MARSHALL – The Minnesota Supreme Court weighed in on a long-running legal dispute between Avera Marshall Regional Medical Center and members of its medical staff on Wednesday. A majority ruling reversed previous decisions from the Lyon County District Court and the Minnesota Court of Appeals, regarding the hospital’s medical staff and medical staff bylaws.

However, the Court’s decision doesn’t settle every aspect of the case, attorneys said Wednesday. It will be up to the Lyon County District Court to implement the ruling.

In 2012, a lawsuit was filed against Avera Marshall by Dr. Steven Meister, chief of the hospital’s medical staff, and Dr. Jane Willett, on behalf of the medical staff. The lawsuit alleged that Avera Marshall had violated medical staff bylaws and prevented the chief of staff and the hospital’s Medical Executive Committee from fulfilling their duties. However, the key issues in the lawsuit that a Lyon County District Court judge ruled on were whether the medical staff was a legal entity that could sue; whether the medical staff bylaws were a contract between the hospital and the medical staff; and whether Avera Marshall had the power to change the bylaws without the medical staff’s approval.

The district court ruling said the medical staff was not an entity that could sue or be sued in court. The ruling also said the medical staff bylaws were not a contract, and that Avera Marshall could change the bylaws without getting the approval of a two-thirds majority of the medical staff, as long as it “substantially complies” with procedures in the bylaws.

Meister and Willett took the case to the Minnesota Court of Appeals in 2012, where the district court ruling was upheld, and then to the state Supreme Court in 2013. Oral arguments in the case were given last February.

The Supreme Court opinion released Wednesday ruled on two of the three main issues in the previous court rulings. The Supreme Court opinion said that under Minnesota statutes, a group of people acting under a common name has the ability to sue or be sued in court. The Avera Marshall medical staff would qualify, the opinion said. The opinion also said the medical staff bylaws did form a contractual relationship between Avera Marshall and each member of the medical staff. Abiding by the bylaws is a condition to becoming part of the medical staff, the opinion notes.

The Supreme Court ruled to reverse the appeals court decision and remand the case to the Lyon County District Court for further proceedings.

The Supreme Court’s ruling was not unanimous. Justice G. Barry Anderson and Chief Justice Lorie Skjerven Gildea wrote a dissenting opinion upholding the previous court decisions. The dissenting opinion said the medical staff bylaws were not a contract between medical staff and Avera Marshall, and that Avera Marshall had the power to unilaterally change its medical staff bylaws. In the opinion, Anderson expressed concerns that the majority opinion would “encourage conflict between medical staffs and a hospital’s board of directors.”

Reactions from the plaintiffs in the lawsuit on Wednesday were positive.

“I feel absolutely overjoyed,” Meister said Wednesday afternoon. Meister said the Supreme Court’s decision emphasized the important role medical staff members had in making decisions that affect patient care.

Meister and Willett released a statement saying the Supreme Court’s decision was positive for physicians and patients.

“This action was started to protect the fundamental and unique role that we physicians serve in a hospital’s decision-making process that impact patient care,” Meister and Willet said in the statement. “We are pleased that the Minnesota Supreme Court agreed with us that the medical staff bylaws are an enforceable contract between physicians and the hospital. As members of the medical staff, we look forward to working with the hospital’s decision-makers to implement the Court’s decision.”

David Crosby, the attorney representing Avera Marshall in the case, said the hospital “respectfully disagrees” with the Supreme Court’s decision.

A statement released by Avera Marshall on Wednesday said, “Our position has always been that a hospital must be allowed to govern itself, particularly in the critical areas of patient safety and care.” The statement went on to say that maintaining a clear line of authority is consistent with the law. However, the statement also said the hospital’s commitment to patient care and safety will be unaffected by the Supreme Court ruling.

Crosby said the Supreme Court ruling leaves open the question of whether Avera Marshall did anything wrong by changing its staff bylaws. While the dissenting opinion discussed the hospital’s authority to change the bylaws, he said, the Supreme Court didn’t rule on it.

Crosby said the question may reappear when the case is remanded to the Lyon County District Court. But based on the earlier court rulings, Crosby said, he felt the district court was likely to agree with Avera Marshall.

Kathy Kimmel, attorney for the plaintiffs in the lawsuit, said the Supreme Court didn’t have to rule on the issue of Avera Marshall’s authority to change staff bylaws. If the bylaws are a contract with the medical staff, existing contract laws would apply to them, she said.

Kimmel said members of the medical staff hoped to meet with Avera Marshall representatives soon to work on implementing the Supreme Court’s decision.

The lawsuit had received attention from both the American Medical Association and the Minnesota Medical Association, with both organizations submitting friend-of-the-court briefs. MMA president Donald Jacobs also weighed in on the Supreme Court ruling in a statement Wednesday.

“The Minnesota Medical Association is very excited with the Court’s ruling because this is an important issue to all physicians and their patients,” Jacobs said. He said an independent, autonomous medical staff is critical to maintaining quality patient care at a hospital, and medical staff should have a voice in the decision-making process about patient care.