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How To Promote Patient Safety and Minimize Risk
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About the Author
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12/2009: Original document written by Jo Ann Hertford, MD, FAAP and revised by:  The Risk Management Department at Medical Mutual Insurance Company of Maine

How to Promote Patient Safety and Minimize Risk

DOCUMENTATION

• Develop medical record templates and forms to standardize documentation requirements and care delivery.
• Place two patient identifiers such as age, practice number, or date of birth on each page or computer screen of the medical record.
• Display current medication allergy information in an easily accessible, prominent location. An absence of allergies should be recorded as "No Known Allergies" or "NKA" to confirm that the information is assessed. Verify allergy information at each patient contact including telephone discussions for medication refill.
• Utilize a problem list that reflects current information on chronic/significant conditions with date diagnosed.
• Maintain an updated medication list. The medication list should reflect the drug, dose, date prescribed, and discontinuation date.
• Require that medical record entries are dated and signed by the person authoring the entry.
• Reflect in physician encounter notes:

• Date
• Presence of a chaperone
• Problem statement
• Health maintenance information , i.e., colonoscopy, mammogram, vaccination status
• Positive and negative system findings
• Unresolved problems/conditions from prior visits
• Patient non-adherence
• Treatment plan
• Patient education
• Prescriptions to include the drug name, dose of medication, instructions and patient understanding
• Follow-up instructions
• Suggested return (follow-up date)
• Physician signature

• Complete encounter notes at the time of the visit.
• Require that physicians sign and date the history form completed by the patient indicating review.
• Document findings from consultation reports and test reports:
  • Date report received
  • The physician’s initials indicating that he or she received and reviewed the results
  • Documentation that the patient was notified of the results (abnormal and normal)
  • Follow-up visit scheduled or other action taken

• Document each call to and from a patient in the medical record, including after hours calls. The documentation should include recommendations for follow-up and onsite evaluation at the office or emergency department.
• Document discussions on consent for surgical procedures, including the patient’s understanding of the risks involved. See Informed Consent discussion. 
• Document all “no-shows” in the patient’s record.
• Obtain the patient’s permission to discuss his or her health care with family members. Document discussion with family members in the patient’s record.

CORRECTIONS, LATE ENTRIES and ADDENDUMS

• In manual records, use the SLIDE rule to correct a written error:
• Single Line through the error
• Initials
• Date
• Explanation

When a pertinent entry was missed or not written in a timely manner, a late entry should be used to record the information.

• Identify the new entry as "late entry."
• Enter the current date and time.
• Identify or refer to the date and incident for which the late entry is written.
• When using a late entry format, document the information as soon as possible. There is no time limit, however, as more time passes the entry becomes less reliable.
• A late entry should not be added after the record has been copied and released to an attorney.
• An addendum is a type of late entry. With this type of correction, a previous note has been made and the addendum provides additional information.

• Document the current date and time.
• Write “addendum” and state the reason for the addendum, referring back to the original entry by date.
• Identify any source(s) of information used to support the addendum.
• Complete it as soon as possible after the original entry.
• Never delete, obliterate or alter an entry after completion.
• An addendum should not be added after the record has been copied and released, i.e., to an attorney.
• Do not use an addendum to state opinions, perceptions or defenses.
• In an electronic medical record it is recommended that the organization have a link to the original entry or a symbol by the original entry to indicate an amendment.

INFORMED CONSENT PROCESS

The Informed Consent discussion should include the following elements:

• The diagnosis and nature of illness
• The recommended treatment or procedure to be performed
• The purpose of the treatment or procedure
• The likelihood of success
• The side effects of the treatment or procedure
• The inherent risks and potential hazards of the treatment or procedure
• The alternatives to this treatment or procedure
• The consequences of no treatment or alternative treatments

When the discussion with the patient is completed the treating physician should make a timed and dated notation in the patient's medical record documenting the occurrence of the discussion and summarizing the content.

The informed consent form should reflect the above elements and be signed by both the provider performing the procedure and the patient.

ELECTRONIC MEDICAL RECORD

Place the computer screen in a position facing the physician and patient so that both can view it.

Begin the exam by speaking directly with the patient before focusing on the patient’s EMR.

Indicate your awareness of the purpose of the patient’s visit and his or her previous history.

Maintain eye contact with the patient while the patient discusses his or her concerns and symptoms.

 Be aware of the pitfalls of computerized templates. Templates should not guide the patient evaluation as they may exclude meaningful patient involvement.

Explain to the patient what information is retained in the EMR. Show the patient specific information and discuss its usefulness in providing treatment.

Enter notations that are individualized to the patient. Although it may hasten the completion of documentation requirements during the patient visit, standardized pre-determined information (auto-fills) should not automatically populate fields without consideration given to their applicability to the individual patient.

Perform patient satisfaction surveys before and after the implementation of electronic medical records.

[American Health Information Management website: www.ahima.org]

CONFIDENTIALITY

Ensure medical records are secure. Do not remove records from your office, take records home and or leave records in your car.

Do not share your EMR/computer passwords and log off the computer when you have finished your records. Never use a computer under someone else’s log-in.

Regularly train office staff on information privacy and confidentiality. Patients have the right to review their records, to request copies, to request the record be corrected or amended and to limit disclosure.

Close the registration window between patient encounters and when speaking on the phone.

Consider playing music in waiting areas to decrease the likelihood that confidential patient information can be overheard.

Review your Notice of Privacy Practices. Is it current, comprehensive and being practiced?

TELEPHONE TRIAGE

• Establish a process that outlines how telephone calls will be managed.
• Have the triage personnel use a written clinical protocol, developed either by the practice or one which is commercially available. Review protocols annually.
• Document triage information on a telephone triage encounter form and include the following information.
• Date of the call
• Time of the call
• Patient's name
• Name of caller if different than patient and relationship to the patient
• Urgency
• Reason for call/patient complaint
• Allergies
• Name of person taking the call
• Reference material used to assess patient's needs, i.e., telephone triage protocol
• Treatment plan, i.e., appointment, emergency room, advice given
• Specific clinical advice given
• Acknowledgement of patient understanding of advice
• Acknowledgement of need of call back or seek emergency care if symptoms worsen
• Physician orders if physician consulted
• If return call planned, call back number
  
  • Date and time of call back
  • Information discussed in call back
• Signature of nurse providing advice
• Signature of review and approval by physician

All telephone triage forms/information should be reviewed and signed by the physician on the day of the call. After it has been reviewed and signed by the physician, the form should then become a permanent part of the patient's medical record.

• Patients who call more than once about a related issue should be scheduled for an appointment with the provider as soon as possible.
• Provide time in the provider’s schedule for acute care visits.
• Never turn away patients who wish to be seen. Document referral to the local urgent care center or emergency department if necessary.
• Make sure the patient is aware that a call is not a substitute for an office visit, and have a low threshold for offering the patient an appointment.
• The provider should speak directly with patients who call with significant concerns.
• The triage personnel should always request that the patient call back if the situation does not improve, or go to an urgent care facility/emergency department if the condition worsens.

TRACKING SYSTEMS 

• Establish a tracking system to ensure that patients referred for clinical testing or specialty consultation receive the services recommended by the physician and that the test results are received. A similar system should monitor consults and referrals. Without these systems, an ordered test or consult may not be completed by a patient or a report of results not received. 
• Notify the patient of all normal and abnormal test results. This is a failsafe policy to assure that patients do not assume test results are normal because no call or letter was received. Patients should be advised to expect results via phone or mail and to call the office if results are not forthcoming within two weeks.
• Implement a system to ensure consult findings are sent to the referring provider.

MISSED/CANCELED APPOINTMENTS

• Develop a missed/canceled appointment protocol/policy.
• Advise patients on the importance of keeping scheduled appointments.
• Contact every patient who misses (no shows) or cancels an appointment and does not reschedule.
• Notify the physician of patients who missed or canceled an appointment allowing the physician to direct any additional follow-up activity.
• When continued follow-up with the patient is directed by the physician, at least three contact attempts should be made. This should be reflected in the policy.
• Documentation should occur in the medical record and reflect:
  
  • Each contact or attempt to contact the patient. This includes telephone contact or letters sent to the patient.
  • The date of the missed or cancelled appointment and the date of the rescheduled appointment.
  • The reason why an appointment is no longer necessary (when applicable).
  • Refusal of the certified letter as discussed above.

MEDICATION REFILL BY PROTOCOL

Refills by protocol should be limited to drugs with a low risk for side effects or interactions.

Utilize a medication record that contains:

• Patient allergy
• Medication name
• Dose
• Route of administration
• The dosage schedule
• Name of the pharmacy
• The ordering physician’s name
• Refill dates
• The initials of the individual calling (relaying) the information to the pharmacy.

Establish written refill protocols that address:

• Dosing parameters
• Definition of critical lab values
• Specific questions to ask the patient regarding current medications (interactions), side effects, activity level, changes in health status, over the counter medications, etc.
• Frequency requirements for patient appointments with a physician (i.e., every six months, annually)
• Frequency requirements for lab testing or monitoring
• Specifics on when to consult with a physician, i.e., critical lab values

Prior to refilling the medication request, the record should be reviewed for:

• Medication allergy information
• A written physician order for the prescription specifying the name of the drug, dose, frequency, etc.
• Date of last refill or new order
• Date of last visit with physician
• Any change in the patient’s status that may negate the refill such as new medications , new medication allergies, new use of over-the-counter drugs, change in patient’s health condition

Require that the patient be seen by a physician in a predetermined time frame appropriate for the specific medication. Require annual visits.

Documentation of the refill should include: the date, medication, dosage, frequency, number of refills, and signature of person calling the pharmacy.

Protocols should be reviewed by each physician in the practice annually with signed approval.

Regularly review a pre-set number of medical records to ensure the medication refill protocols are administered appropriately.

Provide ongoing training and education to the person responsible for implementing the protocol. This education should include:

• The indications for usage of this medication
• Purpose and desired effect of medication
• Side effects of the medication
• Interactions with other medications
• Knowledge of and the significance of the therapeutic range and adherence to it
• Significance of ordered lab tests associated with medication, i.e., INR
• Definition and significance of critical lab values
• Importance of asking specific questions of the patient prior to adjustment
• Significance of patient education regarding the medication program
• Importance of complete documentation in the patient record
• Importance of providing the patient with written instructions for medication changes
• Instructions on when to notify/consult with physician on patient situations such as untoward effect from drug, critical values, missed lab test, etc.
• Correct usage of protocol

EMERGENCIES IN THE OFFICE PRACTICE 

Develop emergency protocols and post for easy reference.

Evaluate the integrity of the emergency equipment and medication monthly.  Maintain a date log of the reviews.

If your office has an Automated External Defibrillator (AED), train all personnel responsible for operation of the AED.

Inform your local emergency medical services provider that your office has an AED available.

Create a schedule to ensure that the "ready for use" indicator (if present) is checked daily and that all maintenance is provided according to the manufacturer's recommendations.

Require that key staff members maintain CPR and AED training.

Incorporate use of the AED into the office emergency protocol and planning. [Source: “Medical Emergency Preparedness in Office Practice” American Family Physician; June 1, 2007. Volume 75. Number 11]

Conduct regular emergency drills.

If the practice is hospital affiliated, explore potential EMTALA implications with hospital leadership.

PATIENT RELATIONS AND COMMUNICATION

• Be courteous and respectful to your patients.
• Be ethical and honest in interactions, including interactions with patients, family members, colleagues, and insurance companies.
• Treat each patient as a partner in their health care, not a passive recipient of information and instructions.
• Listen to patients – do not allow distractions, listen for more than facts, avoid excessive note taking, do not be dismissive.
• Return patient phone calls promptly.
• Apologize to patients when they have waited beyond the scheduled visit time.
• If a patient disagrees with your treatment, offer the patient a referral for a second opinion.
• In the event of an unexpected outcome, notify your risk manager, if applicable, and/or your malpractice liability carrier.
• Speak with your malpractice insurance carrier before deciding how you will approach a patient who refuses to pay as a result of the unexpected outcome.

When disclosing negative outcomes or difficult information:

• Offer a factual explanation in an open manner communicating clearly in language that the patient understands.
• Be honest, empathetic and compassionate. Express concern to the patient and family members
• Encourage the patient to express his feelings, thoughts, fears, or anger about an adverse event
• Listen and be responsive to the patient's concerns
• Respond to questions with honest answers
• Ask open-ended questions, "Is there something you would like to ask?"
• Maintain open communication with those involved.

Note: An apology may avert a lawsuit, and is not an admission of wrongdoing. The Vermont “Sorry Works and Medical Safety Act” enacted in 2006 provides that an expression of regret or apology by a health care provider made in writing, orally, or by conduct, that is provided within 14 days of when the provider knew or should have known of the consequences of the error, does not constitute admission of liability for any purpose and is inadmissible in any civil or administrative proceeding. The expression of regret should not include blaming others or making excuses and should sincerely express concern for the patient.

[Applegate, William B. MD, MPH Campion, Francis X, MD. Grand Rounds on Malpractice Article 4.3 Physician Management of Patients with Adverse Outcomes pg. 163-166, 186-190

American Society of Healthcare Risk Management, Monographs: www.ashrm.org Disclosure of Unanticipated Events: Creating an effective Communication Policy; Disclosure: what works now and what can work even better]

TERMINATING THE PHYSICIAN PATIENT RELATIONSHIP 

• As appropriate, discuss the reasons for termination of the relationship with the patient or their legal agent.
• Author a termination letter that contains the following:
  • Notification that the physician’s relationship with patient is being terminated.
  • As appropriate, the reason for termination.
  • Clarification that the physician will treat the patient during the transfer period or in an emergency. A thirty-day deadline for end of coverage, from the date of the termination letter, is recommended.

  §  State clearly the need for ongoing care if necessary.

• Include an authorization to release the patient’s records with the termination letter:
  • Send the patient or legal agent the written termination letter via certified mail request return receipt, restricted delivery.
  • File a copy of the letter and the return receipt in the patient’s record.
  • If patients refuses the certified letter, copy the letter and place it and the unsigned return receipt in the patient’s record with a note stating that it was not accepted. Send the letter in a plain envelope with no return address to the patient or legal agent. Document this action in the patient’s record.
  • Document in the patient’s record a brief valid reason for terminating the relationship (i.e., noncompliance, failure to keep appointments). Assure that the documentation does not include subjective inflammatory content.

Note: According to the AMA’s Council on Ethical and Judicial Affairs, a physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable notice to make alternative arrangements for their care.

What can I do to minimize my risk in the hospital?

Participate in the hospital committees.

• Respect patients, family peers and staff.
• If the hospital has an electronic medical record, familiarize yourself with the functions and use it as much as possible.
• Print hand-written orders and do not use abbreviations.
• Have the nurse read back your telephone order and sign the order as soon as possible.
• If you receive a call about your patient, and there is any doubt about his or her condition, evaluate the patient in person.
• Assure patient information is adequately communicated during transfer to another provider’s service and upon discharge.
• Be sure to read and understand your hospital’s medical staff bylaws, particularly as they apply to clinical privileges and disciplinary action.

What can I do to minimize my risk in performing surgical procedures?

• The operative consent form should describe the procedure, reason for the procedure, most common adverse outcomes, and other potential outcomes.
• Be sure all of the patient’s questions were answered.
• Fully document the consent discussion in the patient’s record including the patient’s understanding of the discussion.
• Provide the patient with a copy of the signed consent form.
• Post-operatively, fully document that the patient understands the discharge instructions, and has a copy. Provide contact information for the patient to use, including an off-hours number, for any questions or concerns.
• Schedule a post-operative office visit before discharge.

What do I do if I receive legal correspondence?

• Notify your malpractice liability carrier if you receive notice that you have been named in a lawsuit or you receive correspondence putting you on notice that a suit is being prepared.
• If you are served with a subpoena for medical records, contact your legal counsel to determine the validity of the subpoena.
• When a record has been requested and shared (if appropriate), make a copy to facilitate on-going care and secure the original to prevent alteration and preserve the record as evidence.
• If you receive a letter of complaint from the Board of Medical Practice, do not answer it yourself. Notify your malpractice insurance carrier. The company can provide you with advice/guidance or refer you to an attorney who can assist you in drafting a response.  
• If you are requested to appear for a deposition (out-of-court testimony), your attorney will help you prepare in advance.

Upon receiving a subpoena for information regarding peer review process, consult your risk manager or malpractice carrier immediately. You should not proceed to answer any questions without advice from a lawyer. 

What should I do if I witness a serious event or occurrence at my hospital?

Medical errors continue to be a significant source of patient morbidity and mortality. Hospitals across the country have implemented strategies for patient safety including reporting medical error. If you become aware of a serious event, your first priority should be ensuring that the patient has received appropriate follow-up care. You should then immediately notify the hospital’s risk manager of the event.    

What can I do if I believe that a peer review proceeding has not been managed appropriately?

If you have been subject to a peer review proceeding and disagree with the process or outcome, you should consult an attorney. The Vermont Medical Society can refer you to an attorney.  

How do I pay for lawyer services?

Many professional liability insurance companies provide some coverage to pay legal fees related to legal/disciplinary actions (e.g., disciplinary hearings before a state medical board). Speak to your insurance agent/broker or claims representative before seeking legal counsel to determine if coverage is available.  

How do courts/juries determine the “Standard of Care” when assessing whether or not a physician has been negligent? 

Traditionally, the applicable standard of care was defined by the “locality rule.” Physicians were held to the standards of their community peers. This has been replaced by the “national standards test” in which physicians are held to national standards. 

The “national standards test” is tempered by the “resource component” which allows the court/jury to consider factors such as the facilities, staff, and other equipment available to the practitioner.

What about “clinical practice” guidelines?

Clinical practice guidelines/clinical pathways are designed to reduce variation in practice, and are being created by specialty societies, the federal government, and hospitals. Medicare is linking “pay for performance” to incentive payments under the Medicare payment system.  

The American Medical Association, recognizing a large sphere of physician discretion, has recommended that all guidelines include a disclaimer, to prevent them from being treated as conclusive evidence as to the standard of care. Clinical practice guidelines may be used as a defense by physicians to show compliance with accepted practice, but courts are careful in evaluating the use of clinical practice guidelines as evidence of substandard medical care.

Can peer review proceedings find their way into the courtroom?

The records of peer review committees are confidential, privileged and protected from discovery, subpoena, or admission into evidence in court. However, in order to claim the privilege, it must be demonstrated that the records in question are linked to a specific peer review committee. Peer review or quality assurance documents that have been produced outside of the organized peer review structure are not entitled to the same legal protection afforded to similar documents that have been prepared for a peer review committee.

Does the Good Samaritan defense apply to emergency assistance by a physician who acts as a volunteer in a hospital emergency setting? 

No. Hospital emergencies do not fall within the protection of the Good Samaritan statutes. 

Outside of the hospital, on the street, the Good Samaritan rule applies. It is expected that doctors provide emergency assistance. In fact, Vermont is unique in that it is the only state that imposes an affirmative obligation on individuals to come to the aid of other individuals. Fines may be imposed for failure to render aid under some circumstances.  Physicians who render voluntary care under the Good Samaritan Statute are immune from civil liability unless it can be proved that the care they rendered was grossly negligent. 

May I prescribe controlled substances to myself or a family member?

It is unacceptable medical practice, unprofessional conduct, and a violation of Vermont law for a licensee to prescribe controlled substances listed in DEA Schedules II, III, and IV for his or her own use or that of his or her immediate family member. This includes a spouse and spousal equivalent, parent, grandparent, child sibling, in-laws (including son/daughter/brother and sister-in-law), step-parent, child, sibling, or any other person who is permanently residing in the residence of the licensee. The only exception applies in a bona fide emergency of short term and unforeseeable character.7

According to the AMA Code of Medical Ethics Opinion 8.19, “physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination.”

How does Vermont law define unprofessional conduct? 

Under Vermont law, 30 actions are defined as unprofessional conduct, which evidences unfitness to practice medicine. The statutes may be found at the end of this section, as well as at http://www.healthyvermonters.info/bmp/legal/26sec1354.shtml.

How do I decrease risk when a consultation is requested?

• Communicate effectively with the patient about the need for a consult, respecting the patient’s preference.
• It is best for the requesting physician to notify the consultant directly, rather than leaving it to the nurse or unit clerk/secretary. Direct communication will allow you to provide the specialist with the information he or she needs.
• Discuss and document the reason for consultation and expectations for consultation including whether or not you wish the consultant to take over the management of the patient in this area, or just seek the consultant’s advice.
• When transferring care to another provider, ensure the following:
  • Use clear language. Avoid unclear or potentially confusing terms (“she’s a little unstable,” “he’s doing fine,” or “she’s lethargic”).
  • Define the terms you are using. Do not use abbreviations or jargon that could be misinterpreted.
  • Incorporate effective communication techniques. Limit interruptions, focus on the information being exchanged, and allocate sufficient time to this important task.
  • Tailor the hand-off protocol to its users, the environment in which the hand-off is occurring, such as the emergency department, and to the type of patient.

If you are asked to supply a consultation:

• Be sure to talk directly to the provider requesting the consult. 
• Discuss and document expectations of the requesting provider, including whether or not you are to take over the management of the patient, or if the request is just for your advice. Discuss and document your findings with the patient/family, and referring provider as soon as possible.

What about the “curbside consult?”

Curbside consultations should be avoided whenever possible. One obvious danger associated with this practice is liability for the requesting and consulting parties. There are also quality of care issues, as the consultant is not afforded the chance to evaluate the patient to the extent possible with a formal consultation. Regardless of the countless reasons where such consultations are desired, resist the temptation, except in the event of an urgent situation, where a formal consult would be impractical.

• Keep curbside consultations brief and simple. Complex cases require a formal consultation.
• Insist on evaluating the patient if the reason for the consult is vague, complex, unusual, or does not provide enough information to render an opinion.
• Multiple, informal, curbside consults on the same patient require consideration of the need for a formal evaluation.
• After a “curbside” informal consult, do not record the name of the consulting physician in the patient’s medical record (e.g. "Dr. XYZ neurologist agrees with the plan of care"). Obtain permission from the consultant to include his/her name in the record. 
• If the consultant’s name is in the record, be sure to pursue a formal consultation to follow.

Be aware that even if the name of the consulting physician is not in the record, curbside consults are not peer protected, and are discoverable in the event of a lawsuit.

Are all liability insurance policies the same?

No, there are two different types of liability policies – “claims made” and “occurrence” policies.  

• “Occurrence” policies provide coverage for malpractice claims for incidents that occurred while the insurance was in force, even if the incident is reported after the policy is no longer in effect.
• “Claims-made” policies provide coverage for malpractice claims made and reported to the insurance company only when the plan was in place.
• “Tail Coverage” may be purchased when a practitioner changes insurance companies, or retires from practice altogether. The coverage lasts for the practitioner’s life for claims made from patients seen when the policy was in effect.

What is the statute of limitations in Vermont? 

The Vermont statute of limitations for medical malpractice is:

• Three years of the incident date; or
• Two years from the date the injury attributed to the physician was discovered, but not more than seven years from the injury (except in the case of fraud or foreign body discovery);
• Two years for wrongful death;
• If a birth injury is claimed, the injured party may sue upon turning 18 years old when the statute of limitations begins to run.

Is data from Physician Clinical Performance Assessment (PCPA) admissible in medical malpractice suits?

Quality measurement of physician performance has become a tool used by health insurers, hospitals and payers. A recent study published in JAMA suggests that the measures that “rank physicians and track clinical outcomes have the highest likelihood of admissibility.” Although it is unlikely that such data will be successfully admitted in malpractice litigation, this is not the case for “proceedings by state licensing boards, hospital review committees and other adjudicatory bodies with more relaxed rules of evidence.”

Disclaimer

This information is offered as reference information only and is not intended to establish practice standards or serve as legal advice. It is recommended you obtain a legal opinion from a qualified attorney for any specific application to your practice.

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About the Authors

ABOUT THE AUTHORS

The Risk Management Department at Medical Mutual Insurance Company of Maine

Sue Boisvert is a Senior Risk Manager with Medical Mutual Insurance Company of Maine. Sue has a bachelor’s degree in nursing from the University of Connecticut and a masters degree in Health Services Administration from St. Joseph’s College of Maine. She has over 20 years of experience in health care quality and risk management, has written extensively on health care issues and is a member of ASHRM and NAHQ.

Nancy Brandow is a Senior Risk Manager with Medical Mutual Insurance Company of Maine.  She has a Bachelors Degree in Health Education from the University of Maine and a Masters Degree in Business Science with a concentration in Healthcare Administration from Husson College.  She has over 25 years of experience in hospital operations and health care risk management.  She has served on local, state and national committees advising on healthcare issues. 

Georgia Downs is a Senior Risk Manager at Medical Mutual Insurance Company of Maine.  She graduated from a diploma nursing program and proceeded to obtain a Bachelor of Science Degree in Nursing and a Master’s Degree in Adult Education from the University of Southern Maine.  She is an education committee member of the Maine Medical Group Management Association (MEMGMA) and a member of the Northern New England Society of Healthcare Risk Managers (NNESHRM).  Her professional background includes nursing education and management positions.

Ann Turbyne is a Senior Risk Manager at Medical Mutual Insurance Company of Maine and has been involved in Quality Improvement and Risk Management since 1984. Ann graduated from the Massachusetts General Hospital Diploma Program in 1969 and from the University of Southern Maine’s BSN program in 1985. Ann is a Certified Professional in Healthcare Quality (CPHQ.) She is a member of the American Society for Healthcare Risk Management (ASHRM) and is a Certified Professional in Healthcare Risk Management (CPHRM.) She is past president of the Northern New England Society of Healthcare Risk Managers (NNESHRM.)

Cheryl Peaslee is the Asst. Vice President of Risk Management at Medical Mutual Insurance Company of Maine. She has worked in the field of quality and risk management since 1986. Cheryl holds a Bachelor of Science degree in Nursing and a Master of Business Administration degree. She is also a Certified Professional in Healthcare Quality (CPHQ.)  She is a member of the American Society for Healthcare Risk Management (ASHRM), Northern New England Society for Healthcare Risk Management (NNESHRM), National Association for Healthcare Quality (NAHQ) and Maine Association for Healthcare Quality (MAHQ).

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Footnotes

¹ Adapted from Furrow et al, Health Law, 5th ed. West Publishing Co., 2004, Pg. 196
2 Id at 252, 275
3 Id at 216, 217
4 Id at 252
5 Id at 263, 264
6 Id at 253
7 Self-prescribing and prescribing for family members, Section 4.3, Rules for the State of Vermont Board of Medical Practice, Feb. 16, 2001, Feb. 16, 2001; available upon request at medicalboard@vdh.state.vt.us.; 26 V.S.A. §1398
8 26 V.S.A. §1354
9 JAMA, Vo 275, No. 6,1996, 145-147.
10 Burkman, Ronald, MD, Medical Liability- What Physicians Need to Know, The Forum, Vol.3, No. 1, April, 2005, 16-20.
11 12 V.S.A. §521
12 14 V.S.A. §1492(a)
13 12 V.S.A. §551
14 Kesselheim, Aaron et al, Will Performance-Level Measures of Clinical Performance Be Used in Medical Malpractice Litigation? JAMA Vol. 295, No. 15, 1831-1834, April 19, 2006.