Is the Medical Staff Independent in California? Not Exactly

Some commentators have misinterpreted the Bichai choice to imply {that a} medical workers and its affiliated hospital are completely unbiased of one another. In actuality, the two entities are virtually and legally interdependent.

In Bichai v. Dignity Health (2021), the Fifth District Court docket of Attraction accurately famous that California hospitals and medical staffs are separate authorized entities. Consequently, the Bichai courtroom held – additionally accurately – that when a medical workers recommends opposed motion in opposition to considered one of its members, however the hospital’s board has not but taken motion, no reason behind motion arises for retaliation in opposition to the hospital below Well being and Security Code § 1278.5. In different phrases, till the board acts, the aggrieved doctor could not deliver a retaliation lawsuit in opposition to the hospital.

Since then, nevertheless, some commentators have said that Bichai means medical staffs are usually not solely legally separate but in addition unbiased from their hospitals. That conclusion considerably overstates Bichai’s affect. 

It ignores the nuanced relationship in California between medical staffs and their affiliated hospitals. Additionally it is complicated and divisive. As a substitute, a way more correct studying of Bichai, along with relevant California legislation, is that: (1) the medical workers and hospital are certainly separate authorized entities; (2) the medical workers enjoys statutory unbiased rights[1]; and (3) as a result of the hospital and the medical workers rely upon each other to advance the hospital’s mission, they’re largely interdependent. That is clear from each a sensible and authorized standpoint.  

Virtually Interdependent

Virtually, the hospital and medical workers have a transparent and plain frequent curiosity in the hospital’s success. Each entities profit from the hospital’s service success, affected person loyalty, and stellar market repute. To pursue this frequent curiosity, the hospital and medical workers should have interaction in day-to-day cooperation and develop a powerful, trusting partnership.

Legally Interdependent

Legally, sure realities make it clear that California medical staffs are usually not completely unbiased of their hospitals, however should work together cooperatively in sure respects.

  • Sure, the medical workers is self-governing, however:

    • It can not unilaterally amend its personal medical workers bylaws.[2]

    • It can not appoint or terminate its personal members – it will probably solely suggest appointment and termination to the hospital board, which makes the last choice.[3] This authorized division of disciplinary accountability is the foundation for the right Bichai choice: The board hardly ever acts on such issues till after the medical workers has acted.[4]

    • The medical workers’s peer evaluate should be overseen by the hospital, which has a authorized obligation to make sure the medical workers’s competence.[5]

    • The medical workers depends on the hospital to “indemnify the medical staff and its individual members from and against losses and expenses [arising from] litigation-related costs…relating or pertaining to any alleged act or failure to act within the scope of peer review… activities.” This can be a common requirement in medical workers bylaws all through California.[6]

    • If any hospital ceased to exist, so would its medical workers.

  • Sure, the hospital governing physique (board) has final authority over the hospital, however:

    • It can not unilaterally amend the medical workers bylaws.[7]

    • When withholding approval of bylaws amendments, the board can not accomplish that unreasonably.[8]

  • Sure, the hospital board appoints members of the medical workers and grants privileges, however:

    • It might accomplish that solely on the medical workers’s advice.[9]

    • It might not take motion in opposition to a medical workers member’s privileges or membership with out the medical workers’s advice, besides in excessive circumstances when the medical workers has failed or refused to behave.[10]  (As famous above, that is the division of disciplinary accountability forming the foundation for the Bichai choice.)

    • The hospital board has last approval authority over a medical workers member’s enchantment of a reportable opposed peer evaluate choice, however it nonetheless should give nice weight to the medical workers’s suggestions and choices.[11] It should attain a choice by making use of the customary of evaluate offered in the bylaws, and in most instances not by exercising its unbiased judgment.[12]

In a few of the dialogue about Bichai, the above realities are disregarded. To make certain, the medical workers is a separate authorized entity from the hospital, and thus the hospital isn’t answerable for the medical workers’s suggestions on which the hospital has not but acted. Nonetheless, that doesn’t imply that both the medical workers or the board is unbiased of the different. The uniquely interdependent relationship between the two entities is simply too necessary to permit them to be so totally disconnected. Peer evaluate attorneys, medical workers leaders, and hospital board members on either side of those issues can deliver extra stability, cause, and accuracy to this important dialogue.


[1] See Bus. & Prof. Code, § 2282.5.

[2] Id., §(a)(6).

[3] See Cal. Code Regs., tit. 22, § 70703.

[4] See Bus. & Prof Code, §§ 809.05 (b) and (c).

[5] See Elam v. School Park Hospital (1982) 132 Cal.App.3d 332, 341-42, 347; Hongsathavij v. Queen of Angels/Hollywood Presbyterian Medical Heart (1998) 62 Cal.App.4th 1123, 1143.

[6] CHA Mannequin Medical Staff Bylaws, § 9.5.1; see CMA Mannequin Medical Staff Bylaws, § 13.6.

[7] See Bus. & Prof. Code, § 2282.5(a)(6); Cal. Code Regs., tit. 22, § 70701.

[8] Ibid.

[9] See Cal. Code Regs., tit. 22, § 70701.

[10] See Bus. & Prof. Code, § 809.05(b) and (c).

[11] See Bus. & Prof. Code, § 809.05(a).

[12] Huang v. Board of Administrators (1990) 220 Cal.App.3d 1286, 1294-95.

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