Medical staff prevails in legal battle over medical staff self-governance

July 23, 2018
Area(s) of Interest: Advocacy Medical Staff Self Governance Hospital Medical Staff Issues 

A settlement has officially been reached in the case of the Tulare hospital embroiled in a bitter legal battle over the self-governance rights of its medical staff.



The case stems from actions taken in 2016, when hospital administrators at Tulare Regional Medical Center (TRMC) terminated the entire medical staff and its duly elected officers. The hospital then adopted new medical staff bylaws in secret and without input from physicians at the hospital. The hospital dictated leadership and standards of medical care, seized control of the disciplinary process without legal or factual justifications, and prohibited the terminated medical staff from voting on medical staff matters or holding leadership positions.

The settlement fully reinstates the original medical staff and its officers and bylaws. The hospital also consented to the Tulare court ending the lawsuit with a stipulated judgment agreed upon by the parties that, among other things, expressly recognizes that the 2016 actions of the hospital board violated the medical staff’s rights to self-governance under California law.

The California Medical Association (CMA) actively and aggressively supported the medical staff in this case. Had the hospital’s actions been left unchallenged, it would have created a dangerous precedent that could have much broader implications for the fundamental rights of medical staffs and physicians’ ability to care for patients in hospitals.

“The settlement is a significant victory in protecting the ability of doctors, individually and through their medical staffs, to care for patients in Tulare County,” said CMA President Theodore M. Mazer, M.D. “This settlement brings closure to a long legal fight over the improper interference into the physician-patient relationship and the autonomy of a medical staff's responsibility for medical decision making and peer review. It sends an important message well beyond Tulare, but most importantly, it allows for the Tulare Regional Medical Center to begin the process of reopening its doors to the patients of Tulare County, who have suffered tremendously from its closure.”

CMA filed pre- and post-trial amicus briefs and organized fundraising for the case. Recognizing the critical national implications of this case, the Litigation Center of the American Medical Association (AMA) also provided significant legal support and monetary contributions to this case. AMA’s contributions to the litigation in this case represent the single largest legal contribution in the history of the AMA.

It cannot be understated how grave the consequences could have been on patient care and safety if the hospital’s illegal actions were left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic.

This case was also featured in a New York Times op-ed, which provides a good look at why this local conflict could have had a dangerous effect on patient care in U.S. hospitals.

If your medical staff is interested in contributing to CMA’s Legal Defense Fund, which is used to litigate cases of critical importance to physicians, please download the contribution form or email Nathan Skadsen (NSkadsen@cmadocs.org).


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