EXAMPLE 3: AGREEABLE BY LAWS
Carlini v. Highmark, 756 A.2d 1182
The insurance company asked the hospital not to re-admit a physician. do to malpractice claims. The peer review afforded him due process, and decided that he should be re-admitted. The administrator, without due process overruled the committee and denied the physician privileges. The court granted an injunction to require the physician to be reinstated.
Some good by-laws found in the case. (not all were reported, the case notes that the committee cannot be in economic competition, and there was a procedure for objecting to the committee. )
Pursuant to the applicable bylaws, Article X, Disputes and Controversies Involving Doctors, provides:
Section 1. Review Committees. All matters, disputes or controversies arising out of the relationship between the Corporation and professional providers who render health services to the Corporation's subscribers, including any questions involving professional ethics, shall be considered, acted upon, disposed of and determined by the appropriate one of the two Review Committees hereinafter referred to.
Section 2. Medical Review Committee. There shall be [**10] a Medical Review Committee consisting of at least five (5) members, each of whom shall be appointed by the Chairman of the Board of Directors of the Corporation and each of whom shall serve until his successor is appointed. A majority of the members of the Medical Review Committee shall be doctors who are either members of the Board of Directors of the Corporation or members of the Corporation.
Section 8. Proceedings Involving Status of a Doctor as a Participating Doctor. If a Review Committee determines that a hearing should be held with respect to any matter which has been
stated in a Complaint, the Chairman shall promptly fix a time, date and place for such hearing. The Participating Doctor involved shall be given at least fifteen (15) days written notice by the Secretary of the Committee of the date, time and place of such hearing, and the doctor shall be furnished with a copy of the Complaint. ... At the hearing such witnesses may be heard and such evidence may be received as is deemed to be relevant and of reasonable probative value, provided, however, that formal [*1187] rules of evidence need not be adhered to. The doctor affected by the Complaint shall be afforded an opportunity [**11] to be heard before the Committee, either in person or by counsel, and to produce evidence and witnesses at such hearing. ... After the hearing, the Review Committee, by majority vote of those members who are doctors, shall take whatever action it deems appropriate, based on the evidence and testimony produced at the hearing and, if such action involves either suspension or termination of a doctor as a Participating Doctor, the matter shall be promptly referred to the Secretary of Health of the Commonwealth of Pennsylvania for approval or for such other action as he may deem appropriate. (emphasis added).