The California Medical Association (CMA) has filed an amicus brief in support of the medical staff at Tulare Regional Medical Center in its lawsuit against the hospital alleging violations of state laws when the hospital terminated the entire medical staff and its duly elected officers.

The hospital has recognized a replacement medical staff formed by a group of seven physicians led by the vice chairman of the hospital board. This group presented itself as a newly formed medical staff after it selected new bylaws and named officers to the medical executive committee. None of the other physicians at the hospital were aware of such actions or voted on the new bylaws and officers. The physicians were told that they would have provisional membership in the replacement medical staff, without any right to hold office or vote on medical staff matters.

CMA's amicus brief explains that the replacement medical staff has no legal basis and that the hospital has committed serious violations of the self-governing rights of the original medical staff and its physician members. The brief asserts that the hospital has effectively unseated duly elected medical staff officers in favor of unelected individuals that support the hospital to serve in their stead, unilaterally imposed new medical staff bylaws and blocked the proper use of medical staff funds. Nothing in state law permits a hospital to dissolve an entire medical staff in such manner, CMA notes.

CMA emphasizes in its brief that these violations can undermine physician independence and patient care. The laws establishing medical staff independence and self-governance are designed to insulate medical decision-making from interference by hospital administrators or other lay individuals who are motivated by concerns not related to patient welfare. The replacement medical staff, which does not conform to these laws, is already showing signs of undue influence and control by the hospital. Under the bylaws for the replacement medical staff, privileging and other conditions of membership are connected to patient admissions at the hospital. The hospital board also gets control over who serves as medical staff officers, and there are general conditions requiring physicians to uphold the welfare of the hospital.

CMA has a long history of fighting for legislation and regulations that establish the right of self-governance for medical staffs. It is also the only statewide advocacy group dedicated to protecting the professional interests of medical staffs to ensure quality care in California’s hospitals.

CMA is concerned that the hospital’s actions will create a dangerous precedent if left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic.

The Tulare County Superior Court declined to grant a temporary restraining order as requested by the medical staff, claiming there was not enough evidence at the early stages of the case to impose such extraordinary relief. The case next proceeds to discovery and fact finding.

Read the brief here.