Emergency Call Exemption Rejected by the Board
Riverside Regional is a 410-bed nonprofit hospital. At the March medical staff meeting, 62 of 118 eligible members vote, and the proposed amendment to Article VII of the medical staff bylaws passes 41–18. The amendment would end mandatory unassigned emergency department call for any member age 65 or older with 25 years of continuous staff membership, and would let each department chair grant individual call exemptions. The Medical Executive Committee endorsed the change 11–2. In April the board of trustees votes 9–2 to reject it, citing a 22% gap in unassigned neurosurgery and general surgery call and a two-month history of emergency department diversion. On its own motion the board also adds a new bylaws clause requiring board approval of every department chair election, and directs the CMO to "implement the intent of the board's action immediately." The medical staff president says the staff will not comply and asks you, the medical staff services professional, to advise on the conflict.
1. Who has authority to decide the call-exemption amendment, and what process governs the deadlock?
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The governing body has the authority, and the accreditation framework confirms it. Under CMS §482.12(a)(1) the governing body appoints medical staff members after considering medical staff recommendations, and §482.22(a) requires organized medical staff bylaws that the governing body approves. The medical staff's role is to evaluate credentials and make recommendations; it is not a parallel sovereign. Joint Commission MS.01.01.01 adds a protected list-criteria for privileges, focused and ongoing evaluation, corrective action, fair hearing plan and similar provisions-that the medical staff must approve and the board cannot amend unilaterally. Emergency call is generally not on that protected list; it is a hospital obligation under §482.12(f), where the governing body determines the emergency services and call coverage the community needs. So the board's rejection likely stands, and the staff cannot impose a change that removes a call obligation the board has determined is necessary.
The useful path is procedural, not confrontational: convene the joint conference committee to produce an alternative the staff can recommend and the board can approve-paid call stipends, a call pool, locum coverage, or a phased, capped exemption with a review date. Separately, verify the March vote against the bylaws' quorum and majority requirements; a valid vote strengthens the staff's negotiating position without transferring authority.
2. Can the board add the department chair approval clause on its own motion?
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This is a different question from the call amendment, and the answer is probably no. If the election procedure for department chairs sits in the medical staff–approved section of the bylaws, the board cannot add a board-approval step by unilateral resolution; it must use the bylaws amendment article, which typically requires a medical staff vote and board approval, and for protected provisions requires medical staff approval as a precondition. The board's ultimate appointment authority is not in doubt, but it must be exercised through the process the bylaws define.
Two concrete risks follow from the unilateral action. First, courts have treated medical staff bylaws as a contract among the hospital, the staff, and individual practitioners, so a practitioner denied a chair election could argue breach. Second, a surveyor reviewing medical staff self-governance will see a board that amends medical staff provisions at will, which is a governance finding even where no patient is harmed.
Recommended remedy: the CMO's "implement immediately" instruction should be paused pending legal review; the clause should be withdrawn and reintroduced through the bylaws committee with a stated rationale. If the board genuinely wants a veto, negotiate a provision requiring board concurrence against a defined standard, with a process and timeline, rather than an open-ended approval right.
3. What should medical staff services do in the next two weeks?
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Six steps, all documented. (1) Preserve the record: the March minutes and vote count, the MEC endorsement, the board resolution, and the call-coverage and diversion data the board relied on. (2) Confirm the quorum and vote against the bylaws article that governs amendments. (3) Advise the medical staff president in writing that the current bylaws remain in effect until validly amended, so noncompliance with call is not a lawful option while the dispute is unresolved. This protects patients and protects the staff from corrective action; it is not a concession on the merits. (4) Request a joint conference committee meeting within 30 days with a written agenda. (5) Ask legal to review whether the board's unilateral clause breached the bylaws. (6) Start the interim operational fix-locum tenens or stipends-so emergency coverage is not compromised while governance works.
The MSP's role is process integrity, not advocacy. A dated chronology of every action and communication is the single most useful artifact if this escalates to a regulator, a court, or a medical staff vote, and it should be built now rather than reconstructed later.