The Medical staff counselor
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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.
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Physicians often find themselves the victims of uninformed peer review practices whereby hospital boards make decisions regarding medical staff privileges without adequately evaluating the charges and without affording physicians the appropriate due process protections. In addition to damaging a physician's reputation, such unfair review practices can lead to liability exposure and expensive and prolonged litigation. This article describes how medical staff physicians and hospital board members can avoid these problems by taking an active and informed role in the peer review process.
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This two-part article examines the statutory framework in New York State for the issuance of DNR orders. Part I addresses the procedure for issuance of a DNR order, including determination of capacity to consent to issuance, the effect of consent to a DNR order by an adult patient or a surrogate, issuance of a DNR order for an adult who lacks capacity and for whom no surrogate is available, and consent to DNR on behalf of a minor. Part II, which will appear in the next issue of this journal, will address revocation of consent to, and cancellation of, DNR orders, the dispute mediation system, the role of the courts, and the effects of a DNR order. [Note: As this article was going to press, the New York State Legislature passed a statute (1991 N. ⋯ Laws Ch. 370) that amends New York Public Health Law Article 29-B, discussed herein. As a result of these amendments, some of the provisions discussed in Part I have been modified. A summary of these modifications will appear in Part II.]
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This article discusses the duties of hospital governing boards, medical staffs, medical staff officers, and individual medical staff members regarding the credentialing of physicians, including the potential liability of these groups for negligent medical care and wrongful denial of staff privileges. This article also proposes possible measures these groups may take to avoid or limit their exposure to such liability.