Homework answers / question archive / Here is the comment I received on the last assignment: You've done a very nice job of organizing your response

Here is the comment I received on the last assignment: You've done a very nice job of organizing your response

Business

Share With

Here is the comment I received on the last assignment:

You've done a very nice job of organizing your response. I'm going to provide some detailed feedback below, but keep in mind that the point of these assignments (especially the early ones) is for you to try out a type of analysis and writing that's new to you. I do not expect you to have mastered it right off the bat. The point is for you to have a go at it and then for me to provide feedback that you can use in the next assignment.

You did a really nice job of inhabiting the assigned role and keeping your audience in mind. Your tone and writing style were just right. For the next assignment, there's no need to include citations. They usually wouldn't be used in a memo of this sort. Or, if they were, they'd be to materials that are specific to the jurisdiction. For teaching purposes, in this course we use materials from multiple jurisdictions. It would be odd to cite these materials in a real-word setting, though.

For the next assignment, you might work on being more specific about the risks you are working with your audience to manage. E.g., "the hospital could be held liable for breaching a duty to the patient by failing to implement reasonable rules and policies to protect her safety. The damages could be quite high if the fetus does not survive."

One way to approach these assignments is to think in terms of what value you can provide for your audience based on the material and skills you're learning in the MLS program generally (e.g., compliance principles and skills, basic tort law concepts) and this course in particular (e.g., the elements of negligence and how the standard of care is assessed for the purposes of the breach element for a tort claim against a hospital).

The main thing I'm looking for in these assignments is how you apply your knowledge of the relevant material from the course to the fact pattern in the assignment. You did a really nice job of this for your first assignment. For the next one, I think you can do even better! One way to check over your work before submitting an assignment is to scan your draft for key terms that you've learned in the course. If you've written a paragraph or two without using any key terms related to health care law (e.g. for Assignment 1, the most important terms include: "liability," "breach," "standard of care," and "informed consent") and/or compliance (e.g., for Assignment 1, the key terms were "written policies and procedures," and "training") there's a good chance you're missing something. In some cases, you used terms that were close to the key terms (e.g., you wrote a lot about the importance of "informed decisions" and the importance of respecting the patient's autonomy, but you didn't explain that ensuring the patient gives "informed consent" to forgo continuous monitoring, after being informed about the risks and benefits, could help protect the hospital from liability for negligence and the physicians and nurses from malpractice liability if there's a bad outcome.

Reichenbach Falls Problem 74-year-old Andrew Reichenbach has a subdural hematoma. He first arrived at Dresden Hospital (a hospital located in Philadelphia, Pennsylvania, and accredited by the Joint Commission) on Friday morning via the emergency department. His chief complaint was severe abdominal pain, which he’d been experiencing since Thursday evening. The admissions assessment completed by a triage nurse in the emergency department noted that Mr. Reichenbach’s wife explained that he had gotten up in the middle of the night on Thursday due to the pain and had fallen, chipping a tooth. The patient’s medical history included mild colitis (inflammation of the lining of the colon) and high blood pressure. Mr. Reichenbach’s abdominal pain subsided somewhat, but his blood pressure remained high during his time in the ED, prompting the attending physician to admit him for monitoring. Mr. Reichenbach was admitted to the hospital at 3 p.m. on Friday afternoon. At approximately 8 p.m. on Friday night, Mr. Reichenbach got up from his hospital bed to use the bathroom and fell. He immediately pulled a cord in his room to signal the nurses on duty that he required help. The nurse who responded filled out and signed an incident report and handed it to the nursing supervisor on duty. The supervisor also signed the report and recorded the incident in the daily log that nursing staff uses to communicate with each other through shift changes. The supervisor also sent a copy of the report to the hospital’s compliance department. No one inquired as to the cause of the fall, however. No one conducted a clinical assessment of the patient to assess his risk of falling again, nor were fall-prevention measures (e.g., instructions that the patient should remain in bed and contact a nurse for assistance to use the bathroom) instituted. The nursing supervisor says that she planned to inform the attending physician about the fall during the shift change at 6 a.m. At approximately 5 a.m. on Saturday morning, Mr. Reichenbach got up to use the bathroom and fell again. He was found a few minutes later by a floor nurse. A complete medical evaluation was conducted, and the attending physician determined that Mr. Reichenbach had a subdural hematoma, necessitating immediate brain surgery to relieve the pressure. The general counsel and chief compliance officer of the hospital have called a meeting with their associates to discuss measures that should be taken to address this incident and to prevent similar incidents from occurring in the future. Please prepare a memo for the hospital’s chief compliance officer specifying a. Dresden’s obligations under state law b. Dresden’s obligations under Joint Commission accreditation standards c. Any additional steps that should be taken at this time to address exposure to tort liability now and in the future 4: Quality Regulation: Accreditation, Licensure, and Scope of Practice 4.1 Private Accreditation and Certification 1. Similarly, regulators at the state level can and do incorporate private accreditation and certification requirements by reference into their licensing and other regulations, essentially requiring that individual health care professionals abide by certification requirements as a condition of maintaining their professional license conferred by the state board. 2. We're going to be taking a look at requirements of private payers at accrediting bodies as well as later in the week focusing on licensing, disciplinary actions, and scope of practice regulations as ways of addressing these systems failures by focusing on the role of health care organizations that have greater ability to reorganize systems through rules, policies, and procedures that ensure patient safety. 3. Private certification and accreditation examples include the American Board of Neurological Surgery, which conveys neurosurgeons a certification, allowing them to then hold themselves out to patients, to payers, and to hospitals, as in Carter versus Hucks-Folliss as board certified neurosurgeons. 4. But when a hospital is accredited by the Joint Commission or another accrediting organization, it can then signal its accredited status to patients as an assurance that they're offering quality care and to payers as an assurance that they're following the standards of that private accrediting body and being overseen by the organization as well. ---------1. It's government action by a professional board operated as a state agency exercising authority delegated by the legislature at the state level to permit a physician, a nurse, or other individual professional or institution to offer their services on the market. 2. So states have primary responsibility for licensing individual providers-- physicians, nurses, nurse practitioners, physician assistants, pharmacists-but also alternative practitioners, such as acupuncturists, and health care organizations as well. 3. But to be able to prescribe controlled substances, individual providers need something from the federal government in addition to their state license. 4. Licensing also provides a mechanism for government to impose specific requirements or regulations on individuals and businesses who obtain a license as a condition of maintaining that license. 5. Licensing is intended to protect the population from unqualified service providers, for example cosmetologists, insurance and real estate agents, far outside the health care sector. 6. For example, the Maryland Office of Health Care Quality issues licenses to health care facilities and programs authorizing them to do business in the state. ------1. The board noted that homeopathy is not what they deemed an acceptable and prevailing medical practice and was therefore prohibited by statute for licensed physicians, meaning someone else might prepare homeopathic remedies and sell them on the market, but a physician who's licensed by the board could face disciplinary proceedings by that board for engaging in those same practices. 2. It held that the board should have introduced expert testimony to counter the testimony that was offered by Williams' experts, that essentially just introducing the Physician's Desk Reference and relying on their own expertise as physicians and board members was insufficient in this case. 3. Going back to In re Guess, in this case, the court sided ultimately with the board, finding that it had authority to impose orthodoxy on the professionals it regulates even in the absence of any showing of harm to the patients or even any potential for harm to patients. 4. Williams for his past practice, pursuant to a general statute that gave the board broad authority to discipline doctors who fall below the reasonable standard of care. 5. There's a standard of care issue for the purposes of tort cases and a really important question of whether practitioners should be held to the standard of prevailing practice of medical doctors or whether they can be held instead to alternative standards that endorse the use of these treatments. 6. In this lecture, we're going to delve a little more deeply into state board disciplinary proceedings against individual health care professionals. 7. They can range from revocation, permanently, of the physician's license to practice in that state, suspension of the license temporarily, which is what we saw the board try to impose in Williams, to probation, which can be with or without conditions. 8. This case also demonstrates how most of the disciplinary process is governed by the state board, again, functioning as an agency of the state. 9. Going back to In re Williams, Williams ultimately filed suit, going before the courts to ask them to overturn the board's decision, which, again, imposed harsher penalties than even the hearing examiner had recommended. 10. The board charged Williams with a violation of this general provision requiring doctors to follow a standard of care. -----------1. The state licensing statute in the case defined nursing practice to include "teaching health care and prevention to patient and family; assessment; nursing diagnosis; nursing care; counsel of persons who are ill, injured, or experiencing alterations in normal health processes; administration of medication and treatments prescribed by a licensed prescriber; and coordination and assistance in the delivery of a plan of health care." The court in the case noted that the state legislature had adopted this broad definition, explicitly rejecting a narrower alternative with the intention of expanding the scope of nursing practice. 2. So this is true with respect to midwives who are licensed in states like Maryland as well as to nurses who must practice within the scope of their nursing license or potentially run afoul of restrictions on the unlicensed practice of medicine, for example. 3. The court, thus, sided with the East Missouri Action Agency and its nurses and doctors, finding that the nurses' actions under appropriate standing orders from the physicians fell within the scope of nursing practice. 4. As the scope of practice of nonphysicians expand, in these states that require physician supervision, the question of what that supervision looks like becomes a critical risk management area for the physicians who supervise nurses and other nonphysicians and for the organizations where this relationship is playing out. 5. And that may have marked her as a target for enforcement action by the state boards of nursing and medicine, known in Kansas as the Board of Healing Arts, which brought charges that she was performing some functions that should have been properly reserved for licensed doctors and other functions that are permitted for nurses and that she was performing these functions without either license. 6. Most states, instead of defining specific parameters of permitted independent practice in concrete terms and explaining, for example, that the physician may be no more than 10 miles away or must be on-site on the premises-Instead of taking that bright-line rule approach, most states have adopted a flexible approach that requires the physician to adopt reasonable standards in light of the specifics of the case and the specific skills and abilities of the nonphysician at issue. 7. This case was one in which nurses and physicians working for an organization, a private organization called the East Missouri Action Agency, were seeking a declaration, holding that they were not practicing outside of the scope of their license and that the physicians were not improperly supervising the nurses in doing so. 8. If the conduct of an individual professional falls outside of the scope of that person's license-- for example, a nursing license-- and falls within the scope of another license, such as a medical license, then that individual may be subject to civil and criminal penalties for unlicensed practice. --------1. In another case, Allstate Insurance Company versus Northfield Medical Center, a New Jersey case from 2017, the court upheld a $4 million jury verdict awarded to an insurance company against a physician practice management company, its owner, and their attorney for knowingly or with willful blindness violating the state's corporate practice of medicine restrictions and defrauding the insurance company in the process. 2. For example, in Berlin versus Sarah Bush Lincoln Health Center, an Illinois case from 1997, a doctor unsuccessfully invoked the corporate practice of medicine doctrine to argue that a non-competition clause in his employment agreement-- rather his contract with the hospital that had employed him was unenforceable. 3. Stringent corporate practice of medicine restrictions, like stringent and restrictive scope of practice regulations, may be in tension with various forces that are promoting integration in health care and with patient's understanding that they are entering into a treatment relationship with a health care organization and not just the individual physicians involved. 4. Another holding in the Berlin versus Sarah Bush Lincoln Health Center case was that the court found that the corporate practice of medicine didn't even apply to licensed hospitals. 5. Doctors and payers can invoke these state-level corporate practice of medicine restrictions in their disputes with hospitals and other health care facilities. 6. Corporate Practice of Medicine, or CPM, doctrine is a state-level doctrine adopted by statute, regulation, or common law decisions of courts that prohibits businesses or corporations from practicing medicine or, even in some states, employing physicians to practice medicine. 7. In contrast, corporate practice of medicine states say that this isn't an arrangement that is permitted, that hospitals, as business entities, are not permitted to provide medical care directly. 8. This understanding of patients echoes Thompson versus Nason Hospital, the case that we read about the corporate practice of medicine doctrine in the tort context. 5 · Quality Regulation: Compliance with Reporting, Investigation, and Disclosure Requirements 5.1 Reporting and Investigation Requirements 1. The serious event term is defined in the statute as "an event, occurrence, or situation involving the clinical care of a patient in a licensed medical facility that results in death or compromises patient safety and results in an unanticipated injury"-- so not a routine complication but something unexpected-- "requiring the delivery of additional health care services to the patient." Facilities are also required to report two other categories of events defined as incidents and infrastructure failures. 2. A health care worker, according to the statute, who reasonably believes that a serious event, meaning an incident in which a patient is harmed or has died, or an incident-- so including near-misses-- has occurred must report it within 24 hours to the medical facility. 5.2 Patient Disclosure and the Benefits of Communication and Resolution 1. A medical facility through an appropriate designee-- so the facility itself determines who's going to be designated to provide the notification-- shall provide written notification to a patient affected by a serious event or, in cases where the patient has consented, to an available family member or designee. 2. In this lecture, we're going to turn to state-level provisions that require health care providers to disclose the occurrence of an adverse event directly to a patient or the family. 3. So that's someone who's designated by the patient, as either a family member or other surrogate decision maker to receive that notice, when the patient is incapacitated-- within seven days of the occurrence or discovery of the serious event. 4. A serious event is defined here as an event, occurrence, or situation involving clinical care of a patient in a medical facility that results in death or compromises patient safety and results in an unanticipated injury. 5. Good communication between health care providers and patients-- including disclosure to patients and their families when an adverse event has occurred- is strongly supported by evidence, indicating that it improves health outcomes, and it also reduces the likelihood of a suit being filed. 6. So this is the same definition that applies to the reporting requirement to the state agency, but now we're talking about how this kind of event also triggers a requirement to disclose directly to the patient or other surrogate. 7. This is a particularly important provision, because health care providers might be nervous about speaking with patients about adverse events due to a sense that their words may be held against them, if the patient ultimately sues.