Basic Standards Legal Issues

Michael D. Adelman, D.O.

Major Consideration

Avoid Law Suits!

Legal Briefs!

Most Law Suits Arise From:

Failure to follow process Interpretation of unclear standards Requiring standards that are impossible

to achieve

Failure To Follow Process Evaluating one program differently than

another when both have the same deficiencies• Program in New York has deficiency in number of cases a

resident sees per week and also no OPP is documented. Given two year accreditation

• Program in Cleveland has same deficiencies but is given 3 year accreditation

Using a different set of standards when evaluating a program

• Program has been using Yr. 2000 standards• New standards come out in January of 2002• Program is evaluated in April 2002 based on new

standards

Failure To Follow Process

• Remember: You can’t change the standards and evaluate a program on these new standards without allowing sufficient time for a program to meet the standards.

• How Much Time?• It depends on the changes in standards

• 1 Month for resident work hours

• 6 Months for evaluation standards

• 12-24 months for new rotation requirements

Interpretation Of Unclear Standards

“The goals of an emergency medicine residency program are to…– Prepare the resident to meet certification

requirements of the AOA through the AOBEM”

• Does this mean that if a resident doesn’t pass the certification test he can sue the program because they did not meet this goal set forth in the basis standards? Can he sue the specialty college or AOA since they accredited the program?

Interpretation Of Unclear Standards

“Emergency medicine residency program shall prepare the resident to…Demonstrate proficiency in the psychomotor skills required of a competent emergency physician.”

• How? How is the program supposed to document this? What PROCESS is followed to assess the resident? Is the Process different in different EM Programs? This becomes a MAJOR problem if it is claimed that the resident doesn’t meet the standards!

Interpretation Of Unclear Standards

Different evaluators may interpret standards differently• Institutional Requirements (std I): “The institution must ..have an

organized department/section of emergency medicine which must provide evidence that there is a review of the quality of care provided by all..”

The institution has a division of Specialty Medicine. The EM docs meet with this group and various chart reviews, [including EM], to evaluate quality standards are discussed within this meeting.

• One program evaluator cited a hospital with this structure for failing to meet the standard.

• At a different hospital, another program evaluator, noting that this committee meets the “spirit of the standard” gave the program full credit.

Requiring Standards That Are Impossible To Achieve

“All Family Practice Residents will spend at least two months in an in-patient pediatric rotation” AND “ All Family Practice Residents must maintain a continuity care FP clinic 4 days a week.”

• If the in-patient Peds has to take place at a children’s hospital in another city, there is no way that the resident can also maintain a 4-day a week FP continuity clinic at the same time.

Requiring Standards That Are Impossible To Achieve

Review standards for conflicts Residents are employees—review employee

law and workforce regulations prior to writing standards about work hours, leave of absence issues and contracts.

Review Health Care Law prior to writing patient treatment standards (eg EMTALA-Emergency Medical Treatment And Labor Act)

• Create a Standard process

• Follow that Process

• Write clear unambiguous standards

• Train All evaluators to interpret the standards

precisely the same way

• Review all standards to make sure they do not

conflict with each other or with federal laws