An introduction to the three-part series by John Hill, MD, the physician who was at the center of a major medical staff-hospital administration conflict.
With pleasure, I provide this introduction as a preface to a series of articles devoted to medical staff issues and rights. As one who has been in the vortex of a medical staff-administration maelstrom, I cannot emphasize enough the importance of knowing your rights as medical staff members and leaders. Equally important is constant vigilance in guarding and protecting these rights.
In 2002, the medical staff of Community Memorial Hospital in Ventura got a jarring reality check when we found that the traditional role of our medical staff had been subverted by an aggressive and controlling administrator and a complicit hospital board of directors. The opening salvo in our crisis was fired when the administrator, for all practical purposes, cashiered the entire hospital radiology department and replaced it with unknown locum tenens physicians who were unable to provide the quality services our patients had previously enjoyed.
When we approached our medical staff leaders about this serious medical quality issue, we received another rude awakening. It was immediately apparent that the administrator had been successful in co-opting a significant component of the medical executive committee's leadership--and that those leaders would not be of help in resolving this or subsequent problems. We then started to explore our options, first by looking at our medical staff bylaws. We were again jolted when it became obvious that our bylaws had been neglected and corrupted. They were so inconsistent that we couldn't even impeach our medical staff officers without their prior approval.
The medical staff, unfortunately, bore some responsibility for the genesis of this meltdown. When this situation was developing, it was a particularly difficult time for practicing physicians. We were being bombarded by managed care, capitation and medical group bankruptcies, as well as the alphabet soup of unfunded government mandates, such as EMTALA and HIPAA. As a result, apathy regarding hospital involvement had set in and medical staff participation played second fiddle to the economic survival of our practices. The resulting vacuum provided fertile ground for the administration's takeover of control from the medical staff.
Most physicians are aware of the positive outcome of the Community Memorial Hospital medical staff lawsuit. It has been almost three years since the medical staff gained an extremely favorable settlement. For more than two years, the hospital has been very fortunate to have a forthright, pro-physician administrator, Gary Wilde, who the hospital board selected with significant medical staff input. It is not an overstatement to say that his leadership changed the entire culture of the hospital.
Also, the hospital board of directors has new leadership and new membership, which has infused a refreshing collaborative spirit that accepts and includes physicians at every level. An early and gratifying example of this new philosophy was apparent when almost immediately after the lawsuit was settled, I was asked to sit on the committee tasked with rewriting the hospital board bylaws-something unheard of under the prior regime. Additionally, in an attempt to obviate future conflicts, the medical staff completely rewrote its bylaws, which were so contradictory that they were not amenable to revision.
As another sign of reconciliation, I am now a full voting member of the board of directors, along with three regular medical staff officers who also sit on the board. These examples are only a small sample of the positive changes that our hospital has undergone since the settlement, but they serve to illustrate the validity of our cause and what a committed medical staff can accomplish.
During the medical staff-administration crisis and subsequent lawsuit, the medical staff and I had the good fortune to be represented by Tom Curtis, and to work closely with Howard Lang, MD, on bylaws issues. I am certain that you will find their expert comments useful and informative. Also, over the past few years, as the chair of the California Medical Association Organized Medical Staff Section, I have worked with the CMA legal department on the annual revision of the CMA Model Medical Staff Bylaws. This valuable resource can provide your medical staff with a template for ongoing bylaws updates, which are essential to safeguarding your rights as an independent medical staff.