Sec. 11151. Definitions
(From the Health Care Quality Act)
(1) The term ''adversely affecting'' includes reducing,
restricting, suspending, revoking, denying, or failing to renew
clinical privileges or membership in a health care entity.
(2) The term ''Board of Medical Examiners'' includes a body
comparable to such a Board (as determined by the State) with
responsibility for the licensing of physicians and also includes
a subdivision of such a Board or body.
(3) The term ''clinical privileges'' includes privileges,
membership on the medical staff, and the other circumstances
pertaining to the furnishing of medical care under which a
physician or other licensed health care practitioner is permitted
to furnish such care by a health care entity.
(A) The term ''health care entity'' means -
(i) a hospital that is licensed to provide health care
services by the State in which it is located,
(ii) an entity (including a health maintenance organization
or group medical practice) that provides health care services
and that follows a formal peer review process for the purpose
of furthering quality health care (as determined under
regulations of the Secretary), and
(iii) subject to subparagraph (B), a professional society (or
committee thereof) of physicians or other licensed health care
practitioners that follows a formal peer review process for the
purpose of furthering quality health care (as determined under
regulations of the Secretary).
(B) The term ''health care entity'' does not include a
professional society (or committee thereof) if, within the
previous 5 years, the society has been found by the Federal Trade
Commission or any court to have engaged in any anti-competitive
practice which had the effect of restricting the practice of
licensed health care practitioners.
(5) The term ''hospital'' means an entity described in
paragraphs (1) and (7) of section 1395x(e) of this title.
(6) The terms ''licensed health care practitioner'' and
''practitioner'' mean, with respect to a State, an individual
(other than a physician) who is licensed or otherwise authorized
by the State to provide health care services.
(7) The term ''medical malpractice action or claim'' means a
written claim or demand for payment based on a health care
provider's furnishing (or failure to furnish) health care
services, and includes the filing of a cause of action, based on
the law of tort, brought in any court of any State or the United
States seeking monetary damages.
(8) The term ''physician'' means a doctor of medicine or
osteopathy or a doctor of dental surgery or medical dentistry
legally authorized to practice medicine and surgery or dentistry
by a State (or any individual who, without authority holds
himself or herself out to be so authorized).
(9) The term ''professional review action'' means an action or
recommendation of a professional review body which is taken or
made in the conduct of professional review activity, which is
based on the competence or professional conduct of an individual
physician (which conduct affects or could affect adversely the
health or welfare of a patient or patients), and which affects
(or may affect) adversely the clinical privileges, or membership
in a professional society, of the physician. Such term includes
a formal decision of a professional review body not to take an
action or make a recommendation described in the previous
sentence and also includes professional review activities
relating to a professional review action. In this chapter, an
action is not considered to be based on the competence or
professional conduct of a physician if the action is primarily
based on -
(A) the physician's association, or lack of association, with
a professional society or association,
(B) the physician's fees or the physician's advertising or
engaging in other competitive acts intended to solicit or
(C) the physician's participation in prepaid group health
plans, salaried employment, or any other manner of delivering
health services whether on a fee-for-service or other basis,
(D) a physician's association with, supervision of,
delegation of authority to, support for, training of, or
participation in a private group practice with, a member or
members of a particular class of health care practitioner or
(E) any other matter that does not relate to the competence
or professional conduct of a physician.
(10) The term ''professional review activity'' means an
activity of a health care entity with respect to an individual
(A) to determine whether the physician may have clinical
privileges with respect to, or membership in, the entity,
(B) to determine the scope or conditions of such privileges
or membership, or
(C) to change or modify such privileges or membership.
(11) The term ''professional review body'' means a health care
entity and the governing body or any committee of a health care
entity which conducts professional review activity, and includes
any committee of the medical staff of such an entity when
assisting the governing body in a professional review activity.
(12) The term ''Secretary'' means the Secretary of Health and
(13) The term ''State'' means the 50 States, the District of
Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa,
and the Northern Mariana Islands.
(14) The term ''State licensing board'' means, with respect to
a physician or health care provider in a State, the agency of the
State which is primarily responsible for the licensing of the
physician or provider to furnish health care services.