DARLAK v. BOBEAR

RANDALL, Circuit Judge:

Joseph Darlak appeals the district court's grant of the defendants' motions for summary judgment, for dismissal for failure to state a claim upon which relief could be granted, and for dismissal for lack of subject-matter jurisdiction. We affirm.

I. Factual Background

Joseph Darlak, M.D., was an associate professor of radiology at the Louisiana State Medical School and a member of the visiting staff at Charity Hospital of Louisiana at New Orleans ("Charity"). Charity Hospital is a part of the Louisiana Department of Health and Human Resources ("DHHR"). See La.Rev.Stat.Ann. § 36:251(c) (West 1985).

On December 7, 1984, Dr. Darlak performed a CT-guided biopsy procedure on Abraham Brown, a patient at Charity. The patient's primary care physicians were Drs. Juan Lastra and Mary Moore Abel, two resident physicians at Charity. On December 11, 1984, Drs. H. William Barkman and Barbara Hanna, two assistant professors of medicine at Tulane Medical Center, wrote a letter to Dr. John Bobear, the medical director of Charity, stating that Dr. Darlak performed the biopsy procedure without verbal or written confirmation and against the wishes of the primary care team and failed to provide adequate guidance and follow-up instructions for the patient's care.1 On December 17, 1984, Dr. Bobear contacted the primary care physicians, who corroborated the allegations of Dr. Barkman and Dr. Hanna.

On December 18, 1984, Dr. Bobear and Dr. George Meckstroth, the director of professional support services at Charity, met with Dr. Darlak to discuss the allegations contained in the letter of December 17. Based upon this meeting, Dr. Bobear, by letter of December 18, 1984, temporarily suspended Dr. Darlak from hospital privileges at Charity, pending the outcome of a full investigation and a hearing before Charity's Credentials Committee. Dr. Bobear relied upon hospital regulations for the authority to temporarily suspend Dr. Darlak.2

The Credentials Committee met on January 8, 1985. Evidence was taken at this hearing, and Dr. Darlak was permitted to make a statement. After considering the evidence and the statement of Dr. Darlak, the Committee recommended that Dr. Darlak's privileges at Charity be suspended for two months, effective December 18, 1984, the date that Dr. Darlak was temporarily suspended. The Committee's recommendations were adopted and, by a letter signed by Elliot C. Roberts, the director of Charity, and dated January 10, 1985, Dr. Darlak was suspended from the medical staff at Charity for a period of two months. On January 28, 1985, Dr. Darlak was informed of his right to appeal the suspension decision. On the same date, Dr. Darlak indicated by letter his intent to appeal, and a hearing was scheduled for February 21, 1985. Settlement negotiations ensued, and the appeal date was continued. When no agreement could be reached, Dr. Darlak was notified on October 2, 1985, that appeal proceedings should be reinstated. Dr. Darlak did not seek further appeal.

Instead, Dr. Darlak filed this action on December 5, 1985, under 42 U.S.C. § 1983, claiming that the defendants, under color of state law, had violated his right to procedural and substantive due process of law and to the equal protection of the laws. Dr. Darlak also alleged pendent state law claims sounding in negligence and unfair trade practices. Dr. Darlak sought actual damages of $500,000, punitive damages of $2 million, and an injunction forcing the defendants to void his suspension. Dr. Darlak named the following persons and entities as defendants: (1) DHHR; (2) Charity; (3) Dr. Bobear, the medical director of Charity; (4) Dr. Sandra L. Robinson, the Secretary of DHHR; (5) Elliot Roberts, Jr., the director of Charity; (6) Dr. Barkman; and (7) Dr. Hanna. The individual defendants were sued in both their individual and official capacities.

On January 17, 1986, DHHR, Charity, Dr. Robinson, and Elliot Roberts moved to dismiss Dr. Darlak's complaint for lack of subject-matter jurisdiction under Federal Rule of Civil Procedure 12(b)(2) as to DHHR, Charity, and Robinson and Roberts in their official capacities, and for failure to state a claim upon which relief can be granted under Federal Rule of Civil Procedure 12(b)(6) as to Robinson and Roberts in their individual capacities. On February 10, 1986, Drs. Bobear and Barkman moved for summary judgment under Federal Rule of Civil Procedure 56, claiming that there were no disputed facts and that as a matter of law Dr. Darlak had received all the process that was due him.

On March 11, 1986, the district court granted these motions. The district court held that the eleventh amendment barred suit against DHHR and Charity. The district court noted that a suit alleging the unconstitutionality of a state official's conduct is not barred by the eleventh amendment, but held that since neither Roberts nor Robinson acted unconstitutionally, the eleventh amendment precluded suit against them. The district court did not discuss its reasons for granting summary judgment in favor of Drs. Bobear and Barkman, but since the district court found no violation of Dr. Darlak's due process rights, the district court probably concluded that these defendants were entitled to judgment as a matter of law. Finally, the district court held that there was no duty on the part of the Credentials Committee to interview Dr. Sarcar, and that the suspension of Dr. Darlak's staff privileges was not an unfair trade practice under Louisiana law. Hence, the only remaining defendant was Dr. Hanna.

On April 11, 1986, Dr. Hanna moved to dismiss under Federal Rule of Civil Procedure 12(b)(6). The district court, treating Dr. Hanna's motion as one for summary judgment, granted the motion, stating that the motion was being granted for the same reason that Dr. Barkman's motion was granted. In the same minute entry, the district court dismissed without prejudice Dr. Darlak's pendent state law negligence claims against all of the defendants. On May 28, 1986, the district court entered judgment in favor of all defendants and dismissed Dr. Darlak's complaint. On June 3, 1986, Dr. Darlak filed a timely notice of appeal to this court.

On appeal, Dr. Darlak argues that the district court erred in dismissing his complaint on eleventh amendment grounds. He contends that the federal courts have jurisdiction to declare that the hospital regulation that he was initially suspended under is unconstitutional. On appeal, he apparently has given up his claims for damages, and asserts that a federal court can at least grant him prospective injunctive relief forcing the defendants to void his suspension ab initio, despite the bar of the eleventh amendment.

In addressing Dr. Darlak's arguments, we will first consider whether and to what extent the eleventh amendment constitutes a bar to suit against the various defendants. In order to make this determination, we will review the general principles of eleventh amendment constitutional law and will analyze separately the eleventh amendment defenses of the state entities and the state officials. Based upon the above analysis, we will determine which of the defendants the district court properly dismissed on eleventh amendment grounds. After deciding the eleventh amendment issue, we will consider the issue of whether the temporary suspension of Dr. Darlak comported with due process of law. In making this determination, we will consider the United States Supreme Court's latest teaching on this subject: Cleveland Bd. of Educ. v. Loudermill, 470 U.S. 532, 105 S.Ct. 1487, 84 L.Ed.2d 494 (1985). We turn now to our consideration of the eleventh amendment.

II. The Eleventh Amendment — State Entities

The principles of the eleventh amendment3 relevant to this case are well settled:

Voisin's Oyster House, Inc. v. Guidry, 799 F.2d 183, 185-86 (5th Cir.1986). Eleventh amendment analysis differs depending upon whether the defendant is a state entity or a state official. "The Eleventh Amendment bars suits against a state entity, as opposed to a state official, regardless whether money damages or injunctive relief is sought." Id. at 186.

In determining whether a particular entity enjoys eleventh amendment immunity, this court engages in an analysis based upon six factors.

Minton v. St. Bernard Parish School Bd., 803 F.2d 129, 131 (5th Cir.1986) (footnote omitted). Applying these factors to the case sub judice convinces us that DHHR and Charity are alter egos of the state and are therefore entitled to eleventh amendment immunity.

The first factor, whether state statutes and case law characterize the entity as an arm of the state, points toward eleventh amendment immunity for both DHHR and Charity. Louisiana statutory and decisional law characterize DHHR as an arm of the state. See La.Rev.Stat.Ann. § 36:251(A) (West 1985) (creating DHHR as part of the executive department); id. § 36:251(C) (office of Charity Hospital a part of DHHR); Wright v. Moore, 380 So.2d 172, 173 (La.App. 1st Cir.1979) (holding that the state of Louisiana was the real party in interest in a suit against one of its executive departments).

The second factor, the source of funds for the agency, also points to a finding of eleventh amendment immunity for both DHHR and Charity. As executive departments, DHHR and Charity receive their funding from the State of Louisiana. Furthermore, and of critical importance to our eleventh amendment analysis,4 any judgment against either DHHR or Charity would be paid from state funds appropriated for that purpose. See La. Const. art. 12 § 10(C) (no judgment against a state entity is payable except from funds appropriated therefor by the legislature); Pettis v. State, 336 So.2d 521 (La.App. 3d Cir.1976) (state liable for damages in medical malpractice suit against state hospital).

The third factor in our analysis, the degree of local autonomy that the agency enjoys, also points to a finding of immunity on the part of both DHHR and Charity. The Secretary of DHHR is under the control and supervision of the governor, and serves at the pleasure of the governor. La.Rev.Stat.Ann. § 36:253 (West 1985). Charity is under the supervision of an assistant secretary, who is also appointed by the governor with the advice and consent of the state senate, and who serves at the pleasure of the governor. Id. § 36:257. Hence, far from being autonomous entities, DHHR and Charity are under the direct control of the executive branch of state government.

The fourth factor in our analysis, whether the entity in question is concerned with local or statewide problems, points in different directions for DHHR on the one hand, and Charity on the other. DHHR is clearly concerned with statewide health problems. Id. § 36:251. Charity, however, is concerned only with the administration of the hospital, which is one factor against a finding of immunity in its case. See id. § 36:258(F).

The fifth and sixth factors, whether the entity has the right to sue and be sued in its own name and whether the entity has the right to hold property, point toward a finding of no eleventh amendment immunity. DHHR, as well as all other executive departments of Louisiana, has the capacity to sue and be sued in its own name, id. § 36:251(A), and has the authority to hold and use property. See Louisiana Ass'n for Mental Health v. Edwards, 322 So.2d 761, 767 (La.1975) (construing powers of Louisiana Health and Human Resources Administration — the predecessor agency to DHHR). Similarly, Charity Hospital may sue and be sued in state court, and the board of administrators of Charity has broad powers to dispose of property owned by Charity. See La.Rev.Stat.Ann. § 46:759, 46:773-:774 (West 1982). We note, however, that this court has not found these factors to be controlling when the other factors considered above point to a finding of eleventh amendment immunity. See Voisin's Oyster House, 799 F.2d at 187.

With the exception of the final two factors, therefore, our analysis points strongly to a finding of eleventh amendment immunity for DHHR and Charity. Hence, based upon the above analysis, we hold that both DHHR and Charity are the alter egos of the State of Louisiana, and that therefore suit against them, whether for damages or injunctive relief, is barred by the eleventh amendment.5

III. The Eleventh Amendment — State Officials

The analysis of eleventh amendment immunity in the case of state officials differs from that applicable to state entities.6 The Supreme Court has recently summarized the law on this subject. The Court stated:

Pennhurst State School & Hosp. v. Halderman, 465 U.S. 89, 101-03, 104 S.Ct. 900, 908-09, 79 L.Ed.2d 67, 79-80 (1984) (citations and footnotes omitted). In this case, Dr. Darlak has alleged that the defendant state officials acted unconstitutionally in suspending his staff privileges at the hospital without providing him with a due process hearing, and he seeks injunctive relief requiring the officials to rescind his suspension. Hence, that part of this case7 is a suit seeking prospective injunctive relief against state officials who are alleged to have acted unconstitutionally, and therefore the Ex parte Young exception to the eleventh amendment applies and both the district court and this court have jurisdiction to reach the due process issue presented.

IV. Due Process of Law

Turning to the due process issue, we must first determine whether Dr. Darlak had a property right in his staff privileges at Charity before we may decide the issue of whether he was deprived of such a right without due process of law. Cleveland Bd. of Educ. v. Loudermill, 470 U.S. 532, 538, 105 S.Ct. 1487, 1491, 84 L.Ed.2d 494, 501 (1985). It is well-settled in this circuit that a physician's staff privileges may constitute a property interest protected by the due process clause of the fourteenth amendment. See Northeast Georgia Radiological Assoc. v. Tidwell, 670 F.2d 507, 511 (Former 5th Cir. Unit B March 1982) (collecting cases). As this court has stated:

Daly v. Sprague, 675 F.2d 716, 727 (5th Cir.1982) (citations omitted), cert. denied, 460 U.S. 1047, 103 S.Ct. 1448, 75 L.Ed.2d 802 (1983). We think that the Charity regulations providing for a hearing prior to the suspension or termination of staff privileges implies that such privileges will be suspended or terminated only for cause, and that therefore such privileges constitute a property interest protected by the fourteenth amendment.

Having determined that Dr. Darlak's staff privileges at Charity constituted a property right within the meaning of the due process clause of the fourteenth amendment, it is next necessary to determine whether Dr. Darlak received all the process that he was due prior to both the interim suspension of his staff privileges and the suspension of his staff privileges after the hearing before the Credentials Committee. In determining what process was due Dr. Darlak, we again turn to the teaching of the Supreme Court on this issue. Writing in the context of termination of government employment, that Court has stated:

Loudermill, 470 U.S. at 542, 105 S.Ct. at 1493, 84 L.Ed.2d at 503-04 (1985) (citations and footnote omitted) (emphasis in original). In determining the type of hearing required by the due process clause in a given situation, the Supreme Court, in reviewing its prior decisions on the subject, stated:

Mathews v. Eldridge, 424 U.S. 319, 334-35, 96 S.Ct. 893, 902-03, 47 L.Ed.2d 18, 33 (1976) (citations omitted). Applying these principles to the facts of the case sub judice convinces us that Dr. Darlak received all the process that was due, both with respect to the initial suspension of his staff privileges pending a full hearing8 and with respect to the two-month suspension of his staff privileges following the hearing before the Credentials Committee. We analyze each suspension separately.

On the issue of the interim suspension pending investigation by the Credentials Committee, the private interest at stake is relatively minor. Admittedly, a physician would rather not be suspended from staff privileges even temporarily, but the affected physician may continue to practice medicine, albeit not at that hospital, and therefore is not deprived of his livelihood. Furthermore, the temporary suspension allowed by Charity's regulations provides that the time between the temporary suspension and the hearing before the Credentials Committee will be only 30 days. Finally, although the record is barren on this point, it seems obvious that if the hearing before the Credentials Committee results in a finding of no professional misconduct on the part of the suspended physician, the temporary suspension would be rescinded as imposed without cause. The physician's private interest in not being temporarily suspended pending a full hearing, therefore, while certainly not de minimus, is relatively minor when compared to the other interests at stake. Turning to the state interest, it is clear that "[t]he state has a legitimate interest, through continuing supervision, in maintaining the quality of medical care provided within its facilities." Daly v. Sprague, 742 F.2d 896, 899 (5th Cir.1984).

Considering the final factor, the risk of an erroneous deprivation of a physician's staff privileges through the temporary suspension procedures used, and the probable value, if any, of additional or substitute procedural safeguards, we think that the procedures afforded Dr. Darlak served to minimize, as much as possible, the risk of erroneous deprivation. In this case, Dr. Bobear, after receiving the letter from Drs. Barkman and Hanna containing the allegations against Dr. Darlak, spoke to both Drs. Barkman and Hanna concerning the allegations, spoke with Drs. Lastra and Abel, the patient's primary care physicians, and met with Dr. Darlak and another physician to discuss the allegations. Whereas additional procedures would undoubtedly contribute to minimize the possibility of error, we think that the temporary suspension procedures employed in this case were sufficient under the circumstances to insure that there was some basis for the suspension.

Balancing the competing interests in light of the procedures employed convinces us that the requirements of due process were satisfied in the case of Dr. Darlak's initial suspension pending a full investigation. In this case, an expedited investigation of the allegations was undertaken by Dr. Bobear, and Dr. Darlak was given an opportunity at the meeting with Dr. Bobear to explain or deny the allegations. These procedures "provide a meaningful hedge against erroneous action," and are sufficient to satisfy procedural due process. See Goss v. Lopez, 419 U.S. 565, 583, 95 S.Ct. 729, 741, 42 L.Ed.2d 725, 740 (1975).9

Turning to the procedures followed which resulted in the two-month suspension of Dr. Darlak, we believe that his interest in the maintenance of his staff privileges at Charity, which constitutes the first prong of our analysis, increased in importance, since the potential deprivation in this case is for a longer period of time, and could result in permanent suspension of staff privileges and a permanent blemish on his professional record. We note that the state's interest in this case is much the same as in the case of temporary suspensions pending a full hearing — the maintenance of the quality of medical care at state hospitals. However, to counter the increased private interest in this case, additional procedures were employed. A full investigation was conducted by the Credentials Committee. Dr. Darlak was allowed to address the Committee and, although he presented no witnesses and offered no evidence, there is no allegation in the record that he was prevented from doing so.10 Under Charity's regulations, Dr. Darlak was also entitled to appeal the recommendation of the Credentials Committee, which he chose not to do. Based on our weighing of the above factors, we hold that Dr. Darlak received all the due process required by the Constitution.11

V. Disposition Below

In summary, the district court was correct in dismissing DHHR and Charity, the state entities in this case, on eleventh amendment grounds, by granting their motion to dismiss for lack of subject-matter jurisdiction, but this dismissal does not constitute a judgment on the merits. "`A dismissal for want of jurisdiction bars access to federal courts and is res judicata only of the lack of a federal court's power to act. It is otherwise without prejudice to the plaintiff's claims, and the rejected suitor may reassert his claim in any competent court.'" Voisin's Oyster House, Inc., 799 F.2d at 188 (quoting Daigle v. Opelousas Health Care, Inc., 774 F.2d 1344, 1348 (5th Cir.1985)). In its judgment, the district court did not specify that the dismissal as to DHHR and Charity was without prejudice, and did not expressly state that the dismissal was for lack of jurisdiction. However, in its minute entry the court made it clear that the dismissal was on eleventh amendment grounds. We affirm this dismissal, expressly noting that it does not constitute a judgment on the merits.

Similarly, the district court was correct in granting summary judgment in favor of Drs. Bobear and Barkman. Because we hold that under the undisputed facts of this case, Dr. Darlak received all the process that was due him, these defendants were entitled to judgment as a matter of law, and we therefore affirm the district court's grant of summary judgment as to them. See Fed.R.Civ.P. 56(c).

Turning to the district court's disposition of Dr. Darlak's claims against Dr. Hanna, we also affirm. As noted above, the district court treated Dr. Hanna's Federal Rule of Civil Procedure 12(b)(6) motion to dismiss for failure to state a claim upon which relief can be granted as a motion for summary judgment. The district court's authority to do this is provided in Federal Rule of Civil Procedure 12(c), which provides:

Fed.R.Civ.P. 12(c). Turning to Rule 56, the Rule provides that "[t]he motion shall be served at least ten days before the time fixed for the hearing." Fed.R.Civ.P. 56(c). "It is a well established rule in this circuit that a motion to dismiss, under Rule 12(b), when treated as a motion for summary judgment, must also abide by the procedural safeguards of Rule 56." Capital Films Corp. v. Charles Fries Prods., Inc., 628 F.2d 387, 391 n. 1 (5th Cir.1980). However,

Clark v. Tarrant County, 798 F.2d 736, 746 (5th Cir.1986) (citing Dayco Corp. v. Goodyear Tire & Rubber Co., 523 F.2d 389 (6th Cir.1975)). We find Clark to be controlling in the instant case. As the district court noted in its minute entry treating Dr. Hanna's motion as one for summary judgment, both Dr. Darlak and Dr. Hanna adopted by reference the memoranda they filed in support of and in opposition to the summary judgment motions of Drs. Bobear and Barkman. Furthermore, in his opposition to Dr. Hanna's motion to dismiss filed on May 8, 1986, Dr. Darlak adopted by reference affidavits filed with his earlier memorandum in opposition to the summary judgment motion of Drs. Bobear and Barkman. Hence, we hold that on May 8, 1986, the time that Dr. Darlak adopted by reference matters outside the pleadings, Dr. Darlak had ample facts to put him on notice that the district court could properly treat Dr. Hanna's motion to dismiss as one for summary judgment because it had accepted for consideration on the motion matters outside the pleadings. Since the district court did not render judgment before the expiration of ten days after the filing of Dr. Darlak's opposition to Dr. Hanna's motion, we hold that the requirements of Rule 56 were met in this case.

We turn now to the district court's disposition of the claims against the remaining defendants, Dr. Robinson and Elliot Roberts. These defendants moved for dismissal for lack of subject-matter jurisdiction under Rule 12(b)(1) as to suit against them in their official capacities, and for dismissal for failure to state a claim upon which relief can be granted under Rule 12(b)(6) as to suit against them in their individual capacities. As we held above, the district court did not lack subject-matter jurisdiction over the claims against these defendants in their official capacity, because those claims seeking prospective injunctive relief fall within the Ex parte Young exception to the doctrine of eleventh amendment immunity. However, as this opinion makes clear, there was no violation of Dr. Darlak's due process rights, and therefore these defendants have no liability to Dr. Darlak in their official capacity. Hence, we affirm on other grounds the district court's dismissal as to Roberts and Robinson in their official capacities.

The district court also granted the Rule 12(b)(6) motion of these defendants on the claims against them in their individual capacities, stating that "[a]lthough plaintiff sued Roberts and Robinson in their individual and official capacities, the facts do not warrant the imposition of individual liability." In the memorandum in support of their Rule 12(b)(6) motion, Roberts and Robinson argued that there was no allegation in Dr. Darlak's complaint that either of these defendants had any role in the alleged wrongful acts or policies, and we assume that this was the ground upon which the district court granted their motion.

We agree with the district court. Dr. Darlak's complaint fails to allege any acts on the part of these defendants which would impose individual liability. "In the now familiar cases involving 42 U.S.C. § 1983 we consistently require the claimant to state specific facts, not merely conclusory allegations." Elliott v. Perez, 751 F.2d 1472, 1479 (5th Cir.1985) (footnote omitted). Hence, we affirm the district court's dismissal of the claims against Roberts and Robinson in their individual capacities.

VI.

For the above reasons, the judgment of the district court is AFFIRMED.