March 17 Court Order In Favor of Tulare Hospital Board

Re: Tulare Regional Medical Center Medical Staff v. Tulare Local Healthcare District, et al.

Case No: VCU 264227

Date: March 17, 2016

Time: 8:30 A.M.

Dept. 2 – The Honorable David Mathias

Motion: Plaintiff/Petitioner’s Application for Issuance of Temporary Restraining Order and Order to Show Cause Re: Preliminary Injunction

The court’s intended decision is as follows.  To deny plaintiff/petitioner’s Application for Issuance of Temporary Restraining Order and Order to Show Cause Re: Preliminary injunction. This matter was very well briefed by all parties. The parties may address any issues raised by the court during oral arguments.

Rulings on timely objections to evidence have been made on the forms provided and are located in the court’s file.

Plaintiff/petitioner filed its application on an ex parte basis on February 16, 2016. The application was before the court on February 17, 2016, at which time the court ordered the matter continued in order for further briefing to be filed and considered.

To accommodate a suitable briefing schedule the hearing on plaintiff/petitioner’s Application for Issuance of Temporary Restraining Order and Order to Show Cause Re: Preliminary Injunction was continued by the court to March 17, 2016. The matter appears to have been fully briefed.

Defendant/respondent Tulare Local Healthcare District (“District”) is a statutorily authorized local agency which through its Board of Directors operates the Tulare Regional Medical Center (“Hospital”) in Tulare, California. The District owns, operates and supports the Hospital and its assets. Board members of the District are elected by the residents of the hospital district. The District has contracted with defendant/respondent Healthcare Conglomerate Associates, LLC (“HCA”) to provide administration services to the Hospital.

Prior to January 26, 2016 plaintiff/petitioner Tulare Regional Medical Center Medical Staff (“Medical Staff”), an unincorporated association, was an organization of approximately 130 physicians and surgeons with practice privileges at the Hospital. The Medical Staff was led by a Medical Executive Committee (“MEC”) comprised of elected physician leaders.

On January 26, 2016, the District, by and through its Board of Directors,  announced that it was withdrawing its recognition of the existing Medical Staff and MEC and was recognizing a new medical staff entitled the Professional Medical Staff of Tulare Regional Medical Center (“Professional Medical Staff”).

The Professional Medical Staff immediately adopted amendments to the medical staff bylaws and structured a new MEC. The District advised the then existing Medical Staff and MEC of its action by letter dated January 27, 2016. The within Verified Petition for Writ of Mandate and Complaint and associated Application for Injunction soon followed.

This matter before the court is flush with disputed facts, accusations and inconsistencies. What is apparent, however, is that the relationship between the District directors and Medical Staff prior to January 26, 2016 was dysfunctional, sometimes toxic and potentially harmful to the patients that were in the care of both the Hospital and tending physicians alike.

The parties appear to concede that there were chronic problems in their professional relationship, including, but not limited to, the issues raised in the CMS survey, peer review, privileges, infection control, maintaining quality patient care, deteriorated working relationship with the prior MEC, issues raised in the CDPH survey, software systems, credentialing, ER management, construction delays, staffing and the application of financial resources.

Exhaustive measures have been taken by each party to place blame for each of the referenced items on other parties.  The parties also appear to concede that the existence of these chronic problems were detrimental to the operations and ultimate success of the Hospital.

The unfortunate result of the dysfunction between the District directors, Hospital, HCA and the prior Medical Staff is that the ultimate survival of the Hospital has been placed at risk and patient care may suffer.

It is well settled law that the general purpose of the preliminary injunction is to preserve the status quo of the parties pending a determination of the case on its merits. In deciding whether to issue a preliminary injunction, the trial court must evaluate the likelihood the moving party will ultimately prevail on the merits and must balance the harm presented for each party.

As to the second factor, and as related to this case, the court must examine all of the material before it in order to consider whether a greater injury will result to the defendant from granting the injunction than to the plaintiff from refusing it.

In ruling on plaintiff/petitioner’s request for temporary restraining order and preliminary injunction the court has considered all filed pleadings, declarations (and objections thereto) and law provided, including the Amicus Curiae brief filed by the California Medical Association.

For purposes of this ex parte application, the plaintiff/petitioner has failed to meet its burden that it will suffer irreparable harm if its present prayer for relief is not granted. Plaintiff/petitioner assertions that it will suffer irreparable injury due to reduced staff privileges, loss of voting power and ability to hold management positions, and all related claims of deprivation of rights are not supported by the moving papers.

There has been insufficient evidence provided that physician privileges have been affected, that the medical staff is not fully operational, that the financial health of the hospital has been negatively affected or that patient health and safety has in any way been sacrificed.

The evidence further supports the defendant’s argument that the Professional Medical Staff, although only for a limited time, has been fully functioning and has been actively addressing the dire issues facing the hospital.

Plaintiff/petitioner has not shown a sufficient likelihood of success on the merits based on the evidence presented at this stage of the litigation. The court finds the factual and legal arguments as provided by defendant/respondent in its points and authorities are persuasive related to the plaintiff/petitioner’s likelihood of success on the merits in this matter.

The evidence provided by each party clearly indicates a high level of dysfunction in the relationship between the District, the Hospital, HCA and the Medical Staff that led to the crisis facing the Board of Directors in January 2016. It also appears that the parties unsuccessfully attempted to resolve issues including those raised in the CMS survey, peer review, privileges, infection control, maintaining quality patient care, a deteriorated working relationship with the prior MEC, issues raised in the CDPH survey, software systems, credentialing, ER management, construction delays, staffing and the application of financial resources.

The parties’ inability to resolve these issues over an extended period of time appears to have had a severely detrimental effect on Hospital operations and may place the health and safety of the Hospital’s patients at risk.

Under the appropriate standard of judicial review, this court is not prepared to substitute its judgment for that of the Board of Directors and does not find at this stage that the Board of Directors acted in a manner that was substantially irrational, unlawful, contrary to establish public policy, or procedurally unfair. The governing board of the hospital has ultimate responsibility for the quality of patient care delivery.

For the reasons stated in defendant/respondent’s points and authorities related to the Brown Act and for retaliation pursuant to Health & Safety Code section 1278.5, the court likewise finds that at this stage of the litigation the plaintiff/petitioner has not provided sufficient evidence that it is reasonably likely to prevail on the merits based on these causes of action.

The implementation of the Professional Medical Staff and its MEC was the status quo at the time this matter was presented for ex parte relief and injunction. It appears from the evidence provided that the Professional Medical Staff and its officers are meeting the needs of the hospital and appropriately addressing patient care issues.

The placement of the Professional Medical Staff also appears to have eliminated conflict and the ongoing “war” by and between the Board of Directors, Hospital, HCA and prior Medical Staff. The court is not prepared to upset the current status quo by affirmatively requiring the District Board to reinstate the prior Medical Staff.

The court has carefully reviewed all Points and Authorities, declarations, and briefs filed by all parties, including the Amicus Curiae brief filed by the California Medical Association. The plaintiff/petitioner and California Medical Association have raised important issues related to the events and circumstances leading to the January 26, 2016 Board of Directors meeting and the resulting removal and replacement of the previous Medical Staff.

After careful consideration, however, the issues raised are not sufficiently supported by the evidence presented to grant the requested relief.

This matter is scheduled for oral argument.  No further notice or request for oral argument is required.

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