Med Mal News

The American Medical Association (AMA) voted at its annual meeting on June 22 to update its principles and guidelines for the formation and implementation of pay-for-performance. Updates include the need for pilot testing prior to implementation of pay-for-performance programs and a call for programs not to penalize physicians based on factors outside of the physician's control. “The primary goal of any pay-for-performance program must be to promote quality patient care,” said Dr. John H. Armstrong, MD, AMA Secretary. “Some so-called pay-for-performance programs are a lose/lose proposition for patients and their physicians with the only benefit accruing to health insurers. We believe that pay-for-performance programs done properly have the potential to improve patient care, but if done improperly can harm patients.”

JCAHO Proposes Standards for Qualifying Emergency Volunteers

The Joint Commission on Accreditation of Healthcare Organ-zations (JCAHO) has released for review proposed standards that could help organizations qualify volunteers who offer assistance following a disaster. The need for health care organizations to effectively and efficiently identify the competence and credentials of health care volunteers became clear in the aftermath of the 9/11 attacks. The first proposed standard addresses privileging of licensed independent practitioners who volunteer in disaster situations. Such a standard already exists for volunteer licensed independent practitioners in hospitals, and the proposed standard would extend these requirements to ambulatory care organizations, critical access hospitals and long term care organizations.

The second proposed standard would address the credentialing and assignment of duties to volunteer practitioners who offer their services immediately following a disaster, but are not classified as licensed independent practitioners. The standard is designed to streamline credentialing requirements for hospitals, critical access hospitals, assisted living facilities, ambulatory care organizations, long term care, and laboratories.

The draft standards are available at http://www.jcaho.org/accredit ed+organizations/field_reviews.htm.

Letter-Writing Campaign Aims At Electing Sympathetic Legislators

According to The Washington Post, a group of Maryland doctors sent letters in June to more than 10,000 of the state's medical professionals, urging them to contribute to a fund that will be used to help elect physician-friendly candidates to the Maryland General Assembly (Wagner/Wiggins, The Washington Post, 6/19). The campaign is called, “Stop the Bleeding, Elect a Doc.”

AMA Survey Finds Students and Residents Still Overworked and Tired

One-half of resident physicians and 45% of medical students believe sleep deprivation or fatigue may have had a negative affect on the quality of patient care they delivered, according to the latest AMA Member Connect' Survey.

In July 2003, the Accreditation Council for Graduated Medical Education (ACGME) restricted resident duty hours to 80 per week and their on-call schedules to every third night or less often. (No guidelines have been set for medical students.) The 12-question survey examined the effects of those restrictions on AMA student and resident members 2 years later.

On average, residents worked a total of 68 hours per week, while medical students worked 60 hours per week. About 11% of residents reported working more than 80 hours per week. The majority of both residents (63%) and students (56%) reported their typical on-call schedule was every fourth night or less often.

Despite working well within the ACGME's guidelines, half of residents said they believed sleep deprivation or fatigue might have had a negative effect on the quality of patient care they delivered. A similar number of medical students said they felt the same way. Additionally, 50% of residents said they would be uncomfortable reporting excessive duty hours to ACGME (which handles such reports for residents), while 75% of students said they would be uncomfortable doing so to their medical schools.

Anesthesiologists Get a Lower Premium the Old Fashioned Way: They Earn It

The Wall Street Journal reported on June 21 that anesthesiologists have found a way beyond tort reform to reign in insurance costs; they are instead embracing increased use of safety standards and methods of training that help doctors learn to avoid mistakes (Hallinan, The Wall Street Journal, 6/21).

The article notes that, in today's dollars, the amount anesthesiologists pay for malpractice insurance has actually gone down over the past 20 years, and that the average anesthesiologist now pays about $21,000 per year for coverage.

Abortion Rights Activists Sue, But Don't Stop Parental Notice Law

The Center for Reproductive Rights and the Planned Parenthood Federation of America unsuccessfully sought a temporary injunction in federal court to block a Florida law that requires doctors to inform parents of their teen daughters' conditions before performing abortions. The suit was filed in June, but the law went into effect July 1. It imposes a requirement for a telephoned or in-person notice 48 hours before the pregnancy of a teen who is 17 years old or younger can be terminated unless there is a medical emergency or a waiver of the notice requirement is obtained from a court.

New Hampshire to Institute Med-Mal Panel Review

New Hampshire legislators have passed a bill that will require medical malpractice cases to be put before a panel for review prior to going to trial. A group made up of one judge, one lawyer and one doctor will review each case to determine if there is adequate evidence to justify trial.

However, the panel's opinion will not determine whether a suit may go to trial; instead, if the group unanimously decides the case should not have gone forward, that information will be given to the jury if the litigation goes forward.

Hospitals Mistakenly Use Wrong Cleaning Solution

Lawsuits against an elevator company and detergent supplier have already been filed in a case that could lead to malpractice charges against two hospitals run by Duke University Health System of North Carolina. The unusual scenario went something like this: Elevator company workers drained hydraulic fluid into empty detergent buckets, which were then mistaken for buckets of detergent and were shipped to the hospitals for use in cleaning surgical instruments. The hospitals – -Duke Health Raleigh Hospital and Durham Regional Hospital — did not discover the mix-up for some weeks. In the meantime, they cleaned medical instruments with the fluid even though medical personnel were complaining of slippery tools.

Pay-for-Performance Criticized

The American Medical Association (AMA) voted at its annual meeting on June 22 to update its principles and guidelines for the formation and implementation of pay-for-performance. Updates include the need for pilot testing prior to implementation of pay-for-performance programs and a call for programs not to penalize physicians based on factors outside of the physician's control. “The primary goal of any pay-for-performance program must be to promote quality patient care,” said Dr. John H. Armstrong, MD, AMA Secretary. “Some so-called pay-for-performance programs are a lose/lose proposition for patients and their physicians with the only benefit accruing to health insurers. We believe that pay-for-performance programs done properly have the potential to improve patient care, but if done improperly can harm patients.”

JCAHO Proposes Standards for Qualifying Emergency Volunteers

The Joint Commission on Accreditation of Healthcare Organ-zations (JCAHO) has released for review proposed standards that could help organizations qualify volunteers who offer assistance following a disaster. The need for health care organizations to effectively and efficiently identify the competence and credentials of health care volunteers became clear in the aftermath of the 9/11 attacks. The first proposed standard addresses privileging of licensed independent practitioners who volunteer in disaster situations. Such a standard already exists for volunteer licensed independent practitioners in hospitals, and the proposed standard would extend these requirements to ambulatory care organizations, critical access hospitals and long term care organizations.

The second proposed standard would address the credentialing and assignment of duties to volunteer practitioners who offer their services immediately following a disaster, but are not classified as licensed independent practitioners. The standard is designed to streamline credentialing requirements for hospitals, critical access hospitals, assisted living facilities, ambulatory care organizations, long term care, and laboratories.

The draft standards are available at http://www.jcaho.org/accredit ed+organizations/field_reviews.htm.

Letter-Writing Campaign Aims At Electing Sympathetic Legislators

According to The Washington Post, a group of Maryland doctors sent letters in June to more than 10,000 of the state's medical professionals, urging them to contribute to a fund that will be used to help elect physician-friendly candidates to the Maryland General Assembly (Wagner/Wiggins, The Washington Post, 6/19). The campaign is called, “Stop the Bleeding, Elect a Doc.”

AMA Survey Finds Students and Residents Still Overworked and Tired

One-half of resident physicians and 45% of medical students believe sleep deprivation or fatigue may have had a negative affect on the quality of patient care they delivered, according to the latest AMA Member Connect' Survey.

In July 2003, the Accreditation Council for Graduated Medical Education (ACGME) restricted resident duty hours to 80 per week and their on-call schedules to every third night or less often. (No guidelines have been set for medical students.) The 12-question survey examined the effects of those restrictions on AMA student and resident members 2 years later.

On average, residents worked a total of 68 hours per week, while medical students worked 60 hours per week. About 11% of residents reported working more than 80 hours per week. The majority of both residents (63%) and students (56%) reported their typical on-call schedule was every fourth night or less often.

Despite working well within the ACGME's guidelines, half of residents said they believed sleep deprivation or fatigue might have had a negative effect on the quality of patient care they delivered. A similar number of medical students said they felt the same way. Additionally, 50% of residents said they would be uncomfortable reporting excessive duty hours to ACGME (which handles such reports for residents), while 75% of students said they would be uncomfortable doing so to their medical schools.

Anesthesiologists Get a Lower Premium the Old Fashioned Way: They Earn It

The Wall Street Journal reported on June 21 that anesthesiologists have found a way beyond tort reform to reign in insurance costs; they are instead embracing increased use of safety standards and methods of training that help doctors learn to avoid mistakes (Hallinan, The Wall Street Journal, 6/21).

The article notes that, in today's dollars, the amount anesthesiologists pay for malpractice insurance has actually gone down over the past 20 years, and that the average anesthesiologist now pays about $21,000 per year for coverage.

Abortion Rights Activists Sue, But Don't Stop Parental Notice Law

The Center for Reproductive Rights and the Planned Parenthood Federation of America unsuccessfully sought a temporary injunction in federal court to block a Florida law that requires doctors to inform parents of their teen daughters' conditions before performing abortions. The suit was filed in June, but the law went into effect July 1. It imposes a requirement for a telephoned or in-person notice 48 hours before the pregnancy of a teen who is 17 years old or younger can be terminated unless there is a medical emergency or a waiver of the notice requirement is obtained from a court.

New Hampshire to Institute Med-Mal Panel Review

New Hampshire legislators have passed a bill that will require medical malpractice cases to be put before a panel for review prior to going to trial. A group made up of one judge, one lawyer and one doctor will review each case to determine if there is adequate evidence to justify trial.

However, the panel's opinion will not determine whether a suit may go to trial; instead, if the group unanimously decides the case should not have gone forward, that information will be given to the jury if the litigation goes forward.