welcome. legal aspects of optometric practice pamela j. miller, o.d., f.a.a.o., j.d. highland,...
TRANSCRIPT
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Welcome
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Legal Aspects Of Optometric Practice
Pamela J. Miller, O.D., F.A.A.O., J.D.Highland, California
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Pamela J. Miller, O.D., J.D.
• Became owner: 1974• Staff size: 3• Member: AOA, former
member CA St. Bd. of Optometry, National Academies of Practice in Optometry, staff O.D. San Bernardino Co. Medical Center
• SCCO 1973
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Dr. Miller and staff
Mission statement: To provide premium vision care by a warm, caring and supportive
doctor and staff
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Legal terms you need to know• Plaintiff• Defendant• Doctrine of informed consent• Duty to warn• Duty to mitigate• Document• The average reasonable person standard
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Legal concepts you need to know
• Respondeat superior: Let the master answer• Deep pockets• Joint and severable liability• Res ipsa loquitur: The thing speaks for itself• Rebuttable presumption of negligence:
instrument causing injury was in defendant’s exclusive control and the accident was one which ordinarily does not occur in the absence of negligence
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Documentation
• The most important piece of legal advice• Document completely but judiciously• Do not change, erase or alter a writing• Adding to a writing is permissible – sign, date,
state why you are adding to the document (ex. new information, research, addendum, etc.)
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Contract law
“A promissory agreement between two or more persons that creates, modifies, or destroys a
legal relation.” “An agreement consisting of a promise or mutual
promises which the law will enforce or the performance of which the law in some way recognizes as a duty.”
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Contract basics
• Oral or written• Express or implied• UCC – commerce, goods• Statute of frauds
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Contract statute of frauds
• “No action shall be maintained on certain classes of contracts or engagements unless there shall be a note or memorandum thereof in writing signed by the party to be charged or his authorized agent.”
• Personal services, sale of land, etc.
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Contract requirements
“Four corners of the document”• Offer• Acceptance (mirror image)• Consideration• Parties with at least limited capacity (duress,
fraud, free will, mental capacity)• Mutuality of terms
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It’s as simple asA ActB BreachC ConsequencesD Damages
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Damages• Actual• Compensatory
– Unforeseeable: future earnings– Foreseeable: actual expenses,
retraining, lost wages, counseling
• Nominal• Punitive
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Contracts you’ll encounter• Real estate - office
Purchase rentalLeaseRentConstruction
• PracticePurchasePartnershipMergerShared overhead
• EmploymentIndependent contractorEmployee
• EquipmentPurchaseLease
• Third party providerPanel member
Employee health care
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Always read the fine print!
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Pre-nup• Pre-nuptial agreement• Pros and cons• Spousal involvement in business• Purchase/sale of office and assets• Protection from liability• Tax filing – married, filing separately• Keeping it separate vs. co-mingling
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Legal entitiesSolo it’s just you, all the way
Partnership joint owners (equal?)
Group 3 or more
Affiliation share overhead; separate (but equal?)
Merger 2 or more practices join
Franchise purchase the right to be part of a larger organization in return forspecific privileges, expense sharing, etc
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Hiring: Your responsibilities
• Human resources• Educate• Inform• Follow-up• Oversee• Evaluate and re-evaluate
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Stop litigation before it starts• Review your policies• Keep up on the law• Post required notices• Accept no nonsense• Set an example• Treat everyone equally and fairly• Watch your opinions
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New hires• Contract• Office policy manual• Verify education,
experience, references• Background check, criminal
or court records• Complete all hiring forms;
copy of right to work verification; federal forms
• Introduce to office, duties
• Continued employment predicated on successful completion of physical and drug test, if applicable
• Provide training• Safety training; passwords,
keys, etc.• Employee has opportunity to
explain or refute information• Learning, not probationary
period
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Independent contractor or
associate
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Independent contractor• New practice owners often are also
independent contractors (or employees) inother settings to supplement their income
• Clearly defined by the IRS• Not an employee• Responsible for all taxes and contributions• Look to the relationship between the parties
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Employee contracts
• Policy vs. contract• What should I include• What should I exclude• How comprehensive should it be• Court interpretation• Burden of proof
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Employment at will
• Disclaimer• Termination at any time• With or without cause
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Protect interests by
• Confidentiality agreements• Covenant not to solicit patients• Covenant not to solicit employees• Covenant not to compete during employment• Return of property upon leaving the practice• Beware of out-of-state corporations
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Confidentiality agreementNon-disclosure agreements
• Designed to protect the employer, seller or partner from disclosure of trade secrets– i.e. May contain trade secret protections
• Separate from non-competition clause• May be severable from a non-compete agreement so
not to violate “right to work”
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Confidentiality agreementNon-disclosure agreements cont.
• Covenant not to compete arising from sale of business or partnership dissolution may be valid
• Employers may not force an employee to sign a covenant not to compete or a condition of employment – unfair competition
• Look to geographic area, time, activity, public’s right to receive care
• State court may differ from federal court
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Covenants
• Covenant not to compete• Competition agreement
Purpose: To protect practice value and goodwill
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Covenant not to compete• Restrictive or a restraint of trade
– Is it reasonable, consistent with public welfare and bargained for pursuant to lawful contact?
• Goal is to prevent patient or record stealing or punish someone who does
• Enforceable if reasonable in light of the facts and circumstances
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Covenant not to compete cont.• Cannot restrain trade – cannot be too
restrictive and unfair to the parties involved or public welfare
• Generally not honored in CA – check state law– Reasonable time limit only long enough to enable
former employer or buyer to protect the practice• Part of an employment contract, purchase
agreement, partnership or “pre-existing” relationship
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Compete clause(Employees, partners, mergers, associates)
• Shows greater durability and enforceability• Doctor #2 can leave doctor #1, BUT to practice in the
same town, he or she must pay X to #1 • Holds up in court• Must have consideration• Must be reasonable and specific• Designed to mitigate damages
– liquidated damages
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Boilerplate language• Confidentiality• Employment at will• Privacy• Electronic media• Harassment• Discrimination• Zero tolerance
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Employer
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Taxes – 2008• Paid by Employer Employee• FICA – social security 6.20% 6.20%• Medicare 1.45% 1.45%• SDI (CA) 0.08%• Federal schedule• State schedule• SUI 3.4%• ETT 0.10% on 1st $7000
(employer training tax)• Workers’ comp schedule
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Hire to fire documentation• Handbooks – policy manual• Handbooks vs. Application• Be understanding of personal
problems• Supervisor Training• Evaluations – written warnings;
document• Communicate, communicate,
communicate• Don’t stress out
• Consistency – praise & suggestions for improvement
• Resignation• Post-Termination• No surprises• No discussion once
termination is necessary – end of day, end of pay; stand and escort to door
• Return keys, change codes
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Hire defensively
• Be specific about rules• Be vague about rights
– Progressive discipline policies• Oral warnings• Written warnings• Suspensions• Terminations
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Employment application• Authorizations
– Background check– Reference check– Drug & alcohol testing– Certification that all info provided by applicant is true
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Successfully enforce policies
– Don’t ignore a situation or conflict– Take action to achieve resolution– Document your actions– Employee should sign all performance reviews & keep a copy– Pyramid any disciplinary measures if
possible
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Develop a game plan• Address a complaint or issue immediately• Employee rights• Following through - consistency• Posting• Right of Privacy• Annual review - Do not puff• Review/update office policy manual periodically
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Boilerplate language
• Employment at will• “Employees are forbidden from disclosing,
taking, or copying confidential information”
• “Zero tolerance”• Right of privacy• ADA - “reasonable accommodation”
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What is sexual harassment or discrimination?
• Unwanted and offensive touching• Objectionable behavior• Unwelcome sexual advances• Requests for sexual favors• Boss has no special right• Hostile environment
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Protect yourself• Prompt and effective action to end alleged
harassment after complaint• Employee must make a complaint• If no action is taken to resolve the complaint,
the employee may sue and receive actual damages, court costs, attorney’s fees, and even punitive damages for willful violation
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RED YELLOW GREEN
• RED: Not allowed - always unacceptable
• YELLOW: Questionable - Usually unacceptable or inappropriate
• GREEN: Allowed - acceptable
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The golden rule
• All employees must be treated with dignity and mutual respect
• By everyone, at all times• You set the example and are responsible
for the whole office
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Office illness and injury prevention manual
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Leases & purchase agreements
EquipmentReal property
Practice
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Equipment lease• Lease purchase – annual tax paid
– $1 buy out or fair market value buy out– May be higher cost; shown as expense– Doesn’t show as an asset or liability
• Outright purchase vs. finance• Write-off value: depreciation per year• Lease without option of purchase
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Office lease considerations• Mistake to pay operating expenses based on leased
space rather than on leasable space• Lease rate: rent + operating expenses and how
calculated; increases• Maintenance and upkeep; remodeling• Amount of free rent• Length of time space has been available; %
occupancy; length of current tenant’s leases, lease incentives to current residents
• Any exclusionary businesses (i.e. other optical)
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Office lease considerations cont.• In event of fire, loss of use, loss of space/contents;
remodeling, improvements, change of entrances, relocation; hours of business; square footage, parking
• Termination clause – right to sublet• Tax indemnification clause• Ownership change; buy-out clauses and down payments• Insurance specifications• Warranties on premises, equipment, etc.• Included services, signage, hours of operation
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Is it better to purchase or own?• Real property
– Purchase outright– Finance– Lease to own
• Equipment– Purchase outright– Finance– Lease to own
• Employees
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Practice purchase or sale
• Lump sum is not the best option• Serial sale: interest on sale is paid monthly (with
principal). Tax may be computed on this interest – as a gift tax against the selling doctor unless the interest is already worked into the price
• Structured sale (best option): buyer has option to speed up payments
• Check with your accountant and tax attorney
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Own your ownAdvantages
– Cash accounting system– Liability mitigation: notice not required– Control
Disadvantages– Repair and upkeep– Annual price hikes or upon lease renewal– Liability
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Partnerships
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Protect your partnership• Choose wisely, carefully, consider a “trial run”• Balance the work load; establish your roles• Compromise• Have a contingency plan• Consult an attorney and put it in writing• Communication is important to avoid a divorce• Keep your spouse out of the business
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Considerations• Events causing termination of a relationship• Retirement• Voluntary termination to leave • To start a competitive practice• Involuntary termination –principals disagree• Death• Disability• Felony conviction – loss of license
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Partnership contracts• Name, time commitment; prohibited acts, duration• Contributions, allocations & cash flow• Loans & leases; partnership sale or adding new partner• Income, expenses, capital expenditures & withdrawals• Books & records• Competition agreements• Partner relations – death, disability, buy out, resignation• Insurance: how to be paid?
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Read carefully• Document everything• Never argue; never yell• Never get angry• Do your research• Don’t be greedy• Remember, act in haste, repent in leisure• Plan and prepare for the worst
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Going for help
• State chamber of commerce
• Professional associations
• Buying groups
• State/federal employment agencies
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To do list
• Take a basic tax preparation class • Select a CPA for small businesses• Review contracts and categorize by topic• Create a profit-and-loss statement• Set 5- & 10-year financial & practice goals• Write or re-evaluate office policy document • Establish emergency protocols• Develop a mentor relationship
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References
• Classe, John, O.D., J.D. - Legal Aspects of Optometry
• Dufour, James T. - Optometric Office Injury& Illness Prevention Guide
• Miller, Pamela J. O.D., J.D. - A Handbook for the Ophthalmic Practice Documentation and Record Keeping Made Easy
• AOA
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References cont.• Primary Eyecare Network - Personnel File
Desk Reference Set • Steinberg, Craig S. O.D., J.D. - Employer’s
Guide for Optometrists• The Optometric Office and Illness Prevention
Guide - Vision West• California Compliance Catalog–
www.calbizcentral.com
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Thank you
Pamela J. Miller, O.D., F.A.A.O., J.D.
909.862.4053