McKeesport Hospital v. Pennsylvania State Board of Medicine

628 A.2d 476, 156 Pa. Commw. 480, 1993 Pa. Commw. LEXIS 391
CourtCommonwealth Court of Pennsylvania
DecidedJune 28, 1993
DocketNo. 1811 C.D. 1992
StatusPublished
Cited by5 cases

This text of 628 A.2d 476 (McKeesport Hospital v. Pennsylvania State Board of Medicine) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McKeesport Hospital v. Pennsylvania State Board of Medicine, 628 A.2d 476, 156 Pa. Commw. 480, 1993 Pa. Commw. LEXIS 391 (Pa. Ct. App. 1993).

Opinions

PALLADINO, Judge.

McKeesport Hospital (Hospital) appeals from an order of the State Board of Medicine (Board) dismissing its complaint against the Accreditation Council for Graduate Medical Education (ACGME).1 We vacate and remand to the Board for further proceedings.

[482]*482The Hospital is a teaching hospital which operates graduate medical training programs, commonly referred to as residencies, in several specialties. The Hospital’s general surgery residency training program (Program) has been accredited since 1961. Since 1979, when its accreditation was first withdrawn and, then upon reconsideration, was granted on a provisional basis, the Program’s accreditation has been provisional. The ACGME, through its Residency Review Committee (Committee),2 reviews the Program annually.

Following a site inspection on November 6, 1990 and a review of the Program by the Committee, the Committee advised the Hospital on July 29, 1991 that the Program’s accreditation was being withdrawn. The withdrawal of the Program’s accreditation, which had an effective date of June 30, 1992, was based on the Program’s alleged failure to be in substantial compliance with the Essentials of Accredited Residencies. The Hospital filed a request for reconsideration which was denied by the Committee. The effective date for withdrawal, however, was extended to' June 30, 1993. The Hospital then appealed to the Board of Appeals which sustained the Committee’s action.3

On June 9, 1992, the ACGME adopted the recommendation of the Board of Appeals, and by letter dated June 10,1992, the ACGME advised the Hospital of its decision to withdraw accreditation.4 The Hospital subsequently filed a complaint against the ACGME with the Board. The complaint request[483]*483ed, inter alia,5 that a hearing be scheduled before the Board wherein the Program would be able to present evidence that the ACGME’s action was unjustified, improper and without just cause.6

Without a hearing, the Board issued an order dismissing the Hospital’s complaint. Specifically, the Board concluded that it has no authority under the Act to affect the internal accreditation process of the ACGME. The Board further concluded that because the Program failed to meet one of the two criteria required to enable it to serve as a medical training facility, the Board has no jurisdiction over the subject matter of the complaint and therefore may not provide any of the relief sought by the Hospital.

On appeal to this court, two issues are presented: 1) whether the Board is the final arbiter in matters involving the accreditation of medical training facilities in Pennsylvania; and 2) whether the Hospital is entitled to a hearing before the Board prior to its accreditation being withdrawn.7

With respect to whether the Board is the final arbiter in matters involving the accreditation of medical training facilities in Pennsylvania, the Medical Practice Act of 1985 [484]*484(Act)8 and the regulations promulgated by the Board are instructive. Section 23 of the Act provides that in order to qualify candidates for medical licensure in Pennsylvania, the curricula and training to be offered by medical training facilities,9 such as the Hospital, “shall meet the requirements set by the board and any accrediting body which may be recognized by the board.” 63 P.S. § 422.23(a).

Section 23 further provides that:

[i]t shall be the duty of the board, in its discretion, periodically to ascertain the character of the instruction and the facilities possessed by each of ... medical training facilities offering or desiring to offer medical training in accordance with the requirements of this act.... In enforcing this provision, the board shall give due notice to any ... hospital upon which it has rendered a decision that its training and facilities do not meet the standards required by the board.

63 P.S. § 422.23(b).

In the event the Board determines that a medical training facility has failed to provide adequate facilities, curricula or training, the Act provides that the Board shall not recognize the education or degrees obtained from the medical training facility during the period of inadequacy. 63 P.S. § 422.23(c).

A plain reading of the statute indicates that the final authority with respect to accreditation rests with the Board and not with a private accrediting body. Although the Board may recognize an accrediting body, it is not required to do so. All authority remains with the Board unless the Board affirmatively appoints an accrediting body. Furthermore, nowhere in the Act is an accrediting body given sole discretion to set the standards by which residency programs are evaluated.

[485]*485Nor does the Act give an accrediting body the power to enforce the Act or the power to regulate or eliminate a program without the Board’s review. Instead, it is the Board which, in enforcing the provisions of the Act, must give notice to any hospital upon which it has rendered a decision that its training and facilities do not meet the requisite standards. Clearly, the Act vests the Board with the primary authority to accredit residency programs and otherwise enforce and give effect to the Act.

The Board’s regulations further define the role of the Board in the accreditation process. Pursuant to 49 Pa.Code Section 17.23, the Board is responsible for determining the character of instruction and the facilities possessed by each of the hospitals which carries out graduate medical education programs in this Commonwealth. This regulation also explains the role of the ACGME and its interaction with the Board. Specifically, the regulation provides as follows:

The Council on Medical Education of the American Medical Association[10] possesses the facilities and staffing required to perform evaluations of the qualifications of the various programs and also the mechanism for accreditation of acceptance programs. The Board and the [Council] work cooperatively in evaluating and approving the training programs in this Commonwealth. A comity exists between the Board and the [Council] under which all intended observations of training programs for accreditation are communicated to the Board and the Board makes all requests for accreditation or investigation of training programs to the [Council]. If an investigation of the programs of the various institutions in this Commonwealth is to be conducted, the Board will provide one of its members or appoint an individual to accompany the investigator on each occasion. An institution within this Commonwealth seeking approval of its programs by the [Council] will be informed that action [486]*486taken by the accrediting agency will be related to the Board.

49 Pa.Code § 17.23 (footnote added).11

A plain reading of the Board’s regulations also supports the conclusion that the final authority regarding accreditation of medical training facilities rests with the Board.

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Bluebook (online)
628 A.2d 476, 156 Pa. Commw. 480, 1993 Pa. Commw. LEXIS 391, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mckeesport-hospital-v-pennsylvania-state-board-of-medicine-pacommwct-1993.