First of all, I want to thank you for our previous conversations regarding the possibility of my coming to work at your hospital. I was truly interested in the position. Unfortunately after reading your bylaws, I must decline.

Your Medical Staff Bylaws have been reviewed in detail and are antithetical for any physician who wants to advocate for their patients, and are beneath the standards of such a quality organization as yours.

These Bylaws appear to have been either written by or modeled after those of the law firm, Horty Springer. I am very familiar with this firm and know them to be unethical.

They have been a driving force in the draconian policies that many hospitals use to take away Physician’s constitutional rights and have enabled hospitals to ruin the careers of doctors trying to stand up for their patients. No physician in the country should be asked to sign such a document. Your bylaws would enable a less ethical institution to engage in Sham Peer Review and will, in the long run, harm your hospital's recruiting efforts, since the best candidates will not allow themselves to be put in this position.

I have personally witnessed the evolution of Medical Staff Bylaws with increasingly restrictive and unacceptable provisions that make it impossible for any doctor to advocate for better patient care.

Here are some examples:

-Your Bylaws and authorization and release ask physicians to give absolute immunityto the hospital.

Note-Can you imagine what would happen if patients or hospital administrators were asked to give up their rights in order to receive care or work in your institution? I assure you, administration and your legal counsel do not work under similar constraints.

With this provision a physician cannot speak up in the best interest of his patients without the risk of losing his/her job, since any constructive criticism of administration or another physician can be construed by the health system as being detrimental to their bottom line, reputation or operation.  This provision is antithetical to the AMA Code of Ethics and can prevent a physician from advocating for their patients.

 -The requirement to be subjected to a mandatory psychiatric evaluation by a hospital chosen and paid psychiatrist.

Note-The hospital can then get the diagnosis they pay for. Even if the evaluation were normal the hearing committee would be biased by the fact that a psychiatrist was involved, i.e. implying that there was some mental problem.

 -Not having an attorney present at an early quasi hearing.

Note-So it's OK to have hospital counsel involved but no attorney to counsel the accused physician. This stipulation is in place so there will be no witnesses to the actions taken by the hospital.

-"Evidence unrelated to the reasons for the recommendation or to the individual's qualifications for appointment or the relevant clinical privileges shall be excluded."

Note- I was involved in a situation where I complained of multiple deaths, was offered bribe and threatened with an NPDB report if I did not resign. The threat was made by the ethics committee chair. Under your provision those facts underlying my complaint to an HMO would not come up. Only the fact that complaining about such things is disruptive to the operations of the institution would be allowed.

-The physician bears the burden of proof in all proceedings.

Note This is made more difficult because the documents and factsthat exonerate the physician are often withheld or prohibited.

(Whatever happened to innocent until proven guilty?)

-There is no right to a hearing based on the imposition or continuation of a precautionary suspension or restriction.

Note -so the doc can not even tell his side of the story.

-"The hearing shall not be conducted according to rules of evidence. Evidence shall not be excluded merely because it is hearsay. Any relevant evidence shall be admitted if it is the sort of evidence on which responsible persons are accustomed to rely in the conduct of serious affairs, regardless of the admissibility of such evidence in a court of law."

Note-You would never be able to get away with admitting hearsay in a fair proceeding, that’s why it cannot be used in court. Under this provision anyone could say anything and not have to give any supporting evidence.

-"The pre-hearing and hearing processes shall be conducted in an informal manner. Formal rules of evidence or procedure shall not apply."

Note-So the physician can request the information/documents but the hospital does not have to provide them.

You can use hearsay evidence and unnamed witness information without primary source verification.

- Access to and Treatment of witnesses at a peer review hearing. 

"Neither the individual, nor any other person acting on behalf of the individual maycontact Facility employees, patients, patient family members, or other practitioners whose names appear on the Medical Executive Committee's witness list or in documents provided pursuant to this Section concerning the subject matter of the hearing, until the Facility has been notified and has contacted the individuals about their willingness to be interviewed. The Facility will advise the individual once it has contacted such individuals and confirmed their willingness to meet. Any employee, patient, family member, or other practitioner may agree or decline to be interviewed by or on behalf of the individual who requested a hearing."

Note-So the doc cannot ask a witness ahead of time to see if they would be supportive, but because only the hospital or it's representative make the contact, they could gently intimidate the employee to testify as they are told or 'request' that they do not come at all.

-Time restrictions on presentation of testimony, evidence during hearing-limit is 7.5 hours

Note-this is an impossibly short time for a doc to defend themselves.

-The individual shall have no right to discovery beyond the above information. (Only what the MEC has considered) No information shall be provided regarding other practitioners on the Medical Staff. In addition, there is no right to depose, interrogate, or interview witnesses or other individuals prior to the hearing.

Does this mean a physician could lose their job if they do not agree or cooperate? 

 I have found that most docs don't believe that Sham Peer Review will happen to them, therefore they sign these bylaws, without ever having read them or understanding the possible consequences.  But I can tell you that  Sham Peer Review proceedings are becoming more and more prevalent across the country.  Doctors are regularly being driven out of their practices and reported to the NPDB by unscrupulous hospitals/systems and the physicians that are aligned with them. The majority of time it is for economic reasons or docs trying to speak up about unsafe practices.

Large hospital organizations like yours have been encouraged to promote these bylaws, under the guise of protecting the organization and yet, without  fairness provisions that should be included for any physician, it becomes a weapon in their hands to rid themselves of anyone who is not a "team player".  It is "understood" that a team player will side with the organization in all matters, no matter the effect on the patient or other physicians.

What this means is that no physician will be able to advocate for a patient if it is against the interests (eg, monetary, political, contractual or public relations) of the hospital.  No patient can ever assume that their health, well being , quality of life or medical care is the primary agenda of any physician working under these bylaws.

With these bylaws, any other structure or any mechanism to protect patients (govt. mandates, insurance ) become irrelevant and even malpractice lawsuits are irrelevant because any physician with hospital privileges will be reluctant to testify for a plaintiff. (or they'll lose their job and never work again. ie, National Practitioner Data Bank.)

There is a growing movement at the AMA and specialty sociaities to educate their members to avoid hospitals with the above bylaws provisions. These type of bylaws only pass when the medical staff is too weak to oppose the administration, e.g. are employed or they are to busy to read them.