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92nd General Assembly

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Public Act 92-0455

SB933 Enrolled                                 LRB9205026LBmb

    AN ACT concerning health facilities.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.   The  Hospital  Licensing  Act is amended by
adding Section 10.8 as follows:

    (210 ILCS 85/10.8 new)
    Sec. 10.8.  Requirements for employment of physicians.
    (a)  Physician  employment  by  hospitals  and   hospital
affiliates.  Employing  entities  may  employ  physicians  to
practice  medicine  in  all of its branches provided that the
following requirements are met:
         (1)  The employed  physician  is  a  member  of  the
    medical   staff   of  either  the  hospital  or  hospital
    affiliate.  If a hospital affiliate  decides  to  have  a
    medical  staff,  its  medical staff shall be organized in
    accordance  with  written  bylaws  where  the   affiliate
    medical  staff  is responsible for making recommendations
    to the governing body  of  the  affiliate  regarding  all
    quality    assurance    activities    and    safeguarding
    professional   autonomy.   The  affiliate  medical  staff
    bylaws  may not be unilaterally changed by the  governing
    body  of the affiliate.  Nothing in this Section requires
    hospital affiliates to have a medical staff.
         (2)  Independent physicians, who are not employed by
    an employing entity, periodically review the  quality  of
    the  medical  services provided by the employed physician
    to continuously improve patient care.
         (3)  The employing entity and the employed physician
    sign a statement acknowledging that  the  employer  shall
    not  unreasonably  exercise control, direct, or interfere
    with the employed physician's exercise and  execution  of
    his  or  her  professional  judgment  in  a  manner  that
    adversely  affects  the  employed  physician's ability to
    provide quality care to patients.  This signed  statement
    shall  take  the  form  of a provision in the physician's
    employment contract or a separate  signed  document  from
    the  employing  entity  to  the  employed physician. This
    statement shall state: "As the employer of  a  physician,
    (employer's   name)   shall   not  unreasonably  exercise
    control,  direct,  or   interfere   with   the   employed
    physician's   exercise   and  execution  of  his  or  her
    professional judgment in a manner that adversely  affects
    the  employed physician's ability to provide quality care
    to patients."
         (4)  The employing entity shall establish a mutually
    agreed upon  independent  review  process  with  criteria
    under which an employed physician may  seek review of the
    alleged  violation  of this Section by physicians who are
    not employed by the employing entity.  The affiliate  may
    arrange  with the hospital medical staff to conduct these
    reviews.   The independent physicians shall make findings
    and recommendations  to  the  employing  entity  and  the
    employed  physician  within  30 days of the conclusion of
    the gathering of the relevant information.
    (b)  Definitions.  For the purpose of this Section:
    "Employing entity" means a hospital  licensed  under  the
Hospital Licensing Act or a hospital  affiliate.
    "Employed  physician"  means  a physician who receives an
IRS W-2 form, or any successor federal income tax form,  from
an employing entity.
    "Hospital"  means  a hospital licensed under the Hospital
Licensing  Act,  except  county  hospitals  as   defined   in
subsection (c) of Section 15-1 of the Public Aid Code.
    "Hospital  affiliate"  means  a corporation, partnership,
joint  venture,  limited  liability   company,   or   similar
organization,   other   than  a  hospital,  that  is  devoted
primarily to the provision, management, or support of  health
care  services  and  that directly or indirectly controls, is
controlled by, or is under common control  of  the  hospital.
"Control"  means  having  at  least  an  equal  or a majority
ownership or membership interest.  A hospital affiliate shall
be 100% owned or controlled by any combination of  hospitals,
their parent corporations, or physicians licensed to practice
medicine  in  all  its  branches  in  Illinois.     "Hospital
affiliate" does not include a health maintenance organization
regulated under the Health Maintenance Organization Act.
    "Physician"  means  an  individual  licensed  to practice
medicine in all its branches in Illinois.
    "Professional   judgment"  means   the  exercise  of    a
physician's  independent  clinical   judgment  in   providing
medically  appropriate diagnoses, care,  and  treatment  to a
particular patient at a particular time.  Situations in which
an employing entity  does  not  interfere  with  an  employed
physician's    professional    judgment    include,   without
limitation, the following:
         (1)  practice restrictions based upon peer review of
    the  physician's  clinical practice to assess quality  of
    care  and  utilization  of   resources in accordance with
    applicable bylaws;
         (2)  supervision   of  physicians  by  appropriately
    licensed  medical  directors,  medical  school   faculty,
    department  chairpersons  or  directors, or   supervising
    physicians;
         (3)  written  statements  of  ethical  or  religious
    directives; and
         (4)  reasonable  referral  restrictions that do not,
    in the reasonable professional judgment of the physician,
    adversely affect the health or welfare of the patient.
    (c)  Private enforcement. An employed physician aggrieved
by  a  violation of this Act may seek to obtain an injunction
or reinstatement of employment with the employing  entity  as
the  court  may  deem  appropriate.   Nothing in this Section
limits or abrogates any common law cause of  action.  Nothing
in  this  Section  shall  be  deemed  to  alter  the  law  of
negligence.
    (d)  Department  enforcement.  The Department may enforce
the provisions of this Section, but nothing in  this  Section
shall  require  or permit the Department to license, certify,
or  otherwise  investigate  the  activities  of  a   hospital
affiliate  not  otherwise  required  to  be  licensed  by the
Department.
    (e)  Retaliation prohibited.  No employing  entity  shall
retaliate  against  any  employed  physician for requesting a
hearing or review under this Section.     No  action  may  be
taken  that  affects  the  ability of a physician to practice
during this review, except in circumstances where the medical
staff bylaws authorize summary suspension.
    (f)  Physician collaboration.  No employing entity  shall
adopt  or  enforce,  either  formally   or  informally,   any
policy,  rule, regulation, or practice inconsistent with  the
provision   of   adequate  collaboration,  including  medical
direction  of  licensed   advanced   practice    nurses    or
supervision  of  licensed physician assistants and delegation
to other personnel under Section 54.5 of the Medical Practice
Act of 1987.
    (g)  Physician disciplinary  actions.   Nothing  in  this
Section shall be construed to limit or prohibit the governing
body  of  an  employing  entity or its medical staff, if any,
from taking  disciplinary  actions  against  a  physician  as
permitted by law.
    (h)  Physician  review.  Nothing in this Section shall be
construed to prohibit a hospital or hospital  affiliate  from
making  a  determination  not  to pay for a particular health
care service or to  prohibit  a  medical  group,  independent
practice  association,  hospital  medical  staff, or hospital
governing body  from  enforcing  reasonable  peer  review  or
utilization  review  protocols  or  determining  whether  the
employed physician complied with those protocols.
    (i)  Review.   Nothing  in  this  Section  may be used or
construed to establish that any activity  of  a  hospital  or
hospital  affiliate  is  subject to review under the Illinois
Health Facilities Planning Act.
    (j)  Rules.   The  Department  shall  adopt   any   rules
necessary to implement this Section.

    Section  99.  Effective   date.  This Act takes effect on
September 30, 2001.
    Passed in the General Assembly May 30, 2001.
    Approved August 21, 2001.

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