Protect medical staff autonomy

All's quiet at California's Community Memorial Hospital in Ventura. After more than a year of rumbling, the hospital's medical staff and board are no longer gearing up for a courtroom battle over medical staff autonomy.

Instead, the medical staff will drop its lawsuit against the hospital, and both sides are looking forward to an era of better cooperation.

The two sides achieved détente in the form of a negotiated settlement. The agreement is a big win for the doctors who filed the lawsuit in mid-summer 2003 after the hospital board adopted policies that took away the medical staff's right to self-govern.

Both sides said the settlement strikes the balance of power that allows doctors to protect patient safety and administrators to ensure that the hospital remains fiscally sound. It is that delicate balance of power that has delivered quality, safe medical care to patients in hospitals across the county for decades.

But it's also a balance that is increasingly at risk. Skirmishes like the one at Community Memorial Hospital have popped up in other parts of the country as well. Courts in Alabama, Arkansas, Florida, Idaho, New York and Ohio have been asked in recent years to resolve disputes over medical staff bylaws. Driven by mounting economic pressure as well as heightened focus on quality-of-care issues, the issue is not likely to go away any time soon. Physicians must remain involved and vigilant if they are to safeguard medical staff protections.

A look at the early salvos from Community Memorial Hospital gives physicians an idea of what to be wary about.

One of the key issues in the disagreement between the medical staff of Community Memorial Hospital and the hospital board was a policy adopted by the board that prohibited any physician who had a financial stake in a competing entity -- no matter the size of the stake -- from holding a medical staff leadership position or voting as a staff member. The hospital also adopted a "Medical Staff Code of Conduct" giving itself the authority to investigate and discipline physicians who didn't meet the standards. Both of these policies were in direct opposition to the medical staff bylaws.

It is also important to note that the Community Memorial Hospital medical staff fought back. Hard. They were vocal. They quickly enlisted the help of organized medicine. The California Medical Assn. and the American Medical Association stepped in with financial support and a friend-of-the-court brief.

When the Superior Court of California, County of Ventura, ruled that the Community Hospital medical staff had standing to sue under California law, physicians won a victory that likely helped along the hospital's decision to sit down at the negotiating table.

The resulting settlement has been hailed by the AMA as a victory for patients and physicians that will help ensure patient safety and quality of care.

The agreement it produced clearly delineates what medical staffs need to do to retain autonomy and is meant to be a template for settling conflicts of this nature at other hospitals.

It reiterates that medical staff, hospital administration and the board of trustees must comply with medical staff bylaw provisions, including those outlining medical staff elections, peer review, and credentialing and privileging. It also prohibits the hospital from unilaterally changing medical staff bylaws and gives the medical staff the right to obtain its own independent counsel.

The Community Hospital medical staff stood its ground and emerged with its autonomy intact. But these battles can be bruising, and there seems little doubt that both sides would avoid them if they could.

To that end, the AMA and the American Hospital Assn. are working on a draft of principles for hospital-medical staff relationships that they hope to have available by year's end. This resource should most definitely be a first stop for hospitals and hospital staffs facing these issues. Peaceful coexistence is possible, and it's all the better if it can be achieved without a stop in the legal battleground.