{ "id": 3546278, "name": "LOUIS R. HEAD, Plaintiff-Appellant, v. LUTHERAN GENERAL HOSPITAL, Defendant-Appellee", "name_abbreviation": "Head v. Lutheran General Hospital", "decision_date": "1987-11-25", "docket_number": "No. 86\u20142792", "first_page": "682", "last_page": "697", "citations": [ { "type": "official", "cite": "163 Ill. App. 3d 682" } ], "court": { "name_abbreviation": "Ill. App. Ct.", "id": 8837, "name": "Illinois Appellate Court" }, "jurisdiction": { "id": 29, "name_long": "Illinois", "name": "Ill." }, "cites_to": [ { "cite": "302 N.E.2d 257", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "55 Ill. 2d 240", "category": "reporters:state", "reporter": "Ill. 2d", "case_ids": [ 2939879 ], "pin_cites": [ { "page": "250" } ], "opinion_index": 0, "case_paths": [ "/ill-2d/55/0240-01" ] }, { "cite": "497 N.E.2d 1022", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "147 Ill. App. 3d 168", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3603403 ], "pin_cites": [ { "page": "171" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/147/0168-01" ] }, { "cite": "477 N.E.2d 16", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "132 Ill. App. 3d 293", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3441582 ], "weight": 3, "pin_cites": [ { "page": "299" }, { "page": "299-300" }, { "page": "300" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/132/0293-01" ] }, { "cite": "192 N.E.2d 414", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "42 Ill. App. 2d 352", "category": "reporters:state", "reporter": "Ill. App. 2d", "case_ids": [ 5248192 ], "weight": 2, "pin_cites": [ { "page": "369" } ], "opinion_index": 0, "case_paths": [ "/ill-app-2d/42/0352-01" ] }, { "cite": "399 N.E.2d 299", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "80 Ill. App. 3d 28", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3233227 ], "pin_cites": [ { "page": "30" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/80/0028-01" ] }, { "cite": "456 N.E.2d 84", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "99 Ill. 2d 109", "category": "reporters:state", "reporter": "Ill. 2d", "pin_cites": [ { "page": "122" } ], "opinion_index": 0 }, { "cite": "483 N.E.2d 1013", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "136 Ill. App. 3d 822", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3564997 ], "pin_cites": [ { "page": "824" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/136/0822-01" ] }, { "cite": "488 N.E.2d 623", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "140 Ill. App. 3d 127", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3531575 ], "pin_cites": [ { "page": "133" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/140/0127-01" ] } ], "analysis": { "cardinality": 1062, "char_count": 33275, "ocr_confidence": 0.783, "pagerank": { "raw": 1.1480288220017465e-07, "percentile": 0.5806759390219275 }, "sha256": "9892cc83d9521df22208864af9e2917d4f980f303eb04b9aa4b248ad7dafd645", "simhash": "1:0b68fca26d8d4c6e", "word_count": 5307 }, "last_updated": "2023-07-14T17:50:46.695850+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [], "parties": [ "LOUIS R. HEAD, Plaintiff-Appellant, v. LUTHERAN GENERAL HOSPITAL, Defendant-Appellee." ], "opinions": [ { "text": "JUSTICE WHITE\ndelivered the opinion of the court:\nPlaintiff Dr. Louis Head sued defendant Lutheran General Hospital for wrongful termination of his staff privileges. In count I of his third amended complaint plaintiff alleged that defendant failed to follow its bylaws in the termination proceedings; in count II he alleged that the proceedings were fundamentally unfair; and in count III he alleged that the decision to terminate his privileges was arbitrary and capricious. The trial court directed a verdict for defendant on count I, dismissed count II, and entered judgment on the jury\u2019s verdict in favor of defendant on count III. Plaintiff appeals.\nPlaintiff, a chest surgeon, joined defendant\u2019s courtesy staff in 1959. As a member of the courtesy staff he was permitted to admit patients to the hospital, but unlike members of the attending staff he was not required to attend staff meetings and he could not vote on hospital affairs. He also joined the.courtesy staffs of several other hospitals in the area in order to have enough work to sustain his practice as a chest surgeon. In 1969 plaintiff became a member of defendant\u2019s provisional staff due to a change in defendant\u2019s bylaws, retaining the privileges he had as a member of the courtesy staff. Under defendant\u2019s bylaws the credentials committee made recommendations concerning reappointment for all of defendant\u2019s staff members each year. In October 1975, the credentials committee recommended reappointment of plaintiff, but it also voted to monitor his records on an ongoing basis.\nIn February 1976, plaintiff asked a nurse to contact Dr. Charles Staley, who chaired the division of surgery, for consultation regarding a patient in intensive care. Staley told the nurse he was not able to consult on the case. Plaintiff made a note in the patient\u2019s chart stating that Staley refused to see the patient. On February 20, 1976, Staley wrote a letter to plaintiff objecting to the note in the patient\u2019s record, and asking plaintiff not to request any further consultations from him. Also on February 20, 1976, plaintiff received a letter from Dr. Morris Binder, who chaired the credentials committee, notifying plaintiff that the committee reviewed some \u201cdeficiencies\u201d in plaintiff\u2019s records and decided to monitor his records on an ongoing basis. Plaintiff wrote an apology to Staley.\nOn April 6, 1976, plaintiff admitted D.S. into the hospital for surgery which was scheduled for April 8. On April 9, Staley sent a memo to Binder in which he said that plaintiff had not seen D.S. for two weeks prior to his admission, and did not see him for two days after admission. The hospital scheduled the surgery for 3:30 p.m. on April 8, but Staley canceled the surgery when plaintiff failed to appear at the scheduled time. Plaintiff discharged D.S. from the hospital on April 9 without performing the surgery. Plaintiff sent a letter to the utilization review committee explaining that he wanted to discourage D.S. from undergoing the cosmetic surgery he requested, since plaintiff did not believe that the potential advantages were worth the risk. When he was initially unable to dissuade D.S., he agreed to admit him to the hospital. Plaintiff wanted D.S. to spend an extra day in the hospital before surgery because he suspected that D.S. was under the influence of various drugs. On April 9 he effectively persuaded D.S. not to undergo the surgery.\nOn May 25, 1976, Staley sent plaintiff a letter in which he criticized plaintiff for beginning a surgery one half hour late on May 19, 1976. Staley sent Binder a copy of the letter.\nPlaintiff met with Binder on May 27, 1976. Binder criticized plaintiff for failing to see his patients and write progress notes with adequate frequency. Plaintiff drafted a memo summarizing the meeting and he sent a copy to Binder. Plaintiff wrote that\n\u201cthe Credentials Committee evaluates each doctor on the staff in reference to his attendance at hospital meetings, *** the number of times he sees [his] patient[s], and the number of times that he writes hospital record progress notes. *** I told Dr. Binder that complying with these artificial guidelines for the measurement of quality of medical care [was] not consistent \u25a0with my principles of practice and that the problem would certainly continue and would probably only be resolved by a decision of the Medical Staff or Board of Directors.\n* * *\nIn my individual case I do think that there are possible solutions to the problem. One is to resign from the staff and the second is to be expelled from the staff. ***\nThere is a third alternative which *** is to change my status from that of courtesy staff to one of consulting staff. *** It would require *** referring [patients] to other physicians chosen by me as their primary admitting doctor[s].\u201d\nOn October 5, 1976, the credentials committee voted unanimously to recommend that the board of trustees not reappoint plaintiff. According to the bylaws, \u201cIn the event of an adverse Credentials Committee recommendation, the affected Member shall have the privilege of the floor at the meeting with the Attending Medical Staff which considers that recommendation.\u201d Plaintiff requested from Binder a written statement of the charges against him to help him prepare his statement to the staff. Plaintiff testified at trial that Binder told him he was to \u201cgive a general statement *** about anything relative to the matter that [he] thought would be appropriate,\u201d but Binder did not tell him the charges. Binder testified that he told plaintiff that the charges were the same as the matters they discussed at their meeting on May 27, and he told plaintiff he had the privilege of responding to those charges at the medical staff meeting. He admitted that he did not supply a written list of charges.\nAt the staff meeting on November 16, 1976, plaintiff discussed in general terms his desire to remain on the staff. After the staff dismissed him from the meeting, it voted to recommend that plaintiff not be reappointed. The bylaws provide:\n\u201cUpon his receipt of notice of an adverse recommendation [by the Medical Staff] or upon his receipt of notice of an adverse decision [by the Board of Trustees], the affected Member shall have fifteen (15) days within which to deliver to the President a written request for a hearing before the Judicial Review Committee. *** Under no circumstances shall a member be entitled to more than one (1) hearing before the Judicial Review Committee each time reappointment is sought.\u201d\nPlaintiff requested a hearing before the judicial review committee (JRC) and a written statement of the charges. The written statement specified five charges against plaintiff, which the JRC investigated in a five-hour hearing with plaintiff held on January 4, 1977. The JRC summarized its findings in a two-page report, in which it stated that the most important charge was that plaintiff did not meet \u201caccepted standards of medical care *** with regard to frequency of patient visits.\u201d The JRC answered in its report:\n\u201cThe committee carefully considered each of the records cited in this charge. The committee was unable to find any written or unwritten requirement with regard to frequency of patient visits and, therefore, attempted to apply a standard of reasonableness as dictated by the quality of medical care expected from a member of the Medical Staff of Lutheran General Hospital. There were a total of 33 charts which were reviewed by several members of the Medical Staff. Of these 33 charts, 16 were found to be OK and 3 were missing discharge summaries when reviewed and since these were present on the charts, these records were not further considered. Almost all of the remaining charts were reviewed. In each case, Dr. Head reviewed the medical problem with the committee and pointed out that each case represented a long-term chronic illness and the need for therapy of a chronic type but necessary to be done in an acute care institution. In each case, Dr. Head asserted that his only failure was that of writing a progress note. In each case he maintained that there was at least daily telephone communication with the patient usually or a staff nurse occasionally to insure that there was no status change which would require a personal visit. The Medical Staff representative did not assert that any patient had been harmed by this procedure nor tha[t] any specific patient[\u2019]s hospital stay had been unnecessarily prolonged by this procedure. The committee did not express either approval or disapproval of this approach to patient care, but attempted to apply both individually and collectively the above described standard. *** [Considerations of this charge probably formed the basis for each man\u2019s vote at the conclusion of the proceeding.\u201d\nThe JRC recommended that defendant reappoint plaintiff to the staff, thereby reversing the staff\u2019s recommendation.\nAccording to the bylaws:\n\u201cIn the event of a recommendation, made by *** the Judicial Review Committee *** for:\na. The modification of an adverse recommendation, then the body which made the adverse recommendation shall vote again on the matter and forward its second recommendation to the Governing Body [i.e., the Board of Trustees] which shall, upon receipt, take final action thereon;\nb. The upholding of an adverse recommendation in all respects, then the Governing Body shall upon receipt of the recommendation take final action thereon ***.\u201d\nOn March 15, 1977, the medical staff met to reconsider plaintiff\u2019s reappointment in light of the JRC report. The staff did not permit plaintiff to appear at the meeting. The staff voted to sustain its original recommendation to deny plaintiff staff privileges, thereby reversing the JRC\u2019s recommendation.\nThe board of trustees met on April 12, 1977. Binder attended and presented the recommendations of the credentials committee and the medical staff. The minutes of the meeting indicate that Dr. Donald Aaronson, who chaired the JRC, also attended the meeting. Binder had asked that one member of the JRC attend the board meeting in order to present that committee\u2019s recommendation. Aaronson testified at trial, in 1985, that he did not attend the board meeting. The board did not allow plaintiff to attend the meeting. The board voted not to reappoint plaintiff to the staff. William Brown, who chaired the board of trustees, wrote a letter to plaintiff in which he stated that \u201c[t]he Board of Trustees, at its meeting on April 12, 1977, reviewed the recommendations of the Attending Medical Staff, the Credentials Committee and the Judicial Review Committee\u201d before voting to discontinue plaintiff\u2019s staff privileges.\nPlaintiff filed his original one-count complaint in April 1979. In December 1984 plaintiff served interrogatories asking defendant to state the name, qualifications and opinion of its experts. Plaintiff filed his second amended complaint, also in one count, on March 6, 1986, the day before trial began. In section A of the complaint he sought damages for defendant\u2019s failure to follow the procedures set out in its bylaws; in section B he sought damages for defendant\u2019s \u201carbitrary and capricious\u201d decision to terminate plaintiff\u2019s staff privileges, and for its failure to \u201cafford plaintiff substantive due process.\u201d Plaintiff also filed a motion to bar the testimony of defendant\u2019s expert witness, Dr. John Porterfield, on grounds that defendant did not give plaintiff the notice required under Supreme Court Rule 220 (107 Ill. 2d R. 220) and because Porterfield\u2019s opinion lacked foundation. The trial court denied the motion.\nDr. Aaronson, plaintiff\u2019s first witness, testified concerning the JRC hearing. On cross-examination, he testified that he participated in drafting defendant\u2019s bylaws, and in his understanding the bylaws provide that \u201c[i]f the Judicial Review Committee makes any modification of [an adverse recommendation] such as reversing it, then it would go back to the body that made the original adverse recommendation. If they don\u2019t make any modification *** and just uphold it, then there is one further appeal ***.\u201d He testified that the staff\u2019s recommendation on reconsideration following JRC review is then sent to the board of trustees for final decision.\nDuring a break in the trial, plaintiff took Porterfield\u2019s deposition. He then moved for leave to file his third amended complaint in three counts. The trial court reserved the issue of whether to allow plaintiff to file the amended complaint.\nPlaintiff\u2019s next witness, Dr. Marvin Firestone, an expert on hospital bylaws and the malicious deprivation of staff privileges, testified that each hospital\u2019s bylaws must comport with principles of fundamental fairness. Thus, when a hospital considers reducing the privileges of any staff member, it must send that member notice of the charges, it must allow the member to prepare and present a defense at a meaningful hearing before an unbiased tribunal, and it must give the member the right to appeal the decision of the tribunal. Firestone testified that in his opinion, \u201cmodification,\u201d as it is used in the bylaws, means a change which leaves the decision basically adverse. Thus, because defendant\u2019s bylaws provided no further procedures after the JRC reversed the medical staff, the JRC\u2019s recommendation should have gone directly to the board of trustees, without any subsequent consideration by the medical staff. He concluded that defendant failed to follow its bylaws in the proceedings against plaintiff.\nFirestone admitted that, if the term \u201cmodification\u201d in the bylaws is interpreted to include a reversal, then defendant followed its bylaws in this case. However, he testified that under that interpretation the bylaws do not provide for fundamentally fair proceedings because the hearing before the JRC is then essentially meaningless: the JRC can offer only an advisory opinion. Since the final decision maker, the board of trustees, decided to discontinue plaintiff\u2019s staff privileges without directly hearing plaintiff\u2019s defense, in Firestone\u2019s opinion the proceedings were fundamentally unfair.\nAt the close of plaintiff\u2019s case, the trial court granted plaintiff\u2019s motion to file his third amended complaint, but it struck count II, which charged that defendant\u2019s acts were fundamentally unfair, for failure to state a cause of action. The court subsequently struck \u201call testimony produced by any party regarding whether the bylaws are flawed in providing fairness.\u201d The ruling apparently affected only part of Firestone\u2019s testimony. The court subsequently granted plaintiff leave to file a fourth amended complaint restating count I of the third amended complaint, which charged defendant with violating its bylaws, and stating as count II the charge from count III of the third amended complaint that defendant acted arbitrarily and capriciously.\nDr. Porterfield, an expert in hospital management and a former member of the Joint Commission on the Accreditation of Hospitals (JCAH), testified over plaintiff\u2019s objection that in his opinion defendant complied with its bylaws in the procedure by which it terminated plaintiff\u2019s privileges. Since the JRC did not uphold the medical staff\u2019s recommendation, its action constituted a modification of the staff\u2019s recommendation, within the meaning of the bylaws, and therefore the matter was properly sent back to the medical staff for a second vote after the JRC made its recommendation. He based his opinion in part on his work with the JCAH, where he participated in the development of guidelines for medical staff bylaws, although he thought that the JCAH Manual did not define \u201cmodification.\u201d He did not refer to any court decisions or bylaws of other hospitals in determining the meaning of \u201cmodification\u201d in defendant\u2019s bylaws.\nDr. George Scholly, a member of defendant\u2019s staff, testified over plaintiff\u2019s objection that in 1976 he reviewed charts for 32 of plaintiff\u2019s patients, admitted in 1975 and 1976, to determine the frequency with which plaintiff visited each patient. The JRC subsequently reviewed the same charts, and these charts formed the principal evidence the JRC considered in plaintiff\u2019s case. Scholly\u2019s notes concerning the charts indicate that plaintiff failed to see nine of his patients for at least two consecutive days. Plaintiff made no note on the chart of one of his patients until two days after he admitted the patient; he made no note for three consecutive days on the charts of four patients, and for one patient he failed to note any visits for five consecutive days. One other patient was in the hospital for six weeks, and plaintiff failed to see that patient on 16 days during that stay.\nAt the close of the evidence both parties moved for directed verdicts. The court directed a verdict for defendant on count I, and it denied motions for directed verdict on the remaining count. Plaintiff asked the court to instruct the jury that it could find defendant\u2019s acts arbitrary and capricious if defendant\u2019s discharge of plaintiff was \u201cnot according to an established rule, standard or criteria, or which is fundamehtally unfair.\u201d Instead, the court instructed the jury that it could find defendant\u2019s acts arbitrary and capricious if defendant discharged plaintiff \u201cwithout fair, solid or substantial cause or reason.\u201d\nOn appeal plaintiff argues that the trial court erred in that it (1) denied plaintiff\u2019s motion for directed verdict and granted defendant\u2019s motion for directed verdict on count I; (2) struck and dismissed count II of plaintiff\u2019s third amended complaint; (3) denied plaintiff\u2019s motion for directed verdict on count III of the third amended complaint and entered judgment on the jury\u2019s verdict for defendant on that count, contrary to the manifest weight of the evidence; (4) refused plaintiff\u2019s proposed instruction; and (5) admitted testimony from Porterfield and Scholly, but struck part of Firestone\u2019s testimony.\nI\nPlaintiff contends that the trial court should have granted its motion for a directed verdict on count I because defendant violated its bylaws when it sent the JRC\u2019s recommendation back to the medical staff for a further vote instead of sending the recommendation directly to the board of trustees.\nDefendant\u2019s staff forms a voluntary association whose bylaws form part of the contract between the association and its members. (Perkaus v. Chicago Catholic High School Athletic League (1986), 140 Ill. App. 3d 127, 133, 488 N.E.2d 623.) \u201cQuestions of contractual *** interpretation are matters of law for the court to decide ***.\u201d (Northern Illinois Construction Co. v. Zale (1985), 136 Ill. App. 3d 822, 824, 483 N.E.2d 1013.) Although the parties presented conflicting testimony regarding the proper interpretation, of the bylaws, there was substantial agreement regarding the actions which defendant took and the procedures it utilized in discharging plaintiff. Therefore we find that the trial court appropriately chose not to allow the jury to decide upon the disposition of count I.\nThe court must construe each provision of a contract in light of its other provisions (Board of Trade v. Dow Jones & Co. (1983), 99 Ill. 2d 109, 122, 456 N.E.2d 84), and in view of the scope and purpose of those provisions (In re Estate of Klinker (1979), 80 Ill. App. 3d 28, 30, 399 N.E.2d 299). Defendant\u2019s bylaws establish that a doctor is entitled to a hearing before the JRC whenever the medical staff votes to recommend a reduction in the doctor\u2019s staff privileges. Defendant granted plaintiff\u2019s request for such a hearing, and it gave plaintiff a list of the charges against him. The JRC heard evidence both for and against plaintiff. Members of the medical staff and the board of trustees received copies of the JRC\u2019s report which both summarized its findings of fact and stated its recommendation that defendant reappoint plaintiff to the staff, reversing the staff recommendation.\nDefendant sent the JRC recommendation back to the medical staff for further consideration. Although the bylaws specify procedures to follow when the JRC upholds or modifies a staff recommendation, there is no separate provision which details the procedures to follow after the JRC reverses a staff recommendation. Aaronson, who helped write defendant\u2019s bylaws, and Porterfield both interpreted \u201cmodification\u201d in the bylaws to include reversal, and thus they testified that defendant followed its bylaws in this case. Firestone testified that reversal was not a kind of modification, and he believed that in the absence of any express provision for reversals, defendant should have sent the JRC recommendation directly to the board of trustees. Plaintiff introduced into evidence a dictionary definition of modification under which reversal could not be considered a kind of modification.\nThe bylaws expressly provide that the JRC\u2019s recommendation is sent directly to the board of trustees whenever that recommendation is the same as the recommendation of the entire medical staff. The bylaws further provide that the JRC recommendation must be reconsidered by the medical staff whenever the JRC recommends a modification of the staff recommendation. The staff must then reconsider its original recommendation in light of the evidence adduced at the hearing before the JRC. However, in either case the bylaws require the concurrence of a majority of the medical staff in any recommendation before the recommendation, along with the relevant evidence, is presented to the board of trustees. The JRC, comprised of eight members of the medical staff, can make no recommendation which binds the entire staff. In these circumstances we find that the trial court properly concluded that the JRC\u2019s reversal of the staff recommendation was a kind of \u201cmodification\u201d of the recommendation, as \u201cmodification\u201d is used in the bylaws. Since defendant followed its bylaws when it sent the JRC recommendation to the staff for further consideration, we find that the trial court correctly granted defendant\u2019s motion for directed verdict on count I.\nII\nPlaintiff argues that the trial court erred when it struck and dismissed count II of this third amended complaint. Plaintiff alleged in count II that defendant acted in a fundamentally unfair manner because it did not afford him the right to be heard at each step of the process, it did not provide him a written list of charges before the meeting at which he spoke to the staff, and he was not allowed to appeal from the staff\u2019s final recommendation or the board\u2019s decision.\nDefendant is a private institution, and its medical staff is a voluntary association. In Virgin v. American College of Surgeons (1963), 42 Ill. App. 2d 352, 192 N.E.2d 414, this court stated that \u201c[cjourts annul expulsions from voluntary associations when they are *** contrary to rudimentary due process or natural justice.\u201d (42 Ill. App. 2d at 369.) However, voluntary associations do not need to accord their members all of the due process protections provided in the Federal Constitution. Siqueira v. Northwestern Memorial Hospital (1985), 132 Ill. App. 3d 293, 299, 477 N.E.2d 16.\nPlaintiff\u2019s memorandum regarding his meeting with Binder on May 27, 1976, indicates that he was aware of the general nature of the charges against him well before the meeting at which he addressed the medical staff. The lack of a formal, written charge at that point does not amount to a deprivation of fundamental rights. Plaintiff received a formal written statement of charges before the JRC\u2019s fact-finding hearing, and he had adequate time to prepare and present a defense.\nIn Siqueira the defendant hospital summarily suspended Dr. Siqueira\u2019s privileges and he requested a hearing before an ad hoc committee. The committee held a full fact-finding hearing, and it recommended lifting the suspension. The hospital board of directors rejected the recommendation and decided to suspend Dr. Siqueira indefinitely. The court found that the hospital had not deprived Dr. Siqueira of his right to due process, since the hospital held a fact-finding hearing, and the hearing committee\u2019s recommendation was subject to review by the medical executive committee and the board of directors. (132 Ill. App. 3d at 299-300.) In the instant case defendant\u2019s bylaws require essentially the same procedures, and following Siqueira we hold that these procedures adequately comport with the requirements of fundamental fairness. Although plaintiff could recover if defendant violated its bylaws or acted arbitrarily and capriciously, on the facts stated in his complaint, he has no separate cause of action for violation of principles of fundamental fairness. We find that the trial court properly struck count II of the third amended complaint.\nIll\nPlaintiff next claims that the trial court should have granted his motion for a directed verdict on count III of the third amended complaint because defendant acted arbitrarily and capriciously when it rejected the JRC\u2019s recommendation. We disagree. Although the board was bound to accept the JRC\u2019s findings of fact, it was not bound to accept its recommendation. (Siqueira, 132 Ill. App. 3d at 300.) The JRC found that in one year plaintiff either failed to see or failed to make chart notations for 10 of his patients for at least two consecutive days and he failed to record any contact with one patient for five consecutive days. The JRC found that these 10 cases involved long-term chronic illnesses, plaintiff said that for all 10 cases he contacted either the patient or the nurse by telephone every day, and the staff did not show that any patient had been harmed by the omissions. The JRC also heard evidence that plaintiff sometimes delayed filling out discharge summaries for substantial periods of time, and it heard evidence regarding D.S., the patient whom plaintiff finally discouraged from undergoing elective surgery after a three-day hospital stay during which plaintiff failed to appear for surgery at the scheduled time.\nThe JRC found that defendant had no published standard for frequency of patient visits or for writing progress notes, so it applied a standard of reasonableness to evaluate plaintiff\u2019s behavior. In the judgment of the majority of members of the JRC, plaintiff\u2019s actions were not unreasonable. The medical staff applied its own judgment to the JRC\u2019s findings of fact, and it decided to recommend that plaintiff not be reappointed to the staff, showing that a majority of its members felt that plaintiff\u2019s conduct was unreasonable.\nPlaintiff asserts that the staff and the board were not entitled to rely on their own information in arriving at their decisions. However, as plaintiff conceded at oral argument, there is no indication in the record that either the staff or the board considered any evidence not presented to the JRC. The board stated in its letter to plaintiff that it considered the JRC report and the recommendations of the medical staff and the JRC. The board chose to accept the staff recommendation, evidently agreeing with the staffs judgment that plaintiffs acts were unreasonable. On the basis of the evidence in the JRC report, we cannot say that the board\u2019s decision was arbitrary and capricious. The trial court correctly denied plaintiff\u2019s motion for directed verdict on that count of his complaint. Similarly, we cannot say that the jury verdict was contrary to the manifest weight of the evidence.\nIV\nPlaintiff contends that the trial court instructed the jury to apply an inappropriate definition of \u201carbitrary and capricious.\u201d Plaintiff proposed the following instruction:\n\u201cWhen I use the term \u2018arbitrary and capricious\u2019, I mean an action or omission which is not according to an established rule, standard or criteria, or which is fundamentally unfair.\u201d\nThe court refused the instruction and instead told the jury:\n\u201cWhen I use the term \u2018arbitrary and capricious\u2019, I mean an action or omission which is without fair, solid or substantial cause of reason.\u201d\nBoth plaintiff and the court based their instructions on the definition of \u201carbitrary\u201d given in Black\u2019s Law Dictionary (5th ed. 1979), page 96, which states that an act is arbitrary when it is done \u201c[without adequate determining principle; *** not done or acting according to reason or judgment ***. Without fair, solid, and substantial cause; *** not governed by any fixed rules or standard.\u201d In his proposed instruction plaintiff goes beyond the dictionary definition in an effort to reintroduce the issue of fundamental fairness, which the court properly excluded from this case. Plaintiff also sought to focus the jury\u2019s attention on the fact that defendant had no written standard for frequency of patient visits and for writing progress notes. In the absence of a written standard, the JRC, the medical staff, and the board of trustees all applied a standard of reasonableness to evaluate plaintiff\u2019s actions. Courts have long applied a standard of reasonableness to evaluate behavior, and the fact that people can disagree on the application of this standard to certain cases does not render the decisions based on this standard arbitrary. Similarly, the fact that the board and the staff disagreed with the JRC\u2019s application of the reasonableness standard to the defendant\u2019s acts does not render the board\u2019s decision arbitrary. We find that plaintiff\u2019s proposed instruction would have unfairly focused attention on the lack of a written standard in this case; the instruction which the court gave is a fair summary of the law.\nV\nFinally, plaintiff contends that the trial court committed prejudicial error when it permitted Dr. Porterfield and Dr. Scholly to testify and when it struck part of Dr. Firestone\u2019s testimony. Firestone testified that the procedures defendant afforded plaintiff were fundamentally unfair. We have held that the trial court correctly removed that issue from the case, and therefore Firestone\u2019s testimony pertaining to that count was also properly stricken. Insofar as Firestone\u2019s testimony was relevant to the issue of whether defendant followed its own bylaws, plaintiff was not prejudiced by the striking of the t\u00e9stimony because the court correctly decided that issue without assistance from the jury. The court did not strike Firestone\u2019s testimony in support of the charge that defendant acted arbitrarily and capriciously. When the court struck part of Firestone\u2019s testimony, it told the jury to disregard \u201call testimony produced by any party regarding whether the bylaws are flawed in providing fairness.\u201d This manner of describing the stricken testimony assured that the jury would not be prejudiced against plaintiff by the fact that the testimony was stricken. We find that plaintiff was not prejudiced by the trial court\u2019s decision to strike part of Firestone\u2019s testimony.\nScholly testified concerning the review of plaintiff\u2019s charts which he performed in 1976. Since Scholly\u2019s review formed an important part of the evidence before the JRC, the medical staff, and the board of trustees, it was highly relevant to a determination of whether the board\u2019s action was arbitrary and capricious. Therefore the trial court properly admitted Scholly\u2019s testimony into evidence.\nPlaintiff maintains that Porterfield\u2019s testimony should have been excluded because defendant failed to comply with Supreme Court Rule 220. That rule requires the parties to disclose their expert witnesses at the later of either the first pretrial conference or 90 days after the party who seeks to present an expert knows the substance of his opinion. (107 Ill. 2d R. 220(b)(1)); Fischer v. G & S Builders (1986), 147 Ill. App. 3d 168, 171, 497 N.E.2d 1022.) The record on appeal contains no indication of the date on which defendant disclosed Porterfield to plaintiff, nor does the record indicate the date of any pretrial conferences. Therefore, on the basis of this record we cannot say that the trial court erred in its decision not to bar Porterfield due to the alleged violation of Supreme Court Rule 220.\nPlaintiff also maintains that Porterfield\u2019s testimony should have been barred because he stated at his deposition that he based his opinion regarding the meaning of the bylaws on \u201ccommon knowledge.\u201d At trial he explained that he based his opinion in part on his work for JCAH on guidelines for hospital bylaws, even though he did not base his opinion on any specific publication of JCAH or on any court opinions. We hold that the trial court did not abuse its discretion in allowing Dr. Porterfield to testify as an expert. Hardware State Bank v. Cotner (1973), 55 Ill. 2d 240, 250, 302 N.E.2d 257.\nFor the reasons stated above we affirm the trial court decisions directing a verdict for defendant on count I of plaintiff\u2019s third amended complaint, striking count II, and entering judgment on the jury verdict for defendant on count III.\nAffirmed.\nMcNAMARA, P.J., and RIZZI, J., concur.", "type": "majority", "author": "JUSTICE WHITE" } ], "attorneys": [ "Donald T. Morrison & Associates, P.C. of Waukegan (Donald T. Morrison, of counsel), for appellant.", "Cassiday, Schade & Gloor, of Chicago (Rudolf G. Schade, Jr., Michael J. Gallagher, and Judith A. Schieber, of counsel), for appellee." ], "corrections": "", "head_matter": "LOUIS R. HEAD, Plaintiff-Appellant, v. LUTHERAN GENERAL HOSPITAL, Defendant-Appellee.\nFirst District (3rd Division)\nNo. 86\u20142792\nOpinion filed November 25, 1987.\nDonald T. Morrison & Associates, P.C. of Waukegan (Donald T. Morrison, of counsel), for appellant.\nCassiday, Schade & Gloor, of Chicago (Rudolf G. Schade, Jr., Michael J. Gallagher, and Judith A. Schieber, of counsel), for appellee." }, "file_name": "0682-01", "first_page_order": 704, "last_page_order": 719 }