December 22, 2016

Posted on December 22, 2016December 29, 2016 by hortyspringer

QUESTION: As we are preparing for a medical staff hearing, a member of our Medical Executive Committee asked why our Medical Staff Bylaws state that the Chief Executive Officer appoints the hearing panel and not the Chief of Staff since it’s the Chief of Staff who knows most of the members of the medical staff. We are trying to figure out whether this was a typo or not. Should the Chief of Staff appoint the panel?

ANSWER: No – that’s not a typo! While we do still sometimes see bylaws which assign the Chief of Staff the responsibility to appoint the hearing panel (and worse yet, occasionally it’s the whole Medical Executive Committee that does so), it’s long been our recommendation that the CEO or the CMO fulfill that responsibility – in consultation with the Chief of Staff.

This is because, generally speaking, the Chief of Staff, both in his/her role as a Medical Staff officer as well as a member of the MEC (the body that will most often be making the adverse recommendation that triggers a hearing) tends to be someone who is very intimately involved in the underlying matter that led to the hearing. The Chief of Staff will frequently be the individual who engaged in collegial intervention and other progressive steps with the affected physician, who was involved in the development of any conditions or restrictions and, ultimately, is involved in the adverse recommendation made by the MEC as the chair of that committee. When an involved Chief of Staff is then responsible for appointing the hearing panel and presiding officer, we have seen the argument made that the selections were biased in favor of the MEC and are not neutral – which can lead to objections and legal challenges (both before and after the hearing) to the appointment of the panel.

While we know that these claims are largely groundless, it is very important to manage the appearance of fairness at all steps of the hearing process. The goal is to isolate the volunteer physician leaders – like the Chief of Staff – from these types of claims and allegations as much as possible, which is why the CEO or CMO should appoint the panel after consulting with the Chief of Staff.

January 28, 2016

Posted on January 28, 2016January 28, 2016 by hortyspringer

QUESTION: Our MEC voted at its last meeting to make a contribution to the political campaign of Ben Carson, from the Medical Staff fund. There was some talk about how great it would be to see a doctor leading the country. The Medical Staff fund is comprised solely of dues paid by Medical Staff members. The Chief of Staff and the Secretary/Treasurer are the only signatories to the account. The money is held in an account associated with the hospital’s Employer Identification Number (“EIN”), but the hospital has never spent any money from the account and does not intend to exercise any control over the money. We consider the money to belong to the Medical Staff. So, is the donation okay?

ANSWER: As a general rule, physicians can spend their money however they see fit. The same is not necessarily true of a Medical Staff. Because the Medical Staff is an integral part of the Hospital, rather than a separate legal entity, when the Medical Staff controls and spends money, it is the legal equivalent of the hospital controlling and spending that money. So, any use of the Medical Staff fund must be consistent with the way the hospital could and would use the money. That does not mean the hospital has to be involved in each decision to spend from the Medical Staff fund (which is why the leaders are signatories to the account). But, it does mean that the hospital should step in to prevent spending that is inconsistent with the hospital’s mission or legal compliance.

In the case of your Medical Staff, a donation to the campaign of Ben Carson would be prohibited if your hospital is a 501(c)(3) nonprofit since the federal tax code which exempts such organizations from taxation prohibits nonprofits from participating in any campaign activity for or against political candidates.

If the physicians on your Medical Staff feel very strongly about supporting Ben Carson, they are of course welcome to pool their resources and submit a campaign contribution together, as a group. But, that money cannot be pulled from the Medical Staff fund without running afoul of the tax code.

If your hospital is a for-profit hospital, you are not subject to the same prohibitions on spending as nonprofits. Even if a campaign contribution would not put you at risk of violating federal law, however, be aware that it may not be consistent with the goals of the organization. In what way does Ben Carson’s success as a presidential candidate matter for the hospital and its patients’ quality? Or its physicians’ ability to provide quality care to hospital patients? If there are identifiable benefits, then perhaps a contribution makes sense. But, if not, then the contribution is a questionable spending of dues.

To avoid any confusion in the future, we suggest adopting a policy governing Medical Staff dues, which specifies who will be the signatories, the authority of the signatories (for example, “any spending over $500 per transaction requires the signatory to obtain the consent of the MEC or Board”), and the types of spending that are and are not appropriate and authorized.

September 17, 2015

Posted on September 17, 2015 by hortyspringer

QUESTION: Our MEC recently commenced an investigation regarding a practitioner with a long history of behavioral incidents. The MEC has decided to conduct the investigation itself. Who should be present for the investigation? All of the people normally present at MEC meetings? Only members of the committee? Only voting members of the committee?

ANSWER: If the MEC has decided to undertake a task, the whole committee can and should be involved. This means all members of the committee, including any individuals who are members by virtue of their position (i.e., ex officio members) and regardless of whether those members are physicians or have voting rights. Members are members because they have a valuable role to play (sometimes, providing expertise or information or administrative support for the committee). Take advantage!

Individuals who often attend MEC meetings as guests, but who are not members, may be excluded from investigations or other sensitive matters, if that makes sense. For example, if the investigation involved a psychiatrist, there would probably be no reason to have the director of the OR or the nurse manager present for the investigation, even if those individuals routinely attend MEC meetings as guests.

Medical Staff Services professionals and other administrative support persons, on the other hand, are often asked to attend and be involved in the MEC’s investigation because they may be able to offer valuable support to the committee as it proceeds (including offering support regarding the terms of the Bylaws, the contents of the practitioner’s credentialing and peer review files, keeping minutes, coordinating meetings, and assisting in drafting or coordinating the drafting of documentation regarding the investigation process – such as interview summaries).