California deal reaffirms medical staff autonomy

One of the more public fights between a hospital's medical staff and its administration and board has been resolved in a way that physicians say maintains the independence they need, while also fostering better cooperation between the two sides.

"Things are definitely looking up," said orthopedic surgeon John Hill, MD, medical staff president at Community Memorial Hospital in California. "The most important thing is that we accomplished the things we set out to do."

What the medical staff set out to do more than a year ago was to re-establish a balance between the hospital and medical staff that allows physicians to protect patients' safety and lets administrators ensure the hospital is financially sound.

The California physicians hope their agreement will serve as a model for other physicians embroiled in conflicts with hospitals nationwide.

Relationships between the two entities have traditionally experienced some strain, but the tension has mounted as financial pressures on both have increased.

Things became so strained for doctors on the medical staff at Community Memorial Hospital of San Buenaventura in Ventura, Calif., that they sued the hospital in 2003 after the board adopted policies recommended by the administration that took away the medical staff's right to self-govern.

For example, the hospital adopted a 20-page "Medical Staff Code of Conduct" under which the hospital gave itself the authority to investigate and discipline physicians not meeting the conduct standards. The hospital also decided that physicians with a financial stake in an entity competing with the hospital couldn't hold a medical staff leadership position or vote as a staff member.

But physicians, board members and administrators at the hospital say they've put their differences behind them.

On Aug. 18 they announced that they have agreed to a settlement that will allow them to move forward with "renewed trust and unity." The agreement is expected to be finalized Sept. 21 when the medical staff is scheduled to vote on proposed bylaw changes outlined in the settlement.

Both sides were pleased with the agreement and expect the medical staff as a whole to give its approval.

"The settlement confirms the rights of the self-governance of the medical staff," said Tom Curtis, an attorney who represented the medical staff. "It also establishes a framework for resolving conflict in the future."

The hospital has hired a new president and CEO, Gary Wilde, since the lawsuit was filed, and physicians say that helped ease the tension.

"We are all very happy with the new administration in place since April," Dr. Hill said. "It's physician-friendly."

At one point, the previous administration refused to recognize Dr. Hill as the medical staff president because of his small financial interest in another entity.

Hospital administrators did not return calls for comment, but in a joint statement with the medical staff president they said that they are united in their resolve to support physicians and other caregivers at the hospital.

"The medical staff has full confidence in the board's leadership, and the board recognizes the medical staff's indispensable role in fulfilling CMH's mission," Community Memorial Hospital said in the statement.

A framework for others

Doctors say the agreement addresses their grievances, and they hope other physicians can use it as a template.

Among the highlights:

• The medical staff, hospital administration and board of trustees must comply with medical staff bylaw provisions, including those outlining medical staff elections, peer review, and credentialing and privileging.
• The hospital governing body cannot unreasonably withhold approval of medical staff bylaw amendments.
• The hospital staff cannot unilaterally change medical staff bylaws.
• The medical staff has the right to obtain its own independent legal counsel and to take action against the hospital using its own dues fund.
• The hospital administration will return the $250,000 medical staff dues fund that it confiscated before the lawsuit was filed.

"These are much more reasonable policies," said California Medical Assn. legal counsel Greg Abrams. The CMA, along with the American Medical Association, supported the physicians' lawsuit.

Abrams said that the settlement also sends a message that organized medicine is serious about making sure hospitals don't trample on medical staff rights. He said that without cooperation between the two sides, physicians will choose to take their patients to another hospital if they have the option.

"It's a relationship," Abrams said. "There has to be respect from both sides."

Added benefits

The lawsuit sparked other significant advances in California, doctors said.

A court ruling in the case gave medical staffs standing to sue hospitals -- a right hospitals argued that staffs didn't have.

The ruling spurred California lawmakers this summer to pass a measure that would strengthen the hospital medical staff self-governance rights and pave the way for medical staffs to resolve future disputes in court. The law awaited the governor's signature at press time.

Abrams said the Ventura experience should make doctors pay more attention to their own relationships with hospitals and make sure they have their own attorney to consult.

Hospital-recommended changes to bylaws; quality issues being decided by the hospital without medical staff input; external medical chart reviews without the medical staff's knowledge; and administrators demanding to be part of medical staff meetings are warning signs that a medical staff could be losing autonomy.

"It's important for doctors to pay attention," Abrams said.