March/April 2008

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Reusing syringes and vials leads to class action suits

The Nevada clinic accused of reusing syringes and spreading hepatitis and HIV to several patients has been named in a class action lawsuit that could involve as many as 40,000 people.

The Endoscopy Center of Southern Nevada is being asked to pay for tests for the HIV antibody, hepatitis B and C and damages for pain and suffering, according to the Las Vegas Sun. Attorneys Will Kemp, Gerald Gillock and Peter Wetehrall have filed suits.

Plaintiffs without actual infections may seek emotional distress damages. Nevada has tort caps of $350,000. •

CE article: knowledge of aging process vital

By Frances W. Sills, RN, MSN, ARNP

The number of elderly individuals in our society continues to grow and we are seeing a much more active role in increasing society’s awareness of the qualities, rights and needs of our older population.

Popular literature has continued to dispel the myths concerning the aging process. The media continue to bombard us with “anti-aging products,” steps we can take to “reverse the aging process” and ongoing, improved plastic surgery procedures that keep us looking younger. Government is demonstrating greater sensitivity to the problems of old age, as evidenced by new legislation promoting increased security and care for the aged.

This CE offering will address the normal aging process which is a…

Texas’ med mal caps being challenged by Dallas Cowboy Ron Springs

A former Dallas Cowboys football player is a plaintiff in a lawsuit challenging the constitutionality of Texas’ medical malpractice “pain and suffering” damages cap, according to the Associated Press.

The football player, Ron Springs, slipped into a coma last fall after surgery to remove a cyst. Spring’s wife brought the suit in January and called the surgery routine.

According to the AP, Springs joins with 10 other plaintiffs seeking class action status to overturn Texas’ Medical Malpractice and Tort Reform Act, which limits a plaintiff’s pain and suffering awards at $250,000 per provider for a total of $750,000. •

5th in a series: Legal issues in quality of care: A primer for consultants, experts

By Cheryl L. Wagonhurst, Janice A. Anderson, and Nathaniel M. Lacktman, Esqs.

Introduction

Quality of care has emerged as the hot issue in the healthcare industry. Healthcare industry experts and consultants should familiarize themselves with the main legal issues arising from the government’s efforts to promote quality healthcare. This article provides the information experts and consultants need for a general understanding of: 1) the development of the government’s quality of care legal initiative, 2) the three prongs of that initiative (payments, public reporting and enforcement), and 3) the issues hospitals and their boards of directors must understand and address in the current legal climate.

A landmark report leads to an industry revolution

Since the Institute of Medicine released its 1999 landmark report…

Hospital settles surgeons’ complaints of quality control for $4 million

• The Gist: In such a complex he said/she said case, accurate scrutiny of medical records and billing would be key.

By Sam Hemingway
for The Medical-Legal News

Vermont’s medical community is still scratching its head over the outcome of a lawsuit filed in federal court in Burlington by a physician who claimed a 70-bed community hospital near the Canadian border plotted to destroy his career after he voiced criticism about its quality control procedures.

The hospital, the privately owned Northwestern Medical Center in St. Albans, announced on Jan. 28 that it will pay $4 million to settle the case…

Failure to spot child abuse brings civil suit

A hospital and two doctors in Indiana have been accused of violating medical standards by not reporting the suspected child abuse of an 11-month-old boy.

The Indianapolis Star reported that a lawsuit claims a Clarian Health hospital was negligent in its communications policies and that the two doctors failed to identify and report child abuse as required by law .

The child was killed a month after the hospital visit in question. The child’s mother’s boyfriend confessed to the crime. •

Focus on: Nursing processes, diagnoses in amputees’ LCP

By Dorajane Apuna, BSN, MA, RN, CCM, CNLCP

When planning the future care for an amputee, the nurse life care planner (LCP) must not only use the skills he or she has as am LCP, but must also employ critical thinking processes and the clinical judgment necessary to make accurate diagnoses. Use of the nursing process begins with the initial on-site assessment and continues throughout the development of appropriate outcomes for the client, during the planning of care interventions, and evaluation of outcomes of care. The diagnosis considers…

Rhode Island Hospital makes changes after 3 errors

• The Gist: The hospital here may have fallen victim to simple, yet easily avoidable, errors that were largely do to poor communication. Look for these gaps in records review.

By Barbara J. Levin, BSN, RN, ONC, LNCC

“To the world you may be one person but to one person you may be the world.” This famous saying is applicable to the hospitalized patient. Patients admitted to the hospital rely upon the hospital staff physicians, nurses and others to provide the best quality care.

Rhode Island Hospital has had four wrong site surgeries, all involving brain surgeries, within six years. Three of the incidents have occurred within the last year, according to ABC News. Questions are raised about the safeguards and lessons learned by the institution and how these incidents should have been prevented.

A brief review of the facts…

Written by “The Entrepreneurial MD,” this column was originally written for physician business owners, but the advice is relevant for all professional enrepreneurial consultants.

Winning teams for small business owners

By Philippa Kennealy, MD, MPH, CPCC

Kids’ leagues and amateurs can get away with dad coaches and ringside advice, but no self-respecting professional will try to go it alone in the quest for gold — correct?

Likewise, no matter how independently-minded physician entrepreneurs may be, they need a good team behind them for any serious business venture.

Even if you are determined to be a micro-practice with no staff, or a one-person consulting gig, you’ll still need a support team to provide the business expertise that no single human being can possess.

Here then are some suggestions for whom to invite to play on your winning team:

1. A supportive significant other or family member. Entrepreneurship is tough enough, but attempting to start and run a business venture without the emotional, and sometimes financial, support of family or close friends makes the effort seem monumental. Find yourself at least one raving fan — someone who will cheer you on from the sidelines when you’re cramping up and ready to run from the field.

2. A business attorney. The mistake many early entrepreneurs make is to turn to Aunt Sally, the one family member…

Oversight: The element of compliance that puts management in the hot seat

• 
The Gist: Attorneys and consultants will want to look at a provider’s compliance systems and structure when defending or litigating cases involving healthcare organization wrongdoing.

By Angela L. Tobias, RN, BSN, MSHSA, LNCC

A successful compliance program must have appropriate oversight. Someone at the top of the organization must ensure that the compliance program is fulfilling its overall function of detecting and deterring fraud and abuse.

The Office of Inspector General (OIG) considers the oversight responsibility to land ultimately with an organization’s board of directors.

The board recognizes the need, and authorizes the launch and implementation of the organization’s compliance program. The federal sentencing guidelines are very clear…

Are you sabotaging your consulting practice?

This column was written for expert witnesses, but is applicable across professional fields.

By Rosalie Hamilton

Your most effective marketing tool is the quality of your work. When used correctly, this marketing tool leads to clients who retain your services again, clients who refer you to others, inquiries about your services from opposing counsel, and a good reputation in the circles and communities that make up your pool of potential clients.

What I’m referring to is not just the accuracy and relevancy of your work, although of course that is a big part of it. But there are other components that add to the perception of your value in the eyes of your clients. Most of these involve simple actions you can take that make life easier for others. Ask yourself the following questions…

Your website speaks loudly of you: Tips to improve it

By Rosalie Hamilton

I talked to a CPA this week about creating a website for his forensic
practice. He asked me about CPA sites we’ve done. I smiled, thinking of the variety of sites we completed most recently — for a securities expert, a forensic engineering firm, an MD specialist and a vocationologist; we’re currently working on sites for an electrical engineer, a medical not-for-profit organization, an agricultural equipment expert and a life care planner.

The commonality of expert web sites is not related to your particular area of expertise, but instead to…

Getting-started tips for LNCs

By Elizabeth K. Zorn, RN, BSN, LNCC

Each new LNC has to make his or her own decision on how to proceed, but in every case you must network with other LNCs and get a sense for the legal community in your area and the extent to which lawyers value LNCs. I advocate an entry level LNC course (there are many options) to obtain some basic information about putting medical issues in the context of the applicable legal standards, work products, medical literature searches and getting a small business up and running. I also recommend…

Medicare, Medicaid fraud and abuse: avoiding common misunderstandings

• The Gist: Know the fundamentals of Medicare and Medicaid fraud and abuse cases. Providers can be held personally responsible, and can be deemed to have acted fraudulently even when they only “should have known” of the fraud.

By Elizabeth E. Hogue, Esq.

Providers are generally familiar with prohibitions against fraud and abuse in the Medicare and Medicaid programs, including Medicaid waiver programs, and other state and federal healthcare programs. Fraud and abuse in the form of billing for services that were never actually provided to patients, for example, may be especially familiar.

But there are at least two common misconceptions about fraud and abuse…

States are under pressure from feds to stop Medicaid fraud and abuse

• The Gist: Pressure to cut costs in Medicaid can mean opportunities for attorneys and records reviewers in these cases.

By Elizabeth E. Hogue, Esq.

Many providers are aware that state Medicaid programs are under enormous pressure from the federal government to identify instances of fraud and abuse and to recoup as much money as possible. These enforcement efforts are primarily based on the Deficit Reduction Act (DRA). 

The State of New York is one of the first states to take aggressive action against home care agencies in an operation called “Home Alone.” Enforcement actions have included the following: A number of home health aides provided services …

• To obtain more information about fraud and abuse enforcement in a book entitled Medicare/Medicaid Fraud and Abuse: A Practical Guide for Providers, send a check for $30 that includes shipping and handling made out to Elizabeth E. Hogue, Esq. to Fulfillment, 107 Guilford, Summerville, SC 29483. To obtain an 80-minute video or DVD on fraud and abuse compliance presented by Elizabeth Hogue, send a check for $105 to the above address.

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