Transcript Document

W W W . D I N S LA W . C O M
Reporting Requirements
to Government Agencies
November 6, 2008
Stacey A. Borowicz, Esq.
Dinsmore & Shohl LLP
191 W. Nationwide Blvd.
Suite 300
Columbus, OH 43215
(614) 227-4212
[email protected]
Reporting Requirements to Government
Agencies
Presentation Outline:

Reporting Obligations Arising From Peer Review, Quality Assurance, and
Utilization Committees

The National Practitioner Databank

The Basics of Reporting Professional Misconduct

Responding to Government Subpoenas

Miscellaneous Reporting Obligations
© 2008 Dinsmore & Shohl LLP
Peer Review & Reporting Obligations

Peer Review Materials Are Generally Treated as
Confidential (O.R.C. 2305.252)

WHY: to encourage the free flow of information (Browning
v. Burt (1993), 66 Ohio St.3d 544, 613 N.E.2d 993)
© 2008 Dinsmore & Shohl LLP
Peer Review & Reporting Obligations
The Definition of a Peer Review Committee:
“. . . a utilization review committee, quality assessment committee, performance
improvement committee, tissue committee, credentialing committee, or other committee
that does either of the following.” O.R.C. 2305.25.
© 2008 Dinsmore & Shohl LLP
Peer Review & Reporting Obligations
What is Protected from Discovery or Introduction as
Evidence?

Peer review proceedings and records

Testimony from any individual that attends a meeting, serves as a member, works for,
provides information to a peer review committee

See O.R.C. 2305.252 and Gates v. Brewer (1981), 2 Ohio App.3d 347, 442 N.E.2d 72.
© 2008 Dinsmore & Shohl LLP
Peer Review & Reporting Obligations
Caution:
Some Exceptions Exist That Allow
Discovery and Introduction as Evidence
(O.R.C. 2305.252)

Original sources

Personal knowledge
© 2008 Dinsmore & Shohl LLP
Peer Review & Reporting Obligations
Special Issue:
Incident / Risk Management Reports

What are they?

Is there an Incident Report statute?

How do we use them?
© 2008 Dinsmore & Shohl LLP
Peer Review & Reporting Obligations
Keys to the Proper and Safe Use of Incident Reports:

The Incident Report Must Have Been Prepared for Use by the Peer Review Committee.

Merely labeling something an “Incident Report” is not enough.

See Manley v. Heather Hill, Inc. (2007), 175 Ohio App.3d 155, 885 N.E.2d 971, 2007-Ohio6944.
© 2008 Dinsmore & Shohl LLP
Peer Review & Reporting Obligations
Question:
What particular kind of
information belongs in
incident reports?
Medical Record:
Incident Report

history,

assessment,

diagnosis,

impressions,

prognosis,
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the real story, so to speak,
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philosophical take,
things actually seen or actually
heard,


etc.
things believed, but not seen or
heard,

I-told-you-so comments and
suggestions,


Answer:
All the subjective stuff that
should never make it into a
medical record.
© 2008 Dinsmore & Shohl LLP
etc.
Peer Review & Reporting Obligations
Practical Advice:
1.
Develop and Maintain Peer Review Committee Formalities
2.
Use Incident Reports That Are Created
3.
Investigate Related Matters
4.
Develop Policies and Educate Staff on What Should Be Included in Incident Reports
© 2008 Dinsmore & Shohl LLP
The National Practitioner Data Bank
What Gets Reported:
(42 C.F.R. 60.6-60.9)

Malpractice Payments
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Licensure Actions
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Adverse Actions

Reporting Errors, Omissions, and Revisions
When It Gets Reported:
(42 C.F.R. 60.5)

The above items must be reported within 30 days.
© 2008 Dinsmore & Shohl LLP
The National Practitioner Data Bank
Reporting Medical Malpractice Payments:
(42 C.F.R. 60.7)
Who Gets Reported: physicians, dentists, other health care
practitioners (those licensed by a state providing health care
services)
Who Reports: the entities and insurance companies that make
payments for the benefit of the practitioner in satisfaction of a
settlement or judgment
To Whom is Information Reported: the appropriate state licensing
board and to the NPDB
© 2008 Dinsmore & Shohl LLP
The National Practitioner Data Bank
Reporting Medical Malpractice Payments:
(42 C.F.R. 60.7)
What is Reported:
(1) the practitioner’s information
(2) the reporting entity’s information
(3) claim, conduct, settlement or judgment information
© 2008 Dinsmore & Shohl LLP
The National Practitioner Data Bank
Reporting Licensure Actions:
(42 C.F.R. 60.8)
Who Gets Reported: physicians and dentists
Who Reports: relevant Board of Medical Examiners
To Whom is Information Reported: NPDB
What Gets Reported: revocation, suspension, or surrender of the license, as well as censures,
reprimands, or probation
Other Reported Information: practitioner information
© 2008 Dinsmore & Shohl LLP
The National Practitioner Data Bank
Reporting Adverse Actions on Clinical Privileges:
(42 C.F.R. 60.9)
Who Gets Reported: physicians and dentists (must report); other health care practitioners (may
report)
Who Reports: entities that take adverse actions
First Level of Reporting: the entity to the Board of Medical Examiners
What Gets Reported: actions affecting privileges for longer than 30 days, accepted surrender or
restriction of privileges during investigation
© 2008 Dinsmore & Shohl LLP
The National Practitioner Data Bank
Reporting Adverse Actions on Clinical Privileges:
(42 C.F.R. 60.9)
Other Reported Information: practitioner information
Second Level of Reporting: the Board of Medical Examiners to NPDB
What Gets Reported: the information reported to the board by the health care entities, and any
known instances of a health care entity’s failure to report information for adverse actions
taken with respect to clinical privileges
© 2008 Dinsmore & Shohl LLP
Professional Misconduct
State Medical Board:
(OAC 4731-15-02)
Who Reports: the chief administrative or executive officer
Individual Subject to Reporting: physician assistants, physicians,
limited practitioners, anesthesiologists, acupuncturists
To Whom is Information Reported: the State Medical Board of Ohio
What Gets Reported: any “formal disciplinary action”
© 2008 Dinsmore & Shohl LLP
Professional Misconduct
Board of Nursing:
(O.R.C. 4823.34)
Who Reports: employers
Individual Subject to Reporting: nurses, LPNs, dialysis technicians,
certified community health workers, medication aids
To Whom is Information Reported: State Board of Nursing
What Gets Reported: professional misconduct under Nurse Practice Act
© 2008 Dinsmore & Shohl LLP
Responding to Subpoenas
Definition:
Subpoenas are a legal command, not a court order,
that request testimony or the production of documents
Types of Subpoenas:
subpoena ad testificandum: requires attendance of witness at a hearing, deposition, or trial
subpoena duces tecum: requires the production or copying of documents
Issuers:
attorneys, arbitrators, government boards / commissions, judges, grand juries
© 2008 Dinsmore & Shohl LLP
Responding to Subpoenas
Procedure for Handling a Subpoena:

Don’t Panic

Read the Subpoena

Contact Your Attorney
© 2008 Dinsmore & Shohl LLP
Miscellaneous Reporting Requirements
Ohio Department of Health:
Birth Defects: R.C. 3705.30-31
Cancer: R.C. 3701.261-262
HIV/AIDS: R.C. 3701.24
Protective Reporting:
Child Abuse: R.C. 2151.421
© 2008 Dinsmore & Shohl LLP
W W W . D I N S LA W . C O M
Stacey A. Borowicz, Esq.
Dinsmore & Shohl LLP
191 W. Nationwide Blvd.
Suite 200
Columbus, Ohio 43215
[email protected]