Oklahoma Court Supports Plaintiff’s Request for Physician Peer Review and Credentialing Documents

Med Law Blog alerts us to a recent decision by the United States District Court for the Northern District of Oklahoma. 

The Oklahoma court ruled that Ardent Health Services must produce unredacted documents relating to physician peer review.  The plaintiff in the case, George Cohlmia, Jr., M.D. alleges that the documents are necessary to prove that his peer review was handled differently than that of other physicians in the hospital. 

The court ruled that Oklahoma’s peer review privilege does not apply in this case, and that some of the requested documents must be supplied.    

The November 14, 2008 opinion, which calls the case “already overly contentious” states in part:

“Defendants shall produce for inspection and copying all peer review and/or credentialing files for cardiovascular surgeons, interventional radiologists and cardiologists who practiced at SJMC, Hillcrest, and the AHS entities within Defendants defined, “relevant geographical market,” i.e, that is, Northeastern Oklahoma, from January 1, 1998 through December 31, 2007, including the 17 OHI physicians listed in Exhibit 1 of Cohlmia’s Reply (Dkt. #233). These should be produced in an unredacted form.”

Read the full text: George Cohlmia, Jr., M.D. v Ardent Health Services, LLC

Perform CPR to the Beat of (appropriately) Stayin’ Alive

In a review of 2008 in Medicine, Time.com reports that a 15-doctor study revealed that teaching CPR to the tune of the Bee Gees’ song “Stayin’ Alive” (the snappy anthem of the movie Saturday Night Fever) helped students perform the compressions at the proper speed and pace on a test five weeks later. Who said disco was dead?

Need a music refresher? – Get the beat via e-snips

CMS Proposes New National Determination Coverage Policies

CMS is accepting comments until January 1, 2009 regarding these proposed National Coverage Determination policies.  

Unlike the HAC (Hospital Acquired Conditions) provisions, which affect only payments to hospitals for inpatient stays, the final NCDs (National Coverage Determinations) could affect payment to hospitals, physicians, and any other health care providers and suppliers involved in the erroneous surgeries.   

  • Wrong body part

  • Wrong patient

  • Wrong surgery performed on a patient  



Source:  CMS Press Release – December 2, 2008

New Blog Title

You may have noticed that I’ve changed the name of my blog from MSSPNexus to Supporting Safer Healthcare.   The blog name has changed but not the web address, which remains msspnexus.blogs.com.  (Update 2/2/09:  This blog is now available at www.supportingsaferhealthcare.com)

Although there will continue to be information posted here that reflects and comments on the valuable work of the Medical Staff Service Professional (MSSP), over the years the blog has expanded to include commentary on healthcare compliance, risk management, law, accreditation, and other administrative and regulatory issues.  When I began to think of the current scope and purpose of this blog, I realized that it all revolved around supporting a safer healthcare environment. 

I hope you’ll continue to stop by and leave comments.  Safer healthcare is a challenging but worthy goal, and everyone from patient to physician plays a part. 

Altered Medical Records May Lead Jury to Award Punitive Damages

The Presidio Insurance blog offers clinicians this important risk management reminder:

“It has been consistently shown that medical malpractice juries tend to defer to the physician, to believe the doctor’s opinion and, usually, to trust the doctor initially. But if a record has been changed in any way, that trust is gone, and the jury is patently suspicious. White-out, strike-out, a hand-written note squeezed in after the fact, these are all reasons for suspicion to a jury, no matter if the doctor is simply intending to clarify or actually means to deceive.”

“When a jury finds that a patient’s records have been changed, they are able to levy punitive damages in a medical malpractice suit…”

From Dictionary.com: 

Pu”ni*tive, a. Of or pertaining to punishment; involving, awarding, or inflicting punishment; as, punitive law or justice.

Honest, accurate record keeping is often the best defense when allegations of medical malpractice are made.

2009 Joint Commission National Patient Safety Goals for Hospitals

NPS Goal List




Improve the accuracy of patient identification.


Use at least two patient identifiers when providing care, treatment and services.


Prior to the start of any surgical or invasive procedure, individuals involved in the procedure conduct a final verification process, such as a time out, to confirm the correct patient, procedure and site using active, not passive communication techniques.


Eliminate transfusion errors related to patient misidentification.


Improve the effectiveness of communication among caregivers.


For verbal or telephone orders or for telephone reporting of critical test results, the individual giving the order verifies the complete order or test result by having the person receiving" the information record and read-back" the complete order or test result.


There is a standardized list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.


The organization measures, assesses, and if needed, takes action to improve the timeliness of reporting, and the timeliness of receipt of critical tests, and critical results and values by the responsible licensed caregiver.


Improve the safety of using medications.


The organization identifies and, at a minimum, annually reviews a list of look-alike/sound-alike medications used by the organization, and takes action to prevent errors involving the interchange of these medications.


Label all medications, medication containers (for example, syringes, medicine cups, basins), or other solutions on and off the sterile field.


Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.


Reduce the risk of health care-associated infections.


Comply with current World Health Organization (WHO) Hand Hygiene Guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.


Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection.


Implement evidence-based practices to prevent health care associated infections due to multiple drug-resistant organisms in acute care hospitals.


Implement best practices or evidence-based guidelines to prevent central line associated bloodstream infections.


Implement best practices for preventing surgical site infections.


Accurately and completely reconcile medications across the continuum of care.


A process exists for comparing the patient's current medications with those ordered for the patient while under the care of the organization.


When a patient is referred or transferred from one organization to another, the complete and reconciled list of medications is communicated to the next provider of service and the communication is documented. Alternatively, when a patient leaves the organization's care directly to his or her home, the complete and reconciled list of medications is provided to the patient's known primary care provider, or the original referring provider, or a known next provider of service.


When a patient leaves the organization's care, a complete and reconciled list of the patient's medications is provided directly to the patient, and the patient's family as needed, and the list is explained to the patient and/or family.


In settings where medications are used minimally, or prescribed for a short duration, modified medication reconciliation processes are performed.


Reduce the risk of patient harm resulting from falls.


The organization implements a fall reduction program that includes an evaluation of the effectiveness of the program.


Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.


The organization develops and implements protocols for administration of the flu vaccine.


The organization develops and implements protocols for administration of the pneumococcus vaccine.


The organization develops and implements protocols to identify new cases of influenza and to manage outbreaks.


Reduce the risk of surgical fires


The organization educates staff, including licensed independent practitioners who are involved with surgical procedures and anesthesia providers, on how to control heat sources, how to manage fuels while maintaining enough time for patient preparation, and establish guidelines to minimize oxygen concentration under drapes.


Encourage patients’ active involvement in their own care as a patient safety strategy.


Identify the ways in which the patient and his or her family can report concerns about safety and encourage them to do so.


Prevent health care associated pressure ulcers (decubitus ulcers).


Assess and periodically reassess each resident's risk for developing a pressure ulcer (decubitus ulcer) and take action to address any identified risks.


The organization identifies safety risks inherent in its patient population.


The organization identifies patients at risk for suicide.


The organization identifies risks associated with home oxygen therapy such as home fires.


Improve recognition and response to changes in a patient’s condition.


The organization selects a suitable method that enables health care staff members to directly request additional assistance from specially trained individual(s) when the patient’s condition appears to be worsening.


Universal Protocol – The organization meets the expectations of the Universal Protocol.


Conduct a pre-procedure verification process.


Mark the procedure site.


A time out is performed immediately prior to starting procedures.

Source:  http://www.jointcommission.org/NR/rdonlyres/F71BC4E9-FEB6-495C-99D8-DB9F0850E75B/0/09_NPSG_General_Presentation.ppt

CMS Releases Interpretive Guidelines Update for Hospital CoPs – October 17, 2008

Kathy Matzka, CPMSM, CPCS was kind enough to forward a link this week that I’ve been searching for with limited success.  In October, the Centers for Medicare and Medicaid Services (CMS) issued an update to their interpretive guidelines for the Hospital Conditions of Participation.  One would think that release would be well advertised and easy to find; not so.  

Since all hospitals in the United States that rely on government reimbursement are expected to live by these standards, it’s good to know what they are.  Thanks Kathy!


 2008 Interpretive Guidelines as they pertain to patient grievance requirements

Is Your Doctor Thinking of Quitting?

 “Our physicians are suffering from regulatory fatigue.”  So said an administrator at my hospital recently, and he’s right.  Healthcare regulations seem to be multiplying like bunnies, but unlike cute little bunnies, the penalties and fines attached to many of these regulations make them seem more like baby alligators.

In a sad commentary, CNN reports that one half of the nation’s primary care physicians would leave medicine within the next three years if they could find an alternative career.  

The survey was released this week by the Physicians’ Foundation. Of the 12,000 respondents, 49 percent said they’d consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there’s too much red tape generated from insurance companies and government agencies.

I work in an administrative healthcare field, and confess to being the (second hand) source of some of that red tape. Some of it I wield with absolutely no apology.  Do you need to be reminded to perform a 10 second “time-out” before making that first surgical incision?  Did you forget that you need to apply for hospital privileges before you treat patients in the hospital?  My colleagues and I will be right there, red tape and scissors in hand.  Work with us and the red tape can be snipped into short little pieces; work against us and it will just continue to unwind and snarl. 
That having been said, I have an inordinate amount of respect and sympathy for physicians, especially primary care docs.  In general they work very long hours, spend a great deal of time on-call, and don’t receive the respect they deserve from patients and patients’ families.  They also work in an environment that is often emotionally draining. I may not be able to do much to change that, but I can at least make sure that I personally treat the physicians with whom I work with the respect they’re due.  
We need them. I don’t want them to quit.

Cleveland Clinic and Microsoft HealthVault Partner for Home Health Monitoring

Earlier this year I wrote about the take-away message from the Estes Park Institute Conference I attended in Orlando.

The delivery of healthcare is beginning to decentralize.  Care that now requires a trip to the doctor’s office, (sometimes considerable) time in the waiting room, and a wait of hours (or days) for test results, will increasingly be available remotely or in the local (think Walmart clinic) community. 

The Cleveland Clinic, often a leader in healthcare technology innovation, announced this week that it is partnering with Microsoft HealthVault to pilot a home-based chronic condition management program.  Patients involved in the pilot will be able to  monitor high blood pressure, diabetes and heart failure at home. These patients will use high-tech devices, home computers and the Internet to keep Clinic doctors posted on their conditions. 

Doctors could rely on the information to adjust medications or order aggressive medical care without seeing patients for office visits. Early medical interventions could lead to healthier patient.

The Clinic and Microsoft are providing patients with digital blood pressure and heart rate monitors, as well as blood sugar meters, said Peter Neupert, vice president of Microsoft’s Health Solutions Group.

The monitors and meters can be plugged into computers, which upload information into HealthVault – the online service that enables users to collect, organize and share their health information.

The Clinic hopes to involve between 400 and 500 patients in the 90-day pilot project, which began Nov. 5th.

November 2-8, 2008 – National Medical Staff Services Awareness Week

The first week in November has been designated National Medical Staff Services Awareness Week.  The 1992 White House proclamation that established this annual observance opens with the words:   “The professionals who direct or manage medical staff services, from hospital communications to the accreditation of physicians and nurses, play an important role in our Nation’s health care system.” 
When Emily Berry, Associate Editor for HcPro’s Briefings on Credentialing contacted me recently to ask for a quote for an article she was working on for the November issue, I saw it as an opportunity to highlight the excellent work performed by Medical Staff Service Professionals around the country.    
“Having worked in both medical staff services and healthcare risk management, I remain exceedingly impressed with the depth of knowledge and commitment I see in the vast majority of MSPs. Most medical staff service professionals spend considerable time learning and applying both Joint Commission standards and CMS Conditions of Participation, and it is time well spent. They function as invaluable resources to organization and medical staff leadership and play a vital role in patient safety.”  
“In many organizations, they are the best, and sometimes only, resource for assuring that credentialing and privileging policies are developed in accordance with accreditation standards and carefully followed. Because of their diligent, thorough efforts, patients and providers are safer, and the workload of the department of risk management is diminished.”
So this week in particular, take a moment to recognize the work of NAMSS and the medical staff service professionals in your organization.  Happy Medical Staff Services Awareness Week.