ࡱ>  @~789:;<=>?F{/9=DdNabGJFIFExifMM*bj(1r2i''Adobe Photoshop CS3 Macintosh2008:05:01 14:47:33Р&(.HHJFIFHH Adobe_CMAdobed            x" ?   3!1AQa"q2B#$Rb34rC%Scs5&DTdE£t6UeuF'Vfv7GWgw5!1AQaq"2B#R3$brCScs4%&5DTdEU6teuFVfv'7GWgw ?>}`z+XeucW`.k ,սߠmߜtޥq~3z] my7;m_͝<=} %VWk,qs#Mcz5y 'jRԲsʮ~ Y鏡zxEam)c_f[(4/J5/yւ\rJMs^p.YU29_k lӵnnknF- =WWَo&f5ouhU_ٽW>QʪϴٲԌq۾ƽc=>~Ղ%%())%())%())%())%())%())%())?&/Y±/}ݴ25ҳL,&dW<>Է11ϨۭkI%ҳL,&dW<>Է11ϨۭkI%ҳL,&dW<>Է11ϨۭkI%ҳL,&dW<>Է11ϨۭkI%ҳL,&dW?$IFI$JRI$I$$I)I$JRI$I$$I)I$J$IFI$JRI$I$$I)I$JRI$I$$I)I$J%% J q?E\`kN p[6+>~:s h"u{⤒I$$I)I$JRI$I$$I)I$JRI$` ?41;k y2vpO%I3A'< $% )I% BJRIBPP$$% )I% BJRIBPP$ힵ9_I~_co?$%}|_Mֿ+I/=k,r䗙$=k,rֿ+IyIj|_Mֿ+I/=k,r䗙$=k,rֿ+IyIj|_Mֿ+I/=k,r䗙$=k,rֿ+IyIj|_Mֿ+I/=k,r䗙$=k,rֿ+IyIj|_Mֿ+I/=k,r䗙$+|Photoshop 3.08BIM%8BIM com.apple.print.PageFormat.PMHorizontalRes com.apple.print.ticket.creator com.apple.printingmanager com.apple.print.ticket.itemArray com.apple.print.PageFormat.PMHorizontalRes 72 com.apple.print.ticket.client 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com.apple.print.ticket.client com.apple.printingmanager com.apple.print.ticket.modDate 2008-05-01T18:47:11Z com.apple.print.ticket.stateFlag 0 com.apple.print.PaperInfo.ppd.PMPaperName com.apple.print.ticket.creator com.apple.print.pm.PostScript com.apple.print.ticket.itemArray com.apple.print.PaperInfo.ppd.PMPaperName US Letter com.apple.print.ticket.client com.apple.print.pm.PostScript com.apple.print.ticket.modDate 2003-07-01T17:49:36Z com.apple.print.ticket.stateFlag 1 com.apple.print.ticket.APIVersion 00.20 com.apple.print.ticket.privateLock com.apple.print.ticket.type com.apple.print.PaperInfoTicket com.apple.print.ticket.APIVersion 00.20 com.apple.print.ticket.privateLock com.apple.print.ticket.type com.apple.print.PageFormatTicket 8BIM8BIM&?8BIM 8BIM8BIM 8BIM 8BIM' 8BIMH/fflff/ff2Z5-8BIMp8BIM8BIM8BIM08BIM-8BIM@@8BIM8BIMG base-4C-2nullboundsObjcRct1Top longLeftlongBtomlongRghtlongslicesVlLsObjcslicesliceIDlonggroupIDlongoriginenum ESliceOrigin autoGeneratedTypeenum ESliceTypeImg 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Arial&Monotype Typography    hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography ___PPT10D0000҉0 Pro W3nLL̕ׯ0̕DTimes New RomanLL̕ׯ0̕ DArialNew RomanLL̕ׯ0̕ l___PPT9N/ 02? %UOThe First 24 Hours: Time-Sensitive Risk Management in the Face of Catastrophe 6PME3fG 3f$ (Today s PresentationpGeneral Guidelines and Considerations to Observe During First 24-Hours Putting it All Together - An Action Plan Recent Developments  Electronic Records Takeaway Thoughts and QuestionsGGeneral Guidelines and Considerations to Observe During First 24-Hours HH$\I m Sorry Law / Doctor-Patient Relationship Peer Review / Quality Assurance Privilege Preserve Medical Record / Evidence Employee s File / Reprimand Privacy Considerations J XI m Sorry Law / Doctor-Patient Relationship  ,-BXI m Sorry Law / Doctor-Patient Relationship --GBackground Initiatives that advocate full disclosure and apology to patients who suffer unanticipated outcomes during medical care are gaining momentum. 35 states have adopted variations of  I m Sorry law. Advocates of disclosure point to emerging literature that suggests that full disclosure of unanticipated outcomes decreases rather than increases the likelihood of lawsuits. * ZtZ t@XI m Sorry Law / Doctor-Patient Relationship --G Ohio Law  R.C. 2317.43 - Use of defendant's statement of sympathy as evidence in medical liability action prohibited: (A)In any civil action brought by an alleged victim of an unanticipated outcome of medical care or in any arbitration proceeding related to such a civil action, any and all statements, affirmations, gestures, or conduct expressing apology, sympathy, commiseration, condolence, compassion, or a general sense of benevolence that are made by a health care provider or an employee of a health care provider to the alleged victim, a relative of the alleged victim, or a representative of the alleged victim, and that relate to the discomfort, pain, suffering, injury, or death of the alleged victim as the result of the unanticipated outcome of medical care are inadmissible as evidence of an admission of liability or as evidence of an admission against interest. (B)For purposes of this section, unless the context otherwise requires: (1)"Health care provider" has the same meaning as in division (B)(5) of section 2317.02 of the Revised Code. (2)"Relative" means a victim's spouse, parent, grandparent, stepfather, stepmother, child, grandchild, brother, sister, half brother, half sister, or spouse's parents. The term includes said relationships that are created as a result of adoption. In addition, "relative" includes any person who has a family-type relationship with a victim. (3)"Representative" means a legal guardian, attorney, person designated to make decisions on behalf of a patient under a medical power of attorney, or any person recognized in law or custom as a patient's agent. (4)"Unanticipated outcome" means the outcome of a medical treatment or procedure that differs from an expected result. PCCCCCgCCtCC05'& I M SORRY STATUTE$3fHill v. St. Onge, 2009 U.S. Dist. LEXIS 82195 (S.D. Ohio). Defendant sought to exclude statements under R.C. 2317.43 Plaintiff claimed Fed. R. Evid. applied R.C. 2317.43 controls because it is  intimately bound up with the state s substantive policy of allowing doctors to express sympathy to patients without penalty:=*, ?XI m Sorry Law / Doctor-Patient Relationship --GImportant Considerations: Unanticipated Outcomes - Terminology Term first used by JCAHO to refer to outcome of care that is different from that expected by health care professionals and the patient at the start of health care intervention. Refers to outcome of care, the process of care. Does not imply medical error. Informed consent. Ethical Considerations JCAHO requires patients, and families when appropriate, are informed of outcomes of care, including unanticipated outcomes Patient Surveys Patients want explicit statement that an error occurred, an apology, and information about what the error was, how it will affect their health, why the error occurred, and how recurrence will be prevented. Impact on Potential Resolution Studies show a full apology tends to promote more rapid dispute resolutions and lower financial awards. Opponents of I m Sorry Policy Many still believe that a vast majority of patients injured by negligent care never sue, and the lack of awareness of the error may be an important contributor to this low rate of litigation. Importance of Doctor-Patient Relationship / Bedside Manor.P%PPP{PPPPiPPP:P%{    i:TVI m Sorry Law / Doctor-Patient Relationship,,G{PRACTICAL DISCUSSION Who communicates with patient? What is said? Does strength of doctor-patient relationship have impact?(ggK *Peer Review / Quality Assurance Privilege  *+A Peer Review / Quality Assurance !!G^As Defined by Statute  Tort Reform  Ohio Revised Code 2305 Case Law Interpretation Around Ohio Incident Reports Review Committees Documentation How does that apply to me? Lc1c 1  *PORC 2305.25 "$Health care entity Any entity, that conducts as part of its regular business activities professional credentialing or quality review activities involving the competence of, professional credentialing, professional conduct of, or quality of care provided by health care providers. Incident report Means a report of an incident involving injury or potential injury to a patient as a result of patient care provided by health care providers, that is prepared by or for the use of a peer review committee of a health care entity and is within the scope of the functions of that committee. Peer review committee Means utilization review committee, quality assessment committee, performance improvement committee, credentialing committee, or other.PPP!PPP!  QORC 2305.24 "$Confidentiality Any information, data, reports, or records made available to a quality assurance committee is confidential and shall be used by the committee and the committee members only in the exercise of the proper functions of the committee. RORC 2305.252 "$DProtection of Peer Review Committee Information: Proceedings and records within the scope of the peer review committee of a health care entity shall be held in confidence and shall not be subject to discovery or introduction in evidence in any civil action against a health care entity or health care provider. No individual who attends a meeting of a peer review committee, or provides information to a peer review committee shall be permitted or required to testify as to any evidence or other matters produced or presented during the proceedings of the peer review committee. 01ZZ/SORC 2305.253  Protection of Incident Reports: An incident report and the contents of an incident report are not subject to discovery in, and are not admissible in evidence in the trial of, a tort action. An individual who prepares or has knowledge of the contents of an incident report shall not testify, and shall not be required to testify, in a tort action as to the contents of the report. , ` `+Absolute Slam Dunk?& w<Pretty Clear Statutes Umbrella of protection to information collected and maintained by peer review committee Specifically targets incident reports regarding injury suffered by patient&Z"   6Very Broad Language Any information, data, reports, or records made available to a QA committee are confidential End of topic/discussion  Complete shield? ,.01234567M "Preserve Medical Record / Evidence##>Never Ever Alter !: 6f,f6fsDo not obliterate Errors: Date, Time, Initial Never chart for someone else If documented later, chart the time ptD#Preserve Medical Record / Evidence $$$)Maintain Complete Original Medical RecordV#Preserve Medical Record / Evidence $$$The Complete Medical Record May or May Not Include: Admission record History and Physical Physician orders, and/or certifications of medical necessity Patient questionnaires associated with physician services Progress notes and/or progress of another provider that are referenced in your own note Nursing notes Treatment logs Related professional consultation reports Procedure, lab, x-ray and diagnostic reports Amended Medical Records Discharge Plan04PP4W#Preserve Medical Record / Evidence $$  Ohio Statutory Guidance regarding the  Complete Record ? The Ohio Administrative Code (Section 5122-14-13), when referring to the administration of a psychiatric facility, describes the  necessary components of the  medical record as follows: (1) Patient demographic information, including indication of legal status as a voluntary or involuntary patient; (2) All legal documents, including, as appropriate, an application for voluntary admission signed and dated by the patient, written requests for release pursuant to section 5122.03 of the Revised Code, and all legal documents pertaining to civil commitment and guardianship; (3) The reason for admission including presenting problem(s), precipitating factors, and initial diagnosis; (4) Previous hospitalizations; (5) Reports of all patient assessments and examinations; (6) An individualized treatment plan which shall include criteria for discharge and which shall meet requirements of section 5122.27 of the Revised Code; (7) All medical orders; (8) Documentation of the patient s progress, and other significant patient events which could impact on treatment; (9) Appropriate, complete, signed and dated consents for treatment, and for release of confidential information; (10) A discharge summary completed within thirty days after discharge and signed by the attending or treating physician; and (11) A plan for aftercare.:P{P<? X#Preserve Medical Record / Evidence $$$Other Evidence to Preserve: Staffing, Schedules, Patient Census Names and Contacts of Potential Witnesses Written Policies and Procedures Business Records Chain of Custody / Medical Records (N 6Employee s File / ReprimandE6Employee s File / Reprimand^Do not discard Defense against negligent hiring, negligent retention Assume file may be read by Plaintiff s Counsel May help establish employment relationship, or lack thereof66k6k[6Employee s File / Reprimand&RRACTICAL DISCUSSION: Personnel File F--O Privacy ConsiderationsFPrivacy ConsiderationsCommunication with family regarding care and outcome Records Requests Pursuant to R.C. 3701.74, medical records may only be provided at the request of a "patient, a patient's personal representative or an authorized person." The "personal representative" in some instances may include person with health care power of attorney, or an executor of the patient's estate. A Will naming someone as executor is not sufficient. The Will must be probated first. The Court must then provide the designated person with a letter of authority. T5ZZZZ6YPPutting it All Together  An Action Plan))$Secure Record / Evidence / Equipment / Data Back-up Interviews with Personnel Counseling for Involved Personnel Communication with Patient / FamilyZ)Recent Developments - Electronic Records**$ U)Recent Developments - Electronic Records** Takeaway Thoughts and Questions $ & 0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғq>9y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@(|?" dd@   "  \ n?" dd@   @@``PR      ` p>>     (  b  C ,Abase-4C-2"  0 p   p  T Click to edit Master title style! !  s *xp   p  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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Courts& w<    | 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK`P <$D 0   pOhio legislature intends for safeguards to protect DISCOVERY Case law erodes the protection Doe v. Mt. Carmel Health Sys.  Franklin County 2005 Court narrowly construed purpose of statutes  no duties, rights or obligations Statutes only  clarified whether information is discoverable or protected by privilegeT\""""@`  0l  0,$ 0 k%Recent cases that erode the privilege*& ( 2&g H  0޽h ? I}OPM,$___PPT10.М&+ Dh'  = @B D#' = @BA?%,( < +O%,( < +D_' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+#.<*%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*=%(D' =-6B%slide(fromBottom)*<3<*=D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*=\%(D' =-6B%slide(fromBottom)*<3<*=\D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*\%(D' =-6B%slide(fromBottom)*<3<*\D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*%(D' =-6B%slide(fromBottom)*<3<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*9%(D' =-6B%slide(fromBottom)*<3<*9D' =%(D' =%(DR' =A@BB BB0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B%slide(fromBottom)*<3<*+p+0+0 ++0+0 +/0 *(     # |ܪ 0e0e?Title 1"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!k<drs/shapexml.xmlU]ob7}`BrDJ[F(ھ{l_6lvg|pKZk*~aș4֭y g!IY#+~[7!؄6F7 JMuX)B/e&RCZ F@Sk2[$ҳp:̐ƫ6*.w) +vAG}GAqc'=,3Gz:M8Ė,97-m0<}}3^NJF7y:.0 {A`n> ~󉆊(ozᯎLn\@2LGPesn1~*5WIޱ$<'ڒفS}ZHWARrqN#P!M~ӆE55,^0Xj٬izO|/ia.X? T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPKp<$ 0   p8First Prove Existence of Statutory Peer Review Committee99& w<    |p 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK`<$D 0   Bansal v. Mt. Carmel Health Systems, Inc.  Franklin County 2009 Committee must conduct quality review activities involving the competence of, professional conduct of, or quality of care provided by health care provider. Must next prove documents are records within scope of a peer review committee. ORC 2305.25(E)(1) Conducts professional credentialing or quality review activities. Conducts any other attendant hearing process initiated as a result of a peer review committee s recommendations or actions. A,"""""""@`H  0޽h ? I}OPM___PPT10.М&+^2D['  = @B D' = @BA?%,( < +O%,( < +D_' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+#.<*%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*A%(D' =-6B%slide(fromBottom)*<3<*AD' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*A%(D' =-6B%slide(fromBottom)*<3<*AD' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*,%(D' =-6B%slide(fromBottom)*<3<*,D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*,@%(D' =-6B%slide(fromBottom)*<3<*,@D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*@%(D' =-6B%slide(fromBottom)*<3<*@D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*%(D' =-6B%slide(fromBottom)*<3<*+8+0+0 ++0 (  .   # |8 0e0e?Title 1"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!k<drs/shapexml.xmlU]ob7}`BrDJ[F(ھ{l_6lvg|pKZk*~aș4֭y g!IY#+~[7!؄6F7 JMuX)B/e&RCZ F@Sk2[$ҳp:̐ƫ6*.w) +vAG}GAqc'=,3Gz:M8Ė,97-m0<}}3^NJF7y:.0 {A`n> ~󉆊(ozᯎLn\@2LGPesn1~*5WIޱ$<'ڒفS}ZHWARrqN#P!M~ӆE55,^0Xj٬izO|/ia.X? T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPKp<$ 0   RCan We Just Call it an  Incident Report ?**& w<B    |@ 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK``0 <$D 0   ^Rinaldi v. City View Nursing & Rehab.  Cuyahoga County 2005 Mere use of title  investigation report or  incident report is insufficient to demonstrate the reports were actually incident reports prepared for use by a peer review committee. Committee must perform functions identified in ORC 2305.25 (and prove it if discovery dispute arises). r=PPP%"""""@`  0  @0,$0 ENO!& ( 2&H  0޽h ? I}OPM6.___PPT10.М&+!mDr'  = @B D-' = @BA?%,( < +O%,( < +D_' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+#.<*%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*D' =%(D' =%(DV' =A@BB5BB0B%(D' =1:Bvisible*o3>+#.<*%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*D' =-g6B fade*<3<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*=%(D' =-6B%slide(fromBottom)*<3<*=D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*=%(D' =-6B%slide(fromBottom)*<3<*=D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*[%(D' =-6B%slide(fromBottom)*<3<*[+p+0+0 ++0+0 +K'0 8(  D    | 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK``p<$D 0   `xAre they  incident reports within definition of ORC 2305.25(D)? In camera review if necessary to determine that records sought are in fact incident reports Smith v. Manor Care of Canton  Stark County 2006 If unclear whether documents used by peer review committee and if existence of committee is at issue, party claiming privilege must provide trial court with list of evidence the peer review committee considered So much for the shield! CC" "R"""" " "@`  Fh  ?Title 1"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!k<drs/shapexml.xmlU]ob7}`BrDJ[F(ھ{l_6lvg|pKZk*~aș4֭y g!IY#+~[7!؄6F7 JMuX)B/e&RCZ F@Sk2[$ҳp:̐ƫ6*.w) +vAG}GAqc'=,3Gz:M8Ė,97-m0<}}3^NJF7y:.0 {A`n> ~󉆊(ozᯎLn\@2LGPesn1~*5WIޱ$<'ڒفS}ZHWARrqN#P!M~ӆE55,^0Xj٬izO|/ia.X? T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPKPpp RCan We Just Call it an  Incident Report? **& w<H  0޽h ? I}OPMKC___PPT10#.М&+%\D'  = @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*C%(D' =-6B%slide(fromBottom)*<3<*CD' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*C%(D' =-6B%slide(fromBottom)*<3<*CD' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*%(D' =-6B%slide(fromBottom)*<3<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*%(D' =-6B%slide(fromBottom)*<3<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*%(D' =-6B%slide(fromBottom)*<3<*+,0  i(    # |# 0e0e?Title 1"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!k<drs/shapexml.xmlU]ob7}`BrDJ[F(ھ{l_6lvg|pKZk*~aș4֭y g!IY#+~[7!؄6F7 JMuX)B/e&RCZ F@Sk2[$ҳp:̐ƫ6*.w) +vAG}GAqc'=,3Gz:M8Ė,97-m0<}}3^NJF7y:.0 {A`n> ~󉆊(ozᯎLn\@2LGPesn1~*5WIޱ$<'ڒفS}ZHWARrqN#P!M~ӆE55,^0Xj٬izO|/ia.X? T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPK<$ 0   QPrivilege is NOT Absolute& w<4    |B 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK``<$D 0   PvBrzozowski v. Univ. Hosp. Health Sys.  Cuyahoga County 2005 Patient fell in room resulting in subdural hematoma and subsequently died Plaintiff sought incident report in discovery Privilege is not absolute if the information cannot be obtained from original sources Hospital could have avoided disclosure of report if the medical records sufficiently detailed the event and incident report indicated it was prepared for peer review committee.=%""""""" @`H  0޽h ? I}OPM___PPT10.М&+^2D^' ; = @B D' = @BA?%,( < +O%,( < +D_' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+#.<*%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*=%(D' =-6B%slide(fromBottom)*<3<*=D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*=%(D' =-6B%slide(fromBottom)*<3<*=D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*%(D' =-6B%slide(fromBottom)*<3<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<* %(D' =-6B%slide(fromBottom)*<3<* D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<* %(D' =-6B%slide(fromBottom)*<3<* +8+0+0 +)0 0R(    # |P 0e0e?Title 1"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!k<drs/shapexml.xmlU]ob7}`BrDJ[F(ھ{l_6lvg|pKZk*~aș4֭y g!IY#+~[7!؄6F7 JMuX)B/e&RCZ F@Sk2[$ҳp:̐ƫ6*.w) +vAG}GAqc'=,3Gz:M8Ė,97-m0<}}3^NJF7y:.0 {A`n> ~󉆊(ozᯎLn\@2LGPesn1~*5WIޱ$<'ڒفS}ZHWARrqN#P!M~ӆE55,^0Xj٬izO|/ia.X? T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPK<$ 0   LYou Have The Burden!& w<"    |f 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK`<$D 0   >Manley v. Heather Hill  Geauga County 2007 In order to invoke the peer review privilege, a defendant must establish that the documents being sought were incident reports prepared by, or for the use of, a peer review committee. Party claiming privilege must prove the existence of the peer review committee and that the committee investigated the incident in question. Party asserting a report as an incident report has the burden of proving it is an incident report.b,"""""@`H  0޽h ? I}OPM___PPT10.М&+^2Da' T = @B D' = @BA?%,( < +O%,( < +D_' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+#.<*%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*,%(D' =-6B%slide(fromBottom)*<3<*,D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*,%(D' =-6B%slide(fromBottom)*<3<*,D' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*q%(D' =-6B%slide(fromBottom)*<3<*qD' =%(D' =%(DE' =4@BB BB%(D' =1:Bvisible*o3>+#.<*q%(D' =-6B%slide(fromBottom)*<3<*q+8+0+0 +,0 ?7@(    # |Xw 0e0e?Title 1"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK!k<drs/shapexml.xmlU]ob7}`BrDJ[F(ھ{l_6lvg|pKZk*~aș4֭y g!IY#+~[7!؄6F7 JMuX)B/e&RCZ F@Sk2[$ҳp:̐ƫ6*.w) +vAG}GAqc'=,3Gz:M8Ė,97-m0<}}3^NJF7y:.0 {A`n> ~󉆊(ozᯎLn\@2LGPesn1~*5WIޱ$<'ڒفS}ZHWARrqN#P!M~ӆE55,^0Xj٬izO|/ia.X? T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPK`p<$ 0   [#NO Privilege Under ORC 2305.253?$$& w<    | 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK``<$D 0   Flynn v. Univ. Hosp.  Hamilton County 2007 Hospital failed to show that an incident report was privileged under statute because it failed to show what was required under ORC 2305.25(D). Did not prove it was created for purpose of submission to quality assurance committee. However, the attorney-client privilege did apply Incident report was prepared for the attorney in its risk management department for the specific purpose of notifying the department and its outside legal counsel of possible claims.~,""""1""@`H  0޽h ? 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T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPK <$ 0   u=Always Submit to a Peer Review Committee to Protect Privilege>>& w<    |P 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK`<$D 0   &.Freudeman v. The Landing of Canton  United States District Court (Northern District of Ohio)  May 2010 Nursing home had to disclose reports of patients medication errors to plaintiff after conceding no peer review protection (no indicia documents were used for peer review and protected). Send report to peer review committee to ensure privilege argument. Can still argue physician-patient privilege as it co-exists with peer review privilege. Report must be a communication necessary for a physician to treat or diagnose a patient.iCXY""F"""C"X"Y "  @`H  0޽h ? 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T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPKp<$ 0   OYou May Have to Testify& w<.   | 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK0<$D 0   J6Giusti v. Akron Gen. Med. Ctr.  Summit County 2008 Participating in peer review does not automatically protect against having to give testimony in deposition. Still must testify as to items within your knowledge. To avoid disclosure, must prove information sought falls into protected categories: Testimony before the peer review committee Information provided to the committee Opinions formed as a result of the committee s activities No protection in this case - doctors conversations were not part of peer review committee proceeding.4l6Tg"""l"6"T""g"@`H  0޽h ? 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T-ْy,;#@X%RDTag OM޺_2nU|D_'iSMs}ӀclL$O8fN~i ȹ\|^a4Hl*.] Iҷ;cWYl'}Zvh4cQ U&j"]if[dn}4$a`exc[J>$0Әֲۥ:$:䪷ڗh§< &Fx[.=˹qlH ue`O=[M3F}$*u?%d\-Ig/~Š=7 PK!!drs/downrev.xmlDK0߅ kݍ!&9ksf6II >7[ =Eg ؖNi[#lϧ B$u`1(W` 7 bCNM].e(6ƮcyC1E_Kক,M u|p4ؿ=reNCz~/j.k*(DI/&QPK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-!k<*drs/shapexml.xmlPK-!!drs/downrev.xmlPKp<$ 0   E Practice Tips& w<   |` 0e0e?Subtitle 2"PK!Zf[Content_Types].xmlMO &2WR=cJ`F0iK`#̼vLw 9uSq:w`G ^i ½KI)c/ $oVjTMRc|}042ҥCƔM̏P~*ka/8^DkHbL8e i"K\XN\6rco4y@_;oPK!1_a _rels/.relsj0 ѽqCNo^K [ILcX&m߾0XFo;>0xM e`|X}đ I`߽N4aG2$RKIZ)4(M9`ctB{m:f@`3n|O,ܗr޾jxR0T ,0@}WBLǬ5vPK! `~: drs/shapexml.xmlVMo7 x-Y^TW*јZU+Klŧ&9[Cr|XZAZS3ajHXO۳e(AqO.a +&FF uYkK8r^a"D|H$f# ^ev[y3}6qf@eWE`>@K[o  f "zmX<8DjMh8|:^擋!K^ )= uq m[Odz 5;ڈrF4>C9Ҟ%=jqmEW*~;XV'nM(x:Eh1-8Iuzb:}c)xkѼ,vt59R.·rN$-C$O}Ӳ.Q!$mmĦP ~F>!4k]Y#5< XkMīTA ep!0<@ϱ" UplKz\/.W6=NF>[yƾ!Ұ2#հ1dݯ kl-+yX.i.Pa:.5#Ǯ`UR;#ܴr$4p|uMc}vc7ѽ|Ksqð4v#׭CZs(߯߮{􁜂e(/PK-!Zf[Content_Types].xmlPK-!1_a /_rels/.relsPK-! `~: *drs/shapexml.xmlPK-!gsdrs/downrev.xmlPK0<$D 0   Establish a Peer Review Committee Create formal positions, name of committee and/or scope of committee Establish a meeting schedule Discuss each case that is presented Create bylaws or policies THAT ARE FOLLOWED! Do not discuss the subject outside of the formal process Label all documents part of the process Author Prepared at whose direction Date request was made Label that indicates Peer Review Committee s Eyes Only Notes from meeting categorized/saved similarly Keep abreast of the current definition and requirements Involve legal counsel Prepare the incident report for legal counsel with the specific purpose of notifying counsel of possible claims to invoke the attorney-client privilege (must actually do it, not just put language on form)"PPPpP}PP""""p"}" " @`H  0޽h ? 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Advocates of disclosure point to emerging literature that suggests that full disclosure of unanticipated outcomes decreases rather than increases the likelihood of lawsuits. * ZtZ t@XI m Sorry Law / Doctor-Patient Relationship --G Ohio Law  R.C. 2317.43 - Use of defendant's statement of sympathy as evidence in medical liability action prohibited: (A)In any civil action brought by an alleged victim of an unanticipated outcome of medical care or in any arbitration proceeding related to such a civil action, any and all statements, affirmations, gestures, or conduct expressing apology, sympathy, commiseration, condolence, compassion, or a general sense of benevolence that are made by a health care provider or an employee of a health care provider to the alleged victim, a relative of the alleged victim, or a representative of the alleged victim, and that relate to the discomfort, pain, suffering, injury, or death of the alleged victim as the result of the unanticipated outcome of medical care are inadmissible as evidence of an admission of liability or as evidence of an admission against interest. (B)For purposes of this section, unless the context otherwise requires: (1)"Health care provider" has the same meaning as in division (B)(5) of section 2317.02 of the Revised Code. (2)"Relative" means a victim's spouse, parent, grandparent, stepfather, stepmother, child, grandchild, brother, sister, half brother, half sister, or spouse's parents. The term includes said relationships that are created as a result of adoption. In addition, "relative" includes any person who has a family-type relationship with a victim. (3)"Representative" means a legal guardian, attorney, person designated to make decisions on behalf of a patient under a medical power of attorney, or any person recognized in law or custom as a patient's agent. (4)"Unanticipated outcome" means the outcome of a medical treatment or procedure that differs from an expected result. PCCCCCgCCtCC05'& I M SORRY STATUTE$3fHill v. St. Onge, 2009 U.S. Dist. LEXIS 82195 (S.D. Ohio). Defendant sought to exclude statements under R.C. 2317.43 Plaintiff claimed Fed. R. Evid. applied R.C. 2317.43 controls because it is  intimately bound up with the state s substantive policy of allowing doctors to express sympathy to patients without penalty:=*, ?XI m Sorry Law / Doctor-Patient Relationship --GImportant Considerations: Unanticipated Outcomes - Terminology Term first used by JCAHO to refer to outcome of care that is different from that expected by health care professionals and the patient at the start of health care intervention. Refers to outcome of care, the process of care. Does not imply medical error. Informed consent. Ethical Considerations JCAHO requires patients, and families when appropriate, are informed of outcomes of care, including unanticipated outcomes Patient Surveys Patients want explicit statement that an error occurred, an apology, and information about what the error was, how it will affect their health, why the error occurred, and how recurrence will be prevented. Impact on Potential Resolution Studies show a full apology tends to promote more rapid dispute resolutions and lower financial awards. Opponents of I m Sorry Policy Many still believe that a vast majority of patients injured by negligent care never sue, and the lack of awareness of the error may be an important contributor to this low rate of litigation. Importance of Doctor-Patient Relationship / Bedside Manor.P%PPP{PPPPiPPP:P%{    i:TVI m Sorry Law / Doctor-Patient Relationship,,G{PRACTICAL DISCUSSION Who communicates with patient? What is said? Does strength of doctor-patient relationship have impact?(ggK*Peer Review / Quality Assurance Privilege  *+A Peer Review / Quality Assurance !!G^As Defined by Statute  Tort Reform  Ohio Revised Code 2305 Case Law Interpretation Around Ohio Incident Reports Review Committees Documentation How does that apply to me? Lc1c 1  *PORC 2305.25 "$Health care entity Any entity, that conducts as part of its regular business activities professional credentialing or quality review activities involving the competence of, professional credentialing, professional conduct of, or quality of care provided by health care providers. Incident report Means a report of an incident involving injury or potential injury to a patient as a result of patient care provided by health care providers, that is prepared by or for the use of a peer review committee of a health care entity and is within the scope of the functions of that committee. Peer review committee Means utilization review committee, quality assessment committee, performance improvement committee, credentialing committee, or other.PPP!PPP!  QORC 2305.24 "$Confidentiality Any information, data, reports, or records made available to a quality assurance committee is confidential and shall be used by the committee and the committee members only in the exercise of the proper functions of the committee. RORC 2305.252 "$DProtection of Peer Review Committee Information: Proceedings and records within the scope of the peer review committee of a health care entity shall be held in confidence and shall not be subject to discovery or introduction in evidence in any civil action against a health care entity or health care provider. No individual who attends a meeting of a peer review committee, or provides information to a peer review committee shall be permitted or required to testify as to any evidence or other matters produced or presented during the proceedings of the peer review committee. 01ZZ/SORC 2305.253  Protection of Incident Reports: An incident report and the contents of an incident report are not subject to discovery in, and are not admissible in evidence in the trial of, a tort action. An individual who prepares or has knowledge of the contents of an incident report shall not testify, and shall not be required to testify, in a tort action as to the contents of the report. , ` `+Absolute Slam Dunk?& w<Pretty Clear Statutes Umbrella of protection to information collected and maintained by peer review committee Specifically targets incident reports regarding injury suffered by patient&Z"   6Very Broad Language Any information, data, reports, or records made available to a QA committee are confidential End of topic/discussion  Complete shield? ,.01234567M"Preserve Medical Record / Evidence##>Never Ever Alter !: 6f,f6fsDo not obliterate Errors: Date, Time, Initial Never chart for someone else If documented later, chart the time ptD#Preserve Medical Record / Evidence $$$)Maintain Complete Original Medical RecordV#Preserve Medical Record / Evidence $$$The Complete Medical Record May or May Not Include: Admission record History and Physical Physician orders, and/or certifications of medical necessity Patient questionnaires associated with physician services Progress notes and/or progress of another provider that are referenced in your own note Nursing notes Treatment logs Related professional consultation reports Procedure, lab, x-ray and diagnostic reports Amended Medical Records Discharge Plan04PP4W#Preserve Medical Record / Evidence $$  Ohio Statutory Guidance regarding the  Complete Record ? The Ohio Administrative Code (Section 5122-14-13), when referring to the administration of a psychiatric facility, describes the  necessary components of the  medical record as follows: (1) Patient demographic information, including indication of legal status as a voluntary or involuntary patient; (2) All legal documents, including, as appropriate, an application for voluntary admission signed and dated by the patient, written requests for release pursuant to section 5122.03 of the Revised Code, and all legal documents pertaining to civil commitment and guardianship; (3) The reason for admission including presenting problem(s), precipitating factors, and initial diagnosis; (4) Previous hospitalizations; (5) Reports of all patient assessments and examinations; (6) An individualized treatment plan which shall include criteria for discharge and which shall meet requirements of section 5122.27 of the Revised Code; (7) All medical orders; (8) Documentation of the patient s progress, and other significant patient events which could impact on treatment; (9) Appropriate, complete, signed and dated consents for treatment, and for release of confidential information; (10) A discharge summary completed within thirty days after discharge and signed by the attending or treating physician; and (11) A plan for aftercare.:P{P<? X#Preserve Medical Record / Evidence $$$Other Evidence to Preserve: Staffing, Schedules, Patient Census Names and Contacts of Potential Witnesses Written Policies and Procedures Business Records Chain of Custody / Medical Records (N6Employee s File / ReprimandE6Employee s File / Reprimand^Do not discard Defense against negligent hiring, negligent retention Assume file may be read by Plaintiff s Counsel May help establish employment relationship, or lack thereof66k6k[6Employee s File / Reprimand&RRACTICAL DISCUSSION: Personnel File F--OPrivacy ConsiderationsFPrivacy ConsiderationsCommunication with family regarding care and outcome Records Requests Pursuant to R.C. 3701.74, medical records may only be provided at the request of a "patient, a patient's personal representative or an authorized person." The "personal representative" in some instances may include person with health care power of attorney, or an executor of the patient's estate. A Will naming someone as executor is not sufficient. The Will must be probated first. The Court must then provide the designated person with a letter of authority. T5ZZZZ6YPPutting it All Together  An Action Plan))$Secure Record / Evidence / Equipment / Data Back-up Interviews with Personnel Counseling for Involved Personnel Communication with Patient / FamilyZ)Recent Developments - Electronic Records**$U)Recent Developments - Electronic Records** Takeaway Thoughts and Questions $0 Communications Control Preservation \ Thank You$ 0 T$(  Tr T S T    r T S ,    H T 0޽h ? 3380___PPT10.t$ 0  \$(  \r \ S d<   /  r \ S A  /  H \ 0޽h ? 3380___PPT10.*Ihr#;\g"\1  !"#$%&'()*+,՜.+,D՜.+,     pOn-screen ShowStern Advertisingכ+' 2Arialヒラギノ角ゴ Pro W3 Arial Narrow Arial BlackCandaraTimes New RomanBlank PresentationPThe First 24 Hours: Time-Sensitive Risk Management in the Face of Catastrophe Today’s PresentationHGeneral Guidelines and Considerations to Observe During First 24-Hours Slide 4/I’m Sorry Law / Doctor-Patient Relationship /I’m Sorry Law / Doctor-Patient Relationship “I’M SORRY” STATUTE/I’m Sorry Law / Doctor-Patient Relationship .I’m Sorry Law / Doctor-Patient Relationship Slide 10!Peer Review / Quality Assurance Confidential by StatuteORC § 2305.25 ORC § 2305.24 ORC § 2305.252 ORC § 2305.253Absolute Slam Dunk?General Assembly v. Courts9First Prove Existence of Statutory Peer Review Committee.Can We Just Call it an “Incident Report”? Slide 21Privilege is NOT AbsoluteYou Have The Burden!%NO Privilege Under ORC § 2305.253?>Always Submit to a Peer Review Committee to Protect PrivilegeYou May Have to TestifyPractice Tips Slide 28Never Ever Alter !$Preserve Medical Record / Evidence $Preserve Medical Record / Evidence $Preserve Medical Record / Evidence $Preserve Medical Record / Evidence Slide 34Employee’s File / ReprimandEmployee’s File / Reprimand Slide 37Privacy Considerations+Putting it All Together – An Action Plan*Recent Developments - Electronic Records*Recent Developments - Electronic Records Takeaway Thoughts and Questions Thank You  Fonts UsedDesign Template Slide Titles+( 8@ _PID_HLINKSAShttps://www.lexis.com/research/buttonTFLink?_m=cf1122a0d0f24736cd19682bc7206d2a&_xfercite=%3ccite%20cc%3d%22USA%22%3e%3c%21%5bCDATA%5bORC%20Ann.%202317.43%5d%5d%3e%3c%2fcite%3e&_butType=4&_butStat=0&_butNum=2&_butInline=1&_butinfo=OHCODE%202317.02&_fmtstr=FULL&docnum=1&_startdoc=1&wchp=dGLbVzt-zSkAl&_md5=125895ee8b1e6c95fba6a8549e3ba7ae_㳛DValentDValent