Eric N. Grosch, M. D. and cosignatory physician, hereinafter designated, "emergency-physician," shall hold entitlement to all rights and privileges, including due process and appellate review, accorded to any other medical-staff member except for admission privileges and, in addition, have the additional rights and privileges described in the wording of the following supplement, which shall replace and supersede the corresponding passages in the medical staff bylaws and in any governing contract in respect to any penal, corrective or disciplinary action against the emergency-physician.

        The hospital agrees to compensate the emergency-physician for his work at
a rate at least of $______/hour and at the prevailing rate if it increase from time to time.

        This agreement shall have a term of ________ years from the date of execution.  No restrictive covenant shall govern this agreement, either in respect to time or location.  If the corporation and hospital sever their mutual obligations, by mutual consent or if either party sever unilaterally, or if the corporation's agreement with the hospital expire or suffer cancellation, the hospital and emergency-physician shall maintain in force their independent mutual obligations under this agreement for the remainder of the term until severed by mutual agreement.

        The provisions of this agreement supersede and nullify any agreement
whatsoever between any parties whomsoever which permits any person
whomsoever, whether administrator, hospital governing body member,
medical staff officer or member, or emergency-department director from
removing the emergency physician from the emergency-department schedule
for any reason whatsoever or arbitrarily, without either:

1. obtaining his written permission to remove him or

2. prevailing against him by due process, as defined in the due-process
provisions contained in the bylaws, as amended by the wording of this
supplement.

        The on-duty nurse(s) shall have responsibility for the choice of patients
and timing in bringing patients from the waiting room to the emergency
department proper, subject to modification at the emergency-physician's
discretion.

        The hospital recognizes that the emergency-physician occupies the
clinical "front line," that he bears primary responsibility for emergency
patient-care, that he has insufficient time to deal with in-hospital
conflicts and that conflicts with physicians on emergency-call and
hospital employees do not fall within his purview.  The Chief of Staff
shall establish a conflict-resolution back-up call rota, in effect 24
hours per day and confer his entire authority for conflict resolution to
the designated physician on-call from time to time on that rota.  The
emergency-physician may, at his sole discretion, refer to the designated
physician on the conflict-resolution rota:

1) any complications in the primary-physician emergency-call schedule,
such as claims from physician on the printed schedule about subsequent
arrangements he may have made with another physician to cover him

2) any policy of the department, to which the primary physician on
emergency call belongs, that the printed emergency-call schedule does not
reflect

3) any disagreement about whether or not to admit a given patient to
hospital from time to time

4) any other conflict that may arise

        Upon notification of any conflict, the designated physician on the
conflict-resolution call-rota shall relieve the emergency physician of
all duties related to such conflict and of all liability risk related to
a decision to discharge a patient whom the emergency physician proposed
for admission.  Neither the hospital nor any member of the medical staff
shall impugn the emergency physician's clinical judgment or criticize him
in any other way for his decision to call upon the designated physician
on the conflict-resolution rota for any reason.  Neither the hospital nor
any member of the medical staff shall impugn the emergency physician's
clinical judgment or criticize him in any other way for his decision to
admit a patient, whether the primary physician on emergency-call or the
conflict-resolution physician or both or any hospital employee disagree
with that decision.

        The emergency physician may, at his sole discretion, write admitting
orders for a patient as a courtesy to the admitting physician but the
admitting physician shall bear full responsibility for writing admitting
orders and professional liability risk for errors in those orders in any
case, while the emergency physician shall bear no risk whatever, either
of blame or of liability for such errors.  Neither the hospital nor any
member of the medical staff shall impugn the emergency physician's
clinical judgment or criticize him in any other way for any aspect of
admitting orders that he has written, whether the physician on
emergency-call or the designated physician on the conflict-resolution
rota or both or any hospital employee disagree with them or whether or
not any such person believe that the emergency physician committed any
error(s) in writing them.

        The hospital acknowledges that the emergency physician's alertness
represents a valuable renewable asset that works to the benefit of
patient-care. The emergency physician works, occasionally or often while
fatigued, perhaps on the edge of human endurance, at the mercy of
sporadic, random patient arrivals, so the emergency physician shall have
the right, indeed the obligation, to enhance his alertness: to eat when a
lull in patient traffic gives him a chance to eat and to sleep when a
lull gives him a chance to sleep, at any time during his shift, at his
sole discretion.  When patient care needs arise from time to time, the
on-duty nurse(s) shall notify the emergency physician on-duty and keep a
log of times of her notifications.  The emergency physician shall respond
to such nursing notifications and shall enter the time of his response to
each notification in the same log and authenticate the nurse's
notification at the same time.  Supervisory authorities shall attribute
to the nurse any documented delay between the arrival of a patient or his
laboratory or X-ray results and her notification of the emergency
physician and shall attribute only delays which occur after the nurse's
notification to the emergency physician.

        The Chairman and each member of the Hospital Governing Body, the hospital administrator, Chief of the Medical Staff, emergency-department director, and Director of Nursing of ____________ Hospital and president and corporate medical director of  ___________ Emergency Services, shall all signify their assent to and obligation to abide by the wording and spirit
of this agreement by signing in the spaces provided below.

QUALIFICATIONS FOR MEMBERSHIP

        Qualification for membership on the medical staff shall include
documentation of the physician's professional education, training,
experience, demonstrated competence, judgment, character and current
capability; and good reputation sufficient to assure the medical staff
and governing body that any patient he treats in the hospital shall
receive an acceptable standard of medical care and professional skill.
Furthermore, the physician shall demonstrate the highest professional and
moral character and integrity and adhere to the highest ethics of his
profession. The hospital administrator and governing body recognize that
a physician's fiduciary responsibility to his patients, to their health
and to their welfare constitutes his primary and most important ethical
obligation and that the hospital has a primary duty to support and aid
the physician in fulfilling that obligation.

WHISTLEBLOWER PROTECTION CLAUSE

        The physician shall work cooperatively with others if possible and if
doing so remains consistent with his ethical obligations but the hospital
recognizes the primacy and dominance of the physician in matters relating
to patients' care, health and welfare: the hospital shall understand that
physicians do not always agree about proper treatment for a patient or
proper practices in the hospital and the goal of providing high standards
of medical care requires that any physician shall feel free to assert his
views and "blow the whistle" when he finds treatment of any patient
improper or any hospital practice negligent.  Considerations of harmony
in the hospital must give way to patients' welfare:

        Each governing-body member, the hospital administrator, each
medical-staff member and each ancillary-staff member shall diligently
support any physician who makes his objections known, whether tactfully
or not, and, in practical terms, none of those persons shall retaliate
against him for his whistleblowing by:

1) refusing initiation or renewal of medical-staff privileges to any
physician or

2) terminating any emergency physician who sees fit to blow the whistle to
correct the performance of ancillary personnel, another physician or any
other person in order to ensure reasonable pursuit of his primary
fiduciary responsibility to his patients or

3) construing his whistleblowing as "inability to work cooperatively with
others, or

4) construing his whistleblowing as failure to "get along" with hospital
personnel or other physicians when he criticizes their work performance,
or

5) censuring a physician for rudeness in extremis in the course of his
trying to save a patient's life or health, or

6) threatening or interfering with the physician's hospital privileges,
his contractual relationships with any entity or with any other aspect of
his livelihood or professional relationships because of any circumstance
surrounding the physician's fulfilling his ethical obligations, as he sees
them.

        Substantial evidence of such retaliation shall remove any dispute between the hospital or its medical staff and the accused physician from the
jurisdiction of all hospital bodies and place it instead in the
jurisdiction of a court of law.

        Any physician shall have the authority immediately to remove any
ancillary-staff member who interferes with his legitimate discretion or
functioning.  The hospital shall provide for that ancillary-staff member's immediate replacement.  All hospital employees shall agree in writing to abide by those principles and their employment shall depend on
their agreeing.  A hospital employee's failure to signify his agreement
in writing shall constitute grounds for terminating him or for not hiring
him initially.

Unique to Ascension Hospital:

NOTIFICATION OF CLAIMS
        Members of the Medical Staff shall be required to notify the hospital
administrator immediately upon receipt of notice of any type of claim or
action pending against them regardless of the nature of such claim or
action and its anticipated final outcome.  A record of such claim or
action and its ultimate outcome will be maintained in the practitioner's
credentialling file.

CORRECTIVE ACTION FOR MARGINAL PRACTICE OR BEHAVIOR, DISREGARD FOR RULES, PHYSICAL OR MENTAL IMPAIRMENT, UNETHICAL CONDUCT - CHOOSING A REMEDY:

        An initiator of corrective action, namely, any officer of the medical
staff, any chairman of a standing committee of the medical staff or the
chairman of any clinical department, may initiate corrective action
against any medical staff member for any professionally justifiable and
substantial reason, defined in the textbook- or scientific-periodical
literature of medicine, surgery, obstetrics, gynecology, pediatrics,
medical ethics or etiquette, with the proviso that consideration of
etiquette must yield if it conflict with operational necessity.

        The governing body and hospital administrator shall recognize that
processes, not people, usually make quality, so they shall seek and
correct flawed processes in hospital organization redesign them and
observe for a reasonable time, no less than six months, to determine
whether the redesign has produced the desired effect before presuming
fault of an individual and pursuing him with penal intent.

        If they find the performance of an individual practitioner at fault, the
medical staff may resolve the issue(s) by one or a combination of several
methods.  The hospital hierarchy shall treat the practitioner with
dignity throughout all corrective-action processes.  The choice of
approach may depend on the urgency, recurrence, frequency or severity of
the specific incident(s) as well as on the accused practitioner's
cooperation.  Whatever the approach, the hospital hierarchy shall record
all conversations in the context of any meeting and in any informal
context, that relate to the issues between any two or more persons who
have any decision-making power in the case.  Failure of any two such
persons to record their conversation(s) that relate to the case in any
context at any point in the proceedings, whether constructive or penal,
shall receive treatment under the principles of zero-tolerance and shall
constitute grounds for immediate exoneration of the subject practitioner:

1) the hospital shall apply the word-to-the-wise, blame-free, shame-free
Total-Quality-Management approach by addressing that problem in an ongoing physician-performance improvement program, in which all physicians participate and which shall continue during the term of any contract
between the hospital and physician.  The hospital shall not construe the
physician's participation in a physician-improvement program as derogatory
against him, nor shall the hospital report his participation in such a
program to the National Practitioner's Data Bank, the Federation of State
Medical Boards, or any other national, regional, state, local or other
governmental regulatory or licensing agency.  The physician-improvement
program shall incorporate at least the following essential steps:

a) Identify the perceived deficit

b) To ensure use of a realistic standard, verify that the perceived
deficit represents a true deficit by reference to accepted standards of
performance in an appropriate nationally-recognized data-base

c) Notify the physician of the verified deficit

d) Refine the issues by collegial discussion between the physician and all
concerned parties to accumulate data in a constructive spirit of free and
open inquiry: explore the thinking, reasons for actions, muster evidence
pro and con from all parties

e) Reassess physician performance at least once per week according to
consistent criteria

f) Feedback assessment to physician and discuss whether he needs to
improve and ways he can improve further

g) Repeat the feedback cycle at least ten times

2) Only if those steps fail, administration, any member of the governing
body or any medical-staff member may request to initiate penal action The
initiator shall address his request for penal action, only in writing, to
the hospital administrator.  Penal action shall proceed only with the
advice and consent, by a two-thirds-majority vote of the medical staff as
a whole.

        Within ten (10) days of receiving a medical-staff approval for penal
action, the hospital administrator shall have organized or prompted the
medical staff president or executive committee to have organized, a
committee to investigate the allegations against the accused
practitioner.  If the hospital administrator fail to complete those tasks
within the allotted ten (10) days, he shall annul the penal action or
obtain a time-extension from a court of law by showing reasonable cause
why he has failed to do so.

        The investigating committee shall present a report of its conclusions,
including an assessment of the cause, whether organizational and systemic
or individual, attributable to the subject practitioner.  If
organizational and systemic, the investigating committee shall refer the
systemic issues to the hospital-administrator and relevant departments
for resolution and dismiss all allegations against the tentatively
accused practitioner.  If individual and attributable to the subject
practitioner, the committee shall report on the urgency, recurrence,
frequency or severity of the specific incident(s) in question, as well as
on the subject practitioner's cooperation, or lack thereof, in the
physician-improvement program to the medical executive committee.
     
   Prior to making any report, the committee shall inform the accused
practitioner in writing of the specific charge(s) against him, which
shall specify and limit their wording to relevant patient name(s),
name(s) of accuser(s) and/or witness(es), specific allegation(s) and
citations of relevant scientific standard(s), by reference to relevant
citation(s) from the medical textbook or periodical literature or both,
which allegedly justify the charge(s).  Notification of charges shall
guarantee the accused practitioner's right to pre-hearing discovery of
evidence, including, but not limited to, citation of scientific
literature which provides a basis for the scientific validity of the
charges against him, all documentation which purports to support the
charges, as well as any evidence, which the accused may specify, at his
sole discretion, of the hospital hierarchy's irrationally or oppressively
proceeding against him, its application of any double standard, such as
disparate or inconsistent treatment of similarly situated parties,
different standards for similar situations, its proceeding undertaken for
an improper purpose, such as to harass and all the evidence listed below
under COMPOSITION OF HEARING COMMITTEE.  To that end, the hospital shall:
1. produce all:
a) internal memos that relate to his case
b) notes that relate to his case and
c) other written communications, formal and informal, that relate to his case
d) sound- or video-recordings of the entirety of every meeting, formal or
informal, of two or more members of any and every hospital- or
medical-staff-body whose members discussed the accused's case at any stage
of the process, whether investigative, deliberative or otherwise,
particularly if, but not only if, they proposed or discussed subjecting
the accused to the penal peer-review process to which the charges relate
2) provide copies, at its own expense, of all such documentation to the
accused.
        Failure of the hospital to provide the accused with such papers and
audible and comprehensible copies of all such recordings within ten (10)
days after notification of charges shall result in annulment of all
charges that relate to the omission.  If discovery of the omission occurs
after the proceeding has progressed, the hospital should annul the
applicable charges and all related findings in retrospect.  Even the
omission or inaudibility of a copy of one such recording among many shall
suffice to result in such annulment by the just doctrine of
zero-tolerance.
        After the accused practitioner has had reasonable time, at least thirty
(30) days per charge, at his sole discretion, to examine that evidence
and prepare his response(s) to the charge(s), the committee may interview
him.
        Though the committee may invite the accused to discuss, explain or refute
the allegations, it shall have the power neither to compel him to appear
at the interview, to respond to its queries nor otherwise to speak if he
does.  Neither the ad hoc committee nor the governing body nor any other
agency shall have the discretion to construe evidence of guilt from his
silence at this preliminary interview or in any other penal-action
hearing.  All of the procedural rules provided in these bylaws with
respect to hearings shall apply to this preliminary interview, including
right to presence and advice of counsel, at all hearings.
        The investigative committee and the medical executive committee shall
base penal-action allegations and charges against the accused
practitioner only upon nationally recognized standards of care.  The
investigative committee shall bear in mind the multiplicity of stylistic
variations in patient care from community to community and the
impracticality of a physician's knowing of local variations in advance.
Relevant citation(s) from the medical textbook literature, medical
periodical literature, medical ethical literature and/or etiquette
literature shall justify and accompany all charges.
        In particular, in the absence of such relevant supporting citation(s), no
statement(s) from any source, including any medical-staff member or
member of the hospital's ancillary staff, governing body or
administration, analogous to or to the effect of the following shall
support or justify any penal-action allegation:
A. "I do not feel comfortable with accused's patient-management."
B. "I do not feel confident in accused's patient-management."
C. "I find the accused's patient-management improper."
D. "I believe that the accused's patient-management should have consisted
of (this) instead of (that)."
E. "We do not do things that way in these parts."
F. "The accused's personal style of interaction with patients and staff
precipitated his removal."
G. "Patients have complained against the accused."
H. "The accused is quiet."
I. "The accused does not communicate."
J. "I don't have time to go into details."
        The hospital shall recognize and acknowledge the validity of the thinking
of William Osler, in particular, that in Aequanimitas: a physician's
thoughtful contemplation in a mood of equanimity in the service of
patient-care positively benefits patients' welfare - a thinking physician
is a quiet physician.  The hospital shall recognize the validity of no
complaint whatever against a physician which directly or indirectly
addresses his quietude or equanimity of mood or manner.
        Any patient-advocate or -representative who receives any complaint(s)
about any aspect of a physician or his treatment or of any other nature
whatever, without limit, shall refer the complaint soon enough to that
physician to permit him to resolve it face-to-face with the complainant
while the complainant remains on site.  If any person, whether physician
or non-physician, including any patient advocate or representative,
receives any such complaint(s) but does not refer such complaint(s) soon
enough to the physician to whom the complaint(s) refer(s) to permit him
to address the complainant(s) about the complaint(s) before the
complainant(s) leave(s) the hospital that day, the complaint(s) shall
have no validity in support of any penalty(ies) of any kind, including
termination, against that physician, irrespective of whichever other
person(s) whom notification of the complaint(s) reached initially,
including the hospital administrator or chief of medical staff.
        The medical executive committee, after verifying the investigating
committee's compliance with all strictures cited above, may reject or
modify the request for penal action, issue a warning or letter of
admonition or reprimand, impose terms of probation or requirement for
consultation, or recommend reduction, suspension or revocation of
clinical privileges or termination.  If the investigating committee,
medical executive committee or governing body has failed to comply with
any stricture cited above, the jurisdiction of the governing body and all
hospital-based committees and bodies shall cease and the accused
practitioner shall have the right to seek adjudication, in a court of
law, of the investigating committee's finding(s), the medical executive
committee's actions(s), including, but not limited to, its finding(s),
recommendation(s), warning(s), letter(s) of admonition, reprimand(s), or
governing body's final decision(s) or all the above.
        A medical-executive-committee's recommendation for reduction or
revocation of clinical privileges, of staff membership or of termination
shall entitle the accused practitioner to a hearing, subject to the
following provisions:

COMPOSITION AND COMPETENCE OF MEDICAL-EXECUTIVE, INVESTIGATIVE AND
HEARING- COMMITTEES
        When a hearing relates to a recommendation of the medical staff, the
medical-staff president shall designate an outlying hospital, agreeable
to the accused, as a venue for the hearing.  The medical-staff president
of that outlying hospital shall designate at least twelve voting active
members of the medical staff in good standing, all good physicians and
true, none of whom shall have any professional relationship with the
hospital of origin, to conduct the hearing.  The members of the ad hoc
committee shall vote to appoint its own foreman.
        The ad hoc hearing committee's members shall fulfill the highest ethical
standard of avoidance of conflict of interest and even of the appearance
thereof.  Accordingly, no member of the ad hoc hearing committee shall:
1. have any commercial or business interest(s) in competition with the
accused practitioner's interest(s)
2. have prior knowledge of the material issues in dispute;
3. have participated in any of the deliberations leading to preference of
charges against the accused
4. have any personal friendship or acquaintance with any member or
employee of the hospital of origin where the accused practices.
        The hospital of origin shall hire, at its own expense, an
administrative-law judge to preside at each hearing of each deliberative
body and ensure that each such body conduct its hearing according to
established legal protocols.  The administrative-law judge shall
adjudicate only matters of procedure, law and logic and leave
adjudication of medical matters to the ad hoc committee proper, except
for that of standard-of-care, mentioned below, under this article, which
he shall determine with expert medical help.
        The hospital and its agents shall hold every practitioner on its medical
staff to scientifically valid and realistic standards of care,
performance and diligence.
        To prevent the hospital of origin and its agents from holding an accused
practitioner to scientifically invalid, unrealistic or imaginary
standards of care, performance and diligence, a physician's membership on
the medical-executive committee or a physician's assigment as an
investigator of a case against an accused practitioner shall guarantee to
that accused practitioner the right to determine whether the medical
practices of such members comply with standards to which the executive
committee proposes, by its deliberation, charge(s), and recommended
verdict(s), to hold the accused practitioner.
        A physician's appointment to and acceptance of membership on the ad hoc
hearing committee which considers the accused practitioner's case shall
guarantee to the accused practitioner the right to determine whether the
practices of the members comply with standards to which the hearing
committee proposes, by its discussion(s) and recommended verdict(s), to
hold the accused practitioner.
        To those ends, the hospital of origin, for executive committee members
and investigators, and the hearing-venue hospital, for ad hoc
hearing-committee members, shall provide, for the scrutiny of the accused
practitioner, or any person(s) he shall designate as his expert
witness(es) and of his representative(s), access to originals, and, at
either hospital's expense, to the same persons, copies of, documentation,
including, but not limited to, the following:
1. to establish each physician's ethical track-record with respect to his
own medical practice, each member's record of disciplinary actions by
every state he has ever held a license, by any hospital where he has ever
held privileges and by any medical society in which he has held
membership.
Such records shall include at least:
a. an official statement from each state licensing authority about each
member, including all derogatory information
b. an official report of disciplinary actions from the Association of
State Medical Boards, Euless, TX
c. an official report from the AMA
d. an official report from the
e. the personnel dossier, including, but not limited to, records of all
prior or current disciplinary penal action hearings each member shall have
undergone and any other record(s) of every hospital at which he has held
privileges, including the hearing-venue hospital
2. to establish reasonable sufficiency of each physician's knowledge of
the medical-scientific principles touching the case in dispute, the
member's speciality, results of past examination-scores
3. the member's performance in cases similar or analogous to the case
which forms the basis of accusations against the accused, as evidenced in
all prior and current clinical charts of patients whom each member has
attended in the hearing-venue hospital and all other hopsitals in which
each member has held privileges
4. to facilitate the accused practitioner's access and inspection, a list
of such patients, together with their respective diagnoses, whom each
committee member shall have attended in each hospital.
5. to ensure reasonable standards of logical and scientific integrity of
the various committee's deliberations and recommended verdict(s), the
acused shall have discovery-access to transcripts of all deliberations.
        All parties shall apply customary confidentiality precautions to the
above-mentioned scrutiny of patient medical records and physician
penal-action disciplinary hearing-records.  If such precautions preclude
the accused practitioner's inspecting original medical records, then, at
its own expense or at the expense of the hospital of origin, each such
hospital shall provide him a photocopy of each of as many of such records
as he shall designate, at his sole discretion, with all patient
identifiers removed, except for patient identification numbers.
        The accused practitioner may present evidence he derives from inspection
of such charts at any point in the proceeding, including the appeal to
the governing body, whether or not he has presented it prior to that
time, since he may have no inkling before the ad hoc committee has
rendered its recommended verdict whether it has applied a realistic
standard of care in assessing his performance.
        On the basis of the same evidence, the accused shall have the authority
to challenge for cause the appointment of, and remove, any member and as
many of each member's successors as shall please him, without limit at
his sole discretion.  The hearing-venue hospital shall have the joint
obligation with each committee member to produce such objective evidence,
which shall include, but not be limited to:
        In case of an ethics- or competence-challenged member's counter-assertion
of his ethical purity and competence to judge the issues in question, the
accused practitioner may, at his sole discretion, compel the member in
question either to withdraw his membership on the ad hoc hearing
committee or to undertake a written or oral examination or both on the
subject matter at issue, administered by an independent expert, whom the
accused practitioner may designate at his sole discretion and whom the
hospital shall reimburse for that service according to any agreement it
may make with the expert.
        The accused practitioner shall have the right peremptorily to challenge
and remove a maximum of twelve members and their successors, in
aggregate, over and above his challenges for cause.
        The accused practitioner shall have the right to challenge any standard
of care which any hospital hearing committee propose by its charges,
deliberations or verdict by submitting it to the presiding
administrative-law judge.  The hospital of origin may elect to dismiss
the related charge or reaffirm the charge by a counter-challenge.  If the
hospital counter-challenge, the judge shall adjudicate the dispute with
the advice of an independent expert, agreeable in advance to both sides,
by comparison with the accepted standard of care, according to relevant
scientific medical literature, and the standard of care which any index
clinical chart indicates a member of the hearing committee practiced in
his prior patient-management.
        The judicial action shall depend on the outcome of that adjudication,
which falls into discrete categories:
1) The accused met an accepted standard of care, whether or not he met or
exceeded the standard of care the charges proposed.
2) The accused failed to meet an acceptable standard of care
3) The accused has not shown that any index case of any adjuciting or
investigating member shows failure to meet an acceptable standard of care.
4) A medical-executive-committee member's index case shows that he failed
to meet an acceptable standard of care.
5) an investigating-committee member's index case shows that he failed to
meet an acceptable standard of care.
6) An ad hoc hearing-committee member's index case shows that he failed to
meet an acceptable standard of care.
        In case 1) and 3), the judge shall dismiss the charge related to the
subject standard of care and the hospitals of origin and venue shall
abide by that dismissal.  He shall resubmit the rest of the case to the
sitting ad hoc committee to determine a recommended verdict.
        In cases 2) and 3), he shall affirm the charge as a recommended verdict
and resubmit the rest of the case to the sitting ad hoc committee to
determine the rest of recommended verdict.
        Whether case 1) or 2) pertain:
        In case 4), or 5), the administrative-law judge shall dismiss the case on
the grounds of incompetent personnel.  At that point, the hospital of
origin shall have the choice of accepting the dismissal or further
pursuing the charges against the accused.
        If the hospital choose to pursue, it shall, in case 4), re-constitute its
medical-executive committee and investigating committee from entirely
different medical-staff members with clean hands, re-investigate the case
and re-submit it to another ad hoc hearing-committee; in case 5),
re-constitute a fresh investigating committee from medical-staff members
with clean hands, re-investigate the case and re-submit it to another ad
hoc hearing-committee.
        In case 6), the administrative-law judge shall direct the hospital of
origin, if it choose to pursue, to re-submit the case to another ad hoc
hearing committee.
        In each of cases 4), 5) and 6), the administrative-law judge shall direct
the hospital to maintain logical consistency by submitting the index
chart of the committee member who failed to attain an acceptable standard
of care to the newly-constituted executive committee for investigation
with a view to disciplining the challenged committee-member.  The
administrataive-law judges engaged shall recuse themselves and the
hospital of origin shall engage different administrative-law judges to
preside at fresh hearing(s) of a new ad-hoc hearing committee at a
separate, distant hearing-venue hospital consisting of medical-staff
members who shall satisfy all the criteria for inclusion and subject
themselves and their personnel and patient records to inspection
provisions listed above and shall have had no knowledge of any charges
against the accused prior to their appointment
REQUEST FOR HEARING
        Prior to taking professional review action that may adversely affect a
physician's appointment to the Medical Staff or clinical privileges, the
administrator shall give the physician written notice, by Certified Mail,
of the proposed action and the specific charges which support the action.
The charges shall specify and limit their wording to relevant patient
name(s), name(s) of accuser(s) and/or witness(es), specific allegation(s)
and citations of relevant standard(s) which the accused allegedly
violated and, hence, which allegedly justify the charge(s).
Exclusionary Rule:
        The Administrator shall have initiated a thorough investigation of the
allegation(s) and verified the investigation committee's satisfaction
with their validity, before proposing them.  Sufficient evidence of the
administrator's irresponsibly notifying a physician of a charge shall
consist in a showing of a conflict between the charge and available
documentation. The administrator's irresponsible notification of the
accused physician of a charge against him shall result in immediate
dismissal of the charge notified, with prejudice and without possibility
of subsequent recourse.
CONDUCT OF HEARING
        Every witness and every other participant in the hearing shall swear
before the presiding administrative law judge, under penalty of perjury,
to tell the truth, the whole truth and nothing but the truth.  If a
witness suffer impeachment in the course of testimony before the ad hoc
hearing committee, that committee shall disregard all of that witness's
testimony as unreliable under the doctrine, falsus in unum, falsus in
omnibus (false in one instance, false in all).
The hospital shall:
1) conduct all hearings strictly according to rules of law relating to the
examination of witnesses, and the presentation of evidence.
2) proscribe the admission of hearsay evidence.
3) hire, at its own expense, a court reporter, who shall record  verbatim
the entirety of all hearing deliberations touching the accused
practitioner's case, including any closed-door deliberations, of the
various hearing committees, including those of the executive committee, of
the ad hoc hearing committee and of the governing body, meeting as a whole
or in subcommittee(s).  Those verbatim transcripts shall, for all
purposes, enter the official, on-the-record case archive.  The accused
practitioner, his representative(s), and his expert witness(es) shall have
access to all transcripts of all deliberations in the case archive, both
his own and prior or concurrent cases touching other practitioners who
serve as hearing-committee members for his case.
        The accused may have the right to attorney representation in the hearing
whether or not the hospital elects attorney representation.
        The accused practitioner shall have the right to remain silent and no
hospital authority or committee shall construe his silence as evidence of
guilt of preferred charges.  With adequate representation, the accused
practitioner shall have the right to confine his utterances to his
testimony as a factual witness.
        No person, whether a member of any of the several hearing committees or
not, shall discuss the case outside The context of hearing-committee
hearings and deliberations.
        The hearing committee's conclusions shall relate strictly to the charges
initially preferred.  If new issues arise during the hearing, the hearing
committee shall table them and a separate hearing committee, composed of
twelve active medical staff members of a different
hearing-committee-venue hospital, who shall satisfy all the criteria for
inclusion and voluntarily subject themselves and their personnel and
patient records to inspection provisions listed above and shall also have
had no knowledge of any charges against the accused prior to their
appointment, shall address them in and separate subsequent inquiry and
hearing.
        The Hospital shall bear the burden of proving the charge(s) against the
accused practitioner by clear and convincing proof.
OBLIGATORY PREVALENCE OF LOGICAL PRINCIPLES IN ALL HEARINGS AND DELIBERATIONS
        The governing body, medical staff, including its hearing committees,
appointed from time to time in hearing-venue hospitals, and the
corresponding hospital administrators shall recognize that enlightened
application of logic and reason and correct principles of dialogue
distinguish civilized society from primitive, savagery, barbarity and the
brute beast. Accordingly, they each, severally and collectively, endorse
and embrace logical enlightenment.  In order actively to prevent
introduction of fallacious arguments into the proceedings and avoid the
danger which fallacy poses to enlightened revelation and pursuit of
truth, the governing body, hospital administrator and medical staff agree
that initiation of penal action against the accused shall oblige the
hospital of origin to hire, at its own expense, a logician with an
academic rank at least of full professor, agreeable to the accused, to
participate in all investigations, hearings and deliberations and verify
whether or not the other participants' thinking and arguments bear
consonance with correct principles of logic.  He shall halt the
proceedings by intoning, "point of logic!" if he detect any error or
fallacious argument, to wit:
I. sophismata in dictione or sophismata in voce fallacies (semantic
fallacies) oi para thn lexin
A. Æquivocatio or Homonymia (fallacies of ambiguity or equivocation) omwnumia
1. quaternio terminorum (fallacy of four terms)
2. fallacia compositionis (fallacy of composition) sunqesiV, non causa pro
causa (fallacies of false cause) to mh aition wV aition tiqenai
a. fallacious generalization from parts to a whole
b. fallacious generalization from parts to a collection; confusion of
distributive and collective
3. fallacia divisionis (fallacy of division) diairesiV
a. fallacious generalization from a whole to its parts
b. fallacious generalization from a collection to its parts
4. fallacies of immediate inference (paralogisms)
a. fallacy of illicit obversion (the wicked alternative)
b. fallacy of illicit conversion
5. fallacies of analysis
a. incomplete analysis
b. overlapping analysis
c. cross-analysis
B. fallacia amphiboliæ (fallacy of amphiboly) amfibolia
1. fallacy of rearranging operators
2. fallacy of extensional substitution in nonextensional contexts
C. fallacia figuræ dictionis (figure of speech) schmaV
D. fallacia prosodiæ proswdia or fallacia accentus (fallacy of accent):
confusion arising from:
1. tone of voice
2. stress
3. context (selection)
E. fallacies of vagueness
1. undefined terms
2. omission of specificity
3. doublethink
4. argumentum ad nauseam (obfuscation)
F. fallacy of semantic questions
II. sophismata extra dictionem or sophismata in re oi exw thV lexewV
A. petitio principii or petitio quæsti (begging the question, seeking to
prove an argument by presuming its truth a priori) to para to en arch
lambanein h aiteisqai
1. assuming the conclusion
a. hysteron proteron (identity or inadvertent proposal of change which
preserves the status quo) usteron proteron
b. circulus probando (circular argument)
2. assuming something universal to prove a particular
3. assuming a particular to show a universal:
4. dividing a proposition and assuming in detail
5. assuming one of two reciprocally involved facts to prove the other
a. fallacy of metaphysical conjectures
b. fallacy of fictitious conjectures
6. fallacia plurium interrogationum (to ta pleiw erwthmata en poien),
fallacy of many questions or complex question
7. leading or declarative question
8. fallacious wisdom of hindsight (fallacy of the Monday-morning quarterback)
9. deterministic thinking
a. fallacy of metaphysical conjectures
b. fallacy of fictional questions
10. inconsistency (conflicting propositions)
a. Catch-22 (internal contradiction)
b. Irish Bull
B. assumptio non probata (false or unproven premise)
1. hypothesis contrary to fact
a. existential fallacy
b. antecedent contrary to fact
2. fallacia plurium interrogationum (fallacy of many questions or complex
question) to ta pleiw erwthmata en poiein
3. half-truth
4. psychic pitfalls and ego defense mechanisms
a. attitudes
b. mind-set
c. thought-habit
d. stereotypes
e. acting out
f. rationalization (finding the good reason)
g. intellectualization (isolation)
h. fallacious denial
i. displacement
j. reaction formation (overreacting, tampering)
k. compensation
l. undoing
m. projection
n. selective amnesia
o. repression
p. emotional insulation
q. identification
r. introjection (conformity)
s. fantasy (wishful thinking)
t. regression
u. avoidance, procrastination, decision by indecision
5. fallacy of expanding rumor
6. special pleading:
a. fallacy of the impromptu definition
b. weasel-gambit (or weasel-word)
c. double standard
(1). arbitrary preference, favoritism
(2). obsequious appeasement
d enjoying an unfair advantage both ways
(1). planning for unfair advantage
(2). ex post facto
7. argumentum ad auditores (attitude fitting, hypocrisy, duplicity, lip
service, cant)
8. false analogy
a. animism: imbuing abstractions or inanimate objects with life
b. personalization: imbuing abstractions or inanimate objects with human
character
c. depersonalization: converse of personalization: treating humans as
objects, often contemptible ones
d. The Great Jackass Fallacy: treating humans as beasts of burden
(instrumental fallacy, theory X)
e. fallacy of false expertise
f. segmentation fallacy
9. fallacia a dicto simpliciter ad dictum secundum quid: from a saying
[taken too] simply [ without restriction] to a saying according to what
[it really is] that is, according to its truth as holding only under
special provisos or restrictions, fallacy of accident (a rule that applies
in general applies in every circumstance, oversimplification:
a. forgetful induction
b. slothful induction
10. fallacia a dicto secundum quid ad dictum simpliciter: from a saying
according to what [it really is] - that is,according to its truth as
holding only under special provisos or restrictions - to a saying [taken
too] simply [without restriction] fallacy of converse accident, infer a
generalization from a specific, unrepresentative instance,
overgeneralization, to adlwV h mh aplwV alla ph h pou h pote h proV ti
legesqai
a. neglected aspect
b. sample bias
c. hasty induction
(1). tabloid-, capsule- or slogan-thinking
(a). "Where there's smoke, there's fire"
(b). "That raises a red flag"
(c). "Perception is reality"
(2). Summation of zeroes
(3). gambler's fallacy
(4) error of meaningless statistics
(5) error of unknowable statistics
C. non sequitur (conclusion does not follow from premises, whether valid
or not, fallacies of mediate inference)
1. conversion of an A-proposition (universal affirmative)
2. conversion of an O-proposition
3. fallacia consequentis (affirming the consequent) to para to epomenon
4. denying the antecedent
5. converting a conditional
6. negating an antecedent and consequent
7. asserting an alternative
8. fallacy of exclusive premises (two negative premises)
9. affirmative premises, negative conclusion
10. negative premises, affirmative conclusion
11. undistributed middle
12. ambiguous middle
13. fallacy of illicit process (fallacy of illicit distribution)
a. illicit process of the major term
b. illicit process of the minor term
14. contradicting a disjunct in a contrary disjunctive syllogism
15. affirming a disjunct in a subcontrary disjunctive syllogism
16. dilemmatic fallacies
a. consequents do not follow from antecedents in the major premise
b. imperfect disjunction in the minor premise
c. conclusion capable of rebuttal by a minor dilemma
17. unitary relational fallacies
a. confusion of an asymmetric relation with a symmetric relation
b. confusion of a nonsymmetric relation with a symmetric relation
c. confusion of an intransitive relation with a transitive relation
d. confusion of a nontransitive relation with a transitive relation
18. Compound relational fallacies
a. confusion of a symmetric transitive relation with any other
b. confusion of an asymmetric transitive relation with any other
c. confusion of a nonsymmetric transitive relation with any other
d. confusion of a symmetric intransitive relation with any other
e. confusion of an asymmetric intransitive relation with any other
f. confusion of nonsymmetric intransitive relation with any other
g. confusion of a symmetric nontransitive relation with any other
h. confusion of asymmetric nontransitive relation with any other
i. confusion of nonsymmetric nontransitive relation with any other
D. post hoc ergo propter hoc
1. confusion of necessary with sufficient conditions
2. fallacy of assumption of irreversible order
a. fallacy of insufficent positive correlation between two events
b. confusion of cause with effect
c. third factor
d. complex linkage: failure to recognize multiplicity of causes
3.fallacy of inappropriate extrapolation
4. statistical artifact
5. fallacy of overlooking alternative explanations
6. fallacies of inappropriate attribution of responsibility
a. fallacy of inappropriate evasion of responsibility
b. complaining about or seeking sympathy or compensation for self-caused
injury
c. fallacy of inappropriate assignment of responsibility
d. fallacy of inappropriate attribution of blame
(1) scapegoating: Dreyfus syndrome (blaming a party wholly unconnected
with an issue)
(2) blaming the victim
(3) killing the messenger
e. fallacy of inappropriate usurpation of responsibility (rescuer-syndrome)
E. ignoratio elenchi or ignoratio or mutatio conclusionis (Fallacies of
irrelevance, arguing off the point) to adlwV para thn tou elegcon agnoian
1. straw man fallacy
2. red herring fallacy
a. humor, irony and sarcasm
b. extraneous or tangential matter (fishing expedition)
c. clamorous insistence on irrelevancies
3. fallacy of persistent objection
4. fallacy of perfection
a. I need all my ducks in a row before I can start
b. fallacy of spurious presumption of irrelevant complexity
5. fallacy of extension
a.exaggeration, substituting "all" for "some"
b.witch-hunt, demonization, horribilization, making a mountain out of a
molehill, making a tempest in a teacup
c. putting words in an opponent's mouth
d. slippery-slope arguments
(1) precedent, thin-end-of-the-wedge, camel's-nose-in-the-tent,
foot-in-the-door slippery-slope argument
(2) converse of false dichotomy.
domino-theory, snowball, genie-in-the-bottle, toothpaste-out-of-the-tube,
all-hell-will-break-loose slippery-slope argument
(3) sorites, argument-of-the-beard, bald-man (falakroV),
there-is-no-cutoff-point, no-place-to-draw-the-line, slippery-slope
argument
(4) fallacious gradation of a discrete entitity
6. fallacy of false dichotomy (fallacious bifurcation, the all-or-nothing
mistake, black-and-white thinking, thinking in extremes)
7. pettifogging
a. quibbling
b. making unreasonably fine distinctions (splitting hairs)
c. wrangling about trivialities
d. fallacy of pusillanimous exactitude
e. reversal: turning day into night: eclipsing an opponent's virtues by
emphasizing his trivial or even imaginary faults or eclipsing the greater
good by miring a discussion in trivialities
8. argumentum ad ignorantiam (argument on the basis of ignorance)
9. misuse of the mean
10. argumentum ad hominem (argument against the man)
a. abusive argumentum ad hominem
(1). name-calling
(2). character assassination (poisoning the well)
b. guilt by association
c. circumstantial argumentum ad hominem
d. argumentum ad personam (vested interest)
e. tu quoque (you too)
11. argumentum ad verecundiam (appeal to awe)
a. appeal to inappropriate authority
b. fallacious presumption of institutional correctness ("The King can do
no wrong")
c. illegitimate institutional application of legitimate authority
d. self-righteousness (excessive self-esteem)
e. insolence of office (official arrogance)
12. argumentum ad misericordiam (appeal to pity)
13. argumentum ad populum (appeal to passion)
a. argumentum ad judicium (bandwagon fallacy appeal to herd-instinct,
fallacy of prevalent proof)
b.slanting
(1). misuse of "purr-words"
(a). euphemism
(b). clichés
(c). prestige jargon
(d). pseudo-technical jargon
(e). pesumptive prefacing
(2). intimidating with snarl-words
(a). threat
(a). threat of disapproval
(b). argumentum ad risibilim threat of reputation diminution by ridicule
(g). argumentum ad baculum
(b). argumentum ad infernum: insult or curse)
(3). emotional misinterpretation
(a). emotional misinterpretation of emotionally neutral, terms
(b). fallacy of reference: taking general comments personally
c. fallacy of appeal to Old Adam
14. the big lie
15. argumentum ad lapidem (abandoning the discussion)
The hopital's governing body, administrator medical staff and agents shall
acquaint themselves with logical principles, apply them diligently to all
penal-action hearings and proceedings, disregard fallacies if they arise
inadvertently and censure or expel those who insist on advancing them.
RULES OF DIALOGUE IN HEARING
        Several types of dialogue, herein dilineated, will likely occur.  The
hospital shall recognize the importance of the types of dialogue because
of the significant errors, misunderstandings misinterpretations, and
fallacies of argumentation that an unannounced dialogue shift
(dialectical shift) from one type to another may occasion.  All
participants in the process shall adhere to correct principles of
argument, herein set forth.
        Each of the hospital's agent-committees that participates in any phase of
corrective action shall bear the burden of responsibility of announcing
the type of dialogue at the beginning of its portion of the proceeding
and whenever the dialogue-type shifts.  Each member of each such
committee shall maintain a written list of commitments as the proceeding
progresses and keep his list available to the accused and his counsel.
The accused or his counsel shall keep a commitment-list for the accused.
If any participant withdraws a commitment, he shall do so only for good
and logical cause.  The logician shall determine the validity of all such
commitment-withdrawals.
        The accused, his counsel, the logician and every other participant shall
have the right to declare a failure to announce a dialogue-shift or
failure of a committee-member to record a commitment on his
commitment-list by intoning, "point of dialogue" or "point of
commitment," whenever any of them detects such a violation.  Thereupon,
the proceeding will halt and the parties shall resolve that dispute
before proceeding with the hearing proper.
        As much as possible, participants of all phases of corrective action
should confine their dialogue to the inquiry-fomat because it combines
the virtues of scientific objectivty and exclusion of unsupported
partisan opinion:
        The inquiry begins with an initial position of a certain lack of
knowledge to overcome, proceeds in a cooperative context, applyies
logical proof, where appropriate, to develop increments of knowledge by
cumulative dialogue (i. e., each participant commits to a proposition
only after he has satisfied himself that the given evidence has proven
its validity, so he will usually not retract any commitment after he
makes it), derives conclusions from premises that solid evidence can
establish as reliable knowledge to the satisfaction of all parties to the
inquiry and pursues a goal of proving a set of propositions by
establishing as much certainty as the given evidence permits.
        Participants may find themselves drawn by force of circumstances into
other  dialogue-forms that the hospital's committee-agents must recognize
and announce as they occur.  For instance, the process of achieving
satisfaction of all parties to an inquiry about any issue may involve
persuasion-dialogue.  When it does, all participants must know of the
change in dialogue-type.  All the other dialogue-types may involve
persuasion from time to time.  Participants shall adhere to Walton's
positive and negative rules of asymmetrical persuasion dialogue: the
hospital bears the burden of proof and ultimate persuasion:
POSITIVE RULES OF PERSUASION DIALOGUE.
The positive rules of persuasion dialogue provide a normative model of
good persuasion dialogue.
A. Types of dialogue, as above: Inquiry, Information-seeking,
Persuasion-dialogue, Debate, Negotiation, Action-seeking, Educational.
B. All participants shall recognize the stages of dialogue:
1. Opening stage
        In the opening stage, the hospital's agenent shall specify the type of
dialogue.
2. Confrontation stage:
        A dialogue arises from a problem, difference of opinion, or question to
be resolved that has two sides.  The two sides constitute the issue of
the dialogue.  In the confrontation stage, the hospital's agent shall
announce the issue of the dialogue, subject to participants' agreement,
so the goal of the dialogue is clear to all.
3. Argumentation stage
        The argumentation stage: each party has an obligation to contribute to or
fulfill the goal of the dialogue by appropriate methods.  A participant
has an obligation to make a serious effort to fulfill his own goal in the
dialogue.  He also has an obligation to allow the other party to fulfill
his own goal.  These obligations imply certain dialogue rules that
require participants to take turns in an orderly fashion to give the
other party a reasonable opportunity to reply to a question or make a
point.
4. Closing stage: Occurs when the participants agree that the dialogue can
end bcause they have fulfilled the goal of the dialogue or for other
reasons.  Proper ways of closing a dialogue have implications for the
rules of conducting a good dialogue.  A participant should not try to opt
out illicitly just because things do not seem to be going his way.
Participants must continue to carry on a dialogue, following the rules,
until they close it properly.
C. Five components of dialogue:
1. participants, called the proponent and the respondent, or some
equivalent names.  For purposes of theory, a participant can be thought of
as a set of propositions, or a repository of propositions that can be
enlarged or diminished by adding or deleting propositions from the set.
2. Moves or speech acts: Participants take turns making those moves.
Locution rules: permissible locutions:
a. questions
b. assertions
c. presentation of evidence
3. Commitment-set gets attached to each of the participants.  As the
sequence of moves in a dialogue progresses, a recorder must keep a record
of each participant's set of commitments at each point in the sequence.
Commitments are propositions.  At each move, a participant can incur
commitments, or retract previous commitments.
        A commitment-set is like a knowledge base or database.  It provides a
collection of premises, a pool of data for information retrieval.
        Whenever a participant advances an assertion, he becomes committed to the
proposition in the assertion.  Commitments need not arise conclusively
through moves in a dialogue.  They can comprise presumptions already
included in a participant's commitment-set prior to any moves in a
dialogue.
        Commitment-rules specify how each type of locution leads to commitments.
a. Assertion of a proposition by a participant implies that this
participant now has this proposition in his store of commitments.
b. If a participant asks a question or answers a question directly, the
presuppositions inherent in the question enter his store of commitments.
c. Any participant may withdraw from a commitment by satisfying the burden
of proof, if any, that underlies the contrary to his commitment and by
withdrawing from the conclusions that depend upon those commitments for
their validity.
d. Each side in a dispute shall list its commitments and the conclusions
they support on a running list for both sides to see throughout the
dialogue.
e. Once a participant has committed to a proposition, he may not later say
"No reply" if asked about it.  He may not know whether A is true but if he
has committed to A, then his commitment should guide his subsequent
dialogue.
4. Rules of Procedure define the conditions under which moves are
required, allowed, or forbidden during the course of the game at each
characteristic type of move-situation set and agreed upon during the
opening moves, or prior to the initiation of the sequence of dialogue.
Game does not mean something frivolous or played for entertainment.
Rather, it is a two-person, or many-person organized, interactive,
goal-directed activity-structure with a sequence of moves which each party
takes a turn performing and the moves are governed by rules of procedure.
a. Dialogue rules:
All good dialogue has procedural rules.
The dialogue rules specify turn taking and other guidelines for when and
who is allowed or required to advance locutions.
1) Every argument has two sides and each side deserves a fair evaluation.
2) He who asserts bears the burden of proof for the assertion.
3) He who asks a loaded question bears the burden of proof for the
presupposition inherent in the question and his respondent may challenge
the presupposition by demanding that the questioner meet his burden before
requiring an answer to the question.
4) Turn-taking and other guidelines for when and who is allowed or
required to advance locutions, e. g., Robert's Rules of Order
b. Question-and-Answer rules in dialogue: In reasonable dialogue one is
obliged to try to give a direct answer to a question, if one knows the
answer, and if the question is appropriate.  If one does not know the
direct answer, or for some reason cannot give it, then one is obliged to
be as informative as possible.  A question is presumably a sincere request
for information.  The questioner expects, or hopes, that the answerer may
have this information and be able to give it.  If the answerer does not
give a direct answer, his opponent may perceive his reply as unhelpful or
evasive.
1) Except for witnessing against oneself, a respondent's answer must
cooperatively reflect what he honestly and truly thinks, if he has a
definite opinion or commitment on the question.  To ensure the progress of
reasonable dialogue such rules are matters of politeness and helpful
collaboration, which are essential to the progress and success of a
critical discussion.
2) Question-and-answer analysis:
A) Identify type of question:
(1) yes-no
(2) whether
(3) why
B) Identify and state question's presuppositions
        A presupposition of a question consists of a proposition the questioner
presume the respondent can accept when he asks the question, so that the
respondent becomes committed to all its propositions when he gives any
direct answer.  Asking questions may be a form of asserting propositions
in dialogue.  Asking questions can affect the answerer's position.
(1) Identify whether the presupposition is complex
(2) Identify whether the presupposition is loaded
(3) If (1) and (2) yes, identify whether question entails the fallacy of
complex question.
C) Evaluate whether answer is direct
        A direct answer supplies exactly the information requested.  An indirect
answer supplies only part of that information.  A reply may not be a
direct or indirect answer.  Sometimes, a reasonable reply is to question
the question.
D) Evaluate whether the question is fallacious or overly aggressive.
        (1) A question is overly aggressive when it attempts to force the
answerer, by an unreasonable sequence of questions, to accept unwillingly
presuppositions of the question unwelcome to the answerer. Unwelcome
propositions mean propositions to which the answerer is not committed and
to which he should not become committed because they are prejudicial to
his side of the argument if the question attempts to preempt the
answerer's acceptance of the unwelcome proposition by presupposing that
the answerer already accepts it.
        When argument becomes too aggressive or personal, it tends to become less
reasonable and more bellicose and poses the danger of precipitating a
personal quarrel, hence, becomes especially dangerous and objectionable,
for example:
Q: How long are you prepared to condemn this company to continued failure
by your stubborn failure to change your disastrous policies?
        If the answerer gives a direct answer, as directed by the question, he is
undone and discredited.
        Begging the question is an attempt to push on a respondent an argument or
premise that he could accept only at the cost of prejudicing or
destroying his own point of view in the issue of the dialogue.  Such
questions are not sincere requests for information.  They are
mischievous, aggressively posed with harmful presuppositions that may
discredit the answerer if he attempts to respond directly.
(2) The Respondent may shift the burden of proof back onto the overly
aggressive questioner to compel him to justify presuppositions he alleges
in his loaded question, for example:
A: I do not accept your assumptions that my policies are disastrous or
that my behavior has been stubborn.
Q: You haven't answered the question!  That's typical of your evasive
tactics.
(3) If the answerer does not give a direct answer, then the questioner can
accuse him of being evasive (committing an error of irrelevance) even if
he has tried only to rebut an unwelcome presupposition of the question.
Such an accusation could make the answerer look guilty and evasive so the
answerer must answer.  But what fair and reasonable rules of dialogue
should regulate when and how an answerer must answer?
(4) Failure to give a direct answer should not necessarily be open to
criticism as evasive or irrelevant.  To give a direct answer in such a
case would be to fall into the questioner's trap.  Some questions ought to
be answered reasonably by posing another question.
        A criticism always invites a reply, but a good, well-argued criticism in
dialogue also shifts the burden of proof onto the proponent of the
argument criticized.

(5) Reasonable dialogue should be open and encourage the asking of probing
questions on all relevant aspects of a controversial issue.  The
adversarial cut and thrust of pointed criticisms and forceful rebuttals is
not, in itself, fallacious.  Adversarial interplay, which pits one
argument against another reveals and enlightens through argumentation.

(6) The opponent should not criticize his adversary's arguments too
aggressively either:
     
   Many valuable criticisms of argument do not completely refute the
argument to make an important point of criticism.  To interpret them so
strongly would imply an unwarranted dogmatism (itself an error).
       
In arguments on controversial subjects, the reasonable critic must not
necessarily show that an argument he criticizes is fallacious, logically
inconsistent, or based on worthless evidence that can be rejected
completely.  Most often, such strong refutation is not appropriate.  More
often, the critic need only shift the burden of proof or show that an
argument is open to reasonable doubt or lacks needed support and is open
to questioning.  This weaker form of criticism is very often enough to
persuade an audience to whom the argument is directed to change its point
of view on an issue.  The critic may have no more to do to have achieved
a worthwile objective.  (page 25)

(7) If the answerer has no firm commitment, he should reply "No commitment."
  
      If a person does not know the answer to a question, and he is forced to
answer the question, 'yes' or 'no,' then the rule of dialogue that
requires this direct answer commits a form of ad ignorantiam fallacy.
The answerer is unwisely forced to argue from his own ignorance.
Question-answering rules and conventions should not be so strict that the
ad ignorantiam error is built into the rules.
     
   On the other hand, if we always allow an answerer the 'No commitment'
option to any question, then [he] could always frivolously play the
skeptic, if he wished, and say 'No commitment' in answer to every
question.  Then the dialogue could go nowhere, and a truculent
participant could prevent his companion in dialogue from proving anything
or getting anywhere in his questioning.  An answerer could be as evasive
as he wished, with no penalty.  That would not be conducive to reasonable
dialogue either.

The solution to that arises from good-faith adherence to rules of
relevance and cooperativeness.

c. Rules of relevance require that a participant not wander too far off
the point (the goal of dialogue), or else he can be challenged.

d. Rules of cooperativeness require that a participant answer questions
cooperatively and accept commitments if they reflect his position
acurately.

e. Rules of informativeness require that a participant tailor his
arguments to what his respondent knows or does not know.  A participant
should provide enough information to convince his respondent but not
provide more information than is required or useful for that purpose.

5. Goal of Dialogue or criterion of success, so that a particular type of
sequence of moves, according to the rules, counts as a successful
culmination or resolution of the dialogue: to prove a proposition, to
explain a proposition, to obtain advice on a problem, to solicit help to
carry out an action, or to obtain information.

Strategic (win-loss) rules: determine what sequence of locutions and
logical operations constitute fulfillment of the goal of the dialogue.
a. Rules of proof: two kinds of proof may be involved.

1) Internal proof by a participant means proof by inferring a proposition
from the other participant's concessions in the dialogue.  This is the
primary method of persuasion dialogue.

2) External proof entails the introduction of new facts into the argument
by appealing to scientific evidence or the expert opinion of a third party
or group of expert sources.  Once a proposition is advanced by one
participant on the basis of external proof and accepted by the other
participant, it can then be appealed to as a premise suitable for an
internal proof.

b. If the premises are plausibly true, then the conclusion is as plausibly
true as the least plausible premise.
so,

c. If the arguer is committed to the premises, as part of his position,
then he should be no less strongly committed to the conclusion.

d. If he rejects the conclusion while he is committed to acceptance of the
premises, then the burden of proof is placed upon him to show why he does
not accept the conclusion as plausible.

e. In scientific inquiries, the test of an argument is whether it can be
falsified by contrary empirical evidence.

f. In disputation on controversial issues, where reasoned conviction is
the best outcome one can hope for, the strength of an argument should be
judged on how well it has fared in reasonable dialogue and free discussion
against countervailing arguments.
      
  The goal is the end-point of a dialogue, the commitment-set is the
initial point or basis of the dialogue, and the moves provide the
connecting sequence that bridges the gap between the initial point and
the end-point.

g. Each participant has an obligation to work toward fulfilling his own
goal and to cooperate with the other participant's fulfillment of his
goal.
    
    The reason that any argument can be criticized as a bad argument always comes down to failure to meet one of these basic obligations.  For
example, the peer-review process, as defined in bylaws modeled on the
JCAHCO's Guidelines, permits the hospital's power-hierarchy not to
cooperate with the accused, thus to obviate any possible conclusion in
favor of the accused by obfuscatory vagueness, particularly by omitting
any a priori definition of the goal of the dialogue or criteria of a
successful outcome.  The hospital can commit the fallacy of impromptu
definition of the criteria of success ad infinitum and defeat the
accused, irrespective of the facts at issue.
        These positive rules also imply negative rules that state prohibitions.

NEGATIVE RULES OF PERSUASION DIALOGUE

Opening stage

1. Reasonable standards of good argument shall prevent argument from
deteriorating into the personal quarrel, characterized by each arguer's
having a goal to attack or "hit" his opponent at all costs, using any
means, whether reasonable, fair or not, aggressive personal attack,
heightened appeal to emotions, a desire to win the argument at all costs
bitter recriminations and loss of balanced perspective.

2. Unlicensed shifts from one type of dialogue to another are not allowed.
Confrontation stage

1. Unlicensed attempts to change the agenda are not allowed.

2. Refusal to agree to a specific agenda of dialogue prohibits continuing
to the argumentation stage.
Argumentation stage

1. Not making a serious effort to fulfill an obligation is bad strategy.
Notable here are failures to meet a burden of proof or to defend a
commitment when challenged.

2. Trying to shift your burden of proof to the other party, or otherwise
alter the burden of proof illicitly, is not allowed.

3. Purporting to carry out an internal proof by using premises that have
not been conceded by the other party is not allowed.

4. Appealing to external sources of proof without backing up your argument
properly can be subject to objection.

5. Failures of relevance can include providing the wrong thesis, wandering
away from the point to be proved, or answering the wrong question in a
dialogue.

6. Failing to ask questions that are appropriate for a given stage of
dialogue should be prohibited, along with asking questions that are
inappropriate.

7. Failing to reply appropriately to questions should not be allowed,
including replies that are unduly evasive.

8. Failing to define, clarify, or justify the meaning or definition of a
significant term used in an argument, in accord with standards of
precision appropriate to the discussion, is a violation, if the use of
this term is challenged by another participant.

Closing stage

1. A participant must not try to force the premature closure of a dialogue
until it is properly closed, either by mutual agreement or by fulfillment
of the goal of the dialogue.
    
    Particupants shall recognize that persuasion-dialogue poses a challenge
to maintaining objectivity, avoiding fallacious argument and avoiding
deterioration into a personal quarrel.  If a personal quarrel occurs, the
logician shall intone, "point of dialogue," the proceeding shall cease
and participants shall re-initiate the proceeding in the inquiry-format.
    
    During the hearing-process, advocate(s) on either side of the dispute may subject the validity of articles or books cited in charges to collateral
attack on legitimate scientific bases but the mere recency of one article
over another shall not necessarily mandate its dominance over an earlier
article.  For one article to override another in validity, its proponent
must demonstrate objective evidence which addresses and refutes the
earlier article's assertions and conclusions, seriatim.
 
       If the accused can justify his side of the conflict by legitimate
reference to the medical literature, he shall prevail on the verdict
relating to the corresponding charge.
    
    If a conflict in the medical literature over a material point arise in the course of penal?action deliberations and if the accused prevail in that conflict, he shall also prevail on the verdict relating to the corresponding charge.  If the conflict persist among the hearing-committee members, despite all reasonable argumentation, then the hospital and its various hearing committees shall acknowledge and declare the issue equivocal, hence, resolved in the accused's favor on the basis of reasonable doubt of the validity of the charge related to the issue in dispute.
 
       If dispute persist between the accused and the united hearing committee
over the validity of a point of contention, an impartial academic
expert-physician agreeable in advance to both sides shall arbitrate the
issue at the request of either side.
  
      The hospital and its various hearing committees shall acknowledge and
declare any procedural complication which any article in the medical
literature lists as a recognized complication as:

        1. characteristic of the procedure

        2. a complication which may predictably occur by chance a certain
percentage of the time even in the best and most experienced of hands.
  
      Hence, the accused practitioner shall prevail on and enjoy exoneration
from, any charge(s) related to a procedural complication(s) upon showing
that said complication appears listed in the medical literature as a
recognized complication.
   
     The governing body, medical staff, their agents and committee(s) shall
support and justify all conclusions arising from their penal-action
deliberations by reference to relevant citation(s) from the
medical-textbook- or periodical literature or both.
   
     Under the foregoing rules, the ad hoc  committee shall conduct the
hearing on the accused practitioner's case.  The ad hoc committee shall
base its verdict(s) solely and explicitly upon the charges which the
executive committee originally preferred.  The findings and verdicts may
relate to only a portion of the original charges but shall not include
issues which the original charges did not include.  The executive
committee shall recommend finding(s), restricted to the provisions of the
ad hoc committee's verdict.  The executive committee may reject any of
the ad hoc committee's verdict(s) of guilt against the accused on any
issue but may not reject any finding or verdict in favor of the accused,
though it may challenge it (see next paragraph).  The executive committee
shall in no case supplement the ad hoc committee's verdict with any
finding of its own against the accused.  The governing body shall shall
affirm findings, restricted to the provisions of the executive
committee's recommendation(s).  The governing body may reject any of the
executive committee's recommendation(s) of guilt against the accused on
any issue but may not reject any recommendation, finding or verdict in
favor of the accused.  The governing body shall in no case supplement the
executive committee's recommendation(s) with any finding of its own
against the accused.
     

   The executive committee may recommend the ad hoc committee's verdict
against the accused practitioner or challenge it.  If the executive
committee challenge the validity or propriety of the ad hoc committee's
proceeding or recommended verdict, the hospital of origin shall hire, at
its own expense, with the approval of the accused and his
representative(s), a second administrative-law judge to preside at a
separate hearing on, and to adjudicate, that question.  To prevail, the
executive committee must convince the second administrative-law judge by
clear and convincing proof, that the ad hoc committee or executive
committee had proceeded improperly or reached an arbitrary, unreasonable
or capricious verdict.
       
The governing body may affirm the executive committee's verdict or
challenge it.  If the governing body challenge the validity or propriety
of the executive committee's proceeding or recommended verdict, the
hospital of origin shall hire, at its own expense, with the approval of
the accused and his representative(s),a third administrative-law judge to
preside at a separate hearing on, and to adjudicate, that question.  To
prevail, the governing body must convince the third administrative-law
judge, beyond reasonable doubt, that the ad hoc committee or executive
committee or both had proceeded improperly or reached an arbitrary,
unreasonable or capricious verdict.
       
If the hearing committee(s) adjudge the evidence presented against an
accused practitioner prove the case beyond reasonable doubt, it shall
recommend and the governing body shall determine, a penalty against him
which, to the gravity of each offense, proportionates according to a
reasonable application of principles in a set of penalty guidelines which
the medical staff shall frame in advance, for the edification and
guidance of those bodies, on the basis of prior adjudications.  The
accused and his representative(s) shall have access to the penalty
guidelines and may challenge his assigned penalty on their bases before
the first administrative-law judge, described above.
       
The first administrative-law judge's finding that the ad hoc committee
had proceeded improperly shall mandate the hospital's dismissing all the
ad hoc and executive committee's recommended verdicts and instituting a
new hearing before a newly constituted ad hoc committee, drawn from a
separate, distant hospital medical staff, consisting of members who shall
satisfy all the criteria for inclusion and subject themselves and their
personnel- and patient-records to inspection-provisions listed above and
shall have had no knowledge of any charges against the accused prior to
their appointment.  The medical council shall present charges to the new
ad hoc committee which shall consist only of the original charges or
portion thereof and charges based upon any new facts revealed during the
hearing(s) before the prior ad hoc committee.
       
The case shall enter a court's jurisdiction if the hospital of origin
fail to convene for the new hearing such new ad hoc committee in thirty
(30) days from the date of that dismissal.
      
  The governing body and medical staff, each and separately, affirm and
ratify the foregoing articles with the intent of ensuring that the
conduct of fair hearings of accused practitioners in and on behalf of the
hospital shall accord with American principles of law and fair dealing
which govern our local, state and Federal laws and to which our national
forefathers pledged their lives, their fortunes and their sacred honor.
__________________________________________
__________________________________________
Chairman, Hospital-Governing Body                          Chief of the Medical Staff
__________________________________________
__________________________________________
Member, Hospital-Governing Body                          Hospital-Administrator
(etc.)