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Ramos v. Kewanee Hospital

Court of Appeals of Illinois, Third District

May 31, 2013

JULIO RAMOS, M.D., Plaintiff-Appellant,
v.
KEWANEE HOSPITAL, Defendant-Appellee.

Appeal from the Circuit Court of the 14th Judicial Circuit, Henry County, Illinois, Circuit No. 11-L-14 Honorable Charles H. Stengel, Judge, Presiding

Justices Carter and O'Brien concurred in the judgment and opinion.

OPINION

SCHMIDT JUSTICE

¶ 1 Plaintiff, Julio Ramos, M.D., filed a three-count second amended complaint against defendant, Kewanee Hospital (the hospital), seeking injunctive relief, a declaration that the hospital improperly summarily suspended his privileges, and damages arising from the summary suspension. Plaintiff voluntarily dismissed his second amended complaint, then filed the current action six weeks later. Following trial, a jury returned a verdict in favor of the defendant hospital. Plaintiff appeals, claiming, inter alia, he was improperly assessed fees and costs in the refiled case that were associated with the original action, the trial court erred in denying his motion for substitution of judge, the trial court made numerous erroneous evidentiary rulings, and he is entitled to a judgment notwithstanding the verdict. We affirm in part, vacate in part, reverse in part, and remand for further proceedings. ¶ 2 BACKGROUND

¶ 3 Dr. Ramos is a family practice physician. He worked from August of 2002 through November of 2007 as an employee of the defendant hospital. In November 2007, he sought to terminate his employment with the hospital. On November 30, 2007, he entered into an agreement with Regional Family Health Center, S.C. (Regional Family), to provide physician services for it. Dr. Remi Satkauskas and Dr. Kevin Jeffries own Regional Family. By December of 2007, Dr. Ramos also began working full-time as an emergency room physician at Graham Hospital in Canton, Illinois. During these times, he maintained clinical privileges at Kewanee Hospital.

¶ 4 The defendant hospital has adopted medical staff bylaws that set forth procedures by which a physician can apply for clinical privileges, as well as a process by which those privileges may be suspended or revoked. The process includes review by the medical executive committee (MEC). The MEC is a committee of active members of the hospital medical staff with responsibility for various staff activities. The MEC advises the board concerning a physician's qualifications and the propriety of maintaining privileges. The board, however, maintains the final and ultimate decision making authority regarding whether to grant, revoke, or suspend a physician's clinical privileges.

¶ 5 The bylaws' conflict of interest provision prohibits a member of any hospital committee from participating in the discussion or voting on a matter in which the member "has or reasonably could be perceived to have a conflict of interest or to be biased in any matter involving another medical staff member." The bylaws further provide that the chief executive officer (CEO), the board, or any active member of the medical staff may initiate a request for investigation or corrective action against a physician with clinical privileges.

¶ 6 On or about June 3, 2008, the hospital received a report from HealthSystems of Illinois (HSI report) concerning patient care involving Ramos. HealthSystems is an independent quality review organization contracted by the Illinois Department of Healthcare and Family Services to perform review of inpatient services provided to Medicaid program participants. The hospital did not solicit the HSI report and had never previously received an HSI report.

¶ 7 Prior to June of 2008, the CEO of the hospital, Gufstason, was aware of two other patient care incidents involving Ramos, which were under review by the hospital's peer review committee. After receiving the HSI report, the hospital board issued a written request to the hospital's MEC to review the three patient care incidents and initiate corrective action if warranted.

¶ 8 The MEC sent a letter to Ramos on July 11, 2008, informing him of the three patient care incidents and advising him that a special meeting of the MEC was scheduled for July 17, 2008. The letter requested he attend the meeting, which he did. At the meeting, he responded to questions regarding the incidents, submitted written materials to the MEC, presented his version of the events surrounding the incidents and acknowledged that he reviewed the medical records of all three patients prior to the meeting.

¶ 9 On July 17, 2008, the board received a fourth patient care incident involving Ramos and referred this incident to the MEC as well. The MEC declined to consider the fourth incident until it completed the review of the previous three.

¶ 10 The MEC declined to appoint an ad hoc committee to investigate the three patient care incidents. The MEC issued a "Letter of Concern" to Ramos and felt no other action was warranted. Dr. Satkauskas and Dr. Jeffries were members of the MEC at the time it issued the letter of concern.

¶ 11 The board claims that prior to June of 2008, it engaged a peer review consultant to provide peer review education to the MEC as the board felt there were serious deficiencies in its review process. One recommendation made by this consultant was for the hospital to refer cases to an external entity for peer reviews. In July of 2008, the board decided to send the four patient care incidents involving Dr. Ramos to CIMRO Quality Healthcare Solutions (CIMRO).

¶ 12 CIMRO prepared a report that was presented to the board. Thereafter, on August 1, 2008, the hospital directed Dr. Satkauskas to ask Dr. Ramos if he would voluntarily refrain from practicing or taking calls at the hospital pending further review of the four patient care incidents. Ramos rejected the request.

¶ 13 The board then met on August 5, 2008, where the CIMRO physician reviewer gave an oral presentation concerning her findings and recommendations. Two days later, the board provided Ramos with written notice that his clinical privileges were summarily suspended pending further investigation. The bylaws of the hospital state that in such instances the physician is entitled to a hearing within 15 business days, commonly referred to as a "fair hearing."

¶ 14 On August 15, 2008, Ramos requested a fair hearing pursuant to the bylaws. Ramos, the medical staff and Gufstason agreed on a hearing officer who presided over the hearing. Nineteen hours of testimony and argument were presented at the hearing. The initial session of the fair hearing did not commence until August 27, 2008, which the hospital admits is 3 days beyond the 15-day period. The hospital attributes this three-day delay to difficulties in coordinating the schedules of the hearing officer and physicians on the fair hearing committee.

¶ 15 On October 14, 2008, the fair hearing committee issued a report and recommendation. The board, pursuant to the report, decided to reinstate Ramos's clinical privileges subject to certain monitoring and supervision requirements. The board notified Ramos of this decision on October 30, 2008. He rejected the proposal the next day and demanded an appellate hearing before the board.

¶ 16 On November 25, 2008, the board conducted the appellate hearing. Thereafter, on December 1, 2008, the board asked Ramos to inform it in 10 days how and why the proposed monitoring plan was unacceptable. Ramos made no response. On December 12, 2008, the board provided Ramos with notice of final action, that being continuing the summary suspension.

¶ 17 While the administrative proceedings detailed above were pending, on August 26, 2008, Ramos filed a two-count complaint seeking injunctive relieve and a declaration that his clinical privileges were improperly suspended. In April of 2009, the trial court conducted a five-day hearing on the preliminary injunction, ultimately denying plaintiff's request for the injunction.

¶ 18 On July 24, 2009, Ramos filed an amended complaint adding a count seeking damages. The trial court dismissed that count, without prejudice, after which plaintiff filed a second amended complaint.

¶ 19 Defendant filed a counterclaim alleging that article VI, section 2(a), of the bylaws is void and unenforceable under Illinois law as that section purports to require the consent of the medical staff before the hospital may summarily suspend a physician's clinical privileges. This section clearly states that the CEO and chief of staff must act jointly when issuing a summary suspension of a physician's privileges. The trial court held this language violated the court's pronouncement in Lo v. Provena Covenant Medical Center, 342 Ill.App.3d 975 (2003), which stated that bylaws requiring a hospital to obtain the staff's approval prior to disciplining the staff violate public policy. As such, the trial court found article VI, section 2(a)'s requirement to that effect unenforceable as against Illinois public policy.

¶ 20 The trial court also, in August of 2010, set a trial date of January 10, 2011. In October of 2010, the trial court struck plaintiff's jury demand as untimely. Plaintiff filed another jury demand, which was also struck by the court. On January 4, 2011, the parties appeared for a final pretrial at which time the plaintiff announced his intention to exercise his right to a voluntary dismissal. The trial court entered an order on January 6, 2011, dismissing plaintiff's original case, No. O8-CH-123, without prejudice. Plaintiff paid defendant $136 in costs associated with the filing of defendant's answer in case No. 08-CH-123.

¶ 21 The plaintiff filed case No. 11-L-4 on February 16, 2011. Case No. 11-L-4 asserts two counts. Count I is for declaratory relief seeking a declaration that Ramos's summary suspension is contrary to the bylaws of the hospital and void ab initio. Count II is a breach of contract count in which Ramos seeks money damages. Both of these counts were pled in case No. 08-CH-123. On February 28, 2011, plaintiff filed a motion for substitution of judge as a matter of right. On March 19, 2011, in case No. 11-L-4, defendant moved pursuant to Illinois Supreme Court Rule 219(e) (eff. Nov. 27, 2002) for costs associated with case No. 08-CH-123. Eventually, the trial court denied plaintiff's motion for substitution of judge and awarded defendant $22, 649.03 in costs and expenses associated with the defense of case No. 08-CH-123.

¶ 22 Despite repeated requests at the administrative level and during the discovery phase at the trial level, the hospital failed to disclose to the plaintiff the original copy of CIMRO's report until August 17, 2011, which was approximately one month prior to trial. When reviewing the original version CIMRO sent to Christine Bermudez, the hospital's quality control director, and the version that was ultimately given to the MEC, the plaintiff determined the following language was added to the conclusion of the second version:

"The PR (physician reviewer), as a board certified family physician, upon review of the four episodes of care provided by the physician, under review in multiple settings, provided the following recommendations:

*Refer for formal assessment of potential impairment; physical, emotional, mental, and substance-related.

*Refer to the governing board of the hospital due to the potential imminent threat to patient safety."

¶ 23 Upon learning of the existence of the original report which omitted this language, plaintiff issued subpoenas for depositions of Diane Homan, M.D., and Judy Ring, RN, BSN of CIMRO. The subpoenas also sought to obtain documents associated with CIMRO's review of Dr. Ramos's activities. Homan and Ring filed a motion to quash the subpoenas. The trial court granted the motion, thereby prohibiting plaintiff from deposing anyone from CIMRO.

¶ 24 Case No. 11-L-4 proceeded to a six-day trial in September of 2011. As neither party felt it necessary to recap the trial testimony in their briefs to this court, that which is relevant to our analysis will be detailed below. Ultimately, the jury returned a verdict in favor of the hospital. Plaintiff filed a posttrial motion seeking, inter alia, a judgment notwithstanding the verdict (judgment n.o.v.). The trial court denied plaintiff's motion. The trial court also stayed enforcement of its order awarding defendant $22, 649.03 in costs and expenses related to case No. 08-CH-123. This timely appeal followed.

¶ 25 ANALYSIS

¶ 26 Plaintiff raises numerous issues on appeal. The vast majority of these arguments can be separated into two categories: arguments claiming plaintiff is entitled to a judgment n.o.v., and arguments claiming plaintiff is entitled to a new trial. Plaintiff also claims the trial court erred in entering a judgment against him in this case, No. 11-L-4, for $22, 649.03 in costs and expenses associated with case No. 08-CH-123.

¶ 27 I. Judgment N.O.V.

¶ 28 Plaintiff claims the trial court improperly denied his motion for a judgment n.o.v. Specifically, plaintiff identifies a number of provisions of the hospital's bylaws and claims he unequivocally proved violations of these provisions. Proving a violation of any one of these bylaws, plaintiff submits, entitled him to a verdict in his favor. Therefore, plaintiff argues he is entitled to a judgment n.o.v.

¶ 29 We review de novo a trial court's denial of a motion for judgment n.o.v. Serrano v. Rotman, 406 Ill.App.3d 900, 908 (2011). A judgment n.o.v. is properly entered only where the evidence, when viewed in a light most favorable to the opponent, so overwhelming favors the movant that no contrary verdict based on the evidence could ever stand. Pedrick v. Peoria & Eastern R.R. Co., 37 Ill.2d 494, 510 (1967); Maple v. Gustafson, 151 Ill.2d 445, 453 (1992). In ruling on a motion for judgment n.o.v., the trial court does not weigh the evidence, nor is it concerned with the credibility of witnesses. Id. A judgment n.o.v. is improper where there is any evidence, together with reasonable inferences to be drawn therefrom, demonstrating a substantial factual dispute, or where witness credibility or a resolution of conflicting evidence is decisive of the outcome. Id. at 454.

¶ 30 Again, plaintiff adduced evidence at trial and argued to the jury that he proved the hospital violated its own bylaws when issuing his summary suspension. To fully analyze his theories of why he is entitled to a judgment n.o.v., we must first discuss the applicable burden of proof employed at the trial court level when a physician claims his hospital privileges were improperly suspended or terminated.

¶ 31 Illinois subscribes to the rule of nonreview when it comes to cases involving private hospital staff privileges. Adkins v. Sarah Bush Lincoln Health Center, 129 Ill.2d 497 (1989). As a matter of Illinois public policy, staffing decisions of private hospitals are only subject to judicial review when the decision involves a revocation or reduction of existing staff privileges. Id. at 506. In such instances, the hospital's action is subject to limited judicial review to determine whether the decision made was in compliance with the hospital's bylaws. Id. at 506-07. The judicial reluctance to review these internal staff decisions reflects the unwillingness of courts to substitute our judgment for the professional judgment of hospital officials with superior qualifications to consider and decide such issues. Id. at 507. A court may reverse the decision of the hospital officials if it is not in accordance with the bylaws or if the bylaws were followed but "actual unfairness on the part of the hospital, its committees or individual members of the committees is demonstrated in the record." Id. at 514. A hospital need not employ "perfect" compliance with its bylaws as substantial compliance will suffice. Chessick v. Sherman Hospital Ass'n, 190 Ill.App.3d 889, 899 (1989); Carson v. Northwest Community Hospital, 192 Ill.App.3d 118, 121 (1989).

ΒΆ 32 Plaintiff identifies specific sections of the bylaws, which we will discuss individually below, and claims that he unequivocally proved the hospital violated these sections. Defendant asserts the plaintiff failed to adduce overwhelming evidence of a material breach of the bylaws. Therefore, defendant concludes that the trial court properly ...


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