PROFESSIONAL ISSUES IN
REHABILITATION NURSE PRACTICE
"Rehab Nurses...The Force is Strong With You"
Presented by:
Main Office:
1101 Douglas Avenue
Altamonte Springs, Florida 32714
2
Phone: (407) 331-6620
Fax: (407) 331-3030
Email: [email protected]
Website: www.TheHealthLawFirm.com
OBJECTIVES
• License defense and protection
• BON, DOH & the initial complaint
• Selection of counsel
• Malpractice insurance
OBJECTIVES cont.
• The anatomy of a lawsuit
• Components & consequences of medical negligence
• Litigation
• Depositions
• Trial
• Professional liability insurance
• Social Media Do’s & Don'ts
Protecting Your Nursing
License
Do you need to worry about
your nursing license?
AND
What can you do to protect it?
Your Nursing License
• A Privilege vs. a Right
• The Florida Department of Health, Board of
Nursing, Regulates and Disciplines Florida
Nurses
The Florida Board of Nursing
• The Regulatory Body Charged with Ensuring the
Minimum Requirements for Safe Nursing
Practice
• Organized Under the Department of Health
• Members Appointed by the Governor
• Duty is to Protect the Public -
Not to Advocate for the Nurse
The Nursing Disciplinary
Process• Complaint
• Investigation
• Probable Cause Panel
• Administrative Complaint
• Hearing
• Discipline
The Initial Complaint: Sources
• Disgruntled Employee/Employer,
Colleague/coworker, Patient/family member
• Code 15 Or Adverse Incident Report
• AHCA Surveys
• Law Enforcement
The Initial Complaint: Sources
cont.
• Self report of adjudication
• Malpractice allegation
• National practitioner data bank (NPDB)
• Other
The Initial Complaint:
Common Allegations
• Unprofessional conduct
• Failure to practice with reasonable skill and
safety
• Criminal conduct
The Initial Complaint:
Common Allegations cont.
• Engaging or Attempting to Engage in the
Possession, Sale or Distribution of Controlled
Substances
• Exceeding the Scope of Nursing Practice
• Filing a False Report
Visit: www.TheHealthLawFirm.com
Our Video Q&A:
Speaker: President & Managing Partner,
George Indest III, Esq.
The Investigation:
Notice Letter & Case Summary
• What it really means
• What it can tell you
• What you should and should not do upon receipt
Typical Questions from Nurses
• What is going to happen to me?
• Am I going to lose my license?
• Am I going to be reprimanded by the facility?
• Am I going to lose my house?
• Am I going to go to jail?
• Do I need to carry my own malpractice insurance?
The Investigation:
The Investigator
• The investigator’s role
• The investigator: your best friend or worst
enemy?
The Prosecution Stage
• The Role of the Department of Health (DOH)
Attorney
• The Role of the Emergency Action Unit
• Review and Rebuttal of the DOH Investigative
Findings
• Presenting Mitigating Factors
Probable Cause
• The Probable Cause Panel
• The Panel’s Review of the Case File and Determination
of Whether Probable Cause Exists
• The Panel’s Determination Options:
- Dismissal
- Dismissal with a Letter of Guidance
- Finding of Probable Cause
Prosecution
• The Administrative Complaint
• The Election of Rights
- Informal Hearing
- Formal Hearing
----------
- Relinquishment of License
- Stipulation
Discipline
Potential Penalties:
• Revocation or Suspension of License
• Restriction of Practice
• Probation – direct or indirect
• Imposition of a Fine
• Mandatory Continuing Education
• Issuance of a Reprimand
• Issuance of a Citation
Discipline:
Collateral Consequences
• Discipline remains on the nursing license forever
• Will generate a NPDB Report
• Will usually precipitate an investigation and/or
discipline by other states where the nurse holds
a license
Discipline:
Collateral Consequences cont.
• When discipline is imposed, the nurse generally
has an affirmative duty to report to other states
where a license is held
• Could serve as a basis for exclusion from
Medicare/Medicaid programs
Sure-fire Ways To Put Your
License At Risk
• Lie on your application for license or license renewal
• Fail to report a guilty or nolo contendere plea,
regardless of adjudication
Sure-fire Ways To Put Your
License At Risk
Drink and drive,
Or commit any another crime
Sure-fire Ways To Put Your
License At Risk
Take A Controlled Substance That Has Not
Been Legitimately Prescribed For You
Sure-fire Ways To Put Your
License At Risk
Chart something as done
that was not done
Sure-fire Ways To Put Your
License At Risk
Fail to chart things that were done,
especially the administration of controlled
substances or the wastage of unused
controlled substances
Sure-fire Ways To Put Your
License At Risk
Improperly Alter Or Attempt To
Correct A Record
Sure-fire Ways To Put Your
License At Risk
Act without a physician order
Sure-fire Ways To Put Your
License At Risk
Fail to report a plea or adjudication
Some Ways To Protect Your
Nursing License
• When In Doubt, Look It Up Or Consult
• Work Only In Places That Do Not Put You At
Risk
Some Ways To Protect Your
Nursing License cont.
• Be Familiar With Facility Policies and
Procedures
• Document Accurately And Timely
Some Ways To Protect Your
Nursing License cont.
Be familiar with Florida’s Nurse Practice Act and
the act of any other state where you hold a license
Some Ways To Protect Your
Nursing License cont.
• Never Plead To A Crime Without Knowing The
Implications To Your Nursing License
• Cooperate With Internal Investigations, But
Always Maintain Caution
Our Health Law Blogs:
SEARCH - Nurses: Insuring Your Legal Protection
SEARCH - If You Are a Health Professional
Facing Legal Challenges, Choose a Specialized
Law Firm
Visit: www.TheHealthLawFirm.com
Malpractice Insurance
• Most employers cover
nurses for ordinary
negligence
• Usually only when
classified as an
“employee” and not an
“independent
contractor” (i.e. 1099)
Malpractice Insurance
• Do you need your own policy?
– As an employee, probably
– As an independent contractor, absolutely
• Covers many things your employer will not such
as:
– Depositions
– License defense
– Subpoenas for testimony
Professional Liability Insurance
Check your professional liability insurance to
make sure you are covered for professional
license defense expenses
Professional Liability Insurance
Many professional liability insurance policies
provide no coverage for license defense expenses.
Others provide only an insufficiently low amount of
coverage such as $5,000. This is not enough
coverage and you should obtain more.
Coverage for Legal Defense of a
Professional License
If you do not have at least $25,000 in professional
licensure defense coverage, obtain more. Some
insurance companies have this much coverage as
part of their basic policies (Healthcare Providers
Service Organization Insurance [HPSO] and CPH
& Associates, for example).
Coverage for Legal Defense of a
Professional License
If you do not have at least $25,000 in coverage
(and preferably $50,000) contact your insurer to
see if you can pay for increased coverage limits for
this one type of coverage. If not, contact your
insurance agent.
Coverage for Legal Defense of a
Professional License
You must have enough coverage available to be
able to afford to hire expert witnesses in your
defense, if needed, and to go all the way through a
full formal administrative hearing (trial) on your
case if needed.
Visit: www.TheHealthLawFirm.com
SEARCH - Nursing Malpractice Insurance
or
Malpractice Insurance for Nurses
Our Health Law Blogs:
Subpoenas
• Help, I just got a subpoena and I don’t know what to do!
– If employed, bring it to your manager
– Contact an attorney to review it
- The employer’s attorney is not always looking out
for your best interests
– Don’t ever just show up for testimony or produce the
requested documents without checking with someone
Depositions
• What is a deposition?
– Deposition (Under Oath)
Questioning by other parties as to knowledge of
incident, policies of facility, background, prior
incidents
Depositions
• What to do if you get a Deposition Notice?– Contact your attorney
– Contact your employer
– Review the applicable records (if you can get them)
– Prepare your testimony- Do not go in cold
Deposition Tips and Best
Practices
There are three types of Plaintiff
Lawyers to look out for...
Deposition Tips and Best
Practices cont.
The Ignorant Lawyer - I don’t know nothin’
bout medicine but I think I do...
Deposition Tips and Best
Practices cont.
The Pompous Lawyer - I am going to try to
intimidate you by throwing out complex
medical terms...
Deposition Tips and Best
Practices cont.
The Intimidator - I am going to be mean
and nasty to intimidate you
THIS IS AN OPEN BOOK TEST – USE THE
MEDICAL RECORDS!!!
Justin Bieber 2014 Deposition
Full deposition: https://www.youtube.com/watch?v=uaS8YXgb8YU
Trial
• Jury selection
• Opening Statements
• Presentation of Witnesses
• Closing Statements
• Jury Deliberation - Verdict
Social Media’s Role in HIPAA
Social media is a growing area of concern for
violations of patient privacy. Breaches by individual
employees harm patients and place the facility at
risk. HIPAA breaches by employees can occur in
many ways, however, social media seems like the
easiest way to get caught.
Example of Social Media
HIPAA Violations
• A few nurses who work together in a hospital
emergency department were fired for discussing
patients on a social media site. Even though
they did not post any identifying information,
they still violated the hospital's HIPAA policy.
Source: https://www.verywell.com/social-
medias-role-in-privacy-breaches-2317518
SHOULD YOU…
Have combined personal and professional
social media accounts?
SHOULD YOU…
Friend patients or accept friend requests
from patients?
Interacting With Patients
• Nurses should refrain from interacting with
past or current patients on personal social
media sites
• Never discuss information pertaining to the
provider-patient relationship
SHOULD YOU…
Give specific medical advice online?
Discussion of Medicine Online
• Nurses must ensure that information
exchanged on these sites remains
confidential
• Nurses must ensure that others do not rely
on the online discussion as medical advice
SHOULD YOU…
Share health care articles or videos for
informational purposes?
DISCLOSURE
Nurses may write online about their
experience as healthcare professionals, but
they should reveal existing conflicts of
interest and be honest about their
credentials
SHOULD YOU…
Talk about patients’ conditions, treatments
or research online, even in general terms?
– e.g. “We had a fifty-year-old male in the ER
last night with alcohol-induced liver disease.”
Privacy/Confidentiality
• Patient privacy and confidentiality must be
protected at all times
• Providers can discuss their clinical
experience but should refrain from
including details that may identify a patient
SHOULD YOU…
Post photos like this on social media?1
Note: These are hypothetical photos from Dr.
Ryan Greysen, assistant professor at the
University of California, San Francisco
SHOULD YOU…
Report unprofessional behavior of others to
authorities?
SHOULD YOU…
Share vacation photos, some of which show
you drinking?
Posting Content
• Providers need to know that any
information posted online can be
disseminated without consent to a huge
audience
• Content can be taken out of context and
will remain online forever
Using Social Media & Social
Networking in Medical Practice
Federation of State Medical Boards released
“Model Policy Guidelines for the Appropriate
Use of Social Media and Social Networking”
Main Office:
1101 Douglas Avenue
Altamonte Springs, Florida 32714
70
Phone: (407) 331-6620
Fax: (407) 331-3030
Email: [email protected]
Website: www.TheHealthLawFirm.com