A letter from the OMSS Chair

September 16, 2021

Dear OMSS Members and respected colleagues:

Thank you for your ongoing membership in the California Medical Association (CMA) Organized Medical Staff Section (OMSS).  CMA’s robust advocacy on medical staff issues would not be possible without your support.

I would like to highlight just a few of the important advocacy issues that CMA has been working on.

Medical Board Sunset Review

SB 806 is the periodic sunset review bill regarding the Medical Board of California, and various other healing arts boards. This bill was amended suddenly to include problematic provisions without being vetted by any policy committee in the California Senate. CMA, its component medical society and physician leaders responded quickly by contacting lawmakers to explain why these provisions and process were so troubling for the profession of medicine. Due to this advocacy, many of the most problematic provisions were amended.

Office of Health Care Affordability

AB 1130 (Wood) would create an Office of Health Care Affordability with the authority to set cost-growth targets for the state, for geographic regions, and for each sector of the health care delivery system, collect data it deems necessary to set those targets, and penalize those entities that do not meet those cost targets. The broad definition of provider in the bill does not take into account the corporate structures and operations that can create significant variances in cost. Without a more focused definition, the office could be bogged down by minutia and analysis of entities that might do little to contribute to ballooning health care costs.

The issue of health care affordability is one that needs to be addressed and one that the medical profession has devoted significant resources to develop creative solutions to. CMA is opposed to AB 1130 because, as currently drafted, it will create more administrative complexities for physicians, further incentivize health care consolidation, and lead to further cost increases for patients. 

AB 1130 stalled in the Senate this year, and CMA will remain engaged as the conversation around health care affordability continues.

Corporate Power Plays

Two hospital medical staffs became victimized by major corporate power plays. In 2018, St. Mary Medical Center was acquired by Dignity Health. Beginning in January 2019, Dignity began to terminate its relationships with medical groups which held exclusive contracts with the hospital. This included termination of the longstanding contract with the anesthesia group with whom St. Mary had contracted for over six decades. This unfortunately led to immediate turmoil in the MEC of St Mary, as the Chief of Staff belonged to the previously contracted Anesthesiologists. He, along with other members of the medical staff's leadership, was forced to resign due to this sudden change in contracted physicians.

Similarly, earlier this year, the administration at Palomar Health decided to unilaterally replace longstanding physician contracts for emergency care, hospitalists, and intensivists at the health system's hospitals in Poway and Escondido. The Palomar Administration undertook these actions against the recommendations of the facilities' medical staffs, and allegedly stifled the ability of the MEC to provide meaningful input. This led to immediate push back by the medical staff, which subsequently filed a unanimous vote of no-confidence against the Administration and resulted in substantial public pushback against the Administration's actions.

Unfortunately, as corporate consolidation increases and smaller hospital get gobbled up by huge corporate entities and private equity firms, these power plays will become all too common. Courts are reluctant to get involved in hospital overhead decisions. This was evidenced by their refusal to accept the amicus curiae brief drafted by CMA in the St. Mary case, which highlighted the grave concerns surrounding medical staff self-governance and the prohibition on the corporate practice of medicine.

That leaves us with only one recourse: tighten up your Medical Staff Bylaws so that they are consistent with the CMA Model Bylaws, which were recently cited by the California Supreme Court in its decision in Natarajan v. Dignity Health. In fact, if there were stronger provisions in the St. Mary Medical Staff bylaws against replacing MEC members despite any changes in the status of physician contracts, this probably would have averted this situation.

I urge all OMSS Members to take advantage of their Membership: the CMA Model Bylaws are available free to all OMSS Member Medical staff. We review these Bylaws annually and make changes to reflect current law and protect medical staff self-governance rights.

If these topics interest you, please visit the OMSS page on the CMA website. There are many other stories of relevance to medical staff. I also encourage you to register to participate in the virtual CMA OMSS Assembly meeting to be held on October 22, 2021. As always, we welcome and encourage your participation at all OMSS events. 

Until next time, 

Vimal I. Nanavati, MD, FACC, FSCAI
Chair, CMA Organized Medical Staff Section (OMSS)
California Medical Association



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