On appeal from the Superior Court of New Jersey, Chancery Division, Atlantic County.
Bilder, Muir, Jr. and Brochin. The opinion of the court was delivered by Bilder, J.A.D.
This appeal arises from a hospital disciplinary proceeding in which plaintiff, a physician specializing in obstetrics and gynecology, was sanctioned for disruptive behavior and failure to have medical malpractice insurance. For the former conduct, he was placed on supervised probation for one year; for the latter failure, his medical staff privileges were suspended for 21 days. He sought judicial review by way of an injunctive action. Defendants, Shore Memorial Hospital and its medical staff, appeal from so much of the resulting Chancery Division order as enjoined the imposition of the three week suspension. Plaintiff Robert L. Courtney, the doctor, cross-appeals from that part of the order which upheld the probation.
The action instituted in the Chancery Division essentially sought a review of the final decision of the Board of Trustees of the Shore Memorial Hospital. The attack was directed solely at the result as being arbitrary, capricious and unreasonable. The procedure employed by the hospital was not questioned.
The Chancery Division review is very much analogous to appellate review of the final action of an administrative body except that there is a more relaxed standard -- the test is whether the decision is supported by sufficient reliable evidence to justify the result. See Nanavati v. Burdette Tomlin Memorial Hosp., 107 N.J. 240, 249, 526 A.2d 697 (1987); Garrow v. Elizabeth General Hospital and Dispensary, 79 N.J. 549, 565, 401 A.2d 533 (1979). When the decision relates to subjective matters such as disruptive conduct, a termination of hospital
privileges requires a finding that prospective disharmony will probably have an adverse impact on patient care. See Nanavati v. Burdette Tomlin Memorial Hosp., supra, 107 N.J. at 254, 526 A.2d 697. Such a test is, of course, not relevant to more objective grounds such as failure to comply with statutory qualifications or to adhere to rules and regulations required by law or reasonably adopted for the proper governance of the hospital and the carrying out of its functions. In all events, the courts are enjoined to recognize the expertise of the Board and the extensive external regulation to which it is subjected. Id. at 251, 526 A.2d 697. "In so specialized and sensitive an activity as governing a hospital, courts are well advised to defer to those with the duty to govern." Ibid.
The standard of our appellate review is essentially the same. Our function is to review the record to see whether the trial court has properly fulfilled its function and to see whether the record made before the hospital committee supports the Board's findings.
As noted, the Board dealt with two discretely different matters: a contention that Dr. Courtney engaged in disruptive behavior as evidenced by 22 separate incidents, each of which resulted in a specific charge, and a contention that he had allowed his medical liability coverage to lapse in violation of the Medical Staff By-laws and had failed to provide proof of insurance when requested. Neither Dr. Courtney's competence nor the quality of care provided his patients was challenged.
Following administrative hearings with respect to the incidents of disruptive behavior, the propriety of which is unchallenged, the Board found that "four of them specifically, and all of them in the aggregate, show[ed] a pattern of disregard for authority, rules and procedures applicable to all members of the Medical Staff." The details of these incidents are set forth in the Report and Recommendations of the Ad Hoc Appeals/Hearing Committee and need not be repeated. Suffice it to say that we are satisfied that the Board's findings were supported by
sufficient reliable evidence and that the hospital established that prospective disharmony will probably have an adverse impact on patient care, essentially for the reasons given by the trial judge in his oral opinion of October 19, 1989. Moreover, we note that the probationary period has already been served, rendering this aspect of the appeal moot.
With respect to the failure to maintain medical malpractice insurance, we are similarly satisfied that the Board's findings that Dr. Courtney allowed his coverage to lapse during the period from July 1, 1987 to January 13, 1988 and that he purposefully avoided requests for proofs and information as to insurance during that period are supported by sufficient credible evidence. The fact that he later obtained retroactive coverage begs the question. The fact is that insurance-wise he practiced naked during that period. The conclusion of the Board that the subsequent arrangements for retroactive coverage did not excuse or cure the clear violation of the Medical Staff By-laws was a reasonable determination entitled to our deference. See Nanavati v. Burdette Tomlin Memorial Hosp., supra, at 250-251, 526 A.2d 697. Although the trial judge did not specifically sustain ...