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GERALD F. CLAIR v. CENTRE COMMUNITY HOSPITAL (07/15/83)

filed: July 15, 1983.

GERALD F. CLAIR, M.D., APPELLANT,
v.
CENTRE COMMUNITY HOSPITAL, A NON-PROFIT CORPORATION; MEDICAL STAFF EXECUTIVE COMMITTEE, RICHARD J. MCGUIRE, M.D., CHIEF OF THE MEDICAL STAFF AND CHAIRMAN OF THE MEDICAL STAFF EXECUTIVE COMMITTEE, INDIVIDUALLY AND AS A REPRESENTATIVE OF THE MEDICAL STAFF OF THE CENTRE COMMUNITY HOSPITAL, AN UNINCORPORATED ASSOCIATION



No. 2900 Philadelphia, 1981, Appeal from the Order of the Court of Common Pleas of Centre County, Civil Division, at No. 1978-636

COUNSEL

John R. Miller, Jr., Bellefonte, for appellant.

Robert L. Martin, Bellefonte, for appellees.

Wickersham, Brosky and Wieand, JJ. Wickersham and Wieand, JJ., concur in the result.

Author: Brosky

[ 317 Pa. Super. Page 27]

This appeal is from the dismissal of exceptions following the denial of an injunction. The sought-for injunction

[ 317 Pa. Super. Page 28]

    would have prevented appellee from enforcing the suspension of appellant's physician-staff privileges at appellee-hospital. On appeal, appellant claims that the suspension violated the substantive due process aspects of the Fourteenth Amendment. After careful review, we conclude that appellant does not prevail in these arguments. Accordingly, we affirm.

FACTS

Out of a lengthy and complex factual history, only a few elements need concern us here. At the direct insistence of the Commissioner and Deputy Commissioner of Health of this Commonwealth, appellee-hospital adopted certain by-laws. They required, in their application, that appellant accept as a patient every third indigent obstetrical or gynecological patient at the hospital. (At the time there were two other such specialists at the hospital.) The Commissioners were concerned that the hospital conform with the State's community service regulations, which were, in turn, established to ensure conformity with Federal Hill-Burton regulations. Their intervention was prompted, in part, by their awareness of appellant's non-conformity. In response, appellant refused to comply with the regulations, explaining that he felt unable to take on an unlimited number of patients and still properly care for them.*fn1

Appellant's staff privileges were then suspended, pending an indication of his willingness, in writing, to comply with the bylaw. Appellant sought, and was denied, an order enjoining appellee from enforcing that suspension. He appeals from that denial.

STATE ACTION

A. Symbiotic Relationship

Appellant's case is based on an alleged violation of his right to due process of law as guaranteed by the Fourteenth

[ 317 Pa. Super. Page 29]

Amendment to the Federal Constitution. The Bill of Rights protects the individual only from governmental action.*fn2 However, actions ostensibly taken by a private, non-governmental party, can, under certain circumstances, be attributed to the state and thus be subject to constitutional limitations.

Two theories justifying a finding of state action are advanced by appellant. First, he contends that the state and the hospital are in a symbiotic relationship. He sees as evidence of this relationship the receipt by the hospital of Federal Hill-Burton funds for hospital construction, receipt of medicaid and medicare funds, tax benefits and its monopoly position in the community.

It is somewhat doubtful that appellant would prevail in this argument. See Hodge v. Paoli Memorial Hospital, 576 F.2d 563 (3rd Cir., 1978). However, we need not decide that issue because we find that there was state action under the second theory.

B. Close Nexus

The Third Circuit has instructed us that the second theory advanced by appellant is independently adequate to constitute state action.

Thus, it is possible that a symbiotic relationship between a state and private enterprise could give rise to state action, or in the absence of such a relationship, state action still might be found if "the state is closely involved in the very activity challenged."

Fitzgerald v. Mountain Laurel Racing, Inc., 607 F.2d 589 at 595 (3rd Cir., 1979) quoting Braden v. University of Pittsburgh, 552 F.2d 948 at 958 (3rd Cir., 1977).

The enquiry before us then is two-fold: what type of state activity can constitute close state involvement sufficient

[ 317 Pa. Super. Page 30]

    for a finding of state action; and, did such activity occur here?

In determining what can constitute close state involvement, it will be helpful to determine what involvement is insufficient. Regulation of the private institution in general does not sufficiently involve the state in the challenged activity. By virtue of a broad regulatory scheme, the challenged activity does not become a state activity.

The contention that New York's regulation of educational standards in private schools, colleges and universities, e.g., Education Law ยงยง 207, 215, 305(2), makes their acts in curtailing protest and disciplining students the acts of the State is equally unpersuasive. It overlooks the essential point -- that the state must be involved not simply with some activity of the institution alleged to have inflicted injury upon a plaintiff but with the activity that caused the ...


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