Sherman Health | SHBylaws

(a) These Medical Staff Bylaws and the subordinate Policy Manual are adopted and made effective upon approval of the Medical Staff and the Board, superseding and replacing any and all previous Medical Staff Bylaws, and henceforth all activities and actions of the Hospital, Medical Staff and of each individual exercising Clinical Privileges at the Hospital shall be taken under and pursuant to the requirements of these Bylaws and the Policy Manual. The provisions of these Bylaws and the Policy Manual shall only apply to actions initiated after their effective date.

(b) The present rules and regulations of the Medical Staff are hereby placed into effect insofar as they are consistent with these Bylaws and Policy Manual, until such time as they are amended and readopted in accordance with the terms of these Bylaws, such time not to exceed two (2) years.

Adopted by the Medical Staff on:

_____________________________

(Date)

Approved by the Board on:

_____________________________

(Date)

PREAMBLE

The Hospital and Medical Staff acknowledge that they must work together to assure that patient care within the Hospital meets all relevant standards and to maintain and improve the quality of medical care delivered in the Hospital.� The Hospital acknowledges the special expertise of the Medical Staff in those areas where medical judgment and the evaluation of medical competence are involved.� The Medical Staff acknowledges that it bears responsibility for monitoring, evaluating and improving the quality of the clinical services provided by Members and APP (Adjunct Professional Personnel) in the Hospital, which responsibility must be exercised in conjunction with the Board’s ultimate responsibility for quality of care in the Hospital and consistent with the Hospital's legal fiduciary obligations to the community it serves.� Recognizing that the best interests of their patients are protected by concerted efforts and harmonious relationships between the Medical Staff, its individual Members and the Hospital, the Medical Practitioners practicing at Sherman Hospital hereby organize themselves as the Medical Staff of the Hospital in conformity with these Bylaws.

ARTICLE I

GENERAL PROVISIONS

Section 1. Definitions. The following definitions shall apply to terms used in these Bylaws and the Policy Manual. Amendments to this Section, which can only be made pursuant to Article XXIV of these Bylaws, shall automatically apply to the Policy Manual.

"Adjunct Professional Personnel (APP)" means those Health Care Professionals who are not Members of the Medical Staff but who provide clinical services (for which Clinical Privileges are granted), clinical management (to extend the Clinical Privileges of a Member) or hospital services (excluding Clinical Services for which Members are privileged) in the Hospital and who may provide independent professional recommendations regarding patient care. Persons granted APP status shall not be considered Medical Staff Members (as that term is defined in this Section). APPs are divided into three (3) categories:

"Independent APP". This Category consists of APPs who provide clinical services to patients by expressing independent judgment at the order and under the general supervision of a Member in accordance with the Bylaws and the Adjunct Professional Personnel Policy contained in the Policy Manual attached hereto and incorporated by reference.
"Dependent APP". This category consists of those APPs who provide clinical management to patients pursuant to a documented relationship with an employing or sponsoring Member or Members by performing a portion of the Member's or Members’ professional responsibilities to patients in the Hospital under the direct supervision of their employing or sponsoring Member or Members, all in accordance with the Bylaws and the Adjunct Professional Personnel Policy contained in the Policy Manual attached hereto and incorporated by reference.
"Hospital APP". This category consists of those APPs who provide hospital services to patients in the Hospital pursuant to a contract or employment relationship with the Hospital.

"Adverse Action" shall mean an action limiting, reducing, suspending, restricting, or revoking Medical Staff Membership or Clinical Privileges.
"Adverse Decision" shall mean a decision denying or not renewing Medical Staff Membership or Clinical Privileges.
“All Reasons” shall mean each of the defaults, failures, deficiencies or conditions determined to be present by the Medical Executive Committee, Board or Hearing Committee when an Adverse Action or Adverse Decision is recommended or imposed, and the general grounds or findings of fact relied upon for the conclusions reached, including all reasons based on the quality of medical care or any other basis, including economic factors.� The term “All Reasons” shall not be interpreted to require a recitation of each fact relied upon by the decision making body or a detailed exposition of the supporting rationale for the decision but such general detail as may be necessary for the affected Provider or, if applicable, the Medical Executive Committee, to properly evaluate the facts and opinions relied upon by the decision maker and to effectively prosecute a hearing or appeal.
"Associated With" means an applicant who is a bona fide current or prospective employee, independent contractor, partner or co-owner in the medical practice of a current Member for which all medical services to be rendered by the applicant for Hospital patients are billed by the current Member's medical practice.
"Board" or "Board of Directors" means the Local Governing Board of Sherman Hospital, which has responsibility for the operation of the Hospital, or other institution where indicated.
"Chief Executive Officer" means the individual appointed by the Board to act on its behalf in the management of the Hospital or his designee.
"Clinical Privileges" means the permission granted to a Practitioner to render specific diagnostic, therapeutic, medical, surgical, podiatric or dental patient care and treatment services ("Clinical Services") in the Hospital.
“Clinical Services” means specific diagnostic and therapeutic medical, dental or podiatric patient care and treatment services for which Clinical Privileges are normally granted.
"Dentist" means an individual who has a doctor of dental surgery degree who is duly licensed to practice dentistry in the State of Illinois.
"Department" shall mean the Clinical and/or Hospital Departments of the Medical Staff as delineated in Article XXI.
"Department Chiefs" shall mean those parties elected or appointed to preside over a Department as provided in Article XXI.
"Economic Factor" shall mean any information or reasons for Adverse Decisions or Adverse Actions unrelated to quality of care or professional competency.
"Employed Practitioner" means a practitioner who is compensated and issued an applicable W-2 form for Clinical Services to patients by an employer under whom the professional fees for those services are billed.
"Ex Officio" means service as a member of a body by virtue of an office or position held and, unless otherwise expressly provided, means without voting rights.
"Fair Hearing" shall mean the procedural rights of applicants and Members under the Fair Hearing Plan set forth in Article XIV.
"Hospital" means Sherman Hospital and, depending on the context, includes both the physical building and the licensed not-for-profit entity which owns and operates the facility including, without limitation, such entity's administrators, employees, agents and assigns.
"Hospital Affiliate" means any parent, subsidiary or affiliate of the Hospital or any joint venture or other business entity in which the Hospital may have a controlling equity or ownership interest.
"Medical Staff" means the Medical Staff Organization the structure of which is defined by these Bylaws and which includes all Members collectively.
"Medical Staff Representative" means any and all Medical Staff officers, Clinical Department Chiefs and Medical Executive Committee members at large.
"Medical Staff Year" shall mean that period commencing on the first day of July of each year and ending on the thirtieth day of June in the following year.
"Member" means any Practitioner who has been granted Medical Staff membership and Clinical Privileges.
"Non-restrictive Actions" shall mean minor disciplinary measures such as issuing a warning to a Member, imposing a probationary period with retrospective review but without special requirements of prior or concurrent consultation and direct supervision, issuing a formal letter of reprimand or other similar actions which do not restrict a Member's right to exercise Clinical Privileges independently.
"Oral and Maxillofacial Surgeon" means an individual who has a doctor of dental surgery degree, has completed a residency in oral and maxillofacial surgery and is state licensed as a Dental Specialist in Oral and Maxillofacial Surgery.
"Pertinent Information" shall mean all written information utilized or reviewed in the decision making process relating to the initial grant or renewal of a Member's Medical Staff membership or Clinical Privileges or to summary suspensions, administrative suspensions or Adverse Actions, or Adverse Decisions, whether threatened or imposed, except the phrase "pertinent information" shall not include credentialing information on other Practitioners, Hospital or corporate business plans, any information obtained or generated which is privileged or confidential as attorney-client privilege, physician-patient privilege, or which is privileged or confidential under any applicable state or federal law, rule or regulation.
"Physician" shall be interpreted to include doctors of medicine ("M.D.s"), doctors of osteopathy ("D.O.s") and Oral and Maxillofacial Surgeons.
"Podiatrist" shall be interpreted to mean a doctor of podiatric medicine (“D.P.M.”).
"Policy Manual" means the manual adopted with these Bylaws and approved by the Medical Executive Committee and Board describing certain Hospital policies affecting the Medical Staff.
"Practitioner" means a duly licensed Physician, Dentist or Podiatrist.
"Prerogatives" means the rights granted, by virtue of Staff category or otherwise, to a Member or APP to perform, manage, supervise, assist or otherwise provide clinical services in the Hospital and to participate in Medical Staff Self-government, which rights are exercisable subject to the conditions imposed by these Bylaws and in other Hospital and Medical Staff policies.
"President" means the Physician elected as President of the Medical Staff pursuant to Article XVII.
“Professional Affairs Committee” is a subcommittee of the Board of Directors.� The membership of this committee is determined by the Board and may include Medical Staff Members.� The members of this committee are appointed by the Board for terms determined by the Board.
“Proximate Service Area" means the geographical area described as that portion of the Elgin Township north of the Illinois Central railroad tracks and that portion of the Dundee Township south of Illinois Route 72.
"Self-government" means the duty of the Members, officers, committees and Departments of the Medical Staff to initiate and carry out the functions assumed by the Medical Staff, to govern their own representative and organizational affairs, and to fulfill the obligations provided for in these Bylaws and by law.
“VPMA” means the individual appointed as Vice President for Medical Affairs or equivalent position of professional liaison between the Hospital Administration and the Medical Staff, such individual preferred to possess both medical knowledge and administrative ability.

Section 2. Delineation of Duties. Under these Bylaws and in accordance with applicable state and federal law, the Medical Staff shall be responsible for: i) reviewing, analyzing and evaluating the quality of patient care within the Hospital, ii) determining appropriate standards of care, including, without limitation, appropriate tests required on all admissions and the Hospital formulary, iii) quality improvement activities in the Hospital, iv) Self-government, and v) safeguarding the professional autonomy of all Members.� Members and those Practitioners with temporary privileges granted as provided hereunder shall be responsible for: i) providing all medical, podiatric and dental care to patients in the Hospital, ii) assuring the ethical treatment of their patients, and iii) securing continuity of care.� The Board shall be responsible for the overall maintenance, operation and administration of the Hospital facilities as well as ultimate responsibility for the quality of care and for providing such allied professionals, technicians and other support staff as appropriate for the effective and ethical delivery of quality medical care to patients in the Hospital.� The Hospital shall not furnish nor directly provide Clinical Services, or otherwise exercise professional medical judgment, which duties may only be performed by Members who are duly licensed by the State of Illinois and who are granted credentials in accordance with the procedures established in these Bylaws.� Inpatients and outpatients may only be admitted to the Hospital by a Member with admitting privileges and must remain under the professional care of a Member until discharged.� Patients admitted by a non-Physician Practitioner shall be under the care of both the Physician Member and the non-Physician Practitioner Member.� The non-Physician Practitioner Member shall be responsible for all care within the limits of the privileges granted to them while the Physician Member shall be responsible for all aspects of general medical care.� All persons performing clinical services in the Hospital must either be Members or be generally supervised by a Member.� The Hospital and Medical Staff shall work cooperatively to evaluate credentials of applicants for Medical Staff membership and clinical privileges.

Section 3. Fair Assignment of Duties to Members. The assignment of administrative duties, responsibility for the care of unassigned, uninsured or underinsured Hospital patients, emergency call within each Department and other compulsory duties shall be assigned amongst the Members in a reasonable and equitable manner. Emergency call for the Practitioners in each Department may be made compulsory in the rules adopted for each Department; provided, however, emergency call for Members fifty five (55) years of age or older may be declined at the discretion of the Member without penalty or prejudice.

Section 4. Delivery of Medical Care. Each Member shall be allowed to employ his or her skills as a fiduciary for his or her patients and neither the Hospital nor the Medical Staff shall interfere with or restrict a Member's exercise of independent medical judgment in the diagnosis, treatment or referral of patients unless such independent medical judgment is not consistent with applicable law and regulations, the standards imposed in these Bylaws or the standard of care in the medical community as determined by the Board and the Medical Staff in accordance with these Bylaws.

Section 5. Professional Judgments�. The Medical Staff and the Hospital recognize that the formation of Hospital policy may at times require the expert advice of its Medical Staff.� The Medical Executive Committee has the right to participate with the Hospital in policymaking activities related to the delivery of clinical care and professional medical care in the Hospital.� Without limiting the scope of the foregoing, the Hospital will specifically provide the Medical Staff with information and solicit feedback from the Medical Staff regarding the Hospital’s strategic planning goals, financial goals, and capital and operational budget items which impact patient care.� Further, the Hospital shall solicit the reasoned opinion of its Medical Staff before adopting Hospital operational policies which may impact the quality of patient care in the Hospital, or the exercise of Prerogatives under these Bylaws.� The Board of Directors shall give great weight to the professional opinions and recommendations of the Medical Executive Committee in matters regarding Self-government or regarding the exercise of professional medical judgment in the evaluation of the medical care provided by Members of the Medical Staff, including matters relating to the quality of care provided and the utilization of facilities, tests, therapies, or medications.� If the Board of Directors does not follow the Medical Executive Committee’s recommendations regarding matters of general policy such as Self-government, quality of care, or utilization, the Medical Executive Committee may request that the above-specified general policy matters be referred to an individual who is a qualified specialist in the subject under consideration with such individual providing a recommendation to the Professional Affairs Committee.� The cost of the qualified specialist, who will be mutually agreed upon by the Medical Executive Committee and the Board, shall be shared equally by the Medical Executive Committee and the Board of Directors. Upon receipt of the recommendation, the Professional Affairs Committee shall make a decision in the matter.� The Hospital and Medical Executive Committee shall cooperate regarding the development and implementation of policies related to delivery of clinical care and professional medical care in the Hospital.

Section 6. Self Government. The Hospital shall not interfere with the Medical Staff's process of Self-government under these Bylaws.

Section 7. Construction.

Time Frames. The time periods specified within these Bylaws are intended to be guidelines for action. An action shall not be invalidated solely because a party did not strictly comply with specified time periods.

Pronouns and Plurals. Words used in these Bylaws shall be read as the masculine or feminine gender, and as the singular or plural, as the content requires.

Captions. The captions and headings supplied in these Bylaws are for convenience only and are not intended to limit or define the scope or effect of any provision of these Bylaws.

Interpretation. If any provision in these Bylaws requires judicial interpretation, the judicial body interpreting or construing such provision shall not apply the assumption that the terms hereof shall be more strictly construed against the one who either itself or through its agents prepares the same. The Hospital, Board, Medical Staff and Members hereby agree that they and their agents have participated in preparation of these Bylaws equally.

Preamble. The Preamble shall be considered an integral part of these Bylaws.

Abide By Bylaws. The Hospital, including its Board of Directors, and the Medical Staff, as an integral part of the Hospital, agree to abide by the provisions contained in these Bylaws when performing activities affected by these Bylaws.

Relationship Created. Nothing contained in these Bylaws shall be deemed or construed to create the relationship of principal and agent or of partnership or of joint venture or of any other business association between the Hospital and the Medical Staff, and neither the Hospital's payment of administrative compensation to the Medical Staff nor any other acts of the Hospital and its Medical Staff shall be deemed to create any relationship between the Hospital and the Medical Staff other than the relationship of independent advisor, the duties of each for providing patient care being separate and distinct.

Exercise of Discretion. Whenever the Hospital, Medical Staff or Medical Staff Member has the right to exercise discretion in the interpretation, performance or administration of these Bylaws, such discretion must be exercised fairly, reasonably and in good faith.� Reasonableness shall be determined under a reasonably prudent business person standard.

Severability. If any provision of these Bylaws, or the application of such provision to any person or circumstance, shall be held invalid by any court, governmental agency or regulatory body, the remainder of these Bylaws, or the application of such provisions to persons or circumstances other than those to which it is held invalid, shall not be affected thereby and shall remain in full force and effect. To the extent permitted by applicable law, the parties hereto hereby waive any provision of law that renders any provision hereof prohibitive or unenforceable in any respect.

Successors. The Hospital's and Medical Staffs adoption of these Medical Staff Bylaws, and each Member's acceptance of Clinical Privileges and Prerogatives, shall be binding upon and inure to the benefit of the parties and their legal representatives, successors and assigns.

Waiver. No waiver of any provision of these Bylaws shall be valid except in specific instances when agreed to by each party affected by the waiver, provided, however, notwithstanding the above, a Member may waive or have his rights waived under the Fair Hearing Plan at Article XIV of these Bylaws if the Hospital has granted an exclusive contract to provide a particular service at the Hospital, and an exclusive contract signed either individually or by a representative of the group contains a waiver of rights under the Fair Hearing Plan at Article XIV and/or rights under 210 ILCS 85/10.4(b) 2A-H.

Section 8. Disputes.

A. Dispute Resolution.� Disagreements between the Medical Staff and the Hospital involving the proper interpretation of these Bylaws shall be referred to the Joint Conference Committee in accordance with the procedures established in Article XIII.

B. Remedies.�� After the exhaustion of all administrative procedures set forth herein and upon the failure of all efforts to resolve a matter in a fair, reasonable and amicable manner, the Hospital, Medical Staff or any individual Member may file a suit in equity to enjoin the others, and all persons associated with them, from any breach of these Bylaws as well as any other remedies available in law or equity.

C. Recovery of Costs.� If any action at law or equity, including an action for declaratory judgment, is brought to enforce or interpret the terms, covenants or provisions of these Bylaws, the prevailing party in such litigation shall be entitled to recover reasonable attorney fees from the other party, which fees may be set by the Court in the trial or appeal of such action or may be enforced by a separate action brought for that purpose and which fees shall be in addition to any other relief which may be awarded.

ARTICLE II

CATEGORIES OF THE MEDICAL STAFF

All appointments to the Medical Staff shall be as approved by the Board upon recommendation of the Medical Executive Committee and shall be to one of the following categories listed as Sections in this Article. All Members shall be assigned by the Medical Executive Committee to a specific Department, but may be eligible for Clinical Privileges in other Departments as applied for and approved pursuant to these Bylaws. All initial Clinical Privileges for new appointees and existing Members shall be provisional for a period of twelve (12) months from the date of appointment as provided in Article VII Section 1. Continuance of appointment after the provisional period shall be conditioned on an evaluation of the factors set forth in Article IV of these Bylaws.

Section 1. Attending Staff.

Qualifications. The Attending Staff shall consist of Practitioners who regularly provide Clinical Services in attendance to patients at the Hospital. Candidates for the Attending Staff must have served on the Associate Attending Staff for at least one (1) year prior to becoming eligible for advancement to the Attending Staff. The homes and offices of Attending Staff appointees shall be located close enough to the Hospital, as determined in the rules of the Medical Staff, to fulfill their responsibilities to the Hospital and the Medical Staff and to provide, either personally or through another qualified Member, timely and continuous care for their patients in the Hospital.
Prerogatives. Appointees to the Attending Staff shall be entitled to vote on all Medical Staff, assigned Department or assigned committee matters, to hold office, to serve on Medical Staff committees, and to serve as Chiefs of Departments and chairpersons of committees except as may be provided to the contrary in Article XVII and Article XXV of these Bylaws. Voting rights and eligibility to serve as a Medical Staff representative are subject to attendance requirements as provided for in Article XX Section 2. Attending Staff appointees may admit patients without limitation except as may be otherwise provided in the Medical Staff Rules and Regulations and Hospital admission policies, and may exercise such Clinical Privileges as may be granted under Article VII of these Bylaws.
Obligations. Each appointee to the Attending Staff, by accepting appointment, shall agree to assume all of the following functions and responsibilities, where appropriate and when required by these Bylaws or assigned by the Medical Executive Committee: 1) to contribute to the organizational and administrative affairs of the Medical Staff, including service on Medical Staff and Department committees, and to faithfully perform the duties of any office or position to which elected or appointed, 2) to provide care for unassigned patients, 3) to provide specialty emergency coverage, 4) to provide consultation to other Members consistent with delineated Clinical Privileges, 5) to participate in teaching assignments and educational programs offered by the Medical Staff, 6) to participate in performance improvement and monitoring activities, including the evaluation of provisional appointees, 7) to attend Medical Staff and Department meetings as provided in Article XX Section 2, and 8) to fulfill such other Medical Staff functions as may be reasonably required by the Medical Executive Committee and the Board.
Advancement. Appointees to the Attending Staff may submit a written request to their assigned Department Chief for consideration of transfer to any other Staff Category at any time. Denial of the request shall not be considered an Adverse Action or Adverse Decision and shall not entitle the affected Member rights under the Fair Hearing Plan.

Section 2. Associate Attending Staff.

Qualifications. The Associate Attending Staff shall consist of Practitioners who regularly provide Clinical Services in attendance to patients at the Hospital. Associate Attending Staff appointees must have completed at least one (1) year of satisfactory performance on the Associate Staff. The homes and offices of Associate Attending Staff appointees shall be located close enough to the Hospital, as determined in the rules of the Medical Staff, to fulfill their responsibilities to the Hospital and the Medical Staff and to provide, either personally or through another qualified Member, timely and continuous care for their patients in the Hospital.
Prerogatives. Associate Attending Staff appointees may admit patients without limitation except as may be otherwise provided in the Medical Staff Rules and Regulations and Hospital admission policies, may exercise such Clinical Privileges as may be granted under Article VII of these Bylaws, and may vote on all matters presented at meetings of the committees to which they have been appointed. Associate Attending Staff appointees are not eligible to be Medical Staff Representatives and shall not have the right to vote at Department or Medical Staff meetings.
Obligations. Appointees to the Associate Attending Staff, by accepting appointment, shall agree to assume the same functions and responsibilities as appointees to the Attending Staff and may be required to assist in the Medical Executive Committee's evaluation of Associate Staff appointees and shall participate in such peer review activities of their own conduct as the Medical Executive Committee or its designee may require in order to evaluate their performance. Appointees to the Associate Attending Staff shall attend regular and special meetings of the Medical Staff and the Department and committees of which they are a member as provided in Article XX Section 2.
Advancement. Appointees to the Associate Attending Staff may submit a written request to their assigned Department Chief for consideration of advancement to the Attending Staff after serving at least one (1) year on the Associate Attending Staff, or of transfer to any other Staff Category at any time. Failure to change Staff Category shall not be considered an Adverse Action or Adverse Decision and shall not entitle the affected Member rights under the Fair Hearing Plan.

Section 3. Associate Staff.

Qualifications. The Associate Staff shall consist of those Practitioners who have received initial appointment to the Medical Staff pursuant to the provisions of Article V and who have not been initially appointed to another medical staff category. The homes and offices of Associate Staff appointees shall be located close enough to the Hospital, as determined in the rules of the Medical Staff, to fulfill their responsibilities to the Hospital and the Medical Staff and to provide, either personally or through another qualified Member, timely and continuous care for their patients in the Hospital.
Prerogatives. Associate Staff appointees may admit patients without limitation except as may be otherwise provided in the Medical Staff Rules and Regulations and Hospital admission policies, and may exercise such Clinical Privileges as may be granted under Article VII of these Bylaws. Associate Staff appointees shall not be entitled to vote at any Medical Staff or Departmental meetings. They may serve as voting members on Medical Staff committees but shall not be eligible to be a Medical Staff Representative.
Obligations. Appointees to the Associate Staff, by accepting appointment, shall agree to assume the same functions and responsibilities as appointees to the Attending Staff and shall participate in such peer review activities of their own conduct as the Medical Executive Committee or its designee may require in order to evaluate their performance. Appointees to the Associate Staff shall attend regular and special meetings of the Medical Staff and the Department and committees of which they are a member as provided in Article XX Section 2.
Advancement. Appointees to the Associate Staff will be considered for advancement to the Associate Attending Staff or may submit a written request to their assigned Department Chief for consideration of transfer to the General Courtesy Staff after serving not less than one (1) year on the Associate Staff.

Section 4. General Courtesy Staff.

Qualifications. The General Courtesy Staff shall consist of Members who wish to provide Clinical Services in attendance to a limited number of patents in the Hospital. A person shall be eligible for appointment to the General Courtesy Staff only after satisfactorily serving as an Associate Staff appointee for a minimum of one (1) year.
Prerogatives. Members of the General Courtesy Staff shall be permitted to admit or attend only twenty four (24) patients during a calendar year. A group practice of Practitioners with more than one member on the General Courtesy Staff shall be considered as one Member and shall be allowed twenty four (24) admissions/consultations per year for that group. General Courtesy Staff appointees shall not be entitled to vote at Medical Staff, Departmental or committee meetings and may not serve as a Medical Staff Representative. If the General Courtesy Staff appointee wishes to admit or attend more than twenty four (24) patients a year, he must apply through his assigned Department for transfer back to the Staff Category from which he last transferred to the General Courtesy Staff.
Obligations. General Courtesy Staff appointees shall be responsible to provide emergency coverage at the request of their respective Department. Such consultations, when requested, shall not be counted against the twenty four (24) patient restriction imposed by these Bylaws. General Courtesy Staff appointees shall also satisfy the mandatory appearance requirements for peer review meetings set forth in Article XX Section 2.
Advancement. General Courtesy Staff appointees may submit a written request to their assigned Department Chief for consideration of transfer back to the Staff Category from which they last transferred to the General Courtesy Staff at any time. Failure to change Staff Category shall not be considered an Adverse Action or Adverse Decision and shall not entitle the affected Member rights under the Fair Hearing Plan.

Section 5. Consulting Staff.

Qualifications. The Consulting Staff shall consist of certified specialists who have distinguished themselves as authorities in their areas of specialization who can assist on a special project or provide services to the Hospital or Medical Staff which are not otherwise offered by current Members. Appointment may be made directly to the Consulting Staff category without going through Associate and Associate Attending Staff categories.
Prerogatives. Consulting Staff appointees shall have all the rights and privileges of Medical Staff membership insofar as their specialties are concerned except they may not vote on any Medical Staff, Department or committee matter, serve as a Medical Staff Representative or admit patients.
Obligations. Consulting Staff appointees shall not be required to take emergency call, however, they must meet the basic responsibilities of all Members provided in these Bylaws and satisfy the mandatory appearance requirements for peer review meetings set forth in Article XX Section 2.
Advancement. Consulting Staff appointees desiring to change their Medical Staff category must meet the requirements of the new category and must submit an application for change in Medical Staff category for review by the Department, Credentials Committee, Medical Executive Committee and Board of Directors.

Section 6. Honorary Staff.

Qualifications. The Honorary Staff shall consist of Members who have retired from Hospital practice or Practitioners with outstanding professional obtainment.
Prerogatives. Honorary Staff appointees may attend Medical Staff and Department meetings and any Hospital education programs. Honorary Staff appointees may not admit patients or provide clinical services within the Hospital. Honorary Staff appointees are not eligible to vote or serve as a Medical Staff Representative.
Obligations. Honorary Staff appointees have no specific obligations under these Bylaws.
Advancement. Honorary Staff appointees desiring to change their Medical Staff category must meet the requirements of the new category and must submit an application for change in Medical Staff category for review by the Department, Credentials Committee, Medical Executive Committee and Board of Directors.

Section 7. Part-Time Hospital Based Staff.

Qualifications. The Part-Time Hospital Based Staff shall consist of those appointees to Hospital Departments working less than an average of thirty two (32) hours per week at the Hospital. Part-Time Hospital Based Staff may be appointed directly to this category without first being appointed to the Associate Staff category. If an appointee to this category, during a term of appointment, exceeds the aforementioned work hour limit, the individual must apply for transfer to the Associate Staff category to continue Medical Staff membership.
Prerogatives. Appointees to the Part-Time Hospital Based Staff may serve without vote on Medical Staff committees but they are not eligible to serve as a Medical Staff representative or to vote at Departmental or Medical Staff meetings and they may not admit patients.
Obligations. Each appointee to the Part-Time Hospital Based staff Category is encouraged to attend general and special Medical Staff meetings and Departmental meetings but are not required to do so except to satisfy the mandatory appearance requirements for peer review meetings set forth in Article XX Section 2.
Advancement. Part-Time Hospital Based Staff appointees desiring to change their Medical Staff category must meet the requirements of the new category and must submit an application for change in Medical Staff category for review by the Department, Credentials Committee, Medical Executive Committee and Board of Directors.

Section 8. Distance Staff

A. Qualifications. The Distance Staff shall consist of Practitioners who regularly provide Clinical Services to patients at the Hospital from a distance through a suitable form of interactive communication. Appointment may be made directly to the Distance Staff category without going through Associate and Associate Attending Staff categories.

B. Prerogatives. Appointees to the Distance Staff may serve without vote on Medical Staff committees provided that they may elect to participate in said meetings from a distance through a suitable form of interactive communication. They are not eligible to serve as a Medical Staff representative or to vote at Departmental or Medical Staff meetings, and they may not admit patients.

C. Obligations. Distance Staff appointees shall be responsible to provide emergency coverage at the request of their respective Department and shall satisfy the mandatory appearance requirements for peer review meetings set forth in Article XX Section 2, provided that they may elect to provide said coverage and satisfy said appearance requirements from a distance through a suitable form of interactive communication.

D. Advancement. Distance Staff appointees desiring to change their Medical Staff category must meet the requirements of the new category and must submit an application for change in Medical Staff category for review by the Department, Credentials Committee, Medical Executive Committee and Board of Directors.

ARTICLE III

ADJUNCT PROFESSIONAL PERSONNEL

Section 1. Eligibility. Only those specialties of APP for whose skills the Board of Directors and the Medical Executive Committee, pursuant to the Adjunct Professional Personnel Policy in the Policy Manual has determined a demonstrated need shall be eligible to provide patient care services in the Hospital. Persons granted APP status shall not be considered Members.

Section 2. Three Categories. APP shall be divided into three (3) categories: Independent APP, Dependent APP, and Hospital APP.

Section 3. Departmental Qualifications. Where appropriate, the Medical Executive Committee may establish particular qualifications required for a specific specialty of APP, provided that such qualifications are not arbitrary or contrary to applicable law, and the Department to which the APP is assigned may develop, implement and enforce quality control criteria.

Section 4. Independent APP.

Qualifications. Independent APP shall consist of:

Individuals with an advanced degree in Psychology from an accredited college or university who are certified and licensed to practice by the State of Illinois.

Prerogatives. Independent APP may provide patient care services within the limits of their qualifications as provided for in this Section 4 and the clinical privileges granted to them in accordance with the credentialing and privileging process detailed in this Section 4. The Fair Hearing Plan provided for in Article XIV of these Bylaws shall apply to Independent APP as it would to any other applicant or Member. If asked, they may serve on appropriate committees of the Medical Staff with vote if allowed by the terms of their committee appointment.
Obligations. Independent APP shall:

Exercise independent judgment in their areas of competence, provided that a Member shall have the ultimate responsibility for patient care;
Participate directly in the care of patients under the general supervision or direction of a Member;
Record reports and write notes on patient records in accordance with Hospital policy and write orders for treatment to the extent established in the Rules and Regulations of the Medical Staff, provided that such orders are within the scope of licensure, certification or other legal credential;
Not admit or discharge patients at the Hospital;
Such individuals may be invited to attend certain Medical Staff meetings and may, as a condition of continued privileges, be required to attend meetings involving the clinical review of patient care in which they participated; and
Maintain professional liability insurance in accordance with the Member requirements of Article IV of these Bylaws. Certification of coverage must be provided prior to the granting of APP privileges, and coverage must be maintained throughout the Independent APP's tenure at the Hospital.

Supervisor Responsibility. While a Member may supervise the general care being provided a particular patient by an Independent APP, the Independent APP assumes full responsibility and is fully accountable for the clinical services he or she renders.
Application, Credentialing and Privileging. Applications of Independent APP shall be reviewed as any applications for membership and Clinical Privileges are reviewed under Articles IV, V, VI and VII of these Bylaws.
Department Assignment. The Medical Executive Committee shall assign Independent APP to a clinical Department appropriate to their professional training.
Performance Improvement. The quality of clinical services provided by Independent APP shall be reviewed as part of the performance improvement program of the Medical Staff and Hospital.

Section 5. Dependent APP.

Qualifications. Dependent APP shall possess such training, experience and licensure as may be provided by Rule, pursuant to the Adjunct Professional Personnel Policy contained in the Policy Manual, or required by law. Each Dependent APP must be employed by, sponsored by, or have a collaborative agreement with a physician Member of the Medical Staff who assumes full responsibility and is fully accountable for the Clinical Management (described herein) rendered by the Dependent APP. The collaborative agreement shall, at a minimum, contain such terms and conditions as required by law and as the Medical Executive Committee may establish by rule.
Application. The employing, sponsoring or collaborative Member and the Dependent APP shall jointly make application for Dependent APP status, which shall be processed and reviewed in accordance with the procedures and criteria set forth in the Adjunct Professional Personnel Policy in the Policy Manual. While the employing, sponsoring or collaborative Member must hold clinical privileges, the Dependent APP is not granted privileges by the Medical Staff.
Description of Clinical Management. Dependent APP may only serve to extend the existing privileges as an agent of their employer, sponsor, or collaborative physician Member within the scope of their training, experience and licensure, and consistent with and rules established by the Medical Executive Committee upon recommendation of the applicable Departments and Divisions.
Prerogatives. A Dependent APP may:

Provide specified clinical management services as an agent and under the direct authority of his or her Medical Staff employer, sponsor or collaborative physician member within the scope of the Dependent APP's license, certificate or other legal credential.
Not admit patients; and
Exercise such other Prerogatives as shall be accorded any specific of APP as may be approved by the Medical Executive Committee.

Employer, Sponsor, or Collaborative Physician Responsibility. The employer, sponsor, or collaborative physician of the Dependent APP shall assume full responsibility and be fully accountable for the conduct of such individual within the Hospital. It is also the responsibility of the employer, sponsor, or collaborative physician of the Dependent APP to acquaint said individual with these Bylaws and the applicable Rules and Regulations of the Medical Staff and with the Hospital personnel with whom said individual will be working at the Hospital. Said employer, sponsor, or collaborative physician shall furnish evidence of professional liability insurance coverage for such individual in the same manner as described in Article IV Section 5 of these Bylaws.
Department Assignment. The Dependent APP shall be assigned to the Department of which his employer, sponsor, or collaborative physician is a member.
Termination of Duties. The clinical duties and responsibilities and APP status of the Dependent APP within the Hospital shall automatically terminate if: i) the employment, sponsorship or collaborative agreement of the Dependent APP is terminated, or ii) if the Medical Staff membership of the employer, sponsor or collaborative physician Member is terminated for any reason, or iii) if the employer's, sponsor's, or collaborative physician's Clinical Privileges are curtailed to the extent that the professional services of said individual within the Hospital are no longer permissible to assist the employer, sponsor, or collaborative physician. The Dependent APP is not granted privileges by the Medical Staff and no additional hearing or review rights under these Bylaws shall apply.� However, the terminated APP shall be granted an audience with the Chief and appropriate subcommittee of his Department if requested.

Section 6. Hospital APP.

Qualifications. To provide specific hospital services, Hospital APP shall be under contract or have an employment relationship with the Hospital for the provision of said hospital services and have such training, experience, licensure, and supervision provided by Rule pursuant to state and federal law and the Adjunct Professional Personnel Policy contained in the Policy Manual. Hospital APP shall not be eligible to provide clinical services for which members are ordinarily privileged.
Specialties of Hospital APP. The permissible specialties of Hospital APP and the patient care functions which may be performed by each specialty of Hospital APP shall be as agreed by the Hospital, the Medical Executive Committee and the applicable Departments and Divisions.
Applications. Applications by individuals for Hospital APP status need not be reviewed or approved by the Medical Staff. The Hospital APP is not granted privileges by the Medical Staff and no additional hearing or review rights under these Bylaws shall apply.
Hospital Responsibility. Hospital APPs act as agents of the Hospital and the Hospital shall assume full responsibility and be fully accountable for the conduct of Hospital APPs within the Hospital. It is also the responsibility of the Hospital to acquaint said individual with any applicable policies, rules and regulations.
Obligations. Hospital APPs shall participate in medical performances improvement activities as may be required by the Medical Executive Committee.

Section 7. Removal Procedures and Status. The Hospital may, upon recommendation of the Medical Executive Committee, suspend or terminate any or all of the privileges or functions of any APP, without recourse on the part of the APP or others to the review or hearing and appeal process of these Bylaws, except as provided in subparagraphs 7(A), 7(B) and 7(C) below.

Independent APP. Independent APP's are subject to Summary Suspension (Article X), Administrative Suspension (Article XI), Corrective Action (Article XII), Fair Hearing (Article XIV) and Informal Proceedings (Article XV) as would any physician Member.
Dependent APP. The Dependent APP's are not granted privileges by the Medical Staff and only serve to extend the existing privileges of their employer, sponsor, or collaborative physician Member. The employer, sponsor, or collaborative physician Member of a Dependent APP may terminate the relationship with the Dependent APP without involvement of the Hospital or Medical Staff. The Dependent APP shall have no additional rights to hearing or review under these Bylaws. After Informal Proceedings as provided for in Article XV, the Hospital may terminate the status of a Dependent APP.� Except for automatic termination as provided for in Section 5 of this Article III, said termination shall be considered a corrective action against the employer, sponsor, or collaborative physician Member.
Hospital APP. The Hospital may at its sole discretion solicit the recommendation of the Medical Executive Committee or the President in the case of a summary suspension before it restricts, suspends or terminates a Hospital APP.� Hospital APP are not granted privileges by the Medical Staff and shall have no additional rights to hearing or review under these Bylaws, such rights, if any, exclusively arising under the Hospital's employment manual or policies and any contract the Hospital APP may have with the Hospital.

ARTICLE IV

APPOINTMENT TO THE MEDICAL STAFF

Section 1. General Principles for Appointment or Reappointment.

Qualifications. Appointment and reappointment to the Medical Staff is a privilege which shall be extended only to professionally competent individuals who continuously meet the qualifications, standards and requirements set forth in these Bylaws. All individuals providing Clinical Services in the Hospital, unless excepted by specific provisions of these Bylaws, must first have been appointed to the Medical Staff.
Confidentiality. All processes described in this Article shall be subject to the confidentiality and peer review provisions set forth in Article XV Sections 2 and 3 of these Bylaws.
Economic Criteria. Except for membership or privileges exercised exclusively under a contract or employment relationship with the Hospital, the denial, restriction or termination of Medical Staff Membership or Clinical Privileges based on economic criteria unrelated to clinical qualifications, professional competen�cy, or quality of care is prohib�ited; provided, however, that such prohibition shall not apply if the Medical Executive Committee recommends and the Board concurs, based upon an objective standard, that the Practitioner has demonstrated a consistent pattern of medically inappropriate utilization of Hospital services and facilities and has failed to appropriately modify his or her utilization pattern following reasonable notice.
Participation in Specific Programs. Except pursuant to a contract with the Hospital, Medical Staff Membership and Clinical Privileges shall not be conditioned on a Practitioner's participation or non-participa�tion in provider contracts with a third party payer or in any Hospital sponsored health care or managed care plans or programs.