TRI NI TYCOUNTYGRANDJURY

FI NAL REPORT

2000- 2001

HEALTHANDHUMANSERVI CESCOMMI TTEE

Thi s r epor t was appr ovedOn May 22, 2001

TRI NI TY COUNTYGRANDJURY

2000- 200

HEALTH COMMI TTEEFI NAL REPORT

CI TI ZENS COMPLAI NT

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VW12 21i 0>SUPERI ORCOURTOFCALI FORNI ACOUNTYOF TRI NI TY8Y. DONNAREGNANT,

DEPUTYCLERK

PURPOSE;

BACKGROUND:

2000- 2001 TRI NI TYCOUNTYGRANDJURYHEALTHCOMMI TTEE

FI NAL REPORT

CI TI ZENSCOMPLAI NT

The 2000- 2001 Gr and Jur y r ecei ved a ci t i zen' s compl ai nt al l egi ng t hat Tr i ni t yHospi t al st af f pr i vi l eges had been i nappr opr i at el y gr ant ed t o a car di ol ogi st who had beenpl aced on pr obat i on by t he Cal i f or ni a St at e Di vi si on of Medi cal Qual i t y, f or gr ossnegl i gence. Thi s r epor t i s a r esul t of t he Gr and Jur y' s i nvest i gat i on of t hat compl ai nt .

On Jul y 14, 1998, an Accusat i on al l egi ng t en causes f or di sci pl i ne was f i l ed byt he Cal i f or ni a St at e Depar t ment of Just i ce bef or e t he Di vi si on of Medi cal Qual i t y, agai nstDal e Rober t St empl e, M. D. a car di ol ogi st . The Accusat i on r ef er r ed t o t en separ at epat i ent s t r eat ed and/ or eval uat ed by Dr . St empl e. Ni ne of t hese pat i ent s wer e t r eat edand/ or eval uat ed by Dr . St empl e bet ween August of 1994, and Januar y of 1995. Ther emai ni ng pat i ent was eval uat ed and t r eat ed by Dr . St empl e i n Januar y and Febr uar y of1992.

The Accusat i on al l eged gr oss negl i gence, negl i gence, and i ncompet ent conduct byDr . St empl e, summar i zed as f ol l ows :

A. I nappr opr i at el y r ecommended t he per f or mance of i nvasi ve pr ocedur es i n t heabsence of cl ear sympt omat ol ogy, evi dence of i schemi a by non- i nvasi ve t est i ng,or sever i t y of st enosi s whi ch woul d war r ant such r ecommendat i ons ori nt er vent i ons ;

B. I nappr opr i at el y or der ed a second angi ogr amwhen a no- r ef l owsi t uat i on wasal r eady pr esent ;

C. I nappr opr i at el y pr escr i bed ant i coagul ant s t o per sons f or whose condi t i on t hemedi cat i ons wer e cont r ai ndi cat ed;

D. Fai l ed t o or der echocar di agr ams or t hal l i umt r eadmi l l t est s i n si t uat i ons wher esuch t est s wer e i ndi cat ed;

E. Fai l ed t o r ecogni ze ser i ous compl i cat i ons and f ai l ed t o i mpl ement appr opr i at epr ocedur es i n r esponse t o t hose compl i cat i ons ;

F. Fai l ed t o obser ve hospi t al pol i cy and pr ocedur es r egar di ng PTCA, cor onar yst ent pl acement ;

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G. Recommended st ent pl acement i n pat i ent s wi t hout sever e st enosi s and/ or whower e asympt omat i c ;

H. Fai l ed t o appr opr i at el y document t he pat i ent s' char t s wi t h suf f i ci enti nf or mat i on t o assi st ot her physi ci ans and hospi t al st af f i n t he car e and t r eat mentof t he pat i ent ;

I . Fai l ed t o obser ve hospi t al medi cal st af f pol i cy r egar di ng t he schedul i ng l evel sf or PTCAand cor onar y at her ect omy ;

J . Fai l ed t o appr opr i at el y moni t or pat i ent s and/ or di schar ged t hempr emat ur el y .

NOTE; PTCA, ( Per cut aneous Tr ansl umi nal Cor onar y Angi opl ast y)

On Jul y 12, 1999, t he Di vi si on of Medi cal Qual i t y adopt ed a " St i pul at i on andOr der f or Set t l ement of Di sci pl i nar y Act i on, " whi ch r evoked Dr . St empl e' s cer t i f i cat i ont o pr act i ce medi ci ne. I n t he same " St i pul at i on and Or der , " t he Di vi si on of Medi calQual i t y st ayed t he r evocat i on and pl aced Dr . St empl e on pr obat i on f or f i ve year s . ( Dr .St empl e had si gned hi s accept ance of t he " St i pul at ed Set t l ement and Di sci pl i nar y Or der "on June 18, 1999) .

METHODOFI NQUI RY:

Publ i c document s pr epar ed by t he Cal i f or ni a Depar t ment of Just i ce and t he St at eMedi cal Boar d wer e r evi ewed . The Heal t h Commi t t ee I nt er vi ewed al l member s of t heTr i ni t y Hospi t al Boar d of Di r ect or s, as wel l t he Tr i ni t y Hospi t al Chi ef of St af f . TheHospi t al Admi ni st r at or and t he Chai r man of t he Hospi t al Boar d of Di r ect or s wer ei nt er vi ewed at a Gr and Jur y gener al meet i ng. .

FI NDI NG:

I n ear l y 2000, t he Tr i ni t y Hospi t al Chi ef of St af f , act i ng at t he r equest of t heTr i ni t y Hospi t al Admi ni st r at or , i nt er vi ewed Dr . St empl e as a candi dat e f or st af fpr i vi l eges at Tr i ni t y Hospi t al . Subsequent l y, Dr . St empl e was i nt er vi ewed by t her emai ni ng member s of t he Hospi t al Medi cal St af f . The Chi ef of St af f r epor t ed t hat Dr .St empl e vol unt ar i l y di scl osed hi s pr obat i onar y st at us and t he r easons t her ef or e. Dr .St empl e al so di scl osed t hat hi s ear l i er r equest s f or st af f pr i vi l eges at Reddi ng Medi calCent er , and Mer cy Hospi t al , had been deni ed . Fol l owi ng a t hor ough di scussi on of t heal l egat i ons and di sci pl i nar y or der , t he Medi cal St af f deci ded t o r ecommend Dr . St empl ebe gr ant ed st af f pr i vi l eges subj ect t o t he f ol l owi ng pr obat i onar y r equi r ement s as set f or t hby t he St at e medi cal Qual i t y Di vi si on:

He woul d be pr ohi bi t ed f r omper f or mi ng i nvasi ve pr ocedur es .

Hi s pr act i ce woul d be moni t or ed by member s of t he hospi t al Medi cal St af f .

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The deci si on t o r ecommend Dr . St empl e f or st af f pr i vi l eges was made at t heMar ch 20, 2000 meet i ng of t he Medi cal St af f .

At t he Apr i l 20, 2000, meet i ng of t he Hospi t al Boar d of Di r ect or s, Dr . St empl e' sr equest f or st af f pr i vi l eges was pr esent ed f or appr oval by t he Hospi t al Admi ni st r at or .The Boar d appr oved Dr . St empl e' s r equest f or hospi t al st af f pr i vi l eges at t he Apr i l 20t hmeet i ng. The Gr and Jur y f i nds t hat t he Hospi t al Boar d was not f ul l y i nf or med at t he t i meof t he Apr i l 20, 2000 meet i ng. Al t hough t wo of t he Di r ect or s r ecal l ed t he Admi ni st r at orst at i ng, " he, ( Dr . St empl e) comes t o us wi t h some baggage" , or wor ds t o t hat ef f ect , t heywer e gi ven no addi t i onal backr ound i nf or mat i on about Dr . St empl e by t he Hospi t alAdmi ni st r at or . When i nt er vi ewed, t he Chi ef of St af f was unabl e t o r ecal l bei ng pr esent att he Apr i l 20t h meet i ng. However , he was qui t e cer t ai n he had never di scussed Dr .St empl e' s backgr ound or pr obat i onar y st at us wi t h t he Boar d of Di r ect or s .

CONCLUSI ON:

The Hospi t al Admi ni st r at or di d not advi se t he Hospi t al Boar d of Di r ect or s of Dr .St empl e' s pr obat i onar y st at us as est abl i shed by t he St at e Medi cal Qual i t y Di vi si on, or t her easons f or t hat pr obat i on. He di d not pr ovi de t he Boar d wi t h copi es of ei t her t heaccusat i ons f i l ed by t he St at e Medi cal Boar d, or t he Di vi si on of Medi cal Qual i t ydi sci pl i nar y or der . He al so f ai l ed t o advi se t he Boar d of t he need f or Tr i ni t y Hospi t alMedi cal St af f t o moni t or Dr . St empl e' s pr act i ce f or t he r emai nder of hi s pr obat i onar yper i od. By f ai l i ng t o f ul l y di scl ose appr opr i at e i nf or mat i on, t he Admi ni st r at or depr i vedt he Boar d of Di r ect or s of t he oppor t uni t y t o make an i nf or med deci si on about Dr .St empl e' s r equest f or st af f pr i vi l eges .

RECOMMENDATI ONS:

Wi t hout any i nt ent t o j udge Dr . St empl e' s pr esent ski l l as a physi ci an, t he Gr andJur y r ecommends t he Hospi t al Boar d of Di r ect or s under t ake an i mmedi at e r evi ew of t heabove ment i oned Accusat i on and Causes f or Di sci pl i nar y Act i on, and St i pul at i on andOr der f or Set t l ement of Di sci pl i nar y Act i on, and i f deemed necessar y, r eeval uat e t hei rdeci si on t o gr ant st af f pr i vi l eges t o Dr . St empl e.

I f i t i s t he Boar d' s deci si on t o al l owDr . St empl e t o r et ai n hi s st af f pr i vi l eges, t heGr and Jur y r ecommends t he Boar d r equi r e t he Hospi t al Admi ni st r at or t o pr ovi de t heBoar d wi t h a det ai l ed schedul e set t i ng f or t h t he names of t hose Medi cal St af f member swho wi l l be r esponsi bl e f or moni t or i ng Dr . St empl e' s pr act i ce, t he speci f i c t i me per i odsdur i ng whi ch t hey wi l l be r esponsi bl e f or pr ovi di ng t he moni t or i ng, and i n as pr eci se amanner as possi bl e, descr i be what t he moni t or i ng f unct i on wi l l amount t o.

The Gr and Jur y r ecommends t he devel opment and i mpl ement at i on of t her ecommended moni t or i ng schedul e wi t hi n t en days of t he r ecei pt of t hi s r epor t .

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The Gr and Jur y r ecommends t he Hospi t al Boar d of Di r ect or s devel op a wr i t t enpol i cy st at ement r equi r i ng, dur i ng f ut ur e consi der at i on of r equest s f or st af f pr i vi l eges,t hat t he Hospi t al Admi ni st r at or pr ovi de t he Boar d of Di r ect or s wi t h at l east t he f ol l owi ngi nf or mat i on, i n addi t i on t o r el evant Medi cal St af f r ecommendat i ons :

Al l pr esent and past pr obat i onar y or der s or act i ons .

Al l pr esent and past al l egat i ons i nvol vi ng accusat i ons of i ncompet ence,negl i gence, or gr oss negl i gence f i l ed wi t h, and/ or i nvest i gat ed by t he Cal i f or ni aDepar t ment of Just i ce, t he St at e Medi cal Boar d, or t he Di vi si on of Medi calQual i t y .

The Gr and Jur y r ecommends devel opment and i mpl ement at i on of t he abover ef er enced pol i cy st at ement r el evant t o f ut ur e r equest s f or st af f pr i vi l eges occurwi t hi n t hi r t y days of t he r ecei pt of t hi s r epor t

RESPONSEREQUESTEDFROM:

Tr i ni t y Hospi t al Boar d of Di r ect or s, Tr i ni t y Count y Boar d of Super vi sor s, and t he Tr i ni t yHospi t al Chi ef of St af f .

i ~~' , , Tr i ni t y

2000- 2001 TRI NI TYCOUNTYGRANDJURYP. O. BOX2308WEAVERVI LLE, CA96093- 1117

Dear Si r s,

P. O. Box 1229Weaver vi l l e, Cal i f or ni a 96093

( 916) 623- 5541

I wi sh t o comment on your heal t h commi t t ee r epor t i nvol vi ng a ci t i zens compl ai nt about hospi t alappr oval of pr ocedur es f or Dr . St empl e. I wi sh t o cl ar i f y sever al poi nt s . I t was st at ed t hat as chi efof st af f , i t sai d I was " qui t e cer t ai n t hat he ( Dr . Kr ouse) had never di scussed Dr . St empl e' sbackgr ound or pr obat i onar y st at us wi t h t he boar d of di r ect or s" . I n f act , I sai d t hat I had di scussedt he case wi t h many di f f er ent gr oups i n di f f er ent venues and t hat i t woul d sur pr i se me t hat Dr .St empl e' s case had not been di scussed i n det ai l si nce t hat was t he usual oper at i ng pr ocedur e at t hehospi t al .

I woul d al so l i ke t o comment t hat t he gener al t enur e of t he r epor t i s t hat t her e was a pr obl emwi t hDr . St empl e, t hat he shoul d per haps have not been accept ed on t he hospi t al st af f . As I ment i oned i nour i nt er vi ew, Dr . St empl e' s cr edent i al s and hi s pr obl ems wi t h t he medi cal boar d wer e di scussedext ensi vel y . Dr . St empl e was i nt er vi ewed ext ensi vel y . The medi cal st af f st ands behi nd i t s appr ovalof hi mf or medi cal st af f . I n cases of medi cal st af f cr edent i al i ng, t he medi cal st af f i s t he key gr oup t oj udge any newphysi ci ans qual i f i cat i ons . Davi d Yar br ough was wel l awar e of al l t he i ssuesconcer ni ng Dr . St empl e and I bel i eve t hat t he hospi t al boar d was pr obabl y made awar e of al l t hecont r over si al ar eas as wel l .

I woul dwel come any f yr f hg' r cl ar i f i cat i ons on t hi s i ssue.

Si ncer el y,

bonal d Kr ouse,

. D.

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A Count y Heal t h Car e Faci l i t v

A Ser vi ce of Tr i ni t y Count y

June 28, 2001

Hon . John Let t on, Pr esi di ng JudgeTr i ni t y Count y Super i or Cour tP. O. Box 1258Weaver vi l l e, CA96093

Dear Judge Let t on:

RI NI TY HOSPI TALBOARDOFDI RECTORS

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Re: 2000- 2001 Tr i ni t y Count y Gr and Jur y Heal t h Commi t t ee Fi nal Repor t i n t he Mat t er ofTr i ni t y Hospi t al , Ci t i zen Compl ai nt Al l egi ng I nappr opr i at e Gr ant i ng of Cl i ni cal Pr i vi l egest o Dal e R. St empl e, M. D.

On June 7, 2001, t he Tr i ni t y Count y Gr and Jur y sent a copy of t he above- r ef er enced Repor t t ot he under si gned Bob Fl i nt , Chai r man of t he Boar d of Di r ect or s, and Donal d Kr ouse, M. D. , Chi efof t he Medi cal St af f , of Tr i ni t y Hospi t al . Thi s i s our j oi nt r esponse on behal f of t he Boar d ofDi r ect or s and t he Medi cal St af f .

Wi t hout debat i ng t he Gr and Jur y' s concl usi ons about t he f ai l ur e of Mr . Davi d Yar br ough,Hospi t al Admi ni st r at or , t o submi t copi es of speci f i c document at i on t o t he Boar d of Di r ect or sbef or e Dr . St empl e' s appl i cat i on f or cl i ni cal pr i vi l eges was appr oved, i t must be not ed t hat t heBoar d of Di r ect or s was awar e of gener al nat ur e and ext ent of t he pr obl ems associ at ed wi t h Dr .St empl e' s pr i or pr act i ce and hi s di sput e wi t h t he Medi cal Boar d of Cal i f or ni a. The Medi cal St af fwas acut el y awar e of t hose mat t er s, and expl or ed t hemext ensi vel y, bef or e r ecommendi ng t hatDr . St empl e' s appl i cat i on be appr oved.

Accor di ng t o Sect i on 6 . 3 . 7 ( b) of t he Medi cal St af f Byl aws, i n t he event of a f avor abl er ecommendat i on f r omt he Medi cal St af f , t he Admi ni st r at or i s r esponsi bl e f or conveyi ng t hatr ecommendat i on t o t he Boar d of Di r ect or s and " maki ng avai l abl e" t he suppor t i ngdocument at i on . That r equi r ement was met i n t hi s i nst ance.

The Gr and Jur y has r ecommended i n i t s Repor t t hat t he Boar d of Di r ect or s r evi ew cer t ai ndocument at i on per t ai ni ng t o t he Medi cal Boar d' s pr oceedi ngs agai nst Dr . St empl e, and r e-eval uat e i t s deci si on t o gr ant hi m cl i ni cal pr i vi l eges . The speci f i ed document at i on i s anAccusat i on dat ed June 14, 1998, and a St i pul at i on and Or der f or Set t l ement of Di sci pl i nar yAct i on dat ed June 18, 1999.

The Boar d of Di r ect or s has r evi ewed t he above mat er i al s, and i s f ami l i ar wi t h ot herdocument at i on whi ch was al so consi der ed by t he Medi cal St af f bef or e maki ng i t s f avor abl er ecommendat i on r egar di ng Dr . St empl e' s appl i cat i on f or Medi cal St af f member shi p. Thi si ncl uded a l et t er f r omMr . Yar br ough, Dr . Kr ouse, and Randal Mer edi t h, M. D. ( anot her member

of t he Medi cal St af f ) , t o El i zabet h Schl i e, Seni or I nvest i gat or i n t he Medi cal Boar d' s Pr obat i onUni t , dat ed Mar ch 22, 2000, descr i bi ng i n det ai l t he nat ur e and scope Dr . St empl e' s ant i ci pat edpr act i ce i n t hi s communi t y and t he pl ans f or moni t or i ng i t i n compl i ance wi t h t he Medi calBoar d' s r equi r ement s . Al so i ncl uded was a r epl y f r om Ms . Schl i e, dat ed Apr i l 17, 2000,expr essl y appr ovi ng t hat pl an.

The Gr and Jur y st at ed i n i t s Repor t t hat i t s i nt ent was not t o r equi r e any j udgement of Dr .St empl e' s pr esent ski l l as a physi ci an, but r at her a r e- eval uat i on of t he deci si on t o gr ant hi mpr i vi l eges i ni t i al l y . Ost ensi bl y, t he Gr and Jur y i s suggest i ng t hat i f t he or i gi nal deci si on t oappr ove Dr . St empl e' s pr i vi l eges was f l awed, i t shoul d be r econsi der ed wi t hout r egar d t o t heski l l s he has exhi bi t ed si nce t hat t i me. Thi s woul d make l i t t l e sense. Our ul t i mat e obj ect i ve i s t opr ovi de adequat e car e f or t he pat i ent s i n t hi s communi t y, and t hat can onl y be achi eved by t aki ngi nt o account al l r el evant i nf or mat i on, i ncl udi ng Dr . St empl e' s demonst r at ed cur r ent compet ence.

Si nce Dr . St empl e has been pr act i ci ng her e, he has been an i mpor t ant asset t o t he communi t y .He does a degr ee of pr i mar y car e, he has a gr owi ng i nt er nal medi ci ne pr act i ce, and he has ast abl e car di ol ogy pr act i ce ( wi t hout per f or mi ng i nvasi ve pr ocedur es) . He has been af f i l i at ed wi t hot her physi ci ans as appr oved by t he Medi cal Boar d, and he i s cur r ent l y an act i ve member of t heMedi cal St af f i n good st andi ng. No speci al moni t or i ng ar r angement s ar e i n pl ace, nor ar e t heyr equi r ed by t he Medi cal St af f Byl aws or Dr . St empl e' s Set t l ement wi t h t he Medi cal Boar d.

We do not di sput e t he gr avi t y of t he char ges agai nst Dr . St empl e i n t he Medi cal Boar d' sAccusat i on, whi ch cont ai ned a Pr ayer f or t he r evocat i on or suspensi on of hi s l i cense. However ,t he Medi cal Boar d ul t i mat el y deci ded not t o pur sue t hose al l egat i ons t hr ough a f or mal hear i ngpr ocess di r ect ed at r eal i zi ng t hat goal . I nst ead, i t deci ded t o gi ve Dr . St empl e an oppor t uni t y t or et ai n hi s l i cense subj ect t o st r i ct t er ms of pr obat i on, and r edeemhi msel f by demonst r at i ng t hathe coul d pr act i ce compet ent l y goi ng f or war d. Our act i ons have been ent i r el y consi st ent wi t ht hose of t he Medi cal Boar d, and we bel i eve t hat we ( and t hey) have done t he r i ght t hi ng.

I n shor t , we ar e sat i sf i ed t hat t her e i s no r easonabl e basi s f or di st ur bi ng Dr . St empl e' s af f i l i at i onwi t h or unsuper vi sed cl i ni cal pr i vi l eges at Tr i ni t y Hospi t al at t hi s t i me. To do so woul dcompl i cat e t he pr ovi si on of heal t h. car e ser vi ces i n t he communi t y and t ax our l i mi t ed r esour cesf or no appar ent pur pose.

The Gr and Jur y has al so r ecommended i n i t s Repor t t hat t he Boar d of Di r ect or s devel op a wr i t t enpol i cy st at ement r equi r i ng t hat , i n f ut ur e cr edent i al i ng mat t er s, t he Admi ni st r at or pr ovi de t heBoar d wi t h cer t ai n i nf or mat i on al ong wi t h t he Medi cal St af f ' s r ecommendat i on. I t i s suggest edt hat t he i nf or mat i on i ncl ude:

" Al l pr esent and past pr obat i onar y or der s or act i ons"

" Al l pr esent and past al l egat i ons i nvol vi ng accusat i ons of i ncompet ence, negl i gence, orgr oss negl i gence f i l ed wi t h, and/ or i nvest i gat ed by t he Cal i f or ni a Depar t ment of Just i ce,t he St at e Medi cal Boar d, or t he Di vi si on of Medi cal Qual i t y. "

Apol i cy f r amed i n t hose speci f i c t er ms coul d not be i mpl ement ed, as a pr act i cal mat t er , because

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t he Hospi t al may not have access t o al l of t he i nf or mat i on descr i bed, no mat t er howdi l i gent wear e i n our cr edent i al i ng act i vi t i es . For exampl e, t he Medi cal Boar d' s Di vi si on of Qual i t y ( whi chi s one ent i t y, not t wo) does not publ i cl y di scl ose i nf or mat i on r egar di ng i t s pendi ngi nvest i gat i ons ; such i nf or mat i on i s onl y avai l abl e when and i f a f or mal Accusat i on i s f i l ed.

St i l l , we under st and and agr ee wi t h t he f undament al poi nt t hat t he Boar d of Di r ect or s shoul d becl ear l y al er t ed t o not ewor t hy f act s whi ch may cal l i nt o quest i on a physi ci an' s compet ence bef or ei t appr oves hi s or her appl i cat i on f or Medi cal St af f member shi p and cl i ni cal pr i vi l eges . I n t hi sr egar d, we not e t hat t he Medi cal St af f Byl aws al r eady cont empl at e an i nf or mat i ve pr esent at i onby t he Admi ni st r at or , consi st ent wi t h t he r esponsi bi l i t i es of t he Medi cal St af f and t he Boar d ofDi r ect or s, r espect i vel y, under Cal i f or ni a hospi t al l i censi ng l aws and t he St andar ds of t he Joi ntCommi ssi on on Accr edi t at i on of Heal t hcar e Or gani zat i ons . What we have l ear ned f r om t hi sexper i ence i s t hat , i n t he f ut ur e, we need t o do a bet t er j ob of appl yi ng t hose Byl aws anddocument i ng our ef f or t s . Thi s we have r esol ved t o do. We do not bel i eve t hat our oper at i onswoul d be enhanced by t he cr eat i on of a newand separ at e pol i cy .

The i ndi vi dual whose compl ai nt pr eci pi t at ed t hi s i nvest i gat i on has a l egi t i mat e i nt er est i n t heway we di schar ge of our cr edent i al i ng r esponsi bi l i t i es . The publ i c depends on us t o saf eguar dt he qual i t y of heal t h car e ser vi ces i n t he communi t y by act i ng pr udent l y i n t he scr eeni ng andappr oval of Medi cal St af f appl i cant s . We al so acknowl edge t he Gr and Jur y' s l egi t i mat e i nt er esti n t he mat t er , and we bel i eve t hat i t s i nvest i gat i on was wel l - i nt ent i oned.

At t he same t i me, however , we woul d ask t he publ i c t o r ecogni ze t hat t he Hospi t al ' s Boar d ofDi r ect or s and Medi cal St af f ar e compr i sed of ci vi c- mi nded peopl e who have wor ked har d t opr ovi de f or t he publ i c' s heal t h car e needs . I n t he case of Dr . St empl e, our cr edent i al i ng act i vi t i eswer e car r i ed out i n good f ai t h, and we bel i eve t hat our deci si on t o appr ove hi s appl i cat i on was i nt he publ i c' s best i nt er est .

Si ncer el y,Or n

Kat hf een ManausaVi ce Ch '

n of

e

i t y Hospi t al Boar d of Di r ect or s

Donal d Kr ouse,

D.Chi ef of t he Tr i ni t y Hospi t al Medi cal St af f

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410 Nor t h Tayl or P. O. Box 1229, Weaver vi l l e, CA96093530- 623- 5541 FAX 530- 623- 6421

RECEI VEDTO:

The Honor abl e John K. Let t on,Pr esi di ng Judge of t he Super i or Cour t

DEC 1

1 2001

FROM:

Tr i ni t y Count y Boar d of Super vi sor s

SUBJECT:

Response t o Recommendat i ons of 2000- 01 Gr and Jur yHeal t h Commi t t ee Fi nal Repor tCi t i zen' s Compl ai nt - St af f Pr i vi l eges

DATE:

November 13, 2001

BOARDOF SUPERVI SORSP. O. Dr awer 1613

( 530) 623- 1217WEAVERVI LLE, CALI FORNI A96093

Der o B. For sl und, Cl er kJeanni e Ni x- Templ e, Count y Admi ni st r at i ve Of f i cer

The Gr and Jur y Heal t h Commi t t ee has r equest ed a wr i t t en r esponse t o t hei r Fi nal Repor ton t he Ci t i zen' s Compl ai nt concer ni ng St af f Pr i vi l eges . The Boar d of Super vi sor sr esponds as f ol l ows :

Recommendat i on: The Gr and Jur y r ecommendat i on t o t he Tr i ni t y Hospi t al Boar d ofDi r ect or s i s t o r equi r e t he Admi ni st r at or t o pr ovi de t he Hospi t al Boar d wi t h cer t ai ni nf or mat i on at t he t i me t hat t he Boar d i s consi der i ng gr ant i ng f ut ur e st af f pr i vi l eges .

The Boar d of Super vi sor s has pur posel y del egat ed such deci si ons t o t he Hospi t al Boar dand i s unwi l l i ng t o under mi ne t hei r aut hor i t y by comment i ng on t hi s r ecommendat i on.

Thank you f or t he oppor t uni t y t o r espond.

Si ncer el y,

R. Ber r y St ewar t , Chai r manTr i ni t y Count y Boar d of Super vi sor s

CHRI SERI KSON

BI LLI EMI LLERDi st r i ct I

Di st r i ct P

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R9LPHMODI NEDi st r i ct 9

BERRYSTEWARTDi st r i ct !

SUPERI OR COURTJUDGE' SCHAMBERS

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