State of Illinois
92nd General Assembly

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SB933 Enrolled                                 LRB9205026LBmb

 1        AN ACT concerning health facilities.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5.  The Hospital  Licensing  Act  is  amended  by
 5    adding Section 10.8 as follows:

 6        (210 ILCS 85/10.8 new)
 7        Sec. 10.8.  Requirements for employment of physicians.
 8        (a)  Physician   employment  by  hospitals  and  hospital
 9    affiliates.  Employing  entities  may  employ  physicians  to
10    practice medicine in all of its branches  provided  that  the
11    following requirements are met:
12             (1)  The  employed  physician  is  a  member  of the
13        medical  staff  of  either  the  hospital   or   hospital
14        affiliate.   If  a  hospital  affiliate decides to have a
15        medical staff, its medical staff shall  be  organized  in
16        accordance   with  written  bylaws  where  the  affiliate
17        medical staff is responsible for  making  recommendations
18        to  the  governing  body  of  the affiliate regarding all
19        quality    assurance    activities    and    safeguarding
20        professional  autonomy.   The  affiliate  medical   staff
21        bylaws   may not be unilaterally changed by the governing
22        body of the affiliate.  Nothing in this Section  requires
23        hospital affiliates to have a medical staff.
24             (2)  Independent physicians, who are not employed by
25        an  employing  entity, periodically review the quality of
26        the medical services provided by the  employed  physician
27        to continuously improve patient care.
28             (3)  The employing entity and the employed physician
29        sign  a  statement  acknowledging that the employer shall
30        not unreasonably exercise control, direct,  or  interfere
31        with  the  employed physician's exercise and execution of
SB933 Enrolled             -2-                 LRB9205026LBmb
 1        his  or  her  professional  judgment  in  a  manner  that
 2        adversely affects the  employed  physician's  ability  to
 3        provide  quality care to patients.  This signed statement
 4        shall take the form of a  provision  in  the  physician's
 5        employment  contract  or  a separate signed document from
 6        the employing entity  to  the  employed  physician.  This
 7        statement  shall  state: "As the employer of a physician,
 8        (employer's  name)  shall   not   unreasonably   exercise
 9        control,   direct,   or   interfere   with  the  employed
10        physician's  exercise  and  execution  of  his   or   her
11        professional  judgment in a manner that adversely affects
12        the employed physician's ability to provide quality  care
13        to patients."
14             (4)  The employing entity shall establish a mutually
15        agreed  upon  independent  review  process  with criteria
16        under which an employed physician may  seek review of the
17        alleged violation of this Section by physicians  who  are
18        not  employed by the employing entity.  The affiliate may
19        arrange with the hospital medical staff to conduct  these
20        reviews.   The independent physicians shall make findings
21        and  recommendations  to  the  employing  entity  and the
22        employed physician within 30 days of  the  conclusion  of
23        the gathering of the relevant information.
24        (b)  Definitions.  For the purpose of this Section:
25        "Employing  entity"  means  a hospital licensed under the
26    Hospital Licensing Act or a hospital  affiliate.
27        "Employed physician" means a physician  who  receives  an
28    IRS  W-2 form, or any successor federal income tax form, from
29    an employing entity.
30        "Hospital" means a hospital licensed under  the  Hospital
31    Licensing   Act,   except  county  hospitals  as  defined  in
32    subsection (c) of Section 15-1 of the Public Aid Code.
33        "Hospital affiliate" means  a  corporation,  partnership,
34    joint   venture,   limited   liability  company,  or  similar
SB933 Enrolled             -3-                 LRB9205026LBmb
 1    organization,  other  than  a  hospital,  that   is   devoted
 2    primarily  to the provision, management, or support of health
 3    care services and that directly or  indirectly  controls,  is
 4    controlled  by,  or  is under common control of the hospital.
 5    "Control" means having  at  least  an  equal  or  a  majority
 6    ownership or membership interest.  A hospital affiliate shall
 7    be  100% owned or controlled by any combination of hospitals,
 8    their parent corporations, or physicians licensed to practice
 9    medicine  in  all  its  branches  in  Illinois.     "Hospital
10    affiliate" does not include a health maintenance organization
11    regulated under the Health Maintenance Organization Act.
12        "Physician" means  an  individual  licensed  to  practice
13    medicine in all its branches in Illinois.
14        "Professional    judgment"  means   the  exercise  of   a
15    physician's  independent  clinical   judgment  in   providing
16    medically appropriate diagnoses, care,  and  treatment  to  a
17    particular patient at a particular time.  Situations in which
18    an  employing  entity  does  not  interfere  with an employed
19    physician's   professional    judgment    include,    without
20    limitation, the following:
21             (1)  practice restrictions based upon peer review of
22        the   physician's  clinical practice to assess quality of
23        care and utilization of   resources  in  accordance  with
24        applicable bylaws;
25             (2)  supervision   of  physicians  by  appropriately
26        licensed  medical  directors,  medical  school   faculty,
27        department   chairpersons  or  directors, or  supervising
28        physicians;
29             (3)  written  statements  of  ethical  or  religious
30        directives; and
31             (4)  reasonable  referral  restrictions that do not,
32        in the reasonable professional judgment of the physician,
33        adversely affect the health or welfare of the patient.
34        (c)  Private enforcement. An employed physician aggrieved
SB933 Enrolled             -4-                 LRB9205026LBmb
 1    by a violation of this Act may seek to obtain  an  injunction
 2    or  reinstatement  of employment with the employing entity as
 3    the court may deem  appropriate.   Nothing  in  this  Section
 4    limits  or  abrogates any common law cause of action. Nothing
 5    in  this  Section  shall  be  deemed  to  alter  the  law  of
 6    negligence.
 7        (d)  Department enforcement.  The Department may  enforce
 8    the  provisions  of this Section, but nothing in this Section
 9    shall require or permit the Department to  license,  certify,
10    or   otherwise  investigate  the  activities  of  a  hospital
11    affiliate not  otherwise  required  to  be  licensed  by  the
12    Department.
13        (e)  Retaliation  prohibited.   No employing entity shall
14    retaliate against any employed  physician  for  requesting  a
15    hearing  or  review  under  this  Section.   No action may be
16    taken that affects the ability of  a  physician  to  practice
17    during this review, except in circumstances where the medical
18    staff bylaws authorize summary suspension.
19        (f)  Physician  collaboration.  No employing entity shall
20    adopt or enforce, either  formally   or    informally,    any
21    policy,   rule, regulation, or practice inconsistent with the
22    provision  of  adequate  collaboration,   including   medical
23    direction   of  licensed   advanced   practice    nurses   or
24    supervision of licensed physician assistants  and  delegation
25    to other personnel under Section 54.5 of the Medical Practice
26    Act of 1987.
27        (g)  Physician  disciplinary  actions.   Nothing  in this
28    Section shall be construed to limit or prohibit the governing
29    body of an employing entity or its  medical  staff,  if  any,
30    from  taking  disciplinary  actions  against  a  physician as
31    permitted by law.
32        (h)  Physician review. Nothing in this Section  shall  be
33    construed  to  prohibit a hospital or hospital affiliate from
34    making a determination not to pay  for  a  particular  health
SB933 Enrolled             -5-                 LRB9205026LBmb
 1    care  service  or  to  prohibit  a medical group, independent
 2    practice association, hospital  medical  staff,  or  hospital
 3    governing  body  from  enforcing  reasonable  peer  review or
 4    utilization  review  protocols  or  determining  whether  the
 5    employed physician complied with those protocols.
 6        (i)  Review.  Nothing in this Section   may  be  used  or
 7    construed  to  establish  that  any activity of a hospital or
 8    hospital affiliate is subject to review  under  the  Illinois
 9    Health Facilities Planning Act.
10        (j)  Rules.    The   Department  shall  adopt  any  rules
11    necessary to implement this Section.

12        Section 99.  Effective  date.  This Act takes  effect  on
13    September 30, 2001.

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