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Spindle v. Sisters of Providence in Washington (12/20/2002) sp-5651
Spindle v. Sisters of Providence in Washington (12/20/2002) sp-5651
Notice: This opinion is subject to correction before
publication in the Pacific Reporter. Readers are
requested to bring errors to the attention of the Clerk
of the Appellate Courts, 303 K Street, Anchorage,
Alaska 99501, phone (907) 264-0608, fax (907) 264-0878,
e-mail corrections@appellate.courts.state.ak.us.
THE SUPREME COURT OF THE STATE OF ALASKA
DAVID A. SPINDLE, M.D., )
) Supreme Court No. S-10169
Appellant, )
) Superior Court No.
v. ) 3AN-98-10026 CI
)
SISTERS OF PROVIDENCE IN ) O P I N I O N
WASHINGTON d/b/a PROVIDENCE )
ALASKA MEDICAL CENTER; ) [No. 5651 - December 20,
2002]
ALASKA REGIONAL HOSPITAL; )
ANCHORAGE NEUROSURGICAL )
ASSOCIATES, INC.; JOHN C. )
GODERSKY, M.D.; and LOUIS )
KRALICK, M.D., )
)
Appellees. )
________________________________)
Appeal from the Superior Court of the State
of Alaska, Third Judicial District,
Anchorage, John E. Reese, Judge.
Appearances: Andrew K. Kurzmann, Attorney at
Law, Anchorage, for Appellant. John M.
Conway and Robert J. Dickson, Atkinson,
Conway & Gagnon, Anchorage, for Appellee
Sisters of Mercy Providence Hospital, Inc.
Matthew K. Peterson and Scott Hendricks
Leuning, Clapp, Peterson & Stowers, LLC,
Anchorage, for Appellees Anchorage
Neurosurgical Associates, John Godersky,
M.D., and Louis Kralick, M.D.
Before: Fabe, Chief Justice, Matthews,
Eastaugh, and Carpeneti, Justices. [Bryner,
Justice, not participating.]
CARPENETI, Justice.
I. INTRODUCTION
Dr. David K. Spindle appeals from the decision of the
superior court granting summary judgment to Drs. Louis Kralick
and John C. Godersky as well as their business Anchorage
Neurosurgical Associates, Inc. and Sisters of Mercy Providence
Hospital, Inc. on Dr. Spindles claims arising from his failure to
obtain privileges at Providence Hospital. Because the superior
court correctly found that Dr. Spindles failure to finish his
application for privileges at the hospital rendered his antitrust
and tort claims premature and thus not actionable, we affirm the
decision of the superior court.
II. FACTS AND PROCEEDINGS
Dr. David K. Spindle is a neurosurgeon and is licensed
to practice medicine in Alaska. Dr. Spindle has been licensed to
practice in California, Nevada, and Hawaii as well.
Dr. Spindle practiced medicine at Downey Community
Hospital (Downey) in California before coming to Anchorage,
Alaska in 1996. Dr. Spindle came to Alaska after seeing an
advertisement in a medical journal for a neurosurgeon at Alaska
Native Medical Center (ANMC). Dr. Spindle worked at ANMC for
approximately fourteen months.
There are a limited number of neurosurgeons in Alaska.
Drs. Louis Kralick and John C. Godersky, who practice together
at Anchorage Neurosurgical Associates, Inc. (ANA), and Dr.
Lawrence Dempsey were the only neurosurgeons in practice when Dr.
Spindle arrived. Drs. Kralick and Godersky were the only
neurosurgeons with privileges at Sisters of Mercy Providence
Hospital, Inc. (Providence). Dr. Godersky serves as chair of the
department of surgery at Alaska Regional Hospital, Inc. (ARH) and
formerly served as a member on the credentials committee and
board of trustees there, as well as chief of staff. At
Providence, Dr. Godersky was the subsection chairperson of
neurosurgery at the time of Dr. Spindles application and had
served as the treasurer of the medical staff. Dr. Godersky now
serves as chairperson of the department of surgery at Providence.
On August 8, 1995 Dr. Spindle applied for medical
privileges at ARH, and he applied for privileges at Providence on
August 10. In applying to Providence, Dr. Spindle completed an
appointment consent and release. In it, he acknowledged that, as
an applicant for appointment to staff membership and privileges,
I have the burden of producing adequate information for a proper
evaluation of the above criteria and for resolving any doubts
about such qualifications. Dr. Spindle also agreed through the
release to provide any additional information as may be requested
by the hospital, its Medical Staff or their representatives.
On November 2, 1995 Dr. Steven Floerchinger, chair of
surgery at Providence, found Dr. Spindle qualified for privileges
pending review by Dr. John Godersky, neurosurgery subsection
chair. Dr. Godersky then allegedly reviewed the file and said
Dr. Spindle could have privileges. Dr. Godersky, however,
refused to interview Dr. Spindle or sign off on his application.
An applicant for privileges at Providence is required
to complete a page naming the exact procedures for which
privileges are requested. In his application for medical
privileges at Providence, under neurosurgical privileges Dr.
Spindle checked off every category of procedures except for two.
The credentials committee at Providence found certain
things unusual about Dr. Spindles application. First, the
committee found it unusual that Dr. Spindles professional
liability insurance had been terminated. Second, the committee
found it unusual that Dr. Spindle had professional liability
claims pending at the time of his application and that his letter
of reference was from a doctor outside of his specialty.
Finally, the committee found it strange that Dr. Spindle wrote
board qualified in neurosurgery in 1965 on his application. This
was odd because the industry term is board eligible. Board
eligible means a practitioner has been accepted to take the exam
for board certification. One is board eligible for a limited
period of time while the exam is pending. Dr. Spindle is not
certified by the American Board of Neurological Surgery, having
twice failed the oral section of the board exam.
On January 10, 19961 Douglas Bruce, Chief Executive of
Providence, wrote to Dr. Spindle informing him he had been
granted temporary privileges, effective January 10 through
February 29, 1996. The letter also stated that Dr. Spindle had a
scheduled interview with the committee on January 23, 1996.
Following that interview, Bruce wrote Dr. Spindle and informed
him that his temporary privileges were terminated because Dr.
Spindle ha[d] not completed the application process and that the
credentials committee had tabled his application pending
completion of the following:
a. The Chair of the subsection of Neurosurgery must review,
interview, and provide a recommendation for privileges to the
Credentials Committee.
b. Submit your plan for surgical coverage of your patients when
you are not available to the Credentials Committee.
c. Submit your plan to have a Class I neurosurgeon[2] assist
you on all major cases as noted in the Department of Surgery
Rules and Regulations, Eligibility, Class II.
a. The redacted minutes of the committees meeting reflect this
action. Dr. Godersky did not attend the meeting where Dr.
Spindles privileges were terminated and alleged that he had no
input in the termination of those privileges.
In early 1996, after moving to Anchorage, Dr. Spindle
telephoned Dr. Kralick. During the conversation Dr. Spindle and
Dr. Kralick spoke of the possibility of a cross-coverage
arrangement. Dr. Godersky also spoke to Dr. Spindle on the
telephone. Dr. Godersky inquired into the scope of Dr. Spindles
practice after being asked by Dr. Spindle to consider a cross-
coverage arrangement. Dr. Spindle replied that he was performing
procedures for operations on the cervical spine for degenerative
disk disease and disk herniations, and operations on the lumbar
spine for degenerative disk disease, and . . . carpal tunnel
surgery. Dr. Godersky specifically asked Dr. Spindle whether he
cared for pediatric patients and Dr. Spindle responded that he
did not. Dr. Spindle also responded that he did not provide care
for intercranial aneurysms, brain tumors, and trauma patients.
Dr. Spindle attempted to find alternate physicians to
provide coverage for him in the event of his unavailability but
he was unsuccessful. The doctor covering for Dr. Spindle would
have to have privileges at Providence to be able to provide
coverage. According to the letter from Providence, Dr. Spindle
needed general coverage for when he fell ill or was on vacation
as well as coverage by a Class I neurosurgeon for major
procedures. Dr. Spindle contacted Providence on February 5, 1996
to inform it that he was having problems obtaining coverage. Dr.
Spindle was then informed by Providence that any qualified
physician could provide his general coverage. Providence also
provided Dr. Spindle with a list of doctors to contact about
coverage. Dr. Spindle alleges that he was told that Drs. Kralick
and Godersky would not provide coverage for him. Dr. Spindle
also alleges that both Dr. Godersky and Dr. Kralick refused to
even meet with me regarding providing Class 1 neurosurgeon
coverage and that he was told by Drs. Kralick and Godersky in
essence, that I should have asked for their permission before
having moved up to Alaska seeking neurosurgical privileges. Dr.
Spindle alleges he spoke to a Dr. Scott Mackie who said he would
like to provide coverage for him but declined to do so
specifically stating that if he did so, Drs. Godersky and
Kralick would no longer see his patients.
As a part of the application process, the committee
asked Dr. Godersky as the chairperson of Providences neurosurgery
subsection to appear before it to respond to questions regarding
Dr. Spindles application. During this meeting on February 27,
1996 Dr. Godersky was asked what he thought of the subcategories
of practice for which Dr. Spindle sought privileges at
Providence. This question most likely arose because the
committee had noted that neither [Dr. Spindle] nor his references
had provided information regarding the types of surgeries [Dr.
Spindle] performed and their outcomes for the recent past despite
the fact he had requested full neurosurgical privileges. Dr.
Godersky replied that from the previous conversation he had had
with Dr. Spindle, he did not believe Dr. Spindle was currently
performing all of the procedures for which he had requested
privileges.
Dr. Godersky thus made a recommendation that if [Dr.
Spindle] was applying for those particular privileges to take
care of those problems, that [the committee] ask him to provide
information documenting that he, in fact, had current, recent
experience in taking care of the people that he was requesting
privileges to care for. Dr. Godersky did not make a
recommendation as to whether Dr. Spindle was qualified to obtain
privileges at Providence. Dr. Godersky does not recall being
asked to interview Dr. Spindle or refusing to interview him as a
part of Dr. Spindles application process. However, Dr. Godersky
does recall that the reason he did not interview Dr. Spindle is
that regardless of what he recommended, it could be judged as
[him] making a recommendation solely on the basis of economics
. . . . Dr. Godersky claims he had no input regarding whether
Dr. Spindle was granted temporary privileges. Also, Dr. Godersky
testified that he never even saw all of Dr. Spindles application
and that he reviewed only the page with the list of procedures
Dr. Spindle had requested the privilege to perform at Providence.
On March 26, 1996 Providence wrote Dr. Spindle
requesting he provide the discharge diagnoses and discharge
summaries of all cases he had served on as the primary surgeon
over the past two years for review by the department of surgery
chair. Providence sometimes requires these documents to help it
assess the specific privileges requested by an applicant as well
as his or her current clinical competence,3 which must be
assessed in each subcategory of privileges an applicant applies
for. It is not unusual to request discharge summaries from
applicants and, according to Providences assistant administrator
half maybe half of the applicants who then supply such
information are granted requested privileges. Dr. Spindle
responded on April 19, 1996, but he did not provide the discharge
summaries. He provided only a partial list of patients. The
list came from Nancy Stoner, director of medical record services
at Downey. In her cover letter to Dr. Spindle, she informed him
that if he still wanted the discharge diagnoses and discharge
summaries there would be a charge. On May 20, 1996 Providence
again wrote Dr. Spindle, asking him to provide a complete list of
all procedures done at all hospitals during this time frame,
including the discharge summaries for each patient.
Discharge diagnoses and discharge summaries were
required so that the credentials committee could see the
documentation of the outcome of a patients surgery and the
discharge instructions the status of the patient and what was
performed and make clinical judgments about what theyre reading.
No such information was received from Dr. Spindle. On June 27,
1996, at the request of the committee, Providence inquired as to
the status of its request for information and noted that if the
documentation was not received by July 20, 1996, Dr. Spindles
application would be retired as incomplete.
On July 3 Dr. Spindle contacted Providence and informed
it that he was presently in the process of collecting the
information requested in the committees May 26, 1996 letter. In
that conversation Dr. Spindle also allegedly noted that he had
spoken to an attorney with the intent to sue the medical center
for not expediting his privileges, but was advised by his
attorney to provide the requested information, and then if his
application for privileges is not approved he will have better
grounds for this lawsuit.
On September 20, 1996 Barbara Kuper, the medical staff
coordinator at Providence, not having received the requested
information, telephoned Dr. Spindle. Kuper stated that when she
spoke to Dr. Spindle, he was surprised Providence had yet to
receive the documents. Dr. Spindle told Kuper that he would call
Downey and request them again. On September 26 Dr. Spindle
dropped off a large packet of documents at Providence with Kuper.
However, the documents were not the discharge diagnoses and
discharge summaries previously requested; rather, they were
operative reports. Stoner, the director of medical record
services at Downey, told Kuper that Dr. Spindle had requested
only the reports about three weeks prior and that he had
specifically asked for operative reports instead of discharge
diagnoses and discharge summaries.
On October 16, 1996 Providence again wrote Dr. Spindle
to inform him his application was still incomplete. In the
letter, Providence extended the deadline, notifying Dr. Spindle
that if it did not receive the discharge diagnoses and discharge
summaries by October 29, 1996, his application would be retired,
requiring re-application for privileges in the event he did
produce the requested information.
There is a record of a phone message left by Dr.
Spindle on October 29, 1996 to Kuper. In it, Dr. Spindle stated
that Downey did not have the time nor the personnel to supply
these discharge summaries. Dr. Spindle further stated that he
was trying to comply, preparatory to a lawsuit if he is not put
on staff.
Providence again wrote Dr. Spindle regarding the
discharge diagnoses and discharge summaries on November 5, 1996.
In the letter, the chair of the committee stated that ten percent
of the discharge summaries previously requested would be adequate
for its review. The letter also stated that in order for Dr.
Spindles application to be complete, he would still have to
submit his plans for coverage.
On May 16, 1997 Providence received a call from Stoner
at Downey regarding Dr. Spindles request for ten percent of his
discharge diagnoses and discharge summaries. Stoner stated she
was surprised since she had not heard from Dr. Spindle in such a
long time. Kuper informed Stoner that the request for ten
percent of the discharge summaries dated from November 1996 and
that she would check with the committee to see if it needed any
further information from her.
No discharge diagnoses or discharge summaries from
Downey were ever received by Providence. Dr. Spindle did provide
some discharge diagnoses and discharge summaries from his
employment at ANMC.
On March 12, 1998 Dr. Spindles file was retired as
incomplete. No action had been taken on the file since May 16,
1997.
On September 16, 1999 Dr. Spindle filed his complaint
in superior court against Providence, ARH, ANA, and Drs. Kralick
and Godersky individually, alleging restraint of trade,
negligence, and intentional interference with a prospective
economic advantage. He also alleged defamation, but that claim
was later dismissed in a stipulation by the parties.
On October 25, 2000 all claims against ARH were
dismissed with prejudice by the superior court. ARH is not a
party to this appeal.
On December 4, ANA and Drs. Kralick and Godersky moved
for summary judgment on all claims. Providence joined in the
motion. The superior court granted summary judgment. On March
20, 2001 Dr. Spindle objected to the entry of final judgment in
the matter, arguing that all claims contained in the complaint
had not been disposed of, but final judgment was entered on April
10.
Dr. Spindle now appeals.
III. STANDARD OF REVIEW
I. We review a trial courts grant of summary judgment de novo
and affirm its ruling if the record presents no genuine issues of
material fact in dispute and the moving party is entitled to
judgment as a matter of law.4 We are not bound by the trial
courts articulated reasoning and can affirm a grant of summary
judgment on alternative grounds, considering any matter appearing
in the record, even if not considered by the trial court.5 All
reasonable factual inferences are drawn in favor of the non-
moving party.6
In antitrust litigation, courts attempt to use the
summary judgment process sparingly.7 When an antitrust plaintiff
has established a prima facie case, he [or she] should have an
opportunity to prove the necessary supporting facts at trial.8
However, the very nature of antitrust litigation encourages
summary disposition of such cases when permissible . . . .9
IV. DISCUSSION
Dr. Spindles Failure To Complete the Application Process Was
Fatal to His Claims.
Although requested by the committee, Dr. Spindle failed
to provide Providence with ten percent of the discharge diagnoses
and discharge summaries that it had requested from his previous
work. Dr. Spindle also failed to submit a plan for surgical
coverage of his patients and a plan to have a Class I
neurosurgeon assist him with all major cases. Dr. Spindle claims
that his failure to complete the application process was a direct
result of the appellees anticompetitive conduct. Appellees
respond that Dr. Spindles failure to furnish the necessary
information renders any claim he might have ineffective because
he never finished his application for medical privileges at
Providence.
We proceed cautiously when asked to review the actions
of a hospitals governing body. Courts are in general agreement
that the decisions of a hospital governing body regarding
applications for hospital privileges are to be accorded great
deference, and that judicial review should be limited to factors
which are within the expertise of courts.10 The evaluation of
professional proficiency of doctors is best left to the
specialized expertise of their peers, subject only to limited
judicial surveillance.11 We recognize that the governing body of
a hospital must be given great latitude in establishing standards
which an applicant must meet before privileges will be granted.12
At the same time, we may require a hospitals procedures and
standards to be fair and reasonable as well as ensure that they
are not applied in an arbitrary or capricious fashion.13
Appellees actions with respect to the discharge records
comfortably satisfy the deferential review that we apply in these
situations. In requiring the discharge diagnoses and discharge
summaries, appellees merely required verification that Dr.
Spindle maintained current clinical competence in the procedures
for which he sought privileges. We have previously recognized
that it may be difficult for a hospital to establish a set of
objective criteria to determine whether an applicant is qualified
for every medical privilege applied for.14 Especially in light of
the telephone conversation with Dr. Godersky, in which Dr.
Spindle admitted that his practice was limited in contrast with
the number of privileges he applied for at Providence, the
committees request for the discharge diagnoses and discharge
summaries was unquestionably reasonable and within its
discretion. Furthermore, Providence decreased the initial
requirement from all Downey discharge diagnoses and discharge
summaries to ten percent of those records to ensure that its
request was reasonable. And Dr. Spindle signed the consent and
release in his initial application, acknowledging that he had the
burden to produce adequate information for a proper evaluation of
the above criteria and for resolving any doubts about such
qualifications. Finally, in creating a provision regarding the
civil liability of hospitals for certain physicians, the Alaska
legislature specifically found that a hospital is responsible for
exercising reasonable care in granting privileges to practice in
the hospital, for reviewing those privileges on a regular basis,
and for taking appropriate steps to revoke or restrict privileges
in appropriate circumstances.15
Under all of these circumstances, Dr. Spindles failure
to provide the credentials committee with the discharge summaries
information that the committee needed to assess his application
is fatal to his claims. The committee, denied the information
that was necessary to determine his fitness to practice the broad
range of neurosurgical procedures that Dr. Spindle sought
privileges to practice at Providence, was justified in retiring
his file as incomplete. Thus, without even considering Dr.
Spindles anticompetitive conduct claims, which related to his
failure to obtain coverage for his patients when he was not
available and his failure to obtain Class I neurosurgeon
assistance on his major cases, there was a sufficient basis for
the grant of summary judgment.
The requirement to provide the committee with ten
percent of his discharge diagnoses and discharge summaries was
within Dr. Spindles control and he failed to meet it.16 Thus,
despite Dr. Spindles arguments to the contrary, this case is
analogous to Evers v. Edward Hospital Assn.17 In Evers, the court
held that an applicant must provid[e] all information deemed
necessary by the hospital . . . as a condition precedent to the
hospitals obligation to process the application.18 Dr. Spindle
argues in response that this case is inapplicable because it is a
breach of contract action as opposed to an antitrust claim. But
while Dr. Spindle argues that the appellees prevented him from
competing for privileges, they did not prevent him from supplying
the discharge records that were requested. It was within Dr.
Spindles power to obtain the discharge summaries but he failed to
do so. Based on the undisputed evidence before us from Stoner,
the only inference that can be drawn from the record is that he
simply chose not to do so.
We conclude, as in Evers, that the hospitals
requirement that a sample of discharge records be supplied was a
reasonable condition precedent to any required action by the
hospital. The failure of Dr. Spindle to comply with this request
renders his claim of anticompetitive conduct and conditions in
the application process premature. Until and unless Dr. Spindle
complies with the clearly reasonable conditions he may not be
heard to complain that other acts and practices are unreasonable
and monopolistic.19
V. CONCLUSION
Because there are no genuine issues of material fact in
dispute, we AFFIRM the decision of the superior court granting
appellees motion for summary judgment.
_______________________________
1 The letter is actually dated January 10, 1995, but this
appears to be a simple typographical error.
2 A Class I neurosurgeon is a term specific to
Providence. To obtain this status, a neurosurgeon is evaluated
by his or her peers and recommended to that status.
3 Current clinical competence means peers have assessed
the clinical performance of a physician and think that it is
current, up-to-date and clinically appropriate competent within
the standard of practice expected in that field.
4 Lincoln v. Interior Regl Hous. Auth., 30 P.3d 582, 585-
86 (Alaska 2001).
5 Wright v. State, 824 P.2d 718, 720 (Alaska 1992).
6 Lincoln, 30 P.3d at 586.
7 Odom v. Lee, 999 P.2d 755, 762 (Alaska 2000) (citing
KOS v. Alyeska Pipeline Serv. Co., 676 P.2d 1069, 1073 (Alaska
1983)).
8 Id.
9 Collins v. Associated Pathologists, Ltd., 844 F.2d 473,
475 (7th Cir. 1988).
10 Kiester v. Humana Hosp. Alaska, Inc., 843 P.2d 1219,
1223 (Alaska 1992).
11 Eidelson v. Archer, 645 P.2d 171, 177 (Alaska 1982)
(quoting Sosa v. Bd. of Managers, 437 F.2d 173, 177 (5th Cir.
1971)).
12 Kiester, 843 P.2d at 1225 (citing Sosa, 437 F.2d at
176).
13 Id. at 1223.
14 Id. at 1225.
15 AS 09.65.096(a).
16 Dr. Spindle claimed at one point that he was unable to
provide the summaries because of cost. But the record shows that
he never determined the actual cost. Moreover, Dr. Spindles
request for operative reports instead of the discharge diagnoses
and discharge summaries that the committee had actually requested
served to increase the costs.
17 617 N.E.2d 1211 (Ill. App. 1993).
18 Id. at 1219.
19 This conclusion also justifies the entry of summary
judgment on the hospitals immunity claims under federal and state
law and Dr. Spindles claim of intentional interference with
prospective economic advantage, and makes it unnecessary for us
to consider those issues.
