As hospitals and health systems continue to partner with one another, we are often asked to guide directors and trustees with respect to their duties when considering a combination. This concept can be a bit of a “rabbit hole” where advice can get muddy and confused, and this can be especially true when an organization is financially distressed or in a jurisdiction with a particularly intense degree of regulation. The need for this advice has become more acute as these partnerships have become larger and more sophisticated in an effort to create structures that are designed to be transformative to the communities served as well as to the participants to the combinations. Below, we outline three basic concepts that should apply to any combination, no matter the structure, context, or jurisdiction.
As a general rule, directors of nonprofit corporations have two main duties: the duty of loyalty and the duty of care.
Duty of Loyalty: As a general proposition, the duty of loyalty requires a director to do the following in conjunction with a proposed transaction:
Duty of Care: In addition to the duty of loyalty, directors and trustees owe a duty of care, which focuses on the process by which the decisions with respect to a proposed transaction are made. That process should mirror the significance of those decisions. In this regard, the duty of care includes a duty to be adequately informed before making decisions related to a proposed transaction.
Under concepts of common law, and under many state laws, a director must perform his or her duties of loyalty and care in connection with the consideration of the proposed transaction:
When performing his or her duties, a director or trustee is often entitled to rely on information, opinion, reports, or statements, including financial statements and other financial data, if prepared or presented by:
Officers or other employees of the organization that the director or trustee reasonably believes are reliable and competent in the matters, such as, for example, the organization’s CEO, CFO, CSO, General Counsel or the like
Legal counsel, public accountants or other persons as to matters the director or trustee reasonably believes are within that person’s professional or expert competence, such as outside counsel auditors or, for example, a nationally recognized investment banking or financial advisory firm
A committee of or appointed by the board, of which the director or trustee is not a member, if the director reasonably believes the committee merits confidence.
Under most laws, if a director or trustee complies with the above requirements with respect to any matter, that person will not be liable for any action taken (or for a failure to take action). This is often referred to as the “business judgment rule.” The rule means that a court will start its evaluation (or a claim of breach of fiduciary duty) by presuming that a director’s or trustee’s actions followed those requirements—to prevent those persons from becoming liable when they make a good faith decision that turns out poorly for the organization. In a legal challenge, the burden is on the challenger to establish facts that rebut that presumption by “clear and convincing evidence.”
Duty of Loyalty and Conflicts: With respect to any aspect of a proposed transaction in which any board member has an interest or potential interest, ensure that independent consultants and/or committees comprised of disinterested directors take the lead in evaluating such aspects. As noted above, if any conflict or potential conflict is identified, appropriate steps should be taken to ensure that the board is able to make decisions based on objective criteria.
Duty of Care and The Questions to Ask, Consider, and Answer:
When evaluating a proposed transaction the questions below provide an outline of the sort of inquiry a board member may want to consider.
As transaction volume remains strong, and as deals among provider entities become larger and more sophisticated, it’s important that directors and trustees of health care organizations understand their duties when considering these combinations. The foregoing basic concepts outline critical duties and ways to approach them regardless of the nature or structure of a particular transaction.
This article was originally published in Healthcare Business Today on October, 19, 2019.