AINSWORTH, Circuit Judge:
Appellants, two Negro physicians, residing in the City of Mobile, Alabama, instituted this suit as a class action against defendants Mobile County General Hospital Board, its officers and members, to enjoin the denial of admission
The Hospital staff is composed of practicing physicians in Mobile County, Alabama. Staff membership may be temporary or regular. Temporary privileges, although not conditioned upon membership in the Mobile County Medical Society, are automatically revoked upon failure of the physician to apply for staff membership within six months. The regular staff consists of the courtesy
Staff membership by a physician is a requirement for admission and treatment of patients in the Hospital. Any patient of appellants (or any other non-staff physician) who requires hospital treatment and who is able to pay for services must be cared for by a staff physician who is remunerated by the patient. Use by a physician of the Hospital's facilities is also contingent upon his being a member of the staff. The Hospital is the only public hospital in the County and the largest in the area. Among other services it provides facilities and treatment for most of the charity patients in the County and operates on a 24-hour schedule for emergencies.
Thus appellants, by reason of their being denied staff membership, are restricted in their medical practice. Unless the care of appellants' patients is transferred to other physicians who have staff membership, the patients are denied the use of the Hospital's modern electronic and mechanical equipment and emergency lifesaving devices and materials readily available in this Hospital which operates on a large scale and has access to substantial public funds. Appellants' rights to adequate financial remuneration for the care of their patients in the Hospital, rights to which they are entitled by virtue of their training and experience, are also severely curtailed. The physician and patient must forego the doctor-patient relationship so important to both of them.
In Wyatt v. Tahoe Forest Hospital District, 174 Cal.App.2d 709, 345 P.2d 93, 97 (1959), a California appellate court, recognizing the importance of a physician's right to practice medicine in a hospital, said:
Appellants are unquestionably qualified to follow their profession. They are graduates of Meharry Medical School, Nashville, Tennessee. Both are members of the Gulf Coast Medical Society, the Alabama Medical Society, and the National Medical Association. Dr. Maynard V. Foster, is licensed to practice in Alabama, Kentucky, and Michigan. He completed his internship at Hurley Hospital, Flint, Michigan, where he was the top student in his class which consisted of eleven interns. He treats an estimated seventy-five to a hundred patients a day. Dr. LeBaron A. Foster interned at St. Joseph Mercy Hospital, Pontiac, Michigan, and is temporarily serving as a Captain in the U. S. Army Medical Corps in Augusta, Georgia. He is licensed to practice medicine in Alabama and Georgia. The record does not indicate that admission of appellants to the Hospital staff was denied because of lack of professional qualifications. The only basis for denial evident from the record is the failure of the applicants to meet the two requirements — membership in the Mobile County Medical Society (which necessitates endorsements from four Society members) and endorsement of their applications by two Hospital staff physicians.
The District Court, after trial on the merits without a jury, found that there was no evidence of racial discrimination, that the admission requirements were reasonable, and denied injunctive relief. While we agree that the evidence does not support a finding of discrimination based on race, this determination alone does not preclude appellants from prevailing if there are other grounds alleged which would entitle them to the relief they seek. The question, therefore, which we must decide is whether the requirements of the "By-Laws, Rules and
It is not disputed by appellees that the Mobile County Hospital Board, which was created by Act No. 46 of the Alabama Legislature, and which receives both state and federal funds, is a public institution. Its acts, therefore, are state acts subject to the provisions of the Fourteenth Amendment. Ex parte Commonwealth of Virginia, 100 U.S. 313, 25 L.Ed. 667 (1880); Cooper v. Aaron, 358 U.S. 1, 78 S.Ct. 1401, 3 L.Ed.2d 5, 19 (1958); Robinson v. State of Florida, 378 U.S. 153, 84 S.Ct. 1693, 12 L.Ed.2d 771 (1964).
That such state action demands equal treatment of members of the same class (i. e. physicians) is a fundamental requisite of equal protection rights. Any distinction between such members must be on a reasonable basis. Carrington v. Rash, 380 U.S. 89, 85 S.Ct. 775, 13 L.Ed. 2d 675 (1965). Moreover the distinctions which are drawn must in some way relate to the purpose of the classification made. Baxstrom v. Herold, 383 U.S. 107, 86 S.Ct. 760, 15 L.Ed.2d 620 (1966); Rinaldi v. Yaeger, 384 U.S. 305, 86 S.Ct. 1497, 16 L.Ed.2d 577 (1966); McLaughlin v. State of Florida, 379 U.S. 184, 85 S.Ct. 283, 13 L.Ed.2d 222 (1964); Morey v. Doud, 354 U.S. 457, 77 S.Ct. 1344, 1 L.Ed. 2d 1485 (1957).
The bylaws of the Hospital medical staff which require membership in the Mobile Medical Society thus discriminate between members and nonmembers of the Society, all of whom are members of the same profession, thereby denying the nonmembership class the equal protection demanded by the Constitution. The distinctions drawn between members and nonmembers of the Mobile County Medical Society are not related to the express purpose for the formation of the medical staff, stated in the staff's bylaws to be, "To insure that all patients admitted to the hospital or treated in the outpatient department receive the best possible care." Nor do such distinctions rest on any reasonable basis, such as the professional and ethical qualifications of the physicians or the common good of the public and the Hospital, which may be constitutionally applied in determining the class of people who are eligible to practice medicine in a public hospital. Undoubtedly reasonable conditions may be imposed by the Hospital, but we do not view the requirements of the endorsement by two staff members as having satisfied that standard, as the necessary endorsements may be arbitrarily and discriminatorily withheld. The staff bylaws provide for no appeal or review procedure to an applicant who has been unable to secure the requisite endorsements; they provide for no right to be heard in order that the applicants might present their qualifications or the right to be informed on what basis they are excluded. Cf. Wyatt v. Tahoe Forest Hospital District, supra; Sussman v. Overlook Hospital Ass'n, 95 N.J.Super. 418, 231 A.2d 389 (1967).
In Ware v. Benedikt, 225 Ark. 185, 280 S.W.2d 234 (1955), the Arkansas Supreme Court struck down as invalid a public hospital bylaw which conditioned admission to practice in the hospital upon approval and recommendation of a county medical society. The Indiana Supreme Court reached the same result in similar factual circumstances in Hamilton County Hospital v. Andrews, 227 Ind. 217, 84 N.E.2d 469, 85 N.E.2d 365 (1949).
We, therefore, remand this case to the District Court for the entry of a judgment permanently enjoining the defendants from limiting admission to the medical staff of the Hospital on the basis of the articles of the bylaws requiring membership by appellants in the Medical Society of Mobile County and further requiring that each application of appellants be signed by at least two members of the active medical staff, and for such other relief consistent with this opinion.
Reversed and remanded.
42 U.S.C. § 1983 provides that "Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State or Territory, subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress."
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"Article III, Section 3, Subsection 3a — Temporary Hospital Privileges — * * * each application must be signed by at least two members of the Active Medical Staff who are acquainted with the applicant, attesting that he has such character and general fitness as justifies his being granted hospital privileges."
Both letters denying admission to the medical staff are dated December 8, 1965, and are signed by the Administrator of Mobile General Hospital.
The letter to Dr. M. V. Foster reads:
"In reply to your letter of December 2, after due consultation with members of the Executive Committee of the Medical Staff and with members of the Hospital Board, I am returning your application for completion.
"Article III, Section 1, of the Staff Constitution states:
"Article III, Section 3, Subsection 3a states:
"Your application is therefore returned for fulfillment of these two constitutional requirements. If you wish to re-submit it upon completion, it will be reconsidered."
The letter to Dr. LeBaron A. Foster is substantially identical and based on the same reasons.