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Miller v. Huron Regional Medical Center, Inc.

United States District Court, D. South Dakota, Southern Division

November 5, 2015

LINDA A. MILLER, M.D., Plaintiff,
HURON REGIONAL MEDICAL CENTER, INC., CY B. HAATVEDT, M.D., as a Member of its Executive Committee and Individually, and MICHAEL N. BECKER, M.D., as a Member of its Executive Committee and Individually, Defendants

          For Linda A. Miller, M.D., Plaintiff: Bradley P. Gordon, Kenneth E. Barker, Barker Wilson Law Firm, LLP, Belle Fourche, SD.

         For Huron Regional Medical Center, Inc., Defendant: Jon C. Sogn, Michelle Himes Randall, LEAD ATTORNEYS, Lynn, Jackson, Shultz & Lebrun, P.C., Sioux Falls, SD.

         For Cy B. Haatvedt, M.D., as a member of its Executive Committee and Individually, Michael N. Becker, M.D., as a Member of its Executive Committee and Individually, Defendants: Kathryn Jean Hoskins, LEAD ATTORNEY, Jon C. Sogn, Jeffrey L. Bratkiewicz, Siegel, Barnett & Schutz, L.L.P., Sioux Falls, SD; Michelle Himes Randall, LEAD ATTORNEY, Lynn, Jackson, Shultz & Lebrun, P.C., Sioux Falls, SD.

         For ProAssurance Casualty Company, Intervenor: Mary M. Schott, LEAD ATTORNEY, Sodoro, Daly & Sodoro, P.C., Omaha, NE.



         Linda Miller, M.D., filed a complaint against Huron Regional Medical Center, Inc. (HRMC), Cy B. Haatvedt, M.D., and Michael N. Becker, M.D. The complaint was subsequently amended. Docket 81. The first amended complaint alleges the following causes of action against HRMC: breach of express contract, breach of implied contract, negligence, and defamation. The first amended complaint alleges the following causes of action against Dr. Becker and Dr. Haatvedt: negligence, defamation, and interference with business relationship and expectation. Defendants, HRMC, Dr. Haatvedt, and Dr. Becker, move for summary judgment on all claims asserted by Dr. Miller. Docket 132; Docket 133. Dr. Miller resists the motion. For the following reasons, the court grants the motions in part and denies the motions in part.


         Viewing the evidence in the light most favorable to the nonmoving party, Dr. Miller, the facts are:

         Dr. Miller is a general surgeon, who began working at HRMC in February 2004. Dr. Miller and HRMC entered into a contract in February 2009 that established that Miller would be employed as an independent contractor for HRMC. A Surgical Services Agreement and HRMC Medical Staff Bylaws govern the terms of the contract.

         The Medical Staff Bylaws create a Medical Executive Committee (MEC). The MEC oversees any request from the HRMC administration or medical staff that seeks review of a physician's quality of care. During the relevant time period, Dr. Haatvedt, Dr. Becker, Dr. Jim Schwaiger, and Dr. Karl Blessinger were members of the MEC.

         On August 24, 2010, the HRMC Board of Directors passed a motion requesting that the MEC conduct a review of Dr. Miller's medical records to determine whether there were any medical trends of concern. Docket 135 - 2, at 16. In response, on October 14, 2010, the MEC met with Dr. Miller and determined it would review 100% of Dr. Miller's patient charts for a three month period. The MEC sent a letter to Dr. Miller confirming the three-month review and stated, " The charts will be reviewed for improvement in timeliness of documentation as well as improvement in thoroughness and quality of content." Docket 135 - 5. The MEC completed its review and did not report any problem with the charts during this review period. Despite this finding, the Board of Directors decided to continue the review for an additional 90 days.

         The MEC reviewed a grievance filed with the hospital on February 7, 2011. The grievance asserted that Dr. Miller performed an unnecessary surgery that resulted in a patient's physical complications. The MEC elected to send the case to ProAssurance Casualty Company for further review. Docket 135 - 2, at 8. At the time, ProAssurance was HRMC's professional liability insurance carrier.

         On March 22, 2011, the HRMC Board of Directors requested that John Single, HRMC's Chief Executive Officer, meet with Dr. Miller " regarding medical record deficiencies, the need to achieve consistent compliance, and that future deficiencies may result in specific action by the Board." Docket 135 - 2, at 30.

         In April 2011, Dr. Miller treated a patient suffering from acute pancreatitis. Dr. Miller performed surgery on the patient with the assistance of Dr. Haatvedt. The patient later developed complications and was transferred to Sioux Falls, South Dakota, for further care. The patient died in Sioux Falls from unknown complications.

         On April 25, 2011, three members of the HRMC Board of Directors met with the MEC to discuss the internal and external reviews of Dr. Miller's work. Dr. Miller was not present during this meeting. After the meeting, the MEC decided that Dr. Blessinger should meet with Dr. Miller to discuss whether she would be willing to voluntarily reduce her surgical privileges.

         In the afternoon of April 25, 2011, Dr. Blessinger met with Dr. Miller and informed her about the MEC meeting earlier in the day. Dr. Blessinger notified Dr. Miller that the Board of Directors requested that the MEC address Dr. Miller's recent issues associated with patient care. Furthermore, Dr. Blessinger suggested that Dr. Miller voluntarily reduce her surgical privileges. Even though the voluntary reduction in privileges was no guarantee that HRMC would maintain its contract with Dr. Miller, Dr. Blessinger informed Dr. Miller that there were no other viable options at that time. In addition, based on a conversation with Single, Dr. Blessinger informed Dr. Miller that a voluntary reduction in privileges was not a reportable event to the National Practitioner Data Bank (NPDB). The following morning, on April 26, 2011, Dr. Miller submitted her reduction of privileges paperwork to Single.

         After Dr. Miller submitted her paperwork to Single, HRMC determined that Dr. Miller's voluntary reduction in surgical privileges was a reportable event. Single reviewed the NPDB Guidebook and sought the advice of Huron attorney Rodney Freeman. Single believed that the internal and external reviews of Dr. Miller's quality of care, coupled with a voluntary reduction in privileges, created a situation where HRMC was required to report the event to the NDPB. An Adverse Action Report, dated May 11, 2011, was filed with the NPDB. It stated that " Dr. Miller voluntarily surrendered a portion of her surgical privileges while the Medical Executive Committee was investigating her quality of care. The Board of Directors approved this surrender of certain privileges April 29, 2011." Docket 135 - 8, at 3. Dr. Miller responded to the first Adverse Action Report on June 6, 2011, and stated the following:

In late April, I voluntarily reduced my privileges as I was concerned about the quality of care I was able to give. At that time, I was managing some personal issues along with a demanding call schedule of solo practice. I was working 24/7 and hadn't taken time off in several months. Since that time, the issues have been resolved, I took some much needed vacation time, and at the subsequent Board Meeting in May, I requested and was granted the majority of my privileges. (I did not request open Thoracic or Vascular as I don't have the need here.)


         Following Dr. Miller's reduction in surgical privileges, there was some confusion regarding whether Dr. Miller had any remaining privileges. On May 18, 2011, Dr. Miller sent a letter to Dr. Haatvedt that requested the approval of privileges relating to modified radical mastectomy. Docket 137 - 5, at 4. The letter also requested that the board consider approving privileges associated with elective abdominal cases. Id. Dr. Miller proposed two conditions in support of obtaining the new privileges: (1) the procedure would be completed in the presence of another general surgeon; and (2) the patient's diagnosis, co-morbidities, and proposed surgery would be presented to Dr. Haatvedt at least 24 hours before the surgery. Id. On June 3, 2011, Dr. Miller sent a letter to the MEC that requested a myriad of additional privileges. Id. at 5. The request suggested the imposition of the same two conditions listed in Dr. Miller's first letter. The HRMC Board of Directors approved the issuance of new privileges with the conditions suggested by Dr. Miller.

         Following the approval of new surgical privileges, HRMC sent two additional Adverse Action Reports to the NPDB. These reports indicated that Dr. Miller received new privileges with the imposition of the conditions listed above. HRMC sent the reports on July 21, 2011. Dr. Miller resigned from her position at HRMC on September 2, 2011.

         Standard of Review

         Summary judgment is appropriate if the movant " shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). The moving party can meet this burden by presenting evidence that there is no dispute of material fact or by showing that the nonmoving party has not presented evidence to support an element of its case on which it bears the ultimate burden of proof. Celotex Corp. v. Catrett, 477 U.S. 317, 322-23, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). To avoid summary judgment, " [t]he nonmoving party may not 'rest on mere allegations or denials, but must demonstrate on the record the existence of specific facts which create a genuine issue for trial.'" Mosley v. City of Northwoods, Mo., 415 F.3d 908, 910 (8th Cir. 2005) (quoting Krenik v. Cty. of Le Sueur, 47 F.3d 953, 957 (8th Cir. 1995)).

         Summary judgment is precluded if there is a factual dispute that could affect the outcome of the case. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). For purposes of a motion for summary judgment, the court views the facts and the inferences drawn from such facts " in the light most favorable to the party opposing the motion." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 588, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986).


         I. HRMC's motion for summary judgment.

         A. Is HRMC entitled to summary judgment on the breach of implied contract claim.

         South Dakota Codified Law 53-1-3 establishes that a contract is either " express or implied." An express contract is " one, the terms of which are stated in words," whereas " [a]n implied contract is one, the existence and terms of which are manifested by conduct." Id. " A contract can either be express or implied, but not both." Humble v. Wyant, 2014 SD 4, 843 N.W.2d 334, 343 (S.D. 2014) (citing SDCL 53-1-3). HRMC asserts that the court should grant summary judgment on count two of Dr. Miller's complaint, alleging a breach of implied contract, because the dispute involves a written Surgical Services Agreement and HRMC Medical Staff Bylaws. Because the parties signed and operated in accordance with the written agreement, HRMC's motion for summary judgment regarding count two of the complaint, alleging a breach of implied contract, is granted.

         B. Is HRMC entitled to summary judgment on the breach of express contract claim.

         " It is well settled in South Dakota that 'a hospital's bylaws constitute a binding contract between the hospital and the hospital staff members.'" Mahan v. Avera St. Luke's, 2001 SD 9, 621 N.W.2d 150, 153 (S.D. 2001). When analyzing whether a party has breached the bylaws, the court applies " the normal principles for construction and interpretation of a contract." Id. at 154. Typically, a jury determines whether a party's conduct constitutes a breach of contract. Harms v. Northland Ford Dealers, 1999 SD 143, 602 N.W.2d 58, 63 (S.D. 1999).

         Dr. Miller alleges that HRMC breached the contract by disregarding the Bylaws' procedural mandates relating to corrective action. Specifically, Dr. Miller argues that HRMC and the MEC breached the Bylaws by requesting that Dr. Miller voluntarily reduce her surgical privileges without providing a formal hearing. In its motion, HRMC asserts that the corrective action procedures were inapplicable because formal corrective action proceedings were never instituted against Dr. Miller.

         The contractual provisions relied upon by each party are found in the HRMC Medical Staff Bylaws. Bylaw 10.2 provides the criteria and procedures associated with corrective action. Docket 135 - 4, at 33. Bylaw 10.2(a) provides:

Whenever the medical activities or professional conduct of any Member are, or are reasonably probable to be, contrary to the delivery of quality patient care or to effective hospital operations, corrective action against such Member may be requested by any member of the Medical Staff, Board, President/CEO or any employee of the Medical Center. Initiation of any corrective action proceedings shall be the responsibility of the Executive Committee.

         Additionally, Bylaw 10.2(b) states that " all requests for corrective action shall be in writing, shall be made to the Executive Committee and shall be supported by reference to the specific activities or conduct which constitutes the grounds for the request." Id. According to Bylaw 10.2(d), within fifteen days of the date the request for corrective action is filed, the Executive Committee must determine whether to dismiss the complaint or to appoint three physicians, who are not in direct competition with the affected physician, to investigate the charges. Id.

         After the investigation is complete, under Bylaw 10.2(h), the Executive Committee may recommend the following corrective actions:

(i) Reject or modify the request for corrective action;
(ii) Issue a warning, a letter of admonition, or a letter of reprimand;
(iii) To impose terms of required clinical education, probation or consultation;
(iv) Recommend reduction, suspension or revocation of clinical privileges;
(v) Recommend reduction of staff category or limitation of any staff prerogative directly ...

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