ECMS May/June Bulletin Newsletter

www.escambiacms.org

MAy/JUnE 2012

BULLETIN

VolUME 42, no. 3

Upcoming Events Tuesday July 10, 2012 General Membership Meeting “Asset Protection/Estate Planning” Speaker: Gary Leuchtman Cactus Flower 5:30p Tuesday August 14, 2012 General Membership Meeting “Veterans Mental Health: What Are Local Resources?”

Speakers: AHEC Heritage Hall 5:30p Sunday September 30, 2012 Women in Medicine Brunch Fish House 11:30a -1:30p RSVP: 478-0706 info@escambiacms.org

2012 E.C.M.S. Officers President George A.W. Smith, M.D. President-Elect Wendy Osban, D.O. Vice President Susan Laenger, M.D. Secretary/Treasurer Christopher Burton, M.D.

President’s Message

Scope of Practice Dr. George A.W. Smith Dr. George A.W. Smith The Florida 2012 legislative session went from January 10th through March 9th. It ended early this year due to the redistricting process that happens every ten years following the federal census. There were 2,052 bills and resolution filed for consideration during this session. The total number of bills which passed both the House and Senate were 292. On the final day of Session , the Legislature fulfilled its annual constitutional responsibility by passing a state budget, adopting a $70 billion spending plan for fiscal year 2012 to 2013. The healthcare budget totals $29.9 billion which is a $67.8 million (0.23%) increase over last year but will make significant cuts to health care providers. It provides for 155,720 anticipated additional Medicaid beneficiaries to the sum of $304.7 million. The Florida Kidcare Program is anticipated to serve an additional 11,612 children and the Medicaid budget provides $4.6 million for this growth. There will be reduction in some Medicaid provider rates including an approximate 5.6% reduction for hospital inpatient and outpatient and a 1.25% reduction for nursing homes. Effective August 1,2012 non-pregnant adult Medicaid recipients’ emergency room visits will be limited to six visits per fiscal year and general physician visits will be limited to 2 visits per month. Though not included in the final budget, the senate included $438 million increase for physician services.

A number of the bills that passed may be of interest to you. Every year there are a number of bills that relate to scope of practice. Chiropracters pursued legislation to allow them to clear head injured youth athletes to return to play. HB 291 provides for the make up of a Sports Medicine Advisory Committee of the Florida High School Athletic Association (FHSAA) which will adopt guidelines, bylaws and policies on the nature and risk of concussion and head injuries in youth athletes. Clearance for return to play must be by an appropriate health care practitioner trained in the diagnosis, evaluation and management of concussions as defined by the Sports Medicine Advisory Committee of the FHSAA. HB 509 allows a pharmacist to administer the

pneumococcal and shingles vaccines to adults in accordance with CDC guidelines and within the framework of an established protocol with a supervising physician. The latter requires a prescription. It also allows the pharmacist to administer epinephrine to address any allergic reaction and will require the maintenance of $200,000 in professional liability insurance. All vaccines administered by the pharmacist must be reported to Florida SHOTS. HB 119 revises personal injury protection (PIP) medical benefits effective January 1,2012 and HB 227 creates a 15 member Statewide Taskforce on Prescription Drug Abuse and newborns within the Department of Legal Affairs.

ARNP prescribing of controlled substances and Optometrist administering and prescribing oral medications were scope of practice bills that did not pass. Several of these bills have been presented to the legislature year after year and they are wearing everyone thin.The FMA is to be commended for establishing a scope of practice task force with representation from the specialty societies that will have its first meeting this month. The purpose of the FMA scope of practice task force is to develop specific recommendations for the FMA Board of Governors on scope of practice issues prior to the beginning of the 2013 legislative session. It will analyze national trends, review the legislative and political landscapes in Florida, and seek input from all interested parties.

This will allow for a unified proactive approach to scope of practice issues. There will be a meeting led by the Florida Academy of Family Physicians (FAFP) with leaders from the FMA, FOMA, and the PA and ARNP organizations to look specifically at the issue of ARNP prescribing controlled substances .These issues affect the entire physician community and impact patient safety so we need your involvement and your voice to make sure that when legislations are passed we can all live with them. As scope of practice issues are reviewed the safety of the citizens of Florida is of the utmost importance and will at all times take priority.

E.C.M.S. Bulletin The Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.

Vision for the Bulletin: • Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond.

• Collaborate with the Alliance to bring together Escambia and Santa Rosa County medical families. To know the needs of the community and promote the healthcare needs.

• A powerful instrument to attract and induct members to organized medicine.

Views and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the directors, staff or advertisers.

Editors: Christopher Burton, MD Erica Laxson, Executive Director

Ad placement Contact Erica Laxson at 478-0706 Ad rates 1/8 page: $100 • 1/4 page: $150 • 1/2 page: $300

Contents Page 3 - ECMS Events Calendar Page 4 - Remembering Craig Page 5 & 8- ECMS Disablility Income Insurance Page 6 & 7 - ECMS Health Fair Page 9 - Legal Page 10 - Hospital News Page 11 - Letter to the Editor

Membership

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

E.C.M.S. 2012 Events Calendar Tuesday, July 10, 2012 | Cactus Flower | 5:30 pm Speaker: Gary Leuchtman, Florida Bar Board Certified in Wills, Trusts and Estates | Topic: Asset Protection/Estate Planning Sponsors (Social | Dinner): Fisher Brown Bottrell Insurance | Landrum Human Resources Friday July 27- Sunday July 29 | Boca Raton, Florida FMA ANNUAL MEETING Tuesday August 14, 2012 | Cactus Flower | 5:30 pm Speakers: Area Health Education Centers (AHEC) | Topic: Veterans Mental Health: What are local resources?

Sponsors (Social | Dinner): BBVA Compass | Sunday September 30, 2012 | Fish House | 11:30 am-1:30 pm WOMEN IN MEDICINE BRUNCH Sponsors: Baptist Health Care & Virginia College Tuesday October 9, 2012 | Angus | 5:30pm Speaker: Patricia Green, MD | Topic: Breast MRI Sponsors (Social | Dinner): Express Employment Professionals | Fisher Brown Botrell Insurance [1AMA Category 1 CreditsTM] November 2012 Topic: Electronic Health Records/Meaningful Use Summit Sponsors (Social | Dinner): Underwood Anderson & Associates Inc.| ServisFirst Bank Saturday January 19, 2012 | Paul’s on the Bay ECMS INAUGURAL BALL For updates and changes please visit www.escambiaCMS.org

DON’T LEAVE! There are several people who have not paid their 2012 ECMS membership dues. Please remit payment before May 25. Anyone who has not paid by June 1st will be dropped and become inactive.

If you have any questions call Erica Laxson, Executive Director 850-478-0706 opt 2

OOPS!

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Membership

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

REMEMBERING CRAIG Written by 2003 ECMS President Robert L. Kincaid, M.D. At the time of this writing it has been one week since my good friend, former patient and mentor in the Medical Society Craig Broome has died. It all happened so quickly.

Craig was an amazing person. He was born into a military family and lived in many places around the globe as a boy. He graduated from Frankfurt American High School in Germany in 1965. As a young man, Craig dreamed of becoming an astronaut. He received his BS in aerospace engineering at the University of Texas at Austin and then worked for NASA for several years after graduation. After earning his Master’s degree he joined TRW and worked on the Skylab space station.

After Craig’s father died early of cancer he abandoned his idea of becoming an astronaut in favor of medical school. He attended University of Texas then did his residency in Virginia. He practiced as an emergency room physician in the Pensacola area for 35 years. He was very active in the medical society and served in various offices including as its President in 2001.

Craig was a member of the Disaster Medical Assistance Team and helped provide medical care during Hurricanes Andrew and Katrina along with care at ground zero after the September 11 attacks. Ironically Craig fell in love with a hospice nurse several years ago and became interested in training to become a hospice physician just before being diagnosed with a glioblastoma. She remained with him until his death.

Craig had a lifelong love of tennis and was a nationally ranked tennis player and served as President of the American Medical Tennis Association and was the winner of many AMTA tournaments.

What impressed me most about Craig were always his humility and his basic kindness. I rarely heard him speak ill of anyone and although he was a fierce competitor, I never saw him angry. I remember his patience trying to teach me to windsurf, watching me get on then fall off his board for nearly 3 hours. These are admirable traits we can all learn from.

They made him a joy to work with in the Medical Society. He will be sorely missed.

Practice Management

ESCAMBIA ESCAMBIACOUNTY COUNTYMEDICAL MEDICALSOCIETY SOCIETYININCONJUNCTION CONJUNCTIONWITH WITHSANTA SANTAROSA ROSACOUNTY COUNTY

Disability Income Insurance: What Every Physician Needs to Know Would you ever consider scrimping on your malpractice insurance— buying a cheaper policy to save money—or one-size-fits-all coverage to save time? Probably not, because most physicians know that a solid malpractice policy is a vital part of practicing medicine today. Without it, you could be ruined, so the time and money spent on getting the best possible coverage is a good investment in your own economic safety.

But did you know the same is true for disability insurance (DI)? It’s simply not safe to rely solely on a group policy your practice may have purchased. While group DI is often relatively inexpensive and easy to administer, it can also fall short just when you need it most—leaving you in for some unpleasant surprises when it’s too late to correct the situation.

Furthermore, disability may be far more common than you imagine.

Even if you’re young and careful, it could happen to you—through an accident… an injury… or a lengthy illness. Statistics show that disability is much more commonplace than most people think: In a recent survey

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By John Gary Bruce; Disability Income Specialist at The Guardian Life Insurance Company of American

more than half of employees surveyed felt they had less than a 2% chance of becoming disabled during their working years, but in reality more than 25% of Americans entering the work force today (1 in 4) will become disabled before they retire.2 Want to be better prepared? Consider the following: Learn to speak the lingo The right disability income policy can help you keep your household going if you suffer a long-term disability. But before you go shopping for a DI policy, you need to know which features to look for—and the language the insurance industry uses to describe them. The following terms are part of the language describing high-quality policies, and are what you should look for to get coverage you can count on: Non-cancellable and Guaranteed Renewable: To avoid the possibility of losing your coverage just when you need it most, choose a policy that’s non-cancellable and guaranteed renewable to age 65. This will also guarantee premiums until age 65. With group or association coverage, you run the risk of being dropped and left unprotected at a time in your life when, due to your age or a change in your health, it would be very difficult to qualify for coverage from another provider. The premiums for your classification group can also be increased at any time.

Conditionally renewable for life: Although premiums may increase after age 65, your policy should be guaranteed renewable for life, as long as you are at work full time.

The core of any disability income policy is its definition of “Total Disability” which outlines what constitutes being “totally disabled” and therefore eligible for benefits. This definition is in every carrier’s policy; however, it does not always mean the same thing. For example, some policies pay benefits if you are unable to perform the duties of your own occupation, even if you are able to work successfully in another occupation, while others pay only if you cannot work at all.

Residual Disability coverage: Through a rider, a good individual DI plan can provide you with a benefit when you suffer a loss of income as a result of partial (residual) disability—even if you have never suffered a period of total disability. This kind of residual coverage is not available with many group plans.

A choice of Riders: Riders offer optional additional coverage such as Catastrophic Disability Benefit (CAT), annual Future Increase Options, Automatic Increase and Cost of Living Adjustments, or “COLA.” Protect your practice and yourself As a physician, you must also protect the source of your income: the practice you’ve worked so hard to establish and grow. Special business DI policies, available from the same DI providers who offer highquality individual coverage, offer your practice protection while you recover from a disability.

For example, to help meet the expenses of running the office while you are disabled, consider a separate type of disability coverage known as Overhead Continued on page 8

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Health Fair

E.C.M.S. Annual Vendor Fair

Vendors AHEC BBVA Compass Bank ECMSF We Care Express Employment Professionals The Fellows Memorial Fund Fisher Brown Bottrell Insurance

Guardian Life Insurance LANformation Landrum Staffing Mertins Wealth Services MAG Mutual Regions Bank

Saltmarsh Cleaveland & Gund Servis1st Bank Underwood Anderson & Associates, Inc. Twelve Oaks

Health Fair

ESCAMBIA ESCAMBIACOUNTY COUNTYMEDICAL MEDICALSOCIETY SOCIETYININCONJUNCTION CONJUNCTIONWITH WITHSANTA SANTAROSA ROSACOUNTY COUNTY

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Physician’s Speed Networking

Hotline (561) 306-5699

ECMS Member Benefit!

Members can all AFTER hours with a specific legal issur or question and receive a response no later than noon the next day.

This service is available for all members at no charge.

THE FLORIDA HEALTHCARE LAW FIRM The Law Offices of Jeff Cohen, P.A.

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Practice Management

Disability Income Insurance: continued from page 5 Expense (OE). Benefits reimburse your practice for expenses such as rent for your office, electricity, heat, telephone, utilities, interest on business debts and lease payments on furniture and equipment.

Overhead expense insurance specifically designed for professionals pays some additional costs not included in regular business overhead expense policies—including the salaries of employees who are not members of your profession. In a practice such as yours, for example, salaries for the receptionist and nurse would be covered, but not the salary of your physician partner or employee. However, high-quality professional overhead policies will cover at least part of the salary of a professional temporary replacement for you, such as a doctor retained to fill in during your total disability.

In addition…

Physicians who are partners in a group practice will want to consider a policy known as a Disability Buy-Out (DBO). In much the same way that life insurance benefits can be set aside to fund a buy-out by the remaining partner (or partners) if one partner dies, DBO is designed to fund the healthy partners’ purchase of the disabled partner’s share of the business. With the proper agreement in place before a disability occurs, hard feelings and the conflicts of interest that can result from a partner’s disability can be avoided.

Take the time to consider upgrading your DI coverage today. Like your malpractice insurance, it could be vitally important to your economic wellbeing in the future—and help protect one of your most valuable assets: the ability to earn an income.

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CDA 2010 Consumer Disability Awareness Survey.

Social Security Administration Fact Sheet, January 2011.

Registered Representative of Park Avenue Securities LLC (PAS), 3664 Coolidge Court, Tallahassee, FL 32311, (850) 562-9075. Securities products and services are offered through PAS. Disability Income Specialist, Manager/Northwest FL, The Guardian Life Insurance Company of America, New York, NY (Guardian). PAS is an indirect wholly owned subsidiary of The Guardian. PAS is a member FINRA, SIPC. 2

Medical/Legal

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

How Secure is the Patient Data in Your Medical Practice?

The question is not if your medical practice is going to have a data security breach, rather when you have a data breach, are you prepared to address it?

The healthcare industry is more likely to be a major target for data breached because of the amount of protected data. Medical practice have become more efficient as a result of the increased use of Electronic Health Records (EHRs) and new technology in mobile devices, such as iPads, laptops, and cellular phones. This efficiency has exposed the provider to more security risks. With EHRs, more providers are entrusting their patients' data to a third party, moving the security of that data beyond their office or hospital. Adding the increase in regulatory requirements (i.e.

HIPPA, Red Flag Rules, and HITECH) makes achieving compliance extremely challenging.

In April, the 2012 HIMSS Analytic Report: Security of Patient Data, the third installment of a survey of healthcare provider facilities in the United States, regarding patient data was published. The survey was commissioned by Kroll Advisory Solutions.

Kroll Advisory Solutions is a leading risk consultant firm that has helped some of the largest healthcare providers in the U.S. respond to data security breaches partnered with HIMSS Analytics, the leading organization representing health information management system and services. The survey's goal was to provide a more accurate picture of the current state of security of patient data in the U.S. and to be more effective in addressing the security threats by improving security measures.

According the the Department of Health and Human Services (HHS) Annual Report to Congress on Breaches of Unsecured Protected Health Information, theft was once again the most commonly reported cause of large breaches in healthcare organizations in 2010. Among the 207 breaches that affected 500 or more individuals: • 99 incidents involved theft of paper record or electronic media. Together affecting approximately 2,979,121 individuals.

• Loss of electronic medical or paper records affected approximately 1,156,847 individuals.

• Unauthorized access to, or uses or disclosures of, protected health information affected approximately 1,006,393 individuals.

• Human or technological errors, or other failures to take adequate care of protected

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By Dawn Lintner, AIP, Business Insurance Agent, Underwood Anderson and Associates, Inc.

health information, affected approximately 78,663 individuals.

• Improper disposal of paper affected approximately 70,279 individuals.

Other important findings in the 2012 HIMSS Analytic Report are: • Majority of breaches result from internal sources (individuals employed at the time of breach) • In 2012, 79% of survey respondents stated a breach was reported by an employee.

• 56% of respondents indicated the source of the breach was unauthorized access to information by an individual employee employed at the time of the breach.

• 16% of the breaches were due to actions taken by an outsourced or contracted employee.

• 45% of the respondents indicated lack of staff attention to policy put data at risk.

• 98% of respondents require 3rd parties to sign a Business Associate (BA) Agreement, but only half (56%) stated that they ensure these 3rd party vendors conduct a periodic risk analysis to identify security risks.

• 22% of respondents reporting a breach state that data was compromised when a laptop, handheld device or computer was lost or stolen, double the amount (11%) reported in 2010.

• Among the 250 respondents reporting a breach, approximately 31% reported their organization had 1 breach in the past 12 months, 28% reported 2 breaches in the past 12 months, 35% reported having 3 to 9 breaches in the past 12 months and 6% reported having more than 10 breaches in the past 12 months.

• In conclusion of this survey, the HIMSS Analytics Report states that, while healthcare practices are conducting mandated formal risk analyses, they are not taking proactive steps to move further than the end goal of compliance. These practice must be proactive and have a response plan in place when there is a breach. Most respondents are open to the idea of using an outside service provider in the event of a future data breach. The survey further summarizes that there continues to be a lack of awareness of the financial implications associated with a data breach. This is surprising, given the fact that breaches in the healthcare industry come at a higher overall price than the cost in the financial and retail sectors. Possible costs include: Sanctions and/or fines for violation of privacy regulations, including but not limited to HIPPA, Red Flag Rule and the New HITECH Act Class Action Lawsuits / Defense Costs Breach Notifications IT Forensics Credit Monitoring Cyber Extortion Expense How prepared is your medical practice to handle data breach? Are you doing a periodic risk analysis that includes a data breach incident response plan? Are you holding your third party vendors to best practice security standards? If you answer NO to any of these questions, there is help. There are consulting firms that provide services, as well as, the new emerging insurance markets for network security and data coverage that may provide a more viable option to mitigate your exposure after a data breach. The time to act is now. http://www.hhs.gov/ocr/privacy/hippa/administrative/breachnotificationrule/breachre pt.pdf 2012 HIMSS Analytics Report: Security of Patient Data commissioned by Kroll Advisory Solutions, April 2012

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

In The Community

Sacred Heart News

Baptist Hospital News

Sacred Heart Initiates New Robotic Surgery Program Sacred Heart Hospital in Pensacola now has state-of-the-art robotic technology with the recent addition of the da Vinci Si Surgical System with dual consoles.

Sacred Heart's surgical robot is currently being used to provide urology and OB/GYN services, including prostatectomy, hysterectomy and gynecologic oncology surgeries. Other procedures, including general surgery applications, will follow. Sacred Heart's da Vinci is the only robotic surgical system in this area with capabilities for fluorescent dye tracking to help identify the location of tumors.

The robotic surgery program has a dedicated surgical team, including Drs. Steven DeCesare, John Grammer, Brett Parra, Davinder Sekhon, as well as Dr. Sidney Stuart, who recently completed the hospital's first da Vinci robotic surgery. These physicians were already credentialed for use of the surgical system and are providing valuable guidance to the robotic surgical team.

Mark Faulkner to Succeed Al Stubblefield as Baptist Health Care CEO Mark T. Faulkner has been named the Chief Executive Officer of Baptist Health Care, replacing Al Stubblefield, FACHE who is retiring after 27 years of service. Faulkner a key member of BHC’s management team and Baptist Health Care Executive Vice President and Chief Operating Officer since 2010, will assume his new role effective June 1st. 2012. He becomes only the fourth CEO in the 60-year history of Baptist Health Care. Stubblefield, a winner of the American Hospital Association Award of Honor, has served Baptist Health Care since 1985 and been CEO since 1999. He will continue as president of the Baptist Leadership Group and as president emeritus of Baptist Health Care.

Sacred Heart Hospital Begins Five-Floor Expansion Sacred Heart Hospital has begun construction on a major expansion that will add a five-story tower and 115 private patient rooms. The tower will be constructed on top of the hospital's Heart and Vascular Institute building.

The vertical expansion on Sacred Heart's campus at Ninth Avenue and Bayou Boulevard will take place over the next 20 months. The building is expected to open for patient care starting in May 2014.

The addition will allow Sacred Heart to expand services and meet the community's need for more beds for critically ill patients – a need driven in part by the hospital's status as a regional Trauma Center and a regional Stroke Center. Of the 115 rooms in the new tower, 40 will be for critically ill patients. ''This project is a big event in the history of Sacred Heart Hospital, and it will allow us to create the patient experience of the future,'' said Susan Davis, interim President and CEO of Sacred Heart Health System. ''Our focus is on patient care so we're thrilled to be able to make this investment to better serve and comfort our patients. The project also fills a need for additional beds in our busy hospital.''

Baptist welcomes new system vice president and CIO, Steve Sarros Baptist is pleased to announce Steve Sarros as their new system vice president and chief information officer. Sarros brings a broad and deep background in healthcare IT, having spent the last 25 years in roles of progressive responsibility. He starts his new role in May 2012.

Baptist Medical Group makes great progress in EHR implementation Baptist has committed $2.1 million dollars to the implementation of Electronic Health Record to improve quality of care, patient safety and access to crucial clinical information. In turn, this will significantly enhance clinical collaboration among physicians. This challenging, but exciting process is now underway throughout the physician network. Once completed in 2013, BMG anticipates having more than 500 EHR system users at more than 60 office locations.

The Fisher Brown HealthCare Practice team provides All Lines of Insurance & offers Risk Management advice for all aspects of the HealthCare Industry.

Our Commitment is to reduce your Long Term Cost of Risk

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850-444-7606

In The Community

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

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LETTER TO THE EDITOR “This article is being printed In the interest of facilitating conversation among our member and providing a voice to all. This article does not reflect the opinion of the ECMS Board.

POLST remains an important ECMS initiative” POLST: Too Many Questions?

Daily, we physicians confront an array of patients ranging from those who want care even if it is unneeded and potentially harmful to those who reject treatment likely to be helpful with little risk. An experienced physician works with each patient using knowledge about the diagnosis and treatment options to guide the patient and family to the best medical decision. This “in the moment” care cannot be provided impersonally or met by standing protocols or even previous discussions. Does the POLST paradigm (Physician Orders for Life-Sustaining Treatment) promote unquestionable trust between the physician and patient as the standard of care?

POLST is intended to formalize patient treatment preferences into actionable orders signed by a physician for those who may die within 6-12 months.

In OR, 92% of all nursing home patients (including those who will likely live for years) have a POLST. In CA, 73% of nursing home patients who completed a POLST were inaccurately told that it was mandatory.

In CA, 72% of POLST forms are completed by a non-medically trained person, frequently a social worker or admissions coordinator.

In WI & MN, non-medical “facilitators” are trained specifically to complete POLST forms using an approach that discourages selection of more than comfort treatment.

A physician or non-physician provider may sign POLST without any confirmation that they discussed level of care preferences (or that one would occur in the future).

Only check marks on a form are required to document the complex content of that type of discussion.

OR and other states do not require a patient signature. Why not? Could this be a simple oversight after 20 years of forms?

When a patient signature is required, the majority (59%) are signed by a 3rd party even when the patient has mental capacity.

No requirement exists for a witness or family member to be present during the consent process.

Most states grant legal immunity from claims of “wrongful death” for the person completing the form.

In CA, when a person loses capacity, a 3rd party not designated by the patient may change the POLST. In WI, a patient presented to the hospital with a 14 year old POLST that had never been reviewed.

These inadequacies leave patients in a vulnerable state. On the other hand, POLST is certainly inadequate from a physician standpoint as well: While managing a critical illness, will you sign a POLST? When the POLST orders are followed in a year, how confident are you that your understanding of the patient’s wishes will be honored? What if the patient lives 10 years?

What happens should you leave practice? What if you die? Do you think the signed forms should still be used without review? Are we providing another physician (who may not appreciate the nuanced tone and tenor of the original discussion) a blank check to potentially run roughshod over a patient’s rights in your name when you aren’t there?

For ED or ICU physicians receiving new patients who present with POLST: Can you be confident that the patient has been properly informed?

What if the doctor who signed the form does not have privileges at your center?

What if his or her license was suspended?

Will you blindly follow that physician’s orders?

What is your level of confidence that they will make any sense relative to “in the moment” decisions that must be made?

Will you override a POLST for a patient with an acute illness or allow them to die?

Will your own conscience be respected?

Will you have immunity if you appropriately save someone’s life (seemingly) “against his or her will?”

POLST raises more questions than it purports to answer. The POLST paradigm leaves too many uncertainties, too many risks that overtly conflict with the stated (original) purpose of POLST — to ensure that patient wishes are honored. In my judgment, the POLST paradigm and forms pose serious risks to good patient care and doctor-patient relations and they should not be used in Florida.

www.escambiacms.org

8880 University Pkwy., Suite B Pensacola, FL 32514 Ph: 850-478-0706 Fx: 850-474-9783 Email: info@escambiacms.org Executive Director: Erica Laxson

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MECoP Reminder The Diabetic Leg: Primary Care to the Specialist - A Review of Complications and Treatment Strategies Saturday, June 2 | 7 a.m. - 1 p.m.

The Crowne Plaza in Downtown Pensacola 5 AMA PRA Category 1 CreditsTM visit www.mecop.org for topics and agenda Contact 850.477.4956 (option 1) to register

Member Benefit: The Health Care Attorney On Call Hotline (561) 306-5699 View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.