"A problem is a chance for you to do your best."        --Duke Ellington

"The trouble with life isn't that there is no answer, it's that there are so many answers."    --Ruth Benedict

"We are continually faced by great opportunities brilliantly disguised as insoluble problems."    --Lee Iacocca

"Never let the fear of striking out get in your way."   --Babe Ruth

IN THIS ISSUE, FOR YOU:
ON THE SCHEDULE AND DISTRICT MEETINGS
NEW AOA PRESIDENT, PRESIDENT-ELECT
JOINT COMMISSION CALLS FOR ZERO TOLERANCE OF HOSPITAL BULLIES
NOTICE REGARDING PHYSICIAN IN TRAINING PERMIT HOLDERS
LONG TERM CARE SUMMIT
USE OF "MEDICAL HOME" CARE MODEL GROWS
MULTI-MILLION DOLLAR RUILING AGAINST PRESBYTERIAN HOSPITAL THROWN OUT (PEER REVIEW ISSUE)
MY HEALTHY ACCESS, NUPHYSICIA TO OPERATE TELEMEDICINE CLINICS IN WAL-MARTS
PATIENT BOTTLENECKS:  FIND THEM AND FIX THEM
SEVERAL ACTIONS THAT PHYSICIANS CAN TAKE TO HELP PREVENT MEDICAL MALPRACTICE 
DID YOU KNOW?
"THERE IS LITTLE SUCCESS WHERE THERE IS LITTLE LAUGHTER."

ON THE SCHEDULE AND DISTRICT MEETINGS:

District 7           Friday, August 8th
                       Reception / Mixer to welcome students, interns, residents,

                            fellows

                       6:30 p.m.
                       TOMA building, 1415 Lavaca
                       Austin, TX
 
District 7           Thursday, August 21st
                       Austin, TX

District 8           Thursday, Aug. 28th
                       Corpus Christi, TX
 
August 2           Pool Party, for Medical Students (and D.O.s)
                       5:00 p.m., Home Of Mark and Rita Baker
                       6317 Pamlico Road
                       Fort Worth, TX
                       817-919-3259

Aug. 9-10         "Ligamentous Articular Strain Techniques" Basic Course 

                      presented by the Dallas Osteopathic Study Group

                      Doubletree Hotel-Campbell Centre, Dallas, TX 75206

                      Contact: Conrad Speece, D.O. course director

                      214-321-2673  cjspeece@yahoo.com

                      August 9-10, 2008

                      CME: 16 hours OMM category 1-A anticipated from AOA

August 23         HealthFind
                      Hotel Intercontinental, Dallas, TX
                      For more info or to register:  www.torchnet.org/calendar.html

Labor Day         September 1, 2008

NEW AOA PRESIDENT, PRESIDENT-ELECT

Congratulations to Carlo DiMarco, DO, newly elected President of the American Ostoepathic Association. 

Dr. DiMarco was elected during the AOA's HOuse of Delegates meeting in Chicago, July 17-20th.

Dr. DiMarco is a professor and regional dean of clinical medicine at the Lake Erie College of Osteopathic Medicine in Erie, Pa. (LECOM). He also serves as the director of the ophthalmology residency program at LECOM.

Aside from his position at LECOM, Dr. DiMarco is part of Medical Associates of Erie, a network of multi-specialty physicians who practice throughout Erie County and teach in affiliation with LECOM.  

In addition to his involvement with the AOA, Dr. DiMarco was team ophthalmologist for the Philadelphia 76ers from 1995 to 2006.

Dr. DiMarco also has ties to Texas.  Two of his sons own and operate a restaurant in downtown Austin, the "Hog Island Deli."

Larry Wickless, DO, an AOA-board certified osteopathic internist and gastroenterologist of Farmington Hills, Mich., was named president-elect of the American Osteopathic Association (AOA).

A fellow of the American College of Osteopathic Internists, Dr. Wickless practices at South Oakland Gastroenterology Associates, P.C., in addition to serving as clinical professor of medicine at the Michigan State University College of Osteopathic Medicine in East Lansing and as associate director of the gastroenterology training program at Botsford Hospital in Farmington Hills.

Congratulations to Dr. Wickless on his election as President-elect.

JOINT COMMISSION CALLS FOR ZERO TOLERANCE OF HOSPITAL BULLIES
Group says culture of intimidation contributes to mistakes

AUSTIN- The Joint Commission is recommending that hospitals and other
healthcare providers adopt a "zero tolerance policy" for rude language, bullying,
and other hostile behavior from physicians, nurses and other healthcare professionals.

"Most healthcare workers do their jobs with care, compassion, and professionalism," says The Joint Commission President Mark Chassin, MD. "But sometimes professionalism breaks down and caregivers engage in behaviors that
threaten patient safety. It is important for organizations to take a stand by
clearly identifying such behaviors and refusing to tolerate them."

Chassin says the issue is so serious that The Joint Commission has introduced
new standards requiring more than 15,000 accredited healthcare organizations
to create a code of conduct that defines acceptable and unacceptable
behaviors among healthcare professionals and other employees. The new standards will go into effect on Jan. 1, 2009, at hospitals, nursing homes, home
health agencies, laboratories, ambulatory care facilities, and behavioral health
care facilities across the United States.

Joyce Cunningham at the The Texas Nurses Association says that organization
has had a long-standing zero tolerance stance on bullying in the workplace.
"Bullying in the workplace . . . costs healthcare organizations money, lawsuits,
and increased staff turnover, and jeopardizes the delivery of safe patient care,"
she wrote in an association newsletter.

The Joint Commission says intimidating and disruptive behavior is widespread.
The commission cites a Safe Medication Practices survey, which found
that 40% of clinicians said they had kept quiet or remained passive during
patient-care events that involved intimidating behavior by a colleague.
The commission issued what it calls a Sentinel Event Alert that recommends
11 steps to deal with unacceptable behavior, including: educating healthcare
workers about the need for courteous professional behavior and holding
them accountable to that standard; establishing a zero tolerance policy toward
abusive behavior; determining how and when to discipline infractions; and developing a system to report and detect abusive behavior. - Kathryn Mackenzie

From:  Texas Healthflash, HCPro, Inc., www.healthleadersmedia.com.

NOTICE REGARDING PHYSICIAN IN TRAINING PERMIT HOLDERS

If you are a Physician in Training(PIT) permit holder, you must report, in writing, to the Executive Director of the board, the following circumstances within thirty days of their occurrence:
·       the opening of an investigation or disciplinary action taken against you by any licensing entity other than the Texas Medical Board;
·       an arrest, fine (over $100), charge or conviction of a crime, indictment, imprisonment, placement on probation, or receipt of deferred adjudication; and
·       diagnosis or treatment of a physical, mental or emotional condition, which has impaired or could impair your ability to practice medicine.

Failure to comply with the provisions of this chapter (22 Tex. Admin. Code, Section 171) or Tex. Occ. Code, Sec. 160.002 and 160.003 may be grounds for disciplinary action as an administrative violation.  Duties of PIT holders to report are specified in 22 Tex. Admin. Code, Section 171.5.

Mailing Address: 
        Texas Medical Board

        P.O. Box 2018

        Austin, TX   78768-2018

If you have any questions regarding this request, please feel free to contact our office. You can contact the Customer Information Center at (512) 305-7030, by fax at (512) 305-7009, or by e-mail at pits@tmb.state.tx.us mailto:pits@tmb.state.tx.us

LONG TERM CARE SUMMIT
 
The Texas Health Institute is pleased to announce plans to host a Long Term Care Summit (LTC) December 7-9, 2008, in Austin, Texas.  "Anyone who interfaces with LTC, responsible party, provider, agency representative, policy maker or ombudsman, should plan to attend," said Tim Von Dohlen, THI Board Member and member of the LTC Planning Committee. 
 
Mr. Von Dohlen went on to explain the LTC Summit will focus on the Texas economy and healthcare's contribution and the LTC subcomponent and its importance.  Describing the scope and impact on overall economic activity in Texas will demonstrate some compelling facts that raise issues demanding solutions.  Focusing on trends in Texas and their impact on overall state finance will offer meaningful information providing affirmation that LTC in terms of people, financing, jobs and taxes, etc, is unmistakably a worthwhile and necessary topic for all citizens, particularly, policy makers.  Summit discussions covering access and capacity, resources and quality of care, delivery and workforce with thoughtful dialogue will make this Long Term Care Summit one in which any concerned Texan should want to participate.
 
For additional information on the Long Term Care Summit or the upcoming Summit, please contact Lenora Doerfler at 512-279-3915.  Event sponsorship and exhibitor opportunities are still available.  Event details coming soon to www.texashealthinstitute.org.

 
USE OF "MEDICAL HOME" CARE MODEL GROWS

The federal government and insurers are using programs that increase payments or reward primary care providers for creating a "medical home" model in which they coordinate a patient's entire range of care, as well as offer longer office hours, same-day appointments and electronic medical records. The efforts are seen as a way to reduce health care spending through fewer hospitalizations, ER visits and diseases. USA TODAY (7/13)

From:  SmartBrief, SmartBrief, Inc.®, www.smartbrief.com

 
MULTI-MILLION DOLLAR RUILING AGAINST PRESBYTERIAN HOSPITAL THROWN OUT (PEER REVIEW ISSUE)
Hospital, doctors granted immunity in peer review case

DALLAS- The U.S. 5th Circuit Court of Appeals overturned a judgment against
Presbyterian Hospital of Dallas in the case of a physician there who said he was
defamed by a peer review board.

In the original case a jury ordered the hospital and three colleagues of
plaintiff Lawrence Poliner, MD, to pay $366 million in damages after finding that
a peer review process was not conducted in good faith and that there were indications of anti-competitive behavior. The peer review was prompted by a procedure in which Poliner acknowledged in a chart that he missed an arterial blockage.

Poliner settled out of court with two of the defendants named in the original
case, but returned to court to fight an appeal brought by the hospital and
another defendant, James Knochel, MD, who were ordered at that time to pay
Poliner $22.5 million.

Last week, Judge Patrick Higginbotham overturned the judgment in full,
writing on behalf of a three-judge panel that immunity from money damages
afforded to participants in peer review requires only a "reasonable belief that the
action was in the furtherance of quality healthcare," quoting the Health Care
Quality Improvement Act of 1986.

"This case is a matter of principle, not just of business practices. It goes to
the heart of physicians' accountability and responsibility to one another and,
more importantly, to their patients," says Douglas Hawthorne, president and CEO
of Presbyterian Hospital parent Texas Health Resources, in a written statement.
"It goes to the heart of physicians' accountability and responsibility to one
another and, more importantly, to their patients. THR is so committed to the
physicians who practice on the medical staffs of THR-related hospitals, that we
would take this as far as necessary to affirm our commitment to improving quality
and patient safety."

The ruling also gives immunity to the hospital and other doctors involved in
Poliner's case.

From:  Texas Healthflash, HCPro, Inc., www.healthleadersmedia.com

MY HEALTHY ACCESS, NUPHYSICIA TO OPERATE TELEMEDICINE CLINICS IN WAL-MARTS
Paramedics to act as 'hands' of surgeon during exams

HOUSTON- My Healthy Access Inc. and NuPhysicia LLC have partnered to
begin offering telemedicine clinics at some Houston Wal-Mart stores.
Glenn Hammack, NuPhysicia's president says the program replaces the care
typically provided by nurse practitioners at retail clinics. "Our alliance takes that
care a step further, bringing new levels of service, convenience, and value to the
retail healthcare setting through interactive physician visits."

According to the companies, which will operate under the trade name
Walk-In Telemedicine Health Care, a two-way video communication is initiated
during the patient visit, using split-screen technology by which a patient can see
and speak directly to the physician. Electronic medical devices will allow the
physician to visually examine the patient and even listen to his or her heart and
lung sounds. A paramedic acts as the "hands" of the physician.

"The physician performs the exam as if he or she was in the room with the
patient," Hammack says. The program is one of the service lines of NuPhysicia, a
private medical services company produced from the telemedicine program at
the University of Texas Medical Branch at Galveston.

"Our telemedicine methods have served hundreds of thousands of patients
from Texas to as far away as the South Pole," says Hammack. "Similar live-video
technology is now monitoring the most critically ill in ICUs across the nation."
-Kathryn Mackenzie

From:  Texas Healthflash, HCPro, Inc., www.healthleadersmedia.com

PATIENT BOTTLENECKS:  FIND THEM AND FIX THEM

Eliminating big backups will improve patient satisfaction and relieve stress on your staff.

http://medicaleconomics.modernmedicine.com/memag/medical%2bpractice%2bmanagement%3a%2bscheduling/improve-scheduling-to-eliminate-patient-backups/articlestandard/article/detail/530034?contextcategoryid=8485

From:  Medical Economics, Advanstar Communications, www.advanstar.com

SEVERAL ACTIONS THAT PHYSICIANS CAN TAKE TO HELP PREVENT MEDICAL MALPRACTICE 

If patients want to stay out of the hospital, they will need good preventive care. Similarly, if physicians want to stay out of court and avoid medical malpractice suits, it's critical to take good legal preventive care. Based on my experience and the experience of others, here are several actions that physicians can take to help prevent medical malpractice and keep them out of the courtroom:

       Return pages from your answering service with your cell phone. By using your cell phone, there is a record that you called patients back. This could be useful if there is litigation later on. Patients won't usually abuse this privilege if they capture your number.

       Document what is said during patient interactions. Use your electronic medical records system or your call-in transcription service, if you have access to either. If not, create a separate voice mailbox on your office phone to be used for transcription of after-hours messages.

       Guarantee to patients that they will receive laboratory and radiology results in a specified time period or their office visit is free. If you tell patients that they will hear from you regarding their results, they will never assume no news is good news. This is a frequent source of litigation. One way that you can ensure that these results are conveyed to patients is to tie your office manager's bonus to how frequently such refunds are made. By the end of the year, it should be zero times.

       Don't assume your surgical patient stopped smoking. Smoking interferes with wound healing. Explain the risks to patients, have them sign a document stating that they understand these risks, and be sure to perform a urine cotinine test with the rest of the laboratory work before surgery. If the results come back suggesting the patient is still smoking, think about rescheduling the procedure.

       Document what you didn't do and why. Memorializing your reasoning for why you didn't follow a particular "standard" course of treatment is the antidote for a lawyer who later claims you didn't even consider all the alternatives. Addressing it upfront is an explanation; after the fact, it's an excuse.

       Don't send patients to collections for a $22 balance. Threatening to send patients to collections over $22 may push them over the edge to call a lawyer, particularly if they have had an untoward result.

       Speak ill of no one and don't allow anyone else to do the same. Don't talk about other doctors to patients. If you are convinced a colleague is a true danger, speak with the proper authorities. Be wary of patients who speak poorly about their previous physicians. Also, resist the temptation to write in the chart that the patient is crazy because you may pay dearly.

       In the operating room, verify all patients. Check the side, and make absolutely certain that patients about to be wheeled in are indeed the correct patients. Verify that the side with the pathology is indeed the side that will be prepped and draped. Have another person go through the same drill and perform these protocols religiously. The consequences will be severe if surgery is performed on the wrong patient or the wrong side.

       Never, ever alter records after you are served. Getting the documentation right beforehand means that this option doesn't even have to enter your mind.

       Jeffrey Segal, MD has indicated to Physician's Weekly that he has is the CEO and a shareholder of Medical Justice Corporation.

From:  Physician's Weekly Newsletter, Physician's Weekly LLC, www.physweekly.com

DID YOU KNOW?

August 7:  George Washington created the "Purple Heart," decoration medal, 1782

     
"THERE IS LITTLE SUCCESS WHERE THERE IS LITTLE LAUGHTER."         ~ Andrew Carnegie

"The secret of life is honesty and fair dealing. If you can fake that, you've got it made."    --Groucho Marx

My wife invited some people to dinner. At the table, she turned to our six-year-old daughter and said, "Would you like to say the blessing?" "I wouldn't know what to say," she replied. "Just say what you hear Mommy say," my wife said.
Our daughter bowed her head and said, "Dear Lord, why on earth did I invite all these people to dinner?"

It is so hot this summer that gardeners can almost harvest boiled potatoes.

Its So Dry in Texas, the trees are whistlin' for the dogs.

"It's been so dry that we got catfish in the creek three years old that haven't learned to swim yet."

A guy walks into the psychiatrist's and says "Doctor, doctor, you've got to help me! I keep thinking that I'm a deck of cards!" The shrink says "Sit over there and I'll deal with you later."

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