Lo v. Provena Covenant Medical Center

Citations: 796 N.E.2d 607; 342 Ill. App. 3d 975; 277 Ill. Dec. 521Docket: 4-03-0175

Court: Appellate Court of Illinois; September 19, 2003; Illinois; State Appellate Court

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Adolf Lo, M.D., a physician at Provena Covenant Medical Center, was summarily suspended from performing open-heart surgeries due to concerns raised by an independent peer review regarding his surgical practices. The hospital insisted that he operate under the direct supervision of another cardiac surgeon, a condition he was unwilling to accept. In response, Lo sued Provena for breach of contract, leading to a temporary restraining order from the trial court against the suspension.

Provena appealed the trial court's decision, arguing three main points: (1) the suspension did not violate any bylaws, thereby negating the trial court's authority to intervene; (2) both federal and state laws, along with the hospital's bylaws, granted Provena the ultimate authority to suspend a physician's privileges if they posed an imminent risk to patient safety; and (3) Lo did not meet the necessary criteria for a temporary restraining order.

The appellate court found that the summary suspension was permissible under the hospital's bylaws and reversed the trial court's judgment. The bylaws established a governance structure whereby the Hospital Board had delegated authority over clinical privileges and maintained a liaison with the Medical Staff to ensure appropriate patient care.

Bylaws for the Medical/Dental Staff establish its organization and governance, requiring adoption by the Hospital Board. The Medical/Dental Staff is tasked with monitoring and evaluating patient care quality, identifying areas for improvement, and reporting to the Hospital Board. Compliance with PROVENA HOSPITALS policies, Illinois state license requirements, and Joint Commission standards is mandatory. The Medical Staff is accountable for professional performance and participates in Medical Center policymaking. 

Corrective actions can be initiated by various officials when a member’s conduct is deemed substandard or harmful, with written requests submitted to the Executive Committee. In urgent situations, designated leaders may impose a summary suspension of a practitioner's privileges to avert immediate danger, with procedural rights ensured for those affected. 

The bylaws were in effect when the defendant suspended the plaintiff’s privileges for open-heart surgery due to concerns about the cardiovascular surgery program's performance, highlighted by patient statistics from January 2000 to May 2001. The overall mortality rate for the program was reported at 7%, with the plaintiff’s patient mortality rates at 5.3% for 2000 and 5% for both 2001 and 2002.

The national mortality rates for open-heart surgery were reported at 3% in 2000 and 2.3% in 2001. Due to concerns over allegedly high mortality and complication rates, the defendant engaged independent consultants to review its cardiovascular-surgery program, which revealed significant issues with the plaintiff's surgeries. A letter from the defendant's board chair indicated that the report raised unexpected grave concerns about quality. Although the defendant sought collaborative remedial measures, the plaintiff contested the findings and delayed in proposing an action plan. Eventually, the plaintiff agreed to perform surgeries only under the supervision of two designated cardiac surgeons but later withdrew his consent, citing unreasonable conditions imposed by the defendant.

In response to the plaintiff’s announcement of an unsupervised surgery, defendant's CEO, Diane Friedman, consulted medical staff about suspending the plaintiff’s clinical privileges, but faced reluctance from them to engage due to potential litigation. Following this, the executive committee of the defendant's board held a special meeting, concluding that the medical staff was not cooperating and that allowing the plaintiff to operate unsupervised posed an imminent danger to patients. Consequently, they authorized Friedman to suspend the plaintiff's privileges if he continued to reject supervision.

Friedman formally notified the plaintiff of the suspension, citing the medical staff bylaws and informing him of his right to a hearing. The plaintiff contested this action in court, claiming it violated the bylaws, which required a medical staff recommendation for suspension. The trial court issued a temporary restraining order against the defendant from suspending the plaintiff's privileges until compliance with the bylaws was ensured, and this order is the focus of the current appeal.

The appeal involves three standards of review: assessing whether the trial court abused its discretion in issuing a temporary restraining order, evaluating if the factual findings supporting the order are against the manifest weight of the evidence, and interpreting bylaws, regulations, and statutes de novo. 

In cases concerning the suspension of clinical privileges, courts focus solely on whether the suspension violated any bylaws. If no violation occurs, courts defer to the hospital officials' decisions. In this instance, the plaintiff argued that the suspension of their privilege to perform open-heart surgery breached section 8.2.1 of the medical staff's bylaws, which mandates a recommendation from key medical staff before a summary suspension can occur. 

The defendant contended that the plaintiff's interpretation did not consider other bylaws and laws that assign ultimate authority to the hospital board over the medical staff. The bylaws stipulate that the medical staff is accountable to the board for professional performance and compliance with quality improvement standards, in accordance with federal and state law. The governing body of the hospital must ensure that the medical staff maintains quality care, as outlined in relevant regulations and statutes.

The defendant asserts that the hospital board is obligated to ensure the quality of medical care and that the chief executive officer possesses the authority to summarily suspend a physician's clinical privileges upon the board's resolution, particularly when patient safety is at risk. This authority is supported by section 10.4(b)(2)(C)(i) of the Hospital Licensing Act, which allows for such suspensions without prior hearings if a medical staff member's practice poses an immediate danger to patients.

The interpretation confirms that the hospital holds an inherent right to act swiftly in protecting patient safety, stemming from the board's ultimate accountability for care quality. Federal and state laws mandate that the medical staff be accountable to the governing body for the standards of care. If the medical staff could veto the hospital's actions, it would undermine accountability and leave the hospital vulnerable to substandard practices, potentially leading to severe consequences.

The hospital could face liability for a physician's misconduct under the respondeat superior doctrine or due to its independent duty to supervise medical care. The plaintiff's interpretation of the bylaws would leave the hospital powerless to prevent malpractice while still liable for it, a situation the court would deem untenable and contrary to public policy. Moreover, bylaws that conflict with statutes or regulations are unenforceable.

Federal and state regulations impose the ultimate responsibility for medical care quality on hospital governing boards. Hospitals have an independent obligation to ensure patient health and welfare, as established in case law. Specifically, hospitals are required to review and supervise medical care regardless of the physician-patient relationship. Any bylaws that prevent the governing board from fulfilling this duty are void. 

Section 8.2.1 of the medical staff's bylaws permits the chief executive officer (CEO) to suspend a practitioner's clinical privileges based on recommendations from medical staff, but it does not restrict the CEO's authority to act independently in emergencies to protect patient safety. The governing board retains inherent authority to impose summary suspensions, as outlined in state law, and the CEO's actions can be supported by the board’s authority. 

The Joint Commission on Accreditation of Healthcare Organizations emphasizes that while the governing body should consider medical staff recommendations, it ultimately retains the decision-making authority regarding clinical privileges, as long as decisions are not arbitrary or contrary to bylaws. The medical staff's bylaws are intended to align with these accreditation requirements, ensuring the governing body can act decisively to prevent genuine and imminent patient dangers. Any summary suspensions must be informed decisions supported by credible evidence, not solely based on statistical interpretations. The governing body is encouraged to consult the medical staff but is not obligated to rely exclusively on their input.

The Illinois State Medical Society, acting as amicus curiae, expresses concern over potential 'lay control of professional decision-making' in healthcare, arguing that allowing the governing body to dismiss medical staff input undermines legal protections and accreditation standards. However, it is noted that state law assigns ultimate responsibility for medical care quality to the governing body, which must act independently of medical staff recommendations. In this case, the medical staff failed to provide a recommendation regarding the plaintiff's summary suspension of clinical privileges for open-heart surgery. The Society also argues that upholding the defendant's suspension authority without medical staff input would violate the Illinois Supreme Court's prohibition against corporate practice of medicine. Nonetheless, the court finds that this concern is mitigated as the suspension was based on an independent medical peer review rather than a lay assessment. Relevant provisions of the Hospital Licensing Act emphasize the separation of responsibilities between governing boards and medical staff and clarify that peer review can justify practice restrictions. The plaintiff failed to demonstrate a clear right for relief to obtain a temporary restraining order, as the suspension did not violate any bylaws. Consequently, the trial court's decision to grant the restraining order is reversed.