A victory for medical staff autonomy: Physicians win in Florida

Another court has recognized that medical staff bylaws are key to helping physicians protect patients.

Posted May 15, 2006.

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Recently, there was a good day for medical staff bylaws and physician autonomy in Florida, with patient safety also a big winner.

A circuit court there made an important ruling ensuring that physicians at Lawnwood Regional Medical Center -- not hospital trustees -- will be the ones in charge of peer review, medical staff privileges, contracts for hospital-based services and quality assurance.

That's just as it should be.

Physicians who comprise medical staffs are the ones who are in the best position to make decisions on medical issues that affect patients' well-being, not hospital trustees.

The Florida court recognized exactly that when it ruled that the state's 2003 Hospital Governance Law was unconstitutional because, by applying to just one of Florida's 67 counties, it gave a corporation a special privilege. The court also said the measure inappropriately gave the hospital the authority to alter medical staff bylaws.

Physicians in St. Lucie County, with financial help from the American Medical Association/State Medical Societies Litigation Center and expert advice from the AMA Organized Medical Staff Section, fought hard in court against the special law. The hospital had lobbied heavily and got the Legislature to pass the measure despite the Florida Medical Assn.'s extensive lobbying efforts against the bill.

Lawnwood pushed for the sour grapes law after it lost earlier court challenges doctors waged, with the help of organized medicine, to stop the hospital's attempts to alter medical staff bylaws and to remove medical staff officers and suspend physicians. The hospital argues that its actions were aimed at ensuring quality care for its patients.

But Judge Janet E. Ferris saw through that argument and the special law.

She summed up nicely in her March opinion why the law shouldn't stand: "If the substantive provisions of the law protect citizens in St. Lucie County, they should be enacted to protect citizens throughout the state. The fact that the law applies only to the hospital and its internal affairs leads inexorably to the conclusion that its alleged purpose of protecting citizen health and welfare is nothing more than a pretext."

The court also pointedly reaffirmed that medical staff bylaws are a binding contract between the hospital and medical staff that need to be followed once they are in place and can't be disregarded when a dispute occurs.

This is an important victory as financial pressures and increased focus on quality-of-care issues continue to lead to disagreements over medical staff bylaws. The law ultimately could have been used against medical staffs in other counties in the state. And like Florida physicians, doctors in many other states -- California, Illinois, Idaho and Ohio just to name a few -- have faced their own medical staff bylaw disputes in recent years. The battles likely will continue, and this ruling lays out precisely why medical staff bylaws are an important part of patient safety.

The AMA has long advocated to strengthen medical staff's right to self-governance, and has extensive policy on the issue. This case shows yet again that when doctors recognize that their rights are being violated and enlist the help of organized medicine, the best outcome for patients and doctors can be achieved.

As is to be expected, the hospital is appealing the decision. Now it's up to the appeals court to uphold the lower court decision that ensures the ever-important medical staff autonomy -- and ultimately patient safety.

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External links

American Medical Association's Physician's Guide to Medical Staff Organization Bylaws, free to members (link)

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