1. Basic Standards Legal Issues Michael D. Adelman, D.O.

2. Major Consideration Avoid Law Suits!

3. Legal Briefs!

4. Most Law Suits Arise From: Failure to follow process Interpretation of unclear standards Requiring standards that are impossible to achieve

5. Failure To Follow Process Evaluating one program differently than another when both have the same deficiencies Program in New York has deficiency in number of cases a resident sees per week and also no OPP is documented. Given two year accreditation Program in Cleveland has same deficiencies but is given 3 year accreditation Using a different set of standards when evaluating a program Program has been using Yr. 2000 standards New standards come out in January of 2002 Program is evaluated in April 2002 based on new standards

6. Failure To Follow Process Remember: You cant change the standards and evaluate a program on these new standards without allowing sufficient time for a program to meet the standards. How Much Time? It depends on the changes in standards 1 Month for resident work hours 6 Months for evaluation standards 12-24 months for new rotation requirements

7. Interpretation Of Unclear Standards The goals of an emergency medicine residency program are to… –Prepare the resident to meet certification requirements of the AOA through the AOBEM Does this mean that if a resident doesnt pass the certification test he can sue the program because they did not meet this goal set forth in the basis standards? Can he sue the specialty college or AOA since they accredited the program?

8. Interpretation Of Unclear Standards Emergency medicine residency program shall prepare the resident to…Demonstrate proficiency in the psychomotor skills required of a competent emergency physician. How? How is the program supposed to document this? What PROCESS is followed to assess the resident? Is the Process different in different EM Programs? This becomes a MAJOR problem if it is claimed that the resident doesnt meet the standards!

9. Interpretation Of Unclear Standards Different evaluators may interpret standards differently Institutional Requirements (std I): The institution must..have an organized department/section of emergency medicine which must provide evidence that there is a review of the quality of care provided by all.. The institution has a division of Specialty Medicine. The EM docs meet with this group and various chart reviews, [including EM], to evaluate quality standards are discussed within this meeting. One program evaluator cited a hospital with this structure for failing to meet the standard. At a different hospital, another program evaluator, noting that this committee meets the spirit of the standard gave the program full credit.

10. Requiring Standards That Are Impossible To Achieve All Family Practice Residents will spend at least two months in an in-patient pediatric rotation AND All Family Practice Residents must maintain a continuity care FP clinic 4 days a week. If the in-patient Peds has to take place at a childrens hospital in another city, there is no way that the resident can also maintain a 4-day a week FP continuity clinic at the same time.

11. Requiring Standards That Are Impossible To Achieve Review standards for conflicts Residents are employeesreview employee law and workforce regulations prior to writing standards about work hours, leave of absence issues and contracts. Review Health Care Law prior to writing patient treatment standards (eg EMTALA- Emergency Medical Treatment And Labor Act)

12. Create a Standard process Follow that Process Write clear unambiguous standards Train All evaluators to interpret the standards precisely the same way Review all standards to make sure they do not conflict with each other or with federal laws