ARTICLE IV. MEDICAL STAFF CATEGORIES. The Active Staff shall consist of practitioners each of whom:

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1 ARTICLE IV. MEDICAL STAFF CATEGORIES A. ACTIVE STAFF. The Active Staff shall consist of practitioners each of whom: a. meets all the basic qualifications set forth in Article III; b. will be available to the Hospital to provide quality care to patients; and c. regularly admits patients or is otherwise regularly involved in the care of patients in the Hospital. 2. Privileges Members of the Active Staff may: a. admit patients without limitation, unless otherwise provided in the Medical Staff Rules and Regulations; b. exercise such clinical privileges as are granted to him pursuant to Article III; c. vote on all matters presented at general and special meetings of the Medical Staff, and of the department and committees of which he is a member, unless otherwise provided by resolution of the Staff, or the department or committee, and approved by the MEC and the Board; and d. hold office in the Staff organization and in the departments and committees of which he is a member, unless otherwise provided by resolution of the Staff or the department or committee, and approved by the MEC and the Board. Each member of the Active Staff shall: a. meet the basic responsibilities set forth in Article III; b. retain responsibility within his area of professional competence for the continuous care and supervision of each patient in the Hospital for whom he is providing services, or arrange a suitable alternative for such care and supervision. c. actively participate in the patient care quality assessment, utilization review, and other quality evaluation and monitoring activities required of the Staff in supervising initial appointees of his same profession, and in discharging such other Staff functions as may be required from time to time; d. accept membership on and be an active member of at least one standing committee, if appointed; e. satisfy the established requirements by the MEC for attendance at meetings of the Medical Staff and of the departments and committees of which he is a member; and

2 f. Active Staff members, may be assigned to any committee, to supervise the care of indigent patients, to duties in the clinics, to teaching programs and duties, and/or to utilization and/or quality improvement activities and to participate in on call responsibilities for active staff members as set by the Medical Executive Committee. B. AFFILIATE STAFF Members of the Affiliate Staff are practitioners who desire to be associated with the Hospital but do not intend to establish a clinical practice at the Hospital. The Affiliate Staff shall consist of practitioners each of whom: a. meet all of the basic qualifications set forth in Article III. 2. Privileges Members of the Affiliate Staff: a. may not admit patients to the Hospital but may refer patients to other physicians on the Active or Courtesy Staff; b. may follow his/her patient admitted to the hospital but is not permitted to write or give verbal orders or document in the progress notes; c. may not hold clinical privileges; may not d. may attend department, general staff and special meetings of the Medical Staff but vote on matters presented at the meetings; committees. e may not hold office in the Medical Staff organization and in the departments or a. meet the basic responsibilities set forth in Article III that are applicable to membership only with no privileges. C. COURTESY STAFF. The Courtesy Staff shall consist of practitioners each of whom meet all of the basic qualifications set forth in Article III and a. expect to use the Hospital facilities to a limited degree; or b. cannot achieve an Active Staff status because of Hospital, departmental, or service rules or regulations, after serving not more than two (2) years as Medical Staff member.

3 2. Privileges Members of the Courtesy Staff may: a. participate in not more than twenty-four (24) patient care contacts in connection with the Hospital in one calendar year. The term patient care contacts does not include contacts with indigent care patients or hospital clinic patients. At times of full Hospital occupancy or shortage of other facilities, as determined by the President, the elective admissions or use of facilities by Courtesy Staff members shall be subordinate to the needs of Active or Consulting Staff members. No physician on Active Staff may transfer from Active to Courtesy Staff after exceeding twenty-four (24) patient care contacts during the calendar year in which the transfer is requested. If a Courtesy Staff member has more than twenty-four (24) patient care contacts in any calendar year, upon receiving written notice from the Medical Staff Office, his/her clinical privileges shall automatically transfer from Courtesy staff to Active staff membership and he/she will assume all responsibilities of the Active Staff.; b. exercise such clinical privileges as are granted to him pursuant to Article III; and c. attend meetings of the Medical Staff whenever possible and accept membership on committees. However, a member of the Courtesy Staff may neither hold office in any Staff organizations nor have a vote except in committees to which he has been appointed. D. CONSULTING STAFF. a. each member of the Courtesy Staff shall be required to discharge the basic responsibilities specified in Article III and, further, shall retain responsibility within his area of professional competence for the continuous care and supervision of each patient in the Hospital for whom he is providing services, or arrange a suitable alternative for such care and supervision; b. each member will be expected to participate in medical care evaluation studies; and c. Courtesy staff members may elect, if assigned, to serve on any committee, to supervise the care of indigent patients, to fulfill duties in the clinics, to participate in teaching programs and related duties, and to participate in utilization and/or quality improvement activities. Participation in the on-call schedule will be determined on an individual basis as agreed between the practitioner, Chief of Staff and the Medical Executive Committee. If a Courtesy staff member elects to receive any assignment, the assignment is subject to the rules and regulations applicable to the given assignment. There will be an ongoing Consulting Staff. All present members of the Consulting Staff will continue to hold the classification regardless of any present or prior qualifications for appointment to the Consulting Staff. The Practitioner: a. must have served at least twenty-five (25) years as a member of the Hospital's

4 Active Staff; or b. must have served at least fifteen (15) years as a member of the Hospital's Active Medical Staff and attained the age of sixty (60) years; and c. must still be actively practicing. 2. Privileges Privileges for Consulting Staff members shall be the same as for Active Staff members. Responsibilities shall be the same as for Active Staff members. Each member of the Consulting Staff shall retain responsibility within his area of professional competence for the continuous care and supervision of each patient in the Hospital for whom he is providing services, or arrange suitable alternative for such care and supervision. 4. Assignments Consulting Staff members, with their concurrence, may be assigned to any committee, to supervise the care of indigent patients, to duties in the clinics, to teaching programs and duties, to utilization and/or quality improvement activities. If the Consulting Staff member accepts committee assignments or Staff or department offices, he must abide by attendance requirements, if any, for the given assignment or office. 5. Application for Consulting Staff E. HONORARY STAFF. A practitioner qualified for the Consulting Staff, must apply for membership to this Staff category. The application must be approved by the appropriate department, the Credentials Committee, the MEC and the Board. Members of the Active or Consulting Staff no longer actively practicing, practitioners who are not members of the Medical Staff or who do not necessarily reside in the area, but whom, because of outstanding medical reputation, or meritorious service to the Hospital, the Hospital wishes to honor, may be elected to Honorary membership by the concurrence of a department or a service, the Credentials Committee, the Executive Committee, and the Board. They will have no Hospital duties. They will have no vote. They may not hold any Staff office and may not have clinical privileges, other than emergency or special privileges. F. RESIDENT AND FELLOW STAFF. Members of the Resident and Fellow Staff are those practitioners who are participating in either a clinical rotation at the Hospital as part of their residency training, or a fellowship program approved by the Medical Executive Committee and the Board. 2. Privileges and Responsibilities Members of the Resident and Fellow Staff category: a. can only admit patients under the supervision of an assigned attending physician member of the Medical Staff;

5 b. may only provide routing and/or emergency patient care under the supervision of a member of the Medical Staff in accordance with the provisions of the federal Emergency Medical Transfer and Active Labor Act.; c. are not eligible for elected Medical Staff positions; d. have no vote in Medical Staff affairs; e. are not required to attend Medical Staff meetings. 3. Duration of privileges. a. Privileges remain in effect until the completion of the residency training program or fellowship at which time the physician in this category is required to initially apply for membership and privileges if they wish to continue on the Medical Staff. A member of the Resident and Fellow Staff shall not be entitled to the hearing or appeal rights provided in Article IX of these Bylaws in the case of termination from or reduction in status within the individual's residence or fellowship program. b. A resident or fellow assigned to the Hospital pursuant to any training program conducted under an agreement with Wright State University shall be subject to the then effective provisions of the Wright State University training protocols, including the disciplinary provisions. c. A resident or fellow serving in the Hospital pursuant to any other training program shall be subject to the then existing provisions of the agreement between the Hospital and the training program, including the disciplinary provisions. G. RESIDENT AND FELLOW MOONLIGHTING STAFF Opportunities may exist for residents and fellows to provide moonlighting coverage. For such to occur, the clinical department(s) involved must present a request to Medical Executive Committee (MEC) stating requirements and privileges requested which requires MEC approval. The resident or fellow must be credentialed and privileged independently of the residency or fellowship program. Policies and procedures governing this process, approved by MEC, will be maintained in the Medical Staff Office Credentialing Policy and Procedure Manual. The resident or fellow must have the written permission of their program director as part of the credentialing process. In addition, the resident or fellow: a. is not eligible for elected Medical Staff positions; H. PEER REVIEW STAFF. b. has no vote in Medical Staff affairs; c. is not required to attend Medical Staff meetings. The Peer Review Staff shall consist of recognized specialty practitioners appointed by the Chief of Staff and the President, who have signified a willingness to accept consulting appointments for the limited purpose of: (i) evaluating practitioners' credentials or otherwise reviewing selected medical records; (ii) to render an opinion on the quality of health care provided to patients of the Hospital; (iii) to provide needed monitoring or proctoring; or (iv) to participate in any corrective action processing. Members of the Peer Review Staff shall: a. be specially appointed to the Medical Staff for the purpose of completing the above-described peer review functions;

6 b. not be appointed to a specific department nor granted clinical privileges; c. not be eligible to serve as an officer, a committee member, or to vote on Medical Staff matters.

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