Question: You are the lawyer for Marcus Welby Community Hospital. The administrator approaches you about how best to amend the bylaws so that the hospital can get rid of doctors who are costing the hospital too much money under Medicare and HMO insurance. The administrator is concerned about which removal actions can be defended in court and which bylaw amendments are politically feasible with physicians. Advise the administrator on each of these options:
- Amend the Hospital Bylaws to give the hospital board authority to remove doctors from the medical staff for any reason, regardless of the medical staff's own recommendations, as long as the medical staff is first consulted.
- Amend the Medical Staff Bylaws to declare that an additional criterion for medical staff membership is to practice an efficient style of medicine that avoids wasting medical resources or providing unnecessary care.
- Amend the Medical Staff Bylaws to declare that any physician who consistently loses money for the hospital will be removed from the medical staff.
- Forget about amending any bylaws. Instead, go after physicians who are economic losers based on their general medical competence and their unwillingness to be cooperative.
- Keep but supplant the entire medical staff structure by limiting who can practice in each department through one-year renewable contracts with the 200 best doctors out of the present 300.