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