PARRO, J.
Dr. Jerry Sanders and Beck Partners, LLC, d/b/a Cypress Psychiatric Hospital, (collectively, the plaintiffs) appeal a final judgment rendered in conformance with a jury verdict that dismissed their defamation claim against the State of Louisiana, Department of Health and Hospitals (DHH), Patricia Pittman, individually and in her official capacity as a DHH employee, and Renee Hullinger, individually and in her official capacity as a DHH employee. In connection with the appeal of that judgment, they also claim the trial court erred in granting a motion for summary judgment, which dismissed their civil rights complaints and various state law claims against the defendants.
Dr. Sanders is a licensed psychiatrist who, at the time this case was tried, had practiced in Louisiana for over 15 years. Beck Partners, LLC (Beck) is a minority-owned corporation in which Dr. Sanders, who is African-American, is the majority shareholder. Beck operates Cypress Psychiatric Hospital (Cypress) in Baton Rouge, Louisiana, which provides acute, inpatient psychiatric care for adults in a 30-bed environment. Dr. Sanders is the medical director of Cypress.
Under Louisiana's Hospital Licensing Law, LSA-R.S. 40:2100-2115, DHH is responsible for protecting the public health by developing, establishing, and enforcing standards for the patient care provided in hospitals and for regulating the operation and maintenance of hospitals in Louisiana.
Patricia Pittman, a registered nurse, was the program manager for hospitals with DHH from February 1997 until September 2007. Her duties as a medical certification program manager included processing applications for new hospitals and license renewals, investigating complaints, and supervising investigative surveys conducted by field officers. The types of surveys included initial licensing surveys, certification surveys, complaint surveys, follow-up surveys, and validation surveys. Renee Hullinger, who was also a registered nurse, was employed by DHH and had been since 1993, when she was hired as a medical certification specialist. During the relevant time periods, she was a medical certification program manager. Both of the program managers had authority to determine the timing and scope of investigations made by field surveyors, to prioritize investigations on the basis of the possible danger to patient care revealed by complaints, to determine which level to assign to any violations found during the surveys, to report survey results to their DHH superiors and to CMS, to supervise follow-up surveys to determine whether violations of regulatory standards had been remediated, and to recommend approval or revocation of state operating licenses and CMS certifications.
In November 2003, Dr. Sanders and Beck leased premises for a freestanding psychiatric hospital and in January 2004, submitted applications to DHH for its hospital license and Medicare certification. A complex process ensued, including multiple inspections and surveys required by law. On April 19, 2004, Cypress was issued a state license for 30 beds. The initial CMS survey in June 2004 turned up numerous discrepancies that had to be remedied,
The record shows that a number of complaints regarding Cypress were received and investigated by DHH during the next two years. Some were unsubstantiated, while others required remedial action by Cypress. Cypress's operating license was renewed in March 2005 and March 2006, indicating that it was in substantial compliance with all regulations. However, in May 2006, a survey was conducted in response to a complaint from an unidentified nurse at Cypress about numerous "elopements" of patients from the hospital premises, mistreatment of patients, and cover-ups by Cypress staff. Following this survey, Pittman and Hullinger recommended to DHH supervisors that Cypress's license be revoked for its continued inability to stay in substantial compliance with applicable standards and regulations. On July 12, 2006, Cypress was notified that its license was being revoked, effective thirty days from the date of the letter. Cypress exercised its right to suspensively appeal the revocation and continued in operation while the appeal was pending. Its CMS certification was not withdrawn, and its licenses were renewed by DHH in April 2007 and April 2008 with a notation on the license documents that the hospital's license revocation hearing was pending.
In January 2007, a complaint was lodged with DHH, alleging excessive use of medications and physical restraints, the use of chemical restraints, and sexual abuse of a patient by a Cypress employee.
Dr. Sanders and Beck filed this lawsuit on February 23, 2007, alleging that the defendants' actions constituted harassment, libel, slander, defamation, and conspiracy, as well as negligent, reckless, and intentional acts for which the defendants were liable under Louisiana law. They also alleged racially motivated violations of the plaintiffs' civil rights, including interference with the right to contract pursuant to 42 USC § 1981 (Section 1981), and violation of First Amendment rights of free speech and Fourteenth Amendment rights of due process and equal protection, made actionable by 42 USC § 1983 (Section 1983). In supplemental and amending petitions, they alleged that since the filing of the lawsuit, the defendants had conspired to continue a deliberate pattern and practice of harassment, including attempts to bring criminal charges against them; that these actions were malicious and racially motivated and were done in retaliation or reprisal against them for filing the lawsuit; and that these acts constituted obstruction of justice under Louisiana law and violations of their rights under 42 USC § 1985(2) and (3) (Section 1985).
Early in the discovery process, the defendants learned that the survey conducted by Pittman _______________________ and Hullinger in early 2007 had been recorded. They filed a motion in limine to exclude the audio tapes, any transcripts of the recordings, and any reference to the contents of the tapes during depositions and at trial. The motion was granted by the trial court after a hearing on February 9, 2009; the judgment was signed April 16, 2009, and the plaintiffs timely applied to this court for a supervisory writ. The writ was denied by this court on October 6, 2009.
In the meantime, the defendants had filed a motion for summary judgment on July 13, 2009, seeking dismissal of the plaintiffs' claims. It was granted in part in a judgment signed November 16, 2009, dismissing all of the racial discrimination and civil rights claims and all of the state law claims except defamation. The case went to a four-day jury trial on the defamation claim in November 2010. At the close of the plaintiffs' case, the defendants moved for a directed verdict, which was granted in part by the court, dismissing claims for pecuniary damages. At the conclusion of the trial, the jury returned with a verdict that the defendants had not defamed either of the plaintiffs. A judgment in accordance with this verdict, dismissing the plaintiffs' claims in their entirety and at their costs, was signed November 29, 2010. This appeal followed.
In one of their assignments of error, the plaintiffs assert that the trial court erred in granting the defendants' motion in limine and refusing to allow tape recordings of the named defendants into evidence at trial. The plaintiffs argue that, as part of their defense to the plaintiffs' defamation claim, the defendants claimed they were in "good faith" in taking the actions they did, and that the tape recordings contain direct evidence of the defendants' lack of good faith. Therefore, they should have been admitted. The defendants point out that the probative value of the recordings and transcripts was substantially outweighed by the danger of unfair prejudice, confusion of the issues, and misleading the jury. They argue that the recordings were largely inaudible and unreliable, did not identify the participants or speakers, were not certified or authenticated, were made without the defendants' knowledge or consent, and were conducted in violation of regulations requiring that such interviews be conducted confidentially. Therefore, they claim neither the recordings nor the transcripts were admissible and that the trial court did not abuse its discretion in refusing to admit them into evidence.
Under LSA-C.C.P. art. 1636(C), the court's ruling on a motion in limine as to the inadmissibility of certain evidence is reviewable on appeal. Generally, all relevant evidence is admissible. LSA-C.E. art. 402. Relevant evidence is evidence having any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence. LSA-C.E. art. 401. Whether evidence is relevant and admissible is within the discretion of the trial court, and its ruling will not be disturbed on appeal in the absence of a clear abuse of discretion.
In making its determination, the trial court should consider whether the tape accurately depicts what it purports to represent, tends to establish a relevant fact, and will aid the jury's understanding. The court should weigh against those factors whether the tape will unfairly prejudice or mislead the jury, confuse the issues, or cause undue delay.
After listening to the audio recording and reading the transcript(s),
The plaintiffs assign as error the trial court's granting of the defendants' motion for summary judgment and dismissing their civil rights claims. A motion for summary judgment is a procedural device used when there is no genuine issue of material fact for all or part of the relief prayed for by a litigant.
The plaintiffs alleged violations of their civil rights under Sections 1981, 1983, and 1985, claiming that the defendants singled them out for disparate treatment, held them to standards which do not exist at law or in practice, and continued to harass them on account of race and some unspecified prior political affiliation of Dr. Sanders. They claimed these acts impaired, interfered with, and violated their rights to make and enforce contracts, and thus violated Section 1981.
Section 1981(a) states:
With respect to Section 1981, the United States Supreme Court has explained that the provision was "meant, by its broad terms, to proscribe discrimination in the making or enforcement of contracts against, or in favor of, any race."
In the defendants' motion for summary judgment, they alleged, among other things, that there was no evidence of racial discrimination or motivation by racial animus, which is one of the elements needed for the plaintiffs to establish a prima facie case under Section 1981. Having examined the pleadings and the documents submitted by both parties in connection with the motion for summary judgment, we conclude that Dr. Sanders and Beck offered only conclusory allegations to support their claim that the defendants were racially motivated or acted in a racially discriminatory manner when they surveyed Cypress and attempted to revoke its license and CMS certification. Most of the surveys in which Cypress was cited for numerous violations of regulations and standards were done by other field surveyors before Pittman and Hullinger ever set foot in the hospital. In fact, the decision to revoke its license had already been made before Pittman and Hullinger participated in a survey at Cypress. The plaintiffs produced no evidence that these surveys, on which the revocation decision was based, were racially motivated or that Pittman's or Hullinger's reviews of those surveys were tinged with racial animus. Other than their own statements that Cypress was cited for things for which other hospitals were not, the plaintiffs produced no evidence that Dr. Sanders and Beck were treated differently than similarly situated non-minorities engaged in running an acute care psychiatric hospital. Moreover, the record does not show that either Pittman or Hullinger made any racially biased comments to or concerning Dr. Sanders. Simply referring to him occasionally as "the black doctor" does not constitute a pejorative comment. When asked in a deposition why he had filed suit against Pittman and Hullinger, Dr. Sanders replied, "I think they're racist." A subjective belief of discrimination, no matter how genuine, cannot support a claim of discrimination.
The plaintiffs also claim the defendants violated their rights under the Fourteenth Amendment's due process clause and equal protection clause, as well as their protected speech pursuant to the First Amendment, giving rise to a cause of action under Section 1983. Section One of the Fourteenth Amendment to the United States Constitution provides:
The First Amendment of the United States Constitution provides, in part, "Congress shall make no law ... abridging the freedom of speech." The remedy for violations of First and Fourteenth Amendment rights is found in Section 1983, which provides, in pertinent part:
A plaintiff has a cause of action under Section 1983 if he alleges that he has been deprived of a right secured by the Constitution by one acting under color of state law.
The plaintiffs acknowledge that DHH had the authority to conduct investigations and surveys at Cypress, but argue that the surveys were pretextual and exceeded the scope and manner of inspection allowed by law. They also claim that there was ample evidence that they were treated differently and that this treatment stemmed from a discriminatory intent, thus violating the constitutional guarantee of equal protection under the law. They argue that the defendants offered no explanation for their "fervent and express efforts" to cite the hospital for deficiencies and close it down. However, this argument misses the point. The defendants do not have to offer an explanation for their conduct until the plaintiffs have first established a prima facie case in support of their contentions. As noted with respect to the Section 1981 claims, the plaintiffs simply failed to do this. The record shows that most of the surveys were done in response to specific complaints to DHH from Cypress employees or patients. DHH did not always conduct on-site surveys of such complaints, as some of them were obviously the result of a patient's delusions. However, when surveyors investigated the more credible complaints, they often found deficiencies beyond the initial scope of the survey. The survey reports in the record demonstrate that problems existed and were discovered during the surveys. Some of these problems were minor; others were significant. All had to be pointed out to Cypress, so it could make necessary corrections. Cypress always had the opportunity to contest the findings or make changes in its procedures in order to regain its status of being in substantial compliance with the regulations and standards. Thus, the requirement of due process was not violated by the actions of DHH and its employees. Nor was a violation of equal protection shown by the evidence produced by the plaintiffs in connection with the motion for summary judgment. The plaintiffs make much of the fact that surveyors pointed out that Dr. Sanders' handwriting was sometimes difficult to read and that some of his prescriptions were unclear—criticisms that had not been made against him when he worked at other hospitals. They infer that these notations were made "at least in part for the purpose of causing an adverse effect on a minority-owned psychiatric hospital." This inference is not justified by the minor differences in treatment alleged by the plaintiffs. These differences certainly do not rise to the level of a denial of equal protection under the laws. Since the plaintiffs failed to satisfy their burden of proof on these issues on the motion for summary judgment, the district court did not err in dismissing their Fourteenth Amendment claims.
Although the plaintiffs allege that the defendants' actions violated and/or deprived Dr. Sanders of his rights under the First Amendment, there is no factual evidence demonstrating any attempted or actual interference with Dr. Sanders' rights to free speech. In their brief to this court, the plaintiffs claim the defendants attempted to "effectively revoke Dr. Sanders' license on account of his speech," but fail to show how his speech had anything to do with the defendants' actions at Cypress. Once again, the inferences far exceed the facts. The plaintiffs recite several instances when Dr. Sanders complained to the Secretary and Undersecretary of DHH, as well as to the CMS Region VI manager, of the harassment he felt was directed at him by allegedly racist DHH employees. Although the plaintiffs claim that retaliatory actions were taken immediately after such meetings, the record simply does not bear out this contention. The first revocation decision occurred in July 2006; Dr. Sanders met with the DHH officials after that decision, while the appeal was pending. Nothing was done to dissuade him from conversing with officials or from appealing the revocation decision, and, in fact. Cypress's license was renewed in 2007 and 2008. The plaintiffs failed to establish any causal link between Dr. Sanders' complaints to officials and the actions being taken by DHH in response to the surveys. Therefore, the First Amendment claims were properly dismissed on the motion for summary judgment.
The pertinent provisions of Section 1985 state:
The plaintiffs allege that Pittman and Hullinger conspired to revoke Cypress's license because it was a minority-owned psychiatric facility. As previously noted, there is no evidentiary support for the claims of racial discrimination. The fact that these two people worked together at DHH and coordinated their efforts in order to carry out their responsibilities, does not establish a conspiracy to deny the equal protection of the law or to deprive anyone of his property. Therefore, the Section 1985 claim was properly dismissed on the motion for summary judgment.
Two of the plaintiffs' assignments of error deal with the jury instructions given by the court as to the elements of a defamation claim and the defense of conditional or qualified immunity. Louisiana Code of Civil Procedure article 1792(B) requires that a trial judge instruct the jury on the law applicable to the cause submitted to them. The trial judge is responsible for reducing the possibility of confusing the jury and may exercise the right to decide what law is applicable and what law it deems inappropriate.
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The plaintiffs claim the district court erred in instructing the jury as follows:
They contend that since Pittman did not testify, the jury could not know whether anything she expressed at any time was meant to be a factual assertion or was just opinion. They further note that Hullinger was not asked whether any statements made by her were her opinion, as opposed to statements of fact. Therefore the "opinion" instruction was unnecessary under the evidence adduced, and it tended to mislead the jury. The record shows that when this objection was made by counsel to the district court, the court responded that the opinion instruction was directed to a statement made by DHH spokesman Bob Johanesson to a reporter for WAFB television, in which he stated that DHH had received a "litany of complaints" about Cypress. The court explained that whether the number of complaints received might constitute a "litany" was a matter of opinion; therefore, the opinion instruction was given. Having reviewed the jury instructions as a whole, we find that the district court adequately charged the jury concerning the elements of defamation. The opinion charge was an accurate statement of the law and, although directed at a very narrow fact in evidence, was relevant to the jury's deliberations on the defamation issue and was not misleading.
The other jury instruction to which the plaintiffs object concerned the defense of conditional privilege, as follows:
Plaintiffs' counsel objected to this instruction by the trial court, because Pittman did not testify and the issue of good faith or the lack of it was not brought up with Hullinger. Plaintiffs' counsel also told the trial court that she did not recall any evidence about either of them having an interest or duty concerning any particular statement or that the recipient of the statement had a corresponding interest or duty. The court explained that the privilege was directed to letters that were sent by Hullinger to the Louisiana State Board of Medical Examiners and the Louisiana State Board of Nursing, stating that attached information from the February 2007 onsite survey at Cypress was being sent to those boards for their "consideration and action."
In Louisiana, privilege is a defense to a defamation action.
In the present case, the defendants asserted the affirmative defense of qualified or conditional privilege in their answer to the petition, averring that "any action taken by them was reasonable, justified and necessary, given the plaintiffs' conduct and circumstances surrounding the business of [Cypress]." The defendants contend that the qualified or conditional privilege being claimed is that DHH and its employees, who had a duty to protect patient welfare, were simply communicating suspected wrongful acts to officials authorized to protect the public from such acts. In the Smith case, the supreme court was dealing with the question of whether a statutory conditional immunity shielded the defendants from liability for allegedly defamatory statements made during a peer review process that resulted in the termination of a surgeon's hospital privileges.
Given the facts and circumstances of this case, the court did not err in instructing the jury concerning the defense of qualified or conditional privilege. One of the plaintiffs' contentions was that the letters sent to the Louisiana State Board of Medical Examiners and the Louisiana State Board of Nursing were evidence of the defendants' discriminatory and malicious intent against Dr. Sanders and Beck. One of the defenses was that those communications were made in good faith by DHH and its employees, who had an interest in and a duty to protect patient safety, to officials charged with that same interest and duty. Another claim was that the defendants had defamed the plaintiffs by informing the Chief Executive Officer of Baton Rouge Medical Center that Cypress's license had been revoked, and an appeal was pending. One of the defenses to that claim was that the statements were true; the other was that they were communications from one party with a duty to safeguard the wellbeing of patients to another party with the same duty and interest. Therefore, the question of whether the defendants had or abused a conditional privilege certainly was a relevant issue and one that the jury had to decide, based on all the evidence in the case. We conclude that the district court did not err in instructing the jury on the elements of this defense to defamation.
Finally, the plaintiffs assert that the jury verdict was "clearly contrary to the law and the evidence." Having reviewed the law and the evidence presented, both in connection with the motion for summary judgment and at the trial, we disagree with this contention. The plaintiffs simply failed to establish a prima facie case of racial discrimination, denial of due process, denial of equal protection under the law, denial of free speech, or conspiracy to perform such actions. Therefore, the court correctly dismissed the civil rights claims on the motion for summary judgment. The court clearly and correctly explained the law of defamation and the defenses to that claim to the jury. The jury's verdict could reflect that they believed the allegedly defamatory statements were true or that the statements were made in good faith from persons having a duty and interest in patient protection to others who shared that duty with respect to Cypress and the plaintiffs. The trial transcript contains evidence to support either conclusion, both of which would defeat the plaintiffs' defamation claims.
For the above reasons, we affirm the November 16, 2009 judgment dismissing the plaintiffs' racial discrimination and civil rights claims and all other state claims except defamation, and we also affirm the November 29, 2010 judgment in accordance with the jury verdict, dismissing the plaintiffs' defamation claims. All costs of this appeal are assessed to the plaintiffs/appellants, Dr. Jerry Sanders and Beck Partners, LLC, d/b/a Cypress Psychiatric Hospital.