Medical staff

Health-care professionals, such as doctors, were appointed to the HSC's medical staff. As such they were not employees, but were professionals with a hospital appointment. They had hospital privileges, which meant that they were allowed to work in the hospital. As will be seen later in this report, professionals with a hospital appointment enjoyed a degree of autonomy that employees such as nurses did not enjoy.

Every member of the medical staff was appointed to a specific department. However, staff members could have more than one appointment. In such cases, the member had a primary appointment and a secondary appointment.

The medical staff was governed by the HSC's medical staff bylaws. (Exhibit 41) According to these bylaws, the medical staff were responsible:

• for ensuring the provision of optimal medical care to patients at the Centre, of a standard commensurate with the resources available and the state of medical science;
• for ensuring an environment conducive to scholarly inquiry and research at the Centre;
• for ensuring the provision of medical education programs to support the aim of a high standard of care; and
• for advising the Board on medical matters relating to the mission, role, goals and objectives of the Centre.

To accomplish this, the medical staff was expected to maintain an effective system for making recommendations for the appointment, reappointment and the delineation of privileges. In addition, the bylaws stated that the medical staff should:

Maintain an acceptable quality assurance programme for the Medical Staff through the establishment of standards of medical care in the Centre, the monitoring of performance, the identification of problems, and the undertaking of corrective action in relation to the conduct of medical practice in the Centre. (Section 3.2.2.2)

In short, the medical staff were responsible to the board for the "quality of patient care, education and research." (Section 4.1.11)

Members were appointed and reappointed to the medical staff on the basis of the recommendation of the Medical Advisory Committee. This committee made its decision based on applications submitted to it by the appropriate department head. According to the medical staff bylaw, Section 5.2.21,

All medical practitioners shall be qualified to practice in the Province of Manitoba and shall be registered and hold a current license with the College of Physicians and Surgeons of Manitoba.

In addition, the board, when deciding on an application, considered past performance in quality of patient care, ability to work with colleagues and staff, and contribution to administration and committee work.

Members of a department were responsible to the section head and the department head for meeting standards of patient care, performance of teaching and research duties, performance of administrative responsibilities, and appropriate attendance at meetings.

Each department was expected to have its own Department Council to act as a forum for communication and discussion between the department head and members of the department. As well, the Department Council could:

Establish such standing or ad hoc committees as it deems necessary each operating within specific terms of reference. Such Committees shall include a Credentials and Privileges Committee and a Standards Committee. [Section 6.6 (e)]

The Department Council comprised all members of the department (except for honourary and educational members) and persons who the council believed might be appropriately included in membership because of their association with the department.

Medical Staff Council

The Medical Staff Council was composed of the medical staff at the Centre and was intended to represent the interests of the medical staff. The council consisted of members of the active staff, members of the provisional staff and members of the scientific staff.

Medical Advisory Committee

The Medical Advisory Committee was the senior patient care committee responsible for advising the board on all matters concerning medical policy and issues.

According to the HSC bylaws, the main duties of the Medical Advisory Committee included:

• advising the board on all matters concerning patient care policy and issues;
• establishing and maintaining standards of medical practice;
• through the President of the Medical Staff Council informing the medical staff of business transacted at meetings of the Medical Advisory Committee;
• making recommendations to the board concerning the qualifications required for appointment to the medical staff;
• making recommendations to the board on the appointment and privilege delineation of each member of the medical staff; and
• recommending to the board policies and procedures relating to disciplinary matters.

The Medical Advisory Committee's membership included a Senior Vice-President, who acted as the chair. (Both before and after June 1, 1994 this position was occupied by Sutherland.) Other members included the President of the Medical Staff Council, three other officers of the Medical Staff Council, the department heads of the various medical departments and the Dean of the School of Medicine. The committee's non-voting members included the President of the HSC, the Senior VP of Operations, Senior VP of Nursing, Senior VP of Corporate Planning, the HSC Director of Research and the Director of Medical Administration. The Medical Advisory Committee met at least ten times a year.

Remuneration

HSC medical staff received their income in a variety of ways, besides the payment they might receive from the University of Manitoba for their academic duties. Department heads, section heads and subsection heads were paid by the HSC. In addition, they were entitled to bill the Manitoba government for medical services that they performed in the hospital. Surgeons, anaesthetists and other doctors similarly received a combination of direct payments and fee-for-service payments.

The members of the section of pediatric anaesthesia had established an arrangement with the hospital that introduced an element of income sharing to the manner of their remuneration. Essentially, members of the section performed their services and each was paid on the basis of the earnings received by the entire section (less an administrative fee).