A physician in Knoxville, Tennessee, Dr. Abu-Hatab, sued Blount Memorial Hospital alleging that his medical staff membership and clinical privileges had been terminated and retaliation for exercising his First Amendment right of free speech regarding complaints about medical care in the hospital. The United States District Court for the Eastern District of Tennessee granted summary judgment to the hospital in both counts.

Dr. Abu-Hatab joined the practice of Dr. Siddiqi at the hospital. Dr. Siddiqi’s practice had an exclusive contract for dialysis services at the hospital. At some point, Dr. Abu-Hatab started his own practice and attempted to persuade the hospital to terminate its exclusive arrangement with Dr. Siddiqi.

At this point, as usually happens, the plot thickens and Dr. Abu-Hatab is accused of disruptive conduct. This is the classic chicken and egg dilemma with disruptive physician cases, which cannot be resolved without extensive review of the facts, but the question is always whether the hospital is retaliating by harassing a physician who is seeking to change the existing political and contractual structures with the hospital or whether a disgruntled physician, who was unable to legitimately change the situation, then becomes disruptive in an attempt to illegitimately undermine the existing structure.

In this case, the court granted summary judgment in favor of the hospital, basically concluding that the physician was the offending party. In analyzing the elements of immunity under the Health Care Quality Improvement Act, the court concluded:

(1)        There was evidence in the record conclusively demonstrating that the hospital’s decisions were made and they were furthering quality healthcare;

(2)        There was voluminous evidence detailing the hospital’s ongoing and thorough efforts to investigate the complaints against Dr. Abu-Hatab, thereby establishing a reasonable effort to obtain the facts;

(3)        The hospital provided Dr. Abu-Hatab with adequate notice and an opportunity to be heard at every stage of the proceeding; and

(4)        A reasonable jury could not find, based upon the ponderous of voluminous evidence, that the action was not warranted by the facts known to the hospital at the time.

Dr. Abu-Hatab also asserted that he had a constitutional right under the First Amendment to criticize the medical care at the hospital. This issue is analyzed under the law pertaining to public employees’ rights for free speech under the First Amendment. The basic rules establish that the speech is protected only if it touched on a matter of public concern and there was no overriding state interest that would be undermined by allowing the speech. The court concluded that the issue involved Dr. Abu-Hatab’s dispute with management of the hospital, and not a public issue, because Dr. Abu-Hatab’s criticism of the dialysis contract involved administrative issues rather than political, social or economic concerns affecting the local community.

A copy of the opinion is available for review.