Lo v. Provena Covenant Medical Center

Citations: 826 N.E.2d 592; 356 Ill. App. 3d 538; 292 Ill. Dec. 451; 2005 Ill. App. LEXIS 322Docket: 4-04-0362

Court: Appellate Court of Illinois; March 28, 2005; Illinois; State Appellate Court

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Adolf Lo, M.D. filed a lawsuit against Provena Covenant Medical Center for breach of contract, alleging violations of medical-staff bylaws by restricting his clinical privileges without a hearing. After the complaint was filed, the hospital summarily suspended his privilege to perform open-heart surgery. Lo sought a temporary restraining order to prevent the suspension, which the trial court granted. However, upon appeal, the appellate court reversed the restraining order, stating that the board had the authority to suspend privileges to protect patient safety due to concerns raised in a prior peer review.

On remand, the hospital moved to dismiss Lo's complaint with prejudice, citing immunity under the Hospital Licensing Act and the previous appellate decision. The trial court granted the motion, leading to Lo's appeal. The court determined that Lo's request for an injunction was moot and that the Act barred any damages, ultimately affirming the dismissal of the case. Lo's complaint had claimed he was financially harmed and suffered damage to his professional reputation due to the alleged bylaws violations and the suspension.

On October 22, 2003, the defendant filed a motion to dismiss the complaint with prejudice, citing two grounds: immunity under section 10.2 of the Act and a prior statement indicating no bylaw violation occurred concerning a summary suspension. The trial court granted the motion, leading to this appeal. 

A motion to dismiss under section 2-619(a)(9) requires the acceptance of the complaint's factual allegations as true, while determining whether affirmative matters exist that could bar recovery. This motion does not negate the essential facts but admits them, allowing for reasonable inferences in the plaintiff's favor. 

The defendant claims the appeal is moot, arguing that an actual controversy must remain between the parties for the court's jurisdiction. The plaintiff alleges involuntary restrictions on his clinical privileges, which the defendant contests, suggesting that the plaintiff agreed to the restrictions. This disagreement indicates an actual controversy rather than mootness. 

Additionally, two intervening events are acknowledged: the defendant summarily suspended the plaintiff's privileges to perform open-heart surgery in February 2003, and the plaintiff's application for renewal was denied in January 2004. The bylaws required the plaintiff to request a hearing within 30 days of adverse decisions, which he failed to do, leading the defendant to argue that he has waived his right to a hearing on both the suspension and nonrenewal.

Defendant argues that the issue of whether the plaintiff requires a supervising cardiac surgeon is irrelevant, as there are no surgeries to supervise due to the nonrenewal of the plaintiff's clinical privileges. Plaintiff contends that the 30-day period for requesting a hearing regarding the summary suspension or nonrenewal has not commenced because the bylaws mandate that the chief executive officer must provide notice by certified mail, which was not done properly in this case. Plaintiff asserts that until proper notice is given, the 30-day timeline does not start. 

Defendant's position is that the case is moot since the privilege to perform cardiovascular surgery has ceased to exist, making it senseless to lift restrictions on a non-existent privilege. The appeal is also considered moot if the trial court's issues no longer exist. The complaint specifically challenges the September 2002 restrictions, without addressing the summary suspension or nonrenewal, thus rendering the request for an injunction moot. 

Defendant claims that the bylaws do not constitute a contract, which would negate any claim for damages. However, it is maintained that the bylaws do create a contractual relationship between the plaintiff and defendant. Although the bylaws are enforceable via injunction, the absence of an alternative legal theory for enforcement raises questions. The principle of limited judicial review is based on the understanding that bylaws are enforceable under some common law theory, similar to how they function within trade unions, which are regarded as voluntary associations.

The First District has determined that the bylaws of a medical staff constitute part of the contract between a voluntary association and its members. In this case, the bylaws, known as the 'Medical Staff Bylaws,' were formally adopted by the defendant hospital and its medical staff in October 1996. Section 18.2 of these bylaws states they are legally binding on the medical center. The plaintiff's ability to sue the hospital for breach of contract hinges on the hospital's approval of the bylaws, which designates it as a party to the contract.

The mutual agreement between the hospital and the medical staff encompasses certain disciplinary procedures that govern the plaintiff's employment, some of which are legally mandated. This mutual conferral of benefits provides the necessary consideration for the contract. The plaintiff seeks to enforce a procedure promised by the hospital, with the primary legal remedy being monetary damages.

The hospital claims immunity from damages under section 10.2, but the plaintiff argues this immunity does not apply because the hospital's chief executive officer acted without clear committee authority in a prior case. However, the statute was amended to extend immunity to individuals acting for internal quality control purposes. Thus, the distinction from the prior case may not be applicable due to this statutory change.

The chief executive officer's intent is inferred from the correspondence between the parties. Section 10.2 stipulates that hospitals are not liable for civil damages related to acts or omissions by individuals or committees involved in internal quality control, except for willful or wanton misconduct. Willful and wanton misconduct is defined as actions reflecting a deliberate intention to harm or extreme indifference to safety. In this case, it would be a factual determination whether the defendant's conduct constituted such misconduct, as the plaintiff claims his clinical privileges were involuntarily restricted without a hearing, violating both bylaws and statutory law (210 ILCS 85/10.4(b)(2)(C)). The implications of involuntary restrictions could lead a jury to find carelessness. However, the case hinges on a statutory definition of willful and wanton misconduct, which requires evidence of actual intent to harm, of which the plaintiff has provided none. Consequently, the plaintiff's claims do not meet the statutory definition, barring recovery for breach of contract. While specific performance of a contract may be ordered if legal remedies are inadequate, the request for an injunction is moot. The trial court's judgment is affirmed.