Opinion ID: 2362860
Heading Depth: 1
Heading Rank: 4

Heading: clinical privileges

Text: The Hospital next argues that even if the bylaws do constitute a contract, the fair hearing bylaw provisions do not come into play because Alfredson's privileges were not terminated or reduced, and no action taken by the Hospital invokes the provisions of the fair hearing plan set forth in the medical staff bylaws. According to the Hospital, medical staff membership and clinical privileges are distinct and different items. It argues medical staff appointment is membership in the body created by the bylaws. Clinical privileges is the permission granted to render specific services as defined in the bylaws, which set up procedures for a request for privileges which are ultimately granted by the board. The Hospital contends that the two are separate, that clinical privileges granted to hospital-based specialities do not grant access to Hospital equipment or personnel, and that Alfredson's staff privileges have not been adversely affected, even though he has no access to the facilities or personnel at Lewisburg Community Hospital. The Hospital cites Collins v. Associated Pathologist, Ltd., 844 F.2d 473 (7th Cir.1988), for authority that clinical privileges granted in the area of hospital-based specialities do not grant access to the equipment owned by the hospital and the personnel paid by the hospital. However, Collins is inapposite because in that case the plaintiff's dispute was with the separate firm which provided pathology services to the defendant hospital. The firm forced the pathologist to resign from the firm, and he thereafter sought employment at the hospital as an independent pathologist. The hospital, which had played no role in securing the pathologist's resignation, did nothing to reduce or remove the pathologist's staff privileges; the hospital simply refused to employ him as a pathologist. Here, the Hospital has granted privileges, but later affirmatively barred Alfredson from using any Hospital radiological facilities or staff. The Hospital further argues that the exclusive radiology contract protected only Alfredson's medical staff appointment from automatic termination, and that access to equipment and privileges terminated automatically at the end of the contract. It says in light of the circumstances, Alfredson knew from his own contract the Hospital had decided an exclusive radiology contract was the more efficient way to operate. The Hospital contends that if the contract is interpreted to allow clinical privileges to continue, the Hospital has effectively relinquished its ability to enter into an exclusive contract after termination of Alfredson's contract, even though the exclusive contract is the most efficient method of operation. However, the Hospital's Medical and Dental Staff Bylaws recognize the relationship between membership on the active medical staff and a doctor's clinical privileges. As the Court of Appeals noted in its opinion: They define the Medical Staff as `the formal organization of all duly licensed physicians, dentists and podiatrists who have been granted privileges by the Board... .' They also require the medical staff to administer a credentials procedure, including mechanisms for appointment and reappointment and the delineation of clinical privileges. See Bylaws § 2.2(a)(3). Doctors applying for appointment or reappointment to the active medical staff must request the specific clinical privileges they desire. See Bylaws 6.2(b)(3), 7.2(a). Membership on the active medical staff confers only such clinical privileges and prerogatives as have been granted by the Board and the Governing Authority, see Bylaws 3.1, and staff members may exercise only those privileges granted pursuant to Article VII of the Bylaws. See Bylaws §§ 4.2(b)(3), 7.1. Necessarily, it follows that members of the active medical staff may use the hospital facilities necessary to enable them to exercise their delineated staff privileges. After the foregoing analysis, the Court of Appeals observed, and we agree, It is fair to conclude that the hospital granted Dr. Alfredson specific, delineated clinical privileges enabling him to practice radiology at the hospital. His contract required them. The bylaws themselves required that he seek them and likewise required the hospital to grant them. With hospital-based specialties such as radiology, the inability to use the hospital facilities and staff would have rendered the clinical privileges meaningless. Thus, necessarily included with Dr. Alfredson's privileges was the right to use hospital facilities and staff.