Section 410 IAC 26-4-2 - Appointment and conduct of medical staffAuthority: IC 16-21-1-7; IC 16-21-2-2.5
Affected: IC 16-21-1; IC 16-21-2
Sec. 2.
(a) The medical staff of the clinic:(1) consists of physicians appointed to or contracted with to provide medical services at the clinic; and(2) must be composed of at least one (1) physician.(b) The medical director must be a physician licensed to practice in the state of Indiana.(c) If the medical staff consists of more than one (1) physician:(1) the medical director shall serve as coordinator of the medical staff; and(2) a current roster of members of the medical staff shall be maintained.(d) In appointing or contracting with medical staff, the governing body shall do the following: (1) Ensure that appointments to or contracts with medical staff are acted upon with the advice and recommendation of the medical director.(2) Examine credentials of candidates for appointment, reappointment, or contracting to the medical staff in accordance with the following: (B) Applicable state and federal law.(3) Ensure that criteria for selection for medical staff include the following: (A) Individual character.(4) Maintain a reasonably accessible hard copy or electronic file for each member of the medical staff, which includes, but is not limited to, the following:(A) A completed, signed application.(B) The date and year of completion of all Accreditation Council for Graduate Medical Education (ACGME) accredited residency training programs, if applicable.(C) A current copy of the individual's credentials as follows: (i) An Indiana license showing date of licensure and number or available data provided by the Indiana professional licensing agency. A copy of practice restrictions, if any, must be attached to the license issued by the Indiana professional licensing agency through the appropriate licensing board.(ii) Indiana controlled substance registration showing number as applicable.(iii) Drug Enforcement Agency registration showing number as applicable.(iv) Documentation of experience in the practice of medicine.(v) Documentation of specialty board certification as applicable.(e) The governing body is responsible for the conduct of the medical staff activities related to the abortion clinic. The governing body shall ensure the following:(1) That the medical staff is accountable and responsible to the governing body for the quality of care provided to patients.(2) That procedures are performed only by a physician approved by the governing body to perform such procedures.(3) That procedures performed in the clinic are limited to procedures authorized by the governing body.(f) The governing body is responsible for assuring that quality patient care is provided. In accordance with clinic policy, the governing body shall ensure that a qualified licensed physician who is a member of the medical staff is responsible for the care and treatment of each patient.(g) The governing body is responsible for services delivered in the clinic by contractors for medical services. The governing body shall ensure the following: (1) That a contractor of any service furnishes those services in such a manner as to permit the clinic to comply with all applicable statutes and rules.(2) That the services performed under a contract are:(A) provided in a safe and effective manner; and(B) included in the clinic's quality assessment and improvement program.(3) That the clinic maintains a list of all contracted services, including the scope and nature of the services provided.Indiana State Department of Health; 410 IAC 26-4-2; filed May 11, 2006, 9:36 a.m.: 29 IR 3360; readopted filed Jul 12, 2012, 12:08 p.m.: 20120808-IR-410120196RFAReadopted filed 9/26/2018, 2:48 p.m.: 20181024-IR-410180328RFA