Missouri Supreme Court: Doctors can sue if hospitals ignore bylaws in privileging issues

The court also said medical staff bylaws do not create a legal contract. The court will not review the privileging decision itself.

By Amy Lynn Sorrel, AMNews staff. April 7, 2008.

Physicians say a Missouri Supreme Court ruling, though narrow, recognizes the significance of medical staff bylaws and offers doctors some recourse in the face of unfair discipline.

Breaking with a 43-year-old precedent, a unanimous high court opened the door for medical staff members to sue hospitals over privileging disputes if the facilities fail to follow staff bylaws. Justices departed from a long-held principle that hospital privileging decisions were not subject to judicial review, noting that was the "nationwide majority rule" at the time of the high court's 1965 decision.

The court recently carved out an exception to that rule, however, saying courts can intervene to compel hospitals to follow bylaws in disciplinary proceedings before suspending or revoking a doctor's privileges.

"It is implicit under [state] regulation that hospitals not only have a legal duty to adopt bylaws but also a corresponding duty to abide by those bylaws," Justice Stephen N. Limbaugh Jr. wrote in a Feb. 5 opinion. "Although the [hospitals protest] that as a matter of public policy, government regulations for hospital staffing decisions exist to protect patients, not doctors, the public policy behind the regulation here clearly protects both."

The court noted that 46 states and the District of Columbia allow some form of judicial review of hospital privileging decisions. Missouri parted company with three states -- Iowa, Oklahoma and South Carolina -- that adhere to the principle that credentialing matters cannot be challenged in court.