The specific limitations on each classification of privileges may very from hospital to hospital, as long as they are clearly established in the bylaws. The classification apply only to staff members in good standing; they should not be used to limit the privileges of a staff member after disciplinary proceedings. The hospital should establish special classifications for physicians whose privileges have been limited as the result of discipline. This will avoid conflicts with staff members in good standing who would resent being classed with disciplined physicians.
The main risk management concern with staff classification is the requirement that all staff members, regardless of classification, meet the same standards for basic competence and ethical behavior. Courtesy and consulting staff status must not imply a limitation of privileges because of limited qualifications. Rather it must represent a voluntary agreement to accept limited privileges in return for not accepting the administrative duties required of active staff status. Active staff status requires a substantial commitment of time to medical staff administrative functions and usually entails emergency call at the hospital. A physician will typically have active staff status at one hospital and courtesy status at nearby hospitals. This allows the physician to hospitalized a patient even if the physician's primary hospital does not have a bed available. the hospital has the same duty to monitor courtesy staff members as it does to monitor active staff members because they will have few admissions.
Consulting staff members may be allowed to admit a limited number of patients, but primarily they should assist in the care of patients admitted by other staff members. The hospital should endeavor to have a good cross section of medical specialties represented on its consulting staff. The duties of consulting staff members should include being available in emergencies to lend their special expertise. This does not mean they must maintain a formal call system, but it does mean they must be available for second opinions, especially in situations where the hospital bylaws demand a second opinion before a procedure may be performed.
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