## Facts

- Dr. David M. Sokol, a cardiac surgeon on the medical staff of a private hospital, faced concerns about allegedly excessive mortality rates for his coronary artery bypass graft (CABG) patients.
- The hospital’s Medical Council formed a CABG Surgery Quality Task Force and retained an external reviewer, Dr. Michael Pine, to perform risk-adjusted statistical analysis.
- Pine reported Sokol’s CABG mortality rate as 12.09% versus a predicted rate of 3.65% and recommended immediate action.
- Under the hospital’s medical staff bylaws, the matter was referred for internal review; an ad hoc investigatory committee concluded Sokol inadequately screened high-risk patients and failed to take adequate precautions to prevent perioperative myocardial infarctions.
- The investigatory committee recommended measures limiting Sokol’s CABG privileges; the Medical Council approved and implemented those recommendations.
- Sokol obtained a peer review hearing; the Hearing Committee recommended reinstating all CABG privileges, but the Medical Council rejected that recommendation and reaffirmed restrictions.
- Sokol pursued internal appeal to the Executive Committee, which affirmed the Medical Council’s decision and forwarded its recommendation to the Board of Trustees.
- Sokol sued in federal court asserting federal antitrust and state-law claims and sought injunctive relief to stop (1) restrictions on his privileges and (2) reporting of the decision to agencies or other entities.
- A magistrate judge issued a permanent injunction for Sokol, finding inadequate notice and that reliance on the mortality data made the decision arbitrary; the hospital took an interlocutory appeal limited to the injunction.

## Issues

1. Under Ohio law, what level of judicial review applies to a private hospital’s decision to restrict a physician’s staff privileges?
2. Whether the hospital’s privileging decision was arbitrary, capricious, or unreasonable (or otherwise procedurally unfair) such that permanent injunctive relief was proper.
3. Whether the hospital substantially complied with its bylaws and provided sufficient notice and opportunity to be heard before imposing restrictions and reporting the action.

## Decision

- The Sixth Circuit reversed the permanent injunction.
- The court held that Ohio law affords private hospitals broad discretion over staff privileges, subject to limited review for procedural fairness and decisions that are not arbitrary, capricious, or unreasonable.
- The court found substantial evidence supporting the hospital’s patient-care concerns, including Pine’s risk-adjusted mortality analysis and the investigatory committee’s findings.
- The court concluded the hospital provided adequate process: Sokol received notice of concerns, participated in meetings, received a hearing, and obtained internal appellate review.
- The court rejected the view that disagreement among internal bodies (the Hearing Committee versus the Medical Council and later committees) rendered the final decision arbitrary.

## Legal Principles

- A private hospital’s governing body has broad discretion to grant, restrict, or revoke staff privileges.
- Judicial intervention is limited; courts may act only when a hospital decision is arbitrary, capricious, unreasonable, taken in bad faith, discriminatory, or reached through material noncompliance with bylaws or basic procedural fairness.
- A hospital does not abuse its discretion when its privileging decision is supported by evidence and reached through a fair process, even if internal reviewers disagree on the best outcome.
- Courts generally will not substitute their judgment for medical peer-review bodies on clinical performance questions when the hospital’s process is fair and the decision is evidence-based.

## Conclusion

The Sixth Circuit held that the hospital’s restriction of Sokol’s surgical privileges was supported by evidence and reached through adequate procedures, so it was not arbitrary under Ohio law and could not be enjoined.


Sokol v. Akron Gen. Med. Ctr., 173 F.3d 1026 (6th Cir. 1999)