The War Is On: Why Your Medical Staff Needs to Incorporate and Obtain Its Own Independent Counsel

Charles Bond, Esq.

Disclosures

Medscape General Medicine. 2004;6(1):e36 

In This Article

Introduction

The hospital industry, led by its lawyers (notably Horty Springer & Mattern of Pittsburgh, Pennsylvania, who represent hundreds of hospitals nationwide), is out to decimate the independence of medical staffs and take away physicians' rights. Their objective is clear: they want to place unfettered power and economic control over doctors in the hands of hospital administrators.

How do we know? Because they have said so (Footnote 1).

In a January 31, 2003 letter to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (Footnote 2) commenting on its proposed new standards, leaders of the hospital bar made their position clear (Footnote 3). According to them, the medical staff is not an independent, self-governing body -- it is just a part of the hospital, like the dietary department. In their view, the medical staff is not responsible for quality of care, the hospital's board of directors is. Per these lawyers, the board of directors has the unilateral right to amend the medical staff bylaws. These attorneys also discourage medical staff meetings. Most tellingly, they believe:

...That hospitals should have the flexibility to define a core group of medical staff leaders who actually carry out most of the responsibilities of the medical staff. Reinforcing the perception that all actions flow from the entire organized medical staff as a democracy, in effect, perpetuates a structure that does not work and can actually impede the quality of care.

In other words, they see no need for elected medical staff officers, just doctors hand-picked by the administration to act for the medical staff. What they do not say (but most physicians know) is that the members of the hospital's hand-picked "core group" often receive hefty stipends from the administration or are dependent upon hospital contracts. They are not representative of the medical staff, but rather of the administration.

The letter goes on to take the position that hospitals can refuse to give applications to otherwise qualified doctors, based solely on the hospital's own economic plans or financial objectives. They also believe a hospital should refuse to credential any doctor who has a "financial conflict of interest," without defining what that is. Finally, they advocate eliminating any JCAHO standards assuring physicians fair hearing and appeal rights.

In short, the hospital attorneys have taken aim on over 50 years of solid development of "normal" medical staff relations and physicians rights and seek instead to emasculate the medical staff and place all power in the hands of the administration. If hospitals gain this power, they will have the ability to dictate the medical economics of their service area, including physicians' reimbursement and compensation. With no organized medical staff, administrators will also have the power to dictate issues of quality of care.

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