Just a quick recap of election results that may be of interest to physicians.
First, terrific news from California. The California Medical Association led a coalition engaged in a year-long defense of the Medical Injury Compensation Reform Act (MICRA) legislation. The package of liability reforms contained in MICRA are seen as the gold standard for state medical liability policy, and the heart of the package is a $250,000 cap on non-economic damages. The California trial lawyers placed a ballot question before the voters to significantly increase the cap and add random drug testing for physicians.
This message was distributed by CMA yesterday. “[On Tuesday] the voters of California spoke loudly and definitively, sending the trial lawyers’ Proposition 46 to defeat by a vote of 67 to 33. The message is clear – Californians simply don’t want to increase health care costs and reduce health access so trial attorneys can file more lawsuits.”
The 113th Congress included 3 physicians in the Senate and 17 physicians in the House of Representatives (including 1 Delegate). Two of the 17 physicians in the House voluntarily left their seats to run for US Senate. The 114th Congress looks to have 14-15 physicians in the House.
Physicians running as incumbents for Congressional seats were generally successful in their reelection bids. Notable races include Rep. Bill Cassidy, MD is in a run off for his House seat in Louisiana. Rep. Ami Bera, MD won California’s hotly contested 7th District in 2012 but is currently behind his opponent in a race that is still undeclared.
Physicians challenging for first terms in Congress include:
Monica Wehby, MD, a neuro surgeon, was defeated in her US Senate bid in Oregon.
Alieta Eck, MD was defeated in her challenge for the US House of Representatives seat vacated by Rep. Rush Holt in New Jersey.
The key congressional committees with jurisdiction over healthcare will all likely see new leadership. These include The House Energy & Commerce Committee,
The House Ways & Means Committee and the Senate Finance Committee
CDC Intercepts Sick Passenger at Newark Liberty International-Cleared for Ebola
On October 4 the CDC’s Quarantine Public Health Officer met a flight from Europe to assess a sick passenger who had traveled from West Africa. The passenger was evaluated at a local hospital and later discharged from the emergency department. A full medical evaluation was conducted in coordination with federal, state, and local public health officials which found no evidence of Ebola. Read the press release.
Yesterday, the CDC announced that Ebola screenings will begin next week at Newark Airport. A non-contact thermometer will be used to screen for sick passengers. Read the CDC’s statement.
Friday evening, October 3, 2014, the Centers for Disease Control & Prevention (CDC) notified the New Jersey Department of Health that a Mercer County child who died last week tested positive for enterovirus D68 (EV-68). CDC also confirmed a positive case of EV-68 in a Middlesex County child. The state currently has a total of nine confirmed cases in Camden, Burlington, Mercer, Middlesex, Morris, Essex, Passaic and Sussex counties. Read the NJ Department of Health’s Press Release. Visit its web site for more information.
The NJ Department of Health’s FAQ’s can be found here.
The New Jersey Supreme Court recently ruled in C.A. v Bentolila that a document created by Valley Hospital personnel during its self-critical analysis of an adverse event was shielded from discovery in a subsequent medical malpractice lawsuit. At issue was whether the hospital had complied with the requirements of the Patient Safety Act, passed in 2004, which would provide an absolute privilege for such documents. The case involved a birth injury alleged to have been caused by negligent medical care.
Regulations implementing the act and expanding upon some of its requirements were not adopted until 2008. The document at issue was created after the law was passed, but before the regulations were adopted. In a four/three decision the majority decided that the hospital had substantially complied with the act’s requirements because it had followed requirements contained in the statute. The majority held that the hospital should not be expected to anticipate requirements in future rulemaking. For example, the regulations require that the document be prepared exclusively in the setting of an investigation qualified under the act’s self-critical analysis. The regulations also require that a physician be a member of the Patient Safety Committee that conducts the self-critical analysis.
The Supreme Court opinion construed the Patient Safety Act in light of its legislative purpose–to encourage healthcare providers to work together freely and candidly in a confidential self-critical setting in order to avoid future patient harm deriving from facility system failures. Nevertheless, hospitals and physicians who serve on Patient Safety Committees wishing to analyze system failures in a confidential environment must ensure that each specific regulatory requirement is met in order to avail themselves of the privilege in future litigation.
On September 17, the CDC confirmed New Jersey’s first case of enterovirus D68 (EV-D68) and other cases have since been confirmed. Read the DOH FAQ below on confirming cases of EV-D68:
Can individual doctors and hospitals confirm cases of EV-D68?
EV-D68 can only be diagnosed by doing specific lab tests on specimens (samples) and that few laboratories are able to perform. While many hospitals and some doctor’s offices can test ill patients to see if they have an EV infection, very few can do specific testing to determine the type of EV, like EV-D68. There are over 100 EV infections and specific typing of specimens is needed to confirm whether the virus is D68. In order to make the final diagnosis of EV-D68, the CDC in Atlanta would have to confirm the test on the sample. Read more FAQ’s.
The CDC has confirmed that the first case of Ebola was diagnosed in the United States. The patient developed symptoms about four days after arriving in the U.S. on September 20 after traveling from Liberia to Dallas, Texas. On September 24, the patient fell ill and sought medical care at Texas Health Presbyterian Hospital of Dallas on September 26. He developed symptoms consistent with Ebola and was admitted to the hospital on September 28. Based on the patients’ travel history and symptoms the CDC suggested testing for Ebola. The medical facility isolated the patient and sent specimens for testing to the CDC and to a Texas lab participating in the CDC’s Laboratory Response Network. The CDC and the Texas Health Department reported the laboratory test results to the medical center and informed the patient. A CDC team is being dispatched to Dallas to assist with the investigation. Read more. View updates on CDC’s website.
Read the NJ DOH Memo, CDC Update, CDC Key Messages, Clinical Guidelines for Initial Evaluation of Suspect Cases of Ebola, and a guidance document on unaccompanied children from the Southern U.S. border. Other important Ebola information can be found on the NJ DOH website.
Check out MSNJ’s blog for more resources.
IMPORTANT UPDATE: Rescheduling of Hydrocodone Combination Products to Schedule II-New Prescriptions May be Required
Effective October 6, 2014, hydrocodone combination products (including Vicodin) will be considered CDS schedule II drugs. Physicians should keep in mind that there are more restrictions on schedule II drugs, when prescribing hydrocodone combination products after October 6, 2014. Physicians may electronically prescribe schedule II CDS in New Jersey. Likewise they may prescribe a 90 day supply of schedule II CDS by issuing three separate 30-day prescriptions, so long as the 90 day supply will not create an undue risk of abuse by the patient. See N.J.A.C. 13:35-7.6(c) for details. While the federal regulation allows refills up until April 8, 2014 and MSNJ recommended that the state allow refills on these newly scheduled drugs until the April 8 deadline, the New Jersey Department of Consumer Affairs has opted not to permit it. NJ will NOT allow prescriptions written before the October 6, 2014 effective date to be refilled up until April 8, 2015. NJ physicians will have to write new prescriptions for patients with outstanding prescription refills for hydrocodone combination drugs after October 6. Physicians are urged to read the New Jersey Attorney General’s guidance on the rescheduling of hydrocodone combination products, including the exemptions allowed under N.J.A.C. 13:35-7.6.