Memorandum of Understanding in Respect to Governance in Western Australian Government Hospitals and Health Services

2 February, 2001

1. Introduction
2. Hospital Boards and Medical Practitioners
3. Medical Advisory Committees
4. Clinical Privileges Advisory Committee
5. Review of Clinical Conduct
6. Medical Appeals Panel
7. Committees Generally
8. Definitions and Interpretations

This is a MEMORANDUM OF UNDERSTANDING dated Friday, 2nd February 2001 between:

1. The Hon. John Howard Dadley Day, MLA, Minister for Health ('the Minister') and
2. The Australian Medical Association (Western Australia) Incorporated ("the AMA") and
3. The Hospital Boards listed in the Schedule or their successors (individually "Hospital Board" and collectively "Hospital Boards")

1. Introduction

1.1 The Memorandum is intended to apply to all Western Australian Government health care facilities except Royal Perth, Sir Charles Gairdner, Fremantle, King Edward Memorial and Princess Margaret Hospitals, Graylands Selby-Lemnos Health Campus, and Dental Health Services.

1.2 Subject to clause 1.7, the Memorandum is not of itself intended to create legally binding obligations and is not legally enforceable. A Hospital Board may become party to this Memorandum at any time after execution by the Minister and the AMA.

1.3 The parties acknowledge that individual Hospital Boards may wish to introduce processes for clinical privileges, conduct and governance to reflect the requirements of those Hospital Boards, which are different to the processes set out in this Memorandum. In any such event:

1. The Hospital Board must first consult with the AMA and any other key stakeholders;
2. If the AMA agrees to the alternative processes, the Minister will be informed, the amendments will be attached as an annexure to this Memorandum and the Hospital Board may introduce the new processes;
3. If the AMA does not agree to the alternative processes, either the Hospital Board or the AMA may refer the matter to the Minister for a direction as to a resolution of the matter;
4. The Minister will consult with the relevant Hospital Board and the President of the AMA before issuing any direction to the Hospital Board.

1.4 The Minister, the Hospital Boards which are party to this Memorandum and the AMA will review the Memorandum by 30 June each year and may vary the Memorandum at any time by written agreement. Variations to the Memorandum may be general or in part and where appropriate apply to a specific Hospital Board(s).

1.5 This Memorandum will nominally expire 3 years after its commencement. After nominal expiry, the Memorandum will continue to apply until replaced by a new memorandum or agreement, or until the Memorandum is terminated by the Minister, a Hospital Board or the AMA giving 3 months written notice of termination to the others. Termination by one Hospital Board does not affect any other Hospital Board.

1.6 The AMA, the Minister and Hospital Boards who are party to this Memorandum will meet by 30 June 2003 to commence negotiations on arrangements to apply after expiry of this Memorandum.

1.7 The Parties will continue negotiations using their best endeavours to try to agree by 30 June 2001 on: (a) the terms of any indemnity to be granted to Medical Practitioners who sit on any of the committees or panels established under this Memorandum, or who may be appointed as investigators under clause 5; and (b) converting this Memorandum into a legally binding agreement.

2. Hospital Boards and Medical Practitioners

2.1 Hospital Boards are established under the Hospitals and Health Services Act 1927 to provide health services to the community and have responsibility for and control of all aspects of the management and operation of health care facilities. Hospital Boards may from time to time be replaced by other entities responsible for those functions.

2.2 Medical Practitioners provide medical and associated services to public patients within public health care facilities as Hospital Board employees or under independent Contract arrangements and may be granted the right of private practice within those facilities.

2.3 Subject to Clause 2.6 and the approval and maintenance of clinical priviledges, Medical Practitioners practicing in the local community who are qualified in the medical disciplines required at each local health care facility will be able to admit and treat patients at that facility.

2.4 Subject to the Hospital Board's overriding duty of care to patients, and any applicable contract of employment, Medical Services Agreement and Clinical Privileges Conditions, Hospital Boards will not control or be responsible for the clinical decisions of a Medical Practitioner in respect of admission, treatment or discharge of a patient.

2.5 The parties recognise that, amongst other responsibilities Medical Practitioners are personally responsible to their patients and responsible and accountable to:

1. the Medical Board and other statutory authorities;
2. the ethical codes and standards of relevant colleges and professional associations; and
3. the Hospital Board.

2.6 Medical Practitioners may compete for access to the resources of the health care facility. The level of access to health care facilities depends on clinical need, the available human, financial and physical resources and role of the health care facility, and is subject to any applicable contract of employment, Medical Services Agreement and Clinical Privileges Conditions.

2.7 Health care facilities should be managed using a cooperative team approach in which management, Medical Practitioners and other medical, nursing and allied health staff work to achieve the best possible result for patients and the community through best practice management, health care delivery and clinical practice.

2.8 Medical Practitioners provide essential expertise and must participate in the:

1. planning of clinical activities;
2. maintenance of high clinical standards;
3. introduction of new technology and new methods of patient care; and
4. efficient use of resources for the greatest benefit to the community.

3. Medical Advisory Committees

3.1 Hospital Boards shall establish Medical Advisory Committees to:

1. inform and advise the Hospital Board on: medical policy and matters affecting patient care; medical workforce issues and medical requirements of the health care facility; andefficient and equitable use of hospital resources, including theater utilisation policy unless the Hospital Board has delegated this responsibility elsewhere; and other matters referred to it by the Hospital Board;
2. liaise between the Hospital Board and Medical Practitioners at the relevant health care facility;
3. contribute to quality improvement and other activities aimed at better patient care and better use of resources; and (d) consider medical/patient care issues raised by Medical Practitioners at the health care facility.

3.2 Medical Advisory Committees may be established for any number of health care facilities within the responsibility of a Hospital Board or be nominated to advise a number of Hospital Boards. Medical Advisory Committees will be established for each health care facility under the Metropolitan Health Service Board.

3.3 The Commissioner of Health may, in consultation with the AMA and relevant Hospital Boards, establish Medical Advisory Committees to complement the advice of Medical Advisory Committees based at specific rural health care facilities.

3.4 The composition of a Medical Advisory Committee should reflect the main clinical services provided by the health care facility. The Medical Advisory Committee will normally consist of:

1. 4 elected members if there are 15 or less Medical Practitioners at the relevant health care facilities or 6 elected members if there are more than 15;
2. 3 members nominated by the Hospital Board or Boards, including a General Manager, Director of Medical Services and Director of Nursing or equivalents if appointed;
3. members co-opted by the Medical Advisory Committee from Medical Practitioners at health care facilities not otherwise represented on the Medical Advisory Committee or which are, in the opinion of the Medical Advisory Committee, inadequately represented. This may include, where appropriate, Mental Health, Community Health, Aboriginal Medical Services, RFDS and other medical representative services in the community.

3.5 Co-opted members and non-Medical Practitioners will not be entitled to vote at meetings of the Medical Advisory Committee.

3.6 After each meeting of the Medical Advisory Committee, the minutes and recommendations will be forwarded to the Hospital Board for consideration.

3.7 Hospital Boards should ensure adequate information is provided to Medical Advisory Committees to enable them to function and shall take account of their advice when making decisions.

3.8 The Medical Advisory Committee will annually report to the Hospital Board and the Medical Practitioners at the health care facility on the effectiveness of its contribution to the management of the health care facility.

3.9 Any significant issue that is unable to be resolved between a Medical Advisory Committee and a Hospital Board may be raised with the Minister after the relevant Parties have taken all reasonable steps to resolve the matter. Chairperson of the Medical Advisory Committee

3.10 The Chairperson of the Medical Advisory Committee will:

1. liaise between management and Medical Practitioners to ensure each is informed on significant issues;
2. if no Director of Medical Services or equivalent is appointed, serve as the medical coordinator for the health care facility;
3. in conjunction with the General Manager or Director of Medical Services or equivalent where appointed, review the adequacy of the emergency service roster at the health care facility and endeavour to reconcile the health care facility and community requirements having regard to relevant factors including, but not limited to the availability of Medical Practitioners and occupational health and safety considerations;
4. be an ex-officio member of the executive committee of the health care facility.

4. Clinical Privileges Advisory Committees

4.1 Hospital Boards shall establish advisory committees of Medical Practitioners to:

1. advise the Hospital Board on applications for Clinical Privileges; and
2. review the Clinical Privileges of all or specific Medical Practitioners periodically or on request of the Hospital Board and advise the Hospital Board accordingly.

4.2 At the discretion of the Hospital Board, a Clinical Privileges Advisory Committee may be asked to assess an application for Clinical Privileges whether or not a Contract exists.

4.3 A Clinical Privileges Advisory Committee may be specific to a particular health care or serve a number of health care facilities or Hospital Boards. Each Hospital Board will need to nominate the health care facilities in respect of which a Clinical Privileges Advisory Committee provides advice.

4.4 The Commissioner of Health may, in consultation with the relevant Hospital Boards and the AMA, establish or dissolve Clinical Privileges Advisory Committees which advise more than one rural Hospital Board and add or remove rural Hospital Boards to be advised by the Committee.

4.5 The Clinical Privileges Advisory Committee will consist of:

1. Medical Practitioners elected by and from Medical Practitioners at the relevant health care facilities;
2. 1 Medical Practitioner nominated by the AMA;
3. The Director of Medical Services if appointed or otherwise a Medical Practitioner nominated by the Hospital Board;
4. The Chairperson of the Medical Advisory Committee for the health care facility at which Clinical Privileges are sought;
5. The General Manager for the health care facility at which Clinical Privileges are sought; and
6. anyone co-opted by the Clinical Privileges Advisory Committee to provide specialist advice where the Clinical Privileges applied for or under review relate to that specialty.

4.6 Co-opted members and non-Medical Practitioners may not vote on Clinical Privileges applications or reviews.

4.7 The Clinical Privileges Advisory Committee will ensure procedural fairness and act as quickly as is practical in all the circumstances of the case.

4.8 The Clinical Privileges Advisory Committee will have regard to:

1. the role delineation of the health care facility;
2. the Medical Practitioner's formal qualifications, relevant working experience and clinical expertise and the opinion of professional referees where these are sought;
3. the Medical Practitioner's previous compliance with conditions attached to the exercise of clinical privileges at the health care facility or elsewhere; and
4. such other matters as it thinks fit, including any current or past complaints or reviews, current or past litigation, unresolved disputes and any reports of Investigators or Conduct Review Panels, in relation to the Medical Practitioner at the health care facility or elsewhere. Clinical Privileges granted by the Hospital Board

4.9 Clinical Privileges Advisory Committees must specify in their recommendations to the Hospital Board the Clinical Privileges recommended and any conditions attached thereto and the reasons for the Committee's recommendations. Clinical Privileges may be temporary, probationary, conditional or standard.

4.10 The scope of Clinical Privileges to be exercised may not exceed the scope of the medical services to be provided under the relevant contract of employment or Medical Services Agreement, but this does not preclude the exercise of a wider scope of medical services in a medical emergency.

4.11 If the Clinical Privileges Advisory Committee recommends substantial change to the conditions applying to the Clinical Privileges of a Medical Practitioner or the scope of Clinical Privileges is less than applied for, the Medical Practitioner will be given a copy of the recommendation and be allowed the opportunity to make submissions and provide materials to the Hospital Board.

4.12 The Hospital Board will take account of the advice of the Clinical Privileges Advisory Committee when considering applications for or reviewing Clinical Privileges.

4.13 The Hospital Board will inform the health care facility management, the Clinical Privileges Advisory Committee and the Medical Practitioner in writing of its determination as soon as possible.

4.14 A Medical Practitioner practising in the local community aggrieved by a determination of the Hospital Board in respect of their application for Clinical Privileges under clause 4.1(a), or a decision not to refer an application for clinical privileges under clause 4.2, may, within 7 days after receipt of notice of the determination, appeal to the Medical Appeals Panel.

4.15 Any Medical Practitioner aggrieved by a determination of a Hospital Board in respect of a review of their Clinical Privileges under Clause 4.1(b) may, within 7 days after receipt of notice of the determination, appeal to the Medical Appeals Panel.

4.16 The Clinical Privileges Advisory Committee may review the Clinical Privileges of all or some Medical Practitioners periodically, or on request of the Hospital Board and advise the Hospital Board accordingly.

4.17 After consideration of the report and recommendations of the Medical Appeals Panel, the Hospital Board may determine the matter as it sees fit and such determination will be final and binding.

4.18 The General Manager, Director of Medical Services or the Chairman of the Medical Advisory Committee may, in exceptional circumstances, grant temporary Clinical Privileges for periods not exceeding 1 month at any one time.

5. Review of Clinical Conduct

5.1 Hospital Boards have a duty of care to patients and must be able to review the clinical conduct of Medical Practitioners.

5.2 Nothing in this section prevents a matter being resolved informally. Conduct Review Panel

5.3 A Conduct Review Panel will be established for the health care facility comprising:

1. The General Manager or Health Service Manager for the health care facility;
2. The Director of Medical Services or another Medical Practitioner appointed by the Hospital Board;
3. The Chair of the Medical Advisory Committee for the health care facility; and
4. A Medical Practitioner elected by 30 June of each year (to take office from 1 July) by the Medical Practitioners at the health care facility.

5.4 A member of the Conduct Review Panel who is unavailable, or has a conflict of interest, in relation to a particular Review will be replaced for that Review by the Hospital Board in respect of clauses 5.3 (a) and (b) or the Medical Advisory Committee in respect of clauses 5.3 (c) and (d).

5.5 Clauses 7.2 to 7.9, 7.15 and 7.19 to 7.21 shall apply, as far as possible, to the elected member referred to in clause 5.3(d)

5.6 The members of the Conduct Review Panel will elect a Chairperson for a one-year term and that person will be eligible for re-election.

5.7 The Chairperson will determine the appropriate rules of debate to apply and will have a deliberative as well as a casting vote.

5.8 The quorum is 3 members, one of whom must be the Chairperson.

5.9 The Conduct Review Panel may recommend to the Hospital Board that it appoint an investigator ("Investigator") to assist the Conduct Review Panel. In selecting an Investigator, the Hospital Board must consult with the AMA, the Medical Advisory Committee and the Medical Practitioner the subject of the Review, and may consult with others. The Investigator must also be endorsed by the Commissioner of Health.

5.10 The Conduct Review Panel, and any Investigator approved by the Board assisting it, must:

1. act according to equity, good conscience and the substantial merits of the case without being constrained by legal technicalities or forms;
2. not be bound by the rules of evidence, but may inform itself on any matter it thinks just;
3. afford procedural fairness to all persons, but may proceed with a Review if documents or information are not provided within time limits specified;
4. act as rapidly as practicable;
5. whenever informing, reporting or referring matters to the Board, prepare a written report setting out: (i)conclusions arrived at including any dissenting view of a Panel member; (ii) reasons for arriving at those conclusions; and (iii) materials: a) referred or provided to the Conduct Review Panel; and b) relied upon in arriving at the conclusions;
6. inform the Medical Practitioner the subject of the Review of the substance of the material relating to the Review, and details of the Review process;
7. give the Medical Practitioner the subject of the Review an adequate opportunity to put materials and submissions before preparing the report;
8. provide a copy of the report to the Medical Practitioner the subject of the Review;
9. with the prior consent of the Hospital Board, take legal advice if it considers necessary concerning the subject matter and conduct of the Review and may in its discretion keep this advice confidential to itself and the Hospital Board; and
10. otherwise determine the manner in which the Review is to be conducted. Initiation of a Review of Conduct

5.11 A Review will be initiated by a written request to the Conduct Review Panel from the Hospital Board or the Medical Advisory Committee outlining the reasons for the Review. A copy of the request will be sent by the requester at the same time to the Medical Practitioner the subject of the request for Review. A Hospital Board will initiate a Review at the request of the Commissioner of Health.

5.12 The Hospital Board may at any time decide the clinical conduct of a Medical Practitioner warrants restricting, making conditional, varying or suspending the Clinical Privileges of that Medical Practitioner pending a Review. In such a case, the Board must:

1. immediately notify the Medical Practitioner of its decision; and
2. whether or not a Review has already been initiated, within 3 days refer its decision to the Conduct Review Panel for further consideration. Such a reference will initiate a Review if a Review had not already been initiated.

5.13 (a) The Conduct Review Panel will consider within 7 days or as soon as reasonably practicable any request for Review and form an opinion whether the subject matter of the requested Review is prima facie serious.

5.13 (b) The Conduct Review Panel will consider within 3 days or as soon as reasonably practicable any decision of the Hospital Board to restrict, make conditional, vary or suspend Clinical Privileges under clause 5.12 and form an opinion on whether that decision should stand pending further investigation.

5.14 The Conduct Review Panel may consider such matters as it thinks fit, including:

1. whether the alleged conduct departs or appears to depart from generally accepted standards of medical practice and if so, to what extent;
2. whether the alleged conduct is or appears to be an isolated occurrence; and
3. if applicable, any adverse health outcomes for the patient or patients concerned.

5.15 The Conduct Review Panel will inform the Hospital Board and the Medical Practitioner the subject of the Review within 7 days on whether or not it considers the matter to be serious and what, if any, further action it proposes.

5.16 If the Conduct Review Panel considers the matter does not warrant immediately restricting, making conditional, varying or suspending Clinical Privileges, the Conduct Review Panel will immediately inform the Hospital Board and the Medical Practitioner of its opinion and recommend what action, if any, it considers necessary.

5.17 The Conduct Review Panel may on its own initiative at any time decide the matter warrants restricting, making conditional, varying or suspending the Clinical Privileges of the Medical Practitioner pending further consideration. In this case, it shall immediately inform the Medical Practitioner and refer the matter to the Hospital Board for consideration. Hospital Board Determinations

5.18 The Hospital Board must:

1. consider and determine all Reviews;
2. have regard for the recommendations and findings of any Conduct Review Panel;
3. afford procedural fairness to all persons who might be adversely affected by its decision;
4. take such action as it considers appropriate in the circumstances of the case; and
5. notify such persons as it thinks fit of its decision.

5.19 The Hospital Board may, notwithstanding any recommendation of the Conduct Review Panel, exercise one or more of the following powers:

1. dismiss the matter;
2. agree or not agree to the appointment of an Investigator;
3. return the matter to the Conduct Review Panel to further investigate or consider;
4. reprimand the person the subject of the Review; (e) give formal directions to the management or staff of the health care facility;
5. restrict, make conditional, vary, suspend, terminate or reinstate Clinical Privileges of a Medical Practitioner, whether in whole or in part, at any or all health care facilities within its responsibility, or confirm its decision under clause 5.12;
6. suspend or terminate the engagement of a Medical Practitioner;
7. refer the matter to the Medical Board or other appropriate professional body; (i) refer the matter to the Clinical Privileges Advisory Committee; and
8. make such other recommendations or determinations as it considers just. 5.19A A Medical Practitioner aggrieved by a determination of a Hospital Board under clause 5.19(d), (f) or (g) may, within 7 days after receipt of notice of the determination, appeal to the Medical Appeals Panel.

5.20 If the Hospital Board has exercised a power under 5.19(d), (f) or (g), it will report the matter to the Commissioner of Health, who may refer the matter to a State-wide review panel to determine whether it should recommend that clinical privileges be restricted, made conditional, varied, suspended or terminated at other public health care facilities throughout the State.

5.21 Any State-wide panel created under Clause 5.20 will comprise:

1. a Medical Practitioner nominated by the AMA;
2. a Medical Practitioner nominated by the Commissioner of Health; and
3. an independent Medical Practitioner agreed by the AMA and the Commissioner of Health who will be the Chairperson. Timetable for Resolution

5.22 The parties will try to complete the Review as quickly as possible. With the exception of the 7 day limit for appeals to the Medical Appeals Panel, time limits in this clause 5 are indicative only, and failure to comply with a time limit will not in any circumstances invalidate any step or action.

5.23 A Review may be resolved by the approval by the Hospital Board of an offer or proposal ("a Resolution Proposal"). A Resolution Proposal may be formulated:

1. by any person involved in the Review;
2. with the agreement of all parties as a result of a mediation process.

5.24 A Resolution Proposal may be expressed to be without prejudice to the rights of the persons involved in putting forward the proposal. 5.25 A Resolution Proposal may include (but is not limited to) undertakings as to:

1. the types of work which the Medical Practitioner will perform in the future,
2. re-education or further education programmes;
3. attendance at drug or alcohol rehabilitation programmes;
4. modification of health care facility practices or procedures.

5.26 The persons concerned with the Review may agree to participate in mediation. The Hospital Board will appoint a representative to participate in the mediation process. The mediation will be conducted by a trained or experienced mediator. The purpose of a mediation will be to formulate a resolution proposal acceptable to all parties.

5.27 The parties will try to complete the mediation within 21 days.

5.28 The terms on which the mediation is to be conducted will be agreed between the parties involved in the mediation prior to the commencement of the mediation. It is anticipated that ordinarily it would be agreed that:

1. the cost of the mediation will be borne by the parties; and
2. the mediation process will be without prejudice to the legal rights of the parties. Statements made during the course of the mediation will be confidential, without prejudice to the legal rights of the parties and will not be admitted or tendered into evidence by the parties. 5.29 A Review will not be deferred or delayed because of mediation.

5.30 A Resolution Proposal will be considered by the Hospital Board and may be accepted by the Hospital Board as a resolution of the matter. The Hospital Board may take into account:

1. the stage at which the offer or proposal is put;
2. whether the proposal is put on a 'without prejudice' basis; and
3. the views of any person involved in the process concerning the proposal.

5.31 The fact that a Resolution Proposal has been put to the Hospital Board and considered by it will not prejudice or impair the ability of the Hospital Board to consider and determine the Review.

5.32 The determination of a Review under this clause will not affect the rights of:

1. a patient against the Hospital Board or a Medical Practitioner;
2. the Hospital Board and the Medical Practitioner against each other arising out of or in relation to any proceedings brought by a patient; or
3. the Hospital Board or any other person to refer any matter to the Medical Board established under the Medical Act 1894.

5.33 Persons affected by a Review may be represented by a lawyer or other representative.

5.34 Subject to the ordinary obligations of confidentiality, a Medical Practitioner subject to a Review will be entitled to full access to the records of the health care facility which deal with the subject matter of the Review and will co-operate fully in the conduct and resolution of the Review. 6. Medical Appeals Panel 6.1 A Medical Appeals Panel will comprise:

1. a Medical Practitioner nominated by the AMA;
2. a Medical Practitioner nominated by the Hospital Board; and
3. an independent Medical Practitioner agreed by the AMA and the Hospital Board who will be the Chairperson.

6. Medical Appeals Panel

6.1 A Medical Appeals Panel will comprise:

1. a Medical Practitioner nominated by the AMA;
2. a Medical Practitioner nominated by the Hospital Board; and
3. an independent Medical Practitioner agreed by the AMA and the Hospital Board who will be the Chairperson.

6.2 Appointments to the Medical Appeals Panel may be on an ad hoc basis to consider particular appeals and will not involve persons previously concerned with the subject of the appeal.

6.3 Persons appearing before the Medical Appeals Panel may be represented by a lawyer or other representative.

6.4 The Medical Appeals Panel will:

1. in the absence of exceptional circumstances, hear and determine the appeal on the evidence and matters raised before the Hospital Board;
2. determine the matter according to equity, good conscience and the substantial merits of the case without being constrained by legal technicalities or legal forms;
3. afford procedural fairness to all persons, but may proceed to hear an appeal if documents or information are not provided within time limits specified by the Panel;
4. act as rapidly as practicable;
5. prepare a written report setting out: (i) conclusions arrived at including any dissenting view of a Panel member; (ii) reasons for arriving at those conclusions; and (iii) materials:
6. referred or provided to the Panel; and
7. relied upon in arriving at the conclusions;
8. give the Medical Practitioner the subject of the Review an adequate opportunity to put submissions before preparing the report;
9. with the consent of the Hospital Board, take legal advice if it considers necessary concerning the appeal and may in its discretion keep this advice confidential to itself and the Hospital Board; and
10. otherwise determine the manner in which the appeal is to be conducted.

6.5 The Medical Appeals Panel will report and provide its recommendations to the Hospital Board and may make such recommendations concerning the appeal as it considers appropriate to best protect the interests of all parties and members of the public.

6.6 After consideration of the report and recommendations of the Medical Appeals Panel, the Hospital Board may exercise any of its powers and such determination will be final and binding.

6.7 The administrative costs of the Medical Appeals Panel including any fees for members of the Medical Appeals Panel will ordinarily be borne by the Hospital Board. However, the Medical Appeals Panel may recommend an apportionment of costs if, in its view, it is fair and equitable to do so. The legal costs of each party will be borne by that party.

6.8 The Commissioner of Health may establish regional, State-wide or specialist Medical Appeals Panels. These Medical Appeals Panel will comprise:

1. a Medical Practitioner nominated by the AMA;
2. a Medical Practitioner nominated by the Commissioner of Health; and
3. an independent Medical Practitioner agreed by the AMA and the Commissioner of Health who will be the Chairperson.

7. Committees Generally

7.1 This clause applies to Medical Advisory Committees, and the Clinical Privileges Advisory Committees ("Committees"). Elections

7.2 Elections for Committees will generally be held in June. Elections to fill casual vacancies will be held at such time as the Committee may determine. The Committee may determine whether the elections will be biennial elections of the whole of the Committee or annual elections of half the Committee.

7.3 Generally, committee members will take office from 1 July. Committee members elected to fill casual vacancies will take office from the date of their election with their term expiring at the same time as the committee member they replace.

7.4 The Chairperson of the outgoing Committee will nominate a returning officer. The nominee must not be a person seeking election to the Committee. Transitional Arrangement

7.5 Until elections for new committees are held, which should be by 30 June 2001, existing members of Medical Advisory Committees and Clinical Appointments Committees shall continue as the newly constituted committees.

7.6 Where biennial elections are held, up to one half of the members elected will be appointed for 2 years based on the number of votes received. Nominations and Voting

7.7 Nominations for Committees must be in writing signed by the proposer, seconder and nominee.

7.8 Nominations must be in the hands of the returning officer one calendar month before the date fixed for the election. If no one is nominated from a particular health care facility in respect of which a Committee provides advice, the returning officer may accept oral nominations of persons from that health care facility up to 72 hours before the date advertised for election papers to be sent out.

7.9 Medical Practitioners with Clinical Privileges at the health care facility for a term greater than 12 months will be eligible to stand for election, nominate and second candidates and vote for those Committees providing advice in respect of the health care facilities at which they have Clinical Privileges.

7.10 Voting in elections for Committees will be by non-preferential secret ballot submitted to the returning officer by the due date. Postal votes will be accepted, provided that they are in the hands of the returning officer by noon on the day before the day fixed for the poll to be declared.

7.11 The Chairperson of each Committee will be elected by the elected members of the Committee for a one year term and will be eligible for re-election.

7.12 The Chairperson will have a deliberative as well as a casting vote.

7.13 Each Committee will appoint a Deputy Chairperson to act as chairperson at meetings of the Committee and perform the other functions of the Chairperson when the Chairperson is unavailable or unable to perform his or her functions.

7.14 The Chairperson will determine the appropriate rules of debate to apply.

7.15 Any elected member who misses three consecutive meetings of a Committee without good cause being shown will be deemed to have resigned. Quorum and Proxies

7.16 A quorum will comprise two thirds of the elected members of the Committees.

7.17 Members of a Committee may nominate in writing Medical Practitioners as proxies to attend particular meetings in their place when they are unable to attend. Where a member is called to an emergency, or where a member has received less than 48 hours notice of the meeting, the Chairperson may accept an oral proxy.

7.18 Subject to Clause 7.6, the term of office of members of a Committee will be 2 years.

7.19 The health care facility will ensure adequate secretarial support is provided and minutes are maintained of all formal meetings of the Committee. Conflict of Interest

7.20 A member of a Committee who, whether directly or indirectly, has duties or interests in conflict with his or her duties or interests on that Committee, must declare a possible conflict of interest to the Chairperson. The member will withdraw from the Committee for the duration of the deliberations in question, prior to any discussions or decisions on the matter being taken, unless the Committee determines the conflict is trivial or unlikely to affect the outcome.

7.21 Where a member has withdrawn from the Committee for a particular matter that person's nominated deputy may sit on the Committee for the purpose and duration of the period during which such matter is under consideration. Confidentiality

7.22 Subject to this Memorandum, discussions, deliberations and recommendations of Committees will be kept confidential unless the Committee or the Hospital Board (after consultation with the Committee concerned) decides otherwise or as required by law.

8. Definitions and Interpretation

8.1 In this Memorandum, the following definitions apply:

1. Clinical Privileges means the type of medical services that a Medical Practitioner is approved to provide at a health care facility;
2. Clinical Privileges Conditions means the terms and conditions attached to the grant of Clinical Privileges;
3. Health care facility means a community hospital or related community hospitals and associated community clinics or a multi-purpose service where medical practitioners provide services;
4. Medical Practitioner means a medical practitioner registered under the Medical Act 1894 (as amended from time to time) including an employee of a Hospital Board but excluding an intern, resident, registrar or senior registrar;
5. Medical Services Agreement means an agreement between a Hospital Board and an independent contractor for the provision of medical and other services;
6. Review means a review of the clinical conduct of a Medical Practitioner in accordance with clause 5 of this Memorandum.

8.2 A Hospital Board may act through its authorised agents and employees including, without limitation, the General Manager or the General Manager's delegates.

8.3 The Minister and the AMA may act through their officers and representatives.