Med Mal News

Court-Ordered Receivership of CA Prison Health System Winding Down

After finding that the health care now made available to California prisoners has improved significantly since he years ago ordered receivership over the state's prison medical system, U.S. District Court Judge Thelton E. Henderson on Jan. 16 ordered the interested parties to meet to negotiate a system for monitoring inmate care once federal oversight ends. Along with state officials and the advocacy group that sued for better prison health care access, the receiver, J. Clark Kelso, is expected to submit the report to the court by April 30. Once an agreement is reached, according to Judge Henderson, the court will continue for a time to monitor conditions at California prisons, to make sure that quality of care does not backslide.

NJ High Court Limits Delegation to Physician
Assistants

In a case of first impression, New Jersey's Supreme Court has ruled that only licensed physicians may perform electromyography (EMG) ' a diagnostic test of the health of the muscles and the nerves that control them. The ruling, which came in the case of Selective Insurance Company of America Inc. v. Rothman, A-60-10, could affect the outcome of a separate action being pressed by the State Board of Medical Examiners against neurologist Arthur Rothman, M.D. That claim accuses Dr. Rothman of submitting fraudulent claims for payment for EMGs. The EMGs in question were not performed by Dr. Rothman himself ' he delegated them to a physician assistant. Such delegation apparently is not uncommon in New Jersey, as evidenced by an arbitrator's ruling, early in the case, declaring the practice lawful. That finding was confirmed by a state Superior Court judge. However, the Appellate Division reversed after observing that New Jersey's EMG statute, N.J.S.A. 45:9-5.2(a), states that only those licensed to practice medicine and surgery may perform EMGs; physician assistants, therefore, may not do so, as they are not licensed. With the New Jersey Supreme Court's affirmation, doctors and physician assistants in that state would be wise to take note.

Inadequate Adverse Event Reporting Revealed

As a condition for receiving payments under the Medicare program, federal law requires hospitals to develop and carry out a Quality Assessment and Performance Improvement (QAPI) program. How effective are these programs? According to a recent report from the Office of the Inspector General, not very. See http://oig.hhs.gov/oei/reports/oei-06-09-00091.pdf. Researchers found that hospitals reported only about 14% of the events that could lead to patient harm, and that they investigated only those events they considered most likely to lead to quality and safety gains. When asked why 86% of harmful incidents were not in fact reported, hospital administrators indicated that their staff members may not have perceived most of these events as reportable. This being the case, the Inspector General's report suggests that a list of reportable events be compiled by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS). It could then be published and used by hospital personnel as a guide, because reportable events that are not actually brought to a health care facility's attention are not likely to spur safety and quality improvements.

Court-Ordered Receivership of CA Prison Health System Winding Down

After finding that the health care now made available to California prisoners has improved significantly since he years ago ordered receivership over the state's prison medical system, U.S. District Court Judge Thelton E. Henderson on Jan. 16 ordered the interested parties to meet to negotiate a system for monitoring inmate care once federal oversight ends. Along with state officials and the advocacy group that sued for better prison health care access, the receiver, J. Clark Kelso, is expected to submit the report to the court by April 30. Once an agreement is reached, according to Judge Henderson, the court will continue for a time to monitor conditions at California prisons, to make sure that quality of care does not backslide.

NJ High Court Limits Delegation to Physician
Assistants

In a case of first impression, New Jersey's Supreme Court has ruled that only licensed physicians may perform electromyography (EMG) ' a diagnostic test of the health of the muscles and the nerves that control them. The ruling, which came in the case of Selective Insurance Company of America Inc. v. Rothman, A-60-10, could affect the outcome of a separate action being pressed by the State Board of Medical Examiners against neurologist Arthur Rothman, M.D. That claim accuses Dr. Rothman of submitting fraudulent claims for payment for EMGs. The EMGs in question were not performed by Dr. Rothman himself ' he delegated them to a physician assistant. Such delegation apparently is not uncommon in New Jersey, as evidenced by an arbitrator's ruling, early in the case, declaring the practice lawful. That finding was confirmed by a state Superior Court judge. However, the Appellate Division reversed after observing that New Jersey's EMG statute, N.J.S.A. 45:9-5.2(a), states that only those licensed to practice medicine and surgery may perform EMGs; physician assistants, therefore, may not do so, as they are not licensed. With the New Jersey Supreme Court's affirmation, doctors and physician assistants in that state would be wise to take note.

Inadequate Adverse Event Reporting Revealed

As a condition for receiving payments under the Medicare program, federal law requires hospitals to develop and carry out a Quality Assessment and Performance Improvement (QAPI) program. How effective are these programs? According to a recent report from the Office of the Inspector General, not very. See http://oig.hhs.gov/oei/reports/oei-06-09-00091.pdf. Researchers found that hospitals reported only about 14% of the events that could lead to patient harm, and that they investigated only those events they considered most likely to lead to quality and safety gains. When asked why 86% of harmful incidents were not in fact reported, hospital administrators indicated that their staff members may not have perceived most of these events as reportable. This being the case, the Inspector General's report suggests that a list of reportable events be compiled by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS). It could then be published and used by hospital personnel as a guide, because reportable events that are not actually brought to a health care facility's attention are not likely to spur safety and quality improvements.