Report of the Supervisor by jonathanscott

VIEWS: 99 PAGES: 160

									                            Report to the Honourable David Caplan
                            Minister of Health and Long-Term Care
                   Concerning the Supervision of Stevenson Memorial Hospital
                                        December 2008

The purpose of this report is to provide an overview of the factors that led to my appointment as
Supervisor of Stevenson Memorial Hospital, my observations and significant decisions taken. I
am appreciative of the support afforded to me by the Honourable George Smitherman, Minister
of Health and Long-Term Care (to June 2008), the Honourable David Caplan, Minister of Health
and Long-Term Care, Ron Sapsford, Deputy Minister of Health and Long-Term Care, Hy
Eliasoph, Chief Executive Officer of the Central Local Health Integration Network and Daniel
Carriere, President and Chief Executive Officer of Southlake Regional Health Centre.


Context
The provision of health care in any jurisdiction is a complicated and challenging matter requiring
informed decisions about one of the most important services provided to citizens and paid for by
taxpayers. Decision making at all levels within the health system is fraught with challenges
many of which stem from varying perspectives on the interplay and trade-offs between quality,
safety, affordability and accessibility.


Until recently, health care policy and decision making has been largely centralized at Queen’s
Park in structures and processes that have not stimulated the integration of service nor decisions
sensitive to local or regional circumstances. While other Provinces in Canada devolved some
authority to regional bodies, Ontario remained largely centralized in its approach to system level
governance and decision making until 2005 when the Government of Ontario introduced the
concept of Local Health Integration Networks or LHINs and established 14 LHINS across
Ontario’s vast geography. LHINs were established under the Local Health System Integration
Act 1 to plan, fund and promote the integration of health services consistent with the strategic
directions of the Province. LHINs are governed by a Board of Directors appointed by the
Lieutenant Governor-in-Council. While LHINs are a relatively new addition to health care


1
    Local Health System Integration Act, 2006; S.O. 2006, Chapter 4
                                                  2

decision making processes in Ontario, they are important organizations in the evolution of
Ontario’s health care system.


The need to balance quality, safety and accessibility and affordability will become an
increasingly important set of considerations as resource limitations of all types intersect with the
health care requirements of a growing and aging population. Decisions about how much
resource to allocate to the various competing demands within the health care system, demands
stimulated by both citizens, providers and LHINs as payors will become increasingly more
challenging.


Promoting inter-dependence among health care providers will be a critical factor in the evolution
of the health system. Health care providers, including hospitals and homecare providers, have
examples of working together to improve the experiences of patients and it is expected that
LHINs will help to stimulate even more of this type of productive activity. Health care is a team
endeavour whether one considers the inter-professional aspects of care within an organization
like a hospital or the inter-organizational relationships that are required for improved patient care
as patients move from family practitioners to hospital to home care to rehabilitation facilities to
long-term care centres. The need for the elements of the health system to behave more like a
true system has never been more critical. One need only consider the challenges of citizens with
chronic co-morbid conditions as they navigate, often with great difficulty, from one health care
provider to another as a pressing rationale for integration. The need for organizations to work
together for the benefit of patients must be a central theme of decision making in concert with
considerations of quality, safety, accessibility and affordability.


The implication for organizations like Stevenson Memorial Hospital (SMH) is that it must
continue to pursue relationships with other health care providers that will serve to improve the
level of service to the people who live in and around New Tecumseth.       This will mean continual
change so that the services provided to people who reside in the SMH catchment area are offered
within the context of a larger system. Decisions that will promote relationships with other
organizations, services close to home where quality, safety and cost are appropriate and travel to
other organizations for care when travel is warranted on the same basis of quality, safety and
                                                  3

affordability will be increasingly important themes considered by the board and management.
Decision making in health care is always difficult, however, it is my view as Supervisor that the
individuals charged with the responsibility to lead SMH have the skills and knowledge to make
decisions that will be in the best public interest of the community.


Circumstances that led to the Appointment of the Supervisor
On June 8, 2007, the Board of Directors of Stevenson Memorial Hospital resigned. This mass
resignation followed a divisive debate in the community over the provision of maternal and
newborn services. In the fall of 2006 the Board of Directors decided to close maternal and
newborn services due to the hospital’s inability to attract and retain Canadian certified specialists
in obstetrics and the decline in the number of births at the hospital.


This decision was met with significant concern within the hospital and the community served by
SMH. Interest groups were formed to attempt to reverse this decision. The hospital attempted
through community meetings to explain the rationale for its decision, however, community
concern remained unabated.


In the winter of 2007 the Ministry of Health and Long-Term Care appointed an Expert Panel, led
by Jessica Hill, an individual with very credible experience and thoughtful judgement in public
and health care policy, to review the circumstances leading to the decision to close the obstetrical
unit and to explore options for the future. In the spring of 2007 the Expert Panel delivered its
report and recommended the establishment of a regional maternal and new born service in
partnership with Southlake Regional Health Centre (SRHC) with primary obstetrical services
offered at SMH within this regional model.


Some segments of the community continued to raise concern over the governance of SMH. As
of May 31, 2007, 654 corporate memberships were purchased by members of the community
compared to the previous year when there were only 87 corporate members. The corporate
structure of SMH provided members with the opportunity to call and attend members meetings,
approve, reject or amend the corporate by-laws and elect directors. The by-laws of SMH left the
                                                  4

corporation vulnerable to the goals of single interest groups in the community with a desire to
assume control of the hospital in order to achieve their aims.


Attempts to achieve a mediated solution between the individuals who wished to see change at the
governance level and the then board failed. The board, in the face of a likely defeat of its slate of
proposed directors at the Annual General Meeting resigned on June 8, 2007.


Terms of reference associated with the appointment of the Supervisor
On June 11, 2007 I was appointed Supervisor by the Lieutenant Governor-in-Council pursuant to
section 9(1) of the Public Hospitals Act. The terms of reference of the appointment are as
follows:


   1. The Supervisor will fulfill all the responsibilities of the board, the corporation, its officers
       and members in governing the hospital in accordance with the Public Hospitals Act, its
       regulations and all other applicable legislation.


   2. The Supervisor will review governance issues and prepare a plan to create a new board
       and senior management team as appropriate.


   3. Acting as the board of the hospital, the Supervisor will provide direction to the senior
       management team as appropriate during the term of the involvement of the Supervisor.


   4. Acting as the board of the hospital, the Supervisor will pass by-laws that provide for the
       management and administration of the hospital, the organization of the medical staff, and
       business of the corporation.


   5. The Supervisor will oversee the implementation of the recommendations of the Expert
       Panel on Maternity Services at The Stevenson Memorial Hospital, which includes the
       partnership of obstetrics with the Southlake Regional Hospital.
                                                   5

   6. The Supervisor will liaise with the Assistant Deputy Minister, Acute Services Division of
       the Ministry of Health and Long-Term Care and the Chief Executive Officer of the
       Central Local Health Integration Network as appropriate.


   7. The Supervisor will report to the Minister of Health and Long-Term Care.


Observations
On June 15, 2007 I attended SMH to introduce myself to the management and staff of the
hospital. In my introduction to the staff I stated that:
   •   I was looking forward to working with the staff of the hospital
   •   that the circumstances that led to my appointment took time to unfold and that it would
       take time to find resolutions to these issues
   •   that I would be meeting with members of staff, volunteers, past board members,
       management and the community to gain an understanding of their perspectives on the
       circumstances that preceded my appointment
   •   that they, as staff of SMH, were doing a terrific job in the face of controversy and that
       they should know that their efforts are appreciated by those who rely on SMH for
       services


On June 22, 2007, I initiated a series of meetings that extended over July and August with groups
or individuals to explore:
   1. What they believed led to the resignation of the board and the appointment of a
       Supervisor?
   2. What advice they would have to assist me in helping to advance the interests of the
       hospital?


I met with in excess of 150 people in groups or in private meetings including hospital employees,
medical staff, volunteers, municipal and provincial politicians, past board members and business
leaders. While the relative ranking of issues varied, the people I met with shared:
   •   a desire to see the hospital prosper
   •   a desire to establish a predictable and stable level of operations at SMH
                                                  6


   •   a desire to see the hospital improve its communication internally and externally
   •   a desire to re-establish the Child and Maternal Program
   •   the need for improved relationships between the leadership of SMH and internal and
       external constituencies


In the spring of 2007 Pesce & Associates was retained to undertake a review of the
organizational climate at SMH. The conclusions from the review can be summarized as:


   •   the need to address morale through improved communication and decision making
   •   the need to resolve outstanding issues within a reasonable time frame and communicate
       the relative priority of issues requiring resolution
   •   the need for improvements to be evident in a timely manner


Many of the observations noted by Pesce & Associates were raised by individuals in meetings
with me. A number of recommendations were made by Pesce & Associates aimed at improving
the morale and decision making processes. While some progress had been made in
implementing the proposed recommendations, at the time of my appointment as Supervisor,
there was still much work to be done.


Appointment of Interim Management
On September 12, 2007 the President & CEO and Vice President of Patient Care resigned from
SMH. On October 12, 2007 the Chief of Staff resigned and on November 2, 2007 the Chief
Financial Officer resigned to accept a position at another hospital.


In order to establish ongoing management at SMH, I negotiated the provision of interim
management with SRHC. Daniel Carriere, the President & CEO of SRHC was very helpful in
assisting with the appointment of two members of his senior staff to assist with the management
of SMH. Gary Ryan, Vice President of Acute Care Services at SRHC was appointed Acting
President & CEO of SMH and Annette Jones, Vice President, Chief Nursing Officer and
Professional Practice of SRHC was appointed Vice President of Patient Care at SMH. Their
appointments were effective September 10, 2007. They have done an outstanding job in
                                                 7

providing leadership to the organization and establishing relationships with members of the
community. Dr. Trevor Hunt was appointed Acting Chief of Staff on October 13, 2007 and Bob
Breedon was appointed Acting Chief Financial Officer on November 5, 2007. They too have
made outstanding contributions to the organization.


Establishment of Regional Maternal and Newborn Program
In partnership with SRHC a Regional Maternal and Newborn Program was established with the
appointment of Laurie Reynolds as Director, Maternal Child Program. She led the planning at
SMH to re-establish primary obstetrical services at the hospital. Recruitment of Canadian
certified obstetricians was initiated.


In April 2008, Dr. A. Barnett, Obstetrician and Gynaecologist was appointed to the medical staff
at SMH. On April 26, 2008 the first newborn was delivered in the re-established program at
SMH. In November 2008, Dr. G. Lawson, Obstetrician and Gynaecologist was appointed to the
medical staff at SMH.


As of the date of this report, in excess of 135 newborn deliveries have taken place at SMH in the
re-established program.


The creation of a joint Regional Material and Newborn Program with SRHC is an example of the
benefits inherent in inter-organizational relationships that promote the provision of high quality
health services consistent with the needs of the population and the capabilities of the
organization.


The process undertaken to identify potential board members and arrive at the
selection of directors

Based upon the advice I received during consultations I undertook during July and August 2007,
I established an Advisory Committee to assist me with the identification of potential directors
and the selection of directors who would form the Board of Directors and provide governance
level leadership once I relinquished my responsibilities as Supervisor.
                                                  8

Members of the Advisory Committee were:


Peter Gordon
Mr. Gordon was the senior vice president at Honda of Canada Manufacturing from May 2004
until his recent retirement in April of 2007. He is currently a director and treasurer of the
Stevenson Memorial Hospital Foundation and has lived in the community for more than 30
years.


Larry Keogh
Mr. Keogh served as Mayor of New Tecumseth and Simcoe County Councillor for six years. His
community experience includes a five year term on the Simcoe York District Health Council
where he was involved in a number of local and regional health care initiatives. He is board chair
of the Gibson Cultural Centre and currently chairs the Physician Recruitment and Retention
Committee for Stevenson Memorial Hospital.


Elizabeth Kirley
Ms. Kirley has practised criminal, family and children's law for over 15 years, as both a defence
lawyer and Assistant Crown Attorney. She also served as representative of the Office of the
Children's Lawyer in Dufferin County for more than five years. She is a founding director of the
New Tecumseth and Area Arts Council and the Gibson Cultural Centre.


Dana Stehr

Ms. Stehr has owned and operated a senior level executive search business for the past 20 years,
specializing in the health care, social service and not-for-profit sectors. She has extensive
volunteer leadership experience. Ms. Stehr spent five years on the Board of Directors of
Stevenson Memorial Hospital and two years on the Board of Directors of Stevenson Memorial
Hospital Foundation.



I am grateful to these four community spirited individuals for their wise counsel in selecting
directors for SMH.
                                                9



The skill set requirements for directors was established and widely publicized in the local media
and was made available on the hospital’s website along with relevant excerpts from the Ontario
Hospital Association’s Guide to Good Governance. (see Appendix 1)


Many individuals expressed interest in becoming a director and interviews were held through the
fall of 2007 to select 12 individuals who would be appointed directors designate pending the
termination of my role as Supervisor at SMH. On December 17, 2007 the following individuals,
all of whom reside in the area served by SMH, were appointed as directors:


Scott Anderson
Mr. Anderson has extensive business experience as a partner/owner of several successful
privately owned businesses, primarily focused on corporate and consumer services. As a
chartered account, he has executive level business experience, including finance, operations,
marketing, sales and human resources.


He has a variety of Board experiences over a 20 year period. At the time of his appointment he
was a member of the Sleep Country Canada Board (Chair of the Audit Committee) and of
ListenUP Canada, the Ontario market leader in hearing health care.


Justice Jon-Jo Douglas
Prior to his appointment in 1998 as a Judge of the Ontario Court of Justice, Justice Douglas was
an Assistant Crown Attorney in London and Toronto, counsel with the Ontario Securities
Commission and the Ontario Pension Commission, and Executive Vice-President with the
Ontario Pension Board.


Justice Douglas was previously the volunteer President of the York Region Division of the
Canadian Cancer Society.
                                                10

On January 14, 2008 Justice Jon-Jo Douglas resigned from the Board.


Alan Dresser
Mr. Dresser owns and operates the Tottenham Pharmacy since 1992 and the Tottenham Medical
Pharmacy since 1995. He is experienced in offering health related clinics in the community and
has worked as a Teaching Assistant with the Faculty of Pharmacy at the University of Toronto.
He has also been a member of the Finance Committee for the Ontario Pharmacists’ Association.


Mr. Dresser is a recent graduate of the Schulich School of Business at York University,
specializing in Organizational Behaviour and Health Industries Management.


Hart Holmstrom
Mr. Holmstrom is the owner of Temp Air Control, a mid-size company in the heating,
ventilation, air conditioning and refrigeration industry for more than 30 years. Prior to entering
business, he was in the Canadian Armed Forces for 15 years, four of which were with the NATO
Forces serving as a peacekeeper in Europe.


Mr. Holmstrom serves on several local boards in Alliston; notably as the Executive Director of
NT Temps and as a Director for the Sir Frederick Banting Legacy Foundation, the Veterans’ and
Seniors’ Villa of Alliston, and the South Simcoe Concert Band. He is Past President of the
Alliston Lions Club. Mr. Holmstrom is a member of the Royal Canadian Legion and St. John’s
United Church.


Debbie Hudson
Ms. Hudson is a Certified Financial Planner and Branch Manager with Investment Planning
Counsel in Alliston. Ms. Hudson is founder and organizer of Women at Their Best, an annual
charity event held locally for the past 12 years. She has served as a Board member and Chair of
People In Transition, My Sister’s Place, Treasurer of Shelburne Minor Hockey and was on the
Board of Stevenson Memorial Hospital. She currently sits on the Board of The Gibson Centre.
                                               11



Marilyn Lawrence
Ms. Lawrence has been a resident and worked in the area for the past 27 years. She and her
husband currently reside in Essa Township. Marilyn is a Certified Human Resources
Professional with a registered nursing background. She has worked in a hospital environment
and provided industrial health nursing in a manufacturing facility. Ms. Lawrence is currently the
Manager of Human Resources for a company in the transportation sector.


Gilles Madore
Mr. Madore, since 1986, has been employed by Honda of Canada Manufacturing. in various
management roles. Currently as Vice-President at Honda, he is a project leader for the new
engine plant. Prior to this assignment, Mr. Madore was Plant Manager for the light truck plant
and the Civic plant. He also worked for seven years as General Manager of Quality.


Catherine Morden
Ms. Morden is a resident of Alliston whose career experiences include 32 years as an educator
for the Metropolitan Separate School Board of Toronto. She has extensive community
leadership experience, including eight years as a member of the Board of the Markham
Stouffville Hospital, Chairperson of the Markham Theatre for Performing Arts, and Chairperson
of Unionville Festival. She has also served as a committee member for the Markham
Achievement and Civic Recognition Awards and the Frederick Varley Art Gallery, as well as
Past President of Briar Hill Community and Director of the Gibson Cultural Centre.


Pat Morrison
Ms. Morrison has lived and farmed in the community with her husband, John, since 1973. She
currently works for Shannon-Moore Financial Services in Alliston. Over the years, Ms.
Morrison has volunteered in many organizations, including Kinettes, St. John’s Church, minor
hockey and baseball, and the Alliston Hornets Jr. C.
                                                12


John Swinden
Mr. Swinden is a retired partner of Ernst & Young Canada, where he served for 39 years. His
last assignment with the firm was worldwide Director of Risk Management for Ernst & Young
International, in London, UK. He is a Fellow of the Institute of Chartered Accountants, and Life
Member. He also holds a Certified Fraud Examiner credential, and briefly practiced forensic
accounting. His professional work has involved being in charge of an independent audit at a
large Toronto hospital.


Recently, his experience includes being a Director and Audit Committee Chair of an Ontario
automobile parts manufacturing company with a number of factories in three countries.


Ted Vandevis
Mr. Vandevis is President & Chief Executive Officer of Electrical & Utilities Safety Association
of Ontario in Mississauga. He is a member and chair of numerous Boards and committees, all
related to the prevention of illness and injuries. In 1996, he graduated from the University of
Western Ontario, Ivey School of Business with a Masters in Business Administration and is
presently a PhD candidate in Capella University's Organization and Management program.


John Ytsma
Mr. Ytsma and his family have lived and worked in Alliston for 15 years and currently own the
Alliston Home Building Centre. Mr. Ytsma served on the Board of Directors of Stevenson
Memorial Hospital for the past seven years sitting on various sub committees of the Board. He
also held the position of Vice-Chair of the Board for two years.


Paul Farley
On May 29, 2008 Mr. Farley was appointed a director designate. Since 1984, he has served as
Senior Counsel to the Professional Conduct Committee of the Institute of Chartered Accountants
of Ontario. Mr. Farley’s current and past volunteer experience includes serving as Chair of the
Financial Services Commission of the Ontario Advisory Board and Chair of the High School
Community Council in Bradford.
                                                13


Appointment of Board Officers
On May 29, 2008, in consultation with the directors designate, the following appointments were
made:
        Ted Vandevis – Chair
        Scott Anderson – Vice Chair
        John Swindon – Treasurer
Directors and board officers served in an advisory capacity to me in my capacity as Supervisor.


Orientation Process for Directors
Maureen Quigley and Graham Scott, consultants in health care governance, were engaged to
provide an orientation program beginning in January 2008 for the newly appointed directors.
The program was organized into modules and included the following topics:
   •    Orientation to Stevenson Memorial Hospital
   •    Stevenson Memorial Hospital in the context of the broader health system
   •    Overview Critical Elements for Effective Governance in a changing health care
        environment
   •    Ensuring Viability (financial and human resources considerations)
   •    Ensuring Program Quality, Effectiveness and Patient Safety
   •    Building relationships with the Central LHIN


A Governance Task Force was struck with the objective of creating governance policies and
practices that would guide the work of the board.


The rationale to enter into a Management Service Agreement with Southlake
Regional Health Centre
One of the most important responsibilities of a Board of Directors of any organization is the
selection and evaluation of its Chief Executive Officer (CEO). In considering the options
available for the appointment of a Chief Executive Officer I came to the conclusion that given
the significant challenges facing SMH, a relationship with a larger organization that would,
under contract, provide the services of a CEO and also provide the managerial depth to assist
                                                14

SMH would be advantageous to the organization and to the community. SRHC would be in a
position to provide SMH with the expertise that it could not afford given the limited scale of the
organization. I discussed the concept of SRHC providing management services to SMH with the
CEO of SRHC. Under the proposed model, the board of SMH would maintain governance of the
organization while at the same time benefiting from the capacity of a larger organization to
manage SMH.      The model has the necessary ingredients to lead to stronger management and
improved clinical and support service integration while at the same time maintaining strong local
governance. A similar model that exists between Hamilton Health Sciences Centre and several
hospitals in close proximity to Hamilton was reviewed and found to be a productive model. This
concept was discussed with the directors designate of SMH in early 2008 over several meetings.
Upon the recommendation of the directors designate of SMH, I executed a Management Services
Agreement with SRHC.


The Board of Directors established a selection committee and interviewed the CEO proposed by
SRHC.


On June 12, 2008 Gary Ryan was appointed CEO of SMH in addition to maintaining senior
leadership responsibilities at SRHC.


Community Engagement
Hospitals must consider and implement strategies to communicate with and engage with their
community. Given the diversity of communities in Ontario, approaches to community
engagement will vary, however, the objectives are similar and include:
   •    creating awareness of the hospital, its operating environment challenges and plans for the
        future
   •    benefiting from the perspectives of the community in developing hospital plans
   •    generating support for the hospital
Successful meaningful community engagement is an important responsibility of directors and
hospital management. Communities served by hospitals expect to be kept informed of the many
issues facing the organization and provided opportunities to provide perspectives concerning the
evolution of the organization and options for the future. Creating venues for citizens served by
                                                  15

the hospital to be heard will provide directors with a wide range of perspectives that ought to be
taken into consideration when making decisions.


Legal Framework for Hospitals
With some limited exceptions, hospitals are established as non-share capital corporations under
the Corporations Act.2


The provisions of the Corporations Act create a structure which requires the hospital to have
members who meet membership requirements established by the Board of Directors and are
admitted to membership status by the board. Neither the Corporations Act nor the Public
Hospitals Act prescribe a specific model of corporate membership leaving it to each hospital to
make its own determinations in this regard.


The duties of members of a non-share capital corporation include:
      1. the election of directors
      2. the appointment of auditors
      3. the approval of by-laws
      4. the calling of special meetings of the corporation (called by a certain minimum threshold
           of directors)


Corporate Membership Considerations
The model of corporate membership with the opportunity for broad corporate membership has
served hospitals well, particularly in circumstances that are relatively stable and free of
controversy. Hospital corporate membership usually becomes an issue in circumstances where
the hospital board has made a decision that is controversial for a segment of the community
served by the hospital. The model provides the opportunity for single interest groups to form
coalitions with the objective of gaining control of the hospital board through strategies including
the bulk purchase of corporate memberships. A recent Ontario Hospital Association survey
indicates that approximately 43% of hospital by-laws restrict their corporate membership to the


2
    Corporations Act; R.S.O. 1990, Chapter C.38
                                                   16

directors of the hospital. Of those hospitals with broad corporate membership, 67% of hospitals
restrict the election of directors to a board approved slate3.


I established the following as desired outcomes relating to the inter-related matters of corporate
membership structure, director selection and community engagement:
      •   A skills based board recognizing that hospitals are among the most complicated
          organizations to operate. They require a broad set of skills and experience to navigate the
          challenges of health provider organizations. In order to establish and maintain a skills
          based orientation into the future the hospital must have the ability to attract and appoint
          the best volunteers for this important role.
      •   The need for engagement with the community in identification of potential directors
          recognizing that while the need for a skills based board is important, so too is the need to
          engage the community in the identification and selection of directors. The board’s
          nomination process must be open to ensure that directors are identified from a broad
          constituency to attract not only those with the requisite skills, experience and knowledge
          but also those with varying perspectives and backgrounds to ensure that the board not
          only possess the necessary skills, but is representative of the community served by the
          hospital.
      •   The need for stability recognizing that having come through a difficult period it is
          important for the community, the staff and those thinking about becoming staff members
          to know that the board not only has the necessary skills to do the job but also will not be
          subject to threat of removal by corporate members who purport to represent the interests
          of the entire community. The board must be comprised of individuals who take a system
          level approach to governance and understand the importance of balancing various
          interests in making significant decisions.


To balance the need to ensure that directors with appropriate skills will lead the hospital in a
stable circumstance with the need to understand the views of the community and discharge the
organization’s accountability to the community, the by-law of SMH was amended to provide for
the following:

3
    2007 OHA Governance Survey
                                                 17

    1. The establishment of advisory members of the corporation
            o Advisory membership is open to citizens 18 years or older who are residents in
               the community and pay a nominal fee as set by the board.
            o Advisory members would have the opportunity to participate as members of
               board committees (including the Nomination Committee, be considered as
               potential directors and call and attend meetings of the Advisory Membership
               (Appendix 2, section 2.1.2; section 2.1.5(1); section 2.2.1(2).
    2. The nomination process for directors requires the board to:
            o advertise for directors
            o establish a skills matrix to guide director recruitment
            o invite two advisory members and a municipal representative to participate in the
               nomination process on the Nominations Committee (Appendix 2, section 3.4).
    3. The election of directors by the voting corporate members of the hospital (Appendix 2,
        section 2.1.3; 2.1.5(2))


By policy of the Board of Directors, meetings of the board will be conducted in open forum.
Also by board policy, the Chair of the Board and CEO shall on an annual basis, offer to make
presentations to the municipal councils of New Tecumseth, Adjala-Tosorontio, Essa, and
Innisfil.


It is my expectation that these measures will serve to promote stability at the governance level of
the organization, the recruitment and retention of directors with requisite skills, while at the same
time, provide for community engagement in the affairs of the hospital.


It is recommended that this framework will be reviewed by the board in five years.


Summary
Stevenson Memorial Hospital, with the support and engagement of its community, the leadership
of its Board of Directors and management and positive relationship with Southlake Regional
Health Centre and the Central Local Health Integration Network, is in a strong position to
continue to develop as a model community hospital.
                                               18



It has been an honour for me to be associated with the staff, directors and community leaders
who share a common desire for Stevenson Memorial Hospital to succeed as a high quality
provider of health care services.


Respectfully submitted,




Mark Rochon,
Supervisor
                  Stevenson Memorial Hospital is recruiting
                          12 new Board members
Stevenson Memorial Hospital is recruiting 12 positions for a new Board of Directors to be
appointed during the fall of 2007. We are proactively canvassing the community and seeking
expressions of interest from possible candidates.

The Supervisor of Stevenson Memorial Hospital, Mark Rochon, is recruiting the 12 positions
with assistance from a community Advisory Committee. The Advisory Committee members are
Peter Gordon, Larry Keogh, Elizabeth Kirley and Dana Stehr.

Ideal candidates will be passionate and committed to Stevenson Memorial Hospital and to
excellence in community health care. In addition to skills and expertise, Board members will
reflect strong ethics, and must be prepared to work in a team environment and to commit
adequate time.

Potential interested candidates are encouraged to review our website for more information about
the positions available with SMH and to learn how to apply. We have also made available
supplemental information that will be of interest including an excerpt from the OHA Guide to
Good Governance about the duties and obligations of individual directors, a sample code of
conduct for Hospital Directors, as well as a sample Position Description.

The deadline for submissions from possible candidates is Friday, October 19, 2007.

For more information about the positions available with Stevenson Memorial and the
information referenced above, please click here:

   -   Recruitment ad
   -   News release
   -   Letter to Corporate Members of SMH
   -   OHA guide to Good Governance: Chapter 4
   -   Sample Board Code of Conduct
   -   Sample Position Description
                        Stevenson Memorial Hospital
Stevenson Memorial Hospital, a fully accredited facility located in the community of
Alliston, Ontario, within the Town of New Tecumseth, is actively recruiting candidates
for 12 positions for its

                                 Board of Directors

The Hospital offers a wide scope of medical and surgical services to a catchment area
including Adjala-Tosorontio, Canadian Forces Base Borden, Essa, Innisfil and New
Tecumseth.

A new, 12-member Board of Directors will be recruited and appointed during the fall of
2007. The length of appointment will be staggered between three groups of four
Directors, with terms ending in June 2010, June 2011 and June 2012. The Board governs
the affairs of the hospital and provides strategic leadership and oversight of operations
subject to the Public Hospitals Act, hospital by-laws and other requirements.

The Board member composition will reflect a mix of skills and experience required for
operating a contemporary rural health care facility. Candidates for consideration should
have skills such as: business management experience; health care and clinical experience;
knowledge of government and health policy; financial expertise and literacy; experience
in human resources, information technology, construction, quality control or strategic
planning; patient care; and previous governance experience.

Health care delivery is a highly interdependent service influenced by technology,
demographics, funding limitations and other factors. It will be important for Board
members to reflect strong ethics, appropriate levels of education and specific skills such
as legal and accounting. Candidates must be prepared to devote adequate time, work in a
team environment and share a passion for delivering excellence in health care to the
community.

Candidates are encouraged to submit letters of interest along with a current resume of
education, occupational, volunteer and other relevant experience, and references (who
will not be contacted without the consent of the candidate). The Supervisor of SMH,
assisted by a committee from the community, will evaluate submissions and conduct
interviews with suitable candidates.

More information about the responsibilities and duties of board members and the
positions being recruited can be found on the Stevenson Memorial Hospital website at:
http://www.smhosp.on.ca. The deadline for submissions is Friday, October 19, 2007.
Applications can be submitted by mail or e-mail to:

Sharon Knisley,
Executive Assistant to President & CEO
Stevenson Memorial Hospital
200 Fletcher Crescent, PO Box 4000
Alliston ON L9R 1W7
Fax: (705) 434-5138
Email: sknisley@smhosp.on.ca

Please note that only applicants to be interviewed will be contacted. Thank you in
advance for your interest.
                    Stevenson Memorial Hospital recruiting
                            12 new Board members
September 26, 2007, Alliston, Ontario – The Supervisor of Stevenson Memorial Hospital,
Mark Rochon, with assistance from a community Advisory Committee, is actively recruiting
candidates for 12 positions for a new Board of Directors to be appointed during the fall of 2007.

The 12-member Board governs the affairs of the hospital and provides strategic leadership and
oversight of operations subject to the Public Hospitals Act, hospital by-laws and other
requirements. The Board member composition will reflect a mix of skills and experience
required for operating a contemporary rural health care facility.

Following the resignation of the Board of Directors of Stevenson Memorial on June 8, 2007,
Rochon was appointed Supervisor by the Minister of Health & Long-Term Care with a mandate
that includes the oversight of operations, establishment of a new Board of Directors and review
of governance issues.

“We are proactively canvassing the community and seeking expressions of interest from
candidates through advertising in local media, direct approaches to potential candidates and
communication with the membership of the Hospital Corporation. We are taking this
multifaceted approach to attract talented individuals to the Board. In addition to expertise and
skills, we want people who care deeply about Stevenson Memorial Hospital and health care in
the community,” said Rochon.

“It is also important for Board members to reflect strong ethics, be able to work in a team
environment and be prepared to devote adequate time,” said Rochon. “It is estimated that Board
membership involves approximately ten hours of time each month and there will be a greater
time commitment during the orientation phase.”

The length of appointment will be staggered between three groups of four Directors, with terms
ending in June 2010, June 2011 and June 2012. The terms are structured to help maintain
stability and continuity on the Board. A number of governance models for the future that will
achieve community engagement and stability are also being considered.

The deadline for submissions from possible candidates is Friday, October 19, 2007. The
Supervisor and the Advisory Committee will evaluate submissions and conduct interviews with
suitable candidates. The Advisory Committee members are Peter Gordon, Larry Keogh,
Elizabeth Kirley and Dana Stehr.

More information about the responsibilities and duties of Board members can be found on the
Stevenson Memorial Hospital website at http://www.smhosp.on.ca.


                                              - 30 -
For more information contact:
Kathryn (Kate) Mooij
Community Relations Coordinator
Stevenson Memorial Hospital
(705) 435-3377 ext # 3254
Form 8
Sample Board Code of Conduct

Purpose
The hospital is committed to ensuring that in all aspects of its affairs it maintains the highest standards of public trust
and integrity.

Application
This Code of Conduct applies to all directors, including ex-officio directors and non board members of board
committees. Directors are also required to comply with the hospital’s policy on Ethics and Standards of Business
Conduct, which applies to employees and professional staff.

Directors’ Duties
All directors of the hospital stand in a fiduciary relationship to the hospital corporation. As fiduciaries, directors must
act honestly, in good faith, and in the best interests of the hospital corporation.

Directors will be held to strict standards of honesty, integrity and loyalty. A director shall not put personal interests
ahead of the best interests of the corporation.

Directors must avoid situations where their personal interests will conflict with their duties to the corporation.
Directors must also avoid situations where their duties to the corporation may conflict with duties owed elsewhere.

In addition, all directors must respect the confidentiality of information about the corporation.

Best Interests of the Corporation
Directors must act solely in the best interests of the corporation. All directors, including ex-officio directors, are held
to the same duties and standard of care. Directors who are nominees of a particular group must act in the best
interests of the corporation, even if this conflicts with the interests of the nominating party.

Confidentiality
It is recognized that the role of director may include representing the hospital in the community. However, such
representations must be respectful of and consistent with the director’s duty of confidentiality. In addition, the chair
is the only official spokesperson for the board. Every director, officer and employee of the corporation shall respect
the confidentiality of information about the hospital whether that information is received in a meeting of the board or
of a committee or is otherwise provided to or obtained by the director.

A director is in breach of his or her duties with respect to confidentiality when information is used or disclosed for
other than the purposes of the hospital corporation.




                                                             1
Form 8
Sample Board Code of Conduct

Board Spokesperson
The board has adopted a policy with respect to designating a spokesperson on behalf of the board. Only the chair or
designate may speak on beahalf of the board. The CEO, or the Chief of Staff or their designates may speak on behalf
of the organization.

No director shall speak or make representations on behalf of the board unless authorized by the chair or the board.
When so authorized, the board member’s representations must be consistent with accepted positions and policies of
the board.

Media Contact and Public Discussion
News media contact and responses and public discussion of the hospital corporation’s affairs should only be made
through the board’s authorized spokespersons. Any director who is questioned by news reporters or other media
representatives should refer such individuals to the appropriate representatives of the corporation.

Respectful Conduct
It is recognized that directors bring to the board diverse background, skills and experience. Directors will not always
agree with one another on all issues. All debates shall take place in an atmosphere of mutual respect and courtesy.

The authority of the chair must be respected by all directors.

Corporate Obedience – Board Solidarity
Directors acknowledge that properly authorized board actions must be supported by all directors. The board speaks
with one voice. Those directors who have abstained or voted against a motion must adhere to and support the
decision of a majority of the directors.

Obtaining Advice of Counsel
Request to obtain outside opinions or advice regarding matters before the board may be made through the chair.

Amendment
Board of Directors approval.


Approval Date:

Last Review Date:




                                                           2
Form 9
Sample Position Description - Board of Directors
Duties and Expectations of a Director


Purpose
The hospital is committed to ensuring that it achieves standards of excellence in the quality of its governance and has
adopted this policy describing the duties and expectations of directors.

Application
This policy applies to all elected and ex-officio directors and is provided to directors before they are recruited for
appointment to the board. A director who wishes to serve on the board must confirm in writing that he or she will
abide by this policy.

Position Description - Board of Directors
As a member of the board, and in contributing to the collective achievement of the role of the board, the individual
director is responsible for the following:

• Fiduciary Duties
  Each director is responsible to act honestly, in good faith and in the best interests of the hospital and in so doing,
  to support the hospital in fulfilling its mission and discharging its accountabilities.

  A director shall apply the level of skill and judgment that may reasonably be expected of a person with his or her
  knowledge and experience. Directors with special skill and knowledge are expected to apply that skill and
  knowledge to matters that come before the board.

• Accountability
  A director’s fiduciary duties are owed to the corporation. The director is not solely accountable to any special
  group or interest and shall act and make decisions that are in the best interest of the hospital, as a whole.
  A director shall be knowledgeable of the stakeholders to whom the hospital is accountable and shall appropriately
  take into account the interests of such stakeholders when making decisions as a director, but shall not prefer the
  interests of any one group if to do so would not be in the best interests of the hospital.

• Education
  A director shall be knowledgeable about:
   The operations of the hospital;

   The health care needs of the community served;

   The health care environment generally;

   The duties and expectations of a director;

   The board’s governance role;

   Board’s governance structure and processes;

   Board adopted governance policies; and,

   Hospital policies applicable to board members.



  A director will participate in a board orientation session, orientation to committees, board retreats and board
  education sessions. A director should attend additional appropriate educational conferences in accordance with
  board approved policies.




                                                            1
Form 9
Sample Position Description - Board of Directors
Duties and Expectations of a Director


• Board Policies and Hospital Policies
  A director shall be knowledgeable of and comply with the board and hospital policies that are applicable to the
  board including:
   The Board’s Code of Conduct;

   The Board’s Conflict of Interest Policy;

   The Board’s Confidentiality Policy; and,

   The Ethics and Business Conduct Policy of the hospital.



• Teamwork
  A director shall develop and maintain sound relations and work co-operatively and respectfully with the board
  chair, members of the board and senior management.

• Community Representation and Support
  A director shall represent the board and the hospital in the community when asked to do so by the board chair.
  Board members shall provide financial support to the hospital’s foundation in accordance with their means and
  shall support the hospital and the foundation through attendance at hospital and foundation sponsored events.

• Time and Commitment
  A director is expected to commit the time required to perform board and committee duties. It is expected that a
  director will devote a minimum of between [10 and 15] hours per month.

  The board meets approximately nine times a year and a director is expected to adhere to the board’s attendance
  policy that requires attending at least [70 to 80] percent of board meetings.

  A director is expected to serve on at least one standing committee. Committees generally meet monthly.

• Contribution to Governance
  Directors are expected to make a contribution to the governance role of the board through:
   Reading materials in advance of meetings and coming prepared to contribute to discussions;

   Offering constructive contributions to board and committee discussions;

   Contributing his or her special expertise and skill;

   Respecting the views of other members of the board;

   Voicing conflicting opinions during board and committee meetings but respecting the decision of the majority

    even when the director does not agree with it;
   Respecting the role of the chair;

   Respecting the role and Terms of Reference of board committees; and,

   Participating in board evaluations and annual performance reviews.



• Continuous Improvement
  A director shall commit to be responsible for continuous self-improvement. A director shall receive and act upon
  the results of board evaluations in a positive and constructive manner.




                                                          2
Form 9
Sample Position Description - Board of Directors
Duties and Expectations of a Director


Term and Renewal
A director is elected for a term of three years and may serve for a maximum of nine years. A director’s renewal is not
automatic and shall depend on the director’s performance.

Amendment
This policy may be amended by the board.



Approval Date:

Last Review Date:




                                                          3
THE STEVENSON MEMORIAL HOSPITAL

        Corporation By-laws




           Revised May 8, 2008
The Stevenson Memorial Hospital Corporation By-laws                                                                           May 8, 2008


                                                  TABLE OF CONTENTS

BY-LAW NO. 1 ............................................................................................................................. 9
1.        DEFINITIONS .................................................................................................................. 9
          1.1        INTERPRETATION............................................................................................... 9
2.        CORPORATION ............................................................................................................ 13
          2.1        MEMBERS OF THE CORPORATION............................................................... 13
                     2.1.1 Classes of Members .................................................................................. 13
                     2.1.2 Advisory Members.................................................................................... 13
                     2.1.3 Voting Members ....................................................................................... 13
                     2.1.4 Fees ........................................................................................................... 13
                     2.1.5 Rights of Classes of Members .................................................................. 14
                     2.1.6 Term and Termination of Membership..................................................... 15
          2.2        Advisory MEMBERS meetings............................................................................ 15
                     2.2.1 Time, Place and Purpose........................................................................... 15
                     2.2.2 Voting At Advisory Members Meetings................................................... 16
                     2.2.3 Notice And Attendance Rights At An Advisory Members Meeting ........ 16
          2.3        ANNUAL MEETING OF THE CORPORATION .............................................. 16
                     2.3.1 Time and Place.......................................................................................... 16
                     2.3.2 Notice........................................................................................................ 16
                     2.3.3 Quorum and Adjournment ........................................................................ 16
                     2.3.4 Business at Annual Meeting ..................................................................... 17
          2.4        VOTING AT MEMBERS MEETINGS ............................................................... 17
          2.5        SPECIAL MEETINGS OF THE CORPORATION............................................. 18
                     2.5.1 Special Meetings of Members .................................................................. 18
                     2.5.2 Time and Place.......................................................................................... 18
                     2.5.3 Notice........................................................................................................ 18
                     2.5.4 Attendance ................................................................................................ 18
          2.6        CHAIR OF THE MEETINGS OF THE CORPORATION.................................. 18
                     2.6.1 Chair.......................................................................................................... 18
          2.7        FISCAL YEAR OF THE CORPORATION ........................................................ 19
3.        BOARD OF DIRECTORS............................................................................................. 20
          3.1        BOARD COMPOSITION .................................................................................... 20
          3.2        qualifications of directors ..................................................................................... 20
          3.3        TERM AND TERMINATION ............................................................................. 20
          3.4        NOMINATIONS and ELECTION OF DIRECTORS and non-director Members
                     of standing committees ......................................................................................... 21
          3.5        RESIGNATION BY A DIRECTOR .................................................................... 23

Table of Contents                                                                                                                           1
The Stevenson Memorial Hospital Corporation By-laws                                                                        May 8, 2008


        3.6       REMOVAL OF A DIRECTOR............................................................................ 23
        3.7       VACANCY........................................................................................................... 23
        3.8       BOARD EDUCATION ........................................................................................ 24
        3.9       BOARD EVALUATION...................................................................................... 24
        3.10      RESPONSIBILITIES OF THE BOARD.............................................................. 24
        3.11      DUTIES AND RESPONSIBILITIES OF EVERY DIRECTOR ......................... 28
        3.12      CONFLICT OF INTEREST ................................................................................. 30
        3.13      CONFIDENTIALITY AND PUBLIC RELATIONS .......................................... 32
        3.14      INDEMNIFICATION........................................................................................... 32
        3.15      MEETINGS OF THE BOARD ............................................................................ 33
                  3.15.1 Special Guests........................................................................................... 33
                  3.15.2 Call and Notice ......................................................................................... 33
                  3.15.3 Chair.......................................................................................................... 34
                  3.15.4 Voting ....................................................................................................... 34
                  3.15.5 Minutes ..................................................................................................... 35
                  3.15.6 Quorum ..................................................................................................... 35
        3.16      RULES OF ORDER ............................................................................................. 35
4.      OFFICERS ...................................................................................................................... 35
        4.1       THE OFFICERS OF THE CORPORATION....................................................... 35
        4.2       DUTIES OF EVERY OFFICER .......................................................................... 36
        4.3       DUTIES OF THE OFFICERS.............................................................................. 36
                  4.3.1 Duties of the Chair .................................................................................... 36
                  4.3.2 Duties of the Vice-Chair ........................................................................... 38
                  4.3.3 Duties of the Treasurer.............................................................................. 38
                  4.3.4 Duties of the Secretary.............................................................................. 39
5.      COMMITTEES OF THE BOARD ............................................................................... 40
        5.1       ESTABLISHMENT OF STANDING AND SPECIAL COMMITTEES OF THE
                  BOARD................................................................................................................. 40
                  5.1.1 Committees of the Board .......................................................................... 40
                  5.1.2 Functions, Duties, Responsibilities and Powers of Committees............... 40
                  5.1.3 Committee Members, Chair...................................................................... 40
                  5.1.4 Committees Required by Public Hospitals Act ........................................ 41
                  5.1.5 Procedures at Committee Meetings .......................................................... 41
                  5.1.6 Executive Committee................................................................................ 41
                  5.1.7 Voting ....................................................................................................... 41
        5.2       Fiscal Advisory Committee .................................................................................. 41
                  5.2.1 Membership .............................................................................................. 41
                  5.2.2 Chair.......................................................................................................... 42

Table of Contents                                                                                                                        2
The Stevenson Memorial Hospital Corporation By-laws                                                                        May 8, 2008


                  5.2.3     Functions................................................................................................... 42
6.      PRESIDENT and CHIEF EXECUTIVE OFFICER................................................... 42
        6.1       APPOINTMENT OF THE PRESIDENT and CHIEF EXECUTIVE OFFICER. 42
        6.2       DUTIES OF THE PRESIDENT and CHIEF EXECUTIVE OFFICER............... 42
7.      MEDICAL STAFF.......................................................................................................... 45
        7.1       PURPOSE OF THE MEDICAL STAFF ORGANIZATION .............................. 45
        7.2       APPOINTMENT OF MEDICAL STAFF ............................................................ 45
        7.3       APPOINTMENT TO HONORARY STAFF ....................................................... 46
        7.4       APPOINTMENT TO MEDICAL STAFF............................................................ 46
                  7.4.1 Application for Appointment to the Medical Staff ................................... 46
                  7.4.2 Criteria for Appointment to the Medical Staff.......................................... 48
                  7.4.3 Term.......................................................................................................... 49
        7.5       RE-APPOINTMENT............................................................................................ 49
                  7.5.1 Application for Re-Appointment and Performance Review..................... 49
                  7.5.2 Criteria for Re-Appointment to the Medical Staff.................................... 50
                  7.5.3 Refusal to Re-Appoint .............................................................................. 50
        7.6       CHANGE OF PRIVILEGES................................................................................ 50
                  7.6.1 Application For Change of Privileges....................................................... 50
        7.7       MID-TERM ACTION .......................................................................................... 51
                  7.7.1 Mid-Term Action ...................................................................................... 51
        7.8       MEDICAL STAFF GROUPS............................................................................... 51
                  7.8.1 Medical Staff Groups................................................................................ 51
                  7.8.2 Active Medical Staff ................................................................................. 51
                  7.8.3 Associate Medical Staff ............................................................................ 52
                  7.8.4 Courtesy Medical Staff ............................................................................. 54
                  7.8.5 Locum Tenens........................................................................................... 55
                  7.8.6 Temporary Medical Staff.......................................................................... 56
                  7.8.7 Honorary Staff .......................................................................................... 57
        7.9       MEDICAL STAFF DUTIES ................................................................................ 57
                  7.9.1 Duties, General ......................................................................................... 57
                  7.9.2 Chief of Staff............................................................................................. 59
                  7.9.3 Duties of the Chief of Staff....................................................................... 59
                  7.9.4 Monitoring Aberrant Practices.................................................................. 62
                  7.9.5 Viewing Therapeutic Actions, Operations or Procedures......................... 62
                  7.9.6 Transfer Of Responsibility........................................................................ 62
        7.10      MEDICAL STAFF DEPARTMENTS AND PROGRAMS ................................ 63
                  7.10.1 Departments .............................................................................................. 63
                  7.10.2 Chief Of Department................................................................................. 64
                  7.10.3 Duties of Chief of Department.................................................................. 64


Table of Contents                                                                                                                        3
The Stevenson Memorial Hospital Corporation By-laws                                                                      May 8, 2008


        7.11      MEETINGS - MEDICAL STAFF........................................................................ 66
                  7.11.1 Meetings of the Medical Staff................................................................... 66
                  7.11.2 Notice of Annual Meetings....................................................................... 67
                  7.11.3 Notice of Regular Meetings ...................................................................... 67
                  7.11.4 Special Meetings....................................................................................... 67
                  7.11.5 Quorum ..................................................................................................... 67
                  7.11.6 Order of Business...................................................................................... 67
                  7.11.7 Attendance At Regular Staff Meetings ..................................................... 68
                  7.11.8 Department Meetings................................................................................ 68
                  7.11.9 Attendance At Department Meetings........................................................ 68
        7.12      MEDICAL STAFF ELECTED OFFICERS......................................................... 68
                  7.12.1 Officers of the Medical Staff .................................................................... 68
                  7.12.2 Eligibility For Office................................................................................. 68
                  7.12.3 Election Procedure .................................................................................... 68
                  7.12.4 Duties of the President of the Medical Staff............................................. 69
                  7.12.5 Duties of the Vice-President of the Medical Staff .................................... 70
                  7.12.6 Duties of the Secretary/Treasurer of the Medical Staff ............................ 70
        7.13      MEDICAL ADVISORY COMMITTEE.............................................................. 71
                  7.13.1 Membership of the Medical Advisory Committee ................................... 71
                  7.13.2 Duties of the Medical Advisory Committee ............................................. 72
        7.14      MEDICAL STAFF COMMITTEES ESTABLISHED BY THE BOARD .......... 73
                  7.14.1 Medical Staff Committees Established by the Board ............................... 73
                  7.14.2 Appointment To Medical Staff Committees............................................. 73
                  7.14.3 Medical Staff Committee Duties .............................................................. 73
                  7.14.4 Medical Staff Committee Chair ................................................................ 73
                  7.14.5 Medical Staff Committee Chair Duties..................................................... 73
                  7.14.6 Credentials/Nominating Committee Duties.............................................. 74
                  7.14.7 Health Record Committee Duties ............................................................. 75
                  7.14.8 Medical Quality and Utilization Committee Duties ................................. 76
                  7.14.9 Infection Control Committee Duties......................................................... 79
                  7.14.10 Pharmacy And Therapeutics Committee Duties................................... 80
8.      DENTAL STAFF ............................................................................................................ 81
        8.1       APPOINTMENT OF DENTAL STAFF .............................................................. 81
        8.2       APPOINTMENT TO DENTAL STAFF .............................................................. 81
                  8.2.1 Application For Appointment to the Dental Staff..................................... 81
                  8.2.2 Criteria For Appointment to the Dental Staff ........................................... 83
                  8.2.3 Term.......................................................................................................... 84
        8.3       RE-APPOINTMENT............................................................................................ 84
                  8.3.1 Application for Re-Appointment and Performance Review..................... 84
                  8.3.2 Criteria for Re-Appointment to the Dental Staff ...................................... 85
                  8.3.3 Refusal to Re-Appoint .............................................................................. 85
        8.4       CHANGE OF PRIVILEGES................................................................................ 85

Table of Contents                                                                                                                      4
The Stevenson Memorial Hospital Corporation By-laws                                                                     May 8, 2008


                 8.4.1     Application for Change of Privileges ....................................................... 85
        8.5      MID-TERM ACTION .......................................................................................... 85
                 8.5.1 Mid-Term Action ...................................................................................... 85
        8.6      DENTAL STAFF DUTIES .................................................................................. 86
                 8.6.1 Dental Staff Duties.................................................................................... 86
                 8.6.2 Monitoring Aberrant Practices.................................................................. 87
                 8.6.3 Viewing Therapeutic Actions, Operations Or Procedures........................ 87
                 8.6.4 Transfer Of Responsibility........................................................................ 87
        8.7      DENTAL SERVICE............................................................................................. 87
                 8.7.1 Dental Service........................................................................................... 87
                 8.7.2 Head Of Dental Service ............................................................................ 88
                 8.7.3 Duties Of the Head Of Dental Service...................................................... 88
        8.8      MEETINGS - DENTAL STAFF .......................................................................... 88
                 8.8.1 Attendance By Dental Staff At Medical Staff Meetings .......................... 88
        8.9      DENTAL STAFF ELECTED OFFICERS ........................................................... 88
                 8.9.1 Eligibility To Hold A Medical Staff Office.............................................. 88
9.      MIDWIFERY STAFF .................................................................................................... 88
        9.1      APPOINTMENT OF MIDWIFERY STAFF ....................................................... 88
        9.2      APPOINTMENT TO MIDWIFERY STAFF....................................................... 89
                 9.2.1 Application for Appointment to the Midwifery Staff ............................... 89
                 9.2.2 Criteria for Appointment to the Midwifery Staff...................................... 90
                 9.2.3 Term.......................................................................................................... 92
        9.3      RE-APPOINTMENT............................................................................................ 92
                 9.3.1 Application for Re-Appointment and Performance Review..................... 92
                 9.3.2 Criteria for Re-Appointment to the Midwifery Staff................................ 92
                 9.3.3 Refusal to Re-Appoint .............................................................................. 92
        9.4      CHANGE OF PRIVILEGES................................................................................ 93
                 9.4.1 Application for Change Of Privileges....................................................... 93
        9.5      MID-TERM ACTION .......................................................................................... 93
                 9.5.1 Mid-Term Action ...................................................................................... 93
        9.6      MIDWIFERY STAFF GROUPS.......................................................................... 93
                 9.6.1 Midwifery Staff Groups............................................................................ 93
                 9.6.2 Active Midwifery Staff ............................................................................. 94
                 9.6.3 Associate Midwifery Staff ........................................................................ 94
                 9.6.4 Courtesy Midwifery Staff ......................................................................... 96
                 9.6.5 Locum Tenens........................................................................................... 97
                 9.6.6 Temporary Midwifery Staff...................................................................... 98
        9.7      MIDWIFERY STAFF DUTIES ........................................................................... 99
                 9.7.1 Midwifery Staff Duties ............................................................................. 99
                 9.7.2 Monitoring Aberrant Practices................................................................ 100

Table of Contents                                                                                                                     5
The Stevenson Memorial Hospital Corporation By-laws                                                                     May 8, 2008


                9.7.3 Viewing Deliveries, Therapeutic Actions Or Procedures....................... 100
                9.7.4 Transfer Of Responsibility...................................................................... 100
        9.8     MIDWIFERY STAFF ........................................................................................ 100
                9.8.1 Midwifery Staff: Function Within Medical Staff Department .............. 100
                9.8.2 Head Midwife ......................................................................................... 100
                9.8.3 Duties Of The Head Midwife ................................................................. 101
        9.9     MEETINGS ........................................................................................................ 101
                9.9.1 Attendance By Midwifery Staff At Medical Staff Meetings .................. 101
        9.10    MIDWIFERY STAFF ELECTED OFFICERS .................................................. 101
                9.10.1 Eligibility To Hold A Medical Staff Office............................................ 101
10.     NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF ................. 101
        10.1    APPOINTMENT OF NURSE - EXTENDED CLASS NURSE WITH
                PRIVILEGES STAFF........................................................................................ 101
        10.2    APPOINTMENT TO NURSE - EXTENDED CLASS NURSE WITH
                PRIVILEGES STAFF........................................................................................ 102
                10.2.1 Application For Appointment to the Nurse - Extended Class Nurse With
                Privileges Staff.................................................................................................... 102
                10.2.2 Criteria for Appointment to the Nurse - Extended Class Nurse With
                Privileges Staff.................................................................................................... 104
                10.2.3 Term........................................................................................................ 105
        10.3    RE-APPOINTMENT.......................................................................................... 105
                10.3.1 Application for Re-Appointment and Performance Review................... 105
                10.3.2 Criteria For Re-Appointment to the Nurse - Extended Class Nurse With
                Privileges Staff.................................................................................................... 105
                10.3.3 Refusal to Re-Appoint ............................................................................ 106
        10.4    MID-TERM ACTION ........................................................................................ 106
                10.4.1 Mid-Term Action .................................................................................... 106
        10.5    NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF GROUPS
                       106
                10.5.1 Nurse - Extended Class Nurse With Privileges Staff Groups................. 106
                10.5.2 Courtesy Nurse - Extended Class Nurse With Privileges Staff .............. 106
                10.5.3 Locum Tenens Nurse - Extended Class Nurse with Privileges Staff...... 107
        10.6    NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF DUTIES
                       107
                10.6.1 Nurse - Extended Class Nurse With Privileges Staff Duties .................. 107
                10.6.2 Monitoring Aberrant Practices................................................................ 108
                10.6.3 Viewing Therapeutic Actions or Procedures .......................................... 108
                10.6.4 Transfer Of Responsibility...................................................................... 108
        10.7    NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF........... 108
                10.7.1 Nurse - Extended Class Nurse With Privileges Staff: Function Within
                Medical Staff Department................................................................................... 108

Table of Contents                                                                                                                     6
The Stevenson Memorial Hospital Corporation By-laws                                                                       May 8, 2008


        10.8      MEETINGS ........................................................................................................ 108
                  10.8.1 Attendance By Nurse - Extended Class Nurse With Privileges Staff At
                  Medical Staff Meetings....................................................................................... 108
        10.9      NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF
                  ELECTED OFFICERS ....................................................................................... 109
                  10.9.1 Eligibility To Hold A Medical Staff Office............................................ 109
11.     THE MEDICAL ADVISORY COMMITTEE AND BOARD PROCESS FOR
        APPLICATIONS, RE-APPLICATIONS, CHANGES IN PRIVILEGES AND MID-
        TERM ACTION............................................................................................................ 109
        11.1      THE MEDICAL ADVISORY COMMITTEE MEETING ................................ 109
        11.2      THE BOARD HEARING................................................................................... 110
12.     MID-TERM ACTION .................................................................................................. 112
        12.1      NON-IMMEDIATE MID-TERM ACTION ...................................................... 112
                  12.1.1 Preliminary Steps in Mid-Term Review ................................................. 112
                  12.1.2 Request to the Medical Advisory Committee for Recommendation For
                  Mid-Term Action ................................................................................................ 114
                  12.1.3 The Medical Advisory Committee Meeting ........................................... 115
        12.2      IMMEDIATE MID-TERM ACTION IN AN EMERGENCY SITUATION .... 116
                  12.2.1 Immediate Steps...................................................................................... 116
                  12.2.2 The Medical Advisory Committee Meeting ........................................... 117
                  12.2.3 The Board Hearing.................................................................................. 118
13.     PROGRAMS ................................................................................................................. 120
        13.1      OCCUPATIONAL HEALTH AND SAFETY PROGRAM.............................. 120
        13.2      HEALTH SURVEILLANCE PROGRAM......................................................... 121
14.     ORGAN DONATION................................................................................................... 121
15.     PARTICIPATION OF NURSES................................................................................. 122
        15.1      NURSING ADVISORY COMMITTEE ............................................................ 122
                  15.1.1 Membership of the Nursing Advisory Committee.................................. 122
                  15.1.2 Duties of the Nursing Advisory Committee ........................................... 123
                  15.1.3 Membership of the Executive Committee of the Nursing Advisory
                  Committee........................................................................................................... 123
                  15.1.4 Duties of the Executive Committee of the Nursing Advisory Committee
                         124
        15.2      PARTICIPATION OF NURSES ON COMMITTEES ...................................... 124
        15.3      ELECTION OF STAFF NURSES ..................................................................... 125
        15.4      FAILURE TO ELECT A STAFF NURSE AND VACANCIES ....................... 125
        15.5      ELECTION OR APPOINTMENT OF NURSES WHO ARE MANAGERS.... 126
16.     VOLUNTARY ASSOCIATIONS ............................................................................... 126

Table of Contents                                                                                                                       7
The Stevenson Memorial Hospital Corporation By-laws                                                                            May 8, 2008


        16.1       AUTHORIZATION............................................................................................ 126
        16.2       PURPOSE ........................................................................................................... 126
        16.3       CONTROL.......................................................................................................... 126
        16.4       REPRESENTATION ON BOARD.................................................................... 126
        16.5       AUDITOR........................................................................................................... 126
17.     RECORDS ..................................................................................................................... 127
        17.1       RETENTION OF WRITTEN STATEMENTS .................................................. 127
18.     BONDING - FIDELITY INSURANCE ...................................................................... 127
19.     SIGNING OFFICERS .................................................................................................. 127
20.     AUDITOR...................................................................................................................... 127
21.     AMENDMENTS ........................................................................................................... 128
        21.1       AMENDMENTS TO BY-LAWS....................................................................... 128
        21.2       MEDICAL STAFF, DENTAL STAFF, MIDWIFERY STAFF AND NURSE -
                   EXTENDED CLASS NURSE WITH PRIVILEGES STAFF AMENDMENTS
                        129
22.     SEAL .............................................................................................................................. 129
        BY-LAW NO. 2 ............................................................................................................. 130




Table of Contents                                                                                                                            8
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                                        BY-LAW NO. 1

       NOW THEREFORE be it enacted and it is hereby enacted as By-law Number 1 of The
Stevenson Memorial Hospital (the “Hospital”).

1.      DEFINITIONS

1.1         INTERPRETATION

            (1)    In this By-law and all other by-laws of the Corporation, unless the context
                   otherwise requires:

                    “Act” means the Corporations Act (Ontario) and any statute that may be
                    substituted therefor, as from time to time amended;

                    “Admitting Privileges for the medical staff” means the privileges granted to
                    members of the medical staff related to the admission of inpatients,
                    registration of outpatients, and the diagnosis, assessment and treatment of
                    inpatients and outpatients in the Hospital;

                    “Admitting Privileges for the dental staff” means the privileges granted to
                    members of the dental staff who hold a specialty certificate from the Royal
                    College of Dental Surgeons of Ontario authorizing practice in oral and
                    maxillofacial surgery, related to the admission of inpatients, registration of
                    outpatients, and the diagnosis, assessment and treatment of inpatients and
                    outpatients in the Hospital;

                    “Admitting Privileges for the midwifery staff” means the privileges granted to
                    members of the midwifery staff related to the admission of inpatients,
                    registration of outpatients, and the assessment and treatment of inpatients and
                    outpatients in the Hospital;

                    “Advisory Members” mean those individuals who have been admitted
                    annually as an Advisory Member by the Board pursuant to clause 2.1.2;

                    “Advisory Members Meetings” means the meetings referred to in clause 2.2;

                    “Annual Meeting of Members” means the annual meeting referred to in
                    clause 2.3;

                    “Board” means the board of directors of the Corporation;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                    “Chair” means the Chair of the Board;

                    “Chief of Staff” means the Chief of the Medical Staff appointed by the Board;

                    “Corporation” means The Stevenson Memorial Hospital with Head Office at
                    200 Fletcher Crescent, Alliston, Ontario L9R 1W7;

                    “Director” means a member of the Board;

                    “Excluded Person” means:

                           (i)      Any member of the medical, dental, midwifery or extended
                                    class nursing staff other than the members of the Medical Staff
                                    appointed to the Board pursuant to the Public Hospitals Act;

                           (ii)     Any employee other than the current Chief Executive Officer;

                           (iii)    Any individual who has been within the preceding five (5) year
                                    period an employee of the Corporation;

                           (iv)     Any person who lives in the same household as a member of the
                                    medical, dental, midwifery or extended class nursing staff or an
                                    employee of the Corporation or a person referred to in
                                    subsection below;

                           (v)      A person who is or who within the preceding five (5) year
                                    period has been either a party to a contract with the Corporation
                                    or who is an employee or service provider to an entity that is a
                                    party to a contract with the Corporation where the nature of the
                                    duties or services provided by that person are, in the opinion of
                                    the Governance Committee, substantially similar to the nature
                                    of the duties and services that might be provided by an
                                    employee of the Corporation; provided that the decision of the
                                    Governance Committee in this regard shall be final.

                    “Ex-officio” means membership “by virtue of the office” and includes all
                    rights, responsibilities, and power to vote unless otherwise specified;

                    “Governance Committee” means the Standing Committee established by the
                    Board to be responsible for governance;
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                    “Guidelines for Director Selection” means the guidelines adopted from time
                    to time by the Board with respect to the election of Directors;

                    “Hospital” means The Stevenson Memorial Hospital;

                    “Hospital Auxiliary” means the volunteer association of the Hospital;

                    “Hospital Foundation” means The Stevenson Memorial Hospital Foundation;

                    “LHIN” means the Central Local Health Integration Network;

                    “Medical Staff” means those medical, dental, midwifery, and nurse –
                    extended class nurse who have been granted privileges at the hospital;

                    “Member” includes Voting Members and Advisory Members of The
                    Stevenson Memorial Hospital Corporation;

                    “Nominations Sub-Committee” means the committee established by the Board
                    to be responsible to make recommendations to the Board with respect to the
                    election of Directors;

                    “Nurse” means a holder of a current Certificate of Competence issued in
                    Ontario as a registered nurse;

                    “Nurse – Extended Class” means a holder of a current Certificate of
                    Competence issued by Ontario as a registered nurse – extended class;

                    “Nurse – Extended Class Nurse with privileges” means those registered nurses
                    who are not employed by the hospital and to whom the governing body or
                    authority of the hospital has granted privileges to diagnose, prescribe for or
                    treat inpatients and outpatients in the hospital;

                    “Patient” means a person received in a hospital for the purpose of treatment
                    and includes inpatients and outpatients;

                    “President and Chief Executive Officer” or “CEO” means the person who has
                    the direct and actual superintendence and charge of the Hospital and who is
                    the administrator of the Hospital as defined in the Public Hospitals Act;

                    “Service Area” means the principle area served by the Corporation determined
                    by the Board from time to time;
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                    “Special Meeting of Members” means a meeting referred to in clause 2.5;

                    “Supervisor” means a physician, dentist, midwife or registered nurse in the
                    nurse -extended class nurse with privileges who is assigned the responsibility
                    to oversee the work of another physician, dentist, midwife or nurse - extended
                    class nurse with privileges staff;

                    “Public Hospitals Act” means the Public Hospitals Act of Ontario and the
                    Regulations thereunder; and

                    “Vice President/Chief Nursing Executive” means the senior employee
                    responsible to the President and Chief Executive Officer for the nursing
                    functions in the hospital. The employee is the Chief Nursing Executive.

                    “Voting Members” means the Directors from time to time who are ex-officio
                    voting members of the Corporation for so long as they continue to serve as
                    Directors.

            (2)    In this By-law and in all other by-laws of the Corporation, unless the context
                   requires otherwise, words importing the singular number shall include the
                   plural number and vice versa, and reference to persons shall include firms and
                   corporations and words importing one gender shall include the opposite.
The Stevenson Memorial Hospital Corporation By-laws                                  May 8, 2008




2.      CORPORATION

2.1         MEMBERS OF THE CORPORATION

2.1.1        Classes of Members

            (1)     There shall be two classes of Members in the Corporation: Voting Members
                    and Advisory Members.

2.1.2        Advisory Members

            (1)     An Advisory Member is an individual who:

                    (a)    has submitted an application to the Board in accordance with an
                           application form approved by the Board from time to time;

                    (b)    is eighteen (18) or more years of age;

                    (c)    has paid the annual Advisory Member membership fee, as determined
                           from time to time by resolution of the Board; and

                    (d)    at the time of the payment of the fee has been a resident within the
                           Service Area for a continuous period of at least three months
                           immediately prior thereto or is employed in or carries on business in
                           the Service Area.

2.1.3        Voting Members

            (1)     The Voting Members shall consist of the Directors from time to time of the
                    Corporation who shall be Voting Members so long as they shall be a Director
                    of the Corporation.

2.1.4        Fees

            (1)     Fees for Advisory Members shall be set by the Board from time to time. No
                    membership fees shall be payable by Voting Members.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


2.1.5        Rights of Classes of Members

            (1)    Advisory Members shall:

                   (a)     be entitled to notice of and to attend Advisory Members Meetings
                           referred to in clause 2.2 and the Annual Meeting of Members referred
                           to in clause 2.3;

                   (b)     be entitled to receive the annual financial statements and the report of
                           the auditor that a member is entitled to receive under the Act;

                   (c)     be entitled to nominate individuals for consideration by the
                           Nominations Sub-Committee for election as Directors or for
                           appointment as non-Director members of committees established by the
                           Board;

                   (d)     be entitled to apply to be considered for appointment to the
                           Nominations Sub-Committee and other Board Standing Committees
                           (other than the Governance Committee and the Executive Committee)
                           as a non-Board member of such committees;

                   (e)     not be entitled to vote; and

                   (f)     not be entitled to notice of, or to attend any Special Meetings of
                           Members referred to in clause 2.5.

            (2)    Voting Members shall:

                   (a)     be entitled to all of the same rights as the Advisory Members as set out
                           in clauses 2.1.5 (a), (b) and (c);

                   (b)     be entitled to notice of and to attend any Special Meetings of Members
                           referred to in clause 2.5;

                   (c)     be entitled to one vote in respect of any vote to be taken at an Annual
                           Members Meeting or Special Members Meeting. Voting Members may
                           not vote by proxy; and

                   (d)     be entitled to all other rights of a member under the Act.

            (3)    Advisory Members shall have no rights except as expressly provided in
                   clause 2.1.5 (1).
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


2.1.6        Term and Termination of Membership

            (1)    Advisory Members shall be admitted by the Board in March of each year (or
                   such other time as the Board may determine) for a term of one year that shall
                   run from April 1 to March 31.

            (2)    An Advisory Member may resign his or her membership in the Corporation at
                   any time by submitting their resignation in writing to the Corporation.

            (3)    Voting Members shall be Members so long as they serve as Directors.

            (4)    Membership in the Corporation terminates automatically upon the happening
                   of any of the following events:

                   (a)     if the Member resigns in writing as a Member;

                   (b)     if the Member dies;

                   (c)     if the Member is expelled by a resolution of the Board;

                   (d)     in the case of an Advisory Member when their term of membership
                           expires; and

                   (e)     in the case of a Voting Member, upon ceasing to be a Director.

2.2         ADVISORY MEMBERS MEETINGS

2.2.1        Time, Place and Purpose

            (1)    The Board may, and the Board shall upon receiving a request in writing signed
                   by not less than ten (10%) percent of the Advisory Members, call and hold a
                   meeting of Advisory Members.

            (2)    An Advisory Members Meeting shall be held at such time and place and for
                   such purpose as the Board shall determine provided that an Advisory Members
                   Meeting shall be held within thirty (30) days of a request by the Advisory
                   Members in accordance with clause 2.2.1 (1).
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


2.2.2        Voting At Advisory Members Meetings

            (1)    No votes binding on the Corporation shall be taken at an Advisory Members
                   Meeting.

2.2.3        Notice And Attendance Rights At An Advisory Members Meeting

            (1)    Advisory Members and Voting Members shall be entitled to notice of and to
                   attend Advisory Members Meetings.

2.3         ANNUAL MEETING OF THE CORPORATION

2.3.1        Time and Place

            (1)    The Members (Voting Members and Advisory Members) of the Corporation
                   shall meet annually before July 31 of each year at a time and place to be
                   determined by the Board of Directors.

2.3.2        Notice

            (1)    Notice of the time and place for holding the Annual Meeting of Members
                   (Voting Members and Advisory Members) of the Corporation shall be given
                   by at least one of the following methods:

                   (a)     to each Member (Voting Members and Advisory Members) by prepaid
                           mail at least ten (10) days in advance of the meeting to the Member’s
                           last address as shown on the records of the Corporation; or

                   (b)     by publication at least once a week for two (2) successive weeks
                           immediately preceding the meeting in a newspaper circulated in the
                           municipality or municipalities in which Members of the Corporation
                           reside as shown by their addresses on the records of the Corporation.

2.3.3        Quorum and Adjournment

            (1)    A quorum for an Annual Meeting of Members or Special Meeting of Members
                   of the Corporation shall be a majority of the Voting Members.

            (2)    If within one half-hour (1/2) after the time appointed for a meeting of the
                   Corporation, a quorum is not present, the meeting shall stand adjourned until a
                   day within two (2) weeks to be determined by the Board.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (3)    At least three days' notice of the re-scheduled meeting following an
                   adjournment shall be given by publication in a newspaper circulated in the
                   municipality in which the Corporation is located.

2.3.4        Business at Annual Meeting

            (1)    The business transacted at the Annual Meeting of Members shall include:

                   (a)     approval of minutes of the previous annual meeting;

                   (b)     report of the Chair of the Board;

                   (c)     report of the President and Chief Executive Officer;

                   (d)     report of the auditor;

                   (e)     report of the Chief of Staff;

                   (f)     report of the President of the Hospital Auxiliary;

                   (g)     election of Directors; and

                   (h)     appointment of the auditor until the next annual meeting and
                           authorizing the Board to fix the auditors remuneration.

2.4         VOTING AT MEMBERS MEETINGS

            (1)    All votes at any meeting of Members shall be taken by a show of hands of the
                   Voting Members, or by ballot if so demanded by any Voting Member present,
                   and after the vote by ballot on the motion is completed, ballots are destroyed
                   by the Secretary or delegate.

            (2)    The chair of the meeting, shall be the Chair of the Board who shall, have one
                   original vote but shall not have a second vote to break a tie.

            (3)    A declaration by the Chair that a resolution or motion has been carried or
                   carried by a specified percentage vote and an entry to that effect in the minutes
                   shall be admissible in evidence as prima facie proof of the fact without proof
                   of the number or proportion of votes recorded in favour of or against such
                   resolution or motion.
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


            (4)    In the case of a tie in the election of Directors, the vote shall be decided by
                   some method of random choice to be decided by the Chair, such as drawing
                   names.

            (5)    Only Voting Members shall be entitled to vote.

            (6)    Voting Members may not vote by proxy.

2.5         SPECIAL MEETINGS OF THE CORPORATION

2.5.1        Special Meetings of Members

            (1)    All meetings of the Corporation other than the Annual Meeting of Members
                   referred to in clause 2.3 shall be considered to be a Special Meeting of
                   Members.

2.5.2        Time and Place

            (1)    Special Meetings of Members of the Corporation may be called by the Chair or
                   by the Board at any time.

2.5.3        Notice

            (1)    Notice of a Special Meeting of Members shall be given to the Voting Member
                   in the same manner as provided in clause 2.3.2.

            (2)    The notice of a Special Meeting of Members shall specify the purpose for
                   which it was called.

2.5.4        Attendance

            (1)    Only Voting Members shall be entitled to notice of and to attend Special
                   Meetings of Members.

2.6         CHAIR OF THE MEETINGS OF THE CORPORATION

2.6.1        Chair

            (1)    The meetings of the Corporation shall be chaired by:

                   (a)     the Chair; or
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   (b)     the Vice-Chair if the Chair is absent or unable to act; or

                   (c)     the Treasurer if the Chair or Vice-Chair is absent or unable to act; or

                   (d)     a Chair elected by the members present if the Chair, Vice-Chair, and
                           Treasurer are absent or unable to act.

2.7         FISCAL YEAR OF THE CORPORATION

            (1)    The fiscal year of the Corporation shall end with the 31st day of March in each
                   year.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008




3.      BOARD OF DIRECTORS

3.1         BOARD COMPOSITION

            (1)    The Board of Directors shall consist of seventeen (17) Directors.

            (2)    The Board of Directors shall be comprised of:

                   (a)     twelve (12) Directors elected by the Voting Members of the
                           Corporation;

                   (b)     the following five (5) Directors who shall be ex-officio Directors:

                           (i)      Chief of Staff,

                           (ii)     President of Medical Staff,

                           (iii)    the President of the Hospital Foundation,

                           (iv)     President of Hospital Auxiliary, and

                           (v)      President and Chief Executive Officer.

3.2         QUALIFICATIONS OF DIRECTORS

            (1)    No Excluded Person shall be eligible for election to the Board of Directors as
                   one of the twelve elected Directors.

            (2)    Directors must be at least 18 years of age.

            (3)    No undischarged bankrupt shall be eligible to serve as a Director.

3.3         TERM AND TERMINATION

            (1)    Directors shall be elected for terms of three years provided that at least four
                   Directors terms shall expire each year. Subject to clauses 3.6 and 3.7,
                   Directors shall continue in office until their successors are elected. No person
                   may be elected or appointed a Director for more than nine (9) consecutive
                   years of service. Following a break in the continuous service of at least one
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   year the same person may be re-elected or re-appointed a Director. Despite the
                   foregoing the Board may, by resolution, extend the maximum term of a
                   Director for the purpose of enabling that Director to serve as the next Chair
                   provided that no such Director shall serve more than eleven (11) consecutive
                   years.

            (2)    Despite clause 3.3 (1), the first Directors elected after the coming into force of
                   this By-law shall be elected for terms of one, two or three years respectively,
                   as determined by the Voting Members, in order to establish a rotation of
                   Directors so that thereafter four elected Directors shall be elected each year.

3.4         NOMINATIONS AND ELECTION OF DIRECTORS AND NON-DIRECTOR
            MEMBERS OF STANDING COMMITTEES

            (1)    Subject to clause 3.1 and all other provisions of this By-law, nominations for
                   election as a Director at the Annual Meeting of Members or as a non-Director
                   member of a Standing Committee may be made only by the Board in
                   accordance with the following process:

                   (a)     the Board shall establish a Nominations Sub-Committee which shall
                           consist of:

                           (i)      the chair of the Governance Committee who shall serve as chair
                                    of the Nominations Sub-Committee;

                           (ii)     two (2) additional elected Directors;

                           (iii)    two (2) Advisory Members;

                           (iv)     an elected municipal council representative as determined by
                                    the Board from time to time; and

                           (v)      the Chair who shall be an ex-officio member of the Nominations
                                    Sub-Committee.

                   (b)     The Nominations Sub-Committee shall:

                           (i)      review the vacancies and specific skills and expertise which are
                                    required on the Board of Directors and non-Director positions
                                    on Board Standing Committees as identified by the Governance
                                    Committee;
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                           (ii)     notify the Advisory Members of vacancies on the Board of
                                    Directors and Board Standing Committees and advertise
                                    vacancies on the Board of Directors and Board Standing
                                    Committees in the local daily and weekly papers and on the
                                    Hospital website, including a summary of the responsibilities as
                                    a Director and the Guidelines for Selection of Directors. Where
                                    an incumbent director is seeking re-election, that fact shall be
                                    stated in the notice and advertisement;

                           (iii)    invite formal applications by interested individuals on a
                                    standard form to be provided by the Corporation, which shall be
                                    submitted to the Secretary of the Corporation and forwarded to
                                    the Chair of the Nominating Sub-Committee for review.
                                    Consider all applicants submitted by Advisory Members.
                                    Applicants who do not meet the basic qualifications set out in
                                    clause 3.2 shall be advised of their ineligibility to serve as
                                    Directors;

                           (iv)     identify a short-list of candidates for interview by the
                                    Nominations Sub-Committee and interview and evaluate the
                                    short-listed candidates against the criteria set out in the
                                    Guidelines for the Selection of Directors;

                           (v)      obtain and check references for the candidates selected for
                                    nomination as Directors and non-Director members of Board
                                    Standing Committees;

                           (vi)     recommend to the Board of Directors a slate of candidates for
                                    Director equal to the number of vacancies for approval by the
                                    Board of Directors and for subsequent election by the Voting
                                    Members of the Corporation at the Annual Meeting of
                                    Members; and

                           (vii)    recommend to the Governance Committee for recommendation
                                    to the Board candidates to fill non-Director vacancies on Board
                                    Standing Committees for appointment by the Board of
                                    Directors.

            (2)    Advisory Members of the Corporation may submit nominations for the
                   election of an individual as a Director or as a non-Director Member of a
                   Standing Committee to be considered by the Nominations Sub-Committee in
                   accordance with the process outlined in clause 3.4 (1) (b).
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


3.5         RESIGNATION BY A DIRECTOR

            (1)    A Director may resign his or her office by communicating in writing to the
                   Secretary of the Corporation, which resignation shall be effective at the time it
                   is received by the Secretary or at the time specified in the notice, whichever is
                   later.

3.6         REMOVAL OF A DIRECTOR

            (1)    The Voting Members of the Corporation may by a resolution passed by at least
                   two-thirds (2/3) of the votes cast by the Voting Members in attendance and
                   voting at a meeting of which notice specifying the intention to pass such
                   resolution has been given, remove any Director before the expiration of his or
                   her term of office, and may, by a majority of the votes cast by the Voting
                   Members at that meeting, elect any person in his or her stead for the remainder
                   of the term.

            (2)    In addition to clause 3.6 (1), if a member of the Board, or any Committee
                   established under the Corporation By-laws, is absent from three
                   (3) consecutive meetings or fails to attend 75% of the meetings of the Board or
                   any Committee of the Board, the member may be removed as a Director or
                   committee member, by the resolution of the Board.

3.7         VACANCY

            (1)    The office of a Director shall automatically be vacated if the Director:

                   (a)     by notice in writing to the Secretary of the Corporation, resigns his or
                           her office, which resignation shall be effective at the time it is received
                           by the Secretary or at the time specified in the notice, whichever is
                           later;

                   (b)     dies;

                   (c)     becomes a bankrupt; or

                   (d)     becomes an Excluded Person, unless the Board by resolution
                           determines the individual should remain a Director.

            (2)    If a vacancy occurs for any reason among the elected Directors, such vacancy
                   may be filled by an eligible person appointed by the Board for the balance of
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   the term vacated. So long as a quorum remains in office the remaining
                   Directors may exercise all the powers of the Board.

3.8         BOARD EDUCATION

            (1)    Members shall participate in an orientation process within the first six (6)
                   months of their term.

            (2)    To be current with emerging issues in health care, all Board members must
                   participate in ongoing appropriate education on a regular basis.

3.9         BOARD EVALUATION

            (1)    All Board members shall carry out a regular individual and group evaluation of
                   its performance in governing the Hospital.

3.10        RESPONSIBILITIES OF THE BOARD

            (1)    The Board of Directors shall be responsible for the governance and
                   management of the affairs of the Corporation.

            (2)    The Board of Directors governs by fulfilling the following roles:

                     Policy Formulation         Establish policies to provide
                                                guidance to those empowered with
                                                the responsibility to lead and
                                                manage Hospital operations.

                     Decision-Making            On matters that specifically require
                                                Board approval, choose from
                                                alternatives that are consistent with
                                                Board policies and that advance the
                                                goals of the Hospital.

                     Oversight                  Monitor and assess organizational
                                                performance and outcomes.
The Stevenson Memorial Hospital Corporation By-laws                                         May 8, 2008


            (3)    The Board of Directors shall be responsible to, without limitation:

                   (a)     Establish Strategic Direction

                           (i)      establish and periodically review the Corporation’s mission,
                                    vision and values;

                           (ii)     engage with the LHIN, other health service providers and the
                                    communities served when developing plans and setting
                                    priorities;

                           (iii)    contribute to the development of and approve the Corporation’s
                                    strategic plan, ensuring that it is aligned with government
                                    policy, the LHIN integrated health services plan, and promotes,
                                    where appropriate interdependencies with other health service
                                    providers and conduct a review of the strategic plan as part of a
                                    regular annual planning cycle;

                           (iv)     monitor corporate performance regularly against approved
                                    strategic and operating plans and Board-approved performance
                                    indicators.

                   (b)     Provide for Excellent Management

                           (i)      select and appoint the President and Chief Executive Officer;

                           (ii)     establish measurable annual performance expectations and
                                    assess performance annually and determine compensation;

                           (iii)    delegate responsibility and authority to the CEO for the
                                    management and operation of the Corporation and require
                                    accountability to the Board;

                           (iv)     select and appoint the Chief of Staff;

                           (v)      establish measurable annual performance expectations in
                                    cooperation with the Chief of Staff assess Chief of Staff
                                    performance annually and determine compensation;

                           (vi)     delegate responsibility and authority to the Chief of Staff for the
                                    supervision of the practice of medicine, dentistry and midwifery
                                    and require accountability to the Board;
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                           (vii)    ensure that there is an effective working relationship between
                                    the CEO and Chief of Staff;

                           (viii) ensure a contingency plan for CEO and Chief of Staff
                                  succession in the event that they are unable to fulfill their
                                  duties;

                           (ix)     appoint chiefs and other medical leadership positions, on the
                                    recommendation of the Chief of Staff as required under the
                                    by-laws and the Public Hospitals Act; and

                           (x)      establish and monitor implementation of policies to provide the
                                    framework for the management and operation of the
                                    Corporation in compliance with applicable laws and
                                    regulations.

                   (c)     Monitor Program Quality and Effectiveness

                           (i)      review and approve appointments, reappointments and
                                    privileges for medical and dental staff, midwives as
                                    recommended by the Medical Advisory Committee, in
                                    consideration of the Corporation’s resources and the
                                    community’s needs and be assured as to the effectiveness and
                                    fairness of the total credentialing process;

                           (ii)     review and approve a process and schedule for monitoring
                                    Board-approved indicators of quality of care, patient safety and
                                    organizational risk;

                           (iii)    review and approve policies to provide a framework for
                                    addressing ethical issues arising from care; and

                           (iv)     ensure that management has plans in place to address variances
                                    from performance standards and oversee implementation of the
                                    remediation plans.

                   (d)     Ensure Financial and Organizational Viability

                           (i)      approve the annual operating and capital budget and monitor
                                    financial performance against the budget and performance
                                    indicators in the service accountability agreement entered into
                                    from time to time with the LHIN;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                           (ii)     ensure that management undertakes multi-year financial
                                    planning, optimizes the use of resources and operates within the
                                    services accountability agreement entered into from time to
                                    time with the LHIN and acceptable levels of risk;

                           (iii)    ensure that organizational risks are identified and managed and
                                    that mitigation plans are in place;

                           (iv)     approve an investment policy and monitor compliance;

                           (v)      ensure that management has in place a financial reporting
                                    process with appropriate internal controls;

                           (vi)     ensure the accuracy of financial information through review of
                                    financial reports and approval of annual audited financial
                                    statements;

                           (vii)    ensure that business continuity plans are in place.

                   (e)     Ensure Board Effectiveness

                           (i)      recruit Directors who are skilled, experienced and committed to
                                    the Corporation and plan for the succession of Directors and
                                    Officers;

                           (ii)     establish a comprehensive Board orientation program and
                                    ongoing Board education;

                           (iii)    establish an annual work plan for the Board and its committees
                                    and ensure that the Board receives timely appropriate
                                    information to support informed policy formulation, decision-
                                    making and oversight;

                           (iv)     establish and periodically review policies concerning
                                    governance structures and processes to maximize the effective
                                    functioning of the Board; and

                           (v)      establish a policy and process for evaluating the performance of
                                    the Board as a whole and of individual Directors that fosters
                                    continuous improvement.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (f)     Build Relationships

                           (i)      ensure that the Corporation builds and maintains good
                                    relationships with the government in fulfilling its obligations
                                    under provincial policies;

                           (ii)     ensure that the Corporation builds and maintains good
                                    relationships with the LHIN in fulfilling its service
                                    accountability agreement entered into from time to time with
                                    the LHIN;

                           (iii)    ensure that the Corporation is filling its role within the LHIN
                                    region by fostering effective coordination of patient care and
                                    positive working relationships with the Corporation and other
                                    health service provider organizations;

                           (iv)     ensure that the Corporation builds and maintains good
                                    relationships with community stakeholders including
                                    volunteers, political leaders and donors and related
                                    organizations; and

                           (v)      ensure that the Corporation has a policy to enable it to
                                    communicate effectively with its stakeholders and the public
                                    generally.

3.11        DUTIES AND RESPONSIBILITIES OF EVERY DIRECTOR

            (1)    Every Director shall act ethically, honestly, in good faith and make decisions
                   that are in the best interests of the Corporation and in so doing, support the
                   Corporation in fulfilling its mission and mandate and discharging its
                   accountabilities. Each Director shall exercise the care, diligence and skill that
                   a reasonably prudent person would exercise in comparable circumstances.
                   Directors with special skill and knowledge are expected to apply that skill and
                   knowledge to matters that come before the Board. A Director does not
                   represent the specific interests of any constituency. A Director complies with
                   all applicable laws, including but not limited to the Public Hospitals Act, the
                   Act, by-laws and Board policies.

            (2)    In contributing to the achievement of the responsibilities of the Board as a
                   whole, the responsibilities of each Director shall include the following
                   responsibilities and requirements:
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   (a)     Exercise of Authority

                   A Director carries out the powers of office only when acting as a voting
                   member during a duly constituted meeting of the Board or one of its appointed
                   bodies. A Director respects the responsibilities delegated by the Board to the
                   CEO.

                   (b)     Conflict of Interest

                   A Director complies with the Board of Directors’ conflict of interest policy as
                   adopted by the Board from time to time and the Corporation’s By-Laws.

                   (c)     Team Work

                   A Director works positively, cooperatively and respectfully with all members
                   of the Board of Directors and the management team in the performance of their
                   duties. A Director communicates with the CEO through the Board Chair with
                   respect to any issues/concerns related to the management or operations of the
                   Corporation.

                   (d)     Formal Dissent

                   A Director who is absent from a Board meeting is deemed to have supported
                   the decisions and policies of the Board taken in their absence unless they
                   formally record a dissenting view with the Board secretary.

                   (e)     Policy Solidarity

                   A Director supports approved Board policies and Board decisions.

                   (f)     Attendance

                   A Director is expected to attend all meetings of the Board and assigned
                   committees and Board retreats in person or by electronic means. In the event of
                   extenuating circumstances, at a minimum a Director is expected to attend 75%
                   of these meetings on an annual basis. All Directors are expected to serve on at
                   least one Standing Committees and to represent the Board when requested.
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


                   (g)     Participation

                   A Director comes prepared to meetings (of both Board and its Committees)
                   and events, asks informed questions, and makes a constructive contribution to
                   discussions.

                   (h)     Competencies

                   A Director brings unique expertise and skills which will inform Board
                   discussion and decisions. It is recognized that a Director does not provide
                   advice to the Board in a professional capacity.

                   (i)     Confidentiality

                   A Director respects the confidentiality of Board discussions and information.

                   (j)     Education

                   A Director takes advantage of opportunities to be educated and informed about
                   the Board and the key issues related to the Corporation and broader health
                   system through participation in initial orientation and ongoing Board
                   education.

                   (k)     Self-Evaluation

                   A Director participates in the evaluation of the performance of the Board as a
                   whole and of their performance as a Director.

                   (l)     Financial Support and Fundraising

                   A Director makes a personal financial contribution to the fundraising activities
                   of the Foundation.

3.12        CONFLICT OF INTEREST

            (1)    Every Director who is in any way directly or indirectly interested in a proposed
                   contract or a contract, a proposed financial transaction or a financial
                   transaction with the Hospital shall declare his or her interest at a meeting of the
                   Directors.
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


            (2)    In the case of a contract or financial transaction or proposed contract or
                   proposed financial transaction, the declaration required by this clause shall be
                   made at the meeting of the Directors at which the question of entering into the
                   contract or financial transaction is first taken into consideration or, if the
                   Director is not at the date of that meeting interested in the contract or financial
                   transaction or proposed contract or proposed financial transaction, at the next
                   meeting of the Directors held after he or she becomes so interested, and, in a
                   case where the Director becomes interested in a contract or financial
                   transaction after it is made, the declaration shall be made at the first meeting of
                   the Directors held after he or she becomes so interested.

            (3)    For the purposes of this clause, a general notice given to the Directors by a
                   Director to the effect that he or she is a shareholder of or otherwise interested
                   in any other company, or is a member of a specified firm and is to be regarded
                   as interested in any contract or financial transaction made with such other
                   company or firm, shall be deemed to be a sufficient declaration of interest in
                   relation to a contract or financial transaction so made, but no such notice is
                   effective unless it is given at a meeting of the Directors or the Director takes
                   reasonable steps to ensure that it is brought up and read at the next meeting of
                   the Directors after it is given.

            (4)    If a Director has made a declaration of his or her interest in a proposed contract
                   or a contract, a proposed financial transaction or a financial transaction in
                   compliance with this clause and has not voted in respect of the contract or
                   financial transaction, the Director is not accountable to the Hospital or to any
                   of its members or creditors for any profit realized from the contract or financial
                   transaction, and the contract or financial transaction is not voidable by reason
                   only of the Director holding that office or of the fiduciary relationship
                   established thereby.

            (5)    Despite anything in this clause, a Director is not accountable to the Hospital or
                   to any of its members or creditors for any profit realized from such contract or
                   financial transaction and the contract or financial transaction is not by reason
                   only of the Director's interest therein voidable if it is confirmed by a majority
                   of the votes cast at a general meeting of the members duly called for that
                   purpose and if the Director's interest in the contract or financial transaction is
                   declared in the notice calling the meeting.

            (6)    Directors and their families shall not enter into any contract or financial
                   transaction with the Hospital, except:

                   (a)     on a competitive bid basis or other basis in writing; and
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   (b)     where the Director has declared any interest therein, and where he or
                           she has absented himself or herself from the meeting and where he or
                           she has refrained from voting thereon.

3.13        CONFIDENTIALITY AND PUBLIC RELATIONS

            (1)    Every Director, Officer, member of a committee of the Board, member of the
                   medical staff, dental staff, midwifery staff and nurse - extended class nurse
                   with privileges and employee of the Corporation shall respect the
                   confidentiality of matters brought before the Board or before any committee,
                   subcommittee or task force, or any matter dealt with in the course of the
                   employee's employment or of the medical staff, dental staff, midwifery staff or
                   nurse - extended class nurse with privileges staff member’s activities in the
                   Hospital.

            (2)    The Chair of the Board is responsible for Board communications and may
                   delegate authority to one or more Directors, Officers or employees of the
                   Corporation to make statements to the news media or public about matters that
                   the Chair determines appropriate for disclosure to the media.

            (3)    Such provisions notwithstanding, the President and Chief Executive Officer
                   and the Board Chair are automatically delegated to assume such authority.

3.14        INDEMNIFICATION

            (1)    Every Director or Officer of the Corporation and every member of a
                   committee, and his or her heirs, executors and administrators, and estate and
                   effects, respectively, shall from time to time and at all times, be indemnified
                   and saved harmless out of the funds of the Hospital, from and against:

                   (a)     all costs, charges and expenses whatsoever which such Director,
                           Officer or committee member sustains or incurs in or about any action,
                           suit or proceeding for damages or otherwise which is brought,
                           commenced or prosecuted against him or her, for or in respect of any
                           act, deed, matter or thing whatsoever, made, done or permitted by him
                           or her, in or about the execution or intended execution in good faith of
                           the duties of his or her office; and

                   (b)     all other costs, charges and expenses that he or she sustains or incurs in
                           or about or in relation to the affairs thereof, except such costs, charges
                           or expenses as are occasioned by his or her own wilful neglect or
                           default.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (2)    The indemnity provided for in the preceding clause shall not apply to any
                   liability which a Director or Officer of the Corporation who is a member of the
                   medical staff may sustain or incur as the result of any act or omission as a
                   member of the medical staff of the Corporation.

3.15        MEETINGS OF THE BOARD

3.15.1       Special Guests

            (1)    Guests may attend meetings of the Board only upon:

                   (a)     invitation by the Chair of the meeting through the President and Chief
                           Executive Officer;

                   (b)     invitation by the President and Chief Executive Officer with the
                           approval of the Chair of the meeting; or

                   (c)     resolution or policy of the Board.

3.15.2       Call and Notice

3.15.2.1    Regular Meetings of the Board

            (1)    The Board shall meet at the Head Office of the Corporation on such day as the
                   Board may from time to time determine.

            (2)    The Secretary of the Board shall give notice of the meeting to the Directors if
                   the meeting is to be held at another day or at a place other than the Head
                   Office.

            (3)    A meeting of the Board may be held without notice immediately following the
                   annual meeting of the Corporation.

3.15.2.2    Special Meetings of the Board

            (1)    The Chair may call special meetings of the Board.

            (2)    The Secretary shall call a special meeting of the Board if three (3) Directors so
                   request in writing.
The Stevenson Memorial Hospital Corporation By-laws                                          May 8, 2008


            (3)    Notice of a special meeting of the Board shall specify the purpose of the
                   meeting, may be given by telephone, and shall be given at least twenty-four
                   (24) hours in advance of the meeting.

3.15.3       Chair

            (1)    Board meetings shall be chaired by:

                   (a)     the Chair; or

                   (b)     the Vice-Chair if the Chair is absent or unable to act; or

                   (c)     a Chair elected by the Directors present if the Chair and Vice-Chair are
                           absent or unable to act.

3.15.4       Voting

            (1)    Questions arising at any meeting of the Board, or any committee established by
                   or by means of the By-law, shall be decided by a majority of votes, as follows:

                   (a)     the Chair shall have one original vote but shall not have a second vote
                           to break a tie;

                   (b)     any motion is lost if there is an equality of votes including that of the
                           Chair;

                   (c)     all votes at any meeting shall be taken by;

                           (i)      a show of hands, with the right to vote or abstain, or

                           (ii)     if so requested by any voting member present, votes may be
                                    taken by ballot, and after the vote by ballot is completed, ballots
                                    are destroyed by the Secretary or delegate. All members have
                                    the right to vote or abstain, or

                           (iii)    if so requested by any voting member present, votes may be
                                    taken by a recorded vote, where the Secretary reads aloud the
                                    name of each eligible member and their vote on the issue is
                                    declared and recorded.
The Stevenson Memorial Hospital Corporation By-laws                                   May 8, 2008


            (2)    A declaration by the Chair that a resolution, vote or motion has been carried
                   and an entry to that effect in the minutes shall be admissible in evidence as
                   prima facie proof of the fact without proof of the number or proportion of the
                   votes recorded in favour of or against such resolution, vote or motion.

            (3)    Notwithstanding any provision in this By-law, a Director may request that his
                   or her vote on a motion or resolution be recorded in the minutes, and if such
                   request is made, the Director’s vote shall be recorded in the minutes.

3.15.5       Minutes

            (1)    Minutes shall be kept for all meetings of the Board.

3.15.6       Quorum

            (1)    A quorum for any meeting of the Board or its Committee shall be a majority of
                   the Directors.

3.16        RULES OF ORDER

            (1)    Any questions of procedure at or for any meetings of the Corporation, of the
                   Board, of the medical staff, or of any committee, which have not been
                   provided for in this By-law or by the Business Corporations Act or by the
                   Public Hospitals Act, or the Medical, Dental, Midwifery Staff, and Nurse –
                   Extended Class Nurse With Privileges with Privileges Rules, shall be
                   determined by the current edition of Kerr and King, “Procedures for Meetings
                   and Organizations”.

4.       OFFICERS

4.1         THE OFFICERS OF THE CORPORATION

            (1)    The following shall be Officers of the Corporation:

                   (a)     the Chair;

                   (b)     the Vice-Chair;

                   (c)     the Treasurer; and

                   (d)     the Secretary.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


            (2)    The Directors shall annually elect a Chair, Vice Chair and Treasurer of the
                   Board from among themselves at the meeting immediately following each
                   annual meeting of the Corporation.

            (3)    The President and Chief Executive Officer shall be the Secretary.

            (4)    No Director may serve as Chair or Vice-Chair, for more than two (2)
                   consecutive years in one office, provided however that following a break in the
                   continuous service of at least one year the same person may be re-elected or
                   re-appointed to any office. The Treasurer may be elected for a maximum of
                   three (3) one-year terms.

            (5)    Ex-officio Directors are ineligible for election as Chair or as Vice-Chair.

            (6)    The Officers of the Corporation shall be responsible for the duties set forth in
                   the By-laws and they are not necessarily required to perform such duties
                   personally, but they may delegate to others the performance of any or all such
                   duties.

            (7)    Any Officer of the Corporation shall cease to hold office upon resolution of the
                   Board.

4.2         DUTIES OF EVERY OFFICER

            (1)    Every Officer shall:

                   (a)     be loyal to the Corporation;

                   (b)     exercise the powers and discharge the duties of the office honestly, in
                           good faith and in the best interest of the Corporation; and

                   (c)     exercise the degree of care, diligence and skill that a reasonably
                           prudent person would exercise in comparable circumstances.

4.3         DUTIES OF THE OFFICERS

4.3.1        Duties of the Chair

            (1)    The Chair shall preside at meetings of the Board or in his or her absence at any
                   meeting, the Vice-Chair shall preside thereat, or in the absence of both the
                   Chair and the Vice-Chair, any Director appointed by the Directors at the
                   meeting shall preside at that meeting;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


            (2)    The responsibilities of the Chair shall include the following:

                   (a)     Agendas. Establish agendas in collaboration with the CEO that are
                           aligned with the Board’s roles and responsibilities and annual board
                           goals and preside over meetings of the Board. Ensure that meetings are
                           effective and efficient for the performance of governance work. Utilize
                           a practice of referencing Board policies in guiding discussions in order
                           to support the decision-making processes of the Board. Ensure that a
                           schedule of Board meetings is prepared annually.

                   (b)     Direction. Serve as the Board’s central point of official communication
                           with the CEO and the Chief of Staff with respect to both Board policy
                           direction and decisions and matters of interest/concern to individual
                           Directors; guide and counsel the CEO and the Chief of Staff regarding
                           the Board’s expectations and concerns. In collaboration with the CEO,
                           develop the standards and format for reporting by Board Committees
                           and the management team which will ensure that the Board has
                           appropriate information to make informed decisions.

                   (c)     Performance Appraisal. Lead the Board in monitoring and evaluating
                           the performance of the CEO and monitoring the performance of the
                           Chief of Staff through an annual process as outlined in Board policies.

                   (d)     Work Plan. With the assistance of the CEO and the Governance
                           Committee, ensure that a work plan is developed and implemented for
                           the Board that includes annual goals for the Board and embraces
                           continuous improvement.

                   (e)     Committee membership. Serve as the Chair of the Executive
                           Committee, a member of the Governance Committee and, at the Chair's
                           discretion, as an ex-officio member of all other Board Standing
                           Committees.

                   (f)     Representation. Ensure that the Board is appropriately represented at
                           hospital functions, other official functions and to the public at-large.
                           Serve as the Board’s exclusive contact with the media, unless otherwise
                           delegated.

                   (g)     Reporting. Report regularly and promptly to the Board regarding issues
                           that are relevant to its governance responsibilities.

                   (h)     Board Conduct. Set a high standard for Board conduct and enforce
                           policies and by-laws regarding Board member conduct.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (i)     Mentorship. Serve as a mentor to other Board members. Ensure that all
                           members of the Board contribute fully. Address issues associated with
                           underperformance of individual Directors.

                   (j)     Succession Planning. Ensure succession planning occurs for the CEO
                           and the Board of Directors.

                   (k)     Other Matters. Such other matters as the Board may from time to time
                           determine.

4.3.2        Duties of the Vice-Chair

            (1)    The Vice-Chair shall have all the powers and perform all the duties of the
                   Chair in the absence or disability of the Chair and perform any other duties
                   assigned by the Chair or the Board.

4.3.3        Duties of the Treasurer

            (1)    The Treasurer shall be a Director and shall work collaboratively with the
                   Board, Chair and the CEO to support the Board in fulfilling their fiduciary
                   responsibilities. In addition the Treasurer shall have the following
                   responsibilities:

                   (a)     Reporting Requirements.      Keep up to date on audit and financial
                           reporting requirements.

                   (b)     Mentorship. Serve as a mentor to other Directors.

                   (c)     Committee Membership. Serve as chair of the Board Standing
                           Committee responsible for finance and as such establish agendas in
                           collaboration with the staff support and preside over meetings of the
                           Committee and fulfill the other responsibilities of a Committee Chair as
                           required in the position description for Committee Chairs adopted by
                           the Board from time to time.

                   (d)     Audited Financial Statements. Present to the Board of Directors and
                           Members of the Corporation at the Annual Meeting of Members, an
                           audited financial statement of the financial position of the Hospital and
                           the report thereon of the independent auditors.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


4.3.4        Duties of the Secretary

            (1)    The Secretary shall:

                   (a)     attend meetings of Members, meetings of the Directors including
                           closed sessions and meetings of the standing and special committees of
                           the Board, except when excused by the Chair, and shall enter or cause
                           to be entered in books kept for that purpose, minutes of all proceedings
                           at such meetings and shall circulate or cause to be circulated, the
                           minutes of all such meetings of standing or special committees, to the
                           members of such committees, as applicable;

                   (b)     give, or cause to be given, all notices as required by the By-law of the
                           Hospital of all meetings of the Corporation, the Board and its
                           committees;

                   (c)     attend to correspondence of the Board;

                   (d)     prepare all reports required under any applicable Act or Regulation of
                           the Province of Ontario;

                   (e)     be the custodian of all minute books, documents and registers of the
                           Corporation required to be kept by the provisions of the Act and all
                           minutes, documents and records of the Board;

                   (f)     keep copies of all testamentary documents and trust instruments by
                           which benefits are given to the use of the Hospital;

                   (g)     be the custodian of the seal of the Corporation; and

                   (h)     perform such other duties as may from time to time be determined by
                           the Board.
The Stevenson Memorial Hospital Corporation By-laws                                 May 8, 2008


5.      COMMITTEES OF THE BOARD

5.1         ESTABLISHMENT OF STANDING AND SPECIAL COMMITTEES OF THE
            BOARD

5.1.1        Committees of the Board

            (1)    The Board may appoint committees whose members will hold their offices at
                   the will of the Board. The Board shall determine the duties of each
                   committees. The committees of the Board shall be:

                   (a)     Standing Committees, being those committees whose duties are
                           normally continuous; and

                   (b)     Special Committees, being those committees appointed for specific
                           duties whose mandate shall expire with the completion of the tasks
                           assigned.

5.1.2        Functions, Duties, Responsibilities and Powers of Committees.

            (1)    The functions, duties, responsibilities and mandate of committees shall be
                   provided in the resolution of the Board by which such committee is
                   established.

5.1.3        Committee Members, Chair

            (1)    Each Standing Committee shall include at least three (3) elected Directors.
                   Unless otherwise provided by by-law or by Board resolution, the Board shall,
                   after receiving the recommendation of the Governance Committee, appoint the
                   members of the committee, the chair of the committee and, if desirable, the
                   vice-chair thereof. The Chair shall be an ex-officio member of the Executive
                   Committee and Governance Committee and may, at the Chair’s discretion, be
                   an ex-officio member of any other Standing Committee. The CEO shall be an
                   ex-officio member of each Standing Committee. Each chair of a Standing
                   Committee shall be a member of the Board. The Board may appoint up to two
                   (2) Advisory Members to each Standing Committee other than the Executive
                   Committee and the Governance Committee.

            (2)    Except for decisions of the Executive Committee in accordance with
                   clause 5.1.6, no decision of a committee shall be binding on the Board until
                   approved or ratified by the Board.
The Stevenson Memorial Hospital Corporation By-laws                                  May 8, 2008


5.1.4        Committees Required by Public Hospitals Act

            (1)    The Board shall ensure that the Corporation establishes such committees and
                   undertakes such programmes as are required pursuant to the Public Hospitals
                   Act.

5.1.5        Procedures at Committee Meetings

            (1)    Procedures at and quorum for committee meetings shall be determined by the
                   chair of each committee, unless established by the Board by resolution or by
                   way of general committee regulations from time to time.

5.1.6        Executive Committee

            (1)    The Board may elect an Executive Committee consisting of not fewer than
                   three (3) elected Directors and may delegate to the Executive Committee any
                   powers of the Board, subject to such restrictions, as may be imposed by the
                   Board by resolution. The Executive Committee shall fix its quorum at not less
                   than a majority of its members. Any Executive Committee member shall be
                   removed by a majority vote of the Board.

5.1.7        Voting

            (1)    Unless the Board shall by resolution provide otherwise, members of a Standing
                   Committees who are Directors or Advisory Members shall be entitled to vote.

5.2         FISCAL ADVISORY COMMITTEE

5.2.1        Membership

            (1)    Pursuant to the Hospital Management Regulation, the Fiscal Advisory
                   Committee shall consist of;

                   (a)     the President and Chief Executive Officer;

                   (b)     the Vice President/Chief Nursing Executive;

                   (c)     the Chief Finance and Information Officer;

                   (d)     one person representing the Medical and Dental staff;
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   (e)     one person representing nurses who are Managers;

                   (f)     one person representing staff nurses; and

                   (g)     other persons appointed by the President and Chief Executive Officer.

5.2.2        Chair

            (1)    The Fiscal Advisory Committee shall be chaired by the President and Chief
                   Executive Officer or his or her designate.

5.2.3        Functions

            (1)    The Fiscal Advisory Committee shall make recommendations to the Board
                   with respect to the Operating Plan of the hospital including financial and
                   statistical information; programs and service plan; and human resources and
                   nursing plan.

6.      PRESIDENT AND CHIEF EXECUTIVE OFFICER

6.1         APPOINTMENT OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER

            (1)    The President and Chief Executive Officer shall be appointed by the Board in
                   accordance with its approved selection process.

            (2)    The Board may at any time revoke or suspend the appointment of the President
                   and Chief Executive Officer.

            (3)    Despite the foregoing the Board may from time to time enter into a contract
                   with another public hospital for the provision of management services which
                   may include CEO services.

6.2         DUTIES OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER

            (1)    The President and Chief Executive Officer shall:

                   (a)     be responsible to the Board for the organization and management of the
                           Hospital in accordance with policies established by the Board and
                           subject to direction of the Board;
The Stevenson Memorial Hospital Corporation By-laws                                         May 8, 2008


                   (b)     ensure appropriate systems and structures are in place for the effective
                           management and control of the Hospital and its resources including the
                           employment, development, control, direction and discharge of all
                           employees of the Hospital;

                   (c)     ensure structures and systems for the development, review and
                           recommendation of new programs, program expansion or changes;

                   (d)     ensure effective human resources strategic planning and identify
                           resource implications;

                   (e)     establish an organizational structure to ensure accountability of all
                           departments and staff for fulfilling the mission, objectives and strategic
                           plan of the Hospital;

                   (f)     provide leadership in support of the Board's responsibility to develop
                           and periodically review the mission, objectives and strategic plan of the
                           Hospital;

                   (g)     develop, recommend and foster the values, culture and philosophy of
                           the Hospital;

                   (h)     communicate with related health care agencies to promote co-
                           ordination and/or planning of local health care services;

                   (i)     represent the Hospital externally to the community, government, media
                           and other organizations and agencies;

                   (j)     be responsible for the payment by the Corporation of all salaries and
                           amounts due from and owing by the Corporation which fall within the
                           purview and scope of the approved annual budget or otherwise as may
                           be established from time to time by resolution of the Board;

                   (k)     prepare and forward a detailed report to the College of Physicians and
                           Surgeons of Ontario where:

                           (i)      the application of a physician for appointment or reappointment
                                    to the medical staff of the hospital is rejected by reason of his or
                                    her incompetence, negligence or misconduct,
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


                           (ii)     the privileges of a member of the medical staff of the hospital
                                    are restricted or cancelled by reason of his or her incompetence,
                                    negligence or misconduct, or

                           (iii)    a physician voluntarily or involuntarily resigns from the
                                    medical staff of the hospital during the course of an
                                    investigation into his or her competence, negligence or conduct;

                   (l)     notify the Chief of Staff, the Chief of Department, and in the case of a
                           member of the nurse - extended class nurse with privileges staff the
                           Vice President/ Chief Nursing Executive, and the Board if necessary,
                           of:

                           (i)      any failure of any member of the medical, dental, midwifery or
                                    nurse – extended class nurse with privileges to act in
                                    accordance with statute law or regulations thereunder, or the
                                    Hospital By-law and Rules,

                           (ii)     any belief that a member of the medical, dental, midwifery or
                                    nurse – extended class nurse with privileges is unable to
                                    perform the person's professional duties with respect to a patient
                                    in the Hospital,

                           (iii)    any patient who does not appear to be receiving the most
                                    appropriate treatment and care or who is not being visited
                                    frequently enough by the attending member of the medical,
                                    dental, midwifery or nurse – extended class nurse with
                                    privileges; and

                           (iv)     any other matter about which they should have knowledge;

                   (m)     establish the selection process for the engagement of a Vice President/
                           Chief Nursing Executive and hire the Vice President/Chief Nursing
                           Executive in accordance with the process;

                   (n)     establish the functions and responsibilities of the Vice President/Chief
                           Nursing Executive;

                   (o)     annually conduct the Vice President/Chief Nursing Executive’s formal
                           performance evaluation and review and approve his or her
                           compensation, and set his or her goals for the coming year;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (p)     report to the Board as necessary regarding the occupational health and
                           safety program;

                   (q)     report to the Board as necessary in respect of the health surveillance
                           program;

                   (r)     be responsible to the Board for taking such action as considered
                           necessary to ensure compliance with the Public Hospitals Act, the
                           Regulations thereunder, the By-laws of the Hospital and all other
                           statutory and regulatory requirements;

                   (s)     be an ex-officio member of the Board and report to the Board on any
                           matters about which it should have knowledge and subject to this
                           By-law, be an ex-officio member of Board Standing Committees; and

                   (t)     perform such other duties as may be directed from time to time by the
                           Board.

7.      MEDICAL STAFF

7.1         PURPOSE OF THE MEDICAL STAFF ORGANIZATION

            (1)    The purposes of the medical staff organization, in addition to fulfilling the
                   responsibilities established by the laws of Ontario and this By-law, are:

                   (a)     to provide a structure whereby the members of the medical staff
                           participate in the Hospital's planning, policy setting, and decision
                           making;

                   (b)     to serve as a quality assurance system for medical care rendered to
                           patients by the medical staff and to ensure the continuing improvement
                           of the quality of medical care; and

                   (c)     to provide a structure and process to ensure that all patients receive
                           appropriate medical care.

7.2         APPOINTMENT OF MEDICAL STAFF

            (1)    The Board shall appoint annually a medical staff for the Hospital.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


7.3         APPOINTMENT TO HONORARY STAFF

            (1)    Notwithstanding the other requirements of this By-law, a person who is not a
                   physician may be honoured by appointment to the Honorary Staff.

7.4         APPOINTMENT TO MEDICAL STAFF

7.4.1        Application for Appointment to the Medical Staff

            (1)    An application for appointment to the medical staff shall be processed in
                   accordance with the provisions of the Public Hospitals Act, and in accordance
                   with the Regulations thereunder and this By-law.

            (2)    On request, the President and Chief Executive Officer shall supply a copy of
                   the By-laws, the Rules of the Hospital and the Public Hospitals Act and the
                   Regulations thereunder to each physician who expresses in writing the
                   intention to apply for appointment to the medical staff.

            (3)    An applicant for appointment to the medical staff shall submit one (1) original
                   written application to the President and Chief Executive Officer.

            (4)    Each application shall contain:

                   (a)     a statement by the applicant that he or she has read the Public Hospitals
                           Act and the Hospital Management Regulation thereunder, and the
                           By-laws and Rules of the Hospital;

                   (b)     an undertaking that, if he or she is appointed to the medical staff of the
                           Hospital, he or she will govern himself or herself in accordance with
                           the requirements set out in the By-laws and Rules of the Hospital;

                   (c)     evidence of medical practice protection coverage satisfactory to the
                           Board;

                   (d)     a list of the privileges which are requested;

                   (e)     an up-to-date curriculum vitae;

                   (f)     a list of three (3) appropriate physicians, one of which must be from the
                           Chief of Staff or Chief of Department from where the applicant
                           previously practiced, who can provide information regarding the
                           medical knowledge, performance and ability to work with people;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (g)     information of any previous disciplinary proceeding where there was an
                           adverse finding;

                   (h)     information of any civil suit where there was a finding of negligence or
                           battery;

                   (i)     a signed consent authorizing any medical regulatory body or referee to
                           provide a report on:

                           (i)      any action taken by its disciplinary or fitness to practice
                                    committee, and

                           (ii)     whether his or her privileges have been curtailed or cancelled
                                    by any medical regulatory body or by another hospital because
                                    of incompetence, negligence, incapacity or any act of
                                    professional misconduct; and

                   (j)     a current Certificate of Professional Conduct from the College of
                           Physicians and Surgeons of Ontario and consent to the release of
                           information from the Registrar of the College, and/or a certificate from
                           the governing body where the applicant was most recently registered.

            (5)    Each applicant shall be interviewed by the hospital's Credentials Committee,
                   Chief of Staff, President and Chief Executive Officer or delegate and other
                   members as appropriate.

            (6)    The President and Chief Executive Officer shall retain a copy of the
                   application and shall refer the original application immediately to the Medical
                   Advisory Committee through its Chair who shall keep a record of each
                   application received and then refer the original application forthwith to the
                   Chair of the Credentials Committee.

            (7)    Each application shall be considered by the Medical Advisory Committee
                   which shall make a recommendation thereon in writing to the Board within
                   sixty (60) days from the date of the application.

            (8)    Despite 7.4.1(7), the Medical Advisory Committee may make its
                   recommendation later than sixty (60) days after the date of the application if,
                   prior to the expiry of the sixty (60) day period, it indicates in writing to the
                   Board and the applicant that a final review cannot yet be made and gives
                   written reasons therefor.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (9)    The Hospital and the Medical Advisory Committee shall deal with the
                   application in accordance with the Public Hospitals Act and the procedure set
                   out in subsections 11.1(1) to (7) and 11.2(1) to (13) of this By-law.

7.4.2        Criteria for Appointment to the Medical Staff

            (1)    Only an applicant qualified to practice medicine and who holds a current, valid
                   certificate of Registration with the College of Physicians and Surgeons of
                   Ontario is eligible to be a member of and be appointed to the medical staff of
                   the Hospital except as otherwise provided for in this By-law.

            (2)    The applicant will have:

                   (a)     a certificate of Registration with the College of Physicians and
                           Surgeons of Ontario;

                   (b)     a current certificate of Professional Conduct from the College of
                           Physicians and Surgeons of Ontario;

                   (c)     a demonstrated ability to provide patient care at an appropriate level of
                           quality and efficiency;

                   (d)     a demonstrated ability to communicate, work with and relate to all
                           members of the medical, dental, midwifery, nurse - extended class
                           nurse with privileges staff and Hospital staff in a co-operative and
                           professional manner;

                   (e)     a demonstrated ability to communicate and relate appropriately with
                           patients and patients' relatives;

                   (f)     a willingness to participate in the discharge of staff obligations
                           appropriate to membership group;

                   (g)     adequate training and experience for the privileges requested;

                   (h)     evidence of medical practice protection coverage satisfactory to the
                           Board;

                   (i)     a report on, among other things, the experience, competence and
                           reputation of the applicant from the Chief of Staff, Chief of
                           Department, or other such persons as is appropriate to contact, in the
                           hospitals in which the applicant trained or held an appointment; and
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


                    (j)    in the case of a certified specialist, a report from the Chief of
                           Department in which training was completed, and/or a report from the
                           Chief of the Department in which he or she last practiced.

            (3)     The applicant must agree to govern himself or herself in accordance with the
                    requirements set out in this By-law, the Rules of the Hospital and the Hospital
                    policies.

            (4)     The applicant must indicate to the Credentials Committee adequate control of
                    any significant physical or behavioural impairment that affects skill, attitude or
                    judgment.

            (5)     There is a need for the services in the community.

7.4.3        Term

            (1)     Each appointment to the medical staff shall be for one (1) year, but shall
                    continue in effect until the Board has made appointments for the ensuing year.

7.5         RE-APPOINTMENT

7.5.1        Application for Re-Appointment and Performance Review

            (1)     Upon recommendation by the Medical Advisory Committee, the Board shall
                    establish and approve a process for the annual performance review of each
                    member of the medical staff:

                    (a)    a review of the applicant’s performance and health during the past year;

                    (b)    a discussion of the applicant’s plans for any changes in type or level of
                           service provided and reasons therefor;

                    (c)    a discussion of the applicant’s retirement plans; and

                    (d)    a discussion of any other matter listed in clause 7.4.2.

                    (e)    Each year each member of the medical staff shall make a written
                           application for re-appointment to a group of the medical staff of the
                           Hospital in the prescribed form.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (2)    Where a member of the medical staff has applied for re-appointment, the Chair
                   of the Credentials Committee shall conduct a review of the applicant’s
                   performance for the past year in accordance with the prescribed process as
                   established in 7.5.1(1), and shall make a written report to the Medical Advisory
                   Committee in respect of the applicant’s performance for the past year.

            (3)    The application for re-appointment to a group of the medical staff of the
                   Hospital shall be processed in the same manner as set out in clause 7.4.1.

7.5.2        Criteria for Re-Appointment to the Medical Staff

            (1)    In order to be eligible for re-appointment, the applicant shall:

                   (a)     continue to meet the criteria set out in Clause 7.4.2;

                   (b)     have demonstrated an appropriate use of Hospital resources; and

                   (c)     meet other requirements that may be needed from time to time.

7.5.3        Refusal to Re-Appoint

            (1)    Pursuant to the Public Hospitals Act, and in accordance with the Regulations
                   thereunder, the Board may refuse to re-appoint a member of the medical staff.

            (2)    Where a member has applied under clause 7.5.1 for re-appointment, his or her
                   appointment shall be deemed to continue:

                   (a)     until the re-appointment is granted; or

                   (b)     where he or she is served with notice that the Board refuses to grant the
                           re-appointment, until the time for giving notice requiring a hearing by
                           the Health Professions Appeal and Review Board has expired and,
                           where a hearing is required, until the decision of the Health Professions
                           Appeal and Review Board has become final.

7.6         CHANGE OF PRIVILEGES

7.6.1        Application For Change of Privileges

            (1)    Where a physician wishes to change his or her privileges, the physician shall
                   make a written application, in the prescribed form, listing the change of
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   privileges which is requested and shall submit evidence of appropriate training
                   and competence in respect of the privileges being requested.

            (2)    An application for a change in privileges made by a member of the medical
                   staff shall be processed in the same manner as set out in Clause 7.4.1.

7.7         MID-TERM ACTION

7.7.1        Mid-Term Action

            (1)    Pursuant to the Public Hospitals Act and the Regulations thereunder and in
                   accordance with this By-law, the Board at any time may revoke or suspend any
                   appointment of a member of the medical staff or dismiss, suspend, restrict or
                   otherwise deal with, the privileges of the member.

            (2)    Mid-term action in respect of a member of the medical staff, shall be processed
                   in accordance with, and in the same manner provided in part 12 of this By-law.

7.8         MEDICAL STAFF GROUPS

7.8.1        Medical Staff Groups

            (1)    The medical staff shall be divided into the following groups:

                   (a)     active;

                   (b)     associate;

                   (c)     courtesy;

                   (d)     locum tenens;

                   (e)     temporary; and

                   (f)     honorary.

7.8.2        Active Medical Staff

            (1)    The active medical staff shall consist of those physicians who have been
                   appointed as active medical staff by the Board.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (2)    Except where approved by the Board, no physician with an active medical staff
                   appointment at another hospital shall be appointed to the active medical staff.

            (3)    Every physician applying for appointment to the active medical staff will have
                   served on the associate staff for a probationary period.

            (4)    Each member of the active medical staff is responsible for ensuring that
                   medical care is provided to his or her patients and other patients as required in
                   the Hospital.

            (5)    All active medical staff members shall have admitting privileges unless
                   otherwise specified in their appointment to the medical staff.

            (6)    Active medical staff members shall be eligible to vote at medical staff
                   meetings, to hold office and to sit on any committee of the medical staff.

            (7)    Each member of the active medical staff shall:

                   (a)     undertake such duties in respect of those patients classed as emergency
                           cases as may be specified by the Chief of Staff or by the Chief of the
                           Department to which the physician has been assigned;

                   (b)     attend patients, and undertake treatment and operative procedures only
                           in accordance with the kind and degree of privileges granted by the
                           Board;

                   (c)     act as a supervisor of a member of the medical, dental or midwifery
                           staff, as and when requested by the Chief of Staff or the Chief of
                           Department, and act as a supervisor of the nurse - extended class nurse
                           with privileges staff, for the diagnosing, prescribing for or treating of
                           inpatients and outpatients, as and when requested by the Chief of Staff
                           or the Chief of Department; and

                   (d)     participate in utilization and quality improvement.

7.8.3        Associate Medical Staff

            (1)    Each associate medical staff member shall have admitting privileges unless
                   otherwise specified in the appointment.

            (2)    An associate medical staff member shall work for a probationary period under
                   the supervision of an active medical staff member named by the Chief of Staff
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   on the recommendation of the Chief of the Department to which the associate
                   medical staff member has been assigned.

            (3)    A supervisor shall carry out the duties in accordance with the Rules of the
                   Hospital.

            (4)    During the probationary period, the supervisor shall make a written report to
                   the Chief of Staff at least every six months or at any time if there are concerns.
                   Every report made under this subclause shall include:

                   (a)     information concerning the knowledge and skill which has been shown
                           by the associate staff member;

                   (b)     the nature and quality of their work in the hospital;

                   (c)     comments on the utilization of hospital resources; and

                   (d)     the associate staff member's ability to function in conjunction with the
                           other members of the hospital staff.

            (5)    After one (1) year, the appointment of a physician to the associate medical
                   staff shall be reviewed by the Credentials Committee who shall report to the
                   Medical Advisory Committee.

            (6)    The Medical Advisory Committee may recommend that the physician be
                   appointed to the active medical staff or may require the physician to be subject
                   to a further probationary period not longer than six (6) months.

            (7)    The Chief of Department, upon the request of an associate medical staff
                   member or a supervisor, may assign the associate medical staff member to a
                   different supervisor for a further probationary period.

            (8)    At any time an unfavourable report may cause the Medical Advisory
                   Committee to consider making a recommendation to the Board that the
                   appointment of the associate medical staff member be terminated.

            (9)    No member of the medical staff shall be appointed to the associate medical
                   staff for more than eighteen (18) consecutive months.

            (10)   An associate medical staff member shall:
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (a)     attend patients, and undertake treatment and operative procedures under
                           supervision in accordance with the kind and degree of privileges
                           granted by the Board on the recommendation of the Medical Advisory
                           Committee; and

                   (b)     undertake such duties in respect of those patients classed as emergency
                           cases as may be specified by the Chief of the Department to which the
                           physician has been assigned.

            (11)   A member of the associate medical staff shall not vote at medical staff
                   meetings nor be elected a medical staff officer, but may be appointed to a
                   committee of the medical staff.

7.8.4        Courtesy Medical Staff

            (1)    The Board may grant a physician an appointment to the courtesy medical staff
                   in one or more of the following circumstances:

                   (a)     the applicant has an active medical staff commitment at another
                           hospital; or

                   (b)     the applicant lives at such a remote distance from the Hospital that it
                           limits full participation in active medical staff duties, but he or she
                           wishes to maintain an affiliation with the Hospital; or

                   (c)     the applicant has a primary commitment to, or contractual relationship
                           with, another community or organization; or

                   (d)     the applicant requests access to limited Hospital resources or outpatient
                           programs or facilities; or

                   (e)     where the Board deems it otherwise advisable.

            (2)    (a)      The Board may grant a physician an appointment to the courtesy
                            medical staff with such privileges as the Board deems advisable.
                            Privileges to admit patients shall only be granted under specified
                            circumstances.

                   (b)     The circumstances leading to an appointment under subsection 7.8.4 of
                           this By-law shall be specified by the physician on each application for
                           re-appointment.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


            (3)    A courtesy medical staff member shall work for a probationary one year period
                   under the supervision of a medical staff member named by the Chief of Staff.

            (4)    The named supervisor shall carry out the duties in accordance with the Medical
                   Staff Rules.

            (5)    During the probationary period, the supervisor shall make a written report to
                   the Chief of Staff at least every six months or at any time if there are concerns.
                   Every report made under this subsection shall include:

                   (a)     information concerning the knowledge and skill which has been shown
                           by the courtesy staff member;

                   (b)     the nature and quality of their work in the hospital;

                   (c)     comments on the utilization of hospital resources; and

                   (d)     the courtesy staff member's ability to function in conjunction with the
                           other members of the hospital staff.

            (6)    Each physician on the courtesy medical staff may attend medical staff,
                   departmental meetings, but unless the Board so requires, shall not be subject to
                   the attendance requirements and penalties as provided by this By-law and the
                   medical staff rules.

            (7)    Unless required to attend by the Chief of Staff or the Chief of Department,
                   members of the courtesy medical staff shall not have the right to vote at
                   medical staff or departmental meetings.

            (8)    A member of the courtesy medical staff shall not vote at general medical staff
                   meetings nor be elected a medical staff officer, but may be appointed to
                   hospital or medical staff committees with the power to vote.

7.8.5        Locum Tenens

            (1)    The Medical Advisory Committee upon the request of a member of the
                   medical staff may recommend the appointment of a locum tenens as a planned
                   replacement for that physician for a specified period of time.

            (2)    A locum tenens shall:

                   (a)     have admitting privileges unless otherwise specified;
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   (b)     work under the counsel and supervision of a member of the active
                           medical staff who has been assigned this responsibility by the Chief of
                           Staff or his or her delegate;

                   (c)     attend patients assigned to his or her care by the active medical staff
                           member by whom he or she is supervised, and shall treat them within
                           the professional privileges granted by the Board on the
                           recommendation of the Medical Advisory Committee; and

                   (d)     undertake such duties in respect of those patients classed as emergency
                           cases as may be specified by the Chief of Staff or by the Chief of the
                           Department to which the physician has been assigned.

7.8.6        Temporary Medical Staff

            (1)    A temporary appointment of a physician to the medical staff may be made only
                   for one of the following reasons:

                   (a)     to meet a specific singular requirement by providing a consultation
                           and/or operative procedure; or

                   (b)     to meet an urgent unexpected need for a medical service.

            (2)    Notwithstanding any other provision in this By-law, the President and Chief
                   Executive Officer, after consultation with the Chief of Staff or his or her
                   delegate, may:

                   (a)     grant a temporary appointment to a physician who is not a member of
                           the medical staff provided that such appointment shall not extend
                           beyond the date of the next meeting of the Medical Advisory
                           Committee at which time the action taken shall be reported; and

                   (b)     continue the appointment on the recommendation of the Medical
                           Advisory Committee until the next meeting of the Board.

            (3)    A temporary appointment shall not include privileges to admit patients. A
                   physician holding temporary staff privileges, only in the Emergency Room,
                   may admit patients, however, the Emergency Room physician must transfer
                   the care of those patients to another staff member by personal direct contact
                   before leaving the facility.
The Stevenson Memorial Hospital Corporation By-laws                                           May 8, 2008


7.8.7        Honorary Staff

            (1)    A physician may be honoured by the Board with a position on the honorary
                   staff of the Hospital because he or she:

                   (a)     is a former member of the medical staff who has retired from active
                           practice; or

                   (b)     has an outstanding reputation or made an extraordinary
                           accomplishment, although not necessarily a resident in the community.

            (2)    Each member of the honorary staff shall be appointed by the Board on the
                   recommendation of the Medical Advisory Committee.

            (3)    Membership on the honorary staff is not restricted to physicians.

            (4)    Members of the honorary staff shall not:

                   (a)     have regularly assigned duties or responsibilities;

                   (b)     be eligible to vote at medical staff meetings or to hold office;

                   (c)     be bound by the attendance requirements for medical staff meetings; or

                   (d)     have admitting privileges.

7.9         MEDICAL STAFF DUTIES

7.9.1        Duties, General

            (1)    Each member of the medical staff is accountable to and shall recognize the
                   authority of the Board through and with their Chief of Department, the Chief
                   of Staff and the President and Chief Executive Officer.

            (2)    Each member of the medical staff shall:

                   (a)     attend and treat patients within the limits of the privileges granted by
                           the Board, unless the privileges are otherwise restricted;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (b)     notify the President and Chief Executive Officer of any change in the
                           Certificate of Registration with the College of Physicians and Surgeons
                           of Ontario;

                   (c)     give such instruction as is required for the education of other members
                           of the medical, dental, midwifery, nurse - extended class nurse with
                           privileges staff and Hospital staff;

                   (d)     abide by the Rules of the Hospital, this By-law, the Public Hospitals
                           Act and the Regulations thereunder and all other legislated
                           requirements;

                   (e)     co-operate with;

                           (i)      the Chief of Staff and the Medical Advisory Committee,

                           (ii)     the Chiefs of Department,

                           (iii)    the Head of the applicable services, and

                           (iv)     the President and Chief Executive Officer;

                   (f)     notify patients and/or their families or other appropriate persons about
                           their options with respect to tissue and organ transplantation;

                   (g)     participate in Utilization and Quality Improvement, and any other
                           program which the Board may institute;

                   (h)     maintain a program of Continuing Medical Education relevant to the
                           privileges granted by the Board and as set out by the Credentials
                           Committee;

                   (i)     provide coverage in emergency situations as required by the Board, the
                           Medical Advisory Committee, or the Chief of Staff; this coverage shall
                           be at least sufficient to maintain the level of service provided to the
                           community by the hospital; and

                   (j)     perform such other duties as may be prescribed from time to time by, or
                           under the authority of the Board, the Medical Advisory Committee or
                           the Chief of Staff.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (3)    Each member of the active and associate medical staff groups shall attend 50
                   percent (50%) of the regular staff meetings and 70 percent (70%) of the
                   meetings of the Committee of which he or she is a member.

7.9.2        Chief of Staff

            (1)    The Board shall appoint a member of the medical staff to be the Chief of Staff
                   after giving consideration to the recommendations of a Selection Committee,
                   which shall seek the advice of the Medical Advisory Committee.

            (2)    The membership of a Selection Committee may include:

                   (a)     a Director, who shall be chair;

                   (b)     two (2) members of the Medical Advisory Committee, one of whom
                           shall be the President of the Medical Staff;

                   (c)     the President and Chief Executive Officer, or his or her delegate;

                   (d)     Vice President/Chief Nursing Executive; and

                   (e)     such other members as the Board deems advisable.

            (3)    Subject to annual confirmation by the Board, an appointment made under
                   subsection 7.9.2 (1) of this By-law shall be for a term of three (3) years, but
                   the Chief of Staff shall hold office until a successor is appointed.

            (4)    The maximum number of terms under subsection 7.9.2 (3) of this By-law shall
                   be three (3), provided however that following a break in the continuous service
                   of at least one (1) year the same person may be re-appointed.

            (5)    The Board may at any time revoke or suspend the appointment of the Chief of
                   Staff.

7.9.3        Duties of the Chief of Staff

            (1)    The Chief of Staff shall:

                   (a)     be accountable to the Board;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   (b)     organize the medical, dental and midwifery staff to ensure that the
                           quality of the medical, dental and midwifery care given to all patients
                           of the Hospital is in accordance with policies established by the Board,
                           and organize the nurse - extended class nurse with privileges staff care
                           to ensure that the quality of the nurse - extended class nurse with
                           privileges care, with respect to diagnosing, prescribing for or treating
                           inpatients and outpatients of the Hospital, is in accordance with policies
                           established by the Board;

                   (c)     Chair the Medical Advisory Committee;

                   (d)     advise the Medical Advisory Committee and the Board with respect to
                           the quality of medical and dental diagnosis, care and treatment
                           provided to the patients of the Hospital, and the quality of midwifery
                           assessment, care and treatment provided to the patients of the Hospital,
                           and the quality of nurse - extended class nurse with privileges staff care
                           with respect to diagnosing, prescribing for or treating inpatients and
                           outpatients of the Hospital;

                   (e)     report regularly to the Board and medical staff about the activities,
                           recommendations and actions of the Medical Advisory Committee and
                           any other matters about which they should have knowledge;

                   (f)     assign, or delegate the assignment of a member of the medical, dental,
                           midwifery or nurse – extended class nurse with privileges;

                           (i)      to supervise the practice of medicine of any other member of
                                    the medical staff, the practice of dentistry of any other member
                                    of the dental staff, the practice of midwifery of any other
                                    member of the midwifery staff, or the practice of registered
                                    nurses in the extended class with respect to diagnosing,
                                    prescribing for or treating inpatients and outpatients of any
                                    other member of the nurse - extended class nurse with
                                    privileges staff, as appropriate for any period of time, and

                           (ii)     to make a written report to the Chief of Staff;

                   (g)     assign, or delegate the assignment of, a member of the medical, dental,
                           midwifery or nurse – extended class nurse with privileges staff to
                           discuss in detail with any other member of the medical, dental,
                           midwifery or nurse – extended class nurse with privileges staff as
                           appropriate, any matter which is of concern to the Chief of Staff and to
                           report the discussion to the Chief of the appropriate department;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   (h)     in consultation with the President and Chief Executive Officer,
                           designate an alternate to act during an absence;

                   (i)     supervise the professional care provided by all members of the medical,
                           dental and midwifery staff in the Hospital, and supervise the
                           professional care provided by all members of the nurse - extended class
                           nurse with privileges staff, with respect to diagnosing, prescribing for
                           or treating inpatients and outpatients of the Hospital;

                   (j)     be responsible to the Board through and with the President and Chief
                           Executive Officer for the appropriate utilization of resources by all
                           medical, dental and midwifery departments and nurse - extended class
                           nurse with privileges staff;

                   (k)     report to the Medical Advisory Committee on activities of the Hospital
                           including the utilization of resources and quality assurance;

                   (l)     participate in the development of the Hospital's mission, objectives, and
                           strategic plan;

                   (m)     work with the Medical Advisory Committee to plan medical human
                           resources plan needs of the Hospital in accordance with the Hospital's
                           strategic plan;

                   (n)     participate in Hospital resource allocation decisions;

                   (o)     ensure a process for the regular review of the performance of the Chiefs
                           of Department;

                   (p)     ensure there is a process for participation in continuing medical, dental,
                           midwifery and nurse - extended class nurse with privileges education;

                   (q)     receive and review recommendations from Chiefs of Department
                           regarding changes in privileges;

                   (r)     receive and review the performance evaluations and the
                           recommendations from Chiefs of Department concerning re-
                           appointments. Ensure that the evaluations and recommendations are
                           forwarded to the Medical Advisory Committee. Notify the Credentials
                           Committee of the completion of the evaluations and the completion of
                           the recommendations;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (s)     advise the medical, dental, midwifery and nurse - extended class nurse
                           with privileges on current Hospital policies, objectives and rules;

                   (t)     be an ex-officio member of all medical staff committees without the
                           attendance requirement as outlined in clause 7.8.7(4); and

                   (u)     delegate appropriate responsibility to the Chiefs of Department.

7.9.4        Monitoring Aberrant Practices

            Where any member of the medical, dental, midwifery, nurse – extended class nurse
            with privileges or hospital staff believes that a member of the medical staff is
            attempting to exceed their privileges or is incapable of providing a service that they
            are about to undertake, the belief shall be communicated immediately to the Chief of
            Staff, or to the President and Chief Executive Officer, or their delegates. Section
            12.1 Non-immediate Mid-term Action) or section 12.2 (Immediate Mid-term Action
            in an Emergency Situation) shall be followed as appropriate.

7.9.5        Viewing Therapeutic Actions, Operations or Procedures

            (1)    Any therapeutic action, operation or procedure performed in the Hospital may
                   be viewed without the permission of the physician by:

                   (a)     the Chief of Staff or delegate; or

                   (b)     the Chief of the Department or delegate.

7.9.6        Transfer Of Responsibility

            (1)    The admitting physician will be the Most Responsible Physician (MRP) for
                   any patient admitted by that physician. As applicable, substitute MRP with
                   Most Responsible Dentist or Most Responsible Midwife or Most Responsible
                   Nurse –Extended Class Nurse with privileges.

            (2)    The MRP can transfer a patient to another physician by contacting that
                   physician who agrees to accept responsibility for the patient. The delegation of
                   duty must be documented on the patient’s medical record including the time of
                   transfer of responsibility and duration, if applicable.

            (3)    Should a patient's usual attending physician take over the care from the
                   admitting physician prior to being contacted by the admitting physician, the
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   attending physician must notify the admitting physician of this acceptance of
                   the MRP responsibilities.

            (4)    Any MRP who knowingly will be unavailable for twelve (12) hours or more
                   must delegate to another physician as the MRP for that time, in accordance
                   with subsection (2) above.

            (5)    In the event a MRP, or delegate, cannot be contacted, the physician on-call for
                   inpatients is responsible to act on behalf of, or delegate for, the MRP.

            (6)    The patient shall be advised of the transfer of responsibility.

7.10        MEDICAL STAFF DEPARTMENTS AND PROGRAMS

7.10.1       Departments

            (1)    When warranted by the professional resources of the medical staff, the Board,
                   on the advice of the Medical Advisory Committee, may divide the medical
                   staff into departments which shall include:

                   (a)     medicine;

                   (b)     surgery;

                   (c)     emergency medicine;

                   (d)     general and family practice; and

                   (e)     maternal and childhealth.

            (2)    Any medical staff department shall function in accordance with the medical
                   staff rules.

            (3)    Whenever a separate department is established, physicians and where
                   appropriate, dentists, midwives and registered nurses in the extended class and
                   patients related to such a department shall come under the jurisdiction of that
                   department.

            (4)    The Board, after considering the advice of the Medical Advisory Committee, at
                   any time, may establish or disband departments of the medical staff.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


7.10.2       Chief Of Department

            (1)    The Board shall appoint as Chief of Department a physician from that
                   department who is on the active staff, after giving consideration to the
                   recommendations of a Selection Committee.

            (2)    The membership of a Selection Committee may include:

                   (a)     the Chief of Staff who shall be chair;

                   (b)     a Director;

                   (c)     a member of the Medical Advisory Committee;

                   (d)     the President and Chief Executive Officer or his or her delegate;

                   (e)     Vice President/Chief Nursing Executive; and

                   (f)     a member of the Department.

            (3)    Subject to annual confirmation of the Board, the appointment of a Chief of
                   Department shall be for a term of three (3) years, but the Chief of Department
                   shall hold office until a successor is appointed.

            (4)    The maximum number of terms under subsection 7.10.2 (3) of this By-law
                   shall be two (2), provided however that following a break in the continuous
                   service of at least one (1) year the same person may be re-appointed.

            (5)    The Board may at any time revoke or suspend the appointment of a Chief of
                   Department.

7.10.3       Duties of Chief of Department

            (1)    The Chief of Department shall:

                   (a)     through and with the Chief of Staff supervise the professional care
                           provided by all members of the medical, dental and midwifery staff,
                           and nurse - extended class nurse staff who have privileges with respect
                           to diagnosing, prescribing for or treating inpatients and outpatients in
                           the Hospital;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (b)     participate in the orientation of new members of the medical, dental,
                           midwifery and nurse - extended class nurse with privileges appointed to
                           the department;

                   (c)     be responsible for the organization and implementation of a quality
                           assurance program in the department to ensure that it is integrated with
                           program-wide quality assurance measures;

                   (d)     advise the Medical Advisory Committee through and with the Chief of
                           Staff with respect to the quality of medical, and where appropriate,
                           dental, diagnosis, care and treatment provided to the patients and
                           outpatients of the department;

                   (e)     advise the Medical Advisory Committee through and with the Chief of
                           Staff with respect to the quality of midwifery assessment, care and
                           treatment provided to the patients and outpatients of the department;

                   (f)     advise the Medical Advisory Committee through and with the Chief of
                           Staff with respect to the quality of care provided in the hospital by
                           registered nurses in the extended class who have privileges with respect
                           to diagnosing, prescribing for or treating inpatients and outpatients in
                           the Hospital;

                   (g)     advise the Chief of Staff and the President and Chief Executive Officer
                           of any patient who is not receiving appropriate treatment and care;

                   (h)     be responsible to the Chief of Staff, through and with the President and
                           Chief Executive Officer for the appropriate utilization of the resources
                           allocated to the department;

                   (i)     report to the Medical Advisory Committee and to the department on
                           activities of the department including utilization of resources and
                           quality assurance;

                   (j)     make recommendations to the Medical Advisory Committee regarding
                           medical human resource needs of the department in accordance with
                           the Hospital's strategic plan following consultation with medical staff
                           of the department, the Chief of Staff and, where appropriate, Heads of
                           Services;

                   (k)     participate in the development of the department's mission, objectives
                           and strategic plan;
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (l)     participate in department resource allocation decisions;

                   (m)     review or cause to be reviewed the privileges granted members of the
                           department including members of the dental staff, members of the
                           midwifery staff and nurse - extended class nurse with privileges staff
                           for the purpose of making recommendations for changes in the kind
                           and degree of such privileges;

                   (n)     review and make written recommendations regarding the performance
                           evaluations of members of the department including members of the
                           dental, midwifery and nurse - extended class nurse with privileges staff
                           annually and concerning re-appointments and these recommendations
                           shall be forwarded to the Medical Advisory Committee;

                   (o)     be a member of the Medical Advisory Committee;

                   (p)     establish a process for continuing education related to the department;

                   (q)     advise the members of the department, including members of the
                           dental, midwifery and nurse - extended class nurse with privileges staff
                           regarding current Hospital and departmental policies, objectives, and
                           rules;

                   (r)     hold regular meetings with the staff of the department and where
                           appropriate with the Heads of Services within the department;

                   (s)     notify the Chief of Staff of his or her absence, and designate an
                           alternate from within the department; and

                   (t)     delegate appropriate responsibility to the Heads of Services within the
                           department.

7.11        MEETINGS - MEDICAL STAFF

7.11.1       Meetings of the Medical Staff

            (1)    Every medical staff shall hold at least four (4) meetings in each fiscal year of
                   the hospital, one of which shall be the annual meeting.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


7.11.2       Notice of Annual Meetings

            (1)    A written notice of each annual meeting shall be posted in a prominent location
                   by the Secretary of the medical staff at least ten (10) days before the meeting.

7.11.3       Notice of Regular Meetings

            (1)    A written notice of each regular meeting shall be posted in a prominent
                   location by the Secretary of the medical staff at least five (5) days before the
                   meeting.

7.11.4       Special Meetings

            (1)    The President of the medical staff may call a special meeting.

            (2)    Special meetings shall be called by the President of the medical staff on the
                   written request of any five (5) members of the active medical staff or a
                   Department.

            (3)    Notice of such special meetings shall be as required for a regular meeting,
                   except in cases of emergency, and shall state the nature of the business for
                   which the special meeting is called.

            (4)    The usual period of time required for giving notice of any special meeting shall
                   be waived in cases of emergency, subject to ratification of this action by the
                   majority of those members present and voting at the special meeting, as the
                   first item of business at the meeting.

7.11.5       Quorum

            (1)    Five (5) members of the medical staff members, entitled to vote, shall
                   constitute a quorum at any annual, general or special meeting of the medical
                   staff.

7.11.6       Order of Business

            (1)    The order of business at any meeting of the medical staff shall be as set out in
                   the rules of the medical staff.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


7.11.7       Attendance At Regular Staff Meetings

            (1)    Each member of the active staff shall attend at least fifty per cent (50%) of the
                   regular medical staff meetings.

7.11.8       Department Meetings

            (1)    Department meetings shall be held in accordance with medical staff rules.

7.11.9       Attendance At Department Meetings

            (1)    Each member of the active and associate staff groups shall attend at least
                   70 per cent (70%) of the meetings of the department of which he or she is a
                   member.

7.12        MEDICAL STAFF ELECTED OFFICERS

7.12.1       Officers of the Medical Staff

            (1)    The following shall be Officers of the Medical Staff:

                   (a)     the President;

                   (b)     the Vice-President; and

                   (c)     the Secretary/Treasurer.

7.12.2       Eligibility For Office

            (1)    Only members of the active medical staff may be elected or appointed to any
                   position or office.

7.12.3       Election Procedure

            (1)    The Nominating Committee shall be the members of the Credentials
                   Committee.

            (2)    At least thirty (30) days before the annual meeting of the medical staff, its
                   Nominating Committee shall post in a prominent location a list of the names of
                   those who are nominated for the offices of the medical staff which are to be
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   filled by election in accordance with this By-law and the regulations under the
                   Public Hospitals Act.

            (3)    Any further nominations shall be made in writing to the Secretary of the
                   medical staff within fourteen (14) days after the posting of the names referred
                   to in subsection 7.12.3(2) of this By-law.

            (4)    Further nominations referred to in subsection 7.12.3(3) of this By-law shall be
                   signed by two (2) members of the medical staff who are entitled to vote and the
                   nominee shall have signified in writing on the nomination acceptance of the
                   nomination. Such nominations shall then be posted alongside the list referred
                   to in subsection 7.12.3(2) of this By-law.

            (5)    No nominations may be made from the floor at the Annual Meeting.

7.12.4       Duties of the President of the Medical Staff

            (1)    The President of the Medical Staff shall:

                   (a)     be a member of the Board and as a Director, fulfil his or her fiduciary
                           duties to the Hospital by making decisions in the best interest of the
                           Hospital;

                   (b)     be a member of the Medical Advisory Committee;

                   (c)     be the liaison between the medical staff and the President and Chief
                           Executive Officer and in the event the President and Chief Executive
                           Officer cannot be consulted, then liaise with the Board on any issues
                           raised by the medical staff and not assigned to the Medical Advisory
                           Committee or to the Chief of Staff;

                   (d)     be accountable to the medical staff and advocate fair process in the
                           treatment of individual members of the medical staff;

                   (e)     preside at all meetings of the medical staff;

                   (f)     call special meetings of the medical staff;

                   (g)     be a member of the Joint Conference Committee;

                   (h)     be a member of the Executive/Finance Committee; and
The Stevenson Memorial Hospital Corporation By-laws                                         May 8, 2008


                   (i)     be a member of such other committees as may be deemed appropriate
                           by the Board.

7.12.5       Duties of the Vice-President of the Medical Staff

            (1)    The Vice-President of the Medical Staff shall:

                   (a)     act in the place of the President of the medical staff, perform his or her
                           duties and possess his or her powers, in the absence or disability of the
                           President;

                   (b)     perform such duties as the President of the medical staff may delegate;
                           and

                   (c)     be a member of the Medical Advisory Committee.

7.12.6       Duties of the Secretary/Treasurer of the Medical Staff

            (1)    The Secretary/Treasurer of the Medical Staff shall:

                   (a)     be a member of the Medical Advisory Committee;

                   (b)     attend to the correspondence of the medical staff;

                   (c)     keep the funds of the medical staff in a safe manner and be accountable
                           therefore;

                   (d)     disburse medical staff funds at the direction of the medical staff as
                           determined by a majority vote of the medical staff members present and
                           entitled to vote at a medical staff meeting;

                   (e)     give notice of medical staff meetings by posting a written notice
                           thereof;

                           (i)      in the case of a regular or special meeting of the medical staff at
                                    least five (5) days before the meeting, and

                           (ii)     in the case of an annual meeting of the medical staff, at least ten
                                    (10) days before the meeting;

                   (f)     ensure that minutes are kept of all medical staff meetings;
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   (g)     ensure that a record of the attendance at each meeting of the medical
                           staff is made;

                   (h)     receive the record of attendance for each meeting of each department of
                           the medical staff;

                   (i)     make the attendance records available to the Medical Advisory
                           Committee;

                   (j)     perform the duties of the Treasurer for medical staff funds and be
                           accountable therefore, when a Treasurer of the medical staff has not
                           been elected; and

                   (k)     act in the place of the Vice-President of the medical staff, performing
                           his or her duties and possessing his or her powers in the absence or
                           disability of the Vice-President.

7.13        MEDICAL ADVISORY COMMITTEE

7.13.1       Membership of the Medical Advisory Committee

            (1)    The Medical Advisory Committee shall consist of:

                   (a)     Chief of Staff, who shall be chair;

                   (b)     All Chiefs of Departments;

                   (c)     President of the medical staff;

                   (d)     Vice-President of the medical staff;

                   (e)     Secretary/Treasurer of the medical staff; and

                   (f)     other members of the Medical/Dental/Midwifery Staff/Nurse –
                           Extended Class Nurse with privileges as may be determined by the
                           Medical Advisory Committee.

            (2)    The President and Chief Executive Officer shall attend meetings of the
                   Medical Advisory Committee but shall not have a vote.
The Stevenson Memorial Hospital Corporation By-laws                                         May 8, 2008


            (3)    The Vice President/Chief Nursing Executive shall attend meetings of the
                   Medical Advisory Committee but shall not have a vote.

7.13.2       Duties of the Medical Advisory Committee

            (1)    The Medical Advisory Committee shall elect a Secretary to the Medical
                   Advisory Committee from among themselves.

            (2)    The Medical Advisory Committee shall perform the functions as set out in the
                   Hospital Management Regulation.

            (3)    The Medical Advisory Committee shall:

                   (a)     receive and consider the report of the Credentials Committee;

                   (b)     in considering a recommendation for appointment, review;

                           (i)      the need of the Hospital for such an appointment, and

                           (ii)     the impact such an appointment would have on available
                                    Hospital and community resources;

                   (c)     in the case of a recommendation for appointment, specify the privileges
                           which it recommends the applicant be granted.

            (4)    Develop a medical, dental, midwifery and nurse - extended class nurse with
                   privileges human resources plan.

            (5)    Through the Chief of Staff, advise the Board on:

                   (a)     medical, dental, midwifery and nurse - extended class nurse with
                           privileges quality assurance;

                   (b)     education;

                   (c)     clinical role of the Hospital; and

                   (d)     medical, dental, midwifery and nurse - extended class nurse with
                           privileges staff human resources plan.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


7.14        MEDICAL STAFF COMMITTEES ESTABLISHED BY THE BOARD

7.14.1       Medical Staff Committees Established by the Board

            (1)    The following Medical Staff Committees are hereby established:

                   (a)     Credentials/Nominating Committee;

                   (b)     Health Records Committee;

                   (c)     Medical Quality and Utilization Committee;

                   (d)     Infection Control Committee; and

                   (e)     Pharmacy and Therapeutics Committee.

7.14.2       Appointment To Medical Staff Committees

            (1)    Pursuant to the Hospital Management Regulation, the Medical Advisory
                   Committee shall appoint the medical members of all Medical Staff Committees
                   provided for in this By-law of the Hospital. Other members of Medical Staff
                   Committees shall be appointed by the Board or in accordance with this By-law.

7.14.3       Medical Staff Committee Duties

            (1)    In addition to the specific duties of each Medical Staff Committee as set out in
                   this By-law, all Medical Staff Committees shall:

                   (a)     meet as directed by the Medical Advisory Committee; and

                   (b)     present a written report including any recommendations of each
                           meeting to the next meeting of the Medical Advisory Committee.

7.14.4       Medical Staff Committee Chair

            (1)    The Medical Advisory Committee shall appoint the chair of each Medical Staff
                   Committee.

7.14.5       Medical Staff Committee Chair Duties

            (1)    A Medical Staff Committee Chair shall:
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (a)     chair the Medical Staff Committee meetings;

                   (b)     call meetings of the Medical Staff Committee;

                   (c)     at the request of the Medical Advisory Committee, be present to
                           discuss all or part of any report of the Committee; and

                   (d)     carry out such further and other duties as may be prescribed by the
                           Medical Advisory Committee from time to time.

7.14.6       Credentials/Nominating Committee Duties

            (1)    The Credentials/Nominating Committee shall ensure that a record of the
                   qualifications and professional career of every member of the medical, dental,
                   midwifery and nurse - extended class nurse with privileges is maintained.

            (2)    The Credentials/Nominating Committee shall establish the authenticity of and
                   investigate the qualifications of each applicant for appointment and re-
                   appointment to the medical, dental, midwifery and nurse - extended class nurse
                   with privileges and each applicant for a change in privileges.

            (3)    The Credentials/Nominating Committee shall ensure that:

                   (a)     each applicant for appointment to the medical staff meets the criteria as
                           set out at clause 7.4.2;

                   (b)     each applicant for appointment to the dental staff meets the criteria as
                           set out at clause 8.2.2;

                   (c)     each applicant for appointment to the midwifery staff meets the criteria
                           as set out at clause 9.2.2;

                   (d)     each applicant for appointment to the nurse - extended class nurse with
                           privileges staff meets the criteria as set out at clause 10.2.2;

                   (e)     each applicant for re-appointment to the medical staff meets the criteria
                           as set out at clause 7.5.2;

                   (f)     each applicant for re-appointment to the dental staff meets the criteria
                           as set out at clause 8.3.2;
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (g)     each applicant for re-appointment to the midwifery staff meets the
                           criteria set out at clause 9.3.2;

                   (h)     each applicant for re-appointment to the nurse - extended class nurse
                           with privileges staff meets the criteria as set out at clause 10.3.2; and

                   (i)     each applicant for a change in privileges continues to meet the criteria
                           for re-appointment set out respectively for physicians at clause 7.5.2,
                           dentists at clause 8.3.2, midwives at clause 9.3.2, and complies with
                           clause 7.6.1 for physicians, clause 8.4.1 for dentists, and clause 9.4.1
                           for midwives.

            (4)    The Credentials Committee shall consider reports of the interviews with the
                   applicant.

            (5)    The Credentials Committee shall consult with the appropriate Chief of
                   Department.

            (6)    The Credentials Committee shall receive notification from the Chief of Staff
                   when the performance evaluations and the recommendations for
                   re-appointments have been completed.

            (7)    The Credentials Committee shall submit a written report to the Medical
                   Advisory Committee at or before its next regular meeting. The report shall
                   include the kind and extent of privileges requested by the applicant, and, if
                   necessary, a request that the application be deferred for further investigation.

            (8)    The Committee shall perform any other duties prescribed by the Medical
                   Advisory Committee, e.g., nominating of medical staff executive.

7.14.7       Health Record Committee Duties

            (1)    The Health Records Committee shall recommend procedures to the Medical
                   Advisory Committee to ensure that the provisions of the Hospital Management
                   Regulation, this By-law and the Rules of the Hospital are observed, including:

                   (a)     the development of rules to govern the completion of medical records;

                   (b)     a review of medical records for completeness and quality of recording;

                   (c)     a report in writing to each regular meeting of the Medical Advisory
                           Committee with respect to;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                           (i)      the review of the medical records and the results thereof, and

                           (ii)     the names of members of the medical, dental, midwifery and
                                    nurse - extended class nurse with privileges who are delinquent
                                    with respect to the rules governing medical records;

                   (d)     a review and revision of forms as they pertain to medical staff record
                           keeping; and

                   (e)     the retention of medical records and notes, charts and other material
                           relating to patient care.

            (2)    The Committee shall perform any other duties pertaining to medical record
                   keeping as may be requested by the Medical Advisory Committee.

7.14.8       Medical Quality and Utilization Committee Duties

            (1)    The Medical Quality and Utilization Assurance Committee shall,

                   (a)     develop a Medical Quality and Utilization Program which includes
                           mechanisms to;

                           (i)      monitor trends and activities,

                           (ii)     identify potential problem areas, and

                           (iii)    develop action plans and provide follow-up;

                   (b)     report to the Medical Advisory Committee and to the Quality and Risk
                           Committee of the Board;

                   (c)     receive reports of and monitor the functioning of Medical Staff
                           Committees including the Medical Advisory Committee;

                   (d)     review, evaluate and make recommendations on policy affecting the
                           medical, dental, midwifery and nurse – extended class nurse with
                           privileges:

                           (i)      privileges,

                           (ii)     human resources planning, impact analysis,
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                           (iii)    program, departmental and service activities,

                           (iv)     process for handling complaints, and

                           (v)      Hospital By-laws, Rules of the Hospital and policies of the
                                    Hospital;

                           (vi)     constitute a forum for dialogue on patient specific clinical
                                    ethical issues and develop guidelines for involvement in policy
                                    formulation relating to these ethical matters;

                   (e)     recommend procedures to the Medical Advisory Committee to assure
                           that an ongoing peer review process is established for assessment of the
                           quality of patient care as follows:

                           (i)      study, record, analyse and consider the agreement or
                                    disagreement between the pre-operative diagnosis shown on the
                                    Hospital records, and the pathology reports on tissues removed
                                    from patients in the Hospital or post mortem reports,

                           (ii)     review or cause to be reviewed regularly medical records,

                           (iii)    report in writing to each regular meeting of the Medical
                                    Advisory Committee and to the appropriate Chiefs of
                                    Departments,

                           (iv)     assure a review of all Hospital deaths to assess the quality of
                                    care that has been provided,

                           (v)      identify the continuing educational needs of the medical, dental,
                                    midwifery and nurse - extended class nurse with privileges and
                                    assure that actions are taken on the recommendations of the
                                    Committee,

                           (vi)     assure that other department medical, dental, midwifery and
                                    nurse – extended class nurse with privileges audits are
                                    undertaken as necessary; and

                   (f)     perform such further duties as the Medical Advisory Committee may
                           direct concerning the quality and quantity of professional work being
                           performed in any department of the medical, dental, midwifery and
                           nurse - extended class nurse with privileges of the Hospital;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   (g)     assume the following Terms of Reference/Membership when reviewing
                           Quality of Care Information Protection Act (QCIPA) investigations;

                           (i)      Membership,

                                            Manager, Quality and Risk,

                                            Chief of Staff,

                                            Vice President/Chief Nursing Executive,

                                            Medical Directors/Chief of Medical Departments, and

                                            Representatives from other clinical departments/units

                           (ii)     Matters Reviewed by the Committee;

                                    The Committee shall review matters which may give rise to
                                    significant quality of care concerns, including specifically,

                                            an occurrence involving an unexpected death or serious
                                             bodily harm

                                            an occurrence or series of occurrences that have the
                                             potential to result in death or serious bodily harm, and

                                            an occurrence or series or occurrences that have the
                                             potential to result in harm to a number of patients.

                                    Depending on the matter to be reviewed, the Committee may
                                    seek or receive information/report from any hospital staff
                                    member, committee and/or external person/entity.

                                    The Committee may disclose information pertaining to reviews
                                    (this may include recommendations and any other information):

                                            to management if the Committee considers it is
                                             necessary for the purpose of improving or maintaining
                                             the quality of health care provided at the hospital, and
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


                                            for the purpose of eliminating or reducing a significant
                                             risk of serious bodily harm to a person or group of
                                             persons.

7.14.9       Infection Control Committee Duties

            (1)    The Infection Control Committee shall:

                   (a)     make recommendations to the Medical Advisory Committee on
                           infection control matters related to;

                           (i)      the Occupational Health and Safety Program,

                           (ii)     immunization programs,

                           (iii)    visitor restrictions or instructions both in general terms and in
                                    special circumstances,

                           (iv)     patient restrictions or instructions,

                           (v)      educational programs for all persons carrying on activities in the
                                    Hospital,

                           (vi)     isolation procedures,

                           (vii)    aseptic and antiseptic techniques,

                           (viii) environmental sanitation in the Hospital, and

                           (ix)     patient safety initiatives from the Infection Control perspective;

                   (b)     make recommendations to the President and Chief Executive Officer
                           with respect to,

                           (i)      infection control matters related to the Occupational Health and
                                    Safety Program, and

                           (ii)     infection control matters related to the Health Surveillance
                                    Program;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (c)     follow-up and evaluate the results of each of its recommendations made
                           under subsections 7.14.8(1)(a) and (b) of this By-Law;

                   (d)     develop, monitor and evaluate an infection control system which
                           includes a reporting system by which all infections, including post
                           discharge infections will come to the Committee's attention;

                   (e)     review reports from all departments and programs in the Hospital;

                   (f)     meet at least quarterly and at the call of the Committee Chair as
                           required; and

                   (g)     perform such other duties as may from time to time be requested by the
                           Medical Advisory Committee.

7.14.10      Pharmacy And Therapeutics Committee Duties

            (1)    The Pharmacy and Therapeutics Committee shall:

                   (a)     serve in an advisory capacity to the medical, dental, midwifery and
                           nurse - extended class nurse with privileges by assessing regularly the
                           appropriateness and adequacy of medication-related policies and make
                           policy recommendations to the Medical Advisory Committee regarding
                           drug utilization to ensure safe, effective and economical use of drugs;

                   (b)     evaluate drug utilization, new drugs and current therapeutics and
                           develop a formulary which is suited to the Hospital's needs, and
                           periodically assess the effectiveness of and adherence to the formulary;

                   (c)     develop a procedure for the use of non-formulary drugs and
                           mechanisms for their evaluation;

                   (d)     periodically analyze a summary of medication errors and their
                           causative factors and make appropriate recommendations regarding
                           prevention to the medical, dental, midwifery and nurse – extended class
                           nurse with privileges staff, and nursing and/or pharmacy staffs;

                   (e)     develop an adverse drug reaction reporting program, review all these
                           reports and ensure that a summary is circulated to medical, dental,
                           midwifery, and nurse – extended class nurse with privileges and
                           nursing staffs when the need arises;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (f)     review all standing orders annually, or more often if deemed necessary;

                   (g)     develop protocols governing programs such as total parenteral
                           nutrition, investigational drugs, self-medication, or ensure that such
                           protocols have been developed after appropriate committee review;

                   (h)     identify and/or arrange appropriate educational programs for the
                           medical, dental, midwifery, nurse – extended class nurse with
                           privileges and Hospital staff to enhance their knowledge of drug
                           therapy and practices;

                   (i)     perform such other duties as the Medical Advisory Committee may
                           direct; and

                   (j)     meet quarterly or more frequently at the call of the Committee Chair.

8.      DENTAL STAFF

8.1         APPOINTMENT OF DENTAL STAFF

            (1)    The Board, on the advice of the Medical Advisory Committee, may appoint,
                   annually, one or more dentists to the dental staff of the Hospital and shall
                   delineate the privileges for each dentist.

8.2         APPOINTMENT TO DENTAL STAFF

8.2.1        Application For Appointment to the Dental Staff

            (1)    An application for appointment to the dental staff shall be processed in the
                   same manner as an application for appointment to the medical staff as set out
                   in Clause 7.4.

            (2)    On request, the President and Chief Executive Officer shall supply a copy of
                   the By-laws, the Rules of the Hospital, the Public Hospitals Act and the
                   Regulations thereunder to each dentist who expresses in writing the intention
                   to apply for appointment to the dental staff.

            (3)    An applicant for appointment to the dental staff shall submit one original
                   written application to the President and Chief Executive Officer.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (4)    Each application shall contain:

                   (a)     a statement by the applicant that he or she has read the Public Hospitals
                           Act and the Hospital Management Regulation thereunder, and the
                           By-laws and Rules of the Hospital;

                   (b)     an undertaking that, if he or she is appointed to the dental staff of the
                           Hospital, he or she will govern himself or herself in accordance with
                           the requirements set out in the By-laws and the Rules of the Hospital;

                   (c)     evidence of dental practice protection coverage satisfactory to the
                           Board;

                   (d)     a list of the privileges which are requested;

                   (e)     an up-to-date curriculum vitae;

                   (f)     a list of three (3) appropriate references, preferably dentists, who can
                           provide information regarding the dental knowledge, performance, and
                           ability to work with people;

                   (g)     information of any previous disciplinary proceeding where there was an
                           adverse finding;

                   (h)     information of any civil suit where there was a finding of negligence or
                           battery; and

                   (i)     a signed consent authorizing any dental regulatory body or referee to
                           provide a report on;

                           (i)      any action taken by its disciplinary or fitness to practice
                                    committee, and

                           (ii)     whether his or her privileges have been curtailed or cancelled
                                    by any dental regulatory body or by another hospital because of
                                    incompetence, negligence, incapacity or any act of professional
                                    misconduct.

            (5)    Each applicant shall be interviewed by the hospital’s Credentials Committee,
                   Chief of Staff, President and Chief Executive Officer or delegate, and other
                   members as appropriate.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (6)    The President and Chief Executive Officer shall retain a copy of the
                   application and shall refer the original application immediately to the Medical
                   Advisory Committee through its Chair who shall keep a record of each
                   application received and then refer the original application to the Chair of the
                   Credentials Committee.

            (7)    Each application shall be considered by the Medical Advisory Committee
                   which shall make a recommendation thereon in writing to the Board within
                   sixty (60) days from the date of the application.

            (8)    The Hospital and the Medical Advisory Committee shall deal with the
                   application in accordance with the Public Hospitals Act and the procedure set
                   out in subsections 11.1(1) to (7) and 11.2(1) to (13) of this By-law.

8.2.2        Criteria For Appointment to the Dental Staff

            (1)    Only an applicant qualified to practice dentistry and who holds a current, valid
                   certificate of Registration with the Royal College of Dental Surgeons of
                   Ontario, or an applicant qualified to practice a dental specialty recognized by
                   the Royal College of Dental Surgeons of Ontario and who holds a current,
                   valid Specialty Certificate of Registration with the Royal College of Dental
                   Surgeons of Ontario, is eligible to be a member of and appointed to the dental
                   staff of the Hospital.

            (2)    The applicant will have:

                   (a)     a current valid Certificate of Registration with the Royal College of
                           Dental Surgeons of Ontario, and in the case of an oral maxillofacial
                           surgeon, a current valid Specialty Certificate of Registration from the
                           Royal College of Dental Surgeons of Ontario authorizing practice in
                           oral and maxillofacial surgery;

                   (b)     a demonstrated ability to provide patient care at an appropriate level of
                           quality and efficiency;

                   (c)     a demonstrated ability to communicate, work with and relate to all
                           members of the dental, medical, midwifery, nurse - extended class
                           nurse with privileges staff and Hospital staff in a co-operative and
                           professional manner;

                   (d)     a demonstrated ability to communicate and relate appropriately with
                           patients and patients' relatives;
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


                    (e)    a willingness to participate in the discharge of staff obligations
                           appropriate to the dental staff;

                    (f)    adequate training and experience for the privileges requested;

                    (g)    evidence of dental practice protection coverage satisfactory to the
                           Board; and

                    (h)    a report on, among other things, the experience, competence and
                           reputation of the applicant from the Chief of Staff or Chief of
                           Department in the last hospital in which the applicant trained or held an
                           appointment.

            (3)     The applicant must agree to govern himself or herself in accordance with the
                    requirements set out in this By-law, the Rules of the Hospital and the Hospital
                    policies.

            (4)     The applicant must indicate to the Credentials Committee adequate control of
                    any significant physical or behavioural impairment that affects skill, attitude or
                    judgment.

            (5)     There is a need for the services in the community.

8.2.3        Term

            (1)     Each appointment to the dental staff shall be for one (1) year, but shall
                    continue in effect until the Board has made appointments for the ensuing year.

8.3         RE-APPOINTMENT

8.3.1        Application for Re-Appointment and Performance Review

            (1)     Upon recommendation by the Medical Advisory Committee, the Board shall
                    establish and approve a process for the annual performance review of each
                    member of the dental staff.

            (2)     Each year each member of the dental staff shall submit annually an application
                    for reappointment to the dental staff to the President and Chief Executive
                    Officer.

            (3)     The application for re-appointment to the dental staff shall be processed in the
                    same manner as set out in Clause 7.5
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


8.3.2        Criteria for Re-Appointment to the Dental Staff

            (1)    In order to be eligible for re-appointment, the applicant shall:

                   (a)     continue to meet the criteria set out at sub-section 8.2.2;

                   (b)     have demonstrated an appropriate use of Hospital resources; and

                   (c)     meet other requirements that may be needed from time to time.

8.3.3        Refusal to Re-Appoint

            (1)    In a manner consistent with the provisions of the Public Hospitals Act and in
                   accordance with the Regulations thereunder, the Board may refuse to
                   re-appoint a member of the dental staff.

8.4         CHANGE OF PRIVILEGES

8.4.1        Application for Change of Privileges

            (1)    Where a dentist wishes to change his or her privileges, the dentist shall make a
                   written application, in the prescribed form, listing the change of privileges
                   which is requested and shall submit evidence of appropriate training and
                   competence in respect of the privileges being requested.

            (2)    An application for a change in privileges made by a member of the dental staff
                   shall be processed in the same manner as set out in clause 8.2.1.

8.5         MID-TERM ACTION

8.5.1        Mid-Term Action

            (1)    In a manner consistent with the Public Hospitals Act and in accordance with
                   the Regulations thereunder and this By-law, the Board at any time may revoke
                   or suspend any appointment of a member of the dental staff, or dismiss,
                   suspend, restrict or otherwise deal with the privileges of the member.

            (2)    Mid-term action in respect of a member of the dental staff, shall be processed
                   in accordance with, and in the same manner provided in part 12 of this By-law.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


8.6         DENTAL STAFF DUTIES

8.6.1        Dental Staff Duties

            (1)    Each member of the dental staff is accountable to and shall recognize the
                   authority of the Board through and with their Chief of Department, the Chief
                   of Staff, and the President and Chief Executive Officer.

            (2)    Each member of the dental staff shall:

                   (a)     attend and treat patients within the limits of the privileges granted by
                           the Board unless the privileges are otherwise restricted;

                   (b)     notify the President and Chief Executive Officer of any change in the
                           Certificate of Registration with the Royal College of Dental Surgeons
                           of Ontario, and in the case of an oral and maxillofacial surgeon, the
                           Specialty Certificate of Registration with the Royal College of Dental
                           Surgeons of Ontario;

                   (c)     give such instruction as is required for the education of other members
                           of the dental, medical, midwifery, nurse - extended class nurse with
                           privileges staff and Hospital staff;

                   (d)     abide by the Rules of the Hospital, this By-law, the Public Hospitals
                           Act, the Regulations thereunder and all other legislated requirements;

                   (e)     perform such other duties as may be prescribed from time to time by, or
                           under the authority of the Board, the Medical Advisory Committee or
                           the Chief of Staff; and

                   (f)     provide consultations on patients as are required.

            (3)    Every member of the dental staff who is an oral and maxillofacial surgeon and
                   who holds a valid Specialty Certificate from the Royal College of Dental
                   Surgeons of Ontario authorizing practice in oral and maxillofacial surgery shall
                   have admitting privileges unless otherwise specified in their appointment to the
                   dental staff.

            (4)    Every member of the dental staff shall co-operate with:

                   (a)     the Chief of Staff and the Medical Advisory Committee;
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (b)     the Head of Dental Service;

                   (c)     the Chief of the Department of Surgery; and

                   (d)     the President and Chief Executive Officer.

            (5)    Maintain a program of Continuing Medical Education relevant to the privileges
                   granted by the Board and as set out by the Credentials Committee.

            (6)    Participate in Utilization and Quality Improvement, and any other programs
                   which the Board may institute.

            (7)    Provide coverage in emergency situations as required by the Board, the
                   Medical Advisory Committee, or the Chief of Staff; this coverage shall be at
                   least sufficient to maintain the level of service provided to the community by
                   the hospital.

            (8)    Perform such other duties as may be prescribed from time to time by or under
                   the authority of the Medical Advisory Committee.

8.6.2        Monitoring Aberrant Practices

            (1)    Refer to Clause 7.9.4.

8.6.3        Viewing Therapeutic Actions, Operations Or Procedures

            (1)    Refer to Clause 7.9.5.

8.6.4        Transfer Of Responsibility

            (1)    Refer to Clause 7.9.6.

8.7         DENTAL SERVICE

8.7.1        Dental Service

            (1)    The dental staff shall function as a service within the department of surgery.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


8.7.2        Head Of Dental Service

            (1)    Where the Board has appointed more than one (1) dentist to the staff of the
                   dental service, one (1) of the members of the dental staff shall, subject to
                   annual confirmation by the Board, be appointed by the Board annually for a
                   term of three (3) years to be the Head of Dental Service upon the
                   recommendation of the Chief of Surgery.

            (2)    The Board may at any time revoke or suspend the appointment of the Head of
                   Dental Service.

8.7.3        Duties Of the Head Of Dental Service

            (1)    The Head of Dental Service shall supervise the professional care given by all
                   members of the dental staff and shall be responsible to the Chief of the
                   Department of Surgery for the quality of care rendered to patients by members
                   of the dental staff.

8.8         MEETINGS - DENTAL STAFF

8.8.1        Attendance By Dental Staff At Medical Staff Meetings

            (1)    A member of the dental staff may attend medical staff meetings but shall not
                   be eligible to vote at a medical staff meeting.

8.9         DENTAL STAFF ELECTED OFFICERS

8.9.1        Eligibility To Hold A Medical Staff Office

            (1)    A member of the dental staff is not eligible to hold an office other than Head of
                   Dental Service.

9.      MIDWIFERY STAFF

9.1         APPOINTMENT OF MIDWIFERY STAFF

            (1)    The Board, on the advice of the Medical Advisory Committee, may appoint,
                   annually, one or more midwives to the midwifery staff of the Hospital and
                   shall delineate the privileges for each midwife.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


9.2         APPOINTMENT TO MIDWIFERY STAFF

9.2.1        Application for Appointment to the Midwifery Staff

            (1)    An application for appointment to the midwifery staff shall be processed in the
                   same manner as an application for appointment to the medical staff as set out
                   in clause 7.4.

            (2)    On request, the President and Chief Executive Officer shall supply a copy of
                   the By-laws, the Rules of the Hospital, the Public Hospitals Act and the
                   Regulations thereunder to each midwife who expresses in writing the intention
                   to apply for appointment to the midwifery staff.

            (3)    An applicant for appointment to the midwifery staff shall submit one (1)
                   original written application to the President and Chief Executive Officer.

            (4)    Each application shall contain:

                   (a)     a statement by the applicant that he or she has read the Public Hospitals
                           Act and the Hospital Management Regulation thereunder, and the
                           By-laws and the Rules of the Hospital;

                   (b)     an undertaking that, if he or she is appointed to the midwifery staff of
                           the Hospital, he or she will govern himself or herself in accordance
                           with the requirements set out in the By-laws and the Rules of the
                           Hospital;

                   (c)     evidence of midwifery practice protection coverage satisfactory to the
                           Board;

                   (d)     a list of the privileges which are requested;

                   (e)     an up-to-date curriculum vitae;

                   (f)     a list of three (3) appropriate referees, including one (1) from a
                           physician who is active in obstetrics and who has worked with the
                           midwife;

                   (g)     information of any previous disciplinary proceeding where there was an
                           adverse finding;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (h)     information of any civil suit where there was a finding of negligence or
                           battery;

                   (i)     a signed consent authorizing any midwifery regulatory body or referee
                           to provide a report on:

                           (i)      any action taken by its disciplinary or fitness to practice
                                    committee, and

                           (ii)     whether his or her privileges have been curtailed or cancelled
                                    by any midwifery regulatory body or by another hospital
                                    because of incompetence, negligence, incapacity or any act of
                                    professional misconduct; and

                   (j)     a current certificate of Professional Conduct from the College of
                           Midwives of Ontario and consent to the release of information from the
                           Registrar of the College.

            (5)    Each applicant shall be interviewed by the hospital’s Credential Committee,
                   Chief of Staff, President and Chief Executive Officer or delegate, and another
                   members as appropriate.

            (6)    The President and Chief Executive Officer shall retain a copy of the
                   application and shall refer the original application immediately to the Medical
                   Advisory Committee through its Chair who shall keep a record of each
                   application received and than refer the original application forthwith to the
                   Chair of the Credentials Committee.

            (7)    Each application shall be considered by the Medical Advisory Committee
                   which shall make a recommendation thereon in writing to the Board within
                   sixty (60) days from the date of the application.

            (8)    The Hospital and the Medical Advisory Committee shall deal with the
                   application in accordance with the Public Hospitals Act and the procedure set
                   out in subsections 11.1(1) to (7) and 11.2(1) to (13) of this By-law.

9.2.2        Criteria for Appointment to the Midwifery Staff

            (1)    Only an applicant qualified to practice midwifery and who holds a current,
                   valid Certificate of Registration with the College of Midwives of Ontario is
                   eligible to be a member of and appointed to the midwifery staff of the Hospital.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


            (2)    The applicant will have:

                   (a)     a certificate of Registration with the College of Midwives of Ontario;

                   (b)     a current certificate of Professional Conduct from the College of
                           Midwives of Ontario;

                   (c)     a demonstrated ability to provide patient care at an appropriate level of
                           quality and efficiency;

                   (d)     a demonstrated ability to communicate, work with and relate to all
                           members of the midwifery, medical, dental, nurse - extended class
                           nurse with privileges staff and Hospital staff in a co-operative and
                           professional manner;

                   (e)     a demonstrated ability to communicate and relate appropriately with
                           patients and patients' relatives;

                   (f)     a willingness to participate in the discharge of staff obligations
                           appropriate to his or her membership group;

                   (g)     adequate training and experience for the privileges requested;

                   (h)     evidence of midwifery practice protection coverage satisfactory to the
                           Board; and

                   (i)     a report on, among other things, the experience, competence and
                           reputation of the applicant from the Chief of Staff or the Chief of
                           Department in the last hospital or facility in which the applicant trained
                           or held an appointment, if possible, or where such report is not
                           available, a report from any other physician where the physician has
                           had direct knowledge of the midwife's experience, competence and
                           reputation.

            (3)    The applicant must agree to govern himself or herself in accordance with the
                   requirements set out in this By-law, the Rules of the Hospital and the Hospital
                   policies.

            (4)    The applicant must indicate to the Credentials Committee adequate control of
                   any significant physical or behavioural impairment that affects skill, attitude or
                   judgment.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


            (5)     There is a need for the services in the community.

9.2.3        Term

            (1)     Each appointment to the midwifery staff shall be for one (1) year, but shall
                    continue in effect until the Board has made appointments for the ensuing year.

9.3         RE-APPOINTMENT

9.3.1        Application for Re-Appointment and Performance Review

            (1)     Upon recommendation by the Medical Advisory Committee, the Board shall
                    establish and approve a process for the annual performance review of each
                    member of the midwifery staff.

            (2)     Each member of the midwifery staff shall submit annually an application for
                    re-appointment to the midwifery staff to the President and Chief Executive
                    Officer.

            (3)     The application for re-appointment to the midwifery staff shall be processed in
                    the same manner as set out in Clause 7.5

9.3.2        Criteria for Re-Appointment to the Midwifery Staff

            (1)     In order to be eligible for re-appointment, the applicant shall:

                    (a)    continue to meet the criteria set out at clause 9.2.2;

                    (b)    have demonstrated an appropriate use of Hospital resources; and

                    (c)    meets other requirements that may be needed from time to time.

9.3.3        Refusal to Re-Appoint

            (1)     In a manner consistent with the provisions Public Hospitals Act and in
                    accordance with the Regulations thereunder, the Board may refuse to re-
                    appoint a member of the midwifery staff.
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


9.4         CHANGE OF PRIVILEGES

9.4.1        Application for Change Of Privileges

            (1)    Where a midwife wishes to change his or her privileges the midwife shall
                   make a written application, in the prescribed form, listing the change of
                   privileges which is requested and shall submit evidence of appropriate training
                   and competence in respect of the privileges being requested.

            (2)    An application for a change in privileges made by a member of the midwifery
                   staff shall be processed in the same manner as set out in clause 9.2.1.

9.5         MID-TERM ACTION

9.5.1        Mid-Term Action

            (1)    In a manner consistent with the Public Hospitals Act and in accordance with
                   the Regulations thereunder and this By-law, the Board at any time may revoke
                   or suspend any appointment of a member of the midwifery staff, or dismiss,
                   suspend, restrict or otherwise deal with the privileges of the member.

            (2)    Mid-term action in respect of a member of the midwifery staff, shall be
                   processed in accordance with, and in the same manner provided in part 12 of
                   this By-law.

9.6         MIDWIFERY STAFF GROUPS

9.6.1        Midwifery Staff Groups

            (1)    The midwifery staff shall be divided into the following groups:

                   (a)     active;

                   (b)     associate;

                   (c)     courtesy;

                   (d)     locum tenens; and

                   (e)     temporary.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


9.6.2        Active Midwifery Staff

            (1)    The active midwifery staff shall consist of those midwives who have been
                   appointed as active midwifery staff by the Board.

            (2)    Except where approved by the Board, no midwife with an active midwifery
                   staff appointment at another hospital shall be appointed to the active midwifery
                   staff.

            (3)    Every midwife applying for appointment to the active midwifery staff will
                   have served on the associate staff for a probationary period.

            (4)    Each member of the active midwifery staff is responsible for ensuring that
                   midwifery care is provided to his or her patients in the Hospital.

            (5)    All active midwifery staff members shall have admitting privileges unless
                   otherwise specified in their appointment to the midwifery staff.

            (6)    Each member of the active midwifery staff shall:

                   (a)     undertake such duties in respect of those patients classed as emergency
                           cases as may be specified by the Chief of Staff or by the Chief of the
                           Department to which the midwife has been assigned;

                   (b)     attend patients, and undertake treatment and procedures only in
                           accordance with the kind and degree of privileges granted by the
                           Board;

                   (c)     act as a supervisor of a member of the midwifery staff when requested
                           by the Chief of Staff or the Chief of Department; and

                   (d)     participate in utilization and quality improvement.

9.6.3        Associate Midwifery Staff

            (1)    Each associate midwifery staff member shall have admitting privileges unless
                   otherwise specified in the appointment.

            (2)    An associate midwifery staff member shall work for a probationary period
                   under the supervision of an active medical staff or midwifery staff member
                   named by the Chief of Staff on the recommendation of the Chief of the
                   Department to which the associate midwifery staff member has been assigned.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


            (3)    A supervisor shall carry out the duties in accordance with the Rules of the
                   Hospital.

            (4)    During the probationary period, the supervisor shall make a written report to
                   the Chief of Staff at least every six months or at any time if there are concerns.
                   Every report made under this subsection shall include:

                   (a)     information concerning the knowledge and skill which has been shown
                           by the associate staff member;

                   (b)     the nature and quality of their work in the hospital;

                   (c)     comments on the utilization of hospital resources; and

                   (d)     the associate staff member’s ability to function in conjunction with the
                           other members of the hospital staff;

            (5)    After one (1) year the appointment of a midwife to the associate midwifery
                   staff shall be reviewed by the Credentials Committee who shall report to the
                   Medical Advisory Committee.

            (6)    The Medical Advisory Committee may recommend that the midwife be
                   appointed to the active midwifery staff or may require the midwife to be
                   subject to a further probationary period not longer than six (6) months.

            (7)    The Chief of Department, upon the request of an associate midwifery staff
                   member or a supervisor, may assign the associate midwifery staff member to a
                   different supervisor for a further probationary period.

            (8)    At any time an unfavourable report may cause the Medical Advisory
                   Committee to consider making a recommendation to the Board that the
                   appointment of the associate midwifery staff member be terminated.

            (9)    No member of the midwifery staff shall be appointed to the associate
                   midwifery staff for more than eighteen (18) consecutive months.

            (10)   An associate midwifery staff member shall:

                   (a)     attend patients, and undertake treatment and procedures under
                           supervision in accordance with the kind and degree of privileges
                           granted by the Board on the recommendation of the Medical Advisory
                           Committee; and
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   (b)     undertake such duties in respect of those patients classed as emergency
                           cases as may be specified by the Chief of the Department to which the
                           midwife has been assigned.

9.6.4        Courtesy Midwifery Staff

            (1)    The Board may grant a midwife an appointment to the courtesy midwifery
                   staff in one or more of the following circumstances:

                   (a)     the applicant has an active midwifery staff commitment at another
                           hospital; or

                   (b)     the applicant lives at such a remote distance from the Hospital that it
                           limits full participation in active midwifery staff duties, but he or she
                           wishes to maintain an affiliation with the Hospital; or

                   (c)     the applicant has a primary commitment to, or contractual relationship
                           with, another community or organization; or

                   (d)     the applicant requests access to limited Hospital resources or outpatient
                           programs or facilities; or

                   (e)     where the Board deems it otherwise advisable.

            (2)    (a)      The Board may grant a midwife an appointment to the courtesy
                            midwifery staff with such privileges as the Board deems advisable.
                            Privileges to admit patients shall be granted under specified
                            circumstances; and

                   (b)     The circumstances leading to an appointment under this clause shall be
                           specified by the midwife on each application for re-appointment.

            (3)    A courtesy midwifery staff member shall work for a probationary one year
                   period under the supervision of an active midwifery or medical staff member
                   named by the Chief of Staff.

            (4)    The named supervisor shall carry out the duties in accordance with the Medical
                   Staff Rules.

            (5)    (a)      During the probationary period, the supervisor shall make a written
                            report to the Chief of Staff at least every six months or at any time if
The Stevenson Memorial Hospital Corporation By-laws                                         May 8, 2008


                            there are concerns. Every report made under this subsection shall
                            include:

                           (i)      information concerning the knowledge and skill which has been
                                    shown by the courtesy staff member;

                           (ii)     the nature and quality of their work in the hospital;

                           (iii)    comments on the utilization of hospital resources; and

                           (iv)     the courtesy staff member's ability to function in conjunction
                                    with the other members of the hospital staff.

                   (b)     At any time during a probationary period, upon the request of the
                           courtesy midwifery staff member, or the supervisor, the Chief of Staff
                           and/or the Medical Advisory Committee may assign a different
                           supervisor.

                   (c)     At any time an unfavourable report may cause the Medical Advisory
                           Committee to consider making a recommendation to the Board that the
                           appointment of the courtesy midwifery staff member be terminated.

            (6)    Members of the courtesy midwifery staff may attend medical staff meetings
                   but unless the Board so requires shall not be subject to the attendance
                   requirements and penalties as provided by these By-laws and the Medical Staff
                   Rules.

            (7)    A member of the courtesy midwifery staff shall not vote at medical staff
                   meetings nor be elected a medical staff officer, but may be appointed to
                   hospital or medical staff committees.

9.6.5        Locum Tenens

            (1)    The Medical Advisory Committee upon the request of a member of the
                   midwifery staff may recommend the appointment of a locum tenens as a
                   planned replacement for that midwife for a specified period of time.

            (2)    A locum tenens shall:

                   (a)     have admitting privileges unless otherwise specified;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   (b)     work under the counsel and supervision of a member of the active
                           medical or midwifery staff who has been assigned this responsibility by
                           the Chief of Staff or his or her delegate;

                   (c)     attend patients assigned to his or her care by the active medical or
                           midwifery staff member by whom he or she is supervised, and shall
                           treat them within the professional privileges granted by the Board on
                           the recommendation of the Medical Advisory Committee; and

                   (d)     undertake such duties in respect of those patients classed as emergency
                           cases as may be specified by the Chief of Staff or by the Chief of the
                           Department to which the midwife has been assigned.

9.6.6        Temporary Midwifery Staff

            (1)    A temporary appointment of a midwife to the midwifery staff may be made
                   only for one of the following reasons:

                   (a)     to meet a specific singular requirement by providing a consultation
                           and/or procedure; or

                   (b)     to meet an urgent unexpected need for a midwifery service.

            (2)    Notwithstanding any other provision in this By-law, the President and Chief
                   Executive Officer, after consultation with the Chief of Staff or his or her
                   delegate, may:

                   (a)     grant a temporary appointment to a midwife who is not a member of
                           the midwifery staff provided that such appointment shall not extend
                           beyond the date of the next meeting of the Medical Advisory
                           Committee at which time the action taken shall be reported; and

                   (b)     continue the appointment on the recommendation of the Medical
                           Advisory Committee until the next meeting of the Board.

            (3)    A temporary appointment shall not have privileges to admit patients.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


9.7         MIDWIFERY STAFF DUTIES

9.7.1        Midwifery Staff Duties

            (1)    Each member of the midwifery staff is accountable to and shall recognize the
                   authority of the Board through and with their Chief of Department, Chief of
                   Staff, and the President and Chief Executive Officer.

            (2)    Each member of the midwifery staff shall:

                   (a)     attend and treat patients within the limits of the privileges granted by
                           the Board, unless the privileges are otherwise restricted;

                   (b)     notify the President and Chief Executive Officer of any change in the
                           certificate of Registration with the College of Midwives of Ontario;

                   (c)     give such instruction as is required for the education of other members
                           of the midwifery, medical, dental, nurse - extended class nurse with
                           privileges staff and Hospital staff;

                   (d)     abide by Rules of the Hospital, this By-law, the Public Hospitals Act
                           and the Regulations thereunder and all other legislated requirements;

                   (e)     perform such other duties as may be prescribed from time to time by, or
                           under the authority of the Board, the Medical Advisory Committee or
                           the Chief of Staff; and

                   (f)     provide consultations on patients as required.

            (3)    Every member of the midwifery staff shall co-operate with:

                   (a)     the Chief of Staff and the Medical Advisory Committee;

                   (b)     the Head Midwife; and

                   (c)     the President and Chief Executive Officer.

            (4)    Participate in Utilization and Quality Improvement, and any other program
                   which the Board may institute.
The Stevenson Memorial Hospital Corporation By-laws                                  May 8, 2008


            (5)    Maintain a program of Continuing Medical Education relevant to the privileges
                   granted by the Board and as set out by the Credentials Committee.

            (6)    Provide coverage in emergency situations as required by the Board, the
                   Medical Advisory Committee, or the Chief of Staff; this coverage shall be at
                   last sufficient to maintain the level of service provided to the community by
                   the hospital.

            (7)    A member of the midwifery staff shall be a voting member of the Obstetrical
                   Committee as established by the Medical Advisory Committee and shall attend
                   a minimum of 70 percent of Committee meetings.

            (8)    Perform such other duties as may be prescribed from time to time by or under
                   the authority of the Medical Advisory Committee.

9.7.2        Monitoring Aberrant Practices

            (1)    Refer to Clause 7.9.4.

9.7.3        Viewing Deliveries, Therapeutic Actions Or Procedures

            (1)    Refer to Clause 7.9.5

9.7.4        Transfer Of Responsibility

            (1)    Refer to Clause 7.9.6.

9.8         MIDWIFERY STAFF

9.8.1        Midwifery Staff: Function Within Medical Staff Department

            (1)    The midwifery staff shall function within the Maternal and Child Health
                   Department.

9.8.2        Head Midwife

            (1)    Where the Board has appointed more than one (1) midwife to the midwifery
                   staff, one (1) of the members of the midwifery staff shall, subject to annual
                   confirmation by the Board, be appointed by the Board upon the
                   recommendation of the Medical Advisory Committee annually for a term of
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   three (3) years to be the Head Midwife upon the recommendation of the Chief
                   of Staff.

            (2)    The Board may at any time revoke or suspend the appointment of the Head
                   Midwife.

9.8.3        Duties Of The Head Midwife

            (1)    The Head Midwife shall supervise the professional care given by all members
                   of the midwifery staff and shall be responsible to the Chief of Staff for the
                   quality of care rendered to patients by members of the midwifery staff.

9.9         MEETINGS

9.9.1        Attendance By Midwifery Staff At Medical Staff Meetings

            (1)    A member of the midwifery staff may attend medical staff meetings but shall
                   not be eligible to vote at a medical staff meeting.

9.10        MIDWIFERY STAFF ELECTED OFFICERS

9.10.1       Eligibility To Hold A Medical Staff Office

            (1)    A member of the midwifery staff is not eligible to hold an office of the medical
                   staff other than Head Midwife.

10.      NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF

10.1        APPOINTMENT OF NURSE - EXTENDED CLASS NURSE WITH
            PRIVILEGES STAFF

            (1)    The Board, on the advice of the Medical Advisory Committee, may appoint,
                   annually, one or more registered nurses in the nurse - extended class nurse with
                   privileges who are not employees of the Hospital to the nurse - extended class
                   nurse with privileges staff of the Hospital and shall delineate the privileges
                   with respect to diagnosing, prescribing for or treating inpatients and outpatients
                   in the Hospitals.
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


10.2        APPOINTMENT TO NURSE - EXTENDED CLASS NURSE WITH
            PRIVILEGES STAFF

10.2.1       Application For Appointment to the Nurse - Extended Class Nurse With
             Privileges Staff

            (1)    An application for appointment to the nurse – extended class nurse with
                   privileges staff shall be processed in the same manner as an application for
                   appointment to the medical staff as set out in clause 7.4.

            (2)    On request, the President and Chief Executive Officer shall supply a copy of
                   the By-laws, the Rules of the Hospital, the Public Hospitals Act and the
                   Regulations thereunder, to each registered nurse in the nurse - extended class
                   nurse with privileges who expresses in writing the intention to apply for
                   appointment to the nurse - extended class nurse with privileges staff.

            (3)    An applicant for appointment to the nurse - extended class nurse with
                   privileges staff shall submit one (1) original written application to the President
                   and Chief Executive Officer.

            (4)    Each application shall contain:

                   (a)     a statement by the applicant that he or she has read the Public Hospitals
                           Act and the Hospital Management Regulation thereunder, and the
                           By-and the Rules of the Hospital;

                   (b)     an undertaking that, if he or she is appointed to the nurse - extended
                           class nurse with privileges staff of the Hospital, he or she will govern
                           himself or herself in accordance with the requirements set out in the
                           By-laws and the Rules of the Hospital;

                   (c)     evidence of appropriate protection coverage for practice as a registered
                           nurse in the extended class satisfactory to the Board;

                   (d)     a list of the privileges which are requested;

                   (e)     an up-to-date curriculum vitae;

                   (f)     a list of three (3) appropriate referees, including one (1) from a
                           physician who has worked with the registered nurse in the extended
                           class;
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   (g)     information of any previous disciplinary proceeding where there was an
                           adverse finding;

                   (h)     information of any civil suit where there was a finding of negligence or
                           battery;

                   (i)     a signed consent authorizing the College of Nurses of Ontario, and any
                           other governing regulatory body or referee, to provide a report on:

                   (j)     any action taken by its disciplinary or fitness to practise committee, and

                   (k)     whether his or her privileges have been curtailed or cancelled by the
                           College of Nurses of Ontario, or by any other governing regulatory
                           body, or by another hospital because of incompetence, negligence,
                           incapacity or any act of professional misconduct; and

                   (l)     a current Annual Registration Payment Card from the College of
                           Nurses of Ontario and consent to the release of information from the
                           Registrar of the College.

            (5)    Each applicant shall be interviewed by the hospital’s Credential Committee,
                   Chief of Staff, President and Chief Executive Officer or delegate, and another
                   members as appropriate.

            (6)    The President and Chief Executive Officer shall retain a copy of the
                   application and shall refer the original application immediately to the Medical
                   Advisory Committee through its Chair who shall keep a record of each
                   application received and than refer the original application forthwith to the
                   Chair of the Credentials Committee.

            (7)    Each application shall be considered by the Medical Advisory Committee
                   which shall make a recommendation thereon in writing to the Board within
                   sixty (60) days from the date of the application.

            (8)    The Hospital and the Medical Advisory Committee shall deal with the
                   application in accordance with the Public Hospitals Act and the procedure set
                   out in subsections 11.1(1) to (7) and 11.2(1) to (13) of this By-law.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


10.2.2       Criteria for Appointment to the Nurse - Extended Class Nurse With Privileges
             Staff

            (1)    Only an applicant qualified to practise as a registered nurse in the nurse-
                   extended class with privileges and who holds a current, valid Annual
                   Registration Payment Card as a registered nurse in the extended class with the
                   College of Nurses of Ontario and is not an employee of the Hospital is eligible
                   to be a member of and appointed to the nurse - extended class nurse with
                   privileges staff of the Hospital.

            (2)    The applicant will have:

                   (a)     an Annual Registration Payment Card as a registered nurse in the
                           extended class with the College of Nurses of Ontario;

                   (b)     a demonstrated ability to provide patient care at an appropriate level of
                           quality and efficiency;

                   (c)     a demonstrated ability to communicate, work with and relate to all
                           members of the nurse - extended class nurse with privileges staff,
                           medical staff, dental staff, midwifery staff, and Hospital staff in a co-
                           operative and professional manner;

                   (d)     a demonstrated ability to communicate and relate appropriately with
                           patients and patients' relatives;

                   (e)     a willingness to participate in the discharge of staff obligations
                           appropriate to his or her membership group;

                   (f)     adequate training and experience for the privileges requested;

                   (g)     evidence of appropriate protection coverage for practice as a registered
                           nurse in the extended class satisfactory to the Board; and

                   (h)     a report on, among other things, the experience, competence and
                           reputation of the applicant from the Chief of Staff or the Chief of
                           Department in the last hospital or facility in which the applicant trained
                           or held an appointment, if possible, or where such report is not
                           available, a report from any other physician where the physician has
                           had direct knowledge of the registered nurse in the extended class
                           experience, competence and reputation.
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


            (3)     The applicant must agree to govern himself or herself in accordance with the
                    requirements set out in this By-law, the Rules of the Hospital and the Hospital
                    policies.

            (4)     The applicant must indicate to the Credentials Committee adequate control of
                    any significant physical or behavioural impairment that affects skill, attitude or
                    judgment.

            (5)     There is a need for the services in the community.

10.2.3       Term

            (1)     Each appointment to the nurse - extended class nurse with privileges staff shall
                    be for one (1) year, but shall continue in effect until the Board has made
                    appointments for the ensuing year.

10.3        RE-APPOINTMENT

10.3.1       Application for Re-Appointment and Performance Review

            (1)     Upon recommendation by the Medical Advisory Committee, the Board shall
                    establish and approve a process for the annual performance review of each
                    member of the nurse - extended class nurse with privileges staff.

            (2)     Each member of the nurse – extended class nurse with privileges staff shall
                    submit annually an application for re-appointment to the nurse – extended class
                    nurse with privileges staff to the President and Chief Executive Officer.

            (3)     The application for re-appointment to the nurse – extended class nurse with
                    privileges staff shall be processed in the same manner as set out in Clause 70.

10.3.2       Criteria For Re-Appointment to the Nurse - Extended Class Nurse With
             Privileges Staff

            (1)     In order to be eligible for re-appointment, the applicant shall:

                    (a)    continue to meet the criteria set out at clause 10.2.2;

                    (b)    have demonstrated an appropriate use of Hospital resources; and

                    (c)    meets other requirements that may be needed from time to time.
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


10.3.3       Refusal to Re-Appoint

            (1)    In a manner consistent with the provisions of the Public Hospitals Act and in
                   accordance with the Regulations thereunder, the Board may refuse to
                   re-appoint a member of the nurse - extended class nurse with privileges staff.

10.4        MID-TERM ACTION

10.4.1       Mid-Term Action

            (1)    In a manner consistent with the Public Hospitals Act and in accordance with
                   the Regulations there under and this By-law, the Board at any time may revoke
                   or suspend any appointment of a registered nurse in the nurse - extended class
                   nurse with privileges or dismiss, suspend, restrict or otherwise deal with the
                   privileges of the member.

            (2)    Mid-term action in respect of a member of the nurse - extended class nurse
                   with privileges staff, shall be processed in accordance with, and in the same
                   manner provided in part 12 of this By-law.

10.5        NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF GROUPS

10.5.1       Nurse - Extended Class Nurse With Privileges Staff Groups

            (1)    Nurse - extended class nurse with privileges staff may be divided into the
                   following groups:

                   (a)     courtesy; and

                   (b)     locum tenens.

10.5.2       Courtesy Nurse - Extended Class Nurse With Privileges Staff

            (1)    The Board may grant a registered nurse in the nurse - extended class nurse
                   with privileges, who is not an employee of the Hospital, an appointment to the
                   courtesy nurse - extended class nurse with privileges staff to register
                   outpatients in the Hospital to diagnose, prescribe for or treat such inpatients
                   and outpatients.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


10.5.3       Locum Tenens Nurse - Extended Class Nurse with Privileges Staff

            (1)    The Medical Advisory Committee upon the request of a member of the nurse -
                   extended class nurse with privileges staff may recommend the appointment of
                   a locum tenens as a planned replacement for that registered nurse in the nurse -
                   extended class nurse with privileges for a specified period of time.

            (2)    A locum tenens shall:

                   (a)     register outpatients in the Hospital to diagnose, prescribe for or treat
                           such outpatients; and

                   (b)     work under the counsel and supervision of a member of the active
                           medical staff or courtesy nurse - extended class nurse with privileges
                           staff who has been assigned this responsibility by the Chief of Staff or
                           his or her delegate.

10.6        NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF DUTIES

10.6.1       Nurse - Extended Class Nurse With Privileges Staff Duties

            (1)    Each member of the nurse - extended class nurse with privileges staff is
                   accountable to and shall recognize the authority of the Board through and with
                   their Chief of Department, the Chief of Staff, and the President and Chief
                   Executive Officer.

            (2)    Each member of the nurse - extended class nurse with privileges staff shall,

                   (a)     register a person as an outpatient for purposes of diagnosing,
                           prescribing for or treating inpatients and outpatients in the Hospital;

                   (b)     notify the President and Chief Executive Officer of any change in the
                           class of registration on the Annual Registration Payment Card from the
                           College of Nurses of Ontario;

                   (c)     give such instruction as is required for the education of other members
                           of the nurse - extended class nurse staff with privileges, medical staff,
                           dental staff, midwifery staff and Hospital staff;

                   (d)     abide by the Rules of the Hospital, this By-law, the Public Hospitals
                           Act and the Regulations thereunder and all other legislated
                           requirements;
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   (e)     co-operate with:

                           (i)      the Chief of Staff and the Medical Advisory Committee,

                           (ii)     the Chief of Family Practice, and

                           (iii)    the President and Chief Executive Officer;

                   (f)     perform such other duties as may be prescribed from time to time by, or
                           under the authority of the Board, the Medical Advisory Committee or
                           the Chief of Staff.

10.6.2       Monitoring Aberrant Practices

            (1)    Refer to Clause 7.9.4.

10.6.3       Viewing Therapeutic Actions or Procedures

            (1)    Refer to Clause 7.9.5.

10.6.4       Transfer Of Responsibility

            (1)    Refer to Clause 7.9.6.

10.7        NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF

10.7.1       Nurse - Extended Class Nurse With Privileges Staff: Function Within Medical
             Staff Department

            (1)    The nurse - extended class nurse with privileges staff shall function within the
                   Department of Family Practice.

10.8        MEETINGS

10.8.1       Attendance By Nurse - Extended Class Nurse With Privileges Staff At Medical
             Staff Meetings

            (1)    A member of the nurse - extended class nurse with privileges staff may attend
                   medical staff meetings, but shall not be eligible to vote at a medical staff
                   meeting.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


10.9        NURSE - EXTENDED CLASS NURSE WITH PRIVILEGES STAFF
            ELECTED OFFICERS

10.9.1       Eligibility To Hold A Medical Staff Office

            (1)    A member of the nurse - extended class nurse with privileges staff is not
                   eligible to hold an office of the medical staff.

11.  THE MEDICAL ADVISORY COMMITTEE AND BOARD PROCESS FOR
APPLICATIONS, RE-APPLICATIONS, CHANGES IN PRIVILEGES AND MID-TERM
ACTION

11.1        THE MEDICAL ADVISORY COMMITTEE MEETING

            (1)    In the case of an application for appointment, reappointment or change in
                   privileges, within sixty (60) days from the date of the application, the Medical
                   Advisory Committee shall give written notice to the Board and the applicant or
                   member, as the case may be, of its recommendation.

            (2)    In the case of mid-term action, within fourteen (14) days from the date of the
                   Medical Advisory Committee meeting, the Medical Advisory Committee shall
                   give written notice to the Board and the member of its recommendation.

            (3)    The notice referred to in subsection (1) and (2) shall:

                   (a)     include the written reasons for the recommendation; and

                   (b)     inform the applicant or member, as the case may be, that he or she is
                           entitled to a hearing before the Board if a written request is received by
                           the Board and the Medical Advisory Committee within seven (7) days
                           of the receipt by the applicant or member, as the case may be, of the
                           written reasons under clause (a).

            (4)    The time period to provide the written notice required in subsection (1) or (2)
                   may be extended, if, prior to the expiry of the time period, the Medical
                   Advisory Committee gives written notice to the Board and the applicant or
                   member, as the case may be, that the final recommendation cannot yet be made
                   and provides written reasons therefore.

            (5)    Service of a notice to the applicant or member may be made personally or by
                   registered mail addressed to the person to be served at his or her last known
                   address and, where the notice is served by registered mail, it shall be deemed
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   that the notice was served on the third day after the day of mailing unless the
                   person to be served establishes that he or she did not, acting in good faith,
                   through absence, accident, illness or other cause beyond his or her control
                   receive it until a later date.

            (6)    Where the applicant or member does not require a hearing by the hospital
                   Board, the hospital Board may implement the recommendation of the Medical
                   Advisory Committee.

            (7)    Where the applicant or member requires a hearing by the hospital Board, the
                   hospital Board shall appoint a place and a time for the hearing.

            (8)    Where the member continues in his or her duties at the hospital and the Chief
                   of Department believes the member's work should be scrutinized, the applicant
                   or member's work shall be scrutinized in a manner to be determined by the
                   Chief of the Department.

            (9)    If at any time it becomes apparent that the member's conduct, performance or
                   competence is such that it exposes, or is reasonably likely to expose patient(s)
                   to harm or injury and immediate action must be taken to protect the patients,
                   then the procedures under immediate measures in an emergency situation shall
                   be invoked.

11.2        THE BOARD HEARING

            (1)    The hospital Board shall name a place and time for the hearing.

            (2)    The hospital Board hearing shall be held within fourteen (14) days of the
                   hospital Board receiving the notice from the applicant or member requesting a
                   hearing.

            (3)    The hospital Board shall give written notice of the hearing to the applicant or
                   member and to the Chair (or substitute) of the Medical Advisory Committee at
                   least seven (7) days before the hearing date.

            (4)    The notice of the hospital Board hearing shall include:

                   (a)     the place and time of the hearing;

                   (b)     the purpose of the hearing;
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   (c)     a statement that the applicant or member and the Medical Advisory
                           Committee shall be afforded an opportunity to examine prior to the
                           hearing, any written or documentary evidence that will be provided or
                           any report, the contents of which will be given in evidence at the
                           hearing;

                   (d)     a statement that the applicant or member may proceed in person or be
                           represented by counsel, and that in his or her absence the hospital
                           Board may proceed with the hearing and that the applicant or member
                           will not be entitled to any further notice of the proceeding;

                   (e)     a statement that the applicant or member may call witnesses and tender
                           documents in evidence in support of his or her case; and

                   (f)     a statement that the time for the hearing may be extended by the
                           hospital Board.

            (5)    The parties to the hospital Board hearing are the applicant or member, the
                   Medical Advisory Committee and such other persons as the hospital Board
                   may specify.

            (6)    The applicant or member requiring a hearing before the hospital Board shall be
                   afforded an opportunity to examine, prior to the hearing, any written or
                   documentary evidence that will be produced, or any report the contents of
                   which will be given in evidence at the hearing.

            (7)    Members of the hospital Board holding the hearing shall not have taken part in
                   any investigation or consideration of the subject matter of the hearing before
                   the hearing and shall not communicate directly or indirectly in relation to the
                   subject matter of the hearing with any person or with any party or his or her
                   representative, except upon notice to and an opportunity for all parties to
                   participate.

            (8)    The findings of fact of the hospital Board pursuant to a hearing shall be based
                   exclusively on evidence admissible or matters that may be noticed under
                   clauses 15 and 16 of the Statutory Powers Procedure Act.

            (9)    The hospital Board shall consider only the reasons of the Medical Advisory
                   Committee that have been given to the applicant or member in support of its
                   recommendation. Where through error or inadvertence, certain reasons have
                   been omitted in the statement delivered to the applicant or member, the
                   hospital Board may consider those reasons only if those reasons are given by
                   the Medical Advisory Committee in writing to both the applicant or member,
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


                   as the case may be, and the hospital Board and the applicant or member is
                   given a reasonable time to review the reasons and to prepare a case to meet
                   those additional reasons.

            (10)   No member of the hospital Board shall participate in a decision of the hospital
                   Board pursuant to a hearing unless he or she was present throughout the
                   hearing and heard the evidence and argument of the parties and, except with
                   the consent of the parties, no decision of the hospital Board shall be given
                   unless all applicant or members so present participate in the decision.

            (11)   The hospital Board shall make a decision to either follow or not follow the
                   recommendation of the Medical Advisory Committee.

            (12)   A written copy of the decision of the hospital Board and the written reasons for
                   the decision shall be provided to the applicant or member, as the case may be,
                   and to the Medical Advisory Committee secretary.

            (13)   Service of the notice of the decision and the written reasons to the applicant or
                   member may be made personally or by registered mail addressed to the
                   applicant or member at his or her last known address and, where the notice is
                   served by registered mail, it shall be deemed that the notice was served on the
                   third day after the day of mailing unless the person to be served establishes that
                   he or she did not, acting in good faith, through absence, accident, illness or
                   other cause beyond his or her control receive it until a later date.

12.      MID-TERM ACTION

12.1        NON-IMMEDIATE MID-TERM ACTION

12.1.1       Preliminary Steps in Mid-Term Review

            Criteria For Initiation

            (1)    Mid-term action may be initiated wherever the member is alleged to have
                   engaged in, made or exhibited acts, statements, demeanour or professional
                   conduct, either within or outside of the hospital, and the same exposes, or is
                   reasonably likely to expose patients to harm or injury, or the same is, or is
                   reasonably likely to be, detrimental to patient safety or to the delivery of
                   quality patient care within the hospital, or the same is, or is reasonably likely to
                   be, detrimental to hospital operations; or the same is, or is reasonably likely to
                   constitute abuse; or the same results in the imposition of sanctions by the
                   professional College; or the same is contrary to the By-laws, hospital policies,
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   the rules, the Public Hospitals Act or the regulations made thereunder or any
                   other relevant law or legislated requirement.

            Initiation

            (2)    Where information is provided to the President and Chief Executive Officer,
                   Chief of Staff, or Chief of Department which raises concerns about any of the
                   matters in clause 12.1.1(1), the information shall be in writing and shall be
                   directed to the President and Chief Executive Officer, Chief of Staff, or Chief
                   of Department.

            (3)    If either of the President and Chief Executive Officer, Chief of Staff, or Chief
                   of Department, receives information about the conduct, performance or
                   competence of a member, he or she shall inform the other individuals.

            Initial Interview

            (4)    An interview shall be arranged with the member.

            (5)    The member shall be advised of the information about his or her conduct,
                   performance or competence and shall be given a reasonable opportunity to
                   present relevant information on his or her own behalf.

            (6)    A written record shall be maintained reflecting the substance of the interview
                   and copies shall be sent to the member, the President and Chief Executive
                   Officer, the Chief of Staff, and Chief of Department

            (7)    If the member fails or declines to participate in the interview after being given
                   a reasonable opportunity, the appropriate action may be initiated.

            Investigation

            (8)    The Chief of Staff, Chief of Department or President and Chief Executive
                   Officer shall determine whether a further investigation is necessary.

            (9)    The investigation may be assigned to an individual(s) within the hospital, the
                   Medical Advisory Committee, a body within the hospital other than the
                   Medical Advisory Committee or an external consultant.

            (10)   Upon completion of the investigation, the individual or body who conducted
                   the investigation shall forward a written report to the President and Chief
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                   Executive Officer, Chief of Staff, and the Chief of Department. The member
                   should be provided with a copy of the written report.

            (11)   The Chief of Staff, Chief of Department and President and Chief Executive
                   Officer, shall review the report and determine whether any further action may
                   be required.

12.1.2       Request to the Medical Advisory Committee for Recommendation For
             Mid-Term Action

            (1)    Where it is determined that further action may be required and the matter
                   relates to the dismissal, suspension or restriction of a member's hospital
                   privileges and/or the quality of medical care or dental care in the hospital, the
                   matter shall be referred to the Medical Advisory Committee who shall make a
                   recommendation to the Board.

            (2)    All requests for a recommendation for mid-term action must be submitted to
                   the Medical Advisory Committee in writing and supported by reference to the
                   specific activities or conduct which constitute grounds for the request.

            (3)    Where the matter is referred to the Medical Advisory Committee, a copy of
                   any reports made by a body or consultant with respect to the matter shall be
                   forwarded to the Medical Advisory Committee.

            (4)    The Medical Advisory Committee may initiate further investigation itself,
                   establish an Ad Hoc Committee to conduct the investigation, refer the matter to
                   an external consultant, dismiss the matter for lack of merit or determine to
                   have a meeting of the Medical Advisory Committee.

            (5)    Where the Medical Advisory Committee establishes an Ad Hoc Committee to
                   conduct the investigation or refers the matter to an external consultant, that
                   individual or body shall forward a written report of the investigation to the
                   Medical Advisory Committee as soon as practicable after the completion of the
                   investigation.

            (6)    Upon completion of its own investigation or upon receipt of the report by the
                   body that conducted the investigation, as the case may be, the Medical
                   Advisory Committee may either dismiss the matter for lack of merit or
                   determine to have a meeting of the Medical Advisory Committee.

            (7)    Within twenty-one (21) days after receipt by the Medical Advisory Committee
                   of the request for a recommendation for mid-term action, unless deferred, the
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


                   Medical Advisory Committee shall determine whether a meeting of the
                   Medical Advisory Committee is required to be held.

            (8)    If additional time is needed for the investigative process, the Medical Advisory
                   Committee may defer action on the request. The Medical Advisory Committee
                   must act within thirty (30) days of the deferral.

            (9)    If the Medical Advisory Committee determines that there is merit to proceed to
                   a Medical Advisory Committee meeting, then the member is entitled to attend
                   the meeting.

12.1.3       The Medical Advisory Committee Meeting

            (1)    At least fourteen (14) days prior to the Medical Advisory Committee meeting
                   the member and the Medical Advisory Committee shall be given written notice
                   of the Medical Advisory Committee meeting. The notice shall include:

                   (a)     the time and place of the meeting;

                   (b)     the purpose of the meeting;

                   (c)     a statement that the member will be provided with a statement of the
                           matter to be considered by the Medical Advisory Committee together
                           with any relevant documentation;

                   (d)     a statement that the member is entitled to attend the Medical Advisory
                           Committee meeting and to participate fully, to answer all matters
                           considered by the Medical Advisory Committee and to present
                           documents and witnesses;

                   (e)     a statement that the parties are entitled to bring legal counsel to the
                           meeting and consult with legal counsel, but that the legal counsel will
                           not be entitled to participate in the meeting; and

                   (f)     a statement that in the absence of the member, the meeting may
                           proceed .

            (2)    The Medical Advisory Committee secretary shall provide the member with a
                   short but comprehensive statement of the matter to be considered by the
                   Medical Advisory Committee, together with any relevant documentation,
                   including any reports and other documentation which will be reviewed at the
                   meeting.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (3)    At the meeting of the Medical Advisory Committee, a record of the proceeding
                   shall be kept in the minutes of the Medical Advisory Committee meeting.

            (4)    The member involved shall be given full opportunity to answer each ground as
                   well as to present documents and witnesses if so desired.

            (5)    Where the Medical Advisory Committee determines that the matter has no
                   merit, this shall be noted in the minutes of the Medical Advisory Committee.

            (6)    Where the Medical Advisory Committee determines that the matter has merit,
                   the Medical Advisory Committee shall make a recommendation to the Hospital
                   Board.

            (7)    Where the Medical Advisory Committee considers the matter at a Medical
                   Advisory Committee meeting, then the procedure set out herein at
                   subsections 11.1(1) to (9) and 11.2(1) to (13) of this By-law are to be followed.

12.2        IMMEDIATE MID-TERM ACTION IN AN EMERGENCY SITUATION

12.2.1       Immediate Steps

            (1)    Where the conduct, performance or competence of a member exposes, or is
                   reasonably likely to expose patient(s) to harm or injury and immediate action
                   must be taken to protect the patients and no less restrictive measure can be
                   taken, the Chief of Staff or Chief of Department, or his or here delegate, may
                   immediately and temporarily suspend the member's privileges, with immediate
                   notice to the President and Chief Executive Officer, or his or her delegate, and
                   pending a Medical Advisory Committee meeting and a hearing by the Hospital
                   Board.

            (2)    The Chief of Staff or Chief of Department shall immediately notify the
                   member, the Medical Advisory Committee, and the hospital Board of his or
                   her decision to suspend the member's privileges.

            (3)    Arrangements, as necessary, shall be made by the Chief of Staff or Chief of
                   Department for the assignment of a substitute physician to care for the patients
                   of the suspended member.

            (4)    Within forty-eight (48) hours of the suspension, the individual who suspended
                   the member shall provide the member and Medical Advisory Committee with
                   written reasons for the suspension and copies of any relevant documents or
                   records.
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


12.2.2       The Medical Advisory Committee Meeting

            (1)    The Medical Advisory Committee shall set a date for a meeting of the Medical
                   Advisory Committee to be held within five (5) days from the date of the
                   suspension to review the suspension and to make recommendations to the
                   Hospital Board.

            (2)    As soon as possible, and in any event, at least forty-eight (48) hours prior to
                   the Medical Advisory Committee meeting, the Medical Advisory Committee
                   shall provide the member with a written notice of:

                   (a)     the time and place of the meeting;

                   (b)     the purpose of the meeting;

                   (c)     a statement of the matter to be considered by the Medical Advisory
                           Committee together with any relevant documentation;

                   (d)     a statement that the member is entitled to attend the Medical Advisory
                           Committee meeting and to participate fully, to answer all matters
                           considered by the Medical Advisory Committee and to present
                           documents and witnesses;

                   (e)     a statement that the parties are entitled to bring to the meeting and
                           consult with legal counsel, but that the legal counsel will not be entitled
                           to participate in the meeting; and

                   (f)     a statement that, in the absence of the member, the meeting may
                           proceed.

            (3)    The member may request and the Medical Advisory Committee may grant a
                   postponement of the Medical Advisory Committee meeting.

            (4)    At the meeting of the Medical Advisory Committee, a record of the proceeding
                   shall be kept in the minutes of the Medical Advisory Committee meeting.

            (5)    The staff member shall be given full opportunity to answer each ground as well
                   as to present documents and witnesses if so desired.

            (6)    Before deliberating on the recommendation to be made to the Hospital Board,
                   the Chair shall require the member involved, and any other persons present
                   who are not Medical Advisory Committee members, to retire. The Medical
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                   Advisory Committee shall not consider any matter or case to which they did
                   not give the member a fair opportunity to answer.

            (7)    The Medical Advisory Committee shall provide to the member within twenty-
                   four (24) hours of the Medical Advisory Committee meeting written notice of:

                   (a)     the Medical Advisory Committee's recommendation and the written
                           reasons for the recommendation; and

                   (b)     the member's entitlement to a hearing before the Hospital Board.

            (8)    The Medical Advisory Committee shall provide to the Hospital Board within
                   twenty-four (24) hours of the Medical Advisory Committee meeting written
                   notice of the Medical Advisory Committee's recommendation.

12.2.3       The Board Hearing

            (1)    The Hospital Board names a place and time for the hearing.

            (2)    The Hospital Board hearing shall be held within seven (7) days of the date of
                   receipt by the member of the Medical Advisory Committee's recommendation
                   and written reasons.

            (3)    The Hospital Board shall provide written notice of the Hospital Board hearing
                   to the member and to the Chair (or substitute) of the Medical Advisory
                   Committee at the earliest possible opportunity and in any event, at least
                   seventy-two (72) hours prior to the date of the hearing.

            (4)    The notice of the Hospital Board hearing shall include:

                   (a)     the date, time and place of the hearing;

                   (b)     the purpose of the hearing;

                   (c)     a statement that the member and the Medical Advisory Committee shall
                           be afforded an opportunity to examine prior to the hearing, any written
                           or documentary evidence that will be produced or any report, the
                           contents of which will be given in evidence at the hearing;

                   (d)     a statement that the member may proceed in person or be represented
                           by counsel, and that in his or her absence the Hospital Board may
The Stevenson Memorial Hospital Corporation By-laws                                    May 8, 2008


                           proceed with the hearing and that the member will not be entitled to
                           any further notice of the proceeding;

                   (e)     a statement that the member may call witnesses and tender documents
                           in evidence in support of his or her case; and

                   (f)     the time for the hearing may be extended by the Hospital Board.

            (5)    The parties to the Hospital Board hearing are the Member, the Medical
                   Advisory Committee, and such other persons as the Hospital Board may
                   specify.

            (6)    The member requiring a hearing before the Hospital Board shall be afforded an
                   opportunity to examine, prior to the hearing, any written or documentary
                   evidence that will be produced, or any report the contents of which will be
                   given in evidence at the hearing.

            (7)    Members of the Hospital Board holding the hearing shall not have taken part in
                   any investigation or consideration of the subject matter of the hearing before
                   the hearing and shall not communicate directly or indirectly in relation to the
                   subject matter of the hearing with any person or with any party or his or her
                   representative, except upon notice to and an opportunity for all parties to
                   participate.

            (8)    The findings of fact of the Hospital Board pursuant to a hearing shall be based
                   exclusively on evidence admissible or matters that may be noticed under
                   clauses 15 and 16 of the Statutory Powers Procedure Act.

            (9)    The Hospital Board shall consider only the reasons of the Medical Advisory
                   Committee that have been given to the member in support of its
                   recommendation. Where through error or inadvertence, certain reasons have
                   been omitted in the statement delivered to the member, the Hospital Board may
                   consider those reasons only if those reasons are given by the Medical Advisory
                   Committee in writing to both the applicant or member and the Hospital Board
                   and the member is given a reasonable time to review the reasons and to prepare
                   a case to meet those additional reasons.

            (10)   No member of the Hospital Board shall participate in a decision of the Hospital
                   Board pursuant to a hearing unless he or she was present throughout the
                   hearing and heard the evidence and argument of the parties and, except with
                   the consent of the parties, no decision of the Hospital Board shall be given
                   unless all members so present participate in the decision.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (11)   The Hospital Board shall make a decision to either follow or not follow the
                   recommendation of the Medical Advisory Committee.

            (12)   A written copy of the decision of the Hospital Board and the written reasons
                   for the decision shall be provided to the member and to the Medical Advisory
                   Committee secretary.

            (13)   Service of the notice of the decision and the written reasons to the member
                   may be made personally or by registered mail addressed to the member at his
                   or her last known address and, where the notice is served by registered mail, it
                   shall be deemed that the notice was served on the third day after the day of
                   mailing unless the person to be served establishes that he or she did not, acting
                   in good faith, through absence, accident, illness or other cause beyond his or
                   her control receive it until a later date.

13.     PROGRAMS

13.1        OCCUPATIONAL HEALTH AND SAFETY PROGRAM

            (1)    There shall be an Occupational Health and Safety Program for the Hospital.

            (2)    The program referred to in subsection 13.1(1) shall include procedures with
                   respect to:

                   (a)     a safe and healthy work environment in the Hospital;

                   (b)     the safe use of substances, equipment and medical devices in the
                           Hospital;

                   (c)     safe and healthy work practices in the Hospital;

                   (d)     the prevention of accidents to persons on the premises of the Hospital;
                           and

                   (e)     the elimination of undue risks and the minimizing of hazards inherent
                           in the Hospital environment.

            (3)    The person designated by the President and Chief Executive Officer to be in
                   charge of occupational health and safety in the Hospital shall be responsible to
                   the President and Chief Executive Officer for the implementation of the
                   Occupational Health and Safety Program.
The Stevenson Memorial Hospital Corporation By-laws                                        May 8, 2008


            (4)    The President and Chief Executive Officer shall report to the Board as
                   necessary on matters in respect of the Occupational Health and Safety
                   Program.

13.2        HEALTH SURVEILLANCE PROGRAM

            (1)    There shall be a Health Surveillance Program for the Hospital.

            (2)    The program referred to in subsection 13.2(1) shall:

                   (a)     be in respect of all persons carrying on activities in the Hospital; and

                   (b)     include a Communicable Disease Surveillance Program.

            (3)    The person designated by the President and Chief Executive Officer to be in
                   charge of health surveillance in the Hospital shall be responsible to the
                   President and Chief Executive Officer for the implementation of the Health
                   Surveillance Program.

            (4)    The President and Chief Executive Officer shall report to the Board as
                   necessary on matters in respect of the Health Surveillance Program.

14.     ORGAN DONATION

            (1)    Pursuant to the Hospital Management Regulation, the Board shall approve
                   procedures to encourage the donation of organs and tissues including:

                   (a)     procedures to identify potential donors; and

                   (b)     procedures to make potential donors and their families aware of the
                           options of organ and tissue donations;

                    and shall ensure that the procedures in clause are implemented in the Hospital.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


15.      PARTICIPATION OF NURSES

15.1        NURSING ADVISORY COMMITTEE

15.1.1       Membership of the Nursing Advisory Committee

            (1)    The Nursing Advisory Committee shall consist of 12 voting members,
                   including:

                   (a)     the Vice President/Chief Nursing Executive who shall be chair;

                   (b)     Managers of;

                           (i)      Acute Care Services,

                           (ii)     Ambulatory Care Services, and

                           (iii)    Quality and Risk Management;

                   (c)     Nursing staff from each of the;

                           (i)      Acute Care Services,

                           (ii)     Ambulatory Care Services including,

                                                      i.      Emergency / Primary Care Service,

                                                      ii.     Perioperative Care Service,

                                                      iii.    Maternal and Child Health Service,

                                                      iv.     Dialysis Service, and

                                                      v.      Community Mental Health Services;

                   (d)     Staff Registered Nurse in the Extended Class (RNEC); and

                   (e)     Coordinator, Education and Organizational Development.

            (2)    Other professional staff as may be required to attend but shall not have a vote.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


            (3)    The President and Chief Executive Officer shall attend meetings of the Nursing
                   Advisory Committee but shall not have a vote.

            (4)    The Chief of Staff shall attend meetings of the Nursing Advisory Committee
                   but shall not have a vote.

15.1.2       Duties of the Nursing Advisory Committee

            (1)    The Nursing Advisory Committee shall elect a Secretary to the Nursing
                   Advisory Committee from among themselves.

            (2)    Develop and recommend to the Fiscal Advisory Committee on an annual basis,
                   the Nursing Staff Human Resources Plan.

            (3)    Through the Vice President/Chief Nursing Executive, advise the Board on:

                   (a)     nursing staff quality assurance;

                   (b)     education;

                   (c)     clinical role of the Hospital; and

                   (d)     nursing staff human resources plan.

            (4)    The Nursing Advisory Committee shall determine the necessity and develop
                   time limited ad hoc committees or working groups, as required.

15.1.3       Membership of the Executive Committee of the Nursing Advisory Committee

            (1)    The Executive Committee of the Nursing Advisory Committee shall consist of:

                   (a)     Vice President/Chief Nursing Executive, who shall be chair;

                   (b)     A Registered Nurse elected by the Committee;

                   (c)     A Registered Practical Nurse elected by Committee; and

                   (d)     The Secretary of the Committee.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


            (2)    The President and Chief Executive Officer and the Chief of Staff shall be
                   invited to attend meetings of the Executive Committee of the Nursing
                   Advisory Committee but shall not have a vote.

15.1.4       Duties of the Executive Committee of the Nursing Advisory Committee

            (1)    The Executive Committee of the Nursing Advisory Committee shall:

                   (a)     act as an advisory committee to the Nursing Advisory Committee on
                           issues brought to the Nursing Advisory Committee or referred to the
                           Executive Committee by the Board or the President and Chief
                           Executive Officer;

                   (b)     exercise the full powers of the Nursing Advisory Committee in all
                           urgent matters reporting every action at the next meeting of the Nursing
                           Advisory Committee;

                   (c)     report at each meeting of the Nursing Advisory Committee; and

                   (d)     meet weekly or at the call of the chair.

15.2        PARTICIPATION OF NURSES ON COMMITTEES

            (1)    The Vice President/Chief Nursing Executive, a staff nurse elected in
                   accordance with this By-law and a nurse who is a manager appointed in
                   accordance with this By-law shall be a member, with full-voting privileges, of
                   those committees, approved by the Board to have nurse representation, that
                   deal with one or more of the following:

                   (a)     nurses' clinical practice;

                   (b)     utilization review;

                   (c)     quality assurance;

                   (d)     risk management;

                   (e)     hospital planning process; and

                   (f)     any other matter as the Board may deem advisable.
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


15.3        ELECTION OF STAFF NURSES

            (1)    There shall be an annual meeting of the staff nurses.

            (2)    A Nominating Committee shall be elected by staff nurses at each annual
                   meeting of the staff nurses and shall consist of three (3) staff nurses.

            (3)    The Nominating Committee shall at least thirty (3) days before the annual
                   meeting of the staff nurses, post in a prominent location, a list of the names of
                   those staff nurses who are nominated to the various Hospital committees that
                   require nursing participation.

            (4)    The Nominating Committee shall call for any further nominations to be made
                   in writing to the chair of the Nominating Committee within fourteen (14) days
                   after the posting of the names referred to in subsection 5.1.4(3):

                   (a)     These further nominations shall be signed by two (2) staff nurses; and

                   (b)     These nominations shall be posted alongside the list referred to in
                           subsection 5.1.4(3).

            (5)    All nominees shall have signified in writing on the Nomination Form,
                   acceptance of the nomination.

            (6)    Elections of staff nurses to the various committees in the Hospital that require
                   nursing participation shall be conducted at each annual meeting of the staff
                   nurses.

15.4        FAILURE TO ELECT A STAFF NURSE AND VACANCIES

            (1)    Where the election process for staff nurses has been carried out and no staff
                   nurse is elected, then the Board may appoint a staff nurse to be a member of
                   such committee.

            (2)    Where a duly elected staff nurse resigns his or her seat on a committee, or is
                   unable to complete his or her term for any reason, then the Board may appoint
                   the staff nurse with the next highest number of votes, or appoint a staff nurse to
                   complete the term.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


15.5        ELECTION OR APPOINTMENT OF NURSES WHO ARE MANAGERS

            (1)    The Vice President/Chief Nursing Executive shall determine the mechanism by
                   which nurses who are managers are elected or appointed to the various
                   committees in the Hospital that require nursing participation.

16.     VOLUNTARY ASSOCIATIONS

16.1        AUTHORIZATION

            (1)    The Board may sponsor the formation of a voluntary association(s) as it deems
                   advisable.

16.2        PURPOSE

            (1)    Such associations shall be conducted with the advice of the Board for the
                   general welfare and benefit of the Corporation and the patients treated in the
                   Hospital.

16.3        CONTROL

            (1)    Each such association shall elect its own officers and formulate its own
                   By-laws, but at all times the By-laws, objects and activities of each such
                   association shall be subject to review and approval by the Board.

16.4        REPRESENTATION ON BOARD

            (1)    The Board may determine a mechanism to provide for representation by the
                   voluntary association(s) on the Board.

16.5        AUDITOR

            (1)    Each unincorporated voluntary association shall have its financial affairs
                   reviewed by an auditor.

            (2)    The auditor for the Hospital may be the auditor for the voluntary association(s)
                   under this clause.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


17.     RECORDS

17.1        RETENTION OF WRITTEN STATEMENTS

            (1)    The President and Chief Executive Officer shall cause to be retained for at
                   least (25) years, all written statements made in respect of the destruction of
                   medical records, notes, charts and other material relating to patient care and
                   photographs thereof.

18.     BONDING - FIDELITY INSURANCE

            (1)    Directors, Officers and employees as the Board may designate shall secure
                   from a guarantee company a bond of fidelity of an amount approved by the
                   Board.

            (2)    The requirements of subsection 18 (1) may be met by an alternative form of
                   employee fidelity insurance such as, but not limited to, a blanket position bond,
                   a commercial blanket bond, or a comprehensive dishonesty, disappearance and
                   destruction policy, at the discretion of the Board.

            (3)    The Corporation shall pay the expenses of any fidelity bond or policy secured
                   under this clause.

19.     SIGNING OFFICERS

            (1)    The Chair or Vice-Chair and the Treasurer or President and Chief Executive
                   Officer jointly shall sign on behalf of the Corporation and affix the seal of the
                   Corporation to all contracts, agreements, conveyances, mortgages, or other
                   documents, as may be required by law or as authorized by the Board.

            (2)    In addition to the signing officers set out in clause 19 (1), the Board may from
                   time to time by resolution direct the manner in which and the person or persons
                   by whom any particular instrument or class of instruments or document may or
                   shall be signed. Any signing officer may affix the seal of the corporation to
                   any instrument or document and may certify a copy of any instrument,
                   resolution, by-law or other document of the Corporation to be a true copy.

20.     AUDITOR

            (1)    The Voting Members of the Corporation shall at each Annual Meeting of
                   Members appoint an Auditor who shall not be a member of the Board or an
                   Officer or employee of the Corporation or a partner or employee of any such
The Stevenson Memorial Hospital Corporation By-laws                                       May 8, 2008


                   person, and who is duly licensed under the Public Accountancy Act, to hold
                   office until the next annual meeting of the Corporation.

            (2)    The auditor shall have all the rights and privileges as set out in the
                   Corporations Act of Ontario and shall perform the audit function as prescribed
                   therein.

            (3)    In addition to making the report at the Annual Meeting of Members of the
                   Corporation, the auditor shall from time to time report to the Board on the
                   audit work with observations on internal control that comes to the auditor's
                   attention during the audit work.

21.     AMENDMENTS

21.1        AMENDMENTS TO BY-LAWS

            (1)    The Board may pass or amend the By-laws of the Corporation from time to
                   time.

            (2)    Subject to the Act and to clause 21.1(3)(b), a By-law or an amendment to a
                   By-law passed by the Board has full force and effect:

                   (a)     from the time the motion was passed; or

                   (b)     from such future time as may be specified in the motion.

            (3)    (a)      A By-law or an amendment to a By-law passed by the Board shall be
                            presented for confirmation by the Voting Members at the next Annual
                            Meeting of Members or to a Special Meeting of the Voting Members
                            of the Corporation called for that purpose. The notice of such Annual
                            Meeting of Members or Special Meeting of Members shall refer to the
                            By-law or amendment to be presented.

                   (b)     The Voting Members at the Annual Meeting or at a Special Meeting of
                           Members may confirm the By-law as presented or reject or amend it,
                           and if rejected it thereupon ceases to have effect and if amended it takes
                           effect as amended.

            (4)    In any case of rejection, amendment, or refusal to approve a By-law or part of
                   a By-law in force and effect in accordance with any part of this clause, no act
                   done or right acquired under any such By-law is prejudicially affected by any
                   such rejection, amendment or refusal to approve.
The Stevenson Memorial Hospital Corporation By-laws                                     May 8, 2008


21.2        MEDICAL STAFF, DENTAL STAFF, MIDWIFERY STAFF AND NURSE -
            EXTENDED CLASS NURSE WITH PRIVILEGES STAFF AMENDMENTS

            (1)    Prior to submitting amendments to clauses 7 through 15 inclusive of this
                   by-law, to the process established in clause 21.1, the following procedures
                   shall be followed:

                   (a)     notice specifying the proposed amendments thereto shall be posted;

                   (b)     the medical staff, dental staff, midwifery staff and nurse - extended
                           class nurse with privileges staff shall be afforded an opportunity to
                           comment on the proposed amendments thereto; and

                   (c)     the Medical Advisory Committee shall make recommendations to the
                           Board concerning the proposed amendments thereto.

22.     SEAL

            (1)    The seal of the Corporation shall be in the form impressed hereon.
The Stevenson Memorial Hospital Corporation By-laws                                      May 8, 2008


                                        BY-LAW NO. 2

                                 BORROWING BY-LAW

            BE IT ENACTED as a special By-law of the Corporation, that:

            The Directors may, from time to time,

                (a)     borrow money from a bank on the credit of the Corporation;

                (b)     subject to any provision in the Public Hospitals Act, issue, sell or pledge
                        securities of the Corporation;

                (c)     subject to any provision in the Public Hospitals Act, charge, mortgage,
                        hypothecate or pledge all or any of the real or personal property of the
                        Corporation, including book debts and rights, powers, franchises and
                        undertakings, to secure any securities or any money borrowed, or other
                        debt, or any other obligation or liability of the Corporation; and

                (d)     authorize any Director, Officer or employee of the Corporation to make
                        arrangements with reference to the monies borrowed or to be borrowed as
                        aforesaid, and as to the terms and conditions of the loan thereof, and as to
                        the securities to be given therefor, with power to vary or modify such
                        arrangements, terms and conditions and to give such additional securities
                        for any monies borrowed or remaining due by the Corporation as the
                        Directors may authorize, and generally to manage, transact and settle the
                        borrowing of money by the Corporation.
The Stevenson Memorial Hospital Corporation By-laws   May 8, 2008




ENACTED this 8th day of May, 2008.

WITNESS the Corporate Seal of the Corporation.




Per:    __________________
        Supervisor

								
To top