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Physician's Guide to Medicine - Hospital Medical Staffs
Who is allowed on hospital medical staffs?
Aside from clinical practice, what prominent issues should a
physician be aware of as a medical staff member?
What do the JCAHO standards have to say regarding medical staff
self-governance?
What due process rights do physicians have in Missouri?
Are model medical staff bylaws available?
Who is allowed on hospital medical staffs?
Under Missouri's hospital licensing regulations,
hospital medical staffs are limited to licensed physicians, dentists,
psychologists, and podiatrists. It is up to the hospital governing body and
medical staff to approve or disapprove appointments to the medical staff and
determine which privileges will be made available to those members.
Aside from clinical practice, what prominent issues should a physician be
aware of as a medical staff member?
Since the medical staff bylaws are typically viewed by
courts as creating a contract between the medical staff member and the hospital,
a number of issues contained in the bylaws should be carefully considered:
(1) Due Process Rights - The medical staff bylaws should afford meaningful
notice, and an opportunity to be heard with respect to any corrective action or
disciplinary action to be taken. There should be an adequate opportunity to
present evidence to the hospital peer review panel. And the appellate body
should contain medical staff representation.
(2) Exclusive Contracts - The medical staff bylaws should not allow the hospital
to act without medical staff input regarding any medical staff member's
privileges or the closing of a department or service.
(3) Appointment Decisions - The bylaws should not permit the exclusive
consideration of economic or operational factors in the appointment and
reappointment decisions. If cost-effective- ness is a consideration in
reappointment decisions, the hospital should be required to educate the
physicians regarding clinical practices that may be more cost effective.
(4) Definitions - The term "clinical privileges" should be defined to include
access to facilities and personnel necessary to deliver health care. Otherwise,
the hospital may be entitled to restrict or revoke privileges without due
process.
(5) Joint Conference Committee Provisions - In the event of an impasse between
the hospital and medical staff, there should be a mechanism whereby a joint
conference committee or arbitrator or mediator can resolve the impasse. Any
joint conference committee should be equally balanced between physician and
hospital representatives.
(6) Hospital Staff Attorney - The hospital medical staff should have access to
an attorney who represents their interests and who does not have any potential
conflicts.
(7) Organizational Control - Medical staff officers should be elected entirely
by the medical staff. Also, the hospital should not be permitted to unilaterally
amend the medical staff bylaws.
What do the JCAHO standards have to say regarding medical staff
self-governance?
(1) There must be a single organized medical staff with overall responsibility
for quality of professional services and responsibility of
accounting to the governing body;
(2) The organization must establish hospital-specific mechanisms for appointing
and reappointing medical staff members and granting, renewing, or revising
clinical privileges;
(3) Medical staff membership and privileges are granted by the governing body,
based on medical staff recommendations, according to the bylaws, rules and
regulations, and policies of the medical staff and hospital;
(4) Mechanisms for appointment, reappointment and initially granting or renewing
or revising clinical privileges must be approved and implemented by the medical
staff and the governing body, fully documented in the medical staff bylaws,
rules and regulations and policies, and described to each applicant;
(5) The medical staff must develop and adopt bylaws and rules and regulations to
establish a framework for self-governance in medical staff activities and
accountability to the governing body;
(6) The bylaws and the rules and regulations of the medical staff must be
adopted by the medical staff and approved by the governing body prior to
becoming effective. Neither body may unilaterally amend the medical staff
bylaws;
(7) The bylaws, rules and regulations of the medical staff create a framework
within which medical staff members can act with a reasonable degree of freedom
and confidence;
(8) Medical staff bylaws include at least the following: the method of selecting
officers; the qualifications, responsibilities and tenures of officers; and the
conditions and mechanisms for removing officers from their positions;
(9) The bylaws must contain a mechanism for adopting and amending the bylaws,
rules and regulations, and policies of the medical staff;
(10) The bylaws must provide for medical staff representation and participation
in any hospital deliberation affecting the discharge of medical staff
responsibilities;
(11) The medical staff must be organized to accomplish its required functions;
(12) As part of the medical staff's quality assessment and improvement
activities, the medical staff must strive continuously to improve the quality of
patient care.
What due process rights do physicians have in Missouri?
Missouri's hospital licensing regulations provide as
follows:
"Bylaws of both the governing body and medical staff shall provide for appeal
and hearing procedures for the denial of reappointment and for the denial,
curtailment, suspension, revocation or other modification of clinical privileges
of a member of the medical staff. These bylaws also shall provide that
notification of denial or appointment, reappointment, curtailment, suspension,
revocation or modification of privileges shall be in writing and shall indicate
the resons(s) for this action."
Are model medical staff bylaws available?
Yes. The Missouri State Medical Association has created a
set of model medical staff bylaws. This document is available to Association
members.
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