Better ways to control costs than ‘affordable health plan’

Shaken by ever-rising health care costs, businesses large and small are reacting. Read more

Q&A: Mandatory participation

Q: Should physician licensure be tied to mandatory participation in a certain health plan to control costs? Read more

Good Medicine

Q. Should marijuana be legalized for medical use?

A. “Marijuana as a medicine needs to be approached as many other medicines are approached: with thoughtfully-designed, randomized, controlled trials to determine safety and effectiveness. Read more

Marijuana: Is it medicine or not?

Americans have a split personality when it comes to marijuana.

A Gallup Poll last October found that support for legalizing marijuana reached an all-time high at 44 percent of the population. But that’s still a minority. Read more

A closer look at health care solutions for the drug epidemic

Following months of hearings and testimony, the Massachusetts OxyContin and Heroin Commission issued its report and recommendations in November. Read more

Doctor’s View: Aging drivers and public safety: The physician’s role

Following several widely reported incidents in which older drivers caused auto accidents, including one that resulted in the death of a 4-year-old, the elderly driver is increasingly seen as a major public safety concern. Read more

Why saying ‘I’m sorry’ helps to heal: Patients’ attorneys shed light on the benefits of apology

By Jeffrey N. Catalano, Esq.
and Lisa G. Arrowood, Esq.
Mediation in a medical negligence lawsuit we handled last year started like any other, but took an unexpected twist.
The case involved the tragic death of a young girl, whom we will call Samantha, from an undiagnosed and untreated shunt malfunction in her brain. Read more

Reporting of serious reportable events may impact peer review

By Mario Motta, M.D.
For some time, state regulations on hospital licensure have required hospitals to report serious incidents that affect patient health and safety to the Department of Public Health (DPH). Read more

Q&A: Serious Reportable Event reporting and peer review

Q:  Do the new state Department of Public Health requirements for hospitals and other facilities to undertake a “root cause analysis” as part of disclosing Serious Reportable Events compromise the confidentiality of physician peer review?

“We firmly believe that any public reporting of SREs or their analysis should not be viewed as a voluntary relinquishment of a provider’s peer
review safeguards and that protecting the integrity of the peer review process is essential for improving patient safety,
our most important responsibility. There should be more explicit protections to ensure that peer review discussions are exempt from any public review.”
—Timothy F. Gens, senior vice president, policy & regulation, general counsel, Massachusetts Hospital Association

“While this new regulation does not directly jeopardize the confidentiality of individual physician peer review, there is a concern that erosion of protections for one type of peer review may weaken an entire system that is designed to promote quality care. … The new regulations require that the root cause analysis – which previously remained confidential – be provided to the payor and the patient as well as to DPH, which appears to create a conflict with
existing peer review law.”
— Pamela Heacock, associate general counsel, UMass Memorial Health Care Inc.

“I think there is an irreconcilable tension between at least one section of the regulations and the confidentiality provided to a medical peer review committee under state law. Shortly after the peer review privilege was created, the Board of Registration in Medicine promulgated regulations to implement their newly created patient care assessment duties, some of which were challenged by a consortium of hospitals as violating the peer review statute. It may be that hospitals and or medical staffs will need to mount a similar challenge to these new DPH regulations.”
— Paul R. Cirel, partner,
Dwyer & Collora, Boston

“As best I can tell, the Legislature did not intend to undercut the medical peer review privilege when it adopted [the new reporting requirements]. I anticipate that hospitals will complete the new reporting form by providing a short, non-privileged narrative. For those SREs that may also become the subject of a medical peer review proceedings, a hospital may do well to conduct two separate review processes. The first is not privileged and would focus on preventability and provide the basis of the hospital’s SRE report to DPH. The second would likely include a root cause analysis that remains privileged as part of the confidential medical peer review proceedings.”
—Regina Rockefeller, partner, Nixon Peabody health services group, Boston

Q&A: Domestic violence reporting

Q: What steps can be taken to improve or clarify the reporting system for suspected acts of domestic violence?

“Many victims’ experiences of domestic violence do not fit into categories of prosecutable crimes. A seemingly innocuous data collection system can compromise the health care provider’s primary responsibility to increase victim safety. Every health care worker needs deep training and support to conduct a conversation and screening in a safe and respectful environment, to identify both victims and perpetrators, to address these complex and often high-risk situations and to facilitate referrals to domestic violence programs and other resources in ways that allow for victim autonomy in decision-making and do not endanger them or their children.”

- Isa Woldeguiorguis, director of policy & systems advocacy, Jane Doe Inc.

“By creating a new domestic violence unit in Worcester and giving a direct supervisor to three full-time attorneys, we can put a renewed focus on these cases. Because 30 to 60 percent of domestic violence cases also involve child abuse, filing a [report] with the Department of Social Services (DSS) lets the offender know that we’re watching. But we also need to show compassion to the victim’s family - in these times of economic stress, going straight for a guilty verdict is not always the best solution. If a spouse loses his job and his house, it’s the mother and children who suffer.”

- Joseph D. Early Jr., Worcester County District Attorney

“Educating staff on a regular basis about the many facets of domestic violence, from its most concrete to more obscure forms, is a very important step. For staff that have a suspicion that domestic violence is occurring but are hesitant to report it, I think it would be helpful to have a system in place where workers are organized into small groups of two or three, so that they can immediately consult with colleagues on these difficult decisions. In such emotional situations, this kind of close-knit support could mitigate the stress of the environment and help them to make a clearer decision about the next steps to take.”

- Manisha H. Bhatt, senior counsel, Greater Boston Legal Services

“The most important thing to consider when responding to suspected domestic violence is the safety of the victim. Providing resources and information about victim services, including safety planning, counseling and shelter, can be critical. Policies that diminish a victim’s control over decision-making with respect to reporting can have the unintended consequence of diminishing victim safety. When health care providers are encouraged to screen for domestic violence, the goal is not to increase reports to officials, but to provide potentially life-saving and empowering information and choices to victims as well as to make them aware of the effects of domestic violence on their health.”

- Carlene Pavlos, director, Mass. Department of Public Health Violence & Injury Prevention Program

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