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Home My WebLink About1971 Fi 3 R111JI'S AND 11EGULATIOPI ; r of the zz,, M1'AICAL STA11' e' s o l' a PLOW MEMORI'AL' 110S"P1TAI• r•l. DEWTCN, TY.XAS The montlily mooting of the MedfCnl Staff shall be held the third r Tuasday evening of ench month, in the Staff Dining Room of tho hospital, ANNUAL MPEYING OF T}1h M+iDICAL STAFF The Annu l' Meeting of the Medical Staff shell be in December of each year. CALL BCURDULI: There bu referred emergency times 'membera of, the Active oases, Now oh y4icians W4,11 be , I placed on the Cmergency"Room Call List as soon as they are spproved for Staff memburshi.p. E CIIANGC' OF. DOCTOR DURING HOSPITAL STAY f ,1 Wh*n a pattomt rgquosts a change of a doctor sifter the doo'tor on emergency 6all,'has been called, the doctor shall abide by the pstie,nt'a wish#1j,' "The hospital shall be released from further rispon!'ibilit'y regarding the-mattev of obtaining professional aexvice for the patient, : When a,changp.c,£ a doctor Is made after the patient is admitted, rho doctor who :admitted is ree onsible.for the history and-physictl examination, s ' and the care of the patiunt until properly relieved, ' LABORATORY WORK RRQOIRED All cases admitted to the hospital roust have routine laboratory werk,unlais a'traltscript of recent laboratory work done within 49 hours i is received from a~xeoognized laboratory and accompanies the patient to the hospital . cnd becomes a ~ pert of the Medical Record, , Routine laboratory'w,or~ shall include urinalyaie, complete blood count (if r not done iA the past: two weaks)I a sarolo gypwithin the last three mantha ' :i is adequate. j r.° n. I 2 ORDERS FOR TRI:ATMEN1' All orders for truntment shall ba in writing, Verbal orders shall not bn accepted or carried out unless dictntod to n quol.ified person,' 1 Orders dictated over the telephone shall Ne signed by i..: person to whom dietptod with the n'amo of the physician per' his o'r her own flame, At hiH next visit, the attending physician shn11 sign' such order, I MEDICAL RECORDS REQUIR"Ut PROPNRTY OF 11OSYITAL3 RESPONSIBILITY OF PHYSICIAN. The attending physician shall be held responsible for the preparation i of a caraplote medical record for each pntiont, Thin record shall include identification, dates complaint, personal history, family history, history of present llnoses physical oxamination, working diagnosis, spacial i reports such`as consultations, clinical laboratory, x-srayso provisional diagnesis,`medical or surgical treatment,"pathological findin s ro roe . g . p g e notes, final diagnosis, final summary', condition on discharge, follow up €1 and autopsy ropovt when yvailable, No modieel record shall be filed untie it id complete excopt on order of the Medical Records Committee, All complete. or incomplete records are the property of the bospitai ` and shall not be removed from the hospital or copied without signed permission by the administrator, x-rays excepted. In case of readmission of a patient, all, previous records shall be available for the use of the i attending,physicinn. In,any calondar year, when an attending phyeioian has not completed hie or bar charts within 30 days after the discharge 6f his patieh'ts, 9 he shell be temporarily relieved of staff privileges until such Mime as the chart or charts are completed, 141th the third offense in any year, the i Executive Committee` shall recommend tothe hospital Hoard of Managers that the of,fen4ing physician be suspended fur thirty days after the completion of, his charts,. During the, thirty day susp$nsion, any emergency adminsions shall he referrad to,the Rxecutiva Committea`for aalIonment I to a 1 staff mambµr, 'Vollowing the thirty day 'suspeneion in,d compI-*t n s r ~f 3 (+a„•r. of the chartoI the physician'a atvff privilogcs shell a towati.wily be i rot urnet1. A coinpleto history and physical examination in all cages will be written within 24 sours after admisa'ion. Chronic offenders will be referred to the EXO CUtive Cem011itte6 for appropriate disciplinary action, INTRADLPARTMI;NTAL REGULATIONS Intradopartmontal rogtslntions may be revised and brought up to F data by the chief o£'ttse department and two members of that department. i 11owaver, each ahnnfe must bn approved by the kxecutive Committee, i ADMISSION OF PATIENTS t The, hospital shall admit paticnis suffering from all types of issases, Priority for admisoions if the need arises will be governed- by the Utili%ovion Committee, Patients may be treated only by phyrioians who have submittal proper credentials and have been duly appointed to ' membership of the Medical Staff, t + )JEPAItTMR T OF'Nx$RN.AL ,MDICIN " 1, The Chief of Staff shall appoint a chairman to head a Department of ~ i Internal Fledicino, y QUAhIFICATIONSt Thts shall be based on the confidence and esteem of the doctor's fellow practitioners as to his'exoerienea and paint contributions to the hospital and to the,specalty of medicine, rather than to his, qualifications as based on board certification, college, academy or other spacial accreditation, 2. Qualifieatians'for membership on the staff of the Department of Internal' Medicine. A. Membership is limited to physicians who-,have completed rotating or, internal medicine intornahipg in hospi-tale that are accredited by JOAN, a , : r •1 '1 ,llljt 5 tS, Mombors on the probationary ntriff will be p ovided .with a list of connu]tnnts. Consultation will be expected on all mujor illnenn es and is mandatory on all admissions to ICU: The eAent of the consttl'trition is determined by the conaultant. C, llurint the probationary year, doctors are expected to present 4 all deaths at the;depnttmontal meeting. 34 Tho,chairman shall appoint, two (2) members to serve with him as a ; i committee. 4. The functions and duties 'of the committee will be as followsi A. Raneralized supervision to ascertain that the rulao and ,regulations of the medical staff assigned to the 4ection of Internal Medicine are carried out. These rulen and regulations are tkre same as those for the Medical Staff as a,whole. S. Supervision and evaluation of medical records ae to substantisti4 of dfagnosi`s ans regards history, laboratory work„ disgnosti'c wnrkup and procsduras, Adequacy of treatment, progrssa notes, j iia., a'logical and aequantial chain t1 events from admission to discharge, in accordance with the practice of good ganerMl j sad internal medicine to fit the standaids of this community, C. Evaluation of Medical consultations ae,to„what"indicated, ability of the consultant concerned, compliance with the above ovklinad proceduroo with special attention to follow up and eventual disposition of the case in question. D. Department of electrocardiography, supervision of the mena;smento i and tha ability and quslificatio,,s of physicians interp.rating 1 tracings and'uvaluation of quIslity, promptness and availability of EKO intorp•rotation, supervision of and;ev~alustion of any other r ancillary sarvicos ron'derod'by this socti,on, i. e., phonocardiography,I ? etn~ i ~l s t F, Oxygen the rnpyi Full. Ju,riodietion over Chia section as it regMrdts ' qunlificntiona avaailobility rf; promp.tness in aroones undar emergency ciretunstancas" of all therapists, -appraisal of and evaluation of all preaant At.d new equipment, tochniquen, ancillary medications. F S.. Intensive Corn Uniti Thin unie to be under the jurisdiction of the medical •eaction.'in conjunction with ra , prosentativae from the sections of Bur oe obstetrica- ' g y, gynecology, pediatrics, pathology and laboratory a4ctIuna. The medical department will be responsible for carrying out the f follow)na intensiva card unit policies. I , A. CLe-asification of patients 1. Admission Requirements - Admission requirements for the Intensive Cara Unit as establishbd by the Intensive Care 'Vnit Committee of th.e ?fe'diceI Staff are be!followet a. , The need to r+,aintain or establish adequate fluid balanco s ind'renal function. b.:The maintenance of cardiovascular integrity, r r I c. The control of toxemia of metabolic or infectious origin. d. The relief and prevention of severe shock from any' 6sui,gp e. Maintenance or establishment of edequaCe airway 2. Medical indications a. Coronaries in shock 'b. Severe heart failure t 4. Massive gastrointestinal blaadtng d.' Diabetic coma e'. Renal shut-doton , r f Adrenal crisis ~g~ Any other'msdical or surgical'problema deemed by patient's, r physician to be serious enough to require' intznrivay,care not'spaoifionliy r'aatricte 44 a ew -W% 1 I F y . 3, 18urgica.1 indicaCi or..s , a, Thoracgtomins for ltf119 an<I• hoarc, nurgwry h. Cruuhing injurtos of the cheat 0 e, Complier.ted gas4rointoatinal surgery ' } d, C.rani.otomies e, Major urological surgery f f; Trachoucomlas S,_ Symhntheetomiae h. Adreniilectomies } i. Severe shock or. trauma, both pre and postoperative 3 j. Severe burns for first three 'days k. Hyper and hypothormia 1y Any other medical or, surgi'c'al problems, deemnd by patient's physician to be,aarious enough to require intensive care if' not speoificelly restricted. 4. General Restrietione No other diagnostic problems will be admitted to the Intensive Care Unit without the permission of the Chairman of the ICU Committee. It is reserved for those postoperative cases and medical cameo where the nfture of the operation or the condition of the patyont warrants, S, Specific Aostrlctiona - Chronicelly ill, Osych6tic* alcoholic, and terminal patients Are epocifically excluded from :.n• Intensive Caro Unit. - 8. Admission Policies 1. Dirsct Admission A patient may' ba admitted directly, to the ICU in case of emergency.L The nurse 1n charge may,admit'such pgtiadts directly to the Intensive 'Core 'Unit `upon orders from the attending phyaiciau,' The nursa in a%arge will otify the smergency,.room, admitting offider orlnight admitt$tig clark' q immodintely Of any diract admission, u ,F,r. Maw 2 1'i'nnafn, 7 i~ rr, A ptttlent inay be transferred to -the Intensive Care tilt it only 0n writtcsn order- of the attending phytinn, f. j SUah truasfers.will ' be. handled througn the admitting office, The >ationt'a'hospital.r.oom'must be vacated upon his transfer E to the ICU,' moo; NO TN'; ArranAementa for transfer ahould be m<ide woll In a advance when it .is anticipated, that a patient will nood ICU care following surgory« The dato and time of surgery should It be. givan at the time' the requent in tnasdo. r 3. Discharges A. Transfers to Regular Nursing Unit - When,the attending physician determines that a patient is no longer in need of the services of the Intensivu-Cars Unit $ the Patient will ba transferred upon' 'the doc'tor's written orders to a regular ~ nursing unit: ~ Such transfera will be handled routinely through -the Admitt,kn'g Office, ' '146TEr Evory possible attempt will be made to eeaura the type of accommodations the patient requests when he' ie returned to a regular nursing unit. b#, Terminal Patients - Terrai al R patienttt..aill net he admitted to thu,Intensive Cara Unit and patients who bicome terminal following admission to the ICU dheuld,be transferred to a regul4f 'nursing unite as Pdriodtc,.Raview.of ICU Patients The Chairman of the Medica7.'oepartment or Medical Staff besign'eo will reyieu tha elise of ovary potfent who roold'Ins in the unit tor mare f , than five days, He may then recotnm,nd'to the' attending physician continued ICU Hoare Ar trannfar to 'a regular nursing unit, ' Y> rarer a. ( low t "Ov i 3 d. Yriurity uf,ICU i'atiento Yf tho Intonuive'L'are Unit' it io filled to cnvacity0 the tledica.l, Dopnrtment Chairman or 14edi'r.ai SesfE deni6nra'hn the authority to request an f attending phyolcian to 'tranufar a lass critical patient 9 lot] to provide care for a more critical one, ; out of Lille j + In such cnsaa tile decision Of the !jedical Department Chairman 18 final, j C, Vis•lting Policies E 1. patient's Namilios - 14ambora of the patients.' families will be I . allowed to visit for five-minute periods every two hours The i time for visiting will be established by the n'ursa in charge. •::S be with the patient at any one time: Only one visitor may 2. Re,etriction of Visitors The hospital reserves the right to vile&os to anyone if such visitins is d•emsa ~ f rafusq vis ting,pri by the atteading'physician to be detrimental to the welfare of the patient. I b, boneral Ragulnt,ions ' 1, ICU Will be staffed by' trained personnel to inolude an IN et xll times that it is open, A ratio of two patients. Per' nures but, no ieAa than two nurses at „ny time, ih' rscommanded, 2, Private Duty Nurses - Since the presence of,private duty nurses would duplicate offort and posolbly inturfers.with the work of the intensive nursing tesm, private duty nursing servicea will not be permitted in the Intensive Care Unity 3, gt,dking in ICU Area - Because of the exten9lv.g use of volatils gages OVA the ICU, bmoking~is absolutely prohibited Iti the unit itself and in the adjaesnt corridors r Whe"n a patient in admitted toothe Intenst + b; Pe'sonal Delongingu Care Unit. his personal belongings will be turned'dVer to a . s , •9 membar of his f6tiily for oafo'-kocpinr. When 'no family member In nvailnbla, the pa.tient,'s belcnginp;s will be turned over to the Admittisig Office for storag$. 5. Flowers and Oifts - No 'flowers or gifts will be delivered to patients in;the Intensive Cara Unit. 6. Radios and Television' No radio or television -sets will be permitted in the Intensive Care Unit. ~Y d, p, •.Telcphorie Information - The hospital switchboard will be instructed to screen all calla to the lnteh W,-1 Care Unit. Only official cams will be allowed to go trrough. All ta11s requesting information on the condition of patients will he given to the information desk where up-to-dote condition reports on all ICU patients will be kept. the information 'desk is closed,, , NOTLi During the hours when ` condition reports will be kept by the hospital switchboard. The nurse in charge'will isbue a condition report on all ICU patients at 9, 12, 3 and 6 o'clock, day and night, 2. Ancillary Services All raqusats,for hospital ancillary servi.oee,• viO40 lab,-x-rays;- oxygen tharahy, EXO, pharmacy, central service, at"a:, will be handfed on a preferred basis,, F., Any"mesgber of the attanding :staff may be requosted for emarge rcy f ' procedures, 4. Nursing Care Routine The folloiing potato of nursing oar* will be routinely carried out in the Intensive Care Unit. Any 4aparture from this routine will require a d+rittsn order, from the attending phy,si6ion i 1`,' Intake and output Intake and pueput records will b'e i , -maintained 'on all pat,iants. 'Co~tals will be reoord on Is, } 11 .w..,.: ,:,w ...-,...r arm 1 Q Irw W% loci ?.4-hour bards ending nt 6 A-M) 2. Vital Si9uu pulse, renpiation, blood pressure, will be secured and recorOed every two hours.; . 3. TtmperaluLO Temporatura will be taken and recorded pverY j , four hours, , i i DEPA_R'1' IVNT OF MORRY A. ThefChairmap of thin Surgical Department shall be `appointed by the Chief of the'heo pttnl ataff,and his chairman shall then select tvu other ourgoons to' serve with him. This committee shall be responsible for the Opernting Room, Recovery Room, Emergency Rooia, and Dept, of Anesthesia from a professional standpoint, Be Requirements for appointment to Surgical Staff 1. Ono y6Xr internship and two years advnuced training above the grade of first year internship, on the rooidant staff in general surgery t or surgery specialties in an approved, accredited hospit'sl by the Joint commission of Accreditation of Hospitals, 24 full certifioation of membership by the American Board of Surgery, or the American Coiloga of Surgeons, or eg4ivalent quxlifieetionsa 3, When qualifications and training in a special field art-offered and are adequate under (1) abova, privilagas s'Aail,bA granted in the specialty only. 4. Appointment to the Suvgieal Staff and/or op:rating room prdvilsgas j may be granted in major surgical specialties to an indiviauai'who does not meat the above requirements but ohoso training or ; .sxperia•nce.is considered'adequate by the surgical committee and approved by the staff.' C. ADMISSION ' 1. Uoapttin cases Of emerguncy; patients for major surgery should be y~ admitted not later thnn 2140 p.m. tha' day prior to burgiry4 n Ni.rt.f.dtufmur4Y.fbMsY l1V`fmf•.rtmyyµitltHKf.Rf4%N~`e.&lli:~tlWW rt'.t>'xa i4•:w..vi fem., ....x , Y sw:.rsP4k1MPN,14NJi(~pjN~'.;f.~{;~~j 1 Ir i!; NM t orw -W% Jt I 1 y . , l1 All patiatttn mur~t have urii.aly.si~ And blood pount's'doun within 48 ho,prs of it rgorY. This iK the rartpo:tribilit Y Of' the surgeon, ! To:iaillecton~lr.'s mush have stu(tias, to insure against hemorrha witliin twonty-four hours pc. pre codinf: ourzter, Iy s , f j 3, 111at0ry and physic,-11 cril.i,bo on all surgical. Charts j" sU,rger'y or a I>raEresn :tote imp1 ino prior to Y dictatlott Of history physi.cdI except when ntton-lin and E phyTtician corti?aa delay would endanger tho' patient. 1) SCI;MLINf, l• Thin mu0t depend on the 0,n, per,eonnel available, ;'i room supervisor under the direction of the oha ikmanrhe Opekattng I surgical department has cP the t h.e fight i to make: the beet and txoet efficient use of the avel,lable faoli3ties, with due regard the listen for . g. ( 2, rpmorgmey operations uhnll have priority over all scheduled i aleotive oporetio'na, 3, No oporation, except an smargoncyr may be d~ohedu2e , Performed on Saturday afternoon Sunday or official holidays. C a~' Operations scheduled for Saturday morning must be limited to while surgery can be anticipated ro be dot, e~within tour flours, Prr OPMR TINd 'ROOM , lr NO visitors are to be allowed in the o A perating Room except phpolfcians or regular employees of the o orating room with the i , a ~ Mill i t Y exception of Mcdlcul students in their final two years', or E medical assistant::. j 2, All tiusue removed at the time of nurgary Fhnll be sent to the Hospital laboratory and the'roby bocom,is, the property of the Hospital laborutot•y Paid 'then to a recognized Pathologist who r j shall malte such examinations as he may consider nocucsary to arrive, at a pathological diagnoais. I 3. Operatlons munt start on time, This means that the incision shall be made at'thr- scheduled time. If the do,.tor is detained, he must k notify the O.R4 Pupervisor, who has the right to go ahead with j mother surgical case if tho`delay will inonnVnni,onee the v operating schedule, q. A pee>fiit is to be signed for all slo'etive surgery by the patient ' or in the case of minors or unconscious patients, the person t legally, responsible for them,r I } .e J 5, Only,doctors on one of iho staffs in the hospital may perform . 'surgery. gxtra nursing help is permissible in the Operating hoots, r 1 subjuot to the approval of the operating roost supervisor. The 1 surgeon himself must assume all responsibility for each person '~U I ' L r' % w not smpi"oysd by 'Flow Hospital and is expegted to be able to, ;justify ta,e capabilities of all such help'for the duties required. Al: f I 6. Dangerous drugs, stop, orders' Antibiotics, G days,l norcatice 72 hours; hypnotics, 7 days. Oxytoxics will be used on~y When. the attending,physioian is present. Class g narcotics are xoluded from the stop order, F. CONSULTA'T01 3 1, A condultatidt in writing from on member of the ataff is required for 'primary Cacgdrnan suction, Nr..hitrrruerMY.s -t.,NMi1NY M+A rFr kuru'.r r ' ` ' R^ X,1M1` w'!~.1WIiWr?N7Nif+tiRVwNN4.Vrr,r .r,r. ,.1uAFY94rr..r. r ~Myy4 )MJMfrfll,r.{'Wy~,(~„~~~+ i1lV~ 4 I F , y, r .4 1 ,1. .la r Two r.utt,iul.r,ntlona wr.it.nlt I'1•om tw1 t mc.mharc of .the Stuff. ate p 2. 5 toquire.d for sods therapeutic tiburt ion• Y 'ti L, DfA50R SURCL'RY`~ ti eon is oil tit o Staff of 'Blow ~ ? 1. During tale first year that a Burg . ~ro~od for dainty major surgery, he must hnvo Hospital and apl i anoCher member of file surgical staff assist him with all, major - of the surgeon who`ison, ~i ~ iliCy It is the responsib »uxfaXY 9+, pxoUation to provide hia own aasietant and this assistant must status. not be another nomber who is on probationary i Y E 2, Me Surgicai ComntC^d retalna the option t.), doaiC~nat.e the assistant for anyone on probationary status At its•diacretion. OB$x rRICALAND, GY.__.NNE0011001C.,AL DE►'ARTMRNT , The Chief of Staff shall appoint a Chief of O$.GYN Department. All c Members who practice an shall'o be members of the hA staff. • A, RgGULATI4N5 There 'should be a consuitat><on on 0l1 ptimary Caeaarssn saationa. I onsultationa are required on repeat Caesarean vectl,r, ns, No a. 1 Nn G j consultation is required on tuba, ligatons. • " ~ sutd+>: abortions, and There should be two consultations on,tberap 1 scialtios involved rY one of the oonsultants sbduld be' Erase the ap ,with thin dondit'ion neosssitating the aborti'uu Oars applicable, ;f etc. Written permission by both •i`; that ,is; psYchfatry, cardiology, husband and wife, if lsgalr.y married, should be obtained ;on these }i Qaaea. Room. d3, 4,' k 3. No 1ay: personnel shat bm 011ewod in the rielivary f saraan sa A, A third dootor should bo in attendance on all pao'otion4 to tnkb cars of Cho new}>itrn infant, r , YYY $ ~:f ' ' • ~ Ilea Ith Clinie patients shaL'1 b a c UneAgiBned QIS.Fpatioht's ar} pubiio a1L 1, cs11 A1~ dantoxs prpat34ing 6`Ah} rided y 'th 4~3' da0tor pn . '1 f 1 Otto) b e .,.I..aawx~+unnw ~I~i•3 + N.v M.WhAW K~itUtiY.Yn.M14`~vn.wY•fi+M.ix•Ei {f ~.yt~ t, IRS 1' t.. , - __.J. 41 I . E# 3. 4 li o ba ,JubJv ct to this call orr'n,rotntion basin. 64 New'hou,pital staff members desiring on prlvi.leges shrill have conoultati'oa for cacti operative OX proccdureo including breebbiasp uiiti.l, thn new member has ndaquately demonstrated fits proficiency f ' r{ in the customary 0$ procedures. I 7 On 'all inductioris of Labor, whother given IV, IM, or, by another route, this ihducti.on should be initiated by the attending physician and he should be available throughout the 'entire course of this Induction. t r 1j, 8. Physical examination, homoglohin, hematoeri,t,.and uri,nalysla shopid be done on all Ori patienta who have major abdominal surgery , unless an emergency, PEDIATRIC DEPARTMENT The Chief of. Staff shall appoint a Chairman of Pediatrics. The Chairman bha! 1 appoint two to servo•with him. 1. Requirement's. for appoinCmant to Pediatric Staff A.. A 2 year Pediatric reaidenoyt or a 1 yearediatrin internships r, or a rotating internship with ppdiatrio training in an approved;' accredited hospital. 3. •.P,rivile es ,ma be $ Y granted in Podiatric Do pa rCman t to an individual who does no4t meet' tho above raquiremestts burr wh'o'se " . I ' training or experience is considerad adequate'by the Pediatric department and-'approved by the staff, j 2. Pediatric Department is for the care of all infante and children to i the agar of 12`yeara. 31 An approved nursery will be maintained for the care of newborn infante H whiah will, comply with the recommendations of the Academy of Podiatrica;" Suoh a manual is present in he nursery and the service wLa1 be 'undor ,t" the suporvipion ore the Chief of the Pod&dtrio Sorvice and -a quatified, { I-Y i ~ i ' X15 1 l5 Y i tlllt~ all 'MIIA8klVfj7 of care ,yitl be .stri.ttly enforcod, j Is oI ati on Nursury will be mzintaIlled so that all infected babies may, bo rdwoved fmmddiatoly from the 'clean nursery. Strict isolation I , . a technique will be maintziiind. S, promntur.e infants will he cared for in n special nursery that has j~ special facilities slid medical and nursing serviced. This nursery will f} ~I " be under the care, of a qualified nurse who will be responsible -for general supervision. ; F 6. A Pediatric floor wilj be provided in the new hospital plans but for the present, Pediatrics and Medicine must use th%N same facilities. 7,. One parent may accompany the patient and stay with him during the # hoop ttal stay. Visiting should be strictly controlled and pstien'te s } r mudt stay inn their rooms. r S An i.eolation unit is,'provided for pediatric patients who must be must be observed. ieoatdd 'and strict aoihtion, routine I 9, consultation with other.se'rvi.ces is left to the discretion of the E physician in care of the patient. , ~.AbI41.0t1Y PEPARTMRNT_ OF The Chi af of Staff shall 'oppoi»t a Chairman of Radiology. The Chairman I I E shahl appoint two to serve with him, E Qualificati.one Par Chairmani The Radiologist shell, be fullqueliflod to practice radiology and shall have sufficient training in titdiology tb' be certified 'by the American toard of Radiology or to be eligible for aura dortfftcatldn'and a membar of the Active Medical Staff, 19OULAT%ONB The Department of Radiology shall be supervised by the Radicc.ogiat. F j The Radiologist shall be responsibla that its administratlon', eguipmaitt, personnel; procaduraa, and safety are maintained with a E' adequate standards and to the complete sa.titfnetion of the #edicdl {IS 7 ! i. ~ 1. naM,,~ , 1G l' i r Staff of t'ho hospital, e 2, The Rndiologist "hall be a member of the Antivo Mac icn.l Staff. Ile 10 shall provida complete radiological covoragc and shall he available 14 for personal ionaultution at all times, The Radiologist shall i provide ouch 'additionnl similarly qualified', staff-ap¢roved i _ radiological assoeiatos an are noede,4 to.keep the department covared to, the satisfaction of the Staff, { 9. The gapartinont of Radiology shall conaie't of three diviaionol i (4) Diagnostic Radiology, (2) Radintion There i i pYr and (3) Radioactive Isotopes. ,4. Division of Diagnostic Radiology ! A Equipment: All equipment shall be provided by the hospital. 'The equipment shall be ,Adequate for all diagnostic j c procedures appropriate to a hospital of this sirs. and type. The equipment shall be kept in good opora-tins condition at all times. As the equipment bec•omla obs116ter it shall be replaced by the hospital# All xK a'.juipinent located 'anywhere in thA hospital $hal'l r bbd:. 0r the 'supervision of the Division of niaguastic' Radiology. I. Personneli All peraonnel of the Division"of Disgnostic Radiology E shall be under the, supervision. of the Radiologist. The Radiologiat shall determine if now ampl,oyees Ara properly qualified and all naw'dimployeas Nhdll be.91rod with the mutual consent of the Radiologist and the Administration, 1Technical coverage shall be provided' #A 12 hours a day, seven days a wbak, and for emargoncy ! work the remainder of the time', Additional coverage shall be added as naoagsery.. 'Ell I G, Raquastsl , All X-ray prooodurea shall be requested by is tRiinber df }d. - .....r....aw....u...........,.,p..fMk.•.wka~a¢EvlM:+iu'~sW.~+YA.~n...T.,~:..lx~n14VNY+uH,~.._. .wvAn-,a.v✓r.nromuJrw✓vr V~Rfruieh Sa.stisur nwU i,i l d 4W r.Ci}(~IE ~,y,61iB, r 1 . • I d • , Mrs, 17 . w, U, Re portp The Rnd10J.o',1st nr as 1;0clntvo shell give n wriCten interpretation of all x-ray films muds in the hospital. , This report shall be dictntod within 24 hours 'of the i' completion of sucli an, examination. The Radiologist )i shall, be available for personal consultation at all timen ;,q h. 5o re ry: The Radiologist shall bo responsible for the radiological safety of all patients, visitors, and hospital pe'raonnal !f wile may come in contact with ionizing radiation. 6 ~J Adequate monitoring equipme'at shall b's provided and ; maintained by the hospital, -In the event thet•any aquipment or area barfound unsafe, the hospital, in ednaultation with the radiologist,.shall take appl;opr,iate steps to correct this 5. Division o€ Radiation Therapy ' In. the event it is dec•id'ed that Radiation 'therapy shall be provided in the hospital:, it 'shall be und'ar complete suparvision of the Radiologist. Its equipment _and!ae personnel a s ~ rvica hall•be ov I, erned b regulations 6 Y si%ila>" to those' of the Division of Diagnostic Radiology, 6. }division Of Radioactive isotopes In the event it is decided that A Division of Radioactive Isotopea afialI be provided in the ho'psiial, it shall bs under compiete•auparvision of the Radiologist. Its aquipment, personnel, and astvioes shall 'be ;overned by ragulationa.similar to those of the Division of Di'senostia Radiology. PATgbLOCY D9PARTttY.Nx i f 4 The Chief bf Staff shall appoint-$a Chairman of >tethology, The ' Chairman shilliappoint two members bf the active staff to 'serve with him, Regulations w I.' Employment and disoharga of service personnel' in a department sh'buld I' 01 . v.. r•r~NWNYYAN4M!\YMLN ..e1In4'.~M1Y\F.RM\I~~W`k.wn H.•\4•.~-v ...r v.• • .r,ny. ..r 1 •1''• . , I ~f o- Vol 3 f he aubiect to appt'nval of the hand of the department in re4.,ation for A. Tochninal competene;, ` 1 i D. Ability is respond to professional authority 2, The riipointr.d and staff approved pathologist, or his agent, shall LI I , orfaem all autopnics, p I I 3. Clinical laboratory ahould be siiporv+sod by the appointed pathologist. t ~ 4. Frozen Qoctiona will be obtained on sehodule w'..'ti', the patho,lof~ist. Emorg"ency frozon sectione toill bo done as iircumetances roquire. • y ,I r , I!~ F .w ..+.+.err,.rw,rr~.uw.v..Nw.ik.n+...» v N, w:w.•.. ......av . r.:w wW. n,arwvwfxa,w+NN rtnNNVA4S,4iMaRNE1'1~flfix•~f• ~ FF( j~ RBV19FD BY-'LAWS 0r T11B STArk rL011 H8140111AL HOSPITAL Danton, Toxos F„ r Adapted liy thn Staff Apti1 20t 1971 Approved by the Board of bireetbrs PREAMBLE f; Rooognizi,ng that-the Medical Staff is responsible"for,the.quality of the medical care in the hospital and must accept and assume this jl responsibility, subject to the ultimate authority of the hospital s € governing body, and that the best interests of the patient are protected'by conca'rned effort, the physicians practicing iA Flow I, Memorial Hospital hereby organize themselves in conformity with the s hereinalter stated, Ay-Laos Rules and Regulation For ".the p u zpoae of the s e By °Laws 'the words "medical staff" shall , be interproted to"incluAe all phy"sicians who are privileged to attend 1 n en t a in Plow Memorial Hnmpital~ p a - 1 a~ Whenever the term govern'isrg body appears, it shall be interpreted 4 , ! to refer to the Board of Managers, I `.I ARTICLE I. NAHB r The nama of this organization shall be Medical St4kff0Y'Fl0a Mamori6i Hospital, ARTICLE 11 PURPOSE i The purpose of this organization shall bat 41, To insure that all, patients admitted to the hospital or, treated" in ,the outpatient department reosiv"e the bast p'osaible cars, 1, To provide a means whereby probley of madico~adminiserIttive nature may be discussed by the medical staff with the governing body slid the adminiatration, 94 To initiate and maintain rules and rogulations folk govornment of the " medical staff,' 41 To provide aduciti'on and to maintain educational standardr.~ :I . ~'~'{~l1~116GMY,hMM1k4rNiliwtdL'.i3•A4rA Wiv.MtM M'.dls'gNr~.Ja.51 ~nv.l4vnv*yri'•IA UHY,r)tlrga~t1n.r.•l.ila:..• ......1n~J.~y a~sxtitVpi~lk$i~i1.N48bVal#iN i" • is • r • `j ' .-..u ...5_ s v r ct,. ...a.::' . . _~ti_~ _._...._-•z.t:..: ~ !.l .t •1L i BYLAWS Or TfA STAFF (Con+lnued) r1190 2 I 11; ' 1, _v:.. ~ _ a..'-_ = r_... - t ARTICLE III - bf};M3iNlifiNlk SECTION 1. QUALIFICATIONS r , 1; The applicant for membership shall bo a person legally licensed by the TekAS State Board of Medical Examiners to prnetice medicine s and surgery in the State of Texas.,' The applicant shall, in 'addition, 4 meat all of .the-'requitementb for membership in the Department or . I Departments of the !Medical Staff of which the applicant' desires SECTION 2, ETHICS • AND 'MiliCAL• RELATIONSHrP8 Ir r The professional conduct of members of the medical staff shall E be 'governed by principles of ethics adopted by the A.M,A. . SECTION 3. TEt£M9 OP APPOXNtRENT' Sabsection 16 Appoint%onto shall be made by 'the governing body of the hospital ,after recommtN dation of the medical staff and shall } be for the•period'ot one year or until tad and of We calendar year Subaectiow 2.'' In no case shall the , governing body saki actioh I on sn appAiaant, tibfu$e to renew an appointment or cancel, an appointment r I previavoly made 'without aohisrenc• with the dodical staff, Subsection 3, 'Appointment to the madioal staff shall confer on thr,appointea only such privileg" as bay hereinafter be providad, SLCTION'4.. PROCEDURR OP APpOINThSNNT i Subsection 1. Application for membership on,the madicAl staff 0~011 be presented in' writing, and shell s'tat'e the, quallfiastions.,ond r C relerengee'at`the 4pplioant and shall also signify hie agreement to abide by the by-Laws'p Rules hnd Regull~tions of the Madical Staff, ono appit0ition for mambarship,on the medical, staff ebal4 be presented to, the administrator of the hospital who shallr,trAsmit ii to the 'secretary of the medical etafl,' r. SubscCtian 2.c At the' ftre`t regular; mamtipa thira'eftor the s' *cV*tary : ...eunW'rA,i,MaW3wH'aNAa1+/A3{Q+ia.j+Yie v ...+r wv..~.r• .~•.K.~.. . s..rn . E1: 1 e 13:' k 1., r d ' BYLAWS OF THE SI P (Confinuecd) rJjo 3 f; shall present the application to the medical staff, at whidh time it i shall be referred to the credentials committeo. c $ubaoction 3. Tho credentials committee shall invests gate the i cliaractor, qualifications, and standing of the applicant aid shall scibmit i- r $ a report of, findings to the Executive Committee as soon as possible, and in All, cases ;q1t hin throe months, recommending that the application be accepted, daferlld or rejected. All proposed recommendations for new and reappointments shall*be submitted by the cradentiAls. committee to the S Executive Committee for subsequent approval at a regular medical staff meeting, Where a recommendation to'defor`is made it must to followed* by one to accept or reject the applicant at the next meeting of the Executive Commi1tes. Any recommendation for nppointmant'shall incllda + a delineation of privileges and category. Subsection ,4. Recommeadationa for reappointment shall normally b6 ponsidered.at the. annual staff moat ng so that action may be taken by the governing board at its next meeting ahd shall' include designation of rank, privileges, and service for each physiaian. ;8ubsaation S. On receipt of the report of the Executive co mmIitae thot medical staff shall i'mmedistely recommend to tale governing body thrt the application be-sccapted, deferred, or rejected an'd if aacaptado, thb privile$ao to be granted. j subsection b.. The recommendation of the medical staff shall be transmAttod to the governing body of .the hospital through the adm riatraeo 8ubsectiaon The governing body shall either accept the reoomman'dat 'd'. of the madioal staff'or shall refer iti}tbaak for further consideration stating the rnsona fdr such action, Subsection 8. When final action has been taken by the governing , l body, the administrator of the hospital shall be authorized to•transMit 1,/ e[I '~t_-•exL ---C=""'tC[t'.•zri`.atfse 'rit~'~enk`tl+1.~1 t'~~~srrWf~1ffitc~?!d'ktYmrs=ltmi•••.••.•...w....r,....~..~'CttrSlatL':•. t '.y,'rµ~kh~#~~~~,}~r,~,-{j.~f3}tj4'.}INM S.ViAq;jlN+•r~alra YVa..e .r.. r. r q..r.,. r. o,rw vraei .t gran...,.. grvar.nONbt9 \I NeVR.CI.asN.~•+h ..urNl ~4 1 1. BYLAWS or THE STAFF (runfinuod) iago k this decision to the candi.daCe for, memb4rship, and if lie in accepted to securd his signod agraement'to he govarne'd'by these By-Laws, Rules and Rettulati.ons, i 3 UCTION 5.' ,APHALS 3 Subacetion 1. In any case whore the Credentials Committee floes not recommend for appointment or eeappoittmapt, or the Executive Committee i does not rocomm6nd :appointment or 'reappointa,ant; or where reduction, of ' privileges is recommended, the Administrator shail notify the phyei,cian concerned and he shall be given an opportunity of appeasing before the j Credentials Committee and Joint Conference Committee in joint session. i 'Subseetton 2. Aftgr a hearing to outlined above, the joint Oonforan•ce committee ohail make, final'racommendation to the Governing Soar . SUCTION 6.. EMERGENCY AND TEMPORARY MVILBOES14 'Subsection 1. Regardless of'his Departmental or Staff status, in ass`a of smbr$enty the;pf{yaioian attending the patient shall be expacted to ; d.o'all in`hta power to save the life of the patient, indiudlftg-'the calling of $dah consultation as may be available. Por the purpose of'this lection an eraergancy.is defined as a condition in which life of the patient I's in immediate danger and• in which any delay in administering treatment would incraasq the danger. scot of the hospital aft®t,caefarecaa wit ' Subsection 2. The Adminiatr ,the Chief of'Stsff, shall„hava the authority to Srant temporary privileges 3 to at physician 'who is not a member of th'e Mad•icdl StaffThe Chief of Staff shall Siva &A authoritative opi ion as to the competence and et•hioal standing,of thl physician who desires such temporary privileges and in the exarciso of ouch. pri.vilfgae he shall he under direct "supervision of the 1Chief of Staff. Temporary privileges may not be granted for more than four months in Any one year, of tar which the+'physician to whom tempdiary v Y~'N3•!dW?AiW'krM..4 ",WKtlw&eeak.•:d.wr.n, 54y{t~eVA' N.^ Ib.a.I Asa nu.wrY } }i f 1! A' s BYLAWS OF 1 FIF STAFF (Conlinuud) VaQc privileges have fiacn granted, shall be r.Wequired to become a member of .the ' Plecli,cnl ;tn[[ bef.ore being al].ocrnd to aCWnd additional pfsCients. It ARTICLE IV - CATRGOVES OF THE MEDICAL STAFF h SECTION •1. ' THC MEDICAL STAFF F k' The Mo dical staff shall be,divided into active and courtesy groups. SECTION 2. TliE ACTIVB MEDICAL STAFF. 5ufisection 1. The active stuff shall consist of ali physictan,s 1 t whose practice involves the active and continuing utilization of tN* . facilities of Flow Memorial Hospital and'who reside and praotteo in j Denton County. The privileges of members of the active staff shall ba 1) to vote, 2) to hold dffice, 3) admit and discharge patients, 4) atherwi e E utilize hospital facilities in'aacordance with the Ay~Laws, Rules and is Reguls"tions and Department 41 Pulse of the Staff of Flow Memorial Hospital. SECTION 3. THE'COVRTESY STAFF } Subsection 1. The'courtesy staff shall coiteist of all phye'iciane i who do nod meet the requirements for active membarship', but whoee,praotice t involves the'oocasional utilization`of the hospital facilities or~ who ts.d by, a member of the active staff to $ea pat i are raquag' ishts in consultation. Hembe,rs of the courtesy ataff shall cat be privileged to y n • t/ vets, hold office, admit or discharge patients, but members of the, oourtdsy staff may otherwise utilize hospital fl*ilitiae inacaoA ance I with the 9y-Laws, Rules and Regulations and Departmental tules of the k Medical staff'of Plow Memorial. I , AATICLL' V w EPARTMMS. ! SECTION I.. DEPARTMENT'S ~ r Dopar:tmestty of the medical ataff,shall, be'as forlowss' Internal i A' Medicines kanaral Spr8ery, Obstetrics and tiynecologyo Pediatrics, Radiolag '•,f ti < and Pathology. I ' vid{;mkNtidkiApP:aUdax4'+~a~'4fK:+4.`"~"~"1~"'•..nus,iro+rrd anw„•,. i 1 I, . ~a k ~o ~f.~pNy1. V pf{ r BYLAWS C» THP STAFF (C,onlmued) • vd90 6 I The size of the hospital and tho degree of spccinlizntion of the medical staff, steal determine the scope of departments and the extent of j separate sections within them, General medicine-should include any of. the following that are not designated as separate sections or departments: Comt:,unicable disonneu, cardiology, diseases of the lunge, diseases of Imetaboli~sm, gastroanterology, endocrinology, neurology, psychi'etry, and. dermatology. Goneral surgery should include any of the following that are not designated as separate` sections or dopartmentai Neurological surgery, proctology, urology, thoracic surgery,,orthopedic surgery, plastie'aurgery, traumatic surgory,'neoplastic surgery, ophthalmology, ot'orhinolaryngelogy, oral surgery, anesthesiology, and physical medicine, { SECTION 2. A$SIGNMLNT TO DEPARTMENTS Subsection 1. At the annual meeting u member 'of the active stuff { shall be elected- to the office of Chief of Staff. 1;a shell be rasponsible for the futi'otioning of the clinical organization of the hospital and $halt keep or cause to be kept a careful supervision over all tha~olinical Mark done in the hoopital. The duties of the president of the. Staff are thoser described -in Article -V> . I 64baeotion 1. The President of the Staff has~no responsibilities far . supervision of tho`clinical work doge in the hospital, 'The Chief of Staff may also be the President of the Staff and he assumes the combined duties t• of both posts. Subsection 2. Each department shall be organized as a diviei.po of the staff as a whole and, shall have a departmental head who shall be, y i i appointed by and responsible to the Chief of Staff for the functioning of his department, shall have general supervision 'overr the clinical work falling within his department` whether it ba'servipo or -private, The head of each department shall be the member of the dapartmo'nt r qualified by training, experience,, and demof>strakad ability for, the 06altit r r. r-::._: ~~ss-- -~'~--yy,, yyt;...+lxfi~:C'i`'R-'..!-n,.,f+''.r%ll.ati-~:rnT#""'`•,*'C',,e .n e.. .l.wL!{Yf~iy a~'iF~tifi5t:4 r8i~w'dH.Sii1p~INn'X • i i, l , Pr, 7 r, G Suhvoct:tou 3. Bach dcpart:meut: may inert acparutely i,ul"Haab maaLi.ngs shall ' not rel.aoaa the mo+ubera from their obligation ~Q attend the general meetings of tho• +,5 I madi.cAl staff as provided in Article VIII of throe BY-LAWS. ( AUTiCLL VI- D1.'fV1P11NAT1ON OF QUALIFICATIONS SKTION 1. DL"1'IaiMINATION ON PRIVI1II-IOL5 licantta training, 1. Determination of initial privi].egoo shall be based upon an aPP ' i experience, and demonaCrgLed comprtonce, a%id shall be daternlined by each department. , } ARMY, Y,, VII - OFIJ1C1;ttS AND COMMITTEES E SECTION 11 OFFICERS ' The officers of the medical staff taball• be the President, the vice-presidont, the Secretary, and the Treasurer, These shall be slacte<i at the annual meeting of . I 1 the Staff and shall hold office untilthe next annual meeting or until a successor i. is elected ; rhq pRO t shall call aad prdbide at all meetings and ahali be member ex p officiq of all committees wnd may be Chief 'of Staff. Ea will attend all hospital , R board me4tinge or have his ripresontative present. L { { The Chie4 o_, _f Sta.~`f, if not the prosident, is also an officer of the staff, f the Vioi a ident in the absence of the president shall assume all hie uutiAs and have all his authority, Hs shall also be expected to perfortl.gueh duties of i tuporvision as may be assigned to him by tote President. { I ,I The L,acreMV shall keep securers and complete minutes of All meetings, call meetings in order of the president, attend to all correspondence and pWorm such' ,duties M ordinarily pertain to his office. I 'The 'free Or shall be accountable for all funds entrusted to him. This a~llce 4 ~ is optional and may be' combined with that of ~he georetary~ aLC?zON 2. COAiti~TThC!s Wmlittoas shall be standing and special. All, committees other than th~ ?r grehutiVO Committee shall be appointed by the president. ' I ; Lr.lrv4f1 N'W `/.ere rAlef...l e.M •)a MIY. •YWIFUdaa • NM.'WA11~.Jh.?nf.14;Af tlL+Cy.v.I..vb;P.u.vr.bi. u. uu .b w..c l..l ♦.Ne11M .4Y 1. wA.14rn,sF.i~+d•~-M#JYLI.sfn.b'1~ f mum, wG rs. ~ j BYLAWS Or THE STAFF (Continvod) Stan dingy committees shah bey i 10 The Pxoctstivo Committea shnll consist', of the officers of the ;Msdioal t' Staff, Chairman of. Medicino, Padintrics, Surgery, ai%d OR, find two members elected at large; However) the exact size, composition and method of selection of the Executivo Committee should be at the discretion L of the Chief a'f Staff and flexible according to the hospitalneed's. The Administrator of the hospital.sholl be an o'x officio member., The duties of the Executive Committee shall be to coordinate the activities and general policies of the various departments, to act for the Staff as a eahole under such 'limitations as may be imposed by the Staff and ' t to raceive and act upon,•the reports. of the Medical Records,'-Tissue,'and such other committees as the biedical'S,ta£g m ey designate. The Executive Committee shall meet at I6aWt once d Month and maintain a permanent record of its pvooeedings and actions. Unless a Program Committee is appointed,'the Executive Committas shall be responsible for the preparati'o a and preaaritatldn ,+f the program of all meetings or the delaga`tion of this responsibility. It shall report at each ganeral'staff meeting. The Credentials Committee shall consist of members of not less than bras nor more than seven members so selected as to ineuYe representation of the major departments. Its duties shall be.to inveetYgate the credentials of all applicants for membership and to make recommandat•ions' in conforming with Article 111, Section 4, Subseotiona 3 and 4 of these' $y-t,ews; to investigate arty breach of athice thiltmay`be veportedi''to review any recerdb that may bo referred by the ',+,xeautiv® Committaa`an<d to arrive at a docieion regarding the perfo`r.manea of the Staff member or t refer the oeae, to' the full active staff if this is conaidered'desirabla:,: f j to, review gill information available regarding the, competence of staff i.' members and as a r4sult of such reviews to make racomrkendattond for the a,~ i• 2f~'L"ditlr`~""'l~ltibt~(tC~.4A%Jt Yht•Jaf Gy6Ckrbll f+•.b~Y~"`rF,'1Y5TSS•tlC.4G::".6~°'S<t "i~.Y }3h."N~OL1S ~yy BYLAWS or- 'f -ir sivi (Continuod) P,co 9 ( grnntin~, .of privileges, reappaintiacats atldtor, app ointments, and the 1 1 aani8nment of members of the va'ribun divinions and d6rArtments as provided i~ in A ti.cloo V and VI of the By-Laws, Tho Joint Conference Committeo shall consi.nt of the President and ! Vice-President of the Active Medicad staff and three membora.of the P i Governing Boaro,ornd tie honpital Administrator. The Medical staff; rcpresontativeaN~ri ll be npokgamen for the Medical staff on this committee. This committee shall be a medico-administrative liaison committee and the i official point of contact among the Medical Staff, the Governing Board' ` and the Ada, niatrator. It will most monthly and-report to the Staff. s The Mer dicai A_ eeords Committee shall consist of at least three members of the Active Medical Staff, The Medical Records Committee shall' r supervise the maintenance of medical records at the required stafidard of completeness. On the basis of documented evidence, the committee shall also review and evaluate 'th'e'qualit~y of medical care given the patient. The Committee shall meot at least once a month and submit 'a { report in writing to the Executive Cotrimittee. i The Tissue Committee shall include representatives of the departments of surgery, gynecology, obstetrics and such other departoentp as desired usually the p,othologiat should a14 as a. member of thka committee of ax offic16o The duties of the Tissue Committes shall be to study,''sind report to the. Staff or to the Exeoutive Committee of ehe Staff on the 4jrsem4nt or disagreement among the preoperitivs,'postoporative, sad pathological diagooais and on whathar the surgical procedures undertaken in the hospital ware acceptable or note. This study will also include those p,rocedureg in which no tissue was removed. The report to the Exeoutive bomrnittas'shn11 be in "writing an qt lesst a~monthly bdsii. The Utilizatidin Committee shall be comp coed of four members of the r ; ' ~:.z e , Y^ttY#t?~7f'A`ti ~!+da-5're9.:9!Waa+u+a?±ma+n~mrr_+?. .....,~.kws; , s n„nn.r.• - , BYLAWS Of THE S'frlpl (4;ontEnt~ed~ poem 10 . ' ointod, E app Medicill Staff whose term or offico shall be ono year, These j } ryunrGar):y, The tit al rman is to be thc'mcintber of 1:ongdat tenure. physicians shall rOprosent rho major clinical divisions of the hospital. i A memt•eti; of the Ntsreinp, Staff and the Administrative Staff shall also ba represented on thin colamittoo: The purpose of the Committee is to assure that al'1 of the hospital inpatient service is necasasry and could. pot t) providad:as effectiveiy in another facility, and to assure that t ail hospifnl beds are occupied on the beat possible modical priority basis. `'fhe, Committee shall moDt at monthly intervals to review selected i#iecharged patients records and inpatient records where a question has arisen about the necessity for further patient hospitalization. In reviewing records, the Committee shall determine the following's l. Could services have been provided on an'outpatient,basis? r<I • i 2. Were diagnostic atdies ordered; performed, and reported promptly y, Wero - untiecessary diagnostic studies ordered? f i 4,, Was them undue delay in requesting or pravidi,ng,consultiti,on? S. Was period of hospitalization before surgery,too_long? 6. Was tits 'postoperative period too long? ' j 7. If transfer Co'another service or facility was indicated,. was it carried out promptly? I ~ r Mora physiician's visit to'the,pationt;of sufficient freq.uancy to provide the earliest possible diagnosis and treatment? 4. Was'the hospital stay prolonged because of family or social rauson ? 1 1 k 10. Could this length of hospital stay have been short-mined by:xritnsfdr to a'itursing hoMe, home for the aged, mental diseases facility or. E. altothir feoility? lx, Ctruld the patient have returned home sooner through utillzati'ots o Viaitbng nursa or other home Barb aeYVioee? r 12, Wure diaehnrga order"e written at ail appropriate time? y?, ld, ~b ld tho,len$th lot hospital stay have been shortened without r adverse effects on'.the,patient? 1., ld.=L1t~'Y.~''S`~ .nNw..r.s.. .,a r...N.. 0., x..v J.n♦ '.tW.~^<.mYF:i vt7.~r LJia'isIMWWdMGCx'.M 1MNM,.,ruw,s a!,4tsY!LArc. • pa'sx" BYLAWS OF THE S1/tFf Coni nued Pogo 31 IA If the length of hoe ital stay atoms dxcoasiVe could prepayment of other egvornga have bben a fnctor4 j The Utilization Committae shall submit a monthly report to the I € Executive Committoo and hospital staff as to number of charts reviewed and general recommondationa, The Utilization Committee shall notify the i physician involvt;d In-any Cabe where it feels improper utilization has been topioyod. In tba event of continued abuse Of utilization by a ' physician, he shall be reported to the Executive' Committee. After being warned by the Executive Committee, further fail.Ura to conform shall lead to suspension o'f Staff privileges and even failure to recommend f~ reappointmont for chronic offenders. F Other committees, such as Infection Commi'ttoo, a Pharmacy and JI Therapeutics Committee, as may be, required to carry' 'out prOperl duties of the Medical Staff slsould be appointed, } Such committees shall confine their ~roik to the purpose for'which r ' they were appointed and shall report to the Executive Committee of' the Medical Staff. They shall not have power of Action tunless 'such is specifically granted by the motion which created the Committee. ARTICLE VIII - MPETI'NGS I SHCTXON 1 THE ANNUAL MEETING The"Al'inual meeting of the stafZ shall be the last general meeting before. the end of the calendar year of -the hospita;. At this' maatins th`a retiring offiears and committees shall make such reports-as ma'y.ba { doairoble, off c'era.for the ensuing year shall be Sleeted, and'raoommanda t f' ` tions for appoihtsaen`t to the various casCegoriea of the medical stsff-xmd assignment of privilegas and, departments shall be madfA SECTION 2',' REGULAR MEL'TINGS { The 'primary ob4ocEive' of'atoff meotinps,is improvement in the care i and treatment of.pay,ionts in the hoapital, Regular Staff meetings' shiill 1 l"1'.L` _ =L"~J.1 .:5.. H`TTSlKTb,.. , i' .H♦, NV~p j{,j i *owl r ra Pays MAWS Or. I i(. ST.AV- (Contiui~od~ I a, .e,~ I_._._. yp- y - partmejktal meotingd, and j bo of throe t eq Ceneral meetings, pa I J? j Educational moctinrs; t. . Subsection 1-' reneral 'meetings 1 Cnnera], meetings tittended by all memboro of the active staff shall be held at least every three months but %io more often than once a month. The time an,d place of the general meeting shall be determined i b the-preeident'of the staff with the npproval of the Executive Committee t 'Written notice eh4Z1 be given to each member of the active staff in ample time to ensure his presence. THE pURPOOE Ot THE CLNFRAL 14EPtINOS StIALL flEt , f~ 10 To coAduet matters of business and policy affecting the entire j Oita ff.~ ' 2. To oonoider matters pertaining to the By-Lawe and the Rules and i Regulations of the Medical staff. f 3. To review the overall performance of the Departments of the Redical staff, j ' 4. , the reports end recommendations of Staff co mmi t tees v , ' To review h , , Records of attendance and minutes that adequotely„i'eflect the transactions, conclusions, and recommendations of the meetings mual. be kept. Attendance at threa-fourths of the general meetings is required, as provided under' Artiale,0 11, Section G, of these By-La%+s. Subsection 2. 'DEPARTMENTAL MMETIN05 i Departman~tal meetings attendfd by all members of each Department ' j of the.Medi,cal Staff shall be hold onto a month, The time and plapa of ' each departmental meeting,ahall,be determined by the thief of that % of the members of. the depaitmont. Notice bep4rtmont with r,ha , t F ? t~..'. 'Cp shall be given to oach momber of the dopartmoht in Amp Ia time ensure , to presence. Fir 1 SI 9R BYLAWS OF THE STAFF (Continuod) Pago 13 I" T8E PU1t1'Ua"l; OF THE b9PARTMENTAT, mrPTINrs 111ALL BPI To conduct'mhttore of businosis and policy affecting the department 21 To consider matters pertaining to the intradepartmental I ' regulations and to keep theme re8ulations current. Iff 3. To re'viow the care and treatment of patients served by thedepartm nt I This review should include consideration of selected deaths, " unimproved patients, patients with infections, complications, " errors in diagnosis and treatment, and such rep6rts as are'b8liev d ` j to be important by those charged with the responsibilities of the s . department. E Records of attendance and minutes that adequately reflect the transactions, conclusions, and recommendations of the meetings Must be j kept and a copy bent monthly Ito the Chief of Staff, including all proposed changes in "Intradepartmental regulations to be preauntad to the `Executive Committee-for final approval,, Attendance at nine departmental meetings per year is required as i, provided under Article V1II Secti on 4 of these By-Laws, in the. event ' that a staff member is'ansigned to more than one department, he is urged to attend all his departmental meetings, but is required to attend nn c more than a total of nine year year. } Subeeotion 3 EDUCATIONAL MEETIN•OS ' Educational meetings shall be made available to fail membltre of C the staff. They shall be arranged by th'e Committee for Continuing' Medical 1 I Iduaati.on and hold at a aonvenient time and location'. Notice shall be I 'I given in, ample 'time to allow the members of the etefVto attend, Tng, IURI'OSG OF t9t EDUCATIONAL 48ETIN'O5 'SHALL BE TO IMPROVE THE gUALxTY OV 412DICAL CARE, BY PROVIDINOi k',, 1. C1inleo-Pathologic Conferences } , rt;r. BYLAWS Of- THE SiAPE (Conhnu1d) P°4 4~ i r 2, Tumor; Confernn¢eq ' j 3, Review of current subjects pertinent to the care of patiaribe i t nl,, in the 11001>1 Minutes that reflect the subiect matter of the meeting should be kept an'd sent to the Chief of Staff, Atfendanco•at educational meetipgs'is strongly urged for 'All members ' of the staff; but should be on a voluntary beat's, SECTION 3.. SPECIAL MEETINGS f Spacial meetings of the medical staff may be called at, any time by l the president and ehal'l be called at the lYOqueat of the governing body, • rkr In ~ [ j the Executive Committee04 or any five mem~'1'79, ofd the active kedicai staff. At any epetial"maating no business shall b transacted sxoept that stated ; in' the. notice calling the *eeting. Sufficient,notice of any Westing { shall bean notice post ad on the bulletin board at all doctor's 'registrie's at least b8 hours before, the time set for.the.meating. SECTION, 4 ATTiODAN•CE AT MEETINGS Subsection 1. REQt1IM ATTENDANCE Each member of the active staff shall be required to attend 'G three-fourths of the general and special vies tings per year and at least a total of tint lopartmentai meetings per year in order to remain oo tAe active staff. Failure to meet the attendance requiremente'.ihall eonstitut r ~ r resignation from the active staff, unless excused by the Executive Commi't t for dust cause, including sickness or absence from the community. Subsection 2. ' REINSTATEMENT , { , fix'.. peineCatamant of 'members too the Active Staff stay be wade on ' fI ' application to the Governing Body, the procedure being,tho same as in the. a cas,s of original appointment. i Subsection ~3, ATTENDANCE OF OTIMR 'STAPP,.CX'T'VdORIZS •7.5p r. ti s~MI. ~6i. oq,A: r (gdtl W UYta w^r.+u#+ ' 6d +'t- q. ,..m.n MyWYr{~*^+Y+A+ ;RttoA6C° I..Nee,lWwH ` ritNlNe•a14 /t"wel II s 1 35 page OF THE $TAFI (Con+lnued) Membors of categories of the medical staff other than Active are urged to attonl 611 meetings, but attendance is not required. SECTION 54 QUORUM f At a General Moeting,,fifty percent of the total memberahip'of. E the Active Medical Staff shall constituta.a quorum. 1 E At a.Depnr'tmental meeting, the Chief of the Departmant, or his E, dasignata, and two additional members, shall constitute a quorum. E SECTION 6, AGENDA f The Agenda at any General Meeting shall bet ff i B'usinesa'E 1. Call to order 1 I. 2. Acceptance of the minutes of the last regular and of all special i meetings, 30Unfiniahed business. 4 Coeimttttieations. 5 4 `Rep'orts o'f'stan'din8 and of spacial buainnas oommittoes, ' 6, New buriiuoAa 4 j F Medical 7. Review and analysis of the clinical work of the hospital, { S. Reports of standing and of.special medical committees, 9, Discussion and recommendations for improvement of the pro fees ion& work of the hospital, ti 10'. Adjournment, The agenda at-any U pArtmen a,l Mostityl shall oonform to the purposes ' as stated in'Article VIII, Section 2 Subsection 2,'peragrAph of these By-Laws. w The agenda at,any Syacia! hies i shall bet, 1; Rending of the notice calling the hesting. N.t~"til t . w.........zc+s.sYrr~a+~anxx.."Yrs::ruarr~mv~sema+r,Ak.4~'nMeW+!~ ~ +aw n BYLAWS OF THE STAFF (Conrinuod) rage ) 6 2. Transaction of the business for sahlch the meeting was oalle'd. ~J 1 3. Ad,juurnmoft. 'ARTICLE IX RULES AND RrCULATI0N9 i Tha Medical Staff shall adopt such rules and regulations as-may be necessary for the proper conduct of its owrk. Such rules and regulations shall be a part of these By-Laws, except that they may be amended at any -rspulat'meeting without previous notice by 'a two-thirds majority of those present and, voting. Such amendments shall become effective when approved by the governing body. ARTICLE X - AMENDMENTS ol, ' These By-Laws.may be amended after notice given at any regular meeting of the Medical Staff. Such notice shell be roferied to a „ 'a special committee which shall report at the next regular meeting and' shall require a two-thirds majority of,those present and voting for adoption. 'Amendments eu made shall be effective when approved by the `td 51 , • r governing .body. i ARTICLE XI - ADOPTION These By-Laws together with the appended Rules and Regulations, 4N shall be adopted at any regular meeting of the Aeti'va Medical Staff, t shall' replace any provitius By-Laws, Rules and Regulations and shad become effective when approved by the governing body of the hospital, j They shall, when adoptedand approved, be equally binding on th*N r ' Governing body, and the-Medical staff. k ~?!.tav+Yv t `:caeixm:ee:tt-..:..--rs+z3~rewetx~ru.4rm~ss~~or~»~•+••Smrrr_-~t.•~ersarrw 4 ,avuaOfA lcq(q ea.e a ,a - , n _ _ 1 ;J ~ 1 l i BYLAWS OF 'f!-IC• al'A!•~ (Continuod) • . P.qe l7 psroro,~n• tir ! i Approved by fire Abtiva tf~dici,l Sr~af~ of D~low lfemorial Hospital, ` ~ 1)atr~•Ah,.zi1 20~,~k97~1 , ' R. ki. CI20YSSAN F~.~ , i Provident of t~,e Medical Stra ~E ~ ' i i , ~ ~ i ~ d. H. DAMON, M, p. ' Saczetery of the btedical Stq,~t . i~ 1 ~ ~ li ~ Approv0d,by the Governing Board of Flow Memorigl Hospital. j ! ; ~ bate - r ~ ~ ~c " , `Alw T~ s , Secretary ~ ~ ; ~ noar~ o!a Manasera ,I ~ r , , i ~ i • ~ , ~r u , , ~ / ~r~ ~ k 1. r., , 1 - r w. i 1 i • k. ~ + i , ~ _ 4 ~ ~ ~ 1 (i - ~ • S e ' ~i t, ~ i~ ~ , ~ . i i. r , i" e •r.?uL.eK4n'?rst~zi~r'+rtem~~w.J'yyt'»" j y ( ~ ..YM YGHZ a i~~ ~ , + • ~MUItfAM YAttE kb EOn.MYrX IIIIA011 ~ ~ - r 1irf l~~lll1~E~~~~ 1 t ~ ri. u~ ~ ,S y ~ " ~~i;~: k . V 1 p c, I , kn Ilk t 17 ~ I Sf F dos ty ~I ' 1 1 V ~ n V lt£ ~ 1 ~7 r n t e f~ y / It a tt t f a ~ , 4, 1 r fff TIN 1 ,P T 'Dj x N. I 6~1 -1 iv 1 s, 4 O ' r 1 4 55164411'.,. 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ACCOUNTS R~Lr1VAtLE"rHAVsi4-t ON R£POK7--UPDATE " 4 AGED tR1AL tlAEANi;E F , r ,y t'1 1' , "r. 5. 'INQUIKY VI PA0GKAM 114fERRUPt G. ACZUUNrI AEi CSVAbLE S7ArcAEo4T6 i1f PAY406L 1. hOJAS )IUKK ~HEf l ; 2, udDuuTIgN Ar"U1STEK " V lliy(``1 D. NAYAULL KcV10ER s 4. CHE"K Kt:GISTER f}f, '.rr~ - t1 5. Emkum, 1'1FuKMATIbiV RE 3I5rGK Yfu-wil.A(vi;E f, u. GHELKS i a i , 1 y I'if AO:OU.45 P,iYAULE 1 AGCVUUNT5 PAVAELK LI sI P4U'--I vV0I(;L5 UY VcNuJi < 7f . ACCOUN 6 NA Wit. k: LXPrNSt ii 1.)fAIdu IIW uY DFPAiijlliYr r, 1 Y" ~ f ° 4YAti~r. »r../..u,..n , 1. ..n ( , nlnir.-.., ,f?.".,..r...,,sv.,.N01(.uiNAy.1..: [Mei;nr.. 1. • iH, f o , ' ICI.'?'~~e~ f AMU 1 k t, r 'R IT F' 4 X~l) r 1 k ~ St(. .'•j ~ •"•Cb~tWI(~Sdr~f1~17~fi1kxri•h~N~h?NJV.u:Wl9.em..:,v.,...,.. .,x ~av ~„~we..,.n..fl:nhin.:vr,H ~:1.uvu~+aillY:7.51~'y i 1 l~ rrrr ~-r;r 4•... r sA ,47i 7~ X41! ~ ~w;1 1 I t ss ~*1~.. y,~t :p: 1 ~.y'A 3 nir .1^~,:L_,atf. r.. .rmny....r y.;: Yn •.r.,j.'.;«+....r:...:~. _ lu. 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