JACHO and Handwriting
JACHO has stated that the surveyors will be spending more
time on the nursing units reviewing open charts. This will allow them to look at
the handwriting and ask secretarial and nursing personnel to read the
physician’s writing. Legibility falls under IM.3.2.1 and MS.8.2.3.
It would behoove hospitals to do their own records check to see who’s
handwriting is illegible. If only a few physicians are involved, they should be
educated and if there is no improvement the problem should be taken up with the
Department Chair to discuss with the physician. If the problem is more systematic then a medical executive
committee discussion regarding systemic changes such as computerized medical
records should follow.
Electronic Signatures in Commerce
President Clinton signed into law the Electronic Signature
and National Commerce Act that became effective October 1, 2000.
This new law states that contracts and signatures may not be denied legal
effect just because they are in electronic form.
This means that physicians may now be able to sign orders and
prescriptions remotely. Medical
staffs should review their policies with the above in mind regarding completion
of records and the balancing of flexibility with privacy issues. Some have
suggested that one use a two-factor authentication system.
This would be the use of two of the three factors; (1) something you know
such as a PIN or password; (2) something you have such as a token or smart card;
and (3) something you are, a biometric such as a fingerprint, retinal scan etc.
Public Law Number 106-229 (June 30, 2000)
Chemical Restraints on Medical/Surgical Units
Restraints come into concern when there are aggressive
patients that are a potential danger to themselves or others.
The concern is why the medications are being used.
If they are part of a treatment program, they are not considered
restraints. If the drug is being used for staff convenience then it is
considered a restraint and the HCFA and JACHO standards must be followed.
Forced Anti-psychotic Drugs
The American Hospital Association in it’s October 19,
2000 e-newsletter stated the Ohio Supreme Court agreed that mentally ill persons
committed involuntarily to mental health treatment centers can be forced to take
anti-psychotic drugs, unanimously backing a lower court order. The ruling
confirmed that such an order could be made if a patient lacks the capacity for
informed consent, that the medication is in the patient's best interest and if
no less-intrusive treatment is available. As opposed to previous rulings, the
court said such orders could be enforced even if patients do not pose a danger
to themselves or others
OIG Compliance Program for Individual and Small Group Practices
This new law detailing the above program is found in the
Federal Register Volume 65, Number 194/ Thursday October 5, 2000/Notices.
Physician Information on the Internet
York Governor George Pataki signed legislation on October 6, 2000 that gives New
Yorkers easier access to information about malpractice cases and disciplinary
actions involving their physicians. Under the provisions of the new law,
patients will be able to use the Internet or a toll-free telephone line to
review physician profiles that will include: (1) criminal convictions within the
last 10 years; (2) office for Professional Misconduct (OPMC) final actions taken
against licensee (currently available on the OPMC Web site); (3) current
limitations of licensee to a specified area, type, scope, or condition of
practice; (4) any loss or involuntary restriction of hospital privileges within
the last 10 years for reasons related to the quality of patient care delivered;
(5) all medical malpractice judgments made within the past 10 years; and (6) all
medical malpractice settlements if the physician has three or more within 10
years, or any individual settlement if the New York Department of Health (DOH)
commissioner deems disclosure is warranted. According to New York DOH officials, it will be some time due
to their Internet limitations before the information is accessible to the
OIG to Study Nonphysician Practitioners and other Physician Issues
As part of the OIG year 2001 plans is the study of
nonphysician practitioners and their treatment of Medicare patients.
The OIG wants to make sure the treatments by clinical nurse
practitioners, nurse practitioners and physician assistants in the physician
offices are appropriate as defined by the individual states.
This study has the potential to either place more limits on the services
these practitioners may provide or may allow them to do more.
Other items on the 2001 OIG agenda include the study of how often
physicians see their home health patients, whether physicians are providing
direct medical supervision to allied health professionals when they are billing
for care “incident to” physician professional services and the use of
advance beneficiary notices explaining that certain procedures or tests are not
a covered benefit.
DISCLAIMER: Although this article is
updated periodically, it reflects the author's point of view at the time of
publication. Nothing in this article constitutes legal advice. Readers should
consult with their own legal counsel before acting on any of the information