September 15, 2003 Legislation
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The Florida physicians are understandably not happy with the new tort reform law. They are now considering following the lead of Nevada and getting a constitutional amendment on the ballot. They continue to want what California has; a rigid $250,000 cap on non-economic damages and a limit on the contingency fees paid to attorneys.
In California, the Insurance Commissioner has rejected a requested 15.6% malpractice insurance premium rise. In its place he has allowed a 9.9% rise. This comes after a hearing on the matter by a ALJ.
In Missouri, the Governor is awaiting an agreement between alll parties prior to calling a special session of the legislature to ratify the agreement. Top
The new EMTALA regs will be out soon. They will mandate physicians to be on backup as before but will allow them to do elective surgery and be on call at multiple hospitals at the same time. Also hospitals may exempt senior and other physicians from coverage. The hospital does not have to have full coverage 24/7. If the hospital doesn't have 24/7 coverage, they will need to have policies as to what to do when the situation occurs. The new rules will also make inpatients non EMTALA patients unless they are admitted only to get around the EMTALA rules. The patients who are turned away from hospitals will still be able to sue but the hospitals will have some defenses which under current rules they do not have. The rule will limit where the patient can expect emergency care to the emergency room and not outlying clinics or centers.
The new rules also state that the EMTALA obligations end when the patient has been seen and screened. The old rules went farther and stated the end was stabilization. This gets all follow-up visits to physicians away from EMTALA concerns.
Other major changes relate to the ED. One is the ED physician may now call the patient's physician for information as long as it does not unnecessarily delay the medical screening exam. Also patient registration may be accomplished as long as it does not impede the medical screening exam. Top
Hospital Want Legislation Re Matching Program
In typical hospital fashion, if they see the tide is against them either in court or public opinion the attempt to pay the legislators to get a law passed that favors them. They are doing this in Ohio for specialty hospitals and now in Washington for the suit regarding the Matching program. The teaching hospitals rely on the slave labor of their residents. The residents have filed an antitrust suit against the Matching program since they have no free choice in what program they can go to. Kennedy is the first purchased Senator to state he is for the requested law. Senator Clinton of New York is the next person that will be purchased by the hospital lobby. She usually follows the Kennedy coattails. The whole idea is to subvert the legal process and not allow the current suit to be heard or allow it to become a class action suit. Top
Drew/King Loses Surgical Accreditation
The ACGME has stripped Los Angeles' Drew/King Medical Center of its ability to continue with its surgical training program. It takes effect immediately and can not be appealed. This may put its entire training program out of existence. The hospital cares for mostly low income and uninsured patients. The hospital had already lost its radiology accreditation which takes effect in June, 2004. The surgical program was canned because it had two more residents than allowed and there was not enough surgical experience. This will probably lead to a loss of its trauma designation. The chief of surgery has been relieved but remains as a staff physician. The hospital will need to apply for a new residency program. The hospital, in order to continue to function, will need to hire staff physicians at a high cost. This loss may also cost Drew/King money from the LA County for breach of contract. Top
Redding Hospital may Lose Medicare
Tenet Hospital in Redding, California has already agreed to repay Medicare $54 million that it got for the allegedly unnecessary cardiac tests and surgery. Now the CMS is going after their ability to treat Medicare or Medicaid patients. The hospital has until October 8 to provide the documents necessary to head off the expulsion.
In an interesting twist, the whistle blower who started the federal investigation has become greedy. Dr. Patrick Campbell, an internist at the hospital, is now suing to stop the settlement. He and his attorney believe the settlement should have been about $500 million. Remember whistle blowers and their attorneys get a significant amount of the money obtained by the feds. The feds have stated they have gotten back all the money paid plus a penalty and the settlement was fair. The doctor and his attorney may have to look to a lower style of living in their retirement. Top
California Refuses Suits Against HMO Patients
California's Department of Managed Care has decreed that no HMO patient may be sued for non-payment of their bills by hospitals. The hospitals will only be able to look for payment from the HMO. This is an emergency probably because of the California Governor's recall. Top
The Joint has just announced two options for its newly required mid-cycle self-assessment. They had to do this since there is legal doubt that the information sent to the organization is privileged. The hospital can either phone the basic information to the Joint without telling about any specific problems or have, for a small fee, an inspection. Top
As all know, the California Governor is up for recall. This is mainly due to his lack of communication and fiscal ineptness. The Democratic controlled legislature is attempting to get the Gov some good press. They are doing it on the back of physicians who see Workers' Comp patients. There is no doubt the premiums for business have skyrocketed in the state. The legislature is looking for about $5 Billion in cuts to the program. The way to do this is reduce what is paid to the physicians by 5% and how much medical treatment the patient should receive, especially in chiropractic therapy. It is imperative that this and the attempted pay or play bill in the legislature be passed and signed prior to the recall. There will probably be a new governor and that one may not believe in the tax and spend philosophy of this governor and his cronies. The Republicans on the committee state it will save about $2.5 Billion of the necessary $10 Billion of WC Waste. The largest cost saver is a cap on what is paid to outpatient surgical centers. This will be Medicare plus 20%. Also the prescription costs will be at Medicaid rates.
Interestingly, at the same time a different Legislative Committee voted to drive more business out of the state by mandating the pay or play healthcare scheme originally sought by Blue Shield. This will increase payments by all companies in the state dramatically to cover the one million workers who currently do not have health insurance. One person from central California who has two pizza shops put it into perspective. He stated he would need to sell an additional 175,000 pizzas to pay the tab. He expects to close up shop and move to another state. This also need to be signed prior to the Gov leaving. Top
Illinois has finally suspended the licenses of eight physicians who one year ago abandoned all their medical records, about 100,000, after they filed for bankruptcy. The physicians had been accused at a prior time of dishonorable, unethical or unprofessional conduct but the action against their licenses were dropped after they pledged $120,000 to safeguard the records. The state recently found more abandoned records and are again suspending the licenses.
California is going after a Berkeley physician who has given over 7500 recommendations for medical marijuana. The Medical Board states this has nothing to do with the proceedings. They contend his conduct is unprofessional and has been negligent in handling 16 cases since 1998. The State paid reviewer stated that after reviewing all of 17 medical records that the records revealed some serious inadequacies and were very inadequate. The physician had previously turned down a plea bargain that would have put him on probation for four years, take an ethics course, take a clinical training program and pay the state $10,000 for their investigation. The case is now before a judge who will make a recommendation to the Board for final disposition. Top
Coming up for a final vote in the state legislature is the penalties for failure to meet the nurse ratio law in California. This law comes into being in January, 2004. It will require one nurse for each medical-surgical patients. The non-compliance of the ratio law penalty will be $10,000 per day and $5000 per day for other patient violations. This high fine will definitely lead to closures of those units where the ratios can not be met. This will also give nurses unwanted time off while until the ratios can be met. Top
Kaiser Call Centers in Trouble
The California Nurses Union is at it again. They care about themselves and not their colleagues. They pushed through the California legislature a bill mandating that only licensed nurses may give instructions over the phone at the call centers. This will lead to the loss of about 1000 jobs at the Kaiser call centers and a huge backlog and wait for the Kaiser members. Currently non-licensed people use scripts to help determine whether a person needs to speak to a licensed individual or just needs an appointment. There are not enough nurses to cover the call center so the waits will be indefinite. Currently there is a lack of 700 nurse positions. This will increase by another 1000. The CNA doesn't care as long as they get the jobs. However, in typical union gobblygook, they cloak the job issue in quality phrases. These changes could cost Kaiser an additional $64 million to implement if there were nurses available. Top
The California Assembly has passed a bill to have the Department of Health give ID cards to patients using medical marijuana and their caregivers. This bill had been previously passed in a slightly different form by the Senate. It now returns to the Senate for further consideration. Top
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.