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
- Whether a self-employed physician with hospital staff privileges qualifies as an “employee” of the hospital for Title VII purposes.
- Whether Title VII permits a discrimination claim based on revocation of staff privileges absent proof of an employment relationship with the hospital (or patients).
- 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.