Fair hearing triggers


Your medical staff bylaws must specifically state the exact details as to when, by whom, and how a fair hearing is triggered at the medical staff level and an appeal is triggered at the board level. In addition, the bylaws should have a "bright line" definition of the actions that will trigger the fair hearing and appeal due process.

The Health Care Quality Improvement Act (HCQIA) of 1986 protects hospitals and individual physicians participating on medical peer review committees from potential liability. However, to obtain immunity under the HCQIA, medical staff bylaws must state an exact process that will be followed whenever an adverse recommendation with regard to a practitioner's clinical competence or professional conduct has been made by the medical executive committee or the hospital board.

Your bylaws should state clearly that hearings would be triggered only by the following actions:

  • Denial of medical staff appointment or reappointment
  • Revocation of medical staff appointment
  • Denial or restriction of requested clinical privileges
  • Reduction in clinical privileges
  • Involuntary reduction or revocation of clinical privileges
  • Suspension of staff appointment or clinical privileges, but only if the suspension is for more than 30 days and is not caused by the member's failure to complete medical records or any other reason unrelated to clinical competence or professional conduct