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"The physician shall refrain from engaging in business practices, which are predatory and harmful to the Hospital and the community."

Is it unreasonable to expect defamatory peer-review when there is restraint of trade?

Digest View
Discussion: Clinical Medicine
Section: Neurology
Topic: Can Neurologists Perform EEG's in the Office againts Hospital Wishes?

Topic - on 01/23/03 02:24 PM

Recently, I discovered an interesting clause in the medical staff bylaws of our rural community hospital.

Under the section titled "Basic Responsibilites of Staff Membership" paragraph 3 reads:

"The physician shall refrain from engaging in business practices, which are predatory and harmful to the Hospital and the community."

I've never seen such a clause in hospital bylaws before. What would be an example a "predatory" business practice? Is this clause meant to deter potential competition with the hospital?

Some physicians in the community including me, offer diagnostic testing services that the hospital also provides. Is that predatory? Could I be kicked off the medical staff as a result?

If a physician in the community does not accept Medicaid or offer free indigent services, would that qualify as "harmful" or "predatory"?

Anyone seen similar bylaws?

This seems to be a tremendous intrusion into the private business of physicians, over which the Hospital has no jurisdiction.

I'm going to bring this up at the next MEC meeting as an issue. However, I may not have a legal leg to stand on.

Comments appreciated..

Reply 1 of 5 -  on 01/24/03 08:56 PM

1) The clause is so vague as to be unenforcable.
2) Doing EEGs in your office is not predatory.
I would ignore is designed to scare you. The hospitals are trying to get into ventures which are not in their customary realm...One hospital here had a "health and wealth" seminar.

Reply 2 of 5 -  on 01/24/03 09:24 PM

I agree with Anon_3611b3. Such wording needs to be revised by the Bylaws Committee and made more explicit. Hospitals in general cannot dictate the scope of practice of staff members who are not contractors or employees. Limiting office based diagnositc procedures would be illegal. I would not go on the attack....would wait for them to try to limit my practice (if they do) and then force them to defend their actions.

Reply 3 of 5 -  on 01/25/03 12:23 AM

Our hospital Bylaws state that we have to see and scedule any patient referred to us from the emergencey room, while we are on ER call, within 3 business days. It also states we cannot charge the patient up front to be seen and must see the patient even if we are not a provider on their insurance. This policy clearly goes beyond EMTALA. I would welcome your opinion. I think it violates anti trust laws.

Reply 4 of 5 -  on 01/26/03 10:59 PM

Ooops! I have participated in many Bylaw committees and have not seen such language. It seems to me the hospital can dictate the physician to see and schedule a patient referred to him while on ER call if: ER call is a condition for staff membership (mandatory) or if the physician receives a stipend for being on call. If call is voluntary I see no duty of the physician to assume care of patients. it is different if the ER discusses the patient with the physician on call and the physician agrees to see the patient in follow up. On the other hand, hospitals can not dictate policy in physician's office: cannot force the physician to do charity work (see uninsured patients for free or see patients out of network). That wording needs to be reviewed and changed.

Reply 5 of 5 on 02/08/03 05:33 PM

I would think that for the hospital to "forbid" your doing any legitimate procedure in your office would constitute restraint of trade. I know that is the case in California.

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