California federal court upholds board certification requirements for physicians

A federal court ruled board certification is a good way to ensure doctors are trained to perform certain surgeries.

By Tanya Albert, amednews staff. March 12, 2001.

Hospital requirements that physicians be board certified to obtain certain staff privileges do not necessarily violate antitrust laws, according to a recent 9th Circuit Court of Appeals decision.

Family physician Eric Runte, MD, of Sonora, Calif., challenged the high standard after he was denied privileges to perform cesarean sections at Sonora Community Hospital.

Although he had done about 110 C-sections during residency, he didn't meet the hospital's requirements for privileges: completion of a 36-month residency program in obstetrics-gynecology or status as a board-certified or board-eligible obstetrician.

Dr. Runte said the criteria, which were in the process of being adopted when he applied for privileges at Sonora, hurt his business and broke antitrust laws.

But the hospital said it had set the standards because it wanted to ensure that patients got the best care for a high-risk procedure. They also helped minimize liability associated with C-sections, court documents said.

The 9th Circuit Court of Appeals in California disagreed with the doctor and dismissed his claim.

"It hurts all physicians," said Barbara J. Hensleigh, a Los Angeles attorney who represented Dr. Runte. "It means a court will defer to the hospital under the guise of quality of care."

Dr. Runte argued that he should receive privileges based on letters of recommendation and surgical reports that show that he can provide excellent patient care.

But the court said Dr. Runte had not convinced it that there was a better way than board certification to ensure that doctors were trained to do a particular procedure. The court also said the doctor had not shown that there was a conspiracy against him.

"It is difficult to see how a hospital, acting independently and relying solely on letters of recommendation and surgical reports, can assure itself that a physician has the surgical competence represented by board certification or the supervised experience of a 36-month residency program," the court wrote in its opinion.

It would be very expensive for a hospital to independently evaluate each doctor's skills to decide whether he or she had the knowledge to perform surgeries in the operating room, the court said. "The issue, after all, is professional standards in potentially life-threatening situations," it said.

Hensleigh said there were no plans to appeal the decision to the U.S. Supreme Court.