Kohn v. FirstHealth of the Carolinas, Inc. – July 2015 (Summary)

CREDENTIALING CRITERIA

Kohn v. FirstHealth of the Carolinas, Inc., No. COA14-1210 (N.C. Ct. App. July 7, 2015)

The North Carolina Court of Appeals affirmed summary judgment for the hospital with respect to a physician’s claim that the hospital had been arbitrary and capricious in denying him appointment and clinical privileges because he failed to satisfy the hospital’s threshold eligibility criteria, which included completion of a residency program accredited by the Accreditation Council for Graduate Medical Education (“ACGME”).

The physician, a native of Canada, completed his internship and residency in Canada. In 1999, he applied for appointment and clinical privileges at the hospital. At that time, he was informed that his application could not be accepted because a pre-application screening revealed that he had not completed a residency program approved by the ACGME as required by the medical staff bylaws.

In 2010, the physician reapplied and his application was denied based on the fact that the residency program he attended was in Canada and was certified by the Royal College of Canada and not the ACGME. The physician tried to argue that his program was compliant with the medical staff bylaws because it was “recognized” by the ACGME. However, the hospital argued that it interpreted the word “approved” in their bylaws as “accredited,” and his request was denied. Both the Credentials Committee and Medical Executive Committee reviewed the physician’s complaints, and both groups determined the physician did not meet the minimum standards as set forth in the medical staff bylaws.

In granting summary judgment to the hospital, the court held: “[i]t is not arbitrary, capricious, and discriminatory to [deny staff privileges to physicians who] have been unable to comply with the standards properly established by the [hospital].” In response to the physician’s argument that many hospitals accept Canadian residencies as functionally equivalent to a residency accredited by the ACGME, the court cited to the broad deference given to hospital boards in making staff privileges determinations. According to the court, hospital staffing decisions will be upheld as long as they are (1) reasonably related to the hospital’s operation; (2) rationally compatible with the hospital’s responsibility; and (3) not based on irrelevant considerations. The court found that the hospital’s requirement – that physicians complete an ACGME-accredited residency training program – met these standards.

The court also affirmed the dismissal of the physician’s attempted monopolization claim, noting the physician’s argument relied upon the “essential facility” doctrine, which the court found inapplicable to the case. Lastly, the court dismissed the physician’s race and ethnic discrimination claim, holding the claim was barred by res judicata because the claim could have properly been litigated in his prior action.