THE CHRIST HOSPITAL MEDICAL STAFF BYLAWS

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE XITITLE:ADOPTION & EFFECTIVE DATEORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 1998; December 2000REVISION DATE: February 1998; October 2008; October 2009; August 2010; October 2010; July 2011September, 2008Approved at General Med.Staff meeting 9/23/08Revised onOctober 15, 2008Revised October 2009Revised August 19, 2010Revised October 20, 2010Revised July 2011THE CHRIST HOSPITALMEDICAL STAFF BYLAWSCINLibrary 0113651.0554388 1827559v23

PREAMBLEWHEREAS, The Christ Hospital is a not-for-profit corporation organized under the laws of the State of Ohio;WHEREAS, its purpose is to serve as a general hospital providing patient care, education and research; andWHEREAS, the Medical Staff is a self-governing body and is a constituent part of the Hospital, and must work withand is subject to the ultimate authority of the Board of the Hospital.WHEREAS, the Medical Staff acts on behalf of the Hospital and the Board of the Hospital in peer review, qualityassurance, credentialing, utilization review and other matters that are appropriately delegated to the Medical Staff.THEREFORE, the members of the Medical Staff practicing in the Hospital shall carry out the functions delegated tothe Medical Staff by the Board in conformity with the following Bylaws duly approved by the Board.1CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE ITITLE:NAME, AUTHORITY, PURPOSES AND RESPONSIBILITIES OF THE MEDICALSTAFFORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; December 2000; July 2002; September 2005;May 2007; October 2008; October 2009; August 2010; July 20111.4-2 Each Member shall agree to:A. Notify the President and CEO and the President of the Medical Staff in writing within five (5)working days of: (i) the limitation, reduction, suspension, non-renewal or voluntary limitation orrelinquishment of the Practitioner's license in any state; (ii) any limitation, reduction, suspension,non-renewal or termination of any medical staff appointment or clinical privileges at anotherhospital; or (iii) the commencement of a formal investigation by, or of the filing of felony chargesby the Department of Health and Human Services, any law enforcement agency, or any State orFederal health regulatory agency;B. Notify the Medical Staff office of any change in address, phone, electronic mail or FAX number,malpractice insurance coverage, etc.;C. Discharge such Medical Staff, Department, service, committee and Hospital functions for whichthe Practitioner is responsible by appointment, election, or otherwise;D. Provide appropriate health education to patients and their families;E. Coordinate all patient care, treatment and services with other Practitioners and Hospital personnel;F. Prepare and complete, in a manner compliant with all Medical Staff Policies, all Hospital andother required records for all patients Member admits or in any way provides care to in theHospital;G. Participate in the educational programs conducted by the Hospital; andH. Name an alternate Practitioner with comparable privileges who agrees to attend to patients whenthe Member is unavailable, to notify the alternate (or other suitable designee) when services areneeded, and to confirm the availability of such alternate in order to assure continuity of care.I. Comply with and enforce the Medical Staff Bylaws, rules, regulations and policies.1.5 STAFF FUNCTIONS: The Medical Staff shall, as a self-governing body, establish and maintain appropriatestandards for patient care and to oversee the quality of such care. Provision shall be made in these Bylaws or byresolution of the Medical Executive Committee approved by the Board, either through assignment to theDepartments, to Staff committees, to Medical Staff Officers or officials, or to interdisciplinary Hospital committees,for the effective performance of the Medical Staff functions specified in this section and described in the current“Organization and Functions Manual” and of such other Medical Staff functions as the Medical ExecutiveCommittee or the Board shall reasonably require. These are to:A. Monitor and evaluate patient care provided in and develop clinical policy for: special care areas, such asintensive or coronary care units; patient care support services, such as respiratory therapy, physicalmedicine and anesthesia; and emergency, outpatient, home care and other ambulatory services;B. Participate in the patient care review of quality and appropriateness and monitoring activities, includingtissue discrepancies, blood component usage, antibiotic and drug usage, autopsy discrepancies, medicalrecord clinical pertinence and surgical case reviews;C. Conduct, coordinate, and review utilization review activities;D. Conduct, coordinate and review credentials investigations and recommendations regarding Medical Staffappointments and granting of Clinical Privileges and specified services;E. Provide continuing education opportunities responsive to performance improvement findings, new state-ofthe-artdevelopments and other perceived needs and act in an advisory capacity to the Hospital’sprofessional library services;F. Develop and maintain surveillance over drug utilization policies and practices;5CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE ITITLE:NAME, AUTHORITY, PURPOSES AND RESPONSIBILITIES OF THE MEDICALSTAFFORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; December 2000; July 2002; September 2005;May 2007; October 2008; October 2009; August 2010; July 2011G. Prevent, investigate and control nosocomial infections and monitor the Hospital’s infection controlprogram;H. Plan for response to fire and other disaster, for Hospital growth and development, and for the provision ofservices required to meet the current and future needs of the community;I. Direct Medical Staff organizational activities, including Medical Staff Bylaws review and revision,Medical Staff Officer and committee nominations, liaison with the Board and Hospital administration andreview and maintenance of Hospital accreditation;J. Coordinate the care provided by Practitioners with the care provided by nursing service and withthe activities of the Hospital patient care and administrative services6CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IITITLE:MEDICAL STAFF CATEGORIESORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 28, 1998; September 2005; May 2007; October 2008; October 2009;August 2010; October 2010; July 2011The qualifications, prerogatives and responsibilities of each category are summarized in the following table:Qualifications/Prerogative/Responsibility Active Courtesy Telemed Honorary Affiliate House PhysicianAdmits patients* YES YES NO NO NO NORequired to take call in Department YES YES** NO NO NO NOExpected to participate in the training of House Physicians YES NO NO NO NO NOEligible to vote on matters before the Medical Staff YES NO NO NO NO NOEligible to hold Medical Staff office YES NO NO NO NO NOExpected to participate in peer review and PI YES YES YES NO NO YESExpected to attend general meetings of Medical Staff YES NO NO NO NO NOExpected to attend Department/committee meetings YES NO NO NO NO NOInitial Appointment is Subject of FPPE review YES YES YES NO NO YESRequired to pay Medical Staff annual dues YES YES YES NO YES NORequired to maintain Ohio license and malpractice insurance YES YES YES NO YES YES* Subject to delineation of privileges** In accordance with Department policies and procedures8CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IITITLE:MEDICAL STAFF CATEGORIESORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 28, 1998; September 2005; May 2007; October 2008; October 2009;August 2010; October 2010; July 2011D. Advance to the Active Staff category, provided that satisfactory performance at this level has beencompleted, and the general requirements of the Active Staff are met in the year preceding suchadvancement;E. Act as a collaborating or supervising physician for any Allied Health Professional with which theCourtesy Staff Member has an appropriate Supervision Agreement or Standard Care Arrangement.2.5-3 Responsibilities/Limitations: Appointees to this category must:A. Pay all dues and assessments promptly;B. Participate, if assigned, and vote, where appropriate, as members of Medical Staff committees;C. Provide service to or refer patients to the Hospital;D. Participate in the call schedule of the Department as determined by the Department Director orMedical Executive Committee. Physicians who are 60 years of age or older are exempt from callparticipation requirements. Call participation requirements may also be waived on a case by casebasis by the Department Director, with such waiver being subject to the approval of the MedicalExecutive Committee.2.6 TELEMEDICINE STAFF:2.6-1 Telemedicine privileges may be granted to remote Practitioners who prescribe, render diagnosis orotherwise provide clinical treatment to patients in the Hospital by means of telemedicine from a site outsidethe Hospital. All Practitioners providing telemedicine services shall complete the same credentialing andprivilege process that is conducted for other applicants to the Medical Staff. Additionally, non-OhioPractitioners must meet all requirements for the practice of telemedicine of their own state and for the Stateof Ohio, including having a current and valid telemedicine certificate issued by the Ohio State MedicalBoard.2.6-2 Practitioners providing telemedicine services must be successfully evaluated pursuant to the FPPE and/orOPPE as appropriate and applicable.2.6-3 A Practitioner credentialed for telemedicine privileges shall provide medical consultation in accordancewith the scope of his, her, or their certificate (if applicable) and the contractual relationship with a Memberof the Active or Courtesy Staff who shall be responsible for the service provided by the remotetelemedicine Practitioner(s).2.6-4 Responsibilities/Limitations: Appointees to this category:A. Shall meet the general requirements for appointment;B. Shall practice within the State of Ohio or have a valid, current certificate authorizing their practiceof telemedicine that has been issued by the Ohio State Medical Board;C. Shall pay all dues and assessments promptly; andD. May not vote or hold Medical Staff or Department office.2.7 AFFILIATE STAFF2.7.1 Eligibility: Appointees to this category must meet the general requirements for appointment;11CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IITITLE:MEDICAL STAFF CATEGORIESORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 28, 1998; September 2005; May 2007; October 2008; October 2009;August 2010; October 2010; July 20112.10 FOCUSED PROFESSIONAL PRACTICE EVALUATION (“FPPE”): After a Practitioner has initially beengranted Privileges, he or she shall be subject to a period of FPPE. The Credentials Committee, after receiving arecommendation from the Department Chair, with the approval of the Medical Executive Committee, will definecircumstances that require the clinical performance of each Practitioner to be monitored and evaluated. Such monitoring andevaluating may be prospective, concurrent, or retrospective proctoring, including but not limited to:A. Chart review;B. Tracking performance monitors and/or indicators;C. External peer review; andD. Morbidity and mortality reviews.The Credentials Committee will establish the duration of FPPE in accordance with the FPPE policy.Additionally, the Credentials Committee will establish criteria, measures, and indicators that indicate theneed for additional performance monitoring.2.11 ONGOING PROFESSIONAL PRACTICE EVALUATION (“OPPE”): The Medical Staff, or a subcommitteeof it, will engage in OPPE to identify professional practice trends that affect the quality of care and patient safety.Information from this evaluation process will be factored into the decision to allow Practitioners to maintain existingPrivileges, revise existing Privileges, or revoke an existing Privilege prior to or at the time of reappointment. OPPEshall be undertaken as part of the Medical Staff’s evaluation, measurement, and improvement of Practitioner’scurrent clinical competency. In addition, each practitioner may be subject to FPPE when a new privilege isrequested by a member of the Medical Staff or when issues that may affect the quality of care and/or patient safetyare identified during the OPPE process. Decisions to assign a period of performance monitoring or evaluation shallbe based on the evaluation of a Practitioner’s current clinical competence, practice behavior, and ability to perform aspecific Privilege.2.12 PROCEDURE FOR APPOINTMENT: Candidates for membership or privileges shall prepare and file anapplication. Completed applications will be reviewed by the Department Director and the Medical Staff Servicesoffice and then submitted for review by the Credentials Committee; as further described in the Credentials Policyand Procedures Manual. If more information concerning the application is needed, the application will be deemedincomplete, and no action will be taken until the application is complete.13CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IIITITLE:MEDICAL STAFF OFFICERSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; September 2005; May 2007; October 2008; October 2009; August 2010;July 20113.1 GENERAL OFFICERS OF THE MEDICAL STAFF3.1-1 The Medical Staff Officers shall be:A. President of the Medical StaffB. President-Elect of the Medical StaffC. Secretary-Treasurer of the Medical StaffD. Immediate Past President3.1-2 Other Medical Staff leadership positions may include Department Directors, Division Chiefs, and otherofficials as may be selected by the Medical Staff pursuant to these Bylaws.3.1-3 Eligibility: Medical Staff Officers must be appointees of the Active Staff at the time of nomination andelection and must remain appointees in good standing during their term of office. Failure to maintain suchstatus shall result in immediate removal from office and create a vacancy in the office involved. EachMedical Staff Officer must demonstrate competence in his or her field of practice, and demonstratequalifications based on training, experience, and ability to direct the medico-administrative aspects ofHospital and Medical Staff activities. Officers of the Medical Staff may not hold leadership positionswithin any other hospital Medical Staff organization. The Medical Executive Committee will furtherdefine and determine application of this provision.3.1-4 Nominations:A. By Nominating Committee: The Medical Staff Officer Nominating Committee shall consist ofthe two most recent past Presidents of the Medical Staff who are Members of the Active Staff, thecurrent President of the Medical Staff, the President-Elect of the Medical Staff, and the Secretary/-Treasurer. The Nominating Committee shall identify one qualified nominee for any office that isor will become vacant as result of the next Officer election. The names of such nominee(s) shallbe reported to the voting appointees of the Medical Staff at least thirty (30) days prior to the Maygeneral Staff Meeting.B. By Petition: Nominations may also be made by petition signed by at least fifteen percent (15%)of the Active Staff and filed with the Secretary/-Treasurer at least fifteen (15) days prior to theMay general Staff Meeting. As soon thereafter as reasonably possible, the names of theseindividuals shall be reported to the voting appointees of the Medical Staff.C. By Other Means: If before the election of any individual nominated for an office, the candidateshall refuse, be disqualified from, or otherwise be unable to accept the nomination, then theNominating Committee shall submit one or more substitute nominees at the May general StaffMeeting.3.1-5 Election: Officers shall be elected at the May general Staff Meeting. Only appointees of the Active Staffshall be eligible to vote. Voting shall be by written ballot or by voice vote, at the discretion of the Presidentof the Medical Staff. Voting by proxy shall not be permitted. A nominee shall be elected upon receivingover fifty percent (50%) of the valid votes cast and subject to approval by the Board. If no candidate forthe office receives a Majority vote on the first ballot, a run-off election shall be held promptly between thetwo candidates receiving the highest number of votes.Exceptions: Sections 3.1-4 and 3.1-5 shall not apply to the office of President of the Medical Staff or to the President-Electof the Medical Staff. The President-Elect shall, upon satisfactory completion of his or her term of office in that position,immediately succeed to the office of President of the Medical Staff. The Secretary/-Treasurer shall, upon satisfactorycompletion of his or her term of office in that position, immediately succeed to the office of the President-Elect of theMedical Staff.14CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IIITITLE:MEDICAL STAFF OFFICERSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; September 2005; May 2007; October 2008; October 2009; August 2010;July 20113.1-6 Term of Elected Office: Each Medical Staff Officer shall serve a two-year term, commencing inSeptember following the election unless he or she shall sooner resign or be removed from office.3.1-7 Removal of Elected Officers: Except as otherwise provided, removal of a Medical Staff Officer may beby the Board acting upon its own initiative or by a two-thirds majority vote of the Medical ExecutiveCommittee. Removal may be based only upon ineligibility to continue to serve or failure or inability toperform the duties of the position held as described in the Bylaws.3.1-8 Vacancies: If there is a vacancy in the Office of the President of the Medical Staff, the President-Electshall serve out the remaining term. If there is a vacancy in the office of President-Elect, the Secretary /Treasurer shall serve out the remaining term. A vacancy in the office of the Secretary / Treasurer shall befilled for the remaining term by an appointee of the Medical Executive Committee. All Medical StaffOfficer positions which are filled on an interim basis by the Medical Executive Committee shall be filled atthe next general Medical Staff meeting, following the general election mechanisms outlined in Sections3.1-4 and 3.1-5.3.2 DUTIES OF MEDICAL STAFF OFFICERS3.2-1 President of the Medical Staff: The President of the Medical Staff serves as the Chief Medical Officer ofthe Hospital. As the principal elected official of the Medical Staff, the President of the Medical Staff shall:A. Aid in coordinating the activities and concerns of the Hospital Administration and of the nursingand other patient care services with those of the Medical Staff;B. Communicate and represent the opinions, policies, concerns, needs and grievances of the MedicalStaff to the Board, the President and CEO and other officials of the Medical Staff;C. Be responsible for the enforcement of the Medical Staff Bylaws, Rules and Regulations, and otherMedical Staff policies, and for implementation of sanctions and corrective action where indicated,and for Medical Staff compliance with procedural safeguards in all instances where correctiveaction has been requested against a Practitioner;D. Call, preside at, and be responsible for the agenda of all general Medical Staff meetings;E. Serve as Chairman of the Medical Executive Committee, and as an Ex Officio member of all otherMedical Staff committees.3.2-2 President-Elect: Shall be a member of the Medical Executive Committee and Chairperson of theCredentials Committee. In the absence—temporary or permanent—of the President of the Medical Staff,the President-Elect shall assume all the duties and have the authority of the President of the Medical Staff.The President-Elect shall perform such additional duties as may be assigned to him or her by the Presidentof the Medical Staff, the Medical Executive Committee or the Board.3.2-3 Secretary-Treasurer: Shall be a member of the Medical Executive Committee and the CredentialsCommittee. The Secretary-Treasurer’s duties shall be to:A. Assure that proper notice of all Medical Staff meetings is given;B. Assure that accurate and complete minutes for all meetings are prepared;C. Supervise the collection and accounting for any funds that may be collected in the form of MedicalStaff dues, assessments or other fees; andD. Perform such other duties as ordinarily pertain to this office.3.3 OTHER OFFICIALS OF THE MEDICAL STAFF3.3-1 Department Directors:A. Qualifications: Each Department Director shall be a board certified appointee of the Active Staff,and shall be willing and able to discharge the functions of the office. Should a Department15CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IIITITLE:MEDICAL STAFF OFFICERSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; September 2005; May 2007; October 2008; October 2009; August 2010;July 2011Director be recruited or nominated who is not a Member of the Active Medical Staff, the initialappointment of such Member as a Department Director shall be designated as “acting” until suchtime as Active Staff status is achieved.B. Selection and Appointment: Selection and Appointment: Candidates for Department Directorsshall be identified and nominated by the Nominating Committee. Additionally, the membership ofeach Department may recommend nominees to the Nominating Committee. Subject to finalapproval of the Board, the Department Director shall be elected by a majority of the valid votesthat are cast by the Active Staff Members of the Department at a meeting where Quorumrequirements are met, or pursuant to a proxy vote in which enough votes are cast to meet Quorumrequirements. Elections may be conducted by mail ballots using Authorized CommunicationsEquipment or at meetings called for that purpose. Following the election, those elected shall beconsidere`d and reviewed by the Medical Executive Committee, and if approved by them,recommended to the Board. The Board of Directors reserves the final authority to approve anelected Department Director. Department Directors may not hold leadership positions within anyother Medical Staff organization that does not have a formal affiliation with the Hospital.Additionally, no Department Director, during that Department Director’s term, shall serve asdepartment director at another hospital.C. Term of Office and Removal: A Department Director shall serve a two (2) year termcommencing on the date specified by the Medical Executive Committee or Board. Removal of aDepartment Director from office may be initiated by the Board acting upon its own initiative orupon the recommendation of the Medical Executive Committee, or by two-thirds vote of theDepartment members eligible to vote on Departmental matters.D. Vacancies: Where a vacancy results from either voluntary resignation or removal of aDepartment Director, the Medical Executive Committee or Board may appoint an interimDepartment Director. An interim Department Director must meet the qualifications outlined inthis section, and may hold such position for a period up to one (1) year. During such period, withthe approval of the President and CEO and the President of the Medical Staff of the Hospital, aDepartment Director appointed for a one (1) year interim period can be appointed to serve the fulltwo (2) year term.E. Duties: Each Department Director shall:1. Be accountable to the Medical Executive Committee and to the President of the MedicalStaff for all professional, administrative and clinical activities within his or herDepartment and particularly for the quality of patient care rendered by appointees of theDepartment and for the effective conduct of the patient care evaluation and monitoringfunctions delegated to his or her Department.2. Coordinate and ensure Department staff members participate in the continuousassessment and improvement of the quality of care and services provided andmaintenance of quality control programs as appropriate;3. Submit reports to the Medical Executive Committee as required concerning: 1) findingsof Department review, evaluation and monitoring activities, actions taken thereon, andthe results of such action; 2) recommendations for maintaining and improving the qualityof care provided in the Department and the Hospital; 3) recommending criteria forclinical privileges relevant to the care provided within the Department; 4)recommendations for the number of qualified and competent Practitioners that theDepartment Director deems appropriate to provide patients with appropriate levels ofcare and services; and 5) such other matters as may be required by the Medical ExecutiveCommittee;16CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IIITITLE:MEDICAL STAFF OFFICERSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; September 2005; May 2007; October 2008; October 2009; August 2010;July 20113.3-2 Division Chiefs:4. Develop and implement Departmental programs in cooperation with the President of theMedical Staff and consistent with the provisions of Article IV, for evaluation of patientcare, ongoing monitoring of practice, credentials review and privilege delineation,medical education and utilization review, including orientation and continuing educationof all persons in the Department;5. Provide for the continuing monitoring of professional performance of all individuals inthe Department who have delineated clinical privileges;6. Give guidance on the medical policies of the Hospital and make specificrecommendations and suggestions regarding the Director’s Department, includingintegration of the Department/service into the primary functions of the organization;7. Maintain continuing review of the professional competence, qualifications, andperformance of all Practitioners with clinical privileges and of all Allied HealthProfessionals with specific services in the Department who provide patient care andreport regularly thereon to the President of the Medical Staff and to the MedicalExecutive Committee.8. Transmit to the appropriate authorities as required by these Bylaws, his or herrecommendations concerning appointment and classification, reappointment, delineationof clinical privileges or specific services, and corrective action with respect toPractitioners in the Department;9. Appoint such committees as are necessary to conduct the functions of the Department asspecified in Article IV and designate a chairperson;10. Enforce the Hospital and Medical Staff Bylaws, Rules and Regulations and policies andprocedures of both the Medical Staff and the Department within the Departmentincluding initiating corrective action and investigation of clinical performance andordering consultations to be provided or to be sought when necessary;11. Implement within the Department actions taken by the Medical Executive Committee andby the Board; coordinate and integrate interDepartmental and intraDepartmental services;develop and implement policies and procedures that guide and support provision ofservices;12. Participate in most phases of administration of the Department through cooperation withthe nursing service and the Hospital administration in matters affecting patient care,including personnel, supplies, special regulations, standing orders and techniques;13. Assess and recommend to the relevant Hospital authorities off site sources for neededpatient care services not provided by the Department or organization and for space andother resources needed by the Department;14. Assist in the preparation of annual reports, including budgetary and planning reports,pertaining to the Department, as may be required by the Medical Executive Committee,Hospital leadership or the Board;15. Appoint a vice or assistant Department director with the concurrence of the President ofthe Medical Staff to act in the absence of the Department Director;16. Perform such other duties commensurate with his office as may be reasonably requestedof him or her by the President of the Medical Staff, the Medical Executive Committeeand the Board.17CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IIITITLE:MEDICAL STAFF OFFICERSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; September 2005; May 2007; October 2008; October 2009; August 2010;July 2011A Department Director may, in his or her discretion, appoint Division Chiefs to serve the interests of theDepartment. A Division Chief must be board certified in an appropriate specialty or sub-specialty, andshall serve a term that is coterminous to that of the appointing Department Director. The duties of theDivision Chief shall be commensurate with his or her license and clinical privileges, and may include anyor all of those Department Director duties listed in the section above, as they are delegated from time totime by the Department Director.18CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IVTITLE:MEDICAL STAFF CLINICAL DEPARTMENTSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: June 1995; February 1998; September 2005; May 2007; October 2008; October 2009;August 2010; July 20114.1 ORGANIZATION OF DEPARTMENTS: Each Department shall have a Department Director who is elected andhas the authority, duties and responsibilities as specified in Article III. Additionally, the Departments are alignedwith the clinical Service Lines of the Hospital, with the exception of the Departments of Surgery and Medicine.Each Service Line has a Service Line Executive Medical Director who will also serve as the Department Director.4.2 DESIGNATION4.2-1 Current Departments: An up-to-date list of Departments and Divisions of the Medical Staff will be keptin the Medical Staff Services Office.4.2-2 Future Departments: When deemed appropriate and consistent with the provisions of Section 4.5, theMedical Executive Committee and the Board, by their joint action, may create, eliminate, subdivide, orcombine Departments.4.3 ASSIGNMENT TO DEPARTMENTS: Each appointee of the Medical Staff and each Allied Health Professionalshall be assigned to one Department, which will be considered their primary Department, but may be grantedClinical Privileges or granted authority to provide care or service in one or more other Departments. The exercise ofClinical Privileges or the performance of specified services within any Department shall be subject to the Rules andRegulations or policies and procedures of that Department and the authority of the Department Director.Department Directors may agree to exempt an appointee or AHP authorized in two or more Departments fromparticipation in the administrative activities of all but his or her primary Department.4.4 FUNCTIONS OF DEPARTMENTS: The primary responsibility delegated to each Department is to implementand conduct specific review and evaluation activities that contribute to the preservation and improvement of thequality and efficiency of patient care provided in that Department.To carry out this responsibility, each Department shall:A. Conduct special studies of care and specific monitoring activities, including mortality and surgical casereview, for the purpose of evaluating clinical work performed under its jurisdiction;B. Recommend guidelines to the appropriate committee for the granting of clinical privileges and theperformance of specified services within the Department;C. Conduct or participate in, and make recommendations regarding the need for continuing educationprograms and to findings of review, evaluation and monitoring activities;D. Monitor on a continuing and concurrent basis, adherence to: 1) all applicable Medical Staff and Hospitalpolicies and procedures; 2) requirements for alternate coverage and for consultations; and 3) soundprinciples of clinical practice;E. Coordinate the patient care provided by the Department’s appointees with nursing and ancillary patient careservices and with administrative support services;F. Meet not less than twice annually, or at such frequencies established by the Department Director, or by theMedical Executive Committee for the purpose of reviewing, receiving and considering patient care findingsand the results of the Department’s other review, evaluation, and monitoring activities and of performing orreceiving reports on other Department and Medical Staff functions; andG. Establish such committees or other mechanisms as are necessary and desirable to properly perform thefunctions assigned to it.19CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IVTITLE:MEDICAL STAFF CLINICAL DEPARTMENTSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: June 1995; February 1998; September 2005; May 2007; October 2008; October 2009;August 2010; July 20114.5 MODIFICATIONS IN CLINICAL ORGANIZATION UNIT: In creating, eliminating, subdividing orcombining Departments or Divisions, the Board will act after receiving a recommendation from the MedicalExecutive Committee, or on its own initiative, after having consulted with the Medical Executive Committee. In allinstances of modification, the Hospital’s written plan of development as currently being implemented and anyconstraints or mandates imposed by external planning authorities shall be considered.20CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VTITLE:MEDICAL STAFF COMMITTEES AND FUNCTIONSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: June 1995; February 1998; September 2005; May 2007; October 2008; October 2009;August 2010; July 20115.1 DESIGNATION AND SUBSTITUTION: There shall be a Medical Executive Committee and such otherstanding, special and ad-hoc committees of the Medical Staff as may be necessary and desirable to perform theMedical Staff functions listed in Sections 5.2, 5.5 and elsewhere in these Bylaws. The Medical ExecutiveCommittee may establish one or more Medical Staff committees, and such Medical Staff committees shall beresponsible to the Medical Executive Committee, in the performance of one or more required Medical Stafffunctions.5.2 MEDICAL EXECUTIVE COMMITTEE5.2-1 Composition: All Members of the Active Medical Staff are eligible for appointment or election to theMedical Executive Committee. The Medical Executive Committee shall consist of not more than15 people including the President of the Medical Staff, President-Elect of the Medical Staff, Secretary /Treasurer of the Medical Staff, Past President of the Medical Staff and a minimum of five (5) and amaximum of nine (9) physician members at large who shall be appointed by the President of the MedicalStaff, and may include other Practitioners and other individuals as determined by the Medical Staff. ThePresident and CEO, Vice President/Chief Medical Officer, the Chairperson of the PerformanceImprovement Committee (if that position is held by an individual other than the Past President of theMedical Staff), and such other members of Hospital administration as are appropriate to the subject mattermay be appointed as Ex Officio members of the Medical Executive Committee by the President of theMedical Staff. The President of the Medical Staff shall serve as Chairman of the Medical ExecutiveCommittee. Members of the Medical Executive Committee may be removed by a vote of the majority ofthe Medical Executive Committee.5.2-2 Duties: The duties of the Medical Executive Committee shall be to:A. Receive or act upon reports and recommendations from the Departments, committees, andOfficers of the Medical Staff concerning patient care quality and appropriateness of reviews,evaluations, and monitoring functions, and the discharge of their delegated administrativeresponsibilities and to recommend to the Board specific programs and systems to implement thesefunctions;B. Oversee all activities relating to the operations of the Medical Staff;C. Oversee performance improvement initiatives relating to professional services provided by allPractitioners and any Allied Health Professional privileged through the Medical Staff ServicesOffice;D. Oversee the provision of care, treatment and services to ensure that patients with comparableneeds receive a comparable standard of care;E. Review, act on, where appropriate, and coordinate the activities of and policies adopted by theMedical Staff, Departments and committees;F. Relay (with or without comment) recommendations to the Board all matters relating toappointments, reappointments, Medical Staff category, Department assignments, ClinicalPrivileges, corrective action, termination of Staff membership and the mechanisms for fair hearingprocedures;G. Account to the Board and to the Medical Staff for the overall quality and efficiency of patient carein the Hospital and for the Medical Staff’s participation in performance improvement activitiesincluding physician peer review;H. Take reasonable steps to attempt to ensure professionally ethical conduct and competent clinicalperformance on the part of the Medical Staff appointees including conducting evaluations21CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VTITLE:MEDICAL STAFF COMMITTEES AND FUNCTIONSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: June 1995; February 1998; September 2005; May 2007; October 2008; October 2009;August 2010; July 2011appropriate to assess the clinical ability of any Practitioner where a reasonable ground to doubtthat the Practitioner has the appropriate ability to perform any clinical privilege requested,initiating investigations and initiating and pursuing corrective action, when warranted;I. Make recommendations to the Board and administration on a variety of issues including thoserelating to the structure of the Medical Staff, Medical Staff credentialing and privilegingprocesses, delineations of privilege for each Practitioner, reports of other Medical Staffcommittees, and policies for organ and tissue procurement and donation;J. Inform the Medical Staff of the accreditation program and the accreditation status of the Hospital;K. Participate in identifying community health needs and in setting Hospital goals and implementingprograms to meet those needs;L. Formulate and/or approve processes to review all requests for Clinical Privileges, Medical StaffRules and Regulations, and policies and procedures; andM. Act for the Medical Staff at intervals between Medical Staff meetings, subject to any limitationimposed by these Bylaws or other Medical Staff policies and procedures.5.2-3 Removal: The Medical Staff can remove any, or various, aspects of the Medical Executive Committee’sdelegated authority as appropriate to protect the interests of the Medical Staff by a vote of at least twothirdsof the Members of the Medical Staff.5.3 CREDENTIALS COMMITTEE:5.3-1 Composition: The Credentials Committee shall be composed of the President-Elect of the MedicalStaff, serving as the chairperson, the Secretary-Treasurer of the Medical Staff, and not less than nine (9) additionalvoting Members, who are appointed by the President of the Medical Staff, and subject to the approval of the Board.Voting Members of the Credentials Committee shall be Members of the Active Medical Staff, and are selected froma variety of Departments and specialties. Other non-physician Members and/or representatives of Hospitaladministration may serve, as appropriate, as Ex Officio Members of the Credentials Committee.5.3-2 Duties: The primary duties of the Credentials Committee shall be to:A. Investigate the credentials of all initial applicants for appointment and reappointment to either theMedical Staff or the AHP staff; andB. Make recommendations to the Board concerning applications for initial appointment, granting ofClinical Privileges, applications for reappointment, changes in Clinical Privileges, and changes inStaff category.5.4 PARTICIPATION ON INTERDISCIPLINARY HOSPITAL COMMITTEES: Medical Staff functions andresponsibilities, including but limited to, those relating to the relationship with the Board and Hospitaladministration, Infection Control Committee, Hospital accreditation, disaster planning, facility and servicesplanning, and financial management shall be discharged by the appointment of Medical Staff appointees to suchHospital functions by the President of the Medical Staff. Participants on such interdisciplinary Hospital committeesby individuals other than Medical Staff appointees shall be by appointment as appropriate.5.5 COMMITTEES OF THE STAFF5.5-1 Composition and Appointment: A Medical Staff committee or Collaborative Clinical Committeeestablished to perform one or more of the Medical Staff functions required by these Bylaws shall becomposed of the appointees of the Active and Courtesy Staffs and may include, where appropriate, AlliedHealth Professionals, and representation from Hospital administration, nursing service, medical records,pharmacy, social service, and such other Departments as are appropriate to the function(s) to be discharged.Unless otherwise specifically provided, the Medical Staff appointees shall be appointed in the followingmanner: The President of the Medical Staff in cooperation with the President and CEO will appoint a22CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VTITLE:MEDICAL STAFF COMMITTEES AND FUNCTIONSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: June 1995; February 1998; September 2005; May 2007; October 2008; October 2009;August 2010; July 2011committee chairperson who will then have the authority to select and appoint the individual committeemembers. The Past-President of the Medical Staff or designee of the President shall serve as Chairpersonof the Performance Improvement Committee. The Medical Executive Committee will maintain the right offinal approval of all members. The President of the Medical Staff, the President and CEO, or theirdesignees, may attend any committee meeting without vote on all committees.5.5-2 Terms and Prior Removal: Unless otherwise specifically provided, a Medical Staff committee member(other than one serving Ex Officio) shall continue as such for two (2) years or until his successor is electedor appointed, unless he/she shall sooner resign or be removed from the committee. A Medical Staffcommittee member, other than one serving Ex Officio, may be removed by a Majority vote of the MedicalExecutive Committee. Any administrative committee member shall serve for a term equivalent to that of aMedical Staff committee member and until his/her successor is elected or appointed, unless he/she shallsooner resign or be removed from the committee. Any representative of Hospital Administration acting asan Ex Officio member of a Medical Staff committee may be removed by action of the President and CEO.5.5-3 Vacancies: Unless otherwise specifically provided, vacancies on any Medical Staff committee shall befilled in the same manner in which original appointment to such committee is made.5.5-4 Meetings: A Medical Staff committee established to perform one or more of the Medical Staff functionsrequired by these Bylaws shall meet, with a Quorum present, as often as is necessary to discharge theassigned duties, but shall not meet less than quarterly.5.5-5 Conflict of Interest: In any instance where a member of the Medical Executive Committee or a peerreview committee has a conflict of interest in any matter involving another Medical Staff appointee of thatcommittee, or in any instance where a member of the Medical Executive Committee or peer reviewcommittee brought the complaint against that appointee, that individual shall not participate in thediscussion or voting on the matter and shall absent himself/herself from the meeting during that time,although he or she may be asked and answer any questions concerning the matter before leaving. Anymember of a Medical Staff committee, including but not limited to the Credentials Committee, who is indirect economic competition with a Practitioner about whom a recommendation or decision must be madeshall abstain from participation in all discussions and votes about such matter.23CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VITITLE:MEDICAL STAFF MEETINGSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; September 2005; May 2007; October 2008;October 2009; August 20106.1 MEDICAL STAFF MEETINGS:6.1-1 Regular Meetings: A minimum of two (2) annual Medical Staff meetings will be held each calendar year.Regular Staff meetings will be held, subject to change by the President of the Medical Staff, during themonths of May and September. The Medical Executive Committee may authorize the holding of additionalgeneral Staff meetings by resolution. The resolution authorizing such additional meetings shall requirenotice specifying the place, date and time for the meeting, and that the meeting can transact any business asmay come before it.6.1-2 Special Meetings: A special meeting of the Medical Staff may be called at any time by the President of theMedical Staff. A special meeting of the Medical Staff must be called by the President of the Medical Staffat the written request of the Board, the Medical Executive Committee, or by fifteen (15%) percent of theappointees of the Active Staff of the Medical Staff.6.2 DEPARTMENT AND COMMITTEE MEETINGS6.2-1 Regular Meetings: Departments and committees may, by resolution, provide the time for holding regularmeetings and no notice other than such resolution is required. Departments must meet at least twiceannually, or as otherwise specified by the Medical Executive Committee or Department Director. Thefrequency of committee meetings is as required by these Bylaws.6.2-2 Special Meetings: A special meeting of any Department or committee may be called by the DepartmentDirector or committee chair thereof, and must be called by the director/chair if requested in writing by theBoard, the President of the Medical Staff or at least fifty-one percent (51%) of the members of the ActiveStaff (who are members of such Department, with respect to Departmental meetings).6.2-3 Executive Session: All Departments and committees of the Medical Staff may sit in executive session.During this time, the President of the Medical Staff or designee may remain at the meeting.6.3 ATTENDANCE REQUIREMENTS6.3-1 General: Each appointee of the Active Staff must attend meetings as specified in Bylaws Article II.Attendance at committee meetings will be required for those committees so specified by the MedicalExecutive Committee.6.3-2 Special Appearances or Conferences:A. Whenever a Medical Staff or Department educational program is prompted by findings resultingfrom performance improvement program activities, the Practitioner whose performance promptedthe program will be notified of the time, date, and place of the program, of the subject to becovered, and its special applicability to the Practitioner’s practice. Except in unusualcircumstances, the Practitioner will be required to be present.B. Whenever a pattern of suspected deviation from standard clinical practice or other indicator of apotential need for corrective action against a Practitioner is identified, the procedures andprocesses set forth in the Fair Hearing Plan shall govern.C. A practitioner shall attend a collegial intervention when notified by the President and CEO, VicePresident/Chief Medical Officer, President of the Medical Staff, by the Department Director, ortheir designee.24CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VITITLE:MEDICAL STAFF MEETINGSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; September 2005; May 2007; October 2008;October 2009; August 20106.4 MEETING PROCEDURES - GENERAL MEDICAL STAFF6.4-1 Order of Business and Agenda at General Medical Staff Meetings: The order of business at a generalMedical Staff meeting shall be determined by the President of the Medical Staff.6.4-2 Notice of Meetings: Written notice stating the place, day and hour of any general Medical Staff meeting,or any special meeting of the Medical Staff shall be delivered either personally, by fax, by mail (regular orexpress), courier service, or by the use of Authorized Communications Equipment to each person entitledto be present thereat not less than five (5) calendar days nor more than thirty (30) calendar days before thedate of such meeting. If mailed, the notice of the meeting shall be deemed delivered seventy-two (72)hours after deposited, postage prepaid, in the United States Mail addressed to each person entitled to suchnotice at his address as it appears on the records of the Hospital. If notice is given by personal delivery orby use of Authorized Communications Equipment, the notice shall be deemed to have been given whendelivered or transmitted. It is the responsibility of each Practitioner to provide written update notice to theMedical Staff Services Office of any change in address, facsimile number, and electronic mail address.Personal attendance at a meeting shall constitute a waiver of notice of such meeting.6.4-3 Quorum: Quorum for general Medical Staff Meetings shall consist of a Quorum, as defined herein, of thevoting members present at any regular or special meeting for all purposes.6.4-4 Minutes: Minutes of all general Medical Staff meetings shall be prepared under the direction of theSecretary-Treasurer of the Medical Staff and shall include a record of attendance, a description of itemsdiscussed, and all actions taken. Copies of such minutes shall be signed by the President of the MedicalStaff, approved by the attendees, forwarded to the Medical Executive Committee and made available to theMedical Staff. A permanent file of the minutes of each general Medical Staff meeting shall be maintainedin the Medical Staff Services Office.6.4-5 Manner of Action: Except as otherwise provided, action at all general Medical Staff meetings may betaken by a Majority of the voting members present and eligible to vote.6.5 MEETING PROCEDURES – DEPARTMENT AND COMMITTEE MEETINGS6.5-1 Order of Business and Agenda at Department and Committee Meetings: The order of business at aDepartment or committee meeting shall be determined by the presiding officer over such meeting.6.5-2 Notice of Meetings: Notice of Department or committee meetings may be given orally, by mail, byposting of a notice in any prominent location, which may include in the Department common area, near theelevator, and / or in the physician lounge, or by Authorized Communication Equipment. If mailed, thenotice of the meeting shall be deemed delivered seventy-two (72) hours after deposited, postage prepaid, inthe United States Mail addressed to each person entitled to such notice at his / her address as it appears onthe records of the Hospital. If notice is given by personal delivery or by use of AuthorizedCommunications Equipment, the notice shall be deemed to have been given when delivered or transmitted.It is the responsibility of each Practitioner to provide written update notice to the Medical Staff ServicesOffice of any change in address, facsimile number or electronic mail address. Personal attendance at ameeting shall constitute a waiver of notice of such meeting.6.5-3 Quorum: Unless the presiding officer otherwise determines in advance of any regular or special meeting,the presence of ten percent of the voting members of the Department or committee eligible to vote shallconstitute quorum.6.5-4 Minutes: Minutes of Department or committee meetings shall be taken as directed by the presiding officerof such meeting.6.5-5 Manner of Action: Attendance through the use of Authorized Communications Equipment at Departmentor committee meetings may, when determined in advance of such meeting, and in the sole discretion of thepresiding officer, be permitted, so long as the use of the Authorized Communications Equipment allows all25CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VITITLE:MEDICAL STAFF MEETINGSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; September 2005; May 2007; October 2008;October 2009; August 2010members participating in the meeting to contemporaneously communicate with each other. Action may betaken without a meeting by a Department or committee by a document setting forth the action so taken, andapproved by each member entitled to vote on such matter.26CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VIITITLE:PROCEDURAL RIGHTSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; September 2005; May 2007; October 2008;October 2009; August 20107.1 ADVERSE ACTION / RIGHT TO HEARING7.1-1 By The Medical Executive Committee or the Board: When a Practitioner receives a recommendation ofcorrective action that may adversely impact Clinical Privileges, the Practitioner is entitled to request ahearing under and subject to the terms of the Fair Hearing Plan of the Hospital.7.1-2 Summary Suspension: When a Practitioner receives notice that his or her Clinical Privileges have beensummarily suspended pursuant to the Credentials Policy and Procedure Manual or the Fair Hearing Plan,the Practitioner shall be entitled to request a hearing under and subject to the terms of the Fair Hearing Planof the Hospital.7.2 ADVERSE ACTIONS: Events triggering a right to a hearing are set forth in the Fair Hearing Plan, and shallinclude:7.2-1 denial of initial staff appointment (except as set forth in the Fair Hearing Plan);7.2-2 denial of reappointment (except as set forth in the Fair Hearing Plan);7.2-3 suspension of staff appointment;7.2-4 revocation of staff appointment;7.2-5 suspension of admitting privileges7.2-6 denial or restriction of requested Clinical Privileges;7.2-7 reduction in Clinical Privileges;7.2-8 imposition of a joint admission requirement;7.2-9 suspension of Clinical Privileges; or7.2-10 revocation of Clinical Privileges.7.3 ACTIONS NOT DEEMED ADVERSE: Neither:7.3-1 issuance of a warning or a formal letter of reprimand, nor;7.3-2 the imposition of a probational period with retrospective review of practice but without specialrequirements of consultation or supervision, nor;7-3.3 the denial, termination or reduction of temporary privileges, nor the suspension;7.3-4 for failure to complete medical records, nor any other actions except those specified in the CredentialsPolicy & Procedure Manual, entitle the Practitioner to any hearing or appellate review rights.7.4 PROCEDURES FOR HEARINGS AND APPELLATE REVIEWS: All hearings and appellate reviews will beconducted in accordance with the procedures and safeguards set forth in the Fair Hearing Plan and are incorporatedherein by reference.7.4-1 Practitioners have thirty (30) days from the date of receipt of notice of corrective action to file a writtenrequest for a hearing. Such request must be timely delivered to the President of the Medical Staff and CEOof the Hospital. Further information on scheduling hearings is in the Fair Hearing Plan.7.4-2 Practitioners have thirty (30) days from the date of receipt of notice of an adverse recommendation by theMedical Executive Committee to file an appeal. Such request must be timely delivered to the President ofthe Medical Staff and CEO of the Hospital. Further information on scheduling appeals is in the FairHearing Plan.7.4-3 As more fully described in the Fair Hearing Plan, during a hearing, each party may:7.4-3.1 call, examine and cross examine witnesses on any matter relevant to the issues;7.4-3.2 introduce exhibits7.4-3.3 impeach any witness7.4-3.4 rebut any evidence, and27CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VIITITLE:PROCEDURAL RIGHTSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; September 2005; May 2007; October 2008;October 2009; August 20107.4-3.5 if the Practitioner does not testify on his or her own behalf, he or she may be called and examinedas if under cross-examination7.4-4 As more fully described in the Fair Hearing Plan, Fair Hearings are presided over by either a presidingofficer who may or may not be an attorney appointed by the President of the Medical Staff, or by anarbitrator selected by the Hospital and approved by the Practitioner. Any fees or costs resulting from theuse of an arbitrator as the hearing officer shall be borne equally by the Hospital and the Practitioner.7.5 NOTIFICATION OF ADVERSE ACTIONS TO THE MEDICAL STAFF OF AFFILIATED ENTITIES :After an adverse action which is final under these Bylaws and the Fair Hearing Plan, (that is, an action taken oreffective after all appeals and rights to appeal have been concluded) if the President of the Medical Staff has reasonto believe that the Practitioner is a member of the Medical Staff of any entity with which the Hospital has a formalwritten affiliation, the President shall furnish a written notice to the presidents of the medical staffs of each suchother affiliated entity. The Notice shall contain a recitation of the adverse action and the date such action was takenor was effective; provided however, such notice may not contain any information that was presented during thereview and hearing process. The Practitioner shall be sent a copy of all such Notices.7.6 AUTOMATIC SUSPENSION : A Practitioner’s Medical Staff membership and Clinical Privileges areautomatically suspended in the following cases:7.6-1 when a Practitioner fails to appear after two notices of a special meeting have been given under Section 1.7of the Fair Hearing Plan;7.6-2 when an action by any state board of medical examiners has the effect of revoking, suspending, orrestricting a Practitioner’s license, as further described in Section 1.11 of the Fair Hearing Plan;7.6-3 when a Practitioner’s Drug Enforcement Administration or other controlled substances license issuspended, as further described in Section 1.11 of the Fair Hearing Plan;7.6-4 when a Practitioner fails to complete medical records, as set forth in the Hospital Rules and Regulationsand in Section 10.14 of the Medical Staff Rules and Regulations;7.6-5 if a Practitioner fails to maintain the minimum amount of professional liability insurance, as set forth in theMedical Staff Rules and Regulations;7.6-6 if a Practitioner is excluded, debarred, suspended or deemed ineligible to participate in federal or statehealth care programs, as further described in Section 1.11 of the Fair Hearing Plan.7.6-7 The Practitioner will be provided written notice of any such automatic suspension, as more fully describedin Section 1.13 of the Fair Hearing Plan.7.7 SUMMARY SUSPENSION : At any time when it is determined that a failure to take immediate action may resultin an imminent danger to the health or safety of any individual, all or a portion of the clinical privileges and/or staffmembership of a Practitioner may be summarily suspended, restricted, or limited by the Department Director, VicePresident/Chief Medical Officer, President of the Medical Staff, his or her designee, or the President and CEO of theHospital, by giving written notice to the Practitioner, as more fully described in Section 1.10 of the Fair HearingPlan.7.8 VOLUNTARY TERMINATION : A Practitioner shall be deemed to have voluntarily terminated their MedicalStaff appointment if: their dues have not been paid within four (4) months of the due date; or if they fail to completethe process for reappointment.7.9 RECOMMENDATION FOR TERMINATION, SUSPENSION OR REDUCTION IN CLINICALPRIVILEGES AND/OR MEDICAL STAFF MEMBERSHIP: When a Practitioner exhibits acts, demeanor, or28CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VIITITLE:PROCEDURAL RIGHTSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: September 1997; September 2000; September 2005; May 2007; October 2008;October 2009; August 2010conduct reasonably likely to be one or more of the following: (a) detrimental to patient safety or to the delivery ofquality patient care within the Hospital; (b) contrary to the ethics of the medical profession; (c) contrary to theMedical Staff Bylaws, Rules and Regulations, or the policies and procedures of the Hospital, as the same may bemodified from time to time; (d) below applicable professional standards; (e) disruptive to Hospital operations ordetrimental to the best interests of the Hospital; or (f) interpreted by any individual working in the Hospital to createreasonable suspicion that a Practitioner is an impaired physician, the Medical Executive Committee may initiate anInvestigation that may have several steps and components as more fully described in the Fair Hearing Plan. Wherethe Medical Executive Committee, after conclusion of any additional Investigation, and/or the special meeting,concludes that sufficient cause exists to substantiate the request for corrective action against the Practitioner, and thecorrective action which is recommended could result in a reduction, suspension, restriction, denial, nonrenewal, ortermination of clinical privileges, the President of the Medical Staff shall, within a reasonable time, normally notmore than five (5) days after issuance of the Medical Executive Committee’s report of findings, provide notice to thePractitioner of the recommendation of the Medical Executive Committee and of the Practitioner’s right to request ahearing under the Fair Hearing Plan.7.10 REDUCTION IN CLINICAL PRIVILEGES DUE TO NONUSE: Where a reduction in the clinical privilegesof a Practitioner is deemed appropriate as result of nonuse, a recommendation to reduce clinical privileges can bemade by the President of the Medical Staff, and, where the Medical Executive Committee and Board concur, thereduction in clinical privileges shall be immediately effective.7.11 TERMINATION OF DISASTER, VISITING AND TEMPORARY PRIVILEGES: Visiting and/or TemporaryPrivileges may be reduced, suspended or terminated by the Department Director, or President of the Medical Staff,as more fully described in the Credentials Policy and Procedures Manual.29CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VIIITITLE:CONFIDENTIALITY, IMMUNITY AND RELEASESORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: May 2007; October 2008; October 2009; August 20108.1 AUTHORIZATIONS AND CONDITIONS: By submitting an application for Medical Staff appointment orreappointment, or by applying for or exercising Clinical Privileges or providing specified patient care services at thisHospital, a Practitioner:A. Authorizes Representatives of the Hospital and the Medical Staff to solicit provide and act uponinformation bearing on his or her professional ability and qualifications;B. Agrees to be bound by the provisions of this Article and to waive all legal and equitable claims against anyRepresentative who acts in accordance with the provisions of this Article; andC. Further agrees that he will not seek legal or equitable redress until such time as all administrative remediesprovided for in any Medical Staff Policy, including the Fair Hearing Plan, has been exhausted.8.2 CONFIDENTIALITY OF INFORMATION: Information with respect to any Practitioner submitted, collected orprepared by any Representative of this or any other health care facility, or organization, or the Medical Staff for thepurpose of evaluating and improving the quality and efficiency of patient care, reducing morbidity and mortality,and performed in compliance with the applicable standards of care shall, to the fullest extent permitted by law, beconfidential and shall not be used in any way except as provided herein or except as otherwise provided by the law.Such confidentiality shall also extend to information of the kind that may be provided by Third Parties. Thisinformation shall NOT become a part of any particular patient’s medical record.8.3 IMMUNITY AND LIABILITY8.3-1 Professional Review Body: Each Representative is constituted as a Professional Review Body (as thatterm is defined under HCQIA) and in the State of Ohio, and each claims all privileges and immunitiesafforded to it by said federal and state statutes.8.3-2 No Liability For Action Taken: No Representative of the Hospital or Medical Staff shall be liable to aPractitioner for damages or other relief for any decision, action, statement or recommendation made withinthe scope of any appointment, reappointment, credentialing or peer review consideration or decision, aslong as such action is reasonable and done in good faith.8.3-3 For Providing Information: Neither the Hospital, a Representative of the Hospital or Medical Staff, or aThird Party shall be liable to a Practitioner for damages or other relief by reason of providing information,including otherwise privileged or confidential information, to a Representative of this Hospital or MedicalStaff or to an appropriate local, State or Federal regulatory agency, concerning a Practitioner who is or hasbeen an applicant to or an appointee of the Medical Staff or who did or does exercise Clinical Privileges orprovide specific patient care services at this Hospital and provided further that such information is relatedto the performance of duties and reported by such Representative without malice and in the reasonablebelief that such information is warranted by the facts. Such information will not be provided to any otherhospital, health care facility, organization of health professions, or individuals without that Practitioner’sexpress written consent, except as stated in Section 7.5 and except as may otherwise be required by law.8.4 ACTIVITIES AND INFORMATION COVERED8.4-1 Activities: The confidentiality and immunity provided by this Article applies to all acts, communications,proceedings, interviews, reports, records, minutes, forms, memoranda, statements, recommendations,findings, evaluations, opinions, conclusions, or disclosures performed or made in connection with this orany other healthcare facility or organization’s activities concerning but not limited to:A. applications for appointment, clinical privileges or specified services;B. periodic reappraisals for reappointment, clinical privileges or specified services;C. corrective or disciplinary action;30CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE VIIITITLE:CONFIDENTIALITY, IMMUNITY AND RELEASESORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: May 2007; October 2008; October 2009; August 2010D. hearings and appellate reviews;E. performance improvement program activities;F. utilization and claims review;G. profile and profile analysis;H. malpractice loss prevention; andI. other Hospital and Medical Staff activities related to monitoring and maintaining quality patientcare and appropriate professional conduct.8.4-2 Information: The information referred to in this Article may relate to a Practitioner’s professionalqualifications, clinical ability, judgment, character, physical or mental health, emotional stability,professional ethics, or any other matter that might directly or indirectly affect patient care.8.5 RELEASES: Each Practitioner shall, upon request of the Hospital, execute general and/or specific releases inaccordance with the tenor and import of this Article. Execution of such releases is not a prerequisite to theeffectiveness of this Article.31CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE IXTITLE:GENERAL PROVISIONSORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; April 1998; May 2007; October 2008; October 2009; August 2010;October 2010; July 20119.1 MEDICAL STAFF RULES AND REGULATIONS: Subject to final approval by the Board, the Medical Staffmay implement such Rules and Regulations as may be necessary to implement more specifically the generalprinciples found in these Bylaws. Such Rules and Regulations may be amended by the Medical ExecutiveCommittee acting on behalf of the Medical Staff. Such amendments to the Rules and Regulations shall be publishedand may be appealed within 30 calendar days in accordance with the procedure provided for in Article X.9.2 DEPARTMENT POLICIES: Subject to the approval of the Medical Executive Committee, each Department mayformulate its own policies for the conduct of its affairs and discharge of responsibility; provided that such policiesshall not be inconsistent with these Medical Staff Bylaws, Rules and Regulations, or other policies of the Hospitaland Medical Staff.9.3 MEDICAL STAFF DUES: The Medical Executive Committee will establish the amount and manner ofdisposition of the annual Medical Staff dues. Dues are payable at the beginning of each new Medical Staff year orat the anniversary of the Practitioners dues cycle. Unless excused by the Medical Executive Committee for goodcause, failure to render payment within two months of the due date, may, after special notice of the delinquency,result in voluntary suspension of Medical Staff appointment (including all prerogatives) and clinical privileges untilthe delinquency is remedied; provided that if dues have not been paid within four (4) months of the due date, thePractitioner shall be deemed to have voluntarily terminated their Medical Staff appointment. The MedicalExecutive Committee and the Department in which the delinquent Practitioner holds privileges will be notified ofthe suspension.9.4 SPECIAL ASSESSMENTS: If funds of the Medical Staff are insufficient for any expenditure authorized by theMedical Executive Committee, additional funds may be obtained through a special assessment of the Medical Staff.Prior to any such assessment, there must be a meeting of the Medical Staff, called by the Medical ExecutiveCommittee, for that purpose. At this meeting, there must be a Quorum present and two-thirds affirmative vote isnecessary for approval of the assessment.9.5 CONSTRUCTION OF TERMS AND HEADINGS: Words used in these Bylaws shall be read as the masculineor feminine gender and as the singular or plural, as the context requires.9.6 CONFLICT: The Bylaws, Rules and Regulations and policies and procedures of the Medical Staff shall notconflict with the Hospital’s Articles or Regulations, or the Bylaws of the Board. In the event of such conflict,Hospital Conflict Resolution Administrative Policy will be followed. In the event of a conflict between theseMedical Staff Bylaws and any other Medical Staff policy and procedure, or Rules and Regulations, these MedicalStaff Bylaws shall control.32CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE XTITLE:ADOPTION & AMENDMENTORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; April 1998; May 2007; October 2008; October 2009; August 201010.1 MEDICAL STAFF RESPONSIBILITY: The Medical Staff shall have responsibility to formulate, adopt, andrecommend to the Board, Medical Staff Bylaws and amendment(s) thereto, which shall be effective when approvedby the Board. Such responsibility shall be exercised in good faith and in a reasonable, responsible, and timelymanner. In addition, the Medical Staff may adopt and amend the related manuals and protocols, or the MedicalStaff may delegate that authority to the Medical Executive Committee. Such related manuals and protocols, include,but are not limited to the Rules and Regulations, the Organization and Functions Manual, the Credentials Policy andProcedure Manual, the Allied Health Professionals Manual, and the Fair Hearing Plan, that are developed toimplement various sections of these Bylaws.10.2 METHOD OF ADOPTION AND AMENDMENT: The Medical Staff Bylaws cannot be amended by the actionof any entity acting unilaterally. The Medical Staff Bylaws may be changed, adopted, amended or repealed by thefollowing combined actions:10.2-1 Medical Executive Committee Action: The Medical Executive Committee may initiate proposedcorrection(s), change(s), adoption(s) and/or amendment(s)to the Medical Staff Bylaws but may notunilaterally amend them; and10.2-2 Medical Staff Action: A copy of any proposed adoption(s) and/or amendment(s) to the Medical StaffBylaws will be given to each Medical Staff appointee entitled to vote thereon, or will be made available inthe Medical Staff Office at least twenty-one (21) days prior to the Medical Staff meeting at which a vote onthe adoption(s) and/or amendment(s) to the Medical Staff Bylaws will be taken. The affirmative vote oftwo-thirds of the Medical Staff appointees who are present at the meeting and are eligible to vote onBylaws is required to adopt, amend or repeal Medical Staff Bylaws, subject to final approval by the Board;and10.2-3 Board Action: The Board may approve correction(s), change(s), adoption(s) and amendment(s) to theMedical Staff Bylaws which have been proposed under 10.2-1 or 10.2-4. The Board may also initiateproposed correction(s), change(s), adoption(s) and/or amendment(s) to the Medical Staff Bylaws but maynot unilaterally amend them. Board initiated correction(s), change(s), adoption(s) and/or amendment(s)shall, before becoming effective, either (i) be adopted by the Medical Staff as set forth in 10.2-2 with finalapproval by the Board; or (ii) if not so adopted by the Medical Staff be referred to the ad hoc committeedescribed in 10.2-6 below.10.2-4 Minor Corrections and Changes: The Medical Executive Committee may propose minor correction(s)and change(s) when such correction(s) or change(s) are necessary due to spelling, punctuation, grammar,context, or if required by law. No prior notice of or vote by the Medical Staff with respect to suchchange(s) is required. All change(s) thus proposed will be reported at the next regular Medical Staffmeeting and submitted to the Board for approval under 10.2-3.10.2-5 Urgent Amendments: If there is a documented urgent need to amend the Bylaws, the Rules andRegulations, the Organization and Functions Manual, the Credentials Policy and Procedures Manual and/orthe Fair Hearing Plan in order to comply with law or regulation, the Medical Executive Committee mayprovisionally adopt such urgent amendments and the Board may provisionally approve such urgentamendments without the prior notification to or approval of the Medical Staff; provided however, theMedical Executive Committee must immediately notify the Medical Staff and the Medical Staff shall havean opportunity for retrospective review and may decide to finally approve, propose further amendments, ordisapprove the urgent amendments as described in Section 10.3, below.10.2-6 Conflicts: In the event there are irreconcilable differences between the Medical Staff and the Board withregard to proposed correction(s), change(s), adoption(s), and/or amendment(s) to the Medical Staff Bylaws,upon a written request submitted to the Chairman of the Board by a member of the Medical ExecutiveCommittee or a member of the Board, an ad hoc committee comprised of the Chairman of the Board, thePresident and CEO (or designee), the President of the Medical Staff and the President-Elect of the Medical33CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE XTITLE:ADOPTION & AMENDMENTORIGINATED DATE: March 26, 1992REVIEWED DATE: March 1995; December 1997; December 2000; September 2005; May 2007REVISION DATE: February 1998; April 1998; May 2007; October 2008; October 2009; August 2010Staff shall make a recommendation to the Board to resolve such conflict within sixty days of said writtenrequest. After consideration of the recommendation(s) of the ad hoc committee, the Board shall make thefinal decision on the proposed correction(s), change(s), adoption(s), and/or amendment(s).10.2-7 Effective Date: Bylaws, correction(s), change(s), adoption(s) and/or amendment(s) shall become effectiveupon their approval by the Board.10.3 RELATED POLICIES, RULES AND REGULATIONS: For the purpose of adoption(s), changes, corrections,and amendment(s) of the Medical Staff Policies, Rules and Regulations, Organization and Functions Manual,Credentials Policy and Procedure Manual, the Allied Health Professionals Manual, and / or the Fair Hearing Plan,"Medical Staff Action" means action by the Medical Executive Committee if such authority has been delegated to itby the Medical Staff. In the event that fifteen percent (15%) of the Active Medical Staff object to the adoption,change, correction, or amendment of Medical Staff Policies, Rules and Regulations, Credentials Policy andProcedure Manual, the Allied Health Professionals Manual, and / or the Fair Hearing Plan made by the MedicalExecutive Committee, the issues must be communicated to the Medical Staff and then be brought before a speciallycalled meeting of the Active Medical Staff.10.4 APPLICABLE LAW: Terms used herein shall have the same meaning set forth in HCQIA, unless otherwiseexpressly defined. Notwithstanding anything herein to the contrary, these Medical Staff Bylaws shall be governedby, and construed in accordance with HCQIA and, to the extent not inconsistent therewith, the laws of the State ofOhio without giving effect to its conflict of laws principles.34CINLibrary 0113651.0554388 1827559v23

THE CHRIST HOSPITALMEDICAL STAFF BYLAWSARTICLE XITITLE:HISTORY & PHYSICAL EXAMINATIONSORIGINATED DATE: September 23, 2010REVIEWED DATE:__________________REVISION DATE:__________________11.1 HISTORY & PHYSICAL EXAMINATIONS. : Any physician, dentist or podiatrist in good standing onthe Medical Staff shall have, within the scope of his or her clinical practice, authority to perform history & physicalexaminations. Only Housestaff and specified AHP Staff personnel who are properly privileged or authorized to completehistory & physical exams may do so. In such event, the Attending Physician shall be responsible for monitoring the qualityof such history and physical exams, and accountable for the same. The Attending Physician shall also add his or her ownpersonal observations when clinically indicated. All such history & physical exams, other than those completed by anotherphysician with privileges at the Hospital, must be authenticated by the Attending Physician.11.2 PRIOR HISTORY & PHYSICIAN EXAMINATIONS : If a history & physical examination has beenperformed on the patient within thirty (30) days before the admission or invasive procedure, a durable, legible copy of thisreport (or portions thereof) may be used, provided that any updates to the patient’s condition are recorded at the time ofadmission, the prior history and physical report is authenticated by the Attending Physician, regardless of whether anychanges have occurred.11.3 CONTENT AND TIME FOR COMPLETION . History and physicals are required for patientsreceiving services as inpatient, outpatient or observation. History and physicals are also required for all patients receiving aninvasive procedure. The content of the history and physical examination will be dependent on the patient’s diagnosis orsymptoms that are the basis for admission, reason for service or the nature of the procedure being performed. History andphysicals, will contain, but are not limited to, the following: diagnosis or reason for the procedure, history of present illness,past medical history, past surgical history, relevant family or social history, current medications, allergies, review of relevantbody systems, relevant physical examination, impression based on physical exam, and the planned course of action ortreatment. In the case of a patient having an invasive procedure, the history and physical must also include the results of allindicated diagnostic tests. The history and physical of all inpatients, and outpatients when determined by the AttendingPhysician, shall be completed and placed in the patient’s medical record within twenty-four (24) hours following admission35CINLibrary 0113651.0554388 1827559v23