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Home My WebLink AboutMINUTES - 06262012 - C.149RECOMMENDATION(S): Approve the attached changes to the Medical Staff Bylaws and Rules & Regulations, as recommended by the Medical Executive Committee (MEC), the Joint Conference Committee and County Council and Health Services Director. FISCAL IMPACT: None. BACKGROUND: The Medical Staff Bylaws and the Joint Commission require that changes to the Medical Staff Bylaws be approved by the Board of Supervisors. CONSEQUENCE OF NEGATIVE ACTION: If this Board Order, is not approved the recommened changes to the Medical Staff Bylaws would not be made. CHILDREN'S IMPACT STATEMENT: Not applicable. APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 06/26/2012 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Candace Andersen, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor Federal D. Glover, District V Supervisor Contact: Anna Roth, 370-5101 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: June 26, 2012 David Twa, County Administrator and Clerk of the Board of Supervisors By: June McHuen, Deputy cc: Tasha Scott, Demetria Gary, Cheryl Goodwin C.149 To:Board of Supervisors From:William Walker, M.D., Health Services Director Date:June 26, 2012 Contra Costa County Subject:APPROVE changes to the Medical Staff Bylaws ATTACHMENTS Summary of Bylaw Changes Proposed Bylaws - Redlined version Proposed 2012 Bylaws - Clean version Page 1 of 2 January 18, 2012 SUMMARY OF MEDICAL STAFF BYLAWS CHANGES 1. Several titles have changed: A. The Senior Medical Director is now the Chief Medical Officer B. The Director of Ambulatory Services position is now divided into the Ambulatory Care Medical Director and the Director of Ambulatory Nursing. C. The Executive Director of CCRMC and Health Centers is now the Chief Executive Officer of CCRMC and Health Centers D. The Director of Nursing is now the Chief Nursing Officer E. The Director of Patient Safety and Performance Improvement is now the Chief Quality Officer F. The Chairperson of Infection Control and Safety Committee is now the Manager of Infection Control and Prevention G. The Director of Medical Records is now the Director of Health Information Management H. The Director of Ancillary Services is now the Chief Operating Officer 2. Some committee names have changed: A. The Utilization Review Committee is now the Utilization Management Committee. B. The Performance Improvement Committee (PIC) is now the Patient Safety & Performance Improvement Committee (PS & PIC). 3. Add an Administrative category of Medical Staff Membership (3.1–page 5). Some administrators no longer see patients or have privileges, but continue to work closely with the Medical Staff on medico-administrative issues. We have used language from the CMA model bylaws. 4. Change from active to courtesy staff after one year of decreased activity instead of two years (3.1.3.4-page 7). Providers, who retire or move away or no longer meet the criteria of active membership, should not be able to vote for department or division head. 5. Add to the Qualifications for Medical Staff Officers (7.2.2-page 28) – Each general officer must be licensed as a physician and surgeon. This is a Medicare requirement. California Law requires that the Medical Staff President be an M.D. or a D.O. (not a Ph.D. or D.D.S.) 6. Add an Inpatient Division to the Department of Family Medicine (8.1.1(a)-page 32). With increased inpatient activity by members, it is recommended that there be an Inpatient Division to discuss their performance improvement and other issues. Page 2 of 2 7. Have Inpatient and Outpatient Divisions of Internal Medicine Department (8.1.1(g)-page 32). The Performance Improvement and other issues of inpatient and outpatient internists are different. Therefore, the Internal Medicine Department would like to form two divisions. 8. Remove the Geriatrics Department (8.1.1 (l)-page 32). This is a very small department, which will become part of the Internal Medicine Outpatient Division. 9. Add an ICU Department (8.1.1-page 32). Intensivists come from many departments. They have their unique performance improvement and other issues. 10. Allow the Medical Staff President to appoint an acting Department Head if there is a vacancy until an election can be held subject to MEC approval (8.6.6-page 35). 11. The Department Head can appoint an acting Division Head, subject to MEC approval, to carry out the duties of Division Head until this election is possible. (8.9.6-page 37) 12. List division heads as members of the MEC (9.2.1-page 39). With the addition of more divisions, this clarifies that all division heads are voting members of the MEC. 13. Remove the Ambulatory Quality Improvement Committee (9.3.3-page 41). PSPIC will be restructured to place more emphasis on ambulatory quality rather than having a separate committee for ambulatory quality. 14. Add the statement that the Physicians Assistance Committee will take appropriate action if a practitioner fails to complete the required rehabilitation program (9.3.13.1 h- page 49). This is a Joint Commission Requirement. 15. Remove the Unsatisfactory Patient/Provider Relationship (UPPR) Committee (9.3.17- page 52). This Committee no longer exists. 16. Move requirements for histories and physicials to the bylaws (14.10-page 72 & rules 1.c.ii.3-pages 4 & 5 ). Joint commission now requires that these requirements be in the bylaws, not the rules. MEDICAL STAFF RULES AND REGULATIONS CHANGES 17. Delete section of the Rules and Regulations that says suspended practitioners will be reported to PSPIC (1.7.(b) i-page 7). This is no longer done. 18. Change of fees (1.O.i.1.-page 11). Change Application Fee to $300. This must be approved by a vote. The MEC has changed the Reappointment Fee to $200 for Active staff and $100 for Courtesy staff (1.O .ii-page 12). These fees have not changed in many years. This brings them into line with what other hospitals charge. Contra Costa County Regional Medical Center & Health Centers Medical Staff Bylaws Rules & Regulations 201012 Contra Costa Regional Medical Center & Health Center 2010 Medical Staff Bylaws Table of Contents Definitions ................................................................. 1 Article 1 NAME AND PURPOSES .......................................... 2 Article 2 MEMBERSHIP ....................................................... 2 Nature .......................................................... 2 Qualifications .............................................. 2 Requirements ............................................... 3 Nondiscrimination ....................................... 3 Responsibilities ........................................... 3 Harassment Prohibited ................................. 4 Article 3 CATEGORIES OF THE MEDICAL STAFF ............... 5 Active Staff ................................................. 5 Courtesy Staff .............................................. 7 Provisional Staff .......................................... 8 Resident Staff ............................................ 10 Temporary Staff ........................................ 11 Article 4 ALLIED HEALTH PRACTITIONERS .................... 12 Definitions ................................................. 12 Categories .................................................. 12 Qualifications ............................................ 12 Responsibilities ......................................... 13 Granting Service Authorizations ............... 13 Article 5 PROCEDURES FOR APPOINTMENT AND REAPPOINTMENT ............................................... 13 Applicant’s Burden .................................... 14 Application Procedure ............................... 14 Application Content .................................. 15 Processing the Application ........................ 17 Reappointment and Modification of Staff Status or Privileges .................................... 20 Leave of Absence ...................................... 21 Waiting Period after Adverse Action .................................................................. .21 Article 6 PRIVILEGES ........................................................ 22 Delineation of Privileges ........................... 22 Basis for Privileges .................................... 22 Privileges for Department Heads ............... 23 Limitations for Certain Members .............. 23 Non-licensed Residents ............................. 23 Temporary Privileges ................................ 23 Emergency Privileges ................................ 24 Proctoring .................................................. 24 Disaster Privileges ..................................... 26 Article 7 GENERAL MEDICAL STAFF OFFICERS ............ 27 Qualifications ............................................ 27 Attainment of Office .................................. 28 Vacancies .................................................. 28 Resignation and Removal .......................... 29 Duties ........................................................ 29 Article 8 DEPARTMENTS AND DIVISIONS ....................... 30 Organization .............................................. 30 Assignment to Departments ....................... 31 Functions ................................................... 31 Department Heads ..................................... 32 Election ................................................ 34 Term of Office ...................................... 34 Removal ............................................... 35 Functions of Divisions ............................... 35 Division Heads .......................................... 35 Election ................................................ 35 Term of Office ...................................... 36 Removal ............................................... 36 Article 9 COMMITTEES ................................................... 37 Appointment of Members .......................... 37 Removal from Committees ........................ 37 Conduct of Meetings ................................. 37 Medical Executive Committee .................. 38 Administrative Affairs ............................... 39 Ambulatory Policy..................................... 39 Ambulatory Quality Improvement Committee .............................................. 40 Bioethics .................................................... 41 Cancer ....................................................... 42 Continuing Medical Education .................. 43 Credentials ................................................. 43 Institutional Review .................................. 44 Interdisciplinary Practice ........................... 45 Joint Conference ........................................ 46 Performance Improvement ........................ 46 Medical Errors and Adverse Outcomes ..... 47 Medical Staff Assistance .......................... 48 Patient Care Policy and Evaluation ........... 49 Perinatal M&M ......................................... 50 Professional Affairs ................................... 51 Unsatisfactory Patient/Provider Relationship ............................................... 51 Utilization Review Management ............... 51 Article 10 MEETINGS ........................................................ 52 Medical Staff Meetings ............................. 52 Clinical Department and Committee Meetings .................................................... 52 Quorum ...................................................... 53 Manner of Action ...................................... 53 Notice of Meetings .................................... 53 Minutes ...................................................... 53 Agenda ...................................................... 54 Attendance Requirements .......................... 54 Conduct of Meetings ................................. 54 Article 11 CORRECTIVE ACTION ...................................... 55 Initiation .................................................... 55 Formal Investigation .................................. 55 Medical Executive Committee Action ....... 55 Summary Restriction or Suspension .......... 56 Grounds for Automatic Suspension or Restrictions ................................................ 57 Article 13 CONFIDENTIALITY ........................................... 66 Breach of Confidentiality .......................... 66 Access by Persons Outside the Hospital .... 66 Access by Persons Within the Hospital ..... 68 Article 14 GENERAL PROVISIONS ..................................... 69 Rules and Regulations ............................... 69 Dues or assessments .................................. 69 Division of Fees ........................................ 70 Special Notices .......................................... 70 Requirements for Elections ....................... 70 Disclosure of Interest ................................. 70 Authorization, Immunity and Releases ...... 71 Article 15 ADOPTION AND AMENDMENT OF BYLAWS AND RULES ............................................................... 71 Article 12 HEARINGS AND APPELLATE REVIEWS ............ 59 Notice of Charges ...................................... 60 Grounds for Hearing .................................. 60 Requests for Hearing ................................. 60 Judicial Review Committee ....................... 61 Hearing Procedure ..................................... 61 Appeals ...................................................... 64 Exceptions to Hearing Rights .................... 65 1 CONTRA COSTA REGIONAL MEDICAL CENTER & HEALTH CENTERS 2008MEDICAL STAFF BYLAWS DEFINITIONS The following definitions apply to these Medical Staff Bylaws: 1. Administrator means the Executive Director Chief Executive Officer of Contra Costa Regional Medical Center and Health Centers or her/his designee. 2. Chief Resident means the resident physician chosen by the residents to represent them. 3. Allied Health Practitioners (AHP) are those non-Medical Staff member practitioners described in Article 4 below. 4. Clinical Privileges or Privileges means permission, granted by this Medical Staff to members of the Medical Staff, to provide specific diagnostic, therapeutic, medical, dental, podiatric, surgical, psychiatric or psychological services. 5. AHP Clinical Privileges or Service Authorizations means permission granted by the Governing Body, upon the recommendation of the Interdisciplinary Practice Committee and the Medical Staff, to provide diagnostic and therapeutic services within the scope of the AHP’s training and expertise. 6. County means the County of Contra Costa, California. 7. Department or Clinical Department means a clinical structure of the Medical Staff as further identified in these Bylaws. 8. Department Head means the practitioner elected or appointed, pursuant to these Bylaws to be responsible for the function of a Clinical Department. 9. Medical Director of Contra Costa Regional Medical Center, also referred to simply as the Medical Director, means the physician appointed by the Administrator to oversee clinical activities of the hospital. 10.Senior Chief Medical Director Officer of the Health Services Department means the physician appointed by the Director of the Health Services Department to oversee the clinical activities of the Health Services Department. 11. Ex officio means service as a member of a body by virtue of an office or position held and, unless expressly provided, without voting rights. 12. Governing Body means the County Board of Supervisors. 13. Hospital or Medical Center means the Contra Costa Regional Medical Center and Health Centers. 14. Health Centers means the outpatient clinical facilities operated by the County where the Members of this Medical Staff provide patient care. 15. Medical Staff Year means the 12-month period commencing on the first of July of each year and ending on the thirtieth of June of the following year. 16. Member or Medical Staff Member means any Practitioner or Resident who has been appointed to the Medical Staff pursuant to these Bylaws. 17. Member in Good Standing means a Member of the Medical Staff who is not under a suspension. 18. Physician means an individual with a M.D. or D.O. degree who is currently licensed to practice medicine in the State of California. 19. Practitioner means a physician, dentist, clinical psychologist, or podiatrist who is currently licensed by the State of California to provide patient care services. 20. Residency Director means the physician who directs the postgraduate Family Medicine training program based at the Hospital. 21. Resident means a physician in training who is participating in a residency or fellowship approved by the American Council of Graduate Medical Education. 22. Rules or Rules and Regulations mean the Medical Staff Rules and Regulations that are contained under separate cover and are adopted pursuant to these Bylaws. 2 ARTICLE 1NAME AND PURPOSES 1.1 The name of this organization is the Medical Staff of the Contra Costa Regional Medical Center and Health Centers. 1.2 The Medical Staff purposes are: 1.2.1 To assure that all patients treated by any of its members receive the best possible care. 1.2.2 To provide for professional performance that is consistent with the mission and goals of the Hospital. 1.2.3 To maintain Rules for the Medical Staff to carry out its responsibilities for the professional work performed in the Hospital. 1.2.4 To provide a means for the Medical Staff, Governing Body and Hospital Administration to discuss issues of mutual concern. 1.2.5 To provide for accountability of the Medical Staff to the Governing Body. ARTICLE 2MEMBERSHIP 2.1 Nature of Membership Appointment to the Medical Staff shall confer only such Privileges and Prerogatives as have been granted by the Governing Body in accordance with these Bylaws. Only Members of the Medical Staff may admit patients to the Hospital and provide medical care consistent with those Privileges to patients in the Hospital and/or Health Centers. 2.2 Qualifications for Membership 2.2.1.1 General Qualifications Membership on the Medical Staff and Privileges shall be extended only to Practitioners who are professionally competent and continuously meet the qualifications, standards, and requirements set forth in these Bylaws and the Rules. Medical Staff membership, except for Honorary and Resident membership, shall be limited to Practitioners who are currently licensed and qualified to practice medicine, podiatry, dentistry, and/or clinical psychology. 2.2.1.2 Specific Qualifications In addition to meeting the basic standards as outlined above, a Practitioner must meet the following requirements in order to qualify for Medical Staff Membership: Licensed Physicians. An applicant for physician membership in the Medical Staff must have a valid M.D or D.O. degree (or the equivalent). The Practitioner must have a current and valid license to practice medicine issued either by the Medical Board of California or the Osteopathic Medical Board of California. Resident Physicians. An applicant for Resident Physician membership on the Medical Staff must have a valid M.D. or D.O. degree (or the equivalent). The applicant must have been accepted for training by a residency program affiliated with the Hospital and must be a member in good standing of the residency. Resident physicians do not need to have a full license to practice medicine independently; however, if they do not have such an unrestricted license, a Licensed Physician Member of the Medical Staff must supervise any patient care in which the resident is involved. 3 Dentists. An applicant for dental membership on the Medical Staff must have a DDS or equivalent degree. The Practitioner must have a current and valid license to practice dentistry issued by the California Board of Dental Examiners. Podiatrists. An applicant for podiatric membership in the Medical Staff must have a D.P.M. or equivalent degree. The Practitioner must have a current and valid license to practice podiatry issued by the California Board of Podiatric Medicine. Clinical Psychologists. An applicant for Clinical Psychologist Membership on the Medical Staff must have a doctorate degree in clinical psychology. The Practitioner must have a current and valid license to practice clinical psychology issued by the State of California. 2.3 Membership Requirements An applicant for Membership in the Medical Staff must document his or her adequate experience, education, and training in the requested Privileges. The applicant must demonstrate current professional competence and good judgment in the use of such Privileges. The applicant must demonstrate his or her ability to exercise such Privileges for quality patient care at a level recognized as appropriate to a similar professional within the community. The Medical Executive Committee must determine that the applicant adheres to the lawful ethics of his or her profession; is able to work cooperatively with others in the Hospital so as not to adversely affect patient care or Hospital operations; and is willing and able to participate in and properly discharge Medical Staff responsibilities as described in these Bylaws and in the Rules. 2.4 Effect of Other Affiliations No Practitioner is entitled to Medical Staff Membership merely because he or she holds a certain degree, is licensed to practice medicine in this or in any other state, is a member of any professional organization, is certified by any clinical board, or because he or she had, or presently has, medical staff membership or privileges at another health care facility. 2.5 Nondiscrimination Medical Staff Membership or particular Privileges shall not be denied on the basis of age, gender, sexual orientation, race, religious creed, color, national origin or disability. 2.6 General Responsibilities of Medical Staff Membership Each Medical Staff Member exercising Privileges in the Hospital and Health Centers shall continuously meet all of the following responsibilities: 2.6.1 Provide his or her patients with care meeting the professional standards of the Medical Staff of this Hospital. 2.6.2 Abide by the Medical Staff Bylaws and the Rules and all other lawful standards, policies, and rules of the Medical Staff and the Hospital. 2.6.3 Abide by all applicable laws and regulations of governmental agencies and comply with applicable standards of the JCAHO. 2.6.4 Discharge such Medical Staff, department, division, committee, and service functions for which he or she is responsible by appointment, election, or otherwise. 2.6.5 Prepare and complete in a timely manner the medical and other required records for all patients to whom the Practitioner in any way provides services in the Hospital. 2.6.6 Abide by the ethical principles of his or her profession. 4 2.6.7 Work cooperatively with other Medical Staff Members, nurses, administrators, and other members of the health care team so as not to adversely affect patient care. 2.6.8 Participate in educational programs approved by the Medical Staff and designed to improve the quality of patient care. 2.6.9 Decline to engage in any improper inducements for patient care referrals. 2.6.10 Make appropriate arrangements for coverage for his or her patients when an absence is anticipated. 2.6.11 Complete continuing education programs that are required by the Medical Staff. 2.6.12 Participate in emergency service coverage and consultation (on-call) panels as may be required by the Medical Staff. 2.6.13 Accept responsibility for participating in Medical Staff proctoring in accordance with the Bylaws. 2.6.14 Pay Medical Staff dues and assessments within sixty days of invoice receipt. 2.6.15 Participate in the resident training program as requested by the Residency Director. 2.6.16 Promptly notify the Medical Staff Office of any professional liability action the member is involved in as soon as the member becomes aware of his or her involvement. 2.6.17 Participate in quality assurance programs as determined by the Medical Staff. 2.6.18 Discharge such other duties and obligations as may be lawfully established from time to time by the Medical Staff, the Medical Executive Committee, the Member’s Department, or the Administrator. 2.7 Harassment and Discrimination Prohibited 2.7.1 Statement of Policy The Medical Staff is committed to providing a workplace free of sexual harassment or discrimination as well as unlawful harassment or discrimination based upon age, ancestry, color, marital status, medical condition, mental disability, physical disability, national origin, race, religion, gender, or sexual orientation. The Medical Staff does not tolerate harassment or discrimination by Medical Staff Members of resident physicians, support staff, County employees, patients, or other Medical Staff Members. 2.7.2 Harassment Defined 2.7.2.1 Harassment is unwelcome verbal, visual, or physical conduct that creates an intimidating, offensive or hostile working environment or that interferes with work performance. Such conduct constitutes harassment when: 2.7.2.1.1 Submission to the conduct is made either an implicit or explicit condition of employment; 2.7.2.1.2 Submission to or rejection of the conduct is used as the basis for an employment decision; or 5 2.7.2.1.3 The harassment unreasonably interferes with work performance or creates an intimidating, hostile or offensive work environment. 2.7.3 Harassing conduct can take many forms and includes, but is not limited to, slurs, jokes, statements, gestures, pictures, or cartoons regarding a person’s age, ancestry, color, marital status, medical condition, mental disability, physical disability, national origin, race, religion, gender or sexual orientation. Sexually harassing conduct in particular includes all of these prohibited actions as well as requests for sexual favors, conversation containing sexual comments, and unwelcome sexual advances. 2.7.4 Investigation and Corrective Action 2.7.4.1 Every complaint of harassment made to the Medical Staff will be investigated thoroughly and promptly. The Medical Staff will attempt to protect the privacy of individuals involved in the investigation when appropriate. The Medical Staff will not tolerate retaliation against anyone who reports harassing conduct. Other entities, such as the County and legal authorities, may also separately investigate such complaints. When appropriate, the Medical Staff shall share investigatory information with such authorities. 2.7.4.2 If the Medical Staff determines that harassment occurred, the Medical Staff will take corrective action up to and including termination of Medical Staff privileges or membership. Corrective actions taken by the Medical Staff related to such harassing conduct are not grounds for a hearing unless those actions affect a Member’s Privileges or membership status on the Medical Staff. When appropriate, corrective action may include reporting the harassment to appropriate legal, administrative, and governing authorities. ARTICLE 3CATEGORIES OF THE MEDICAL STAFF 3.1 Categories The Medical Staff Members are divided into the following categories of membership: active, temporary, courtesy, provisional, honorary, administrative and resident. Each Medical Staff Member shall be assigned to a Medical Staff category based upon the respective qualifications set forth in these Bylaws. Members of each Medical Staff category shall have the respective prerogatives and responsibilities as set forth in these Bylaws. Action may be initiated to change the Medical staff category or terminate the membership of any Member who fails to meet the qualifications or fulfill the responsibilities as described in these Bylaws. Changes in Medical Staff category shall not be grounds for hearing unless it affects the Member’s Clinical Privileges. 3.1.1 The Honorary Medical Staff The honorary Medical Staff consists of practitioners who are not active in the Hospital or who are honored by emeritus positions. These may be practitioners who have retired from active hospital practice or who are of outstanding reputation, not necessarily residing in the community. Honorary staff members are not eligible to admit, care for or consult on patients, to vote, to hold office, or to serve on standing Medical Staff committees. 3.1.2 The Active Administrative Medical Staff 3.1.2.1 Qualifications. a. The active Administrative category membership shall be held by any physician, who is not otherwise eligible for another staff category and who solely performs Formatted: Numbered + Level: 1 + Numbering Style: a, b, c, … + Start at: 1 + Alignment: Left + Aligned at: 1.78" + Indent at: 2.03" 6 ongoing medical administrative activities. b. Document their (1) current licensure, (2) adequate experience, education and training, (3) current professional competence, (4) good judgment, and (5) current physical and mental health status, so as to demonstrate to the satisfaction of the medical staff that they are professionally and ethically competent to exercise their duties; 3.1.2.2 Prerotatives The administrative staff shall be entitled to attend meetings of the medical staff and various departments and education programs, but shall have no right to vote at such meetings. Administrative staff members shall not be eligible to hold office in the medical staff organization, admit patients or exercise clinical privileges. 3.1.3 The Active Medical Staff 3.1.3.1 Qualifications. The active staff consists of physicians, dentists, podiatrists, and licensed psychologists, each of whom: (a) meets the qualifications for Medical Staff membership set forth in the Bylaws; (b) has an office and residence that, in the opinion of the Medical Executive Committee, is located closely enough to the Hospital to provide appropriate continuity of quality care; (c) regularly admits patients to the Hospital, is regularly involved in the care of patients at the Hospital, or regularly uses the Hospital and/or Health Centers in the care of patients; (d) has satisfactorily completed his/her term in the provisional staff category. 3.1.23.2 Prerogatives. Each member of the active staff is entitled to: (a) admit patients and exercise Clinical Privileges as are granted to him/her; (b) attend and vote on all matters presented at general and special meetings of the Medical Staff, his/her department, and of committees of which he/she is a member; (c) attend any staff or Hospital education programs; (d) hold staff and/or departmental offices and serve on committees to which he/she has been appointed. 3.1.23.3 Responsibilities. Each member of the active Medical Staff is responsible for the following: (a) carrying out the basic responsibilities of Medical Staff membership set forth in the Bylaws; (b) providing for the continuous care and supervision of each patient in the Formatted: Indent: Left: 1.53", First line: 0" 7 Hospital for whom he/she is providing services, including arranging for care and supervision in his/her absence and outside of his/her area of professional competence; (c) providing consultation, supervision, and monitoring of patients, when requested; and (d) attending meetings of the Medical Staff, his/her department, and committees of which he/she is a member in accordance with the Bylaws. 3.1.23.4 Demotion of Active Staff Member. After two one consecutive years in which a Member of this active staff fails to regularly care for patients in this hospital or be regularly involved in Medical Staff functions as determined by the Medical Staff, that Member may be demoted to a lower staff category. 3.1.34 Courtesy Staff 3.1.34.1 Qualifications. The courtesy staff consists of practitioners, each of whom: (a) meets the qualifications for Medical Staff membership set forth in the Bylaws; (b) has an office and residence that, in the opinion of the Medical Executive Committee, is located closely enough to the Hospital to provide appropriate continuity of quality care; (c) admits patients to the Hospital on an irregular basis, is occasionally involved in the care of Hospital patients, or occasionally uses the Hospital and/or Health Centers in the care of patients; (d) is a member of the active staff of another licensed hospital unless the Medical Executive Committee, in writing, for good cause shown waives this requirement. Dentists holding only General Dentistry, Endodontia, Periodontia, or Orthodontia privileges are exempt from this requirement. (e) has satisfactorily completed his/her term in the provisional staff category. 3.1.34.2 Prerogatives Each member of the courtesy staff is entitled to: (a) admit patients and exercise Clinical Privileges as are granted to him/her; (b) attend meetings of the staff and the department of which he/she is a member and any staff or hospital education programs; (c) be appointed to any committee except the Medical Executive Committee. The courtesy staff member shall not have the right to vote unless the Medical Staff President confers that right at the time of the 8 committee appointment. 3.1.34.3 Responsibilities Each member of the courtesy staff is responsible for the following; (a) carrying out the basic responsibilities of Medical Staff membership set forth in the Bylaws; (b) providing for the continuous care and supervision of each patient in the Hospital for whom he/she is providing services, including arranging for care and supervision in his/her absence and outside of his/her area of professional competence; (c) providing consultation, supervision, and monitoring of patients, when requested; and (d) attending meetings of the Medical Staff, his/her department, and committees of which he/she is a member in accordance with the Bylaws. 3.1.3.4 Limitation Courtesy staff members shall not be eligible to hold office in this Medical Staff organization nor shall they be eligible to vote on matters presented at general and special meetings of the Medical Staff, departmental meetings, division meetings, or committee meetings except as specifically provided in the Bylaws. 3.1.45 Provisional Staff 3.1.45.1 Qualifications. The provisional staff consists of practitioners, each of whom: (a) meets the qualifications for Medical Staff membership set forth in the Bylaws; (b) immediately prior to his/her application and appointment was not a member (or was no longer a member) in good standing of this Medical Staff; (c) has an office and residence that, in the opinion of the Medical Executive Committee, is located closely enough to the Hospital to provide appropriate continuity of quality care. 3.1.45.2 Prerogatives. Each member of the provisional staff is entitled to: (a) admit patients and exercise such Clinical Privileges as are granted pursuant to the Bylaws; (b) attend meetings of the staff and the department of which he/she is a member and any staff or hospital education programs; (c) be appointed to any committee except the Medical Executive Committee. The provisional staff member shall not have the right to vote unless the Medical Staff President confers that right at the time of 9 the committee appointment. 3.1.45.3 Responsibilities. Each member of the provisional Medical Staff is responsible for the following: (a) carrying out the basic responsibilities of Medical Staff membership set forth in the Bylaws; (b) providing for the continuous care and supervision of each patient in the hospital for whom he/she is providing services, including arranging for care and supervision in his/her absence and outside of his/her area of professional competence; (c) providing consultation, supervision, and monitoring of patients, when requested; (d) attending meetings of the Medical Staff, his/her department, and committees of which he/she is a member in accordance with the Bylaws. 3.1.45.4 Limitation. Provisional staff members are not eligible to vote on matters presented at general and special meetings of the Medical Staff, departmental meetings, division meetings, or committee meetings except as specifically provided in the Bylaws. 3.1.45.5 Monitoring of Provisional Staff Member Each provisional staff member shall undergo a period of monitoring. The monitoring shall be to evaluate the member's (1) proficiency in the exercise of Clinical Privileges initially granted and (2) overall eligibility for continued staff membership and advancement within staff categories. Monitoring of provisional staff members shall follow whatever frequency and format each department deems appropriate in order to adequately evaluate the provisional staff member including, but not limited to, concurrent or retrospective chart review, mandatory consultation, and/or direct observation. The results of the monitoring shall be communicated by the department chairperson to the Credentials Committee. 3.1.45.6 Term of Provisional Staff Status A Member shall remain on the provisional staff for a period of six months unless the Medical Executive Committee or the Credentials Committee extends that status for an additional period of up to six months upon a determination of good cause, which determination shall not be subject to review. In special circumstances wherein the Member has had minimal activity at the Hospital and Health Centers, and current information is inadequate to allow a determination to conclude the provisional staff status, the Medical Executive Committee may extend the provisional staff status for an additional period of up to 12 months, which determination shall not be subject to review. In no event shall the total provisional staff status of a member exceed twenty-four (24) months. At the conclusion of provisional staff status, further staff status is determined as stated below. 3.1.45.7 Action at Conclusion of Provisional Staff Status (a) If the provisional staff Member has satisfactorily demonstrated his or her ability to exercise the Clinical Privileges initially granted and 10 otherwise appears qualified for continued Medical Staff membership, the Member shall be eligible for placement in the active or courtesy staff, as appropriate, upon recommendation of the Medical Executive Committee (MEC). The Administrator and the Governing Body shall act upon this MEC recommendation. Should any disagreement occur between the MEC, the Administrator, and the Governing Body, resolution shall occur in compliance with the Bylaws. (b) In all cases, the appropriate department shall advise the Credentials Committee, which shall make its report to the Medical Executive Committee, which, in turn, shall make its recommendation to the Professional Affairs Committee regarding a modification or termination of Clinical Privileges, or termination of Medical Staff membership. 11 3.1.56 Resident/Fellow Staff 3.1.56.1 Qualifications for Residents/Fellow. The resident/fellow staff consists of Members, each of whom: (a) meets the qualifications for Medical Staff membership set forth in the Bylaws; (b) is a graduate of a medical school approved by the American Association of Medical Colleges and is a participant in an approved residency or fellowship program. 3.1.56.2 Prerogatives. Each Member of the resident/fellow staff is entitled to: (a) admit patients under appropriate supervision and direction of the program director, and the head of the department in which he/she is exercising privileges; (b) exercise Clinical Privileges under appropriate supervision and direction of the program director and head of the department in which he/she is exercising Privileges; (c) attend meetings of the Medical Staff and, if invited, the departments to which he/she is currently assigned; (d) be appointed to any committee except the Medical Executive Committee. The resident/fellow staff member shall not have the right to vote unless that right is conferred by the Medical Staff President at the time of the committee appointment; (e) if licensed, apply for provisional status on the Medical Staff without relinquishing his or her resident status with regard to these Bylaws. 3.1.56.3 Responsibilities. Each member of the resident/fellow staff is responsible for the following: (a) carrying out the basic responsibilities of Medical Staff membership set forth in the Bylaws and Rules; (b) contributing to the organization and administrative affairs of the Medical Staff by participating on staff, in the departments, and on committees as reasonably requested, and by participating in fulfilling such other staff functions as are reasonably requested. 3.1.56.4 Limitation. Resident/fellow staff members shall not be eligible to hold office in this Medical Staff organization nor shall they be eligible to vote on matters presented at general and special meetings of the Medical Staff, departmental meetings, division meetings, or committee meetings except as specifically provided in the Bylaws. 12 3.1.67 Temporary Staff 3.1.67.1 Qualifications (a) Temporary staff consists of Members, each of whom: (b) Meets the qualifications for Medical Staff membership set forth in the Bylaws; (c) Has been granted temporary privileges and is not currently on the active, courtesy, provisional, or resident staff; 3.1.67.2 Prerogatives. Each Member of the temporary staff is entitled to: (a) Admit patients and exercise Clinical Privileges as are granted to him/her; (b) Attend meetings of the staff in the department of which he/she is a Member and any staff and hospital educational programs. 3.1.67.3 Responsibilities. Each Member of the temporary staff is responsible for the following: (a) Carrying out the basic responsibilities of Medical Staff membership set forth in the Bylaws; (b) providing for the continuous care and supervision of each patient in the Hospital for whom he/she is providing services, including arranging for care and supervision in his/her absence and outside of his/her area of professional competence; (c) providing consultation, supervision, and monitoring of patients, when requested; and (d) Attending meetings of the Medical Staff, his/her department, and committees of which he/she is a member. 3.1.67.4 Limitations. Temporary staff Mmembers are not eligible to hold office in this Medical Staff organization nor are they eligible to vote on matters presented at general and special meetings of the Medical Staff, departments, divisions, or committees. In the event that a practitioner’s temporary clinical privileges are terminated, said practitioner’s temporary staff status is also deemed terminated and the practitioner is thereafter entitled to the procedural rights afforded by the Bylaws. 3.1.78 Limitation of Prerogatives The prerogatives set forth under each membership category are general in nature and may be subject to limitation by special conditions attached to a particular membership by other sections of these Bylaws and by the Rules. 13 3.1.89 Modification of Membership On its own, upon recommendation of the Credentials Committee, or pursuant to a request by a member, the Medical Executive Committee may recommend a change in the Medical Staff category of a member consistent with the requirements of the Bylaws. ARTICLE 4ALLIED HEALTH PRACTITIONERS 4.1 Definitions 4.1.1 Allied Health Practitioner means a health care professional, other than a Member of the Medical Staff, who holds a license, as required by California law, to provide certain professional services. 4.1.2 AHP Clinical Privileges or Service Authorizations means permission granted by the Governing Body, upon the recommendation of the Interdisciplinary Practice Committee and the Medical Staff, to provide diagnostic and therapeutic services within the scope of the AHP’s training and expertise. 4.2 Categories of AHPs Eligible to Apply for AHP Clinical Privileges and Rules Regarding Them 4.2.1 The categories of AHPs, based upon occupation or profession, that shall be eligible to apply for AHP Clinical Privileges shall be designated by the Governing Board, upon recommendation of the MEC. At a minimum, the AHPs include two categories; 4.2.1.1 Nurse Practitioners who are registered nurses with additional training, expertise, certification and licensing that is recognized by the State of California and allows them to provide specific diagnostic and therapeutic services. 4.2.1.2 Optometrists who are licensed to provide specific optometric services. 4.3 Qualifications. An Allied Health Practitioner is eligible for a Service Authorization in this hospital if he or she: (a) Holds a license, certificate, or other legal credential in a category of AHP which the Governing Body has identified as eligible to apply for Service Authorization pursuant to the Bylaws; and (b) Documents his or her experience, background, training, current competence, judgment, and ability with sufficient adequacy to demonstrate that any patient treated by the practitioner will receive care at the generally recognized professional level of quality established by the Medical Staff; and (c) Is determined, on the basis of documented references to— i. Adhere strictly to the lawful ethics of his or her profession, ii. Work cooperatively with others in the hospital setting so as not to affect adversely patient care, iii. Be willing to commit to and regularly assist the Medical Staff in fulfilling its obligations related to patient care; and (d) Agrees to comply with all Medical Staff and Department and Division Bylaws, Rules and Regulations, and protocols to the extent applicable to the AHP. 28 6.8.5 Management of Persons Granted Disaster Privileges Persons granted disaster Privileges will be assigned duties either by the granting authorities as defined in 6.8.2, or if assigned to a specific department, by the department chair or his/her designee. In the absence of these persons, the incident commander may assign duties or delegate this responsibility to person(s), identified in the disaster plan, who are responsible for designation of duties. The Medical Staff oversees the professional practice of volunteer licensed independent practitioners by direct observation and clinical record review. Disaster Privileges are automatically terminated when the disaster plan is deactivated. Disaster Privileges may be revoked at any time or for any reason by the Medical Staff President, Administrator, department chair, or their designee(s). The Hospital must make a decision (based on information obtained regarding the professional practice of the volunteer) within 72 hours related to the continuation of disaster Privileges initially granted. 6.8.6 Verification Process Verification: Primary source verification of licensure begins as soon as the immediate situation is under control and is usually completed within 72 hours from the time the volunteer practitioner presents to the organization. In extraordinary circumstances, when primary source verification cannot be completed in 72 hours, there must be documentation of the following: x Why the primary source verification could not performed; x Evidence of demonstrated ability to continue to provide adequate care, treatment and services. Primary source verification must still be done as soon as possible. ARTICLE 7GENERAL MEDICAL STAFF OFFICERS 7.1 Identification The general officers of the Medical Staff are the President, the President-Elect, and the Past President. 7.2 Qualifications Each general officer must: 7.2.1 Be a member of the Active Staff at the time of nomination and election and remain a Member in good standing during his/her term of office; 7.2.17.2.2 Be licensed as a physician and surgeon. 7.2.27.2.3 Willingly and faithfully discharge the duties of the office; and 7.2.37.2.4 Exercise the authority of the office held, working with the other general and Department officers of the Medical Staff. 29 7.3 Attainment of Office 7.3.1 The election for the office of President-Elect shall take place in January of odd-numbered years. The person who receives the majority of the votes cast is the President-Elect and shall immediately assume the office. On July 1 of that same year, the President-Elect shall assume the office of President. 7.3.2 Term of Office: The President shall serve one two-year term, but may be reelected to a second consecutive term. At the conclusion of the President’s term(s) of office, the President shall assume the office of Past-President. 7.3.3 Should the incumbent President be reelected, the office of President-Elect shall remain vacant until the next January election for President. 7.3.4 Nomination: The Medical Executive Committee shall nominate qualified candidates for the office of President-Elect. Each nominee must be an M.D. or a D.O. Nominations may also be made from the floor at the October quarterly meeting by a Member of the Active Staff in good standing. Any such floor nomination must be seconded by a Member of the Active Staff in good standing and accompanied by evidence of the nominee’s willingness to be nominated. 7.3.5 Election: The President-Elect is chosen from among the nominated candidates by election as defined in these Bylaws. Candidates for Medical Staff President-Elect may submit a written statement not to exceed two pages to the Medical Staff Office no later than close of business on December 3rd. On or before December 7th, the Medical Staff Office shall mail to all active Members of the Medical Staff a list of the candidates for Medical Staff President-Elect, accompanied by the candidates’ statements, if any. Approximately 30 days, but no less than 25 days, before the January meeting of the Medical Executive Committee, the Medical Staff Office shall mail ballots to all active Members of the Medical Staff. 7.3.6 In order for a ballot to be counted, it must be returned to the Medical Staff Office no later than close of business on the 11th day before the January meeting of the Medical Executive Committee. The Medical Staff President and at least one other member of the Medical Executive Committee shall count the ballots, unless the Medical Staff President is a candidate. In that event, the Medical Executive Committee shall designate a second member of the Medical Executive Committee to count ballots. As soon thereafter as possible, the Medical Executive Committee shall notify all candidates of the election results. Thereafter, but at least seven calendar days before the January meeting of the Medical Executive Committee, the Medical Executive Committee shall post, or otherwise disclose the election results to the Medical Staff. 7.4 Vacancies 7.4.1 A vacancy in the office of President is filled by succession of the President-Elect who serves the remainder of the unexpired term and his/her own full term as President. If the office of President-Elect is vacant, the Past President serves as the Acting President pending the outcome of a special election for the office of President to be conducted as expeditiously as possible and generally in the same manner as provided in this Article. The MEC may determine, however, not to call a special election if a regular election for the office is to be held within 90 days. 7.4.2 In the event of a vacancy in the office of Past President, the MEC shall appoint a Member of the MEC to serve out the remainder of the vacated term. 30 7.4.3 Vacancy in the office of President-Elect shall be filled by the appointment of an acting officer by the Medical Executive Committee. The acting officer serves pending the outcome of a special election to be conducted as expeditiously as possible and generally in the same manner as provided in this Article. 7.5 Resignation and Removal from Office 7.5.1 Resignation Any general Medical Staff officer may resign at any time by giving written notice to the Medical Executive Committee. Such resignation, which may or may not be made contingent upon formal acceptance, takes effect on the date specified in the resignation or, if no date is specified, on the date of receipt. 7.5.2 Removal 7.5.2.1 Authority and Mechanism: Removal of a general staff officer may be effected by a two-thirds majority vote by secret ballot of the members of the Active Staff in good standing. 7.5.2.2 Grounds: Permissible grounds for removal of a general staff officer include, without limitation: 7.5.2.3 Failure to perform the duties of the position held in a timely and appropriate manner; 7.5.2.4 Failure to continuously meet the qualifications for the position; 7.5.2.5 Physical or mental infirmity that renders the officer incapable of fulfilling the duties of his office. 7.6 Duties of General Staff Officers 7.6.1 Medical Staff President The Medical Staff President shall serve as the chief officer of the Medical Staff. The duties of the Medical Staff President shall include, but not be limited to: 7.6.1.1 Enforcing the Bylaws and Rules, implementing sanctions where indicated, and enforcing procedural safeguards where corrective action has been requested or initiated; 7.6.1.2 Calling, presiding at, and being responsible for the agenda of all meetings of the Medical Staff; 7.6.1.3 Serving as the chair of the Medical Executive Committee; 7.6.1.4 Serving as an ex officio member of all other Medical staff committees; 7.6.1.5 Interacting with the Administrator and the Governing Body in all matters concerning the Hospital; 31 7.6.1.6 Appointing, in consultation with the Medical Executive Committee, committee members for all standing and special Medical Staff, liaison, and multi- disciplinary committees, except where otherwise provided by these Bylaws and, except where otherwise indicated, designating the chairpersons of these committees; 7.6.1.7 Representing the views and policies of the Medical Staff to the Governing Body and to the Administrator; 7.6.1.8 Being a spokesperson for the Medical Staff in external professional and public relations; 7.6.1.9 Performing such other duties as may be required by these Bylaws, the Medical Staff, or by the Medical Executive Committee; 7.6.1.10 Serving as an ex-officio member on liaison committees with the Governing Body and Administration and with outside licensing and accreditation agencies. 7.6.2 President-Elect The President-Elect shall assume all duties and authority of the Medical Staff President in the absence of the Medical Staff President. The President-Elect shall also be a member of the Medical Executive Committee and an ex-officio member of the Joint Conference Committee. The President-Elect shall perform such other duties as the Medical Staff President may assign or delegate to the President-Elect. 7.6.3 Past President The Past President shall have the same duties and responsibilities as the President-Elect in the absence of the President-Elect. ARTICLE 8DEPARTMENTS AND DIVISIONS 8.1 Organization of Departments Each Department shall be organized as an integral unit of the Medical Staff and shall have a chair. The authority, duties, method of selection and responsibilities of these Department officers is set forth below. Each Department may appoint such standing or ad hoc committees as it deems appropriate to perform its required functions. A Department may be further divided, as appropriate, into divisions which shall be directly responsible to the Department within which they function, and each of which shall have a division chief selected and entrusted with the authority, duties and responsibilities specified in Section 8.7.1.5. When appropriate, the Medical Executive Committee may recommend to the Medical Staff the creation, elimination, modification, or combination of Departments or divisions. 32 8.1.1 Current Clinical Departments and Divisions The current Clinical Departments and Divisions are: (a) Family Medicine 1. Divisions: i) Antioch-Brentwood ii) Pittsburg-Bay Point iii) Central County iv)West County iv)v)Inpatient (b) Anesthesia (c) Emergency Medicine (d) Surgery (e) Pediatrics (f) Psychiatry/Psychology (g)Internal Medicine 1. Divisions a. Inpatient b. Outpatient (g) (h)Obstetrics & Gynecology (h)(i)Intensive Care Unit (i)(j)Radiology (j)(k)Pathology (k)(l)Dental (l)Geriatrics Intensive Care 8.2 Assignment to Departments Each Member shall be assigned membership in at least one Department, but may also be granted membership and /or Privileges in other Departments. 8.3 Functions of Departments The functions of each Department shall include: (a) Conducting patient care reviews for the purpose of analyzing and evaluating the quality and appropriateness of care and treatment provided to patients within the Department. Formatted Formatted Formatted: Indent: Left: 1.25", No bullets or numbering 33 The Department shall routinely collect information about important aspects of patient care provided in the Department, periodically assess this information, and develop objective criteria for use in evaluating patient care. Patient care reviews shall include all clinical work performed under the jurisdiction of the Department; (b) Recommending to the Medical Executive Committee guidelines for the granting of Clinical Privileges and the performance of specified services within the Department; (c) Evaluating and making appropriate recommendations regarding the qualifications of applicants seeking appointment or reappointment and Clinical Privileges within that Department; (d) Conducting, participating and making recommendations regarding continuing education programs pertinent to departmental clinical practice; (e) Reviewing and evaluating departmental adherence to: (1) Medical Staff policies and procedures and (2) sound principles of clinical practice; (f) Coordinating patient care provided by the Department’s Members with nursing and ancillary patient care services; (g) Submitting written reports to the Medical Executive Committee concerning: (1) the Department’s review and evaluation activities, actions taken thereon and the results of such action; and (2) recommendations for maintaining and improving the quality of care provided in the Department and Hospital; (h) Meeting regularly for the purpose of considering patient care review findings and the results of the Department’s other review and evaluation activities, as well as reports on other Department and staff functions; (i) Establishing such committees or other mechanisms as are necessary and desirable to perform properly the functions assigned to it, including proctoring protocols; (j) Taking appropriate action when important problems in patient care and clinical performance or opportunities to improve care are identified; (k) Accounting to the Medical Executive Committee for all professional and Medical Staff administrative activities within the Department; (l) Appointing such committees as may be necessary or appropriate to conduct Department functions; (m) Formulating recommendations for departmental rules and regulations reasonably necessary for the proper discharge of its responsibilities subject to the approval by the Medical Executive Committee and the Medical Staff; When the department or any of its committees meet to carry out the duties described above, the meeting body shall constitute a peer review body, which is subject to the standards and entitled to the protections and immunities afforded by federal and state law for peer review bodies and/or committees. Each department and/or its committees, if any, must meet regularly to carry out its/their duties. 8.4 Department Heads Each Department shall have a department head who shall be a Member of the active or provisional Medical Staff and shall be certified by an appropriate specialty board, or affirmatively establish, through the Privilege delineation process, that the person possesses comparable competence in at least one of the clinical areas covered by the Department. 34 Each Department Head shall have the following authority, duties and responsibilities: (a) act as presiding officer (chairperson) at departmental meetings; (b) report to the Medical Executive Committee and to the Medical Staff President regarding all professional and administrative activities within the Department; (c) generally monitor the quality of patient care and professional performance rendered by Members with Clinical Privileges in the Department through a planned and systematic process; oversee the effective conduct of the patient care, evaluation, and monitoring functions delegated to the department by the Medical Executive Committee; (d) prepare and transmit to the appropriate authorities, as required by these Bylaws, recommendations concerning appointment, reappointment, delineation of Clinical Privileges, and corrective action with respect to practitioners holding membership or exercising privileges or services in the Department; (e) annually review, and amend as necessary, Department policies and procedures; (f) participate in managing the Department through cooperation and coordination with nursing and other patient care services and with Administration on all matters affecting patient care, including personnel, equipment, facilities, services, and budget; (g) endeavor to enforce the Bylaws, Rules, and policies and regulations within the Department; (h) appoint an acting Department Head (vice-chairperson) during any absence; (i) Assure all Department functions are performed; (j) perform such other duties commensurate with the office as may from time to time be reasonably requested by the Medical Staff President or the Medical Executive Committee; (k) plan and conduct, as requested by and in cooperation with the Residency Director, a program of instruction, supervision, and evaluation of Residents; (m) assess and recommend to the relevant hospital authority off-site sources for needed patient care services not provided by the department or organization; (n) recommend a sufficient number of qualified and competent persons to provide care, treatment and services; (o) determine the qualifications and competence of Department or service personnel who are not licensed independent practitioners and who provide patient care, treatment and services; (p) continually assess and improve the quality of care, treatment and services; (q) maintain quality control programs, as appropriate; (r) oversee the orientation and continuing education of all persons in the Department or service; (s) recommend space and other resources needed by the Department or service; (t) Recommend to the Medical Staff the criteria for Clinical Privileges that are relevant to the 35 care provided in the Department; (u) integrate the Department or service into the primary functions of the organization and coordinate and integrate interdepartmental and intradepartmental services; (v) develop and implement policies and procedures that guide and support the provision of care, treatment and services. 8.6 Election of Department Heads 8.6.1 In April of each election year, the active Medical Staff of the applicable Department shall elect a Department Head. 8.6.2 The following Departments shall elect a Department Head in odd-numbered years: Family Medicine, Anesthesia, Pediatrics, Rehabilitation, Internal Medicine, Pathology and Dentistry. The following Departments shall elect a Department Head in even-numbered years: Emergency Medicine, Surgery, Psychiatry/Psychology, Radiology , Obstetrics & Gynecology and Geriatrics Intensive Care. 8.6.3 The Medical Staff President shall request nominations for Department Head at the January Quarterly Medical Staff meeting and at the applicable Department meeting. Nominations may be made only to the current Department Head or to the Medical Staff President. The last day to nominate a candidate for Department Head is March 1st. Candidates may submit a written statement not to exceed two pages to the Medical Staff Office no later than close of business on March 3rd. The Medical Staff Office shall mail a list of candidates to all active Members of the Medical Staff in the affected Department no later than March 7th. The candidates’ statements, if any, shall accompany the list. 8.6.4 Approximately 30 days, but no less than 25 days, before the April meeting of the Medical Executive Committee, the Medical Staff Office shall mail ballots to all the active Medical Staff Members within the affected Department. In order for a ballot to be counted, it must be returned to the Medical Staff Office no later than close of business on the 11th day before the April meeting of the Medical Executive Committee. The Medical Staff President and at least one other member of the Medical Executive Committee shall count the ballots, unless the Medical Staff President is a candidate. In that event, the Medical Executive Committee shall designate a second member of the Medical Executive Committee to count ballots. As soon thereafter as possible, the Medical Executive Committee shall notify all candidates of the election results. Thereafter, but at least seven calendar days before the April meeting of the Medical Executive Committee, the Medical Executive Committee shall post, or otherwise disclose to the Medical Staff, the election results. 8.6.5 The Medical Executive Committee shall review the newly elected Department Heads for approval at its April meeting. The elected Department Head is thereafter subject to the approval of the Senior Medical DirectorChief Medical Officer. In the event that the elected Department Head is not approved by either the Medical Executive Committee or the Senior Medical DirectorChief Medical Officer, a new election shall be conducted as soon as possible. If the Senior Medical Director Chief Medical Officer does not approve a Department Head, she/he will discuss the reasons for disapproval at the next Medical Executive Committee meeting. 8.6.6 Department Members shall fill vacancies due to any reason for the unexpired term by election as soon as possible. The Medical Staff President can appoint an acting Department Head, subject to MEC approval, to carry out the duties of Department Head until this election is possible. 36 8.6.7 Term of Office The term of office of Department Heads is two Medical Staff years. Each assumes office on the first day of the Medical Staff year, except that a Department Head appointed to fill a vacancy assumes office immediately upon appointment. Each Department Head serves until the end of his or her term and until a successor is elected, unless he/she resigns sooner or is removed from office. A Department Head is eligible to succeed himself/herself. 8.6.8 Removal After election and ratification, removal of a Department Head from office may occur for cause by a two-thirds vote of the Medical Executive Committee or a two-thirds vote of the Department Members on active staff 8.7 Functions of Divisions Subject to approval of the Medical Executive Committee, each division shall perform the functions assigned to it by the Department Chairperson. Such functions may include, without limitation, retrospective patient care reviews, evaluation of patient care practices, credentials review and privileges delineation, and continuing education programs. The division shall transmit regular reports to the Department Head on the conduct of its assigned functions. 8.8 Division Heads Each division shall have a Division Head who shall be a Member of the active or provisional Medical Staff and a Member of the division which he or she heads, and shall be certified by an appropriate specialty board, or affirmatively establish through the privilege delineation process that he/she possesses comparable competence in at least one of the clinical areas covered by the division. Each Division Head shall: (a) act as presiding officer at division meetings; (b) assist in the development and implementation, in cooperation with the Department Head, of programs to carry out the quality review and evaluation and monitoring functions assigned to the division; (c) continually review the patient care and the professional performance of Division members, and report to the Department Head patterns or situations affecting patient care within the Division; (d) as requested by and in cooperation with the Department Head, conduct investigations and submit reports and recommendations to the Department Head regarding the Clinical Privileges to be exercised within his/her division by Members of or applicants to the Medical Staff; (e) manage the Division through cooperation and coordination with nursing and other patient care services and with Administration on all matters affecting patient care, including personnel, equipment, facilities, services, and budget; (f) assure all Division functions are performed; (g) perform such other duties commensurate with the office as may from time to time be reasonably requested by the Department Head, the Medical Staff President, or the Medical Executive Committee. 37 8.9 Election of Division Heads 8.9.1 In April of each election year, the active Medical Staff of the applicable division shall elect a Division Head as set forth. 38 8.9.2 Family Medicine West County and Family Medicine Antioch-Brentwood Divisions, Inapteint Family Medicine and Outpatient Internal Medicine Division shall elect Division Heads in even-numbered years; Family Medicine Central County, and Family Medicine Pittsburg-Bay Point Divisions and Inpatient Internal Medicine Divisions shall elect Division Heads in odd- numbered years. 8.9.3 The Medical Staff President shall request nominations for Division Head at the January Quarterly Medical Staff meeting and at the applicable division meeting. Nominations may be made only to the current Department Head or to the Medical Staff President. The last day to nominate a candidate for Division Head is March 1st. Candidates may submit a written statement not to exceed two pages to the Medical Staff Office no later than close of business on March 3rd. The Medical Staff Office shall mail ballots to all the active Medical Staff Members within the affected division no later than March 7th. The candidates’ statements shall accompany the list, if any. 8.9.4 Approximately 30 days, but no less than 25 days, before the April meeting of the Medical Executive Committee, the Medical Staff Office shall mail ballots to all the active Medical Staff Members within the affected division. In order for a ballot to be counted, it must be returned to the Medical Staff Office no later than the close of business on the 11th day before the April meeting of the Medical Executive Committee. The Medical Staff President and at least one other member of the Medical Executive Committee shall count the ballots, unless the Medical Staff President is a candidate. In that event, the Medical Executive Committee shall designate a second member of the Medical Executive Committee to count ballots. As soon thereafter as possible, the Medical Executive Committee shall notify all candidates of the election results. Thereafter, but at least seven calendar days before the April meeting of the Medical Executive Committee, the Medical Executive Committee shall post, or otherwise disclose to the Medical Staff, the election results. 8.9.5 The newly elected Division Heads shall be reviewed for approval by the appropriate Department Head prior to the April meeting of the Medical Executive Committee and by the Medical Executive Committee at its April meeting. The elected Division Head is thereafter subject to approval of the Senior Medical DirectorChief Medical Officer. In the event that the elected Division Head is not approved by either the Department Head, the Medical Executive Committee or the Senior Medical DirectorChief Medical Officer, a new election shall be conducted as soon as possible. If the Department Head or the Senior Medical Director Chief Medical Officer does not approve a Division Head, she/he will discuss the reasons for disapproval at the next Medical Executive Committee meeting. 8.9.6 Division members shall fill vacancies due to any reason for the unexpired term by election as soon as possible. The Department Head can appoint an acting Division Head, subject to MEC approval, to carry out the duties of Division Head until this election is possible. 8.9.7 Term The term of office of Division Heads is two Medical Staff years. Each assumes office on the first day of the Medical Staff year, except that a Division Head elected to fill a vacancy assumes office immediately upon election. Each Division Head serves until the end of his/her term and until a successor is elected, unless he/she sooner resigns or is removed from office. A Division Head is eligible to succeed himself/herself. 8.9.8 Removal After selection and ratification, a Division Head may be removed for cause by the Department Head, by a 2/3 vote of the Division Members on active Staff, or by a 2/3 vote of the MEC. 39 ARTICLE 9COMMITTEES 9.1 General Provisions 9.1.1 Designation 9.1.1.1 The Medical Executive Committee and the other committees described in these Bylaws shall be standing committees of the Medical Staff unless otherwise indicated. 9.1.1.2 The chairperson of the Medical Executive Committee, a standing committee, or a Department may create subcommittees, special committees, or Ad Hoc committees, in order to carry out specified tasks. These specified tasks must be within the scope of authority of the committee whose chairperson created the committee. Such committees terminate once the specified task is completed and are not standing committees. 9.1.2 Appointment of Members to Committees 9.1.2.1 The Medical Executive Committee, on the recommendation of its chairperson, shall appoint chairpersons and members of standing committees unless otherwise specified in the Bylaws. Committee members are appointed for a term of one Medical Staff year unless otherwise specified by the Bylaws, and shall serve either until the end of this period, until the member’s successor is appointed, or until the member resigns or is removed from the committee. 9.1.2.2 Only Members in Good Standing of the Medical Staff may be voting members of any Medical Staff Committee. Others individuals may be appointed to committee positions as either Ex officio or non-medical Staff members. 9.1.2.3 For committees that are not standing committees, the person creating the committee shall appoint chairpersons and members. 9.1.3 Removal from Committees Unless otherwise specified in the Bylaws, committee members may be removed by the appointing authority without cause. 9.1.4 Vacancies Vacancies on any committee shall be filled in the same manner as an original appointment is made. 9.1.5 Conduct of Meetings of Committees Committee meetings shall be conducted and documented in the manner specified in these Bylaws. 9.1.6 Attendance of Non-Members Members in good standing of the Medical Staff who are not committee members may attend committee meetings only with the permission of the chair of the committee. 40 9.1.7 Accountability All committees of the Medical Staff are accountable to the Medical Executive Committee. 9.2 Medical Executive Committee 9.2.1 Composition The Medical Executive Committee (MEC) consists of the following Members of the Medical Staff as voting members: (a) President of the Medical Staff; (b) President-Elect; (c) Past President; (d)Clinical Department Heads; (d)(e)Division Heads (e) The Chairpersons of the following Committees shall be voting member of the MEC: Administrative Affairs, Ambulatory Policy, Credentials, Performance Patient Safety and Performance Improvement, and Patient Care pPolicy and Evaluation; and the Division Heads of the Department of Family Medicine. (f) Chief administrators may attend the meetings without voting rights. These include the Director of Health Services, the Executive DirectorChief Executive Officer of Hospital and Clinics, the Senior Medical DirectorChief Medical Officer, the Director of NursingChief Nursing Officer, the Director of Ambulatory Care Medical DirectorAmbulatory Services, the Residency Program Director and the Medical Director of the health plan. The chairperson of the MEC may invite other individuals to participate in the MEC meetings as non- voting guests. 9.2.2 Duties The Medical Executive Committee shall: 9.2.2.1 perform and/or delegate performance of all Medical Staff functions in a manner consistent with the Bylaws and the Rules; 9.2.2.2 coordinate and implement the activities of the committees and the Departments; 9.2.2.3 make recommendations regarding Medical Staff membership and privileges; 9.2.2.4 initiate and pursue disciplinary or corrective actions when indicated; 9.2.2.5 supervise the Medical Staff’s compliance with the Medical Staff Bylaws, Rules, and policies; 9.2.2.6 supervise the Medical Staff’s compliance with County laws, rules, policies and procedures; 9.2.2.7 supervise the Medical Staff’s compliance with state and federal laws and regulations; Formatted: List Paragraph, No bullets or numbering, Tab stops: Not at 1.5" 41 9.2.2.8 supervise the Medical Staff’s compliance with JCAHO and other applicable accreditation and certification rules; 9.2.2.9 regularly report to the Governing Body regarding the status of Medical Staff issues; 9.2.2.10 meet monthly to conduct Medical Staff business; 9.2.2.11 represent and act on behalf of the Medical Staff in the intervals between Medical Staff meetings, subject only to such specific limitations as may be imposed by these Bylaws. 9.3 Committees In order to remain in good standing on a committee, a member must attend at least 50 per cent of the meetings. 9.3.1 Administrative Affairs Committee 9.3.1.1 Purpose and Meetings The Administrative Affairs Committee (AAC) fulfills staff responsibilities relating to review and revision of Medical Staff Bylaws and related manuals and forms and assumes the responsibilities for investigating and providing recommendations on such other administrative policy-making and planning matters and activities of concern to the Staff as are referred by the MEC. The AAC oversees the Institutional Review Committee (IRC) which reviews, approves or denies, monitors and evaluates research projects, protocols, and clinical investigations to be conducted within the Medical Services, in compliance with the regulations of the Food and Drug Administration and observing all requirements of any other applicable regulatory authorities for any given study. The AAC may overrule a positive recommendation of the Institutional Review Committee, but the AAC may not approve a study or the use of an investigational agent if disapproved/denied by the IRC. The AAC meets as needed, and reports to the MEC. When appropriate, it shares its monitoring and evaluation findings from research projects with the Performance Improvement CommitteePatient Safety & Performance Improvement Committee (PS & PIC) and vice versa. 9.3.1.2 Composition The Administrative Affairs Committee includes: (a) a physician Chairperson, appointed by the Medical Staff President, subject to MEC approval; (b) at least 4-6 additional Staff Members; (c) Administrator, with vote; and (d) their members with special expertise as necessary on an ad-hoc basis, without vote. 9.3.2 Ambulatory Policy Committee 9.3.2.1 Purpose and Meetings The Ambulatory Policy Committee sets Medical Staff policy in the health centers and acts as a liaison with Nursing and Administration for coordination of policies and procedures under joint Medical Staff-Administration or Medical Staff-Nursing purview. 42 43 APC develops policies to resolve issues that affect more than one Medical Staff Department and focuses on policies and projects that relate to quality of care, the efficiency of the health centers and patient and Staff satisfaction as well as regulatory compliance. APC coordinates its activities with PIC and receives quality assurance reports suggestive of or requiring changes in policies and procedures from individual Medical Staff Departments and from the Ambulatory Subcommittee of PIC. 9.3.2.2 Composition The Ambulatory Policy Committee includes: (a) a physician chairperson appointed by the Medical Staff President, subject to MEC approval; (b) one Staff Member from each Region; (c) the Department Head of Family Medicine or his/her designee; (d) representatives of the Departments of Obstetrics & Gynecology, Surgery, Pediatrics and Medicine, with vote; (e) other members with special expertise as needed on an ad-hoc basis without vote; (f)Director of Medical RecordsDirector of Health Information Management as needed on an ad-hoc basis without vote; (g) a representative of the Allied Health Professionals, without vote; and (h) Director of Ambulatory Care without vote. 9.3.3 Ambulatory Quality Improvement Committee 9.3.3.1 Purpose and Meetings The Ambulatory Quality Improvement Committee (AQIC) has the authority and responsibility for implementing and directing management and quality improvement in the CCRMC health centers. AQIC coordinates with the Performance Improvement Committee and other groups for quality projects that extend beyond the health centers. AQIC is responsible for setting the quality standards, determining criteria by which care will e measured, setting priorities for which aspects of care will be monitored and analyzing the quality of care studies, indicators, utilization data, grievances, survey data and risk management information. A systematic multidisciplinary improvement process is followed. AQIC meets monthly (at least 10 times a year). All departments that provide ambulatory services will report their quality indicators to AQIC at least annually. 9.3.3.2 Composition The ambulatory Quality Improvement Committee includes the following members, supplemented by guests from Safety and Performance Improvement (SPI) and reporting departments as indicated: 44 (a) A physician Chairperson appointed by the Medical Staff President subject to MEC approval; (b) The Ambulatory Care Administrator; (c) A representative for Ambulatory Care Nursing; (d) The Performance Improvement Committee (PIC) Chair; (e) A representative from the Department of Family Medicine; (f) A representative from Obstetrics/Gynecology; (g) A representative from Pediatrics; (h) A representative from Dental (i) Other medical staff departments as desired by the chair; (j) Safety and Performance Improvement (SPI) Ambulatory Care Nurses; and (k) A representative for the CCHP Quality Management Department. 9.3.4 Bioethics Committee 9.3.4.1 Purpose and Meetings The Bioethics Committee provides a multi-disciplinary forum for the development of guidelines for consideration of cases and issues having bioethical implications; development and implementation of procedures for the review of such cases; development and/or review of institutional policies regarding care and treatment in cases or issues having bioethical implications; consultation with concerned parties to facilitate communication and aid in conflict resolution in an advisory capacity; and education of the hospital staff regarding bioethical matters. The committee will meet regularly (at least six times yearly) and will also provide a mechanism for other meetings as necessary to perform the case consultation function. The committee chair will report to the Medical Executive Committee. 9.3.4.2 Composition The Bioethics Committee includes: (a) a physician chairperson appointed by the Medical Staff President subject to Medical Executive Committee approval; (b) multi-disciplinary representation selected to represent the various clinical services of the medical and nursing staff, ancillary support services (such as social workers, chaplains, etc.) and lay members. At least a third of the committee membership will be physicians; (c) a member representing hospital administration; and (d) the committee may invite other professional or community lay members to be utilized when discussing issues involving their particular clinical, ethnic, religious or other background. 45 9.3.5 Cancer Committee 9.3.5.1 Purpose and Meetings The Cancer Committee is a multi-disciplinary committee that organizes, conducts and evaluates hospital-wide oncology services and the cancer registry. The committee assures that full oncology services including surgery, chemotherapy, radiation therapy, as well as rehabilitation and hospice care are available to all patients. The committee will develop and monitor annual goals and objectives for clinical care, community outreach, quality improvement and programmatic endeavors related to cancer care. The committee is responsible for establishing and monitoring the Cancer Conference format, frequency and multidisciplinary attendance. The committee will ascertain if there is a need for specific educational programs — both professional and public — based on survival and comparison data. The committee will also supervise the Cancer Registry for quality control of case-finding, abstracting, staging, reporting and follow-up. The committee will conduct a minimum of two patient care evaluation studies annually, one to include survival data. The committee will implement at least two patient care enhancements each year. The committee will meet at least quarterly or more often as needed and communicate as necessary with the Performance Improvement Committee. The committee will designate one coordinator for each of the four areas of Cancer Committee activity: Cancer Conference, quality control of the cancer registry, quality improvement and community outreach. 9.3.5.2 Composition The Cancer Committee includes: 1. a physician chairperson appointed by the Medical Staff President, subject to Medical Executive Committee approval; 2. at least five (5) additional Medical Staff Members including representation from, Surgery, Pathology, Hematology/Oncology, Family Practice, and Radiology; 3. Cancer Liaison Physician; 4. representation from Administration, Social Services, Nursing, and the American Cancer Society all with vote; and 5. the cancer registrar, who will act as staff to the Cancer Committee, with vote. 46 9.3.5 Continuing Medical Education Committee 9.3.5.1 Purpose and Meetings The Continuing Medical Education Committee (CMEC) directs the development of CME programs for the Staff responsive to quality assurance findings and to developments pertinent to practice at the Hospital and apprises the Staff of outside educational opportunities. It coordinates the educational activities of the Departments and of the Staff and Hospital Departments. The CMEC also analyzes the status and needs of, and makes recommendations regarding, the medical library services. It meets at least quarterly and more frequently if needed and reports on its activities to the MEC. 9.3.5.2 Composition The CMEC includes: (a) a chairperson appointed by the Medical Staff President, subject to MEC approval; (b) at least two additional Staff Members; and (c) Medical Librarian, without vote. 9.3.6 Credentials Committee 9.3.6.1 Purpose and Meetings The Credentials Committee coordinates the staff credentials function by receiving and analyzing applications and recommendations for appointment, provisional period conclusion or extension, reappointment, clinical privileges, and changes therein, and recommending action thereon, and by integrating quality assurance and utilization review and monitoring, membership, and other relevant information into the individual credentials files. It also assists in designing and participates in implementing the credentialing procedures for Allied Health Practitioners. It meets monthly or more often as necessary and reports to the MEC regarding the credentialing of Staff Members. 9.3.6.2 Composition The Credentials Committee includes: (a) A physician chairperson, appointed by the Medical Staff President, subject to MEC approval; and (b) At least 4-6 additional Staff Members, selected to be representative of the Departments and major clinical specialties. 47 9.3.7 Critical Care Committee 9.3.7.1 Purpose and Meetings The Critical Care Committee (CCC) is a multi-disciplinary committee that oversees the quality, safety, and appropriateness of patient care services provided within the Critical Care Unit (CCU) and Intermediate Medical Care Unit (IMCU). The CCC, in consultation with the Patient Care Policy and Evaluation Committee, shall develop written policies and procedures which shall guide the provision of patient care including, but not limited to: criteria for patient admission to and discharge from the CCU and IMCU (including priority determination); guidelines for providing specialized patient care to patients who require such care but who, for pre-determined reasons (e.g., contagious disease) or for unforeseen reasons (e.g., when patient load exceeds optimal operational capacity) cannot be cared for within the CCU and IMCU; guidelines for transferring and referring patients who require services not provided by the CCU; guidelines for circumstances under which consultation is required; the role of the Resident Staff in the these units; and guidelines for appropriate orientation, in-service training, and continuing medical and nursing education. As appropriate and as necessary, the CCC shares information with the Performance Improvement Committee and its subordinate committees. The CCC shall meet at least quarterly and reports to the Patient Care Policy and Evaluation Committee. The Chairperson (or his/her designee) shall serve as the Director of the CCU and IMCU. 9.3.7.2 Composition The CCC includes: (a) at least one Member each from the Departments of Anesthesia, Medicine, and Surgery, one of whom shall be appointed chairperson by the President of the Medical Staff, subject to MEC approval; (b) the nursing supervisor of the Critical Care Unit; (c) the Residency Director or his/her designee; (d) the Director of Cardiopulmonary Services, or his/her designee; and (e) a Member of the Resident Staff. 9.3.8 Institutional Review Committee 9.3.8.1 Purpose and Meetings The Institutional Review Committee shall review and have authority to: approve, require modification in (to secure approval), or disapprove all research activities within the Hospital and Health Centers; approve, require modification in, or disapprove the use of investigation drugs or devices in individuals (i.e. "compassionate use" cases); receive prompt notification of the emergency use of investigational drugs or devices and approve, require modification in or, disapprove their continued use; continue, require modifications in or terminate any ongoing studies at intervals of not greater than 12 months; immediately terminate or suspend any research not conducted in accordance with the IRC's requirements or that has been associated with unexpected serious harm to subjects; ensure all compliance with federal informed consent regulations regarding investigational use of drugs and devices; and assure the protection of the rights and welfare of all human subjects. The Institutional Review Committee shall meet semi-annually or more often as necessary to fulfill its obligations. If the Institutional Review Committee disapproves of any activity within its purview, that decision is final. The Institutional Review 48 Committee chairperson reports to the Administrative Affairs Committee. 9.3.8.2 Composition The Institutional Review Committee includes: (a) a Chairperson appointed by the Chairperson of the Administrative Affairs Committee, subject to Medical Executive Committee approval; (b) at least one member of each gender; (c) at least one member from outside the medical profession; (d) at least one non-scientist; (e) at least one member not affiliated with the Hospital and Health Centers; and (f) a total of at least five members, including representative ethnic and cultural backgrounds, of the community. 9.3.9 Interdisciplinary Practice Committee 9.3.9.1 Purpose and Meetings The Interdisciplinary Practice Committee (IPC) shall perform functions consistent with the requirements of law and regulations (Title 22, Section 70706). The IPC shall routinely report to the MEC; and, in addition, shall submit an annual report to the MEC. The IPC shall meet at least annually, or more often as necessary. 9.3.9.2 Composition The IPC shall consist of: (a) a physician chairperson, appointed by the Medical Staff President, subject to MEC approval; (b) the Director of Nursing; (c) the Administrator or designee; (d) the Director of Ambulatory Care, if not serving as the representative of Administration; (e) two additional physicians, appointed by the Medical Executive Committee; (f) two additional registered nurses, appointed by the Director of Nursing Chief Nursing Officer; (g) an FNP representative selected by the MEC; and (h) one or more licensed or certified health professionals other than registered nurses who are performing or will perform functions requiring standardized procedures will be appointed by the IPC Chair on a temporary basis when issues pertaining to their functions are discussed. 49 9.3.10 Joint Conference Committee 9.3.10.1 Purpose and Meetings The Joint Conference Committee constitutes a forum between the Medical Staff, the Administration and the Governing Body. Two members of the Medical Executive Committee who serve at the will of the Medical Executive Committee represent the Medical Staff. These members shall act as directed to by the MEC in their capacity as members of the Joint Conference Committee. The Governing Body and the Administration shall have representation pursuant to authority separate from these Bylaws. 9.3.11 Performance Improvement Committee 9.3.11.1 Purpose and Meetings The Performance Improvement Committee (PIC) has the authority and responsibility for implementing and directing the Quality Management Program for the Hospital. It is responsible for setting the quality management standards, determining criteria by which care will be measured, setting priorities for which aspects of care will be monitored, and analyzing the quality of care studies, indicators, utilization reports, grievances, survey data and risk management information. A systematic, multidisciplinary improvement process is followed. It develops an annual plan for performance improvement activities (Quality Management Plan). 9.3.11.2 Composition The Performance Improvement Committee includes the following members: (a) a physician chairperson, appointed by the Medical Staff President, subject to MEC approval. The Physician Chair will serve for approximately three (3) years (in addition to one (1) year as chair elect), with the term ending one (1) year after the approximately triennial Joint Commission Survey; (b) A Physician Chair-Elect appointed by The Medical Staff President, subject to MEC approval, will be appointed after the triennial “unannounced” Joint Commission survey. He/She will take over as chair one (1) year after the survey; (c) the Medical Staff President; (d) the CCRMC executive directorChief Executive Officer; (e) the director of Systems Redesign/Senior Medical Director; (f) the Director of Nursing Chief Nursing Officer; (g) the Director of Ambulatory Services; (h) the Director of Ancillary Services Chief Operating Officer; (i) the Director of Patient Safety and Performance Improvement Chief Quality Officer; 50 (j) the Chair, Ambulatory Quality Improvement Committee (k) the Facilities Manager; (l) the Past Medical Staff President; (m) the Chair of the Patient Care Policy and Evaluation Committee, and (n) two Medical Staff Physician representatives, appointed by the Medical Staff President, subject to MEC approval. 9.3.12 Medical Errors and Adverse Outcome Committee 9.3.12.1 Purpose and Meetings The Medical Error and Adverse Outcome Committee (MEAO) provides a multidisciplinary forum to develop and coordinate resources for education, case consultation, and quality improvement with respect to possible medical error and/or unanticipated adverse outcome. Its functions include: (a) Education: The committee develops and implements a system-wide educational program addressing topics relevant to medical error. (b) Case consultation: The committee develops and provides consultative resource services to assist with clinical management of cases involving clear or possible medical error, unanticipated adverse outcome, or “near-miss”. Such services include assistance with patient/family communications, facilitation of prompt medical case reviews, and initiation of debriefing and support services for staff. (c) Quality improvement: The committee works with other structures of the Medical Staff and Administration to apply the lessons learned from case reviews toward system-wide improvements. An important part of the work of the MEAO Committee – through its functions of education, case management, and quality improvement – is to de-stigmatize error and to nurture a culture in which clinicians are supported in their professional responsibilities to acknowledge, constructively discuss, and prevent medical error. The committee meets regularly (at least six times yearly) and reports to the Medical Executive Committee. 9.3.12.2 Composition The MEAO Committee includes: (a) a physician chairperson, appointed by the Medical Staff President, subject to MEC approval; (b) at least two additional staff physicians; (c) at least two nurses; (d) one resident physician; (e) one representative from Administration; (f) one community lay representative; 51 (g) the leader of the staff debriefing and support team; and (h) other members with special expertise as determined by the chairperson. 9.3.13 Medical Staff Assistance Committee 9.3.13.1 Purpose and Meetings In order to improve the quality of care and promote the well-being of the Medical Staff, the Medical Staff Assistance Committee (MSAC) receives reports related to health concerns, well being, or impairment of Medical Staff Members, and, as it deems appropriate, investigates such reports. With respect to matters involving individual Medical Staff Members, the committee may, on a voluntary basis, provide such advice, counseling, or referrals as may seem appropriate. Such activities shall be confidential; however, in the event information received by the committee clearly demonstrates that the health or known impairment of a Medical Staff member poses an unreasonable risk of harm to patients, that information may be referred for corrective action. The process that the MSAC uses to accomplish these goals include: (a) education of the Medical Staff and other organization staff about illness and impairment recognition issues specific to physicians; (b) self-referral by a physician or Licensed Indpendent Practitioner (LIP) and referral by other organization staff; (c) referral of the affected LIP to the appropriate professional internal or external resources for diagnosis and treatment of the condition or concern; (d) maintenance of the confidentiality of the LIP seeking referral or referred for assistance except as limited by law, ethical obligation, or when the safety of a patient is threatened; (e) evaluation of the credibility of a complaint, allegation, or concern; (f) monitoring of the affected LIP and the safety of patients until the rehabilitation or any disciplinary process is complete; and (g) reporting to the Medical Staff leadership instances in which a LIP is providing unsafe treatment. The committee shall also consider general matters related to the health and well being of the Medical Staff, and, with the approval of the Medical Executive Committee, develop educational programs or related activities. The Medical Staff Assistance Committee shall meet as often as necessary, but at least quarterly. It shall maintain only such record of its proceedings as it deems advisable, but shall report on its activities on a routine basis to the Medical Executive Committee. 9.3.13.2 Composition The Medical Staff Assistance Committee includes: (a) a physician chairperson, appointed by the Medical Staff President, subject to Medical Executive Committee approval; 52 (b) at least two (2) additional practitioners; and (c) a Member of the Resident staff. Except for the resident, who shall serve on the committee for one (1) year, each member shall serve for a term of three (3) years, and the term shall be staggered as deemed appropriate by Medical Executive Committee to achieve continuity. Insofar as possible, members of this committee shall not serve as active participants on other peer review or quality assurance committees while serving on this committee. The chairperson may appoint additional individuals who are not members of the Medical Staff, including non-physicians, when such appointment may materially increase the effectiveness of the work of the committee. These individuals shall serve for a term that shall be determined by the Chairperson. 9.3.14 Patient Care Policy and Evaluation Committee 9.3.14.1 Purpose and Meetings The Patient Care Policy and Evaluation Committee (PCP&EC) monitors, assesses and recommends improvements to the MEC for: (a) the clinical and medical records policies and rules of the Medical Staff and of its inpatient clinical units and diagnostic and therapeutic support services (including OR/PAR, ER, CCUs, etc.); (b) medical-related aspects of infection control policies; (c) pharmacy and therapeutics policies and practices; and (d) blood and blood product usage policies and practices. It also acts as liaison with Nursing and Administration for review and coordination of policies, procedures, rules or regulations under joint Medical Staff-Administration or Medical Staff-Nursing purview and coordinates its activities with those of the Ambulatory Policy Committee. The PCP&EC receives quality assurance findings suggestive of or requiring changes in the said policies and practices, and formulates, or directs the formulation of, specific changes. It serves as a forum for identifying and discussing problems in the delivery of patient care services and in the observance of patient's rights. The PCP&EC meets monthly and reports to the MEC. 9.3.14.2 Composition The Patient Care Policy and Evaluation Committee includes: (a) a physician chairperson appointed by the Medical Staff President subject to MEC approval; (b) at least 6-8 staff members selected to be representative of major clinical areas; (c) representative of Nursing Service; (d) Director of Pharmacy ad-hoc for Pharmacy and Therapeutic function; (e) representative from Pathology Department ad hoc for blood and blood product review function; 53 (f) chairperson of Infection Control and Safety Committee Manager of Infection Control and Prevention of the Hospital; (g) representative of Administration responsible for policy committee support without vote; (h) nursing supervisor/coordinators for specialty units invited on an ad-hoc basis without vote; (i) representatives of other clinical services and professional, technical, administrative support staff participate as consultants in relevant areas of expertise ad-hoc without vote; and (j) Director of Medical Records quarterly and as needed without vote. 9.3.15 Perinatal Morbidity and Mortality (PM&M) Committee 9.3.15.1 Function The Perinatal Morbidity and Mortality Committee (PM&M) is an inter-disciplinary committee which monitors perinatal outcomes. It is intended to complement the quality assurance activities of the Departments of Pediatrics and Obstetrics and Gynecology by focusing on those cases whose management involves both obstetrical and pediatric issues. The PM&M reports to the Departments of OB/Gyn and Pediatrics. 9.3.15.2 Composition The Perinatal Morbidity and Mortality Committee consists of: (a) all Members in good standing of the Departments of Ob/Gyn and Pediatrics. The individual departments establish attendance obligations; (b) Nurse Program Manager for the Perinatal Unit, Clinical Nurse Specialists for maternity and nursery and the RN Case Coordinator are members, all with voting privileges; and (c) regularly invited members, all without vote, including: 1. consultant perinatologist; 2. consultant neonatologist; 3. any Member of the Department of Ambulatory Medicine having obstetrical privileges; 4. any Member of the Resident Staff presently assigned to the Pediatrics or OB/Gyn services or with a particular interest in a case being discussed; and 5. any member of the nursing staff with a particular interest in a case being discussed. (The Nurse Program Manager or his/her designee will maintain a file of confidentiality agreements signed by all non-physician attendees.) 9.3.16 Professional Affairs Committee 9.3.16.1 Purpose of Meetings 54 The Professional Affairs Committee of the Governing Body serves as a closed forum for discussion between the Governing Body and the Medical Staff of Quality Assurance, Risk Management, Credentials, and related topics within the limits allowed by law. The Professional Affairs Committee shall exercise other responsibilities set forth in these Bylaws. The Professional Affairs Committee shall meet at least semiannually, and shall transmit written reports of its activities to the Medical Executive Committee and to the Governing Body. 9.3.16.2 Composition The Professional Affairs Committee consists of the two members of the Governing Body who sit on the Joint Conference Committee. The members of the Professional Affairs Committee shall invite representatives from the Medical Staff and Administration, as appropriate, to its meetings. 9.3.17 Unsatisfactory Patient Provider Relationship 9.3.17.1 Purpose and Meetings The Unsatisfactory Patient Provider Relationship Committee was formed to be an advocate for providers, improve patient care, produce educational programs and reduce system costs. The committee meets monthly to discuss case referrals. 9.3.17.2 Composition Participation is open to any Member of the Medical Staff. Membership includes, but is not limited to: (a) a physician chairperson appointed by the Medical Staff President, subject to Medical Executive Committee approval; (b) the Patient Relations Services Coordinator; (c) representation from each of the three regions of the County; (d) representation from the behavioral science faculty; (e) representation from Medical Social Services; and (f) representation from CCHP. 9.3.18 Utilization Review Committee Utilization Management Committee 9.3.18.1 Purpose and Meetings The Utilization Review Management Committee develops and oversees implementation and operation of the utilization review management (UR) plan relating to inpatient, ambulatory and clinical support services, makes utilization decisions as required under the plan, analyzes utilization profiles and evaluates the effectiveness of the UR program. Physician members of the committee act as the physician advisors required by the UR plan. 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