Who Should Control Healthcare?

By Barbara Weissman, MD
CMA Trustee for the Specialty Delegation

Imagine coming to the hospital to work one morning, only to find you are denied admittance to your office and no longer a member of the hospital medical staff. In January 2016, hospital administrators at the Tulare Regional Medical Center (TRMC) terminated the entire medical staff and its elected officers and adopted new medical staff bylaws without input from the hospital’s physicians.

In effect, a single hospital board meeting dissolved a decades-old medical staff organization and replaced it with a sham medical staff with hospital-appointed leaders. The previously active staff members were granted “provisional” status, and the initial replacement bylaws stated that physicians could achieve active status by proving their economic value to the hospital. 

The medical staff filed a lawsuit in February of 2016, and the hospital hired several lawyers and a public relations firm to put out the false message that “the medical staff is out of control.”

Existing California law passed in 2004 supports the independence of medical staffs, including the right to make and enforce medical staff bylaws and elect medical staff leaders. This law is one of the nation’s strongest, and certainly, initial medical staff bylaws provisions imposed by Tulare hospital about economic value, which has been since amended, could fall into the category of an illegal kickback.

But even a strong law is meaningless unless it is reinforced – and the cost for individual physicians to fight a lawsuit against the hospital is extraordinary.

Luckily, the California Medical Association (CMA) got involved and secured matching financial support from the Litigation Center of the American Medical Association (AMA). While not the primary plaintiff, CMA has invested over a million dollars in support of medical staff independence.

The ultimate goal of the lawsuit is to reinstate the original and true medical staff of Tulare hospital, which would involve re-seating duly elected officers and re-establishing medical staff bylaws. The battle has already taken quite a toll – the original medical staff was approximately 170 members, and they are currently down to 60. The hospital has also filed for bankruptcy, which won’t change the trajectory of the lawsuit. But it’s a sad footnote given one of the initial issues between medical staff and the hospital was over the lack of staffing.

Long Do, CMA Legal Counsel and Director of Litigation told AMA Wire, “If the hospital is allowed to do what they did, it basically ends medical staff independence in the state of California. Our biggest concern is that some sort of legal precedent would be set if they were allowed to get away with it. Another hospital could say to its staff, ‘If you don’t cooperate, that’s what we’re going to do to you.’”

This issue doesn’t just impact medical staff – it speaks to the larger societal question of who should direct health care? What role should physicians, hospitals and health plans have in its delivery?

A New York Times column explores this question and argues that when physicians – those on the front line with patients providing care – lead a health care facility, the overall quality of services is better for patients.

About the author: 

Dr. Barbara Weissman is a member of the San Mateo County Medical Association (SMCMA). This article is part of a series addressing matters of interest to SMCMA that come before the CMA Board of Trustees at their quarterly meetings. Francisco Silva also discussed this issue at the House of Delegates, and his presentation provided a basis for this article. If you have related questions, feedback or ideas, please contact Dr. Weissman at Barbara.yatesmd@gmail.com

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