We now reach the specific question involved in the case at bar, namely, whether a private hospital has power to appoint and remove members of its medical staff at will, and whether it has authority to exclude in its discretion members of the medical profession from practising in the hospital. The overwhelming weight of authority, almost approaching unanimity, is to the effect that such power and authority exist. The rule is well established that a private hospital has a right to exclude any physician from practising therein. The action of hospital authorities in refusing to appoint a physician or surgeon to its medical staff, or declining to renew an appointment that has expired, or excluding any physician or surgeon from practising in the hospital, is not subject to judicial review. The decision of the hospital authorities in such matters is final.
The only possible exception is in a case in which there is a failure to conform to procedural requirements set forth in its constitution, by-laws, or rules and regulations. In that event the extent of judicial review is to require compliance with the prescribed procedure. Beyond that, the courts do not interfere. In the instant case, the by-laws, which are a part of the record on this motion, do not provide any specific procedure.
While the question is of novel impression in this jurisdiction, it has been decided time and time again in many of the States. This is the law in Maryland, through which the District of Columbia derives its common law. Thus in Levin v. Sinai Hospital of Baltimore City, 186 Md. 174, 46 A.2d 298, the plaintiff physician had been a member of the visiting staff of the defendant hospital and thereby had been enabled to treat his patients in either private or semi-private rooms. He was dropped from the visiting staff and placed on the courtesy staff, entitling him to attend to patients only in private rooms. He brought suit for an injunction against the hospital. The Court of Appeals of Maryland held that the board of officers of the hospital had a right to appoint physicians to the medical staff, as well as to fail to reappoint any one. Accordingly, a demurrer to the bill of complaint was sustained. The Court stated that 'a private hospital has the right to exclude any physician from practising therein, and such exclusion rests within the sound discretion of the managing authorities' (186 Md. pp. 179-180, 46 A.2d p. 301).
This doctrine has been approved and applied in Virginia. In Khoury v. Community Memorial Hospital, Inc., 203 Va. 236, 123 S.E.2d 533, the plaintiff physician was temporarily extended professional privileges at the defendant's hospital, but this authority was later revoked. He brought suit to enjoin his dismissal. A final decree for the defendant was affirmed. The Court stated:
'We are of the opinion that when the trustees of a private hospital, in their sound discretion, exclude a doctor from the use of the facilities of the hospital, the courts are without authority to nullify that discretion by injunctive process. There are no constitutional or statutory rights of the doctor, or of his patients who wish to be treated in the hospital by him, which warrant such interference.'
The following authorities, among others, hold to the same effect. Edson v. Griffin Hospital, 21 Conn.Sup. 55, 144 A.2d 341; West Coast Hospital Ass'n. v. Hoare (Fla.) 64 So.2d 293; Natale v. Sisters of Mercy of Council Bluffs, 243 Iowa 582, 52 N.W.2d 701; Van Campen v. Olean General Hospital, 210 App.Div. 204, 205 N.Y.S. 554, aff. 239 N.Y. 615, 147 N.E. 219; Leider v. Beth Israel Hosp. Ass'n., 11 N.Y.2d 205, 227 N.Y.S.2d 900, 182 N.E.2d 393; Weary v. Baylor University Hospital (Tex.Civ.App.) 360 S.W.2d 895.
Only recently the Court of Appeals of New York in Leider v. Beth Israel Hosp. Ass'n., supra, stated that a physician's exclusion from the staff, including privileges incident to staff membership, 'rested entirely in the discretion of the board of trustees'.
New Jersey seems to stand alone in apparently adopting a different rule, Raymond v. Cregar, 38 N.J. 472, 185 A.2d 856; Greisman v. Newcomb Hospital, 76 N.J.Super. 149, 183 A.2d 878.
As has been previously indicated, another principle may well be invoked in situations in which a specific procedure is prescribed by the constitution, by-laws, rules or regulations of the hospital for admitting or excluding a physician from its staff and it is claimed that the hospital authorities did not comply with those requirements. Under such circumstances, some courts have intervened, but only to the extent of requiring adherence to the prescribed procedure, Berberian v. Lancaster Osteopathic Hosp. Ass'n. Inc., 395 Pa. 257, 149 A.2d 456. No such question is involved in the case at bar.
Some decisions have distinguished between private and public hospitals in this connection, and have permitted a limited court review in such matters in cases of public hospitals. Rosner v. Eden Township Hospital District, 58 Cal.2d 592, 25 Cal.Rptr. 551, 375 P.2d 431; North Broward Hospital District v. Mizell, Fla., 148 So.2d 1; Dayan v. Wood River Township Hospital, 18 Ill.App.2d 263, 152 N.E.2d 205; Alpert v. Board of Governors of City Hospital, 286 App.Div. 542, 145 N.Y.S.2d 534. This, too, is a phase of the subject that does not confront the Court in this instance.
There are sound reasons that lead the courts not to interfere in these matters. Judicial tribunals are not equipped to review the action of hospital authorities in selecting or refusing to appoint members of medical staffs, declining to renew appointments previously made, or excluding physicians or surgeons from hospital facilities. The authorities of a hospital necessarily and naturally endeavor to their utmost to serve in the best possible manner the sick and the afflicted who knock at their door. Not all professional men, be they physicians, lawyers, or members of other professions, are of identical ability, competence, or experience, or of equal reliability, character, and standards of ethics. The mere fact that a person is admitted or licensed to practice his profession does not justify any inference beyond the conclusion that he has met the minimum requirements and possesses the minimum qualifications for that purpose. Necessarily hospitals endeavor to secure the most competent and experienced staff for their patients. Without regard to the absence of any legal liability, the hospital in admitting a physician or surgeon to its facilities extends a moral imprimatur to him in the eyes of the public. Moreover not all professional men have a personality that enables them to work in harmony with others, and to inspire confidence in their fellows and in patients. These factors are of importance and here, too, there is room for selection. In matters such as these the courts are not in a position to substitute their judgment for that of professional groups.
It is cogently argued that considering the large number of physicians and surgeons found in a big city such as Washington, it is not practicable for any single hospital to accommodate every member of the profession with its facilities. It is persuasively urged that there are a number of private hospitals in the District of Columbia and that no one of them is physically capable of extending its resources to every doctor of medicine practising in the area. It becomes indispensable, therefore, for every such institution to make choices as to whom it will admit to its portals.
The Court is not unmindful of the fact that due to the shortcomings of human nature, an occasional injustice may result, because of clashes of personality or tempermanent, possible likes and dislikes, jealousy or differences of opinion. The Courts, however, do not sit to remedy every ill caused by the frailties of mankind. Their function is but to vindicate legal rights and redress legal wrongs.
In view of the conclusion reached that the Court may not interpose to review the decision of the hospital in failing to renew the plaintiff's appointment on the courtesy staff, no action lies against the corporation or its officers for a declaratory judgment or an injunction.
Little need be said as to the claim for damages for defamation. It does not appear whether the failure to renew the plaintiff's appointment was due to any alleged defect on his part in his professional capability or integrity, or whether it was caused by some circumstance that does not reflect on his professional standing. There is no averment as to the exact contents of the alleged defamatory statement. Clearly no valid claim for damages for defamation, be it libel or slander, is set forth in the complaint.
Accordingly, the defendants' motion for summary judgment is granted.