Fla. doctor carries 1st Amendment issues to hospital


STUART, Fla. -- He's viewed by many as a solitary figure fighting a huge organization trying to quash his right to speak out.

Others see him as having crossed the line from simple criticisms to damaging falsehoods.

At stake are Dr. James Noble's ability to practice medicine in Martin County and Martin Memorial Hospital's reputation. But the debate reaches beyond county borders.

What rights does a doctor have to speak out on hospital policy? How far can a hospital go to protect its image?

Legal experts say Dr. Noble's situation is unusual and could make a good test case, should it ever go to court.

Almost all doctor-hospital disputes arise over medical practices or money. Rarely do First Amendment or whistle-blower issues flare up, as they have here.

Dr. Noble, a longtime critic of Martin Memorial, has accused some of the hospital's management of benefiting from conflicts of interest.

He says members of the board misused tax-free municipal bonds, did business with the hospital ranging from real estate to insurance and illegally earned commissions from those deals.

Richmond Harman, the hospital's chief executive officer, denies the accusations.

"He has accused me in a public forum of racketeering," Mr. Harman said. "He's accused the hospital of Medicare fraud. He may believe those things are true, but they are not true. I don't think those things are criticism.

"I want to draw a line between criticism and what I want to call fairly reckless statements."

Mr. Harman said the hospital has already suffered. Several people have said they won't donate to the not-for-profit facility because of Dr. Noble's statements.

But, perhaps more important, the hospital could lose the community's trust, which could lead to a loss of patients, Mr. Harman said.

Hospital officials suspended Dr. Noble's staff privileges in November.

If the hospital permanently revokes his privileges, the anesthesiologist effectively would be prevented from working in Martin County, since Martin Memorial is its only hospital.

The hospital, through its various committees, has said it does not doubt Dr. Noble's medical ability. But the committees say Dr. Noble has had confrontations with a doctor and a board member and may have violated hospital rules.

Officials also maintain that Dr. Noble has been disruptive. The hospital cited the doctor's many letters to the editor appearing in the Palm Beach Post and the Stuart News, his speeches before the city and county commissions and news media accounts.

"It's more a matter of freedom of speech than anything else," Dr. Noble said. "It's a dangerous situation to the public and to the profession I am sworn to uphold. What has happened to me can happen to any physician."

Dr. Noble says that if he loses his battle with the hospital, other doctors will be less likely to speak out.

The public has rallied around Dr. Noble through letters to the editor.

"He stands up for what he believes," said Dr. Dan Stalker, a friend who describes the anesthesiologist as generally quiet and shy.

Others call him argumentative and say he is overreacting.

A report from a 1983 psychiatric examination, taken during another hospital dispute, noted his "propensity to challenge authority and pursue his individual ideals with tenacity."

Dr. Noble, 47, moved to Stuart in 1974 and was the hospital's first, and for a time only, anesthesiologist.

He has waived his right to confidentiality, saying the public has a right to know about his case.

But hospital officials refuse to do the same, saying it would violate the peer review process. That stance has hampered Martin Memorial's image, Mr. Harman said, because it has prevented the hospital from publicly defending itself.

The confidentiality issue is but one of many aspects of the dispute.

Dr. Noble maintains that since the hospital is a not-for-profit body, is regulated by the state and receives some government money, it is a "quasi-public" institution and is subject to public inspection. And therefore its staff, he reasons, is protected by the First Amendment.

"Quasi-public isn't necessarily enough," said James Green, legal director for the Florida chapter of the American Civil Liberties Union.

"Basically, citizens have a constitutional right to speak freely and truthfully even if their speech turns out to be inaccurate as long as the speech was not made with a reckless disregard for the truth," he said.

That may not protect Dr. Noble from losing his staff privileges.

Florida is an "at-will state" when it comes to private employers who "can fire employees for any or almost any reason," Mr. Green said.

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