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November 6, 2008

Reporting Requirements to Government Agencies. Stacey A. Borowicz, Esq. Dinsmore & Shohl LLP 191 W. Nationwide Blvd. Suite 300 Columbus, OH 43215 (614) 227-4212 stacey.borowicz@dinslaw.com. November 6, 2008. Reporting Requirements to Government Agencies. Presentation Outline:

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November 6, 2008

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  1. Reporting Requirements to Government Agencies Stacey A. Borowicz, Esq. Dinsmore & Shohl LLP 191 W. Nationwide Blvd. Suite 300 Columbus, OH 43215 (614) 227-4212 stacey.borowicz@dinslaw.com November 6, 2008

  2. 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

  3. 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)

  4. 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.

  5. 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.

  6. Peer Review & Reporting Obligations Caution: Some Exceptions Exist That Allow Discovery and Introduction as Evidence (O.R.C. 2305.252) • Original sources • Personal knowledge

  7. Peer Review & Reporting Obligations Special Issue: Incident / Risk Management Reports • What are they? • Is there an Incident Report statute? • How do we use them?

  8. 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-Ohio-6944.

  9. Peer Review & Reporting Obligations Question: What particular kind of information belongs in incident reports? Answer: All the subjective stuff that should never make it into a medical record.

  10. Peer Review & Reporting Obligations Practical Advice: • Develop and Maintain Peer Review Committee Formalities • Use Incident Reports That Are Created • Investigate Related Matters • Develop Policies and Educate Staff on What Should Be Included in Incident Reports

  11. The National Practitioner Data Bank What Gets Reported: (42 C.F.R. 60.6-60.9) • Malpractice Payments • Licensure Actions • 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.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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”

  18. 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

  19. 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

  20. Responding to Subpoenas Procedure for Handling a Subpoena: • Don’t Panic • Read the Subpoena • Contact Your Attorney

  21. 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

  22. Stacey A. Borowicz, Esq.Dinsmore & Shohl LLP191 W. Nationwide Blvd.Suite 200Columbus, Ohio 43215stacey.borowicz@dinslaw.com

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