Patients depend on hospitals and medical staffs to work together to build better healthcare delivery systems. But years after medical staffs were recognized as legal entities, where do these sometimes sensitive partnerships with hospitals stand? Hear what physicians have to say and learn how to strengthen the links.
Doctors who talk about the state of hospital-medical staff relations say things like "There's a lot of suspicion out there" and "Today's healthcare environment has created an atmosphere of tension between medical staffs and hospital management." Further, the factors creating the less-than-perfect circumstances probably aren't going to change soon. In other words, matters may get worse before they get better--especially now that lawyers, judges and juries are getting involved.
At the same time, doctors who talk about the state of hospital-medical staff relations also agree that the vast majority of hospitals and medical staffs function together pretty well. Only the outliers make headlines.
"By far the majority of medical staffs and hospital management get along," emphasizes Lytton Smith, MD, a family practitioner in Yorba Linda and secretary of the California Medical Association Organized Medical Staff Section. "Most hospitals function fairly successfully by each side seeing their mutual goals."
Of course, there are areas where conflict has occurred, Dr. Smith says. So things sometimes look gloomy because those cases get the most attention and the most reaction from hospitals and organized medicine.
Two important cases are playing out on opposite coasts. Recently in Florida, the Lawnwood Regional Medical Center and Heart Institute board of trustees asserted a right to control the medical staff and determine quality of care--and won in court. The case went to the state's highest court, which overturned the prior ruling, saying determinations of quality rest strictly with medical staffs. Dr. Smith calls that "a major affirmation of the role of the medical staff to monitor and give direction to quality of care."
The other case is playing out in an Orange County courtroom right now. In Santa Ana, Western Medical Center medical staff leader Michael Fitzgibbons, MD, expressed concerns about the institution's financial status and direction. In return for his concern, the facility's owner, Integrated Healthcare Holdings Inc., dropped his infection control contract--a move the doctor in question says is "clearly prohibited" by California law. The hospital also sued him for defamation, intentional interference with a contractual relationship, negligent interference with a contractual relationship, breach of contract, breach of the duty of good faith and fair dealing, and violation of the California unfair business practices statutes--all based on an e-mail, which IHHI indicated was responsible for its difficult contract negotiations with a state Blues plan.
Dr. Fitzgibbons says the IHHI suit fails to allege a legally recognizable claim and that it violates the state's anti-SLAPP law. SLAPPs, or "strategic lawsuits against public participation," are designed to quell public criticisms.
Dr. Fitzgibbons lost at trial and appealed. At press time, oral arguments were proceeding before a three-judge panel on the merits of the SLAPP argument. The merits of IHHI's case itself aren't at issue at this point. IHHI bought Western Medical Center and three other hospitals from Tenet Healthcare Corp. in 2004. In May 2005, IHHI defaulted on the two loans it had taken out to fund the acquisitions, leading to Dr. Fitzgibbons' missive.
According to a legal brief in support of Dr. Fitzgibbons filed by the California Medical Association and the American Medical Association, most of the information in his e-mail came from an article in the Orange County Register.
In their brief, the associations say physicians must be allowed to express their opinions on matters affecting the healthcare of their patients without fear of unfounded lawsuits. "The law protects physicians from retaliation where they advocate for medically appropriate healthcare for their patients," the amicus brief says. "These protections, however, would be severely undermined without the specific procedural remedy made available by the anti-SLAPP statute. Without judicial recourse against the tactics of others who intimidate physicians to silence their criticisms, physicians will never be able to truly and completely fulfill the panoply of their professional obligations to their patients."
Dr. Smith warns that the case will have "a very chilling effect" if it prohibits medical staffs from criticizing hospital management's handling of quality of care.
