What is a Medical Executive Committee (MEC) ?
A Medical Executive Committee (MEC) is a governing body within a hospital or healthcare organization that consists of physicians and other key medical staff members. The MEC serves as a representative body for the medical staff and is responsible for making decisions related to patient care, clinical policies, and physician performance.
The specific composition and structure of a Medical Executive Committee can vary depending on the healthcare organization. Typically, the MEC includes elected or appointed physicians who hold leadership positions within the medical staff, such as the Chief of Staff, Vice Chief of Staff, department chairs, and other relevant roles. The CEO team and the Medical Staff are usually equal and above them is the governing Board of the Hospital. THere are other models of co-equals but these are less common.
Primary Functions of an Medical Executive Committee
The primary functions of a Medical Executive Committee which (again) is formed from the Medical Staff, may include:
Credentialing and privileging: The MEC reviews and approves the qualifications and privileges of physicians seeking to practice within the organization. This process ensures that healthcare providers meet the necessary requirements to deliver safe and high-quality care.
Peer review and quality improvement: The MEC oversees the peer review process, which involves evaluating the quality of care provided by physicians, addressing concerns or complaints, and implementing strategies for continuous quality improvement.
Policy development and implementation: The MEC collaborates with hospital administration to develop and implement clinical and administrative policies that govern the medical staff’s activities. These policies may cover areas such as patient safety, medical ethics, and compliance with regulatory requirements.
Collaboration and communication: The MEC serves as a liaison between the medical staff and hospital administration, facilitating effective communication and collaboration between the two groups. The committee ensures that the perspectives and concerns of the medical staff are represented in decision-making processes.
Strategic planning and alignment: The MEC works with hospital leadership to align the medical staff’s activities with the organization’s strategic goals and objectives. This includes participating in strategic planning, resource allocation, and performance evaluation.
By fulfilling these responsibilities, the Medical Executive Committee plays a vital role in ensuring the delivery of quality patient care, maintaining professional standards, and fostering a collaborative and effective healthcare environment within the organization.
Issues such as scope of services (what a hospital offers) are important decisions and the Medical Staff and CEO should be consulted before the Hospital Board makes a decision. In a recent case against John Muir Hospital in Walnut Creek, we are contending that a specialized surgery should not have been performed at the facility and that the Medical Staff should have been consulted before the surgery went forward.
The allocations of responsibility and the independence of the Medical Staff and its MEC are critical to effective hospital management. In general, we have seen the role of the Medical Staff diminished and the CEO’s running the ship.
Can You Sue the MEC?
Our physician clients often ask whether an MEC can be sued. Usually they are sued not for money but to force them to take action in a fair manner. Perhaps if that request is granted a second suit for money can be filed. Here is an example of a major case where the Superior Court reversed the action of an MEC.
In Miller v. Eisenhower Medical Center, 27 Cal.3d 614 (1980), the California Supreme Court addressed a suit challenging the MEC's denial of a physician's application for staff membership. The MEC had denied the application based on negative reference letters, and the physician sued contending the denial lacked a fair basis.
The court examined whether the MEC's decision-making process comported with fair procedure requirements under California common law, illustrating that MEC privilege decisions are subject to judicial review when fair process is alleged to have been denied.
In this case the doctor was faced with letters that described him as a disruptive physician having trouble working well with other doctors. The doctor argued that this was not enough to deny him staff membership. The court found that “"It is quite true, of course, that certain forms of disruptive or noncooperative conduct may have an adverse effect upon the level of patient care; we find ourselves in full accord with language to this effect in Huffaker and certain other cases" Miller v. Eisenhower Medical Center (1980) 27 Cal.3d 614, 629 The disruptive physician challenge is a growing industry with experts who will twist every heated interaction into a disruption so the Miller v. Eisenhower case has gained increasing importance 46 years after it was decided!
However citing an earlier case the court also noted that “(i)n asserting their views as to proper treatment and hospital practices, many physicians will become involved in a certain amount of dispute and friction, and a determination that such common occurrences have more than their usual significance and show temperamental unsuitability for hospital practice of one of the doctors is of necessity highly conjectural.” (58 Cal.2d at p. 598, 25 Cal.Rptr. at p. 555, 376 P.2d at p. 435.) The subject bylaw, if interpreted in the manner suggested by defendant, would permit exclusion of an otherwise qualified physician on just such “conjectural” grounds"
Miller v. Eisenhower Medical Center (1980) 27 Cal.3d 614, 629–630
The court then ruled for the doctor saying:
"We believe that the instant case is one in which the principle of “real doubt” should properly be applied. As we have indicated, the dominant focus of these proceedings was drastically blurred by a failure of the deliberative bodies involved and indeed the parties and their counsel as well to properly understand and apply the hospital's own standards for admission to staff membership insofar as they concerned an applicant's ability to “work with” others. Although evidence was also presented on other matters, our reading of the record as a whole raises a significant and real doubt in our minds as to whether the deliberative bodies involved, had they been faced with only such other evidence, *636 would have reached the result that they did. In any case it is clear that the misconception concerning the proper content of the hospital's standards for admission resulted in a severe misapprehension of the kind and quality of plaintiff's qualifications for admission. In these circumstances, we think the proper course is to return the matter to defendant in order that it may undertake further administrative proceedings directed to the assessment of plaintiff's qualifications for admission to its medical staff in light of a proper interpretation of its standards."
Miller v. Eisenhower Medical Center (1980) 27 Cal.3d 614, 635–636
More often the courts are deferential to the MEC. In Bichai v. Dignity Health, 61 Cal.App.5th 869 (2021), a physician sued the hospital alleging unfair competition and conspiracy to retaliate after the MEC recommended denial of his reapplication for staff membership. The court noted that the MEC is part of the medical staff, which functions as a separate legal entity from the hospital itself. This led the court to rule that claims were not yet ripe because the hospital had not yet made a final decision on the MEC's recommendation. This emphasizes how the administrative process must be fully used (in most cases) before a doctor can petitition a court for relief. As the peer review process can take years this can force a doctor to endure great hardship before he gets a fair hearing in the Superior Court.
The bottom line is that if you can sue organized medical staff as an entity you can also sue the subgroup within that organization - the MEC.
If you are Physician under scrutiny by the MEC or any committee of Organized Medical Staff, Call Daniel Horowitz for assistance. (925) 291-5388
