1. Alabama Chapter-AAP Practice Management Association 2011 ANNUAL MEETING

2. Alabama Chapter-AAP Practice Management Association HARNESSING YOUR PRACTICE RESOURCES

3. What Do I REALLY Want? Terrie Monroe Director, Organizational Development Children's of Alabama

4. VitalSmarts © 2002 4 Bestseller: The New York Times Business Week Wall Street Journal

5. VitalSmarts © 2002 5 Crucial Conversations High Stakes Opposing Opinions Strong Emotions Why are crucial conversations so… crucial?

6. VitalSmarts © 2002 6 Influence Team performance Productivity Change management Diversity Safety Quality Incidents Anytime you’re stuck, there’s a crucial conversation keeping you there. The Principle of Crucial Conversations

7. VitalSmarts © 2002 7 Crucial Conversations are at the Root of All Persistent Problems The measure of success is not whether or not you have a tough problem to deal with, but whether it’s the same problem you had last year. - John Foster Dulles

8. VitalSmarts © 2002 8 This is your brain

9. VitalSmarts © 2002 9 This is your brain in a Crucial Conversation

10. VitalSmarts © 2002 10 Values that Kill Dialogue Save Face Look Good Keep the peace Avoid Conflict Win Be Right Punish

11. VitalSmarts © 2002 11 Start with Heart Stop and ask, “What do I really want?” For me? For the other person? For the relationship?

12. VitalSmarts © 2002 12 Learn to Look We often miss or misinterpret early warning signs of problems.

13. VitalSmarts © 2002 13 Act Feel Tell a Story See/ Hear Master Your Stories Where do emotions come from?

14. VitalSmarts © 2002 14 At first, we control the story. Then the story controls us. They gave me this coffee cup.. so they must be planning a layoff. They gave us prepared sandwiches rather than a deli plate... because they don’t respect us.

15. VitalSmarts © 2002 15 THE STORY The supervisor yelled at the new recruit. The young man waited until the supervisor was gone and poured sand into the machine, smiling at his sister who worked there. Later that month, the boss discovered the problem and fired him. The woman felt bad and quit in protest.

16. VitalSmarts © 2002 16 Facts and Stories Facts –Things we see, hear –Verifiable data –Behaviors Stories –Judgments –Conclusions –Attributions

17. VitalSmarts © 2002 17 Any set of facts could be used to tell an infinite number of stories. At any point in time there are a variety of emotions you could feel. The question is which one will lead to the result you really want.

18. VitalSmarts © 2002 18 STATE Your Path During crucial conversations we tend to say things in the most offensive way possible.

19. VitalSmarts © 2002 19 STATE Skills S hare the facts T ell your story A sk for others’ paths T alk tentatively E ncourage testing

20. VitalSmarts © 2002 20 Talk Tentatively Talking tentatively does not mean expressing false doubts. Talking tentatively means that we tell a story as a story rather than dressing it up as a fact.

21. VitalSmarts © 2002 21 Corrections to Being Too Forceful Too Forceful The fact of the matter is.... That’s a dumb idea.... The only reasonable option is.. You’re completely incompetent... More Tentative In my opinion.... Maybe it would make more sense to.... I believe that what we should do is.... I’m wondering if you’re not as experienced in this task as you need to be...

22. VitalSmarts © 2002 22 Encourage Testing The only limit to how strongly you can express your opinion is your willingness to be equally vigorous in encouraging others to challenge it.

23. VitalSmarts © 2002 23

24. VitalSmarts © 2002 24

25. VitalSmarts © 2002 25

26. VitalSmarts © 2002 26

27. VitalSmarts © 2002 27

28. VitalSmarts © 2002 28

29. VitalSmarts © 2002 29

30. VitalSmarts © 2002 30

31. VitalSmarts © 2002 31

32. VitalSmarts © 2002 32

33. VitalSmarts © 2002 33

34. VitalSmarts © 2002 34

35. VitalSmarts © 2002 35

36. VitalSmarts © 2002 36

37. VitalSmarts © 2002 37

38. VitalSmarts © 2002 38

39. VitalSmarts © 2002 39

40. Alabama Chapter-AAP Practice Management Association HARNESSING YOUR PRACTICE RESOURCES

41. Consent and Confidentiality When The Patient Is A Minor Brandy A. Boone Manager, Risk Resource Risk Management Services ProAssurance Companies

42. What are the laws in Alabama?

43. Consent as an Adult Ala Code § 26-1-1 Age of majority designated as 19 years. (a) Any person in this state, at the arrival at the age of 19 years, shall be relieved of his or her disabilities of minority and thereafter shall have the same legal rights and abilities as persons over 21 years of age. No law of this state shall discriminate for or against any person between and including the ages of 19 and 21 years solely on the basis of age.

44. Consent in Emergency Ala. Code §22-8-1 Persons physically or mentally unable to consent. No consent required when: ▫Person is either physically or mentally unable to consent ▫Has no known relatives or legal guardian ▫Two or more licensed physicians, psychiatrists or psychologists, after consultation, indicate, in writing, that medical services are necessary, and any attempt to secure consent from court or to locate unknown relatives would result in delay of treatment which would increase the risk to the person's life or health.

45. Consent in Emergency Without Parent Ala. Code § 22-8-3 When physician may proceed without consent of parent. ▫In the physician's judgment, an attempt to secure consent would result in delay of treatment which would increase the risk to the minor's life, health or mental health.

46. Consent Without Parent Ala. Code § 22-8-4 When minor may give consent generally. ▫14 years of age or older ▫Graduated from high school ▫Is married or divorced ▫Is pregnant “…and the consent of no other person shall be necessary.”

47. Consent for Child Ala. Code § 22-8-5 Consent of minor for self and child. Any minor who is married, or having been married is divorced or has borne a child may give effective consent to any legally authorized medical, dental, health or mental health services for himself or his child or for herself or her child.

48. Consent for Certain Treatment Ala. Code § 22-8-6 Consent of any minor as to pregnancy, venereal disease, drug dependency, alcohol toxicity and reportable diseases. Testing or Treatment ▫Pregnancy ▫venereal disease ▫drug dependency ▫alcohol toxicity ▫any reportable disease “…and the consent of no other person shall be deemed necessary.”

49. Effective Consent Section 22-8-7 Effect of minor's consent; liability of physicians, etc.; waiver of rights or causes of action. (a) The consent of a minor who professes to be, but is not, a minor whose consent alone is effective to medical, dental, health or mental health services shall be deemed effective without the consent of the minor's parent or legal guardian if the physician or other person relied in good faith upon the presentations of the minor.

50. Other Consent Statutes Ala. Code § 22-8-2: Missing Spouse Consent Ala. Code § 22-8-8: Consents are cumulative Ala. Code § 22-8-9: Consent for Donation of Bone Marrow

51. Consent By Non-Parents Patient/Child if meeting the requirements of Alabama consent statutes Legally appointed guardian Ala. Code § 26-2A-7: Temporary guardian, if: ▫Parent[s] delegate powers; ▫Executed Power of Attorney; ▫For no more than one year

52. Consent By Divorced Parents Absent court order specifying otherwise, or one parent giving up parental rights, either parent may provide effective consent

53. Who can have access to the minor patient’s records?

54. HIPAA Privacy Rule CFR 45 § 164.502(g)(1) Uses and disclosures of protected health information: general rules ▫Standard: personal representatives. ▫As specified in this paragraph, a covered entity must, except as provided in paragraphs (g)(3) and (g)(5) of this section, treat a personal representative as the individual for purposes of this subchapter

55. HIPAA Privacy Rule CFR 45 § 164.502(g)(3) ▫Implementation specification: unemancipated minors ▫If under applicable law a parent, guardian, or other person acting in loco parentis has authority to act on behalf of an individual who is an unemancipated minor in making decisions related to health care, a covered entity must treat such person as a personal representative under this subchapter, with respect to protected health information relevant to such personal representation, EXCEPT… (Emphasis added)

56. HIPAA Privacy Rule CFR 45 § 164.502(g)(3) cont’d “such person” may not be a personal representative of an unemancipated minor and the unemancipated power may have authority to act as an individual, if… ▫Minor consents, and ▫No other consent is necessary by law, and ▫Minor has not requested parent, guardian, etc. to be personal representative, OR

57. HIPAA Privacy Rule CFR 45 § 164.502(g)(3) cont’d Or… ▫Minor may lawfully obtain health care service, ▫Without consent of parent, guardian, etc, and ▫Minor, court, or other person authorized by law consents, OR

58. HIPAA Privacy Rule CFR 45 § 164.502(g)(3) cont’d Notwithstanding previous subsections… ▫If permitted by applicable state law, a covered entity may disclose protected health information to a parent, guardian or other person acting in loco parentis ▫If prohibited by applicable state law, a covered entity may not disclose protected health information to a parent guardian or other person acting in loco parentis ▫If the parent, guardian, etc. is not the personal representative of the unemancipated minor, and there is no applicable state access or provision, a covered entity may provide or deny access, provided such decision is made by a licensed health care professional, in the exercise of professional judgment

59. HIPAA Privacy Rule CFR 45 § 164.502(g)(5) Implementation specification: abuse, neglect, endangerment situations. ▫A covered entity may elect not to treat a person as a personal representative if…  Reasonable belief that  Patient has been or may be subjected to violence, abuse or neglect by such person, and  Treating such person as the individual representative could endanger the patient, OR  In exercise of professional judgment, covered entity determines it is not in best interest of patient for person to be considered personal representative

60. Alabama Law Ala. Code § 22-11A-19: Minor 12 years or older may consent to medical treatment for sexually transmitted disease; medical care provider may inform parent or guardian. ▫Notwithstanding any other provision of law, a minor 12 years of age or older who may have come into contact with any sexually transmitted disease as designated by the State Board of Health may give consent to the furnishing of medical care related to the diagnosis or treatment of such disease, provided a duly licensed practitioner of medicine in Alabama authorizes such diagnosis and treatment. The consent of the minor shall be as valid and binding as if the minor had achieved his or her majority, as the case may be. Such consent shall not be voidable nor subject to later disaffirmance because of minority. The medical provider or facility of whatever description providing diagnostic procedures or treatment to a minor patient who has come into contact with any designated sexually transmitted disease, may, but shall not be obligated to, inform the parent, parents or guardian of any such minor as to the treatment given or needed. (Emphasis added)

61. Alabama Law Ala. Code § 30-3-154: Availability of records to both parents. ▫Unless otherwise prohibited by court order or statute, all records and information pertaining to the child, including, but not limited to, medical, physiological, dental, scholastic, athletic, extracurricular, and law enforcement, shall be equally available to both parents, in all types of custody arrangements. (Emphasis added)

62. Risk Management Points Alabama law allows minors 14 or older (or in other situations described by statute) to consent to medical treatment without additional parental consent, but does not prohibit parents or guardians from also consenting to medical treatment Absent a situation where treatment is required by law, a physician, physician practice or facility may offer to or decline to treat a minor without also receiving parental consent

63. Risk Management Points Confidentiality request Sensitive information: HIV/AIDS, STDs, pregnancy Surgery/invasive procedures Abuse Billing/reimbursement Divorce/custody Absent parents

64. Resources http://alisondb.legislature.state.al.us/acas/ACASLo ginie.asp (click “Code of Ala” and “View”)http://alisondb.legislature.state.al.us/acas/ACASLo ginie.asp http://www.hhs.gov/ocr/privacy/hipaa/understand ing/index.htmlhttp://www.hhs.gov/ocr/privacy/hipaa/understand ing/index.html http://aappolicy.aappublications.org/cgi/reprint/pe diatrics;112/5/1186.pdfhttp://aappolicy.aappublications.org/cgi/reprint/pe diatrics;112/5/1186.pdf http://www.alabamaadministrativecode.state.al.us/ (Choose 420-4-1, Appendix I)http://www.alabamaadministrativecode.state.al.us/ ProAssurance Risk Resource: (800) 282-6242 or (205) 877-4400, ext. 4712.

65. Alabama Chapter-AAP Practice Management Association HARNESSING YOUR PRACTICE RESOURCES