Ohio Administrative Code › Title 3335 - Ohio State University › Chapter 3335-111 - CHRI In General › Section 3335-111-10 - Administration of the medical staff of the CHRI

Current through all regulations passed and filed through July 1, 2024
Medical staff committees.
(A) Appointments: Appointments to all medical
			 staff committees except the medical staff administrative committee (MSAC) and
			 the nominating committee will be made jointly by the chief of staff, chief of
			 staff-elect, and the director of medical affairs with medical staff
			 administrative committee ratification. Unless otherwise provided by the bylaws,
			 all appointments to medical staff committees are for two years and may be
			 renewed. The chairperson shall control the committee agenda, attendance of
			 staff and guests and conduct the proceedings. A simple majority of appointed
			 voting members shall constitute a quorum. All committee members appointed or
			 elected to serve on a medical staff committee are expected to participate fully
			 in the activities of those committees. The chief of staff, director of medical
			 affairs and the chief executive officer of the CHRI may serve on any medical
			 staff committee as an ex-officio member without vote.
(B) The medical staff as a whole and each
			 committee provided for by these medical staff bylaws is hereby designated as a
			 peer review committee in accordance with the laws of the state of Ohio. The
			 medical staff through its committees shall be responsible for evaluating,
			 maintaining and monitoring the quality and utilization of patient care services
			 provided by CHRI.
(C) Medical staff
			 administrative committee:
(1) Composition:
(a) Voting membership includes: chief of
			 staff, chief of staff-elect, immediate past chief of staff, clinical department
			 chief or division director of medical oncology, radiation oncology, anatomic
			 pathology and molecular pathology; department chairperson or division director
			 of hematology, gynecologic oncology, otolaryngology/head and neck, hospital
			 medicine, human genetics, infectious diseases, surgical oncology, thoracic
			 surgery, neurological oncology, orthopaedic oncology/sarcoma pulmonary,
			 critical care, sleep medicine, and urology; medical director of James emergency
			 services; clinical department chiefs of anesthesia, dermatology, physical medicine and rehabilitation,
			 plastic surgery, psychiatry, and radiology; CHRI medical director of quality,
			 CHRI medical director of credentialing, CHRI chief executive officer, CHRI
			 director of medical affairs, director of the division of palliative medicine,
			 chairperson of the cancer subcommittee, CCC director for clinical research, CCC
			 director for cancer control, and medical director of the James surgical
			 services. Up to two additional at-large member(s) may be appointed to the MSAC
			 at the recommendation of the chief executive officer of the CHRI, subject to
			 the approval of the medical staff administrative committee and subject to
			 review and renewal on a yearly basis. If a division director is a member by
			 leadership position, he or she will also fulfill the role of division director
			 appointment. The director of medical affairs shall be the chairperson and the
			 chief of staff shall be the vice-chairperson.
(b) Ex-officio non-voting membership
			 includes: the CHRI executive director, the CHRI chief nursing officer, CHRI
			 executive director of patient services, the medical director of university
			 hospital and/or the chief medical officer of the medical center, the dean of
			 the Ohio state university college of medicine, and the executive vice president
			 for health sciences.
(c) Any member
			 of the committee who anticipates absence from a meeting of the committee may
			 appoint a temporary substitute as a representative at the meeting. The
			 temporary substitute will have all the rights of the absent member. The chief
			 executive officer may invite any member of staff as the chief executive
			 officer's representative at a meeting or to attend any meeting with the chief
			 executive officer.
(d) All members
			 of the committee shall attend, either in person or by proxy, a minimum of
			 two-thirds of all committee meetings.
(e) Any members may be removed from the
			 medical staff administrative committee at the recommendation of the dean of the
			 college of medicine, the director of medical affairs or the executive vice
			 president for health sciences and subject to the review and approval of the
			 medical staff administrative committee. A replacement will be appointed as
			 outlined in this paragraph to maintain the medical staff administrative
			 committee's composition as stated in this paragraph.