the right to terminate employment under certain circumstances, including if AATN voluntarily decides to terminate its provision of services to certain hospitals or healthcare facilities that operate as the Clinicians’ primary service location. In such cases, AATN may impose a 2-year covenant not to compete in which the Clinicians are prohibited from providing services at any health care facility where AATN provided services in the 12 months prior to the employee’s termination.

In January 2023, AATN requested a $14 million per year subsidy from Hospitals in consideration of its services provided by Clinicians. AATN cited, inter alia, the rising cost of clinician salaries and the lower reimbursement rates from patients in support of its request. Prior to this, the Hospitals never directly provided payment to AATN. The Hospitals refused payment of the subsidy, prompting AATN to send written notice of its intent, dated March 23, 2023, to cease providing anesthesia services at the Hospitals in 90 days, specifically at 11:59 p.m. on August 22, 2023.

The Hospitals are prohibited from directly hiring Clinicians. Accordingly, the Hospitals’ parent company, Covenant Health (“Covenant”), sought to directly hire the Clinicians to avoid closure of the Hospitals. AATN then issued a cease and desist letter threatening to sue Covenant for tortious interference of contract if they met with or

1 In Knoxville, AATN is the successor-in-interest to the owners of an anesthesia services group that began providing services to the Hospitals more than 10 years ago. AATN was purchased by its current owners in 2020.

2 NMSC is not a party in the instant litigation. -2- discussed potential employment opportunities with Clinicians. The letter, dated June 7, 2023, and addressed to the Hospitals’ CEO and President and also to the Executive Vice President of Operations, provided, in pertinent part, as follows:

I write on behalf of AATN in connection with the recent activities of [Covenant], including Fort Sanders Regional Medical Center and Parkwest Medical Center (collectively, “Covenant”). It has come to our attention that Covenant is meeting with, and may be discussing potential employment opportunities with, anesthesia clinicians who are employed by AATN (“AATN Clinicians”), so that the AATN Clinicians can render anesthesia services to Fort Sanders Regional Medical Center and Parkwest Medical Center, in place of AATN.

The purpose of this letter is to put Covenant on notice that the AATN Clinicians are subject to employment agreements with AATN and such employment agreements contain restrictive covenants that prohibit the AATN Clinicians from, among other things, providing anesthesia services at Fort Sanders Regional Medical Center and Parkwest Medical Center following termination of their employment agreements.

As a result, we direct you to immediately cease and desist from engaging in the conduct described above. Any act by Covenant to interfere with the contractual obligations of the AATN Clinicians will be considered tortious interference, and AATN will pursue all available legal remedies.

On June 23, 2023, the Hospitals, along with two clinicians, Michael Baird, M.D. and Gregory Hagopian (collectively “Plaintiffs”), filed a petition for declaratory judgment to declare the covenants not to compete unenforceable. In support of the petition, Plaintiffs asserted that the Hospitals would be forced to shut down if anesthesia services were unavailable, requiring transfer of all current and future patients to other facilities. Plaintiffs alleged that finding facilities with the capability and capacity to service the area would be extremely difficult and would require the use of every ambulance in the state, the cooperation of numerous facilities, and the activation of the National Guard.

AATN responded with a motion to dismiss, asserting that the Plaintiffs lacked standing to pursue their claims (1) because there was no justiciable controversy and (2) because the Hospitals were requesting judicial interpretation of contracts that they were neither parties to nor third-party beneficiaries of. The trial court held the motion to dismiss in abeyance and requested briefing on the issue of whether the remaining clinicians should be joined as necessary parties. AATN agreed that they should be joined as necessary parties, while Plaintiffs maintained that the necessary parties had been included. However, the remaining clinicians, through counsel for Dr. Baird and Mr. Hagopian, filed a motion to intervene. AATN then argued against their inclusion and requested denial of the motion. -3- The trial court granted the motion to intervene and denied the motion to dismiss, finding (1) that a case and controversy existed between the parties due to AATN’s notice of cessation of services and its cease and desist letter; (2) that the Hospitals are third-party beneficiaries to the employment contract because the Clinicians provide services to the Hospitals on AATN’s behalf; and (3) that the Hospitals are necessary parties because the enforceability of the noncompetition clauses directly affects the Hospital’s interest.

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Bluebook (online)
Fort Sanders Regional Medical Center v. American Anesthesiology of Tennessee, P.C., Counsel Stack Legal Research, https://law.counselstack.com/opinion/fort-sanders-regional-medical-center-v-american-anesthesiology-of-tennctapp-2024.