Bylaws

ARTICLE VII - HEARINGS AND APPELLATE REVIEWS*

*SB 1211 hearing requirements are applicable to all physicians, dentists, and podiatrists practicing within the hospital whether or not on the medical staff.

7.1             GENERAL PROVISIONS

7.1-1 EXHAUSTION OF REMEDIES

If adverse action described in Section 7.2 is taken or recommended, the applicant or member must exhaust the remedies afforded by these bylaws before resorting to legal action.

In all disciplinary matters prior to a decision to proceed, the accused physician shall be invited to appear before the Medical Executive Committee. Such meeting shall be without attorneys. The physician shall be given a specific listing of allegations in writing at least two weeks prior to the meeting and the discussion shall be restricted to the allegations.

7.1-2 APPLICATION OF ARTICLE

For purposes of this Article, the term "member" may include "applicant," as it may be applicable under the circumstances, unless otherwise stated.

7.1-3 TIMELY COMPLETION OF PROCESS

The hearing and appeal process shall be completed within a reasonable time.

7.1-4 FINAL ACTION

Recommended adverse actions described in Section 7.2 shall become final only after the hearing and appellate rights set forth in these bylaws have either been exhausted or waived.

7.2             GROUNDS FOR HEARING

Except as otherwise specified in these bylaws, any one or more of the following actions or recommended actions shall be deemed actual or potential adverse action and constitute grounds for a hearing:

(a)               denial of medical staff membership;

(b)               denial of requested advancement in staff membership status, or category;

(c)               denial of medical staff reappointment;

(d)               demotion to lower medical staff category or membership status;

(e)               suspension of staff membership;

(f)                 revocation of medical staff membership;

(g)               denial of requested privileges;

(h)               involuntary reduction of current privileges;

(i)                 suspension of privileges;

(j)                  termination of all privileges; or

(k)               involuntary imposition of mandatory consultation or monitoring requirements (excluding monitoring incidental to provisional status and Section 5.3)

(l)                  if the action or recommendation must be reported to the Medical Board of California.

7.3             REQUESTS FOR HEARING

7.3-1 NOTICE OF ACTION OR PROPOSED ACTION

In all cases in which action has been taken or a recommendation made as set forth in Section 7.2, said person or body shall give the member prompt written notice of (1) the recommendation or final proposed action and that such action, if adopted, shall be taken and reported to the Medical Board of California pursuant to Section 805 of the California Business and Professions Code, if required; (2) the reasons for the proposed action including the acts or omissions with which the member is charged; (3) the right to request a hearing pursuant to Section 7.3-2, and that such hearing must be requested within 30 days; and (4) a summary of the rights granted in the hearing pursuant to the medical staff bylaws. If the recommendation or final proposed action adversely affects the privileges of a physician or dentist for a period longer than 30 days and is based on competence or professional conduct, said written notice shall state that the action if adopted will be reported to the National Practitioner Data Bank, and shall state the text of the proposed report.

7.3-2 REQUEST FOR HEARING

The member shall have 30 days following receipt of notice of such action to request a hearing. The request shall be in writing addressed to the Medical Executive Committee with a copy to the Board of Directors. In the event the member does not request a hearing within the time and in the manner described, the member shall be deemed to have waived any right to a hearing and accepted the recommendation or action involved.

7.3-3 TIME AND PLACE FOR HEARING

Upon receipt of a request for hearing, the Medical Executive Committee shall schedule a hearing and, within 15 days give notice to the member of the time, place and date of the hearing. Unless extended by the Judicial Review Committee, the date of the commencement of the hearing shall be not less than 30 days, nor more than 60 days from the date of receipt of the request by the Medical Executive Committee for a hearing; provided, however, that when the request is received from a member who is under summary suspension the hearing shall be held as soon as the arrangements may reasonably be made, but not to exceed 45 days from the date of receipt of the request.

7.3-4 NOTICE OF HEARING

Together with the notice stating the place, time and date of the hearing, which date shall not be less than 30 days after the date of the notice unless waived by a member under summary suspension, the Medical Executive Committee shall provide a list of the charts in question, where applicable, and a list of the witnesses (if any) expected to testify at the hearing on behalf of the Medical Executive Committee.  The content of this list is subject to update pursuant to Section 7.4-1.

7.3-5 JUDICIAL REVIEW COMMITTEE

When a hearing is requested, the Medical Executive shall appoint a Judicial Review Committee. The Judicial Review Committee shall be composed of not less than 3 members of the medical staff with one (1) alternate. The Judicial Review Committee shall gain no direct financial benefit from the outcome, and shall not have acted as accuser, investigator, fact finder, initial decision maker or otherwise have not actively participated in the consideration of the matter leading up to the recommendation or action. Knowledge of the matter involved shall not preclude a member of the medical staff from serving as a member of the Judicial Review Committee. In the event that it is not feasible to appoint a Judicial Review Committee from the active medical staff, the Medical Executive Committee may appoint members from other staff categories or practitioners who are not members of the medical staff. Such appointment shall include designation of the chair. membership on a Judicial Review Committee shall consist of one member who shall have the same healing arts licensure as the accused, and where feasible, include an individual practicing the same specialty as the member. All other members shall have MD or DO degrees or their equivalent as defined in Section 2.2-2(a).

7.3-6 FAILURE TO APPEAR OR PROCEED

Failure without good cause of the member to personally attend and proceed at such a hearing in an efficient and orderly manner shall be deemed to constitute voluntary acceptance of the recommendations or actions involved.

7.3-7 POSTPONEMENTS AND EXTENSIONS

Once a request for hearing is initiated, postponements and extensions of time beyond the times permitted in these bylaws may be permitted by the hearing officer on a showing of good cause, or upon agreement of the parties.

7.4             HEARING PROCEDURE

7.4-1 PREHEARING PROCEDURE

(a)               If either side to the hearing requests in writing a list of witnesses, within 15 days of such request, each party shall furnish to the other a written list of the names and addresses of the individuals, so far as is reasonably known or anticipated, who are anticipated to give testimony or evidence in support of that party at the hearing.  The member shall have the right to inspect and copy documents or other evidence upon which the charges are based, as well as all other evidence relevant to the charges. The member shall also have the right to receive at least 30 days prior to the hearing a copy of the evidence forming the basis of the charges which is reasonably necessary to enable the member to prepare a defense, including all evidence which was considered by the Medical Executive Committee in determining whether to proceed with the adverse action, and any exculpatory evidence in the possession of the hospital or medical staff. The member and the Medical Executive Committee shall have the right to receive all evidence, which will be made available to the Judicial Review Committee.

(b)               The Medical Executive Committee shall have the right to inspect and copy at its expense any documents or other evidence relevant to the charges which the member possesses or controls as soon as practicable after receiving the request.

(c)               The failure by either party to provide access to this information at least 30 days before the hearing shall constitute good cause for a continuance. The right to inspect and copy by either party does not extend to confidential information referring solely to individually identifiable members, other than the member under review.

(d)               The hearing officer shall consider and rule upon any request for access to information and may impose any safeguards the protection of the peer review process and justice requires. In so doing, the hearing officer shall consider:

(a)               whether the information sought may be introduced to support or defend the charges;

(ii)               the exculpatory or inculpatory nature of the information sought, if any;

(iii)             the burden imposed on the party in possession of the information sought, if access is granted; and

(iv)              any previous requests for access to information submitted or resisted by the parties to the same proceeding.

(e)               The member shall be entitled to a reasonable opportunity to question and challenge the impartiality of Judicial Review Committee members and the hearing officer. Challenges to the impartiality of any Judicial Review Committee member or the hearing officer shall be ruled on by the hearing officer.

(f)                 It shall be the duty of the member and the Medical Executive Committee or its designee to exercise reasonable diligence in notifying the chair of the Judicial Review Committee of any pending or anticipated procedural disputes as far in advance of the scheduled hearing as possible, in order that decisions concerning such matters may be made in advance of the hearing, Objections to any prehearing decisions may be succinctly made at the hearing.

7.4-2 REPRESENTATION

The hearings provided for in these bylaws are for the purpose of intraprofessional resolution of matters bearing on professional conduct, professional competency, or character.

The member shall be entitled to representation by legal counsel in all phases of the hearing, and shall receive notice of the right to obtain representation by an attorney at law and such notice shall inform the member that he should be so represented.  The Medical Executive Committee shall be represented by an attorney chosen by the Medical Executive Committee and the member shall be so informed. In the absence of legal counsel, the member shall be entitled to be accompanied by an represented at the hearing only by a practitioner licensed to practice in the State of California who is not also an attorney at law, and the Medical Executive Committee shall appoint a representative who is not an attorney to present its action or recommendation, the materials in support thereof, examine witnesses, and respond to appropriate questions.  The Medical Executive Committee shall not be represented by an attorney at law if the member is not so represented.

7.4-3 THE HEARING OFFICER

The Medical Executive Committee will select the Hearing Officer. The hearing officer shall be an attorney at law qualified to preside over a quasi-judicial hearing, but attorneys from a firm regularly utilized by the hospital, the medical staff or the involved medical staff member or applicant for membership, for legal advice regarding their affairs and activities shall not be eligible to serve as hearing officer.  The hearing officer shall gain no direct financial benefit from the outcome and must not act as a prosecuting officer or as an advocate. The hearing officer shall endeavor to assure that all participants in the hearing have a reasonable opportunity to be heard and to present relevant oral and documentary evidence in an efficient and expeditious manner, and that proper decorum is maintained. The hearing officer shall be entitled to determine the order of or procedure for presenting evidence and argument during the hearing and shall have the authority and discretion to make all rulings on questions which pertain to matters of law, procedure or the admissibility of evidence. If the hearing officer determines that either side in a hearing is not proceeding in an efficient and expeditious manner, the hearing officer may take such discretionary action as seems warranted by the circumstances.  If requested by the Judicial Review Committee, the hearing officer may participate in the deliberations of such committee and be a legal advisor to it, but the hearing officer shall not be entitled to vote.

7.4-4 RECORD OF THE HEARING

A shorthand reporter shall be present to make a record of the hearing proceedings, and the pre-hearing proceedings if deemed appropriate by the hearing officer. The cost of attendance of the shorthand reported shall be borne by the hospital, but the cost of the transcript, if any, shall be borne by the party requesting it. The Judicial Review Committee may, but shall not be required to, order that oral evidence shall be taken only on oath administered by any person lawfully authorized to administer such oath.

7.4-5 RIGHTS OF THE PARTIES

Within reasonable limitations, both sides at the hearing may call and examine witnesses for relevant testimony, introduce relevant exhibits or other documents, cross-examine or impeach witnesses who shall have testified orally on any matter relevant to the issues, and otherwise rebut evidence, as long as these rights are exercised in an efficient and expeditious manner. The member may be called by the Medical Executive Committee and examined as if under cross-examination.

7.4-6 MISCELLANEOUS RULES

Judicial rules of evidence and procedure relating to the conduct of the hearing, examination of witnesses, and presentation of evidence shall not apply to a hearing conducted under this Article. Any relevant evidence, including hearsay, shall be admitted if it is the sort of evidence on which responsible persons are accustomed to rely in the conduct of serious affairs, regardless of the admissibility of such evidence in a court of law. The Judicial Review Committee may interrogate the witnesses or call additional witnesses if it deems such action appropriate. At its discretion, the Judicial Review Committee may request or permit both sides to file written arguments.

7.4-7 BURDENS OF PRESENTING EVIDENCE AND PROOF

(a)               At the hearing the Medical Executive Committee shall have the initial duty to present evidence for each case or issue in support of its action or recommendation, The member shall be obligated to present evidence in response.

(b)               An applicant shall bear the burden of persuading the Judicial Review Committee, by a preponderance of the evidence, of the applicant's qualifications by producing information, which allows for adequate evaluation and resolution of reasonable doubts concerning the applicant's current qualifications for membership and privileges. An applicant shall not be permitted to introduce information requested by the medical staff but not produced during the application process unless the applicant establishes that the information could not have been produced previously in the exercise of reasonable diligence.

(c)               Except as provided above for applicants, throughout the hearing, the Medical Executive Committee shall bear the burden of persuading the Judicial Review Committee, by a preponderance of the evidence, that its action or recommendation is reasonable and warranted.

7.4-8 ADJOURNMENT AND CONCLUSION

After consultation with the chair of the Judicial Review Committee, the hearing officer may adjourn the hearing and reconvene the same without special notice at such times and intervals as may be reasonable and warranted, with due consideration for reaching an expeditious conclusion to the hearing. Both the Medical Executive Committee and the member may submit a written statement at the close of the hearing. Upon conclusion of the presentation of oral and written evidence, or the receipt of closing written arguments, if submitted, the hearing shall be closed.

7.4-9 BASIS FOR DECISION

The decision of the Judicial Review Committee shall be based on the evidence introduced at the hearing, including all logical and reasonable inferences from the evidence and the testimony. The decision of the Judicial Review Committee shall be subject to such rights of appeal as described in these bylaws, but shall otherwise be affirmed by the Board of Directors as the final action if it is supported by substantial evidence, following a fair procedure.

7.4-10 DECISION OF THE JUDICIAL REVIEW COMMITTEE

Within 30 days after final adjournment of the hearing, the Judicial Review Committee shall render a decision, which shall be accompanied by a report in writing and shall be delivered to the Medical Executive Committee. If the member is currently under suspension, however, the time for the decision and report shall be 15 days. A copy of said decision also shall be forwarded to the Administrator, the Board of Directors, and to the member. The report shall contain a concise statement of the reasons in support of the decision including findings of fact and a conclusion articulating the connection between the evidence produced at the hearing and the conclusion reached. If the final proposed action adversely affects the privileges of a physician or dentist for a period longer than 30 days and is based on competence or professional conduct, and shall state the text of the report as agreed upon by the committee. Both the member and the Medical Executive Committee shall be provided a written explanation of the procedure for appealing the decision. The decision of the Judicial Review Committee shall be subject to such rights of appeal or review as described in these bylaws, but shall otherwise be affirmed by the Board of Directors as the final action if it is supported by substantial evidence, following a fair procedure.

7.5             APPEAL

7.5-1 TIME FOR APPEAL

Within 10 days after receipt of the decision of the Judicial Review Committee, either the member of the Medical Executive Committee may request an appellate review. A written request for such review shall be delivered to the Chief of Staff, the Administrator, and the other party in the hearing. If a request for appellate review is not requested within such period, that action or recommendation shall be affirmed by the Board of Directors as the final action if it is supported by substantial evidence, following a fair procedure.

7.5-2 GROUNDS FOR APPEAL

A written request for an appeal shall include an identification of the grounds for appeal and a clear and concise statement of the facts in support of the appeal. The grounds for appeal from the hearing shall be: (a) substantial non-compliance with the procedures required by these bylaws or applicable law which has created demonstrable prejudice; (b) the decision was not supported by substantial evidence based upon the hearing record or such additional information as may be permitted pursuant to Section 7.5-5; (c) action taken was arbitrary, unreasonable or capricious.

7.5-3 TIME, PLACE AND NOTICE

If an appellate review is to be conducted, the Appeal Board shall, within 15 days after receipt of notice of appeal, schedule a review date and cause each side to be given notice of the time, place and date of the appellate review. The date of appellate review shall not be less than 30 nor more than 60 days from the date of such notice, provided however, that when a request for appellate review concerns a member who is under suspension which is then in effect, the appellate review shall be held as soon as the arrangements may reasonably be made, not to exceed 15 days from the date of the notice. The time for appellate review may be extended by the appeal board for good cause.

7.5-4 APPEAL BOARD

The Board of Directors shall appoint an Appeal Board which shall be composed of not less than 5 non physician members of the Board of Directors and two physicians in the active practice of medicine who are not involved in the case, and where feasible are members of the Board of Directors. The members of the Appeal Board shall gain no direct financial benefit from the outcome, and shall not have acted as accuser, investigator, fact finder, initial decision maker or otherwise have actively participated in consideration of the matter leading up to the recommendation or the action, Knowledge of the matter involved shall not preclude an individual from serving as a member of the Appeal Board. Knowledge of the matter involved shall not preclude any person from serving as a member of the appeal board, so long as that person did not take part in a prior hearing on the same matter. The Appeal Board may select an attorney to assist it in the proceeding, but that attorney shall not be entitled to vote with respect to the appeal. The attorney firm selected by the Board of Directors shall not be the attorney firm that represented either party at the hearing before the Judicial Review Committee.

7.5-5 APPEAL PROCEDURE

The proceeding by the Appeal Board shall be in the nature of an appellate hearing based upon the record of the hearing before the Judicial Review Committee, provided that the Appeal Board may accept additional oral or written evidence subject to a foundational showing that such evidence could not have been made available to the Judicial Review Committee in the exercise of reasonable diligence and subject to the same rights of cross-examination or confrontation provided at the Judicial Review hearing; or the Appeal Board may remand the matter to the Judicial Review Committee for the taking of further evidence and for decision. Each party shall have the right to be represented by legal counsel, or any other representative designated by that party in connection with the appeal, to present a written statement in support of that party's position on appeal, and to personally appear and make oral argument. The Appeal Board may thereupon conduct, at a time convenient to itself, deliberations outside the presence of the appellant and respondent and their representatives. The Appeal Board shall present to the Board of Directors its written recommendations as to whether the Board of Directors should affirm, modify or reverse the Judicial Review Committee decision, or remand the matter to the Judicial Review Committee for further review and decision.

7.5-6 DECISION

(a)               Except as provided in Section 7.5-6(b), within 30 days after the conclusion of the appellate review proceedings, the Board of Directors shall render a final decision and shall affirm the decision of the Judicial Review Committee if the Judicial Review Committee's decision is supported by substantial evidence, following a fair procedure.

(b)               Should the Board of Directors determine that the Judicial Review Committee decision is not supported by substantial evidence, the board may modify or reverse the decision of the Judicial Review Committee and may instead, or shall, where a fair procedure has not been afforded, remand the matter to the Judicial Review Committee for reconsideration, stating the purpose for the referral. If the matter is remanded to the Judicial Review Committee for further review and recommendation, the committee shall promptly conduct its review and make its recommendations to the Board of Directors. This further review and the time required to report back shall not exceed 30 days in duration except as the parties may otherwise agree or for good cause as jointly determined by the char of the Board of Directors and the Judicial Review Committee.

(c)               The decision shall be in writing, shall specify the reasons for the action taken, and shall be forwarded to the chief of staff and the Medical Executive Committee, the subject of the hearing, and the Administrator, at least (10) days prior to submission to the MBC.

            7.5-7 RIGHT TO ONE HEARING

No member shall be entitled to more than one evidentiary hearing and one appellate review on any matter which shall have been the subject of adverse action or recommendation.

7.6             EXCLUSIVE CONTRACTS

7.6-1 APPROPRIATENESS OF EXCLUSIVE CONTRACTS

The Board of Directors shall make the final decision to close or continue closure of a department/service pursuant to an exclusive contract or the transfer of an exclusive contract only following a review by the Medical Executive Committee of the related quality of care issues pursuant to Section 13.10 and a determination of the appropriateness of the closure, continued closure or transfer as set forth below. The Medical Executive Committee will provide a forum for medical staff members; administration and other interested parties to express their opinions about closure continued closure of a department/service or transfer of an exclusive contract.

A determination to close, continued closure of a department/service pursuant to an exclusive contract or transfer of an exclusive contract must be based upon the preponderance of the evidence, viewing the record as a whole, presented by any and all interested parties, following notice and opportunity for comment.

The Board of Directors' decision shall uphold the medical staff's determination unless the Board of Directors makes specific written findings that the medical staff's determination is arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the laws.

(a)               In making its recommendation regarding the need to close or continue closure of a department/service pursuant to an exclusive contract, or transfer such contract, the Medical Executive Committee's inquiry will include the following:

(1)   Whether the concerns or problems with respect to the department/service can be resolved with a less restrictive alternative, or

(2)   Whether closure or continued closure would facilitate supervision and training of the nurses and technical staff in the department/service, or

(3)   Whether closure or continued closure is appropriate because of failure of cooperation or arbitrary or intractable conduct interfering with the provision of appropriate care or the proper functioning of the hospital or the medical staff.

(4)   Whether closure or continued closure would result in better access and physician coverage within the department/service, or

(5)   Whether closure or continued closure would simplify scheduling and/or provide more flexibility in scheduling within the department/service, or

(6)   Whether closure or continued closure would promote more efficient use of equipment or personnel within the department/service, or

(7)   Whether closure or continued closure would provide incidental benefits (e.g., medical education, research) to the department/service, or

(8)   An unreasonable refusal to contract with third party payers that imperils access to services or is detrimental to hospital finance.

A determination to close a department/service pursuant to an exclusive contract must be based upon the evidence presented by medical staff members, administration and other interested parties, following notice and an opportunity to comment.

(b)               In the event that the Medical Executive Committee and Board of Directors disagree as to the closure or continued closure of a department/service pursuant to an exclusive contract; the matter shall be referred to the Joint Conference Committee prior to the Board of Directors making a final decision.

(c)               The fair hearing rights of Article VII shall not apply to a physician not previously on the medical staff whose application for medical staff membership and clinical privileges was denied because of the closure of a department/service pursuant to an exclusive contract.

(d)               Medical Staff membership and clinical privileges will not automatically terminate when an exclusive contract is terminated or when the subcontractor's relationship with the contracting physician or contract medical group is terminated. However, when an exclusive contract is terminated, the contracting physician or contracted medical group will: (I) cooperate and facilitate the transition of the exclusive service to the new contracting physician or contracting medical group; (ii) promptly vacate any hospital premises used in connection with the provision of the exclusive service; and (iii) subject to the exception set forth in Section 7.6.2(a) (1), no longer have access to the equipment, personnel and supplies used in providing the exclusive service.

(e)               Notwithstanding any contractual provision, the Article VI and VII procedural rights shall apply if the termination of Medical Staff membership or clinical privileges is for a medical disciplinary cause or reason and, therefore, reportable to the Medical Board of California in accordance with Section 805 of the Business and Professions Code.

7.6-2 PRIVILEGES

(a)               The following applies to departments/services not currently operated pursuant to an exclusive contract as of the effective date (November 1, 1995) of the adoption of these Bylaws:

(1)               Current members of the medical staff with clinical privileges in an open department/service that is subsequently closed pursuant to an exclusive contract will be allowed to continue to exercise those privileges on a case-by-case basis in that specific hospital, only if the physician is specifically requested to provide services by a patient or member of the medical staff. This exception is campus specific, i.e., if the department/service at the other campus is currently operated pursuant to an exclusive contract, the member will not be permitted to exercise privileges on a case-by-case basis at the other campus with a closed department/service.

(2)               The case-by-case exercise of privileges in a closed department/service by a non-contracted physician does not give the non-contracted physician access to the patients served by the contracted physician or contracted medical group.

(3)               The subsequent closure of a department/service pursuant to an exclusive contract will not be grounds to suspend or terminate existing privileges of a current member of the medical staff.

(4)               The subsequent closure of a department/service pursuant to an exclusive contract will not be grounds to deny reappointment of clinical privileges of a current member of the medical staff.

(5)               Regardless of any provision to the contrary, existing privileges or a member of the medical staff in a department or service on any campus that was operated on an open basis as of the effective date of these Bylaws will not be suspended or terminated, nor shall the Hospital by contract seek such suspension of termination, except for such cause and pursuant to such procedures as may be found in these Bylaws.

(b)               The following applies to departments/services currently operated pursuant to an exclusive contract as of the effective date (November 1, 1995) of the adoption of these Bylaws:

(1)               Departments/services currently operated pursuant to an exclusive contract as of the effective date of the adoption of these Medical Staff Bylaws shall have the authority to prohibit and/or restrict the award of clinical privileges and/or provision of services by a non-contracted physician or non-contracted medical group. This clause shall be campus specific as of the effective date of these Bylaws.

(2)               Departments/services currently operated on an exclusive basis may define who shall be the regularly scheduled physicians.

7.6-3      AUTOMATIC SUSPENSION OR LIMITATION OF PRIVILEGES

No hearing is required when a member's license or legal credential to practice has been revoked, suspended or expired as set forth in Section 6.3-1(a). In other cases described in Sections 6.3-1 and 6.3-2, the issues which may be considered at a hearing, if requested, shall not include evidence designed to show that the determination by the licensing or credentialing authority of the DEA was unwarranted, but only whether the member may continue practice in the hospital with those limitations imposed.

7.6-4      DEPARTMENT/SERVICE FORMATION OR ELIMINATION

The Board of Directors shall make the final decision to form or eliminate a department/service only following a review by the Medical Executive Committee. The Medical Executive Committee will make its recommendation based upon consideration of the effects on quality of care, economics and/or community. A determination to form or eliminate a department/service must be based upon the evidence presented by medical staff members, administration and other interested parties, following notice and an opportunity to comment.

In the event that the Medical Executive Committee and Board of Directors disagree as to the formation or elimination of a department/service, the matter shall be referred to the Joint Conference Committee prior to the Board of Directors making a final decision.

7.7       EXPUNCTION OF DISCIPLINARY ACTION

Upon petition, the Medical Executive Committee, in its sole discretion, may expunge previous disciplinary action upon a showing of good cause or rehabilitation.