In Mahmoodian v. United Hosp. Center, Inc., 185 W.Va. 59, 404 S.E.2d 750 (1991), the Court carved out a narrow exception to our holding in Sams for instances where there are allegations against a staff physician of professional incompetence or misconduct. In Mahmoodian, a physician challenged the revocation of his medical staff privileges at a private hospital after he was found to have committed improper conduct. The issue was "whether a decision of a private hospital adversely affecting a medical staff member's previously granted privileges at that hospital is subject to judicial review." 185 W.Va. at 64, 404 S.E.2d at 755. The Court distinguished the holding in State ex rel. Sams v. Ohio Valley General Hospital Association, 149 W.Va. 229, 140 S.E.2d 457 (1965) on the basis that it "involved . . . the denial of an initial appointment to a private hospital's medical staff," id, and explained that: "the scope of judicial review of health care peer review decisions adversely affecting the privileges of a medical staff member is essentially the same for private and public hospitals." 12 While such decisions of public hospitals must be reached after affording "due process," and such decisions of private hospitals must be reached after affording "fair procedures," recent federal legislation will encourage essentially all hospitals to use the same procedures." (185 W.Va. at 62 n. 2, 404 S.E.2d at 753 n. 2.) Finally, the Court held in Syllabus Point 1 of Mahmoodian: "The decision of a private hospital to revoke, suspend, restrict or to refuse to renew the staff appointment or clinical privileges of a medical staff member is subject to limited judicial review to ensure that there was substantial compliance with the hospital's medical staff bylaws governing such a decision, as well as to ensure that the medical staff bylaws afford basic notice and fair hearing procedures, including an impartial tribunal."