ÿWPCõ /# ¢UN­ %û 0(b)w@14q…” 0Jœ 0Tæ 0^: 0h˜ 0r 0|r 0†î 0t 1u 0dyU >ÝB) AQD Æ• 0D[ 0@Ÿ 0Dß DC# D/f B• B² D3Ï AM U*O +y v~¤ vÓ"˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ(ÖÃ9 Z ‹6Times New Roman RegularX($¡¡- ù- Ï$ÀÐ$Ñ$Ò${Ó$Ô$Õ$Ö$×$Ó€á$ê‚_#x93|xá$2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ< Œ 9p`(&Times New Roman% Line 7 d!"#$&Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý("ÿÿ$££Ò  ÒÒ  Ò($$””ò òÚ  Ú1Ú  Úó ó7Border 1dd(('÷ÿ dxd düÿP Pd'''''ÿÿdxd!#%Cþÿ << Gÿÿ< Œ 9p`(Arial !Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€ÔÝ  ÝÝ ƒ""ÝÝ  ÝÔ€+ÔÔ€+ÔÓ  Óò òÔ YYY ÔFILEDÔ€+XÔÌÌNovember€25,€1997ÌÌCecil€W.€CrowsonÌAppellate€Court€ClerkÔ  Ôó óPtPtHHÚ(ÿáÿâùFG(üHHØ(d'`Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  ion-F Geneva ÒÒ  ion-F Geneva ÒÝ ƒ!ÝÔ . ÔÔ€ÔÝ  ÝÑ  ÑÒ  ÒÒ ° ÒÒ  ÒÒ „ ÒÑ\R AØ'\ÑÑ\R AØ'\ÑÑ€ÑÑ7€&qXXdìdÈ7ÑÑ  ÑÑ  Ñò ò›Þ ÞÌDR.€JOE€BRYANT,à àà àà àà à)Ìà àà àà àà àà àà à)Ìà àPlaintiff/Appellant,à àà àà à)à àWilson€Chanceryà àà àà àÌà àà àà àà àà àà à)à àNo.€96332ÌVS.à àà àà àà àà àà à)à àÌà àà àà àà àà àà à)à àÌTENET,€INC.€(NATIONAL€MEDICALà à)ÌENTERPRISES)€d/b/a€UNIVERSITYà à)à àAppeal€No.ÌMEDICAL€CENTER,à àà àà à)à à01A01„9703„CH„00132̜ـ!ÙßR€*,%A1-j|ú` ç `€€@ÿRß›à àà àà àà àà àà à)Ìà àDefendant/Appellee.à àà àà à)ÌÌÌà@ àIN€THE€COURT€OF€APPEALS€OF€TENNESSEEÌà@ àMIDDLE€SECTION€AT€NASHVILLEÌÌà@ àAPPEAL€FROM€CHANCERY€COURT€OF€WILSON€COUNTYÌà@ àAT€LEBANON,€TENNESSEEÌÌà@ àHONORABLE€C.€K.€SMITH,€CHANCELLORÌó óÌÌMr.€Henry€Clay€BarryÌ106€S.€College€StreetÌLebanon,€Tennessee€37087ÌATTORNEY€FOR€PLAINTIFF/APPELLANTà à€ÌÌÌMr.€William€C.€MoodyÌ95€White€Bridge€RoadÌSuite€509,€Cavalier€Bldg.ÌNashville,€Tennessee€37205„1427à àà àà à€ÌATTORNEY€FOR€DEFENDANT/APPELLEEÌÌÌÌœò òòòÓ  ÓÔ€„ÔD€I€S€S€E€N€TóóÔ€¼Ô.ó óÔ€XÔ›ÌÓ  ÓÌÌÌà àà àà àà àà àHENRY€F.€TODDÌà àà àà àà àà àPRESIDING€JUDGE,€MIDDLE€SECTIONÌÌÌÌÌÌÌÌÌÌœÌÌÌÌÌÌò ò›ÌDR.€JOE€BRYANT,à àà àà àà à)Ìà àà àà àà àà àà à)Ìà àPlaintiff/Appellant,à àà àà à)à àWilson€Chanceryà àà àà àÌà àà àà àà àà àà à)à àNo.€96332ÌVS.à àà àà àà àà àà à)à àÌà àà àà àà àà àà à)à àÌTENET,€INC.€(NATIONAL€MEDICALà à)ÌENTERPRISES)€d/b/a€UNIVERSITYà à)à àAppeal€No.ÌMEDICAL€CENTER,à àà àà à)à à01A01„9703„CH„00132Ìà àà àà àà àà àà à)ÌÓÓà àDefendant/Appellee.à àà àà à)ÌÌó óà@ àœòòò òÔ€„ÔD€I€S€S€E€N€TÔ€XÔóóó ó›ÌÓÓÓÓÓ  ÓœÌà àThe€only€difference€of€opinion€in€this€Court€is€whether€the€information€in€the€record€isÏsufficient€to€justify€the€result€reached€by€the€majority.€€The€original€opinion,€which€was€notÏaccepted€by€the€majority,€is€now€filed€as€a€dissent€to€demonstrate€the€necessity€for€a€remand€forÏfurther€information.ÌÌ›à àThe€defendant,€Tenet,€Inc.,€d/b/a€University€Medical€Center,€has€appealed€from€œa€non›Ïjury€judgment€of€the€Trial€Court€regarding€the€practice€of€medicine€by€the€plaintiff,€Dr.€JoeÏBryant,€in€the€defendantððs€hospital.ÌÓÓÒ S ÒÒ „ ÒÓ  ÓÌà àThe€judgment€of€the€Trial€Court€states:ÌÒ  ÒÒ „ ÒÌÒ  ÒÒ « ÒÒ ¸ ÒÒ « ÒÒ  ÒÒ « ÒÓ  Óà àThis€case€having€come€on€to€be€heard€onÏSeptember€12,€1996,€upon€the€plaintiffððs€complaint€forÏinjunctive€relief,€the€Court€having€considered€theÏpleadings,€statements€of€counsel,€stipulations,€exhibits€andÏtestimony€of€witnesses€and€it€appearing€to€the€Court€that€aÏpermanent€injunction€should€be€issued€prohibiting€theÏdefendant€from€conducting€any€further€disciplinary€actionÏagainst€the€plaintiff€as€a€result€of€the€circumstances€givingÏrise€to€this€suit€until€the€defendant€has€provided€theÏplaintiff€with€a€written€notice€of€the€complaints€beingÏinvestigated€ten€days€prior€to€an€Executive€CommitteeÏmeeting€held€to€investigate€such€complaints€at€which€theÏplaintiff€shall€have€an€attorney€present€for€consultation€andÏadvice€only,€it€appearing€to€the€Court€that€the€defendantððsÏby„laws€have€deprived€the€plaintiff€of€his€rights€guaranteedÏby€Section€VIII,€Article€I,€of€the€Tennessee€Constitution,Ïand€the€plaintiffððs€right€to€due€process€under€the€by„lawsÏthemselves.ÌÓ  ÓÌÓ  Óà àIT€IS€HEREBY€DECREED,€that€the€defendant€isÏenjoined€from€conducting€any€further€disciplinary€actionsÏpursuant€to€its€by„laws€against€the€plaintiff€as€a€result€ofÏthe€circumstances€from€which€this€suit€arises€until€suchÏtime€as€the€defendant€has€provided€the€plaintiff€withÏwritten€notice€of€the€complaints€it€is€investigating€and€theÏdefendant€schedules€a€new€Executive€CommitteeÏinvestigation€more€than€ten€days€thereafter€at€which€theÏplaintiff€shall€have€the€right€to€have€an€attorney€present€forÏhis€own€consultation€and€advice.€ÌÌÒ S ÒÒ « ÒÒ S ÒÒ „ ÒÒ  ÒÒ „ ÒÓÓÒ S ÒÒ „ Òà àIn€this€Court,€the€defendant€states€the€issues€as€follows:ÌÒ  ÒÒ „ ÒÒ  ÒÒ ` ÒÒ ¸ ÒÒ ` ÒÓÓÒ  ÒÒ ` Òà à1.à àWhen€a€medical€staff€committee€of€a€privateÏhospital€takes€action,€pursuant€to€its€bylaws,€that€limits€aÏstaff€memberððs€privileges,€is€that€staff€member€entitled€toÏprocedural€due€process€at€each€step€of€the€proceedings€byÏArticle€1,€ðð€8€of€the€Constitution€of€the€State€of€Tennessee?ÌÌà à2.à àIf€so,€do€the€provisions€of€the€defendantððsÏbylaws,€for€taking€action€which€limits€the€privileges€of€staffÏmembers,€comply€with€Article€1,€ðð€8€of€the€Constitution€ofÏthe€State€of€Tennessee?ÌÌà à3.à àDo€the€defendantððs€bylaws€guarantee€theÏplaintiff€procedural€due€process,€as€the€term€is€understoodÏin€a€legal€context,€at€the€Executive€Committee€Stage?ÌÌà à4.à àIs€injunctive€relief€appropriate€at€this€stageÏof€the€proceeding€or€must€the€plaintiff€exhaust€all€of€hisÏadministrative€remedies?ÌÒ S ÒÒ ` ÒÒ S ÒÒ „ ÒÒ  ÒÒ „ ÒÓÓÌÒ S ÒÒ „ Òà àThe€plaintiff€states€the€issues€as€follows:ÌÒ  ÒÒ „ ÒÒ  ÒÒ ` ÒÒ ¸ ÒÒ ` ÒÓÓÒ  ÒÒ ` Òà à1.à àIs€a€doctor€entitled€to€ð ðDue€Processðð,€orÏfairness€and€justice,€before€his€privileges€or€liberties€may€beÏadversely€affected€by€the€Defendant€or€itððs€ExecutiveÏCommittee,€under€the€fact€of€this€case?ÌÌà à2.à àDo€these€by„laws,€either€upon€their€face€orÏby€their€operation€in€this€case,€violate€Due€Process,€whichÏthe€same€guarantee?ÌÓÓÒ S ÒÒ ` ÒÒ S ÒÒ „ ÒÒ  ÒÒ „ ÒÒ S ÒÒ „ ÒÌà àThe€following€facts€are€essentially€undisputed:ÌÌÓÓÓÓà àDr.€Bryant€has€practiced€as€a€general€surgeon€at€University€Medical€Center€for€manyÏyears.€€University€Medical€œCenter,›€(hereafter,€UMC)€is€a€private€hospital€owned€by€Tenet,ÏInc.€€Some€time€in€early€June€1996,€he€performed€a€PEG€procedure€on€a€comatose€patientÏwho€was€on€a€morphine€drip.€€During€this€procedure,€he€apparently€had€a€dispute€with€nursesÏin€the€operating€room€about€his€decision€not€to€anesthetize€the€patient€during€the€procedure.€ÏFollowing€the€procedure,€one€or€more€nurses€filed€a€formal€complaint€with€UMCððsÏadministrator€and€œreported›€the€incident€on€Tenetððs€patient€abuse€hotline.ÌÌà àAt€UMC€there€is€a€ð ðchief€œof›€staffðð,€who€is€presumably€selected€by€the€physiciansÏpracticing€in€the€hospital.€€Whether€he€is€also€an€official€of€the€hospital€itself€does€not€appearÏfrom€the€record.ÌÌà àOne€or€two€weeks€œafter€the€above€described€incident,›€œthe›€œð ðchief›€of€œstaffðð›€discussed€theÏincident€with€Dr.€Bryant€and€asked€him€to€attend€a€meeting€œof€ð ðthe›€executive€œcommitteeðð›€toÍreview€the€incident.€€The€record€does€not€disclose€whether€the€ð ðexecutive€committeeðð€of€theÏmedical€staff€is€a€part€of€the€management€of€the€hospital,€itself.€€Dr.€Bryant€declined€to€attendÏstating€ð ðunless€I€had€a€written€letter€from€someone,€I€wouldnððt€be€there.ðð€€Several€days€later,ÏDr.€Bryant€received€written€notice€of€the€executive€committee€meeting.€€He€also€receivedÏnotice€of€the€number€of€the€patientððs€chart€and€was€even€given€a€copy€of€the€chart€which€heÏshowed€to€other€physicians€before€the€hearing.€€Apparently€he€was€not€given€the€incidentÏreport€that€had€been€filed€by€one€or€more€of€the€operating€room€nurses.ÌÌà àPrior€to€the€meeting,€Dr.€Bryant€wrote€a€lengthy,€detailed€letter€to€UMCððsÏadministrator€presenting€his€response€to€the€nursesðð€complaints€and€accusing€the€nurses€ofÏineffectiveness€in€the€operating€room.€€On€the€day€of€the€executive€committeeððs€meeting,€Dr.ÏBryant€insisted€that€the€committee€permit€his€lawyer€to€attend€the€meeting.€€After€theÏcommittee€denied€his€request,€Dr.€Bryant€refused€to€attend€the€meeting.€€The€record€does€notÏindicate€what,€if€any,€€action€was€taken€by€the€committee€after€Dr.€Bryantððs€departure.ÌÌà àShortly€thereafter,€Dr.€Bryant€filed€suit€this€against€Tenet€seeking€to€œenjoin›€the€hospitalÏð ðfrom€proceeding€against...[him]€under€the€said€œby„laws.ð𛀀It€is€not€clear€whether€the€by„lawsÏwere€those€of€the€medical€staff€or€of€the€management€of€the€hospital.€€He€asserted€that€theÏhospitalððs€œby„laws›€permitted€a€ð ðstar„chamber€type€proceedingðð€and€that€the€œby„laws›Ïð ðunconstitutionally€œdeprive›€the€Plaintiff€of€his€constitutional€right€to€due€process€of€the€law.ðð€€ÏAt€the€hearing€on€the€application€for€permanent€injunction,€the€trial€court€granted€Dr.€BryantððsÏoral€motion€to€amend€to€add€a€breach€of€contract€claim€to€his€complaint.€The€trial€courtÏdetermined€that€the€hospital€procedures€did€not€violate€Dr.€Bryantððs€federal€constitutionalÏrights€but€that€they€did€violate€Dr.€Bryantððs€state€constitutional€and€contractual€rights.€ÍAccordingly,€the€trial€court€entered€an€order€enjoining€UMC€from€conducting€any€furtherÏdisciplinary€proceedings€against€Dr.€Bryant€until€it€(1)€provides€him€with€written€notice€of€theÏcomplaints€against€him,€(2)€commences€a€new€executive€committee€investigation,€and€(3)Ïallows€Dr.€Bryant€to€have€an€attorney€ð ðpresent€for€his€own€consultation€and€adviceðð€during€allÏstages€of€the€proceedings.ÌÌà àThe€injunction€granted€by€the€œTrial›€Court€appears€to€be€intended€to€prevent€the€hospitalÏfrom€curtailing€or€terminating€Dr.€Bryantððs€use€of€the€facilities€of€the€hospital,€but€it€does€notÏappear€to€affect€the€actions€of€the€medical€staff€or€its€committee€who€are€not€parties€to€the€suit.ÌÌà àThe€record€does€not€include€a€complete€set€of€the€œby„laws›€of€the€medical€staff.€€TheÏrecord€does€contain€a€portion€of€the€œby„laws›€of€the€staff€governing€ð ðcorrective€actionsðð€andÏð ðhearing€and€appellate€review€procedures.ðð€ÌÌà àT.C.A.,€Title€63,€Chapter€6€is€entitled,€ð ðMedicine€and€Surgery.ðð€€Part€1€of€Chapter€6Ïcreates€a€Board€of€Medical€Examiners.€€Part€2€of€Chapter€6€is€entitled€ð ðGeneral€Provisions,ððÏSection€63„6„219€reads€as€follows:ÌÒ  ÒÒ ` ÒÒ  ÒÒ ` ÒÓÓà à(a)(1)€In€conjunction€with€the€applicable€policies€ofÏthe€Health€Care€Quality€Improvement€Act€of€1986€(42ÏU.S.C.€ðððð€11101„11152),€it€is€the€stated€policy€ofÏTennessee€to€encourage€committees€made€up€ofÏTennesseeððs€licensed€physicians€to€candidly,Ïconscientiously,€and€objectively€evaluate€and€review€theirÏpeersðð€professional€conduct,€competence,€and€ability€toÏpractice€medicine.€€Tennessee€further€recognizes€thatÏconfidentiality€is€essential€both€to€effective€functioning€ofÏthese€peer€review€committees€and€to€continuedÏimprovements€in€the€care€and€treatment€of€patients.ÌÌà à(2)à àAs€incentive€for€the€medical€profession€toÏundertake€professional€review,€including€the€review€ofÍhealth€care€costs,€òòpeer€review€committees€must€be€protectedÏfrom€liability€for€their€good„faith€effortsóó.€€To€this€end,€peerÏreview€committees€òòshould€be€granted€certain€immunitiesóóÏrelating€to€their€actions€undertaken€as€part€of€theirÏresponsibility€to€review,€discipline,€and€educate€theÏprofession.€€In€instances€of€peer€review€committeesÏexamining€the€appropriateness€of€physiciansðð€fees,€òòthisÏimmunity€must€also€extend€to€restraint€of€trade€claims€underÏtitle€47,€chapter€25óó.€€(Emphasis€supplied)ÌÒ  ÒÒ „ ÒÒ  ÒÒ ` ÒÒ S ÒÒ ` ÒÒ  ÒÒ ` ÒÒ  ÒÒ „ ÒÌà à(b)à àAs€used€in€this€section,€ð ðmedical€review€committeeðð€or€ð ðòòpeerÏreview€committeeóóðð€means€any€committee€of€a€state€or€local€professionalÏassociation€or€society,€including€impaired€physician€peer€review€committees,Ïprograms,€malpractice€support€groups€and€their€staff€personnel,€òòor€a€committeeÏof€any€licensed€health€care€institution,€or€the€medical€staff€thereofóó,€or€anyÏcommittee€of€a€medical€care€foundation€or€health€maintenance€organization,Ïpreferred€provider€organization,€individual€practice€association€or€similarÏentity,€the€function€of€which,€or€one€(1)€of€the€functions€of€which,€is€toÏevaluate€and€improve€the€quality€of€health€care€rendered€by€providers€of€healthÏcare€service€to€provide€intervention,€support,€or€rehabilitative€referrals€orÏservices,€or€to€determine€that€health€care€services€rendered€were€professionallyÏindicated,€or€were€performed€in€compliance€with€the€applicable€standard€ofÏcare,€or€that€the€professional€health€care€services€in€the€area€and€includes€aÏcommittee€functioning€as€a€utilization€review€committee€under€the€provisionsÏof€Public€Law€89„97€(42€U.S.C.€ðððð€1395„1395pp)€(Medicare€law),€or€as€aÏutilization€and€Review€Improvement€Act€of€1982,€Public€Law€97„248,€ðððð€141„150,€or€a€similar€committee€or€a€committee€of€similar€purpose,€to€evaluate€orÏreview€the€diagnosis€or€treatment€or€the€performance€or€rendition€of€medical€orÏhospital€services€which€are€performed€under€public€medical€programs€of€eitherÏstate€of€federal€design.ÌÌà à(c)(1)à àAll€state€and€local€professional€associations€and€societies€andÏother€organizations,€institutions,€foundations,€entities€and€associatedÏcommittees€as€identified€in€subsection€(b),€physicians,€surgeons,€registeredÏnurses,€hospital€administrators€and€employees,€members€of€boards€of€directorsÏor€trustees€of€any€publicly€supported€or€privately€supported€hospital€or€otherÏsuch€provider€of€health€care,€any€person€acting€as€a€staff€member€of€a€medicalÏreview€committee,€any€person€under€a€contract€or€other€formal€agreement€withÏa€medical€review€committee,€òòany€person€who€participates€with€or€assists€aÏmedical€review€committee€with€respect€to€its€functionsóó,€or€any€other€individualÏappointed€to€any€committee,€as€such€term€is€described€in€subsection€(b),€òòisÏimmune€from€liability€to€any€patient,€individual€or€organization€for€furnishingÏinformationóó,€data,€reports€or€records€to€any€such€committee€or€for€damagesÏresulting€from€any€decision,€opinions,€actions€and€proceedings€rendered,Ïentered€or€acted€upon€by€such€committees€undertaken€or€performed€within€theÏscope€or€function€of€the€duties€of€such€committees,€if€made€or€taken€òòin€goodÏfaith€and€without€maliceóó€and€on€the€basis€of€facts€reasonably€known€orÏreasonably€believed€to€exist.€€(Emphasis€supplied)ÌÌà à(2)à àNotwithstanding€the€provisions€of€subdivision€(c)(1),€anyÏperson€providing€information,€whether€as€a€witness€or€otherwise,€to€a€medicalÏreview€committee€regarding€the€competence€or€professional€conduct€of€aÏphysician€is€immune€from€liability€to€any€person,€unless€such€information€isÏfalse€and€the€person€providing€it€had€actual€knowledge€of€such€falsity.ÌÌà à(3)à àA€member€of€a€medical€review€committee,€or€person€reportingÏinformation€to€a€medical€review€committee,€is€presumed€to€have€acted€in€goodÏfaith€and€without€malice.€€Any€person€alleging€lack€of€good€faith€has€theÏburden€of€proving€bad€faith€and€malice.ÌÌà à(d)à àòòAll€informationóó,€interviews,€incident€or€other€reports,Ïstatements,€memoranda€or€other€data€òòfurnished€to€any€committeeóó€as€defined€inÏthis€section,€and€any€findings,€conclusions€or€recommendations€resulting€fromÏthe€proceedings€of€such€committee€are€òòdeclared€to€be€privilegedóó.€€All€suchÏinformation,€in€any€form€whatsoever,€so€furnished€to,€or€generated€by,€aÏmedical€review€committee€shall€be€privileged€communication€òòsubject€to€theÏlaws€pertaining€to€the€attorney„client€privilegeóó.€€The€records€and€proceedingsÏof€any€such€committees€are€confidential€and€shall€be€used€by€such€committee,Ïand€the€members€thereof€only€in€the€exercise€of€the€proper€functions€of€theÏcommittee,€and€shall€not€be€public€records€nor€be€available€for€court€subpoenaÏor€for€discovery€proceedings.€€One€(1)€proper€function€of€such€committeesÏshall€include€advocacy€for€physicians€before€other€medical€peer€reviewÏcommittees,€peer€review€organizations,€health€care€entities,€private€andÏgovernmental€insurance€carriers,€national€or€local€accreditation€bodies,€and€theÏstate€board€of€medical€examiners€of€this€or€any€other€state.€€The€disclosure€ofÏconfidential,€privileged€peer€review€committee€information€to€such€entitiesÏduring€advocacy,€or€as€a€report€to€the€board€of€medical€examiners€under€ðð€63„6„214(d),€or€to€the€affected€physician€under€review€does€not€constitute€either€aÏwaiver€of€confidentiality€or€privilege.€€Nothing€contained€herein€applies€toÏrecords€made€in€the€regular€course€of€business€by€a€hospital€or€other€providerÏof€health€care€and€information,€documents€or€records€otherwise€available€fromÏoriginal€sources€are€not€to€be€construed€as€immune€from€discovery€or€use€inÏany€civil€proceedings€merely€because€they€were€presented€during€proceedingsÏof€such€committee.€€(Emphasis€supplied)ÌÒ S ÒÒ „ ÒÓÓÌÌœ›à àArticle€1€ðð€8€of€the€Constitution€of€Tennessee€provides:ÌÒ S ÒÒ ` ÒÒ  ÒÒ ` ÒÓÓà àNo€man€to€be€disturbed€but€by€law.€„€That€no€manÏshall€be€taken€or€imprisoned,€or€disseized€of€his€freehold,Ïliberties€or€privileges,€or€outlawed,€or€exiled,€or€in€anyÏmanner€destroyed€or€deprived€of€his€life,€liberty€orÏproperty,€but€by€the€judgment€of€his€peers€or€the€law€€of€theÏland.ÌÓ  ÓÌÒ S ÒÒ ` ÒÒ S ÒÒ „ ÒÓÓÓ  Óà àThe€right€to€work€or€to€contract€in€regard€to€work€is€a€property€right€which€is€protectedÏby€the€constitutional€provision.€€òòBryan€v.€International€Allianceóó,€43€Tenn.€App.€180,€306ÏS.W.2d€64€(1957).ÌÌÓÓÓÓà àThe€right€to€contract€is€subject€to€curtailment,€limitation€and€destruction€by€theÏlegislature€where€such€is€done€pursuant€to€ð ðthe€law€of€the€land.ðð€€òòDaugherty€v.€Stateóó,€216ÏTenn.€666,€393€S.W.2d€739,€cert.€denied,€384€U.S.€435,€86€S.€Ct.€1601,€16€L.€Ed.€2d€671Ï(1966).ÌÒ  ÒÒ „ ÒÒ  ÒÒ ` ÒÌÒ S ÒÒ ` ÒÒ S ÒÒ „ Òà àThe€ð ðdue€processðð€right€afforded€by€the€Tennessee€Constitution€includes€the€right€toÏdo€a€lawful€business.€€òòLyle€v.€Amalgamated€Meat€œCutters,›€etc.óó,€174€Tenn.€222,€124€S.W.2dÏ701€(1939).ÌÓÓÓÓÌà àBoth€the€words€ð ðlibertyðð€and€ð ðpropertyðð€include€the€right€to€make€contracts,€andÏcontracts€are€entitled€to€the€same€protection€as€property.€€òòState,€ex€rel.,€Hamby€v.€Cummingsóó,Ï166€Tenn.€460,€63€S.W.2d€515€(1933).̛̜à àHowever,€the€right€to€contract€is€subject€to€legislative€control,€and€is€subject€toÏcurtailment,€limitation€and€destruction€by€ð ðthe€law€of€the€landðð.€€òòDaugherty€v.€Stateóó,€216ÏTenn.€666,€393€S.W.2d€739,€cert.€denied€384€U.S.€435,€865€Ct.€1601,€16€L.€Ed.2d€671Ï(1966).ÌÓÓÌÓÓà àState€licensing€regulations€require€hospitals€to€enact€œby„laws›€containing€ð ðfair€hearingÏproceduresðð€concerning€the€granting,€suspension,€and€removal€of€medical€staff€appointments,Íreappointments,€and/or€delineation€of€privileges.ððòò€€Lewisburg€Community€Hosp.€v.ÏAlfredsonóó,€Tenn.€1992,€805€S.W.2d€756,€759.ÌÌà àThe€portion€of€the€œby„laws›€exhibited€to€this€record€appear€to€establish€a€three„tierÏprocess€that€is€intended€to€incorporate€the€peer€review€process€endorsed€by€the€GeneralÏAssembly€in€Tenn.€Code€Ann.€ðð€63„6„219€(1997).€€The€process€is€triggered€by€the€filing€of€aÏð ðrequest€for€corrective€action.ðð€The€first€step€of€the€process€is€an€informal€ð ðinvestigationðð€byÏthe€executive€committee.€€The€œby„laws›€state€specifically€that€this€step€is€not€a€ð ðhearingðð€andÏpermit€the€executive€committee€to€take€a€broad€range€of€actions.€€The€œby„laws›€are€silent€aboutÏthe€role€of€lawyers€during€the€first€phase;€however,€it€is€uncontradicted€that€lawyers€are€notÏpermitted€to€be€present€at€any€of€the€first€stage€meetings€during€the€investigative€process.ÌÌà àAny€person€dissatisfied€with€the€executive€committeeððs€recommendations€may€appeal.€ÏThe€second€stage€of€the€proceeding€is€much€more€formal€than€the€first€and€involves€a€hearingÏbefore€a€medical€review€committee€specifically€chosen€to€hear€the€appeal.€The€œby„laws›€requireÏa€written€notice.€€They€also€require€the€executive€committee€to€provide€the€physician€withÏð ðnotice€of€the€acts€or€omissions€with€which€the€affected€practitioner€is€charged€or€a€list€of€theÏchart€numbers€under€question,€if€any,€or€the€reasons€for€the€action€or€recommendation.ðð€€TheÏparties€are€permitted€to€use€ð ðrepresentatives,ðð€who€may€be€lawyers.ÌÌà àThe€hearing€procedure€is€quite€formal.€€The€hospital€must€present€its€case€first,€theÏphysician€second,€and€both€parties€are€permitted€to€present€rebuttal€proof.€€If€the€physician€isÏthe€appealing€party,€he€or€she€must€prove€by€clear€and€convincing€evidence€that€the€action€orÍthe€recommendation€of€the€executive€committee€was€arbitrary,€unreasonable,€or€not€supportedÏby€substantial€evidence.ÌÌà àThe€third€and€final€step€of€the€process€is€an€appeal€to€the€governing€body€of€theÏhospital.€€€This€review€is€based€on€the€record€of€the€prior€proceedings,€and€the€grounds€forÏreview€include€(1)€the€failure€of€the€earlier€proceedings€to€comply€with€the€œby„laws,›€(2)€theÏfailure€to€afford€due€process€or€a€fair€hearing,€(3)€that€the€recommendation€was€arbitrary,Ïunreasonable,€or€capricious,€(4)€that€the€medical€review€committeeððs€decision€was€contrary€toÏthe€weight€of€the€evidence,€or€€(5)€that€any€œby„law›€relied€on€by€the€medical€review€committeeÏlacked€substantive€rationality.ÌÌà àDr.€Bryantððs€first€issue€seeks€a€ruling€upon€the€right€of€a€physician€to€due€process€inÏproceedings€by€fellow€physicians€in€respect€to€complaints€made€against€him.€€The€record€isÏnot€sufficiently€definitive€to€permit€a€specific€ruling€in€this€respect.€€Three€elements€must€beÏestablished€to€enable€such€a€ruling.ÌÌà àFirst,€does€there€exist€a€recognized€group€of€doctors€who€have€agreed€together€upon€aÏð ðpeer€reviewðð€procedure€to€improve€the€quality€of€their€practice?€€If€so,€the€nature€of€suchÏprocedure€must€conform€with€the€agreement€formed€by€the€doctors€or€accepted€by€a€newÏarrival€upon€joining€the€group.€€If€this€fact€exists,€and€the€results€reached€in€the€peer€reviewÏprocedure€are€not€final€or€binding€in€respect€to€use€of€hospital€facilities,€then€it€would€appearÏthat€the€affected€doctor€has€contractually€waived€any€constitutional€due€œprocess€in€proceedingsÏbefore€the€peer€review€committee.›€€If,€however,€the€results€of€the€peer€review€procedure€areÍenforceable€by€exclusion€from€use€of€hospital€facilities,€the€doctor€is€entitled€to€ð ðdue€processððÏin€the€procedure.ÌÌà àA€definitive€ruling€upon€the€foregoing€must€await€an€evidentiary€record€whichÏdiscloses€the€details€of€the€controlling€œby„laws€or€agreements.›ÌÌà àAppellantððs€second€issue€seeks€a€ruling€regarding€the€constitutionality€œof€›€ð ðtheÏdefendantððs€œby„laws.ð𛀀The€record€does€not€establish€that€the€portion€of€the€œð ðby„lawsðð›Ïincluded€in€the€record€is€in€fact€a€portion€of€the€œby„laws›€of€the€hospital,€rather€than€of€theÏgroup€of€doctors€who€practice€in€the€hospital.€€If€it€should€be€shown€that€the€hospital€has€a€setÏof€œby„laws›€or€rules,€or€is€bound€to€enforce€the€decisions€of€the€medical€staff€as€to€exclusion€ofÏa€doctor,€then€the€hospital€might€be€enjoined€from€enforcement€of€a€decision€the€staff€reachedÏwithout€due€process.€€On€this€premise,€it€was€not€error€to€enjoin€the€hospital€from€enforcingÏthe€results€of€a€procedure€until€the€constitutionality€of€the€procedure€has€been€examined€andÏdetermined.ÌÌà àIf€the€hospital€is€not€bound€by€the€staff€procedure,€but€conducts€a€òòde€novoóóÏinvestigation€and€determination€of€the€right€of€a€doctor€to€use€its€facilities,€then€it€œmay›€appearÏthat€the€issuance€of€the€œpermanent€injunction›€œwas€not€in€order.›ÌÌà àAppellantððs€third€issue€requests€a€ruling€as€to€œwhether€procedural›€due€process€œisÏguaranteed›€by€ð ðdefendantððs€œby„laws.ð𛀀(Defendant€is€the€hospital.)€€The€record€does€notÏdisclose€the€hospitalððs€œby„laws.›€€Thus,€a€definitive€ruling€on€the€defendantððs€third€issueÏœshould›€await€a€full€disclosure€of€€its€œby„laws,›€rules€or€adopted€procedures.ÌÌà àAppellantððs€fourth,€and€last€œissue›€œsuggests›€that€defendant€be€required€to€exhaust€hisÏadministrative€remedies€before€seeking€injunctive€relief.€€In€view€of€the€constitutional€questionÏinvolved,€the€seriousness€of€the€possible€damage€to€the€œaffected›€physician,€and€the€possibleÏwaste€of€time€and€effort€in€invalid€procedure,€a€precautionary€injunction€was€permissible.ÌÌà àDr.€Bryantððs€two€issues€have€been€explored€above,€but€a€definitive€ruling€thereonÏmust€await€the€development€of€a€more€informative€record.€€œT.C.A.€ðð€27„3„128€provides€forÏremand€where€required€to€do€complete€justice.€€Such€a€remand€is€necessary€in€the€presentÏappeal.›ÌœÌ›à àFor€the€reasons€stated,€the€judgment€of€the€Trial€Court€œshould€be›€modified€to€provideÏthat€the€€œð ðpermanentðð›€injunction€shall€be€effective€until€further€order€of€œcourt,›€after€furtherÏhearing.€€œThe›€cause€œshould€be›€remanded€to€the€Trial€Court€for€further€proceedings€inÏconformity€with€this€œopinion.ÌÓÓÓÓò òÓ  ÓÔ€¼ÔRESPECTFULLY€SUBMITTED.ó óÔ€XÔ›ÌÓÓœÓ  Ó›à àà àà àœÌà àà àà à›à àà àà à___________________________________Ìà àà àà àà àà àà àHENRY€F.€TODDÌà àà àà àà àà àà àPRESIDING€JUDGE,€MIDDLE€SECTIONÌÌœÒ  ÒÒ „ ÒÒ  ÒÒ e ÒÒ , ÒÒ e Ò