Coastal Medicine The official magazine of the Santa Cruz County Medical Society
Winter/Spring 2014 Volume 2, Number 1
Coastal Medicine The official magazine of the Santa Cruz County Medical Society
21 Working Together to End Hunger and Malnutrition
11 New Threats to MICRA
The President’s Desk Jeannine Rodems, MD SCCMS President
Welcome SCCMS/CMA Members
From the Executive Director’s Desk Donna Odryna
Letter from the CMA President Richard Thorpe, MD
MICRA in Context Donaldo Hernandez, MD CMA Trustee and Editorial Chair
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The Troy and Alana Pack Patient Safety Act of 2014: The Details Donaldo Hernandez, MD CMA Trustee and Editorial Chair
Protect Access to Quality Health Care & Patient Privacy CMA Staff Writer
Tips for Lowering Ambulatory-Care Risks Karen D. Davis, MA, CPHRM
Governance Reform Steven Larson, MD, MPH
Advertisers - Classifieds Key Dates / Calendar
President’s Desk Dr. Jeannine Rodems is the SCCMS President and on the Board of the California Association of Family Physicians. She is in Family Medicine at the Los Gatos Center of the Palo Alto Medical Foundation and see patients from Santa Cruz and San Jose.
be an all out assault on the liability reforms that we have achieved here in California. Reforms that have not only maintained access to care and reduced health care costs, but were also highlighted nationally as an excellent example of liability reform during the development of the Affordable Care Act. We will be working on educational meetings for physicians until July when the campaign will transition to a public effort. I strongly encourage you to keep informed about this process and help to support CMA and CAPP in these efforts.
Welcome to our third issue of Coastal Medicine. This issue highlights the Santa Cruz County Medical Society’s efforts to continue to be more relevant and connected to community issues. Its focus is on a discussion about reducing obesity, improving nutritional education, and facilitating healthy food accessibility. We continue to work on our commitment to participate in community efforts and are now working in a partnership with Willy Elliott-McCrae from Second Harvest, Mary Lou Geoke from United Way, and Lisa Hernandez, MD, from Santa Cruz County Public Health on a countywide initiative in support of reducing obesity 10% by 2020. We will continue to work on information for physicians to access non-profit organizations that are providing services to the community, where physicians can be an important educational resource and critical link to these services and their patients. I would like to thank Donna Odryna, our executive director, for spearheading those efforts. One of our top priorities this year is to support the work by CMA to defeat the efforts by Trial Attorneys and Consumer Watchdog,
A student practices suturing on a pig’s foot, under the watchful eye of a SCCMS member physician.
to unravel the important limits in the Medical Injury and Compensation Reform Act (MICRA). A ballot initiative was submitted to the state and will become an official numbered ballot measure in July. CMA and the Coalition for Patient Protection (CAPP) have continued to work on a campaign for both funding and resources for what will
Many of you are aware that Congress postponed the SGR fix for Medicare for another year. However, the geographic pricing cost index, or GPCI, fix was passed for the 14 California counties that were subjected to these reimbursement limitations, including Santa Cruz County. The correction will start with a 6-year phase-in process beginning in 2017. I would like to thank Dr. Larry DeGhetaldi for his long fought effort to reverse the Area 99 problem for our county, and Congressman Sam Farr and his staff for their work and steadfast commitment to that process. Our CruzMed Foundation (CMF) just completed its Strategic Plan with a commitment to focus on three areas: Pipeline, Preparedness, and Public Health.
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SANTA CRUZ COUNTY MEDICAL SOCIETY PRESIDENT Jeannine Rodems, MD Coastal Medicine magazine PRESIDENT-ELECT Brian Brunelli, MD PAST-PRESIDENT Donaldo Hernandez, MD EDITORIAL COMMITTEE Jeannine Rodems, MD and SECRETARY Christopher O’Grady, MD Donaldo Hernandez, MD TREASURER Juan Rodriguez, MD
MANAGING EDITOR Donna Odryna
BOARD MEMBERS CONTRIBUTING WRITERS Donaldo Hernandez, MD;
Nicholas Abidi, MD; John Christensen, MD W. Richard HEncke, MD; Lisa Hernandez, MD Jennie Jet, MD; Parick Meehan, MD Dawn Motyka, MD; Susan Schaefer, MD Kim Schulz, MD; Rosalind Shorenstein, MD Michelle Simon, MD; Jack Watson, MD
COMMITTEE/PROJECT CHAIRS & RREPS FINANCE Juan Rodriguez, MD HEALTH ASCIENCES MENTORSHIP (UCSC) Jack Watson, MD LEGISLATIVE OUTREACH Tim Allari, MD; Jack Watson, MD MEMBERSHIP to be announced MRAC Tobias Yeh, MD NOMINATING Brian Brunelli, MD; Jeannine Rodems, MD NORCAP COUNCIL Rosalind Shorenstein, MD PHYSICIAN WELL-BEING John Gillette, MD and Martina Nicholson, MD PRACTICE MANAGERS NETWORK Mary Champlin QA, CONDUCT, & ETHICS Robert Jones, MD and Michele Van Ooy, MD
CMA HOUSE OF DELEGATES REPRESENTATIVES
Brian Brunelli, MD; John Christensen, MD W. Richard Hencke, MD; Christopher O’Grady, MD Jeannine Rodems, MD; Jack R. Watson, MD
Jeannine Rodems, MD; Willy Elliott-McCrae; VIcki Lowell; Richard Thorp, MD; Steven E. Larson, MD, MPH; Karen D. Davis, MA, CPHRM
LAYOUT Mary Champlin Coastal Medicine magazine is produced by the Santa Cruz County Medical Society. OPINIONS expressed by authors are their own and not necessar-
ily those of Coastal Medicine magazine or SCCMS. Coastal Medicine reserves the right to edit all contributions for clarity and length and to reject any material submittedin whoe or in part. Acceptance of adertising in Coastal Medicine is no way constitutes approval or endorsemennt by SCCMS of products or services advertised. Coastal Medicine and SCCMS reserve the right to reject any advertising.
SUGGESTIONS, story ideas, or completed stories written by current Santa Cruz County Medical Society members are welcome and will be reviewd by the Editoral Committee. DIRECT all inquiries, submissions, and advertising to: Coastal Medicine Magazine 1975 Soquel Dr #215 Santa Cruz CA 95065-1821 Phone: (831) 479-7226 Fax: (831) 479-7223 Email: email@example.com
COMMUNITY ENGAGEMENT/PARTNERS MEDICAL SOCIETY STAFF CMA Richard Thorp, MD, President EXECUTIVE DIRECTOR Donna J. Odryna CRUZMED FOUNDATION Joydip Bhattacharya, DO, President MEMBER SERVICES COORD/OFFICE MANAGER Mary Champlin EMERGENCY MANAGEMENT COUNCIL David McNutt, MD, SCCMS Representative BOOKKEEPER Christie Hicks
EMERGENCY MEDICAL CARE COMMISSION Marc Yellin, MD,
SCCMS Representative HEALTH IMPROVEMENT PARTNERSHIP Donna Odryna, Board SSC MEDICAL RESERVE CORPS Jeff Terpstra, Chair Cover photo: Flowing water drapes the Berry Creek Falls in Big Basin State Park, Santa Cruz County, California. Taken by AwesomeShot Studios from iPhoto.com.
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Copyright ©2014 Santa Cruz County Medical Society All rights reserved. Reproduction in whole or in part without written permission is prohibited.
Send address changes to: Coastal Medicine Magazine 1975 Soquel Dr #215 Santa Cruz CA 95065-1821
tive efforts with the Go For Health Collaborative and the “5210 Plus” Project. Special thanks and acknowledgement to three of our colleagues who have given of their time and talent to our community outreach efforts. Dr. Jack Watson for his leadership and work with the MESA Schools Program since 2008, Dr. Joydip Bhattacharya for serving as the first Board President of CruzMed Foundation and provided leadership during the development phase of the organization, and to Dr. David McNutt who founded the Santa Cruz County Medical Reserve Corps in 2005 and served as the Unit Coordinator until 2011. We will continue to strive for better connections with our Santa Cruz County communities and better transparency and communication of our efforts with the support of our physician members. We hope that you enjoy this issue of the Coastal Medicine magazine. Dr. Fred Tomlinson (L) and Dr. David South (R) teach MESA students how to suture at UCSC.
▸Pipeline – CMF will step up its support and leadership for the MESA Schools Program (MSP) in partnership with UC Santa Cruz. The MSP assists students at middle and senior high schools (and some elementary schools) so they excel in math and science and become competitively eligible for academically rigorous colleges and universities. Additionally, CMF is aggressively pursuing the funding needed to support the Health Care Leaders of Tomorrow Scholarship Fund for undergraduate students interested in medical careers. ▸Preparedness – CMF is now the sponsoring agency for the Santa Cruz County Medical Reserve Corps (MRC) and is working in partnership with the MRC, the County Health Services Agency (HSA) and the American Red Cross (ARC) to prepare for and respond to public health and disaster-related emergencies. ▸Public Health – Through its partnerships, CMF will continue to work on projects in support of reducing obesity among children and adults through collabora-
A students intently follows directions from Dr. Fred Tomlinson as she explores the art of suturing. Winter/Spring 2014 • COASTAL MEDICINE • 5
Welcome SCCMS/CMA Members Rejoining Members
SCCMS, CMA, and the 40,000 other members of California organized medicine thank each of you for your committment to advocacy for all physicians in the state. In this time of need for renewed advocacy vigor necessary to protect the practice of medicine, your membership matters! Thank you. Nicholas Abidi, MD Rami Dakkuri, MD Rex Hsei, MD Bahar Aghighi, MD Thomas Deetz, MD Scott Imahara, MD Kim Albridge, MD Lawrence de Ghetaldi, MD Anne-Marie Jackson, MD Christen Allaman, MD Amr Dessouki, MD Sargon Jacob, MD Timothy Allari, MD Denise Devereaux, MD Julie Jaffe, MD Kenneth Andrews, MD Janna Doherty, MD Laura James-Beckham, MD Carlos Arcangeli, MD William Ebert, MD Sharon Jamieson, MD Nicholas Astromoff, MD Bruce Eisendorf, MD Frank Jan, MD Elise Atkins, MD Michael Ellison, MD Jennie Jet, MD Nathan Atkinson, MD James Engleman, MD Jay Johnson, MD Kenneth Averill, MD Dawn Faber, MD Michael Johnson, MD Rebecca Barker, MD Joseph Fabry, MD Dean Kashino, MD Thomas Barker, MD Hannah Farquharson, MD Eric Kashnow, MD James Beckett, MD Ronald Fisher, MD Victoria Kaufmann, MD David Benjamin, MD Joseph Franks, MD Suzanne Kerley, MD William Berg, MD Katherine Gabriel-Cox, MD Anna Kesler-Diaz, MD Geoffrey Bernstein, MD Jeanne Gallagher, MD Daniel Kim, MD Joydip Bhattacharya, DO Steven Garner, MD Suejin Kim, MD Craig Blackwell, MD Michael Gansaeuer, MD David Kipps, MD Bruce Block, MD Laura Garvin, MD Jeffrey Kishiyama, MD Susan Borba, MD Rudolf Gausling, MD Alexandra Klikoff, MD Edward Bradbury, MD Sharan Gill, MD Wendi Knapp, MD Ryan Brandt, MD James Glancy, MD Phillip Knorr, MD Melissa Braverman, MD Alan Goldsobel, MD Jane Koopman, MD Elizabeth Brennan, MD Nancy Greenstreet, MD Paul Krause, MD Monique Browns, MD Stephen Halpern, MD Surinder Kumar, MD Brian Brunelli, MD Conrad Hamako, MD Alexis Lane, MD Alan Buchwald, MD Richard Hamner, MD Thomas Larson, MD Jacquelyn Busse, MD Margaret Hansen, MD Dawn Lawson, MD Andrew Calciano, MD Matthew Hansman, MD Gordon Lee, MD William Cao, MD Monica Harish, MD Louis Lee, MD Eric Carlblom, MD William Harmon, MD Steven Lee, MD Dennis Chamberlain, MD Ciara Harraher, MD Larry Levin, MD Howard Chen, MD Karen Harrington, MD Andrew Lewis, DO Clement Cheng, MD William Hart, MD Wennie Liao, MD Nancy Chin, MD Kathryn Harvey, MD Laura Likar, MD John Christensen, MD Carlene Hawksley, MD Vanessa Little, DO Karl Christoffersen, MD W. Richard Hencke, MD Greg Loitz, MD Patrick Clyne, MD Rose Marie Hendrix, DO Rodney Lowe, MD Jessica Cohen, MD Donaldo Hernandez, MD Jason Luksich, MD Michael Conroy, MD Lisa Hernandez, MD Karen Lynch, MD Kathy Corby, MD Darien Heron-Ware, MD Beata Mach, MD Steven Cortes, MD Douglas Hetzler, MD Tracy Maclay, MD Michael Coulson, MD Christian Heywood, MD Maggie MacMillan, MD Albert Crevello, MD Bernard Hilberman, MD Steven Magee, MD Brent Culver, MD Patricia Hinz, MD Morgan Magid, MD Michael Dacey, MD Terry Hollenbeck, MD Zen Majuk, MD Anders Dahlstrom, MD Raymond Hong, MD Daniel Marcus, MD 6 • COASTAL MEDICINE • Winter/Spring 2014
Roy Martinez, MD Tony Masri, MD Michelle Massie, MD Diane McGrew, MD Kevin McHugh, MD Amy McMullen, MD David McNutt, MD William Mears, MD Edward Menges, MD Lester Miller, MD Linda Miller, MD Patrick Monahan, MD Holly Moore, MD Peggy Moore, MD Aaron Morse, MD Dawn Motyka, MD Marin Muller, MD Stuart Mumm, MD John Munro, MD Vidya Nagaraju, MD Suzy Nassralla, MD Tanya Nauenberg, MD Howard Nelson, MD Elizabeth Newsom, MD Martina Nicholson, MD Darryl Nounnan, MD Josh Novic, MD Christopher O’Grady, MD Joseph Palascak, MD Mary Patz, MD John Pestaner, MD Alfred Petrocelli, MD David Pilcher, MD Marie Pletsch, MD Rajeswari Ponnuswamy, MD Naghmeh Pooya, MD Lawrence Poree, MD Benjamin Potkin, MD Deepa Prakashpathy, MD
Robert Quinn, MD William Raffo, MD Michael Rankin, MD Janelle Rasi, MD Leroy Rasi, MD Randall Rea, MD Jonathan Redwine, MD Peter Reynolds, MD Francisco Rhein, MD Shawna Riddle, MD Steven Roberts, MD Jeannine Rodems, MD Juan Rodriguez, MD Maritina Rodriguez, MD David Rose, MD Mark Rosen, MD Vaal Rothman, MD Howard Salvay, MD Martha Sandoval-Bernal, MD Ameeshi Sawhney, MD Neil Sawhney, MD Susan Schaefer, MD Casey Schirmer, MD Mark Schmetz, MD Jennifer Schreck, MD Marc Seftel, MD Karl Segnitz, MD Molly Shields, MD Patrick Shields, MD Hakima Schulz, MD Warren Scott, MD Linda Shaw, MD Wells Shoemaker, MD Michael Shorenstein, MD Rosalind Shorenstein, MD Kathrin Sidell, MD Michelle Simon, MD Rajinder Singh, MD Sunita Singh, MD
Rebecca Small, MD Daniel Spilman, MD David Sofen, MD David South, MD James Spiegel, MD Lawrence Spingola, MD Werner Stamm, MD Nicole Sudduth, MD Christopher Summa, MD Sharon Tapper, MD Larisa Taylor, MD James Telfer, MD Marilyn Todd, MD Arthur Vedder, MD Michele Violich, MD Brian Waddle, MD John Walther, MD Brian Ward, MD Paul Ware, MD Suzanne Ware, MD Timothy Washowich, MD Jack Watson, MD Tamara Watson, MD Thomas Welle, DO Kenneth Westphal, MD Bradley Whaley, MD Richard Williams, MD Vickie Winkler, MD James Wolfe, MD Glenn Wong, DO Andrew Wu, MD Michael Wu, MD Adam Yarme, MD Tobias Yeh, MD Marc Yellin, MD Michael Yen, MD Dean Zweng, MD
Dale Bishop, M.D.
Welcome to organized medicine. We appreciate your committment. Brett Lenkin, M.D. Himabindu Pitta, M.D.
Family Medicine CCAH 1600 Green Hills Rd #101 Scotts Valley 95066 430-5588
Physical Medicine & Rehabilitaion 1054-B 41st Ave Santa Cruz 95062 295-2321
Hospitalist Dominican Hospital 1555 Soquel Dr Santa Cruz 95065 462-7700
These members retired in 2013. Congratulations and enjoy your well earned retirement! Duncan Tam Holbert, MD Nancy Jacobsen, MD Jeffrey Roisman, MD
Practice: Palo Alto Medical Foundation Santa Cruz Member 1975—2013
Practice: Pediatric Medical Group of Watsonville Member 2004—2013
Practice: Pediatric Medical Group of Watsonville Member 2004—2013
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2013 Excellence in Health Care Award presented to
John Anane-Sefah, MD
In recognition of 36 years of surgical distinction and atten-tion to the people of Santa Cruz County and for your continuing leadership to the medical community, including your service as President of the SCC Medical Society in 1996-1997 and for your selfless charitable and humanitarian works abroad. Santa Cruz county was fortunate indeed when, in 1973, Dr. Anane-Sefah was unable to return to his home country of Ghana and came to Capitola instead. Read his full amazing biography on the SCCMS website at www.cruzmed.org on the Featured Member page.
Background: © Amy Planz | Dreamstime Stock Photos
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Okay, I will admit that I am not the die hard political junkie like so many of my personal and professional friends, but it is hard, even for me to not be intrigued by all that is afoot in the legislative arena this year. Among the most notable thus far occurred when President Obama signed HR 4302 which does three big things plus some other little things (for details, contact our office for a summary report). They are:
eliminated the in-office exception to the self-referral law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy. We also advocated in support of AB 1771, authored by Assemblymember V. Manuel Perez. This bill will increase access to care by requiring health insurance companies licensed in the State of California to pay contracted physicians for telephone and electronic patient management telehealth services.
Do or do not, there is no “try”. -‐‑Yoda
Donna Odryna is the Executive Director of the Santa Cruz County Medical Society and its affiliated companies, CruzMed Foundation & the Santa Cruz County Medical Reserve Corps.
1. a decision to kick the can down the road for the 17th time (stops the 24% Medicare Sustainable Growth Rate (SGR) cut that was to go into affect on April 1, provides a 0.5 % physician payment update through 12/31/14, and then a 0% update until 4/1/15). 2. ICD-10 implementation is pushed to Oct. 2015, and the big one for us… 3. the GPCI Fix, (Geographic Practice Cost index) permanently eliminates the geographic inequity for select California urban counties (like Santa Cruz). On April 22, a Santa Cruz County contingent joined more than 400 doctors and students in Sacramento for the 40th Annual Legislative Leadership Conference. Among the priority bills discussed with our legislative representatives was the recently defeated SB 1215, authored by Senator Hernandez, which would have
In this issue, there is important information about the MICRA fight and as we all know, every physician and patient in California will be affected if MICRA is overturned. These are just a sampling of many bills and measures before the legislature and the people this year. If you would like additional information or a full list of the priority legislation for 2014, please contact our offices. In summary, if you are a member, I want to thank you. If you are not a member, we need you now more than ever, so join today. The profession needs you to do your part, join the MICRA campaign and get involved by talking to your patients. If you are interested in becoming a MICRA key spokesperson, contact my office. I believe that so much of what we do together is to do what is needed and right, and our strength is our collective voice. It is time to find our inner Yoda and do!
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March 25, 2014
MICRA signatures submitted, physicians must rally to oppose trial lawyers on all fronts Yesterday, Consumer Watchdog, a front group for the Consumer Attorneys of California, submitted roughly 830,000 signatures to qualify a measure for the November ballot that would scrap key provisions California’s Medical Injury Compensation Reform Act (MICRA). This deceptive measure will raise health care costs for all Californians by lifting MICRA’s cap on non-economic damages, thus increasing lawsuits against health care providers and decreasing access to care for patients across the state. California’s physician community must join together and oppose this dangerous measure. This same trial lawyer group is also sponsoring candidates across the state in their bids for the state legislature. The California’s Political Action Committee (CALPAC) is working to defeat these candidates who would vote to change MICRA in the legislature. We need your support to continue to win at the ballot box and in the legislature. Please join your physician colleagues around California by contributing $150, $300, $500 or more to CALPAC! Your contribution will go directly to protecting MICRA and ensuring that all Californians have access to quality and affordable health care. To make a donation, visit www.cmanet.org/micra. MICRA has served as a model for the nation by containing health costs and protecting access to care. Now the state’s trial lawyers and their allies are funding deceptive campaigns to mislead voters into decimating a law that would severely restrict access to care. Jamie Court, President of Consumer Watchdog, recently admitted in an interview with the Los Angeles Times that aspects of the ballot initiative – specifically those pertaining to physician drug testing – were added simply because they polled well and serve as the “ultimate sweetener.” We must reach many voters in California and educate them on the dangers of losing our MICRA protections. We cannot do this without your support. Please contribute $150, $300, $500 or more to CALPAC today! If we are not successful in defending MICRA, not only will the cost of health care increase for all Californians, but access to care for some of California’s most at risk populations will be reduced. To make matters worse, the ballot measure is being floated under guise of “consumer protection” when in reality it is all about the bottom line for the state’s trial lawyers. Again, I implore you to donate $150, $300, $500 or more to CALPAC – the state’s largest physician run political action committee – so it can continue its aggressive efforts on behalf of California physicians. Defeating the attacks on MICRA will be no small task, but together, I am confident we will be successful. Sincerely,
Richard Thorp, MD President, California Medical Association Headquarters: 1201 J Street, Suite 200, Sacramento, CA 95814-2906 10 • COASTAL MEDICINE • Winter/Spring 2014
New Threats to MICRA Dr. Donaldo Hernandez is a CMA Trustee, the Coastal Medicine Editorial Chair, and the Immediate Past President of SCCMS. He is in Internal Medicine and is a Hospitalist with the Palo Alto Medical Foundation Santa Cruz.
hat could not be wrought through the courts or legislature is now clearly being driven through the initiative process, the goal being to disembowel California’s landmark Medical Injury Compensation Reform Act.
What’s that mean you ask? Medical Injury Compensation Reform Act or MICRA is in the crosshairs once again of the Trial Attorneys and they mean to overturn significant portions of the provision aimed at increasing their incomes at the expense of patients and healthcare delivery in the state. A coalition of trial lawyers in conjunction with the consumer attorney front group Consumer Watchdog and businessman Robert Pack have sponsored an initiative to place it on the November 2014 ballot. If passed, it would make it easier and more lucrative to file lawsuits against health care providers, clinics and hospitals generating more revenue from inflated legal fees. This proposition would increase the cap for noneconomic damages from it’s current $250,000.00 level to well over 1.2 million dollars. This increase is reflective of the Consumer Price Index but will be applied retroactively since 1975 with further increases anticipated regularly.
requirements for physician drug and alcohol testing as well new drug prescribing requirements but beyond the rhetoric aimed at baiting and switching the conversation away from the true motive, that being the lifting of the MICRA cap, that has helped stabilize the California Healthcare Marketplace and assure access and care for several at need patients in favor of access to inflated jury awards that the trial lawyers have sought for nearly 40 years. Organized Medicine is rallying and will rise up to meet this clear and present threat. But the help of every member of the healthcare community is now needed. Your help is needed. Please visit www. cmanet.org/micra to donate and learn about the latest developments in the fight to preserve access and true value based medical care. We need you in order to help preserve the malpractice protections that have become the model for the nation. A series of articles designed to educate you about MICRA will follow but please continue to add your voice to unified voices of all California physicians who fight to ensure access, control healthcare cost and assure fair protections for our patients.
The goal of this is initiative is ostensibly to address muddled and misperceived issues related to medical quality, but as the sheep’s clothing is peeled back, the ever growing campaign of misinformation and spin reveals a clear goal of inflated jury awards, (or the anxiety about possible inflated jury awards) as a means to increase legal fees and the amount trial attorneys can collect from their clients. Included in the provision are several new punitive
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MICRA in Context
by Donaldo Hernandez, MD CMA Trustee & Coastal Medicine Editorial Chair
Early 1970s The California Healthcare system was in the midst of malpractice insurance crisis. Rampant litigation driven by frivolous lawsuits and several excessive jury awards resulted in massive malpractice insurance premium increases on a near annual basis for several physicians across the state. This resulted in many physicians picking among several onerous survival strategies including significantly increasing their rates to cover the increased cost, reducing access for high risk patient populations, forgoing any malpractice coverage at all with all the increased anxiety that it entails, or leaving the state entirely and practicing elsewhere. Mid 1970s The CMA urges Governor Jerry Brown (The very same Jerry Brown who our current Governor) to address the ever growing crisis and a special session of the legislature is convened. In that special session representatives from organized medicine, the insurance industry, the trial lawyers bar and the legislature negotiate and grapple with finding a solution to stabilize malpractice
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premiums while still providing for fairness and patient safety. The Legislature passes AB1XX, a collection of laws that collectively has become to be known as the Malpractice Insurance Compensation Reform Act or MICRA and the legislation is signed by Governor Brown. 1970s-1980s Several lawsuits aimed at challenging the constitutionality of MICRA are filed and undergo judicial review through the courts. October 15, 1985 The California Supreme Court finally settles the issue of the constitutionality of MICRA and most legal challenges cease. MICRA does what it was intended to do by providing: • UNLIMITED economic damages for any and all past and future medical costs as well as • UNLIMITED economic damages for lost wages
and lifetime earning potential in addition to • UNLIMITED punitive damages for malicious or willful conduct while providing • ADDITIONAL DAMAGES up to $250,000 for non-economic damages. Malpractice premiums stabilize leading to greater predictability and stability of medical malpractice insurance market and insuring continued access to care for a broad spectrum of patients. 1985-2013 MICRA becomes the model for national medical liability and malpractice reform.
he Model for the Nation
Under the MICRA provisions, California enjoys continued fair and just patient protections and stable insurance marketplaces. Despite the fluctuating trends in the years following MICRA, the California medical malpractice insurance market has become one of the most stable markets in the country. Other states without MICRA protections remain in crisis. The American Medical Association in 2004 identified at least 20 states as being in “full-blown medical liability crisis.” It noted that there are areas of the country where “patient continue to lose access and care… obstetricians and rural family physicians no longer deliver babies…. High risk specialists no longer provide trauma care or perform complicated surgical procedures.” In New York State, a state that lacks the MICRA pro-
tections and reforms, 19 counties are without obstetricians, 22 without internal medicine specialists and 15 do not have surgical specialty physicians in a study performed by the Center for Health Workforce Studies. The New York Times reported in 2012 that several New York City hospitals are completely without liability insurance coverage due to the high cost of liability premiums.
An Internist in California on average can expect to pay around $8,400.00 for his or her annual malpractice coverage. That same provider trying to help patients in Nassau County, New York will pay $34,000.00, or $35,000.00 in Michigan, or in Dade County Florida they can expect to pay $46,400.00.
A General Surgeon in California can expect to pay $31,300.00 and in Michigan, the cost rises to $121,300.00, while in New York they will pay $127,2000 and in Florida, they will pay a staggering $190.000.00 dollars for the same coverage. An Obstetrician in California will pay California on average can expect to pay around $41,300.00 for his or her malpractice coverage. Again the ability to serve and help women and deliver babies in Michigan will cost $108,000.00, in Florida $202,000.00 and in New York expect to pay $205,000.00. MICRA has fulfilled the goals of: • Preserving patients’ access to health care vital medical services by doctors, nurses and other health care providers
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• Has kept hospitals and clinics open • Has saved California’s health care system tens of billions of dollars • Has ensured more money goes to patients, not lawyers by limiting the amount a lawyer can take as payment for representing an injured patient. • Reduced the time for injured patients to receive their awards, 26% sooner in fact than patients in states without MICRA reforms while jury awards for Medical Malpractice in California continue to outgrow the rate of inflation. According to the Journal of the American Medical Association, states with lower medical malpractice premiums tend to have more doctors per capita, including surgeons and specialists.
After several years and several unsuccessful attempts to alter or completely repeal MICRA, a coalition of trial lawyers has moved to sponsor and has started the process to place an initiative on the ballot for the November 2014 election. The goal of this measure is to make it easier and more lucrative to file lawsuits against health care providers, clinics and hospitals generating more revenue from inflated legal fees. California trial attorneys, in association with Robert Pack, a successful businessman who tragically lost his children to an impaired driver, is backing and promoting this legislation in conjunction with a consumer attorney front group called Consumer Watchdog. Some of the provisions relate to physician drug testing and prescription drug database issues, but the main provision increases the cap on non-economic damages from $250,000 to more than 1.2 million with annual increased adjustments. Though hidden behind the drug
testing portions of the proposed statue, the main goal of the initiative is to gut MICRA and to make it easier for lawyers to file lawsuits against physicians, dentists, hospitals, community health clinics, and other health14 • COASTAL MEDICINE • Winter/Spring 2014
care providers in hopes of generating big paydays for the attorney sponsors. The language of the initiative has gone to Kamala Harris, the California State Attorney General, for Title and Summary. The initiative will requires drug and alcohol testing of all doctors with reporting of positive test to the California Medical Board. It will require the Board to suspend doctor pending investigation of positive test and take disciplinary action if doctor was impaired while on duty. It suspends all providers who refuse to be tested whether they are impaired or not. It will requires health care practitioners to report any doctor suspected of drug or alcohol impairment or possible medical negligence. It will require health care practitioners to consult California’s Controlled Substance Utilization Review and Evaluation System (CURES) database before prescribing several controlled substances. And if that wasn’t ominous enough, it increases the $250,000 cap on pain and suffering damages in medical negligence lawsuits to account for inflation retroactively since MICRA took effect in 1975. The Summary by Legislative Analyst and Director of Finance, charged with developing an estimate of the fiscal impact on state and local government concluded: State and local government costs associated with higher medical malpractice costs, likely at least in the low tens of millions of dollars annually, potentially ranging to over one hundred million dollars annually. Potential state and local government costs associated with changes in the amount and types of health care services that, while highly uncertain, potentially range from relatively minor to hundreds of millions of dollars annually.
express your opinion about the treats to the practice of medicine in our county and our state. Become educated about the threats to our practices and our livelihoods. Read the initiative and know how the provisions it contains will directly affect you and your patients. Educate your patients about this initiative and how its passage will affect your ability to meet their needs and your ability to care for them in the future.
The Los Angeles Times has reported: “(the) real rationale almost looks worse. The drug rules are in the initiative because they poll well, and the backers figure that’s the way to get the public to support the measure. “It’s the ultimate sweetener,” says Jamie Court, the head of Consumer Watchdog. He says that when his group brought the proposal before focus groups, “the only thing that made them light up was drug testing of doctors.” -- L.A. Times December 10, 2013 This has now gone forward to the signature gathering stage, the goal being to gather 500,000 signatures and to get it on the November 2014 ballot. The threat is real and the situation requires the attention of the entire healthcare community.
Join the fight and contribute directly to the organized resistance to the Consumer Attorneys and their campaign of misinformation and their goal of higher incomes at the expense of continued care for the people of California. You can out find more at:
www.cmanet.org/micra The money contributed to CALPAC will go directly to protecting MICRA. Monies donated to www.cmanet. org/micra, the CMA Political Education Fund, will go to a MICRA protection specific account controlled by physicians that will devote ongoing resources to educate physicians about the importance of MICRA to their practices and ability to care for patients.
Our patients and our communities depend on us to advocate their right to access and to continually improve the delivery of care.
What can you do?
Add your voice to the organized effort to preserve access and stability by joining Santa Cruz County Medical Society and the California Medical Association and Winter/Spring 2014 • COASTAL MEDICINE • 15
The Troy and Alana Pack Patient Safety Act of 2014: The Details
provided by Donaldo Hernandez, MD CMA Trustee and Coastal Medicine Editorial Chair
TAPPS Act (not yet named), if passed, will fundamentally change the practice of medicine in California by eviscerating major provisions of the Malpractice Insurance Compensation Reform Act or MICRA thus ensuring skyrocketing medical malpractice premiums as well as enacting onerous and draconian drug testing and reporting provisions for Physicians conducting their vital patient care duties. What are the specifics? • Requires a physician to report to the Medical Board of California any information that appears to show that a physician may be of has been impaired while on duty • Allows any person to report to the Medical Board a suspicion of a physician who appears to have been impaired while on duty • Requires a physician report to the Medical Board any physician responsible for care or 16 • COASTAL MEDICINE • Winter/Spring 2014
treatment who appears to have failed to follow the standard of care when an adverse event has occurred • Requires hospitals to conduct random drug and alcohol testing on all physicians with admitting privileges at the expense of the individual physicians • Requires hospitals to conduct immediate drug and alcohol testing of physicians when an adverse event occurs including ALL who treated or prescribed within 24 hours of the event • Legislates it to be the responsibility of the physician to submit to drug and alcohol testing as soon as possible after an adverse event such that failure to submit to testing within 12 hours is grounds for suspension of license • Directs hospitals to charge the physician for the cost of testing to be absorbed completely and totally by the physician as
directed by the Medical Board • Hospitals are directed to report any positive tests or refusal to submit to testing to the Medical Board who are then directed to refer the matter to the States Attorney General and suspend the physicians license pending further investigation and subsequent hearing and to notify the physician and all facilities where the physician practices that the license has been suspended • In the event the Board finds the physician was impaired while on duty or during the adverse event, or if the physician refuses testing, even on moral grounds, the Board is directed to take disciplinary action which may include addiction treatment, probational drug and alcohol testing and/or suspension of licensure until said time as physician passes the as yet to be determined Board return to work process and the Board is satisfied the physician can
return to work • If the Board finds sufficient evidence that the physician was impaired during an adverse event, it is obligated to notify the patient, family of the patient, or in the event of mortality of the family of a deceased patient of those findings. • It directs the Board to assess an annual fee on all physicians licensed in the state to pay for the costs to Medical Board and the Attorney Generals office for the implementation of this program • It amends the MICRA provisions in the Civil Code Section 3333.2 which cover the noneconomic damages to be adjusted to reflect inflation since the cap was established in 1975 thus resulting in increase in the cap from $250,000.00 to 1.25 million with annual increased adjustment based on the Consumer Price Index • The adjustment on the cap will apply to all actions not resolved by final settlement, judgment, or in resolved arbitration
as January 1st, 2015
there is a legitimate need
• Any physician who tests positive for the presence of drugs or alcohol or who refuses to submit to testing in any action shall be presumed to be negligent
• All providers will be presumed to be professionally negligent if they do not maintain compliance with the CURES database consultation and shall be subject to disciplinary action as outlined by the Medical Board
• Prior to prescribing or dispensing any Schedule II or Schedule III controlled substances for the first time to any patient, the healthcare provider must consult the CURES database. • If an existing prescription for the patient is discovered, the practitioner must not prescribe or dispense the medication unless the provider determines
• Any legislative changes to this act will need to two thirds vote of the legislature and signature of the governor This is the essence of the Troy and Alana Pack Patient Safety Act.
Winter/Spring 2014 • COASTAL MEDICINE • 17
Protect Access to Quality Health Care and Patient Privacy OPPOSE THE MICRA MEASURE Here’s why a broad coalition of doctors, community health clinics, hospitals, local governments, public safety, business and labor opposes the proposed November ballot proposition that would UISMQ\MI[QMZIVLUWZMXZWÅ\IJTMNWZTI_aMZ[\WMLWK\WZ[IVLPW[XQ\IT["
YOU MAY BE AWARE OF A TRIAL ATTORNEY-SPONSORED BALLOT MEASURE THAT WOULD UNDERMINE THE PROTECTIONS AFFORDED TO PATIENTS ACROSS CALIFORNIA AS PART OF THE MEDICAL INJURY COMPENSATION REFORM ACT (MICRA).
THIS NOVEMBER, these trial attorneys will ask voters to weigh
THE CALIFORNIA MEDICAL ASSOCIATION (CMA) has joined a
in on “The Troy and Alana Pack Patient Safety Act,” which
broad coalition of doctors, community health clinics, hospitals,
would make it easier and more profitable for lawyers to sue
local governments, public safety, business and labor to oppose
doctors and hospitals. This measure, according to California’s
the proposed November ballot proposition. Visit www.cmanet.
independent Legislative Analyst, could increase state and local
org/micra for more information about what CMA is doing in this
government malpractice and health care costs by “hundreds
fight and how to get involved.
of millions of dollars annually,” ultimately placing the burden of this additional cost on all of us. AS IT STANDS NOW, county and state hospitals have to pay medical malpractice awards out of the budgets they receive from
Community health care clinics, like Planned Parenthood, say this measure will raise insurance costs that will cause specialists, like OB/GYN’s to reduce or eliminate services to their patients.
taxpayers. If medical malpractice awards increase, government costs will increase too. Somebody has to pay, and that will be taxpayers through higher taxes and California citizens through higher health care costs.
NOT ONLY WOULD THIS MEASURE COST patients across the state, it’s a misleading measure intended to fool voters.
ADDITIONALLY, this measure would vastly increase the number
Written by trial attorneys, the measure makes it easier and
of lawsuits filed in California. That’s why the independent
more profitable for lawyers to sue doctors and hospitals —
Legislative Analyst says that county and state hospitals will see
even if that means higher health costs for the rest of us. Our
costs of tens of millions of dollars that taxpayers will have to
health laws should protect access to care and control costs for
everyone, not increase lawsuits and payouts for lawyers.
18 • COASTAL MEDICINE • Winter/Spring 2014
3/31/14 11:02 AM
MICRA > Protect Access
YOU’LL HEAR A LOT OF RHETORIC
patients. Finding doctors to deliver
OVER 1,000 GROUPS have joined
from the proponents of the measure
children in rural areas and community
together in support of MICRA and in
but really, this is another example of
clinics is already difficult and reducing
opposition to this dangerous, costly
special interest legislation trying to
services will make a bad situation worse.
measure. Be part of the effort to protect
fool the voters into thinking this about
patients by visiting
something that it’s not. The authors
of this proposal purposely threw in non- MICRA provisions, like drug testing doctors, to disguise the real intent, which is to increase the limits on medical malpractice awards so that trial lawyers make even more money. The main proponent of the measure was recently quoted in the LA Times, saying, “The drug rules are in the initiative because they poll well, and the backers figure that’s the way to get the public to support the measure. ‘It’s the ultimate sweetener.’” THIS MEASURE also requires a government database with personal information on patients’ prescription drug history. Hackers have already managed to access personal information from millions of Target customers and even the Pentagon, and another big database will only make our information more vulnerable. PHYSICIANS TAKE AN OATH to protect patients – and this dangerous initiative would put patients at risk of losing access to quality medical care. COMMUNITY HEALTH CARE CLINICS, like Planned Parenthood, say this measure will raise insurance costs that will cause specialists, like OB/GYN’s to reduce or eliminate services to their
Winter/Spring 2014 • COASTAL MEDICINE • 19
3/31/14 11:02 AM
For making us better. Thank you. To our physicians and others worldwide, happy Doctors’ Day. Because you did more than just write a prescription. Or put in stitches. Or set a broken bone. Or operate. Because you brought my daughter into this world. Because you showed warmth. Because you gave me strength when I was weak. And listened. Because you comforted me when I was scared. And were kind. And cared. Because you healed more than just my body—you restored my spirit. Thank you.
20 • COASTAL MEDICINE • Winter/Spring 2014
Working Together to End Hunger & Malnutrition by Vicki Lowell and Willy Elliott-McCrae, CEO Second Harvest Food Bank Santa Cruz County
It was just over forty years ago
when a small group of local residents began giving out free breakfast in a parking lot in downtown Santa Cruz, laying the foundation for what would eventually become Second Harvest Food Bank. Today, Second Harvest distributes over 8M pounds of food—more than half fresh produce—to more than 54,000 residents each month. The food is distributed through a network of 200 agencies and programs, including 100 non-profits and churches with food assistance programs; and 100 direct food distribution locations for families countywide. Second Harvest’s mission to end hunger and malnutrition by educating and involving the community informs everything they do. Their Passion For Produce program is an outstanding example of the good that comes from neighbors helping neighbors. Launched in 2010, Passion For Produce currently offers 700 nutrition classes annually at 30 sites located throughout Santa Cruz County. According to Second Harvest’s Chief Executive Officer, Willy ElliottMcCrea, “The program is designed
to serve farm workers and other low-income households, offering nutrition lessons and healthy recipe cooking demonstrations along with market-style fresh produce distriIn a survey of 300 Passion For Produce participants: Over 90% have: −−Increased consumption of fresh fruits and vegetables −−Adopted healthier cooking habits such as cooking with less oil Over 85% have: −−Decreased the amount of soda they drink and their families drink −−Reduced portion sizes of the meals they prepare at home −−Started reading nutrition labels at the grocery store Over 80% have: −−Increased daily minutes of physical activity butions twice monthly at accessible locations, such as schools, churches, community centers, and farm worker housing complexes.” Willy is justifiably excited about
the success of the program. “The peer-to-peer model works!” he exclaims. “We currently have over 300 trained Nutrition Ambassador volunteers providing bilingual education and encouragement for healthy lifestyle changes. Our Nutrition Ambassadors play a vital role, enabling us to reach far more people than we would be able to otherwise.” Willy is not alone in his enthusiasm. Passion For Produce has been recognized as a model peer education program by UC Berkeley’s Atkins Center for Weight and Health. Their 2013 report substantiates what Second Harvest has learned and put into practice with its Nutrition Ambassador program; namely that peer leaders, who share the same language, neighborhood, cultural and/or socioeconomic background as their “students” are typically more successful than outside professionals at reaching people. Overall, the use of peers for health promotion has been shown to be effective at improving diverse outcomes, including nutrition and physical activity behaviors and chronic disease prevention, self-management and screening. There are other benefits too. For
Winter/Spring 2014 • COASTAL MEDICINE • 21
instance, many peer leaders cite improvements in their own habits, increased self-esteem, and confidence. For some peer leaders, participation in these volunteer programs can serve as a springboard for paid employment.
drinking non-fat milk and lots of water, and serving fresh cut up fruit and vegetables at meals. The whole family is more active and feeling better than ever.
Sub: Case Studies
Melanie was in the fourth grade at Starlight Elementary when Nutrition Ambassadors Patricia, Melanie & Maria she was inspired to eat three years. Her daughter Kimberly healthier. She wanted to lose weight has completed the training as well. and knew that the rest of her family This dynamic mother and daughter could be eating healthier too, so she team really enjoy working together encouraged her mother, Patricia, to help their community. and grandmother, Maria, to attend Second Harvest’s nutrition classes They volunteer at food distributions with her. All three generations have twice each month, helping distribcompleted the six-week Nutrition ute food and answering questions. Ambassador certification program. They also give nutrition demonstrations using the curriculum proAs a result, Melanie has lowered vided by Second Harvest’s Nutriher cholesterol and both she and tion Programs team. Each month her mother have lost weight. “The focuses on a different topic and doctor recommended a nutritionincludes a healthy recipe. They are ist but we couldn’t afford it,” Maria also responsible for letting people explains. “This program showed know about upcoming presentaus how to be healthy and we put it tions and they must be doing a into practice.” The whole family is good job because there are often 80 involved in shopping for different people in attendance. types of food and cooking meals based on what they learned in class. Cristina and Kimberly say Passion For Produce helps families by proAll three women feel good because viding a place for people share to not only have they improved the their stories and learn in the comhealth of their own family, their pany of their friends and neighbors. training is enabling them to give back by managing food distribuA graduation ceremony is held tions and sharing the important for each group upon completion lessons they’ve learned with others. of the six-week certification. The “I like doing this,” says Maria. “It participants share a healthy meal makes me feel good about myself.” with Second Harvest staff members and talk about how the program is Cristina has been a Nutrition Amhelping them make healthy lifestyle bassador at Starlight Elementary changes. School in Watsonville for close to
Second Harvest’s volunteer Nutrition Ambassadors are proud of their accomplishments and happy to share their stories. Herminia became a Nutrition Ambassador about a year ago. The healthy food and nutrition education she receives through Passion For Produce has had a big impact on her family’s health. “Everything helped me because I was able to help my daughter,” says Herminia. “The doctor had told us she was going to get diabetes if she didn’t lose weight.” Herminia has lost several pounds and her daughter, Jennifer, lost 53 pounds in one year. Some of the tips Herminia picked up include using olive oil instead of corn oil,
Nutrition Ambassadors Cristina and Kimberly
22 • COASTAL MEDICINE • Winter/Spring 2014
Julio and his wife Silvia went through the workshops together. In the food labeling class, Julio found out just how much sugar was in the five snack cakes he was eating every day. Second Harvest’s Nutrition Programs Manager, Teresa Moran, encouraged him to cut back, but Julio decided to stop eating them altogether. During the celebration he said, “I’m not eating any cakes at all because I am a Nutrition Ambassador.”
Rallying the Community Although the rate of childhood obesity in America has tripled in the last thirty years, we are beginning to see a downward trend in our community. We hope to keep this trend moving in the right
direction. In partnership with the Go For Health Collaborative, Santa Cruz County Health Department, and the Santa Cruz County Medical Society, we are: • Developing baseline data and metrics. • Mobilizing resources for a “52-10” public campaign (at least five fruits and vegetables, no more than two hours screen time, at least one hour of exercise and no sugar drinks). We are committed to building a healthy workforce and vibrant economy through stronger collaboration with health partners and scaling of successful programs such as Passion For Produce. Healthy communities benefit everyone.
Board & Community quotes: “Second Harvest isn’t just an opportunity to give money. It is a chance to share excitement about doing something that is good, something that is very human, that forms a bond that builds relationships and trust.” Ken Kannappan, Plantronics CEO & Second Harvest Board Member “Second Harvest has an amazing group of local leaders excited about helping them keep important nutrition programs funded. Together we are building a healthier future.” Pastor Rene Schlaepfer, Twin Lakes Church
Winter/Spring 2014 • COASTAL MEDICINE • 23
MANAGING PROFESSIONAL RISK
Lowering NORCAL Managing Professional Risk is a quarterly feature of NORCAL Mutual Insurance Company and the NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL Mutual insureds. To learn more, visit www. norcalmutual. com/cme.
Risks Risk Management, PMSLIC Insurance Company and the NORCAL Group
Among the factors that influence the safety of ambulatory care and the liability risk levels of office-based physicians, three of the main ones are: The level of communication with other healthcare providers about patients’ care; the effectiveness of office follow-up processes; and the attention given to documentation of telephone calls. The following tips may help physicians and office staff members increase patient safety and lower liability exposure related to these factors. >>
Karen D. Davis, MA, CPHRM
24 • COASTAL MEDICINE • Winter/Spring 2014
4/8/14 10:35 AM
Communication with Other Healthcare Providers
When you refer a patient to another physician, have some mechanism in place to determine whether your referral recommendation has been carried out and the patient has been seen by the recommended consultant (or another physician of the patient’s choice). Communicate in writing with the consultant about the requested consultation.
An effective way to convey significant details to another physician is to prepare a “fact sheet” with the patient’s clinical information and your impression. After your patient is seen by a consultant, you and the consultant should establish who is responsible for which aspects of the patient’s care and who will order further testing and consultations if necessary. If there is a question about what you or the consultant will do, you should take the time to communicate physicianto-physician and to document the understanding you reach in your discussion. Effectiveness of Follow-up Processes
Systematically monitor compliance with appointments. Establish a process whereby a designated staff member reviews all no-show appointments to determine which patients must be called and rescheduled. Document no-shows, along with the steps taken to contact the patient and reschedule the visit. When a patient is advised to undergo a test, three areas of concern require follow-up:
Has the patient complied with the recommendation? Have test results been
received and reviewed by the ordering physician? Has the patient been notified about the results? An appropriate followup system provides answers to these questions. Patients should not be solely responsible for making appointments for tests, to see FRQVXOWDQWVRUIRUFDOOLQJWKHRIÀFH to obtain results.
You should assist patients in making appointments in order to be assured that the appointment has been made. It is also prudent to notify all patients of all test results (rather than just reporting abnormal results). Such a policy helps close each testing loop and reduces the possibility of patient information “falling through the cracks.” Your follow-up system for tests VKRXOGQRWRQO\FRQÀUPUHFHLSWRI test results but also ensure that you review the results.
The review should be timely. A test result should never be filed until you (as the ordering physician) have personally reviewed, dated, and initialed it. Without such a method, a positive result can be accidentally misplaced or filed away before you review it or the patient is notified. If the patient later alleges that harm occurred as a result of a delay in diagnosis and treatment, the mishandled test result may well be viewed as concrete evidence of negligence. Documentation of Telephone Calls
Generally, the types of telephone calls from patients that should be documented include: clinical questions and what advice was given, calls for prescriptions or renewals, after-hours calls, and calls to an oncall physician. Calls to patients that should be documented include: calls to share test results, calls to contact no-show patients, calls to give patients
instructions or to advise about further access to care, and unsuccessful attempts to contact patients. Telephone contacts should be documented in the appropriate medical record.
If your office simply keeps a call log, information about a specific call can be difficult to retrieve. The facts surrounding a call are not readily available if they are recorded in a call log; thus, using a log can be detrimental if a malpractice claim is filed and your office must produce information about the patient’s interactions with the practice. You should have a system for documenting all after-hours phone calls.
You can use telephone call forms or a tape recorder or dictation machine to record patient name, time of and reason for the call, and your advice or action. When the call is from a patient, the information should be added to the patient’s chart as soon as possible. Giving clinical or medical advice over the telephone without timely, face-to-face follow-up increases your liability exposure.
Prescribing over the phone is also risky, as it requires you to assess the patient sight unseen. You should not prescribe for a patient unknown to you without seeing the patient. It is also prudent to have established parameters as to when prescriptions will be renewed by phone. Consider developing the preceding suggestions as policy and including them in a policy manual.
Make sure all employees review your policy and consider asking them to sign off yearly that they have been advised of the policy and understand it.
Winter/Spring 2014 • COASTAL MEDICINE • 25
4/8/14 10:35 AM
CMA > Governance HOD 2013 Reform
By Steven E. Larson, M.D., MPH, Chair of the CMA Governance Technical Advisory Committee
REFORM CMA ENVISIONS A NEW FUTURE FOR ORGANIZED MEDICINE
Change is never easy. But oftentimes is it necessary, and
In a nutshell, the reforms will make CMA more relevant
even invigorating. The California Medical Association
and effective by focusing the association on, and
(CMA) is about to embark on a journey of change that
bolstering its resources to address, the critical issues of
will position our association as a nimble, proactive
universal importance to physicians. By doing so, CMA
organization ready to lead the practice of medicine
will be better able to protect the interests of its physician
into a brave new world. In 2013, the CMA House of
members and, even more importantly, guide the future
Delegates (HOD) approved a plan to reform the way our
of our profession, not only in California but nationwide.
association is governed. Will it be easy? No. Will it be worth it? There is not a doubt in my mind.
SAN JOAQUIN PHYSICIAN
26 • COASTAL MEDICINE • Winter/Spring 2014
3/31/14 11:00 AM
IN A NUTSHELL
The reforms will make CMA more relevant and effective by focusing the association on, and bolstering its resources to address, the critical issues of universal importance to physicians.
150 YEARS OF TRADITION For 150 plus years, CMA has been guided by the HOD, which meets once a year to set policies and direct resource allocation. This has led to a sometimes unwieldy 581-member HOD, a Board of Trustees numbering more than 50, a seven-member Executive Committee and hundreds of other members serving as alternate delegates and in various capacities on dozens of councils, committees, sections and mode of practice forums. Over the years, there have been several task forces assigned to this subject. It wasn’t until this year, however, that the abstract discussions about “governance reform” began to produce concrete results. These discussions resulted in big questions. Does the HOD foster a reactive culture rather than a proactive one? Does it inhibit CMA’s ability to take quick action in a rapidly evolving health care environment? While these questions were being asked, the HOD was spending most of its time on a growing number of resolutions that struggled to
be assigned or implemented because of resource limitations. The CMA Board of Trustees, realizing that a floundering governing style prevented the organization from quickly acting on issues of universal import to the membership and their patients, created a committee—the Governance Technical Advisory Committee (GTAC)—to look at this issue. The GTAC confirmed what the executive committee had feared —the association was unable to quickly address universal issues that arose faster than the once-a-year HOD meetings could handle. And, there were other inefficiencies in CMA’s governing bodies and processes. And there was the cost. An independent study commissioned by CMA (an activity-based costing, or “ABC” study) found that CMA governance is far more resource-intensive than previously thought, accounting for almost one-third of CMA’s operating budget—an allocation that commensurately reduces resources available for advocacy and other member services.
Winter/Spring 2014 • COASTAL MEDICINE • 27
3/31/14 11:00 AM
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2 Source: Business Insurance, https://www.businessinsurance.com/ article/20130925/NEWS08/130929901
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CMA > Governance Reform
THE GOVERNANCE TAC REPORT The full report of the CMA Governance Technical Advisory Committee, as amended by the House of Delegates at its October 2013 meeting in Anaheim, is available for download on the California Medical Association website. To access the report, available to members only, visit www.cmanet.org/hod and click on the “documents” tab. The report begins on page 12 of the “Actions of the 2013 House of Delegates” document.
The GTAC began its discussion of how to bring relevance, democracy and costeffectiveness to governing the association. It became clear to us that the rank and file members want more advocacy, while the delegates and trustees are heavily invested in leadership.
TACKLING THE BIG ISSUES
A proposal to reform CMA’s governing structure, put before the 2013 CMA HOD by the GTAC this past October, proposed that instead of a diffuse focus on many issues, the HOD take on a limited number of big issues—the most important, most pressing matters facing physicians and the practice of medicine. CMA’s long-standing traditions of
democratic participation and representative governance would continue; the difference, as envisioned by the GTAC, is that specific issues that are of concern to a narrow spectrum of the membership would no longer command HOD’s limited time. Rather, the democratically elected Board of Trustees would act on those issues, as it already does on the increasing number of matters referred to the board for action by a House that is aware of its policy-making constraints. The HOD would continue to set policy on major issues, and its decisions would be informed through a year-round process not constrained by 15-minute limits on debate of recommendations developed in a rushed overnight exercise, as is currently the case. More focused expertise would be brought to bear in a more careful development of
recommendations for action. Policy on other issues would realize the same benefits of a more careful and expert deliberative process throughout the year. We would like to improve the discussion at the House of Delegates to deal with the big issues of the day and to utilize the valuable resources of our delegates for the collective development and direction of important policy matters. We believe this proposal has real potential for a robust discussion around issues that will impact all physicians. The reforms would also open the discussion to individual members who could continue to bring forth their ideas and proposals through a year-round resolution process provided for in the CMA bylaws. Such proposals would be studied, with recommendations acted on by the board. A year-round dialog about timely issues should result in well-thought out policy pieces that could be brought to the floor during HOD.
CHARTING A COURSE FOR THE NEXT 150 YEARS
This year’s discussion and debate at HOD on governance reform has set the stage for the GTAC to make proposals to modify the bylaws to begin the changes needed to set CMA’s course for the next 150 years. I am optimistic that this will result in an improvement for our entire organization. It will make CMA more effective in reaching the average member and give them a direct voice in policy, bringing broader input into our more difficult decisions. Dr. Larson, a Riverside physician, has served as Chairman of CMA’s Board of Trustees since 2011. He is also the Chair of CMA’s Governance Technical Advisory Committee.
Winter/Spring 2014 • COASTAL MEDICINE • 29
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30 • COASTAL MEDICINE • Winter/Spring 2014
KEY DATES CALENDAR Practice Managers Network Is a monthly meeting for practice management staff to network, exchange ideas and share resources. • Meets the 3rd Wednesday each month, 8:00—9:00am at the SCCMS Office. SCCMS Board of Governors Election The annual election for members of the BOG. Every member recives a ballot.Your vote is important! • Ballots mailed: May 8, 2014 • Ballots due back by: May 29, 2014 SCCMS Membership Annual Social The annual meeting of the SCCMS membership. Outgoing BOG members will be thanked and incoming BOG members will be installed. • Thursday, June 26, 2014 6:30p—8:30pm Michael’s on Main, Soquel Leader’s Toolkit A two-day course for physicians seeking leadership roles in organized medicine. Contact Jennifer Moller at (916) 551-2541 • September 14-15, 2013 President’s Reception & Award Gala The CMA and the CMA Foundation host an annual awards gala and auction during the association’s annual meeting. The black-tie optional event is one not to be missed! For more information, visit www.thecmafoundation.org/events/gala. • 2014 Gala – October 18, 2014 Health Care Leadership Forum A local event organzied by SCCMS and supported by various health care partners in the SC area. Keynote speaker and location TBA. • October 23, 2014
House of Delegates (HOD) The delegates meet once a year to establish CMA policies on key issues that affect the practice of medicine, from medical ethics to critical matters of public health. Each year the HOD debates and takes action on more than 100 resolutions, each of them authored by members like you. For more details, visit www.cmanet.org/about/cma-governance/house-of-delegates. • 2014 HOD – December 5-7, 2014 (San Diego) • 2015 HOD – October 16-18, 2015 (Anaheim) SCCMS Membership Winter Dinner Is one of two dinners held annually; this is the Excellence In Health Care Award Dinner held in late winter • February 26, 2015 6:00—9:00pm Location TBA California Health Care Leadership Academy The Leadership Academy is the West Coast’s premier opportunity for physicians, practice managers and other health care leaders to learn about leading-edge trends and developments in the rapidly changing health care marketplace, to access information and tools to help ensure the viability of medical practice, and to acquire the leadership skills needed to successfully manage change. For more information, visit www.caleadershipacademy.com • May 28—31, 2015 Legislative Leadership Day CMA members have the unique opportunity to join hundreds physicians, medical students and CMA Alliance members who come to Sacramento every spring for Legislative Leadership Day to lobby their elected representatives as champions for medicine and their patients. • April 14, 2015 (Sacramento)
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Winter/Spring 2014 â€˘ COASTAL MEDICINE â€˘ 31
Coastal Medicine The Official Magazine of the Santa Cruz County Medical Society
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