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NOVEMBER/DECEMBER2011
Volume 41, No. 6
ESCAMBIA COUNTY MEDICAL SOCIETY
President’s MessageECMS is My Patient Centered Medical Homeby Michelle Brandhorst, MD
Dr. Michelle Brandhorst
Founded in 1873
UpcomingEvents
December 1, 2011General Membership
Meeting5:30 PM
CME / Medical ErrorsSponsors:
ECMS, MECOP, Hancock Bank Location: Hancock Bank
January 14, 20122012 Inaugural Ball
Location: Pensacola Country Club
RSVP: [email protected]
This is my final newsletter of the year as Presi-
dent of the ECMS. It seems that it took forever go-
ing through the usual offices leading up to this year
and then it goes by in what seems to be a heartbeat.
But, I would also do it again in a heartbeat. Preparing
for the Bulletin articles forced me to read and learn
more about the changes that are occurring and af-
fecting our profession. It also forced me to be more
sensitive to the day to day struggle that we all face
when trying to allocate our time to maximize the at-
tention we offer to our patients. The latest article I
read, written by Dr. Sam J.W. Romeo was on the five
principles of Patient Centered Medical Homes which
I outline below. As the author points out these are
principles and are consistent with medial ethics. It is
because I can focus on these principles while work-
ing with and attending meetings of the ECMS, that
I consider the ECMS my Patient Centered Medical
Home.
1. Focus on the Physician/Patient Relationship.
I ended each of my previous articles emphasizing
this essential relationship. We are too often forced to
abbreviate the time necessary in building this rela-
tionship. As a result there can be mistrust of what we
recommend or we are seen as someone who only
orders what the patient feels that they need. As this
relationship builds, physicians become aware of and
respect the patient’s needs and preferences and the
patient is more likely to follow and be satisfied with
the physician’s recommendation.
2. Make the patient the center of care.
The patient, not the payer, should be our focus.
Quality care and value can only occur however when
the patient is a vested and committed participant in
his or her care.
3. Provide care that is accessible, comprehensive
and continuous.
Talking with patients, examining patients, trying to
solve their problems, and receiving a reimbursement
that is agreeable to both of us. It seems old fash-
ioned and idealistic but this is what we do in every
other facet of our lives.
4. Emphasize data
that is meaningful and
understood by the
patient.
Patients are not inter-
ested in how quickly we
sign our orders or if their office note is generated on
a computer or if 72% of your diabetic patients have
Hgba1c’s less that 7. However, these are metrics
by which we are judged. Rather than this top down
approach, patients care about what we do for their
individual medical problems at individual visits in the
context of them as individuals. Implementing and
following requirements to facilitate reimbursement,
when one does not feel that the requirements truly
benefit the patient is not, in my opinion, ethical.
5. Give it time.
These are fundamental principles that have been
slowly subjugated for years. Refocusing on these
principles and resurrecting them will not happen
quickly. Most all of us who become physicians are
very independent and willingly take responsibility
for our actions and the resulting patient outcomes.
We want to fix things and quickly. This will take pa-
tience but cannot start until we as physicians focus
on these principles. My hope is our medical society
as well as others remember one of the founding prin-
ciples of the American Medial Association which is
our duty to seek changes in law and requirements
that are contrary to the best interests of the patient.
In closing, thanks to all the past presidents of
our medical society for their hard work in growing
this important organization. Also to our new incom-
ing President, Dr. George Smith as well as our new
Executive Director, Erica Laxson, best wishes for an
exciting new year. And finally and most importantly,
thank you members for allowing me to lead the Es-
cambia County Medical Society for the past year.
What a great ride!!
ECMS BulletinThe Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/ Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.
EditorsNorman Vickers, MD
Erica Laxson, Executive Director
AD PLACEMENTContact Erica Laxson at 478-0706
Ad RatesFull page: $600 • ½ page: $300 • ¼ page: $150
2011 ECMS OfficersPresident
Michelle Brandhorst, MDPresident-Elect
George Smith, MDVice President
Wendy Osban, DOSecretary /Treasurer
Susan Laenger, MD
Pages 4-5 Pain Management Regulations Affect More Than Pain Management Specialists
Page 6 How Should Yor Disclose a Medical Error?
Page 7-8 Hot Topics in Risk Management: What Physicians Need to Know
Page 9 Case Study: Liability Attributed to Physician Extender
Vision for the Bulletin:-Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond.- Collaborate with the Alliance to bring together Escambia and Santa Rosa County medical families. To know the needs of the community and promote the healthcare needs.- A powerful instrument to attract and induct members to organized medicine. Views and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the directors, staff or advertisers.
For more information, contact Shelly Hakes, Director of Society Relations at (800) 741-3742, Ext. 3294.
IN A MEDICAL MALPRACTICE CLAIM:Be ready for anything and everything.
YOU SAVE LIVES. WE SAVE LIVELIHOODS.
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www.firstprofessionals.com
Endorsed by
Escambia B-W 3.5x10.indd 1 1/8/10 12:08:25 PM
Membership
Benefits of Membership 20129 Dinner Meetings in 2012: Opportunities to receive Free Florida Man-dated Courses.
Representation in Legislature: ECMS has members actively participating in the FMA and AMA. Such topics include: Managed care legislation, PRN sovereign Immunity, Mandatory malpractice, tort reform, and grass roots efforts. ECMS gives our physicians’ updates through our newsletters, email, and faxes.
Malpractice Insurance Discount: FPIC gives ECMS members a 5% dis-count. In addition, FPIC’s claims-free program currently allows for the fol-lowing discounts: 25% discount if claims-free for 15 years; 20% discount if claims-free for 10-14 years; 10% discount if claims-free for 5-9 years.
20% Discount on Pensacola Opera Tickets
DocBookMD: ECMS providers are now listed on the ECMS iPhone and Android application.
Workers’ Compensation Insurance: Members can receive up to 24.8% return on insurance premiums with OptaComp.
CME: ECMS offers free CMEs to our members at many of our meetings.
Directory and Website: ECMS website and Member directory, which in-cludes your office information and picture, as well as allows you to control the information and register for ECMS events. We also work with physicians to create and manage their own internet site.
Patient Referral: ECMS refers patients to our physicians daily.
Physician Information Service: ECMS has connections in Pensacola. The Society is pleased to research, ask, and retrieve information for you or your office personnel.
Vested Vendor Resource Guide: This is a guide offered to all members. These vendors are financially and personally invested in the success of the practice of medicine. They support our CME events, dinners, special events and our Bulletin newsletter. Please make sure to call a supporter of ECMS.
The Florida Healthcare Law Firm: At no charge members of the Escam-bia County Medical Society may call the hotline 561-306-5699 with ques-tions regarding specific legal issues.
Crown Plaza: Mention “Medical Society” for a yearly discounted rate on you or your guest next stay.
Join the Escambia County Medical Society for the Initiation of the 2012 Officers
2012 President: George Smith, MD2012 President-Elect: Wendy Osban, DO2012 Vice President: Susan Laenger, MD
2012 Secretary/Treasurer: Christopher Burton, MDMembers at Large:
Thomas Westbrook, MDSuzanne Bush, MDBrent Videau, MD
Andres Candela, MD
January 14th, 2012 | Pensacola Country Club For more information or to purchase tickets please call Erica Laxson, Executive Director at
850-478-0706 ext 2, or email [email protected]
Reminder Membership Updates
ECMS will be publishing the 2012 Pictorial Directory soon.If you have information that has changed please call or
email us at: 850-478-0706 or [email protected]
It’s time to renew your membership for 2012! Membership dues can be paid at escambiacms.org via PayPal or by check.
Please contact Erica Laxson, Executive Director with any questions: [email protected] or 850-478-0706.
Medical/Legal
Pain Management Regulations Affect More Than Pain Management Specialists
The recently passed House Bill 7095 affects more than just pain management specialists. Practitioners who prescribe controlled sub-stances for individuals with “chronic nonmalignant pain” also are required to comply with new state regulations, including designation “as a con-trolled substance prescribing practitioner on the physician’s practitioner profile with the state Board of Medicine by January 1, 2012. What follows is a bulleted summary of the new regulations. Prescriptions for controlled substances must be either written or electronic. Telephone prescriptions no longer are allowed.
Written Prescriptions for Controlled Substances •Musthavequantityintextualandnumericalformat •Mustbedatedwiththeabbreviatedmonthwrittenout •Mustbewrittenonastandardizedcounterfeit-proofprescription pad produced by a DOH approved vendor Physicians who prescribe any controlled substance for the treatment of “chronic nonmalignant pain” must designate him or herself as a controlled substance prescribing physician on the physician’s practitioner profile and must comply with statutory requirements and applicable board rules.
ECMS Member Benefit!
Members can call AFTER hours with a specific legal issue or question and receive
a response no later than noon the next day.
This service is available for all members at no charge.
•“Chronicnonmalignantpain”isdefinedaspainunrelatedtocancer or rheumatoid arthritis which persists beyond the usual course of disease or the injury that is the cause of the pain or more than 90 days after surgery.
A complete medical history and physical exam must be documented in the medical record. The exact nature of the examination is not dictated, but it must be proportionate to the diagnosis that justifies treatment and must minimally document: m The pain’s nature and intensity m Current and past treatment for pain m Underlying or coexisting diseases or conditions m The effect of the pain on physical and psychological functions m A review of previous medical records and previous diagnostic studies m History of alcohol and substance abuse •Notably,patientswithsuchahistoryrequirereferralto,or consultation with, a phsyiatrist or addictionologist m The presence of one or more recognized indications for the use of a controlled substance
A written individualized treatment plan must be documented and in-clude at a minimum: m Objectives to determine treatment success, such as pain relief and improved physical and psychosocial function m Indication of further planned diagnostic evaluations or other treatments m After treatment begins, adjustment of drug therapy to the individual’s medical needs m Consideration of other treatment modalities, including rehabilitation, depending on the etiology and extent to which pain is associated with physical and psychosocial impairment m Use of an interdisciplinary approach to the pain
Risks and benefits of the uses of controlled substances must be discussed with the patient, persons designated by the patient, or the patient’s surrogate or guardian, if the patient is incompetent and must include: m Risks of abuse and addiction m Physical dependence and its consequences m Although not specifically required by law, a written and signed consent should be obtained
The physician must enter into a written controlled substance agreement outlining the patient’s responsibilities and include at least the following: m Number and frequency of controlled substance prescriptions and refills m Patient compliance expectations m Reasons why drug therapy may be discontinued m Controlled substances for the treatment of the patient’s chronic
by Linda A. Keen, MSN, JD, LHCRM
Continued on next page
Medical/Legal nonmalignant pain will be prescribed by a single treating physician unless the treating physician authorizes otherwise and documents it in the medical record
The patient must be seen at regular intervals, at least every 3 months to: m Assess the efficacy of treatment m Ensure the controlled substance therapy remains indicated m Evaluate the patient’s progress toward treatment objectives m Consider adverse drug effects m Review pain etiology m Determine whether to continue or modify the therapy, based on the evaluation and progress m Reevaluate the appropriateness of continued treatment if treatment goals are not being achieved m Monitor compliance in medication usage, related treatment plans, controlled substance agreements, and indication of substance abuse or diversion at a minimum of 3 month intervals m Although not required by law, a notation that the treatment plan was reviewed and updated as necessary is recommended m Before writing a prescription for a controlled substance, a physician should ask the patient whether he or she is being prescribed controlled substances by another practitioner and it should be documented in the medical record •Ifthephysiciandoesn’t,andprescribesaswell,thephysician could be held complicit in prescribing medically unnecessary medication, in violation of Florida law
In order to achieve treatment objectives, the physician shall refer a patient as necessary for additional evaluation and treatment to achieve treatment objectives. m Special attention must be given to those at risk for misusing medication or those with living arrangements that pose a risk for misuse or diversion Patients with a history of substance abuse or a comorbid psychiatric disorder require referral to, or consultation with, a physiatrist or addiction-ologist. Accurate, current, and complete medical records that are accessible and readily available must comply with law, and the physician’s appli-cable practice act and board rules. The record should include, at a mini-mum: o Medical history and physical, including history of drug abuse or dependence m Diagnostic, therapeutic, and laboratory results m Evaluations and consultations m Treatment objectives m Discussion of risks and benefits m Treatments m Medications, including date, type, dosage, and quantity prescribed. Instructions and agreements m Periodic reviews m Results of any drug testing m A photocopy of the patient’s government-issued photo ID m If a written prescription of a controlled substance is given to a patient, a duplicate of the prescription m The physician’s LEGIBLE full name m Although not required by law, the treatment plan, controlled substance agreement, and informed consent for treatment
document signed by the patient should be included in the medical record Patients with signs or symptoms of substance abuse must be re-ferred immediately to a board-certified pain management physician, an addiction medicine specialist, or a mental health addiction facility. m While waiting for the consultant’s report, a prescribing physician must clearly and completely document justification for continued use of controlled substances and steps taken to ensure medically appropriate use of the medication m On receipt of the consultant’s report, the consultant’s recommendations for controlled substance therapy should be incorporated into the treatment plan, documenting resulting changes in therapy If a physician identifies evidence or behavioral indications of diver-sion, the controlled substance therapy must be discontinued and the pa-tient must be discharged from care. m Results of testing and all actions taken must be documented in the medical record Physicians who dispense medications from their office may not dis-pense Schedule II or Schedule III controlled substances, unless: m The drugs are complimentary and labeled as a drug sample or complimentary drug and are provided to the practitioner’s own patients in the regular course of medical practice without any kind of fee or remuneration m The controlled substance is dispensed in association with the performance of a surgical procedure •Nogreaterthana14daysupplycanbedispensed,andonly one 14 day supply per surgical procedure •Ifaphysician’spracticerequiresthistooccur,thephysician should research and follow applicable law and rules, as they are too involved to discuss here The Department of Health has established an electronic database for those who dispense controlled substances and will provide advisory reports upon practitioner request. m Prescribers will have access to database information relating to their patients if they want to review a patient’s controlled substance prescription history The new law also affects pain management clinics, various pain management specialists, pharmacies, pharmacists and drug distributors. This is a general overview of compliance requirements for general practice practitioners. Continued interpretation of the law and rule devel-opment is expected. Practitioners are encouraged to pay close attention to their licensure boards and medical society information as further inter-pretation and refinement occurs. Practitioners who must comply with the law should consult an attorney for guidance. A link to House Bill 2095 is attached. The reader is encouraged to read it in its entirety to assure com-pliance. http://www.flsenate.gov/Session/Bill/2011/7095/BillText/er/PDF
Editors Note: Linda Keen is available to assist practitioners comply with the new pain man-agement regulations. She also is interested in obtaining feedback from practitioners imple-menting the new regulations. Your feedback is welcome. Linda can be reached at [email protected]
Medical/Legal
How Should You Disclose a Medical Error?by the Risk Management Experts at First Professionals Insurance Company
Although most states require that a physician inform their patient in the event an adverse incident results in injury or serious harm, virtually all physicians consider it a moral and ethical duty. The legal requirements to disclose a medical error are often set forth by statutes and administrative codes governing professional licensing. Generally, such disclosure is a non-delegable duty and should be done, in person, by the physician. In many instances, the same statutes that require disclosure of medical error or outcomes of care that result in harm to a patient also serve to protect the disclosing physician to the extent that the disclosure itself may not lat-er be used against the physician as an acknowledgment of an admission of liability, or introduced as evidence. Regardless, the manner in which an adverse event or medical error is disclosed is tantamount to claim avoid-ance. Defining Medical Error There are situations when it is difficult, if not imprudent, to differenti-ate an adverse event from a medical error and thus determine if the legal threshold to disclose has been met. In such instances it is best to seek legal or risk management guidance before notification is made to the pa-tient. However, in most cases, defining a medical error becomes a legal, rather than medical issue. While some states do not define a medical er-ror, they may have statutes which define a “medical injury”. The following statutory language is an example of one state’s rather expansive definition of what constitutes a medical injury: “…any adverse consequences arising out of or sustained in the course of the professional services being rendered by a medical care pro-vider, whether resulting from negligence, error, or omission in the perfor-mance of such services; or in breach of warranty or in violation of contract; or from failure to diagnose; or from premature abandonment of a patient or of a course of treatment; or from failure to properly maintain equipment or appliances necessary to the rendition of such services; or otherwise arising out of or sustained in the course of such services.” An unanticipated outcome may be an omission as well as a commis-sion. The most common cause of an unanticipated outcome is the known, but low probability, adverse event.Failure to Disclose Medical Error There may, however, be barriers to disclosure. Financial, psychologi-cal and cultural barriers are examples of why disclosure of medical error has been withheld. The pre-mature assignment or assumption of blame and risk of a failed response are prevalent root causes for failing to inform or timely disclose an untoward event to patients. Ethical and legal require-ments notwithstanding, patients are far more likely to seek legal action following an adverse event or unanticipated outcome when disclosure is not made or made incorrectly. How to Disclose Medical Error Disclosure of a medical error or unanticipated outcome is an uncom-fortable situation to be sure. To avoid compounding the situation, adhere to the essential components of disclosure:1. Timely2. Proper Setting3. Accurate4. Factual5. Responsive6. Document
An admission of liability is never required as means of disclosure. Before disclosure is made to the patient or patient’s family members, try to obtain as much factual information pertaining to the error or outcome as possible. Seek legal or risk management guidance. Communicate in a manner that is open, forthright and expresses empathy. Do not seek to lay blame nor make excuses. Make it known should information or details be unknown at the time of disclosure. Indicate what steps will be taken to obtain such information. Invite questions and seek answers. Remain responsive to the emotional needs of the patient or family member. Documenting Disclosure Carefully document the disclosure. Chart the time, date and place as well as the individuals present. Note the information conveyed, includ-ing the known facts, condition and treatment of the patient. Document your discussion of the immediate and long term effects or prognosis, if known. Delineate the current and future clinical interventions. The records should clearly reflect what questions were posed and what the responses were, offers of assistance, if any, as well as the treatment plan agreed upon including consultations. Document the agreement (or refusal) for subsequent meetings, the reason for any incomplete disclosure and what follow-up is intended. Any subsequent discussions should also be carefully documented. The medical record should reflect the efforts that were made to accom-modate the patient and family members as well as the information which was known, or unknown, predicating the extent of disclosure made. The motivation behind pursuing a claim or suit following an unanticipated outcome or medical error may ultimately come from someone other than the patient. Depending on the circumstances, the best risk management measure may be to increase your communication with the patient and the patient’s family members. Risk Management Guidelines:• Complywithapplicablelegalrequirementsregardingdisclosure• Donotdelegatethedutyofdisclosure• Discloseadverseeventsandmedicalerrorinpersontothepatientor family member• Donotassumeorassignblame• Adheretotheessentialcomponentsofdisclosure:Timely,Proper Setting, Accurate, Factual, Responsive, and Document• Ascertainasmuchfactualinformationaspossiblebeforedisclosure is made• Communicateinamannerthatisopen,forthrightandexpresses empathy• Invitequestionsandseekanswers• Remainresponsivetotheemotionalneedsofthepatientorfamily member• Carefullydocumentthedisclosure• Documentthemeasuresundertakentoaccommodatethepatient• Seeklegalorriskmanagementguidance,whennecessary For more information regarding this and other medical professional liability insurance risk management issues, please contact the risk man-agement consultants at First Professionals Insurance Company at (800) 741-3742, ext. 3016 or send an e-mail to [email protected].
Practice Management
Hot Topics in Risk Management: What Physicians Need to Knowby Cliff Rapp, LHRM, Vice President Risk Management, First Professionals Insurance Company
Healthcare providers are faced with a paradox that the more medi-
cine advances, the greater the potential for error. While all undesired out-
comes cannot be eliminated even by extremely well-qualified providers,
today’s legal climate necessitates that physicians are familiar with long-
standing, current, and evolving risk management practices.
There are a number of risk management issues which require a
heightened awareness. These include the use of physician extenders
and hospitalists and issues regarding internet defamation, patient identity
theft, and regulatory requirements.
Physician Extenders
The number of physicians who support the use of physician ex-
tenders continues to escalate. Physician extenders can provide several
benefits, including faster patient access to care, and increased physi-
cian time and focus. However, along with the increasing use of physician
extenders is the spiraling frequency and severity of medical malpractice
claims against physicians who are being exposed to the acts of physician
extenders.
Malpractice claims attributed to PEs can often be traced to clinical
and administrative factors that are easily identified and remedied. Conse-
quently, there are precautions and assurances that the employing physi-
cians should initiate. Determine that your PEs are not providing services
beyond their capabilities or the scope of their licensing. Monitoring en-
ables detection of misdiagnoses, delays in diagnoses, improper orders,
or any other issues requiring attention. Physician extenders are the agents
of their employers—their acts reflect directly upon the supervising physi-
cian.
Although the practical benefits of utilizing PEs are numerous, myriad
legal doctrines hold the physician responsible for the acts and omissions
of such employees. Implementing effective risk management measures
will help ensure that the benefit of using physician extenders in your prac-
tice is not at the expense of increased liability exposure and malpractice
claim development.
Hospitalists
Hospitalists have evolved into a medical specialty that is growing
both in number and sophistication and is a rapidly increasing option for
primary care physicians (PCP) and their patients. Hospitalists are benefi-
cial because they specialize in inpatient care and treatment. They are very
familiar with the workings of the hospitals and the staff who work there.
From a liability standpoint, inpatient and outpatient care inherent to
the hospitalist model presents the greatest challenge, both in terms of
continued erosion in the physician-patient relationship and the incidence
of medical malpractice claims. While there are many types of hospitalist
models, none possess a distinct risk management advantage over an-
other.
The primary cause of claims related to hospitalists result from com-
munication breakdowns and failure to follow up. Discontinuity of care en-
compasses such risks as abandonment, allegations of negligent referral,
and patients lost to follow-up. However, perhaps the greatest risk is that of
patients that are unaware or who do not understand the hospitalist model.
The hospitalist has a responsibility to notify the patient’s PCP of the
diagnosis, clinical status, discharge plan and any necessary follow-up. To
ensure an adequate exchange of clinical information, the PCP and hos-
pitalist should maintain open dialogue and agree upon a “game plan” of
periodic updates.
With a modicum of risk management effort, prevalent liability issues
entailing a hospitalist model can be minimized. As is the case with most
loss prevention measures, effective communication remains the chief ca-
veat.
Physician Internet Defamation
There has been explosive growth of anonymous doctor rating sites
available on the Internet with “hits” that number in the millions. These sites
provide patients with the ability to post false and defamatory statements
alleging physician negligence. Negative postings present potential risks
to the professional reputations of doctors and their practices.
Currently, libel cases are difficult to resolve. Patient confidentiality
laws and federal immunity laws granted to Internet Service Providers (ISP)
limit the options for recourse, increasing the difficulty and expense.
On rating sites, patients, or people posing as patients – such as dis-
gruntled employees, ex-spouses, and even competitors can damage a
hard-earned reputation. In most instances, a doctor has little recourse. As
an arcane nuance of cyberlaw, the websites are immune from account-
ability (Section 230 of the Communication Decency Act). Some sites have
taken the position that they will not monitor or police such content.
As a physician, one of your most valuable assets is your reputa-
tion. Anonymous web postings by disgruntled patients can threaten your
good name and practice. Most medical practices are built through word
of mouth. It only takes one negative Internet posting to impact your liveli-
hood.
Patient Identity Theft
Cases of patient identity theft continue to substantially increase every
year. It is critical that all medical professionals acknowledge the emerging
risk associated with this dilemma. Physician offices, clinics and hospitals
are all prey to the possibility of compromising personal health information
(PHI).
The PHI stolen from a medical office can be used to obtain credit
cards, drain bank accounts, falsely bill Medicare and make e-transactions
– globally. Physicians with sophisticated encrypted electronic files are no
less vulnerable.
Every physician needs to be aware of the Federal Trade Commis-
sion’s “Red Flags” Rule (Rule) pertaining to patient identity theft protection
standards. For purposes of the Rule, a “red flag” is a pattern, practice
or specific activity indicating the possibility of identity theft. The Rule re-
quires “financial institutions” and “creditors” holding consumer or other
“covered” accounts to develop and implement an identity theft rule. Indi-
vidual physicians, physician groups, hospitals and other healthcare orga-
Continued on next page
Practice Management
nizations fall under the FTC’s definition of a creditor because they gener-
ally do not collect payment at the time a service is rendered and often hold
off billing patients in full.
Implementing a written identity theft prevention program is a requirement
of the Rule. The program must detect, prevent and mitigate identity theft.
Noncompliance is subject to monetary penalties and civil litigation.
The FTC identified December 31, 2010 as the starting date for en-
forcement after several previously announced delays. However, pending
the outcome of a U.S. District Court of Appeals case, physicians are cur-
rently exempted. First Professionals will provide updates regarding the
Rule to our policyholders as they become available.
Florida Practitioner Profiles
Florida physicians are required by the Department of Health to up-
date any change that is made to the following:
• education&training
• currentpractice&mailingaddresses
• staffprivileges&facultyappointments
• financialresponsibility
• legalactions
• BOMfinaldisciplinaryactionwithinprevious10-years
• liabilityclaimswhichexceed$100,000($5,000forpodiatrists)
Physicians who do not comply with this requirement are subject to
fines, penalties, and disciplinary action.
Benefits of Risk Management Protection
Although today’s legal and regulatory climate continues to present
additional challenges to doctors, many cases can be prevented or re-
duced by simply utilizing risk reduction strategies and tools. To reduce the
frequency of claims, exceptional risk management services are essential
for any medical practice. The risk management benefits provided by FPIC
are unmatched in the industry and are available at no additional cost to its
policyholders.
For over 35 years, FPIC has maintained a commitment to protect you,
your patients, your reputation and the assets you have worked so hard to
accumulate. We are confident that the products and services we provide
are superior to those offered by other medical professional liability insur-
ance companies.
For more information, please visit the Risk Management link of our
website located at www.firstprofessionals.com. You can also discuss any
of these services directly with a risk management representative via e-mail
at [email protected] or by phone at (800) 741-3742, extension 3016.
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Practice Management
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MS1181 Fellows Med Soc. ad.indd 1 5/16/11 11:33 AM
Case Study: Liability Attributed to Physician ExtenderEditor’s Note: This case study analysis reflects an actual FPIC case.
Case Analysis
A 53-year-old female underwent laparoscopic cholecystectomy with-
out incident. The surgeon saw the patient three days post-op, noting she
was doing well and without complaints other than the expected incisional
pain. The patient was next seen five days post-op by the surgeon’s physi-
cian assistant (PA) who noted an infection at the umbilical surgical wound.
A culture was obtained (which later proved to be Klebsiella) and patient
was started on the antibiotic Levaquin. The patient returned four days
later and was re-evaluated by the surgeon who noted that the wound still
looked infected with the presence of drainage. Cellulitis was diagnosed
and instructions given to continue the Levaquin and return if needed. A
week later the patient returned and was seen by the PA. She complained
of nausea, vomiting, diarrhea and a temperature of 103. Although the PA
noted that the wound still appeared infected, because the abdomen was
non-tender and no masses were felt, he diagnosed “superficial wound
infection” and “gastroenteritis”. The PA instructed the patient to continue
the Levaquin and prescribed Phenergan for nausea and vomiting. Three
days later the patient was admitted through the ER with an acute abdo-
men. She underwent exploratory surgery, was diagnosed with an intra-
hepatic abscess and developed disseminated intravascular coagulation
(DIC). The patient continued to deteriorate until her expiration several
days later.
Suit was filed against the surgeon, the PA and the medical practice
alleging failure to diagnose and treat the intrahepatic abscess. Defense
experts could not support the PA’s failure to properly assess the patient
when she presented with obvious clinical signs of infection. The PA was
criticized for failing to consult with the physician. The surgeon, having
signed off on the PA’s medical management, was held vicariously liable
for the acts of the PA and directly liable for his inadequate supervision of
the PA. Settlement of the case was necessitated for the surgeon’s direct
negligence and his vicarious liability for the PA, for the practice, for the
negligence of the PA, and for the PA.
Risk Management Discussion
Frequently, claims involving post-operative complications involve
known risks. Early recognition and appropriate case management are key
factors in reducing a physician’s exposure in these situations. Consider
the following loss prevention measures in order to help reduce errors and
deter lawsuits and preserve defenses necessary to defeat the unavoid-
able claims:
• Utilizeinformedconsent
• Re-evaluatepost-oppatientspriortodischarge
• Obtainalloutstandinglabsanddiagnosticstudiespriortodischarge
• Documenttheabsenceofclinicalindicationsofcomplications
• Schedulepromptfollow-upappointments
• Documentno-showsorcancellations
• Providewrittenpost-opinstructions,outliningtheexpectedside
effects and the unanticipated signs and symptoms that should be
reported
• Givehighprioritytopost-oppatientcomplaints.
If a complication develops, consider the following steps:
• Informthepatient–expressempathy
• Documentyourmedicalrationale
• Increasecommunication
• Seeklegalorriskmanagementguidance
This information does not establish a standard of care, nor is it a substitute for legal advice. The information and suggestions contained here are generalized and may not apply to all practice situations. First Professionals recommends you obtain legal advice from a qualified attorney for a more specific application to your practice. This information should be used as a reference guide only.
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Hospital News
In The Community
Sacred Heart NewsOutstanding Pediatric Surgeon Receives Prestigious Award
Dr. Jimmy Jones, a retired pediatric surgeon with Nemours Children’s
Clinic and Sacred Heart Children’s Hospital, was recently recognized as
an outstanding children’s surgeon in the state of Florida by the Children’s
Medical Services (CMS.) Dr. Jones was honored with the Philip O. Licht-
bau Award, which is given annually by The Florida Pediatric Society to a
children’s surgeon who has contributed significantly either regionally or
statewide to the CMS program.
“Dr. Jones has spent the past 45 years as an advocate on behalf of
the children of our region and has committed his time and energy to the
cause of children’s healthcare,” said Laura S. Kaiser, CEO and president
of Sacred Heart Health System. “We are so honored and grateful for all of
the contributions he has made to Sacred Heart and Northwest Florida.”
Dr. Jones was the first pediatric surgeon at Sacred Heart Children’s
Hospital and served as the only pediatric surgeon in the entire Panhandle
for 35 years. He is currently the assistant medical director at Nemours
Children’s Clinic. He is active in civic affairs and currently serves on the
Board of the Community Maritime Park.
Baptist HealthcareBaptist Medical Group Welcomes Dr. Edwin Rogers as CMO
Baptist Medical Group, Baptist Health Care’s employed physician
network, announced that Dr. Edwin Rogers, a longtime member of their
medical staff, has been named Chief Medical Officer (CMO). For the last
30 years, Dr. Rogers has served the greater Pensacola community as an
experienced cardiologist with Cardiology Consultants, an affiliate of Bap-
tist Health Care. The CMO position is newly created in response to physi-
cian feedback and continued growth of the medical group, now com-
prised of over 100 primary care and specialist physicians. Learn more at
BaptistMedicalGroup.org.
Comprehensive Care for Arrhythmias Available at the New Baptist
Heart Rhythm Center
BHC and Cardiology Consultants are proud to introduce the Heart
Rhythm Center, the region’s best heart center focused exclusively on the
diagnosis and treatment of complex heart rhythm disorders – known as
arrhythmias. Led by an expert team of board-certified electrophysiolo-
gists, the Heart Rhythm Center offers the most comprehensive, compas-
sionate treatment program in the region. Learn more at eBaptistHealth-
Care.org/HeartRhythm or call 850.444.1717.
RETURN SERVICE REQUESTED
8880 University Pkwy., Suite BPensacola, FL 32514Ph: 850-478-0706 Fx: 850-474-9783Email: [email protected] Director: Erica Laxson
PRSRT STDU.S. POSTAGE
PAIDPERMIT #258
PENSACOLA, FL
View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.
MECOP Reminder
11th Annual Best Clinical Practice SymposiumSaturday, January 14, 2012Sacred Heart Greenhut Auditorium7am-4pmContact: Jenna Coleman 850-477-4956 ext 1Or email [email protected]
Member Benefit: The Health Care Attorney On Call Hotline (561) 306-5699
There’s a guiding philosophy To Mag MuTual’s efforTs to defend your reputation: Whatever it takes. Claims committees staffed 100% by physicians. An exhaustive review and medical opinion for every claim filed. Outside help, when needed, to prepare a physician for deposition. Deep exploration of the best available expert witnesses. A detailed game plan weeks before trial. Testing the defense with focus groups. Mock trials. Continuous involvement of MAG Mutual’s claims specialists.
Much of the above represents an “expense” to other carriers – an expense they often don’t want to pay. We invest in the best interest of the physician, whose reputation, life and livelihood are at stake.
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