Luke v. Redlands Cmty. Hosp. (Summary)

MEDICAL STAFF HEARING

Luke v. Redlands Cmty. Hosp., No. E046969 (Cal. Ct. App. Feb. 10, 2011)

In a case that was a full decade in the making, the California Court of Appeal reversed a trial court ruling and ordered a hospital to provide the physician with a new hearing based on the suspension and subsequent termination of his privileges. The underlying event that led to the termination of privileges involved a terminally ill patient. The physician, allegedly at the urging of the family, substantially increased the patient’s morphine. The patient died shortly thereafter.

A concern was raised that the physician had not followed hospital protocol regarding comfort care. The department chair and chief of staff reviewed the matter and concluded that the physician had increased the morphine at the family’s urging because the family was upset that the patient had not passed away. Finding that the physician posed an imminent threat to patients, his privileges were summarily suspended and the suspension was upheld by the MEC pending an investigation.

After the investigation, the MEC decided to lift the suspension and impose proctoring. However, when it received a second coroner’s report, which listed the cause of death as “homicide” and “acute morphine toxicity,” and when it discovered a second discharge summary, the Medical Executive Committee imposed a suspension. A lengthy hearing and appeal process followed.

The state medical board also conducted an inquiry. Initially, the state medical board revoked the physician’s license. However, after considering additional information from the physician and receiving a third report from the coroner which changed the cause of death to “undetermined,” the state board rescinded the termination and imposed a lesser sanction.

The physician sued the hospital claiming he did not have a fair hearing based on the composition of the hearing panel. His main argument was that the department chair (who was the witness for the Medical Executive Committee) also had a close professional relationship with one of the hearing panel members. The department chair and the hearing panel members were also both members of the same practice group.

The physician also argued that the hearing was not fair because of the admission into evidence of an erroneous toxicology report and the second coroner’s report which had listed the cause of death as “homicide.”

The trial court ordered the hospital to reconsider its decision in light of a third coroner’s report and new evidence supporting that the toxicology report was erroneous. After a review of this evidence, the Board reaffirmed its decision and the trial court concluded that the physician’s due process rights had not been violated.

The Court of Appeal disagreed and found that several factors, including the possibility of “adjudicator bias” tainted the process so as to deny the physician a fair hearing. Although the court did not find evidence of any pecuniary conflict of interest, it was concerned that one of the hearing panel members might not be impartial based on his “professional embroilment in the dispute.” In support of this position, the court pointed to the fact that the hearing panel member had been involved in the development of the protocol at issue and had asked rather pointed questions about euthanasia during the hearing. The court was also persuaded that the close professional relationship between the department chair and the hearing panel member “created a strong appearance – and perhaps even probability – of professional and personal bias.”

The appeals court was even more disturbed by the unreliable toxicology report and second death certificate which was based on that report. According to the court: “the toxicology report and amended (second) death certificate were so intimately entwined with the actions and decision in this case as to undermine the fairness of the peer review proceedings and hospital board decisions.” Thus, the court ordered that the hospital go back and give the physician a new and fair hearing.