W W W. D I N S L A W. C O M November 6, 2008 Reporting Requirements to Government Agencies Stacey A. Borowicz, Esq. Dinsmore & Shohl LLP 191 W. Nationwide.

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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

[email protected]

© 2008 Dinsmore & Shohl LLP

Reporting Requirements to Government AgenciesPresentation 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


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)


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.


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.



Caution: Some Exceptions Exist That Allow

Discovery and Introduction as Evidence(O.R.C. 2305.252)

Original sources

Personal knowledge



Special Issue:

Incident / Risk Management Reports

What are they?

Is there an Incident Report statute?

How do we use them?



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.



Question:

What particular kind of

information belongs in

incident reports?

Answer:

All the subjective stuff that

should never make it into a

medical record.

Medical Record: Incident Report

history,

assessment,

diagnosis,

prognosis,

things actually seen or actually heard,

etc.

things believed, but not seen or heard,

impressions,

the real story, so to speak,

philosophical take,

I-told-you-so comments and suggestions,

etc.



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


The National Practitioner Data BankWhat 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.


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



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


The National Practitioner Data BankReporting 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



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


The National Practitioner Data BankReporting 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


Professional MisconductState 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”


Professional MisconductBoard 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


Responding to SubpoenasDefinition:

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


Responding to SubpoenasProcedure for Handling a Subpoena:

Don’t Panic

Read the Subpoena

Contact Your Attorney


Miscellaneous Reporting RequirementsOhio 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

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Stacey A. Borowicz, Esq.Dinsmore & Shohl LLP

191 W. Nationwide Blvd.Suite 200

Columbus, Ohio [email protected]

W W W. D I N S L A W. C O M November 6, 2008 Reporting Requirements to Government Agencies Stacey A. Borowicz, Esq. Dinsmore & Shohl LLP 191 W. Nationwide.

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