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Relations Between Physicians and Members

Section F-1     Physician-Patient Relationship

     Physicians will maintain the professional and privileged relationship of physician and patient with Members, without intervention in any manner by Health Plan or its agents or employees, and Physicians will be solely responsible for all medical advice to and treatment of Members and for performance of all Medical Services, in accord with accepted professional standards and practices generally prevailing among physicians practicing in the Service Area.

Section F-2.     Termination of Untenable Relationships

     Health Plan and Medical Group recognize that the physician patient relationship is a personal relationship and involves a professional responsibility, and that circumstances may arise under which relations between particular Members and particular Physicians may become unsatisfactory.  In such cases Medical Group will use its best efforts to provide Physicians who may develop a satisfactory physician-patient relationship with such Members.  If Medical Group is unable to do so, then Health Plan, upon written request from Medical Group, will use its best efforts to terminate the membership of any such Member as promptly as reasonably possible.  The parties recognize, however, that termination of such membership may, in some circumstances, be impossible or impractical, in which event Medical Group will refer the Member to outside physicians.  Medical Group will be responsible for payment of such physicians' charges as may result from the rendering of Medical Services by such outside physicians.

Section F-3.     Refusal of Members to Follow Medical Advice for Conscientious or Other Personal Reasons

     Health Plan and Medical Group recognize that a Member, for conscientious or other personal reasons, may refuse to follow or undergo a procedure or course of treatment recommended by the Attending Physician in cases in which the Attending Physician believes that no professionally acceptable alternative to such recommended procedure or course of treatment exists.  Health Plan will endeavor, insofar as practical, to provide in Membership Contracts that a Member's refusal, under such circumstances, to follow medical advice will relieve Medical Group and the Attending Physician from any further responsibility to provide care to the Member for the condition under treatment.  However, Medical Group will furnish Medical Services in all cases in which an alternative professionally acceptable procedure or course of treatment exists which is acceptable to the Member, and Medical Group will not take the position that there are no professionally acceptable alternatives to the recommended course of treatment until after the Attending Physician has consulted with at least two physicians designated by Medical Group management.  The Attending Physician may adopt such course of action as his or her professional judgment dictates, including, where time and surrounding circumstances permit, referral of the Member to other physicians, as provided in Section F-2 above.  Nothing contained in this Agreement or in any Membership Contract will be construed to require Medical Group or any Physician to recommend or carry out any procedure or course of treatment which Medical Group or such Physician deems professionally unacceptable.

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