A hospital medical staff is an unusual entity. It serves the interests of the
hospital but is not part of the hospital corporation. Because most states place
limits on the ability of physicians to work for hospitals directly, the hospital
usually does not employ or control the actions of the members of the
committee. The medical staff is legally separate from the constituent
physicians’ practices. They may engage in joint decision making for the
hospital, but they are not a joint venture with the hospital. It is important to
note that the courts have found that the members of a hospital medical staff
are, by definition, a conspiracy.
This view was articulated in Weiss v. York Hospital, [
Weiss v. York Hosp., 745
F.2d 786 (3d. Cir. 1984).] an antitrust case. The plaintiff in
Weiss had sued
some of the individual physicians on the medical staff, but he had also sued
the medical staff itself as an independent entity. The court found that the
medical staff had no independent legal existence but accepted the plaintiff’s
allegation that the individual physicians were engaged in a conspiracy as
defined in section 1 of the Sherman Antitrust Act:
We agree with the Plaintiffs that, as a matter of law, the medical staff is
a combination of individual doctors and therefore that any action taken
by the medical staff satisfies the “contract, combination, or conspiracy”
requirement of section 1. [Weiss at 815.]
The key to this case is the distinction between the medical staff as an entity
unto itself and the individual physicians who make up the medical staff.
Although the trial court instructed the jury that the medical staff was an
“unincorporated division” of the hospital and thus the two were a “single
entity,” incapable of conspiring, it was careful to distinguish the actions of the
individual members of the medical staff:
The Court also instructed the jury, however, that if they found that some
or all of the individual Defendants took action against the Plaintiffs “in
whole or in part in their individual capacities and motivated in whole or
in part by independent personal economic interests, then such
individual- named Defendants are, under the law, independent
economic entities … legally capable of conspiring with York Hospital or
its Medical and Dental Staff.” [
Weiss at 813.]
In the case of Quinn v. Kent General Hospital, [
Quinn v. Kent Gen’l Hosp., 716
F. Supp. 1226 (1985).] the court expanded on this distinction between the
medical staff and the individual physicians:
It is certainly true that, regardless of their specialty, the members of the
Hospital’s active medical staff have a financial interest in limiting the
number of physicians admitted to active staff privileges at the Hospital,
for all admitting staff members compete with each other.… The active
staff cannot be regarded as a single economic unit, but must be viewed
as a collection of independent economic actors who are capable of
combining or conspiring with each other for purposes of the Sherman
Act. [Quinn at 1242.]
The holdings of the Weiss and
Quinn courts represent the view that medical
staff committees satisfy the legal definition of a
conspiracy: an informal
relationship between independent parties to carry out joint action. Conspiracy
is generally used as a pejorative term, but here it is presumed that the
conspiracy is for good, not evil. Nonetheless, it means that medical staff
committees that act improperly are subject to the same federal laws that
govern traditional illegal conspiracies, including the antitrust laws and the
Racketeering Influenced Corrupt Organizations Act (RICO).
