Health Care Availability and Access Committee
Filed: 3/11/2008
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1 | AMENDMENT TO HOUSE BILL 5193
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2 | AMENDMENT NO. ______. Amend House Bill 5193 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Hospital Licensing Act is amended by | ||||||
5 | changing Section 10.4 as follows:
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6 | (210 ILCS 85/10.4) (from Ch. 111 1/2, par. 151.4)
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7 | Sec. 10.4. Medical staff privileges.
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8 | (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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12 | 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: (1) for medical personnel who
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16 | enter a hospital to obtain organs and tissues for transplant |
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1 | from a donor in accordance with the Illinois Anatomical Gift | ||||||
2 | Act; or (2) for medical personnel who have been granted | ||||||
3 | disaster privileges pursuant to the procedures and | ||||||
4 | requirements established by rules adopted by the Department. | ||||||
5 | Any hospital and any employees of the hospital or others | ||||||
6 | involved in granting privileges who, in good faith, grant | ||||||
7 | disaster privileges pursuant to this Section to respond to an | ||||||
8 | emergency shall not, as a result of their acts or omissions, be | ||||||
9 | liable for civil damages for granting or denying disaster | ||||||
10 | privileges except in the event of willful and wanton | ||||||
11 | misconduct, as that term is defined in Section 10.2 of this | ||||||
12 | Act. Individuals granted privileges who provide care in an | ||||||
13 | emergency situation, in good faith and without direct | ||||||
14 | compensation, shall not, as a result of their acts or | ||||||
15 | omissions, except for acts or omissions involving willful and | ||||||
16 | wanton misconduct, as that term is defined in Section 10.2 of | ||||||
17 | this Act, on the part of the person, be liable for civil | ||||||
18 | damages. The Director of
Professional Regulation shall | ||||||
19 | transmit, in writing and in a timely fashion,
such information | ||||||
20 | regarding the license of the applicant or the medical staff
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21 | member, including the record of imposition of any periods of
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22 | supervision or monitoring as a result of alcohol or
substance | ||||||
23 | abuse, as provided by Section 23 of the Medical
Practice Act of | ||||||
24 | 1987, and such information as may have been
submitted to the | ||||||
25 | Department indicating that the application
or medical staff | ||||||
26 | member has been denied, or has surrendered,
medical staff |
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1 | privileges at a hospital licensed under this
Act, or any | ||||||
2 | equivalent facility in another state or
territory of the United | ||||||
3 | States. The Director of Professional Regulation
shall define by | ||||||
4 | rule the period for timely response to such requests.
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5 | No transmittal of information by the Director of | ||||||
6 | Professional Regulation,
under this Section shall be to other | ||||||
7 | than the president, chief
operating officer, chief | ||||||
8 | administrative officer, or chief of
the medical staff of a | ||||||
9 | hospital licensed under this Act, a
hospital organized under | ||||||
10 | the University of Illinois Hospital Act, or a hospital
operated | ||||||
11 | by the United States, or any of its instrumentalities. The
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12 | information so transmitted shall be afforded the same status
as | ||||||
13 | is information concerning medical studies by Part 21 of Article | ||||||
14 | VIII of the
Code of Civil Procedure, as now or hereafter | ||||||
15 | amended.
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16 | (b) All hospitals licensed under this Act, except county | ||||||
17 | hospitals as
defined in subsection (c) of Section 15-1 of the | ||||||
18 | Illinois Public Aid Code,
shall comply with, and the medical | ||||||
19 | staff bylaws of these hospitals shall
include rules consistent | ||||||
20 | with, the provisions of this Section in granting,
limiting, | ||||||
21 | renewing, or denying medical staff membership and
clinical | ||||||
22 | staff privileges. Hospitals that require medical staff members | ||||||
23 | to
possess
faculty status with a specific institution of higher | ||||||
24 | education are not required
to comply with subsection (1) below | ||||||
25 | when the physician does not possess faculty
status.
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26 | (1) Minimum procedures for
pre-applicants and |
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1 | applicants for medical staff
membership shall include the | ||||||
2 | following:
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3 | (A) Written procedures relating to the acceptance | ||||||
4 | and processing of
pre-applicants or applicants for | ||||||
5 | medical staff membership, which should be
contained in
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6 | medical staff bylaws.
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7 | (B) Written procedures to be followed in | ||||||
8 | determining
a pre-applicant's or
an applicant's
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9 | qualifications for being granted medical staff | ||||||
10 | membership and privileges.
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11 | (C) Written criteria to be followed in evaluating
a | ||||||
12 | pre-applicant's or
an applicant's
qualifications.
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13 | (D) An evaluation of
a pre-applicant's or
an | ||||||
14 | applicant's current health status and current
license | ||||||
15 | status in Illinois.
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16 | (E) A written response to each
pre-applicant or
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17 | applicant that explains the reason or
reasons for any | ||||||
18 | adverse decision (including all reasons based in whole | ||||||
19 | or
in part on the applicant's medical qualifications or | ||||||
20 | any other basis,
including economic factors).
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21 | (2) Minimum procedures with respect to medical staff | ||||||
22 | and clinical
privilege determinations concerning current | ||||||
23 | members of the medical staff shall
include the following:
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24 | (A) A written notice of an adverse decision.
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25 | (B) An explanation of the reasons for an adverse | ||||||
26 | decision including all
reasons based on the quality of |
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1 | medical care or any other basis, including
economic | ||||||
2 | factors.
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3 | (C) A statement of the medical staff member's right | ||||||
4 | to request a fair
hearing on the adverse decision | ||||||
5 | before a hearing panel whose membership is
mutually | ||||||
6 | agreed upon by the medical staff and the hospital | ||||||
7 | governing board. The
hearing panel shall have | ||||||
8 | independent authority to recommend action to the
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9 | hospital governing board. Upon the request of the | ||||||
10 | medical staff member or the
hospital governing board, | ||||||
11 | the hearing panel shall make findings concerning the
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12 | nature of each basis for any adverse decision | ||||||
13 | recommended to and accepted by
the hospital governing | ||||||
14 | board.
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15 | (i) Nothing in this subparagraph (C) limits a | ||||||
16 | hospital's or medical
staff's right to summarily | ||||||
17 | suspend, without a prior hearing, a person's | ||||||
18 | medical
staff membership or clinical privileges if | ||||||
19 | the continuation of practice of a
medical staff | ||||||
20 | member constitutes an immediate danger to the | ||||||
21 | public, including
patients, visitors, and hospital | ||||||
22 | employees and staff. In the event that a hospital | ||||||
23 | or the medical staff imposes a summary suspension, | ||||||
24 | the Medical Executive Committee, or other | ||||||
25 | comparable governance committee of the medical | ||||||
26 | staff as specified in the bylaws, must meet as soon |
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1 | as is reasonably possible to review the suspension | ||||||
2 | and to recommend whether it should be affirmed, | ||||||
3 | lifted, expunged, or modified if the suspended | ||||||
4 | physician requests such review. A summary | ||||||
5 | suspension may not be implemented unless there is | ||||||
6 | actual documentation or other reliable information | ||||||
7 | that an immediate danger exists. This | ||||||
8 | documentation or information must be available at | ||||||
9 | the time the summary suspension decision is made | ||||||
10 | and when the decision is reviewed by the Medical | ||||||
11 | Executive Committee. If the Medical Executive | ||||||
12 | Committee recommends that the summary suspension | ||||||
13 | should be lifted, expunged, or modified, this | ||||||
14 | recommendation must be reviewed and considered by | ||||||
15 | the hospital governing board, or a committee of the | ||||||
16 | board, on an expedited basis. Nothing in this | ||||||
17 | subparagraph (C) shall affect the requirement that | ||||||
18 | any requested hearing must be commenced within 15 | ||||||
19 | days after the summary suspension and completed | ||||||
20 | without delay unless otherwise agreed to by the | ||||||
21 | parties. A fair hearing shall be
commenced within | ||||||
22 | 15 days after the suspension and completed without | ||||||
23 | delay , except that when the medical staff member's | ||||||
24 | license to practice has been suspended or revoked | ||||||
25 | by the State's licensing authority, no hearing | ||||||
26 | shall be necessary .
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1 | (ii) Nothing in this subparagraph (C) limits a | ||||||
2 | medical staff's right
to permit, in the medical | ||||||
3 | staff bylaws, summary suspension of membership or
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4 | clinical privileges in designated administrative | ||||||
5 | circumstances as specifically
approved by the | ||||||
6 | medical staff. This bylaw provision must | ||||||
7 | specifically describe
both the administrative | ||||||
8 | circumstance that can result in a summary | ||||||
9 | suspension
and the length of the summary | ||||||
10 | suspension. The opportunity for a fair hearing is
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11 | required for any administrative summary | ||||||
12 | suspension. Any requested hearing must
be | ||||||
13 | commenced within 15 days after the summary | ||||||
14 | suspension and completed without
delay. Adverse | ||||||
15 | decisions other than suspension or other | ||||||
16 | restrictions on the
treatment or admission of | ||||||
17 | patients may be imposed summarily and without a
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18 | hearing under designated administrative | ||||||
19 | circumstances as specifically provided
for in the | ||||||
20 | medical staff bylaws as approved by the medical | ||||||
21 | staff.
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22 | (iii) If a hospital exercises its option to | ||||||
23 | enter into an exclusive
contract and that contract | ||||||
24 | results in the total or partial termination or
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25 | reduction of medical staff membership or clinical | ||||||
26 | privileges of a current
medical staff member, the |
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1 | hospital shall provide the affected medical staff
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2 | member 60 days prior notice of the effect on his or | ||||||
3 | her medical staff
membership or privileges. An | ||||||
4 | affected medical staff member desiring a hearing
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5 | under subparagraph (C) of this paragraph (2) must | ||||||
6 | request the hearing within 14
days after the date | ||||||
7 | he or she is so notified. The requested hearing | ||||||
8 | shall be
commenced and completed (with a report and | ||||||
9 | recommendation to the affected
medical staff | ||||||
10 | member, hospital governing board, and medical | ||||||
11 | staff) within 30
days after the date of the medical | ||||||
12 | staff member's request. If agreed upon by
both the | ||||||
13 | medical staff and the hospital governing board, | ||||||
14 | the medical staff
bylaws may provide for longer | ||||||
15 | time periods.
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16 | (C-5) All peer review used for the purpose of | ||||||
17 | credentialing, privileging, disciplinary action, or | ||||||
18 | other recommendations affecting medical staff | ||||||
19 | membership or exercise of clinical privileges, whether | ||||||
20 | relying in whole or in part on internal or external | ||||||
21 | reviews, shall be conducted in accordance with the | ||||||
22 | medical staff bylaws and applicable rules, | ||||||
23 | regulations, or policies of the medical staff. If | ||||||
24 | external review is obtained, any adverse report | ||||||
25 | utilized shall be in writing and shall be made part of | ||||||
26 | the internal peer review process under the bylaws. The |
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1 | report shall also be shared with a medical staff peer | ||||||
2 | review committee and the individual under review. If | ||||||
3 | the medical staff peer review committee or the | ||||||
4 | individual under review prepares a written response to | ||||||
5 | the report of the external peer review within 30 days | ||||||
6 | after receiving such report, the governing board shall | ||||||
7 | consider the response prior to the implementation of | ||||||
8 | any final actions by the governing board which may | ||||||
9 | affect the individual's medical staff membership or | ||||||
10 | clinical privileges. Any peer review that involves | ||||||
11 | willful or wanton misconduct shall be subject to civil | ||||||
12 | damages as provided for under Section 10.2 of this Act.
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13 | (D) A statement of the member's right to inspect | ||||||
14 | all pertinent
information in the hospital's possession | ||||||
15 | with respect to the decision.
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16 | (E) A statement of the member's right to present | ||||||
17 | witnesses and other
evidence at the hearing on the | ||||||
18 | decision.
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19 | (F) A written notice and written explanation of the | ||||||
20 | decision resulting
from the hearing.
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21 | (F-5) A written notice of a final adverse decision | ||||||
22 | by a hospital
governing board.
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23 | (G) Notice given 15 days before implementation of | ||||||
24 | an adverse medical
staff membership or clinical | ||||||
25 | privileges decision based substantially on
economic | ||||||
26 | factors. This notice shall be given after the medical |
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1 | staff member
exhausts all applicable procedures under | ||||||
2 | this Section, including item (iii) of
subparagraph (C) | ||||||
3 | of this paragraph (2), and under the medical staff | ||||||
4 | bylaws in
order to allow sufficient time for the | ||||||
5 | orderly provision of patient care.
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6 | (H) Nothing in this paragraph (2) of this | ||||||
7 | subsection (b) limits a
medical staff member's right to | ||||||
8 | waive, in writing, the rights provided in
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9 | subparagraphs (A) through (G) of this paragraph (2) of | ||||||
10 | this subsection (b) upon
being granted the written | ||||||
11 | exclusive right to provide particular services at a
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12 | hospital, either individually or as a member of a | ||||||
13 | group. If an exclusive
contract is signed by a | ||||||
14 | representative of a group of physicians, a waiver
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15 | contained in the contract shall apply to all members of | ||||||
16 | the group unless stated
otherwise in the contract.
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17 | (3) Every adverse medical staff membership and | ||||||
18 | clinical privilege decision
based substantially on | ||||||
19 | economic factors shall be reported to the Hospital
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20 | Licensing Board before the decision takes effect. These | ||||||
21 | reports shall not be
disclosed in any form that reveals the | ||||||
22 | identity of any hospital or physician.
These reports shall | ||||||
23 | be utilized to study the effects that hospital medical
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24 | staff membership and clinical privilege decisions based | ||||||
25 | upon economic factors
have on access to care and the | ||||||
26 | availability of physician services. The
Hospital Licensing |
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1 | Board shall submit an initial study to the Governor and the
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2 | General Assembly by January 1, 1996, and subsequent reports | ||||||
3 | shall be submitted
periodically thereafter.
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4 | (4) As used in this Section:
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5 | "Adverse decision" means a decision reducing, | ||||||
6 | restricting, suspending,
revoking, denying, or not | ||||||
7 | renewing medical staff membership or clinical
privileges.
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8 | "Economic factor" means any information or reasons for | ||||||
9 | decisions unrelated
to quality of care or professional | ||||||
10 | competency.
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11 | "Pre-applicant" means a physician licensed to practice | ||||||
12 | medicine in all
its
branches who requests an application | ||||||
13 | for medical staff membership or
privileges.
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14 | "Privilege" means permission to provide
medical or | ||||||
15 | other patient care services and permission to use hospital
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16 | resources, including equipment, facilities and personnel | ||||||
17 | that are necessary to
effectively provide medical or other | ||||||
18 | patient care services. This definition
shall not be | ||||||
19 | construed to
require a hospital to acquire additional | ||||||
20 | equipment, facilities, or personnel to
accommodate the | ||||||
21 | granting of privileges.
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22 | (5) Any amendment to medical staff bylaws required | ||||||
23 | because of
this amendatory Act of the 91st General Assembly | ||||||
24 | shall be adopted on or
before July 1, 2001.
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25 | (c) All hospitals shall consult with the medical staff | ||||||
26 | prior to closing
membership in the entire or any portion of the |
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1 | medical staff or a department.
If
the hospital closes | ||||||
2 | membership in the medical staff, any portion of the medical
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3 | staff, or the department over the objections of the medical | ||||||
4 | staff, then the
hospital
shall provide a detailed written | ||||||
5 | explanation for the decision to the medical
staff
10 days prior | ||||||
6 | to the effective date of any closure. No applications need to | ||||||
7 | be
provided when membership in the medical staff or any | ||||||
8 | relevant portion of the
medical staff is closed.
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9 | (Source: P.A. 95-331, eff. 8-21-07.)
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10 | Section 99. Effective date. This Act takes effect June 1, | ||||||
11 | 2008.".
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