Presented by: Melanie Balestra, NP, JD Law Offices of Melanie - PowerPoint PPT Presentation

Presented by: Melanie Balestra, NP, JD Law Offices of Melanie Balestra balestralaw@cox.net

OBJECTIVES   Participant will be able to find 11 elements of SPs  Participant will be able to name two types of BRN Accusations  Participant will be able to name two entities a NP can be an owner  Participant will be able to name two types of social  Particpant will be able

PRACTICE TIPS   DRUGS • Diverting for self-use • Diverting to sell • Addiction/Substance abuse • Self-prescribing • Prescribing for family or friends

PRACTICE TIPS  Unprofessional conduct (a) Committing fraud or deceit in obtaining, attempting to obtain or renewing a license or a certificate issued (b) Social media — Facebook, texting (c) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission. (d) Aiding or abetting in a criminal abortion or attempting, agreeing or offering to procure or assist in a criminal abortion

PRACTICE TIPS  (e) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. (f) Being mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public. (g) Having a license, certificate, permit or registration to practice a health care profession denied, suspended, conditioned, limited or revoked in another jurisdiction and not reinstated by that jurisdiction. (h) Willfully or repeatedly violating a provision of the Nurse Practice Act

PRACTICE TIPS  (i) Committing an act that deceives, defrauds or harms the public. (j) Failing to comply with a stipulated agreement, consent agreement or board order. (k) Violating a rule that is adopted by the BON (l) Failing to report to the board any evidence that a professional or practical nurse or a nursing assistant is or may be: (i) Incompetent to practice. (ii) Guilty of unprofessional conduct

PRACTICE TIPS  (iii) Mentally or physically unable to safely practice nursing or to perform nursing related duties. A nurse who is providing therapeutic counseling for a nurse who is in a drug rehabilitation program is required to report that nurse only if the nurse providing therapeutic counseling has personal knowledge that patient safety is being jeopardized. (l) Failing to self-report a conviction for a felony or undesignated offense within ten days after the conviction.

PRACTICE TIPS  Gross negligence  Carelessness in reckless disregard for the safety or lives of others, which is so great it appears to be a conscious violation of other people’s right to safety.  It is just shy of being intentionally evil.  Punitive damages

PRACTICE TIPS — PRACTICING BEYOND YOUR SCOPE  STANDARDIZED PROCEDURES  (1) Be in writing, dated and signed by the organized health care system personnel authorized to approve it.  (2) Specify which standardized procedure functions registered nurses may perform and under what circumstances.  (3) State any specific requirements which are to be followed by registered nurses in performing particular standardized procedure functions.  (4) Specify any experience, training, and/or education requirements for performance of standardized procedure functions.  (5) Establish a method for initial and continuing evaluation of the competence of those registered nurses authorized to perform standardized procedure functions.

PRACTICE TIPS-PRACTICING BEYOND YOUR SCOPE   Standardized Procedures (6) Provide for a method of maintaining a written record of those persons authorized to perform standardized procedure functions.  (7) Specify the scope of supervision required for performance of standardized procedure functions, for example, immediate supervision by a physician.  (8) Set forth any specialized circumstances under which the registered nurse is to immediately communicate with a patient's physician concerning the patient's condition.  (9) State the limitations on settings, if any, in which standardized procedure functions may be performed.  (10) Specify patient record keeping requirements.  (11) Provide for a method of periodic review of the standardized procedures

PRACTICE TIPS   Alcohol use • On the job • DUI  Expunged  Dismissed  No Miranda before arrest

Electronic Medical Records   Cloning  Not documented, not done  Amendments considered late charting

PRACTICE TIPS   Falsification/Misrepresentation  Lying on application  Failing to disclose  Prior discipline  Discipline in another state  Practicing without a license

INDEPENDENT CONTRACTOR   How many hours per provider?  How many collaborating physicians?  Hourly wage, not salary.  Always a written contract.  What to do if abused?  California Labor Board

MEDICAL CORPORATON   Physician 51% shareholder and Medical Director  Job description  Availability  Input on hiring professionals  Familiar with SPs  Nurse Practitioner 49% shareholder  Patient records available to physician  Regular meeting time to discuss business (quarterly)  Consults as necessary

MANAGEMENT COMPANY   Only provides management services  Leasing  Support personnel  Utilities  Management contract  Does not employee any health care providers  Can be LLC or corporation

NURSING CORPORATION   Provide services for one or many physicians  Cannot pay physician directly  Corporate to corporate contracts  Physician provides free collaborating services  Lease space in physician’s office  Online services  Physician participates and understands SPs

SOLO PRACTICE   No corporate protection  Cannot pay physician for collaborating services  Must have physician involved chart review and onsite evaluation

COMPLIANCE ISSUES   Beyond the BRN Office of Inspector General • • National Practitioner Data Bank  Medicare/Medicaid Fraud • Prohibited from working  HIPAA Violations • Social Media • In house comments

COMPLIANCE ISSUES   Antikick back statutes  No reimbursement for referral  Elements of Compliance Program  Written policies & procedures  Compliance professionals  Effective training  Effective Communication  Internal monitoring  Enforcement of standards  Prompt response

COMPLIANCE ISSUES   Last but one of the most important tips  Document, document, document  Electronic Medical Records  Cloning  Eprescribing  Where did my documentation go?

SUNSET REVIEW REPORT   March 23, 2015 Sacramento  Supports IOM  Suggests legal monitoring of reviewers  Will it pass?

SB 323   Sen. Ed Hernandez (D-West Covina) and Assembly member Susan Eggman (D-Stockton) have introduced legislation that will grant full practice authority to nurse practitioners in California, joining 20 other states and the District of Columbia as jurisdictions that permit NPs to practice to the full extent of their education, experience and expertise

NECESSITY OF OWN INSURANCE   Covers NP for disciplinary actions as well as mal  Allows NP to have own lawyer to negotiate terms  Occurrence policy covers you after you leave a job  CANP endorses Nurses Service Organization  First insurance company to offer NPs insurance  Have advisory board comprised of NPs, faculty and RN leaders  Listen to NPs

BASIC PRINCIPLES IN REPRESENTATION   Attorney interview • Ask about experience • Check out credentials • Background representing NPs  Discussion of fees and costs • Accept insurance • Fees beyond insurance  Mitigating evidence/witnesses for defense Everything is confidential with your attorney •

BASIC PRINCIPLES IN REPRESENTATION   Expert witnesses Credentials • • Forensics  Dialogue with prosecuting attorney/investigator  Preparing for the hearing  Preparing the for the outcome Settlements • Administrative ruling/boards ruling •

  QUESTIONS????