COVID- 19 Me dic al- L e gal Impac t on He alth Car e Mar k A. F ogg Color ado De fe nse L awye r s Assoc iation 821 17 th Str e e t, Suite 500, De nve r , CO 80202 P (303) 296- 7300 F (720) 625- 3637 ChildsMc Cune .c om
I N T HE BE GI NNI NG c h 17 th F e de r al He alth & Human Se r vic e s Mar Notic e of De c lar ation unde r the PRE P Ac t Qualifie d immunity for HC pr ofe ssionals & • e ntitie s Applie s to me dic al “c ove r e d c ounte r - • me asur e s” Pr ote c tions ar e pr oduc t- or ie nte d • May be limite d to COVID- 19 patie nts only •
E ARL Y RI SK MANAGE ME NT COUNSE L I NG Doc ume nt alte r ations in c ar e de live r y due to COVID- 19 to maximize liability pr ote c tions (e .g. te le he alth was use d be c ause … ) Still the fir st line of de fe nse : What is r e asonable unde r the c ir c umstanc e s at the time ?
L OOSE NI NG OF T E L E HE AL T HRUL E S c h 17 th Notific ation HHS Offic e of Civil Rights Mar • Waive r of pote ntial HIPAA pe naltie s for good faith use of te le he alth Can use any non-public fac ing r e mote c ommunic ation Applie s to all patie nts, not Just COVID- 19 CMS Re imbur se me nt for te le he alth visits by a physic ian • lic e nse d in anothe r state , Notific ation Mar c h 13 Cr e ate d massive c onfusion DE A e xc e ption on Ryan Haight Ac t •
VOL UNT E E R I MMUNI T Y Pr ior : Volunte e r Pr ote c tion Ac t and state statute s Hodge podge of fe de r al and state L aws Ne w: CARE S ACT Volunte e r Immunity (Se c tion 3215) Unpaid volunte e r , limite d to COVID- 19 patie nts, qualifie d immunity, must be within sc ope of pr ac tic e No liability unde r state or fe de r al law, pr ote c tion e xists dur ing public he alth e me r ge nc y L imite d r ole of Good Samar itan statute s
DE L AY OF E L E CT I VE AND NON-E SSE NT I AL SURGE RI E S AND PROCE DURE S Gove rnors issue E xe c utive Orde rs in almost all state s orde ring de lay of e le c tive s to prote c t PPE Colorado- E O 2020-009, Marc h 23 – April 26: All hospitals, outpatie nt surge rie s and proc e dure provide rs are dire c te d to c e ase all e le c tive and non-e sse ntial surge rie s and proc e dure s
RE SUL T I NG GAPS Conc e r n ove r lac k of liability immunity to c ove r • alte r ations with c ar e de live r y due to COVID- 19 Ne e d pr ote c tion for de lays and alte r e d c ar e de live r y in • non-COVID- 19 patie nts as we ll Pr ac tic ing without a lic e nse in othe r state s (e .g. • te le he alth) Pr ote c t r e asonable judgme nts on de lays of e le c tive • sur ge r ie s and pr oc e dur e s
RE SPONSE : E XE CUT I VE ORDE RS L I ABI L I T Y I MMUNI T Y Powe r to ame nd or modify statute s Ne w Yor k: Gov ame nds the Good Samar itan statute He althc ar e pr ovide r s as state age nts with state immunity pr ote c tions Mic higan: HC as “E me r ge nc y Manage me nt Wor ke r s” Adjusting be st pr ac tic e s to be st e ffor ts Cr isis Standar ds of Car e Color ado: Gove r nor ’s E xpe r t E me r ge nc y E pide mic Re sponse Committe e (“GE E E RC”)
RE SPONSE : I NCRE ASE D F L E XI BI L I T Y I N T E L E HE AL T H, L I CE NSI NG, AND SCOPE OF PRACT I CE F le xibility in c ommunic ation modalitie s (audio inc lude d in • te le he alth de finition) Ability to obtain te mpor ar y lic e nse s, te le he alth lic e nse s, • e xpe dite d lic e nse s, r e ac tivate lic e nse s Allowing out of state lic e nse d physic ians to pr ac tic e • within a state E xpand sc ope of pr ac tic e and foc us on e duc ation and • skill se ts to allow pr ac tic ing outside of tr aditional sc ope Ge ne r ally, E xe c utive Or de r s e xpir e 30 days afte r te r mination of state of e me r ge nc y
COL ORADO APPROACH: COL ORADO DI SAST E R E ME RGE NCY ACT Inte r play be twe e n Gove r nor ’s author ity, r e gulator y statute s, and the Gove r nor ’s E xpe r t E me r ge nc y E pide mic Re sponse Committe e (“GE E E RC”) CRS §§24- 33.5- 704(2): Gove r nor may issue E xe c utive Or de r s that have the for c e and e ffe c t of law § 24- 33.5- 704(7)(a): Gove r nor may suspe nd the pr ovisions of any r e gulator y statute whic h would hinde r c oping with the e me r ge nc y § 24- 335- 704.5: GE E E RC standing c ommitte e de ve lops c r isis standar ds of c ar e and advise s the Gove r nor Cr isis standar ds de viate fr om usual standar ds due to r e sour c e alloc ation
GE E E RC AND COVI D-19 Cr isis Standar ds of Car e that GE E E RC Cr e ate d: • E me rg e nc y Me dic a l Se rvic e s • Pe rso na l Pro te c tive E q uipme nt • Ho spita l, I nc luding Crisis T ria g e Chie f Me dic al Offic e r of CDPHE ac tivate d E MS and PPE c r isis standar ds of c ar e , but not hospital c r isis tr iage
APPL I CAT I ON OF COL ORADO L I ABI L I T Y I MMUNI T Y F OR HE AL T H CARE CRS 24- 33.5-711.5(2) He althc ar e pr ovide r s will r e asonably assist the state to • suc c e ssfully c ontr ol e me r ge nc y e pide mic s Pr ovide r s that in “good faith c omply c omple te ly” with • Boar d of He alth r ule s and E xe c utive Or de r s shall be immune fr om c ivil or c r iminal liability Pote ntial Immunity: • • De la y o f e le c tive pro c e dure s ma nda te d b y E xe c utive Orde r • Re sumptio n o f e le c tive pro c e dure s pursua nt to Pub lic He a lth De pa rtme nt Orde rs
RE SUMPT I ON OF E L E CT I VE SURGE RI E S AND PROCE DURE S Sugge ste d appr oac h, r e sour c e s, and spe c ial COVID- 19 • c onse nt for m for e le c tive s poste d on Childs Mc Cune we bsite : • Colle c t and r e tain bac kgr ound data that it is a safe e nvir onme nt to pe r for m e le c tive sur ge r ie s/ pr oc e dur e s • Cr e ate a patie nt e duc ation c ommunic ation on e le c tive sur ge r ie s/ pr oc e dur e s dur ing the COVID- 19 pande mic • Utilize a spe c ial c onse nt for m for e le c tive s CDPHE ame nde d Public He alth Or de r 20- 29 (May 5, 2020) • • PPE Re se r ve s, ade quate sc r e e ning and te sting, CDC r e c omme nde d infe c tion c ontr ol, fac e masks
COVI D-19: F UT URE HC COVI D-19 CASE S? Na tiona l Pla intiff F irms – L a rg e popula tion c e nte rs Ina de qua te infe c tion c ontrol • Ina de qua te supplie s • Nursing home s • L ic e nsing Ca se s Ka nsa s Boa rd sta te me nt tha t COVID- 19 issue s a re mitig a ting fa c tors •
RE CE NT F E DE RAL L E GI SL AT I VE ACT I VI T Y ON L I ABI L I T Y I MMUNI T Y COVID- 19 He althc ar e Pr ovide r Ac t of 2020 L anguage c ur r e ntly c ir c ulating in le gislative c ommitte e s • and in the c hambe r Br oad de finition of pr ovide r s, applie s to COVID and non- • COVID patie nts Claims r e le gate d to gr oss ne glige nc e • Pr e e mpts state law • One ye ar S/ L •
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