The Florida 2012 legislative session went fromJanuary 10th through March 9th. It ended early thisyear due to the redistricting process that happensevery ten years following the federal census. Therewere 2,052 bills and resolution filed for considerationduring this session. The total number of bills whichpassed both the House and Senate were 292. On thefinal day of Session , the Legislature fulfilled its annualconstitutional responsibility by passing a state budget,adopting a $70 billion spending plan for fiscal year2012 to 2013. The healthcare budget totals $29.9billion which is a $67.8 million (0.23%) increase overlast year but will make significant cuts to health careproviders. It provides for 155,720 anticipatedadditional Medicaid beneficiaries to the sum of$304.7 million. The Florida Kidcare Program isanticipated to serve an additional 11,612 children andthe Medicaid budget provides $4.6 million for thisgrowth. There will be reduction in some Medicaidprovider rates including an approximate 5.6%reduction for hospital inpatient and outpatient and a1.25% reduction for nursing homes. Effective August1,2012 non-pregnant adult Medicaid recipients’emergency room visits will be limited to six visits perfiscal year and general physician visits will be limitedto 2 visits per month. Though not included in the finalbudget, the senate included $438 million increase forphysician services.A number of the bills that passed may be of interest

to you. Every year there are a number of bills thatrelate to scope of practice. Chiropracters pursuedlegislation to allow them to clear head injured youthathletes to return to play. HB 291 provides for themake up of a Sports Medicine Advisory Committee ofthe Florida High School Athletic Association(FHSAA) which will adopt guidelines, bylaws andpolicies on the nature and risk of concussion and headinjuries in youth athletes. Clearance for return to playmust be by an appropriate health care practitionertrained in the diagnosis, evaluation and managementof concussions as defined by the Sports MedicineAdvisory Committee of the FHSAA.HB 509 allows a pharmacist to administer the

pneumococcal and shingles vaccines to adults inaccordance with CDC guidelines and within theframework of an established protocol with asupervising physician. The latter requires aprescription. It also allows the pharmacist toadminister epinephrine to address any allergic reactionand will require the maintenance of $200,000 inprofessional liability insurance. All vaccinesadministered by the pharmacist must be reported toFlorida SHOTS.HB 119 revises personal injury protection (PIP)medical benefits effective January 1,2012 and HB 227creates a 15 member Statewide Taskforce onPrescription Drug Abuse and newborns within theDepartment of Legal Affairs.ARNP prescribing of controlled substances andOptometrist administering and prescribing oralmedications were scope of practice bills that did notpass. Several of these bills have been presented to thelegislature year after year and they are wearingeveryone thin.The FMA is to be commended forestablishing a scope of practice task force withrepresentation from the specialty societies that willhave its first meeting this month. The purpose of theFMA scope of practice task force is to develop specificrecommendations for the FMA Board of Governors onscope of practice issues prior to the beginning of the2013 legislative session. It will analyze national trends,review the legislative and political landscapes inFlorida, and seek input from all interested parties.This will allow for a unified proactive approach toscope of practice issues. There will be a meeting ledby the Florida Academy of Family Physicians (FAFP)with leaders from the FMA, FOMA, and the PA andARNP organizations to look specifically at the issue ofARNP prescribing controlled substances .These issuesaffect the entire physician community and impactpatient safety so we need your involvement and yourvoice to make sure that when legislations are passedwe can all live with them. As scope of practice issuesare reviewed the safety of the citizens of Florida is ofthe utmost importance and will at all times takepriority.

President’s Message

Scope of PracticeDr. George A.W. Smith

www.escambiacms.org

MAy/JUnE 2012VolUME 42, no. 3

BULLETINUpcoming

Events

Tuesday July 10, 2012General Membership

Meeting“Asset Protection/Estate

Planning”Speaker: Gary Leuchtman

Cactus Flower5:30p

Tuesday August 14, 2012General Membership

Meeting“Veterans Mental Health:

What Are Local Resources?”Speakers: AHEC

Heritage Hall5:30p

Sunday September 30, 2012Women in Medicine Brunch

Fish House11:30a -1:30p

RSVP: 478-0706info@escambiacms.org

Dr. George A.W. Smith

2012 E.C.M.S. OfficersPresident

George A.W. Smith, M.D.President-Elect

Wendy Osban, D.O.Vice President

Susan Laenger, M.D.Secretary/Treasurer

Christopher Burton, M.D.

E.C.M.S. BulletinThe Bulletin is a publication for and by the members ofthe Escambia County Medical Society. The Bulletinpublishes six times a year: Jan/Feb, Mar/Apr, May/Jun,Jul/Aug, Sept/Oct, Nov/Dec. We will consider forpublication articles relating to medical science, photos,book reviews, memorials, medical/legal articles, andpractice management.

Vision for the Bulletin:• Appeal to the family of medicine in Escambia and SantaRosa County and to the world beyond.• Collaborate with the Alliance to bring together Escambiaand Santa Rosa County medical families. To know the needsof the community and promote the healthcare needs.• A powerful instrument to attract and induct members toorganized medicine. Views and opinions expressed in the Bulletin are those of theauthors and are not necessarily those of the directors, staff oradvertisers.

Ad placementContact Erica Laxson at 478-0706

Ad rates1/8 page: $100 • 1/4 page: $150 • 1/2 page: $300

ContentsPage 3 - ECMS Events Calendar

Page 4 - Remembering Craig

Page 5 & 8- ECMS Disablility

Income Insurance

Page 6 & 7 - ECMS Health Fair

Page 9 - Legal

Page 10 - Hospital News

Page 11 - Letter to the Editor

Editors:Christopher Burton, MD

Erica Laxson, Executive Director

Membership 3ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

There are several people who have not paid their 2012 ECMS membership dues. Pleaseremit payment before May 25. Anyone who has not paid by June 1st will be dropped andbecome inactive.

If you have any questions call Erica Laxson, Executive Director 850-478-0706 opt 2

Tuesday, July 10, 2012 | Cactus Flower | 5:30 pmSpeaker: Gary Leuchtman, Florida Bar Board Certified in Wills, Trusts and Estates |

Topic: Asset Protection/Estate PlanningSponsors (Social | Dinner): Fisher Brown Bottrell Insurance | Landrum Human Resources

Friday July 27- Sunday July 29 | Boca Raton, FloridaFMA ANNUAL MEETING

Tuesday August 14, 2012 | Cactus Flower | 5:30 pmSpeakers: Area Health Education Centers (AHEC) |

Topic: Veterans Mental Health: What are local resources?Sponsors (Social | Dinner): BBVA Compass |

Sunday September 30, 2012 | Fish House | 11:30 am-1:30 pmWOMEN IN MEDICINE BRUNCH

Sponsors: Baptist Health Care & Virginia College

Tuesday October 9, 2012 | Angus | 5:30pmSpeaker: Patricia Green, MD | Topic: Breast MRI

Sponsors (Social | Dinner): Express Employment Professionals | Fisher Brown Botrell Insurance[1AMA Category 1 CreditsTM]

November 2012Topic: Electronic Health Records/Meaningful Use Summit

Sponsors (Social | Dinner): Underwood Anderson & Associates Inc.| ServisFirst Bank

Saturday January 19, 2012 | Paul’s on the BayECMS INAUGURAL BALL

For updates and changes please visit www.escambiaCMS.org

DON’T LEAVE!

E.C.M.S. 2012 Events Calendar

OOPS!

At the time of this writing it has been one week since mygood friend, former patient and mentor in the MedicalSociety Craig Broome has died. It all happened so quickly.Craig was an amazing person. He was born into a militaryfamily and lived in many places around the globe as a boy. Hegraduated from Frankfurt American High School in Germanyin 1965. As a young man, Craig dreamed of becoming anastronaut. He received his BS in aerospace engineering at theUniversity of Texas at Austin and then worked for NASA forseveral years after graduation. After earning his Master’sdegree he joined TRW and worked on theSkylab space station.

After Craig’s father died early of cancerhe abandoned his idea of becoming anastronaut in favor of medical school. Heattended University of Texas then did hisresidency in Virginia. He practiced as anemergency room physician in the Pensacolaarea for 35 years. He was very active in themedical society and served in variousoffices including as its President in 2001.Craig was a member of the DisasterMedical Assistance Team and helpedprovide medical care during HurricanesAndrew and Katrina along with care atground zero after the September 11attacks. Ironically Craig fell in love with ahospice nurse several years ago and becameinterested in training to become a hospicephysician just before being diagnosed witha glioblastoma. She remained with himuntil his death.

Craig had a lifelong love of tennis andwas a nationally ranked tennis player andserved as President of the AmericanMedical Tennis Association and was thewinner of many AMTA tournaments.

What impressed me most about Craigwere always his humility and his basickindness. I rarely heard him speak ill ofanyone and although he was a fiercecompetitor, I never saw him angry. Iremember his patience trying to teach meto windsurf, watching me get on then falloff his board for nearly 3 hours. These areadmirable traits we can all learn from.They made him a joy to work with in theMedical Society. He will be sorely missed.

4 MembershipESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

REMEMBERINGCRAIG

Written by 2003 ECMS President Robert L. Kincaid, M.D.

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Would you ever consider scrimping on your malpractice insurance—buying a cheaper policy to save money—or one-size-fits-all coverage tosave time? Probably not, because most physicians know that a solidmalpractice policy is a vital part of practicing medicine today. Withoutit, you could be ruined, so the time and money spent on getting the bestpossible coverage is a good investment in your own economic safety.

But did you know the same is true for disability insurance (DI)? It’ssimply not safe to rely solely on a group policy your practice may havepurchased. While group DI is often relatively inexpensive and easy toadminister, it can also fall short just when you need it most—leaving youin for some unpleasant surprises when it’s too late to correctthe situation.

Furthermore, disability may be far more common than you imagine.Even if you’re young and careful, it could happen to you—through anaccident… an injury… or a lengthy illness. Statistics show that disabilityis much more commonplace than most people think: In a recent survey

more than half of employees surveyed felt they had less than a 2% chanceof becoming disabled during their working years, but in reality more than25% of Americans entering the work force today (1 in 4) will becomedisabled before they retire.2

Want to be better prepared? Consider the following:Learn to speak the lingo

The right disability income policy can help you keep your householdgoing if you suffer a long-term disability. But before you go shopping fora DI policy, you need to know which features to look for—and thelanguage the insurance industry uses to describe them. The followingterms are part of the language describing high-quality policies, and arewhat you should look for to get coverage you can count on:

Non-cancellable and Guaranteed Renewable: To avoid the possibilityof losing your coverage just when you need it most, choose a policy that’snon-cancellable and guaranteed renewable to age 65. This will alsoguarantee premiums until age 65. With group or association coverage,you run the risk of being dropped and left unprotected at a time in yourlife when, due to your age or a change in your health, it would be verydifficult to qualify for coverage from another provider. The premiumsfor your classification group can also be increased at any time.

Conditionally renewable for life: Although premiums may increaseafter age 65, your policy should be guaranteed renewable for life, as longas you are at work full time.

The core of any disability income policy is its definition of “TotalDisability” which outlines what constitutes being “totally disabled” andtherefore eligible for benefits. This definition is in every carrier’s policy;however, it does not always mean the same thing. For example, somepolicies pay benefits if you are unable to perform the duties of your ownoccupation, even if you are able to work successfully in anotheroccupation, while others pay only if you cannot work at all.

Residual Disability coverage: Through a rider, agood individual DI plan can provide you with abenefit when you suffer a loss of income as a resultof partial (residual) disability—even if you havenever suffered a period of total disability. This kindof residual coverage is not available with many groupplans.

A choice of Riders: Riders offer optional additionalcoverage such as Catastrophic Disability Benefit(CAT), annual Future Increase Options, AutomaticIncrease and Cost of Living Adjustments, or“COLA.”

Protect your practice and yourselfAs a physician, you must also protect the source of

your income: the practice you’ve worked so hard toestablish and grow. Special business DI policies,available from the same DI providers who offer high-quality individual coverage, offer your practiceprotection while you recover from a disability.

For example, to help meet the expenses of runningthe office while you are disabled, consider a separatetype of disability coverage known as Overhead

Disability Income Insurance:What Every Physician Needs to Know

By John Gary Bruce; DisabilityIncome Specialist at TheGuardian Life InsuranceCompany of American

Continued on page 8

Practice Management 5ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Vendors

6 Health Fair ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

E.C.M.S. Annual Vendor Fair

AHECBBVA Compass BankECMSF We CareExpress Employment ProfessionalsThe Fellows Memorial FundFisher Brown Bottrell Insurance

Guardian Life InsuranceLANformationLandrum StaffingMertins Wealth ServicesMAG MutualRegions Bank

Saltmarsh Cleaveland & GundServis1st BankUnderwood Anderson & Associates, Inc.Twelve Oaks

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Physician’s Speed Networking

Health Fair 7ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

ECMS Member Benefit!

Members can all AFTER hours with aspecific legal issur or question and

receive a response no later than noon thenext day.

This service is available for allmembers at no charge.

THE FLORIDA HEALTHCARE LAW FIRMThe Law Offices of Jeff Cohen, P.A.

Hotline(561) 306-5699

8 Practice ManagementESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Expense (OE). Benefits reimburse your practice for expenses such asrent for your office, electricity, heat, telephone, utilities, interest onbusiness debts and lease payments on furniture and equipment.

Overhead expense insurance specifically designed for professionalspays some additional costs not included in regular business overheadexpense policies—including the salaries of employees who are notmembers of your profession. In a practice such as yours, for example,salaries for the receptionist and nurse would be covered, but not thesalary of your physician partner or employee. However, high-qualityprofessional overhead policies will cover at least part of the salary of aprofessional temporary replacement for you, such as a doctor retained tofill in during your total disability.

In addition…Physicians who are partners in a group practice will want to consider

a policy known as a Disability Buy-Out (DBO). In much the same waythat life insurance benefits can be set aside to fund a buy-out by theremaining partner (or partners) if one partner dies, DBO is designed tofund the healthy partners’ purchase of the disabled partner’s share of thebusiness. With the proper agreement in place before a disability occurs,hard feelings and the conflicts of interest that can result from a partner’sdisability can be avoided.

Take the time to consider upgrading your DI coverage today. Like yourmalpractice insurance, it could be vitally important to your economicwellbeing in the future—and help protect one of your most valuableassets: the ability to earn an income.

1 CDA 2010 Consumer Disability Awareness Survey.2Social Security Administration Fact Sheet, January 2011.Registered Representative of Park Avenue Securities LLC (PAS), 3664Coolidge Court, Tallahassee, FL 32311, (850) 562-9075. Securitiesproducts and services are offered through PAS. Disability IncomeSpecialist, Manager/Northwest FL, The Guardian Life InsuranceCompany of America, New York, NY (Guardian). PAS is an indirectwholly owned subsidiary of The Guardian. PAS is a member FINRA,SIPC.

Disability Income Insurance: continued from page 5

Medical/Legal 9ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

How Secure is the Patient Datain Your Medical Practice?

The question is not if your medical practice is going to have a data security breach,rather when you have a data breach, are you prepared to address it?

The healthcare industry is more likely to be a major target for data breachedbecause of the amount of protected data. Medical practice have become more efficientas a result of the increased use of Electronic Health Records (EHRs) and newtechnology in mobile devices, such as iPads, laptops, and cellular phones. Thisefficiency has exposed the provider to more security risks. With EHRs, more providersare entrusting their patients' data to a third party, moving the security of that databeyond their office or hospital. Adding the increase in regulatory requirements (i.e.HIPPA, Red Flag Rules, and HITECH) makes achieving compliance extremelychallenging.

In April, the 2012 HIMSS Analytic Report: Security of Patient Data, the thirdinstallment of a survey of healthcare provider facilities in the United States, regardingpatient data was published. The survey was commissioned by Kroll Advisory Solutions.Kroll Advisory Solutions is a leading risk consultant firm that has helped some of thelargest healthcare providers in the U.S. respond to data security breaches partneredwith HIMSS Analytics, the leading organization representing health informationmanagement system and services. The survey's goal was to provide a more accuratepicture of the current state of security of patient data in the U.S. and to be moreeffective in addressing the security threats by improving security measures.

According the the Department of Health and Human Services (HHS) AnnualReport to Congress on Breaches of Unsecured Protected Health Information, theft wasonce again the most commonly reported cause of large breaches in healthcareorganizations in 2010. Among the 207 breaches that affected 500 or more individuals:• 99 incidents involved theft of paper record or electronic media. Together affectingapproximately 2,979,121 individuals.• Loss of electronic medical or paper records affected approximately 1,156,847individuals.• Unauthorized access to, or uses or disclosures of, protected health informationaffected approximately 1,006,393 individuals.• Human or technological errors, or other failures to take adequate care of protected

health information, affected approximately 78,663 individuals.• Improper disposal of paper affected approximately 70,279 individuals.

Other important findings in the 2012 HIMSS Analytic Report are:• Majority of breaches result from internal sources (individuals employed at the timeof breach)• In 2012, 79% of survey respondents stated a breach was reported by an employee.• 56% of respondents indicated the source of the breach was unauthorized access toinformation by an individual employee employed at the time of the breach.• 16% of the breaches were due to actions taken by an outsourced or contractedemployee.• 45% of the respondents indicated lack of staff attention to policy put data at risk.• 98% of respondents require 3rd parties to sign a Business Associate (BA) Agreement,but only half (56%) stated that they ensure these 3rd party vendors conduct a periodicrisk analysis to identify security risks.• 22% of respondents reporting a breach state that data was compromised when alaptop, handheld device or computer was lost or stolen, double the amount (11%)reported in 2010.• Among the 250 respondents reporting a breach, approximately 31% reported theirorganization had 1 breach in the past 12 months, 28% reported 2 breaches in the past12 months, 35% reported having 3 to 9 breaches in the past 12 months and 6%reported having more than 10 breaches in the past 12 months.• In conclusion of this survey, the HIMSS Analytics Report states that, whilehealthcare practices are conducting mandated formal risk analyses, they are not takingproactive steps to move further than the end goal of compliance. These practice mustbe proactive and have a response plan in place when there is a breach. Mostrespondents are open to the idea of using an outside service provider in the event of afuture data breach. The survey further summarizes that there continues to be a lack ofawareness of the financial implications associated with a data breach. This is surprising,given the fact that breaches in the healthcare industry come at a higher overall pricethan the cost in the financial and retail sectors. Possible costs include:

Sanctions and/or fines for violation of privacy regulations, including but not limitedto HIPPA, Red Flag Rule and the New HITECH Act

Class Action Lawsuits / Defense CostsBreach NotificationsIT ForensicsCredit MonitoringCyber Extortion Expense

How prepared is your medical practice to handle data breach? Are you doing aperiodic risk analysis that includes a data breach incident response plan? Are youholding your third party vendors to best

practice security standards? If you answer NO to any of these questions, there ishelp. There are consulting firms that provide services, as well as, the new emerginginsurance markets for network security

and data coverage that may provide a more viable option to mitigate your exposureafter a data breach. The time to act is now.

http://www.hhs.gov/ocr/privacy/hippa/administrative/breachnotificationrule/breachrept.pdf

2012 HIMSS Analytics Report: Security of Patient Data commissioned by KrollAdvisory Solutions, April 2012

By Dawn Lintner, AIP, BusinessInsurance Agent, UnderwoodAnderson and Associates, Inc.

10 In The CommunityESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Sacred Heart NewsSacred Heart Initiates New Robotic Surgery Program

Sacred Heart Hospital in Pensacola now has state-of-the-art robotictechnology with the recent addition of the da Vinci Si Surgical System withdual consoles.

Sacred Heart's surgical robot is currently being used to provide urologyand OB/GYN services, including prostatectomy, hysterectomy andgynecologic oncology surgeries. Other procedures, including general surgeryapplications, will follow. Sacred Heart's da Vinci is the only robotic surgicalsystem in this area with capabilities for fluorescent dye tracking to helpidentify the location of tumors.

The robotic surgery program has a dedicated surgical team, including Drs.Steven DeCesare, John Grammer, Brett Parra, Davinder Sekhon, as well asDr. Sidney Stuart, who recently completed the hospital's first da Vincirobotic surgery. These physicians were already credentialed for use of thesurgical system and are providing valuable guidance to the robotic surgicalteam.

Sacred Heart Hospital Begins Five-Floor ExpansionSacred Heart Hospital has begun construction on a major expansion that

will add a five-story tower and 115 private patient rooms. The tower will beconstructed on top of the hospital's Heart and Vascular Institute building.The vertical expansion on Sacred Heart's campus at Ninth Avenue and BayouBoulevard will take place over the next 20 months. The building is expectedto open for patient care starting in May 2014.

The addition will allow Sacred Heart to expand services and meet thecommunity's need for more beds for critically ill patients – a need driven inpart by the hospital's status as a regional Trauma Center and a regional StrokeCenter. Of the 115 rooms in the new tower, 40 will be for critically illpatients.

''This project is a big event in the history of Sacred Heart Hospital, and itwill allow us to create the patient experience of the future,'' said SusanDavis, interim President and CEO of Sacred Heart Health System. ''Ourfocus is on patient care so we're thrilled to be able to make this investment tobetter serve and comfort our patients. The project also fills a need foradditional beds in our busy hospital.''

Baptist Hospital News

Mark Faulkner to Succeed Al Stubblefield as Baptist Health Care CEOMark T. Faulkner has been named the Chief Executive Officer of BaptistHealth Care, replacing Al Stubblefield, FACHE who is retiring after 27 yearsof service. Faulkner a key member of BHC’s management team and BaptistHealth Care Executive Vice President and Chief Operating Officer since2010, will assume his new role effective June 1st. 2012. He becomes onlythe fourth CEO in the 60-year history of Baptist Health Care. Stubblefield, awinner of the American Hospital Association Award of Honor, has servedBaptist Health Care since 1985 and been CEO since 1999. He will continueas president of the Baptist Leadership Group and as president emeritus ofBaptist Health Care.

Baptist welcomes new system vice president and CIO, Steve SarrosBaptist is pleased to announce Steve Sarros as their new system vicepresident and chief information officer. Sarros brings a broad and deepbackground in healthcare IT, having spent the last 25 years in roles ofprogressive responsibility. He starts his new role in May 2012.

Baptist Medical Group makes great progress in EHR implementationBaptist has committed $2.1 million dollars to the implementation ofElectronic Health Record to improve quality of care, patient safety andaccess to crucial clinical information. In turn, this will significantly enhanceclinical collaboration among physicians. This challenging, but exciting processis now underway throughout the physician network. Once completed in2013, BMG anticipates having more than 500 EHR system users at morethan 60 office locations.

The Fisher Brown HealthCare Practice team

provides All Lines of Insurance & offers

Risk Management advice for all aspects

of the HealthCare Industry.

Our Commitment is to reduce your Long Term Cost of Risk

Rob RemigNorthwest Florida Business Consultant

850-444-7606

In The Community 11ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

LETTER TO THE EDITOR“This article is being printed In the interest of facilitating conversation among our member and providing a voice to all. This article does not reflect the opinion of the ECMS Board.

POLST remains an important ECMS initiative”

POLST: Too Many Questions?

Daily, we physicians confront an array of patients ranging from those who want care even if it is unneeded and potentially harmful to those who reject treatment likely to be helpfulwith little risk. An experienced physician works with each patient using knowledge about the diagnosis and treatment options to guide the patient and family to the best medicaldecision. This “in the moment” care cannot be provided impersonally or met by standing protocols or even previous discussions. Does the POLST paradigm (Physician Orders forLife-Sustaining Treatment) promote unquestionable trust between the physician and patient as the standard of care?

POLST is intended to formalize patient treatment preferences into actionable orders signed by a physician for those who may die within 6-12 months.In OR, 92% of all nursing home patients (including those who will likely live for years) have a POLST. In CA, 73% of nursing home patients who completed a POLST were inaccurately told that it was mandatory.In CA, 72% of POLST forms are completed by a non-medically trained person, frequently a social worker or admissions coordinator.In WI & MN, non-medical “facilitators” are trained specifically to complete POLST forms using an approach that discourages selection of more than comfort treatment. A physician or non-physician provider may sign POLST without any confirmation that they discussed level of care preferences (or that one would occur in the future). Only check marks on a form are required to document the complex content of that type of discussion.OR and other states do not require a patient signature. Why not? Could this be a simple oversight after 20 years of forms?When a patient signature is required, the majority (59%) are signed by a 3rd party even when the patient has mental capacity.No requirement exists for a witness or family member to be present during the consent process.Most states grant legal immunity from claims of “wrongful death” for the person completing the form.In CA, when a person loses capacity, a 3rd party not designated by the patient may change the POLST.In WI, a patient presented to the hospital with a 14 year old POLST that had never been reviewed.

These inadequacies leave patients in a vulnerable state. On the other hand, POLST is certainly inadequate from a physician standpoint as well: While managing a critical illness,will you sign a POLST?

When the POLST orders are followed in a year, how confident are you that your understanding of the patient’s wishes will be honored? What if the patient lives 10 years? What happens should you leave practice? What if you die? Do you think the signed forms should still be used without review? Are we providing another physician (who maynot appreciate the nuanced tone and tenor of the original discussion) a blank check to potentially run roughshod over a patient’s rights in your name when you aren’t there?

For ED or ICU physicians receiving new patients who present with POLST: Can you be confident that the patient has been properly informed? What if the doctor who signed the form does not have privileges at your center? What if his or her license was suspended? Will you blindly follow that physician’s orders? What is your level of confidence that they will make any sense relative to “in the moment” decisions that must be made? Will you override a POLST for a patient with an acute illness or allow them to die? Will your own conscience be respected? Will you have immunity if you appropriately save someone’s life (seemingly) “against his or her will?”

POLST raises more questions than it purports to answer. The POLST paradigm leaves too many uncertainties, too many risks that overtly conflict with the stated (original)purpose of POLST — to ensure that patient wishes are honored. In my judgment, the POLST paradigm and forms pose serious risks to good patient care and doctor-patientrelations and they should not be used in Florida.

8880 University Pkwy., Suite BPensacola, FL 32514Ph: 850-478-0706 Fx: 850-474-9783Email: info@escambiacms.orgExecutive Director: Erica Laxson

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PENSACOLA, FL

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Member Benefit: The Health Care Attorney On Call Hotline (561) 306-5699

View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves theright to edit or reject any submission.

MECoP Reminder

The Diabetic Leg: Primary Care tothe Specialist - A Review ofComplications and TreatmentStrategiesSaturday, June 2 | 7 a.m. - 1 p.m.The Crowne Plaza in Downtown Pensacola5 AMA PRA Category 1 CreditsTM

visit www.mecop.org for topics and agendaContact 850.477.4956 (option 1) to register