representation for healthcare professionals

Home/Tag: representation for healthcare professionals

Florida Senate Passes New Legislature to Fix Patient Brokering Act

Attorney Amanda I. ForbesBy Amanda I. Forbes, J.D.

A new act (SB 1120) was recently passed by the Florida Senate and enacted on June 18, 2020, with an effective date of July 1, 2020. SB1120 restored the Florida Patient Brokering Act to its original wording to correct a big glitch made when the Legislature previously amended it. On June 27, 2019, there was an amendment enacted by the Florida Legislature that changed the Florida Patient Brokering Act, Section 817.505, Florida Statutes. It became effective on July 1, 2019. The amendment changed Section 817.505(3)(a), Florida Statutes.

The original wording of the statute stated:

(3) This section shall not apply to the following payment practices:
(a) Any discount, payment, waiver of payment,
or payment practice not prohibited
by 42 U.S.C. s. 1320a-7b(b) or
regulations promulgated thereunder.”

Section 817.503(3)(a). (Emphasis added).

The new amendment to the Florida Patient Brokering Act stated:

(3) This section shall not apply to the following payment practices:
(a) Any discount, payment, waiver of
payment, or payment practice expressly
authorized by” 42 U.S.C. s. 1320a-7b(b)(3) or
regulations adopted thereunder.”

Section 817.505(3)(a). (Emphasis added)

This Federal law exemption had previously been relied on to avoid the Florida statute’s criminal prohibitions, particularly, by health law attorneys advising their clients on proposed business ventures. The most immediate problem with the amendment was that there are no “discounts, payments waivers of payment or payment practices” that are “specifically approved” by the federal statute.

Rather than provide clarification, the amendment only created confusion. The Federal Anti-Kickback Statute (42 U.S.C. Section 1320a-7b(b)) does not “expressly authorize” any exception or safe harbor. The amended language caused confusion regarding whether an arrangement must qualify for safe harbor protection under the Federal anti-kickback statute in order to be legal under Florida law. Therefore, the amendment went from a state law that was similar to and cohesive with the federal statute to one which was much stricter than the federal law and prohibited many current business arrangements.

When there is no safe harbor, the arrangement is evaluated by its intent. The Florida Fourth District Court of Appeal recently confirmed that the Patient Brokering Act is a “general intent” statute. This means that an individual only needs to intend to commit the act prohibited by the statute (e.g. paying for referrals), as opposed to intending to specifically violate the Patient Brokering Act. See State v. Kigar, 279 So. 3d 217 (Fla. 4th DCA 2019)

The bill (SB1120) was passed by the Florida Senate and enacted on June 19, 2020, with an effective date of July 1, 2020. SB1120 restored the Florida Patient Brokering Act to its original wording.

View the bill in full here.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

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

About the Author: Amanda I. Forbes, practices health law with The Health Law Firm in its Altamonte Springs, Florida, office. Its main office is in 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.

KeyWords: Representation for healthcare professionals, representation for healthcare compliance, representation for healthcare facilities, healthcare facility defense lawyer, healthcare compliance defense attorney, healthcare license defense attorney, Complex Healthcare Litigation, complex healthcare litigation defense lawyer, Complex Business Litigation, Complex Commercial Litigation, Class Action Litigation, medical regulatory defense lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2020 The Health Law Firm. All rights reserved.

Emotional Support Animals and Protecting Your License, Pitfalls and Tips, Part 2 of 2

Amanda I. Forbes, J.D.By Amanda I. Forbes, J.D.; and George F. Indest III, J.D., M.P.A., LL.M., Board Certified in Health Law

This is part 2 of 2 in a blog series regarding Emotional Support Animals (ESA) support letters being prepared by counselors and therapists. There are serious pitfalls that exist for the unwary mental health professional and, in part 1, we provided a number of tips on how to avoid these. Click here to read part 1.

The ACA has identified specific potential risks to animals, clients, the public, and counselors which everyone involved in this area of practice should be familiar with.

Potential Risks to Animals:

1. Neglect or other abuse; poor mental health on the part of the client may prevent adequate animal care or may promote neglect or abuse.

2. Undue stress may occur to the animal from constant work during accompaniment, including being placed in stressful environments.

3. The animal may suffer undue stress from being handled by a person who does not have specialized training.

4. The animal may suffer an illness, undue stress, or injury from public interactions.

Possible Risks to Clients:

1. Inadequate treatment of a mental health disorder.

2. Injury or property damage from an inadequately trained or socialized animal.

3. Zoonotic infection or disease.

4. Animal allergies in the client, the client’s family, and the client’s associates.

5. Potential fraud or legal concerns if an ESA is misrepresented as a service animal.

6. Financial and emotional burdens due to potential behavior problems associated with inadequately trained and socialized companion animals.

7. Misconception that a relationship with an ESA replaces or substitutes for professional mental health care or human relationships (especially the latter).

Potential Risk to the Public:

1. Injury or emotional damage from inadequately trained animals.

2. Untrained or improperly socialized animals may be more likely to be stressed out or aggressive in public.

3. Unsocialized animals may be disruptive and interfere with normal activities such as group functions, public travel, public dining.

4. Maladaptive interactions with other animals (especially toward service animals)

5. Zoonotic infection or disease from animals.

6. Animal allergies and phobias (yes, some regular people have phobias against dogs, cats, snakes, weasels, alligators, and monkeys).

7. They may contribute to public skepticism, which hurts those with valid helper animals (e.g., someone who has a full-size alligator that she claims is her emotional support animal and takes it everywhere she goes).

8. The more unsuitable the animal, the greater the risk (i.e., exotic pet, undomesticated or wild animal).

9. When more fraudulent animals have greater public access, the more public risk is incurred.

Risks to the Counselor Who Certifies or Approves an Emotional Support Animal:

1. Liability for adverse client outcomes due to inadequate or substandard treatment.
2. Potential provider role conflicts: Forensic v. Counseling.
3. Potential liability for injury/illness caused by the animal to the client or others.
4. Potential charges of fraud if an inadequate evaluation is done to demonstrate the need for the animal, or if performed in the absence of actual supporting facts, or if performed for a fake client who is just making up everything.
5. Disciplinary action taken against your professional license by your licensing board for any of the above.
6. Ethical considerations for inadequate education about ESAs and their role in comprehensive treatment. Potential to be called to testify if the ESA is challenged or if an incident occurs.

Click here for more information.

An additional potential risk that the ACA did not address was the possibility of disciplinary action against your license by your professional board. The reasons for such an action could possibly be from a failure to establish a proper client relationship prior to writing an ESA recommendation letter. It is important to keep these potential risks in mind when determining whether to write an ESA recommendation letter.

Don’t forget to read part 1 of this blog series for more information.

Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers, and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, social workers, and family therapists in Department of Health (DOH) investigations, FBI investigations, and other types of investigations of health professionals and providers. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. If allowed, we will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company.

We also defend health professionals and health facilities in general litigation matters and business litigation 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 Authors: Amanda I. Forbes, practices health law with The Health Law Firm in its Altamonte Springs, Florida, office. George F. Indest III, J.D., M.P.A., LL.M., is Board Certified in Health Law by The Florida Bar and is licensed in Louisiana, Florida, and the District of Columbia. He is President and Managing Partner of The Health Law Firm. Its main office is in 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.

KeyWords: Representation for healthcare professionals, representation for healthcare compliance, representation for healthcare facilities, healthcare facility defense lawyer, healthcare compliance defense attorney, healthcare license defense attorney, Complex Healthcare Litigation, complex healthcare litigation defense lawyer, Complex Business Litigation, Complex Commercial Litigation, Class Action Litigation, medical regulatory defense lawyer, representation for licensed mental health counselors (LMHCs), mental health counselor defense lawyer, licensed professional counselor (LPC) defense attorney lawyer, mental health counselor legal representation, licensed professional counselor (LPC) legal representation, social worker defense lawyer, representation for social workers, social worker defense attorney, social worker complaint cases, Florida Colorado Louisiana mental health counselor complaint cases, defense lawyer for psychologists, Florida health law defense attorney, medical license defense, Florida Department of Health (DOH) attorney, representation for Louisiana and Florida Department of Health (DOH) complaint investigations, Louisiana and Florida Department of Health (DOH) defense lawyer, Colorado Division of Regulatory Agencies (DORA) defense attorney, representation for Florida Colorado Division of Regulatory Agencies (DORA) complaint investigations, Colorado Division of Regulatory Agencies (DORA) defense lawyer, Lousiana LPC Board defense attorney lawyer, Health Law Firm reviews, reviews of The Health Law Firm attorneys, administrative complaint defense lawyer, administrative complaint defense attorney, administrative hearing defense lawyer, administrative hearing defense attorney, administrative hearing defense legal counsel, representation for health care professionals

“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 © 2020 The Health Law Firm. All rights reserved.

By |2020-10-01T17:18:25-04:00October 5th, 2020|Categories: In the News, Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Certifying Emotional Support Animals and Protecting Your License, Part 1 of 2

Attorney Amanda I. ForbesBy Amanda I. Forbes, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified in Health Law

In today’s stress-filed world if you are a mental health counselor or other professional counselor, it is likely that you will encounter a client seeking to obtain an Emotional Support Animal (ESA)
designation letter from you. Providing such a letter may cause you to face complaints, licensing, and disciplinary actions driven by hostile landlords, homeowners associations, and business establishments that do not want any sort of animals on their premises. Often cases wind up in civil litigation. The client may also try to retaliate against you, should the client be the victim of legal problems because of attempting to keep an ESA and not understanding the legal ramifications.

However, you, as an experienced, licensed mental health professional must know what to do and not to do to protect your license and your career.

This is part 1 of 2 in a blog series regarding Emotional Support Animals. Stay tuned for part two. We also intend to do a follow-up blog series on working animals and how they are legally distinguished from ESAs.

Here are some tips to keep in mind should you decide to provide an ESA recommendation letter:

1. You must develop and document a properly established therapist-client relationship with the client prior to writing a recommendation–do whatever you would normally do for any other client seeking your help who walks in the door.

2. Confirm the actual, true identity of the client to be sure you know with whom you are dealing. Request and obtain at least two different forms of photo ID, one including a driver’s license for the equivalent. Check and verify the name and address on the Internet or with directory assistance. (I have a personal rule of thumb: “If you can’t find a person on the Internet, then he is a fake and does not exist”).

3. Obtain the client’s complete mental health history and medical history, requesting and obtaining other treater’s records just as you would do for any other client/patient.

4. If the client has been referred to you by another provider, especially one in a different medical or health specialty, request a written referral documenting the need for the referral to you.

5. Adequately and thoroughly make and document any decision that an ESA will benefit the client and help in treating any mental health symptoms. Be thorough and document it.

6. Assign a code from the Diagnostic and Statistical Manual, ed. 5 (DSM-5 ), to the patient, or obtain one from the patient’s regular treating psychiatrist, psychologist, or mental health therapist.

7. The most important element involved is to show that there is an actual medical necessity for the client to have an ESA or that there will be a therapeutic benefit for the client to have the ESA. If you cannot justify and document this, then do not approve the request.

8. Evaluate the ESA, preferably by an in-person meeting or tele-health conference, and determine that it will benefit the client, be sure to document this evaluation and comment on the weight, height, aggressiveness, and character of the ESA. It is most helpful to have a form the ESA’s veterinarian will complete, sign, and return to you for confirmation of this information and, perhaps, an indication that the animal is suitable in character. Keep this in your record.

9. Thoroughly document the above in your chart on the client.

10. Have a thorough knowledge of your state’s laws and professional licensing board’s regulations concerning ESAs. You might review past disciplinary cases in which counselors have received discipline relating to ESAs in your state.

Warning About Organizations that Target Mental Health Counselors, Psychoanalysts, and Professional Counselors Who Approve Emotional Support Animals.

Those mental health counselors, social workers, professional counselors, and therapists who are involved in the certification or approval of emotional support animals and working animals should be advised that there are a number of organizations and individuals out there who seek out and target those who certify or approve such animals. These organizations and individuals see many cases of abuse and improper certifications being used. They see individuals who appear to have no real medical need for such an animal “purchasing” such certifications. They view them as a merely “privileged” individual who merely buys such certification for their pet just so that can take the pet everywhere and garner attention for themselves.

Sometimes these organizations and individuals even pretend to be a patient seeking certification of an emotional support animal or a working animal. They do often contact counselors using fake names and pretending to be fake patients to see how far the therapist will go without even having a real patient. Then they file a complaint with the therapist’s professional board in an attempt to have disciplinary action taken against their license.

Therefore, it is imperative that you follow the tips mentioned in this article.

Guidance from the American Counseling Association:

The American Counseling Association (ACA) published a position paper titled: Emotional Support Animals-Human Animal Interactions in Counseling Interest Network Position Statement.

In that position paper the ACA stated:

As Licensed Professional Counselors, the assessment of DSM-5 diagnoses for human clients is within the scope of practice; however, the added practices of animal behavior, behavior assessment or Human-Animal Interventions are (most often) not. Emotional Support Animal may, in some specific circumstances, provide benefits to humans to minimize identified symptoms often associated with a DSM 5 diagnoses; however, because of the potential risks and unanticipated outcomes, the HAIC strongly suggests that counselors abstain from writing letters for persons seeking counseling or assessments for the sole purpose of obtaining an ESA recommendation letter.

Click here to read the ACA letter in full.

However, if the counselor already has an existing treating relationship with a client and the counselor is considering writing an ESA recommendation letter, then the ASA recommends:

[T]he counselor must have a thorough knowledge of the local, state, and federal laws and policies surrounding ESAs and appropriate knowledge, skills, and attitudes with the subject of therapeutic human-animal interactions before writing such a letter.

Click here to learn more.

The ACA also cautions:

The ACA’s Code of Ethics C.2.e Consultations on Ethical Obligations includes “taking reasonable steps with other counselors, the ACA Ethics and Professional Standards Department, or related professionals when they have questions regarding their ethical obligations or professional practice.” This may include working with animal trainers, behaviorists, or veterinary behaviorists to ensure that the clinician remains within their scope of practice. Since there is no overarching licensing or accrediting body for this matter, nor are there federal or state mandates at this time, the onus is on the clinician to ensure ethical practice.

https://www.unh.edu/sites/default/files/departments/student_accessibility_services_/aca.final_version_esa14556_002.pdf. (Emphasis added).

Don’t forget to read part 2 in this blog series to learn more.

Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers, and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, social workers, and family therapists in Department of Health (DOH) investigations, FBI investigations and other types of investigations of health professionals and providers. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. If allowed, we will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company.

We also defend health professionals and health facilities in general litigation matters and business litigation matters.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 or Toll-Free: (888) 331-6620, and visit our website at www.TheHealthLawFirm.com.

GEORGE F. INDEST III, J.D., M.P.A., LL.M.About the Authors: Amanda I. Forbes, practices health law with The Health Law Firm in its Altamonte Springs, Florida, office. George F. Indest III, J.D., M.P.A., LL.M., is Board Certified in Health Law by The Florida Bar and is licensed in Louisiana, Florida, and the District of Columbia. He is President and Managing Partner of The Health Law Firm. Its main office is in 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.

KeyWords: Representation for healthcare professionals, representation for healthcare compliance, representation for healthcare facilities, healthcare facility defense lawyer, healthcare compliance defense attorney, healthcare license defense attorney, Complex Healthcare Litigation, complex healthcare litigation defense lawyer, Complex Business Litigation, Complex Commercial Litigation, Class Action Litigation, medical regulatory defense lawyer, representation for licensed mental health counselors (LMHCs), mental health counselor defense lawyer, licensed professional counselor (LPC) defense attorney lawyer, mental health counselor legal representation, licensed professional counselor (LPC) legal representation, social worker defense lawyer, representation for social workers, social worker defense attorney, social worker complaint cases, Florida Colorado Louisiana mental health counselor complaint cases, defense lawyer for psychologists, Florida health law defense attorney, medical license defense, Florida Department of Health (DOH) attorney, representation for Louisiana and Florida Department of Health (DOH) complaint investigations, Louisiana and Florida Department of Health (DOH) defense lawyer, Colorado Division of Regulatory Agencies (DORA) defense attorney, representation for Florida Colorado Division of Regulatory Agencies (DORA) complaint investigations, Colorado Division of Regulatory Agencies (DORA) defense lawyer, Lousiana LPC Board defense attorney lawyer, Health Law Firm reviews, reviews of The Health Law Firm attorneys, administrative complaint defense lawyer, administrative complaint defense attorney, administrative hearing defense lawyer, administrative hearing defense attorney, administrative hearing defense legal counsel, representation for health care professionals

“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 © 2020 The Health Law Firm. All rights reserved.

By |2020-09-28T19:17:21-04:00September 28th, 2020|Categories: In the News, Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Will a Death from COVID-19 be Considered “Accidental Death” for Life Insurance Policies or a Death from “Accidental Causes?”

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

Almost all life insurance policies, including term policies, pay a “double indemnity,” that is, double the limits of coverage if a death occurs from “accidental causes” as opposed to “natural causes.”  A question arises, given the COVID-19 pandemic, of whether a death caused by the novel corona versus would be considered a natural death or an accidental death.  Fortunately, there is some guidance on this issue.

One reason it is important to distinguish between “accidental death” and “natural death” is that:

There is no pandemic exclusion for life insurance.  General life insurance covers pandemics, assuming you were truthful about your travel plans and exposure to illness during the application process.  . . . .  An accidental death & dismemberment policy is more limited and covers deaths only when they’re accidental.  It generally doesn’t [usually] cover deaths caused by illness and disease.

Nat’l Ass’n of Ins. Comm’rs, COVID-19 & Ins. (2020), https://content.naic.org/sites/default/files/inline-files/Insurance%20Brief%20-%20Covid-19%20and%20Insurance.pdf. (Emphasis added).

Definition of “Accidental Death”

According to Black’s Law Dictionary, an “accidental death” is defined as:  “A death that results from an unusual event, one that was not voluntary, intended, expected, or foreseeable.”  Accidental Death, Black’s Law Dictionary (4th pocket ed. 2011).  Likewise, Ballentine’s Law Dictionary states than an “accidental death” is:

One that occurs unforeseen, undesigned, and unexpected. 29 Am J Rev ed Ins § 1166.  One which occurs by accident, that is, was not designed or anticipated, albeit it may occur in consequence of a voluntary act.

Accidental Death, Ballentine’s Law Dictionary (3rd ed. 1969).

Under the above two definitions, definitions that are usually considered to come from the common law, death from the COVID-19 virus would be considered to be an “accidental death.”

Look to State Insurance Laws for Definitions.

One should also immediately look at the state’s insurance statutes to see if their state’s law defines “accidental death” in terms of insurance coverage.  As an example, Florida law provides such definitions in Chapter 627 of Florida Statues which deals with insurance contracts.

Section 627.429(5)(c), Florida Statutes, is of particular note.  Regarding death from HIV, for example, it states:

Except for preexisting conditions specifically applying to sickness or medical condition of the insured, benefits under a life insurance policy shall not be denied or limited based on the fact that the insured’s death was caused, directly or indirectly, by exposure to the HIV infection or a specific sickness or medical condition derived from such infection. This paragraph does not prohibit the issuance of accidental death only or specified disease policies.

Section 627.429(5)(c), Florida Statutes (emphasis added).

This is significant because the Human Immunodeficiency Virus (HIV) is a very slow-acting disease that harms one’s immune system by destroying the white blood cells that fight infection.  Death may not occur for years, even decades from an infection.  Whereas, COVID-19 is a fast-acting respiratory virus.  If death from HIV could be considered an “accidental death,” than death from COVID-19 certainly could be classified as “accidental death,” as well.


Legal Arguments for “Accidental Death”

If you have a death in your family and there is life insurance coverage on that person, you should not accept the insurance company’s determination that the death is from “natural causes” as opposed to “accidental death.” Challenge this decision, in court, if necessary.

A death caused by the COVID-19 virus is clearly “from an unusual event.”  I doubt that anyone would even contest this issue.  It is also clearly “one that was not voluntary, intended, [or] expected.”  Again, the novel coronavirus pandemic has taken the world by surprise.  How can anyone in their right mind argue that it was truly “expected.”  “Foreseeable” would be an objective test as to whether this was something “reasonably foreseeable.”  It does not appear, from the shock and unreadiness displayed by state and national governments and health officials, that this event was truly reasonably foreseeable.

I did not foresee it, did you?  If 99.999% of the populace did not foresee it, how can it be argued that it is reasonably foreseeable?  At the very least, this is a jury question and the foregoing should be argued to the jury.  If the average reasonable man (the man who is a legal fiction) did not foresee this pandemic and the deaths that result, how can it not be an “accidental death”?  It seems that any jury would be hard-pressed to find other than an “accidental death.”

 
Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm, we provide legal services for all health care providers and professionals.  This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical student professors and clinical staff. We represent facilities, individuals, groups and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, in patient complaints, and in Department of Health investigations.

To contact The Health Law Firm, please call (407) 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 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 © 2020 The Health Law Firm. All rights reserved.

Always Provide Complete Records in Response to Government Subpoenas

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
At a recent Florida Board of Dentistry meeting, a dentist was charged with violations of her practice act and standard of care violations. This happened because her prior practice had provided incomplete patient records to an investigator when it received a subpoena. The records that had been provided were missing written notes and other documentation, along with copies of the prescriptions the dentist had written. This is just one example of what can happen if patient records are not provided in an orderly and complete manner to investigators.

Important Points for Board Hearings.

The dentist attended the Board meeting, having requested an informal administrative hearing. To obtain this type of hearing means that the dentist agrees that there are no disputed issues of fact; this equates to a “guilty” plea. The dentist is waiving her right to have a formal hearing, present a defense and contest the allegations made against her. When questioned by the Board, it was clear that the dentist did not understand this. She also stated that she had an attorney, but the attorney was not present to represent her or to advise her during the Board hearing.

Even though this was a dental case, the same principles of administrative law apply in the case of a physician, nurse, mental health counselor, pharmacist or any other licensed health care professional.

Most importantly, the dentist testified that her prior practice had failed to provide a complete copy of the patient’s health record to the Department of Health (DOH) investigator. The prosecuting attorney showed the Board where the records had been subpoenaed from the prior practice twice, and they had been provided to the DOH twice, along with affidavits from the practice that these were complete copies of the entire record. (These affidavits were false.)

Fortunately for the dentist, the Board members reviewed the records that had been provided and could see for themselves that key portions were missing. Also, fortunately, the Board decided to table the case and send it back for more investigation.

If the Board had decided to go forward, the dentist would likely have received discipline on her license forever.

Important Lessons for Mental Health Care Professionals, Dentists, Physicians, and Other Licensed Health Care Professionals.

Valuable lessons that all licensed health professionals can learn from this case include:

1. Hire an experienced health law attorney as soon as you know you are under investigation. Many times your malpractice (professional) liability insurance will pay your legal defense expenses in these cases.

2. Your experienced attorney will obtain a copy of the complete investigation file (including all documents it contains) shortly after it is completed and long before any hearings. If your attorney doesn’t, then you should do so. You can review it and supplement any incomplete records, documents or information.

3. Do not hire an attorney who is unable to attend the hearing with you. Continuances can be routinely requested and granted if the attorney has a conflicting hearing somewhere else, is ill or is otherwise unable to attend. Don’t attend the hearing without your attorney, if you have one.

4. Know the difference between an informal hearing and a formal hearing. If you request an informal hearing, you are admitting the charges against you are true and you are guilty. (There are only one of two very limited exceptions to this rule) You are only there to argue about how much discipline you should receive.

5. If you are investigated, personally make sure a complete copy of the patient’s record is sent to the DOH investigator. This includes everything: demographics, insurance info, financial responsibility forms, treatment plans, orders, prescriptions, lab reports, periodontal charts, informed consent forms, patient instructions, office visits, telephone notes, operative reports, sedation charts on notes, history and physical, medical clearances from outside physicians, and dental or medical records from other providers. Even if you are no longer employed at that practice, you have the right to request and receive a copy of all of the records you generated when you treated the patient under Section 456.057, Florida Statutes. At least obtain these.

For more information on this topic and to find out more about how The Health Law Firm can assist you in matters like this, read my prior blog here.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to dentists, dental technicians, physicians, nurses, nurse practitioners, CRNAs, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 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.

KeyWords: administrative procedure act defense, representation for administrative hearing, Board of Dentistry defense lawyer, representation for Board of Dentistry investigation, representation for Board of Dentistry hearing, Board hearing defense attorney, Board of Medicine defense lawyer, dental hygienist defense lawyer, dentist defense lawyer, representation for dentists Department of Health (DOH) representation, DOH defense attorney, representation for DOH hearings, representation for DOH investigations, representation for disciplinary charges, representation for disciplinary complaint, representation for Florida Administrative Codes, physician lawyer, representation for doctor, representation for healthcare professionals, representation for deposition coverage, last-minute deposition coverage, short notice representation of physician, short notice of representation of doctors, hearing representation for healthcare professional, Board of Medicine defense, Board of Medicine hearing defense lawyer, representation for administrative procedure act, representation for Rules of Civil Procedure, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“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 © 2020 The Health Law Firm. Altamonte Springs, Florida.

Healthcare Professionals Should Ensure Records Provided in Response to Government Subpoenas are Complete

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
At a recent Florida Board of Dentistry meeting, a dentist was charged with violations of her practice act and standard of care violations. This happened because her prior practice had provided incomplete patient records to an investigator when it received a subpoena. The records that had been provided were missing written notes and other documentation, along with copies of the prescriptions the dentist had written. This is just one example of what can happen if patient records are not provided in an orderly and complete manner to investigators.

Important Points for Board Hearings.

The dentist attended the Board meeting, having requested an informal administrative hearing. To obtain this type of hearing means that the dentist agrees that there are no disputed issues of fact; this equates to a “guilty” plea. The dentist is waiving her right to have a formal hearing, present a defense and contest the allegations made against her. When questioned by the Board, it was clear that the dentist did not understand this. She also stated that she had an attorney, but the attorney was not present to represent her or to advise her during the Board hearing.

Even though this was a dental case, the same principles of administrative law apply in the case of a physician, nurse, mental health counselor, pharmacist or any other licensed health care professional.

Most importantly, the dentist testified that her prior practice had failed to provide a complete copy of the patient’s health record to the Department of Health (DOH) investigator. The prosecuting attorney showed the Board where the records had been subpoenaed from the prior practice twice, and they had been provided to the DOH twice, along with affidavits from the practice that these were complete copies of the entire record. (These affidavits were false.)

Fortunately for the dentist, the Board members reviewed the records that had been provided and could see for themselves that key portions were missing. Also, fortunately, the Board decided to table the case and send it back for more investigation.

If the Board had decided to go forward, the dentist would likely have received discipline on her license forever.

Important Lessons for Dentists, Physicians, and Other Licensed Health Professionals.

Valuable lessons that all licensed health professionals can learn from this case include:

1. Hire an experienced health law attorney as soon as you know you are under investigation. Many times your malpractice (professional) liability insurance will pay your legal defense expenses in these cases.

2. Your experienced attorney will obtain a copy of the complete investigation file (including all documents it contains) shortly after it is completed and long before any hearings. If your attorney doesn’t, then you should do so. You can review it and supplement any incomplete records, documents or information.

3. Do not hire an attorney who is unable to attend the hearing with you. Continuances can be routinely requested and granted if the attorney has a conflicting hearing somewhere else, is ill or is otherwise unable to attend. Don’t attend the hearing without your attorney, if you have one.

4. Know the difference between an informal hearing and a formal hearing. If you request an informal hearing, you are admitting the charges against you are true and you are guilty. (There are only one of two very limited exceptions to this rule) You are only there to argue about how much discipline you should receive.

5. If you are investigated, personally make sure a complete copy of the patient’s record is sent to the DOH investigator. This includes everything: demographics, insurance info, financial responsibility forms, treatment plans, orders, prescriptions, lab reports, periodontal charts, informed consent forms, patient instructions, office visits, telephone notes, operative reports, sedation charts on notes, history and physical, medical clearances from outside physicians, and dental or medical records from other providers. Even if you are no longer employed at that practice, you have the right to request and receive a copy of all of the records you generated when you treated the patient under Section 456.057, Florida Statutes. At least obtain these.

For more information on this topic and to find out more about how The Health Law Firm can assist you in matters like this, read my prior blog here.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to dentists, dental technicians, physicians, nurses, nurse practitioners, CRNAs, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 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.

KeyWords: administrative procedure act defense, representation for administrative hearing, Board of Dentistry defense lawyer, representation for Board of Dentistry investigation, representation for Board of Dentistry hearing, Board hearing defense attorney, Board of Medicine defense lawyer, dental hygienist defense lawyer, dentist defense lawyer, representation for dentists Department of Health (DOH) representation, DOH defense attorney, representation for DOH hearings, representation for DOH investigations, representation for disciplinary charges, representation for disciplinary complaint, representation for Florida Administrative Codes, physician lawyer, representation for doctor, representation for healthcare professionals, representation for deposition coverage, last-minute deposition coverage, short notice representation of physician, short notice of representation of doctors, hearing representation for healthcare professional, Board of Medicine defense, Board of Medicine hearing defense lawyer, representation for administrative procedure act, representation for Rules of Civil Procedure, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“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 © 2020 The Health Law Firm. Altamonte Springs, Florida.

 

Take this Quick and Easy Quiz to See If You Might Be a “Disruptive Physician”

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
I often have consultations with and represent physicians from across the country who are in trouble with their hospital medical staff or their licensing board because a complaint has been filed against them alleging they are a “disruptive physician.” This is often the result of an alienated member of the nursing staff or even an economic competitor trying to make trouble for or get rid of the physician.

A disruptive physician is one whose “obnoxious” behavior upsets patients or other staff members. The American Medical Association defines this in its Code of Medical Ethics as “personal conduct, whether verbal or physical, that negatively affects or that potentially may affect patient care.” This type of behavior is disfavored in hospitals and health systems because it is thought to negatively affect patient care by decreasing morale, teamwork, collaboration and communication among health professionals.

The Joint Commission Gets Involved.

Starting in 2008 the Joint Commission began urging hospitals to incorporate provisions to rein in disruptive behavior in the hospitals by physicians. The Joint Commission started requiring hospitals in 2009 to have a written code of conduct addressing the issue. This code of conduct must define acceptable, disruptive, and unacceptable behavior in the workplace, the latter two of which are usually lumped together.

Take This Quiz to See if You Are a “Disruptive Physician.”

Having represented physicians in hearings before medical staff peer review committees, resident physicians before academic conduct committees and appeal review committees, and physicians in hearings before the board of medicine, I have put together the following quiz from the types of misconduct such bodies use to denote a “disruptive physician.”

DISRUPTIVE PHYSICIAN QUIZ

Check “Yes” or “No” for each statement or question. Each “Yes” answer counts for one (1) point.

 

Add up all your “yes” answers above and see where you fall on the following chart:

SCORE
0 to 1 You are not a disruptive physician. You may be dead, however.
2 to 32 You may be a disruptive physician.

Although the quiz above is tongue-in-cheek, all of the questions or statements on it come from actual cases where a physician had to defend himself or herself against charges that they were a “disruptive physician.”

Legal Defenses To Disruptive Physician Charges.

Allegations against a physician for “disruptive behavior” are often vague and impossible to properly defend. It is imperative that if such charges are made against you, you obtain legal counsel who can get involved right away. Such vague, subjective allegations often are relatively easy to defend against, when the true facts are ascertained.

In the case of Fahlen v. Sutter Central Valley Hosp., 58 Cal. 4th 655 (2014), the physician’s hospital clinical privileges were terminated because of a claim of disruptive behavior. The California Supreme Court reversed the hospital’s decision and allowed the physician the right to proceed with a whistleblower case alleging substandard nursing care by the hospital’s nursing staff and the presence of risk to patient safety. In effect, the Court ruled that the doctor was merely a valid whistleblower complaining about quality of care issues. There are similar cases from other jurisdictions.

One can defend such a case by showing that the doctor’s actions are objectively reasonable under the circumstances. Other times you may have a defense you can show because an economic competitor is filing complaints or causing them to be filed against you. Sometimes complaints are generated by hospital staff as a result of a physician’s complaining about incompetent nursing staff or lack of proper equipment. In some cases, we have seen a single nurse generate enough animosity towards a physician so as to have charged with being disruptive.

Read one of my past blogs titled, “Disruptive Physicians: Nobody Likes a Nuisance” to learn more about this topic.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in accusations of disruptive behavior, Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 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.

KeyWords: Physician representation, hospital, and medical staff peer review hearings, representation for medical staff fair hearings, medical board representation, Professionals Resource Network (PRN) legal representation, “physician health program” and peer assistance representation, PRN attorney, representation for peer review hearings, disruptive physician representation, disruptive physician defense lawyer, peer review defense attorney, Board of Nursing representation, Board of Pharmacy representation, Board of Medicine representation, Board of Medicine defense lawyer, representation for board matters, healthcare board representation, representation for healthcare professionals, physician defense lawyer, medical license defense, healthcare license defense, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2020 The Health Law Firm. All rights reserved.

 

 

Review Your Department Of Health Practitioner Profile or it Could Cost You!

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In 1997, the Florida Legislature passed a statute that requires the Department of Health (DOH) to maintain online practitioner profiles for certain health care professionals. Practitioner profiles are required for medical doctors, osteopathic physicians (DOs), chiropractors (DCs), advanced practice registered nurses (APRNs) and podiatric physicians. The statute specified the required information to be maintained, how it was to be reported, and other requirements dealing with compiling and updating the information in the profiles.

To visit the DOH’s website and learn more about these profiles, click here.

What Information Does the Profile Include?

The profile contains required and optional information from the healthcare provider. Required
information includes:

1. education and training, including other health-related degrees, professional and postgraduate training specialty
2. current practice and mailing addresses
3. staff privileges and faculty appointments
4. reported financial responsibility
5. legal actions taken against the practitioner
6. board final disciplinary action taken against the practitioner
7. any liability claims filed against podiatric physicians which exceed $5,000
8. any liability claims filed against M.D.s and osteopathic physicians which exceed
$100,000

Optional information may include committees/memberships, professional or community
service awards, and publications the practitioner has authored.

These profiles are published on the DOH’s website. They are freely accessible by the public and are frequently used by employers, medical staff committees, and insurance panels to verify information provided by applicants.

Be Sure to Check Your Profile for Accuracy!

If you are a licensed profiled health care practitioner, you should review your profile information frequently and report any corrections to the DOH immediately! By law, you are responsible for updating your profile information within 15 days after a change of an occurrence in each section of the profile.

Unfortunately, information on practitioner profiles is not always 100 percent correct. Oftentimes, the information in a profile is outdated or misreported. The majority of the information in a profile is supposed to be entered through the website by the practitioner personally; however, the DOH is free to add information on its own.

It’s important to note that not all of the information on the practitioner profile is verified by the DOH. To view which information is self-reported, as well as reported by the DOH, click here to view the DOH’s profile guide.

Recently, The Health Law Firm had a client whose employment contract was not renewed due to misreported criminal history information on the DOH practitioner profile. Most troubling was the fact that this information appeared on the profile suddenly; it had not been on the practitioner profile in the past. Furthermore, the information was decades old and had been posted in direct violation of a court order sealing the underlying records.

We have also had cases where information was incorrect, where the same information was repeated several times, or where the information on the profile did not meet the basic requirements for reporting.

Fight False Information on Your Practitioner Profile.

The Health Law Firm has been successful in having the DOH remove criminal history information and other incorrect information from a practitioner profile.

It is imperative that you check your practitioner profile regularly to ensure that it is accurate with respect to the information that you provided and that may have been provided by the DOH. If you find that confidential or incorrect information has been posted to your profile, contact an attorney experienced with dealing with these matters immediately. You never know when your employer, a business associate or potential patient will look up your information on your profile.

Contact Health Law Attorneys Experienced with the Department of Health Matters and Investigations.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment (DME) suppliers, medical students and interns, chiropractors, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider

Our attorneys provide legal representation in the Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, Federal Bureau of Investigation (FBI) investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, healthcare license representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

You Could Face Steep Repercussions From License Discipline or Resignation After Notice of Investigation

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

Do you have a dental, medical, pharmacy or nursing license in several different states? Do you have a license in more than one health care profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following information.

First, you should never voluntarily relinquish or resign your license after you know that an investigation has been opened or that disciplinary action has been taken against you. Such resignation is considered to be a “disciplinary relinquishment” and is treated the same as if your license had been revoked on disciplinary grounds.

Second, this will be reported out to other states, agencies, to the National Practitioner Data Bank (NPDB), to any certifying bodies for certifications you have and to other reporting agencies (such as the National Council of State Board of Nursing, the National Association of Boards of Pharmacy or the American Board of Internal Medicine). Other states and other professional boards will most likely initiate disciplinary action based upon the first one.

Protect Your Professional License from These Adverse Actions.

The following is a list of some of the adverse actions that you can expect to be taken against you after discipline on your license or after you resign your professional license after receiving notice of investigation:

1. A mandatory report to the National Practitioner Data Base (NPDB) which remains there for 50 years. Note: The Healthcare Integrity and Protection Data Bank or HIPDB recently merged into the NPDB.

2. Must be reported to and included in the Department of Health (DOH) profile that is available to the public online (for those having one), and remains for at least ten years.

3. Any other states or jurisdictions in which the nurse has a license will also initiate an investigation and possible disciplinary action against him or her in that jurisdiction. (Note: I have had two clients who had licenses in seven other states and all, even ones that were inactive or not renewed years ago, initiated action).

4. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) will take action to exclude the provider from the Medicare Program. If this occurs (and most of these offenses require mandatory exclusion) the provider will be placed on the List of Excluded Individuals and Entities (LEIE) maintained by the HHS OIG.

a. If this happens, you are prohibited by law from working in any position in any capacity for any individual or business, including hospitals, nursing homes, home health agencies, physicians, medical groups, insurance companies, etc., that contract with or bill Medicare or Medicaid. This means, for example, you are prohibited from working as a janitor in a nursing home that accepts Medicare or Medicaid, even as an independent contractor.

b. If this happens, you are also automatically “debarred” or prohibited from participating in any capacity in any federal contracting, and you are placed on the U.S. General Services Administration’s (GSA) debarment list. This means you are prohibited by law from working in any capacity for any government contractor or anyone who takes government funding. This applies, for example, to prevent you from being a real estate agent involved in selling property financed by a government-backed loan, prohibited from working for an electrical company that bids on contracts for government housing projects, working as a school teacher in a public school, etc.

c. If this happens, your state Medicaid Program is required to terminate you “for cause” from the state Medicaid Program. In many states, this is also grounds for revocation of your license.

5. Any profile or reporting system maintained by a national organization or federation (e.g., NURSYS profile maintained by the National Council of State Boards of Nursing, American Medical Association physician profile, or the Federation of State Board of Physical Therapy profile) will include the adverse action in it, generally available to the public.

6. If you are a nurse practitioner or other professional with clinical privileges at a hospital, nursing home, HMO or clinic, action will be taken to revoke or suspend the clinical privileges and staff members if you have such. This may be in a hospital, ambulatory surgical center, skilled nursing facility, staff model HMO or clinic. This will usually be for physicians, physician assistants (PAs), advanced registered nurse practitioners (ARNPs), certified registered nurse anesthetists (CRNAs), nurse midwives or certified nurse anesthetists (CNAs), podiatrists, clinical psychologist or clinical pharmacists.

7. Third party payors (health insurance companies, HMOs, etc.) will terminate the professional’s contract or panel membership with that organization.

8. The U.S. Drug Enforcement Administration (DEA) will act to revoke the professional’s DEA registration if he or she has one.

9. Many employers will not hire you or will terminate your employment if they discover your license has been disciplined in another state.

So, What Should You Do?

– Don’t take the easy way out by immediately relinquishing your license if you are notified you are under investigation.

– Don’t hide your head in the sand by thinking the case will just go away on its own.

– Don’t take the easy way out. If you are innocent of the charges, request a formal hearing and contest the charges; defend yourself.

– Do not request an informal hearing or a settlement agreement in which you admit the facts alleged against you are all true. If you do this, you are “pleading guilty.”

– Do immediately seek the advice of an attorney who has experience in such professional licensing matters and administrative hearings. They are out there, but you may have to search for one. Do this as soon as you get notice of any investigation and especially before you have talked to or made any statement (including a written one) to any investigator.

– Do purchase professional liability insurance that includes legal defense coverage for any professional license investigation against you, whether it is related to a malpractice claim or not. This insurance is cheap and will provide needed legal assistance at the time when you may be out of a job and not have money to hire an attorney. Beware of the insurance policy that only covers professional license defense if it is related to a malpractice claim.

Professional Liability Insurance.

We strongly encourage all licensed health professionals and facilities to purchase their own, independent insurance coverage. Make sure it covers professional license defense under all circumstances. Make sure you have enough coverage to actually get you through a hearing. $25,000 coverage for just professional licensure defense is the absolute minimum you should purchase; $50,000 may be adequate but $75,000 or $100,000 may be what you really need in such a situation. For a few dollars more (and I do mean only a few) you can usually purchase the higher limits.

Also, I will repeat, make sure it covers your legal defense in an administrative disciplinary proceeding against your license, even if there is no malpractice claim filed against you or likely to be filed against you.

We also recommend that you purchase coverage through an insurance company that allows you to select your own attorney and does not make you use one that the insurance company picks for you.

Companies we have encountered in the past who provide an inexpensive top quality insurance product for professional license defense costs include: CPH & Associates Insurance, Nurses Service Organization (NSO) Insurance, Healthcare Providers Organization (HPSO) Insurance and Lloyd’s of London Insurance.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, nurses, pharmacists, pharmacies, dentists, mental health counselors, massage therapists and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 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.

Keywords: Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for The Health Law Firm

“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 © 2019 The Health Law Firm. All rights reserved.

Although the Law Stacks the Deck Against You, Leaving a Foreign Body in a Patient Doesn’t Always Mean Negligence or Discipline

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

Leaving a foreign object (sometimes referred to as a “retained foreign body” or “RFB”) in a patient, such as a sponge, clamp, forceps, surgical needle, guide wire, part of a surgical instrument or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures, does not necessarily mean that the physician has committed an act of negligence or that the physician will be disciplined by the Board of Medicine (BOM) or Department of Health (DOH). There are many defenses in such a case and many incidents which do not constitute negligence. However, as a preliminary matter, the law does seem to stack the deck against the physician in such cases.

Medical Negligence Statutes.

Section 766.102(3)(b), Florida Statutes (previously Section 768.45, Florida Statutes),
states:

The existence of a medical injury does not create any inference or presumption of negligence against a health care provider, and the claimant must maintain the burden of proving that an injury was proximately caused by a breach of the prevailing professional standard of care by the health care provider. . . . However, the discovery of the presence of a foreign body, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or diagnostic procedures, shall be prima facie evidence of negligence on the part of the health care provider.

Grounds for Disciplinary Action Against a License.

Chapter 456, Florida Statutes, applies to all health professionals who are licensed by the Florida Department of Health (DOH). Section 456.072(1), Florida Statutes, which provides the grounds for possible discipline of any licensed health professional contains a subsection (cc), which provides the following as a basis for disciplinary action:

Leaving a foreign body in a patient, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures. For the purposes of this paragraph, it shall be legally presumed that retention of a foreign body is not in the best interest of the patient and is not within the standard of care of the profession, regardless of the intent of the professional.

Applicable to Others than Just Surgeons and Physicians.

We typically envision objects such as clamps or lap pads (“sponges”) being left in a patient after surgery. Note, however, these provisions of the law could apply equally to a nurse practitioner’s leaving a broken needle in a patient or a dentist’s leaving a burr or broken probe in a patient.

Res lpsa Loquitur.

Many surgeons and other physicians who are charged with such an allegation just give up, do not defend themselves, and agree to accept punishment from their professional board. The statutes quoted above are, basically, a restatement of the common law rule known as “res ipsa loquitur in medical malpractice cases.

The term “medical injury” in the statute refers to an injury sustained as a direct result of medical treatment or diagnosis, and does not encompass injuries totally unrelated thereto. Thus, when a plaintiff establishes that the injury is outside the scope of medical treatment or diagnosis, and the facts and circumstances attendant to the injury are such that, in light of past experience, negligence is the probable cause and the defendant is the probable actor, the doctrine of res ipsa loquitur is applicable.

In Florida, there is a Florida law that is set forth within Chapter 456, Florida Statutes. Chapter 456 of Florida Statutes applies to all health professionals who are licensed by the Florida Department of Health (DOH).

Many surgeons and other physicians who are charged with such an allegation just give up, do not defend themselves, and agree to accept punishment from their professional board.

Florida Cases on Retained Foreign Objects.

Archer v. Maddux, 645 So. 2d 544 (Fla. 1st DCA 1994) a surgeon left a tube in a patient after surgery by accident. The trial court dismissed the case because there was no affidavit from a medical expert corroborating that medical negligence had occurred that had been filed before the running of the statute of limitations. The Court of Appeal upheld the dismissal of the case.

DeAlmeida v. Graham, 524 So. 2d 666 (Fla. 4th DCA 1987), a surgeon left a Kelly clamp inside of a patient.

Moreover, the provision of Fla. Stat. ch. 766.102(4) that discovery of a “foreign body” such as surgical paraphernalia is prima facie evidence of negligence, is clearly inapplicable in a case where the mesh was intentionally placed in patient’s body as part of her treatment, and like screws, plates, pacemakers, and/or artificial joints was intended to permanently remain in her body. (Kenyon v. Miller, 756 So. 2d 133 (Fla. 3d DCA 2000)

Smith v. Zeagler, 116 Fla. 628, 157 So. 328 (1934)
It is negligence per se for a surgeon to leave a sponge in an abdominal incision made in his patient in the course of his performance of a surgical operation upon such patient. The burden of showing due care is upon a surgeon who leaves a sponge enclosed in a wound after the performance of an operation, and he cannot relieve himself from liability unless the sponge was so concealed that reasonable care on his part would not have disclosed it, and conditions were such that, in his professional judgment, a special exploration for the sponge would have endangered the safety of the patient. Where a patient’s condition is critical and the paramount requirement is complete the operation in the shortest possible time, the failure to remove a sponge may be an accidental and excusable ship or inadvertence that is not actionable negligence, depending upon the circumstances of the case, the burden being on the physician to show to the satisfaction of the jury that the particular act was not blame-worthy because of the supervening necessity to complete the operation without delay.

The authorities are legion to the effect that it is negligence [***3] per se for a surgeon to leave a sponge in an abdominal incision made in his patient in the course of his performance of a surgical operation upon such patient. Ruth v. Johnson, 172 Fed. 191; Reeves v. Lutz, 179 Mo. App. 61, 162 S.W. Rep. 280; Rayburn v. Day, 126 Oregon 135, 268 Pac. Rep. 1002; Wynne
v. Harvey, 96 Wash. 379, 165 Pac. Rep. 67; Harris v. Fall, 177 Fed. 79, 27 L.R.A (N.S.) 1174; Moore v. Ivey (Texas Civ. App.), 264 S.W. Rep. 283; 21 R.C.L. 388.

The burden of showing due care is upon a surgeon who leaves a sponge enclosed in a wound after the performance of an operation, and he cannot relieve himself from liability unless the sponge was so concealed that reasonable care on his part would not have disclosed it, and conditions were such that, in his professional judgment, a special exploration [*631] for the sponge would have endangered the safety of the patient. Davis v. Kerr, 239 Pa. 351, 86 Atl. Rep. 1007, 46 L.R.A. (N.S.) 611.


Adverse Consequences of Accepting Discipline in a RFB Case.

Many health professionals agree to accept punishment from their professional board without realizing the harsh consequences. Any disciplinary action will be reported to the National Practitioner Data Bank (NPDB). If you are reported to the NPDB or another health care data base, you could have issues obtaining hospital privileges, state licenses, you may be excluded from the Medicare and Medicaid Programs, and it could also affect your ability to work in the health care field. Additionally, similar actions will be taken against any licenses you have in other states.

Shared Responsibility Between Surgeon and Hospital Staff.

Most hospitals have internal policies and procedures which make it a shared responsibility between the surgeon and the hospital’s staff (especially surgical technicians and operating room nurses) to safeguard against leaving foreign objects in patients.

The Health Law Firm has successfully defended physicians and other licensed health care professionals in administrative investigations and patients complaints relating to retained foreign bodies.

For more information on how we can help you in situations such as this, visit our Areas of Practice page on our website.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 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.

Keywords: Representation for licensed healthcare professionals, National Practitioner Data Bank, NPDB defense lawyer, NPDB representation, Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for The Health Law Firm

“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 © 2019 The Health Law Firm. All rights reserved.

Load More Posts
Go to Top