Why Fight For Self-Governance?
When medical staffs know their rights and powers, exercise them, and if opposed, demonstrate cohesiveness and staying power, the end result is a change in the environment of the hospital and a change in the relationship between the hospital and its medical staff. If you were to consult with the medical staff leaders who participated in the struggles at Community Memorial Hospital, Western Medical Center and Alvarado, you would likely be told that those struggles were worth it, because those medical staffs gained greater influence over matters affecting quality of care.
That influence is critical in many respects. Medical staffs are the principal advocates for quality of care in a system in which many decisions are predicated upon financial considerations. A study released in the May 2007 issue of the journal Medical Care found that hospitals are pushing too hard to streamline and cut costs and are putting patients at risk for medication errors, nerve injuries, infections and other preventable mistakes by doing so.
If we have a system of mutual accountability as the legislative intent in 2282.5 states, hospitals should not be allowed to "push too hard to streamline and cut costs" without someone pushing back. That's the function of the medical staff.
Of course, it is not fair that medical staff leaders, who are paid little if anything for their time, must divert attention away from their practices to serve as advocates for quality of care against competing forces which are, by comparison, extremely well staffed, well funded, and in control of the battlefield. And it is even more unfair that medical staffs should have to fund battles to establish their rights to be advocates for quality of care. However, when quality of care hangs in the balance, what is the alternative?
Where Do We Go From Here?
When I speak at large gatherings of medical staff leaders, there are always some leaders who tell me that my presentation does not reflect what's going on at their hospitals. They have enlightened administrators who work cooperatively with them every step of the way, recognize their authority, and facilitate their actions. My response is always the same: I am delighted and I wish it could be so everywhere. But just in case things change, I advise them to memorialize their successful system in their medical staff bylaws.
And for those not so fortunate, why not learn from the successes of other medical staffs? First, become knowledgeable about your rights and powers. This is not accomplished by going to hospital-sponsored seminars, but rather through your national, state and local medical associations, through independent legal analysis of your current situation, and through your own leadership retreats. Then, make medical staff cohesiveness a goal. Strive for consensus and for internal decision-making that places quality of care above all other considerations. Next, marshal your resources. Establish a treasury sufficient to enable a defense of your positions in court if necessary. Finally, be willing to assert your rights. Demonstrate your knowledge, your cohesiveness and your willingness to fight, and it's likely that you will not have to do so.
Tom Curtis is a partner with Curtis Green & Furman LLP in Pasadena. He graduated from Georgetown University Law Center in Washington, D.C. He was a founder of one of the first law firms specializing in the representation of physicians. His practice focuses on representing physicians and physician organizations in healthcare litigation, medical staff issues, peer review, and disciplinary and licensing matters. Curtis works closely with the California Medical Association and the American Medical Association and serves as chair of the American Bar Association Health Law Section Physician Issues Committee. He was the principal attorney for the Medical Staff of Community Memorial Hospital of San Buenaventura, successfully resolving the leading case in the nation on medical staff self-governance. He can be reached at 626/585-9800.
