Medical staff autonomy a must: Courts take note

An Illinois appeals court ruling would let hospitals ignore important medical staff bylaws.

Editorial. July 17, 2006.

California and Florida are among the state courts that have recognized the importance of medical staff autonomy in recent years, and the Illinois court system needs to do the same.

An Illinois trial court in 2005 got it right. It recognized that a hospital board and medical staff both must approve a change in policy that would require physicians on staff at the hospital to be required to carry medical liability insurance policies with higher limits or face losing their staff privileges.

But in a 2-1 decision in late May, the Illinois Fourth District Appellate Court issued a ruling that undid that and paved the way for the hospital to make some important decisions without needing a vote from the medical staff.

Specifically, the court in Fabrizio v. Provena said it was OK for Provena United Samaritans Medical Center in Danville, Ill., to require physicians to carry medical liability policies with at least $1 million per incident and $3 million aggregate annually even though the medical staff voted against raising the policy limits. Previously, the medical staff and hospital had agreed to a $200,000/$600,000 policy, a much less expensive policy during a time when physicians' medical liability insurance rates in Illinois have skyrocketed.

Although the Third District Appellate Court in a different case, Lo v. Provena, only a year ago had said bylaws are a contract between a hospital and its staff, the Fourth District said the case before it was different because it was not made in the "context of a staff-privileges dispute" as Lo was. The Fourth District court held that Lo enforced procedural rights within the hospital bylaws when staff privileges were revoked, reduced or suspended.