United States District Court, M.D. Florida, Orlando Division
GERMAINE BLAINE; CYNTHIA BRYANT; JUAN CASTRO; ASHISH DALAL; FIRAS MUWALLA; BRENDAN PRENDERGAST; and RICHARD SPRAWLS, Plaintiffs,
NORTH BREVARD COUNTY HOSPITAL DISTRICT, Defendant.
DALTON JR., UNITED STATES DISTRICT JUDGE
the Court is Defendant North Brevard County Hospital
District, d/b/a Parrish Medical Center's
(“PMC”) Motion for Summary
Judgment. (Doc. 137 (“Motion”).)
Plaintiffs responded (Doc. 148), and PMC replied (Doc. 154).
On review, the Motion is granted.
case is about a public hospital's decision to deny seven
doctors reappointment of medical privileges and the process
it used to get there. Plaintiffs are oncologists employed by
Health First, a health system based in Brevard County, who
practice in Brevard County at various facilities. (Doc. 81,
¶¶ 2, 7.) Each successfully applied for medical
privileges at PMC and had been re-appointed every time their
terms came up. (Id. ¶ 12.) So when it came time
to renew in 2017, they followed the same process outlined in
PMC's Medical Staff Bylaws
applications for PMC's CEO George Miktarian to review.
(Id.; Doc. 33-1, ¶ 9; Doc. 81-1, pp. 33-38
(Bylaws reappointment process).) Dr. Miktarian then
transmitted Plaintiffs' applications to the Credentials
and Medical Ethics Committee
(“CMEC”), which sent the
applications to PMC's Medical Executive Committee
(“MEC”). (Doc. 81, ¶¶
21-22.) The MEC reviewed the applications and, on November
21, 2017, provided a favorable recommendation regarding
Plaintiffs' reappointment to PMC's Board of Directors
(“Board”). (Id. ¶
23.) All seemed well; Plaintiffs believed their applications
would be approved again. (Doc. 81, ¶ 12; e.g.,
Doc. 143-4, p. 57:19-23; Doc. 143-7, pp. 82:5-83:3.)
PMC had been seeking renewal of accreditation of their cancer
program from the Commission on Cancer
(“CoC”). This process began in
2016 and involved providing data and working closely with CoC
staff, who would do a site visit. (Doc. 143-11, pp. 16:1-15,
40:17-41:2, 51:21-54:12.) When the process started, Plaintiff
Dr. Dalal was chair of PMC's Cancer Committee and the
representative of Health First. (Doc. 143-4, pp. 40:6-17,
41:6-43:7, 64:20-22.) At the September meeting, PMC's
accreditation initiative was discussed and the subject of
data came up, specifically that PMC needed data from Health
First physicians to complete the accreditation process.
(Id. at 40:6-17, 41:6-43:7.) Dr. Dalal said he would
work on it and at a later meeting reported back that Nancy
Payne, Health First's System Director, was the person to
talk to. (Id.; Doc. 145-1, pp. 33:24-43:8; Doc.
143-8, p. 14:10-12.) He said he would coordinate with her,
and PMC separately reached out to her requesting data. (Doc.
143-4, pp. 40:6-17, 41:6-43:7; Doc. 145-1, pp. 33:24-43:8;
Doc. 143-8, pp. 27:1-28:8, 30:12-13, 32:7-12; 34:13-15,
41:17-22, 40:23-41:8 (Payne received emails over two years
regarding data and received instructions not to provide
certain information to PMC).) PMC didn't get everything
they were looking for and continued to reach out to Nancy
Payne over the next year, as all data requests were funneled
her way. (Doc. 143-8, pp. 41:17-22, 52:5-8, 55:18-56:25,
57:24-58:10, 61:1-63:10, 64:6-65:4, 67:8-25, 75:4-25.)
Separately, PMC asked Dr. Bryant for some specific
information regarding radiation and she complied. (Doc.
143-2, pp. 100:18- 101:19; Doc. 145-4, pp. 33:17-34:18.)
Nancy Payne, however, was unresponsive to numerous inquiries
PMC made about the data. (Doc. 143-8, pp. 41:17-22, 52:5-8,
55:18- 56:25, 57:24-58:10, 61:1-63:10, 64:6-65:4, 67:8-25.)
this was going on, the composition of PMC's Cancer
Committee changed. Dr. Dalal was replaced by Dr. Deligdish,
an oncologist in charge of a different practice group, as
head of the committee. (Doc. 143-4, pp. 90:13-92:6; Doc.
143-5, pp. 10:4-20, 105:18-24, 124:12-20.) PMC noticed a
decline in the amount of patients Plaintiffs treated at PMC,
and chalked it up to Plaintiffs' association with Health
First, which had its own facilities. (Doc. 145-2, p. 35:7-24;
Doc. 33-3, ¶¶ 8-12.) So sometime in September 2017,
after learning that PMC's numerous requests for data from
Health First were outstanding, Dr. Deligdish phoned several
Plaintiffs on PMC's behalf to discuss their association
with Health First and mentioned the data requests to some.
(Doc. 145-1, pp. 89:24-90:11; Doc. 143-5, pp. 105:4-106:19,
109:8-14.) He met with Dr. Dalal in person. (Doc. 143-5, pp.
105:4-106:19.) At that time, Plaintiff Dr. Muwalla was the
medical director of Health First, and on hearing of this data
issue, he went to Nancy Payne. (Doc. 143-7, pp. 42:7-9,
43:11-13.) According to Dr. Muwalla, she told him she'd
get back to him and couldn't release the data PMC was
requesting absent approval from her superiors. (Id.
at 43:16-24.) Those in charge at Health First decided not to
release the data. (Id. at 56:16-25.)
came to a head when Plaintiffs sought reappointment. Their
employer, Health First, had decided not to comply with
PMC's requests for data for re-accreditation purposes.
(Doc. 145-3, pp. 18:6-18, 20:24-25:22.) PMC informed the CoC
surveyor during the on-site visit of the data issues with
Health First, who empathized with PMC's situation and
created workarounds for some of the data requests. (Doc.
143-11, pp. 51:21- 54:12, 73:10-74:17, 81:19-83:6.) Yet at
the time Plaintiffs sought reappointment, there were still
outstanding data inquiries from Health First. (Id.
at 73:10-74:17, 81:19-84:25.) So although the MEC recommended
approving Plaintiffs' reappointment, when their
applications went to the Board, Dr. Miktarian distributed a
memo he had Marsha Richardson, PMC's Director of Oncology
Services, prepare that detailed all the times PMC had
requested data from Health First, naming Plaintiffs. (Doc.
145-2, pp. 12:1-24, 79:23-81:3; Doc. 145-4, pp. 24:20-25,
87:18-92:2.) He also circulated a draft letter prepared by
PMC's legal counsel addressed to each Plaintiff. (Doc.
145-2, pp. 85:1-86:3.) At the meeting, the Board decided to
send back Plaintiffs' reappointment applications to the
MEC because of these data issues (“December 4
Meeting”). (Id. at 57:3-8; Doc. 33-2,
next day, Dr. Miktarian sent each Plaintiff a letter
notifying them their refusal to provide data constituted a
breach of PMC's Bylaws and could be a reason to deny
reappointment. (Doc. 33-2, pp. 16-29 (“December
5 Letter”).) He gave them five days to turn
over any outstanding data and noted that even if they
attempted to cure now, their applications could still be
went to Health First management with the letters, as they
didn't own the data and couldn't individually provide
it. (Doc. 143-1, pp. 45:4-49:23; Doc. 143-2, pp. 93:15-99:24;
Doc. 143-3, pp. 33:19-22, 41:20-46:1; Doc. 143-3, pp.
44:13-50:8; Doc. 143-7, pp. 57:17-64:3; Doc. 143-9, pp.
20:3-22:18; Doc. 143-10, pp. 59:25-60:3, 78:14-81:18.) Health
First decided it would handle the entire situation through
its legal department, taking the position that it didn't
need to hand over the data as PMC was wrongfully attempting
to deny these reappointment applications since Plaintiffs had
no clinical issues. (Doc. 33-3, pp. 30-33; Doc. 143-1, pp.
53:12-56:2, 63:18-75:14; Doc. 143-2, pp. 101:22-108:13; Doc.
143-3, pp. 55:2-64:24; Doc. 143-4, pp. 57:7-62:16; Doc.
143-7, pp. 57:17-64:3, 74:2-24; Doc. 143-9, pp. 20:3-22:18,
100:5-19; Doc. 143-10, pp. 82:3-83:22.) Letters were
exchanged staking out the parties' respective positions.
(Doc. 33-1, ¶¶ 26-31, 33, 35-39; Doc. 33-2, pp.
36-49, 51-62; Doc. 33-3, pp. 30-33, 35-41.)
met after the Board sent back Plaintiffs' applications to
the MEC and discussed Plaintiffs' reappointment. (Doc.
33-2, pp. 31-34.) Plaintiff Dr. Sprawls appeared at the
meeting to provide his side of the story: he objected to the
revocation of his privileges, the Bylaws didn't permit
denial of his reappointment for this data reason, the
provision of data had no bearing on his clinical
capabilities, the data requests hadn't been made to him,
and he had no control over the data. (Doc. 143-10, pp.
97:4-101:11.) The MEC decided to support the Board if the
applications were denied. (Doc. 33-2, p. 33.)
Board met again and heard Plaintiffs hadn't complied with
data requests as Health First was refusing to turn it over.
(Doc. 145-1, pp. 67:6-68:6.) At the same time, PMC was
working with CoC to get an extension on its time to comply
with two outstanding data requests and learning what to do to
finish the accreditation process despite this missing data.
(Doc. 143-11, pp. 81:19-87:13.) The Board decided to deny
Plaintiffs' reappointment applications at the
January 8 Meeting, and Dr. Miktarian sent
each Plaintiff a letter notifying them of the denial and the
expiration of their privileges. (Doc. 33-2, pp. 64-77.) He
offered them the opportunity to appear before the Board for
an interview and appeal the decision as the Bylaws allow.
steamrolled, Plaintiffs responded via letter prepared by
Health First's counsel. (Id. at 79-99.) They
initially accepted the interview offer but then didn't
respond to Dr. Miktarian's request to provide dates and
times, later deciding “to forego” the interview.
(Id.; Doc. 33-3, pp. 2-28, 43-44, 46-47.) They also
didn't send any patient information or attempt to provide
coordination of care plans. (Doc. 143-1, pp. 73:20-74:6; Doc.
143-2, p. 122:20-15; Doc. 143-3, pp. 60:2-13, 62:6-15; Doc.
143-7, pp. 72:15-73:3; Doc. 143-9, p. 97:1-12; Doc. 143-10,
privileges gone, Plaintiffs filed this lawsuit alleging two
claims initially: PMC violated their procedural due process
by denying them reappointment without a hearing, and PMC
breached the Bylaws by denying the applications for not
providing the data, which Plaintiffs dub a non-clinical
business reason. (Doc. 1.) For the breach claim, they say Dr.
Miktarian committed intentional fraud by telling the Board
Plaintiffs failed to comply with numerous data requests made
to them, repeating this in the December 5 Letter, and telling
this to the MEC. (Id. ¶¶ 18, 24-25, 28-31,
61-62, 64-66.) With the Complaint, Plaintiffs moved for
preliminary injunction. (Doc. 5.)
briefing and a hearing on the preliminary injunction (Docs.
32, 33, 35, 38, 39), the Court granted the motion in part on
the procedural due process claim, ordering PMC to provide
Plaintiffs a hearing in conformity with its Bylaws and
reinstating Plaintiffs' privileges in the meantime. (Doc.
42 (“First PI Order”).) PMC
complied, holding a hearing on Plaintiffs' reappointment
applications in conformity with the Bylaws before a neutral
decisionmaker where Plaintiffs were represented by counsel
and presented witness testimony and evidence
(“Ad Hoc Committee”). (Doc.
81-1, pp. 92-96; Docs. 66-4, 66-5 (hearing transcript).) The
focus was on the data: whether PMC requested data from
Plaintiffs, whether Plaintiffs received data requests, how
Plaintiffs responded, should their responses cost them
reappointment, whether they provided the data, and whether
denial of their reappointment applications was appropriate
for not providing the data. (Doc. 81-1, p. 93.)
consideration, the Ad Hoc Committee issued Findings and
Recommendations. (Doc. 81-1, pp. 94-95.) First, the Ad Hoc
Committee addressed “the central question-do the
Medical Staff Bylaws require [Plaintiffs] to have supplied,
or caused to be supplied, the requested data?”
(Id. at 94.) It found:
(Id. at 94-95.) So the Ad Hoc Committee answered the
[Plaintiffs] were aware of the unfulfilled requests for
Patient Data and even if they did not have control of the
data, they had a duty to supply it, or cause it to be
supplied, as part of their obligations as staff members of
(Id. at 96.)
the Ad Hoc Committee asked, “Was denial of
[Plaintiffs'] reappointment applications allowed under
the Medical Staff Bylaws for the ...