Medical staff leaders rejoice! California's Fourth Appellate District Court of Appeals decided that Integrated Healthcare Holdings Inc. did SLAPP Michael Fitzgibbons, MD.

Many of us monitoring medical staff issues view this as upholding our right to speak up for our patients and the quality of care in hospitals. To refresh your memory, Dr. Fitzgibbons was chief of staff at Western Medical Center Santa Ana in 2003 when Tenet Inc. announced plans to sell it and three other hospitals in Orange County.

Dr. Fitzgibbons coordinated an effort on behalf of many physicians at WMCSA to purchase the hospital from Tenet. The sale created significant controversy. However, in 2004, IHHI, a newly formed company, purchased the four hospitals. Although disappointed, Dr. Fitzgibbons and the WMCSA medical staff agreed to support the new owners.

As a public corporation, IHHI reports its financial condition to the Securities and Exchange Commission. So to stay current about IHHI operations, Dr. Fitzgibbons monitored this reporting, as did others. Unfortunately, problems were revealed and local newspapers reported IHHI defaulted on some loans.

In a private e-mail, Dr. Fitzgibbons expressed grave concerns about IHHI's financial condition and ability to maintain quality care at WMCSA. The leadership of IHHI was offended by this
e-mail and sued Dr. Fitzgibbons for defamation and business interference.

The medical staff at WMCSA abhorred this action and established a defense fund to support Dr. Fitzgibbons. Tom Curtis, a veteran attorney in medical staff issues, led the defense.

Curtis claimed IHHI filed a SLAPP (Strategic Lawsuit to Prevent Public Participation). California law prohibits SLAPPs: Corporations cannot file lawsuits to prevent individuals from speaking out
in the public interest.

News of the lawsuit sent a chill through knowledgeable medical staff leaders. The Orange County Medical Association, the California Medical Association and the American Medical Association rallied to support the medical staff at WMCSA. Drs. Howard Lang, Robert Pugash and John Hill--all veterans in past battles with errant hospital administrators--entered the fray.

In the first round, the Orange County Superior Court judge listened but did not hear the arguments placed before him. IHHI won. The legal fees escalated. The OCMA, the CMA and hospital medical staffs donated more to the defense fund. Dr. Fitzgibbons appealed. Tom Curtis sharpened his tongue. The CMA and the AMA filed a brilliant amicus curiae brief.

This time, the appellate judges HEARD and READ the arguments. The appeals court overruled the superior court. They decided IHHI filed a SLAPP to intimidate Dr. Fitzgibbons.

When Dr. Fitzgibbons was first sued, he could have cowered and begged to be released from the suit. But he chose the road of principle. He chose to challenge the administration's efforts to silence him.

To promote the advancement of hospitals, medical staff leaders need to be critical of themselves and of administrations. The precarious financial situations of numerous healthcare institutions across the country require that medical staff leaders take corrective actions and lead these institutions into solvency.

We owe Dr. Fitzgibbons thanks for his tenacity. His willingness to suffer through a lawsuit so that medical staff leaders have the right to voice (or e-mail) their opinions gives us strength. The pain of his SLAPP was not in vain.

Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at editor@socalphys.com.