Greene Publishing, Inc.

By David Abercrombie

MCMH CEO

Are all doctors in Madison County associated with the hospital or are they allowed to visit their patients in the hospital?

Though hospitals and physicians work together to take care of hospitalized patients (and run test on outpatients), only a physician can put a patient into a hospital.  This procedure is called “admitting a patient.”  For the outpatient, the procedure is usually called, “ordering a test.”  To be allowed to do this, the physician must have membership on that hospital’s medical staff.

All hospitals across the country have an organization within the hospital called a physician medical staff.   And all of these hospitals have a similar medical staff organizational structure, though they do vary with the complexity of the hospital.  Physicians (a term that in this context includes medical doctors, or MDs and osteopathic doctors, or DOs) are an independent self-governing professional group of physicians (and sometimes including mid-level practitioners) that operate within the broader hospital policy structure.

A medical membership consists of qualified physicians who have applied for membership and who meet membership criteria, and who have been granted membership through a medical staff membership vote.

These criteria for membership and how membership is granted are part of a medical staff’s governance.  A medical staff governs itself through the development and implementation of its own organizational by-laws and a set of rules and regulations.  Because a medical staff operates within the confines of a hospital building and because everything they do impacts every part of patient care, their by-laws and their rules and regulations are subject to the approval of that hospital’s board of directors (Board). It is exceedingly rare for this approval to be withheld.  As physicians are the experts in the provision of patient care, the Board usually accepts their collective judgment as to what is best in the way of patient care standards and practices.  This high level of expertise makes them essentially autonomous.

Usually each year, a medical staff will elect its own leadership.  In Madison, this leadership consists of a chief of staff (chairman), a vice-chief of staff and a secretary. They meet quarterly to discuss patient care and medical staff organizational issues.  MCMH supplies a medical staff coordinator (Linda Cherry) to help the medical staff schedule its meetings, to take minutes of meetings and to handle other such coordinating duties.

A MCMH Board member (Annette Johnson) and Members of the hospital senior staff (David Abercrombie and Tammy Stevens, RN), as well as the hospital pharmacist (Ted Sanders) also attend these meetings.  They do not attend as members of the medical staff, but rather in a capacity to help coordinate mutual physician/hospital patient care activities.

Madison County Memorial Hospital (MCMH) does indeed employ physicians, but does not employ all of the physicians (nor all of the mid-level practitioners) that practice in Madison County.

Generally, physicians fall in one of four categories – employed by the hospital; self-employed and in private practice; physician-owned special contracted physician services; and physician practicing in Madison County but not associated with the hospital nor the hospital medical staff in any way.  The first two of these are self-explanatory. The third – specially contracted physicians are actually groups of physicians who own a company that contracts with many different hospitals to provide special services. At MCMH, these include Southland EMS, a physician-owned company that provides ER coverage by physicians and mid-level practitioners; and Doctors Laboratories, a physician-owned company that provides the hospital with laboratory pathology, monitoring and directorship.

Physicians from the first three of these categories may hold MCMH medical staff memberships.  Physicians from the fourth group do not.

MCMH medical staff membership allows the member to admit patients to the MCMH and to come into the hospital and take care of their patients (called “following a patient”).  In doing so, they must always abide by the MCMH medical staff by-laws and rules and regulations.   Physicians in that fourth category who do not have membership cannot admit a patient, nor follow a patient at MCMH, nor order outpatient tests.

For example, a MCMH medical staff physician may admit and follow a patient at MCMH.  However, this same physician may not admit and follow a patient at any other hospital unless the physician has membership on both hospital medical staffs.  In large cities, it isn’t unusual for physicians to be on multiple hospital staffs.  However, the number of meetings a physician must attend, along with committee duties, and other associated duties, make it difficult to maintain membership on the medical staff of more than two or three hospitals.

By Joe Boyles

Guest Columnist

A nasty head cold kept me from attending the recent Kiwanis meeting where Senator Bill Nelson and his friend Tommy Tart spoke about Colin Kelly.  I’m sorry I missed it, but I sure didn’t want to pass my germs on to anyone.

I was aware that Senator Nelson was making another appeal to the Department of the Army to upgrade Kelly’s Distinguished Service Cross (DSC) to the Medal of Honor.  Apparently that appeal was unsuccessful.  I’m not surprised.  I came to that conclusion about ten years ago when I came into possession of the Kelly File.

At that time, the appeal was driven by former Congressman Allen Boyd.  When Boyd looked into the matter, many thought that the Kelly File had been destroyed in the 1973 fire at the St. Louis National Records Center, but this file was in a fireproof VIP vault that was not affected by the blaze.  When Boyd was finished with the file, his assistant Bobby Pickles gave the file to me.  Several years later, I copied it for the NFCC Library.

The file consists of about four hundred documents: letters; newspaper articles; special orders; flight records; messages; and the like.  After Kelly’s death in early December 1941, the War Department scoured their files for anything related to Kelly.  The file was added to over the next few years as the name of Colin Kelly passed from history into legend.  Anyone doing serious study on Madison’s greatest hero should look at all of these documents carefully – they are a treasure trove of information.

For example, in his flight records you find that his first pilot training instructor in 1937 at Randolph Field, TX was Bob Scott who would later find fame as a Flying Tiger in China and author of the famous book turned movie, “God is my Co-Pilot.”

The issue of whether or not Colin Kelly deserved the Congressional Medal of Honor (CMOH) has come up repeatedly, most recently by Senator Nelson.  In my mind, the issue was put to bed shortly after his death.  In mid-December 1941, several prominent people called for his decoration of the CMOH and bills were introduced in both houses of Congress to that affect.

The Kelly File contains an exchange of cables between Army Chief of Staff George Marshall and Army Far East Commander Douglas MacArthur on December 21 and 22, each asking whether or not Kelly’s award of the DSC should be upgraded to the CMOH.  This is at exactly the same time that Manila is falling to the Japanese and MacArthur is moving his command to the island of Corregidor.  This likely added to the confusion.

By February 26, 1942, the issue is settled.  In letters to both the House and Senate Military Affairs committee chairmen, Secretary of War Henry Stimson says that a thorough review of the facts indicates that the award of the Distinguished Service Cross is appropriate for Captain Kelly’s act and sacrifice.

Everything else from that point on was moot – the commanders at the time had made a determination.  No subsequent commanders are going to reverse the decision made at the time by the competent authority unless new information is gleaned which wasn’t available at the time.

When I reviewed the file for the first time, I felt the only opportunity to reverse this decision was by bringing new information to light.  I felt that if the December 5th reconnaissance mission over Formosa was properly documented and the entire body of work over six days (December 5-10) was included in a new recommendation — that might succeed.  Since that Friday mission report has never been discovered to my knowledge and all the events documented, we simply don’t have the information that might result in new and further consideration.

I think there was another factor working against Kelly – the details of his heroic action on the December 10th final mission were so grossly misreported.  Some reports indicated that he attacked an aircraft carrier – there were no carriers used by the Japanese in The Philippines operation.  Other reports said that he sank the battleship Haruna; even rammed his aircraft into the ship – not true.  He did attack and put out of commission the heavy cruiser Ashigara, but that wasn’t discovered until years later.  Things were very confusing in those early days of the war, and the media botched the reporting.

None of this in any way diminishes the heroism displayed by Captain Kelly.  He was one of the first to strike a decisive blow at the enemy and lost his life to save his crew.  He was and still is an inspiration to anyone who is familiar with the facts.  I invite anyone who is interested to review the Kelly File and discuss this remarkable man and his legacy.