UNIVERSITY OF MISSISSIPPI MEDICAL CENTER - GRENADA MEDICAL STAFF

Transcription

1 UNIVERSITY OF MISSISSIPPI MEDICAL CENTER - GRENADA MEDICAL STAFF FAIR HEARING PLAN (As Amended) Date Initiated:

2 TABLE OF CONTENTS DEFINITIONS... 1 PART ONE: INITIATION OF HEARING 1.1 TRIGGERING EVENTS RECOMMENDATIONS OR ACTIONS WHEN DEEMED ADVERSE EXCEPTIONS TO HEARING RIGHTS NOTICE OF ADVERSE RECOMMENDATION OR ACTION REQUEST FOR HEARING WAIVER BY FAILURE TO REQUEST A HEARING AFTER ADVERSE ACTION BY THE BOARD AFTER ADVERSE RECOMMENDATION BY THE MSEC... 5 PART TWO: HEARING PREREQUISITES 2.1 NOTICE OF TIME AND PLACE FOR HEARING STATEMENT OF ISSUES AND EVENTS APPOINTMENT OF FINDER OF FACT DESIGNATION ELIGIBILITY FOR HEARING PANEL LIST OF WITNESSES... 7 PART THREE: HEARING PROCEDURE 3.1 PERSONAL PRESENCE PRESIDING OFFICER REPRESENTATION RIGHTS OF PARTIES PROCEDURE AND EVIDENCE OFFICIAL NOTICE BURDEN OF PROOF FOR ACTION IN CONNECTION WITH A REQUEST FOR NEW STATUS OR PRIVILEGES FOR ACTION CHANGING CURRENT STATUS OR PRIVILEGES HEARING RECORD POSTPONEMENT PRESENCE OF HEARING PANEL MEMBERS AND VOTE RECESSES AND ADJOURNMENT... 9 Table of Contents i Date Initiated:

3 TABLE OF CONTENTS, continued PART FOUR: HEARING REPORT AND FURTHER ACTION 4.1 HEARING REPORT ACTION ON HEARING REPORT NOTICE AND EFFECT OF ACTION ON HEARING REPORT NOTICE EFFECT OF FAVORABLE RESULT EFFECT OF ADVERSE RESULT PART FIVE: INITIATION AND PREREQUISITES OF APPELLATE REVIEW 5.1 REQUEST FOR APPELLATE REVIEW WAIVER BY FAILURE TO REQUEST APPELLATE REVIEW NOTICE OF TIME AND PLACE FOR APPELLATE REVIEW APPELLATE REVIEW BODY PART SIX: APPELLATE REVIEW PROCEDURE AND FINAL ACTION 6.1 NATURE OF PROCEEDINGS WRITTEN STATEMENTS PRESIDING OFFICER ORAL STATEMENTS CONSIDERATION OF NEW OR ADDITIONAL MATTERS PRESENCE OF MEMBERS AND VOTE RECESSES AND ADJOURNMENTS ACTION TAKEN REVIEW BODY IN ACCORD WITH MSEC REVIEW BODY NOT IN ACCORD WITH MSEC SPECIAL COMBINED COUNCIL REVIEW PART SEVEN: GENERAL PROVISIONS 7.1 NUMBER OF HEARINGS AND REVIEWS RELEASE PART EIGHT: AMENDMENT PART NINE: ADOPTION 9.1 MEDICAL STAFF BOARD Table of Contents ii Date Initiated:

4 DEFINITIONS The following definitions, as well as those stated in the Medical Staff Bylaws, apply to the provisions of this. 1. APPELLATE REVIEW BODY means the group designated under this Plan to hear request for appellate review properly filed and pursued by a practitioner. 2. DAYS means regular working days, i.e., excluding Saturdays, Sundays and official hospital holidays. In computing any period of time prescribed or allowed under this Plan, the day of the act or the event from which the designated period of time begins to run shall not be included. The last day of the period so computed shall be included, unless it is a Saturday, a Sunday or official hospital holiday, in which event the period runs until the end of the next day which is not a Saturday, a Sunday, or a holiday. If the day on which a notice, request or report under this Plan must be received or sent falls on a Saturday, Sunday or official hospital holiday, the deadline shall be set to be the next regular working day thereafter. 3. HEARING PANEL means a committee appointed under this Plan to hear a request for an evidentiary hearing properly filed and pursued by a practitioner. 4. PARTIES means the practitioner who requested the hearing or appellate review and the body or bodies upon whose adverse recommendation or action a hearing or appellate review request is predicated. 5. PRACTITIONER means the applicant or staff appointee against whom an adverse action has been recommended or taken. 6. SPECIAL NOTICE means written notification sent by certified mail, return receipt requested, or by personal delivery with signed acknowledgement of receipt. Definitions 1 Date Initiated:

5 1.1 TRIGGERING EVENTS PART ONE: INITIATION OF HEARING RECOMMENDATIONS OR ACTIONS Subject to the exceptions set forth in Section below, the following recommendations or actions, if deemed adverse under Section below, entitle the practitioner to a hearing upon timely and proper request: (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) Denial of initial staff appointment. Denial of reappointment. Suspension of staff appointment provided that summary suspension entitles the practitioner to request a hearing only as specified in subsection (m) of this Section Revocation of staff appointment. Denial of requested appointment to or advancement in staff category. Reduction in staff category. Suspension or limitation of the right to admit patients not related to the adoption or implementation of an administrative or medical staff policy within the hospital as a whole or within one or more specific services or other clinical units. Denial or restriction of requested clinical privileges. Reduction in clinical privileges Suspension of clinical privileges provided that summary suspension entitles the practitioner to request a hearing only as specified in subsection (m) of this Section Revocation of clinical privileges. Individual application of, or individual changes in, mandatory consultation or concurrent supervision requirement. Summary suspension of medical staff appointment or clinical privileges, provided that the recommendation of the medical staff executive committee or action by the board under Section 5.2 of the Credentialing Procedures Manual is to continue the suspension or to 2 Date Initiated:

6 take other action which would entitle the practitioner to request a hearing under this Section (n) Formal letter of reprimand WHEN DEEMED ADVERSE A recommendation or action listed in Section above is deemed adverse to the practitioner only when it has been: (a) (b) recommended by the medical staff executive committee (MSEC); or taken by the board under circumstances where no prior right to request a hearing existed EXCEPTIONS TO HEARING RIGHTS (a) Certain Actions or Recommendations: Notwithstanding any provision in this, in the Medical Staff Bylaws, or in the Credentialing Procedures Manual to the contrary the following actions or recommendations do not entitle the practitioner to a hearing: (1) issuing a verbal warning; (2) imposing a monitoring or consultation requirement as a condition attached to the exercise of clinical privileges during a provisional period; (3) imposing a probationary period involving review of cases but with no requirement either for direct, concurrent supervision or for mandatory consultation; (4) expiration or termination of a contract or employment arrangement to provide clinical services unless the contract or employment arrangement provides otherwise; (5) removal of a practitioner from a medico-administrative office within the hospital unless a contract or employment arrangement provides otherwise; and (6) denial of appointment or reappointment or suspension or revocation of appointment because of a misstatement, misrepresentation or omission on an application for appointment or reappointment or on a request for modification of status or privileges; or (7) any other action or recommendation not listed in Section above. 3 Date Initiated:

7 (b) Other Situations: An action or recommendation listed in Section above does not entitle the practitioner to a hearing when it is: (1) voluntarily imposed or accepted by the practitioner; (2) automatic pursuant to any provision of the Medical Staff Bylaws and related manuals or the General Staff Rules and Regulations; or (3) taken or recommended with respect to temporary privileges, unless such action or recommendation is based on the professional competence or professional conduct of the practitioner which affects, or could affect, adversely the health or welfare of a patient. 1.2 NOTICE OF ADVERSE RECOMMENDATION OR ACTION The chief administrative officer shall, within the next business day of receiving written notice of an adverse action or recommendation under Section 1.1-1, give the practitioner special notice thereof. The notice shall: (a) (b) (c) (d) (e) advise the practitioner of the nature of the proposed recommendation or action and of his right to a hearing upon timely and proper request pursuant to Section 1.3 below; specify that the practitioner has 30 days after receiving the notice within which to submit a request for a hearing and that the request must satisfy the conditions of Section 1.3; state that failure to request a hearing within that time period and in the proper manner constitutes a waiver of rights to any hearing or appellate review on the matter that is the subject of the notice; state that any higher authority required or permitted under this Plan to act on the matter following a waiver is not bound by the adverse recommendation or action that the practitioner has accepted by virtue of the waiver but may take any action it deems warranted by the circumstances; and state that as soon as possible after receipt of his hearing request, the practitioner will be notified of the date, time and place of the hearing, and the grounds upon which the adverse recommendation or action is based. 4 Date Initiated:

8 1.3 REQUEST FOR HEARING The practitioner shall have 30 days after receiving a notice under Section 1.2 to file a written request for a hearing. The request must be delivered to the chief administrative officer by special notice. 1.4 WAIVER BY FAILURE TO REQUEST A HEARING A practitioner who fails to request a hearing within the time and in the manner specified in Section 1.3 waives his right to any hearing or appellate review to which he might otherwise have been entitled. Such waiver shall apply only to the matters that were the basis for the adverse recommendation or action triggering the Section 1.2 notice. The chief administrative officer shall as soon as reasonably practicable send the practitioner special notice of each action taken under any of the following sections and shall notify the chief of the staff of each such action. The effect of a waiver is as follows: AFTER ADVERSE ACTION BY THE BOARD A waiver shall constitute acceptance of the action, which shall immediately become effective as the final decision AFTER ADVERSE RECOMMENDATION BY THE MSEC A waiver shall constitute acceptance of the recommendation, which then shall become and remain effective immediately pending the decision of the board, as applicable. PART TWO: HEARING PREREQUISITES 2.1 NOTICE OF TIME AND PLACE FOR HEARING Upon receiving a timely and proper request for hearing, the chief administrative officer (CAO) shall notify the chief of the medical staff or the chairman of the board, depending on whose recommendation or action prompted the hearing request, and shall schedule a hearing. The CAO shall send the practitioner special notice of the time, place and date of the hearing. The hearing date shall be not less than 30 nor more than 60 days from the date of the special notice of hearing; provided, however, that a hearing for a practitioner who is under suspension then in effect may, with the written consent of the practitioner, be held on a date acceptable to all parties that is sooner than 30 days from the date of the special notice of the hearing. The special notice of hearing shall also include the names of the individuals who, as far as is then reasonably known, will give testimony or evidence in support of the party whose action or recommendation gave rise to the hearing rights. 2.2 STATEMENT OF ISSUES AND EVENTS The special notice of hearing must contain a concise statement of practitioner's alleged acts or omissions, a list by number of the specific or representative patient records in question, and/or the other reasons or subject matter forming the basis for the adverse action or recommendation which is the subject of the hearing. 5 Date Initiated:

9 2.3 APPOINTMENT OF FINDER OF FACT DESIGNATION When a hearing has been requested in accordance with Section 1.3 of this Plan, the CAO shall, on behalf of the hospital and after considering any recommendations from the medical staff chief, the chairman of the board and the affected practitioner, designate one of the following before whom the hearing shall be held: (a) (b) (c) an arbitrator mutually acceptable to the practitioner and the hospital; or a hearing officer who is not in direct economic competition with the practitioner involved; or a panel of not less than three (3) individuals who are not in direct economic competition with the practitioner ELIGIBILITY FOR HEARING PANEL The following are eligible for nomination or appointment to membership on the hearing panel: (a) Members of the medical staff except for any such member who: (1) initiated the request for corrective action or otherwise made any report or compliant which resulted in the adverse recommendation or action which gave rise to the request or hearing; (2) was a member of any committee, panel or other group when such committee, panel or other group conducted interviews, heard testimony, considered evidence or undertook any action, recommendation, or review with respect to the unfavorable action or recommendation which gave rise to the request for hearing; (3) is indirect economic competition with the practitioner involved or otherwise has a direct, personal interest in the outcome of the matter such that, in the opinion of the CAO, his impartiality is in doubt. An individual shall not be disqualified from serving on a hearing panel merely because he has heard of the case or has knowledge of the facts involved or what he supposes the facts to be. 6 Date Initiated:

10 2.4 LIST OF WITNESSES At least 10 days prior to the scheduled date for commencement of the hearing, the practitioner who requested the hearing shall give to the party whose action or recommendation gave rise to the hearing rights, by special notice, a list of names of the individuals who, as far as is then reasonably known, will give testimony or evidence in support of the practitioner at the hearing. At the same time and by special notice, the CAO shall update the list of names provided to the practitioner with the special notice of hearing under Section 2.1 of this Plan. Each list shall be amended as soon as possible when a change in witnesses is identified. The hearing panel may permit a witness who has not been listed in accordance with this Section 2.4 to testify if it finds that the failure to list such witness was justified, that such failure did not prejudice the party entitled to receive such list, or that the testimony of such witness will materially assist the hearing panel in making its report and recommendation under Section 4.1 below. PART THREE. HEARING PROCEDURE 3.1 PERSONAL PRESENCE The personal presence of the practitioner is required throughout the hearing, unless such personal presence is excused for any specified time by the hearing arbitrator/ officer/panel. The presence of the practitioner's counsel or other representative does not constitute the personal presence of the practitioner. A practitioner who fails without good cause to be present throughout the hearing unless excused or who fails to proceed at the hearing in accordance with this shall be deemed to have waived his rights in the same manner and with the same consequence as provided in Section PRESIDING OFFICER The hearing arbitrator or officer, or the hearing panel chairman, shall be the presiding officer. The presiding officer shall maintain decorum and assure that all participants have a reasonable opportunity to present relevant evidence. He shall determine the order of procedure during the hearing and make all rulings on matters of law, procedure, and the admissibility of evidence. The presiding officer shall not act as a prosecuting officer or as an advocate to any party to the hearing. If a hearing panel officer is appointed to assist a hearing panel in conducting a hearing, he shall not be entitled to vote. 3.3 REPRESENTATION The practitioner may be accompanied and represented at the hearing by a member of the medical staff in good standing, by a member of his local professional society, by an attorney, or by another person of his choice. He shall inform the chief administrative officer in writing of the name and occupation of that person at least 10 days prior to the hearing date. The body whose adverse action or recommendation gave rise to the request for hearing shall appoint an individual to represent it at the hearing. 7 Date Initiated:

11 3.4 RIGHTS OF PARTIES During a hearing, each party shall have the following rights, subject to the rulings of the presiding officer on matters of law, procedure and the admissibility of evidence and provided that such rights shall be exercised in a manner so as to permit the hearing to proceed efficiently and expeditiously: (a) (b) (c) (d) (e) call and examine the witnesses; introduce exhibits; cross-examine any witness on any matter relevant to the issues; impeach any witness; rebut any evidence. If the practitioner does not testify in his own behalf, he may be called and examined as if under cross-examination. 3.5 PROCEDURE AND EVIDENCE The hearing need not be conducted according to rules of law relating to the examination of witnesses or presentation of evidence. In the discretion of the presiding officer, any relevant matter upon which responsible persons customarily rely in the conduct of serious affairs may be considered, regardless of the admissibility of such evidence in a court of law. Each party shall be entitled, prior to or during the hearing, to submit memoranda concerning any issue of law or fact, and those memoranda shall become part of the hearing record. The hearing arbitrator/ officer/panel may require such memoranda to be filed at a time specified by the hearing arbitrator/officer/panel. The hearing arbitrator/officer/panel may ask questions of witnesses, call additional witnesses or request documentary evidence as deemed appropriate. The presiding officer may, but is not required to, order that oral evidence be taken only on oath or affirmation administered by any person designated by him and entitled to notarize documents in the state where the hearing is held. 3.6 OFFICAL NOTICE In reaching a decision, the hearing arbitrator/officer/panel may take official notice, either before or after submission of the matter for decision, of any generally accepted technical or scientific matter relating to the issues under consideration and of any facts that may be judicially noticed by the courts of the state where the hearing is held. Participants in the hearing shall be informed of the matters to be noticed, and those matters must be noted in the hearing record. Either party shall have the opportunity to request that a matter be officially noticed and to refute any officially noticed matter by written or oral presentation of authority in a manner to be determined by the hearing arbitrator/officer/panel. The arbitrator/officer/panel is also entitled to consider all other information that can be considered under the Medical Staff Bylaws in connection with credentials matters. 8 Date Initiated:

12 3.7 BURDEN OF PROOF FOR ACTION IN CONNECTION WITH A REQUEST FOR NEW STATUS OR PRIVILEGES When a hearing relates to an adverse action or recommendation involving status or privileges not currently held by the practitioner, the practitioner shall have the burden of coming forward with evidence and proving that the adverse action or recommendation lacks any substantial factual basis or is otherwise arbitrary, unreasonable or capricious FOR ACTION CHANGING CURRENT STATUS OR PRIVILEGES When a hearing relates to an adverse action or recommendation involving a change in status or privileges currently held by the practitioner, the body whose adverse action or recommendation occasioned the hearing shall have the burden of coming forward with evidence in support thereof. Thereafter, the practitioner shall have the burden of presenting evidence and proving that the adverse action or recommendation lacks any substantial factual basis or is otherwise arbitrary, unreasonable, or capricious. 3.8 HEARING RECORD A record of the hearing shall be kept. The presiding officer shall determine whether this shall be done by use of a court reporter or a tape recording of the proceedings. If the practitioner requests a copy or transcript of the hearing record, he shall bear the cost of the same. 3.9 POSTPONEMENT Requests for postponement or continuance of a hearing may be granted by the presiding officer or the hearing panel only upon a timely showing of good cause PRESENCE OF HEARING PANEL MEMBERS AND VOTE If a hearing panel is used, a majority of the panel must be present throughout the hearing and deliberations. If a panel member is absent from any part of the hearing or deliberations, the presiding officer, in his discretion, may rule that such member not participate further in the hearing or deliberations or in the decision of the panel RECESSES AND ADJOURNMENT The hearing arbitrator/officer/panel may recess and reconvene the hearing without special notice for the convenience of the participants or for the purpose of obtaining new or additional evidence or consultation. Upon conclusion of the presentation of oral and written evidence, the hearing shall be adjourned. The hearing arbitrator/ officer/panel shall, at a time convenient to himself/itself, conduct his/its deliberations outside the presence of the parties. 9 Date Initiated:

13 PART FOUR. HEARING REPORT AND FURTHER ACTION 4.1 HEARING REPORT Within 10 days after adjournment of the hearing the arbitrator/officer/panel shall make a written report of findings and recommendations, with such reference to the hearing record and other documentation and items considered as deemed appropriate. The hearing arbitrator/officer/panel shall forward the report to the body whose adverse action or recommendation occasioned the hearing. The practitioner shall also be provided a copy of the report by special notice. The practitioner shall have 10 days from receipt of the report to submit a written statement to the chief administrative officer (CAO) for transmittal to the other party identifying all or any portion of the report or of the hearing process with which he disagrees. 4.2 ACTION ON HEARING REPORT Within 10 days after receiving the hearing report, the body whose adverse recommendation or action occasioned the hearing shall consider said report and shall affirm, modify or reverse its recommendation or action. It shall transmit the result, together with the hearing record, the hearing report and all other documentation considered, to the CAO who shall provide notice of the effect of the result as provided in Section 4.3 below. 4.3 NOTICE AND EFFECT OF ACTION ON HEARING REPORT NOTICE As soon as is practicable, the CAO shall send notice of each action taken Under Section 4.2 above and the effect of that action as described in Section or to the practitioner by special notice and to the medical staff chief for transmittal to the medical staff executive committee (MSEC). Where the notice is one indicating the board's final decision, the notice to the practitioner shall include a statement of the basis for the decision EFFECT OF FAVORABLE RESULT (a) Adopted by the Board: If the board's action after receiving the hearing report is favorable to the practitioner, it shall become effective as the final decision in the matter. (b) Adopted by the Medical Staff Executive Committee: If the MSEC's action after receiving a hearing report is favorable to the practitioner, the CAO shall forward it as soon as practicable, together with all supporting documentation, to the board which may adopt or reject the result in whole or in part, or refer the matter back to the MSEC for further reconsideration. Any referral back shall state the reasons, set a time limit within which a subsequent recommendation must be made, and may include a directive for an additional hearing. After receiving a subsequent recommendation and any new evidence, the board shall take action. Favorable action by the board has the same effect as 10 Date Initiated:

14 provided in Section 4.3-2(a) above. If the board action is adverse, the matter shall be submitted to a special combined council as provided in Section EFFECT OF ADVERSE RESULT If the result of the MSEC, the board or the special combined council under Section 4.2 continues to be adverse to the practitioner, the special notice provided in Section shall inform him of his right to request an appellate review as provided in Part Five of this Plan. PART FIVE: INITIATION AND PREREQUISITES OF APPELLATE REVIEW 5.1 REQUEST FOR APPELLATE REVIEW A practitioner shall have 10 days after receiving special notice of an adverse result under Section 4.3 to file a written request for an appellate review. The request must be delivered to the chief administrative officer (CAO) by special notice. If the practitioner wishes to be represented by an attorney at any appellate review appearance that may be granted under Section 6.4, his request for appellate review must so state. 5.2 WAIVER BY FAILURE TO REQUEST APPELLATE REVIEW A practitioner who fails to request an appellate review within the time and in the manner specified shall have waived any right to a review. The waiver has the same force and effect as provided in Section NOTICE OF TIME AND PLACE FOR APPELLATE REVIEW The CAO shall deliver a timely and proper request for appellate review to the chairman of the board. As soon as practicable, the chairman of the board shall schedule an appellate review to commence not less than 30 days nor more than 60 days after the CAO received the request; provided, however, that an appellate review for a practitioner who is under a suspension then in effect shall be held as soon as the arrangements for it may be reasonably made, but not later than 30 days after the CAO received the request. At least 21 days prior to the appellate review, the CAO shall send the practitioner special notice of the time, place and date of the review. The time may be extended by the chairman of the board or appellate review body for good cause. 5.4 APPELLATE REVIEW BODY If an MSEC recommendation occasions the appellate review, the board serves as the appellate review body. If a board action occasions the review, the appellate review is conducted by a special combined council as provided in Section 6.9. PART SIX: APPELLATE REVIEW PROCEDURE AND FINAL ACTION 6.1 NATURE OF PROCEEDINGS The proceedings by the review body are a review based upon the hearing record, the hearing report, all subsequent results and actions, the written statements, if any, provided below and any other material that may be presented and accepted. 11 Date Initiated:

15 6.2 WRITTEN STATEMENTS The practitioner may submit a written statement detailing the findings of fact, conclusions and procedural matters with which he disagrees and his reasons. This written statement may cover any matters raised at any step in the hearing process. The statement shall be submitted to the appellate review body and to the group whose adverse recommendation or action occasioned the appellate review through the chief administrative officer (CAO) at least 14 days prior to the scheduled date of the review, except if the time limit is waived by the presiding officer. A similar statement may be submitted by the group whose adverse recommendation or action occasioned the review, and if submitted, the CAO shall provide a copy to the practitioner and to the review body at least 7 days prior to the scheduled date of the appellate review. 6.3 PRESIDING OFFICER The chairman of the appellate review body is the presiding officer. He shall determine the order of procedure during the review, make all required rulings, and maintain decorum. 6.4 ORAL STATEMENTS The appellate review body, in its sole discretion, may allow the parties or their representatives to personally appear and make an oral statement in favor of their positions. Any party or representative appearing shall be required to answer questions put by any member of the review body. If the practitioner desires to be represented by an attorney at an appellate review appearance, his request for the review must declare his desire to be so represented. The appellate review body shall determine in its sole discretion whether to permit such representation. 6.5 CONSIDERATION OF NEW OR ADDITIONAL MATTERS New or additional matters or evidence not raised or presented during the original hearing or in the hearing report and not otherwise reflected in the record may be introduced at the appellate review only in the discretion of the review body and only if the party requesting consideration of the matter or evidence shows that it could not have been discovered in time for the initial hearing. The requesting party shall provide, through the CAO, a written, substantive description of the matter or evidence to the appellate review body and the other party prior to its being introduced at the review. Any such new or additional matters or evidence shall be subject to the same rights of cross-examination, impeachment and rebuttal provided at the hearing. 6.6 PRESENCE OF MEMBERS AND VOTE A majority of the review body members must be present throughout the review and deliberations. If a member is absent from any part of the proceedings, the chairman of the review body may rule that the members shall not be permitted to participate further in the deliberations or in the decision of the review body. 12 Date Initiated:

16 6.7 RECESSES AND ADJOURNMENTS The review body may recess and reconvene the proceedings without special notice for the convenience of the participants or for the purpose of obtaining new or additional evidence or consultation. At the conclusion of the oral statements, if allowed, the appellate review shall be adjourned. The review body shall then, at a time convenient to itself, conduct its deliberations outside the presence of the parties. 6.8 ACTION TAKEN Within 10 days after adjournment pursuant to Section 6.7 above, the review body shall prepare its report and recommendation with the result as provided below. The CAO shall send notice of each action taken under this Section to the practitioner by special notice and to the medical staff chief for transmittal to the appropriate staff authorities. The notice to the practitioner shall include a statement of the basis for the decision REVIEW BODY IN ACCORD WITH MSEC If the review body's decision is in accord with the MSEC's last recommendation in the matter, if any, it is immediately effective REVIEW BODY NOT IN ACCORD WITH MSEC If the review body's action has the effect of changing the MSEC's last recommendation, if any, the matter is referred to a special combined council as provided in Section 6.9. This special council's recommendation shall be effective immediately as the final decision in the matter. 6.9 SPECIAL COMBINED COUNCIL REVIEW Within 10 days after receiving a matter referred to it under this plan, a special combined council of equal numbers of medical staff and board members shall convene to consider the matter and shall submit its recommendations to the board. The special combined council shall be composed of a total of six (6) members selected in the following manner: three board members appointed by the chairman of the board and three medical staff members appointed by the chief of the staff. PART SEVEN: GENERAL PROVISIONS 7.1 NUMBER OF HEARINGS AND REVIEWS Notwithstanding any other provision of the Medical Staff Bylaws, of the Credentialing Procedures Manual, or of this Plan, no practitioner is entitled as a right to request more than one evidentiary hearing and appellate review with respect to the subject matter that is the basis of the adverse recommendation or action triggering the right. 7.2 RELEASE By requesting a hearing or appellate review under this Plan, a practitioner agrees to be bound by the provisions of the Medical Staff Bylaws relating to immunity from liability. 13 Date Initiated:

17 PART EIGHT: AMENDMENT Suggestions for changes in the shall be referred to the bylaws committee which shall present its recommendations in timely fashion to the Medical Staff Executive Committee (MSEC) for its review and timely recommendation to the board as provided herein. This may be amended or repealed, or a new one adopted, by the affirmative vote of a majority of the members of the medical staff executive committee (MSEC) present at a regular or special meeting at which a quorum is present, provided that a copy of the proposed document or amendments were given to or made available to each member entitled to vote thereon with or at the time of notice of the meeting. Amendments or a new Plan will become effective upon the affirmative vote of a majority of the board. Any changes made in the MSEC recommendations proposed by the board shall first be submitted to the MSEC for its recommendations including 30 days for response, and any response timely made shall be carefully considered by the board prior to its action on the proposed amendments or revisions. 14 Date Initiated:

18 PART NINE: ADOPTION 9.1 MEDICAL STAFF This was adopted and recommended to the board by the medical staff executive committee in accordance with the Medical Staff Bylaws on. Chief of the Medical Staff 9.2 BOARD OF TRUSTEES This was approved and adopted by resolution of the board after considering the medical staff executive committee's recommendations and in accordance with the hospital corporate bylaws on. President, Board of Trustees Chief Executive Officer 15 Date Initiated: