HB 1447 2003
1	CHAMBER ACTION
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6	The Committee on Health Care recommends the following:
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8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to St. Lucie County; providing legislative
12	intent; providing a popular name; providing for
13	consolidation of certain local hospital authority;
14	providing powers and duties of hospital governing boards;
15	providing an effective date.
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17	Be It Enacted by the Legislature of the State of Florida:
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19	Section 1. This act clarifies the delineation of authority
20	within each hospital within St. Lucie County. It is the intent
21	of the Legislature to provide consolidation of a hospital
22	corporation's board of directors' power, authority, duty, and
23	ultimate responsibility under existing statutes with respect to
24	the operation of a hospital, including, but not limited to, the
25	granting, denial, and discipline of medical staff and clinical
26	privileges, and for compliance with statutorily mandated peer
27	review, risk management, and quality assurance activities. This
28	act is not intended to supersede, amend, or terminate any
29	existing medical staff bylaws, but rather to clarify that in the
30	event of a conflict between bylaws of a hospital corporation's
31	board of directors and a hospital's medical staff bylaws, the
32	hospital board's bylaws shall prevail with respect to medical
33	staff privileges, quality assurance, peer review, and contracts
34	for hospital-based services.
35	Section 2. This act may be known by the popular name the
36	"St. Lucie County Hospital Governance Law."
37	Section 3. The board of directors of each general hospital
38	operating in St. Lucie County whose license is held by a
39	corporation shall appoint or elect, in a manner and method of
40	its own choosing, a governing board for each hospital which may
41	be the board of directors of such corporation or a separate
42	governing board. The board of directors may delegate such
43	authority as it deems necessary to the governing board of a
44	hospital, but such delegation does not relieve the hospital
45	corporation of ultimate responsibility, and such delegation of
46	authority shall remain subject to amendment, rescission, or
47	revocation by the board of directors.
48	Section 4. The governing board shall also be ultimately
49	responsible for the administration of the hospital, including
50	managing the operations of the hospital, ensuring patient
51	welfare, conducting peer review, overseeing the risk management
52	program and quality assurance activities, and determining
53	eligibility for medical staff membership and clinical
54	privileges. This authority is granted subject to the provisions
55	of sections 395.0191 and 395.0193, Florida Statutes, and the
56	articles of incorporation and bylaws of the hospital
57	corporation.
58	Section 5. A governing board's authority for the
59	administration of the hospital is not limited by the authority
60	of its medical staff. Therefore, a governing board may reject or
61	modify a medical staff recommendation or may, if the medical
62	staff has failed to act, take action independent of the medical
63	staff concerning medical staff membership, clinical privileges,
64	peer review, and quality assurance in accordance with the
65	procedures specified in section 6. To the extent, if any, that
66	the bylaws or other regulations of the medical staff conflict
67	with the bylaws or other regulations of the governing board, the
68	bylaws or other regulations of the governing board shall control
69	with respect to medical staff privileges, quality assurance,
70	peer review, and contracts for hospital-based services,
71	irrespective of the identity of the drafter of the respective
72	bylaws or regulations. However, in no event shall a decision
73	regarding medical staff privileges be made by the governing
74	board entirely upon economic considerations. Neither the
75	governing board nor a hospital's medical staff shall
76	unilaterally amend a hospital's medical staff bylaws and related
77	manuals, rules, or regulations. Any amendments or revisions
78	proposed by the governing board shall first be submitted to the
79	medical staff for its recommendations, including 30 days' notice
80	for response, and any response timely made shall be carefully
81	considered by the governing board prior to its approval of the
82	proposed amendments or revisions.
83	Section 6. To the extent a governing board seeks to modify
84	a medical staff recommendation, or where a medical staff has
85	failed to act within 75 days after a request from the governing
86	board to take action against, or with regard to, an individual
87	physician concerning medical staff membership, clinical
88	privileges, peer review, or quality assurance, a governing board
89	may take action independent of the actions of the medical staff.
90	Any such action shall be subject to a fair hearing process, if
91	authorized by the medical staff bylaws, in which the physician
92	is entitled to be represented by counsel, to be afforded an
93	opportunity to present oral and written argument in response to
94	the corrective or disciplinary action proposed, and to comment
95	upon and cross-examine witnesses and evidence against such
96	physician. If, after any fair hearing, the governing board
97	determines that corrective or disciplinary action is necessary,
98	it shall recommend such action to a six-member joint conference
99	committee composed of three members of the governing board, to
100	be appointed by the chair of the governing board, and three
101	members of the medical staff, to be appointed by the chair or
102	president of the medical staff. The joint conference committee
103	shall, within 15 days after the governing board's decision after
104	the fair hearing process, review the fair hearing recommendation
105	and notify the governing board that the joint conference
106	committee accepts, rejects, or cannot reach a majority consensus
107	concerning the governing board's recommendation. If the joint
108	conference committee's recommendation is to accept the governing
109	board's recommendation, the governing board's decision shall be
110	final. If the joint conference committee rejects the governing
111	board's recommendation and suggests an alternative corrective or
112	disciplinary action, or finds that no corrective or disciplinary
113	action is warranted, the governing board shall not unreasonably
114	reject the joint conference committee's recommendation. If the
115	joint conference committee cannot reach a majority consensus to
116	either accept or reject the governing board's action concerning
117	the fair hearing decision, the governing board's action shall be
118	final. The governing board shall give full and complete
119	consideration to the joint conference committee’s
120	recommendations.
121	Section 7. This act shall take effect upon becoming a law.