cap scan august 2014

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 1

AUGUST EDITION, VOLUME 2014, NO. 8

CAPITAL MEDICAL SOCIETY 2014 MEETINGS CALENDAR

SEPTEMBER 3, 2014 @ 6:00 PMCMS Meet the Candidates ReceptionGoodwood Museum & Gardens Carriage House

SEPTEMBER 16, 2014 @ 6:00 PM*“Telemedicine” Dean Watson, M.D. & Lauren FaisonMaguire Center for Lifelong Learning at Westminster Oaks

OCTOBER 21, 2014 @ 6:00 PM*“Domestic Violence and Human Trafficking” - 2 Hour Required CMESuzanne Harrison, M.D. & Wendi Adelson, J.D.Maguire Center for Lifelong Learning at Westminster Oaks

*INDICATES IT IS A CMS MEMBERSHIP & CME MEETING FOR MORE INFORMATION, SEE PAGE 3

1 - On behalf of CMS Foundation, Pam Wilson presented a $3,450 check to Mark Baldino, Executive Director of Elder Care Services, Inc., to supply services to at-risk seniors and their caregivers to help them remain at home and remain as independent as possible.

2 - In the fulfillment of CMS’s mission to “promote the practice of medicine,” Dr. Alfredo Paredes, President, presented a $2,000 check to Dr. Ron Hartsfield, Dean of the Tallahassee Regional Campus, FSUCOM, to be used to fund scholarships for 3rd and 4th year medical students at that campus.

3 - Dr. Josh Somerset, CMS Board of Governors’ President-Elect, welcomed new residents in the TMH Family Medicine Residency Program and the FSUCOM Internal Medicine Residency Program at TMH during a joint New Resident Orientation Luncheon at TMH. CMS welcomes these new residents to the Tallahassee medical community!

4 - John Mahoney, M.D. and Walt Colón, DMD presented a program to the Rotary Club of Tallahassee (RCT) on the We Care Network and the We Care Dental Network. RCT has been an ongoing supporter of the We Care Network. Both Dr. Mahoney and Dr. Colón are among the many Rotarian physicians and dentists serving in the We Care Network.

5 - Sue Conte, Chair of the UWBB Health Council Healthy Lifestyles Sub-Committee, enjoyed the opportunity to reconnect with her fellow past and present CMS Executive Directors, Mollie Hill, Karen Wendland and Pam Wilson and past We Care Network Program Coordinator, Rosemary Evans. All are serving on the committee together.

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MICHAEL DOUSO, M.D. – 2ND

CHRISTOPHER RUMANA, M.D. – 3RD

RONALD RAY, M.D. – 4TH

WILLIAM PAUL SAWYER, M.D. – 5TH

BOB SONI, M.D. – 6TH

EMILY ASHMORE, M.D. – 7TH

T. ADAM OLIVER, M.D. – 7TH

JOHN WILLIAMS, JR., M.D. – 7TH

ROBERT CHAPMAN, M.D. – 8TH

T. DEAN DALRYMPLE, M.D. – 8TH

LISA FLANNAGAN, M.D. – 8TH

STANLEY GWOCK, M.D. – 8TH

DAVID PASCOE, M.D. – 8TH

NANCY VANVESSEM, M.D. – 8TH

AKASH GHAI, M.D. – 9TH

MARC INGLESE, M.D. – 11TH

RICK DAMRON, M.D. – 12TH

SERGIO GINALDI, M.D. – 13TH

ALICE POMIDOR, M.D. – 13TH

DAVID CRAIG, M.D. – 15TH

STEPHEN SGAN, M.D. – 15TH

GADI SILBERMAN, M.D. – 17TH

JOSHUA FUHRMEISTER, M.D. – 18TH

DUNG NGUYEN, M.D. – 18TH

TERENCE REISMAN, M.D. – 18TH

EVAN DUSSIA, M.D. – 19TH

MARIE BECKER, M.D. – 20TH

WILLIAM MORSE, M.D. – 20TH

FRANK WALKER, M.D. – 20TH

ERIC BOUCHARD, M.D. – 22ND

MICHAEL FORSTHOEFEL, M.D. – 22ND

SHAYLA GRAY, M.D. – 22ND

P.S. KRISHNAMURTHY, M.D. – 25TH

JAMES THOMAS, M.D. – 26TH

RICHARD DOZIER, M.D. – 27TH

STAN WHITNEY, M.D. – 28TH

CAMILLE BLAKE, D.O. – 29TH

HAPPY BIRTHDAY!{AUGUST BIRTHDAYS}

HAPPY BIRTHDAY! WE ARE SO GLAD YOU WERE BORN!

MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT

OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218

www.capmed.org

BOARD OF GOVERNORSAlfredo Paredes, M.D., PresidentJoshua Somerset, M.D., President ElectJ. Daniell Rackley, M.D., Secretary/TreasurerNancy Loeffler, M.D., Immediate Past-PresidentRobert Chapman, M.D.Garrett Chumney, M.D. Tracey Hellgren, M.D.Zan Batchelor, CMS Alliance PresidentVikki McKinnie, M.D.Hector Mejia, M.D.Margaret Havens Neal, M.D.Philip Sharp, M.D.Timothy Sweeney, M.D.Ernesto Umaña, M.D.Pam Wilson, Executive DirectorFamily Medicine ResidentsWilliam Carlson, M.D./Anna Hackenberg, M.D. Internal Medicine ResidentsChris Rosadzinski, M.D./Prerna Satyanarayana, M.D.

PUBLICATIONEDITORCharles E. Moore, M.D.,

GRAPHIC DESIGNLynne Takacs

ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN? Please contact Dr. Charles Moore at

[email protected] and Shannon Boyle at [email protected]. All articles submitted will be reviewed by your peers prior to publishing.

Cap Scan is published during the first week of each month and is the official publication of the Capital Medical Society. Advertising in Cap Scan does not imply approval or endorsement by the Capital Medi-cal Society. The opinions expressed are those of the individual authors and do not necessarily reflect the official policies of the Capital Medical Society.

If you are a member of the Capital Medical Society and would like a copy of the Minutes from the Board of Governors meeting, please call the CMS office. Thank you.

August Birthdays 2

CMS Meet the Candidates Reception 3

2014 CMS Meetings Calendar 3

CMS Membership Directory 3

Reflections from the Editor 4

CMS Lunch & Learn 8

Viewpoint 9

Medical/Legal 11

CMS Dues Reminder 16

CMS Member Benefits 17

CMS Foundation 18

CMS Foundation: We Care Network 19

MANAGING EDITORShannon Boyle

IN T

HIS

IS

SU

E:

DID WE MISS YOUR BIRTHDAY? IF SO, PLEASE EMAIL ROSALIE CARLIN AT [email protected]!


CMS MEET THE CANDIDATES RECEPTION

SEPTEMBER 3, 2014

CMS MEET THE CANDIDATES RECEPTION6:00 PM | GOODWOOD CARRIAGE HOUSE

SEPTEMBER 16, 2014

“TELEMEDICINE” DEAN WATSON, M.D.

AND LAUREN FAISON6:00 PM | MAGUIRE CENTER

FOR LIFELONG LEARNING AT WESTMINSTER OAKS

OCTOBER 21, 2014

“DOMESTIC VIOLENCE AND HUMAN TRAFFICKING” - 2 HR REQ. CMESUZANNE HARRISON, M.D. AND

WENDI ADELSON, J.D.6:00 PM | MAGUIRE CENTER


NOVEMBER 18, 2014“WOMEN’S HEALTH”

DAVID DIXON, D.O. & STEPHANIE LEE, M.D.6:00 PM | MAGUIRE CENTER


DECEMBER 4, 2014CMS FOUNDATION HOLIDAY AUCTION6:30 PM | FSU UNIVERSITY CENTER

CLUB

2014 MEETINGS CALENDAR

CMS Members, CMS Alliance Members, and Members of the Leon County Dental Association

are cordially invited to attend

Capital Medical Society’s “Meet The Candidates” Reception

-This event is not a fundraiser. It is an opportunity to interact with local candidates.-

Wednesday, September 3, 20146:00 pm – 7:30 pm

Goodwood Museum & Gardens Carriage House1600 Miccosukee Road

We have invited all of the local candidates who have registered.

Candidates making it through the primary will attend. CMS will keep you informed of the attendees.

Light hors d’oeuvres and cash bar

We Thank Our SponsorsPRESENTING SPONSOR

SUPPORTING SPONSOR

Hancock Bank

Please RSVP by August 27, 2014 to Rosalie Carlin at [email protected].

CMS MEMBERS:

IF YOU DID NOT RECEIVE YOUR COPY OF THE 2014 CMS MEMBERSHIP DIRECTORY, PLEASE FEEL FREE TO STOP BY THE CMS OFFICE ANYTIME MONDAY-FRIDAY 8:30 AM-5:00 PM TO PICK UP YOUR COPY.

IF YOU HAVE ANY CORRECTIONS TO YOUR LISTING, PLEASE CONTACT SHANNON BOYLE AT 877-9018 OR [email protected].

4 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

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“So that’s that!” I said to my wife for the second time, pouring

us each a second half glass of second rate Chardonnay. Lynn,

and therefore I, drink Chardonnay, for she is determined

that Sauvignon Blanc tastes like grapefruit juice. She has

a very adept palate, whereas I am not certain whether I

am eating an onion or a carrot. “Consumed, gone, but not

forgotten.” We granted each other a benignant, knowing

smile. “Not that I don’t altogether miss it…somewhat. My

patients treated me well, on the vast 99.7% whole, and

were generous, too. I mean, how often was it that I fell

short of what they ideally may have wanted, but so kindly

“JUNE, 2014: TABULAE RASAE” By Charles Moore, M.D.

accepted?” I sipped a sip of Chardonnay, glancing out the

window to the see the sun slipping below the horizon, the

shadows of the live oaks long.

It had been a busy day. Early in the morning, we had gone

to the storage facility where I had kept, for seven years as

duly required by law, the thousands of charts that had

accumulated over the decades of my practice. We had loaded

them into pick-ups and my old “Explorer,” careful to ensure

that en route they did not blow out all over the highways and

byways, and brought them out to the burn pit of my neighbor.

CONTINUED ON NEXT PAGE



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It was already full of old, dry limbs and timber that he had

pushed into it over the past few months with his tractor. A

little diesel and a match, and that was that.

We stood around, watching everyone, all my paper patients

that is, go up in smoke. I felt both glad and sad. There was

a sort of consummation in their cremation. Many of the

charts, as I toted them from truck to fire pit, happened to

fall open, and I would glance at what I had written, look at

the occasional photo, and find myself kind of astonished.

I was glad that the mechanics of this consumption were so

physical; it made it a sort of “last rite.” Now, or certainly

in the near future, I suppose all one will have to do seven

years after retirement will be to hit the “delete” button on

a computer. Or maybe charts more commonly, even now,

live on in perpetuity in their cozy computers, inherited

by someone else in a large practice that itself will go on

forever. I might have been one of the last of the “solo”

practitioners where paper still ruled.

“Just think,” I thought, “all those sheets of paper, now

turned to ash and flung as dust into the sunset, had once

upon a time been utterly blank. And then along came

the people, and the surgeries, and the follow-ups, and all

those pages got filled with the innumerable notations of a

portion of each person’s life, and the whole bunch of them

a world, and I in the midst.”

Was I impressed with myself ? No, not at all; I just had

happened to have been there, jotting down a few words

while occasionally wringing my hands.

CONTINUED ON PAGE 6



Look, here is Mrs. X who had a post-op bleed. How well

I remember HER! And Mr. Y on whom, all by myself, I

had invented a one stage reconstruction of the columella

that I almost thought might have been worth publishing.

(I never did, of course). And here is good old BZ, shot in

a bar, made paraplegic, spent years letting me turn flaps to

heal yet another huge decubitus ulcer; and finally, after so

much, and so very many years, died. I had come to quite

love him, indomitable right to the end. And there was, of

course, sweet Miss M., a “steel magnolia” if ever one was,

on whom I had done a TRAM flap following a mastectomy.

On the second night she had developed extraordinary

abdominal pain. A flat plate of the abdomen showed

free air, and I horribly thought that during the abdominal

closure I might have caught a loop of bowel with that huge

curved needle I was wielding. In the O.R later that night,

it was discovered (to my not altogether vague relief) that

she had simply had the ill fortune to perforate a duodenal

ulcer. She came from afar, without means easily to get

home, so when she was discharged from the hospital Lynn

and I took her to our house, and while nursing her back

to health we became wonderful friends. When she died

years later, I was asked to say a few words at her funeral.

My notes were in her chart. Ah, lovely lady, so well and

beautifully remembered!

I watched, with the ghost of a smile flickering about the

corners of my mouth, as the ashes of my paper-patients

flew, I suppose, Heavenward.

All that paper! Once upon a time pure and white, a

Tabula Rasa, become filled with this and that, goodness,


“JUNE, 2014: TABULAE RASAE” CONTINUED FROM PAGE 5



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badness, pain, suffering, hope, and some glory too. Quite

gone. As I stood there in front of the fire, sweating (for

the day was almost as hot as the fire)

swigging from my bottle of water, I

actually thought of John Locke: Great

Physician, Empiricist, Philosopher,

Grandfather even of our Declaration

of Independence, the Constitution,

and all our inalienable “natural rights”

to the pursuit of happiness, etc. The

child’s mind at birth was a Tabula

Rasa, Locke said, a “blank slate,” the

wax notebook of the Romans that,

when warmed and made smooth

again, was ready to be written upon once more. I had

melted down, on this hot, June day a lot of wax.

With that chore done, where from there to begin again? Let

me tell you. June, 2014, proved to be a significant month

beyond the obliteration of those thousands

of charts.

In fact, on June 9th, the very day that marked

the eightieth anniversary of Donald Duck’s

birth into the world, I…who had never

assumed the possibility, lacking the age and

wisdom to be one…became a Grandfather.

Little Sebastian Charles (I think this was

after “Dickens”) Tomaszewski (I know

how to spell and pronounce it, by the way)

appeared upon this planet, weighing all of

four pounds, but with all his arms, legs, and fingers, his palate

intact, and his ears close to his head.

CONTINUED ON PAGE 8



So do let me take a moment to thank, very particularly Dr. Dorothy White,

our daughter’s obstetrician, who was invariably so accommodating, patient

and sincere; and Dr. Jana Bures-Forsthoefel, so full of wise experience, both

of them known so well for their brilliant care of delicate pregnancies; Dr.

George Davis, a great gentleman, without whose compassion and surgical

skill this pregnancy could never have been brought to term; Tom Bloom,

J.D., and Dr. Lee Norton, Ph.D, both so seminally helpful; and Dr. Chris

Lipari, who always saw the hope and never once denied the possibility of a

successful pregnancy despite the odds otherwise; and innumerable others,

for sure all the Nurses and Doctors in the NICU unit, who contributed so

deftly to the comfort and care of both tiny Sebastian and his Mom.

It has been a long road to the reality of his birth: many IVFs have sadly

failed, and at age 41, this, for the Mom, was pretty clearly a last, final

chance. But with the help and expertise of all the above, there we have it:

our daughter is a MOM; our wonderful son-in-law a Dad; and my wife

and I, for God’s sake, unbelievably Grandparents.

O tempora! O mores! O tabula rasa! I look upon this mote, with all his

little parts, and try to imagine the mystery of the world’s goings and

comings at this very early moment of life. His retinae at this time must

be utterly confounded by the white hot intensity of the brilliant light of

this sudden world. No wonder he keeps his eyes shut 99% of the time. But

gradually, maybe even when he reaches five or six weighty pounds, he will

begin, ever so tentatively, to start to pick out shapes, lights and darks, the

side of his crib, his Mom, his Dad, and then one of these days a tree. And

so begin to write the pages of his life.

The big question I ask myself, now that I am actually this Grandfather thing,

is “will I be capable, when Sebastian is 15 and I am 95, to play catch, throw

him a fastball, or a long toss with my old, which I still have, lacrosse stick?”

More pages to fill. GO FOR IT!

MARK YOUR CALENDARS FOR THE

LUNCH & LEARN SEMINARS FOR

FALL 2014

WEDNESDAY, SEPT. 17, 2014

MANAGING STRESS IN THE MEDICAL PRACTICE

Hear about managing stress including managing difficult patients.

Speaker: Tracey Morse, Ph.D., Licensed Psychologist

Sponsor: Tallahassee State Bank

WEDNESDAY, OCTOBER 22, 2014

MEDICAL RECORDS: HANDLING SUBPOENAS; CHARGING FOR COPIES

Hear about the costs for reproduction of medical records and responding to medical records subpoenas.

Speakers: Allison Dudley, J.D., Florida Board of Medicine Executive Director,

and Lontejuana Cooper, PhD, RHIA, CPM, FAMU Health Informatics and Information

Management ProgramSponsor: Centennial Bank

WEDNESDAY, NOVEMBER 19, 2014

LOCAL SOLUTIONS TO HIPAA SECURE COMMUNICATIONS

Do the new Transition of Care and Meaningful Use requirements that are required for all offices, regardless of size, have you confused? Do you know how Interfacing, DIRECT Protocols, HISP, HealtheWay, and HIE apply to those requirements? We’ll show you how our set of Care Coordination tools tame these new standards while providing you with a simple HIPAA compliant replacement to phone/fax/mail paper communications. Beyond this, there will be helpful tips for those striving for meaningful use compliance.

Speaker: Zach Finn, HIESponsor: Tallahassee State Bank

TIME: 12 NOON TO 1:30 PM (SEMINARS START AT 12:30 PM)

PLACE: CHP AUDITORIUM, 2ND FL., 1491 GOVERNORS SQ. BLVD.

$10 PER SEMINAR/PER PERSON. YOU CAN REGISTER FOR ALL SEMINARS,

OR ONE AT A TIME!

TO REGISTER OR FOR MORE INFORMATION, CALL ROSALIE CARLIN AT 877-9018.

CMS

“JUNE, 2014: TABULAE RASAE” CONTINUED FROM PAGE 7

“JOIN” THE CAPITAL MEDICAL SOCIETY GROUP PAGE ON LINKED IN.WE WILL ADD INFORMATION THAT WILL BE OF INTEREST TO OUR MEMBERS.


VIEWPOINT

POLST—A Tool to Help All Individuals Stay in Control At the End of LifeBy Kenneth Brummel-Smith, M.D., Charlotte Edwards Maguire Professor and Chair, Department of

Geriatrics, Florida State University College of Medicine, and Marshall B. Kapp, J.D., Director, Florida State

University Center for Innovative Collaboration in Medicine and Law

Individuals and their families confront many different,

important kinds of decisions. Some of those decisions

concern medical care. None are more complex and

emotion-laden, however, than choices about the initiation,

continuation, withholding, or withdrawal of aggressive

medical intervention when illness has advanced to a point

where it is critical and unlikely to be reversed. In those

situations, an individual’s personal values and wishes should

be respected by others and determine the course of medical

action. Sadly, sometimes such respect does not occur and

people in this context, especially when they no longer are

able to make and express their own

present preferences, get subjected to

intrusive and burdensome medical

interventions that they would not

have wanted for themselves. The 1990

federal Patient Self-Determination

Act (PSDA) and the first generation

of advance care planning mechanisms (living wills and

durable powers of attorney) help in many cases to bring

about a humane, autonomy-respecting conclusion to an

individual’s life, but they provide no assurance of an optimal

result.

However, there does exist an effective mechanism for

correcting this problem. A study produced by researchers at

Oregon Health & Science University and published in the

June 9 online issue of the Journal of the American Geriatrics

Society (JAGS) provides yet more evidence that individuals

for whom a POLST (Physician Orders for Life-Sustaining

Treatment) has been written are more likely to receive the

kind of medical care they wish near the end of their lives,

and to be provided with that care in the location of their

choice. The POLST is a document that enables a willing

patient (or the patient’s surrogate) to convert the patient’s

medical treatment wishes into the physical form of medical

orders written by the patient’s physician, instructing other

health care providers such as members of an Emergency

Medical Services about the care of that patient. Because the

POLST document is a set of physician orders and health care

providers are culturally and psychologically used to routinely

following physician orders, studies such as the recent one in

JAGS confirm that a POLST is likely

to receive more respect than patient

wishes expressed in other ways, such

as current mechanisms authorized

by Florida Statutes Chapter 765.

Thus, POLST represents the next

generation in the evolution of health

care advance planning law and policy.

The POLST form is not an advance directive. It is a set

of physician orders that are to be followed as any other

set of medical orders. It includes three major sections:

CPR or DNAR (do not attempt resuscitation), the level of

medical intervention desired (comfort, limited additional

interventions, or full treatment in an ICU), and artificial

feeding. The POLST is designed for the patient who has an

advanced life-limiting illness or who is extremely frail (such as

permanent nursing home residents). It can be revoked at any

time by the patient. The patient must sign the form indicating

that they agree with the orders, and a surrogate may also sign CONTINUED ON PAGE 10


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it if the patient has lost decision-making capacity. Of course,

as with any physician’s order the physician must also sign it

to be valid.

A recent study revealed that physicians are far less likely

to want invasive interventions at the end of life than most

patients. Perhaps that is because we have witnessed first-hand

how often such interventions are either futile or increase

suffering. We should take the lead in ensuring that a well-

informed patient gets only the treatments they desire and

never undergoes treatments they do not want.

A number of other states have already codified the POLST

option in their statutes and/or regulations, giving physicians

the confidence to write such orders in consultation with

the patient or surrogate and giving other health care

professionals the confidence to comply with those orders.

If Florida truly values the principle of self-determination,

especially for its most vulnerable medical populations like

older, frail people nearing the end of their lives, it needs

to join the ranks of states enabling POLSTs to be written

and respected. For the past several years, the Florida State

University Center for Innovative Collaboration in Medicine

and Law, working in close collaboration with the National

POLST Paradigm Task Force, has acted as coordinator of

a statewide POLST effort involving a large group of health

care, human service, religious, and legal professionals who

are committed to protecting and promoting the rights of

individuals approaching the end of life. The time has come

for more Floridians to educate both themselves and others,

including those who represent the citizenry in the public

policy arena, about the Florida POLST initiative (https://

med.fsu.edu/medlaw/polst) and to advocate with local

officeholders, community leaders, and media outlets for

adoption and implementation of the POLST within Florida

law as a significant marker in the development of more

ethical and humane care for each of us. CMS

“POLST” CONTINUED FROM PAGE 9

VIEWPOINT


MEDICAL/LEGAL

10. I recently received a subpoena from an attorney for medical records. It was not issued by the court but rather was only signed by the attorney. Do I have to comply?Answer: Yes. The Florida Rules of Civil Procedure provide that an attorney can sign a subpoena - they do not have to be issued by the court.

9. Does a doctor have to have a staff member present when he is conducting a physical examination of a member of the opposite sex? Answer: No. There is no statute or administrative code provision that requires an individual be present in addition to the doctor during such examination. However, it is strongly recommended that physicians make this a standard practice given the current climate concerning sexual harassment and related lawsuits. Having a staff member present during such examinations is good practice in that it can provide verification as to whether proper procedures were followed should a problem later arise. The AMA’s Council and Ethical and Judicial Affairs recommends that the option of having a chaperone present be given to the patient.

8. May I treat a minor without parental consent? Answer: The general rule is no, but in certain circumstances, parental consent is not required. Those situations involve sexually transmitted diseases, pregnancy, emergency care, mental health and alcohol/drug abuse. In the case of sexually transmitted diseases, the physician is not allowed to notify the parents, i.e. by sending a bill.

7. May I charge interest on an unpaid bill? Answer: Yes, but at no more than the maximum rate set by the state of Florida (18%). In addition, the patient needs to be notified in advance of the interest and other charges by such means as the posting of a notice in the waiting room, the distribution of leaflets, etc. AMA ethical guidelines urges physicians who charge interest to use compassion and discretion in hardship cases.

6. Must I supply an interpreter at the request of a deaf patient? Answer: Not necessarily. A physician’s office is required to provide whatever “auxiliary aids” are required for effective communication with a hearing-impaired person. This requirement is a flexible one. You are not required to hire an interpreter in every situation. What is reasonable depends on the circumstances, as long as there is

“effective communication.” You should consult with the patient before providing a specific auxiliary aid. In lengthy or complex situations, a qualified interpreter is necessary. In other types of routine matters, including a routine office visit, a pad of paper and a pen may be acceptable. A tax credit is available to physician offices to help offset the cost of an interpreter.

5. What notification requirements do I have to my patients when I close my practice? Answer: Florida law provides that the records owner can either place an advertisement in the newspaper advising patients of the change in practice and the location of the medical records or can provide this information to each patient in writing. This must be done 30 days in advance. You must also notify the Board of Medicine of any change of address.

4. What may I charge for a deposition or expert witness fee? Answer: There is no set rate to go by. The law provides that a physician testifying as an expert witness is entitled to a reasonable fee, with what is reasonable decided on a case by case basis. In worker’s compensation cases, however, you are limited to $200 per hour if you treated the patient and $200 per day otherwise.

3. A physician requested medical records on a patient that has an unpaid balance. Can I withhold the records until the patient pays his account? Answer: No. You must provide the records upon request, regardless of whether the patient has an outstanding balance concerning the services you have provided.

2. Can I charge the physician a copying fee? Answer: Yes. Unlike for services rendered, you can condition release of the records upon payment of copying charges.

1. When a patient requests a copy of his medical records, am I allowed to or do I have to provide copies of records generated by other physicians? Answer: You must provide copies of everything you have, including copies of records generated by other physicians. You can, however, charge the patient for all copies made.

THIS ARTICLE, REPRINTED FROM THE FMA LEGAL DOCTOR, IS

PRESENTED FOR EDUCATIONAL PURPOSES ONLY AND SHOULD NOT

BE TAKEN AS A SUBSTITUTE FOR LEGAL ADVICE, WHICH SHOULD BE

OBTAINED FROM PERSONAL LEGAL COUNSEL.

TOP 10 QUESTIONS COMMONLY ASKED BY PHYSICIANS

CMS


THE HIPAA PRIVACY AND SECURITY RULESFrequently Asked Questions about the Disposal of Protected Health InformationU.S. Department of Health and Human Services – Office for Civil Rights

1. What do the HIPAA Privacy and Security Rules require of covered entities when they dispose of protected health information?

The HIPAA Privacy Rule requires that covered entities apply appropriate administrative, technical, and physical safeguards to protect the privacy of protected health information (PHI), in any form. See 45 CFR 164.530(c). This means that covered entities must implement reasonable safeguards to limit incidental, and avoid prohibited, uses and disclosures of PHI, including in connection with the disposal of such information. In addition, the HIPAA Security Rule requires that covered entities implement policies and procedures to address the final disposition of electronic PHI and/or the hardware or electronic media on which it is stored, as well as to implement procedures for removal of electronic PHI from electronic media before the media are made available for re-use. See 45 CFR 164.310(d)(2)(i) and (ii). Failing to implement reasonable safeguards to protect PHI in connection with disposal could result in impermissible disclosures of PHI.

Further, covered entities must ensure that their workforce members receive training on and follow the disposal policies and procedures of the covered entity, as necessary and appropriate for each workforce member. See 45 CFR 164.306(a)(4), 164.308(a)(5), and 164.530(b) and (i). Therefore, any workforce member involved in disposing of PHI, or who supervises others who dispose of PHI, must receive training on disposal. This includes any volunteers. See 45 CFR 160.103 (definition of “workforce”).

Thus, covered entities are not permitted to simply abandon PHI or dispose of it in dumpsters or other containers that are accessible by the public or other unauthorized persons. However, the Privacy and Security Rules do not require a particular disposal method. Covered entities must review their own circumstances to determine what steps are reasonable to safeguard PHI through disposal, and develop and implement policies and procedures to carry out those steps. In determining what is reasonable, covered entities should assess potential risks to patient privacy, as well as consider such issues as the form,

type, and amount of PHI to be disposed. For instance, the disposal of certain types of PHI such as name, social security number, driver’s license number, debit or credit card number, diagnosis, treatment information, or other sensitive information may warrant more care due to the risk that inappropriate access to this information may result in identity theft, employment or other discrimination, or harm to an individual’s reputation.

In general, examples of proper disposal methods may include, but are not limited to:

• For PHI in paper records, shredding, burning, pulping, or pulverizing the records so that PHI is rendered essentially unreadable, indecipherable, and otherwise cannot be reconstructed.

• Maintaining labeled prescription bottles and other PHI in opaque bags in a secure area and using a disposal vendor as a business associate to pick up and shred or otherwise destroy the PHI.

• For PHI on electronic media, clearing (using software or hardware products to overwrite media with non-sensitive data), purging (degaussing or exposing the media to a strong magnetic field in order to disrupt the recorded magnetic domains), or destroying the media (disintegration, pulverization, melting, incinerating, or shredding).

For more information on proper disposal of electronic PHI, see the HHS HIPAA Security Series 3: Security Standards – Physical Safeguards. In addition, for practical information on how to handle sanitization of PHI throughout the information life cycle, readers may consult NIST SP 800-88, Guidelines for Media Sanitization.

Other methods of disposal also may be appropriate, depending on the circumstances. Covered entities are encouraged to consider the steps that other prudent health care and health information professionals are taking to protect patient privacy in connection with record disposal. In addition, if a covered entity is winding up a business, the covered entity may wish to consider giving patients the opportunity to pick up their records

MEDICAL/LEGAL



prior to any disposition by the covered entity (and note that many states may impose requirements on covered entities to retain and make available for a limited time, as appropriate, medical records after dissolution of a business).

2. May a covered entity dispose of protected health information in dumpsters accessible by the public?

No, unless the protected health information (PHI) has been rendered essentially unreadable, indecipherable, and otherwise cannot be reconstructed prior to it being placed in a dumpster. In general, a covered entity may not dispose of PHI in paper records, labeled prescription bottles, hospital identification bracelets, PHI on electronic media, or other forms of PHI in dumpsters, recycling bins, garbage cans, or other trash receptacles generally accessible by the public or other unauthorized persons. The HIPAA Privacy Rule requires that covered entities apply appropriate administrative, technical, and physical safeguards to protect the privacy of PHI, in any form, including in connection with the disposal of such information. See 45 CFR 164.530(c). In addition, the HIPAA Security Rule requires that covered entities implement policies and procedures to address the final disposition of electronic PHI and/or the hardware or electronic media on which it is stored. See 45 CFR 164.310(d)(2)(i). Depositing PHI in a trash receptacle generally accessible by the public or other unauthorized persons is not an appropriate privacy or security safeguard. Instead, covered entities must implement reasonable safeguards to limit incidental, and avoid prohibited, uses and disclosures of PHI. Failing to implement reasonable safeguards to protect PHI in connection with disposal could result in impermissible disclosures of PHI.

For example, depending on the circumstances, proper disposal methods may include (but are not limited to):

• Shredding or otherwise destroying PHI in paper records so that the PHI is rendered essentially unreadable, indecipherable, and otherwise cannot be reconstructed prior to it being placed in a dumpster or other trash receptacle.

• Maintaining PHI for disposal in a secure area and using a disposal vendor as a business associate to pick up and shred or otherwise destroy the PHI.

• In justifiable cases, based on the size and the type of the covered entity, and the nature of the PHI, depositing PHI in locked dumpsters that are

accessible only by authorized persons, such as appropriate refuse workers.

• For PHI on electronic media, clearing (using software or hardware products to overwrite media with non-sensitive data), purging (degaussing or exposing the media to a strong magnetic field in order to disrupt the recorded magnetic domains), or destroying the media (disintegration, pulverization, melting, incinerating, or shredding).

For more information on proper disposal of electronic PHI, see the HHS HIPAA Security Series 3: Security Standards – Physical Safeguards. In addition, for practical information on how to handle sanitization of PHI throughout the information life cycle, readers may consult NIST SP 800-88, Guidelines for Media Sanitization.

3. May a covered entity hire a business associate to dispose of protected health information?

Yes, a covered entity may, but is not required to, hire a business associate to appropriately dispose of protected health information (PHI) on its behalf. In doing so, the covered entity must enter into a contract or other agreement with the business associate that requires the business associate, among other things, to appropriately safeguard the PHI through disposal. See 45 CFR 164.308(b), 164.314(a), 164.502(e), and 164.504(e). Thus, for example, a covered entity may hire an outside vendor to pick up PHI in paper records or on electronic media from its premises, shred, burn, pulp, or pulverize the PHI, or purge or destroy the electronic media, and deposit the deconstructed material in a landfill or other appropriate area.

4. May a covered entity reuse or dispose of computers or other electronic media that store electronic protected health information?

Yes, but only if certain steps have been taken to remove the electronic protected health information (ePHI) stored on the computers or other media before its disposal or reuse, or if the media itself is destroyed before its disposal. The HIPAA Security Rule requires that covered entities implement policies and procedures to address the final disposition of ePHI and/or the hardware or electronic media on which it is stored, as well as to implement procedures for removal of ePHI from electronic media before the media are made available for reuse. See 45 CFR

MEDICAL/LEGAL

CONTINUED ON PAGE 14


164.310(d)(2)(i) and (ii). Depending on the circumstances, appropriate methods for removing ePHI from electronic media prior to reuse or disposal may be by clearing (using software or hardware products to overwrite media with non-sensitive data) or purging (degaussing or exposing the media to a strong magnetic field in order to disrupt the recorded magnetic domains) the information from the electronic media. If circumstances warrant the destruction of the electronic media prior to disposal, destruction methods may include disintegrating, pulverizing, melting, incinerating, or shredding the media. Covered entities may contract with business associates to perform these services for them.

For more information on proper disposal of ePHI and reuse of electronic media, see the HHS HIPAA Security Series 3: Security Standards – Physical Safeguards. In addition, for practical information on how to handle sanitization of PHI throughout the information life cycle, readers may consult NIST SP 800-88, Guidelines for Media Sanitization.

5. How should home health workers or other workforce members of a covered entity dispose of protected health information that they use off of the covered entity’s premises?

The HIPAA Privacy Rule requires that covered entities develop and apply policies and procedures for appropriate administrative, technical, and physical safeguards to protect the privacy of protected health information (PHI), including through final disposition. See 45 CFR 164.530(c). In addition, the HIPAA Security Rule requires that covered entities implement policies and procedures to address the final disposition of electronic PHI and/or the hardware or electronic media on which it is stored. See 45 CFR 164.310(d)(2)(i). The Rules are flexible and thus, do not specify particular types of disposal methods; however, covered entities must ensure that the disposal method reasonably protects against impermissible uses and disclosures of PHI and protects against reasonably anticipated threats or hazards to the security of electronic PHI. See 45 CFR 164.530(c)(2) and 164.306(a). Whatever the disposal method, a covered entity must ensure that appropriate workforce members, either working on the premises or off-site, receive training on and follow the disposal policies and procedures of the covered entity. See 45 CFR 164.530(b) and (i), as well as 164.306(a)(4) and 164.308(a)(5) with regard to electronic PHI. These policies and procedures could require, for example, that employees

or other workforce members who use PHI off-site, including electronic PHI, return all PHI to the covered entity for appropriate disposal. Or, for example, if appropriate under the circumstances, a covered entity could give off-site workforce members the option of either properly shredding PHI in paper records themselves or returning the PHI to the covered entity for disposal. In cases where workforce members fail to comply with the covered entity’s disposal policies and procedures, the covered entity must apply appropriate sanctions. See 45 CFR 164.530(e).

6. Does the HIPAA Privacy Rule require covered entities to keep patients’ medical records for any period of time?

No, the HIPAA Privacy Rule does not include medical record retention requirements. Rather, State laws generally govern how long medical records are to be retained. However, the HIPAA Privacy Rule does require that covered entities apply appropriate administrative, technical, and physical safeguards to protect the privacy of medical records and other protected health information (PHI) for whatever period such information is maintained by a covered entity, including through disposal. See 45 CFR 164.530(c).

“HIPAA FAQ” CONTINUED FROM PAGE 13

MEDICAL/LEGAL

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CMS MEMBERSDUES INVOICES HAVE BEEN SENT!

Renew your membership today; don’t lose your CMS Benefits.

Why not do it now? Take one more thing off your to-do list!

Read more about your CMS Benefits on next page.

CMS DUES REMINDER

MEMBER BENEFITS

ARE YOU TAKING ADVANTAGE OF YOUR

CMS MEMBER BENEFITS? Member Discounts – CMS works to offer member-only benefits including:

• Discounted medical malpractice insurance• Discounted workers compensation insurance• Discounted and free legal documents from the Florida Health Care Law Firm• Discounted office supplies from MyOfficeProducts• Discounted access to CE Broker, and more.

Find a Doctor – Profiles each member on our searchable website, by specialty, by name, and by zip code.

Physician Referral Service – Capital Medical Society makes approximately 2,000 referrals by phone per year to member physicians.

Physician Information Service – CMS answers inquiries about member physicians’ medical backgrounds and board certifications.

Advocacy in the Legislature – CMS works closely with the FMA to support legislation that protects physicians and their patients. We also keep your office informed of any new legislation passed that would impact your practice.

Membership Meetings – An excellent way to keep in touch with your colleagues and hear guest speakers on issues in medicine today.

Family Activities – CMS offers two dinner functions each year where members and their spouse or guest are invited. We also host a Family or Doctor/Child Banquet. Network with colleagues and spend time with your family, at the same time.

CME Programs – CMS co-sponsors a variety of meetings throughout the year, including all CME programs required for licensure.

Political Action – CMS, through FMA-PAC, advises physicians which candidates support issues important to organized medicine.

Employment Service – CMS distributes resumes from people interested in working in physician offices. There is no charge to members.

Lunch and Learn – CMS offers Lunch and Learn Seminars in the Spring and Fall for physician members office staff. The topics are useful and provide current information to enhance daily work life.

We Care Network – Thanks to the volunteer work of many CMS physician members, low-income, uninsured patients have a chance to seek specialty medical care through the We Care Network. Physician volunteers receive well-deserved recognition for their service.

Cap Scan – An award-winning, monthly newsletter includes information you need to know about issues affecting your practice. Members are welcome to submit articles.

Committees – CMS has active committees where your colleagues work on planning CME, access to care issues, newsletter, and membership.

Pagers – Monthly discounts on pagers, voicemail and airtime, plus personalized services for sales and repairs.

Mailings – Mailing lists and labels are available to members only.

CMS Website – Contains information about current and future CMS events, Find a Doctor for public use, News, and a “Members Only” section with proprietary information, such as a complete NPI Database of members. www.capmed.org

CapMed Today – An electronic news bulletin providing breaking news and community events of interest.

Membership Directory – Contains useful information about members including physician member names, specialties, practice addresses, phone numbers, fax numbers, website addresses, medical schools, and a current photograph, whenever possible.


REASONS TO DONATEYou can make a donation to the CMS Foundation in

memory of someone who has passed away or you

can make a donation in honor of someone, such as

a fellow physician you hold in high esteem or has

taken care of you or your family. CMS will send a

letter to those you honor.

ENDOWMENT FUNDSCMS Foundation has created three endowment funds

in order to establish long-term financial stability to

meet our mission. You can donate at any time to one

of the CMS Foundation’s Endowment Funds.

1) The General Endowment Fund

2) The We Care Network Endowment Fund

3) The Scholarship Endowment Fund

Checks should be made payable to the CMS

Foundation and indicate on the “For line” to which

Fund you would like to donate. Bring your check to

the CMS Office or mail it: Capital Medical Society ~

1204 Miccosukee Road ~ Tallahassee, FL 32308.

How to Buy Dr. Williams’ More Simpler TimesBy Shannon Boyle We are very grateful to Dr.

Charles Williams that he has

decided to donate to the We

Care Network, proceeds from the

sales of his new book and sequel,

More Simpler Times. The cost is $20 per book. You can buy copies of the book at:• The CMS office – 1204 Miccosukee Road• The Gift Shop at Capital Regional Medical Center• The Gift Shop at Tallahassee Memorial Hospital • Tallahassee Nurseries – 2911 Thomasville Road• My Favorite Things – 1410 Market Street, B2• Feathered Pony Boutique – 2522 Capital Circle NE, #3

CHECKS SHOULD BE MADE OUT TO: CMS FOUNDATION.

THIS MEANS YOU ARE MAKING A TAX-DEDUCTIBLE

DONATION TO YOUR CMS FOUNDATION.

CMS FOUNDATION

WE THANK THE FOLLOWING PEOPLE WHO MADE A DONATION TO THE CMS FOUNDATION LAST MONTH:

DONATE TO THE

CMS FOUNDATION

WE THANK OUR DONORS

For the We Care NetworkCapital Medical Society – in memory of Rosa M. Conrad

The mission of the Capital Medical Society Foundation is to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s

health needs through innovative projects that are exemplary, affordable and dignified.

Along with his annual dues payment:Robert Chapman, M.D.


TO OUR CMS MEMBERS AND WE CARE PARTNERS WHO SAW NEW PATIENTS FOR THE

WE CARE NETWORK IN JUNE 2014. YOUR GENEROSITY AND SUPPORT OF THE WE

CARE NETWORK MAKES A DIFFERENCE.

PLEASE CONTACT ROSE MARIE WORLEY AT [email protected] OR 201-0130, IF YOU ARE A WE CARE VOLUNTEER AND YOU PROVIDED VOLUNTEER SPECIALTY CARE

IN THE MONTH OF JUNE 2014 AND YOUR NAME IS OMITTED.

THANK YOU!

Received 86 referrals,

with 20 patients new to

the program

Scheduled 65 appointments

with volunteer physicians

and dentists

$42,458 in donated

care was reported by

We Care volunteers

DURING THE MONTH OF JUNE, THE WE CARE NETWORK:

CMS FOUNDATION: WE CARE NETWORK

PHYSICIANSRobert Bradford, M.D.Tim Broeseker, M.D.Viet Bui, M.D.David Burday, M.D.Carlos Campo, M.D.Joseph Camps, M.D.Michael Cavallaro, M.D.C. Raymond Cottrell, M.D.Leo DeRosier, M.D.David Dolson, M.D.Anthony Giralt, M.D.W. Harris Green, M.D.Kristin Harmon, M.D.Celeste Hart, M.D.Muhanad Hasan, M.D.David Huang, M.D.Iman Imanirad, M.D.Amit Jain, M.D.Carey Linker, M.D.Maribel Lockwood, M.D.Nancy Loeffler, M.D.Gordon Low, M.D.Kurt Luhmann, M.D.Michael Mangan, M.D.Winston Ortiz, M.D.Timothy Paulk, M.D.Michael Pentaleri, M.D.James Renehan, M.D.Stephen Richardson, M.D.Andres Rodriguez, M.D.

Jose Rodriguez, M.D.William Sawyer, M.D.Scott Sellinger, M.D.Hardeep Singh, M.D.Francis Skilling, M.D.Joseph Soto, M.D.Mary Swain, M.D.David Vermess, M.D.Anthony Wright, M.D.Jessica Yoon, M.D.

DENTISTSEric Amundson, D.D.S.Joseph Barnett, D.M.D.M. Darrh Bryant, D.M.D.Susan Byrne, D.M.D.Walter Colón, D.M.D.Michael Hartley, D.M.D.William McFatter, D.D.S.E. Lynn McLarty, D.D.S.Jim McSoley, D.M.D.Frank Swerdzewski, D.D.S.James Sykes, D.M.D.Jay Walton, D.D.S.Lawrence Weaver, D.D.S.Ed Zapert, D.M.D.

FACILITIESAffordable DenturesAnesthesiology AssociatesBeachton Denture ClinicCapital Regional Medical CenterDermatology AssociatesDesloge Home OxygenLeon County Dental ClinicPathology AssociatesRadiology AssociatesSeven Hills Surgery CenterSoutheastern Surgery CenterTallahassee Diagnostic ImagingTallahassee Endoscopy CenterTallahassee Health ImagingTallahassee Memorial HealthCareTallahassee Orthopedic and Sports Physical TherapyTallahassee Outpatient Surgery CenterTMH Family Medicine Residency ProgramWomen’s Imaging Center

WE THANK OUR REFERRING PROVIDERS FROM JUNE 2014:

John Agens, M.D.

Eboni Allen, ARNP

Elizabeth Borger, ARNP

Daniel Breivogel, ARNP

Tim Broeseker, M.D.

Steven Bryan, D.M.D.

Susan Byrne, D.M.D.

Armand Cognetta, Jr., M.D.

Leo DeRosier, M.D.

Lysmar Dinguis, M.D.

Susan Dunbar, ARNP

Cynthia Evans, ARNP

Michael Forsthoefel, M.D.

Terreze Gamble, M.D.

Judy Griffin, ARNP

Paul Hartsfield, M.D.

Muhanad Hasan, M.D.

Karl Hempel, M.D.

Susan Horton, ARNP

James Hunt, D.O.

Anneka Johnson, ARNP

Oretha Jones, ARNP

Elaine Larkins, ARNP

Damon McMillan, M.D.

Robert Murrell, D.M.D.

William Necaise, ARNP

Whit Oliver, M.D.

Rose Origa, ARNP

Winston Ortiz, M.D.

Andrea Plagge, M.D.

Stephen Quintero, M.D.

James Renehan, M.D.

Adrian Roberts, M.D.

Temple Robinson, M.D.

Jose Rodriguez, M.D.

Tim Ruark, M.D.

Mark Saunders, M.D.

William Shaner, D.D.S.

Gadi Silberman, M.D.

Jeannine Silberman, M.D.

Francis Skilling, M.D.

Robert Snyder, M.D.

Matthew Standridge, M.D.

Alanna Steaple, ARNP

Seth Stern, M.D.

Tallahassee VA Clinic

Lawrence Weaver, D.D.S.

Quandra Whaley, ARNP

Anthony Wright, M.D.

Cap Scan Newsletter1204 Miccosukee RoadTallahassee, FL 32308

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cap scan august 2014

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