Nanavati v. Burdette Tomlin Memorial Hospital
526 A.2d 697, 107 N.J. 240, 1987 N.J. LEXIS 315 (1987)
Premium Feature
Subscribe to Lexplug to listen to the Case Podcast.
Rule of Law:
A hospital's decision to deny or revoke a physician's staff privileges must be supported by sufficient reliable evidence, and for disharmony to justify termination, the hospital must establish that prospective disharmony will probably have an adverse impact on patient care, rather than merely annoy staff. When hospital proceedings are found to be unfair, courts should generally remand the matter for a new, fair hearing by the hospital or an impartial forum, rather than making independent factual findings.
Facts:
- Dr. Suketu H. Nanavati, a board-certified cardiologist, was granted staff privileges at Burdette Tomlin Memorial Hospital in 1979, becoming the only board-certified cardiologist in Cape May County.
- Dr. Robert Sorensen, chief of cardiology and chairman of the Department of Medicine, held a near monopoly on reading electrocardiograms (ECGs) at the hospital, an activity that generated approximately $75,000 annually.
- Dr. Nanavati was initially allowed to read ECGs one day per week, but Dr. Sorensen rejected his request for an additional day.
- This rejection led Dr. Nanavati to criticize Dr. Sorensen, who in turn retaliated against Dr. Nanavati.
- As the dispute escalated, Dr. Nanavati was alleged to have committed a series of violations of hospital bylaws concerning "Acts of Disruptive Behavior" and "Failure to Cooperate with Hospital Personnel."
- The hospital did not question Dr. Nanavati’s technical competence; the charges centered on his temperament, disposition, and ability to work harmoniously with colleagues and staff.
Procedural Posture:
- On August 2, 1982, the Burdette Tomlin Memorial Hospital’s medical staff executive committee voted unanimously to act toward the revocation of Dr. Nanavati's medical staff privileges.
- An ad hoc committee, appointed by the chief of the Department of Medicine, investigated and found against Dr. Nanavati on all charges, recommending his permanent discharge from the medical staff.
- The medical staff executive committee affirmed this finding, and a subsequent ad hoc committee of the medical staff also unanimously found against Dr. Nanavati, recommending dismissal.
- The hospital administrator advised Dr. Nanavati of the revocation of his staff privileges.
- Dr. Nanavati immediately filed an action in the Chancery Division (trial court), which found the hospital's proceedings were not conducted in accordance with its bylaws, enjoined the revocation, and remanded the matter for further proceedings.
- The hospital's Board of Governors thereupon appointed a new hearing committee, which again recommended affirmation of the medical staff's dismissal, and the Board affirmed this recommendation.
- Meanwhile, Dr. Nanavati also instituted a separate action in the United States District Court for the District of New Jersey against the hospital and Dr. Sorensen, which resulted in a complex jury verdict and a judgment notwithstanding the verdict against Dr. Nanavati, with the matter then on appeal before the Third Circuit.
- The Chancery Division (trial court) found in July 1983 that the second hospital hearing committee had held ex parte hearings without notice, violating fundamental fairness, and again remanded the matter to the hospital.
- The hospital's hearing committee again recommended revocation of Dr. Nanavati’s staff privileges, and the Board again approved the recommendation.
- The Chancery Division (trial court) again found these proceedings unfair and, making independent findings of fact, permanently enjoined the revocation of Dr. Nanavati’s privileges.
- The Appellate Division affirmed the issuance of the injunction but ruled that the trial court should not have made independent findings of fact and that the appropriate standard of review was whether the hospital's decision was supported by sufficient credible evidence; the Appellate Division affirmed the injunction "without prejudice to the relodging of the charges against plaintiff."
- The New Jersey Supreme Court granted Dr. Nanavati’s petition for certification.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
Does a hospital's decision to revoke a physician's staff privileges require a showing of actual interference with patient care, and what is the appropriate standard of judicial review for such a decision when procedural fairness is questioned?
Opinions:
Majority - POLLOCK, J.
No, actual interference with patient care is not required, but a hospital must demonstrate that prospective disharmony will probably have an adverse impact on patient care, and the appropriate standard of judicial review for a hospital's decision regarding staff privileges is whether it is supported by sufficient reliable evidence, with courts generally remanding unfair proceedings back to the hospital. The Court noted that hospitals exist to provide health care and require cooperation among staff. While decisions denying or revoking staff privileges are critical for doctors and patients, hospitals have expertise in medical treatment and administration. Therefore, a more relaxed standard of judicial review applies to hospital decisions than to administrative agencies, requiring only "sufficient reliable evidence." Although actual patient harm is not a prerequisite for termination, general complaints of inability to cooperate are insufficient; hospitals must present concrete evidence of specific misbehavior, such as unjustified altercations or violations of rules, that will "probably have an adverse impact on patient care." The Court recognized that the Chancery Division correctly found the hospital proceedings unfair due to prejudgment and ex parte hearings. However, it held that the trial court should not have made independent factual findings and issued a permanent injunction. Instead, the proper judicial response to an unfair hospital proceeding is to permit the hospital to reinstate disciplinary proceedings with a new, fair hearing. If the physician fears continued prejudice, the court may transfer the proceedings to an impartial forum, such as an arbitrator, or as a last resort, conduct a plenary hearing itself. Given that the hospital's Board of Governors had largely changed since the initial decision, the Court found a remand to the hospital appropriate.
Analysis:
This case clarifies the delicate balance between judicial intervention and hospital autonomy in managing staff privileges in New Jersey. It establishes a deferential standard of judicial review for hospital decisions, requiring only "sufficient reliable evidence" and emphasizing the hospital's expertise. The ruling also defines the threshold for terminating privileges due to disharmony, requiring a showing of a probable adverse impact on patient care rather than just annoyance or actual harm, while stressing the need for concrete evidence of misbehavior. Critically, it sets a strong precedent for procedural fairness, mandating that courts remand procedurally flawed hospital actions for a new, fair hearing, thereby preserving the hospital's primary role in self-governance while ensuring due process for physicians.
