MacArthur v. San Juan County

Antitrust, HIPAA, Medicare – Freedom of Choice, Civil Rights

MacArthur v. San Juan County, No. 2:00-CV-584J
(D.C. Utah June 13, 2005)

A physician, the P.A. he supervised, and a patient sued
a hospital, individual physicians, hospital board members, and various
personnel representing the county. All of the plaintiffs’ claims were dismissed
in a lengthy and complex opinion.

Dr. MacArthur, an OB/GYN, applied for clinical privileges at the hospital
and its birthing clinics. Provisional privileges were granted and the privileges
extended twice. After the second extension, the hospital notified the doctor
that required documentation consisting of a copy of his medical license and
his DEA license was missing from his application packet. Dr. MacArthur did
not pursue his request for clinical privileges and moved his practice to a
neighboring state.

Dr. MacArthur sued the hospital and other named defendants, alleging that
his requests for privileges were deferred in violation of his constitutional
rights and other federal laws. The District Court of Utah found that (1) a
physician’s "liberty" interest in pursuing his or her professional
practices does not per se entitle the physician to exercise clinical privileges
at public hospitals; (2) Dr. MacArthur could not pursue a procedural due process
claim against the hospital because it had not granted nor denied him privileges
before the commencement of the lawsuit; and (3) the doctor’s federal antitrust
claim, that the hospital denied him privileges in order to protect the obstetric
practices of other doctors employed by the hospital, was barred by the Local
Government Antitrust Act and moreover failed on its face because the hospital
never denied privileges to Dr. MacArthur.

A licensed Physician’s Assistant ("PA") requested renewal of her
privileges under the supervision of Dr. MacArthur, but the request was delayed
because of "missing" documentation and because there was no supervising
physician for her privileges. She sued the hospital and other defendants claiming
that the hospital personnel and other physicians deliberately interfered with
her practice privileges in order to inhibit competition.

The district court held that (1) the PA failed to establish a violation of
a constitutional right to practice privileges because her license did not bestow
the same degree of independent judgment that a physician’s license holds and
therefore she was not under the same constitutional protection to pursue her
profession; (2) her federal antitrust claims were moot because no controversy
regarding her entitlement to privileges existed between the hospital and her
as the hospital never denied her privileges; and (3), her HIPAA claims failed
because she failed to point to specific factual allegations or specific instances
in which a breach of confidentiality had occurred.

A patient went to the hospital’s emergency department ("ED") complaining
of flu-like symptoms. Eventually, she was diagnosed with acute diverticulitis.
After filling out the admittance form, Ms. Valdez went to the lavatory because
she felt sick. As she came out of the lavatory, Ms. Valdez observed a nurse
tell the admitting clerk that two patients in the ED could be "set up" in
the emergency room for the physician. Again, she went to the lavatory and during
this visit her sister overheard the nurse tell the admitting clerk to "tell
[the patient] to go to the doctor’s office." When she returned, her sister
related the conversation she had overheard and the two sisters left the emergency
room without speaking to anyone else.

The patient sued the hospital alleging that she was unable to see the provider
of her choice in violation of the Medicare "freedom of choice" statute.
The district court held that this statute did not apply because the complaint
did not allege that any Medicare program officials attempted to interfere with
her choice of health care providers. Further, she did not claim that any provider
was not reimbursed for care provided to her as a Medicare recipient. She also
claimed that she was discriminated against based on national origin because
after she left the ED, the other patient in the waiting room (a white male)
was seen by a physician. The court disagreed because she left on her own without
confirming or denying the conversation her sister claimed to have overheard.
Therefore, she was not "turned away" and/or denied medical services.