Defining and disciplining disruptive physicians has been a difficult problem for hospital administration and the medical staff for quite some time now, long enough for the Joint Commission to actually require leadership standard LD.3.10 beginning in 2009. Medical staffs have frequently been torn between protecting their members, who are frequently high performing physicians, while maintaining appropriate decorum and providing acceptable hospital practice environments.
The Wyoming Supreme Court case of Guier v. Teton County Hospital District affirms the termination of Dr. Guier’s medical staff privileges by St. John’s Hospital, a facility operated by the Teton County Hospital District, and is one of a very few cases that deals specifically with disruptive behavior. Although the opinion mentions the potential connection between disruptive behavior and maintaining a safe practice environment within the Hospital, there are no adverse quality outcomes associated with Dr. Guier’s conduct. By way of background, Dr. Guier had a prior history of disruptive conduct at the hospital. During his most recent medical staff appointment renewal, he was placed on probation and there were conditions regarding his conduct established to continue at the hospital. Following the reappointment, there are at least six more incidents of disruptive conduct and a hospital staff petition refusing to work with Dr. Guier.
Following these new incidents, the MEC met to review the situation and summarily suspended Dr. Guier’s clinical privileges. Dr. Guier exercised the due process procedures in the medical staff bylaws and his suspension was upheld. Dr. Guier then initiated court action to reverse the decision of the hospital, a government under Wyoming law, but the trial court affirmed the hospital board’s decision, and the Wyoming Supreme Court ultimately affirmed the lower court decision.
The litigation issues did not deal with the allegations of disruptive behavior. Although Dr. Guier claimed he did not receive appropriate notice under the fee disruptive physician policy adopted by the hospital, the court held that there was no question that he was made aware of the incident reports, despite his allegations of surprise.
Dr. Guier asserted in court that the hospital due process procedures did not give him the due process procedures that were mandated by Wyoming law and that the hospital board’s decision was arbitrary and capricious because it bypassed the disruptive behavior policy.
The court concluded that the burden of proof, i.e. whether Dr. Guier had the burden of proof and whether it should be a burden requiring either clear and convincing evidence or preponderance of the evidence because the burden was satisfied in any event. The court also concluded that the hospital was not strictly bound by the disruptive behavior policy, because Dr. Guier received the due process guaranteed by the medical staff bylaws, which was required, and the disruptive behavior policy did not carry the authority of the medical staff bylaws.