Medical Staff in Need of Change

The initial Standards by the JCAH (now the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO) required accredited hospitals to have organized medical staffs. The medical staff was responsible for overseeing the clinical practice and quality of care provided by physicians at the hospital. While recognizing the ultimate responsibility for patient care in a hospital is vested in the governing board, a de facto delegation of most of these functions to the medical staff exists in hospitals. External regulation of hospital medical staff functions was very limited until the advent of the federal government payment programs in the 1960s. Additional regulation stemmed from judicial decisions establishing the doctrine of corporate liability of hospitals for the professional negligence of independently practicing physicians providing care at the hospital. The Darling v Charleston Memorial Hospital 2 and Johnson v. Misericordia Hospital 3 cases clearly established that hospitals have liability responsibility for patient injuries caused by acts or omissions of physicians on the medical staff. MEDICAL STAFF ROOTS date back to initial quality improvement efforts of physician leaders such as Ernest A. Codman, a surgeon who led in the initiation of review of the quality of surgical care in the early 1900’s. Paul Starr noted in The Social Transformation of American Medicine 1 that the American College of Surgeons first took a formalized approach to hospital surgical review in 1919, establishing a voluntary standard that ACS-approved hospitals must affiliate physicians into a “definite medical staff.” In addition to dealing with the intense financial and competitive elements then dividing organized medicine, the surgeons recognized a need for an organized quality evaluation of surgical services that required a more formal organization of surgeons at hospitals. These concepts matured to create the Joint Commission on Accreditation of Hospitals (JCAH) in 1951. The historical development of hospitals from charities sponsored by wealthy patrons to today’s medical centers was not an easy road. Three centers of authority and power emerged: