The Medical staff counselor
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This is the second part of a two-part article examining the federal patient anti-dumping statute, under which physicians are required to treat a hospital's emergency patients, including women in labor, and to comply with certain requirements that dictate when it is appropriate to transfer a patient. Part I discussed in detail the provisions of the statute. Part II analyzes various court interpretations of the law and its potential impact on physician liability.
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This article describes the types of medical staff credentialing and peer review activities that invite the scrutiny of the Federal Trade Commission. To avoid antitrust problems, medical staffs and their members are advised to offer recommendations based on specific quality-of-care concerns. Antitrust problems will arise, however, if the medical staff or its members engage in collective activities that involve threats or coercion directed at the hospital's governing board or that are calculated solely to exclude an entire class of potential competitors.
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The occasional imposition of antitrust liability on medical staff members for actions involving peer review is not a sufficient reason to abandon medical staff participation in the peer review process. This article reviews some of the case law in which the applicability of the intracorporate conspiracy doctrine to medical staff peer review activity has been decided and explains why appropriate medical staff involvement in such activity does not raise the risk of antitrust liability.
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Hospital medical staffs will have to make a major transition over the next few years from quality assurance to continuous quality improvement. As this article discusses, many elements of the change are new to health care, as yet untested, and should be approached carefully.