RULES AND REGULATIONS OF THE EXECUTIVE SUBCOMMITTEES AT JACKSON SOUTH COMMUNITY HOSPITAL AND JACKSON NORTH MEDICAL CENTER

RULES AND REGULATIONS OF THE EXECUTIVE SUBCOMMITTEES AT JACKSON SOUTH COMMUNITY HOSPITAL AND JACKSON NORTH MEDICAL CENTER

ARTICLE I. DEFINITIONS. 3 ARTICLE II. PURPOSE. 3 ARTICLE III. FACILITY MEDICAL EXECUTIVE SUBCOMMITTEE: COMPOSITION, DUTIES, AND MEETINGS 3 Section 3.01 Composition of the Facility Medical Executive Subcommittee 3 Section 3.02 Officers of the Facility Medical Executive Subcommittee 8 Section 3.03 Qualifications of Officers 8 Section 3.04 Nominations of Candidates 8 Section 3.05 Election of Officers 9 Section 3.06 Term of Office 9 Section 3.07 Vacancies in Office 9 Section 3.08 Duties of Officers of the Facility Medical Staff Executive Subcommittee 9 Section 3.09 Removal from Office or Resignation 11 Section 3.10 Meetings of the Medical Staff 13 ARTICLE IV. CLINICAL SERVICES. 15 Section 4.01 Clinical Services Defined. 15 Section 4.02 Associate Chief of Service. 16 Section 4.03 Liability. 18 Section 4.04 Individual Medical Staff Members. 18 ARTICLE V. COMMITTEES AND SUBCOMMITTEES. 18 Section 5.01 Subcommittees of PHT Committees 18 Section 5.02 Medical or Multidisciplinary Committees and Subcommittees 18 Section 5.03 Committee and Subcommittee Policies and Procedures 18 Section 5.04 Committees and Subcommittees in General. 19 Section 5.05 Facility Medical Review Subcommittee 22 Section 5.06 The Credentials Subcommittee 23 Section 5.07 Nominating Committee 25 Section 5.08 Rules and Regulations Committee 25 Section 5.09 Multidisciplinary Subcommittees 26 ARTICLE VI. AMENDMENTS. 27 Section 6.01 Approval Process. 27 ARTICLE VII. EFFECTIVE DATE. 29

Page 3 of 29 These Rules and Regulations are adopted in connection with the PHT Medial Staff Bylaws and are made a part thereof. ARTICLE I. DEFINITIONS. The definitions shall be the same as those listed in governing medical staff bylaws. The following additional definitions shall also be applicable to these Rules and Regulations: Facility shall refer to the respective individual community hospital, Jackson South Community Hospital (JSCH) or Jackson North Medical Center (JNMC). ARTICLE II. PURPOSE. The purpose of these Rules and Regulations is fulfill the requirements of Section 12.2(F) of the PHT Medical Staff Bylaws with regard to the establishment of subcommittees at Jackson South Community Hospital and Jackson North Medical Center, as well as rules and regulations at those Facilities for selection of leadership, appointments to subcommittees, recommendations for positions such as associate chief of service and other matters. ARTICLE III. FACILITY MEDICAL EXECUTIVE SUBCOMMITTEE: COMPOSITION, DUTIES, AND MEETINGS Section 3.01 Composition of the Facility Medical Executive Subcommittee (a) Composition 1. Jackson South Community Hospital The Jackson South Medical Executive Subcommittee shall consist of the officers of the Medical Executive Subcommittee for that facility and the Associate Chiefs and Vice-Chiefs of Service, five (5) hospital-based Directors (ED, ICU, Pathology, Anesthesiology, Radiology) and five (5) at-large members elected from the medical staff who practice at Jackson South Community Hospital. The following shall be ex-officio, nonvoting members: the Facility Chief Nursing Officer, the Facility Director

Page 4 of 29 of Fiance, the Chief Administrative Officer of JSCH and the Associate Chief Medical Officer of JSCH. 2. Jackson North Medical Center The Jackson North Medical Executive Subcommittee shall consist of the officers of the Medical Executive Subcommittee for that Facility and; the Associate Chiefs of Service and five (5) at-large members elected from the medical staff who practice at JNMC. The following shall be ex-officio non-voting members: the Facility Chief Nursing Officer, the Facility Director of Fiance, the Chief Administrative Officer of JNMC; and the Associate Chief Medical Officer of JNMC. (b) Elected At-Large Members 1. Nominations. The Nominating Committee shall nominate no more than two (2) candidates for each at-large membership vacancy. The nominating committee shall complete and make available to the Facility Medical Executive Subcommittee a slate of candidates no later than seven (7) days before the annual meeting of medical staff members who practice at the facility. The slate shall be submitted to the Facility Medical Executive Subcommittee, which shall accept such slate and forward it to the medical staff members who practice at the facility for their consideration at the annual meeting. Additional nominations will be accepted from the floor, provided the individuals making the nominations submit evidence of the nominee s willingness to serve. Any member of a qualified medical staff category in good standing who practices at the Facility is eligible to be nominated. Those candidates receiving the greatest number of votes shall be elected to fill the available positions on the Facility Medical Executive Subcommittee. Notwithstanding any other provision herein, a majority of the Facility Medical Executive Subcommittee membership must be medical and osteopathic physicians.

Page 5 of 29 2. Term. The at-large members shall be elected for two (2) year terms commencing with the beginning of the medical staff year. No at-large member shall serve more than two (2) consecutive terms. However, a former at-large member who has served less than one (1) year is eligible for reelection and, upon reelection, shall not have the initial partial term considered in applying the term limits specified herein. The terms of the at-large members shall be staggered such that no more than three (3) at-large positions shall be elected during any one (1) medical staff year. (c) Duties The Facility Medical Executive Subcommittee acts on behalf of the medical staff members who practice at the Facility. The duties of the Facility Medical Executive Subcommittee shall be as follows: 1. Represent and act on behalf of the medical staff members who practice at the Facility, subject to such limitations as may be imposed by these Rules and Regulations, the PHT Medical Staff Bylaws, rules and regulations and policies and procedures; 2. Coordinate the activities and general policies of the various services subject to such limitations as may be imposed by these Rules and Regulations, the PHT Medical Staff Bylaws, rules and regulations and policies and procedures.; 3. Receive and act upon committtee and subcommittee reports; 4. Serve as a liaison between the medical staff who practice at the Facility and the Chief Administrative Officer, Associate Chief Medical Officer, and the PHT Medical Executive Committee; 5. Make recommendations to the Chief Administrative Officer, the Associate Chief Medical Officer, the PHT Medical Executive Committee, the PHT Chief Executive Officer and the PHT on clinical and administrative matters that affect the medical staff members who practice at the Facility;

Page 6 of 29 6. Make recommendations on management matters to the Chief Administrative Officer or Associate Chief Medical Officer; 7. Fulfill the medical staff s accountability to the PHT for the medical care rendered to the patients in the hospital and other designated facilities in conjunction with the appropriate PHT Chief of Service; 8. Ensure that the medical staff receives notice of changes to the accreditation status of the Facility; 9. Provide for the preparation of all meeting programs, whether directly or through delegation to a program committee or other suitable agent; 10. Review the credentials of all applicants seeking to exercise privileges at the Facility as presented by the Facility Credentials Subcommittee and make recommendations for staff membership, assignments to services and delineation of clinical privileges to the PHT Credentials Committee; 11. Periodically review all information available regarding the performance and clinical competence of staff members and, as a result of such reviews, make recommendations for reappointments, renewals, modifications or changes in clinical privileges as recommended by the Facility Credentials Subcommittee; 12. Take all reasonable steps to ensure professional ethical conduct and competent clinical performance on the part of all members of the medical staff in conjunction with the appropriate Chief of Service, including the recommendation to the PHT Medical Executive Committee of corrective action or review measures when warranted pursuant to the governing medical staff bylaws, rules and regulations and policies and procedures; 13. Report on the activities of the medical staff members who practice at the Facility. 14. Elect one (1) member from the Facility Medical Executive Subcommittee to serve as an at-large member of the PHT Medical Executive Committee.

Page 7 of 29 15. These duties may be modified or removed by amendment to these Rules and Regulations. Additional duties may be delegated to the Facility Medical Executive Subcommittee by the PHT Medical Executive Committee or by amendment to these Rules and Regulations. (d) Meetings The Facility Medical Executive Subcommittee shall meet at least ten (10) times during a calendar year at regularly scheduled times and places or after reasonable notice in order to conduct its business. The Facility Medical Executive Subcommittee shall maintain a permanent record of its proceedings and actions. A written agenda of the matters to be considered at the meeting shall be delivered to Facility Medical Executive Subcommittee members prior to the meeting. (e) Chairing the Meetings. The Facility Medical Executive Subcommittee will be chaired by the Chair of the Facility Medical Executive Subcommittee. If the Chair of the Facility Medical Executive Subcommittee is unable to attend a meeting, the Vice-Chair of the Facility Medical Executive Subcommittee shall chair the meeting. If the Vice-Chair of the Facility Medical Executive Subcommittee is also unable to attend the meeting, the Secretary of the Facility Medical Executive Subcommittee shall chair the meeting. If the Secretary is also unavailable, an Associate Chief of Service shall chair the meeting. (f) Attendance. If the Associate Chief of Service is unable to attend a meeting, it will be his or her responsibility to contact the Associate Vice-Chief of Service to request that he or she attend in Associate Chief of Service s absence. Issues concerning excessive absences for members who serve by virtue of their position (for example, the Associate Chiefs of Service) shall be addressed through counseling. If the attendance problem is not resolved, the member shall be requested to send a designee. 1. Removal or Resignations.

Page 8 of 29 a. An at-large member who attends fifty percent (50%) or fewer of the Facility Medical Executive Subcommittee meetings during his/her first year of membership shall automatically be removed from the Facility Medical Executive Subcommittee. The Facility Medical Executive Subcommittee shall fill the vacancy or request that the nominating committee nominate candidates to fill the vacancy at the next annual meeting of the medical staff. The member filling the vacancy shall serve for the remainder of the removed member s term. b. An at-large member may resign from the Facility Medical Executive Subcommittee by providing written notice to the Chair of the Facility Medical Executive Subcommittee, who shall notify the President of the PHT Medical Staff. The Facility Medical Executive Subcommittee shall fill the vacancy or request that the nominating committee nominate candidates to fill the vacancy at the next annual meeting of the medical staff. The member filling the vacancy shall serve for the remainder of the resigned member s term. Section 3.02 Officers of the Facility Medical Executive Subcommittee (a) The officers of the Facility Medical Executive Subcommittee shall be: 1. Chair 2. Vice Chair 3. Secretary 4. Immediate-Past Chair Section 3.03 Qualifications of Officers Candidates for office must be members of a qualified medical staff category in good standing who practice at the Facility at the time of nomination and election. Section 3.04 Nominations of Candidates The Nominating Committee shall nominate from the Public Health Trust medical staff members who practice at the Facility, no more than two (2) candidates for each available office. The Nominating Committee shall complete and make available a slate of the candidates to the Facility Medical Executive Subcommittee no later than

Page 9 of 29 seven (7) days before the annual meeting of the medical staff members who practice at the Facility. The slate shall be submitted to the Facility Medical Executive Subcommittee which shall accept such slate and forward it to the medical staff members who practice at the Facility for their consideration at the annual meeting. Additional nominations will be accepted from the floor of the annual meetings of medical staff members who practice at the Facility, provided the individual making the nomination submits evidence of the nominee s willingness to serve. Section 3.05 Election of Officers Officers shall be elected at the annual meeting of the medical staff members who practice at the Facility. Only members of a qualified medical staff category in good standing who practice at the Facility shall be eligible to vote. The candidate receiving the majority of the votes cast shall be elected to the position in question. The Facility Medical Executive Subcommittee shall then present the election results to the PHT Medical Executive Committee for informational purposes. Section 3.06 Term of Office All officers shall serve a two-year term commencing with the beginning of the medical staff year. If an officer takes office after the start of the medical staff year, that officer shall serve until the next duly scheduled election for that office. No officer shall serve more than two (2) consecutive, two (2) year terms in one office. However, a former officer who has not served for at least one (1) year is eligible for re-election. Section 3.07 Vacancies in Office Except for the position of Chair, vacancies shall be filled by the Facility Medical Executive Subcommittee. If there is a vacancy in the office of the Chair, the Vice- Chair shall serve out the remaining term. Section 3.08 (a) Chair. Duties of Officers of the Facility Medical Staff Executive Subcommittee Each Facility Medical Executive Subcommittee shall have a Chair. The Chair shall practice at the Facility and shall:

Page 10 of 29 1. Collaborate with the Chief Administrative Officer and Associate Chief Medical Officer in all matters of mutual concern between the Facility and the medical staff practicing at the Facility. 2. Call, preside at and be responsible for the agenda of all general meetings of medical staff members who practice at the Facility. 3. Serve as Chair of the Facility Subcommittee as set forth herein. 4. At Jackson North Medical Center, the Chair will serve as Chair of the Jackson North Medical Center Medical Executive Subcommittee and the Medical Review Subcommittee. 5. At Jackson South Community Hospital, the Chair will serve as Chair of the Jackson South Community Hospital Medical Executive Subcommittee, Medical Review Subcommittee and Credentials Subcommittee. 6. Serve as a non-voting, ex-officio member of all Facility medical staff subcommittees. 7. Appoint, in collaboration with the Chief Administrative Officer, medical staff members to all standing, and special medical staff committees and subcommittees, other than the Medical Executive Subcommittee and the multidisciplinary committees and subcommittees. Where appropriate, the Chair of the Facility Medical Executive Subcommittee shall designate a chair for each subcommittee. 8. Represent the views, policies, needs and grievances of the medical staff to the Facility and to the Chief Administrative Officer, Associate Chief Medical Officer and the Medical Executive Committee. 9. Serve on the PHT Medical Executive Committee. 10. Represent the medical staff in its external professional and public relations. 11. Serve as non-voting, ex-officio member of the Facility Advisory Board, as allowed by the PHT Medical Staff Bylaws. 12. Appoint the Associate Vice-Chiefs of Service.

Page 11 of 29 (b) Vice Chair. Each Facility Medical Executive Subcommittee shall have a Vice Chair. In the absence of the Chair, the Vice Chair shall assume all the duties and authority of the Chair. The Vice Chair shall be a voting member of the Medical Executive Subcommittee. The Vice Chair shall automatically succeed the Chair when the latter is unable or fails to serve for any reason. At Jackson North Medical Center, the Vice-Chair shall also serve as the Chair of the Jackson North Medical Center Credentials Subcommittee. (c) Immediate-Past Chair. The Immediate-Past Chair shall be an active member of the Facility Medical Staff Executive Subcommittee. Section 3.09 Removal from Office or Resignation (a) Removal. 1. Any member of the Facility Medical Executive Subcommittee or the PHT Medical Executive Committee may request that an officer be removed for cause. Grounds for removal include, but are not limited to: dereliction of duty; conviction of a felony or misdemeanor; or inappropriate professional or personal behavior which interferes with carrying out of official duties. Requests for removal shall be in writing, addressed to the Chair of the Facility Medical Staff Executive Subcommittee (or the next highest ranking officer in his or her absence or if the request is for removal of the Chair), and specify the grounds for removal. 2. The Facility Medical Executive Subcommittee shall furnish the affected officer with a copy of the request for removal. Within two (2) business days of receipt of the request, the Chair of the Facility Medical Staff (or the highest ranking officer available if the complaint involves the Chair) shall appoint a panel of three (3) members of the Facility Medical Executive Subcommittee to review the complaint. During the panel review, the affected officer shall have the right to: be present to present facts, evidence, or other considerations to refute the charges; and to be

Page 12 of 29 accompanied by a colleague or a member of the medical staff. The affected officer may not have an attorney present. The affected officer may not be present during the deliberations of the panel. The panel shall consider all facts and matters presented and shall act to recommend retention or removal of the officer. 3. The three member panel shall report its findings to the Facility Medical Executive Subcommittee at its next meeting. The panel may request an extension of up to thirty (30) days to report. The report shall be acted upon at the next regularly scheduled meeting of the Facility Medical Executive Subcommittee or at a special meeting called for that purpose. During the Facility Medical Executive Subcommittee panel review the affected officer shall have the right to be present and make a presentation to the Facility Medical Executive Subcommittee and to be accompanied by a colleague or a member of the medical staff. The affected officer may not have an attorney present. The Facility Medical Executive Subcommittee shall consider all facts and matters presented and shall act to retain or remove the officer. The affected officer may not be present during the deliberations of the Facility Medical Executive Subcommittee. Removal shall require two thirds (2/3) vote of the Facility Medical Executive Subcommittee members present. (b) Resignation. An officer may resign by providing written notice to the Facility Medical Executive Subcommittee. (c) Replacement. The Vice Chair shall automatically succeed the Chair if the Chair is removed or resigns. All other officers shall be replaced by appointment from the Facility Medical Executive Subcommittee.

Page 13 of 29 Section 3.10 Meetings of the Medical Staff (a) Annual Medical Staff Meeting. The annual facility medical staff meeting shall be held at least fifteen (15) days before the end of the medical staff year, and at least two (2) weeks prior to the annual meeting of PHT Medical Staff. The medical staff year runs from July 1 st to June 30 th. The agenda shall include a review and evaluation of the work completed in the clinical services; a review and evaluation of the performance of the required medical staff functions; an overview of each medical staff or multidisciplinary committee; the election of officers of the medical staff who practice at the Facility; and if applicable, revisions to these subcommittee rules and regulations. The agenda at any regular medical staff meeting shall include at least the following items: 1. Administrative. Call to order; acceptance of minutes of the last regular and of all special meetings; unfinished business; communications; report from the Chair of the Facility Medical Executive Subcommittee; report from the Chief Administrative Officer; reports of services; reports of subcommittees; report of PHT Medical Executive Committee; new business; elections; and revisions to these Rules and Regulations governing the selection of its leadership, appointments to Facility committees and subcommittees, and any other matters necessary for Facility medical staff functioning. 2. Professional. Review and analysis of the clinical work of the Facility; Reports of medical and multidisciplinary committees and subcommittees; and discussion and recommendations for improvement of the professional work of the Facility; 3. Adjournment. (b) Regular Meetings and Special Meetings of the Medical Staff. 1. Request. The Chair of the Facility Medical Executive Subcommittee, the PHT Medical Executive Committee or the Facility Medical Executive

Page 14 of 29 Subcommittee, or no fewer than ten percent (10%) of the members of qualified medical staff categories in good standing who practice at the Facility may at any time file a written request with the Chair of the Facility Medical Executive Subcommittee requesting that a special meeting of the medical staff members in good standing who practice at that the Facility be called. The special meeting shall occur within thirty (30) days of filing the request. 2. Scheduling. The Chair of the Facility Medical Executive Subcommittee shall designate the time and place of any special meeting. 3. Notice. Written notice stating the place, day, and hour of any special meeting of the medical staff shall be delivered (by U.S. mail, hand delivery, delivery service, facsimile, electronic mail or other electronic communication) to each member who practices at the Facility not less than seven (7) days before the date of the meeting. Notice shall be sent to the address, email address or other contact information that the medical staff member provided to PHT Medical Staff Office. If mailed, the notice of the meeting shall be deemed delivered when deposited, postage prepaid, in the United States mail addressed to each medical staff. The attendance of a member of the medical staff at a meeting shall constitute a waiver of notice of the meeting. 4. Other Business. No business shall be transacted at any special meeting except that stated in the notice calling the meeting. The agenda shall be: reading of the notice calling the meeting; transaction of the business for which it was called; and adjournment (c) Quorum. The presence of ten percent (10%) of the total number of members of qualified medical staff categories in good standing who practice at the Facility

Page 15 of 29 shall constitute a quorum. Unless the Chair requests a quorum count, the existence of a quorum shall be presumed at every meeting of the medical staff. ARTICLE IV. CLINICAL SERVICES. Section 4.01 Clinical Services Defined. (a) Jackson South Community Hospital. Each clinical and consultative service (hereinafter clinical service ) shall be organized as a separate part of the medical staff. The major clinical services of the medical staff practicing at Jackson South Community Hospital are Medicine, Surgery, Psychiatry, and Obstetrics/Gynecology. All medical and surgical subspecialties will be assigned to one (1) of these four (4) clinical services. In addition, radiology will be under the service of Medicine. Pediatrics will be under the service of Obstetrics/Gynecology. Pathology, Podiatry and Anesthesiology will be under the service of Surgery. (b) Jackson North Medical Center. Each clinical and consultative service (hereinafter clinical service ) shall be organized as a separate part of the medical staff. The major clinical services of the medical staff practicing at Jackson North Medical Center are Anesthesiology, Emergency Medicine, Family Medicine, Medicine, Neurology, Neurological Surgery, Obstetrics/Gynecology, Orthopaedics, Pathology, Pediatrics, Psychiatry, Radiology, and Surgery. For purposes of organization at Jackson North Medical Center, Anesthesia will include the section of Pain Management. Included within the section of Medicine will be Cardiology, Dermatology (reporting to the PHT Dermatology Service), Endocrinology, Gastroenterology, Hematology/Oncology, Infectious Diseases, Neurology (reporting to the PHT Neurology Service), Nephrology, Physical Medicine and Rehabilitation (reporting to the PHT Physical Medicine and Rehabilitation Service), and Pulmonary Medicine. Additionally, for purposes of organization at Jackson North Medical Center, Surgery will be comprised of sections of Bariatric Surgery, Neurosurgery (reporting to the PHT Neurosurgery Service), Ophthalmology (reporting to the

Page 16 of 29 PHT Ophthalmology Service), Otolaryngology (reporting to the PHT Otolaryngology Service), Plastic Surgery, and Urology (reporting to the PHT Urology Service). Orthopaedics will be comprised of sections of Orthopaedic Hand, and Podiatry (reporting to the PHT Orthopaedics Service). (c) The above mentioned services provided at each Facility shall report to the appropriately-designated PHT Chief of Service. Section 4.02 Associate Chief of Service. Each Facility shall have an Associate Chief of Service and an Associate Vice-Chief of Service for each clinical service. Each such Associate Chief of Service shall report and be accountable to the appropriate PHT Chief of Service, the Facility s Chief Administrative Officer, and the Facility s Associate Chief Medical Officer. (a) Delegation of Responsibilities. The PHT Chief of Service may delegate the responsibilities described in the PHT Medical Staff Bylaws to the appropriate Hospital-Based Associate Chief of Service for each Facility, but shall retain overall responsibility for those duties. (b) Qualifications. The Associate Chief of Service shall be the Associate Chief of Service at the Facility where s/he has clinical privileges. S/he shall be a member of a qualified medical staff category in good standing who practices at the Facility. Each Associate Chief of Service shall be certified by the appropriate specialty board or the PHT Credentials Committee shall affirmatively establish that he/she possesses comparable competence. (c) Appointment. The Chief of Service, in consultation with the Chief Medical Officer and Facility Chief Administrative Officer, shall provide the Chief Executive Officer with at least two (2) recommendations for appointment, from which the Hospital-Based Associate Chief of Service shall be selected. Each Hospital- Based Associate Chief of Service shall serve in that capacity only at the designated Jackson Health System hospital(s) and shall not serve in a similar

Page 17 of 29 capacity in any other institutional health care facility except as specified by agreement of the PHT. Nothing herein shall prohibit a Hospital-Based Associate Chief of Service from serving as the Chief of Service for the Jackson Health System or serving as the Associate Chief of Service at more than one (1) Jackson Health System hospital. (d) Removal. The Chief Executive Officer may remove a medical staff member from an Associate Chief of Service position after consultation with the appropriate Chief of Service and the Chief Medical Officer. Removal does not affect the individual s membership on the Medical Staff or clinical privileges. (e) Duties and Responsibilities. 1. The Associate Vice-Chief will act in the absence of the Associate Chief. 2. The Associate Chief of Service shall be responsible for maintaining a single standard of patient care within his/her clinical service throughout the Facility where s/he is appointed and for all professional and administrative activities within the service at the Facility where s/he is appointed. 3. The Associate Chief of Service shall ensure that the clinical services meet a minimum of once per year. The frequency of additional meetings is to be determined by clinical needs, as assessed by the Associate Chief of Service, the Facility s Chief Administrative Officer, the Facility s Associate Chief Medical Officer, or the Facility Medical Executive Subcommittee. 4. Each Associate Chief of Service shall report and be accountable to the appropriate PHT Chief of Service. 5. Each Associate Chief shall report regularly to the PHT Chief of Service on the professional performance of medical staff members, practitioners with privileges in the service and health professional affiliate members. 6. The additional responsibilities of aach Associate Chief of Service shall be defined by the PHT Chief of Service.

Page 18 of 29 Section 4.03 Liability. In matters relating to clinical privileges, all medical staff members and other practitioners, and all PHT officers, trustee, employees and agents, shall be acting pursuant to the same rights, privileges, immunities and authority as are provided for in the PHT Medical Staff Bylaws. Section 4.04 Individual Medical Staff Members. Each member of the medical staff and other individuals with clinical privileges shall be assigned to a clinical service by the Governing Board.. Each individual member of the medical staff shall function under an attending physician job description as detailed in medical staff policy. The responsibilities for individual medical staff members are established in the PHT Medical Staff Bylaws and pursuant to relevant PHT policies and procedures. ARTICLE V. COMMITTEES AND SUBCOMMITTEES. Section 5.01 Subcommittees of PHT Committees Each Facility may establish a subcommittee of any committee listed in the PHT Medical Staff Bylaws or in Policy 100.003, Medical Staff Multidisciplinary Committees. Any such subcommittee shall be established in consultation with the applicable PHT committee and in accordance with the PHT Medical Staff Bylaws and relevant policies and procedures. Section 5.02 Medical or Multidisciplinary Committees and Subcommittees Each Facility may establish medical staff or multidisciplinary committees or subcommittees as necessary to address matters unique to that Facility. Section 5.03 Committee and Subcommittee Policies and Procedures Subcommittees and committees shall operate in accordance with the PHT Medical Staff Bylaws and PHT Policy #100.003, Medical Staff Multi-Disciplinary Committees. In addition, except where otherwise set forth herein, subcommittees shall follow the PHT Medical Staff Bylaws as they pertain to the applicable PHT Committee (for example, the Facility Credentials Subcommittee shall follow the

Page 19 of 29 section of the PHT Medical Staff Bylaws related to the PHT Credentials Committee). However, whenever the term President of the Medical Staff is used, the term Chair of the Facility Medical Executive Subcommittee shall be substituted; whenever the term Vice President of the Medical Staff is used, the term Vice-Chair of the Facility Medical Executive Subcommittee shall be substituted; whenever the term Chief Medical Officer is used, Associate Chief Medical Officer of the relevant Facility shall be substituted; and whenever the term Chief Nursing Executive or designee is used Facility Chief Nursing Officer or designee shall be substituted. Section 5.04 Committees and Subcommittees in General. (a) Chair and Vice-Chair. (b) Where appropriate, each committee or subcommittee shall have a chair, cochair and vice-chair, appointed by the Chair of the Facility Medical Executive Subcommittee. The term for the chair and vice-chair shall be two (2) years, which shall begin at the start of the medical staff year. If the chair or vicechair begins his/her tenure after the start of the applicable term, he/she shall serve until the end of the existing term. No member shall serve more than two (2) consecutive, two-year terms in one position. However, a former chair or vice-chair who has served less than one (1) year is eligible for reappointment or reelection and, upon reappointment or reelection, shall not have the initial partial term considered in applying the term limits specified herein. (c) Members. A member cannot serve on one (1) committee or subcommittee for more than four (4) consecutive years unless so required by the member s title or position, or if so approved by the Chair of the Facility Medical Executive Subcommittee. However, a former chair or vice-chair who has served less than one (1) year is eligible for reappointment or reelection and, upon reappointment or reelection, shall not have the initial partial term considered in applying the term limits specified herein. A member shall not serve on more than three (3) subcommittees simultaneously unless so required by the

Page 20 of 29 member s title or position or if so approved by the Chair of the Facility Medical Executive Subcommittee and the President of the PHT Medical Staff. (d) Regular Attendance. Attendance records shall be considered when determining subsequent membership on committees or subcommittees. (e) Ex-Officio Members. Persons serving under these Rules and Regulations as ex-officio members of a committee or subcommittee shall have all rights and privileges of regular members, including the right to vote, except they shall not be counted in determining the existence of a quorum. (f) Eligibility to Serve on a Subcommittee and the Right to Vote. A member s eligibility to serve on a committee or subcommittee and the member s right to vote on matters before a committee or subcommittee is determined by the member s medical staff membership category as set forth in the PHT Medical Staff Bylaws. (g) Meetings. 1. Regular Meetings. Committees and subcommittees shall meet at regularly scheduled times and places or after reasonable notice in order to conduct their business. 2. Special Meetings. a. A special meeting of any committee or subcommittee may be called by or at the request of the Chair of the committee or subcommittee, the Chair of the Facility Medical Executive Subcommittee, or by one-third (1/3) of the committee s or subcommittee s members, but not fewer than two (2) members. b. Notice of Meetings. Written or electronic notice stating the place, day, and hour of any special meeting shall be given to each member of the subcommittee not less than five (5) days before the meeting, by the person or persons calling the meeting or his or her designee. Notice by electronic mail shall be deemed completed when sent to the electronic mail address as it appears in Medical Staff Office

Page 21 of 29 records. If sent via U.S. mail, the notice of the meeting shall be deemed delivered when deposited in the United States mail, postage paid, and addressed to the member at the address as it appears in PHT records. (h) Manner of Action. 1. Quorum. The presence of twenty-five percent (25%) of the eligible medical staff of a committee or subcommittee, clinical service or service sub-unit, but no less than two (2) members, shall constitute a quorum at any meeting. Unless the committee or subcommittee chair requests a quorum count, the existence of a quorum shall be presumed. 2. Formal Action. The action of a majority of the members present at a meeting at which there is a quorum shall be the action of a committee or subcommittee. 3. Informal Action No action of a committee or subcommittee shall be valid unless taken at a meeting at which a quorum is present except that any action may be taken without a meeting if a unanimous consent in writing is signed by each member entitled to vote. (i) Minutes. Minutes shall be prepared and shall include a record of the attendance of members and the vote taken on each matter. The minutes shall be signed by the presiding officer and copies shall be promptly submitted to the attendees for approval and after such approval is obtained, forwarded to the Facility Medical Executive Subcommittee. Each subcommittee shall maintain a permanent file of the minutes of each meeting. (j) Required Attendance for Patient Review. A member whose patient s clinical course is scheduled for discussion at a regular service meeting or clinico-pathological conference shall be notified and shall be expected to attend that meeting if his or her presence is required. The Chair of the Facility Medical Executive Subcommittee or the appropriate

Page 22 of 29 service subcommittee, through the Chief Administrative Officer or his or her designee, shall give the medical staff member or practitioner advance written notice of the time and place of the meeting at which attendance is expected. Whenever apparent or suspected deviation from standard clinical practice is involved, the notice to the medical staff member or practitioner shall so state, shall be given by certified mail, return receipt requested, and shall include a statement that attendance at the meeting at which the alleged deviation is to be discussed is mandatory. (k) Subcommittees. The Facility Medical Executive Subcommittee may create a subcommittee to accomplish the purposes of these Rules and Regulations. Additionally, each PHT committee may determine the need for a separate subcommittee for any Facility. The Facility Medical Executive Subcommittee may create additional rules and regulations consistent with these Rules and Regulations, the PHT Medical Staff Bylaws and applicable PHT policies and procedures to govern such subcommittees. All subcommittees created under the authority of these Rules and Regulations shall report its recommendations to the Facility Medical Executive Subcommittee. Section 5.05 Facility Medical Review Subcommittee (a) Composition. The Medical Review Subcommittee shall consist of only the medical staff members of Facility Medical Executive Subcommittee and shall follow the same requirements as the Facility Medical Executive Subcommittee for chairing the meetings and for allowing designees. (b) Duties. 1. The Facility Medical Review Subcommittee shall evaluate and seek to improve the quality of health care rendered by all clinical/professional services. It shall determine whether the health care services rendered were appropriate, necessary, cost effective and performed in compliance with approved standards of care.

Page 23 of 29 2. The Facility Medical Review Subcommittee shall also actively participate, as appropriate, in significant unresolved issues or serious incidents from the clinical services or medical staff subcommittees as well as patient care problems and/or safety issues not resolved through Quality, Patient Safety and Regulatory Compliance or Risk Management with the understanding that these programs are operating in conjunction with the Medical Review Subcommittee. 3. The Facility Medical Review Subcommittee shall make specific recommendations to the Associate Chiefs of Service, PHT Medical Review Committee, and/or to the Facility Credentials Subcommittee as appropriate. The Facility Medical Review Subcommittee is empowered to make recommendations to the PHT Medical Executive Committee, the President of the PHT Medical Staff, and the Chief Executive Officer. (c) Meetings. The Facility Medical Review Subcommittee shall meet as needed and shall maintain a permanent record of its proceedings and actions and shall make reports to the Facility Medical Executive Subcommittee. A court reporter is required for closed meetings of a disciplinary nature. Section 5.06 The Credentials Subcommittee (a) Composition. 1. Jackson South Community Hospital. The Jackson South Community Hospital (JSCH) Credentials Subcommittee shall consist of the same members as the Facility Medical Executive Subcommittee. The following shall attend the Credentials Subcommittee meetings and provide support to the Credential Subcommittee: one (1) representative from the Facility Quality, Patient Safety and Regulatory Compliance; one (1) representative from the Facility Medical Staff Office; and one (1) representative from the PHT Medical Staff Office. The Chair of the JSCH Medical Executive

Page 24 of 29 Subcommittee shall serve as chair, and the Vice-Chair of the JSCH Medical Executive Subcommittee shall serve as co-chair. 2. Jackson North Medical Center. The Jackson North Medical Center Credentials Subcommittee shall consist of the JNMC Associate Chiefs of Service and the JNMC Chief Nursing Officer or his or her designee. The Associate Chief Medical Officer shall also be an ex-officio, non-voting member. The following shall attend the Credentials Subcommittee meetings and provide support to the Facility Credentials Subcommittee: one (1) representative from Quality, Patient Safety and Regulatory Compliance; one (1) representative from Risk Management; one (1) member from Health Information Management; and one (1) representative from the Facility Medical Staff Office. The Vice-Chair of the JNMC Medical Executive Subcommittee shall serve as chair but a member of a qualified medical staff category in good standing who practices at JNMC may be appointed by the JNMC Medical Executive Subcommittee to serve as co-chair. (b) Meetings. The Facility Credentials Subcommittee shall meet at least ten (10) times during a calendar year at regularly scheduled times and places or after reasonable notice in order to conduct its business and shall maintain a permanent record of its proceedings and actions. Duties The duties of the Facility Credentials Subcommittee shall be to: 1. Review the credentials of applicants for medical staff membership who wish to practice at that Facility and make recommendations for membership and delineation of clinical privileges in compliance with the PHT Medical Staff Bylaws; 2. Make a report to the Facility Medical Executive Subcommittee and then to the PHT Credentials Committee on each applicant for medical staff membership, including specific consideration of the recommendations

Page 25 of 29 for clinical privileges from the services and Facility in which the applicant requests privileges; 3. Review in accordance with the reappointment cycle, all information available regarding the competence of medical staff members and, as a result of such reviews, make recommendations for granting privileges, reappointments and assignment of medical staff and practitioners to the various services as provided in these Rules and Regulations. 4. Investigate any breach of ethics that is reported to it; and 5. Review reports that are referred from the Facility s Medical Executive, Health Information Management, Medical Review and Utilization Review Subcommittees or the Chair of the Facility Medical Executive Subcommittee. Section 5.07 Nominating Committee (a) Composition. The Nominating Committee shall consist of no more than a total of five (5) active members in good standing of the Facility Medical Executive Subcommittee. The members of the Nominating Committee shall be appointed by the Chair of the Facility Medical Executive Subcommittee. The Chair of the Facility Medical Executive Subcommittee shall appoint the Immediate Past Chair of the Facility Medical Executive Subcommittee, who will be designated the chair of the Nominating Committee, and no more than four (4) other members of the Facility Medical Executive Subcommittee. (b) Duties. The Nominating Committee shall nominate candidates for positions, as specifically required by these Rules and Regulations. (c) Meetings. The Committee shall meet as frequently as necessary to discharge its duties. Section 5.08 Rules and Regulations Committee (a) Composition.

Page 26 of 29 (b) The Rules and Regulations Committee shall be composed of members of the medical staff practicing at the Facilities and shall be appointed by the Chairs of the respective Facility Medical Executive Subcommittees. The Rules and Regulations Committee shall receive staff support from the Office of Physician Services, the Office of Care Management, the Office of Quality, Patient Safety and Regulatory Compliance, Office of Risk Management and the County Attorney s Office and any other appropriate staff. The Immediate Past-Chairs of the Facility Medical Executive Subcommittees shall serve as co-chairs of the Rules and Regulations Committee. (c) Duties. The Rules and Regulations Committee shall: 1. Review these Rules and Regulations at least every two (2) years and make recommendations to the Facility Medical Executive Subcommittees, as necessary, to reflect current staff practices and to ensure compliance with accreditation, regulatory and legal requirements. The Rules and Regulations Committee shall seek input from the medical staff members who practice at the Facilities as part of this periodic review. 2. Review any proposed amendments to these Rules and Regulations that may be proposed by the Facility Medical Executive Subcommittees. (d) Meetings. The Rules and Regulations Committee shall meet as frequently as necessary to discharge its duties. Section 5.09 Multidisciplinary Subcommittees (a) The medical staff shall appropriately participate in the maintenance and improvement of high professional standards throughout the Facilities by maintaining physician representation on various multidisciplinary committees and subcommittees that relate to the safety and the quality of care rendered to patients. These may include: 1. The Utilization Management Committee;

Page 27 of 29 2. The Pharmacy and Therapeutics Committee; 3. The Infection Control Committee; 4. The Health Information Management Committee; 5. The Tissue Committee; 6. The Transfusion Committee; 7. The Cancer Committee; 8. The Adult Bioethics Committee; 9. The Trauma Quality Management Committee; 10. The Center for Bloodless Medicine and Surgery (CBMS) Steering Committee; 11. The Cardiopulmonary Resuscitation (CPR) Committee; and 12. Any other multidisciplinary committee created pursuant to PHT policies and procedures or any multidisciplinary committee created by the Facility Medical Executive Subcommittee or the Chief Administrative Officer. (b) The Facility shall maintain a clear statement of the duties and responsibilities of each committee and subcommittee and the name of its respective chair in the Facility Administrative Manual Policy. This policy shall include: 1. the purpose and duties of the committee or subcommittee; 2. the composition of the committee or subcommittee; 3. the duties of the chair; 4. the frequency of the meetings; 5. the nature, frequency and mechanism for reporting on the activities of the committee or subcommittee; and 6. any other details relating to the operations and functioning of the committee or subcommittee and its members. Section 6.01 ARTICLE VI. AMENDMENTS. Approval Process. (a) The members of a qualified medical staff category in good standing who practice at the Facilities shall adopt and approve any amendment, revision or update to these Rules and Regulations in the following manner: Recommendation of the Facility Medical Executive Subcommittees. The

Page 28 of 29 Facility Medical Executive Subcommittees shall have the authority to recommend the approval and amendment of rules and regulations on behalf of the medical staff that practice at the Facilities. If the Facility Medical Executive Subcommittees propose to adopt a rule or regulation or make an amendment to these Rules or Regulations, it shall first notify the medical staff who practice at the Facilities. If the Facility Medical Executive Subcommittees recommend an adoption or amendment to these Rules and Regulations, it shall forward any such adoption or amendment to the PHT Medical Executive Committee. If the PHT Medical Executive Committee also recommends the adoption or amendment of these Rules and Regulations, the adoption or amendment shall be forwarded to the appropriate Board Committee and the Governing Board for review and approval. (b) Recommendation of the Medical Staff. If ten percent (10%) the members of a qualified medical staff category in good standing who practice at the Facilities propose to adopt or make an amendment to these Rules or Regulations the members shall notify the Facility Medical Executive Subcommittees of such proposed amendments. If the Facility Medical Executive Subcommittees decline to adopt such amendment or if the members of a qualified medical staff category in good standing who practice at the Facilities disagree with the adoption of an amendment, then ten percent (10%) of said members may request that the Chairs of the Facility Medical Executive Subcommittees bring the matter before the medical staff who practice primarily at the Facilities for consideration. The Chairs of the Facility Medical Executive Subcommittees may place the proposed amendments to the Rules and Regulation on the agendas at their next annual meetings, call special meetings or arrange for a vote without necessity of a meeting, whichever is most expedient. To be adopted, the proposed rule or regulation must be approved by a majority vote of the total (aggregate) membership of the qualified medical staff categories in good standing who practice at the Facilities and who are present at the annual or special meeting. If a vote is held without a meeting, the proposed

Page 29 of 29 amendment must be approved by a majority of the total responding eligible membership of the Facilities who are in good standing. If an amendment is adopted, it shall be forwarded to the PHT Medical Executive Committee, the appropriate Board Committee and the Governing Board for review and approval. (c) Urgent Amendment. If there is a documented urgent need to amend these Rules or Regulations in order to comply with a law, regulation, accreditation requirement or for other good cause, the Facility Medical Executive Subcommittees and the PHT Medical Executive Committee may each provisionally adopt and the Governing Board may provisionally approve an urgent amendment to these Rules and Regulations without prior notification of the medical staff who practice at the Facilities. However, the medical staff who practice at the Facilities and the PHT Medical Executive Committee shall be immediately notified by the Facility Medical Executive Subcommittees. If there is any objection to the urgent amendment within fourteen (14) days of the notification, then the procedures in Article VII of these Rules and Regulations shall be followed in order to make the amendment permanent. ARTICLE VII. EFFECTIVE DATE. These Rules and Regulations are subordinate to the PHT Medical Staff Bylaws, rules and regulations, policies and procedures and to PHT policies and procedures. Any conflict between these Rules and Regulations and the PHT Medical Staff Bylaws, rules and regulations, policies and procedures or the PHT policies and procedures shall be resolved in favor of the PHT Medical Staff Bylaws, rules and regulations, policies and procedures or the PHT policies and procedures. These Rules and Regulations shall be effective upon approval by the Facility Medical Executive Subcommittees, the PHT Medical Executive Committee and the governing board of the PHT. APPROVED BY PHT-FRB October 29, 2012 (Initial)