97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5481

 

Introduced 2/15/2012, by Rep. Timothy L. Schmitz

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 85/10.4  from Ch. 111 1/2, par. 151.4

    Amends the Hospital Licensing Act. Provides that the minimum procedures, with respect to medical staff and clinical privilege determinations concerning current medical members of the medical staff, shall include the right to be represented by a personal attorney throughout the medical staff credentialing process. Effective immediately.


LRB097 15728 CEL 60872 b

 

 

A BILL FOR

 

HB5481LRB097 15728 CEL 60872 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Hospital Licensing Act is amended by
5changing Section 10.4 as follows:
 
6    (210 ILCS 85/10.4)  (from Ch. 111 1/2, par. 151.4)
7    Sec. 10.4. Medical staff privileges.
8    (a) Any hospital licensed under this Act or any hospital
9organized under the University of Illinois Hospital Act shall,
10prior to the granting of any medical staff privileges to an
11applicant, or renewing a current medical staff member's
12privileges, request of the Director of Professional Regulation
13information concerning the licensure status and any
14disciplinary action taken against the applicant's or medical
15staff member's license, except: (1) for medical personnel who
16enter a hospital to obtain organs and tissues for transplant
17from a donor in accordance with the Illinois Anatomical Gift
18Act; or (2) for medical personnel who have been granted
19disaster privileges pursuant to the procedures and
20requirements established by rules adopted by the Department.
21Any hospital and any employees of the hospital or others
22involved in granting privileges who, in good faith, grant
23disaster privileges pursuant to this Section to respond to an

 

 

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1emergency shall not, as a result of their acts or omissions, be
2liable for civil damages for granting or denying disaster
3privileges except in the event of willful and wanton
4misconduct, as that term is defined in Section 10.2 of this
5Act. Individuals granted privileges who provide care in an
6emergency situation, in good faith and without direct
7compensation, shall not, as a result of their acts or
8omissions, except for acts or omissions involving willful and
9wanton misconduct, as that term is defined in Section 10.2 of
10this Act, on the part of the person, be liable for civil
11damages. The Director of Professional Regulation shall
12transmit, in writing and in a timely fashion, such information
13regarding the license of the applicant or the medical staff
14member, including the record of imposition of any periods of
15supervision or monitoring as a result of alcohol or substance
16abuse, as provided by Section 23 of the Medical Practice Act of
171987, and such information as may have been submitted to the
18Department indicating that the application or medical staff
19member has been denied, or has surrendered, medical staff
20privileges at a hospital licensed under this Act, or any
21equivalent facility in another state or territory of the United
22States. The Director of Professional Regulation shall define by
23rule the period for timely response to such requests.
24    No transmittal of information by the Director of
25Professional Regulation, under this Section shall be to other
26than the president, chief operating officer, chief

 

 

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1administrative officer, or chief of the medical staff of a
2hospital licensed under this Act, a hospital organized under
3the University of Illinois Hospital Act, or a hospital operated
4by the United States, or any of its instrumentalities. The
5information so transmitted shall be afforded the same status as
6is information concerning medical studies by Part 21 of Article
7VIII of the Code of Civil Procedure, as now or hereafter
8amended.
9    (b) All hospitals licensed under this Act, except county
10hospitals as defined in subsection (c) of Section 15-1 of the
11Illinois Public Aid Code, shall comply with, and the medical
12staff bylaws of these hospitals shall include rules consistent
13with, the provisions of this Section in granting, limiting,
14renewing, or denying medical staff membership and clinical
15staff privileges. Hospitals that require medical staff members
16to possess faculty status with a specific institution of higher
17education are not required to comply with subsection (1) below
18when the physician does not possess faculty status.
19        (1) Minimum procedures for pre-applicants and
20    applicants for medical staff membership shall include the
21    following:
22            (A) Written procedures relating to the acceptance
23        and processing of pre-applicants or applicants for
24        medical staff membership, which should be contained in
25        medical staff bylaws.
26            (B) Written procedures to be followed in

 

 

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1        determining a pre-applicant's or an applicant's
2        qualifications for being granted medical staff
3        membership and privileges.
4            (C) Written criteria to be followed in evaluating a
5        pre-applicant's or an applicant's qualifications.
6            (D) An evaluation of a pre-applicant's or an
7        applicant's current health status and current license
8        status in Illinois.
9            (E) A written response to each pre-applicant or
10        applicant that explains the reason or reasons for any
11        adverse decision (including all reasons based in whole
12        or in part on the applicant's medical qualifications or
13        any other basis, including economic factors).
14        (2) Minimum procedures with respect to medical staff
15    and clinical privilege determinations concerning current
16    members of the medical staff shall include the following:
17            (A) A written notice of an adverse decision.
18            (B) An explanation of the reasons for an adverse
19        decision including all reasons based on the quality of
20        medical care or any other basis, including economic
21        factors.
22            (C) A statement of the medical staff member's right
23        to request a fair hearing on the adverse decision
24        before a hearing panel whose membership is mutually
25        agreed upon by the medical staff and the hospital
26        governing board. The hearing panel shall have

 

 

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1        independent authority to recommend action to the
2        hospital governing board. Upon the request of the
3        medical staff member or the hospital governing board,
4        the hearing panel shall make findings concerning the
5        nature of each basis for any adverse decision
6        recommended to and accepted by the hospital governing
7        board.
8                (i) Nothing in this subparagraph (C) limits a
9            hospital's or medical staff's right to summarily
10            suspend, without a prior hearing, a person's
11            medical staff membership or clinical privileges if
12            the continuation of practice of a medical staff
13            member constitutes an immediate danger to the
14            public, including patients, visitors, and hospital
15            employees and staff. In the event that a hospital
16            or the medical staff imposes a summary suspension,
17            the Medical Executive Committee, or other
18            comparable governance committee of the medical
19            staff as specified in the bylaws, must meet as soon
20            as is reasonably possible to review the suspension
21            and to recommend whether it should be affirmed,
22            lifted, expunged, or modified if the suspended
23            physician requests such review. A summary
24            suspension may not be implemented unless there is
25            actual documentation or other reliable information
26            that an immediate danger exists. This

 

 

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1            documentation or information must be available at
2            the time the summary suspension decision is made
3            and when the decision is reviewed by the Medical
4            Executive Committee. If the Medical Executive
5            Committee recommends that the summary suspension
6            should be lifted, expunged, or modified, this
7            recommendation must be reviewed and considered by
8            the hospital governing board, or a committee of the
9            board, on an expedited basis. Nothing in this
10            subparagraph (C) shall affect the requirement that
11            any requested hearing must be commenced within 15
12            days after the summary suspension and completed
13            without delay unless otherwise agreed to by the
14            parties. A fair hearing shall be commenced within
15            15 days after the suspension and completed without
16            delay, except that when the medical staff member's
17            license to practice has been suspended or revoked
18            by the State's licensing authority, no hearing
19            shall be necessary.
20                (ii) Nothing in this subparagraph (C) limits a
21            medical staff's right to permit, in the medical
22            staff bylaws, summary suspension of membership or
23            clinical privileges in designated administrative
24            circumstances as specifically approved by the
25            medical staff. This bylaw provision must
26            specifically describe both the administrative

 

 

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1            circumstance that can result in a summary
2            suspension and the length of the summary
3            suspension. The opportunity for a fair hearing is
4            required for any administrative summary
5            suspension. Any requested hearing must be
6            commenced within 15 days after the summary
7            suspension and completed without delay. Adverse
8            decisions other than suspension or other
9            restrictions on the treatment or admission of
10            patients may be imposed summarily and without a
11            hearing under designated administrative
12            circumstances as specifically provided for in the
13            medical staff bylaws as approved by the medical
14            staff.
15                (iii) If a hospital exercises its option to
16            enter into an exclusive contract and that contract
17            results in the total or partial termination or
18            reduction of medical staff membership or clinical
19            privileges of a current medical staff member, the
20            hospital shall provide the affected medical staff
21            member 60 days prior notice of the effect on his or
22            her medical staff membership or privileges. An
23            affected medical staff member desiring a hearing
24            under subparagraph (C) of this paragraph (2) must
25            request the hearing within 14 days after the date
26            he or she is so notified. The requested hearing

 

 

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1            shall be commenced and completed (with a report and
2            recommendation to the affected medical staff
3            member, hospital governing board, and medical
4            staff) within 30 days after the date of the medical
5            staff member's request. If agreed upon by both the
6            medical staff and the hospital governing board,
7            the medical staff bylaws may provide for longer
8            time periods.
9            (C-5) All peer review used for the purpose of
10        credentialing, privileging, disciplinary action, or
11        other recommendations affecting medical staff
12        membership or exercise of clinical privileges, whether
13        relying in whole or in part on internal or external
14        reviews, shall be conducted in accordance with the
15        medical staff bylaws and applicable rules,
16        regulations, or policies of the medical staff. If
17        external review is obtained, any adverse report
18        utilized shall be in writing and shall be made part of
19        the internal peer review process under the bylaws. The
20        report shall also be shared with a medical staff peer
21        review committee and the individual under review. If
22        the medical staff peer review committee or the
23        individual under review prepares a written response to
24        the report of the external peer review within 30 days
25        after receiving such report, the governing board shall
26        consider the response prior to the implementation of

 

 

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1        any final actions by the governing board which may
2        affect the individual's medical staff membership or
3        clinical privileges. Any peer review that involves
4        willful or wanton misconduct shall be subject to civil
5        damages as provided for under Section 10.2 of this Act.
6            (D) A statement of the member's right to inspect
7        all pertinent information in the hospital's possession
8        with respect to the decision.
9            (E) A statement of the member's right to present
10        witnesses and other evidence at the hearing on the
11        decision.
12            (E-5) The right to be represented by a personal
13        attorney throughout the medical staff credentialing
14        process.
15            (F) A written notice and written explanation of the
16        decision resulting from the hearing.
17            (F-5) A written notice of a final adverse decision
18        by a hospital governing board.
19            (G) Notice given 15 days before implementation of
20        an adverse medical staff membership or clinical
21        privileges decision based substantially on economic
22        factors. This notice shall be given after the medical
23        staff member exhausts all applicable procedures under
24        this Section, including item (iii) of subparagraph (C)
25        of this paragraph (2), and under the medical staff
26        bylaws in order to allow sufficient time for the

 

 

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1        orderly provision of patient care.
2            (H) Nothing in this paragraph (2) of this
3        subsection (b) limits a medical staff member's right to
4        waive, in writing, the rights provided in
5        subparagraphs (A) through (G) of this paragraph (2) of
6        this subsection (b) upon being granted the written
7        exclusive right to provide particular services at a
8        hospital, either individually or as a member of a
9        group. If an exclusive contract is signed by a
10        representative of a group of physicians, a waiver
11        contained in the contract shall apply to all members of
12        the group unless stated otherwise in the contract.
13        (3) Every adverse medical staff membership and
14    clinical privilege decision based substantially on
15    economic factors shall be reported to the Hospital
16    Licensing Board before the decision takes effect. These
17    reports shall not be disclosed in any form that reveals the
18    identity of any hospital or physician. These reports shall
19    be utilized to study the effects that hospital medical
20    staff membership and clinical privilege decisions based
21    upon economic factors have on access to care and the
22    availability of physician services. The Hospital Licensing
23    Board shall submit an initial study to the Governor and the
24    General Assembly by January 1, 1996, and subsequent reports
25    shall be submitted periodically thereafter.
26        (4) As used in this Section:

 

 

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1        "Adverse decision" means a decision reducing,
2    restricting, suspending, revoking, denying, or not
3    renewing medical staff membership or clinical privileges.
4        "Economic factor" means any information or reasons for
5    decisions unrelated to quality of care or professional
6    competency.
7        "Pre-applicant" means a physician licensed to practice
8    medicine in all its branches who requests an application
9    for medical staff membership or privileges.
10        "Privilege" means permission to provide medical or
11    other patient care services and permission to use hospital
12    resources, including equipment, facilities and personnel
13    that are necessary to effectively provide medical or other
14    patient care services. This definition shall not be
15    construed to require a hospital to acquire additional
16    equipment, facilities, or personnel to accommodate the
17    granting of privileges.
18        (5) Any amendment to medical staff bylaws required
19    because of this amendatory Act of the 91st General Assembly
20    shall be adopted on or before July 1, 2001.
21    (c) All hospitals shall consult with the medical staff
22prior to closing membership in the entire or any portion of the
23medical staff or a department. If the hospital closes
24membership in the medical staff, any portion of the medical
25staff, or the department over the objections of the medical
26staff, then the hospital shall provide a detailed written

 

 

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1explanation for the decision to the medical staff 10 days prior
2to the effective date of any closure. No applications need to
3be provided when membership in the medical staff or any
4relevant portion of the medical staff is closed.
5(Source: P.A. 95-331, eff. 8-21-07; 96-445, eff. 8-14-09.)
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.