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Health
Care
Professional –
Patient
Relationship
Topics Covered on This Page
Initiation & Termination Of The Patient-Physician
Relationship
Duty to warn
Residents’ Rights (Long-Term Care Setting)
Patients’ Rights (Hospital Setting)
Reporting to DMV
Professional
Courtesy
About the Author
& Editor
By
Jessa Barnard
Vermont Medical Society
Chapter Editor:
Madeleine Mongan, Esq.
Vermont Medical Society
What constitutes the beginning of a patient-physician relationship?
Vermont law does not specify what
constitutes the beginning of a patient-physician relationship. The CPT
Manual defines a new patient as a patient who has not received any
professional services from the physician or another physician of the
same specialty who belongs to the same group practice within the past
three years. Professional services are defined as face-to-face services
provided by a physician and reported by a specific CPT code.
As a general precaution, a physician
should consider that the relationship has begun at any point where the
physician or a member of the physician’s practice has offered to provide
a medical service, unless it has been explicitly stated in writing to
the patient that the physician is providing care only on an interim or
emergency basis and that the patient should continue looking for another
physician. If, after offering to provide services to a patient, the
physician decides that he or she does not want to or is unable to serve
that patient, the physician should follow the process for discharging a
patient as described below.
May physicians refuse to
see a specific patient even if the practice is accepting other new
patients?
Yes, according to AMA ethical opinion 10.05, physicians have the
prerogative to choose whether to enter into a patient-physician
relationship with any individual. However, a physician must always
respond in cases of emergency and cannot discriminate based on race,
creed, color, national origin, marital status, sex or sexual
orientation. The physician should also be aware of any contractual
relationship, for example a participation agreement with an insurer that
requires him or her to treat certain patients.
As a general guideline, the physician
should balance a prospective new patient’s medical need with the needs
of the physician’s other patients. According to the AMA’s opinion,
“greater medical necessity of a service engenders a greater obligation
to treat.” Other reasons to refuse treatment are if:
-
the treatment request is beyond the
physician’s competence;
-
the treatment request is
scientifically or medically invalid; or
-
the treatment request is incompatible
with the physician’s personal, religious, or moral beliefs.
For more
information, go to:
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-10.05.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-9.132.HTM&nxt_pol=policyfiles/HnE/E-10.01.HTM&
May physicians discharge patients from their
care?
Yes, physicians are allowed to end the
physician-patient relationship if it is the best option. Such situations
may include a patient who is consistently noncompliant, unreasonably
demanding, or threatening to you or your staff. It may also be necessary
to transition a patient due to the relocation or retirement of a health
care professional.
Are there guidelines to
follow when discharging a patient from the care of a practice?
The Vermont Board of Medical Practice (VBMP) and the American Medical
Association (AMA) offer guidance on the process physicians should follow
when discharging a patient from their practice.
The VBMP policy states that the board
recognizes that the physician-patient relationship may be terminated by
either party. However, termination must be done in compliance with the
physician’s obligation to support continuity of care for the patient.
The policy requires that written notice of termination be “presented to
the patient by a method to ensure that the patient received the notice.”
Records should be transferred promptly to the new clinician regardless
of whether the patient has an outstanding bill. The physician should
continue to provide treatment for existing problems or emergencies for
at least a thirty-day transition period.
For more
information, go to:
http://healthvermont.gov/hc/med_board/010699terminationadvisory.pdf
AMA policy 8.11, Neglect of Patient,
states that while physicians “are free to choose whom they will serve,”
once they have accepted a case, they “should not neglect the patient.”
AMA Policy 8.115, Termination of the Physician-Patient Relationship,
elaborates: “Physicians have an obligation to support continuity of care
for their patients. While physicians have the option of withdrawing from
a case, they cannot do so without giving notice to the patient, the
relatives, or responsible friends sufficiently long in advance of
withdrawal to permit another medical attendant to be secured.”
For more information, go to:
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-8.11.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-7.05.HTM&nxt_pol=policyfiles/HnE/E-8.01.HTM&
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/E-8.00.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/H-525.998.HTM&nxt_pol=policyfiles/E-1.00.HTM&
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-8.115.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-7.05.HTM&nxt_pol=policyfiles/HnE/E-8.01.HTM&
What constitutes
abandonment of a patient? How can I avoid charges of neglect or
abandonment?
The AMA Office of General Counsel states that “[a]bandonment is defined
as the termination of a professional relationship between physician and
patient at an unreasonable time and without giving the patient the
chance to find an equally qualified replacement.”
For more
information, go to
http://www.ama-assn.org/ama/pub/category/4609.html
AMA Opinion E-10.01, Fundamental
Elements of the Patient-Physician Relationship elaborates:
The patient has the right to continuity
of health care. The physician has an obligation to cooperate in the
coordination of medically indicated care with other health care
providers treating the patient. The physician may not discontinue
treatment of a patient as long as further treatment is medically
indicated, without giving the patient reasonable assistance and
sufficient opportunity to make alternative arrangements for care.
A 1999 Vermont Board of Medical Practice
advisory similarly emphasizes continuity of care. According to the
advisory, “abandoning” a patient is considered unprofessional conduct
under Vermont law. In assessing whether a physician has abandoned a
patient, the Board will consider three factors:
-
Whether the
physician gave the patient at least 30 days notice (in writing) if
ending a treatment relationship. The physician does not have to state
a reason for ending the relationship, only his or her belief that it
is best to do so;
-
Whether the
physician provided necessary ongoing or emergency treatment for at
least 30 days while a patient transitions to a new physician; and
-
Whether the
physician transferred records to a new physician promptly, as chosen
by the patient, regardless of whether the patient had any outstanding
bills with the practice.
The AMA also suggests that a physician
provide resources and/or recommendations to help a patient locate
another physician of appropriate specialty.
For more
information, go to:
http://healthvermont.gov/hc/med_board/010699terminationadvisory.pdf
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-10.01.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-9.132.HTM&nxt_pol=policyfiles/HnE/E-10.01.HTM&
What could the penalties be?
A patient who believes that he or she has
been abandoned can file a complaint with the Board of Medical Practice
charging the physician with unprofessional conduct. The Board has the
authority to issue warnings, impose fines, or condition, suspend or
revoke licenses to practice medicine.
In addition, if a physician violates the
AMA Code of Ethics, the AMA and the Vermont Medical Society can consider
terminating membership.
In sum, you may terminate the
physician-patient relationship if it becomes necessary, but you cannot
neglect or abandon a patient and must transfer the patient’s medical
records to the new physician. To avoid allegations of neglect or
abandonment, you should provide ample notification and assistance during
the transition.
Sources/Resources:
What immediate and
longer-term steps can a practice take when a patient is dangerous,
threatening or inappropriate for the practice?
If a patient is dangerous or threatening to staff or other
patients you can ask him or her to leave your office immediately, and
call law enforcement if the patient refuses. If necessary you may obtain
a court order such as a “no trespass” order or a restraining order that
will bar the patient from your practice. During the notice period while
the patient finds another physician, you may need to make arrangements
to see the patient at a safe location such as an emergency room, should
he or she require treatment.
If the patient is served by a mental health
agency or other social support agency, you can request that the patient
not come to your office without one or more staff persons from the
agency accompanying the patient.
A practice should also consider
developing an office policy on acceptance or termination of patients.
The policy could include examples of reasons for refusing to accept or
for terminating a patient such as:
-
The patient is displaying hostility or
inappropriate behavior to staff, physicians or other patients;
-
The patient is refusing to cooperate
with staff in diagnosis or treatment, or refusing to follow treatment
instructions;
-
The physician or staff is unable to
communicate effectively with the patient; or
-
The patient is making unreasonable
demands on staff or physicians.
The policy should clarify
the process for providing notice of termination to patients and should
also clarify that the practice will continue to comply with ethical and
legal requirements including:
-
Providing care in an emergency;
-
Continuity of care; and
-
Prohibition of discrimination on basis
of race, creed, color, national origin, marital status, sex or sexual
orientation.
When am I required to disclose patient
information to prevent harm?
The duty to warn is an exception to the patient privilege, which has
evolved in case law in Vermont and other states. It involves the
circumstance where a psychiatrist or other mental health professional
has good reason to believe that his or her patient intends to commit
physical harm to another individual and will actually do so. If this is
the case, the psychiatrist has a duty to take action to avoid such harm
to another person, even if it requires the disclosure of confidential
medical information. It is probable that the Vermont Supreme Court would
extend this duty to other types of practitioners, particularly since the
HIPAA exemption discussed below is broader than mental health.
The duty to warn exception originated in
California with the case of
Tarasoff v. Regents of the University of California,
131 Cal. Rptr., 551 P.2d 334 (1976). In Tarasoff, a university
hospital psychologist was told by his patient that the patient intended
to kill a woman, Tatiana Tarasoff. Two months later, he did so. The
Supreme Court of California ruled that the “public policy favoring
protection of patient-psychotherapist communications must yield to the
extent to which disclosure is essential to avert danger to others.” [551
P.2d at 347]
In 1985, Peck v. Counseling Service
of Addison County [146 Vt 61 (1985)], the Vermont Supreme Court
adopted the Tarasoff ruling and extended it, in a case
where a patient threatened and did burn down his father’s barn. The
court ruled that a mental health professional has a duty to “exercise
reasonable care” to protect identifiable victims from a serious risk of
danger, and that disclosure of a patient’s threats are not prohibited by
the physician-patient privilege established in Vermont statute [18 VSA
Section 1612 (a)].
How do I determine if the patient has an actual
intent to harm?
Vermont law places the burden on mental
health professionals to determine whether the various threats of their
patients may reasonably be fulfilled and if so, to act to protect the
third persons involved. Comments about harming someone need to be
analyzed to distinguish fantasy from situations where an actual intent
to harm has been formed. Questions to consider include:
-
Does the patient have a specific
victim?
-
Does the patient have the means to
follow through with an act? Does he or she have access to a gun or
other weapon?
-
Is there a specific plan?
If the answers to the above questions
are yes, the threat must be taken seriously. In almost all instances,
consultation with a colleague is advised to determine the most
appropriate course of action given the conflicting duties imposed on the
mental health practitioner.
How does the duty to warn relate to HIPAA
privacy requirements?
The federal privacy rule, unlike Vermont
law, does not create a duty to warn or mandate disclosure. However,
Section 164.512(j) of the HIPAA Privacy Rule permits a covered entity to
use and disclose protected health information -- including psychotherapy
notes -- if the covered entity believes, in good faith, that the use or
disclosure is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public. In this
situation, medical records and psychotherapy notes may be disclosed
without authorization or consent of the patient. The disclosure must be
made to a person or persons reasonably able to prevent or lessen the
threat or to the target of the threat. The disclosure must be limited to
the minimum amount of information necessary to prevent the harm from
occurring.
For more
information, go to:
http://www.hhs.gov/ocr/AdminSimpRegText.pdf
Sources/Resources:
-
Vermont Health
Information Privacy Issues: Compliance Challenges Under the HIPAA
Regulations, Volume I, May 17, 2002, Anne Cramer, Madeleine Mongan,
Meg O’Donnell, David Sobel, Frank Fontana
-
Tarasoff v. Regents of the University
of California, 131 Cal.
Rptr., 551 P.2d 334 (1976).
-
Peck v. Counseling Service of Addison
County, 146 Vt 61 (1985)
-
Standards for Privacy of Individually
Identifiable Health Information, 64 CFR §164.512 (j)
http://a257.g.akamaitech.net/7/257/2422/05dec20031700/
edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.512.pdf
Residents’ Rights
(Long-Term Care Setting)
Both the federal and Vermont governments have adopted and passed certain
regulations that promote quality care in nursing facilities. Under these
regulations, all nursing facilities are required by law to have written
policies called the Nursing Home Residents’ Bill of Rights. These rights
were implemented to protect the resident from abuse and neglect and to
provide the resident with an opportunity to participate in his or her
care.
There are two components to the
Residents’ Bill of Rights: the first is basic human rights; the other is
individual rights that are specific to a long-term care setting.
What are some of the basic human rights
guaranteed to all nursing home residents?
Every human being has the right to be
treated fairly, with dignity, with kindness and respect, and to be free
of fear. Violations of these rights may include:
-
Treating
residents differently because of race, sex, age, religious beliefs,
social status, etc.
-
Allowing other people to be present in
the room when personal care is being given without the consent of the
resident.
-
Teasing or harassing a resident.
-
Not allowing a resident to freedom to
choose the types of activities in which he or she wishes to
participate.
-
Withholding treatment, food, mail or
any other service.
What are some of the
individual rights specific to a long-term care setting?
They include, but are not limited to:
-
The right to be fully informed, prior
to or upon admission and during the stay, of the rules of the
facility, his or her rights as a resident in the facility, the
services with related charges available in the facility, and about
Medicare and Medicaid eligibility.
-
The right to choose one’s own personal
physician, be fully informed about his or her care and treatment, to
participate in planning or changing the care or treatment, and to
refuse to participate in experimental research.
-
The right to be free from mental and
physical abuse and free from chemical and physical restraints except
as authorized in writing by a physician.
-
The right to inspect his or her
records, to confidentiality of personal and clinical information, and
to approve or refuse their release to any individual outside the
facility, except, in case of his or her transfer to another health
care institution, or as required by law or third-party payment
contract.
-
The right to send and receive mail
unopened, to have access to a private use of a telephone, to receive
visitors, to voice grievances, to vote, to participate in council
meetings, and to manage his or her personal financial affairs.
-
The right to return to the first
available bed after hospitalization if the facility is able to meet
his or her needs, and to retain his or her bed in the facility while
absent due to hospitalization exceeding ten successive days.
-
The right to be informed
in writing about availability and eligibility for hospice services.
[33 VSA 7301 (2)(B)]
-
The right to professional assessment
and management of pain. [33 V.S.A. 7301 (2)(T)]
-
The right to review current and past
state and federal survey and inspection reports of the facility.
Violations that would be reported
include, but are not limited to:
-
Failure to provide the resident with a
copy of his or her rights and responsibilities or any changes made to
such rights.
-
Failure to disclose all cost and
charges to the resident.
-
Not permitting the resident to manage
his or her finances.
-
Restraining a resident, except in an
emergency, without an order from a physician.
-
Discussing a resident’s medical
condition with someone who is not involved with the resident’s care.
-
Not providing the resident an
opportunity to review the latest inspection report.
How are these rights
implemented?
The governing body of the facility
establishes written policies regarding these rights and responsibilities
of residents and, through the administrator, is responsible for the
development of and adherence to procedures implementing such policies.
All staff of the facility ensures compliance with these rights.
How are these rights communicated to the
residents?
The facility is required to post a
summary of the obligations of the facility to residents in clear
language, in easily readable print and posted conspicuously in a public
place on each floor of the facility. The notice shall summarize the
facility’s grievance procedure and directions for contacting the
ombudsman program. A readable copy of the notice shall be presented to
each resident on admission together with an oral explanation of the
rights, grievance procedure, and directions for contacting the ombudsman
program (Under the federal Older Americans Act, every state is required
to have an Ombudsman Program that addresses complaints and advocates for
improvements in the long term care system.)
What if a right is violated?
When facilities violate these rights, a
resident can file complaints with a variety of state and federal
agencies. If found in violation of the law, nursing homes, their owners,
and administrators can be fined, have their licenses suspended or
revoked, and lose their right to payment by Medicaid or Medicare.
If the resident in not
capable of understanding these rights, who may exercise these rights on
his or her behalf?
These rights and obligations devolve to a resident’s reciprocal
beneficiary, guardian, next of kin, sponsoring agency, or representative
payee (except when the facility itself is a representative payee) if the
resident:
-
has been adjudicated incompetent;
-
has been found by his or her physician
to be medically incapable of understanding or exercising the right; or
-
exhibits a communication barrier.
The facility however will make every
reasonable effort to communicate the rights and obligations directly to
the resident.
Sources/Resources:
http://www.leg.state.vt.us/statutes/fullchapter.cfm?Title=33&
Chapter=073
http://a257.g.akamaitech.net/7/257/2422/14mar20010800/
edocket.access.gpo.gov/cfr_2002/octqtr/pdf/42cfr483.10.pdf
Patients’ Rights (Hospital
Setting)
Vermont has adopted and passed legislation that establishes certain
rights for an individual who is an inpatient at a Vermont hospital.
What are some of these rights?
These include, but are not limited to,
the right to:
-
Considerate and respectful care.
-
Obtain current and understandable
information about his or her diagnosis, treatment and prognosis.
-
Be informed of the name and position
of the doctor in charge of the care.
-
Receive all the information necessary
to give informed consent for any proposed procedure or treatment.
-
Refuse treatment and be told what
effect this may have on the patient’s health.
-
Privacy while in the hospital and
confidentiality of all information and records regarding the care.
-
Receive all reasonable medical
services provided by the hospital, at the request of the physician.
-
Receive an itemized bill and
explanation of all charges.
-
Know what hospital rules and
regulations apply to his or her conduct as a patient.
-
Professional assessment and
management of pain. [18 V.S.A. 1852 (a)(16)]
-
Written information about availability
of and eligibility for hospice services. [18 VSA 1852 (a)(17)]
Violations that would be reported
include, but are not limited to:
-
Failure to provide the patient with a
summary of these rights.
-
Failure to supply information on the
medically significant risks associated with a specific procedure.
-
Discussing a patient’s medical
condition with someone who is not involved with the patient’s care
without permission of the patient.
How are these rights communicated to patients?
A summary of the hospital’s obligation is
distributed to each patient upon admission. The notice shall include
that the patient may contact the licensing agency or the Board of
Medical Practice and the notice shall include their addresses and phone
numbers. Also, the summary must be posted conspicuously at each nurse’s
station throughout the hospital.
What if a right is violated?
Failure to comply with any of these
rights may constitute a basis for disciplinary action against a
physician. A complaint may be filed with the Board of Medical Practice.
Sources/Resources:
http://www.leg.state.vt.us/statutes/fullchapter.cfm?Title=18&
Chapter=042
Are physicians obligated
to report a patient to the Department of Motor Vehicles if the patient
seems unfit to drive?
There is nothing in the Vermont law that either authorizes or requires
physicians to report drivers to the Department of Motor Vehicles, unless
the driver poses such a serious threat that the threshold for the duty
to warn is met.
The duty to warn under Vermont case law
(Peck v. Counseling Service of Addison County) requires health
care professionals who know or should know that a patient poses a
serious risk of danger to warn potential victims and exercise reasonable
care to protect them. The HIPAA Privacy Rule permits, but does not
require, disclosure of a serious and imminent threat to the health or
safety of a person or the public, without authorization. The disclosure
must be based on a good faith belief that disclosure is necessary to
prevent the threatened harm from occurring. The disclosure may only be
made to someone who is able to prevent or lessen the threat and
disclosure. [45 CFR § 164.512 (j)]
The Vermont Department of Motor Vehicles
advises any person with concerns about an individual’s driving,
including a doctor, family member, or neighbor to request writing that a
patient be reexamined by the Department of Motor Vehicles. The
Department will schedule relevant examinations including, if
appropriate, a medical examination.
The examination request should be sent
to:
Vermont Department of Motor Vehicles
120 State Street
Montpelier, VT 05603-0001
Attention: Driver Improvement
Physicians need to balance the duty of
confidentiality to their patient with the duty to warn when there is a
serious and imminent risk of harm.
Sources/Resources:
-
Vermont DMV Administrative Procedures
– #14. Fainting Spells, Blackouts or Other Periods of Unconsciousness
-
AMA Ethical Opinion E-2.24 Impaired
Drivers and Their Physicians
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-2.24.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-1.02.HTM&nxt_pol=policyfiles/HnE/E-2.01.HTM&
http://www.aot.state.vt.us/dmv/documents/TA/VS/Tavs113.pdf
-
Peck v. Counseling Service of Addison
County, 146 Vt 61 (1985)
-
Standards for Privacy of Individually
Identifiable Health Information, 45 CFR §164.512(j)
http://a257.g.akamaitech.net/7/257/2422/05dec20031700/
edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.512.pdf
What constitutes professional courtesy?
Traditionally, “professional courtesy”
has meant waiving the entire fee for the services a physician provides
to office staff, other physicians, or other physicians’ families. It has
also come to mean waiving coinsurance or co-pay requirements.
Is professional courtesy legal?
Yes. New interim final self-referral
rules that went into effect in the summer of 2004 (as part of the Stark
II rules governing conflicts of interest in physician referrals) create
an explicit professional courtesy exception that allows doctors to
provide free or discounted care to other physicians or their families.
American Medical Association (AMA) Opinion H-140.938 also reaffirms a
physician's right to provide professional courtesy. However, if not done
carefully, such actions can violate federal anti-kickback statues, the
Stark II Act, the False Claims Act or health plan contract obligations.
AMA Opinion 6.12 states that physicians should ensure that their
policies on waiving co-payments are consistent with applicable law and
with the requirements of their agreements with insurers.
How do I decide what practices are allowed?
In determining whether a professional
courtesy arrangement is allowed, regulators would weigh how the
recipients of professional courtesy are selected and how the courtesy is
extended.
First, to comply with the Stark II
exception, physicians must have a written professional courtesy policy
that is approved by the practice's governing body, if applicable.
Second, physician practices may not
select recipients of professional courtesy in a way that is directly or
indirectly reflective of the recipient’s ability to generate referrals
for the physician. Stark II self-referral regulations clarify that the
discount must be offered to all physicians and family members regardless
of the business generated between the physicians.
Third, the Stark II interim final rules
clarify that professional courtesy may not be offered to
beneficiaries of federal health care programs such as Medicare, unless
there is genuine financial need. Physician practices should thoroughly
document the criteria used to determine such need and should not
routinely waive Medicare copayments or coinsurance.
Finally, the physician must keep in mind
contractual obligations that specific health plans may have regarding
waiving or collecting co-insurance. If professional courtesy involves a
reduction of a coinsurance obligation, the Stark II rules state that
insurers must be informed in writing of the reduction.
Sources/Resources:
-
OIG Compliance Program for Individual
and Small Group Physician Practices, Federal Register, October 5, 2000
(65 FR 59447)
http://oig.hhs.gov/authorities/docs/physician.pdf
-
Medicare/Medicaid Anti Kickback
Statue, 42 U.S.C. §1320a-7b(b)
-
Stark II Rule, (Physician
Self-Referral Act, Section 1877 of the Social Security Act)
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=7f67da360f5dde571d4fc6614a4e0942&rgn=
div8&view=text&node=42:2.0.1.2.11.10.35.8&idno=42
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-6.12.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-5.09.HTM&nxt_pol=policyfiles/HnE/E-6.01.HTM&
http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-6.13.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-5.09.HTM&nxt_pol=policyfiles/HnE/E-6.01.HTM&
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Home Page
About the
Author & Editor
Jessa (Block) Barnard was
the policy specialist for the Vermont Medical Society from 2002 to
2005. She graduated summa cum laude from Dartmouth College in
2002 with a major in Anthropology and minor in Neuroscience. She is
currently attending Stanford Law School.
Madeleine
Mongan
is counsel and vice president for policy for the Vermont Medical
Society,
representing the interests of the physicians who live and practice in
Vermont.
She works with the Vermont Legislature, state agencies and insurers on
health care policy and provides education and technical assistance to
Vermont physicians on legal issues. Her practice addresses a range of
health law issues including confidentiality, licensing, managed care,
public health, contracting, and fraud and abuse. She represents Vermont
physicians on the steering committee of the Vermont Bar Association Drug
Policy Committee, the Area Health Education Centers Advisory Board, and
the Vermont Health Resource Allocation Plan Board. She is a member of
the American Health Lawyers Association and the Vermont Bar Association
where she co-chairs the Health Law Committee. She received her B.A.
from the University of Delaware, M.A. from Stanford University and J.D.
from the University of California at Davis. |
