## Facts

- Dr. Mark F. Alexander, an Egyptian-born Muslim anesthesiologist, held staff privileges at Rush North Shore Medical Center (formerly Skokie Valley Hospital).
- As a condition of privileges, Alexander was required to participate in an emergency room on-call schedule.
- The hospital’s on-call policy required the on-call physician to be reachable, return calls within twenty minutes, remain within forty-five minutes’ travel time, and come to the hospital if requested.
- On February 20, 1988, an emergency physician sought assistance with intubation of a critically injured patient and requested the on-call anesthesiologist.
- The hospital contended Alexander did not timely respond to pages/calls and did not come to the hospital as required; another physician ultimately intubated the patient.
- After peer-review and medical staff proceedings, the hospital revoked Alexander’s staff privileges, citing failure to comply with the on-call policy and availability/quality-of-care concerns.
- Alexander filed administrative charges alleging the revocation was motivated by discrimination based on religion and national origin; he later filed a Title VII action in federal court.
- The district court granted summary judgment for the hospital, holding Alexander was not an “employee” covered by Title VII.
- Alexander appealed, urging application of prior circuit precedent allowing certain staff-privilege claims to proceed under Title VII without a traditional employment relationship.

## Issues

1. Whether a self-employed physician with hospital staff privileges qualifies as an “employee” of the hospital for Title VII purposes.
2. Whether Title VII permits a discrimination claim based on revocation of staff privileges absent proof of an employment relationship with the hospital (or patients).
3. Whether prior circuit precedent allowing such claims should remain controlling in light of later “employee” decisions applying common-law agency principles.

## Decision

- The Seventh Circuit affirmed summary judgment for the hospital.
- The court held Alexander was not an “employee” of Rush North Shore and therefore could not sue under Title VII.
- The court overruled Doe v. St. Joseph’s Hospital of Fort Wayne to the extent it permitted a Title VII action absent proof of an employment relationship.
- Because Alexander failed to satisfy Title VII’s coverage requirement, the court did not reach the merits of the discrimination allegations.

## Legal Principles

- Title VII applies only to plaintiffs who can show an employment relationship with the defendant; “employee” status is determined under common-law agency principles emphasizing the putative employer’s right to control the manner and means of work.
- A physician who maintains an independent practice, is not on the hospital’s payroll, bills patients/insurers directly, and is subject mainly to credentialing and general policies (rather than day-to-day control of medical practice) is typically an independent contractor, not a Title VII employee.
- Hospital staff privileges, standing alone, generally constitute authorization to use hospital facilities and participate in medical staff structures, not an employment relationship.

## Conclusion

The Seventh Circuit held that a self-employed physician’s hospital staff privileges did not make him a Title VII “employee,” affirmed summary judgment for the hospital, and rejected prior circuit authority that had allowed similar Title VII claims without proof of an employment relationship.


Alexander v. Rush N. Shore Med. Ctr., 101 F.3d 487 (7th Cir. 1996)