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

New 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 public.

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 presented.