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Ladenheim v. Union County Hospital Dist.





APPEAL from the Circuit Court of Union County; the Hon. GEORGE OROS, Judge, presiding.


Plaintiff Charles Ladenheim appeals from a judgment of the circuit court of Union County affirming the Union County Hospital District's denial of staff privileges to plaintiff.

On January 9, 1976, plaintiff made his annual application for reappointment to the medical staff of the Union County Hospital District. The medical staff of the district approved the application on March 15, 1976, and recommended that the district's board of directors approve the reappointment.

By letter dated August 27, 1976, plaintiff was informed that the board of directors had disapproved his application, and that he would no longer be allowed to admit patients to the Union County Hospital. Plaintiff immediately filed a complaint in the circuit court to enjoin the hospital district from denying him the use of the hospital facilities until a hearing was conducted to determine his eligibility for a staff reappointment, and on September 20, 1976, the court entered a restraining order against the hospital district. Plaintiff subsequently received a five-page notice of hearing, stating 16 general charges of unprofessional conduct and listing 21 separate incidents which formed the basis for the charges. The incidents were listed in substantial detail, including the time frame and people involved.

On October 11, 1976, a hearing was conducted before the executive committee of the medical and dental staff sitting as the credentials committee, in accordance with the bylaws of the Union County Hospital District. This committee was composed of three members of the staff, including Dr. R. Dr. R. had assisted the hospital's attorney in preparing the written charges against plaintiff. Apparently, his assistance was limited to an interpretation of a memorandum received by him from the director of nurses. Plaintiff's counsel moved to have Dr. R. removed from the committee on the ground that his participation in this phase of the investigation constituted bias. Upon the advice of the hospital attorney, the motion was denied.

Throughout the hearing the hospital attorney elicited witness testimony by first laying a foundation, then asking the witness to describe his or her particular contacts with plaintiff. The hospital attorney also made occasional objections to evidence presented by plaintiff, and advised the chair on procedural and evidentiary rulings. Dr. R. asked several questions of both plaintiff and other witnesses, as did other members of the committee. Plaintiff's counsel and plaintiff himself were allowed to cross-examine all of the witnesses, and plaintiff was given the opportunity to rebut their testimony. All relevant evidence was admitted without the limitations of formal evidentiary rules.

After hearing the evidence, the credentials committee concluded that the following allegations were true: In August 1976, during a dispute over administrative procedures, plaintiff told a physical therapist that she had body odor and repeated the conversation to two other hospital employees. In March 1976, after receiving a bill for laboratory work done on a patient not sufficiently identified to allow direct billing of the patient, plaintiff returned the bill with a note indicating that the business office staff was stupid. In January 1976, plaintiff refused to admit a patient to Union County Hospital, telling a relative of the patient that he was "mad at the hospital." Plaintiff refused to complete a medical planning form titled "Discharge Planning" on a nursing home patient, writing "you dreamer" across the space provided for his input. On several occasions plaintiff made disparaging remarks to or refused to work with a particular nurse, and in one instance told her that an emergency room patient could go to another hospital "or go to hell" as far as he was concerned, because the patient was receiving medical assistance from welfare. Plaintiff refused to bring his criticisms of the nursing staff to the director of nursing, circumventing her entirely in favor of complaining to the hospital administrator. In addition, he indicated to another staff member that it was useless to request the nursing director's assistance, because she would not take any action. In June of 1975 and in February of 1976, plaintiff refused nurses' requests to come to the emergency room to attend patients. He left standing orders that no nurse was to institute cardio-pulmonary resuscitation on any of his patients until receiving orders from him or another doctor. In May and June of 1976, plaintiff failed to take proper pre- and post-operative measures in the care of a patient who had undergone major abdominal surgery.

On February 24, 1977, the credentials committee submitted its findings to the board of directors of the district, and recommended that the plaintiff's reappointment be denied. Plaintiff thereupon appealed the recommendation and findings to the joint conference committee, a body consisting of the officers of the board of directors and the medical staff. The joint conference committee concurred in the findings and recommendation of the credentials committee.

On June 14, 1977, an appeal was taken to the full medical staff, and plaintiff sought to reopen the hearing before the credentials committee on the grounds that plaintiff had received evidence that one of the witnesses against him had been a narcotics user who stole drugs from the hospital. The motion was denied. The staff approved the actions of the credentials committee. Plaintiff then appealed to the board of directors, who affirmed the findings and recommendation of the credentials committee and denied plaintiff's appointment to the staff of the Union County Hospital.

Plaintiff sought judicial review by writ of certiorari in the Union County Circuit Court, alleging that the hearing procedures employed by the Union County Hospital District denied him due process of law, that the charges against him were vague, and that the findings of the credentials committee were against the manifest weight of the evidence. The circuit court upheld the determination of the credentials committee and the action of the district. We affirm.

• 1 Appellant first contends that the district violated its own bylaws in the hearing procedure because he initially should have received a hearing before the staff as a whole, rather than before the executive committee sitting as the credentials committee. Article VII, sections 2A(1) and (1)h of the bylaws of the medical staff read as follows:

"Additional duties and/or functions of the Executive Committee shall be:

To hear appeals on request of an applicant who has been rejected for membership or a staff member whose privileges have been changed. In the event that a suspension or revocation of staff membership or curtailment or denial of privileges is recommended by the Executive Committee, the practitioner may request a hearing before the staff as a whole. If the appeal to the Board [sic] is not favorably resolved, the practitioner may further appeal to the Board. A final decision will be rendered by the Board within a reasonable number of days after this hearing." (Emphasis added.)

Clearly, a hearing before the staff as a whole is available only upon specific request of the applicant, and then only subsequent to the executive committee's decision. We find no such request in this record. Appellant did request that the hearing be reopened to allow him to present evidence which in his opinion tended to discredit certain of the ...

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