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The CMG Voice

Is your plastic surgeon going to live broadcast your surgery on Snapchat?

Posted Monday, October 16, 2017 by Tyler Goldberg-Hoss

For years, surgeons have uploaded videos on YouTube and other sites for marketing and educations purposes. With the rise of other sites like Snapchat and Instagram, some surgeons have gained significant followings by live broadcasting their surgeries, including the use of “theatrics” such as dressing up in costumes and dancing.

These developments raise significant ethical concerns, prompting the Journal of the American Society of Plastic Surgeons to come out with guidelines regarding the practice. These including making sure the patient consents to such videotaping and/or broadcasting and all that go with it. For example, if the surgery is going to be uploaded to one of the above websites, other social media users can download the videos, share them, and even manipulate them.

Further, the proposed guidelines include considering hiring a trained videographer, so that the amount of operative time isn’t increased because the surgeon him or herself is tasked with taking the video.

You can read the full journal article here:

The Ethics of Sharing Plastic Surgery Videos on Social Media: Systematic Literature Review, Ethical Analysis, and Proposed Guidelines

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Scope of Practice for Physician Assistants expanding nationally

Posted Friday, October 13, 2017 by Tyler Goldberg-Hoss

Most anyone who has received medical care from a doctor’s office, emergency room or hospital has encountered not only doctors and nurses, but also so-called “mid-level” providers, including Advanced Registered Nurse Practitioners (ARNPs) and Physician Assistants (PAs).

For some, primary care these days does not even involve a doctor directly, as many of us have come to view ARNPs and PAs as essentially fulfilling this role. This is due in part to a general shortage of primary care doctors and a general increase in demand for healthcare, particularly with so many additional insured patients under the Affordable Care Act. Additionally, we as a society of health care consumers have become more comfortable with PAs and ARNPs providing us this medical care.

In Washington the PA scope of practice is broad already. Like many states, PAs and ARNPs can do just about anything a doctor can do, other than surgery. They can diagnose illnesses, write prescriptions, and order diagnostic tests. While they necessarily have a supervising physician, that does not mean that the doctor is side by side with the PA during her work day. Rather, often it means, depending on the experience of the PA, the relationship between PA and doctor, and the complexity of care at involved, that the doctor is only overseeing the work done by the PA after the care has been provided.

In recent past, many states have increased the autonomy given to PAs to practice, resulting in an increase in the number of PAs, including in Washington. Expect this to continue as institutional providers look for ways to offer competent, but cheaper, health care to its patient population.

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Washington State, Cities of Everett and Seattle Latest Governmental Entities to sue opioid drug maker for harming communities

Posted Wednesday, October 11, 2017 by Tyler Goldberg-Hoss

The opioid epidemic in the United States is without question concerning. In Washington alone, 718 citizens died from opioid overdoses in 2015. Nationwide, 1 in 4 people who receive prescription opioids for chronic pain struggle with addiction.

Often, the use and misuse of narcotic pain medication touches issues in our practice, including evaluating whether to investigate possible claims, or in cases we are currently litigated.

Sometimes the issue is at the forefront - an allegation that a medical provider negligently prescribed or monitored the use of such medications, resulting in harm. Or an allegation that a person was “drug seeking” when he or she went to the emergency room, explaining why proper care was not provided.

At a 20,000 foot view, it is difficult to answer who or what is responsible for the current opioid crisis in our country. Answers can reasonably include, depending on the circumstances, the patient him or herself, the health care provider prescribing the medication, perhaps even the pharmacy for failing to catch an excessive amount of medication prescribed.

Another possible responsible party is the manufacturer of the medication itself. Lawsuits have been filed all over the country, including in New York, Ohio and Missouri.

Now Washington State and the Cities of Everett and Seattle have filed similar claims against Purdue Pharma. The lawsuits allege that the drug maker should be responsible for the considerable social and economic costs of the problems it asserts is caused by its drug OxyContin.

In the Everett lawsuit, the City alleges that Purdue Pharma knew that its pills were being illegally bought and sold on the black market but did nothing. The Washington State lawsuit alleges in part that the company used deceptive marketing to convince patients and doctors that the drug carried a low risk of addiction.

Recently a judge declined to dismiss the Everett case at the request of the defendant, and the case continues toward resolution at trial. Some of the damages the suits are claiming include specific costs it incurred because of Purdue Pharma’s negligence, including money spent on police, emergency medical services, and social services.

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Why is Washington’s AG suing hospitals for withholding charity care from low-income patients?

Posted Friday, October 6, 2017 by Tyler Goldberg-Hoss

In the last few weeks, Attorney General Bob Ferguson has filed lawsuits against two hospitals for failing to provide charity care to low income patients. The lawsuits against St. Joseph Medical Center in Tacoma and Capital Medical Center in Olympia are based on the responsibilities of hospitals in Washington to provide free care to patients below the federal poverty level, and discounted care to patients with incomes up to twice the poverty level.

The law mandates that hospitals have to be proactive at the outset of determining whether a patient is eligible for charity care, and must provide notice in writing to patients that free or discounted care may be available. Hospitals also have the responsibility of interpret the information for patients for whom English is not their first language.

The lawsuit against St. Joes alleges that it has withheld charity care from tens of thousands of low-income patients since 2012. This includes making it harder for patients to get assistance, and billing patients for care that should be free or discounted.

The case against Capital Medical Center alleges that the hospital trained its staff to pressure patients for upfront payments without notifying them of the possibility of charity care or screening them for eligibility. In particular, the law requires that a patient only needs to verify his or her income with one form, such as a pay stub or tax statement. The lawsuit alleges that Capital required up to eight forms to verify income, creating an unnecessary hurdle to receiving charity care.

St. Joes and Capital Medical Center are not the only two hospitals that appear to be failing in this regard. Columbia Legal Services recently released a report on the subject. You can find it here:

Access Denied: Washington’s Charity Care System, Its Shortfalls, and the Effect on Low-Income Patients

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American Academy of Pediatrics recommends weighing all patients in Kilograms to prevent medication errors

Posted Monday, October 2, 2017 by Tyler Goldberg-Hoss

Recently the American Academy of Pediatrics (AAP) signed on to a statement by the Emergency Nurses Association that calls for the use of kilograms in the Emergency Department.

The announcement comes in the October issue of Pediatrics, and cites the sobering statistic that 40% of fatal medication errors can be traced to an error in dosing, with children being especially vulnerable.

The Nurses’ Statement includes the following recommendations:

You can read the full article in AAP News here:

To reduce errors, ED staff should weigh patients in kilograms

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