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09/20/89 Lewis E. Adkins, M.D., v. Sarah Bush Lincoln Health

September 20, 1989





544 N.E.2d 733, 129 Ill. 2d 497, 136 Ill. Dec. 47 1989.IL.1458

Appeal from the Appellate Court for the Fourth District; heard in that court on appeal from the Circuit Court of Coles County, the Hon. Rolland Tipsword, Judge, presiding.


JUSTICE WARD delivered the opinion of the court. JUSTICE CALVO took no part in the consideration or decision of this case.


Dr. Lewis E. Adkins, a physician, brought this suit in the circuit court of Coles County against the Sarah Bush Lincoln Health Center (the Center), a small private hospital located in Charleston, Illinois, and several physicians serving on the Center's peer review committees. The suit challenged the Center's decision to deny his annual reapplication for staff privileges and to impose a summary suspension of surgical and obstetrical privileges. These disciplinary actions were taken because of Adkins' claimed failure to conform to the Center's standard of competence and care and because of his failure to correct previously found professional deficiencies. Count I of the complaint alleges that the Center failed to follow its bylaws in imposing the summary suspension and in denying surgical and obstetrical privileges on his annual reapplication for staff privileges.

The trial court dismissed counts II and III of the complaint against both the Center and the individual doctors for failure to state a claim. Count II sought money damages and a declaration that the defendants' conduct was not immunized, but was willful and wanton. Treble damages were also claimed in count III for an alleged conspiracy against the plaintiff in violation of the Illinois Antitrust Act (Ill. Rev. Stat. 1985, ch. 38, par. 60-3). The trial court dismissed each of the physician-defendants on count I, holding that the declaratory and injunctive relief requested could be granted, if at all, only against the Center. The trial court then granted summary judgment under count I in favor of the Center with regard to the Center's imposition of the summary suspension and in favor of Adkins with regard to the Center's denial upon reapplication of staff privileges. The plaintiff appealed the trial court's ruling with regard to the summary suspension, the Center cross-appealed with regard to the reapplication and the appellate court affirmed on each appeal. (158 Ill. App. 3d 982.) We granted the plaintiff's petition for leave to appeal (107 Ill. 2d R. 315).

Under the Center's bylaws a staff physician is required to reapply annually for medical staff privileges. In a letter dated November 1, 1983, Adkins, a member of the Center's medical staff since 1977, reapplied for staff membership and renewal of surgical and obstetrical privileges, which were to expire on December 31, 1983. At the time of his reapplication Adkins was on the Center's medical staff subject to a partial summary suspension. Under the terms of the suspension Adkins could exercise clinical privileges, including surgical and obstetrical privileges, at the Center only under the supervision of a consulting physician. The Committee of Three, a peer review body provided for under the Center's bylaws and composed of the president of the medical staff, the chief of family practice and the hospital administrator, had authority to impose summary suspensions of staff members as immediate corrective action when the best interests of the Center required such action. Because of alleged serious professional faults in treating various patients and because of a failure to correct those deficiencies, the partial suspension of Adkins was imposed by the Committee of Three in May of 1983.

It was the responsibility of the Center's Executive Committee, another peer review committee composed of 11 physicians practicing at the Center, to make recommendations to the Center's Governing Body (the board of directors of the Center, the members of which were nonphysicians) as to whether a staff physician's annual reapplication for the renewal of staff privileges should be granted. The Executive Committee, on December 15, 1983, recommended to the Governing Body that Adkins' general staff privileges be renewed, but that his staff privileges in surgery and obstetrics be denied. The Governing Body approved the Executive Committee's recommendation on the same date and on December 16, 1983, notified Adkins that his reapplication for general staff privileges was granted, but that surgical and obstetrical privileges had been denied.

Also on December 15, 1983, in a separate proceeding, the Committee of Three imposed a second summary suspension on Adkins' privileges. This summary suspension suspended his surgical and obstetrical privileges and allowed general clinical privileges only if he obtained and worked with properly credentialed consultants for each patient he admitted to the Center. Adkins was notified on December 16, 1983, of the second summary suspension and of his right to request a hearing before the Executive Committee.

Adkins filed a notice with the Center's administrator on December 28, 1983, requesting a hearing on his "suspension from the medical staff." Adkins was notified by certified mail that a hearing before the Executive Committee had been scheduled for January 17, 1984. The notice stated that both the second summary suspension and the denial of the annual reapplication would be considered. The notification listed 13 areas of professionally deficient performance by Adkins and was accompanied by 30 supporting patient charts. On February 17, 1984, following a continuance to that date at Adkins' request, he appeared before the Executive Committee. Adkins made no objection to the Executive Committee's conducting the hearing until he appeared before it on February 17. At that time he contended that the hearing should not be held before the Executive Committee for two reasons. First, he argued that he was entitled, under the bylaws, to a review before an ad hoc committee immediately following the recommendation that reapplication for staff privileges be denied. Second, he argued that the Executive Committee could not conduct an impartial review of his suspension by the Committee of Three because it had already, in the reapplication proceeding, considered and made a determination on the issues now before it for a hearing, viz., Adkins' competence in surgery and obstetrics.

On March 16, 1984, following the February hearing, the Executive Committee recommended continuance of the terms of the second summary suspension imposed by the Committee of Three and confirmed its own recommendation that Adkins' application for reappointment to the medical staff be denied. Adkins, pursuant to the Center's bylaws, then filed a notice of appeal to the Governing Body, which after consideration of the record, adopted the recommendations of the Executive Committee on May 24, 1984.

Having exhausted the remedies available under the Center's bylaws, Adkins filed this action contending that (1) the actions of the Center were invalid because they violated procedures established in its bylaws; (2) the actions of the defendants were willful and wanton and, therefore, the defendants were not immune from liability under section 2b of the Medical Practice Act (Ill. Rev. Stat. 1985, ch. 111, par. 4406), which provides immunity from civil liability to persons serving on hospital peer review committees except in cases of willful and wanton misconduct; and (3) the defendants had conspired against him in denying his privileges and unreasonably restrained trade in violation of the Illinois Antitrust Act (Ill. Rev. Stat. 1985, ch. 38, par. 60-1 et seq.), entitling him to treble damages against each of the defendants.

We first observe that counsel for the parties agreed at the time of oral argument before us that the summary judgment entered in favor of Adkins by the trial court is not contested on this appeal by the Center. It is clear that Adkins was not provided, as required by the bylaws, with an ad hoc hearing after the Executive Committee had recommended denial upon his reapplication of staff privileges in surgery and obstetrics. Because of this error in the reapplication process, the appellate court properly reinstated Adkins' staff privileges, subject to the restricting conditions of the second summary suspension ordered by the Committee of Three. Therefore, we consider here only the propriety of the circuit court's entry of summary judgment in regard to the summary suspension and its affirmance by the appellate court.

An order granting summary judgment will be reversed only if the pleadings, depositions and admissions show that a genuine issue as to a material fact existed. (Department of Revenue v. Heartland Investments, Inc. (1985), 106 Ill. 2d 19, 31; Lapidot v. Memorial Medical Center (1986), 144 Ill. App. 3d 141, 147.) We hold that no material question of fact existed and that the summary judgment was properly granted.

In the majority of jurisdictions, including ours, there is, in cases involving private hospital staff privileges, a "rule of non-review" under which, as a matter of public policy, internal staffing decisions of private hospitals are not subject, except as hereinafter stated, to judicial review. (Barrows v. Northwestern Memorial Hospital (1988), 123 Ill. 2d 49, 52; Lapidot v. Memorial Medical Center, 144 Ill. App. 3d at 146.) An exception exists when the decision involves a revocation, suspension or reduction of existing staff privileges. In such cases, the hospital's action is subject to a limited judicial review to determine whether the decision made was in compliance with the hospital's bylaws. (Knapp v. Palos Community Hospital (1988), 176 Ill. App. 3d 1012, 1018; Lapidot v. Memorial Medical Center, 144 Ill. App. 3d at 146; Jain v. Northwestern Community Hospital (1978), 67 Ill. App. 3d 420, 425.) The judicial reluctance to review these internal staff decisions reflects the unwillingness of courts to substitute their judgment for the professional judgment of hospital officials with superior qualifications to consider and decide such issues. (Claydon v. Sisters of the Third Order of St. Francis (1989), 180 Ill. App. 3d 641, 644; Gates v. Holy Cross Hospital (1988), 175 Ill. App. 3d 439, ...

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