The by-laws of the hospital and legal corporations and practice groups outline the governance rules for these entities. But hospitals in most cases cannot purely self govern. They have structures that prevent the corporate practice of medicine. Key among those structures are the physicians themselves who organize and largely self govern through a Medical Executive Committee. CLICK HERE for the Contra Costa County by-laws for a standard (but well written) set of MEC rules. One “trick” that a good law firm will use is to conform its work to existing work used by large organizations. In general, courts will favor the large (in this case county) entity and uphold its rules and enforce them in a balanced manner. If your attorney is setting up by-laws for a smaller group, tracking the “big shots” provides a layer of protection.
What Does a Medical Executive Committee (MEC) Do?
A Medical Executive Committee (MEC) is responsible for making important medical and clinical decisions, overseeing medical staff, and addressing various healthcare-related issues within the organization.
A good webpage for seeing the structure of the MEC as it oversees operations is the Stanford Website. The site shows how the MEC structurally works with the other physician led entities.
The specific roles and responsibilities of a Medical Executive Committee may vary depending on the healthcare organization’s structure and policies as well as state law but some common functions include:
- Governance and Leadership: The MEC plays a key role in setting the strategic direction and policies related to patient care, medical staff, and clinical services.
- Credentialing and Privileging: The committee evaluates and approves the credentials and privileges of physicians and other healthcare providers who seek to practice within the organization. This ensures that only qualified and competent professionals are granted the authority to provide patient care.
- Peer Review: The MEC oversees a peer review process to evaluate the quality of medical care provided by the medical staff. This may involve reviewing adverse events, complications, and patient outcomes to identify areas for improvement.
- Compliance and Ethics: The committee may have a role in ensuring that medical staff members adhere to ethical standards and comply with relevant laws, regulations, and organizational policies.
- Quality Improvement: MEC members often collaborate with other hospital committees to implement quality improvement initiatives, enhance patient safety, and promote evidence-based practices.
- Liaison with Administration: The MEC serves as a bridge between the medical staff and the hospital administration, fostering communication and cooperation between the two groups.
- Policy Development: The committee may participate in developing medical policies and protocols, ensuring that the medical staff follows best practices and evidence-based guidelines.
Members of the Medical Executive Committee are typically elected or appointed based on their professional qualifications and experience. The composition of the committee often includes the Chief Medical Officer (CMO), the Medical Director, department chairs, and representatives from various medical specialties. The Chief of Staff, who is usually the highest-ranking physician in the organization, often presides over the committee.
What Laws Require a Medical Executive Committee (MEC) to Exist?
Overall, the Medical Executive Committee plays a crucial role in ensuring the delivery of high-quality medical care and promoting effective collaboration among medical staff, administration, and other stakeholders within the healthcare organization.
In California the MEC is defined and regulated under Cal. Code Regs. title 22 § 71503. That section states:
a) Each hospital shall have an organized medical staff responsible to the governing body for the fitness, adequacy and quality of the care rendered to patients.(b) Medical staff membership.(1) The medical staff shall be composed of physicians and, where dental or podiatric services are provided, dentists or podiatrists.
(2) As required by section 1316.5 of the Health and Safety Code:(A) Where clinical psychological services are provided by clinical psychologists, in a health facility owned and operated by the state, the facility shall establish rules and medical staff bylaws that include provisions for medical staff membership and clinical privileges for clinical psychologists within the scope of their licensure as psychologists.
(B) Where clinical psychological services are provided by clinical psychologists, in a health facility not owned or operated by this state, the facility may enable the appointment of clinical psychologists to the medical staff.
(c) The medical staff, by vote of the members and with the approval of the governing body, shall adopt written bylaws which provide formal procedures for the evaluation of staff applications and credentials, appointments, reappointments, assignment of clinical privileges, appeals mechanisms and such other subjects or conditions which the medical staff and governing body deem appropriate. The medical staff shall abide by and establish a means of enforcement of its bylaws. Medical staff by-laws, rules and regulations shall not deny or restrict, within the scope of their licensure, the voting rights of staff members or assign staff members to any special class or category of staff membership, based upon whether such staff members hold an M.D., D.O. or D.P.M. degree or clinical psychology license.
(d) The medical staff shall meet regularly. Minutes of each meeting shall be retained and filed at the hospital.
(e) The medical staff bylaws, rules, and regulations shall include, but shall not be limited to, provision for the performance of the following functions: executive review, credentialing, medical records, tissue review, utilization review, infection control, pharmacy and therapeutics, and assisting the medical staff members impaired by chemical dependency and/or mental illness to obtain necessary rehabilitation services. These functions may be performed by individual committees, or when appropriate, all functions or more than one function may be performed by a single committee. Reports of activities and recommendations relating to these functions shall be made to the executive committee and the governing body as frequently as necessary and at least quarterly.
(f) The medical staff shall provide in its bylaws, rules and regulations for appropriate practices and procedures to be observed in the various departments of the hospital. In this connection, the practice of division of fees, under any guise whatsoever, shall be prohibited and any such division of fees shall be cause for exclusion from the staff.
(g) The medical staff shall provide for availability of a staff physician or psychologist for emergencies among the in-hospital population in the event that the attending physician or psychologist or his or her alternate is not available.
(h) The medical staff shall participate in a continuing program of professional education. The results of retrospective medical care evaluation shall be used to determine the continuing education needs. Evidence of participation in such programs shall be available.
(i) The medical staff shall provide at least one physician to participate as a member of the hospital infection control committee.
Powers of the Medical Executive Committee (MEC)
When a physician seeks employment with a group or credentials with a hospital the MEC takes tremendous control over the MD’s life. A summary suspension over 14 days is state reportable to the medical board (in California) and 30 days is reported to the National Practitioner Data Bank. These are removed if the physician later prevails but the career threatening power of the MEC should not be underestimated. Before joining an organization know who controls the MEC. Most MEC’s are controlled on paper by the medical staff but in reality by management. Power cliques can wrest control of the MEC from less political but more medically oriented physicians and change the direction of the hospital and the conditions of your employment. At times, the MEC can target a physician with unjustified suspensions, investigations and reporting. (See Our Article on this titled Physicians Have Less Rights than Criminals) When a committee targets a physician with an unfair MEC investigation legal representation is necessary. Rarely do hostile actions resolve without the intervention of an attorney and in truth, even then the lack of physician rights makes the path difficult.
The Eight Unnamed Physicians Case (MEC Gone Haywire)
To understand how the MEC can morph into a Frankenstein, read the case of Eight Unnamed Physicians v. Medical Executive Committee. The basics of this case are that physicians who were eight of 11 members of a medical group who had for years arranged to provide all necessary anesthesia services at the Hospital in return for a virtually exclusive opportunity to do so. On Saturday, November 20, 2004, the Hospital learned that the Physicians would be moving their practices to another hospital on the following Monday, November 22.
The MEC seeks to discipline the Physicians individually for this “precipitous withdrawal” of services that allegedly could have jeopardized patient safety and undermined public confidence in the Hospital. The Physicians deny the charges and contend arrangements for coverage were in place. The rest of this published case outlines the battle. The key point is that a business dispute put a gun in the hand of the MEC and the MEC used the discipline process as a litigation substitute.
The case is too long and detailed to discuss here but the spoiler is that the physicians had far fewer options than you would think.
The Structure of a Medical Executive Committee (MEC)
What is the Composition of a Medical Executive Committee (MEC)?
The composition and leadership of a Medical Executive Committee (MEC) can vary depending on the healthcare organization and its structure. The current trend in hospital ownership centralizes power and control at the executive level. Often, the executives are not medical professionals. Technically, the MEC is responsible for overseeing medical staff affairs and clinical quality within a healthcare facility. In a tiered approach the MEC is consulted by the executive level team and ultimate authority rests with the board of directors. In practice most boards are rubber stamps for corporate executives. The MEC is theoretically independent but the overlap with management can call that independence into question.
The MEC represents the medical staff but it acts primarily as an independent entity much as Congress represents the public – or not. There are common job titles for those who may be involved in running a Medical Executive Committee are:
Chief Medical Officer (CMO): The CMO is often a high-ranking physician within the organization and typically serves as the chairperson of the MEC. They provide leadership and guidance to the committee and represent the medical staff to the hospital administration.
Medical Staff President: In some organizations, the president of the medical staff, who is typically elected by the medical staff members, may lead the MEC or serve as a key member. This role varies depending on the hospital’s bylaws.
Hospital CEO/Administrator: The hospital’s chief executive officer or administrator may be a member of the MEC or attend MEC meetings to provide input from the administrative perspective.
Other Medical Staff Leaders: The MEC may include other medical staff leaders, such as the Vice President of the Medical Staff or department chairs, who help coordinate and lead the committee’s activities.
Medical Staff Members: The MEC often includes elected representatives from various medical departments or specialties within the hospital. These representatives bring the concerns and perspectives of their respective departments to the committee.
Quality and Safety Officers: Individuals responsible for quality and patient safety within the organization may also be part of the MEC to ensure that clinical standards and patient care are closely monitored.
Legal and Compliance Advisors: Some MECs may have legal counsel and compliance officers to provide guidance on legal and regulatory matters related to medical staff affairs.
In a best case scenario the Medical Executive Committee and hospital administration have a level of tension so that there are real checks and balances. In reality, the hospital administration drives customers, reimbursements and advertising so that MEC committee members who repersent and act on behalf of medical staff will have personal interests that are exploited by management to help control and drive their decisions.
The MEC is the voice of the medical staff and it provides a major check on corporate greed, the corporate practice of medicine and the sloppy or incompetent practices of poor quality physicians. However, there is little oversight and few controls when an MEC is corrupted by hospital management or by personal agendas and self interested decisions. We represent many physicians whose careers are on the line because of hostile and completely unjustified MEC practices.
If you are the subject of peer review by the MEC, we can help you. Call our office at (925) 291-5388 to schedule an initial case review. (Our phones are answered by real people who physically work in our office.) Or fill out the confidential contact form below.
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