FP Report -- February 1999 What's it take to get C-section privileges?!
Family physician Eric Runte, M.D., of Sonora, Calif., and his county are appealing a judge's decision not to hear their Caesarean section privileges case.
Runte, the primary surgeon for 70 C-sections during his 1990-93 family practice residency, applied for C-section privileges at Sonora Community Hospital in November 1994.
"That unleashed a cascade of events that culminated in this lawsuit," said Runte.
He directs the Primary Care Clinic at Tuolumne General Hospital in Sonora, and the County of Tuolumne joined the lawsuit as Runte's employer. The hospital has no birth center, so Runte delivers babies at Sonora Community Hospital.
After he applied for C-section privileges, SCH adopted a policy that effectively precluded anyone but OB-Gyns from obtaining the privileges.
Federal District Judge Robert Coyle ruled last July 24 in Fresno, Calif., that Runte and the county had not presented sufficient evidence of antitrust activity by SCH and three OB-Gyns at SCH. However, Coyle peppered his 69-page opinion with statements in Runte's defense (see box).
Barbara Hensleigh, J.D., Runte's lawyer, submitted the notice of appeal Dec. 22 to the federal appellate court in San Francisco, which may rule on the case this year. If the court finds in Runte's favor, it will probably remand the case to Coyle for trial.
Coyle said July 24 the SCH policy allowing only OB-Gyns to perform C-sections was "a business decision which, on balance, this court cannot say was unreasonable."
"We feel the opposite," said Runte. "The judge's line of reasoning could restrict an entire class of physicians from performing C-sections in this county."
The California AFP, other chapters, the AAFP, the County of Tuolumne, residency programs and many individual FPs have helped fund the case.
"If we can bring this lawsuit to a successful conclusion," said Runte, "it will benefit family practice across the country because it will establish case law that could be used in other cases."
Excerpts from judge's order rejecting Runte case
Judge Robert Coyle decided July 24 not to hear a case concerning the right of Eric Runte, M.D., to apply for Caesarean section privileges at Sonora Community Hospital (see story above). Coyle, however, stated points in Runte's favor:
- "There is evidence Dr. Runte is qualified to perform C-sections. ... Dr. Robert B. Lefkowitz, Dr. Runte's evaluating physician, ... an obstetrician, ranked Dr. Runte in the top 10 percent of residents he has seen perform C-sections."
- "Dr. Runte's exclusion from the C-section market harms competition in that market."
- "Dr. (Donovan) Teel (a defendant OB-Gyn) ... apparently made certain notable statements. For example, Dr. Teel, upon learning that Dr. Runte wanted to perform C-sections, informed him that he would never do so in Sonora. When asked why, according to Dr. Runte, Dr. Teel said something similar to 'It's a money issue' or 'There isn't enough of the pie to go around.'"
- "Dr. (Louis) Erich (a defendant OB-Gyn) ... made certain notable statements. ... Dr. Erich stated something similar to 'If there weren't enough obstetricians, Dr. Runte would be welcome to do C-sections.'"
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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