Florida Court Agrees With University of Miami, Tosses Medical Malpractice Suit

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 28, 2020, a Florida appeals court tossed out a medical malpractice suit accusing a University of Miami doctor of providing negligent treatment at a public teaching hospital. A panel of the Florida Third District Court of Appeal upheld a circuit judge’s ruling that the university is protected by sovereign immunity when faculty members provide care at Jackson Memorial Hospital, a teaching hospital.


Background of the Suit.

The ruling arose out of a case in which a University of Miami physician provided treatment in 2013 to a patient at Jackson Memorial. A medical malpractice lawsuit was filed against parties including Jackson Memorial, the university, and the physician. The suit alleged that a failure to provide anticoagulants resulted in disabilities.

Jackson Memorial Hospital is owned and operated by Miami-Dade County through the Public Health Trust. It is supported by Miami-Dade County residents through a portion of the county’s sales tax. Because of this, it is considered to be the same as a state agency, and its employees have the same sovereign immunity as state employees do.

The judge dismissed the suit against the doctor, saying that because the doctor provided services at the public teaching hospital, pursuant to the University’s agreement with Jackson Memorial, he should be considered an agent of the hospital. Therefore, he is entitled to sovereign immunity.

Pointing to state law and an agreement with Jackson Memorial, the university also argued that it was shielded by immunity from liability. The university claimed it was entitled to immunity under Sections 768.28(9)(a) and (10)(f), Florida Statutes. Since any liability the university had would be vicarious liability based on the alleged negligence of the physician, if the physician was determined to be immune, the university would have the same defense.

Additionally, Section 768.28, Florida Statutes, was amended by the Florida Legislature in 2011 to cover nonprofit independent universities that provide patient care at government-owned teaching hospitals. The same year, Jackson Memorial and Miami University amended the terms of their agreement to incorporate the amended sovereign immunity statute, according to the judge’s opinion in the case.

The Trial Court’s Ruling.

The appellate court panel agreed with the circuit judge, saying it was undisputed that the doctor was a University of Miami faculty member and employee at the time of the treatment. Additionally, the agreement between Jackson Memorial and the University of Miami was properly redrafted in 2011 to reflect the amendment to the statute. “Under the terms of the 2011 agreement and section 768.28, Florida Statutes, the university is immune from suit here because the physician treated the patient while acting as Jackson’s statutory agent,” the appellate panel said in the opinion.

Click here to read the court’s opinion in full.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in prosecuting and in defending complex civil litigation in state and federal courts. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

To contact The Health Law Firm please call (407) 331-6620 or Toll-Free: (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

“State Appeals Court: University Of Miami Shielded From Medical Malpractice Lawsuit.” Miami CBS Local. (October 28, 2020). Web.

Kang, Peter. “Fla. Court Says Univ. Of Miami Immune To Med Mal Suit.” Law360. (October 28, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Eight Tips For Academic, Disciplinary or Legal Problems with Your Residency Program

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Here are some tips to set the record straight on various inaccurate information I have heard from physicians in medical residency programs in representing them in appeals of disciplinary actions including suspension and terminations.

1. Nothing you tell your Program Director, advisor, mentors, attendings, senior resident, or co-resident is confidential. Go ahead and pour your heart out about all of your problems and concerns, but none of it is confidential, even if you said it was “in confidence.” What is confidential: what you tell your priest or religious adviser (preacher, rabbi, imam) and what you tell your own personal physician or psychotherapist (unless you have signed a waiver) that you have hired and you are paying. Anyone else, it is not confidential. So if you tell your program director you were raped when you were younger, not confidential. If you tell your senior resident you suffer from panic attacks, not confidential. You tell your attending that you had cancer ten years ago, not confidential. This applies no matter what “magic words” you attach to it.

2. Take and use whatever time period is offered to you to retain counsel and prepare. If you are given ten (10) days to file an appeal or a request for hearing, take the full ten (10) days. Do not file it on the same day. Otherwise, you are using up valuable preparation time that you cannot get back.

3. Make sure that whatever you are required to file is actually received by the due date indicated. If a request for a hearing must be filed within fifteen (15) days, that means that it must be received within the fifteen days. Check after you send it or deliver it to make sure it has been successfully received.

4. It is never too early to hire an attorney. Hire an attorney to represent and advise you at the first sign of trouble. However, you must be sure to hire an attorney who is experienced in representing residents and fellows in disputes with graduate medical education programs. An experienced attorney can help you prepare any written submissions you make, organize your response and any documents you care to submit, and otherwise assist you in identifying what is relevant and what is not relevant.

5. Always read your program’s graduate medical education (GME) manual, residency manual, due process policy or whatever handbook or manual contains your hearing and appeal rights. Be familiar with them and follow them.

6. If you are given remedial actions you must take, documents your completion of each one. Whether the requirement you must perform is in a corrective action plan (CAP), a remediation letter, or a probation letter, document your completion of it in writing and report it to whatever authority gave you the requirement. Send a courtesy copy (“cc”) to your program director.

7. Make sure any correspondence you send to anyone is complete, correct and in the form of a professional business letter. Make sure it meets all of the requirements of a professional business letter. This is especially true for rebuttals, appeals, hearing requests, etc. What, you don’t know what this is? Then go online and Google it. Your letter should look very similar to any letter you received from your program director or institution. Be sure it has all of your return contact information on it as well as a date. Do not start your letter with “Hi,” “Hello,” or “Good day.” Do place a reference (“Re:”) line or subject line on your letter that states what the subject of your letter is.

8. Do not be afraid to appeal, file a discrimination complaint or exercise any of your legal rights. Often I hear from residents, after they are already terminated from their program, that they are afraid to get a lawyer involved. I usually ask: “What are you afraid of? What is the worst that can happen? You have already been terminated.” Remember, also, that if your program retaliates against you for exercising any of your rights, that is illegal. The ACGME would like to hear about that and in almost all cases, you will then have a legal cause of action upon which you can sue the program.

Contact a Health Care Attorney Experienced in the Representation of Medical Resident Physicians, Fellows, Medical Students, Dental Students and Residents, Pharmacy Students and Residents, Mental Health Counselor Interns, and other health professionals. The attorneys of The Health Law Firm, also represent those applicants accused of irregular behavior by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), in responses, hearings and appeals, including on charges of “unprofessional conduct” and “improper behavior.”

The Health Law Firm and its attorneys have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

 

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Florida Court Sides With University of Miami, Says It’s Immune To Medical Malpractice Suit

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 28, 2020, a Florida appeals court tossed out a medical malpractice suit accusing a University of Miami doctor of providing negligent treatment at a public teaching hospital. A panel of the Florida Third District Court of Appeal upheld a circuit judge’s ruling that the university is protected by sovereign immunity when faculty members provide care at Jackson Memorial Hospital, a teaching hospital.


Background of the Suit.

The ruling arose out of a case in which a University of Miami physician provided treatment in 2013 to a patient at Jackson Memorial. A medical malpractice lawsuit was filed against parties including Jackson Memorial, the university, and the physician. The suit alleged that a failure to provide anticoagulants resulted in disabilities.

Jackson Memorial Hospital is owned and operated by Miami-Dade County through the Public Health Trust. It is supported by Miami-Dade County residents through a portion of the county’s sales tax. Because of this, it is considered to be the same as a state agency, and its employees have the same sovereign immunity as state employees do.

The judge dismissed the suit against the doctor, saying that because the doctor provided services at the public teaching hospital, pursuant to the University’s agreement with Jackson Memorial, he should be considered an agent of the hospital. Therefore, he is entitled to sovereign immunity.

Pointing to state law and an agreement with Jackson Memorial, the university also argued that it was shielded by immunity from liability. The university claimed it was entitled to immunity under Sections 768.28(9)(a) and (10)(f), Florida Statutes. Since any liability the university had would be vicarious liability based on the alleged negligence of the physician, if the physician was determined to be immune, the university would have the same defense.

Additionally, Section 768.28, Florida Statutes, was amended by the Florida Legislature in 2011 to cover nonprofit independent universities that provide patient care at government-owned teaching hospitals. The same year, Jackson Memorial and Miami University amended the terms of their agreement to incorporate the amended sovereign immunity statute, according to the judge’s opinion in the case.

The Trial Court’s Ruling.

The appellate court panel agreed with the circuit judge, saying it was undisputed that the doctor was a University of Miami faculty member and employee at the time of the treatment. Additionally, the agreement between Jackson Memorial and the University of Miami was properly redrafted in 2011 to reflect the amendment to the statute. “Under the terms of the 2011 agreement and section 768.28, Florida Statutes, the university is immune from suit here because the physician treated the patient while acting as Jackson’s statutory agent,” the appellate panel said in the opinion.

Click here to read the court’s opinion in full.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in prosecuting and in defending complex civil litigation in state and federal courts. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

To contact The Health Law Firm please call (407) 331-6620 or Toll-Free: (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

“State Appeals Court: University Of Miami Shielded From Medical Malpractice Lawsuit.” Miami CBS Local. (October 28, 2020). Web.

Kang, Peter. “Fla. Court Says Univ. Of Miami Immune To Med Mal Suit.” Law360. (October 28, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Eight Legal Tips If You Are Having Academic, Disciplinary or Problems with Your Residency Program

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Here are some tips to set the record straight on various inaccurate information I have heard from physicians in medical residency programs in representing them in appeals of disciplinary actions including suspension and terminations.

1. Nothing you tell your Program Director, advisor, mentors, attendings, senior resident, or co-resident is confidential. Go ahead and pour your heart out about all of your problems and concerns, but none of it is confidential, even if you said it was “in confidence.” What is confidential: what you tell your priest or religious adviser (preacher, rabbi, imam) and what you tell your own personal physician or psychotherapist (unless you have signed a waiver) that you have hired and you are paying. Anyone else, it is not confidential. So if you tell your program director you were raped when you were younger, not confidential. If you tell your senior resident you suffer from panic attacks, not confidential. You tell your attending that you had cancer ten years ago, not confidential. This applies no matter what “magic words” you attach to it.

2. Take and use whatever time period is offered to you to retain counsel and prepare. If you are given ten (10) days to file an appeal or a request for hearing, take the full ten (10) days. Do not file it on the same day. Otherwise, you are using up valuable preparation time that you cannot get back.

3. Make sure that whatever you are required to file is actually received by the due date indicated. If a request for a hearing must be filed within fifteen (15) days, that means that it must be received within the fifteen days. Check after you send it or deliver it to make sure it has been successfully received.

4. It is never too early to hire an attorney. Hire an attorney to represent and advise you at the first sign of trouble. However, you must be sure to hire an attorney who is experienced in representing residents and fellows in disputes with graduate medical education programs. An experienced attorney can help you prepare any written submissions you make, organize your response and any documents you care to submit, and otherwise assist you in identifying what is relevant and what is not relevant.

5. Always read your program’s graduate medical education (GME) manual, residency manual, due process policy or whatever handbook or manual contains your hearing and appeal rights. Be familiar with them and follow them.

6. If you are given remedial actions you must take, documents your completion of each one. Whether the requirement you must perform is in a corrective action plan (CAP), a remediation letter, or a probation letter, document your completion of it in writing and report it to whatever authority gave you the requirement. Send a courtesy copy (“cc”) to your program director.

7. Make sure any correspondence you send to anyone is complete, correct and in the form of a professional business letter. Make sure it meets all of the requirements of a professional business letter. This is especially true for rebuttals, appeals, hearing requests, etc. What, you don’t know what this is? Then go online and Google it. Your letter should look very similar to any letter you received from your program director or institution. Be sure it has all of your return contact information on it as well as a date. Do not start your letter with “Hi,” “Hello,” or “Good day.” Do place a reference (“Re:”) line or subject line on your letter that states what the subject of your letter is.

8. Do not be afraid to appeal, file a discrimination complaint or exercise any of your legal rights. Often I hear from residents, after they are already terminated from their program, that they are afraid to get a lawyer involved. I usually ask: “What are you afraid of? What is the worst that can happen? You have already been terminated.” Remember, also, that if your program retaliates against you for exercising any of your rights, that is illegal. The ACGME would like to hear about that and in almost all cases, you will then have a legal cause of action upon which you can sue the program.

Contact a Health Care Attorney Experienced in the Representation of Medical Resident Physicians, Fellows, Medical Students, Dental Students and Residents, Pharmacy Students and Residents, Mental Health Counselor Interns, and other health professionals. The attorneys of The Health Law Firm, also represent those applicants accused of irregular behavior by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), in responses, hearings and appeals, including on charges of “unprofessional conduct” and “improper behavior.”

The Health Law Firm and its attorneys have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

 

New Policy Changes to USMLE Exams and How They Impact Medical Students, Graduates

Attorney Achal A. Aggarwal HeadshotBy Achal A. Aggarwal, J.D.

The United States Medical Licensing Examination (“USMLE”) is a three-step examination required to obtain a medical license. It is written and administered by the USMLE Secretariat of the National Board of Medical Examiners (“NBME”) and is sponsored by the Federation of State Medical Boards (“FSMB”) and the USMLE.

Medical students desiring to practice in the U.S. are under immense pressure to not only pass the exams but to excel at them. Specifically, the USMLE Step 1 Examination, the USMLE Step 2 Clinical Knowledge (“CK”) Examination, and the USMLE Step 2 Clinical Skills (“CS”) Examination are the most significant deciding factors that residency programs use for selecting applicants to interview for residency positions. However, a lot is about to change.


Important Changes That Could Affect You.

On February 12, 2020, the FSMB and the NBME announced the following policy changes:

1. The Step 1 Exam will be changed to pass/fail grading;

2. The number of examination attempts for each exam will be reduced from six (6) to four (4); and

3. All examinees must pass the Step 1 Exam before taking the Step 2-CS Exam.


Changing the Step 1 Exam to Pass/Fail.

The USMLE has announced that it will change the Step 1 exam’s grading system from a three-digit score to a pass/fail grading system. This change will go into effect on January 1, 2022.  A statement published on the website states that changing to pass/fail could help reduce some of the current overemphasis on USMLE performance while also retaining the ability of medical licensing authorities to use the exam for its primary purpose of medical licensure eligibility. Click here to visit the USMLE website and read the statement.

It appears that USMLE, FSMB, NBME, and the American Medical Association (AMA) are attempting to alleviate the stress and pressure the Step 1 exam puts on medical students. However, this change may cause issues for residency programs that are trying to screen for which students they want to interview.

In the current system, the Step 1 score is a three-digit score that is graded on a bell-curve. The minimum passing score for each Step 1 exam is different and depends on the performance of the total universe of the students who take that particular examination.

The three-digit score helps residency programs assess which students were more likely to excel in their program and which students would not. By changing the exam to a pass/fail scoring system, residency programs will be forced to rely more heavily on the Step 2-CK scores, medical school performance, and overall curriculum vitae.


Greater Emphasis to Be Placed on Step 2-CK Exam.

Currently, the Step 2-CK exam is only the fourth-most deciding factor in how residency programs select applicants for interviews. Approximately 80% of residency program directors stated that it was an important factor, but not the most.

On the other hand, the Step 2-CS exam score is a less influential factor, with only 56% of residency program directors saying that it was essential to their decision. Students should anticipate that the Step 2-CK and Step 2-CS will become more important as program directors shift their attention to the scores of those exams.

For more information click here.

What remains to be seen is how these changes will impact international medical graduates (“IMG”), commonly referred to as “foreign medical graduates.” To distinguish themselves, IMGs often tried to get the highest possible USMLE score, as this was the most objective way for them to be compared to other U.S. medical school students.

Since each domestic and international medical school has its own unique clinical grading system, the USMLE Step 1 was one of the most objective ways to compare residency applicants. Now that Step 1 scoring has been eliminated, it might be harder for IMGs to make themselves attractive to competitive residency programs.

Reducing Overall Exam Attempts from Six to Four.

Additionally, the USMLE is changing the limit on the total number of times an examinee may take the same Step exam from six (6) attempts to four (4) attempts. This means that after the policy is implemented, it will be ineligible to take a Step exam if the examinee has made four (4) prior attempts on that Step exam, including incomplete attempts.

The policy is set to be implemented on July 1, 2021. Learn more about the policy here.

Examinees Must Pass Step 1 Before Taking Step 2-CS.

Although the USMLE has suspended the Step 2-CS exam administration at the present time because of the COVID-19 pandemic, it is set to implement a rule requiring all examinees to pass the Step 1 exam before qualifying to take the Step 2-CS exam.

Implementing such a rule would reduce the USMLE’s burden of administering the Step 2-CS exam multiple times since students will be required to qualify for the exam. Students can currently take the Step 1 exam, Step 2-CS exam, and Step 2-CK exam in any order they choose, depending on the requirements of their medical school. This new rule seeks to shift that burden by funneling students through the Step 1 exam.

The impact of such a change remains to be seen, however, we anticipate that this policy will reduce the testing burden on the USMLE while also maintaining the importance of the Step 1 exam despite changing its scoring to pass/fail.

It does represent a complete shake-up in how the system of testing has previously been administered.

Tips for the New Rules.

The following are suggestions we have concerning the new rules:

1. Take the Step 1 Exam as soon as you can, and begin preparing for the others.

2. Always treat every test administration extremely seriously, as though your future life and career depend on it; they do!

3. Take maximum advantage of commercial preparation courses and always try to take one of the recommended live ones before you take your examination.

4. Take off several weeks prior to the examination and find a hotel within walking distance of the test site where you will take the examination to study. Get rid of all distractions while studying for and immediately prior to taking the examination.

5. Never solicit actual test content or offer to share it with someone else.

For additional common-sense tips on preparing for and taking the USMLE Step exams, see another blog on this subject here.


Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG)

The Health Law Firm and its attorneys represent interns, residents, fellows, and medical school students in disputes with their medical schools, supervisors, residency programs, and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”

To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: Achal A. Aggarwal, M.B.A., J.D. practice health law with The Health Law Firm, which has a national practice.  Its main office in the Orlando, Florida area.   1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714
Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.  Its regional office is in the Northern Colorado, area. 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456.  www.TheHealthLawFirm.com

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Eight Legal Tips If You Are Having Academic, Disciplinary or Legal Problems with Your Residency Program

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Here are some tips to set the record straight on various inaccurate information I have heard from physicians in medical residency programs in representing them in appeals of disciplinary actions including suspension and terminations.

1. Nothing you tell your Program Director, advisor, mentors, attendings, senior resident, or co-resident is confidential. Go ahead and pour your heart out about all of your problems and concerns, but none of it is confidential, even if you said it was “in confidence.” What is confidential: what you tell your priest or religious adviser (preacher, rabbi, imam) and what you tell your own personal physician or psychotherapist (unless you have signed a waiver) that you have hired and you are paying. Anyone else, it is not confidential. So if you tell your program director you were raped when you were younger, not confidential. If you tell your senior resident you suffer from panic attacks, not confidential. You tell your attending that you had cancer ten years ago, not confidential. This applies no matter what “magic words” you attach to it.

2. Take and use whatever time period is offered to you to retain counsel and prepare. If you are given ten (10) days to file an appeal or a request for hearing, take the full ten (10) days. Do not file it on the same day. Otherwise, you are using up valuable preparation time that you cannot get back.

3. Make sure that whatever you are required to file is actually received by the due date indicated. If a request for a hearing must be filed within fifteen (15) days, that means that it must be received within the fifteen days. Check after you send it or deliver it to make sure it has been successfully received.

4. It is never too early to hire an attorney. Hire an attorney to represent and advise you at the first sign of trouble. However, you must be sure to hire an attorney who is experienced in representing residents and fellows in disputes with graduate medical education programs. An experienced attorney can help you prepare any written submissions you make, organize your response and any documents you care to submit, and otherwise assist you in identifying what is relevant and what is not relevant.

5. Always read your program’s graduate medical education (GME) manual, residency manual, due process policy or whatever handbook or manual contains your hearing and appeal rights. Be familiar with them and follow them.

6. If you are given remedial actions you must take, documents your completion of each one. Whether the requirement you must perform is in a corrective action plan (CAP), a remediation letter, or a probation letter, document your completion of it in writing and report it to whatever authority gave you the requirement. Send a courtesy copy (“cc”) to your program director.

7. Make sure any correspondence you send to anyone is complete, correct and in the form of a professional business letter. Make sure it meets all of the requirements of a professional business letter. This is especially true for rebuttals, appeals, hearing requests, etc. What, you don’t know what this is? Then go online and Google it. Your letter should look very similar to any letter you received from your program director or institution. Be sure it has all of your return contact information on it as well as a date. Do not start your letter with “Hi,” “Hello,” or “Good day.” Do place a reference (“Re:”) line or subject line on your letter that states what the subject of your letter is.

8. Do not be afraid to appeal, file a discrimination complaint or exercise any of your legal rights. Often I hear from residents, after they are already terminated from their program, that they are afraid to get a lawyer involved. I usually ask: “What are you afraid of? What is the worst that can happen? You have already been terminated.” Remember, also, that if your program retaliates against you for exercising any of your rights, that is illegal. The ACGME would like to hear about that and in almost all cases, you will then have a legal cause of action upon which you can sue the program.

Contact a Health Care Attorney Experienced in the Representation of Medical Resident Physicians, Fellows, Medical Students, Dental Students and Residents, Pharmacy Students and Residents, Mental Health Counselor Interns, and other health professionals. The attorneys of The Health Law Firm, also represent those applicants accused of irregular behavior by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), in responses, hearings and appeals, including on charges of “unprofessional conduct” and “improper behavior.”

The Health Law Firm and its attorneys have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

 

Legal Tips If You Are Having Academic, Disciplinary or Legal Problems with Your Residency Program

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Here are some tips to set the record straight on various inaccurate information I have heard from physicians in medical residency programs in representing them in appeals of disciplinary actions including suspension and terminations.

1. Nothing you tell your Program Director, advisor, mentors, attendings, senior resident, or co-resident is confidential. Go ahead and pour your heart out about all of your problems and concerns, but none of it is confidential, even if you said it was “in confidence.” What is confidential: what you tell your priest or religious adviser (preacher, rabbi, imam) and what you tell your own personal physician or psychotherapist (unless you have signed a waiver) that you have hired and you are paying. Anyone else, it is not confidential. So if you tell your program director you were raped when you were younger, not confidential. If you tell your senior resident you suffer from panic attacks, not confidential. You tell your attending that you had cancer ten years ago, not confidential. This applies no matter what “magic words” you attach to it.

2. Take and use whatever time period is offered to you to retain counsel and prepare. If you are given ten (10) days to file an appeal or a request for hearing, take the full ten (10) days. Do not file it on the same day. Otherwise, you are using up valuable preparation time that you cannot get back.

3. Make sure that whatever you are required to file is actually received by the due date indicated. If a request for a hearing must be filed within fifteen (15) days, that means that it must be received within the fifteen days. Check after you send it or deliver it to make sure it has been successfully received.

4. It is never too early to hire an attorney. Hire an attorney to represent and advise you at the first sign of trouble. However, you must be sure to hire an attorney who is experienced in representing residents and fellows in disputes with graduate medical education programs. An experienced attorney can help you prepare any written submissions you make, organize your response and any documents you care to submit, and otherwise assist you in identifying what is relevant and what is not relevant.

5. Always read your program’s graduate medical education (GME) manual, residency manual, due process policy or whatever handbook or manual contains your hearing and appeal rights. Be familiar with them and follow them.

6. If you are given remedial actions you must take, documents your completion of each one. Whether the requirement you must perform is in a corrective action plan (CAP), a remediation letter, or a probation letter, document your completion of it in writing and report it to whatever authority gave you the requirement. Send a courtesy copy (“cc”) to your program director.

7. Make sure any correspondence you send to anyone is complete, correct and in the form of a professional business letter. Make sure it meets all of the requirements of a professional business letter. This is especially true for rebuttals, appeals, hearing requests, etc. What, you don’t know what this is? Then go online and Google it. Your letter should look very similar to any letter you received from your program director or institution. Be sure it has all of your return contact information on it as well as a date. Do not start your letter with “Hi,” “Hello,” or “Good day.” Do place a reference (“Re:”) line or subject line on your letter that states what the subject of your letter is.

8. Do not be afraid to appeal, file a discrimination complaint or exercise any of your legal rights. Often I hear from residents, after they are already terminated from their program, that they are afraid to get a lawyer involved. I usually ask: “What are you afraid of? What is the worst that can happen? You have already been terminated.” Remember, also, that if your program retaliates against you for exercising any of your rights, that is illegal. The ACGME would like to hear about that and in almost all cases, you will then have a legal cause of action upon which you can sue the program.

Contact a Health Care Attorney Experienced in the Representation of Medical Resident Physicians, Fellows, Medical Students, Dental Students and Residents, Pharmacy Students and Residents, Mental Health Counselor Interns, and other health professionals. The attorneys of The Health Law Firm, also represent those applicants accused of irregular behavior by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), in responses, hearings and appeals, including on charges of “unprofessional conduct” and “improper behavior.”

The Health Law Firm and its attorneys have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Florida Court Sides With University of Miami, Says University Is Immune To Medical Malpractice Suit

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 28, 2020, a Florida appeals court tossed out a medical malpractice suit accusing a University of Miami doctor of providing negligent treatment at a public teaching hospital. A panel of the Florida Third District Court of Appeal upheld a circuit judge’s ruling that the university is protected by sovereign immunity when faculty members provide care at Jackson Memorial Hospital, a teaching hospital.


Background of the Suit.

The ruling arose out of a case in which a University of Miami physician provided treatment in 2013 to a patient at Jackson Memorial. A medical malpractice lawsuit was filed against parties including Jackson Memorial, the university, and the physician. The suit alleged that a failure to provide anticoagulants resulted in disabilities.

Jackson Memorial Hospital is owned and operated by Miami-Dade County through the Public Health Trust. It is supported by Miami-Dade County residents through a portion of the county’s sales tax. Because of this, it is considered to be the same as a state agency, and its employees have the same sovereign immunity as state employees do.

The judge dismissed the suit against the doctor, saying that because the doctor provided services at the public teaching hospital, pursuant to the University’s agreement with Jackson Memorial, he should be considered an agent of the hospital. Therefore, he is entitled to sovereign immunity.

Pointing to state law and an agreement with Jackson Memorial, the university also argued that it was shielded by immunity from liability. The university claimed it was entitled to immunity under Sections 768.28(9)(a) and (10)(f), Florida Statutes. Since any liability the university had would be vicarious liability based on the alleged negligence of the physician, if the physician was determined to be immune, the university would have the same defense.

Additionally, Section 768.28, Florida Statutes, was amended by the Florida Legislature in 2011 to cover nonprofit independent universities that provide patient care at government-owned teaching hospitals. The same year, Jackson Memorial and Miami University amended the terms of their agreement to incorporate the amended sovereign immunity statute, according to the judge’s opinion in the case.

The Trial Court’s Ruling.

The appellate court panel agreed with the circuit judge, saying it was undisputed that the doctor was a University of Miami faculty member and employee at the time of the treatment. Additionally, the agreement between Jackson Memorial and the University of Miami was properly redrafted in 2011 to reflect the amendment to the statute. “Under the terms of the 2011 agreement and section 768.28, Florida Statutes, the university is immune from suit here because the physician treated the patient while acting as Jackson’s statutory agent,” the appellate panel said in the opinion.

Click here to read the court’s opinion in full.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in prosecuting and in defending complex civil litigation in state and federal courts. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

To contact The Health Law Firm please call (407) 331-6620 or Toll-Free: (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

“State Appeals Court: University Of Miami Shielded From Medical Malpractice Lawsuit.” Miami CBS Local. (October 28, 2020). Web.

Kang, Peter. “Fla. Court Says Univ. Of Miami Immune To Med Mal Suit.” Law360. (October 28, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Cheating, Irregular Behavior and Other Challenges Facing Medical Students and Graduates

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The road to becoming a physician is paved with many unique challenges. The long, exhausting journey begins and students are faced with the first battle: rigorous undergraduate course work, followed by the MCAT and medical school applications. During medical school, and for some, after graduation, the USMLE (United States Medical Licensing Examination) and its STEP 1, STEP 2, and STEP 3 exams provide another hurdle in the uphill battle. At any of these stages, medical students can face a gauntlet of accusations including cheating, misrepresentation, falsification of information, unfair advantages, and the many faces under the general label of “irregular behavior.”

Challenges Prior to Entering Medical School.

Prior to medical school, pre-med students must be ambitious, inquisitive, and extra cautious about any disciplinary action. A minor blemish on a pre-med student’s academic record (from academic dishonesty or other accusations), will become a major red flag once that student begins applying. Not only will any kind of discipline record hinder a student’s chances of acceptance, but an infraction can also ruin that student’s reputation as they apply for residency and beyond.

Because the process of becoming a physician is difficult without having a discipline record, any charge against a pre-med student must be taken with the utmost seriousness. Don’t raise a white flag early on in the uphill battle!

Challenges After Medical School.

The battle continues for medical students; medical school courses and clinical rotations will be rigorous and challenging, calling on every neuron you possess to fire efficiently. You will be tested, in more ways than one. You will forget the term “MCAT” and substitute for it a new acronym–“USMLE” which stands for United States Medical Licensing Examination.

The USMLE is a four-stage examination required for medical licensure in the United States. Because the USMLE is the barrier between you and your medical license, it is an extremely important component of your medical education.

One such issue is being accused of “irregular behavior.” This broad label includes anything from cheating to disruptions during testing or soliciting information on actual examination content. In the event that your test score is held up or invalidated due to irregular behavior you will want to correct the situation immediately, or you may be prohibited from taking future exams (meaning you won’t be able to obtain your license or a residency in the U.S.). If you are accused of irregular behavior or if you feel that you were faced with inadequate testing conditions, resolving the issue may be as simple as requesting a rescoring of the examination or a retest. Sometimes, because of problems at a test site or because of technical problems, retesting is an option.

The National Board of Medical Examiners and the USMLE take all such matters concerning the administration and the security of the test contents extremely seriously. In certain cases, they have sued those they believe may have compromised actual test contents. Click here to read more about the case.

After years of schooling, don’t allow an allegation of irregular behavior to mark your test transcripts and prevent you from attaining your goals and reaping the benefits of your hard work.

To learn more about USMLE, irregular behavior, and how we can help you, click here to read one of my prior blogs.  Check our Medical Education Law Blog Regularly to stay on top of news and tips!

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows, and medical school students in disputes with their medical schools, supervisors, residency programs, and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

University of Florida Rescinds Prospect For Racist Online Post

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 8, 2020, the University of Florida (UF) reportedly announced via Twitter that it had rescinded its offer of acceptance to a prospective student. The offer was rescinded by the university because of an allegedly racist message posted by the student on social media. According to reports, UF spokesman Steve Orlando stated that the university received multiple e-mails complaining about the post. As a result of the investigation, the student is no longer a UF prospect, according to the announcement.

Social networks provide students, resident physicians, fellows, and clinical professors with opportunities for greater communication, information/experience sharing, collaborative learning, professional interactions, and outreach. However, they can also be dangerous if someone has unprofessional comments or content. Many applicants may not be aware that their social media presence may have an impact on their chances of acceptance, especially for medical students.

Although it is true that we all have a First Amendment right to freedom of speech, by getting up and making a speech that violates a school, institution, or program’s policies, you are asking for trouble. we have had cases of students and of residents getting into trouble for not only allegedly racist FaceBook and Twitter posts and re-posts, but also for “unprofessional” posts and re-posts. These include the use of profanity, racist comments, and “unprofessional” photographs. Those who are students or resident physicians typically are in an environment where there is heightened awareness of and heightened scrutiny regarding such matters. Although they must be provided with “due process of law” before they are terminated, this could be very expensive and result in unnecessary blemishes on a person’s record. If the individual making the comments, posts, or re-posts, hasn’t started yet, then they have far fewer rights and do not have any “interest” that is protectable under due process of law principles. So why take the risk?

How Social Media Can Impact Medical Students and Admissions.

On social media sites, healthcare professionals, including medical students, should always represent themselves in a manner that reflects values of professionalism, integrity, acceptance of diversity, and commitment to ethical behavior. Physicians must be aware that content posted may negatively affect their reputations among patients and colleagues. Basically, your actions online may also affect your medical career, especially for medical students.

In one recent situation, a medical student says the University of New Mexico gave him two options: change his Facebook post or get out. Click here to read more about it.

With the increase in popularity and usage of social media platforms, the American Medical Student Association (AMSA) published Guidelines for Medical Students and Physicians. Click here to read the guidelines in full.

To read about how our firm can assist medical students, residents, and graduates in a variety of legal matters, click here.

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows, and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows, and medical school students in disputes with their medical schools, supervisors, residency programs, and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Keating, Jennifer. “Social Media Guidelines for Medical Students and Physicians.” American Medical Student Association (AMSA). (September 15, 2016). Web.

Nelson, Sarah. “Florida student who wrote racist social media post won’t join UF.” Palm Beach Post. (June 10, 2020). Web.

“How Medical School Applicants Should Manage Social Media.” U.S. News. (June 11, 2018). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

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