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92_SB0933eng SB933 Engrossed LRB9205026LBmb 1 AN ACT concerning health facilities. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Hospital Licensing Act is amended by 5 adding Section 10.8 as follows: 6 (210 ILCS 85/10.8 new) 7 Sec. 10.8. Requirements for employment of physicians. 8 (a) Physician employment by hospitals and hospital 9 affiliates. Employing entities may employ physicians to 10 practice medicine in all of its branches provided that the 11 following requirements are met: 12 (1) The employed physician is a member of the 13 medical staff of either the hospital or hospital 14 affiliate. If a hospital affiliate decides to have a 15 medical staff, its medical staff shall be organized in 16 accordance with written bylaws where the affiliate 17 medical staff is responsible for making recommendations 18 to the governing body of the affiliate regarding all 19 quality assurance activities and safeguarding 20 professional autonomy. The affiliate medical staff 21 bylaws may not be unilaterally changed by the governing 22 body of the affiliate. Nothing in this Section requires 23 hospital affiliates to have a medical staff. 24 (2) An independent medical staff committee or an 25 external independent physician reviewer or organization 26 periodically reviews the quality of the medical services 27 provided by the employed physician. 28 (3) The employing entity and the employed physician 29 sign a statement acknowledging that the employer shall 30 not unreasonably exercise, control, direct, or interfere 31 with the employed physician's exercise and execution of SB933 Engrossed -2- LRB9205026LBmb 1 his or her professional judgment in a manner that 2 adversely affects the employed physician's ability to 3 provide quality care to patients. This signed statement 4 shall take the form of a provision in the physician's 5 employment contract or a separate signed document from 6 the employing entity to the employed physician. This 7 statement shall state: "As the employer of a physician, 8 (employer's name) shall not unreasonably exercise, 9 control, direct, or interfere with the employed 10 physician's exercise and execution of his or her 11 professional judgment in a manner that adversely affects 12 the employed physician's ability to provide quality care 13 to patients." 14 (4) The employing entity shall establish a 15 confidential peer review process with criteria under 16 which an employed physician, who believes that an 17 employing entity has violated this Section, may seek 18 review of the alleged violation by either a mutually 19 agreed upon medical staff committee of the employing 20 entity, if any, or a mutually agreed upon independent 21 external physician reviewer or organization to assess 22 whether the alleged violation involved the unreasonable 23 exercise, control, direction, or interference with the 24 employed physician's exercise and execution of his or her 25 professional judgment in a manner that adversely affected 26 the employed physician's ability to provide quality care 27 to patients. This review is conducted for the purpose of 28 quality control, for reducing morbidity or mortality, and 29 for improving patient care or the employed physician's 30 services in accordance with Section 5 of the Medical 31 Practice Act of 1987. The medical staff committee or 32 external independent physician peer review shall make 33 findings and recommendations to the employing entity and 34 the employed physician within 30 days of the conclusion SB933 Engrossed -3- LRB9205026LBmb 1 of the gathering of the relevant information by the 2 committee or peer review. No action may be taken that 3 affects the ability of a physician to practice during 4 this review, except in circumstances where the medical 5 staff bylaws authorize summary suspension. 6 (b) Definitions. For the purpose of this Section: 7 "Employing entity" means a hospital licensed under the 8 Hospital Licensing Act or a hospital affiliate. 9 "Employed physician" means a physician who receives an 10 IRS W-2 form, or any successor federal income tax form, from 11 an employing entity. 12 "Hospital" means a hospital licensed under the Hospital 13 Licensing Act. 14 "Hospital affiliate" means a corporation, partnership, 15 joint venture, limited liability company, or similar 16 organization, other than a hospital, that is devoted 17 primarily to the provision, management, or support of health 18 care services and that directly or indirectly controls, is 19 controlled by, or is under common control of the hospital. 20 "Control" means having at least an equal or a majority 21 ownership or membership interest. A hospital affiliate shall 22 be 100% owned or controlled by any combination of hospitals, 23 their parent corporations, or physicians licensed to practice 24 medicine in all its branches in Illinois. 25 "Independent external physician review organization" 26 means an organization of physicians licensed to practice 27 medicine in all its branches that conducts peer review for 28 the purposes of medical study, for reducing mortality or 29 morbidity, or for improving patient care as recognized under 30 Section 5 of the Medical Practice Act of 1987. 31 "Independent medical staff committee" means a committee 32 of the medical staff that is not controlled by physicians 33 employed by an employing entity. 34 "Physician" means an individual licensed to practice SB933 Engrossed -4- LRB9205026LBmb 1 medicine in all its branches in Illinois. 2 "Professional judgment" means the exercise of a 3 physician's independent clinical judgment in providing 4 medically appropriate diagnoses, care, and treatment to a 5 particular patient at a particular time. Situations in which 6 an employing entity does not interfere with an employed 7 physician's professional judgment include, without 8 limitation, the following: 9 (1) practice restrictions based upon peer review of 10 the physician's clinical practice to assess quality of 11 care and utilization of resources in accordance with 12 applicable bylaws; 13 (2) supervision of physicians by appropriately 14 licensed medical directors, medical school faculty, 15 department chairpersons or directors, or supervising 16 physicians; 17 (3) written statements of ethical or religious 18 directives; and 19 (4) reasonable referral restrictions that do not, 20 in the reasonable professional judgment of the physician, 21 adversely affect the health or welfare of the patient. 22 (c) Private enforcement. An employed physician aggrieved 23 by a violation of this Act may seek to obtain an injunction 24 or reinstatement of employment with the employing entity as 25 the court may deem appropriate. Nothing in this Section 26 abrogates any common law cause of action. 27 (d) Department enforcement. The Department may enforce 28 the provisions of this Section, but nothing in this Section 29 shall require or permit the Department to license, certify, 30 or otherwise investigate the activities of an employing 31 entity. 32 (e) Retaliation prohibited. No employing entity shall 33 retaliate against any employed physician for requesting a 34 hearing or review under this Section. SB933 Engrossed -5- LRB9205026LBmb 1 (f) Physician collaboration. No employing entity shall 2 adopt or enforce, either formally or informally, any 3 policy, rule, regulation, or practice inconsistent with the 4 provision of adequate collaboration, including medical 5 direction of licensed advanced practice nurses or 6 supervision of licensed physician assistants and delegation 7 to other personnel under Section 54.5 of the Medical Practice 8 Act of 1987. 9 (g) Physician disciplinary actions. Nothing in this 10 Section shall be construed to limit or prohibit the governing 11 body of an employing entity or its medical staff, if any, 12 from taking disciplinary actions against a physician as 13 permitted by law. 14 (h) Physician review. Nothing in this Section shall be 15 construed to prohibit a hospital or hospital affiliate from 16 making a determination not to pay for a particular health 17 care service or to prohibit a medical group, independent 18 practice association, hospital medical staff, or hospital 19 governing body from enforcing reasonable peer review or 20 utilization review protocols or determining whether the 21 employed physician complied with those protocols. 22 (i) Review. Nothing in this Section may be used or 23 construed to establish that any activity of a hospital or 24 hospital affiliate is subject to review under the Illinois 25 Health Facilities Planning Act. 26 Section 99. Effective date. This Act takes effect on 27 September 30, 2001.