WHAT IS THE GOVERNANCE STRUCTURE OF STRUCTURE OF A HOSPITAL?
1. Governing Board
An acute care hospital is “a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care...” (Health & Safety Code, § 1250, emphasis added)
Duties of the Governing Board
1. Insure Competency & Evaluate Quality of Medical Treatment
A “Hospital owes generally a duty to insure the competency of its medical staff and to evaluate the quality of medical treatment rendered on its premises...”. Elam v. College Park Hospital (1982) 132 Cal.App.3d 332, 347
2. Be Accountable to State & Federal Regulators
“It is a hospital's governing body, not its medical staff, that is accountable to federal and state regulators, not to mention to patients themselves and their families.” (Elam v. College Park Hospital (1982) 132 Cal.App.3d 332, 335
3. Power to Render Final Decisions
“A hospital's governing body must be permitted to align its authority with its responsibility and to render the final decision in the hospital administrative context.” (Hongsathavij v. Queen of Angels/Hollywood Presbyterian Med. Ctr. (1998) 62 Cal.App.4th 1123, 1143.)
See also: Alexander v. Superior Court (1993) 5 Cal.4th 1218, 1224 [“an administrative governing body (often comprised of persons other than health care professionals) takes ultimate responsibility for the quality and performance of the hospital”], disapproved on other grounds, Hassan v. Mercy Am. River Hosp. (2003) 31 Cal.4th 709.)
See also: Weinberg v. Cedars-Sinai Medical Center (2004) 119 Cal.App.4th 1098, 1109 [“we further conclude that the Board's authority encompasses final responsibility for the quality of its medical staff and care...”]
2. Executive Leadership
22 CCR 70701 lists the requirements of a hospital’s governing body. It must “Appoint an administrator whose qualifications, authority and duties shall be defined in a written statement adopted by the governing body.” (22 CCR 70701(2)) This is the hospital CEO and top management.
3. Organized Medical Staff
Every acute care hospital must have “an organized medical staff responsible to the governing body for the adequacy and quality of the medical care rendered to patients in the hospital.” (22 CCR § 70703(a).)
A medical staff is required to adopt written bylaws. The medical staff also must provide a means for enforcing its bylaws. (22 CCR § 70703(b).)
Medical Staff is subservient to the Governing Board as 22 CCR 482.12(5) states that the Governing Board must “(5) Ensure that the medical staff is accountable to the governing body for the quality of care provided to patients”.
Many of these rules were summarized in the well known November 12, 2004 CMS letter. An often overlooked fact is that the governing board and not medical staff grants privileges. The CMS letter makes this clear:
Role of Governing Body in Granting Privileges After considering the Medical Staff’s recommendations to grant, deny, continue, revise, discontinue, limit, or revoke specified privileges, and in accordance with established hospital Medical Staff criteria and state and federal laws and regulations, the Governing Body determines whether to grant the recommended privileges for that practitioner. Only the hospital’s Governing Body can grant a practitioner privileges to provide care in the hospital.
But "I knew that much" many people say, but there is more and here is where many hospitals fail. The hospital must have standard privileges and listed specific privileges AND it must also ensure that the hospital can handle the procedures authorized. This is a "scope of services" requirement. It reads:
Any procedure/task/activity/privilege requested by and recommended for a practitioner beyond the specified list of privileges for their particular category of practitioner would require evidence of additional qualifications and competencies, and be an activity/ task/procedure that the hospital can support and is conducted within the hospital. Privileges cannot be granted for tasks/procedures/activities not conducted within the hospital despite the practitioner’s ability to perform the requested tasks/ procedures/ activities. The hospital’s Governing Body and Medical Staff must assure that every individual practitioner who provides a medical level of care and/or who conducts surgical procedures in the hospital is competent to perform all granted privileges.
The CMS letter should be read by every hospital administrator but in our experience if the letter was read it is often misunderstood or ignored.
Why Hire Daniel Horowitz for Hospital Issues
Expertise in Medical Law
Daniel Horowitz is a renowned expert in medical law, specializing in defending physicians facing complex hospital issues. With decades of experience, he understands the intricacies of medical license defense, peer reviews, and hospital politics. His deep knowledge of the Medical Board of California’s procedures and regulations ensures that you receive the best possible legal representation.
Proven Track Record
Daniel Horowitz has a proven track record of successfully defending physicians against unwarranted accusations and disciplinary actions. His expertise in navigating the legal landscape of medical board investigations and hospital disputes has earned him a reputation as one of the best lawyers in this field. His ability to anticipate and counteract the tactics used by hospital administrations and medical executive committees makes him an invaluable ally.
Comprehensive Legal Support
When facing issues with a hospital, you need comprehensive legal support that covers all aspects of your case. Daniel Horowitz provides thorough legal counsel, from initial investigations to appeals. His approach ensures that every detail is meticulously examined, and your rights are fiercely protected. Whether it’s a sham peer review, licensing challenge, or practice dispute, Daniel Horowitz’s expertise will guide you through the process.
Personalized Defense Strategy
Every case is unique, and Daniel Horowitz tailors his defense strategy to meet the specific needs of each physician. He takes the time to understand your situation, evaluate the evidence, and develop a robust defense plan. His personalized approach ensures that you receive the attention and dedication necessary to achieve the best possible outcome.
Unwavering Commitment
Daniel Horowitz is committed to defending your medical license and career. His dedication to his clients is evident in his relentless pursuit of justice and fair treatment. By choosing Daniel Horowitz, you are not just hiring a lawyer; you are gaining a steadfast advocate who will stand by you every step of the way.
Contact Daniel Horowitz Today
If you are a physician facing issues with a hospital, don’t leave your career and reputation to chance. Trust Daniel Horowitz, an expert in medical board matters, to provide the legal support and guidance you need. Contact the Horowitz Medical Law Group today to safeguard your future. Call (925) 283-1863 for expert defense.