Risk Watch e-column
June 2006
An update of risk management news, issues and items of interest
California Enacts New HIV Reporting Method
California Governor Arnold Schwarzenegger signed a bill on April 17 requiring name-based reporting of HIV cases in California. The bill went into effect immediately, reported the California Medical Association, which supported the measure.
The name-based system will replace the previous alphanumeric one introduced in 2002. The old system proved to be a bureaucratic nightmare, resulting in duplications and unreliable data. California was one of only seven states that had yet to move to the name-based system.
Another motivation for passage of the bill was the threat by the federal government to withhold millions in funding for HIV programs from states using alphanumeric and other non-name-based HIV reporting systems. The federal Centers for Disease Control and Prevention do not consider code-based HIV reporting to be accurate.
(Source: California Medical Association)
Diagnosing Older Drivers with Dementia
As the number of older patients grows, family physicians will increasingly face the task of determining whether or not the patient should still be driving an automobile. About 30% of geriatric patients who drive have dementia.
According to the American Academy of Family Physicians, there are a range of causes, conditions and diseases that can be the root of cognitive impairment.
Evaluation begins with a history from a family member or other caregiver who has observed the patient while he or she is driving. The history should focus on unsafe behavior, assessment of the patient’s cognitive abilities, estimation of the severity of dementia and a thorough review of all medications—including nonprescription drugs and herbal supplements. In addition, a recommendation to a driving rehabilitation specialist or the state’s department of motor vehicles (DMV) for a road test should be considered. Physicians should also refer patients to a social worker or community agency that provides transportation if and when the patient is unable to drive.
Physicians who recommend that a patient stop driving should share this recommendation with those who have decision-making authority over the patient. Any rejection of this recommendation by either the patient or caregiver should be documented in the patient’s chart. A letter to the state DMV may also be appropriate and/or required.
As a matter of policy, physicians should ask patients with memory loss if they are actively driving. Even though the patient has some memory loss, he or she may still be capable of driving themselves and should receive ongoing monitoring—during medical visits and via in-person license renewal by the DMV. The latter has been shown to have significantly lowered fatalities among older drivers.
(Source: American Academy of Family Physicians )
How to Identify a Verified Internet Pharmacy
The National Association of Boards of Pharmacy (NABP) has developed an effective certification system for Internet pharmacies, according to the federal Drug Enforcement Agency’s Office of Diversion Control. These VIPPS (Verified Internet Pharmacy Practice Sites) must comply with the licensing and inspection requirements of their home state as well as in each state in which they distribute medications. In addition, the pharmacies have to comply with the NABP guidelines, including those governing patient rights to privacy, authentication and security of prescription orders, adherence to a recognized quality assurance policy and provision of effective consultation between patients and pharmacists. If an Internet pharmacy meets the criteria, then it can display the VIPPS seal on its website. The certification is voluntary. The NABP also lists licensed pharmacies in good standing on its website (www.nabp.net).
(Source: Office of Diversion Control )
Employer Beware: Check Out Applicants Before They Are Hired
For employees who will be handling cash or sensitive patient information, it is crucial to do a thorough background check before hiring, “Practice Pointers: Checking Out Job Applicants,” advises in an article in the March 3 issue of Medical Economics magazine.
The background check begins with the application form, and the applicant’s name, current and former addresses, education, Social Security number and employment history (including dates and if the applicant worked under a different name). Though potential employers cannot legally ask for personal information, such as birth date, vital statistics or health status, they can ask if the applicant is old enough to work, if there is any reason why he or she could not do the job, has been convicted of a crime or has any pending felony charges against them.
The article further states that it is necessary that the applicant consent to a background check in writing. The check should include credit history, education and employment references. It should also be made clear that no job offer will be made until the background check is completed.
Employers should be aware that the criminal background check may come up empty since many employers do not press charges against an employee fired for embezzlement. Asking for prior addresses will help in finding possible felony convictions in other counties and states.
Employers should also make sure that every step of the background check is thoroughly documented, including names, titles and dates of each reference checked. Include notes as to whether or not information was received via the phone, and keep written documents received during the application process.
If the applicant is hired, keep the background information in his or her personnel file. Credit and criminal histories should be kept in a separate, secure file. Even if the applicant is not hired, keep the information for at least a year.
(Source: Medical Economics)
