health care law and legislation week 5

Chapter 17

Legal Reporting Requirements

LEARNING OBJECTIVES

• Describe various forms of child abuse, how to recognize it, and reporting requirements.

• Describe various forms of elder abuse, how to recognize it, and reporting requirements.

• Discuss the importance of reporting births and deaths.

• Explain why it is important to report communicable diseases, adverse drug reactions, and infectious diseases.

LEARNING OBJECTIVES - II

• Explain how and why physician incompetency is reported.

• Understand the importance of incident reporting, sentinel events and the purpose of “root cause analyses.”

• Describe the elements of an effective corporate compliance program.

Child Abuse

A child is one who has suffered intentional serious mental, emotional, sexual, and/or physical injury inflicted by a family or other person responsible for the child's care. Some states extend the definition to include a child suffering from starvation.

Child Abuse – II

• Reporting Child Abuse

• Detecting Abuse

– Physical Signs

• bruises

• burns

• broken bones

Child Abuse – III

• Behavioral Indicators

– diminished psychological & intellectual functioning

– failure to thrive

– no control of aggression

– self-destructive impulses

– decreased ability to think & reason

– acting out & misbehavior

– habitual truancy

Good Faith Reporting

• Reasonable cause to believe injuries not accidental.

• Professional not acting in bad faith to injure another in filing an abuse report.

• Psychologist Immune from Liability

Failure to Report Child Abuse

• Psychologist

– failure to report past abuse

• Nurse

– failure to document and report

• Physician

– Text Case: Entitled to Immunity

Elder Abuse Signs of Abuse – I

• Unexplained or unexpected death • Development of "pressure sores“ • Heavy medication & sedation used in place of

adequate nursing staff • Occurrence of broken bones • Sudden emotional outbursts, agitation, or

withdrawal • Bruises, welts, discoloration, burns, etc. • Absence of hair and/or hemorrhaging below scalp • Dehydration/malnourishment without illness • Hesitation to talk openly

Elder Abuse Signs of Abuse – II

• Implausible stories • Unusual or inappropriate activity in bank accounts • Signatures on checks & other written materials that

do not resemble patient's signature • Recent legal changes or creation of a will, when

person is incapable of making such decisions • Missing personal belongings, including jewelry • An untreated medical condition • Patient unable to speak for himself or herself, or see

others, without presence of caregiver/suspected abuser

Documenting Abuse – I

• Caregivers

– record symptoms and condition

• Witnesses

– record information provided by witnesses

• Photographs

– photograph injuries

– Preserve the evidence

– use of rape kits

Documenting Abuse – II

• Suspected abuse should be defined clearly & objectively.

• Witnesses: Reporters of abuse must describe statements made by others as accurately as possible

– what actions were taken, by whom, when, where, etc.

– Info should be included about how witnesses may be contacted.

Documenting Abuse – III

• Photographs: It may be necessary to photograph wounds or injuries.

– hospital emergency room or the police department can be asked to photograph in emergency situations.

Births & Deaths

• Reportable by statute

• Necessary to maintain accurate census records

• Suspicious Deaths

Suspicious Deaths

• Referral to medical examiner

• Violent deaths

• Criminal activity

• Medical Examiner

• Determines cause of death

• Provides information for criminal investigation

Communicable Diseases

• Reported to protect citizens from infectious diseases

• Reporting required by statutes

Adverse Drug Reactions

• harmful reactions that occur as a result of administration of a drug or combination of drugs

• Report adverse drug reactions to the FDA

– FDA https://www.accessdata.fda.gov

– FDA, 10903 New Hampshire Avenue Silver Spring, MD 20993

– 800-332-1088 or 888-463-6332

HOSPITAL-ACQUIRED INFECTIONS

• 2006, Archives of Internal Medicine

– up to 98,000 deaths annually

• Approximately 30 states have requirements to report infections

• 2010 PPAHCA requires acute care hospitals to report hospital-acquired infections or be subjected to reduction in Medicare reimbursement.

Physician Competency

• Health Care Quality Improvement Act of 1986

–Authorizes National Practitioner Data Bank to collect & release information on competence & conduct of health care practitioners.

National Practitioner Data Bank

• Reporting requirements

• Required queries

– Medical Staff Privileges

• Who should report?

• Data bank queries

• Confidentiality of data bank information

Incident Reporting

• Hospital Incident Reports

– do not place in patient’s record

– direct reports to legal counsel to help prevent discovery

• State Reportable Incidents

– defined by state law/regulations

• Infections

• patient injuries

• Failure to Report

JCAHO Reportable Sentinel Events

• Events that result in an unanticipated death or major permanent loss of function

• Sentinel Events include

– Suicide

– Unanticipated death of a full term infant

– Infant abduction

– Rape

– Hemolytic transfusion reaction

– Wrong site surgery

JCAHO Reportable Reporting Sentinel Events

• http://jointcommission.org/

• The Joint Commission, One Renaissance Blvd.
Oakbrook Terrace, IL 60181

• Washington DC Office, 601 13th Street, NW
Suite 560 South, Washington, DC 20005

• Phone: 630-792-5800

• Fax number: 630-792-5005

Root Cause Analysis – I

A process for identifying the basic or causal factors that underlie the variation in performance including the occurrence or possible occurrence of a sentinel event.

Root Cause Analysis – II

• Thorough

• Credible

• Investigation involves general & special causes

• Researching literature

• Searching for best practices

• . . . implementing & monitoring change

REVIEW QUESTIONS – I

1. What is child abuse?

2. Who should report child abuse?

3. Describe the signs of elder abuse.

4. Why was the HCQIA of 1986 enacted?

5. Describe the purpose of the National Practitioner Data Bank.

6. What is a sentinel event?

7. Discuss the process of conducting a root-cause analysis.