presented by: melanie balestra, np, jd law offices of ... · (11) provide for a method of periodic...
TRANSCRIPT
Participant will be able to find 11 elements of SPs
Participant will be able to name two types of BRN Accusations
Participant will be able to name two entities a NP can be an owner
Participant will be able to name two types of social
Particpant will be able
OBJECTIVES
DRUGS
• Diverting for self-use
• Diverting to sell
• Addiction/Substance abuse
• Self-prescribing
• Prescribing for family or friends
PRACTICE TIPS
Unprofessional conduct (a) Committing fraud or deceit in obtaining, attempting to obtain
or renewing a license or a certificate issued
(b) Social media—Facebook, texting
(c) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission.
(d) Aiding or abetting in a criminal abortion or attempting, agreeing or offering to procure or assist in a criminal abortion
PRACTICE TIPS
(e) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public.
(f) Being mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public.
(g) Having a license, certificate, permit or registration to practice a health care profession denied, suspended, conditioned, limited or revoked in another jurisdiction and not reinstated by that jurisdiction.
(h) Willfully or repeatedly violating a provision of the Nurse Practice Act
PRACTICE TIPS
(i) Committing an act that deceives, defrauds or harms the public.
(j) Failing to comply with a stipulated agreement, consent agreement or board order.
(k) Violating a rule that is adopted by the BON
(l) Failing to report to the board any evidence that a professional or practical nurse or a nursing assistant is or may be:
(i) Incompetent to practice.
(ii) Guilty of unprofessional conduct
PRACTICE TIPS
(iii) Mentally or physically unable to safely practice nursing or to perform nursing related duties. A nurse who is providing therapeutic counseling for a nurse who is in a drug rehabilitation program is required to report that nurse only if the nurse providing therapeutic counseling has personal knowledge that patient safety is being jeopardized.
(l) Failing to self-report a conviction for a felony or undesignated offense within ten days after the conviction.
PRACTICE TIPS
Gross negligence
Carelessness in reckless disregard for the safety or lives of others, which is so great it appears to be a conscious violation of other people’s right to safety.
It is just shy of being intentionally evil.
Punitive damages
PRACTICE TIPS
STANDARDIZED PROCEDURES
(1) Be in writing, dated and signed by the organized health care system personnel authorized to approve it.
(2) Specify which standardized procedure functions registered nurses may perform and under what circumstances.
(3) State any specific requirements which are to be followed by registered nurses in performing particular standardized procedure functions.
(4) Specify any experience, training, and/or education requirements for performance of standardized procedure functions.
(5) Establish a method for initial and continuing evaluation of the competence of those registered nurses authorized to perform standardized procedure functions.
PRACTICE TIPS—PRACTICING BEYOND YOUR SCOPE
Standardized Procedures (6) Provide for a method of maintaining a written record of those persons
authorized to perform standardized procedure functions. (7) Specify the scope of supervision required for performance of
standardized procedure functions, for example, immediate supervision by a physician.
(8) Set forth any specialized circumstances under which the registered nurse is to immediately communicate with a patient's physician concerning the patient's condition.
(9) State the limitations on settings, if any, in which standardized procedure functions may be performed.
(10) Specify patient record keeping requirements. (11) Provide for a method of periodic review of the standardized
procedures
PRACTICE TIPS-PRACTICING BEYOND YOUR SCOPE
(6) Provide for a method of maintaining a written record of those
persons authorized to perform standardized procedure functions.
(7) Specify the scope of supervision required for performance of
standardized procedure functions, for example, immediate supervision
by a physician.
(8) Set forth any specialized circumstances under which the registered
nurse is to immediately communicate with a patient's physician
concerning the patient's condition.
(9) State the limitations on settings, if any, in which standardized
procedure functions may be performed.
(10) Specify patient record keeping requirements.
(11) Provide for a method of periodic review of the standardized
procedures
Alcohol use
• On the job
• DUI
Expunged
Dismissed
No Miranda before arrest
PRACTICE TIPS
Cloning
Not documented, not done
Amendments considered late charting
Electronic Medical Records
Falsification/Misrepresentation
Lying on application
Failing to disclose
Prior discipline
Discipline in another state
Practicing without a license
PRACTICE TIPS
How many hours per provider?
How many collaborating physicians?
Hourly wage, not salary.
Always a written contract.
What to do if abused?
California Labor Board
INDEPENDENT CONTRACTOR
Physician 51% shareholder and Medical Director Job description
Availability
Input on hiring professionals
Familiar with SPs
Nurse Practitioner 49% shareholder Patient records available to physician
Regular meeting time to discuss business (quarterly)
Consults as necessary
MEDICAL CORPORATON
Only provides management services
Leasing
Support personnel
Utilities
Management contract
Does not employee any health care providers
Can be LLC or corporation
MANAGEMENT COMPANY
Provide services for one or many physicians
Cannot pay physician directly
Corporate to corporate contracts
Physician provides free collaborating services
Lease space in physician’s office
Online services
Physician participates and understands SPs
NURSING CORPORATION
No corporate protection
Cannot pay physician for collaborating services
Must have physician involved chart review and onsite evaluation
SOLO PRACTICE
Beyond the BRN
• Office of Inspector General
• National Practitioner Data Bank
Medicare/Medicaid Fraud
• Prohibited from working
HIPAA Violations
• Social Media
• In house comments
COMPLIANCE ISSUES
Antikick back statutes No reimbursement for referral
Elements of Compliance Program Written policies & procedures
Compliance professionals
Effective training
Effective Communication
Internal monitoring
Enforcement of standards
Prompt response
COMPLIANCE ISSUES
Last but one of the most important tips
Document, document, document
Electronic Medical Records
Cloning
Eprescribing
Where did my documentation go?
COMPLIANCE ISSUES
March 23, 2015 Sacramento
Supports IOM
Suggests legal monitoring of reviewers
Will it pass?
SUNSET REVIEW REPORT
Sen. Ed Hernandez (D-West Covina) and Assembly
member Susan Eggman (D-Stockton) have introduced legislation that will grant full practice authority to nurse practitioners in California, joining 20 other states and the District of Columbia as jurisdictions that permit NPs to practice to the full extent of their education, experience and expertise
SB 323
Covers NP for disciplinary actions as well as mal
Allows NP to have own lawyer to negotiate terms
Occurrence policy covers you after you leave a job
CANP endorses Nurses Service Organization
First insurance company to offer NPs insurance
Have advisory board comprised of NPs, faculty and RN leaders
Listen to NPs
NECESSITY OF OWN INSURANCE
Attorney interview
• Ask about experience
• Check out credentials
• Background representing NPs
Discussion of fees and costs • Accept insurance
• Fees beyond insurance
Mitigating evidence/witnesses for defense • Everything is confidential with your attorney
BASIC PRINCIPLES IN REPRESENTATION
Expert witnesses
• Credentials
• Forensics
Dialogue with prosecuting attorney/investigator
Preparing for the hearing
Preparing the for the outcome
• Settlements
• Administrative ruling/boards ruling
BASIC PRINCIPLES IN REPRESENTATION
QUESTIONS????