The Semmelweis Society: Medical Credentials, Privileges, and Unbiased Peer-Review. Safe Practices.
A By-Laws Critique by Ralph Bard M.D., J.D.
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We will publish the by-laws under scrutiny presently.  The following critique is available.

BYLAWS PROBLEMS

 

Preamble

 

1.                  Page 2, Definitions H. A practitioner should not be limited to membership at the hospital, and there should be no other limitations on the term. If this is a practitioner, what is the difference between this and a member of the medical staff? Member covers the term and this definition is redundant. Thus, it is unnecessary. The old language is superior.

2.                  Page 2, Definitions O. What is harassment? What protections are there against false allegations? What happens if a member is accused of harassment? I would not try to delineate this definition as it can be grossly abused by anyone wanting to eliminate a member for any reason. I would eliminate this definition.

3.                  Page 2, Definitions P. This is a completely unacceptable definition. It can basically be defined as anyone covered by the bylaws doing anything that a hospital employee or administrator, or anyone at the behest of the hospital doesnt like. A physician could be assessed as disruptive if he/she complained about the lab being slow or reporting a deficiency to the Tennessee Board of Medical Examiners, or the JCAHO. In addition, reports can be fabricated by anyone and based on the current hospital policy there is no recourse for the accused individual. All this definition does is to formalize the ability of anyone who dislikes a medical staff member to get rid of him/her without due process. Keep in mind that the bylaws are those of the medical staff and not those of the hospital. This definition should be eliminated.

4.                  Page 2, Definitions O. This definition is overbroad and can be once again used to the members detriment. Essentially impaired physician is anything that the accuser wants it to be. Further, a drug abuser who injures patients would be grouped together with a physician having difficulty going up stairs due to a knee injury or arthritis. This term then could be used to paint the most benign problem in a physician with that of a badly mentally disturbed member. This definition should be eliminated.

5.                  Page 2, Definitions R. This is the same as H above. Eliminate H above.

6.                  Page 3, Definitions S. This definition is amazingly overbroad and could potentially cover comments such as you look nice today. Such a definition would result in more concern for avoiding a comment that could potentially be taken poorly than delivering patient care. This definition could be interpreted in almost any way and an accusation could be made with impunity and cover at least some part of this definition. As written this definition should be eliminated. It is inappropriate for these bylaws and could be easily abused, especially by an incompetent nurse to avoid a critical report by a member.

 

Article III: Membership

 

1.                  Section 2, Opening paragraph, page 4. Whether they like it or not, the Medical Staff is by law responsible for all aspects of care in the hospital. Thus, the Medical Staff Bylaws should provide power to the members to carry out this duty. In Section 2 the initial paragraph addresses the medical staff members and limited license practitioners, but does not address the hospital personnel, employees and administrative personnel. The medical staff must be allowed to investigate all complaints against hospital personnel as well as medical staff members. They will be held liable whether they have this ability or not. Any complaint by anyone, including a doctor against a hospital employee requires investigation by the members. Any incident that potentially affects patient care should be made available to the members for evaluation and corrective action. In addition, any protection available to a hospital employee reporting a variance against a physician should apply to any physician reporting a deficiency.

2.                  Section 2 Part C, page 4. This section has several negative connotations. First, no member should be required to give CME as a condition for membership. Voluntary teaching is perfectly OK, but requiring this is crossing the line. Further, the way this section is worded, a member could be required to attend certain CME based on what a medical staff officer feels is appropriate. The members should have complete and total discretion as to whether they would like to teach CME and