Full Text of HB5028 093rd General Assembly
HB5028 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB5028
Introduced 02/05/04, by Brandon W. Phelps SYNOPSIS AS INTRODUCED: |
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210 ILCS 85/10.4 |
from Ch. 111 1/2, par. 151.4 |
210 ILCS 85/10.8 |
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Amends the Hospital Licensing Act. Requires the Hospital Licensing Board to submit annual (instead of periodic) reports relating to the effects that hospital staff membership and clinical privilege decisions based on economic factors have on access to care. Requires that physicians be provided an opportunity to inspect and copy credentialing and other information, and authorizes a physician to use such information in any proceeding concerning medical staff membership or clinical privileges.
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A BILL FOR
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HB5028 |
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LRB093 14821 DRJ 46415 b |
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| AN ACT concerning health facilities.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Hospital Licensing Act is amended by | 5 |
| changing Sections 10.4 and 10.8 as follows:
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| (210 ILCS 85/10.4) (from Ch. 111 1/2, par. 151.4)
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| Sec. 10.4. Medical staff privileges.
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| (a) Any hospital licensed under this Act or any hospital | 9 |
| organized under the
University of Illinois Hospital Act shall, | 10 |
| prior to the granting of any medical
staff privileges to an | 11 |
| applicant, or renewing a current medical staff member's
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| privileges, request of the Director of Professional Regulation | 13 |
| information
concerning the licensure status and any | 14 |
| disciplinary action taken against the
applicant's or medical | 15 |
| staff member's license, except for medical personnel who
enter | 16 |
| a hospital to obtain organs and tissues for transplant from a | 17 |
| deceased
donor in accordance with the Uniform Anatomical Gift | 18 |
| Act. The Director of
Professional Regulation shall transmit, in | 19 |
| writing and in a timely fashion,
such information regarding the | 20 |
| license of the applicant or the medical staff
member, including | 21 |
| the record of imposition of any periods of
supervision or | 22 |
| monitoring as a result of alcohol or
substance abuse, as | 23 |
| provided by Section 23 of the Medical
Practice Act of 1987, and | 24 |
| such information as may have been
submitted to the Department | 25 |
| indicating that the application
or medical staff member has | 26 |
| been denied, or has surrendered,
medical staff privileges at a | 27 |
| hospital licensed under this
Act, or any equivalent facility in | 28 |
| another state or
territory of the United States. The Director | 29 |
| of Professional Regulation
shall define by rule the period for | 30 |
| timely response to such requests.
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| No transmittal of information by the Director of | 32 |
| Professional Regulation,
under this Section shall be to other |
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LRB093 14821 DRJ 46415 b |
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| than the president, chief
operating officer, chief | 2 |
| administrative officer, or chief of
the medical staff of a | 3 |
| hospital licensed under this Act, a
hospital organized under | 4 |
| the University of Illinois Hospital Act, or a hospital
operated | 5 |
| by the United States, or any of its instrumentalities. The
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| information so transmitted shall be afforded the same status
as | 7 |
| is information concerning medical studies by Part 21 of Article | 8 |
| VIII of the
Code of Civil Procedure, as now or hereafter | 9 |
| amended.
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| (b) All hospitals licensed under this Act, except county | 11 |
| hospitals as
defined in subsection (c) of Section 15-1 of the | 12 |
| Illinois Public Aid Code,
shall comply with, and the medical | 13 |
| staff bylaws of these hospitals shall
include rules consistent | 14 |
| with, the provisions of this Section in granting,
limiting, | 15 |
| renewing, or denying medical staff membership and
clinical | 16 |
| staff privileges. Hospitals that require medical staff members | 17 |
| to
possess
faculty status with a specific institution of higher | 18 |
| education are not required
to comply with subsection (1) below | 19 |
| when the physician does not possess faculty
status.
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| (1) Minimum procedures for
pre-applicants and | 21 |
| applicants for medical staff
membership shall include the | 22 |
| following:
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| (A) Written procedures relating to the acceptance | 24 |
| and processing of
pre-applicants or applicants for | 25 |
| medical staff membership, which should be
contained in
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| medical staff bylaws.
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| (B) Written procedures to be followed in | 28 |
| determining
a pre-applicant's or
an applicant's
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| qualifications for being granted medical staff | 30 |
| membership and privileges.
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| (C) Written criteria to be followed in evaluating
a | 32 |
| pre-applicant's or
an applicant's
qualifications.
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| (D) An evaluation of
a pre-applicant's or
an | 34 |
| applicant's current health status and current
license | 35 |
| status in Illinois.
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| (E) A written response to each
pre-applicant or
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| applicant that explains the reason or
reasons for any | 2 |
| adverse decision (including all reasons based in whole | 3 |
| or
in part on the applicant's medical qualifications or | 4 |
| any other basis,
including economic factors).
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| (2) Minimum procedures with respect to medical staff | 6 |
| and clinical
privilege determinations concerning current | 7 |
| members of the medical staff shall
include the following:
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| (A) A written notice of an adverse decision.
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| (B) An explanation of the reasons for an adverse | 10 |
| decision including all
reasons based on the quality of | 11 |
| medical care or any other basis, including
economic | 12 |
| factors.
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| (C) A statement of the medical staff member's right | 14 |
| to request a fair
hearing on the adverse decision | 15 |
| before a hearing panel whose membership is
mutually | 16 |
| agreed upon by the medical staff and the hospital | 17 |
| governing board. The
hearing panel shall have | 18 |
| independent authority to recommend action to the
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| hospital governing board. Upon the request of the | 20 |
| medical staff member or the
hospital governing board, | 21 |
| the hearing panel shall make findings concerning the
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| nature of each basis for any adverse decision | 23 |
| recommended to and accepted by
the hospital governing | 24 |
| board.
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| (i) Nothing in this subparagraph (C) limits a | 26 |
| hospital's or medical
staff's right to summarily | 27 |
| suspend, without a prior hearing, a person's | 28 |
| medical
staff membership or clinical privileges if | 29 |
| the continuation of practice of a
medical staff | 30 |
| member constitutes an immediate danger to the | 31 |
| public, including
patients, visitors, and hospital | 32 |
| employees and staff. A fair hearing shall be
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| commenced within 15 days after the suspension and | 34 |
| completed without delay.
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| (ii) Nothing in this subparagraph (C) limits a | 36 |
| medical staff's right
to permit, in the medical |
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| staff bylaws, summary suspension of membership or
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| clinical privileges in designated administrative | 3 |
| circumstances as specifically
approved by the | 4 |
| medical staff. This bylaw provision must | 5 |
| specifically describe
both the administrative | 6 |
| circumstance that can result in a summary | 7 |
| suspension
and the length of the summary | 8 |
| suspension. The opportunity for a fair hearing is
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| required for any administrative summary | 10 |
| suspension. Any requested hearing must
be | 11 |
| commenced within 15 days after the summary | 12 |
| suspension and completed without
delay. Adverse | 13 |
| decisions other than suspension or other | 14 |
| restrictions on the
treatment or admission of | 15 |
| patients may be imposed summarily and without a
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| hearing under designated administrative | 17 |
| circumstances as specifically provided
for in the | 18 |
| medical staff bylaws as approved by the medical | 19 |
| staff.
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| (iii) If a hospital exercises its option to | 21 |
| enter into an exclusive
contract and that contract | 22 |
| results in the total or partial termination or
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| reduction of medical staff membership or clinical | 24 |
| privileges of a current
medical staff member, the | 25 |
| hospital shall provide the affected medical staff
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| member 60 days prior notice of the effect on his or | 27 |
| her medical staff
membership or privileges. An | 28 |
| affected medical staff member desiring a hearing
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| under subparagraph (C) of this paragraph (2) must | 30 |
| request the hearing within 14
days after the date | 31 |
| he or she is so notified. The requested hearing | 32 |
| shall be
commenced and completed (with a report and | 33 |
| recommendation to the affected
medical staff | 34 |
| member, hospital governing board, and medical | 35 |
| staff) within 30
days after the date of the medical | 36 |
| staff member's request. If agreed upon by
both the |
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| medical staff and the hospital governing board, | 2 |
| the medical staff
bylaws may provide for longer | 3 |
| time periods.
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| (D) A statement of the member's right to inspect | 5 |
| all pertinent
information in the hospital's possession | 6 |
| with respect to the decision.
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| (E) A statement of the member's right to present | 8 |
| witnesses and other
evidence at the hearing on the | 9 |
| decision.
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| (F) A written notice and written explanation of the | 11 |
| decision resulting
from the hearing.
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| (F-5) A written notice of a final adverse decision | 13 |
| by a hospital
governing board.
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| (G) Notice given 15 days before implementation of | 15 |
| an adverse medical
staff membership or clinical | 16 |
| privileges decision based substantially on
economic | 17 |
| factors. This notice shall be given after the medical | 18 |
| staff member
exhausts all applicable procedures under | 19 |
| this Section, including item (iii) of
subparagraph (C) | 20 |
| of this paragraph (2), and under the medical staff | 21 |
| bylaws in
order to allow sufficient time for the | 22 |
| orderly provision of patient care.
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| (H) Nothing in this paragraph (2) of this | 24 |
| subsection (b) limits a
medical staff member's right to | 25 |
| waive, in writing, the rights provided in
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| subparagraphs (A) through (G) of this paragraph (2) of | 27 |
| this subsection (b) upon
being granted the written | 28 |
| exclusive right to provide particular services at a
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| hospital, either individually or as a member of a | 30 |
| group. If an exclusive
contract is signed by a | 31 |
| representative of a group of physicians, a waiver
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| contained in the contract shall apply to all members of | 33 |
| the group unless stated
otherwise in the contract.
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| (3) Every adverse medical staff membership and | 35 |
| clinical privilege decision
based substantially on | 36 |
| economic factors shall be reported to the Hospital
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LRB093 14821 DRJ 46415 b |
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| Licensing Board before the decision takes effect. These | 2 |
| reports shall not be
disclosed in any form that reveals the | 3 |
| identity of any hospital or physician.
These reports shall | 4 |
| be utilized to study the effects that hospital medical
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| staff membership and clinical privilege decisions based | 6 |
| upon economic factors
have on access to care and the | 7 |
| availability of physician services. The
Hospital Licensing | 8 |
| Board shall submit an annual
initial study to the Governor | 9 |
| and the
General Assembly by January 1 of each year , 1996, | 10 |
| and subsequent reports shall be submitted
periodically | 11 |
| thereafter .
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| (4) As used in this Section:
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| "Adverse decision" means a decision reducing, | 14 |
| restricting, suspending,
revoking, denying, or not | 15 |
| renewing medical staff membership or clinical
privileges.
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| "Economic factor" means any information or reasons for | 17 |
| decisions unrelated
to quality of care or professional | 18 |
| competency.
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| "Pre-applicant" means a physician licensed to practice | 20 |
| medicine in all
its
branches who requests an application | 21 |
| for medical staff membership or
privileges.
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| "Privilege" means permission to provide
medical or | 23 |
| other patient care services and permission to use hospital
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| resources, including equipment, facilities and personnel | 25 |
| that are necessary to
effectively provide medical or other | 26 |
| patient care services. This definition
shall not be | 27 |
| construed to
require a hospital to acquire additional | 28 |
| equipment, facilities, or personnel to
accommodate the | 29 |
| granting of privileges.
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| (5) Any amendment to medical staff bylaws required | 31 |
| because of
this amendatory Act of the 91st General Assembly | 32 |
| shall be adopted on or
before July 1, 2001.
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| (6) Every physician licensed to practice medicine in | 34 |
| all its branches shall be provided the opportunity to | 35 |
| inspect and copy all credentialing and other information, | 36 |
| including, but not limited to, credentialing files and |
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| patient medical records, in the hospital's possession with | 2 |
| respect to any medical staff membership or clinical | 3 |
| privileges decision. This information may be used by the | 4 |
| physician in any proceeding concerning medical staff | 5 |
| membership or clinical privileges.
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| (c) All hospitals shall consult with the medical staff | 7 |
| prior to closing
membership in the entire or any portion of the | 8 |
| medical staff or a department.
If
the hospital closes | 9 |
| membership in the medical staff, any portion of the medical
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| staff, or the department over the objections of the medical | 11 |
| staff, then the
hospital
shall provide a detailed written | 12 |
| explanation for the decision to the medical
staff
10 days prior | 13 |
| to the effective date of any closure. No applications need to | 14 |
| be
provided when membership in the medical staff or any | 15 |
| relevant portion of the
medical staff is closed.
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| (Source: P.A. 90-14, eff. 7-1-97; 90-149, eff. 1-1-98; 90-655, | 17 |
| eff.
7-30-98; 91-166, eff. 1-1-00.)
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| (210 ILCS 85/10.8)
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| Sec. 10.8. Requirements for employment of physicians.
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| (a) Physician employment by hospitals and hospital | 21 |
| affiliates. Employing
entities may
employ physicians to | 22 |
| practice medicine in all of its branches provided that the
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| following
requirements are met:
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| (1) The employed physician is a member of the medical | 25 |
| staff of either the
hospital or hospital affiliate. If a | 26 |
| hospital affiliate decides to have a
medical staff, its
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| medical staff shall be organized in accordance with written | 28 |
| bylaws where the
affiliate
medical staff is responsible for | 29 |
| making recommendations to the governing body
of
the | 30 |
| affiliate regarding all quality assurance activities and | 31 |
| safeguarding
professional
autonomy. The affiliate medical | 32 |
| staff bylaws may not be unilaterally changed
by the
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| governing body of the affiliate. Nothing in this Section | 34 |
| requires hospital
affiliates
to have a medical staff.
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| (2) Independent
physicians, who are not employed by an |
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| employing entity,
periodically review the quality of
the | 2 |
| medical
services provided by the employed
physician to | 3 |
| continuously improve patient care.
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| (3) The employing entity and the employed physician | 5 |
| sign a statement
acknowledging
that the employer shall not | 6 |
| unreasonably exercise control, direct, or
interfere with
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| the employed physician's exercise and execution of his or | 8 |
| her professional
judgment in a manner that
adversely | 9 |
| affects the employed physician's ability to provide | 10 |
| quality care to
patients. This signed statement shall take | 11 |
| the form of a provision in the
physician's
employment | 12 |
| contract or a separate signed document from the employing | 13 |
| entity to
the
employed physician. This statement shall | 14 |
| state: "As the employer of a
physician,
(employer's name) | 15 |
| shall not unreasonably exercise control, direct, or
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| interfere with
the employed physician's exercise and | 17 |
| execution of his or her professional
judgment in a manner | 18 |
| that
adversely affects the employed physician's ability to | 19 |
| provide quality care to
patients."
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| (4) The employing entity shall establish a
mutually | 21 |
| agreed upon independent
review
process
with criteria
under | 22 |
| which an employed physician
may seek review of the alleged | 23 |
| violation
of this Section by physicians who are not | 24 |
| employed by the employing
entity. The affiliate may arrange | 25 |
| with the hospital medical
staff to conduct these reviews.
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| The independent physicians
shall make findings and | 27 |
| recommendations to the employing entity and the
employed
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| physician within 30 days of the conclusion of the gathering | 29 |
| of the relevant
information.
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| (b) Definitions. For the purpose of this Section:
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| "Employing entity" means a hospital licensed under the | 32 |
| Hospital Licensing Act
or a hospital
affiliate.
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| "Employed physician" means a physician who receives an IRS | 34 |
| W-2 form, or any
successor
federal income tax form, from an | 35 |
| employing entity.
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| "Hospital" means a hospital licensed under the Hospital |
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LRB093 14821 DRJ 46415 b |
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| Licensing Act, except
county hospitals as defined in subsection | 2 |
| (c) of Section 15-1 of the Public Aid
Code.
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| "Hospital affiliate" means a corporation, partnership, | 4 |
| joint venture, limited
liability company,
or similar | 5 |
| organization, other than a hospital, that is devoted primarily | 6 |
| to
the provision, management,
or support of health care | 7 |
| services and that directly or indirectly controls, is
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| controlled by, or is under
common control of the hospital. | 9 |
| "Control" means having at least an equal or a
majority | 10 |
| ownership
or membership interest. A hospital affiliate shall be | 11 |
| 100% owned or controlled
by any combination
of hospitals, their | 12 |
| parent corporations, or physicians licensed to practice
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| medicine in all its branches
in Illinois.
"Hospital affiliate" | 14 |
| does not include a health maintenance
organization regulated | 15 |
| under the Health Maintenance
Organization Act.
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| "Physician" means an individual licensed to practice | 17 |
| medicine in all its
branches in Illinois.
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| "Professional judgment" means the exercise of a | 19 |
| physician's independent
clinical judgment
in providing | 20 |
| medically appropriate diagnoses, care, and treatment to a
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| particular patient at a
particular time. Situations in which an | 22 |
| employing entity does not interfere
with an employed
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| physician's professional judgment include, without limitation, | 24 |
| the following:
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| (1) practice restrictions based upon peer review of the | 26 |
| physician's
clinical
practice to assess quality of care and | 27 |
| utilization of resources in accordance
with
applicable | 28 |
| bylaws;
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| (2) supervision of physicians by appropriately | 30 |
| licensed medical
directors,
medical school faculty, | 31 |
| department chairpersons or directors, or
supervising | 32 |
| physicians;
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| (3) written statements of ethical or religious | 34 |
| directives; and
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| (4) reasonable referral restrictions that do not, in | 36 |
| the reasonable
professional
judgment of the physician, |
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LRB093 14821 DRJ 46415 b |
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| adversely affect the health or welfare of the
patient.
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| (c) Private enforcement. An employed physician aggrieved | 3 |
| by a violation of
this Act may
seek to obtain an injunction or | 4 |
| reinstatement of employment with the employing
entity as the | 5 |
| court
may deem appropriate. Nothing in this Section limits or | 6 |
| abrogates any common
law cause of action.
Nothing in this | 7 |
| Section shall be deemed to alter the law of negligence.
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| (d) Department enforcement. The Department may enforce the | 9 |
| provisions of
this Section,
but nothing in this Section shall | 10 |
| require or permit the Department to license,
certify, or | 11 |
| otherwise
investigate the activities of a
hospital affiliate | 12 |
| not otherwise required to be licensed by the
Department.
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| (e) Retaliation prohibited. No employing entity shall | 14 |
| retaliate against any
employed
physician for requesting a | 15 |
| hearing or review under this Section.
No action may be taken | 16 |
| that
affects
the ability of a physician to practice during this | 17 |
| review, except in
circumstances
where the medical staff bylaws | 18 |
| authorize summary suspension.
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| (f) Physician collaboration. No employing entity shall | 20 |
| adopt or enforce,
either formally or
informally, any policy, | 21 |
| rule, regulation, or practice inconsistent with
the provision | 22 |
| of adequate
collaboration, including medical direction of | 23 |
| licensed advanced practice
nurses or supervision
of licensed | 24 |
| physician assistants and delegation to other personnel under
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| Section 54.5 of the Medical
Practice Act of 1987.
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| (g) Physician disciplinary actions. Nothing in this | 27 |
| Section shall be
construed to limit or
prohibit the governing | 28 |
| body of an employing entity or its medical staff, if
any, from | 29 |
| taking
disciplinary actions against a physician as permitted by | 30 |
| law.
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| (h) Physician review. Nothing in this Section shall be | 32 |
| construed to prohibit
a hospital or
hospital affiliate from | 33 |
| making a determination not to pay for a particular
health care | 34 |
| service or to
prohibit a medical group, independent practice | 35 |
| association, hospital medical
staff, or hospital
governing | 36 |
| body from enforcing reasonable peer review or utilization |
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| review
protocols or determining
whether the employed physician | 2 |
| complied with those protocols.
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| (i) Review. Nothing in this Section may be used or | 4 |
| construed to establish
that any activity
of a hospital or | 5 |
| hospital affiliate is subject to review under the Illinois
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| Health Facilities Planning Act.
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| (i-5) Every physician licensed to practice medicine in all | 8 |
| its branches shall be provided the opportunity to inspect and | 9 |
| copy all credentialing and other information, including, but | 10 |
| not limited to, credentialing files and patient medical | 11 |
| records, in the employing entity's possession with respect to | 12 |
| any medical staff membership or clinical privileges decision. | 13 |
| This information may be used by the physician in any proceeding | 14 |
| concerning medical staff membership or clinical privileges.
| 15 |
| (j) Rules. The Department shall adopt any
rules necessary | 16 |
| to
implement this Section.
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| (Source: P.A. 92-455, eff. 9-30-01.)
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