Curtis W. Caine, Jr., M.D. v. Hardy, M.D., Woodie L. Mason

EDITH H. JONES, Circuit Judge,

dissenting:

With all due respect to my colleagues, I strenuously disagree with their conclusion that Zinermon v. Burch, — U.S. -, 110 S.Ct. 975, 108 L.Ed.2d 100 (1990), “controls” this case. Depending on our interpretation of Dr. Caine’s procedural due process allegations, Zinermon is either irrelevant or distinguishable. These terse conclusions require elaboration, because Zin-ermon undoubtedly complicated an already overloaded procedural due process jurisprudence.

The majority accept Dr. Caine’s unblushing claim that his initial suspension was “motivated by appellees’ personal vendetta against him” and not by the hospital’s interest in promoting patient safety. Dr. Caine’s 50-page complaint nowhere denies that he was in fact suspended under a hospital regulation which authorizes summary suspension when a practitioner’s conduct “requires that immediate action be taken to protect the life of any patient(s) or to reduce the substantial likelihood of immediate injury or damages to ... any patient ...” Article VI § 2a, Hines General Hospital Medical Staff By-Laws Rules and Regulations (1987).1 Among the voluminous documents attached to his complaint is a letter from the hospital invoking Article VI § 2a to support its initial suspension of his medical privileges. I cannot think that we are bound by Rule 12(b)(6) to defer to the plaintiff’s characterization of his *864claim even though it is contradicted by a “true and correct copy” of one of his allegedly supporting documents. But whether or not we assume that Dr. Caine was summarily suspended, I contend that he received all the process that was constitutionally due and has not stated a claim for relief.

I.

In the event that Dr. Caine was summarily suspended “to protect the life of patients or prevent imminent danger to patients”, he was not constitutionally entitled to a predeprivation hearing. Both the Supreme Court and this court have long struck the procedural due process balance so as to dispense with a requirement for pre-depri-vation remedies when there is a need for immediate state action. Parratt v. Taylor, 451 U.S. 527, 538-39 101 S.Ct. 1908, 1914, 68 L.Ed.2d 420 (1981) overruled in part Daniels v. Williams, 474 U.S. 327, 106 S.Ct. 662, 88 L.Ed.2d 662 (1986); Darlak v. Bobear, 814 F.2d 1055 (5th Cir.1987). In such circumstances, “the Court has held that a statutory provision for a post-deprivation hearing, or a common-law tort remedy for erroneous deprivation, satisfies due process.” Zinermon, — U.S. at -, 110 S.Ct. at 984. The majority apparently would agree that this rule forecloses a procedural due process claim by Dr. Caine if (a) he was suspended pursuant to Article VI § 2a and (b) he was furnished a post-deprivation hearing.

The allegations in Dr. Caine’s complaint and the records attached to it fulfill both of these conditions, demonstrating that he received both pre- and post-deprivation procedural protections. Dr. Caine’s summary suspension was preceded by two conferences with fellow anesthesiologists from the hospital who had been asked to conduct the investigation into his handling of a particular anesthesia case. After Dr. Caine objected to being caught unaware by the allegedly inquisitorial tone of the first meeting, he asked for and participated in a second conference five days later.

Although Article VII of the hospital bylaws provided a right to a formal post-suspension hearing within seven days after summary action, Dr. Caine’s complaint and exhibits demonstrate that he secured immediate legal advice, sought additional informal meetings with the hospital investigating committees, which were granted, and requested several continuances of the formal hearing. In the end, he declined to go through with the formal evidentiary hearing and did not avail himself of Mississippi’s judicial review of the suspension. Miss.Code Ann. § 73-25-27. These facts place his case on all fours with Darlak, 814 F.2d at 1055, in which we rejected a physician's due process challenge to summary suspension followed by a more severe suspension. As in Darlak, Dr. Caine had the chance to defend himself informally before being summarily suspended. 814 F.2d at 1062-63. As in Darlak, Dr. Caine could have, but did not, invoke a formal due process hearing just after summary suspension. Thus, assuming that Dr. Caine was summarily suspended and relying on the facts pleaded and documents attached to his complaint, it is plain that Darlak forecloses any procedural due process claim. It is also plain that Zinermon has no application to a due process claim founded on a summary suspension of medical privileges.

II.

Even if we assume that Dr. Caine’s termination constituted an abuse of the summary suspension procedure or arose from a non-summary action, I cannot agree that he has stated a claim by the conclusory assertion that he was “denied procedural due process.” The documents attached to his complaint prove instead that the hospital provided detailed procedures to protect the rights of a physician under investigation and that both parties, assisted by counsel, referred to these procedures at every turn during the six-month period between the first complaint about Dr. Caine and the board of trustees’ final decision on suspension. Neither on the facts nor on the law is this case at all similar to Zinermon, nor does it warrant the majority’s broad suggestion that Zinermon has significantly changed our circuit’s due process jurisprudence.

I continue to agree with the trial court that according to the Parratt/Hudson doc*865trine, Dr. Caine stated no procedural due process claim because he had an adequate post-termination remedy by way of hospital procedures as well as a state lawsuit for review of the hospital’s suspension order. Miss.Code Ann. § 73-26-27. According to the majority, Zinermon has changed this rule. I agree that Zinermon adds a wrinkle to our current analysis of due process violations, but the import of that case must be judged from its unique facts.

Zinermon undertook to determine whether a due process violation was alleged by a man whose “voluntary commitment” to a Florida mental institution was actually involuntary because he was plainly incompetent at the time he signed the necessary papers. He alleged that the hospital officials knew or should have known of his condition and should have utilized the procedurally safeguarded involuntary commitment process. The Eleventh Circuit split over several issues, including whether a state tort suit for false imprisonment afforded an adequate post-deprivation remedy, i.e., all the process that was due under the Parratt/Hudson doctrine.

The Supreme Court started with the proposition that ordinarily the state may not take a person’s life or liberty until after it has provided due process of law. U.S. Constitution Article XIV.2 The nature of the process that is due before a deprivation varies with the circumstances. Matthews v. Eldridge, 424 U.S. 319, 335, 96 S.Ct. 893, 903, 47 L.Ed.2d 18 (1976).3 If, however, a deprivation occurs in a way that the state could not have been expected to anticipate, for instance, because a state actor took property to which he was not entitled, the only process constitutionally required is an adequate post-deprivation remedy. Parratt, 451 U.S. at 543-44, 101 S.Ct. at 1916-17; Hudson v. Palmer, 468 U.S. 517, 104 S.Ct. 3194, 82 L.Ed.2d 393 (1984). The Court in Zinermon portrayed Parratt/Hudson as a “special case of the general Matthews v. Eldridge analysis, in which post-deprivation remedies are all the process that is due, simply because they are the only remedies the state could be expected to provide.” Zinermon, 110 S.Ct. at 985.4

Zinermon analyzed the state officials’ conduct in admitting Burch to the mental hospital and concluded that Parratt/Hud-son did not vindicate the adequacy of a post-deprivation remedy because the voluntary commitment procedure presented both a high risk of erroneous deprivation of a mentally ill person’s liberty, and the substantial likelihood that minimal further procedural safeguards could readily have avoided the deprivation. Zinermon requires a hard look at a Parratt/Hudson claim to determine whether the state official’s conduct, under all the circumstances of the deprivation, could have been adequately foreseen and addressed by procedural safeguards. If it could, then the case requires classic Matthews balancing and has stated a claim for relief. Zinermon did not, however, explicitly or implicitly disavow the Parratt/Hudson doctrine, nor did it portend that any alleged violation of procedural due process undertaken within the scope of an established and articulated state regulatory framework automatically falls outside the purview of Parratt/Hud-son. Zinermon employs and hence requires case-by-case analysis of the deprivation at issue. See Zinermon, O’Connor, dissenting, — U.S. -, 110 S.Ct. at 995.

The majority and I do not differ in the general conclusion that Zinermon has re*866stricted Parratt/Hudson to cases in which “it truly is impossible to provide pre-depri-vation safeguards.” I disagree strongly, however, that Zinermon breathes life into Dr. Caine's complaint. Referring to the three reasons why the Zinermon court distinguished Parratt/Hudson, 110 S.Ct. at 989-90, the majority first says that “the state could have provided Dr. Caine with full procedural due process before finally removing his hospital privileges.”5 They next suggest that this deprivation was “foreseeable.” Third, they find that the state actors’ conduct, as in Zinermon, was not “unauthorized,” because hospital personnel were “delegated power by the state to deprive actors such as Caine of the staff privileges.” This third conclusion seems tantamount to suggesting that any error committed during a state due process scheme cannot be random and unauthorized because state actors were “authorized” to effectuate the scheme. All of these analogies to Zinermon are too broad.

First, I see no way in which the state could have articulated more explicit procedural safeguards to protect Dr. Caine against the specific risk that his privileges would be suspended because of his peers’ anti-competitive motives. See Zinermon, 110 S.Ct. at 987-88. The hospital regulations state when, how and for what reasons doctors may be disciplined. They permit immediate suspension only to protect the safety of patients and then only after an investigation. Alternately, they provide for a formal investigation and informal hearings, followed by a full evidentiary hearing and possible appeal to the hospital board of trustees. A final resort may be had to prompt state judicial review.6

In Zinermon, the state’s provision for voluntary commitment without procedural protections was explicit and the risk of erroneous application of that procedure undoubtedly high, because it operated against people who already lacked their full faculties. Thus, the Court’s conclusion that Mr. Burch was subjected to a serious risk of deprivation of his liberty is hardly surprising. In Florida, “[t]he staff are the only persons in a position to take notice of any misuse of the voluntary admissions process, and to insure that the proper procedure is followed.” Zinermon, 110 S.Ct. at 988. Dr. Caine clearly is not “victimized” by the panoply of procedural rights created by the hospital regulations. He never alleges that those regulations are infirm. Rather, he alleges that the regulations were violated, purportedly at every stage, by the dozen or so state actors responsible for enforcing them. The violations occurred even though attorneys represented both sides. Zinermon characterizes the risk facing the patient as one of an erroneous deprivation made possible by Florida’s voluntary commitment procedures. The risk to Dr. Caine, however, sprang only from wanton and intentional alleged violations of inarguably controlling state regulations.

The means of deprivation in Zinermon cannot be untied from the Court’s analysis that a more complete state regulatory scheme could have prevented the deprivation. Thus, the addition to the scheme of a simple certification by one of the admitting officers that the patient was competent to commit himself would seem adequate to cure the problem. Zinermon, 110 S.Ct. at 988. The majority engage here in no such analysis, nor can they. There is no deficit in the hospital’s procedural regulations. As previously stated, the doctor challenges solely the bias of his peers and their violation of those regulations. These allegations naturally disprove the majority’s third Zinermon based conclusion that the “state actors’ actions in the present case were not unauthorized.” (emphasis added). Of course they were! Investigatory and judicial bias in implementing the regulations is always unauthorized, if they are not alleged to flow from the regulations themselves. Holloway v. Walker, 784 F.2d 1287, 1292-93 (5th Cir.1986). Nearly every paragraph of Dr. Caine’s 50-page complaint concludes with the assertion that the *867hospital actors’ conduct violated a particular provision of the regulations. The majority have already assumed away the only reason authorized by the regulations for immediate suspension of hospital privileges, i.e., to protect the safety of patients. Hence it follows that any other action which brought about that result had to be unauthorized by the regulations. In Zin-ermon, by contrast, the voluntary admission of the patient may have been an abuse of judgment by the staff authorized to admit him, but their exercise of judgment was specifically condoned by the regulations. “Florida’s [statutory scheme] ... gives state officials broad power and little guidance in admitting mental patients.” Zinermon, 110 S.Ct. at 988. Such is emphatically not the case under the conditions assumed by the majority.

The factors which distinguish Zinermon from Parratt/Hudson do not pertain to this case. Moreover, there were adequate and prompt post-deprivation remedies available to Dr. Caine including a formal hearing, appeal to the board of trustees, and state judicial review.7 Therefore, according to Parratt/Hudson, Dr. Caine was not deprived of procedural due process.

The majority have erred. I respectfully dissent.

. The entire record in the trial court was sealed by agreed order. It should not breach the parties’ desire for confidentiality, however, to reveal that the charges against Df. Caine were of a most serious nature.

. The well-recognized exception to the requirement of a pre-deprivation remedy is that of public safety regulation described in part I above. Zinermon, — U.S. -, 110 S.Ct. at 978, 108 L.Ed.2d 100 (1990).

. Matthews specifies that three factors must be weighed in determining the procedural protections the Constitution requires in a particular case: the private interest that will be affected by the official action; the risk of an erroneous deprivation of the interest through the procedures used, and the probable value of additional procedural safeguards; and the government’s interest, including the function involved and the burdens that additional procedural requirements would entail. Id.

.Also, “Parratt is not an exception to the Matthews balancing test, but rather an application of that test to the unusual case in which one of the variables in the Matthews equation — the value of pre-deprivation safeguards — is negligible in preventing the kind of deprivation at issue.” Zinermon, 110 S.Ct. at 985.

. For the sake of argument only, I shall assume with the majority that Dr. Caine was not sanctioned pursuant to Article VI § 2(a) of the hospital regulations for the safety of patients.

. The majority’s swipe at the "adequacy" of this Mississippi state review is gratuitous, but because it is mere dicta, I shall not discuss it further.

. He never used these remedies. As we stated in Myrick v. City of Dallas, 810 F.2d 1382, 1388 (5th Cir.1987), a party may not refuse to invoke the process to which she is entitled and then claim a denial of constitutional procedural due process.