Shocking Provisions in Medical Staff Bylaws
Association of American Physicians and Surgeons
Jan 7, 2012

Submitted by a physician:

Here is one of the most shocking provisions concerning criteria for initiation of
corrective action in medical staff bylaws I have seen to date.


Comments from physician on above criteria:

1. "fails to provide quality care in an efficient or resource-effective manner

Physicians who prefer to use certain name-brand medications (or expensive IV
over generics, or who believe that certain surgical implants
are superior to cheaper alternatives could be prime candidates
for attack under this provision. I am aware of one case where the
spine surgeon refused to use very cheap, inferior implants because
he believed they were unsafe for patients, and the hospital attacked him
on that issue.

2. "significantly affects reimbursement to the Hospital in an adverse manner"

Those physicians who refuse to go along with the "creative" coding
of the professional coders employed by the hospital (perhaps because
they believe it is fraud) so as to maximize revenue from the third party
payor could find themselves on the hospital's "hit list." Also, what happens
if a managed care company insists that 100% of physicians on medical staff
participate with their plan or they will provide a much lower level of
to the hospital?

3. "causes an intensified review of the Hospital by any government or private
reviewing agency"

A physician who is not successful in correcting a hospital-created
deficiency or substandard or unsafe care situation by going through
the hospital system, may ethically decide to report substandard or
unsafe care to an outside agency - HHS, Dept of Health, JCAHO etc.
However, if the physician did that, it could lead to an investigation,
which would then meet criteria to initiate corrective action against the physician.
We have seen this type of policy promulgated in the "code of conduct" in
where they essentially specifiy "thou shalt not be a physician whistleblower."
This, however, is the first time I have seen it specifically listed in medical staff
bylaws as a criteria to initiate corrective action. Remember the Clark v. Columbia
HCA case from 2001. This is precisely what happened to Dr. Clark. Because he
reported substandard care to outside agencies (after calling it to the hospital
administration's attention and the hospital refused to correct the situation),
the hospital terminated Dr. Clark's privileges. Dr. Clark eventually prevailed in
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