1. Kansas State Board of Healing Arts Safeguarding the Public ~ Strengthening the Healing Arts August 21, 2015 Reese Hays, JD Litigation Counsel Kathleen Selzler Lippert, JD Executive Director

2. KANSAS STATE BOARD OF HEALING ARTS Safeguarding the public ~ Strengthening the Healing Arts

3. KANSAS STATE BOARD OF HEALING ARTS Partners In Protection: KSBHA Working With You

4. KANSAS STATE BOARD OF HEALING ARTS Interstate Compact Licensure Short and Long Cuts Partners In Protection

5. KANSAS STATE BOARD OF HEALING ARTS Interstate Licensure Compact Licensure Short and Long Cuts Partners In Protection

6. INTERSTATE LICENSURE COMPACT Key Concepts: Creates another pathway for licensure by expediting licensing for qualified physicians interested in practicing in multiple states Partners In Protection: KSBHA Working With You

7. INTERSTATE LICENSURE COMPACT Key Concepts: Voluntary for both physicians and states Does not change a state’s existing practice act. Partners In Protection: KSBHA Working With You

8. INTERSTATE LICENSURE COMPACT Key Eligibility Criteria for Physicians Full and Unrestricted medical license Graduate of accredited medical school Certification by specialty board (AMA or AOA) No adverse action Partners In Protection: KSBHA Working With You

9. INTERSTATE LICENSURE COMPACT Benefits for Kansas: Ensure accountability and patient safety Help small community hospitals and clinics recruit physicians Encourage rapidly-expanding practice of telemedicine Share information between states Partners In Protection: KSBHA Working With You

10. KANSAS STATE BOARD OF HEALING ARTS Interstate Licensure Compact Licensure Short and Long Cuts Partners In Protection

11. LICENSURE SHORT AND LONG CUTS The only thing worse than being blind is having sight but no vision. ~ Helen Keller Partners In Protection: KSBHA Working With You

12. LICENSURE SHORT AND LONG CUTS 1.Read and follow instructions 2.Answer all questions 3.Answer questions completely 4.Review answers before submitting 5.Explain and support “yes” answers 6.Change of name complications Partners In Protection: KSBHA Working With You

13. LICENSURE SHORT AND LONG CUTS 7.Use mail tracking service 8.Wait 2 weeks before calling 9.Application is valid for 2 years; but, some documents are valid for only 6 months 10.Provide a release if you want others to have your information. Partners In Protection: KSBHA Working With You

14. KANSAS STATE BOARD OF HEALING ARTS Interstate Licensure Compact Licensure Short and Long Cuts Partners In Protection

15. LIONS & TIGERS & BEARS … SOCs Peer ReviewAFRs

16. KSBHA – OH MY Ferocious? Compatible?

17. SORTING IT ALL OUT Information is key: 1. Statutes 2. KSBHA process 3. Examples

18. SORTING IT ALL OUT: STATUTES Statutes can be intimidating: Public Policy Peer Review Immunity KSBHA Inv. Authority Partners In Protection: KSBHA Working With You

19. SORTING IT ALL OUT: STATUTES Statutes can be intimidating: Public Policy = Public Protection Public Policy = Public Protection Peer Review Immunity KSBHA Inv. Authority Partners In Protection: KSBHA Working With You

20. Public Safety Health care is essential to citizens 65-4914 Licensure is a privilege; not a right 65-2801 Risk Mgmt. and reporting system is necessary 65-4929 Public Safety

21. Health care is essential to citizens 65-4914 Licensure is a privilege; not a right 65-2801 Risk Mgmt. and reporting system is necessary 65-4929 Public Safety

22. SORTING IT ALL OUT: STATUTES Statutes can be intimidating: Public Policy = Public Protection Public Policy = Public Protection Peer Review Peer Review Immunity KSBHA Inv. Authority Peer Review Partners In Protection: KSBHA Working With You

23. SORTING IT ALL OUT: STATUTES Statutes on Peer Review: Define, Describe, and Require that it be provided Remedies for failure to report or provide Peer Review Partners In Protection: KSBHA Working With You

24. SORTING IT ALL OUT: STATUTES Statutes can be intimidating: Public Policy = Public Protection Public Policy = Public Protection Peer Review Peer Review Immunity Immunity KSBHA Inv. Authority Immunity Partners In Protection: KSBHA Working With You

25. SORTING IT ALL OUT: STATUTES Immunity Statutes on Immunity: No liability for reporting information Immunity for person or entity who reports Exception: If clear and convincing evidence that report was completely false and falsity was known to person making report. Partners In Protection: KSBHA Working With You

26. SORTING IT ALL OUT: STATUTES Statutes can be intimidating: Public Policy = Public Protection Public Policy = Public Protection Peer Review Peer Review Immunity Immunity KSBHA Inv. Authority KSBHA Inv. Authority KSBHA Authority to Inv. Partners In Protection: KSBHA Working With You

27. SORTING IT ALL OUT: STATUTES KSBHA Authority to Inv. Statutes on KSBHA Investigation Authority: Board shall have access Hospital shall report What needs to be reported? Any grounds for board action When in doubt, report Partners In Protection: KSBHA Working With You

28. Information is key: 1. Statutes 2. KSBHA process 3. Examples SORTING IT ALL OUT

29. SORTING IT ALL OUT: KSBHA PROCESS Overview of Investigation Process: Obtain relevant information Letter to Licensee asking for their response and info Obtain relevant information Review by Review Committee (RC) or Professional Council Non-board members Same profession [3 MD committees] [1 DO Committee] Review by Disciplinary Panel (DP) Subcommittee of Board members Decision making authority KSBHA process Partners In Protection: KSBHA Working With You

30. SORTING IT ALL OUT: KSBHA PROCESS Adverse Action Report: AFR Critical that KSBHA obtain all of the peer review record: Incident report Documents reviewed and considered Statements Decisions, discipline or remediation KSBHA process Partners In Protection: KSBHA Working With You

31. SORTING IT ALL OUT: KSBHA PROCESS KSBHA Review Committee (RC) and Disciplinary Panel (DP): Review peer review record on this case Prior investigations by KSBHA on licensee Other pending investigations by KSBHA from different sources KSBHA process Partners In Protection: KSBHA Working With You

32. SORTING IT ALL OUT: KSBHA PROCESS KSBHA decision metrics: 1.Violation of practice act (does) / (does not) exist? 2.Competent, admissible evidence (does) / (does not) support violation 3.Action (is) / (is not) necessary to protect the public KSBHA process Partners In Protection: KSBHA Working With You

33. Information is key: 1. Statutes 2. KSBHA process 3. Examples SORTING IT ALL OUT

34. SORTING IT ALL OUT: EXAMPLES Question: 1.When information is subpoenaed by KSBHA, how much of the material is shared with the physician under investigation? Example, if another physician does the peer review, is the name protected? KSBHA example Partners In Protection: KSBHA Working With You

35. SORTING IT ALL OUT: EXAMPLES Question: 2.Do physicians generally hire an attorney to represent them when the Board takes action regarding an event or some type of adverse report is submitted by a patient to KSBHA? KSBHA example Partners In Protection: KSBHA Working With You

36. SORTING IT ALL OUT: EXAMPLES Question: 3.If a physician decides not to hire an attorney, are they treated differently than another physician who is represented? Is the process the same regardless of whether an attorney is representing the physician? KSBHA example Partners In Protection: KSBHA Working With You

37. SORTING IT ALL OUT: EXAMPLES Question: 4.In some cases, more than one physician may be identified on an AFR. Is it permissible to redact the other physicians’ names from the AFR or records that are subpoenaed? If not, why not? KSBHA example Partners In Protection: KSBHA Working With You

38. SORTING IT ALL OUT: EXAMPLES Question: 5.Is the hospital always notified of actions taken by the KSBHA on physicians that are on the hospital’s staff when information is subpoenaed from the hospital? KSBHA example Partners In Protection: KSBHA Working With You

39. SORTING IT ALL OUT: EXAMPLES Concerns KSBHA has seen: 1.Hospital didn’t send the AFR until a long time after the events. KSBHA example Partners In Protection: KSBHA Working With You

40. SORTING IT ALL OUT: EXAMPLES Concerns KSBHA has seen: 2.Hospital sent AFR but then when KSBHA subpoenaed information it was not provided or only provided a portion of the information or did not provide a corrective action plan that was implemented. KSBHA example Partners In Protection: KSBHA Working With You

41. SORTING IT ALL OUT: EXAMPLES Concerns KSBHA has seen: 3.Hospital sent single AFR SOC 3 but have several AFR SOC 2 that illustrate a strong pattern of concern. KSBHA example Partners In Protection: KSBHA Working With You

42. SORTING IT ALL OUT: EXAMPLES Concerns KSBHA has seen: 4.Other issues KSBHA has observed …. KSBHA example Partners In Protection: KSBHA Working With You

43. SORTING IT ALL OUT: EXAMPLES Example #1: (part 1 of 3) AFR for SOC 3 – PA patient order for NS with 20meg KCL to run at 500 ml/hr until blood sugar falls to 250mg.DL. Patient received 5 liters of NS and a total of 100mEQ KCL. Order then changed to NS with 10mEQ KCL (at 0340) to run KSBHA example Partners In Protection: KSBHA Working With You

44. SORTING IT ALL OUT: EXAMPLES Example #1: (part 2 of 3) Order then changed to NS with 10mEQ KCL (at 0340) to run at 150 ml/hr. Lab drawn at 0447 indicated Potassium 7.5 High Critical. Three calls placed during the night. No lab ordered from AM from the PA, lab ordered at 0447 by MD. KSBHA example Partners In Protection: KSBHA Working With You

45. SORTING IT ALL OUT: EXAMPLES Example #1: (part 3 of 3) KSBHA found SOC 3 (same as hospital). Case closed with letter recommending education about diabetes treatment. This case was mismanaged, SOC was not met but it was single instance. Close case. KSBHA example Partners In Protection: KSBHA Working With You

46. SORTING IT ALL OUT: EXAMPLES Example #2: (part 1 of 3) AFR SOC 3 wrong site surgery – Patient scheduled for surgery on right knee. During the surgical site preparation phase, the left knee was inadvertently prepped for surgery. KSBHA example Partners In Protection: KSBHA Working With You

47. SORTING IT ALL OUT: EXAMPLES Example #2: (part 2 of 3) Time out process was completed between the OR staff and providers. Surgery was performed on the left knee in lieu of the scheduled right knee. KSBHA example Partners In Protection: KSBHA Working With You

48. SORTING IT ALL OUT: EXAMPLES Example #2: (part 3 of 3) Informal PDP (professional development plan) authorized. PDP to include a letter stating how timeout process will be changed, send the Board a sample protocol of the process, and education. KSBHA example Partners In Protection: KSBHA Working With You

49. SORTING IT ALL OUT: EXAMPLES Example #3: (part 1 of 3) AFR SOC 3 from hospital + multiple other complaints from other sources Patient admitted for Functional Endoscopic Sinus Surgery. KSBHA example Partners In Protection: KSBHA Working With You

50. SORTING IT ALL OUT: EXAMPLES Example #3: (part 2 of 3) Post-operatively it was noted the patient’s eye was displaced. Patient has permanent loss of vision in eye. Expert review of all cases. KSBHA example Partners In Protection: KSBHA Working With You

51. SORTING IT ALL OUT: EXAMPLES Example #3: (part 3 of 3) Limitation based on pattern of problems. License was cancelled but if reinstated it would include limitation, additional training, and monitoring. KSBHA example Partners In Protection: KSBHA Working With You

52. SORTING IT ALL OUT: EXAMPLES Media reports / headlines from sister states: 1/3 of medical board cases involve impairment 1/3 of medical board cases involve impairment Impaired anesthesiologist Hx. of dishonesty Impaired anesthesiologist Hx. of dishonesty Fentanyl doc not detected by PHP monitoring Fentanyl doc not detected by PHP monitoring Sexting Orthopedic Surgeon KSBHA example Partners In Protection: KSBHA Working With You

53. WHY Statutory Mandate To investigate all patient complaints that involve allegations that, if substantiated, would constitute a violation of the Healing Arts Act, irrespective of any prior pattern of negligence Safeguard the public & strengthen the professions that practice the healing arts. Partners In Protection: KSBHA Working With You

54. WHY Myth Buster: When interacting with the Board on a complaint, physicians believe they are going t the gallows; but the public believe we are protecting the good ole boy network – neither perspective is valid or evidence based. Partners In Protection: KSBHA Working With You

55. MAIN AGENCY CONTACTS Executive Director, Kathleen Selzler Lippert, JD klippert@ksbha.ks.gov 785.296.8561 klippert@ksbha.ks.gov General Counsel, Kelli J. Stevens, JD kstevens@ksbha.ks.govkstevens@ksbha.ks.gov 785.296.8066 Chief Litigation Counsel, Reese E. Hays, JD rhays@ksbha.ks.govrhays@ksbha.ks.gov 785.296.0961 Chief Disciplinary Counsel, Dan Riley, JD driley@ksbha.ks.govdriley@ksbha.ks.gov 785.296.4882 Licensing Administrator, Katy Lenahan klenahan@ksbha.ks.govklenahan@ksbha.ks.gov 785.296.8563 Medical Director, John F. McMaster, M.D. jmcmaster@ksbha.ks.gov jmcmaster@ksbha.ks.gov Contact information

56. QUESTIONS? Kansas State Board of Healing Arts 800 SW Jackson, Lower Level – Suite A Topeka, KS 66612 Phone: (785) 296-7413 Toll Free: 1-888-886-7205 Fax: (785) 296-0852 www.ksbha.org www.ksbha.org Partners In Protection: KSBHA Working With You