Bryan v. Tent, Inc., d/b/a: University Medical Ctr. ( 1997 )

JOE BRYANT, M.D., )
)
Plaintiff/Appellee, )
) Appeal No.
) 01-A-01-9703-CH-00132
VS. )
) Wilson Chancery
) No. 96332
TENET, INC., (NATIONAL MEDICAL )
ENTERPRISES) d/b/a UNIVERSITY )
MEDICAL CENTER, )
)
FILED
Defendant/Appellant. )
November 25, 1997
COURT OF APPEALS OF TENNESSEE Cecil W. Crowson
MIDDLE SECTION AT NASHVILLE Appellate Court Clerk
APPEALED FROM THE CHANCERY COURT OF WILSON COUNTY
AT LEBANON, TENNESSEE
THE HONORABLE C. K. SMITH, CHANCELLOR
HENRY CLAY BARRY
106 S. College
Lebanon, Tennessee 37087
Attorney for Plaintiff/Appellee
WILLIAM C. MOODY
The Cavalier Building, Suite #509
95 White Bridge Road
Nashville, Tennessee 37205
Attorney for Defendant/Appellant
REVERSED AND REMANDED
BEN H. CANTRELL, JUDGE
CONCUR:
KOCH, J.
DISSENT:
TODD, P.J., M.S.
OPINION
On the basis of the due process provision of Article I, § 8 of the
Tennessee Constitution, the Chancery Court of Wilson County enjoined Tenet, Inc.,
the owner of a Lebanon hospital, from proceeding with the investigation of a complaint
against a physician with staff privileges at the hospital. We conclude that the
procedure employed by the hospital does not violate the physician’s constitutional or
contractual rights. We, therefore, reverse the lower court’s judgment.
I.
Facts and Procedural History
Dr. Joe Bryant has practiced for many years as a general surgeon at the
University Medical Center (UMC) in Lebanon. UMC is a private hospital owned by
Tenet, Inc. and is the only hospital in Wilson County. All physicians working at UMC
subscribe to a set of bylaws governing the investigation of complaints. Pursuant to
state regulations the bylaws contain a fair hearing procedure governing decisions
affecting medical staff privileges. See Lewisburg Community Hospital v. Alfredson,
805 S.W.2d 756 (Tenn. 1991).
a. The Bylaws
The UMC bylaws establish a three-tier process that is intended to
incorporate the peer review process endorsed by the General Assembly in Tenn.
Code Ann. § 63-6-219 (1997). The process is triggered by the filing of a “request for
corrective action.” The first step of the process is an informal “investigation” by the
executive committee. The bylaws state specifically that this step is not a “hearing”
and permit the executive committee to take a broad range of actions. The bylaws are
silent about the role of lawyers during the first phase; however, it is uncontradicted
that the hospital does not permit lawyers for anyone to be present at any of the first
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stage meetings during the investigative process. Any person dissatisfied with the
executive committee’s recommendations may appeal.
The second stage of the proceeding is much more formal than the first
and involves a hearing before a medical review committee specifically chosen to hear
the appeal. The bylaws require written notices at this stage. They also require the
executive committee to provide the physician with “notice of the acts or omissions with
which the affected practitioner is charged or a list of the chart numbers under
question, if any, or the reasons for the action or recommendation.” The parties are
permitted to use “representatives,” and these representatives may be lawyers if all
parties desire counsel. The hearing procedure is also quite formal. The hospital must
present its case first, the physician second, and both parties are permitted to present
rebuttal proof. If the physician is the appealing party, he or she must prove by clear
and convincing evidence that the action or the recommendation of the executive
committee was arbitrary, unreasonable, or not supported by substantial evidence.
The third and final step of the process is an appeal to the governing
body of the hospital. This review is based on the record of the prior proceedings, and
the grounds for review include (1) the failure of the earlier proceedings to comply with
the bylaws, (2) the failure to afford due process or a fair hearing, (3) that the
recommendation was arbitrary, unreasonable, or capricious, (4) that the medical
review committee’s decision was contrary to the weight of the evidence, or (5) that any
bylaw relied on by the medical review committee lacked substantive rationality.
b. The Complaint and Subsequent Procedure
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Dr. Bryant’s treatment of a particular patient became the subject of a
complaint to UMC’s administrator. Later, UMC’s chief of staff discussed the incident
with Dr. Bryant and asked him to attend a meeting of the hospital’s executive
committee to review the incident. He declined to attend voluntarily and later was
served with a written notice of the meeting. He also received a copy of the patient’s
chart.
Prior to the meeting, Dr. Bryant wrote a lengthy, detailed letter to UMC’s
administrator presenting his side of the controversy. On the day of the meeting, Dr.
Bryant insisted that the committee permit his lawyer to attend. The committee denied
that request, and Dr. Bryant refused to attend without his lawyer. The committee met
and took some action but the decision is not included in the record.
Shortly thereafter, Dr. Bryant filed suit against Tenet, Inc. seeking to
enjoin the hospital from proceeding under its bylaws because the proceedings violated
the due process provisions of the federal and state constitutions. He later amended
his complaint to allege that Tenet was violating his contractual rights under the bylaws.
The trial court determined that the hospital procedures did not violate the federal
constitution but that they did violate Dr. Bryant’s state constitutional and contractual
rights. Accordingly, the trial court entered an order enjoining UMC from conducting
any further disciplinary proceedings against Dr. Bryant until it (1) provides him with
written notice of the complaint against him, (2) commences a new executive
committee investigation, and (3) allows him to have an attorney present during all
stages of the proceedings.
II.
The Constitutional Issues
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We pass over the first issue in this analysis, the issue of whether Dr.
Bryant has a property interest in his staff privileges at UMC. Although our Supreme
Court in Nashville Memorial Hospital, Inc. v. Binkley, 534 S.W.2d 318 (Tenn. 1976)
held that a doctor did not have a “right” to practice at a private hospital, for the
purposes of this appeal we assume that Dr. Bryant does have such a right.
The next question, then, is whether Article I, § 8 of our Constitution
requires private actors to conform to the requirements of due process before taking
action with respect to that right. We conclude that it does not.
Article I, § 8 of the Tennessee Constitution provides as follows:
That no man shall be taken or imprisoned, or disseized of
his freehold, liberties or privileges, or outlawed, or exiled,
or in any manner destroyed or deprived of his life, liberty
or property, but by the judgment of his peers or the law of
the land.
In State v. Hale, 840 S.W.2d 307, 312 (Tenn. 1992), our Supreme Court
said:
The phrase, ‘the law of the land’, used in this section of
our State Constitution, and the phrase, ‘due process of
law,’ used in the Fifth Amendment and in the first section
of the Fourteenth Amendment to the Constitution of the
United States, are synonymous phrases meaning one and
the same thing.
See also Burford v. State, 845 S.W.2d 204 (Tenn. 1992); State v. Smith, 834 S.W.2d
915 (Tenn. 1992). Since “state action” is necessary to invoke the protection of the
Fourteenth Amendment, Long v. State, 510 S.W.2d 83 (Tenn. Crim. App. 1974), we
conclude that the same is true with respect to Article I, § 8.
We recognize that Article I, § 8 has been interpreted as prohibiting some
state actions that would not violate the due process provisions of the Fifth and
Fourteenth Amendments to the United States Constitution. Compare North v. Russell,
427 U.S. 328 (1976) and State ex rel. Anglin v. Mitchell, 596 S.W.2d 779 (Tenn.
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1980). But, despite the differences in wording in the two constitutional provisions, the
fundamental protection provided by each is protection from the government. State v.
Heer, 412 S.W.2d 218, 220 Tenn. 36 (1967); Ennis v. State, 549 S.W.2d 380 (Tenn.
Crim. App. 1977). We know of no case that applies the protection of Article I, § 8 to
actions by individuals.
Dr. Bryant cites Lyle v. Local 452, 124 S.W.2d 701, 174 Tenn. 222(1939) in support of his contention that Article I, § 8 does apply to private actions. In
that case, our Supreme Court found that a union’s picketing of the plaintiff’s business
was unlawful, a nuisance, and causing irreparable injury to the plaintiff’s property
rights. The court, accordingly, issued a permanent injunction to prohibit the picketing.
The court did say, “we conclude therefore that complainant, as a result of the conduct
of defendants, was deprived of his liberty and property, as guaranteed to him by the
5th and 14th Amendments to the Federal Constitution . . . and Article 1, Section 8, of
the Constitution of Tennessee.” 124 S.W.2d at 704. But, we read the quoted part of
the court’s opinion as a description of the right invaded by the defendants’ unlawful
action rather than a finding that the defendants’ action was prohibited by the
constitutional provisions cited. The court hardly needed a constitutional basis for the
injunction since the common law remedies available for the prevention of irreparable
harm were entirely adequate.
We are convinced that Article I, Section 8 of the Tennessee Constitution
did not apply to the actions of UMC, a private corporation.
III.
Dr. Bryant amended his complaint in the court below to assert a claim
that Tenet, Inc. was violating his contractual rights under the hospital bylaws. We do
not question the fact that the bylaws are part of Dr. Bryant’s contract with the hospital.
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See Lewisburg Community Hosp. v. Alfredson, 805 S.W.2d at 759 (Tenn. 1991). But
the sections of the bylaws governing corrective actions do not give him the rights he
seeks (formal written notice and the right to be represented by an attorney at the
investigative stage.) His complaint on this issue reverts to his constitutional
arguments; in effect he complains that the bylaws do not provide what due process
requires. Since we have already resolved that issue adversely to Dr. Bryant, we think
his complaint based on the bylaws must also fail.
The judgment of the court below is reversed and the complaint is
dismissed. Remand the cause to the Chancery Court of Wilson County for any further
necessary proceedings. Tax the costs on appeal to the appellee.
_____________________________
BEN H. CANTRELL, JUDGE
CONCUR:
_______________________________
WILLIAM C. KOCH, JR., JUDGE
DISSENTING OPINION:
HENRY F. TODD, PRESIDING JUDGE
MIDDLE SECTION
IN THE COURT OF APPEALS OF TENNESSEE
MIDDLE SECTION AT NASHVILLE
JOE BRYANT, M.D., )
)
Plaintiff/Appellee, )
) Appeal No.
) 01-A-01-9703-CH-00132
VS. )
) Wilson Chancery
) No. 96332
TENET, INC., (NATIONAL MEDICAL )
ENTERPRISES) d/b/a UNIVERSITY )
MEDICAL CENTER, ) Reversed and
) Remanded
Defendant/Appellant. )
JUDGMENT
This cause came on to be heard upon the record on appeal from the
Chancery Court of Wilson County, briefs and argument of counsel; upon consideration
whereof, this Court is of the opinion that in the decree of the Chancellor there is
reversible error.
In accordance with the opinion of the Court filed herein, it is, therefore,
ordered and decreed by this Court that the decree of the Chancellor be reversed. The
cause is dismissed, remanded to the Chancery Court of Wilson County for any further
proceedings necessary, and for the collection of the costs accrued below.
Costs of this appeal are taxed against Dr. Joe Bryant, for which
execution may issue if necessary.
ENTER _______________________.
_________________________________
BEN H. CANTRELL, JUDGE
_________________________________
WILLIAM C. KOCH, JR., JUDGE
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