A recent unpublished California Court of Appeal decision—Najibi v. Providence Valley Service Area Community Ministry Board—illustrates real-world tensions that arise when hospital boards and medical staffs approach the same situation from different institutional vantage points. This case is also a useful springboard for exploring the challenges hospital boards and medical staffs face at the intersection of behavioral concerns, peer review and governance.
The Facts: A Workplace Investigation Sparks Concern
Dr. Sasan Najibi, a long-standing member of the medical staff at Providence Saint Joseph Medical Center, became the subject of a hospital-initiated workplace investigation in late 2021. The investigation was led by an ad hoc committee of the Board and concluded that Dr. Najibi contributed significantly to a "toxic work environment" that created "tension and hostility" and posed an "imminent danger to patient and caregiver safety."
Importantly, these findings weren't based on clinical care in the technical sense, but on workplace behavior with downstream effects on the delivery of care. The Board, consistent with its responsibility to oversee hospital operations and ensure patient safety, urged the Medical Executive Committee (MEC) to summarily suspend Dr. Najibi's privileges.
After a six-month investigation, the MEC was given only 30 minutes to review the findings. The MEC declined to impose a summary suspension, citing the lack of direct witness statements and preferring further review. The Board then imposed the suspension on its own under Business and Professions Code section 809.05.
The Litigation: Process Challenges and Procedural Lessons
Following the Board's action, Dr. Najibi filed suit, arguing that the summary suspension and subsequent peer review proceedings did not comply with the medical staff bylaws or state law. Among other things, he challenged the redaction of witness identities and the appointment of arbitrators and outside physicians to serve on the hearing panel.
Ultimately, the courts didn't weigh in on those claims. Instead, the courts turned to a bedrock rule of peer review hearings: physicians must first exhaust the hospital's internal peer review process before suing in court. Because Dr. Najibi's peer review proceeding was still underway, his lawsuit was premature and his claims were dismissed.
Key Takeaways: Practical Lessons for Healthcare Leaders
Though Najibi doesn't break new legal ground, it reinforces some critical points for hospital and medical staff leaders:
Behavioral concerns are peer review issues. Unlike a surgical error or a missed diagnosis, disruptive or unprofessional conduct often doesn't come with a clear before-and-after moment. Its effects can be gradual, diffuse and cumulative—eroding trust, increasing turnover and undermining collaboration in ways that ultimately impact patient care. That makes these cases more difficult to investigate and document, but no less serious. When behavior compromises the functioning of a care team, it falls squarely within the scope of peer review. And early intervention is key. Addressing behavioral concerns before they become entrenched helps avoid more serious actions like summary suspension or board intervention. It's also fairer to the provider, giving them a chance to improve before taking action.
Peer review is about protecting all individuals in the care environment. The Board's findings focused on threats to both patient and caregiver safety, aligning with the law that permits summary suspension to prevent danger to the health of any individual. This highlights an often-overlooked aspect of peer review: hospitals and medical staffs are justified in acting when a physician's conduct creates a risk to nurses, staff or others—not just patients.
A strong working relationship between the Board and MEC is essential. Hospital boards and medical staffs must work together to improve patient care. They won't always agree on how to do that and that's okay. But everyone loses when communication breaks down. An MEC that distances itself from the Board risks being sidelined at critical moments. A board that oversteps can alienate physicians on the front lines of patient care. And most importantly, when boards and medical staffs aren't rowing in the same direction, patients ultimately bear the consequence. The better path is mutual respect, open dialogue and professional collaboration.
Peer review works best when grounded in mutual respect, clear communication and objective decision making. Medical staffs should engage with legal counsel early and often to navigate issues strategically. An engaged, well-advised peer review process is a strong safeguard of medical staff autonomy and an effective tool for protecting patients.
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