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District Health Authorities Medical Staff (Disciplinary) By-laws
made under Section 23 of the
Health Authorities Act
S.N.S. 2000, c. 6
and under Section 6 of the
Hospitals Act
R.S.N.S. 1989, c. 208
N.S. Reg. 289/2007 (April 11, 2007, effective May 1, 2007)
Part I
1 Definitions
1.1 In these bylaws
1.1.1 Act means the Health Authorities Act;
1.1.2 Board means the Board of Directors of the DHA or a committee of the Board which may have delegated authority, under the DHA’s Corporate By-laws made pursuant to subsection 22(1) of the Act, to carry out all or part of the DHA’s Board of Directors’ role under these by-laws;
1.1.3 Capital Health means the Capital District Health Authority, the QEII Health Sciences Centre, and the Nova Scotia Hospital;
1.1.4 CEO means the person appointed by the Board to be the Chief Executive Officer of the DHA;
1.1.5 Credentials Committee means the committee of physicians having privileges granted by the Board whose members and chair are appointed by the District MAC; the committee carries out those functions assigned to it by these bylaws;
1.1.6 Dentist means a person who, under the Dental Act, is registered in the Dentists’ Register and holds a licence to practise dentistry;
1.1.7 DHA means a District Health Authority established pursuant to the Act and for the purposes of these bylaws includes Capital Health;
1.1.8 District means a health district established pursuant to the Act;
1.1.9 District Chief of Staff means a person who is the senior medical administrator (including a Medical Director; Vice President, Medical Services; or in Capital Health, the VP Medicine) for the district, appointed by the CEO;
1.1.10 District Department Chief means a person appointed by the DHA (or the CEO, if the DHA so directs) and who reports to the DHA through the District Chief of Staff (or in Capital Health, the VP Medicine) and the CEO;
1.1.11 District MAC means the committee as defined by subsection 4.1;
1.1.12 District MAC ISC means the District MAC Investigation Sub-Committee defined by Section 4;
1.1.13 District Medical Staff Association means the District Medical Staff Association as defined in the DHA’s Medical Staff (General) Bylaws;
1.1.14 Hospital site means a hospital as defined by the Hospitals Act and allocated to the DHA pursuant to the Act;
1.1.15 Investigation means examinations of materials and documentation provided by the parties and does not include the holding of a hearing;
1.1.16 Medical Staff means those physicians and dentists who have privileges granted by a Board;
1.1.17 Member means a member of the Medical Staff;
1.1.18 Party means
1.1.18.1 the DHA and its representatives, or
1.1.18.2 the Member;
1.1.19 Physician means a person who, under the Medical Act, is registered in the Medical Register and holds a licence to practise medicine;
1.1.20 PRC means the Privileges Review Committee appointed by the Board;
1.1.21 Proposed Agreement means a settlement agreement between the Parties as mediated by the PRC;
1.1.22 Provincial Appeal Board means a board constituted pursuant to clause 23(b) of the Act and carries out those functions assigned to it by these bylaws;
1.1.23 Site-based Medical Leader means a person appointed by the DHA (or the CEO, if the DHA so directs) and who reports to the DHA through the District Chief of Staff and the CEO;
1.1.24 Site Manager means a person who is appointed by the DHA (or the CEO, if the DHA so directs) and reports to the DHA through the CEO and is responsible for the administration of a hospital site;
1.1.25 working day means those days of the week excluding weekends and statutory holidays.
2 Privileges review committee (PRC)
2.1 For the purposes of these bylaws, the PRC shall have the composition as described in the DHA’s Corporate Bylaws.
2.2 In presenting submissions to the PRC, a Member may be represented by legal counsel, if the Member so wishes.
2.3 Notwithstanding that the appointment of a member or members of the PRC expires prior to the completion of any matter before the PRC pursuant to these bylaws, such member or members shall continue to be seized with the jurisdiction to complete such matter and, for this purpose, such member or members shall continue to have the same powers, privileges, immunities and duties as are granted to members of the PRC pursuant to these bylaws.
3 Composition of the provincial appeal board
3.1 For the purposes of these bylaws, the Provincial Appeal Board shall be composed of
3.1.1 a Chair and a Vice-Chair who shall be lawyers and are appointed by the Minister of Health and Wellness,
[Note: The reference to the Minister has been updated in accordance with Order in Council 2011-15 under the Public Service Act, R.S.N.S. 1989, c. 376, effective January 11, 2011.]
3.1.2 9 members consisting of one member appointed by each DHA, who may or may not be members of the board of the DHA, and who shall not be physicians or dentists,
3.1.3 9 physicians appointed by Doctors Nova Scotia, and
3.1.4 9 dentists appointed by the Nova Scotia Dental Association.
3.2 Members of the Provincial Appeal Board shall be appointed to office for a term of three years.
3.3 Notwithstanding subsection 3.2, the terms of office of members of the Provincial Appeal Board upon the first appointment of members to the Provincial Appeal Board shall be
3.3.1 the Chair appointed for a term of three years,
3.3.2 the Vice-Chair appointed for a term of two years,
3.3.3 9 members appointed by DHAs pursuant to clause 3.1.2, as may be determined by the DHAs, provided that no term exceeds 3 years,
3.3.4 9 members appointed by the Medical Society pursuant to clause 3.1.3, as may be determined by the Medical Society, provided that no term exceeds 3 years, and
3.3.5 9 members appointed by the Dental Association pursuant to clause 3.1.4, as may be determined by the Dental Association, provided that no term exceeds 3 years.
3.4 Notwithstanding subsections 3.2, 3.3, and 3.4, persons appointed to the Provincial Appeal Board hold office until such time as they are re-appointed, or until their successors are appointed, even if such re-appointment or appointment does not occur until after their specified term of office has expired.
3.5 Notwithstanding that the appointment of a member or members of the Provincial Appeal Board expires prior to the completion of any matter before the Provincial Appeal Board pursuant to subsections 7.15, 7.16, 8.11 or 8.12 of the Medical Staff (Disciplinary) Bylaws, such member or members shall continue to be seized with the jurisdiction to complete such matter and, for this purpose, such member or members shall continue to have the same powers, privileges, immunities and duties in relation to such matter as are granted to members of the Provincial Appeal Board pursuant to these bylaws.
3.6 Where the Provincial Appeal Board receives notice pursuant to clauses 7.15.1, 7.16.1, 8.11.1 or 8.12.1 regarding a physician’s privileges, the Provincial Appeal Board shall conduct an appeal or a hearing, as applicable, with the following composition:
3.6.1 the Chair or the Vice Chair, who shall sit as Chair of the Provincial Appeal Board,
3.6.2 2 members selected by the Chair from those members who have been appointed by the DHAs to the Provincial Appeal Board pursuant to clause 3.1.2, and
3.6.3 2 members selected by the Chair from those members appointed by the Doctors Nova Scotia to the Provincial Appeal Board pursuant to clause 3.1.3.
3.7 Where the Provincial Appeal Board receives notice pursuant to clauses 7.15.1, 7.166.1, 8.11.1 or 8.12.1 regarding a dentist’s privileges, the Provincial Appeal Board shall conduct an appeal or a hearing, as applicable, with the following composition:
3.7.1 the Chair or the Vice Chair, who shall sit as Chair of the Provincial Appeal Board,
3.7.2 2 members selected by the Chair from those members who have been appointed by the DHAs to the Provincial Appeal Board pursuant to clause 3.1.2, and
3.7.3 2 members selected by the Chair from those members appointed by the Dental Association to the Provincial Appeal Board pursuant to clause 3.1.4.
3.8 No DHA members selected by the Chair pursuant to clauses 3.6.2 or 3.7.2 shall reside within the boundaries of or be a member of the Board of the DHA that is a party to the hearing.
3.9 No Doctors Nova Scotia members selected by the Chair pursuant to clause 3.6.3 shall engage in the practise [practice] of medicine within the boundaries of or be a member of the Medical Staff of the DHA that is a party to the hearing.
3.10 No Dental Association members selected by the Chair pursuant to clause 3.7.3 shall engage in the practise [practice] of dentistry within the boundaries of the DHA that is a party to the hearing.
3.11 The Provincial Appeal Board may seek such specialized or expert advice as it sees fit in a particular case and any reports generated by such specialists or experts for the Provincial Appeal Board must be disclosed to all parties.
3.12 In proceedings of the Provincial Appeal Board, a Member may be represented by legal counsel if the Member so wishes.
4 Composition of District MAC & District MAC ISC
4.1 The District MAC is hereby established for the purpose of these bylaws and shall have such composition as the DHA determines in the DHA’s Medical Staff (General) Bylaws.
4.2 The District MAC ISC is a sub-committee of the District MAC whose purpose is to to deal with
4.2.1 appointments or re-appointments where the Credentials Committee’s recommendation is at variance with the requested privileges, or
4.2.2 discipline processes under Sections 8 and 9; and
members of the District MAC ISC are to sit on the committee on an independent basis and not as representatives of any interests, services, or specialities that they may be viewed as representing under subsection 4.5 or the Departments that they represent on District MAC.
4.3 For the purposes of these bylaws, the District MAC ISC shall be composed of
4.3.1 a Chair and a Vice-Chair appointed by the District MAC and who may or may not be members of the District MAC; and
4.3.2 no less than 3 and no more than 8 members appointed by the District MAC and who may or may not be members of the District MAC.
4.4 Notwithstanding subsection 4.3, at least one half of the members appointed pursuant to clause 4.3.2 shall not be members of the District MAC.
4.5 In making appointments pursuant to clause 4.3.2, the District MAC shall take into consideration
4.5.1 the services offered by the DHA;
4.5.2 the nature of the facilities in the DHA; and
4.5.3 the nature of the medical practice of the potential member.
4.6 The District Chief of Staff and the President of the District Medical Staff Association are not eligible for appointment to the District MAC ISC.
4.7 Members of the District MAC ISC shall be appointed to office for a term of three years.
4.8 Notwithstanding subsection 4.7, the terms of office of members of the District MAC ISC upon the first appointment of members shall be
4.8.1 the Chair appointed for a term of three years;
4.8.2 the Vice-Chair appointed for a term of two years;
4.8.3 50% of the members appointed pursuant to clause 4.3.2 for a term of 3 years; and
4.8.4 50% of the members appointed pursuant to clause 4.3.2 for a term of 2 years.
4.9 Notwithstanding subsections 4.7 and 4.8, persons appointed to the District MAC ISC hold office until such time as they are re-appointed, or until their successors are appointed, even if such re-appointment or appointment does not occur until after their specified term of office has expired.
4.10 Notwithstanding that the appointment of a member or members of the District MAC ISC expires prior to the completion of any matter before the District MAC ISC, such member or members shall continue to be seized with the jurisdiction to complete such matter and, for this purpose, such member or members shall in relation to such matter continue to have the same powers, privileges, immunities and duties as are granted to members of District MAC ISC pursuant to these bylaws.
4.11 Where the District MAC ISC receives notice pursuant to clauses 5.9.1, 7.9.1, subsection 8.1, or clause 9.2.1 regarding a physician’s or dentist’s privileges, the District MAC ISC shall conduct an investigation using a panel with the following composition:
4.11.1 the Chair or the Vice-Chair, who shall sit as Chair of the District MAC ISC panel; and
4.11.2 2 members of the District MAC ISC selected by the Chair of the District MAC ISC.
4.12 Any member of the District MAC ISC who is present at a meeting of the District MAC where information is presented or discussed which has the potential of becoming a source of investigation by the District MAC ISC shall excuse themselves from the meeting for the duration of the discussion and shall not participate in any discussions respecting the matter except in the context of deliberations of the District MAC ISC.
Part II
5 Appointment of medical staff
General
5.1 The Board may appoint new Members in its sole and absolute discretion to the Medical Staff of the DHA in the manner provided for in these bylaws.
5.2 Subject to subsection 5.2A, in districts where there are affiliation agreements with academic institutions, appointments to the Medical Staff and departments shall be made by the Board in accordance with such affiliation agreements.
5.2A Where there is a conflict between these bylaws and an affiliation agreement, these bylaws shall prevail.
5.2B Any physician or dentist whose relationship with the Board is established solely through granting of privileges shall be subject to these bylaws and the provisions of Section 23 of the Act with respect to the variation, suspension, revocation or other non-renewal of privileges.
5.2C Any physician or dentist (or Affiliated Medical Staff in Capital Health) who has a relationship with the Board established by means of a contract or a contract and privileges, (other than an Academic Alternative Funding Agreement to which Dalhousie University, the Department of Health and Wellness, Doctors Nova Scotia and the DHA are parties and wherein funding is provided by the DHA, the Department of Health and Wellness and Dalhousie University) either as an independent contractor or as an employee, shall have the renewal, extension, and termination of that contract and, if applicable, the variation, suspension, non-renewal, extension, and termination of privileges pursuant to that contract determined in accordance with the terms of that contract. Without restricting the generality of the foregoing, in Capital Health, the Clinical Associates, Hospitalists, Clinical Trainees, Residents, and Affiliated Medical Staff shall have the renewal, extension, and termination of their contract and, if applicable, the variation, suspension, non-renewal or revocation of privileges pursuant to that contract determined in accordance with their contract and shall not be entitled to access the provisions of these bylaws and the DHA’s Medical Staff (General) Bylaws, unless their contract otherwise provides.
[Note: The references to the Department of Health have been updated in accordance with Order in Council 2011-15 under the Public Service Act, R.S.N.S. 1989, c. 376, effective January 11, 2011.]
Timelines
5.2D The chair of the Board or of any committee may, upon the application of any party, vary any of the timelines established in these bylaws and the decision of the chair is final and binding on the parties.
New Applications
5.3 The CEO or the CEO’s delegate, on receipt of an inquiry from a physician or dentist seeking appointment to the Medical Staff of the DHA, shall forward the form prescribed by the Board and a copy of the DHA’s Medical Staff (Disciplinary) Bylaws, the Medical Staff (General) Bylaws, and the Rules and Regulations of the DHA to the physician or dentist concerned.
5.4 A physician or dentist seeking appointment pursuant to subsection 5.3 shall apply to the CEO or the CEO’s delegate in the form prescribed by the Board and shall attach documentary proof as required by the DHA, including, but not necessarily limited to, evidence of
5.4.1 registration in the College of Physicians and Surgeons of Nova Scotia’s Medical Register pursuant to the Medical Act or registration in the Provincial Dental Board’s Dentists’ Register pursuant to the Dental Act, as relevant, and
5.4.2 membership in the Canadian Medical Protective Association or of having other equivalent malpractice insurance and in the case of a dentist, such malpractice insurance as required pursuant to the regulations under the Dental Act.
5.5 The CEO shall, within five days of the receipt of an application made under subsection 5.4, forward such application to the District Chief of Staff who, in consultation with the District Department Chief, shall consider the application, determine whether a Physician or Dentist is required and whether there are district resources available to support such Physician or Dentist, and forward a written report together with any recommendations respecting the application to the CEO within 60 days.
5.6 The CEO shall, when it has been determined that a Physician or Dentist is required and the resources to support such Physician or Dentist are available, forward forthwith the application and the recommendations of the District Chief of Staff (and of the CEO, if any) to the Chair of the Credentials Committee.
5.7 Where the report of the District Department Chief pursuant to subsection 5.5 does not support the application,
5.7.1 a copy of the report shall be provided to the applicant;
5.7.2 the applicant has 10 days to provide notice to the Board that the applicant would like the Board to reconsider the report prepared pursuant to subsection 5.5 and in the event the applicant does not provide such notice within 10 days, the application for privileges shall be deemed to have been denied;
5.7.3 in the event that the applicant does provide notice to the Board within 10 days as provided in clause 5.7.2, the Board shall consider the District Department Chief’s report and, after determining whether a Physician or Dentist is required and the resources are available to support such a Physician or Dentist, make a decision accepting or rejecting the application;
5.7.4 in the event that the Board rejects the application, the decision of the Board is final and shall be communicated in writing to the applicant and the District Department Chief within 10 days of making the decision; and
5.7.5 in the event that the Board accepts the application, the CEO shall comply with subsection 5.6.
5.8 The Credentials Committee may carry out such investigations as it deems necessary, including discussion with the applicant, and shall within 60 days submit the written recommendation of the Credentials Committee together with the application, the recommendations of the District Department Chief, and the recommendations of the CEO to the Chair of the District MAC.
5.9 If the recommendation of the Credentials Committee made pursuant to subsection 5.8 is at variance with the application, the following process shall be followed:
5.9.1 The Chair of the Credentials Committee shall within 5 working days after the submission of written recommendation pursuant to subsection 5.8
5.9.1.1 give the applicant notice of the variation, and
5.9.1.2 indicate that the applicant may, within 10 days of receipt of this notice, send written submissions to the Chair of the District MAC ISC with a copy sent to the Chair of the Credentials Committee and the District Department Chief; and to the Chair of DMAC for information purposes.
5.9.2 On receipt of any documentation provided pursuant to subsection 5.8, the District MAC ISC shall conduct any investigations it deems necessary and shall consider
5.9.2.1the application,
5.9.2.2the recommendation of the Credentials Committee,
5.9.2.3 any recommendations forwarded to the Credentials Committee by the CEO and the District Department Chief,
5.9.2.4 any submissions made pursuant to clause 5.9.1.2,
5.9.2.5 any information that it gains through any investigations in its sole discretion it deems appropriate, and
shall prepare a written recommendation.
5.9.3 The Chair of the District MAC ISC shall submit its recommendation and all reports and submissions that the District MAC ISC considered pursuant to subsection 5.9.2 to
5.9.3.1the CEO,
5.9.3.2the applicant,
5.9.3.3the District Chief of Staff,
5.9.3.4the District MAC for information purposes, and
5.9.3.5the Board.
5.9.4 The Board shall consider the District MAC ISC’s recommendation and make a decision. The decision of the Board is final and shall be communicated in writing to the applicant and the District Department Chief within 10 days of making the decision.
5.9.5 The Board in advising the applicant of its decision under clause 5.9.4 shall, if approved in whole or in part, specify the extent and limitation of the privileges granted including, but not necessarily limited to, the category of appointment granted, any specifics of the extent of the privileges granted, and the department at which the applicant may exercise privileges.
5.10 If the recommendation of the Credentials Committee made pursuant to subsection 5.8 is not at variance with the application, the following process shall be followed:
5.10.1 On receipt of any documentation provided pursuant to subsection 5.8, the District MAC shall review the documentation and prepare a written recommendation and forward it to the Board.
5.10.2 The Board shall consider the District MAC’s recommendation and make a decision. The decision of the Board is final and shall be communicated in writing to the applicant and the District Department Chief within 10 days of making the decision.
5.10.3 The Board in advising the applicant of its decision under clause 5.10.2 shall, if approved in whole or in part, specify the extent and limitation of the privileges granted including, but not necessarily limited to, the category of appointment granted, any specifics of the extent of the privileges granted, and the department at which the applicant may exercise privileges.
5.11 Appointments to the Medical Staff shall be for a period of 3 years or for such shorter period as the Board may determine in accordance with Section 14 at the end of which period the appointment shall terminate.
5.12 All appointments to the Medical Staff shall be conditional on the physician or dentist agreeing in writing to abide by the Bylaws and the Rules and Regulations of the DHA, the policies and procedures of the DHA, the extent of limits of the appointment as specified in clauses 5.9.5 or 5.10.3 and the Code of Ethics of the Canadian Medical Association or the Canadian Dental Association’s Code of Ethics.
5.13 If a Member cannot show proof of Canadian Medical Protective Association membership or its equivalent (or malpractice insurance pursuant to the regulations of the Dental Act, in the case of a dentist) the Member shall immediately notify the CEO in writing and the Member’s privileges shall be suspended until such time that the Member can provide proof to the CEO that such coverage or membership has been fully reinstated.
5.14 Where there is any change in the status of the licence granted to the Member by the College of Physicians and Surgeons (or a licence granted by the Provincial Dental Board, in the case of a dentist), the Member shall immediately notify the CEO in writing and where the licence has been suspended or revoked, the Member’s privileges shall be suspended until such time that the Member can provide proof to the CEO that the licence has been fully reinstated.
6 Temporary appointments
6.1 Notwithstanding any other provisions in these bylaws, a CEO, a District Chief of Staff or a Site-based Medical Leader, after gathering such information as he or she deems appropriate in the circumstances, may grant temporary privileges when
6.1.1 a hospital site requires extra Members on a temporary basis,
6.1.2 a Member requests a replacement for a short period of time, or
6.1.3 a specialist who does not have privileges within the district is required to consult on a particular patient.
6.2 The granting of temporary privileges shall be conditional on the Member providing proof of
6.2.1 Canadian Medical Protective Association membership or its equivalent (or malpractice insurance pursuant to the regulations of the Dental Act, in the case of a dentist); and
6.2.2 proof of a licence in good standing granted to the Member by the College of Physicians and Surgeons (or a licence granted by the Provincial Dental Board, in the case of a dentist).
6.3 Temporary privileges granted to a particular individual under this Section shall be for a period of up to 30 days and may be renewed provided that a particular Member may not be granted temporary privileges for more than a total of 120 days in a calendar year.
6.4 Temporary privileges may be revoked by the CEO at any time and the decision is final and shall be communicated in writing to the applicant and the District Department Chief within 3 days of making the revocation.
6.5 The CEO shall report an appointment made under this Section to the Board at the Board meeting following the appointment.
7 Reappointments
7.1 At least 120 days prior to the completion of their current terms of appointment, the CEO shall forward reappointment applications to Members.
7.2 A Member desiring reappointment shall, at least 90 days before the completion of his or her current period of appointment, forward to the CEO the completed re-application form as prescribed by the Board.
7.3 Notwithstanding subsection 7.2,
7.3.1 a Member may, during the term of the Member’s appointment, apply for a variance in privileges, and
7.3.2 in applying for such a variance, the Member shall discuss the nature of the application with the Department Chief and then submit a completed application to the CEO, and
the application shall be processed in the same manner as an application made pursuant to subsection 7.2
7.4 An application for reappointment shall not be considered unless all required documentation has been provided and fully completed.
7.5 The CEO or the CEO’s delegate, shall, within five days of the receipt of an application made under subsections 7.2 or 7.3, forward such application and all accompanying documentation to the District Department Chief.
7.6 Notwithstanding subsection 7.5, in the case of an application for reappointment by a District Department Chief, the CEO or CEO’s delegate shall forward such applications to the District Chief of Staff who shall carry out the functions of the District Department Chief in the reappointment process.
7.7 The District Department Chief shall provide (and the CEO may provide) to the Credentials Committee a written recommendation with respect to applications made pursuant to subsections 7.2 or 7.3 within 45 days of receipt of the application and accompanying documentation pursuant to subsection 7.5.
7.8 The Credentials Committee may carry out such investigations as it deems necessary, including discussions with the Member, and shall submit a written recommendation within 45 days of receipt of the District Department Chief’s recommendation (and any of the CEO) and the application pursuant to subsection 7.2 or 7.3 to the Chair of the District MAC ISC or the Chair of the District MAC, depending upon whether the process in subsections 7.9 or 7.10 is followed and also forward the application and all recommendations received.
7.9 If the recommendation of the Credentials Committee made pursuant to subsection 7.8 is at variance with the application, the following process shall be followed:
7.9.1 the Chair of the Credentials Committee shall give the Member notice and reasons for the variation within 5 working days of its submissions to the District MAC ISC pursuant to subsection 7.8, and
7.9.2in the notice, indicate that the Member may
7.9.2.1 within 10 days of receipt of the notice, send written submissions to the Chair of the District MAC ISC, including any request for an opportunity to make oral submissions to the District MAC ISC, with a copy sent to the Chair of the Credentials Committee, and
7.9.2.2 with the approval of the District MAC ISC, may make oral submissions to the District MAC ISC.
7.9.3 On receipt of the application for privileges and recommendations under subsection 7.8, the District MAC ISC shall conduct any investigations it deems necessary and shall consider
7.9.3.1 the application,
7.9.3.2 the recommendation of the Credentials Committee,
7.9.3.3 any recommendations forwarded to the Credentials Committee by the District Department Chief and the CEO,
7.9.3.4 any submissions made pursuant to clause 7.9.2,
7.9.3.5 any information that it gains through any investigations in its sole discretion it deems appropriate, and
shall prepare a written recommendation.
7.9.4 The Chair of the District MAC ISC shall submit its recommendation and all documentation that the District MAC ISC received pursuant to clauses 7.9.1 to 7.9.4 to the CEO, the District Chief of Staff, and the Member.
7.10 If the recommendation of the Credentials Committee made pursuant to subsection 7.8 is not at variance with the application, the District MAC shall review the submitted documentation and shall submit its written recommendation to the CEO, the District Chief of Staff, and the Member.
7.11 Where the District MAC or the District MAC ISC has recommended approval of the privileges requested by the Member, and neither the CEO nor the District Chief of Staff has objected to the District MAC or the District MAC ISC’s recommendation, the District MAC or the District MAC ISC shall forward the recommendation directly to the Board who shall, subject to the Member’s right to a hearing by the Provincial Appeal Board pursuant to subsection 7.16, without having a hearing, make a final determination with respect to the application within 60 days of the District MAC or the District MAC ISC forwarding the recommendation to the Board and the Board shall inform the Member and the CEO within 10 days of such determination.
7.12 Where
7.12.1 the parties are not in agreement and where either one party or both parties decide to refer the matter to the PRC; or
7.12.2 where the District MAC or the District MAC ISC recommends that the matter be referred,
the District MAC or the District MAC ISC shall refer the matter to the PRC to mediate, either directly or through counsel, a Proposed Agreement between the parties within 60 days from the referral from the District MAC or the District MAC ISC.
7.13 Proposed Agreement
7.13.1 Upon mediating a Proposed Agreement, the PRC shall forward it to the Board for approval.
7.13.2 The Board shall consider the Proposed Agreement and shall, subject to the Member’s right to a hearing by the Provincial Appeal Board pursuant to subsection 7.16, without having a hearing, make a final determinationwith respect to the application, within 60 days of the PRC forwarding the Proposed Agreement and the Board shall inform the Member and the CEO within 10 days of such determination.
7.14 No Proposed Agreement
7.14.1 Where the parties have not agreed to a Proposed Agreement, the PRC shall notify the CEO and the Member that the matter has been forwarded to the Board.
7.14.2 Within 10 days of receiving the PRC’s notification pursuant to clause 7.14.1, the CEO or the Member may give notice to the Board and the District MAC ISC of their intention to proceed to a hearing before the Board.
7.14.3 In the event that the Board does not receive notice pursuant to clause 7.14.2, then the PRC shall forward the District MAC ISC’s recommendation to the Board who shall, subject to the Member’s right to a hearing by the Provincial Appeal Board pursuant to subsection 7.16, without having a hearing, make a final determination with respect to the application within 60 days of the Board being provided notice pursuant to clause 7.14.2, and the Board shall inform the Member and the CEO within 10 days of such determination.
7.14.4 Upon the Board receiving notice from the CEO or the Member of their intention to proceed to a hearing, the District MAC, the District MAC ISC or the PRC, as appropriate, shall forward to the Board all the documentation that it received and any additional documentation it has gained through any investigations.
7.14.5 In holding a hearing, the Board shall give written notice of the hearing to the Member and the CEO and the notice shall include:
7.14.5.1 the place and time of the hearing,
7.14.5.2 the purpose of the hearing, and
7.14.5.3 a copy of the Medical Staff (Disciplinary) Bylaws.
7.14.6 The Board shall, subject to the Member’s right to an appeal to the Provincial Appeal Board, after holding a hearing, make a decision as to the disposition of the Member’s application.
7.15 Provincial Appeal Board - Appeal
7.15.1 Within 10 days of receiving the Board’s decision pursuant to clause 7.14.6, the Member may give notice to the Provincial Appeal Board of intention to proceed to an appeal before the Provincial Appeal Board and provide the grounds for the appeal as per subsection 12.4.
7.15.2 Unless the Member gives notice to the Provincial Appeal Board of intention to proceed to an appeal pursuant to clause 7.15.1, the Board’s decision shall be the final disposition of the Member’s privileges.
7.15.3 Upon receiving the Member’s notice of intention pursuant to clause 7.15.1, the Provincial Appeal Board shall have the recording of any oral evidence heard at the Board hearing transcribed and, within 30 days, shall provide the Member, the CEO, and the Board with notice of the date, time, and place of the appeal, a copy of the transcript before the Board, and the grounds of appeal.
7.15.4 The Provincial Appeal Board shall, after hearing the appeal, make the final decision as to the disposition of the Member’s application.
7.16 Provincial Appeal Board - Hearing
7.16.1 Where pursuant to subsection 7.11 or clauses 7.13.2 or 7.14.3, the Board does not hold a hearing and makes a final determination which is at variance with the District MAC or the District MAC ISC’s recommendation, the Member may, within 10 days of receiving the Board’s decision, give notice to the Provincial Appeal Board of intention to proceed to a hearing before the Provincial Appeal Board.
7.16.2 Unless the Member gives notice to the Provincial Appeal Board of intention to proceed to a hearing pursuant to clause 7.16.1, the Board’s decision shall be the final disposition of the Member’s privileges.
7.16.3 Upon receiving the Member’s notice of intention pursuant to clause 7.16.1, the Provincial Appeal Board shall, within 30 days, provide the Member, the CEO, and the Board with a written notice of the hearing and the notice shall include:
7.16.3.1 the place and time of the hearing,
7.16.3.2 the purpose of the hearing, and
7.16.3.3 a copy of the Medical Staff (Disciplinary) Bylaws.
7.16.4 Upon the Provincial Appeal Board receiving notice from the Member of their intention to proceed to a hearing, the Board shall forward to the Provincial Appeal Board all the documentation that it received pursuant to subsection 7.14 and any additional documentation it has gained through any investigations.
7.16.5 The Provincial Appeal Board shall, after holding the hearing, make the final decision as to the disposition of the Member’s application.
8 Revocation/suspension/variation of medical staff privileges - special review
8.1 The CEO, the Site Manager, the Site-based Medical Leader, the District Chief of Staff, or the District Department Chief (but not their designates) may request a special review of the privileges of any Member at any time and shall advise the District MAC ISC and the Member concerned within 24 hours of such action.
8.1.1 In making a such a request for a special review, the person requesting the special review shall indicate the grounds giving rise to such a review and the remedy or remedies that are sought.
8.2 The District MAC ISC shall review the performance and conduct of the Member and shall notify the Member of his or her right, within 10 days of receiving the notice, to make written submissions to the District MAC ISC.
8.3 The District MAC ISC shall conduct any investigations it deems necessary and submit its recommendation and any submissions that the District MAC ISC received pursuant to subsection 8.2 to
8.3.1 the CEO,
8.3.2 the District Chief of Staff,
8.3.3 the Member, and
8.3.4 the PRC
within 10 days of receiving and/or hearing the Member’s written and/or oral submissions pursuant to subsection 8.2, or within 10 days of the Member waiving the right to make such submissions; and
8.3.5 if the District MAC ISC has not received a Member’s written and/or oral submissions pursuant to subsection 8.2 or a written notification that the Member has waived the Member’s right to make such submissions within the 10 days referred to in subsection 8.2, then it shall be deemed that the Member has waived his or her right to make such submissions.
8.4 Where the District MAC ISC has recommended approval of the suspension and the CEO, the Member and the District Chief of Staff have not objected to the District MAC ISC’s recommendation, the District MAC ISC shall forward the recommendation directly to the Board who shall, subject to the Member’s right to a hearing by the Provincial Appeal Board pursuant to subsection 8.12, without having a hearing, make a final determination with respect to the suspension within 60 days of the District MAC ISC forwarding the recommendation to the Board and the Board shall inform the Member and the CEO within 10 days of such determination.
8.5 Where
8.5.1 the parties are not in agreement and where either one party or both parties decide to refer the matter to the PRC; or
8.5.2 where the District MAC ISC recommends that the matter be referred,
the District MAC ISC shall refer the matter to the PRC to mediate, either directly or through counsel, a Proposed Agreement with the Member within 60 days from the referral from District MAC ISC.
8.6 Proposed Agreement
8.6.1 The PRC shall, subject to final approval by the Board, and
8.6.1.1 subject to a CEO or Member seeking a hearing before the Board pursuant to subsection 8.9; and
8.6.1.2 subject to a Member seeking an appeal or a hearing before the Provincial Appeal Board pursuant to subsections 8.11 or 8.12,
mediate a Proposed Agreement and forward it to the Board for approval.
8.6.2 The Board shall consider the Proposed Agreement and shall, subject to the Member’s right to a hearing by the Provincial Appeal Board pursuant to subsection 8.11, without having a hearing, make a final determination with respect to the application, within 60 days of the PRC forwarding the Proposed Agreement and the Board shall inform the Member and the CEO within 10 days of such determination.
8.7 No Proposed Agreement
8.7.1 Where the parties have not agreed to a Proposed Agreement, the PRC shall notify the CEO and the Member that the matter has been forwarded to the Board.
8.7.2 Within 10 days of receiving the PRC’s notification pursuant to clause 8.7.1, the CEO or the Member may give notice to the Board and the District MAC ISC of intention to proceed to a hearing before the Board.
8.7.3 In the event that the Board does not receive notice pursuant to clauses 8.6.2 or 8.7.2, then the PRC shall forward the District MAC ISC’s recommendation to the Board who shall, subject to the Member’s right to a hearing by the Provincial Appeal Board pursuant to subsection 8.12, without having a hearing, make a final determination with respect to the matter within 60 days of the Board being provided notice pursuant to subsection 8.7.1, and the Board shall inform the Member and the CEO within 10 days of such determination.
8.8 Upon the Board receiving notice from the CEO or the Member of their intention to proceed to a hearing, the DMAC ISC or the PRC, as appropriate, shall forward to the Board all the documentation that it received and any additional documentation it has gained through any investigations.
8.9 In holding a hearing, the Board shall give written notice of the hearing to the Member and the CEO and the notice shall include:
8.9.1 the place and time of the hearing,
8.9.2 the purpose of the hearing, and
8.9.3 a copy of the Medical Staff (Disciplinary) Bylaws.
8.10 The Board shall, subject to the Member’s right of appeal to the Provincial Appeal Board, after holding a hearing, make a final decision concerning the Member’s appointment and privileges.
8.11 Provincial Appeal Board - Appeal
8.11.1 Within 10 days of receiving the Board’s decision pursuant to clause 8.10, the Member may give notice to the Provincial Appeal Board of intention to proceed to an appeal before the Provincial Appeal Board and provide the grounds for the appeal as per subsection 12.4.
8.11.2 Unless the Member gives notice to the Provincial Appeal Board of intention to proceed to an appeal pursuant to clause 8.11.1, the Board’s decision shall be the final disposition of the Member’s privileges.
8.11.3 Upon receiving the Member’s notice of intention pursuant to clause 8.11.1, the Provincial Appeal Board shall have the transcript of the Board hearing transcribed and, within 30 days, shall provide the Member, the CEO, and the Board with notice of the date, time and place of the appeal, a copy of the transcript before the Board, and the grounds of appeal.
8.11.4 The Provincial Appeal Board shall, after hearing the appeal, make the final decision concerning the Member’s appointment and privileges.
8.12 Provincial Appeal Board - Hearing
8.12.1 Where pursuant to clause 8.7.3, the Board does not hold a hearing and makes a final determination, the Member may, within 10 days of receiving the Board’s decision, give notice to the Provincial Appeal Board of intention to proceed to a hearing before the Provincial Appeal Board.
8.12.2 Unless the Member gives notice to the Provincial Appeal Board of intention to proceed to a hearing pursuant to clause 8.12.1, the Board’s decision shall be the final disposition of the Member’s privileges.
8.12.3 Upon receiving the Member’s notice of intention pursuant to clause 8.12.1, the Provincial Appeal Board shall, within 30 days, provide the Member, the CEO, and the Board with a written notice of the hearing and the notice shall include:
8.12.3.1 the place and time of the hearing,
8.12.3.2 the purpose of the hearing, and
8.12.3.3 a copy of the Medical Staff (Disciplinary) Bylaws.
8.12.4 Upon the Provincial Appeal Board receiving notice from the Member of their intention to proceed to a hearing, the Board shall forward to the Provincial Appeal Board all the documentation that it received pursuant to subsection 8.8 and any additional documentation it has gained through any investigations.
8.12.5 The Provincial Appeal Board shall, after holding the hearing, make the final decision concerning the Member’s appointment and privileges
9 Revocation/suspension/variation of medical staff privileges - emergency suspension
9.1 The Site Manager, the Site-based Medical Leader, the District Chief of Staff, or the District Department Chief (but not their designates) may suspend or vary the privileges of any Member at any time where the Member has been found to have engaged in or is engaged in conduct which
9.1.1 exposes or is reasonably likely to expose patients, Medical Staff, employees or the public to harm or injury at any hospital site in the district, or
9.1.2 is adversely impacting or is reasonably likely to adversely impact the delivery of patient care.
9.2 The person who has suspended the Member pursuant to subsection 9.1 shall
9.2.1 advise the District MAC ISC, the District MAC, and the Member concerned within 24 hours of such action,
9.2.2 at the time of advising the Member of the suspension pursuant to clause 9.2.1, shall inform the Member of
9.2.2.1 the grounds giving rise to such a review and the remedy or remedies that are sought; and
9.2.2.2 his or her right to make a written submission to the District MAC ISC and request the consent of the District MAC ISC to make oral submissions; within 10 days of the suspension.
9.3 Within 24 hours of a Member’s suspension or variation of privileges pursuant to subsection 9.1, the person who has suspended or varied the Member’s privileges shall apply to the CEO for a review to determine if the Member’s privileges should be reinstated without further investigation, reinstated while the Member’s conduct is being investigated pursuant to subsection 8.1 or shall remain suspended or varied while the Member’s conduct is being investigated.
9.4 The CEO in completing the review pursuant to subsection 9.3, within 72 hours of a Member’s suspension, shall either:
9.4.1 reinstate the Member’s privileges without further investigation or proceedings;
9.4.2 reinstate the Member pending a final decision with respect to the nature of the suspension or the variation; or
9.4.3 confirm the Member’s suspension or variation pending a final decision with respect to the nature of the suspension or the variation.
9.5 In the event the CEO makes a decision in accordance with the provisions of clauses 9.4.2 or 9.4.3 the[n] the process shall continue pursuant to subsections 8.2 to 8.12 inclusive with changes to cross-references as appropriate.
10 Revocation/suspension/variation of medical staff privileges - automatic suspension
10.1 A Member shall be suspended by the CEO, the Site Manager, the District Chief of Staff, or the District Department Chief when
10.1.1 a Member fails to complete a patient’s record within the Rules and Regulations of the DHA and has failed to comply within a 14 day notice period for completion given by the CEO, the Site Manager, the District Chief of Staff, or the District Department Chief;
10.1.2 a Member has ceased to be a member of the Canadian Medical Protective Association or to carry and have in force equivalent malpractice insurance, and in the case of a dentist, has ceased to carry and have in force such malpractice insurance as required pursuant to the regulations under the Dental Act; or
10.1.3 a Member’s licence has been suspended or revoked or limited by the College of Physician’s and Surgeon’s pursuant to the Medical Act and in the case of a dentist, their licence has been suspended or revoked or a reprimand has been noted by the Provincial Dental Board pursuant to the Dental Act.
10.2 An automatic suspension given pursuant to clause 10.1.1 shall continue until the violation has been corrected at which time the CEO shall automatically reinstate the Member.
Part III
11 Hearings - general
11.1 This Section applies to the hearings held by
11.1.1 the Board pursuant to subsections 7.14.5, 8.9, and 9.5; and
11.1.2 the Provincial Appeal Board pursuant to subsections 7.16, 8.12, and 9.5.
11.1ANotwithstanding that the appointment of a member or members of the Board or the Provincial Appeal Board expires prior to the completion of any matter before the Board or the Provincial Appeal Board pursuant to these bylaws, such member or members shall continue to be seized with the jurisdiction to complete such matter and, for this purpose, such member or members shall continue to have the same powers, privileges, immunities and duties as are granted to members of the Board or the Provincial Appeal Board pursuant to these bylaws.
11.2 Rules of Evidence:
11.2.1 Written or documentary evidence, expert evidence, or testimony of any other witness is not admissible unless the opposing party,
11.2.1.1 in the case of written or documentary evidence, has an opportunity to examine the evidence, or
11.2.1.2 in the case of evidence of an expert, a copy of the expert’s written report or if there is no written report, has a written summary of the evidence, or
11.2.1.3 in the case of testimony of any other witness, knows the identity of the witness;
at least 10 days before the hearing.
11.2.2 Notwithstanding clause 11.2.1 and subject to clause 11.2.3, the Board or the Provincial Appeal Board may, in its discretion, allow the introduction of evidence that would be otherwise inadmissible under clause 11.2.1 and may make directions it considers necessary to ensure that a party is not prejudiced.
11.2.3 Prior to the Board or the Provincial Appeal Board making a ruling on the introduction of evidence pursuant to clause 11.2.2, the Board or the Provincial Appeal Board shall provide the opposing party the opportunity to review the evidence and make submissions as to the admissibility of the evidence.
11.3 Natural Justice:
11.3.1 At a hearing, all parties are entitled to all the rights of natural justice, including the right to be represented by legal counsel; to know all the evidence considered by the DMAC ISC or the Board, as relevant; to present evidence; and to cross examine witnesses;
11.3.2 For greater certainty in the interpretation of these bylaws,
11.3.2.1 hearings held by the Board and the Provincial Appeal Board are judicial in nature and the principles of natural justice apply, and
11.3.2.2 the activities of the Credentials Committee, the District MAC, and other decision-making bodies or persons under these bylaws are not judicial or quasi-judicial in nature.
11.4 The Board and the Provincial Appeal Board may adopt such policies, protocols, rules and procedures for the conduct of the proceedings before them.
11.5 If a Member of the Board or the Provincial Appeal Board [who] has participated in a hearing becomes unable, for any reason, to complete the hearing or to participate in the decision, the remaining Member or Members may complete the hearing and give a decision.
12 Appeals - general
12.1 This Section applies to appeals heard by the Provincial Appeal Board pursuant to subsections 7.15 and 8.11.
12.2 Appeals held by the Provincial Appeal Board are judicial in nature and the principles of natural justice apply.
12.3 The Provincial Appeal Board may adopt such written rules as are consistent with this Section.
12.4 The grounds of review for an appeal before the Provincial Appeal Board shall be
12.4.1 errors in law;
12.4.2 that the decision of the Board is not supported by the evidence presented to the Board; or
12.4.3 that the Board in making its decision materially erred in interpreting the evidence before it.
12.5 At any appeal, the Provincial Appeal Board shall review the record which shall consist of the decision appealed from, and
12.5.1 the transcript of the hearing before the Board;
12.5.2 the notice of the hearing;
12.5.3 all exhibits filed with the Board, if any; and
12.5.4 any statement of facts agreed to by the parties before the Board,
which shall be accepted as being the evidence considered by the Board in making its decision.
12.6 If a Member of the Provincial Appeal Board [who] has participated in an appeal becomes unable, for any reason, to complete the appeal or to participate in the decision, the remaining Member or Members may complete the appeal and give a decision.
13 Notice provisions
13.1 All notices in these bylaws shall be deemed duly given to a party
13.1.1 upon delivery if delivered by hand,
131.2 three days after posting if sent by registered mail with receipt requested, or
13.1.3 upon two days after the date of the transmission, if a facsimile transmission is used.
14 Privileges
14.1 All privileges granted to Members pursuant to these bylaws shall be for a period of 36 months
14.2 Notwithstanding subsection 14.1, privileges granted to a Member shall be for a term less than three years, where
14.2.1 set by the Provincial Appeal Board pursuant to subsections 7.15, 7.16, 8.11 or 8.12;
14.2.2 specified in the Board’s decision, pursuant to clauses 7.14.6 or 8.10;
14.2.3 agreed to by the Member and the CEO or District Chief of Staff or Board;
14.2.4 specified in an initial grant of privileges pursuant to Section 5;
14.2.5 such term is specified when privileges are renewed pursuant to Section 7; or
14.2.6 in Capital Health, the Member’s annual performance appraisal result is unsatisfactory or no appraisal has been provided by the District Department Chief.
14.3 Notwithstanding subsection 14.1, Members shall annually, on a date specified by the District Chief of Staff, provide evidence of insurance, registration, and such other items as may be specified in these bylaws.
15 Transition
15.1 These Bylaws shall govern any complaint arising before the original approval of these Bylaws on May 23, 2002 and thereafter.
15.2 For greater certainty,
15.2.1 “complaint” means any concern, allegation, complaint, disciplinary matter or review;
15.2.2 “former Bylaws” means the bylaws in effect at or for the hospital sites governed by the former Central Regional Health Board, the former Eastern Regional Health Board, the former Northern Regional Health Board, the former Western Regional Health Board, the Queen Elizabeth II Health Sciences Centre, and the Nova Scotia Hospital;
15.2.3 a complaint made pursuant to the former Bylaws shall continue to be proceeded with in accordance with these bylaws as nearly as circumstances permit;
15.2.4 in respect of that complaint, a Medical Advisory Committee appointed pursuant to the former Bylaws is deemed to be the District Medical Advisory Committee appointed pursuant to these bylaws;
15.2.5 in respect of that complaint, a Board of Directors or Appeal Committee appointed pursuant to the former Bylaws is deemed to be the Board appointed pursuant to these bylaws; and
15.2.6 where there is an inconsistency between the former Bylaws and these bylaws, these bylaws shall prevail.