When the Hospital Suspends Your Privileges: Hard Lessons From a "Disruptive Physician" Hearing

A summary suspension of hospital privileges is one of the most dangerous events in a physician's career, and it often arrives with almost no warning. A nurse files an incident report. A colleague in another department complains about a disagreement over a patient's treatment. Human resources opens an "investigation." Then a letter arrives from the Medical Executive Committee stating that your privileges have been precautionarily suspended because of a "reasonable possibility" of danger to "the health or safety of any individual or the orderly operation of the Hospital."

Increasingly, these proceedings are not about clinical competence at all. They are about whether the physician is "disruptive" — a label that has become the preferred vehicle for removing doctors who are demanding, who argue with colleagues about patient care, or who simply do not get along with the people around them.

I recently represented a highly regarded physician through a months-long fair hearing at a New Jersey hospital after his privileges were summarily suspended on exactly these grounds. More than thirty witnesses testified. The physician had an excellent clinical record, and more than twenty colleagues — doctors, nurses, technicians, and physician assistants — testified that they had never seen him behave as alleged. The hearing officer nonetheless upheld the suspension. He then recommended that the physician be permitted to complete a professional assessment program and return to the staff, which is what happened: the physician completed the program, his privileges were restored, and he has since moved his practice to another institution.

That outcome — a loss at the hearing followed by a full restoration of privileges — is instructive precisely because it was not a clean win. The decision illustrates how these hearings actually work, where physicians' intuitions lead them astray, and why the rules are different in New York than in New Jersey.

The Core Problem: "Disruptive" Is in the Eye of the Beholder

Hospitals are complex, high-pressure environments in which physicians regularly disagree — sometimes sharply — about the right course of treatment. A physician who believes a colleague's proposed procedure is the wrong one for the patient will say so. That is not misconduct. It is medicine.

The California Supreme Court made this point more than sixty years ago in Rosner v. Eden Township Hospital District, warning that "considerations of harmony in the hospital must give way where the welfare of patients is involved," and that a physician who makes his objections known, "whether or not tactfully done, should not be required to risk his right to practice medicine." The court also recognized the obvious risk: vague standards of "temperamental suitability" invite arbitrary application and can become "a subterfuge where considerations having no relevance to fitness are present."

The American Medical Association's Code of Medical Ethics draws the same line. Disruptive behavior, it says, "is different from criticism offered in good faith with the aim of improving patient care." The professional literature is explicit that the label should refer to "a pattern of seriously inappropriate behavior that is deep-seated and habitual," not to "the physician who has an occasional bad day."

None of that stops hospitals from using the label broadly. In my experience, "disruptive physician" proceedings often share a recognizable pattern:

• The complaints come from people with their own motives. Staff whose performance the physician has criticized. Colleagues on the losing side of a treatment dispute. A department that resents a high-volume practitioner who demands efficiency.

• The "investigation" is incomplete or one-sided. Exculpatory witnesses are not interviewed. Prior investigations that cleared the physician are omitted from the report. Favorable interview notes never reach the committee.

• The charges are generalized rather than specific. The hospital relies on "communication challenges" and an alleged "culture" problem rather than concrete, dated incidents the physician can actually rebut.

• The physician is presented with a binary choice. Waive the right to a hearing and attend a "behavioral assessment" program, or insist on the hearing and remain suspended for as long as it takes.

Every one of those features was present in our matter. And yet the suspension was affirmed. Understanding why is the point of this article.

What the Hearing Taught

1. The physician often bears the burden — and it may be a heavy one.

Physicians tend to assume that the hospital must prove its case. Under many medical staff bylaws, the opposite is true: once a precautionary suspension is imposed, the physician who requests a hearing must prove that the suspension was "arbitrary, unreasonable, or unfounded or unsupported by credible evidence" — and in our matter the bylaws required that showing by clear and convincing evidence. The hearing officer applied that standard. Twenty favorable witnesses did not carry it, because the hearing officer found the handful of adverse witnesses credible and concluded that the hospital had acted on "a good faith perception" of the physician's behavior.

This is not a New Jersey peculiarity. The medical staff bylaws of one major New York City hospital system, for example, authorize corrective action whenever a physician's conduct is or "reasonably appear[s] to be" disruptive to hospital operations; permit summary suspension whenever "immediate action must be taken in the best interests of patient care and the hospital"; and then provide that, at the hearing, the physician "shall have the obligation to persuade the Hearing Committee, by clear and convincing evidence," that the reasons for the action "lack any factual basis" or are "arbitrary, unreasonable or not in compliance with applicable law." The rules of evidence do not apply, there is no pre-hearing discovery beyond a one-time exchange of witness lists and exhibits, and a physician who fails to appear "shall forfeit the right to a hearing." Those provisions are typical.

The practical lesson is that a fair hearing is not a trial of the accusers. It is a trial of the hospital's reasonableness, with the physician as the moving party. Read the bylaws' burden-of-proof provision before deciding whether to demand a hearing at all.

A related point for the colleagues who step forward. Testifying for a physician under suspension carries professional risk, and physicians are sometimes reluctant to do it. At a public hospital, at least, they have legal protection: in Laftavi v. State University of New York, 2023 WL 5019599 (W.D.N.Y. Aug. 7, 2023), a surgeon who was fired after submitting a written statement supporting a colleague at that colleague's privileges hearing stated a First Amendment retaliation claim, the court reasoning that physician competence and hospital privileges are matters of public concern.

2. Suspension and revocation are governed by different standards.

New Jersey law is comparatively protective of physicians facing termination of privileges. In Nanavati v. Burdette Tomlin Memorial Hospital, 107 N.J. 240 (1987), the New Jersey Supreme Court held that a hospital may not terminate privileges merely because a doctor is "irascible," has "criticized hospital practices and other doctors," or "annoys other doctors, nurses, and administrators." Hospital authorities "should present concrete evidence of specific instances of misbehavior," and the hospital must establish that "prospective disharmony will probably have an adverse impact on patient care." The court added that allegations of disharmony should never "be used as a ruse to deny or terminate staff privileges because of a doctor's race, religion, color, or gender."

We argued that Nanavati governed because a suspension of indefinite duration, coupled with a demand that the physician waive his hearing rights, was a termination in all but name. The hearing officer disagreed. He held that Nanavati's "probability" standard applies to revocation, and that a precautionary suspension is governed by the lower bylaws threshold — conduct that "may" pose a danger to patients or hospital operations — with no need to show actual harm under either standard. Whether or not that reading is correct, it is a warning: a hospital that proceeds by open-ended "precautionary" suspension rather than formal revocation may be able to avoid the more demanding standard altogether, while the practical consequences for the physician are the same.

3. Insight matters more than physicians expect.

This was the most consequential finding in the decision, and the hardest one for a physician who believes he has been wronged to accept. The hearing officer wrote that "significant to my assessment" was "the absence of any admission" by the physician that he had ever raised his voice or spoken disparagingly to anyone over four years, and his "placement of fault on those who filed the complaints." For the physician's account to be true, the hearing officer reasoned, "an enormous conspiracy" would have had to exist across the hospital — a conclusion he would not accept.

There is a real tension here. A physician who concedes misconduct at a hearing hands the hospital its case. But a physician who concedes nothing — not a raised voice, not a sharp word, not a single moment of frustration in four years of high-stakes practice — risks being found not credible on everything else, and risks being seen as exactly the person who needs remediation. Hearing officers, like judges, are people. They find the witness who acknowledges imperfection more believable than the one who does not. The right calibration is a strategic judgment that should be made with counsel before the physician testifies, not improvised on the stand. New York courts have said much the same thing in the pretext context: in Williams v. Mount Sinai Health System, 231 A.D.3d 690 (1st Dep't 2024), the First Department held that a physician's disagreement with the hospital's actions, or his belief "that his behavior was justified," does "not raise an inference of pretext."

4. Procedural flaws will not necessarily save you.

We documented substantial irregularities: a prior internal investigation that had cleared the physician of the central "yelling" allegation was left out of the investigative committee's report; a favorable witness interview was never provided to the committee; a hospital executive destroyed his notes of the meeting at which the suspension was decided; and the hospital's administrators testified incorrectly about whether the physician could attend the assessment program without waiving his hearing rights. The hearing officer acknowledged that the investigation "was not without flaws" and that the hospital had "not gather[ed] all of the available information" — and then found that none of it "materially undermine[d]" the committee's findings.

Procedural irregularities matter, and in some cases they are dispositive. But they are most powerful when they go to the heart of the charge rather than to its edges, and when the physician can show that the outcome would have been different had the process been followed. Documenting every irregularity is essential; expecting the irregularities alone to win is a mistake. New York law is, if anything, less forgiving on this point: Williams held that "any deviation from defendant's normal disciplinary procedures is insufficient to demonstrate pretext" — a reminder that a bylaws violation must be argued as a bylaws violation under Murphy, not merely offered as circumstantial evidence of bad motive.

5. The assessment program may be the fastest road back.

The hardest choice in our matter was the one the bylaws forced at the outset: waive the hearing and attend the assessment program, or demand the hearing and stay suspended. The physician chose the hearing — for understandable reasons, since he had not yet seen the investigative report, the program's start date was months away, and he reasonably feared waiving his only protection "sight unseen." The hearing officer himself acknowledged this was "no easy choice" and that the physician was being asked to "buy a pig in a poke."

But the hearing officer also observed that had the physician attended the program at the outset and "passed," he "would have returned to his practice" — likely months earlier, and without a fifty-page adverse decision in his file. In the end, the program is the route he took anyway, and it worked. The lesson is not that physicians should always accept the assessment track; it is that the decision must be made with clear eyes about what a hearing can and cannot accomplish, what the bylaws' burden of proof is, and how long the physician can afford to be out of practice.

New York: A More Deferential Framework, and Where the Leverage Actually Lies

Physicians practicing in New York should understand that New York has never adopted the Nanavati standard, and that the governing framework here is considerably more deferential to hospitals than New Jersey's — even for revocations.

The starting point is Public Health Law § 2801-b, which makes it an "improper practice" for a hospital to curtail, terminate, or diminish a physician's privileges "without stating the reasons therefor, or if the reasons stated are unrelated to standards of patient care, patient welfare, the objectives of the institution or the character or competency of the applicant." The Court of Appeals held in Fried v. Straussman, 41 N.Y.2d 376 (1977), that review under the statute "may assure only that the exclusion was made in good faith and on objectively reasonable grounds" — a formulation the Second Department applied again just last year in Guterman v. Stony Brook University Hospital, 237 A.D.3d 671 (2d Dep't 2025), describing the scope of review as "limited to the question of whether a hospital acted in good faith by proffering reasons for its action that are 'authentic and not pretenses.'" A court does not decide whether the charges were true; it asks whether the hospital's stated reasons were reasonably related to the statutory concerns, were based on the facts as the administrators reasonably perceived them, and were assigned in good faith. In Cohoes Memorial Hospital v. Department of Health, 48 N.Y.2d 583 (1979), the Court described the hospital's burden as "far from overwhelming."

New York courts have also squarely held that interpersonal conduct is a legitimate basis for action. In Karim v. Raju, 165 A.D.3d 504 (1st Dep't 2018), the First Department upheld a denial of privileges based on "poor interpersonal skills and difficulties in working with subordinates," finding those grounds reasonably related to the statutory standards and to the "core competencies" of interpersonal and communication skills and professionalism in the hospital's bylaws. In Heimlich v. St. Luke's-Roosevelt Hospital Center, 202 A.D.2d 361 (1st Dep't 1994), the court held that a physician's behavior being "disruptive to the hospital community" was "an independent basis for revoking his privileges." The Third and Fourth Departments apply the same deference, and have repeatedly said that it is "not within the province of the court" to decide whether the allegations against the physician were actually true. See Fischer v. Nyack Hospital, 140 A.D.3d 1264 (3d Dep't 2016); Meyer v. Zucker, 160 A.D.3d 1243 (3d Dep't 2018); Tabrizi v. Faxton-St. Luke's Health Care, 66 A.D.3d 1421 (4th Dep't 2009).

In other words, the standard our hearing officer applied in New Jersey — conduct that "may" affect patient care, judged by the hospital's good-faith perception — is close to the standard a New York court would apply in the first instance. A New York physician's leverage therefore lies in three places.

The hospital must follow its own bylaws.

Murphy v. St. Agnes Hospital, 107 A.D.2d 685 (2d Dep't 1985), remains the leading case, and its facts will sound familiar to any physician accused of being "disruptive." An anesthesiologist was summarily suspended after a committee meeting at which the discussion centered on "personality clashes" with other staff, the fact that some surgeons did not want to work with him, and speculation that his "mood swings" might signal impairment. The hospital's own Medical Board later found the allegations "lacking in substance," and a psychiatrist of the hospital's choosing found no illness — yet the suspension was not lifted. The Second Department annulled it because the hospital had failed to give written notice of the adverse determination and had acted through a committee the bylaws did not authorize to take disciplinary action. To suggest a hospital is not bound by bylaws mandated by state regulation, the court said, "would reduce the by-laws to a 'meaningless mouthing of words.'" The Department of Health's regulations, 10 NYCRR § 405.4, still require that medical staff bylaws set forth criteria and procedures for privileges and that they be enforced.

The first thing a physician should do upon receiving a suspension letter is read the bylaws cover to cover — including, as our New Jersey matter shows, the burden-of-proof provision and the section governing the choice between a hearing and a remediation program. The same New York bylaws described above, for instance, require that the notice of summary suspension be in writing and state "the reasons for the decision"; give the physician thirty days to request a hearing, after which the suspension becomes final; require that a majority of the hearing panel be "like specialty" peers, none of whom is "in economic competition with the subject practitioner" and none of whom sat on a committee that previously considered the same issues; and guarantee the right to counsel and to call and cross-examine witnesses. Each of those is a right the hospital must honor and a deadline the physician cannot miss. Every deviation should be identified and preserved in writing at the time it occurs.

"Authentic reasons, not pretenses."

Fried warned that § 2801-b does not allow "devious administrators to circumvent the legislative intent by fabricating reasons which are baseless, but which, if substantiated, would be related to institutional concerns." As the Court put it: "There must be reasons, but they must be authentic ones, not pretenses." That principle has recent teeth. In March 2026, the Fourth Department decided Fogel v. Kaleida Health, involving a physician whose privileges were precautionarily suspended and then revoked. Even though the Public Health and Health Planning Council had already found no improper practice, the court allowed the physician's § 2801-b claim to proceed because he alleged that the suspension and revocation "were based on false statements, as found by the Hearing Officer," and that reports to the National Practitioner Data Bank were "premised on statements manipulated and exaggerated" by the hospital's Chief Medical Officer. The court also refused to dismiss on immunity grounds, noting that neither the federal Health Care Quality Improvement Act nor New York's peer-review immunity protects knowingly false or malicious reports.

The record built at the fair hearing is what makes a pretext claim possible. A hospital that relies on an incident report later admitted to be false in part, buries an exculpatory interview, or resurrects complaints already investigated and closed in the doctor's favor is vulnerable on good faith even where, as in our matter, the hearing officer was unmoved. (Note that under Joseph v. NYU Grossman School of Medicine, 241 A.D.3d 1157 (1st Dep't 2025), Human Rights Law claims that arise from the privileges determination itself must first go through the PHHPC process, while claims arising from separate employment actions such as a demotion or termination may proceed directly in court.)

The two-step process, and no damages.

A New York physician who wants privileges restored cannot simply sue the hospital. Gelbard v. Genesee Hospital, 87 N.Y.2d 691 (1996), and Guibor v. Manhattan Eye, Ear & Throat Hospital, 46 N.Y.2d 736 (1978), require the physician first to present the claim to the Public Health and Health Planning Council, by filing the verified complaint that § 2801-b(2) prescribes. Only after that review may the physician bring an injunction action under § 2801-c, in which the court reviews the matter de novo. The requirement cannot be sidestepped by pleading breach of the bylaws; threshold review, the Court of Appeals said, "is too important to be circumvented by artful pleading." And the remedy is reinstatement, not money: under Mason v. Central Suffolk Hospital, 3 N.Y.3d 343 (2004), no action for damages may be based on a violation of medical staff bylaws unless the bylaws clearly create that right. The internal fair hearing is not a prelude to litigation. For most physicians, it is the case.

Do Not Resign, and Do Not Skip the Hearing

Whatever the forum, the reporting consequences of a suspension are severe and permanent. A professional review action that adversely affects privileges for more than thirty days must be reported to the National Practitioner Data Bank under the Health Care Quality Improvement Act, and a resignation while under investigation is reportable as well. New York's Public Health Law § 2803-e separately requires hospitals to report suspensions related to competence, misconduct, or patient safety to the Office of Professional Medical Conduct. Those reports follow a physician to every future credentialing application.

Two Fourth Department decisions illustrate the cost of walking away. In Virk v. Kaleida Health, 227 A.D.3d 1422 (4th Dep't 2024), the physician declined to request a hearing on his precautionary suspension and resigned; his later claims failed in part because the hospital had offered "adequate notice and hearing procedures" that he chose not to use. In Corines v. Catholic Medical Center, 149 A.D.2d 591 (2d Dep't 1989), a physician's unexcused failure to appear at his post-suspension hearing was held to waive "both his right to a hearing, as well as any further review by the [hospital]." And once a report reaches the Data Bank, it is very difficult to attack: in Joseph, the First Department dismissed a defamation claim over an NPDB entry because the physician had not alleged the hospital's "knowledge of falsity," which federal law requires to overcome the reporting immunity. The hearing is where the record that could later show falsity gets made.

Our client did not walk away. He fought the suspension, lost the hearing, completed the program the hearing officer recommended, regained his privileges, and is practicing today. That is not the outcome he wanted at the outset. But it is a far better outcome than the one that awaits the physician who resigns under investigation, or who assumes that the truth will speak for itself.

A Final Word

Physicians are trained to advocate forcefully for their patients, and the profession's own ethical rules protect that advocacy. But a privileges proceeding is not a clinical debate, and it is not won by being right about the medicine. It is decided by a hearing officer applying the hospital's bylaws, often with the burden on the physician, who will weigh the physician's credibility and self-awareness at least as heavily as the hospital's procedural lapses. The physician who understands that before the first witness is called — and who makes the hearing-or-remediation decision with clear eyes — is the one who preserves the ability to practice.

Ethan A. Brecher has practiced employment and commercial litigation for more than thirty-five years and represents physicians and other professionals in privileges disputes, fair hearings, and related litigation in New York and New Jersey. He also serves as an arbitrator on the American Arbitration Association's Commercial, Employment, and Consumer panels. He can be reached at ethan@ethanbrecherlaw.com.

This article is for general informational purposes only and does not constitute legal advice. Reading it does not create an attorney-client relationship. Client matters are described in general terms to protect confidentiality.