ESCAMBIA COUNTY MEDICAL SOCIETY
President’s Message
JULY/AUGUST2011 Volume 41, No. 4
Whac-A-Mole! More Than a Kids Game by Michelle Brandhorst, MD
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If your work day is like mine there are many things that happen that remind me of how great it is to be a doc. The time spent developing caring relationships with our patients as well as the challenge of keeping up to date with the science of medicine provide satisfaction that I cannot imagine obtainable in any other profession. And then...well there are those other things that I read about and encounter that drive me nuts. I believe it was in the seventies, when I took my daughter to an amusement park that I found the game Whaca-Mole where the furry headed critters would pop up through various holes and one would hit it with a mallet. Whoever invented this game must have had a keen insight into life as there seem to be countless real live analogies. How many ways can the trial bar raise their head to make more money? How many scope of practice challenges are there? How many ways can Government and private payers try to avoid or delay paying for services? Each situation requires a game of legislative Whac-a-Mole. Through the efforts of the Florida Medical Association (FMA) and legislators supported by the FMA these “moles” have been pretty much kept at bay. It is however becoming more evident that the joy of being a physician is threatened by a much more formidable creature, our own government. Because CMS controls much of the reimbursement to physicians and other healthcare entities, CMS can make the receipt of the payment contingent on adherence to whatever it feels makes sense. But too often what CMS feels makes sense robs the patients of physician time. Instead physicians spend time making sure we get enough bullet points in our notes. Forcing us into EMR systems that may be great for sharing data but are onerous at creating it. It forces me to spend three times longer to typing an electronic prescription than writing one, and review four a four medication reconciliation form for nine medications, and spending private time that could be
spent keeping current on science but instead spending it electronically sign off telephone orders when I have Dr. Michelle Brandhorst already reviewed and verified the order with the nurse when it was given. Are there any studies that show that any of this serves to enhance patient care? No! Physicians practice medicine based on best available evidence, but CMS seems to practice by well intentioned whims. We should not be made to be a slave to technology. As always, technology should be used to make work more efficient, consistent and safer. So it is time for physicians to start playing Whac-a-Mole with regulations and requirements that are at best non-beneficial to patient care and at worse rob patients of our time. As long as CMS incentives these requirements, health care entities are reluctant to push back. It is up to physicians to take the lead and I am proud to announce that the Escambia County Medical society is taking a first “Whac.” The ECMS has introduced a resolution asking the FMA to work in conjunction with the Florida Hospital Association to pursue a Florida regulatory change that would extend the length of time physicians have to sign off verbal order from 48 hours to 30 days. As a follow up the last news letter article on patient safety, I would like to acknowledge steps taken by our local hospitals. If you missed Dr. Tim McDonalds lecture on patient safety, it was said by several attendees to be one of the best the ECMS has presented. Fortunately you may get a second chance as there plans be made to try to get Dr. McDonald down for follow up lecture this fall. Have a safe hurricane season as we continue to preserve the patient-physician relationship. Continued on page 3
ECMS Bulletin The 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. Editors Norman Vickers, MD Holly Strickland, Executive Director
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2011 ECMS Officers President Michelle Brandhorst, MD President-Elect George Smith, MD Vice President Wendy Wozniak, MD Secretary /Treasurer Susan Laenger, MD
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Page 4 Dewey At Large Page 7 Health Information Exchanges (HIEs)
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Membership Welcome New Members!
Residents
James Jimenez, MD
Gail Joseph, MD
Vascular/Interventional Radiology Medical School: New York Medical College, Valhalla, NY Residency: LIJ Medical Center, New Hyde Park, NY Board Certified: American Board of Radiology Board Certified: American Board of Phlebology 210 B East Government Street Pensacola, FL 32502 Phone: (850) 607-7570 Fax: (850) 607-7571
FSU Sacred Heart OB/GYN Residency
Pablo Concepcion, MD Pain Management/ Anesthesia Medical School: Pontifcia University Residency: SUNY Upstate New York Board Certified: American Board of Anesthesiology 4624 North Davis Hwy Pensacola, FL 32503 Phone: (850) 494-0000 Fax: (850) 494-0001
Issa Ephtimios, MD The Center for Infectious Disease Medical School: AIN SHAMS Medical School, Cairo, Egypt Residency: RWJMS New Jersey Board Certified: American Board of Internal Medicine – Infectious Disease 8333 North Davis Hwy Pensacola, FL 32514 Phone: (850) 474-8187 Fax: (850) 474-8684
Cecily Collins, MD FSU Sacred Heart OB/GYN Residency
Jessica Jayeson, MD FSU Sacred Heart OB/GYN Residency
Corrections to Directory Craig Broome, MD 11809 Chanticleer Dr Pensacola, FL 32507 Phone: 492-3426
Karanbir Gill, MD 5149 North 9th Ave, Ste 246 Pensacola, FL 32504 Phone: 416-6159 Fax: 416-7198
Moved Lornette Epps, MD 1717 North E Street, Ste 401 Pensacola, FL 32501 Phone: (850) 912-6550 Fax: (850) 912-6554
President’s Message, continued from page 1
Patient Safety Initiatives at Sacred Heart Health System By Deanie Lancaster, CNO, Sacred Heart Hospital Pensacola Sacred Heart Health System has been working in earnest for several years to make healthcare safer. In 2002, Ascension Health, the parent company of Sacred Heart, set the goal for all its ministries to eliminate preventable injuries and deaths. Ascension Health facilities throughout the United States set a goal of preventing 900 patient deaths in five years by focusing on specific adverse events that occur in healthcare settings. They exceeded the goal by three times, and an estimated 3,200 deaths were prevented at Ascension Health facilities during a five-year period. In December of 2007 Sacred Heart leaders and physicians decided to build upon this success by initiating a system-wide focus on preventing specific, preventable adverse events, such as patient falls, pressure ulcers, healthcare-associated infections and adverse drug-related events. Since early 2008, all physicians and associates have been trained to use specific error-prevention techniques that are modeled after those used
in the nuclear power and aviation industries. Pre-procedure checklists, read-back of orders, time-outs before invasive procedures, and double checks, along with technologies like bed alarms and computer alerts, are used consistently to prevent patient injuries. Additionally, the use of unsafe abbreviations in medical records is prohibited. Nurses perform bedside shift report at the change of every shift to include the patient in his or her care. These techniques have resulted in more than a 50 percent reduction in serious safety events throughout the Sacred Heart Health System. Working to prevent harm to patients continues to be top-of-mind for clinical staff at Sacred Heart. Medication safety in an essential area of focus due to many patients taking multiple medications for chronic conditions. More and more commonly, we encounter patients taking more than ten drugs, some of which can counteract each other. To prevent potencontinued on page 9
Membership Dewey at Large By Dr. Charles Moore Short Introduction: This article comes to ECMS courtesy of the Capital Medical Society. Dr. Charles Moore is a long time friend of Dr. Donald Dewey’s. Dr Moore is the Editor of the Capital Medical Society’s newsletter Cap Scan. I confess to some misgivings as I contemplated “Dewey”…that is Donald “Dewbonz” Dewey, M.D….in an airplane. To cram that larger-than-life character into an economy seat in the tail end of even a Jumbo Jet for a ten hour flight seemed asking too much of modern technology. What if he got restless? What if, overcome by some form of ennui, he reverted to his “Elvis” persona? What if he started rockin’ and rollin’ and the tail section began bounding up and down to the “Rhythm of Dewey?” What if we lost the “Bernoulli effect,” or if the tail fell off? As is well known to my acquaintances, I am, of course, rather restrained…except on rare occasions for which I apologize…a quiet sort of guy, Professor Higgins-like. I am inclined, particularly in airplanes on long flights, to simply hunker down, read a book, and eat whatever bit of plastic I am served. Least of all do I want to do anything that might result in the plane losing a wing or two. But Dewey, I thought, did not trouble himself about such details. He drove over from Pensacola to spend the night with us prior to our early departure the next morning for Istanbul, where we were to spend 24 hours looking at various minarets before flying onwards to Simferopol, the capital city of Crimea. There Dewey was to participate in ten or twelve rather complicated surgeries, bad club feet and so on, afflicting a gathering of orphans age two to ten, and who otherwise would be deprived, given the anomalies of health care in the Ukraine, of such services. Good of him to take the time out to come do this; and of his wife Cathy, too, who, given her vaguely morbid fear of flying, fretted. But let me tell you, we had no problems at all. Once in his seat, I was astonished to discover Dewey-the-gentle-lamb. He and the plane appeared to get along wonderfully well, and the wings never fell off, even once. In due course we landed in Istanbul. As Dewey looked about, I could tell that he perceived, and took a highly intelligent interest in, the fact that there was a considerable difference between Istanbul and Pensacola/Tallahassee. Never minding “jet lag,” we toured the “Grand Bazaar” and the “Spice Market,” haggled over the purchase of trifles, and took a cruise on the Bosporus. I demonstrated to him how my fake joints, that he put in so many years ago, were wonderfully holding up, hopping along in fine fettle. In front of the “Blue Mosque,” I bought us each a delicious looking corn on the cob being sold by a vendor; but, just to warn you when you are next in Istanbul, despite the delectable appearance, it was tough and not so sweet as our own cobs. We learned to say “thank you” in Turkish, which is something like Tashecure Aderim, or maybe not. And the next morning we met the rest of our group, and flew off to Simferopol. Dewey, without even the ghost of Elvis at his side, captivated the Ukrainians. They had never seen anything like him, ever; and unlike some of us, every word he spoke was not only sensitively said, and perceptively considered, and very jolly, but perfectly translatable into Russian. The Ukrainians, who actually speak Russian even though they also speak Ukrainian,
a language that Muscovites would consider “Red-Neck,” but which made Dewey easy to translate. By our standards, the children’s hospital where the surgeries are Dewey-the-gentle-lamb-in-a-jumbo-jet performed may be here and there somewhat down-at-heel, although they possess the welcoming advantage of a lot of friendly cats, who perch themselves about the front door. Kids and Dewey like this. The nurses and staff, of course, are more than welcoming, pleased more than my words can describe by the opportunity to have this sharing experience. Lack of funds forbids that they go forth into the world for seminars and learning on their own; so Dewey et al represent a real opportunity. In the office of Dr. Alexander Astakov, the CEO of the hospital, formal introductions were made, and Dr. Alexander made very gracious welcoming remarks. Dewey, I think, thought the remarks went on a bit too long, and then even longer, for he was hankering after some bones to get at. They had plenty for him. Dewey was summery looking in his white rather than bile green scrubs, and enjoyed the rigorously enforced discipline of dipping his hands into some unknown solution prior to entering the OR proper. On the other hand, the OR suite, one where a number of surgeries may be performed at the same time in an elongated room, is by no means without distinction. The entire, long wall is nothing but a big window, the room flooded with natural light and a prospect overlooking Simferopol that was simply lovely, with spring just coming and the first blush of green everywhere seen. Dewey operated with Dr. Svetlana, their own very excellent orthopedic surgeon of many years and much experience, the one assisting the other in sequence. Ahh, with what modesty and discretion did “Dewbonz” assert his own opinions while, justice be done, admiring the expertise of Dr. Svetlana. Who would have ever guessed that “diplomacy” in a foreign setting is yet another of his gifts. Amiability reigned, and those little orphans were all made as straight as the very word “ortho-pedics” says they should be made. And everyone learned quite a great deal from everyone. And then, of course, on the last evening there was a banquet in a Tatar restaurant, the table groaning with exotic foods, wine and vodka flowing by the bottle. Everyone gave toasts and made speeches, although I think I was restrained for various reasons lest I place a foot in my mouth, and so the next morning we flew home. As teachers so often say about their profession, they learn as much from their students as they teach. So with us. Beyond which, and all the more gratifying, are these remarkably sweet little orphans, these “least sparrows,” who because of the generosity of physicians like Dewey, Michael Erhard, Rich Bosco, Kevin Neale and Ashok Manocha, DDS are given such a better chance at life. Dewey about to embrace a foot
Practice Management Giving Medical Receptionists Their Due By Pauline W. Chen, M.D. Not long ago, the receptionist on the hospital floor where I work went on a family leave. Calm and with a wisecracking wit that she attributes to her New Jersey roots, she had worked at the hospital for years and knew better than anyone how to make things happen in the system. What doctors and nurses missed most when she was gone, though, was her ability to soothe emotional family members, intuit medical emergencies on the phone and cut off rude doctors — then tirelessly repeat that good work dozens of times over the course of a day. When she got back from her leave, I told her how much all of us had missed her. “There are some doctors and nurses who don’t think much of
“It’s not that the receptionists don’t feel anything; it’s just that they may be mirroring the kind of ‘objective’ behavior that doctors are taught in order to protect themselves,” Dr. Ward said. But this detachment can also backfire. In an effort to protect doctors from being inundated with patient visits and requests, many of the receptionists relied on emotional distancing to deal with upset patients, a strategy that sometimes only angered patients further. “In a lot of people’s minds, the receptionist is barring access to primary care,” Dr. Ward said. “But the receptionists see themselves in the very difficult position of having to deal with all the emotions of the patients while remaining respon-
what people like me do,” she laughed. “But we are the first ones to see and take care of everything.” While much has been written about the role of doctors, nurses and other clinicians in the care of patients and their families, little attention has been paid to those individuals who make up the very front lines of health care. In almost every clinical practice, office receptionists and the professionals who do comparable work in hospitals, the ward clerks and unit secretaries, are the first people patients see. But serious research on their interactions with patients has been sparse at best. Now the journal Social Science and Medicine has published a new study on the work of this group of professionals. Despite the stereotype that many receptionists bear as mere “gatekeepers” or even “the dragon behind the desk,” the study found that their responsibilities extend far beyond administrative duties. Ward clerks and office receptionists are a vital part of patient care. Over the course of three years, Jenna Ward, lead author of the study and a lecturer in organization studies at the York Management School of the University of York in England, embedded herself in general practice offices and observed and interviewed nearly 30 office receptionists. She found that in addition to their administrative work, receptionists had to deal directly with as many as 70 people during a single day. Their emotionally challenging work ranged from confirming a prescription with an angry patient, to congratulating a new mother, to consoling a man whose wife had just died, to helping a mentally ill patient make an appointment. The demands changed from minute to minute and were often unpredictable. But one thing was certain: A significant portion of their work involved managing the emotions and care of patients and families. “Receptionists are a key part of the relationship between patients and doctors,” Dr. Ward said. “We should be thinking of the relationship not as a two-way one between doctor and patient or nurse and patient, but as a three-way relationship among clinician, patient and receptionist.” Dr. Ward observed that the most experienced and successful receptionists could rapidly change emotions to meet the patient’s needs. For example, seconds after one of the receptionists confided to another how sad she was about the accidental death of a young patient, the office telephone rang. The receptionist immediately collected herself, then answered the phone in a warm and cheery way. During a mix-up over appointment times, another receptionist responded calmly to an elderly patient who had begun shouting racial epithets, helping to defuse the situation.
sible for the practice and protecting their practitioners.” Dr. Ward believes that with more recognition and support for the emotional work receptionists do, such misunderstandings and antagonistic interactions could be avoided. Practices, for example, could make more explicit the fact that any requests to see a clinician would be fulfilled within 72 hours rather than 24. Moreover, those who become receptionists could receive training on handling not only the administrative but also the emotional aspects of their work. “Right now, when you employ people as receptionists, it’s kind of a Russian roulette as to how much emphasis they place on the emotional work,” Dr. Ward said. “If it were more integrated into the culture — health care as being doctors, nurses and administrative staff — we might encourage people to perform these emotional tasks well.” “Patient care is a holistic social process,” Dr. Ward added. “And those on the front line can be a crucial part of that holistic treatment.”
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Medical/Legal Understanding the Types of Professional Liability By the Risk Management Experts at First Professionals Insurance Company In this age of expanding theories of tort liability, physicians may find themselves responsible for more than their own acts. Most physicians realize they have responsibility for the actions of their office staff or those who are directly employed by them. However, they give little thought to the fact they may also be responsible for the acts of their partners, office staff, or others that act under their control or supervision. Liability can be divided into two broad categories – direct and vicarious. Direct Liability Direct liability is defined simply as being responsible for your own acts. If you deviate from the acceptable standard of care in the manner in which you practice medicine, then you are negligent and directly respon-
details of the anesthesiologist’s activities, although the law is less clear with regard to non-physicians, such as a nurse anesthetist. Liability exposure under a captain of the ship legal principle may exist despite the absence of a statutory provision. Surgical assistants generally have been held to be the responsibility of the surgeon. Although an operating assistant may have the same degree of skill as their operating surgeon, the surgeon actually directs the activities. The nurses may not fall under the responsibility of the operating room surgeon. It generally has been held that when they are performing acts that require professional judgment, they are under the surgeon’s supervision and control and, therefore, the surgeon’s responsibility. How-
sible. Vicarious Liability Vicarious liability encompasses those situa¬tions where you may have acted appropriately but find yourself responsible for the failure of another individual. The most obvious type of vicarious liability exists for partners. Some physicians have organized themselves into professional associations to avoid this situation. A partner is liable to the full extent of their own assets for the acts of their partner, which were conducted in the furtherance of the business of the partnership. This occurs even though one partner may have never seen the patient nor participated in the care. Physicians organize into corporate entities, such as professional associations, to avoid this scenario. Once the corporation is established, the physicians become employees rather than partners. Employees are generally not responsible for one another’s acts. Therefore, unlike in a partnership, the physician-employees of the professional association are effectively shielded from the vicarious liability for another physician-employee’s acts or omissions. However, a corporate entity does create another category of responsibility. The corporation employs physicians, physician extenders, and others to accomplish the work of rendering medical care. Consequently, the corporation (professional association) becomes the master and each of the employees becomes a servant. As a result, a theory of law called “respondent superior” comes into play. Under this theory, the corporation is responsible for the acts of each of its employees. A common example occurs when an office assistant renders medical advice on behalf of the physician by telephone. If, in doing so, the physician has fallen below the acceptable standard of care, this physician/employer or corporate employer can be held responsible. Captain of the Ship In addition to the categories of partners and employees are situations entailing a division of responsibility and thus, liability. State laws vary significantly in this regard. One of the most common examples is the operating suite. As the “captain of the ship”, the surgeon is generally thought to be in control of all activities occurring in the operating suite and, therefore, responsible for all treatment during the operation. The captain of the ship legal principle has evolved over the years. It is now recognized that there are other specialists in the operating room who perform independently of the direct supervision of the surgeon. The most obvious example is the anesthesiologist. Although surgeons have ultimate control over the operation, they do not have the technical skill or knowledge to control the
ever, when they perform ministerial acts, such as sponge counting, they are under the responsibility of the hospital that employs them. Borrowed Servant The same rules that apply in the operating suite can be utilized to judge responsibility in other circumstances. If the physician exercises direct supervision and control over the acts of another, then they may have assumed responsibility for those acts. A good example is that of interns or residents in a hospital. If the physician is employed by the hospital, then the hospital becomes the master. Generally, the hospital will be responsible for their negligent acts. However, if the individual temporarily comes under the physician’s exclusive control and direction, the intern may have become the physician’s “borrowed” servant and the physician therefore may have assumed responsibility for the intern’s acts. Assessing liability generally is driven by the degree of control the master exercises over the servant. The question of the consulting physician can be most closely analogous to that of the surgeon and anesthesiolo¬gist. If a physician finds it necessary to call in a specialist for a consulting opinion, one generally selects an individual with greater knowledge in that particular area. One does not exercise direct supervision and control over the consulting physician’s acts. As a result, the physician is not the master and not responsible for that individual. However, this does not mean that the physician calling in the consultant will always escape liability if the consultant performs incorrectly. Once a physician has taken on the obligation and duty of rendering medical care and attention, the physician cannot escape that duty by delegating the responsibility to others. If the physician fails to use reasonable judgment in selecting a consultant or in ensuring that the consultant has performed the task, direct liability for selecting the consultant arises as well as liability for the consultant’s negligent act or omissions. Apparent Agency There are situations where one can assume responsibility for another even though one did not intend for the other to perform tasks on one’s behalf. This theory of law is called “apparent agency.” A real agency is created when one party confides to the other the management of some business to be transacted in the former’s name or on their behalf. An example of this is the office assistant or employee who passes along medical advice by telephone at the physician’s request. However, what if the physician had instructed the assistant not to act in such a fashion? In spite of the doctor’s instruction, the assistant Continued on next page
Technology Health Information Exchanges (HIEs) Nearly 21,000 healthcare providers have applied to the Centers for Medicare and Medicaid Services (CMS) for Meaningful Use (MU) Stage 1 incentive payment since the program was launched in January 2011. Under tight deadlines to receive maximum ARRA monies, hospitals and physicians are focusing on meeting CMSs initial requirements of implementing electronic health records (EHRs) and recording basic patient data. But racing to that goal must not give hospitals and physicians tunnel vision. While the Federal Health Information Technology Strategic Plan 2011-2015, issued by David Blumenthal, MD, prior to his departure from the Office of the National Coordinator for Healthcare Technology (ONCHIT), keyed in on getting healthcare providers to install and adopt EHRs, it also created standards for exchange of that digital information. The Strategic Plan underscores the need for local, regional, state-wide, and national Health Information Exchanges (HIEs) to support this data transfer. One can think of HIEs as the plumbing that will allow advanced uses of healthcare data. ONCHIT believes that HIEs will track patient data and improve clinical outcomes by allowing physicians and hospitals to share EHRs with peers, follow patients when they receive care in different places, and exchange patient population data with public agencies like the Centers of Disease Control (CDC). In addition, ONCHIT envisions HIEs as the infrastructure for accountable care organizations (ACOs), the medical home, and the bundled payments initiative. Exchange networks are not yet mandatory. As stated in the Strategic Plan, “Information exchange, which is central to realizing the benefits of EHRs, is not fully possible today- there is no interoperable infrastructure to securely exchange health information nationwide among providers, between providers and patients, and between providers and public health agencies.” On the other hand, there are many examples of mature HIEs across the country. Today, HIEs are concerned with sustainability (finding the right funding model after initial grant funding dries up), governance, and security. The number of working HIE networks (i.e., ones that actually transmit data) has grown from just nine in 2004 to 73 in 2010. Each state has at least one HIE, but only 44 states have working HIEs, according to an e-Health Initiative survey last summer.
Other challenges exist for nascent HIEs such as connecting providers in different regions or states, misalignment of incentives for public and private stakeholders, existing opt in/ opt out regulations which block effective use of HIEs, and the lack of an effective business model. We must overcome these hurdles before David Blumenthal’s implementation of nationwide HIEs can be realized. Perhaps more fundamentally, hospitals and physicians view their peers as competitors and, consequently, they are not motivated to share patient data. Blumenthal and his successor, Farzad Mostashari, have pledged to remove barriers to effective use of HIEs,in part, by offering about one-half billion dollars for healthcare IT. These monies represent direct ARRA payments to hospitals and providers, direct grants to states for HIE development, Beacon Grants to existing HIEs to underwrite the cost of spread of concept, and support for Regional Extension Centers to help rural physicians select and use EHRs. Also central to this effort is the development of a National Health Information Network (NHIN). The NIHN program was launched in 2004, but it has achieved little traction. Starting connectivity within the federal government including the VA and Department of Defense, the NHIN is intended to coordinate a national, secure health information exchange. Pensacola is fortunate to have a local HIE. Sponsored by the Pensacola Bay Area Chamber of Commerce, it is called Strategic Health Intelligence, LLC or SHI. Chartered in 2008, it currently connects Naval Hospital, Pensacola, Baptist Health Care, and Sacred Heart Health System. Its technology partner is Cogon Systems, and it has qualified for the military’s highest standard for data integrity. Funding comes from the hospitals, an ACHA grant from the State of Florida, and a federal earmark shared with the University of West Florida. SHI is NIHN certified. Soon on SHIs agenda is individual physician and physician group connectivity. This will qualify practitioners for the ARRA federal fund reimbursement. This summer, look for the hospitals’ CMIOs to begin demonstrating the exchange of data across our community hopefully ushering in a new era of ready access to patient data that will improve our patients’ clinical outcomes.
Types of Professional Liability, continued from page 6 gives advice, which is erroneous and results in an injury. Generally, an employer is not liable for or bound by the acts or contracts of an agent, which are not within the scope of the actual or apparent authority of the agent. However, if a physician has conducted the affair in such a way as to lead patients to reasonably conclude that the agent, or assistant in this circumstance, is acting within his or her authority, the physician may be responsible. The most common examples of “apparent agency” occur in hospitals. In most hospitals, the emergency room and department of radiology are staffed by independent staff physicians. However case law has held the hospitals liable for the acts of the staff physician on a theory of “ap-
parent agency.” The courts applied the general reasoning set out above. They noted a reasonable person would have assumed the staff physician was either the employee or agent of the hospital. If that person relied upon that representation in seeking care, then both the hospital and the individual rendering the care would be held liable.
Note: The preceeding 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.
In Memoriam Michael Redmond, A Doctors Doctor By Coy Irvin, MD The family of Medicine lost one of it’s best advocates when Dr. Michael Redmond passed away recently. He lost his battle with pancreatic cancer, but just as he lived his life he fought his illness calmly and was in control right to the end. We all feel a loss in our world today. Dr. Redmond has always been a strong advocate for the practice of medicine and independence of physicians as they take care of their patients. He also was a healer dedicated to helping young patients preserve their vision and thereby helping the quality of life. He was a scientist, an entrepreneur, and an astute businessman, a friend and a loving husband to his wife Janie. His ability to see a situation quickly and understand both sides of an issue and then bring all parties together was a skill which was
dent), he continued to come to meetings to help make sure the past was not forgotten and to be a supportive and knowledgeable source for the many leaders of the Society who followed him. He was readily available for advice or to answer a question to help the leaders of the Medical Society do the right thing for our physicians and our patients. Over the years, because of his strong beliefs, there were times when he took a stand that some would not agree with. However invariably it would turn out to be the right stand for the right reason. I watched him many times at the American Medical Association as well as at the Florida Medical Association stand up in a meeting and turn the debate with his quick wit and his ability to express very complicated
always an amazing thing to behold. Dr. Redmond believed passionately in the power of physicians to heal their patients and to be the leaders in making healthcare available to the patient’s of Florida. He worked tirelessly with the AMA, the FMA and the American Ophthalmologist Association to be sure the voice of the practicing physician was heard in Washington DC and Tallahassee. When he felt strongly about an issue you knew it and you knew how he felt, but he could also bring you over to his side with his reasoned debating skills. Long after he had finished his terms in the many jobs at the Escambia County Medical Society (including being the presi-
issues in a very simple way. He was a master of debate and a diplomat in the highest order, he was also a friend to many who have been active in the medical arena. Pensacola will miss him as will the State of Florida and the US. He had a commanding personality in a quiet and reserved way which will not be forgotten. We have all been blessed to have known Mike and I believe we are better off for all the things he did to advocate for our profession of medicine and for our patients. Mike leaves behind a wonderful family, his loving wife Janie, and a Legacy of a caring dedicated spirit which we do not often see in this world.
InThe Community Hospital News Sacred Heart News Critical-Care Capacity Expanded Sacred Heart Hospital in Pensacola has completed a $4.7-million renovation project to expand its capacity to care for critically ill patients. A new 12-room Surgical Intensive Care Unit (SICU) recently was opened on the third floor of the main hospital. Sacred Heart has recruited highly trained critical-care nurses to staff the unit, which is adjacent to the hospital’s operating rooms and will be used primarily for surgical patients. “Our critical-care patient volume has increased so much that the need often exceeds our capacity,” says Deanie Lancaster, SHHP Chief Nursing Officer. The 12 new rooms expand the hospital’s critical-care capacity to 40 intensive care beds. Major Expansion Announced Sacred Heart Hospital in Pensacola has announced plans for a major expansion that will include a new five-story tower containing 112 private patient rooms. The tower will be constructed on top of the hospital’s existing Heart and Vascular Institute building. Construction will begin spring of next year, with the first 68 beds becoming operational in 2014. Another 44 beds will be added by 2016. “We have pressing needs right now for additional beds, especially for critically-ill patients and other adult patients with acute-care needs,” said Laura S. Kaiser, President and CEO of Sacred Heart Health System. “This expansion will provide the additional private-room capacity we need to accommodate the demand for healthcare services in the decade ahead.”
West Florida Hospital West Florida Hospital Awarded Accreditation West Florida Hospital has been designated as the area’s only Accredited Breast Imaging Center of Excellence by the American College of Radiology. This accreditation has only been given to 52 organizations in the state of Florida and is a testament to the level of quality care that our physicians and staff provide to our patients. The American College of Radiology recognized breast imaging centers that have earned accreditation in: • Digital Mammography
• Stereotactic Breast Biopsy • Breast Ultrasound • Ultrasound-guided Breast Biopsy As an Accredited Breast Imaging Center of Excellence, West Florida Hospital ensures that our patients will be given the highest level of attention and treatment that can be offered. This prestigious designation is confirmation that our physicians and staff are committed to maintaining the highest level of image quality and patient safety standards available. And, our facility is the only hospital in the area that offers all-private rooms.
Baptist Healthcare Baptist Hospital & Gulf Breeze Hospital earn The Joint Commission’s Gold Seal of Approval™ & are Unconditionally Accredited: Baptist and Gulf Breeze hospitals have earned The Joint Commission’s Gold Seal of Approval™ for accreditation by demonstrating compliance with The Joint Commission’s national standards for health care quality and safety in hospitals. The accreditation award recognizes Baptist & Gulf Breeze hospitals’ dedication to continuous compliance with The Joint Commission’s state-of-the-art standards at each of their facilities. Baptist and Gulf Breeze hospitals’ staff underwent a rigorous unannounced on-site four-day survey in June 2011 and May 2011, respectively. A team of Joint Commission expert surveyors evaluated each hospital for compliance with standards of care specific to the needs of patients, including infection prevention and control, leadership and medication management. President of Baptist Hospital David Wildebrant said “During the exit conference The Joint Commission surveyors shared that we were unconditionally accredited and continue to maintain our Gold Seal of Approval. It was particularly gratifying when surveyors shared with our team that they have never met a more dedicated and caring staff. Achieving Joint Commission accreditation, for our organization, is a major step in our journey to excellence and continually improving the care we provide.” “Gulf Breeze Hospital is proud of the success of our Joint Commission Survey,” Bob Harriman, Administrator, Gulf Breeze Hospital & Andrews Institute said. “We are extremely proud of the diligent preparation by our staff and the collaboration with physicians, and we sincerely appreciate the support of our auxiliary, board members and peers at Baptist Hospital who have assisted in our preparations.”
President’s Message, continued from page 3 tially harmful interactions of multiple medications, physicians at Sacred Heart reconcile patient medications from admission through every level of care and ensure the patient is taking appropriate medications in appropriate dosages at time of discharge. Safe outcomes and quality care will always be a major focus for the health system and are now important to payers and regulators as well. Evolving technology such as the electronic medical record (EMR) will be a valuable patient safety tool in the future. Currently, Sacred Heart Health System, Baptist Health Care and Navy Hospital are part of the Pensacola
Health Information Exchange, which soon will allow physicians at each facility to access pertinent data on patients who are seen at any of the three hospitals. This will enable physicians to determine what happened to patients during previous admissions, as well as their existing chronic conditions, to assist with prompt diagnosis and treatment. With rapid improvements in technology and more and more complex care, Sacred Heart physicians and staff remain focused on the goal of producing safe and reliable patient outcomes.
Patient Safety Initiatives at Baptist Hospital Baptist Hospital has initiated innovative practices to prevent patients from falling and sustaining hospital acquired injuries. The first initiative is called “Code Fall.” Similar to a rapid response team or code team, a fall team of dedicated professionals responds to any fall that occurs in our facilities. If a patient fall occurs, personnel ask switchboard operators to announce “Code Fall” over the hospital inter-
com. This signals the falls team to respond. In addition to assisting the patient, the falls team captures real time events leading to the fall and analyzes each fall for opportunities for improvement. The second innovative initiative is modification of order sets. Pharmacy, nursing, and medical staff leadership teamed up to change order continued on next page
President’s Message, continued from page 9 sets regarding the administration of diuretics to prevent administration in the evening and night time hours. Another order set modification is the automatic ordering of the sleeping pill Ambien. Both diuretics administered in the evening and night and the administration of Ambien have been associated with a rise in fall rates for inpatients. The modification of order sets allows physicians to order these medications when deemed appropriate, but the medications are no longer ordered automatically. As a result, Baptist Hospital has seen decreases in falls on the orthopedic unit, critical care unit, and progressive care unit. The Joint Commission, who recently visited Gulf Breeze Hospital and Baptist Hospital, stated that these innovations are best practices in preventing hospital related falls. Both hospitals were praised by surveyors for their progressive approach to falls prevention and their partnership with medical staff to ensure world class outcomes.
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