What’s Inside?
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Viewpoint
Page 8
In Memoriam
Page 9
President’s Page Page 10
To learn more visit www.mcmsonline.com
Marketplace
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Save the date for the MCMS 2015 Annual Event! October 23, 2015 6-9 pm El Chorro Restaurant
Celebrating 60 Years
- 015 1955 2
round-up Volume 61
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Number 8
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August 2015
Providing news and information for the medical community since 1955.
IN THIS ISSUE: PAGE 16, LEGAL: REGULATORY
Arizona’s new quality assurance statute: Protections for physician practice peer review.
PAGE 20, LEGAL: BUSINESS
It’s just business, baby. Ending a business partnership successfully.
PAGE 24, LEGAL: ADVOCACY
The Arizona Center for Law in the Public Interest: Fighting for individuals and groups who lack the power or money to take on big business and big government.
PAGE 12, MEMBER PROFILE: ANTHONY LEE, MD
Taking a Different Approach to Treating Pain. As a board-certified Physical Medicine and Rehabilitation physician with a subspecialty certification in Pain Medicine, Dr. Lee practices in a clinical field that has seen the medical and legal professions become increasingly intertwined.
Are you taking full advantage of your Society benefits? The Maricopa County Medical Society (MCMS) understands the needs of physicians and recognizes that you are all not alike. As such, we have tailored our membership benefits for the different stages in your career, and to the different types of employment arrangements. We encourage you to take advantage of everything the Society has to offer. And if there is a membership benefit you would like to us to consider adding to the roster, please call the Society offices or email us your suggestion.
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what’s inside?
IN THIS ISSUE August 2015: Legal
By MCMS Executive Director Jay Conyers, PhD jconyers@mcmsonline.com • 602-251-2361
W
hen putting together the outline for this year’s legal issue, I wasn’t sure where to start, so I reached out to Dr. Steve Perlmutter, MCMS member physician turned defender of those in receipt of an unwanted notice that a complaint has been filed with the Arizona Medical Board. We wrote about Dr. Perlmutter last August and shared with you his story of how he went from the operating room – where he was a successful eye surgeon – to the courtroom.
Since last fall, I’ve run into Dr. Perlmutter on numerous occasions at the Arizona Medical Board, and have seen him in action defending physicians brought before the board for disciplinary hearings. Having attended many of these meetings in the last year, I noticed that an alarming number of physicians subject to disciplinary action are in hot water for over-prescribing of painkillers.
I asked him about my observation, and why he thought the nation’s opioid epidemic was having such a direct impact on physicians. He explained to me how it’s almost impossible for a primary care physician who lacks training in pain management to comply with the onerous requirements of opioid prescribing. To prescribe opioids, one must know about pain contracts, urine drug screens, pharmacy queries, questionnaires and assessments, monthly visits, unan-
4 • Round-up Magazine • August 2015
nounced pill counts, and transitions from short to long-acting medications. Unless an office is specifically set up for this type of practice, the doctor is unlikely to remain compliant with the rules.
He shared with me his opinion on the matter, and how he advises physicians who ask about the legal perils of opioid prescribing. “My advice to primary care doctors is simple. I suggest that they write one prescription for Tylenol #3, 12 tablets, no refills. If the patient needs more than that, I suggest referral to a pain specialist.”
He added, “Opioid prescribing can be criminalizing. Doctors may be in trouble if their patients are diverting drugs, even if the doctors don’t know about it. There is little reward in caring for these patients. They are often dissatisfied with their care, tend to be time-consuming, and may be economically unfeasible to treat.”
After my conversation with Dr. Perlmutter, I thought we owed it to our readers to profile a physician who understands the opioid epidemic and specializes in pain management. So I sat down with MCMS Member, Dr. Anthony Lee, a boardcertified Physical Medical & Rehabilitation physician at Southwest Spine and Sports. Dr. Lee works with patients who suffer from various sports injuries, and we spoke with him about the balance of treating pain while rehabilitating
what’s inside? injured patients, and the dangers of prescribing opioids. In this issue of Round-up, we share his story as well as his opinion on the dependence epidemic and what role physicians play.
But this issue isn’t just about opioid prescribing. We’ve assembled a collection of legal articles that deal with current topics that stand to have a direct impact on medicine here in Arizona. We bring you a summary from Tim Hogan, Executive Director of the Arizona Center for Law in the Public Interest. The Center is a non-profit public interest law firm that has been focused on public health since its establishment in 1974. Mr. Hogan explains the history of the Center and some of the pivotal lawsuits it’s filed and defended on behalf of Arizona citizens, including their recent defense of AHCCCS expansion. We also bring you an article from Kercsmar & Feltus, a boutique litigation firm specializing in business disputes. Two of their attorneys, founder Geoff Kercsmar and managing member Greg Collins, offer some advice on how to end a business partnership when physicians working together in a practice choose to go their separate ways. We also bring you a comprehensive article by By Neel Kothari and Bob Milligan on recent legislation in Arizona that af-
fords the same peer review protection for physician practices that hospitals and surgery centers have long enjoyed.
Next month we focus on insurance, and profile Dr. Jim Carland. As a board-certified pediatrician who saw patients in a private practice setting for 28 years, Dr. Carland is a pioneer in the medical professional liability (MPL) insurance industry and currently serves as CEO of the Mutual Insurance Company of Arizona, known to most as MICA. We have a great issue planned around Dr. Carland’s profile, and hope you all enjoy it. I hope you’ll join me in counting down the days until we no longer reach 100 degrees. The earliest Phoenix has seen the thermometers no longer reach triple digits has been September 2nd, but that hasn’t happened in 101 years, so we’re more likely to end closer to the average of September 28th. I’m just hopeful we’re not close to the 2003 record of October 23rd, which, coincidentally, happens to be the date of our Annual Event this year! With an outdoor venue planned again this year, let’s keep our fingers crossed that we’ve cooled off by then. Until next time....Jay. ru
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Round-up Magazine • August 2015 • 5
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round-up
August 2015
Providing news and information for physicians and the healthcare community since 1955. Published monthly by the Maricopa County Medical Society.
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what’s inside
viewpoint: breast cancer screenings Early breast cancer screenings essential in saving lives
in memoriam
president’s page The weight of practicing medicine under the risk of malpractice.
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member profile: anthony lee, md
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legal: regulatory
Taking a different approach to treating pain.
Arizona’s new quality assurance statute: Protections for physician practice peer review.
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legal: business
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legal: advocacy
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marketplace – classifieds
It’s just business, baby. Ending a business partnership successfully. The Arizona Center for Law in the Public Interest: Fighting for individuals and groups who lack the power or money to take on big business and big government.
6 • Round-up Magazine • August 2015
Correction: In the June issue of Round-up, Dr. Ted Diethrich’s last name was spelled incorrectly. Our apologies to Dr. Diethrich. On the cover: Dr. Anthony Lee at his practice, Southwest Spine and Sports. Cover photo by: Denny Collins Photography www.dennycollins.com 602-448-2437 Connect with your Society. Letters and electronic correspondence will become the property of Round-up, which assumes permission to publish and edit as necessary. Please refer to our usage statement for more information. Editor: Ryan Stratford, MD, MBA rstratford@mcmsonline.com Managing Editor: Jay Conyers, PhD jconyers@mcmsonline.com
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Round-up is a publication of the Maricopa County Medical Society (MCMS). Submissions, including advertisements, are welcome for review and approval by our editorial staff at roundup@mcmsonline.com. All solicited and unsolicited written materials and photos submitted to Round-up will be treated as unconditionally and irrevocably assigned to and the property of MCMS and may be used at MCMS’ sole discretion for publication and copyright purposes and use in any publication, website or brochure. MCMS accepts no responsibility for the loss of or damage to material submitted, including photographs or artwork. Submissions will not be returned. The opinions expressed in Round-up are those of the individual authors and not necessarily of MCMS. Round-up reserves the right to refuse certain submissions and advertising and is not liable for the authors’ or advertisers’ claims and/or errors. Round-up considers its sources reliable and verifies as much data as possible, but is not responsible for inaccuracies or content. Readers rely on this information at their own risk and are advised to seek independent legal, financial or other independent advice regarding the content of any submission. No part of this magazine may be reproduced or transmitted in any form or by any means without written permission by the publisher. All rights are reserved.
Round-up Magazine • August 2015 • 7
viewpoint: breast cancer screenings
First Doctor, Do No Harm: Early Breast Cancer Screenings Essential In Saving Lives By Ian Grant-Whyte, MA, MD
T
he field of early breast cancer detection involving self-examination and mammography has resulted in many mixed messages for both doctors and their patients, which can add stress and frustration to an already frightening situation.
To help navigate these concerns, please consider the following selection of quotes and information to help women and their doctors make the best decision possible. Many of the statements come from helpful online videos, and we encourage you to visit the MCMS website resource page (http://www.mcmsonline.com/member-resources) for a full list of links.
The U.S. Preventative Services Task Force (USPSTF) is currently in the process of reviewing and updating their breast cancer screening recommendations. Since 2009, the official USPSTF recommendation has been mammography screening every two years for women between 50-74 years old.
Carol H. Lee, MD, Chair of the American College of Radiology Breast Imaging Commission expressed that these recommendations, “Ignore the valid scientific data and place a great 8 • Round-up Magazine • August 2015
many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives, including in women aged 40-49.”
One concern is that Medicare and private insurers will adopt these recommendations as a rationale for refusing coverage of breast-screening exams to women outside the stated age range, or more often than the recommended two years, which could have deadly effects for America women.
Regarding regular screenings, Daniel B. Kopans, MD, FACR, Professor of Radiology Harvard Medical School, and a leading expert in breast cancer detection, has this to say: “The United States Preventive Services Task Force is a powerful body with great influence on the medical profession. However their guidelines on mammography were ill-conceived from the start. There is irrefutable scientific evidence that most lives are saved by screening women every year beginning at age 40. There should be no confusion or controversy,” he said.
Otis Brawley, MD, Chief Medical Officer of the American Cancer Society, said, “The recommendation is based on data that find that mammo-
grams do reduce the risk of death in these women, but apparently not enough deaths to recommend that all women 40 to 49 should be screened. The guidelines could result in fewer women getting screened and a return to the days when we caught cancers only when they were big enough to feel. Without mammography, many women would not be candidates for treatment. You cannot treat a tumor until you find it.”
Another concern is that careful, thorough self-examination is under-utilized, especially in younger women who believe they are not at risk until they are older. Breast cancer is the robber of too many women’s lives, and so many happy family times. Many of the women affected are in their prime: wives, mothers, daughters, co-workers, and friends with many years of life ahead. Early detection can be a key in the battle for a life.
May common sense and sweet reason guide your future decisions! It is your life, your choice! ru
Ian Grant-Whyte, MA, MD, Cambridge, is a retired physician and member of MCMS since 1978. He can be reached by email to gwmdcantab@gmail.com.
in memoriam
Thomas James McNaughton, DO, MD
Dr. Thomas James McNaughton, 86, passed away peacefully on March 12, 2015 after a long illness. Dr. McNaughton was born on July 12, 1928 in Milwaukee, Wisconsin. He received a Doctor of Osteopathic degree from the Chicago College of Osteopathy (now Midwestern University’s College of Osteopathic Medicine) and his Medical Degree from Marquette University School of Medicine (now the Medical College of Wisconsin).
After completing a surgical internship at the University of Chicago Hospital and Clinic, Dr. McNaughton completed his residency in Neurosurgery at the Barrow Neurological Institute in Phoenix, Arizona. He received the great honor of being chosen for a Fellowship in Surgical Neurology at the University of Edinburgh, Scotland, where he served as Chief Resident, Honorary Lecturer and Senior Registrar of Professor John Gillingham. It was a very memorable year for Dr.McNaughton and one that he spoke of often. After residency completion, Dr. McNaughton held the positions of research fellow and part-time faculty at The Barrow Neurological Institute. He also established a private practice of neurosurgery in Sun City, Arizona.
Dr. McNaughton served the people of Arizona in a tireless and devoted manner at the Maricopa County Medical Center where he held the position of Chief of Neurosurgery from 19711987. One of his most memorable moments during his 16 years of employment at the medical center occurred in 2014 when he was honored by his peers during grand rounds for his work and contributions to healthcare and the community. Later in his career, Dr. McNaughton completed a Psychiatric Residency at the University of California, San Diego. He practiced Psychiatry until he retired in the mid1990s. After retirement, Dr. McNaugton continued to help many people. He would travel long distances and spend many hours if anyone reached out to him for help. He did this all with nothing to gain but the joy he received from sharing his vast medical knowledge and comforting those who were suffering.
Dr. McNaughton loved life and was well-known in the community for his commitment to nutrition, wellness and physical fitness. Perhaps the one story that everyone will remember is when he drank so much carrot juice that he turned bright orange for many days. He loved hiking, working out at the gym, animals, reading voraciously, and listening to classical music. He was a true gentleman, kind and assertive, with strong opinions that he was not afraid to express. Everyone that knew him says that he was “one of a kind.”
He was predeceased by his parents Howard and Mary McNaughton, his beloved sister Muriel and his brotherin-law Merlyn, formerly of Wisconsin. He is survived by his devoted wife, Janice, his son Jamison, granddaughter Marjorie, cousin Robert Gorske and other relatives in the Wisconsin area.
Alois Falkenstein, MD
Alois Falkenstein, MD, 68, passed away on July 4, 2015. Born May 3, 1947 in Hubing, Germany, but raised in Akron, Ohio, his energy will be remembered by his wife, Myra Jane Falkenstein; his two sons, Christian and Alexander; his daughter-in-law, Danielle and two grandchildren, Vincent and Heidi; along with his siblings, Rose, Emily, and Alexander who helped shape his energy as a child.
Dr. Falkenstein’s accomplishments were many, including his time as an officer in the Air Force where he was able to travel and embrace the diversity of the world. Humble and dedicated to his work and his patients, Dr. Falkenstein diligently cared for his patients for 36 years as a Ophthalmologist in Mesa, Arizona. His passionate energy continued in his backyard where he defied the Arizona sun and grew exotic and tropical fruit including dragon fruit, mango, papaya, lychees, plus countless others. He was a teacher and mentor to many and will be forever missed, but never forgotten.
Round-up Magazine • August 2015 • 9
president’s page
The Weight of Practicing Medicine Under the Risk of Malpractice By Ryan R. Stratford, MD, MBA
MCMS President 2015 Ryan Stratford, MD, MBA Dr. Stratford specializes in Urogynecology/Pelvic Reconstructive Surgery. He joined MCMS in 2005. Contact Information: The Woman's Center for Advanced Pelvic Surgery 4344 E. Presidio Street Mesa, AZ 85215 www.TheWomansCenter.com P: 480-834-5111 E: rstratford@mcmsonline.com
I
n today’s age of medicine, we all face medical-legal risk. Among the many risks we incur, there are none that I have encountered that is more life-altering than malpractice.
Whether we realized it or not, physicians, at some point in our career, are likely to become intimately familiar with the legal system. I, like many of you, have learned first-hand about the weight of practicing medicine under the risk of malpractice. Nothing in my training could have fully prepared me for the impact that malpractice risk would have on me. Nor did I think that I would spend so much time as I have in my short 15-year career as a physician pouring over legal documents.
The truth is that legal issues in medicine affect all of us and the impact can be very personal. I was told early on that choosing Obstetrics and Gynecology as a specialty was inevitably choosing to someday be sued. In fact, the chance of being sued not only once but multiple times is quite high as an Obstetrician/Gynecologist (OB/Gyn). A 2010 study from the American Medical Association (AMA) showed that 54% of OBGyns will be sued at least twice in their career. Chances of avoiding a lawsuit in my career were clearly not in my favor when I started my practice.
As I began practicing medicine, I was not supercilious about the likelihood of someday being sued, but I felt somewhat immune as an Urogynecologist. I recognized that most lawsuits in OBGyn dealt with complications from delivering babies and I no longer practiced obstetrics after completing fellowship training in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology). However, as a subspecialist, very complicated cases started coming through the door and I was quickly involved with treating patients who were eager to find someone at fault for poor outcomes from other physician-performed surgeries and treatments. I realized that it was only a matter of time before one of these patients would find fault in me as well.
Despite my acceptance of likely being sued, I was not prepared in any way to understand the full impact a lawsuit would have on how I practice. To be questioned not only about my decision making but also about my personal intention was very upsetting and unnerving. My initial reaction was not anger but introspection about what I could have done better. I began questioning everything. Then, I became more critical of patients. I began questioning their motives. I
10 • Round-up Magazine • August 2015
president’s page became somewhat aloof and despondent, feeling unappreciated for the mental and physical effort treating patients required, not to mention the years of training, learning and sacrifice that allowed me to treat my patients.
“As I have thought deeply about how best to practice medicine while avoiding the terrible impact of being sued, I have worked more and more on trying to overcome the information gap that can easily occur between me and my patients. It is my hope that by improving communication I will be better able to see what they are truly seeking from my care, and hopefully, they will better be able to see what I believe I can provide them.”
I witnessed similar reactions in the lives of other physicians. As an expert witness in complicated cases, I have seen first-hand the fear and uncertainty going through a lawsuit can create. The level of uncertainty in outcomes and dramatic swings that can occur at the whim of a jury is daunting and overwhelming. Then, there are the downstream affects, such as defensive medicine, physician apathy and sometimes abandonment of practice.
Despite the life-altering impact a lawsuit can have on the life of a physician, I fully recognize the importance of a legal system that protects patients, and I am in full support of such a system. In fact, as advocates for patients, physicians should support a system that protects patients. However, seeing firsthand the level of severe impact that can result from a lawsuit without providing much help to patients has engendered great distain within me for our current legal system.
Patients who have sought remediation through a lawsuit rarely report feeling made whole, even if they win the suit. The fact is that the compensation to patients through legal action is less than the compensation to the legal system, so patients do not always benefit. A 2011 study, published in the New England Journal of Medicine, reviewed thousands of malpractice cases. They reported $0.54 of every dollar paid out for medical malpractice law suits was spent on administrative costs (i.e. attorney fees, experts and courts). Even if a patient wins a case that rightfully should restore losses incurred due to medical negligence, the patient takes home less than 50% of the compensatory reward. It is no wonder emphasis has been placed less on compensatory damages and more on punitive damages. Arizona remains one of 15 states that still has not adopted caps on punitive damages. Although the number of malpractice cases in Arizona has been declining over the past three to four years and the rates for malpractice insurance are either remaining stable or decreasing, the cases that have been settled have settled for much greater amounts. The impact of no cap on punitive damages may not wholly prevent
physicians from practicing in the state, but it clearly incentivizes plaintiff attorneys to accept cases that may otherwise have little merit because the windfall can be great.
As I have thought deeply about how best to practice medicine while avoiding the terrible impact of being sued, I have worked more and more on trying to overcome the information gap that can easily occur between me and my patients. It is my hope that by improving communication I will be better able to see what they are truly seeking from my care, and hopefully, they will better be able to see what I believe I can provide them.
During my training as a fellow, I was impressed with my fellowship director’s approach to counseling patients prior to surgery about the risks of surgery. After explaining the risks he would add, “If I injure your bladder or bowel during surgery, I will fix it or make sure it gets fixed.” He never spoke in the third person but rather the first person when he counseled patients about risk. I believe he wanted the patient to focus less on the risks of surgery and more on the trust they could have in him as a surgeon that if something did not go well, he would do everything in his power to help them. The message was well received and changed the way I counsel my patients. Ultimately, I believe that much of the legal risk we face as physicians derives from the underlying disillusionment in society that someone else is responsible for outcomes and the attitude that someone must be at fault if the outcome is not what was desired. Unfortunately, it is difficult to stem the tide of decreased personal responsibility so prevalent in our society today, but at least we can avoid getting caught up in it ourselves. We may feel disenfranchised by the current legal system and feel frustrated by the fact that we cannot change it, but there is one thing that we can change — ourselves. ru
Round-up Magazine • August 2015 • 11
member profile
Taking a Different Approach to Treating Pain
ANThONy LEE, MD
Photos by Denny Collins Photography www.dennycollins.com 602-448-2437
12 • Round-up Magazine • August 2015
member profile
A
nthony “Tony” Lee, MD, practices in a clinical field that has seen the medical and legal professions become increasingly intertwined in recent years. As a board-certified Physical Medicine and Rehabilitation (PM&R) physician with a subspecialty certification in Pain Medicine, Dr. Lee treats patients in pain and works tirelessly to restore their abilities and functions to the point that they can return to playing, whether recreational or professional. Yet in a time when many patients hope to get a ‘quick fix’ for pain and ignore the time-consuming rehabilitation of the underlying injury causing the pain, physicians are finding themselves contributing to an opioid epidemic that is spreading at a rampant pace. When asked about the cause of the opioid epidemic, Lee explains, “We physicians are partly to blame. Like antibiotics, we should not over prescribe pain medications. We need to treat the cause of the problem and not just treat the symptoms.” This has seen many physicians – nationwide – in hot water with state medical boards for overprescribing of opioid drugs. From New York, to Georgia, to New Hampshire, to Georgia, to Pennsylvania, to Arizona...
Lee’s path to Southwest Spine & Sports in Scottsdale began in the rural South, where he was raised by Chinese parents who grew up in Cuba. His father, a now retired radiologist, attended medical school in Germany and trained in New York City before moving the family to a small town in Georgia when Lee was a young boy. “I grew up in a town of about 6,000 people. You know the whole two traffic light type of town,” recounts Lee. “Since my parents stressed education, I ended up going to a better school – private Catholic – an hour away in Macon. It was not unusual for us to drive an hour in the morning to school and then drive back after school.”
With Lee’s Asian background, and a father trained as a physician, it was expected that he would either follow in his father’s footsteps or some other highly respected profession. Lee recalls, “I went through my early schooling focusing on my studies in order to get into college and then medical school. Lucky for me though I learned that I wanted to be a physician on my own.” Lee took up tennis at an early age, and put in enough hours in the sweltering Georgia heat to earn a place on the
Dartmouth tennis team. After graduation, he returned to Georgia to complete a master’s degree in Microbiology from Georgia State University, and then on to medical school at Mercer University, a mere two blocks from where he attended high school. After that, Lee was off to the University of Pennsylvania, where he served as Chief Resident for two years while completing his training in PM&R.
When asked about his path to Arizona, Lee explains, “My wife, Judy, and I were trying to figure out whether we wanted to stay in Philadelphia or explore a new area. Honestly, growing up in Georgia I never thought I would end up in Arizona. Luckily, I found the fellowship and training that I was looking for at Southwest Spine and Sports. It works out especially since it is closer to many of my wife’s family and I enjoy all of the outdoor activities like golf and tennis.”
Since joining the practice at Southwest Spine and Sports in 2005, Lee has enjoyed the uniqueness of his environment at the Scottsdale facility. Despite the group’s private practice roots, they support a teaching fellowship and participate in educating local medical students, which has created an academic feel that the providers recall from their own days training to become physicians. Says Lee, “This allows us to practice using both traditional and innovative models. Although we are also practicing pain management, we are first and foremost PM&R physicians with the goal of restoring function and treating the patient comprehensively.”
Lee’s enthusiasm for his profession is infectious, and he’s confident he made the right choice to specialize in PM&R. He wasn’t even acquainted with the specialty until the end of his third year of medical school, but soon realized it was the perfect fit for him. He explains, “Understand that my father, brother, and sister are all radiologists. As much as I respect them, I knew that was not the right specialty for myself. I loved the fact that restoring a patient’s abilities and function were goals of a PM&R doctor.”
“Musculoskeletal PM&R allows me to combine my enthusiasm for sports with the enthusiasm my patients have for getting back to playing. At some point, I have played pretty much every sport there is so I wanted a specialty where I was going to be able to relate to most of my patients. Practicing sports medicine and PM&R allows me to do just that,” Lee adds. Prescribing Opioids – A Legal Conundrum
The opioid epidemic is rampant, with Arizona nearing the top of many lists that our state’s residents – and physiRound-up Magazine • August 2015 • 13
member profile
Dr. Lee in his surgery suite.
cians – would rather we not be on. We currently rank 6th nationally in the annual number of fatal drug overdoses, and have the nation’s 4th highest rate of adolescent and adult nonmedical use of prescription pain relievers. In an effort to educate our state’s residents of the growing epidemic, last January nearly three dozen television stations and nearly 100 radio stations broadcasted a documentary produced by Arizona State University that examined opioid use in young adults.
Yet despite efforts to educate the public, many still question whether or not today’s physicians truly understand the federal and state policies that govern the distribution of opioids. When asked, Lee suggests that most physicians have the basic understanding of the policies that govern distribution, and the majority understand the dangers and risks involved. He explains, “Although most may have the basic understanding, most physicians would benefit from knowing even more. I think knowing more is not just safer to the physician from a legal stand point but it would be more beneficial in regards to patient care.”
Most states have now put in place safeguards to monitor prescription drug abuse, through the establishment of Prescription Drug Monitoring Programs (PDMPs). In Arizona, the Board of Pharmacy oversees the state’s Controlled Substance Prescription Monitoring Program (CSPMP). Established in 2009, the CSPMP requires pharmacies and practitioners to report prescription information when Sched14 • Round-up Magazine • August 2015
ule II, III, and IV drugs are prescribed to patients. While some states have passed laws requiring physicians to access PDMP databases prior to prescribing controlled substances such as opioids, Arizona has yet to follow.
Arizona’s lack of regulation explains the 30% participation rate for physicians registering with the CSPMP, yet the state’s 2012 Prescription Drug Reduction Initiative has seen enrollment in the CSPMP increase by more than 50% in surrounding counties (excluding Maricopa). Still, most physicians do not take advantage of the resources available to them. Lee explains, “I don’t feel that enough physicians are using the database. It’s a great start but it only helps if you are checking it. And I think time management is a significant reason why physicians are not using it.”
He continues, “I am not saying that this is a valid excuse, but it seems that providers are being asked to do so many extra steps – many of which do not seem relevant to the issue at hand – in treating patients. It doesn’t seem like such a big deal to just access a website to check the database, but it’s another step that providers have to add to their evaluation of the patient. If providers can get into the habit of making the database a part of their patient routine, it would be even more beneficial.”
Despite safeguards such as Arizona’s PDMP, the opioid epidemic continues to grow. And physicians are partly to blame. They’re overburdened from a time standpoint, and at the end of the day, they simply want to care for their patients
member profile and relieve them of their pain. But Lee says that can’t be an accepted excuse.
“We turn to what we feel will help the patient the quickest. But at the same time, it means we’re taking the easy way out,” says Lee. “Another issue is that, unfortunately, many physicians are seeing more patients, yet spending less time with them. Thus, they turn easily to prescribing medications. The patient then follows up weeks or months later, and then it becomes easy to just refill the medication. Before the physician realizes it, the patient has been on short-acting pain medications for a long period of time and the viscous cycle has started.” In Lee’s opinion, physicians are not the only ones to shoulder the blame. He explains, “Society itself has to share the blame as well. Many patients these days are honestly just looking for a quick fix. They don’t want to put in the time it takes to recover and correct the underlying problem, nor do they want to take any responsibility for the their problem. That behavior, in my opinion, has led some patients to want to just pop a pill for a short term fix.”
According to Lee, physicians can help combat the epidemic through ongoing education. He acknowledges that many patients clearly benefit from the use of opioids, yet be-
lieves that physicians need to be more aware of what they are prescribing and when. For those in need of education, CMEs are readily available on the topics of opioid dependence and prescribing guidelines.
But it can’t just be about physicians being more knowledgeable. “We really need to educate patients on the goals of their treatment, including the usage of medications. As a PM&R doctor treating pain, I want to know what functional improvements are made with the medication management. Rating their pain with a number is so hard for many patients, but asking about functional improvement is key,” Lee said.
Lee’s approach is to treat patients with a multi-disciplinary and multi-treatment plan of care, with medication as a component of the plan. He explains, “We need to look at adding physical therapy, complementary alternative medicine options, interventional procedures, and behavioral treatment options.”
“There are times when a pain complaint does not have a simple answer. In treating a patient, however, we have to take a comprehensive approach and be open to finding alternative models or options. Of course, this requires a patient to be willing as well.” ru
Dr. Tony Lee, his wife Judy and daughter, Sophie.
Round-up Magazine • August 2015 • 15
legal: regulatory
Arizona’s New Quality Assurance Statute: Protections for Physician Practice Peer Review By Neel Kothari and Bob Milligan
F
About the authors: Neel Kothari is an associate attorney at Milligan Lawless, P.C., in Phoenix. He assists healthcare providers and organizations with a wide variety of matters, including business transactions, regulatory compliance, and reimbursement. Neel received his law degree with honors from the University of Chicago Law School. He can be reached at 602-792-3511 or neel@milliganlawless.com. Robert J. Milligan is a shareholder in Milligan Lawless, P.C., and specializes in healthcare law. He limits his practice to the representation of individuals and companies in the healthcare and life sciences industry. In addition to his law practice, he has received an LLM degree in Biotechnology and Genomics. He received his J.D. from DePaul University, where he was a Dean’s Scholar, and his B.S. from Northern Illinois University. Contact him at 602-792-3501 bob@milliganlawless.com
16 • Round-up Magazine • August 2015
or
or many years, peer review activities in hospitals and ambulatory surgery centers have been afforded broad and durable protections. Under the relevant statute, the process is well-protected from efforts by medical malpractice claimants and others to discover who said what about whom during the peer review.1 Until recently, physician practices did not enjoy similarly clear protections. They do now.
The peer review statute for hospitals and surgery centers provide participants with immunity from liability for their participation in the process. In theory, the immunity is available even to a participant who acted in bad faith. Putting aside the question of whether that is a good thing, the statute provides a great deal of protection for peer review processes and participants, and it allows hospitals and surgery centers to perform effective review.
In recent years, more physician practices have tried to develop their own peer review, quality assurance (QA), and morbidity and mortality processes for their services, including services provided in the outpatient setting. Until this year, however, these processes and physician groups had very limited confidentiality and immunity protections. This is because another Arizona statute (the “QA Statute”)2, which applied to peer review or quality assurance activities conducted outside the hospital and surgery center settings, was perceived as providing limited and uncertain protection. Some practices that were highly motivated to engage in QA activities refrained from doing so based on fears about the lack of assured confidentiality and immunity. This fact has been recognized by the Institute of Medicine, as follows: Fear of legal discoverability or involvement in the legal process is believed to contribute to underreporting of errors. Collaborative quality improvement efforts may be inhibited by the loss of statutory peer review protection that may occur when data are shared across institutions. Some form of protection appears necessary for each of the three components of an error reporting system: (1) the original reporters; (2) the various recipients of
legal: regulatory
Practices that are interested in developing a QA process that is protected by the QA Statute need to take care to structure a process that qualifies, and to avoid actions that might result in a waiver of the protections. It will not surprise you to hear us say that some amount of legal advice is necessary to avoid a misstep, but the following tips should reduce the likelihood of unpleasant surprises. Develop written policies and procedures describing the healthcare entity’s QA protocol.*
01 Record and maintain detailed minutes and reports describing the scope and conduct of QA activities.**
04 If QA information is shared outside the healthcare entity, make sure that any such sharing is specifically permitted under the QA Statute.
07
Form a QA committee and/or designate the correct personnel to periodically coordinate and participate in the QA process, and explain to them their roles.
All QA investigations should be conducted at the direction of designated personnel.
02
03
Educate providers and personnel about the healthcare entity’s QA process, during their orientation, and refresh and update this training through ongoing education.
Mark all QA information as privileged and confidential. Keep a secured area to store and maintain the information. Restrict access to designated personnel only.
05
06
If an outside consultant is engaged to assist with QA activities, clearly define the scope of the work and document the healthcare entity’s direction to create QA information.
08
Do not share QA activities with or in the presence of unauthorized persons, through e-mail, in public, or otherwise.
09
*The policies should describe the purpose, elements, and timing of QA activities; the criteria and standards for QA information, e.g., minutes, forms, data collection, and reports; the positions of QA participants that create and have access to QA information; the permissible sharing of QA information inside and outside the healthcare entity; how QA information is stored securely; and the consequences of the improper distribution of QA information. ** These documents may later be useful in asserting the privilege over QA information.
Round-up Magazine • August 2015 • 17
legal: regulatory the information (including processors, investigators, de-identifiers, and analyzers); and (3) the reported information itself.3
This situation was problematic for several reasons. First, on the patient care side, physician practices that scrutinize the care they deliver through an effective QA process are likely to deliver better care to their patients.4 Second, as healthcare financing models move to fee for bundled payment and other models that reward quality, practices that can improve and document quality through the use of data will have an advantage over those of their peers that rely on the age-old claim that their costs are higher because “my patients are sicker.”
In recent years, more physician practices have tried to develop their own peer review, quality assurance (QA), and morbidity and mortality processes for their services, including services provided in the outpatient setting. Until this year, however, these processes and physician groups had very limited confidentiality and immunity protections. This is because another Arizona statute (the “QA Statute”), which applied to peer review or quality assurance activities conducted outside the hospital and surgery center settings, was perceived as providing limited and uncertain protection. Some practices that were highly motivated to engage in QA activities refrained from doing so based on fears about the lack of assured confidentiality and immunity. This fact has been recognized by the Institute of Medicine, as follows: Fear of legal discoverability or involvement in the legal process is believed to contribute to underreporting of errors. Collaborative quality improvement efforts may be inhibited by the loss of statutory peer review protection that may occur when data are shared across institutions. Some form of protection appears necessary for each of the three components of an error reporting system: (1) the original reporters; (2) the various recipients of the information (including processors, investigators, de-identifiers, and analyzers); and (3) the reported information itself.
This situation was problematic for several reasons. First, on the patient care side, physician practices that scrutinize the care they deliver through an effective QA process are likely to deliver better care to their patients. Second, as healthcare financing models move to fee for bundled payment and other models that reward quality, practices that can improve and document quality through the use of data will have an advantage over those of their peers that rely on the 18 • Round-up Magazine • August 2015
age-old claim that their costs are higher because “my patients are sicker.” The 2015 Amendments to the Quality Assurance Statute Through amendments to the QA Statute, the Arizona legislature recently expanded the protections for the QA activities of “healthcare entities,” which include physician practices. The protections offered by the amended statute are intended to “allow more healthcare entities to conduct quality assurance activities5...”
Under the QA Statute, state healthcare providers, hospitals, and outpatient surgical centers are required to conduct QA activities while other healthcare entities are permitted to do so.6 Healthcare entities may also conduct joint QA activities.7
“QA activities” are defined as activities that are intended to (a) reduce morbidity and mortality and improve the quality of care, or (b) encourage proper utilization of healthcare services and facilities through the review of “the qualifications, professional practices, training, experience, patient care, conduct, processes or data of licensed healthcare providers.”8 To qualify for protection, QA activities must “follow a process adopted by the healthcare entity that includes written standards and criteria.”9 The QA Statute protects the QA activities of the following “healthcare entities”: (a) licensed healthcare providers; (b) entities that provide healthcare services through one or more licensed providers; (c) entities that contract to provide or pay for healthcare services; (d) professional organizations of licensed providers; (e) utilization or quality control peer review organizations; (f) state healthcare providers; (g) components of the statewide emergency medical services and trauma system; (h) qualifying community health centers; and (i) committees or other organizational structures of a healthcare entity.10
Immunity from Damage Claims for Quality Assurance Participants The QA Statute limits the liability of QA participants. A
legal: regulatory healthcare entity, and any person who has information about or participates in QA activities, or assists a healthcare entity with QA activities, is not subject to liability for civil damages or any legal action, except for certain actions seeking injunctive relief.11 These protections do not, however, insulate the healthcare entity from liability for patient treatment or negligent credentialing decisions.12 Confidentiality of Quality Assurance Information The QA Statute provides that QA information is confidential and not subject to subpoenas or orders to produce except in proceedings before state licensing or certifying agencies, or in actions by a provider against a healthcare entity related to discipline or privileges.13 The term “QA information” is defined as any information that is “submitted to, prepared for or by or considered by” a healthcare entity for QA activities, including a record of the entity’s QA actions and proceedings.14 A healthcare entity or person who has information about or participates in QA activities may not be subpoenaed to testify about those activities.15 If a legal action is brought under the QA Statute alleging that QA activities were inadequate or negligently conducted, however, a healthcare entity’s representatives are allowed to testify about whether the QA activities in fact occurred and their timing.16 These protections do not affect a patient’s claim to privilege or privacy or the subpoena of a patient’s medical records.17
The QA Statute also protects against potential waivers of confidentiality.18 The sharing of QA information with agencies, providers, or healthcare entities as described above does not waive its confidentiality. In addition, a healthcare entity’s governing bodies and administrative and other personnel may participate in QA activities without waiver.19 Importantly, all those who are privy to QA information are required to maintain its confidentiality.20 Information that is otherwise discoverable (e.g., a patient’s medical record) does not become confidential just because it is used for QA activities, with one exception—a healthcare entity may not produce such information if discovery might reveal the deliberative process of the QA activities.21
With the enactment of the QA Statute, physician practices now have reliable confidentiality and immunity protections for their peer review and QA activities. Practices that comply with the statutory requirements discussed above can evaluate and measure their outcomes candidly, while protecting their work product from discovery by civil litigants and other third
parties in situations governed by state law. (Note that the protections under the QA Statute do not apply to claims arising out of federal law.)
These efforts can help practices improve the structure, process, and outcomes of their healthcare delivery, improving the quality of care they provide to their patients, and improving their ability to develop aggregate data showing that they can provide high quality, cost-effective care. ru
References:
1. A.R.S. § 36-445, et seq. Utilization review processes enjoy similar protections. A.R.S. § 36-441. Note that the confidentiality does not apply to proceedings before the Arizona allopathic and osteopathic medical boards, or in actions brought against the facility by the provider whose care was the subject of the peer review. 2. A.R.S. § 36-2401.
3. From Institute of Medicine, “To Err is Human: Building a Safer Health System” 127 (Kohn ed. 1999), available at www.nap.edu/openbook.php?record_id=972
4. QA activities help providers measure clinical indicators related to the structure, process, and outcomes of healthcare delivery so that they can identify deficiencies and improve the quality of care. J. Mainz, “Defining and Classifying Clinical Indicators for Quality Improvement,” Int’l J for Quality in Health Care, 15-6:523-530 (2003). The AMA has declared that “accountability through voluntary, professionally directed quality assurance mechanisms should be part of every system of healthcare delivery.” American Medical Association, Policy H-450.994 – Quality Assurance in Health Care, 2015; accessible at www.ama-assn.org. 5. H.B. 2556, 2015 Leg., 1st Reg. Sess. (Ariz. 2015), at Sec.7. 6. A.R.S.§36-2402(A). 7. A.R.S.§36-2402(F).
8. A.R.S.§36-2401(3)(a).
9. A.R.S.§ 36-2401(3)(b).
10. A.R.S.§36-2401(1) (emphasis added). 11. A.R.S.§36-2402(D).
12. A.R.S.§36-2402(G). 13. A.R.S.§36-2403(A). 14. A.R.S.§36-2401(4).
15. A.R.S.§36-2403(A). 16. A.R.S.§36-2403(B). 17. A.R.S.§36-2403(B).
18. A.R.S.§36-2403(C). 19. A.R.S.§36-2403(C).
20. A.R.S.§36-2403(C)(D). 21. A.R.S.§36-2403(E).
Round-up Magazine • August 2015 • 19
legal: business
20 • Round-up Magazine • August 2015
legal: business
IT’S JUST BUSINESS, BABy: Ending a Business Partnership Successfully By Gregory B. Collins and Geoffrey S. Kercsmar
W
e frequently meet with clients who want to – or need to – bring an end to a business partnership. Often, the client is a physician or dentist that is involved with a multi-professional practice with two or more equity partners. The client is usually concerned that ending the partnership will be disruptive to his or her practice or income stream. Invariably, the physicianclient wants to be able to move on with minimal conflict and financial disruption.
Round-up Magazine • August 2015 • 21
legal: business It is a growing trend among lawyers to refer to such transitions as a “business divorce,” but we have always resisted this term. It’s true, business partnerships can certainly seem
like a marriage. A business partnership involves frequent contact and close cooperation. Almost every business partnership involves collaborative financial decision-making, just like marriage. For that reason, the partners must understand each other’s visions and management styles. Many good partnerships start out as social relationships outside the office, or they become that way over time. But businesses are not marriages. Unlike a marriage, no business is expected to last “forever.” Most people begin a business relationship expecting it to end when they retire, if not sooner. A business partnership typically has limited, defined goals and each partner has a limited, defined role.
Perhaps the most striking difference between a business partnership and a marriage is that the partnership is expected to last only as long as it is economically beneficial to the partners; try telling your spouse that you expect to remain married only until “something better comes along!” In our free-market system, individuals are expected to act out of self-interest, even when entering into long-term contracts like a business partnership agreement. And generally, they do. So, for most professionals, business separation is a nearcertainty. By contrast, unless you’re a reality-TV star, divorce is something most people try to avoid. A divorce is one of 22 • Round-up Magazine • August 2015
the most emotional and stressful situations that a person can endure. It usually involves a high degree of conflict and the emotional and financial repercussions of a divorce can be felt for many years. No one wants to get divorced and when entering into a marriage, no one expects the marriage to end that way.
For these reasons, the termination of a business partnership should not be likened to or treated as a divorce. The “divorce” label brings with it all the baggage and emotions that ending a marriage normally entails. Our experience is that clients who look at business separation as a “divorce” often find themselves fighting to “save” the business – even when the business is no longer viable. Business separation should be minimally stressful and disruptive. That begins with the most fundamental principal of a successful business separation: it should not be looked at as a failure. Simply because the partnership is ending does not mean that it was not successful. The partners may have had several years, or even several decades, of lucrative collaboration that benefitted not only themselves and their families but also their patients and the community at large. Even if the partners have only been together a short time and have elected to transition into other business arrangements, the partnership may have enabled those transitions, and everyone may end up happier and more successful in future endeavors. In other words, the break-up of a partnership may simply be the proverbial “new beginning” for everyone involved. This is not to say, of course, that every professional break-up is a “win-win.” One or more of the partners may be upset that the partnership is ending, or may be upset in the way the partnership is ending. That is often when lawyers are introduced into the picture. What expectations should a physician have when hiring a lawyer in this situation?
First, the physician-client should ensure the lawyer understands the physician’s goals. Those goals will be dependent on the client’s personal circumstances and individual outlook. The client may be the one who initiated the end of the partnership and is moving on to a new business opportunity. Or the client may be the one suddenly told on a Friday afternoon that “things aren’t working out.” The lawyer must
legal: business understand the circumstances and internalize the client’s goals. Only then can a lawyer provide advice to achieve those goals in the most expeditious and cost-efficient manner possible. And make no mistake: the client should expect the lawyer to operate in a cost-efficient manner, given the unique goals and directions of the client. It never makes sense to litigate—or even negotiate—for months or years, only to obtain the same result that was offered by the opposing party at the outset of the dispute.
How should a physician (or any other business person) find the right lawyer? The same way that a lawyer with a medical concern should find a doctor: by asking for referrals. Past experience and personal connections is the most reliable way to find a professional service provider. Ask your colleagues if they have ever needed to retain a lawyer to handle a dispute. Ask your transactional lawyer, your tax lawyer, and your trust lawyer who they would recommend for your situation. Ask your friends if they know any lawyers who handle business litigation. Once you have a list of names, visit those lawyers’ websites. Today, every lawyer has a website that explains what they do and how they do it. Just like physicians, lawyers can be highly specialized. Does this lawyer handle business litigation and business separation? Does he or she have real experience handling those issues? Those questions can often be answered from the lawyer’s Internet biography page.
Once you’ve identified which of the lawyers on your list have appropriate experience, call them to talk about that experience. That conversation, whether over the phone or in person, should be open and frank. (All of your conversations with prospective lawyers will be covered by the attorneyclient privilege, but make sure to raise this at the outset of your discussion.)
Among the things you should ask about are the lawyer’s fees—most will expect to be paid on an hourly basis—and whether and how much of a retainer will be charged. The lawyer should be willing to put all of the financial terms of the prospective engagement in a letter for you to review after the call or meeting.
After speaking with several lawyers, you should have a good feel for which lawyers are not a good fit. Any lawyer unwilling to spend a little time with you, or who wants to charge for an initial meeting, is probably not someone you want to hire. But among the lawyers who were open with their time, which one made you feel most comfortable? Keep
in mind that lawyers are often justified in avoiding offers of concrete predictions or nuts-and-bolts advice in an initial meeting; the lawyer is at an information disadvantage, and it is an unfortunate reality that no lawyer has a crystal ball to predict how a lawsuit will go or when an opposing party will settle (and on what terms). Clients should be skeptical when a lawyer predicts that anything outside your control will “definitely” occur. The lawyer should, however, be able to describe his or her experience in these kinds of matters, explain his or her philosophy on achieving a resolution, commit to making time available to handle your matter, and give some feedback on the situation. From an initial meeting or phone call, a second conversation may be necessary, or you may have all the information you need to make a decision. Either way, don’t put it off; if you think it’s time to hire a lawyer, it probably is. This is not to say that there’s a magic bullet: some resolutions are achieved quickly and easily because the former partners prioritize those aims. Other separations take a great deal of time (and money) because the former partners have incompatible views about what the outcome should be. But in each and every case, lawyers are brought into the situation to help facilitate a resolution, never to make things worse. When a lawyer tells his or her client that the opposing side is going to “feel the pain,” it is usually both sides that end up paying the price. ru Geoffrey Kercsmar is the founder of Kercsmar & Feltus, PLLC, a commercial litigation boutique with ten lawyers in Arizona and California. He represents a wide range of clients, from Fortune 500 companies to individuals, and he has appeared on behalf of clients on Good Morning America, Fox Business News Channel and local news stations. He is a 1998 graduate of The Pennsylvania State University’s Dickinson School of Law. Gregory Collins is a Managing Member of Kercsmar & Feltus, PLLC. He practices business litigation with an emphasis on intellectual property disputes. Mr. Collins was recently ranked as a Southwest Super Lawyer in intellectual property litigation — a ranking bestowed on only 12 Arizona attorneys. He is an adjunct professor at Arizona Summit School of Law and a published legal author. Round-up Magazine • August 2015 • 23
legal: advocacy
THE ARIZONA CENTER FOR LAW IN THE PUBLIC INTEREST: Fighting for individuals and groups who lack the power or money to take on big business and big government. By Timothy M. Hogan
F
or over forty years, the Arizona Center for Law in the Public Interest has been using legal advocacy to protect the public in a number of important areas including school finance, environmental protection, consumer protection and many others.
One area that the Center has continuously focused on since it was established in 1974 is public health. Just last month, Center attorneys were in court defending Arizona’s Medicaid Expansion Program that was enacted in 2013. Legislators voting against the expansion sued the state claiming that the hospital assessment authorized by the legislature constituted a tax that required a two-thirds legislative vote under Arizona’s Constitution.
With a new Governor who had opposed Medicaid Expansion, the Center was skeptical about the current administration’s enthusiasm for defending the expansion of healthcare to over 300,000 people so we intervened on behalf of individuals in the expansion 24 • Round-up Magazine • August 2015
population to defend the program. The Center’s focus on public health issues isn’t new. In 1981, we filed a class action lawsuit in state court on behalf of indigent individuals with serious mental illness. We argued that state law required the legislature to establish a system of care and services for the seriously mentally ill and then deliver those services. In 1989, the Supreme Court agreed with us in a landmark decision and determined that the legislature had breached its duty to provide the required care and services.
We spent the next 25 years – that’s right, 25 years – to induce compliance with the Court’s decision. Those efforts culminated in a final resolution of the case in early 2014. We reached a comprehensive settlement with Governor Brewer and the Arizona Department of Health Services to significantly enhance the quality and expand the capacity for community based mental health services for thousands of people with mental illness that included provisions for assertive community treatment, supported housing, supported employment and peer and family support services.
In 1991, we filed a companion case in federal court on behalf of Medicaid eligible children entitled to mental health and substance abuse treatment services. Ten years later, we reached a settlement with the state that reformed the state’s behavioral healthcare system for children. The settlement was unique in its approach to reform because it spelled out in a legal document a “vision” defining the purpose of children’s behavioral health services and a set of 12 principles for improving the quality of those services to be incorporated in all aspects of the system’s operations. When the great recession hit, the Arizona legislature decided that one way to reduce the state budget was to eliminate the Arizona Health Care Cost Containment System (AHCCCS) eligibility for individuals without children, so-called “childless adults.” The Center stepped in to try to stop what it thought was an unlawful attempt by the legislature to circumvent Proposition 204 that was approved by Arizona voters in 2000. That Proposition increased AHCCCS eligibility for low income individuals to all individuals whose income
legal: advocacy fell below 100% of the federal poverty level.
Unfortunately, the courts disagreed. In late 2011, the Arizona Court of Appeals ruled that Proposition 204 required the Arizona legislature to provide supplemental funding and agreed that the Proposition prohibited any caps on enrollment. So far, so good. But the court held that it could not provide any relief because the question of whether adequate funding was available was a “political question” and not subject to review by the courts.
That was a devastating loss for over 150,000 Arizonans who would have otherwise qualified for healthcare under Proposition 204. However, the Court’s determination that the legislature was required to provide the supplemental funding necessary to extend healthcare to all eligible individuals laid the groundwork for the Governor’s support for Medicaid expansion in 2013. She cited the Court’s ruling as a primary reason for supporting Medicaid expansion which is now back in court because of opposition from a minority of legislators. Earlier this year, the Center filed another important lawsuit on behalf of foster children in state custody. The case was filed as a class action in federal court on behalf of children removed from their families and in the custody of the state but who are not receiving necessary medical services and treatment. These children are routinely separated from their siblings and bounced around from one institutional setting to another and regularly denied medical and behavioral health services that they desperately need. If successful, this lawsuit will improve the lives of over 16,000 children in state foster care.
Not all of the Center’s public health efforts have focused on the provision of services and treatment. The Center was established not long after President Nixon signed the Clean Air Act. That Act was intended to improve the health of all Americans by reducing air pollution. The Act set national air quality standards and required that states submit implementation plans to meet those standards in metropolitan areas that exceeded them.
One of those areas was Phoenix. The problem is that the state was unwilling to do very much to clean up the dirty air in Phoenix so the Center filed numerous citizen enforcement actions over the years to require meaningful implementation plans to reduce ozone, carbon monoxide and particulate pollution. Those lawsuits have almost all been successful and have played an important part in moving the Phoenix metropolitan area into compliance with the clean air standards.
Since 1974, the Center has established a track record of holding government accountable when it fails in its duties to protect the public health of its citizens. It stands ready to collaborate with the physician community to identify important public health issues and develop strategies to address them.
The Center is a non-profit public interest law firm. It has a staff of three dedicated lawyers and is governed by a Board of Directors. Over half of its budget comes from individual contributions made by supporters throughout the state. If you’re interested in reading more about, or supporting, the Center’s work you can do so on its website at www.aclpi.org. ru
Timothy M. Hogan is the Executive Director and Chief Legal Counsel for the Arizona Center for Law in the Public Interest. Under his leadership, the Center has won major victories for Arizonans in the areas of consumer rights, education, the environment and healthcare. Mr. Hogan also has been instrumental in the creation of Arizona's progressive energy standards, both for increased energy efficiency and the mandatory use of renewable energy resources. Mr. Hogan has received numerous awards and honors in recognition of his selfless devotion to the public interest. In July 2011, Mr. Hogan received a prestigious award from the National Education Association for his work toward the achievement of equal opportunity for Hispanics. Prior to joining the Center, Mr. Hogan was Chief Counsel for the Arizona Corporation Commission. He also served as an Assistant Arizona Attorney General in the Civil Rights and Financial Fraud Divisions, and as Program Director of the Phoenix Program at Community Legal Services. Mr. Hogan received his undergraduate degree from Arizona State University and his law degree from the University of Notre Dame Law School.
Round-up Magazine • August 2015 • 25
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We buy, sell, consign, service, and finance your CAPITAL MEDICAL EQUIPMENT NEEDS. Global Medical Solutions Contact: Don Creedon TEL. (480) 874-0333 www.igogms.com. Member AIUM.
28 • Round-up Magazine • August 2015
FULL OR PART TIME MD OR DO NEEDED for physical medicine, physical therapy, neuropathy and chiropractic clinic in SW Phoenix. Responsibilities include primary care, neuropathy treatment and evaluating patients for various physical medicine treatments. Neuropathy and physical medicine experience not necessary. Current medical doctor retiring so position is available immediately. Fun, energetic place to work.
Patients are cooperative, appreciative and staff is bilingual, well trained, motivated, professional and sincere. Please contact us with any questions or provide resume to drmaher@arizonahealthpros.com
• Regulatory Compliance • Approved Packaging Supplies
Round-up Magazine’s Marketplace provides local classifieds for full-time or part-time jobs, office space for sale or lease, medical services, community events, and much more! For rates, specs and deadlines, contact Candice at cscheibel@mcmsonline.com or call 602-251-2363.
platinum
Arizona Central Credit Union
Medical Professional Liability Insurance for Arizona, Colorado, Nevada and Utah
Your personal and business banking partner.
www.mica-insurance.com
www.azcentralcu.org
MICA is a mutual insurance company that is owned by its members. As such, when financial conditions warrant, MICA returns dividends to its members. In fact, over the past ten years, MICA has distributed $337 million in policyholder dividends.**
MCMS members receive $200* when they join Arizona Central Credit Union.
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Unique. Exclusive. Preferred. The Maricopa County Medical Society has been a valuable partner to the medical community since 1892. Now we are teaming up with Your favorite companies to bring you even more value!
Premier Southwest Planning Group Let’s start a conversation.
Introducing our all-new Preferred Partner Program.
www.premierswplanning.com
Bringing you:
MCMS members receive a 15% discount on Individual Disability insurance through Ohio National. Initial consultations are free of charge.
• • • •
silver Ensemble Real Estate Solutions www.ensemblere.com
Healthcare Medical Waste Services hmws@cgmailbox.com
MCMS members receive free initial consultation and complimentary a follow-up market survey (valued at $250).
MCMS members enjoy a 2% discount.
Superior services Personal recommendations Exclusive discounts Incredible value
Discover how you can be preferred! www.mcmsonline.com/partner 602-252-2015 mcms@mcmsonline.com
Plaza Companies www.the plazaco.com
Global Financial Leasing Services www.gfrservices.com
MCMS members receive a complimentary leasing market research.
MCMS members receive a free credit review and consultation with application.
* Visit joinus.azcentralcu.org **Past performance does not guarantee future dividends.
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Did you know? MICA Risk Management provides onsite in-service presentations for MICA members and their staff. Call today to get us on your calendar.
Medical Professional Liability Insurance (602) 956-5276 (800) 352-0402 www.mica-insurance.com