Lawnwood ruling preserves medical staff role

A recent Florida Supreme Court ruling upholding the authority of medical staff bylaws is a major victory for both doctors and patients.

In late August, Florida's high court threw out a 2003 state law instigated by Lawnwood Medical Center Inc. and passed despite strenuous objection from physicians. The measure applied only to the two hospitals in St. Lucie County, both of which are owned and operated by Lawnwood. It aimed to strip away the hospital medical staff's influence over medical staff membership, peer review, clinical privileges and quality assurance.

As the state Supreme Court put it, the law would have granted Lawnwood "almost absolute power in running the affairs of the hospital, essentially without meaningful regard for the recommendations or actions of the medical staff."

The hospital's extreme approach flies in the face of good decision-making. The medical staff is the only body in the hospital with the expertise and experience necessary to provide and oversee medical care, note the Litigation Center of the American Medical Association and State Medical Societies and the Florida Medical Assn. in their joint friend-of-the-court brief filed in the case. So hospital boards, removed as they are from patient care, need to listen to medical staffs to make the best choices for their institutions and, most important, for patients.

This hospital-medical staff relationship is spelled out and cemented in medical staff bylaws, a contract approved by both doctors and hospitals.

But in the Lawnwood case, the hospital completely disregarded that contract after a dispute arose between the board and medical staff about how to handle an issue regarding two pathologists. When the staff declined to recommend disciplinary action, the hospital unilaterally suspended the two doctors' privileges.

A trial court reinstated the physicians, a decision upheld on appeal. Instead of availing itself of the other options at hand, the hospital summarily removed the medical executive committee. The hospital board then passed new bylaws saying it could unilaterally amend medical staff bylaws. When the medical staff naturally rejected this action, the hospital turned to the Legislature.

The Lawnwood board's original bylaws, adopted in 1988, gave it final decision-making authority on credentialing, peer review and quality assurance, but only after considering the medical staff's recommendations. The medical staff bylaws, created in 1993 and approved by the board, stipulated that the hospital could not override those recommendations without reasonable cause. The 2003 act, formally known as the St. Lucie County Hospital Governance Law, took away the requirement that any dismissal of the medical staff's recommendations had to be based on good cause.

Both doctors and the hospital corporation took the law to court, the physicians wanting it overturned and the hospital wanting it affirmed. The Litigation Center and the FMA, both of which contributed financially to the medical staff's legal expenses, argued that the law was unconstitutional because it violated physicians' contract rights and gave special privileges to a single private corporation. They also argued that the measure violated doctors' equal protection rights by creating two classes of hospitals and medical staffs -- those under the Lawnwood umbrella and all those who are not.

The physicians' views prevailed at each legal level, from the trial court to the Florida Supreme Court.

Not only did the high court agree with the argument that the law gave a private corporation unfair privileges, it also firmly rejected Lawnwood's claim that its push for the measure was motivated by patient safety concerns.

The ruling averted a terrible precedent that could have jeopardized medical staffs' role in hospitals throughout Florida. It discourages hospitals in other states that might have an interest in weakening medical staff influence from trying this new route to accomplish their goals. In doing so, the decision upholds the medical staff's crucial role in advocating for patients.