The EMPSF Newsletter
The Newsletter for Members of the Emergency Medicine Patient Safety Foundation
Autumn 2005
The EMPSF Newsletter
The Newsletter for Members of the Emergency Medicine Patient Safety Foundation
Autumn 2005
Mission Statement: The Emergency Medicine Patient Safety Foundation (EMPSF) is dedicated to improving patient safety in America’s emergency departments (ED).
In This Issue:
Protect Patients
Patient Safety News
EMPSF Awards Grant
Patient Safety Resources
EMPSF Calendar
Download a PDF file of the newsletter here
Message from the Editor
Robert A. Bitterman, MD, JD, FACEP
The mission of the Emergency Medicine Patient Safety Foundation (EMPSF), for two interrelated reasons, is to improve patient safety in our nation’s emergency departments (EDs).
Our foremost reason is to provide the best emergency care possible for all patients. We want to help physicians provide quality healthcare, satisfy patient and family needs, and avoid adverse outcomes. In many ways, “patient safety” is the new buzzword for competent healthcare, or in some circles, refers to risk management in emergency medicine.
It certainly is equivalent to providing competent medical care, as good medicine is obviously what avoids errors and ensures patient safety. But it has gathered new attention in the last few years, for example, in the Institute of Medicine’s publication of “To Err is Human,” as the public and political leaders have become aware of the morbidity attributed to medical intervention as the result of the fragmentation, sophisticated technology, and increasing complexity of delivering healthcare. Even Congress has reacted, enacting the Patient Safety and Quality Improvement Act of 2005.
Risk management, on the contrary, is not the same as patient safety. Instructing hypertensive patients to follow up with a doctor in one week, and documenting that instruction, is risk management (in reality it merely substitutes the medical-legal risk of the physician for a life-and-death risk to the patient); actually seeing the patient later and providing treatment is patient safety. Implementing a system to follow up on radiology over-reads of x-rays within 24 hours of the patient’s ED visit is risk management; providing real-time readings by the appropriately trained radiologist while the patient is still in the ED is patient safety.
A nursing policy and procedure to re-evaluate sick patients waiting hours on end in the ED waiting room is risk management and part patient safety; devising a delivery system whereby the emergency physician sees all sick patients almost immediately is patient safety. Risk management techniques do not always improve patient safety; many are designed primarily to protect providers from litigation.
Our secondary objective, the second reason for focusing on patient safety, is to reverse the negative consequences of malpractice lawsuits, which directly affect our ability to deliver emergency care. We must decrease medical liability losses not to alleviate our own personal suffering, although it is a desirable byproduct, but principally to maintain the hospital resources and physician expertise necessary to providing timely, competent, and “safe” emergency care to our patients.
Time, energy, and money expended in the litigation system are resources no longer available to provide patient services in safer ways. If a hospital’s annual liability insurance premium jumps from $3 million to $9 million in two years, that is $6 million each year no longer available to provide healthcare, which always seems to translate into fewer nurses in the emergency department, loss of ultrasound techs at night, fewer ICU beds available (more crowding in the ED), and less money to procure on-call physician services for ED patients.
If money is diverted from capital programs to cover insurance, it jeopardizes the future of those hospitals to provide technology, buildings, and additional or upgraded services at the very time the need for such services is predicted to grow as the baby boomers age.
The accelerating diversion of resources from patient care into liability costs threatens the very existence of emergency services in our country. In the last 25 years, more than 1,500 hospitals in the U.S. have ceased operating emergency departments. Simultaneously, the number of ED visits has grown from 37 million per year to well over 115 million ED visits per year.
Ninety percent of our larger hospitals have saturated their capacity for treating patients, resulting in ED overcrowding. Many trauma centers have closed, and most remaining trauma centers are routinely overwhelmed. Ambulance diversion is common, ED waiting times have increased substantially, and the number of individuals seeking emergency care who leave the ED before being seen has tripled in some areas of the country.
Emergency physicians do not practice in a vacuum. Unlike depictions on the TV show “ER,” emergency physicians are unable to take care of every illness or injury on our own: We need EMS providers in the field, hospital resources and nursing services, and particularly the specialty expertise of our on-call colleagues.
Unfortunately, an increasing number of hospitals are wholly unable to provide on-call specialty services, particularly neurosurgery, thoracic surgery, orthopedics, psychiatry, hand or plastic surgery, and ear, nose, and throat surgery. Instead, they must transfer patients they could treat because physicians decline to participate in hospital ED on-call lists due, in part, to the fear and costs of litigation.
Numerous studies have confirmed the erosion of on-call coverage of our hospital emergency departments, which delays patient access to necessary emergency care and increases the number of patients that must be transferred to obtain the required services. Furthermore, the declining capacity of many of our secondary and tertiary facilities increases the delay and difficulty in arranging such transfers or increases the distance they must travel, and thus the healthcare risk, to obtain competent emergency care.
For example, I recently accepted a transfer of a major trauma victim from a ED well over two-and-a-half hours away from my hospital, because it had lost some of its trauma resources and closer facilities that usually accepted its cases in transfer either had no physicians willing or able to accept the patient in transfer or had no ICU beds available to treat the patient. A two-hour-plus delay to definitive treatment is not optimal or “safe” trauma care.
Even if emergency physicians can survive the liability insurance crisis and maintain their practices, patients will still suffer “unsafe patient care” if we do not save the hospital support systems and on-call physician specialists we need to provide quality emergency care.
This is where risk management techniques and tort reform become important, because improving patient safety alone will not eliminate litigation losses. By protecting ourselves, our on-call colleagues, and the collective assets of hospitals and physicians, we also protect our ability to provide access to care and quality care, “patient safety,” for our mutual patients.
Patient safety programs, risk management tools, and tort reform will not solve the litigation problem or the access-to-care problem, but they may curtail the extraction of dollars and the exodus of skilled physician services out of the emergency healthcare system.
Therefore, we must identify and attack all significant impediments to the delivery of safe patient care, whether they arise from medical science, system or management problems, policies, procedures, practice patterns, political measures, economics or educational issues. The objective of this newsletter is to assist in those efforts.
References
1. Institute of Medicine (IOM) To Err is Human: Building a Safer Health System, National Academy Press, Washington, DC (2000).
2. HHS Report. Addressing the New Healthcare Crisis: Reforming the Medical Litigation System to Improve the Quality of Healthcare. March 3, 2003. Available on the government’s website at http://aspe.hhs.gov/daltcp/reports/medliab.htm.
3. HHS Report. Confronting the New Healthcare Crisis: Improving Healthcare Quality and Lowering Costs by Fixing Our Medical Liability System. July 24, 2002.
4 GAO Report (GAO-03-0836) August 2003. Medical Malpractice: Implications of Rising Premiums on Access to Healthcare. Available at http://www.gao.gov/new.items/d04128t.pdf.
5 Studdert DM et al. Health Policy Report: Medical Malpractice. NEJM 2004;350:283-292.
6. Berenson RA, Kuo S, May JH. Medical Malpractice Liability Crisis Meets Markets: Stress in Unexpected Places (EDs), Issue Brief No. 68, September 2003, Published by the Center for Studying Health System Change.
7. Derlet RW. Overcrowding in Emergency Departments: Increased Demand and Decreased Capacity. Annals of Emergency Medicine 2002;39:430-432.
Protect Patients with ED Policies, Procedures, and Protocols
Police Requests for Blood Alcohol Draws in the Emergency Department (ED)
Robert A. Bitterman, MD, JD, FACEP
Handling persons brought to the ED by law enforcement officers to obtain a blood draw for measuring their alcohol level is fraught with controversy and risk – a patient safety risk and a liability risk. Two primary issues must be addressed by your emergency department:
1. What is the most practical and equitable way to provide this service (legal blood draw) in the ED while protecting the hospital and clinical staff from liability, ensuring the patient’s safety, and simultaneously expediting the process for the police officers?
2. Does federal law, EMTALA, require the hospital to provide a medical screening examination to individuals brought to the hospital’s ED in police custody for a legal blood draw?
Basis of Concerns
The legal and medical problems surrounding this ED interaction arise mostly from three sources. First, these individuals often have occult medical problems or injuries, rather than alcohol intoxication, that warrant examination and treatment by a physician. In fact, persons arrested for drunk driving, involved in car accidents, or other altercations are actually not brought to the ED for blood alcohol testing (BAT); they are brought to the ED because the police noticed aberrant behavior and suspected it to be caused by alcohol intoxication.
Many conditions mimic alcohol intoxication: hypoglycemia; cerebral hypoxia; head injury; metabolic abnormalities; and ingestion of toxins other than alcohol. Though the police officer’s assessment will most often be correct, alcohol intoxication should not automatically be presumed to be the cause of a patient’s condition. The role of emergency medicine is to ensure these patients’ safety.
Second, the Centers for Medicare and Medicaid Services’ (CMS) new EMTALA regulations and interpretive guidelines relating to EMTALA’s screening mandate for police blood draws may be misunderstood, create confusion, or provide a false sense of security in the management of these patients.*1,*2 Furthermore, even if the hospital’s conduct complies with federal law, EMTALA, it may still expose the hospital to malpractice liability under state law. The diagnosis and treatment of alcohol-related patients in hospital emergency departments is historically a well-known source of adverse patient outcomes and a high-risk encounter.
Third, when the patient has been drinking alcohol, the hospital and emergency physician must balance the patient’s autonomy, the right to refuse examination or treatment, with the physician’s responsibility to protect individuals who are intoxicated and medically incapable of making informed decisions to refuse medical care. This tension between a patient’s right to choose and a physician’s duty to protect intoxicated individuals from harm also contributes to the difficulty in managing these interactions and the attendant liability under both federal and state law.
Legal Authority: EMTALA Statute
Two “prongs” are required to trigger EMTALA’s duty to provide a medical screening examination (MSE):
1. An individual must “come to the emergency department;” and
2. “Request examination or treatment for a medical condition.” *3
It is obvious that persons brought to the ED by police meets the legal definition of “coming to the emergency department.” *1, *2, *3 Therefore, the only real issue is whether the police officer’s request for a blood draw for blood alcohol testing (BAT) constitutes a “request for examination or treatment of a medical condition” which would trigger the hospital’s duty under the law to provide an MSE.
Note that the request is for examination or treatment of a medical condition; the law does not state for an emergency medical condition – an important distinction – which is commonly misunderstood by hospitals, physicians, attorneys, and commentators. The purpose of the MSE is to determine if the patient’s presenting condition is an emergency medical condition (EMC), as defined by law. *3,*4
The statute does not define the request prong any further, but CMS’s regulations and 2004 interpretive guidelines directly address the request issue related to police legal blood draw requests.
Legal Authority: CMS Regulations and Interpretive Guidelines
The relevant section of the regulations on the “request” prong is:
…the individual…requests examination or treatment for a medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs examination or treatment for a medical condition…*1
Therefore, the “request” may be made by anyone, and it may be expressed or implied by word or by deed. The request may be made by the patient, a family member, a medic, or a law enforcement officer; it does not have to come from the patient.
Additionally, in the absence of an actual request, CMS will presume a request exists if a prudent layperson observer would believe the individual needs examination or treatment for a medical condition. CMS recognizes that hospital personnel must be aware of the individual’s presence and appearance or actions that indicate a need for examination or treatment for a medical condition before the hospital would incur a duty to screen the individual under EMTALA. *5
This prudent layperson (PLP) standard for creating a “request” is especially relevant in persons brought to the ED for BAT, as commonly their behavior, appearance, or obvious intoxication would lead a PLP to believe the person needs examination or treatment for a medical condition. CMS would interpret the PLP standard to be an implied request for an MSE and that the hospital was on notice that a request for an MSE existed. Therefore, the only way the hospital could avoid its duty to provide an MSE was if the individual refused the MSE offered by the hospital. The refusal would need to be an informed refusal, after the emergency physician determined that the patient was medically competent to refuse examination and treatment.
In the regulations, CMS attempted to avoid imposing a duty on hospitals to provide an MSE for traditionally nonemergency services, such as BAT, stating:
…if the nature of the request makes it clear that the medical condition is not of an emergency nature, then the hospital is required to only perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an EMC. *6
However, this new regulation did not change anything. The hospital is still required to perform an MSE to the extent necessary to determine if an EMC exists. In other words, the scope of the MSE must be whatever it takes to decide if an EMC exists in the same manner as would be done for anyone else presenting with the same complaint. Thus, all patients presenting with any medical condition must be provided an MSE to determine if that medical condition is an emergency medical condition.
CMS’s Interpretive Guidelines of May 13, 2004, state the following regarding police blood alcohol testing in the emergency department:
If an individual presents to a dedicated emergency department and requests services that are not for a medical condition, such as … gathering evidence for criminal law cases (e.g.,…blood alcohol test) the hospital is not obligated to provide a MSE under EMTALA to this individual. *2
Thus, at first glance, it appears that CMS believes persons presenting for a blood alcohol draw for BAT would not require an MSE, since essentially CMS considers that BAT does not count as a medical condition. However, CMS’s guidelines further state:
Attention to detail concerning blood alcohol testing (BAT) in the ED is instrumental when determining if a MSE is to be conducted. If an individual is brought to the ED and law enforcement personnel request that emergency department personnel draw blood for a BAT only and does not request examination or treatment of a medical condition, such as intoxication and a prudent lay person observer would not believe that the individual needed such examination or treatment, then the EMTALA’s screening requirement is not applicable to this situation because the only request made on behalf of the individual was for evidence. However, if for example, the individual in police custody was involved in a motor vehicle accident or may have sustained injury to him or herself and presents to the ED a MSE would be warranted to determine if an EMC exists. *2 (author’s emphasis)
And CMS continues:
Surveyors will evaluate each case on its own merit when determining a hospital’s EMTALA obligation when law enforcement officials request screening or BAT for use as evidence in criminal proceedings. *2
These last two paragraphs reiterate the PLP standard for creating a request for an MSE, even though the individual is presenting purely for a blood draw for BAT. CMS will retrospectively review details from police reports, nursing notes, EMS run sheets, triage information, and the interaction/interview of the patient to determine whether there was an actual or implied (PLP) request for an MSE. If the patient gives the slightest hint they want to be examined, or says or does something to suggest to a PLP that they need to be examined, then the hospital’s duty to provide an MSE will be triggered.
CMS considers persons with substance-abuse problems, including alcohol-related problems, to be a “protected class,” and therefore applies greater scrutiny in evaluating their care by the hospital. *7 Because of concerns that these patients are often given short shrift by EDs, and may have occult injuries or medical conditions that present similar to alcohol intoxication, the CMS regional offices expect hospitals to extensively interview police officers and the patient to determine whether a medical issue exists. Many state surveyors and regional offices also question whether an intoxicated patient can make an informed refusal of care. If an individual suffers an adverse outcome, CMS or a jury could easily conclude retrospectively that the person had an EMC and that the hospital failed to perform an appropriate MSE or stabilize the EMC. *8
The only way for the hospital to assure that medical or trauma issues do not exist, and that the PLP standard is not present, is for its clinical staff to interact with the patient. Nurses may be able to judge the situation in most instances, but not as well as physicians, and they cannot determine medical competence under the state’s nurse practice act. The emergency physicians need to be involved in the management of these patients in the ED.
Recommendations
In light of the above, any time an individual is brought to the emergency department by police officers for blood alcohol testing, the emergency physician, for medical reasons, patient safety reasons, and legal reasons should personally interact with that person. The emergency physician should offer to provide an MSE to determine if an EMC exists, and ascertain whether the person is medically competent to refuse the offered screening exam.
If the patient refuses the MSE, the emergency physician should be involved to determine whether the patient is capable of making an informed refusal of medical care, just like any other scenario where a patient is trying to leave or refuse care against medical advice (AMA). *9 If the physician determines the patient is not medically competent to refuse care at that moment in time, then the physician should retain the patient by whatever means necessary, just as the physician would retain any other patient incapacitated by a medical or psychiatric condition.
Policy Considerations
Regardless of how the hospital decides to handle blood draws for BAT in the ED, it should implement written policies and procedures to address the situation. Following the policy proves the hospital’s intent to provide screening examinations to all who ask or need one and demonstrates its intent to provide other services to the community. The process of writing and adopting these policies requires the EMTALA issues to be addressed, educates the medical staff and hospital administrators on the issues, and helps prevent medical errors, all of which enhance patient safety.
* Notes
1. 68 Fed. Reg. 53,221-53264 (2003): the new final EMTALA regulations on EMTALA published by CMS can be found at 42 CFR 489.24 or via the Federal Register Online GPO Access at: http://www.access.gpo.gov/su_docs/fedreg/a030909c.html under “Separate parts in this issue.”
2. HHS CMS/Survey and Certification Group. S&C-04-34, Revised Final EMTALA Interpretive Guidelines, May 13, 2004; available at: http://www.cms.hhs.gov/medicaid/survey-cert/sc0434.pdf (The section near the end of Tag 406 specifically addresses police blood alcohol testing in the emergency department.)
3. 42 USC 1395dd(a).
4. Bitterman RA. Chapter 200: Medicolegal Issues. In Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th Edition 2002, John A. Marx, Editor. (Discusses the medical and legal issues related to persons refusing a medical screening examination under EMTALA and state laws.)
5. 68 Fed Reg 53221-53264 (2003).
6. 42 CFR 489.24(c).
7. 59 Fed Reg 32107-32108 (1994).
8. Evans v. Montgomery Hosp. Medical Ctr., 1996 U.S. Dist. LEXIS 5785 (D.Pa. 1996) is an example of the civil courts applying the PLP standard even before CMS incorporated it into the regulations and interpretive guidelines. In Evans, police arrested a man for “driving erratically and acting abnormally.” The police took him to the hospital’s emergency department for a blood alcohol test to use in criminal proceedings. A nurse drew the blood, and the man was taken to jail. The next morning he was found dead in his cell from a stroke; his aberrant behavior the night before was the result of cerebral hypoxia, not alcohol. The man’s estate sued the hospital, claiming that it failed to provide the patient an appropriate MSE as required by EMTALA. The court held that signing the standard hospital consent form was substantial evidence that the man had sought treatment for a medical condition, and that the man’s obvious lethargy and difficulty sitting up without assistance while the nurse drew his blood also represented an apparent request for examination and treatment. See also Kraft v. Laney, No. CIV S-04-0129 GGH (E.D. Cal. Aug. 24, 2005).
9. Bitterman RA. Providing Emergency Care Under Federal Law: EMTALA. Published by the American College of Emergency Physicians in January 2001 and now in 2nd printing. A supplement addressing the impact of the new 2003 EMTALA regulations was published in May of 2004. Both are available from ACEP at 1-800-798-1822, touch 6, or on its website at www.acep.org/bookstore. (Pages 39-40 specifically address the police blood alcohol draw by hospital emergency departments under EMTALA.)
Hurricane Katrina and Liability Protection
In 1996, the U.S. Congress approved a framework to encourage assistance and cooperation among the states to devastated areas after natural disasters. The Emergency Management Assistance Compact (EMAC) goes into effect once a state’s governor declares a state of emergency or disaster, and it provides rules to follow when sharing first responders, emergency medical workers, utility workers, and other state employees. Among other things, the EMAC relieves officers or employees of the states providing assistance from liability for acts and omissions taken in good faith. The two states most severely damaged by Katrina, Louisiana and Mississippi, are both parties to the EMAC (See Miss. Code Ann. § 45-18-3 (2005), and La. Rev. Stat. § 29:751 (2005)).
The Governor of Louisiana signed an executive order which suspends licensure requirements for out-of-state medical professionals. It also states that all out-of-state medical professionals offering services to the state shall be considered agents of the state for tort liability purposes, and thus will come under the tort protections of the EMAC. [Source: The Centers for Disease Control and Prevention (CDC) Public Health Law New, September 7, 2005.]
Texas Medical Liability Trust Awards Patient Safety Scholarships
A mutual medical malpractice company, the Texas Medical Liability Trust (TMLT) awarded $5,000 Memorial Scholarships to medical students, one from each Texas medical school, who submitted essays on creative ways to enhance public safety. The winning essays will be published on the TMLT website, www.tmlt.org.
Foundation to Award Research Grant
This year, EMPSF will award a $5,000 grant to a selected emergency medicine residency program for original research on an issue in emergency medicine patient safety. In 2006, the Foundation hopes to award several grants and to open submissions to all EM residency programs. Watch for more details in the next issue of the EMPSF Newsletter.
First Annual Patient Safety Award Created
The Emergency Medicine Patient Safety Foundation (EMPSF) has created the Annual Stuart Fleming Patient Safety Award to acknowledge and reward the EMPSF-member emergency medicine group that has best demonstrated a commitment and dedication to improving patient safety in their emergency medicine department through collaboration and compliance with their malpractice insurance carrier, EPIC RRG, and its Risk Management/Patient Safety Program.
A $10,000 check from EPIC and an honorary plaque will be presented to the EMPSF-member emergency medicine group selected as the recipient of the 2005 Annual Stuart Fleming Patient Safety Award at the ACEP 2005 Scientific Assembly in Washington, DC, by EMPSF Chairman Graham Billingham, MD, FACEP.
The EMPSF Patient Safety Award was created in memory of Stuart Fleming, MD, an emergency physician who practiced for nearly 25 years. A founding member of the EPIC Board of Governors, Dr. Fleming was a devoted advocate of patient safety and risk management. He was among the first emergency physicians in California to embrace the electronic medical record and ED informatics as significant tools for creating a safer environment for patients. He was medical director of the Sierra Nevada Emergency Medical Group in Grass Valley, California, until he passed away in July 2004 after a courageous fight against cancer. Dedicated to carrying out the vision of patient safety in emergency medicine shared by EPIC and the Foundation, Dr. Fleming was an inspiring example of how one individual’s commitment to patient safety in their own emergency medicine department can positively impact the lives of so many.
American College of Emergency Physicians (ACEP) Rally at the US Capitol
ACEP will hold a rally on September 27th at 10:00 a.m. on the Capitol’s West Lawn. Stand up for patient safety and ask Congress to pass meaningful legislation that will:
For more information, visit www.acep.org/webportal/Advocacy/Federal/2005rally.htm.
President Bush Signs Patient Safety and Quality Improvement Act of 2005
This legislation is intended to enhance patient safety by encouraging voluntary reporting of healthcare errors or events that adversely affect patients. The intent is to foster an attitude of reporting errors which leads to improved patient care, instead of a culture of silence from fear of ruinous litigation or risk to one’s license to practice.
The bill provides legal and confidentiality protections for patient information that providers share for the purpose of improving patient safety and the quality of healthcare delivery. Notwithstanding any other federal, state, or local law, such patient safety information shall not be discoverable or admissible in any proceedings against healthcare providers, such as malpractice actions, government EMTALA investigations, or professional disciplinary proceedings. See full text at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_public_laws&docid=f:publ041.109.pdf.
The American Hospital Association has written an advisory letter with an overview and discussion of the new law’s key provisions, including what is privileged and what protections exist for physicians. It is available at http://www.ashrm.org/ashrm/aboutus/notices.html.
Patient Safety Link Provides Free Online Information
The Joint Commission International Center for Patient Safety manages a free online resource dedicated to improving patient safety. The site is www.jcipatientsafety.org, and it features journal articles, book excerpts, and other resources from the Joint Commission and its affiliate, Joint Commission Resources. It also provides a monthly newsletter, “Patient Safety Link,” for healthcare professionals. To subscribe, contact patientsafetylink@jcrinc.com.
ACEP’s Online QTIPS: “Quality Tips to Improve Patient Safety”
ACEP has valuable EM patient safety tips on its website. This is practical clinical and risk management information drawn from ACEP educational lectures. The QTIPS are available at www.acep.org/QTIPS/default.aspx.
Links to Patient Safety Resources highlighted in the EMPSF Newsletter will be published on the EMPSF website, www.empsf.org.
EMPSF 2005 Meeting and Conference Calendar
September 15 – 17
2005 Emergency Nurses Association (ENA)
Scientific Assembly
Nashville, TN
September 25
EMPSF Board of Directors Meeting
Washington, DC
September 26 – 28
2005 American College of Emergency Physicians (ACEP) Scientific Assembly
Washington, DC
October 23 – 26
American Society for Healthcare Risk Management (ASHRM)
25th Annual Conference and Exhibition
San Antonio, TX
See You in September...at ACEP’s 2005 Scientific Assembly
We look forward to seeing you in Washington, DC, for ACEP’s 2005 Scientific Assembly, September 26 through 28. Both EPIC and EMPSF will be exhibiting at ACEP: EPIC will be in booth #1207, and EMPSF will be right next door at booth #1205. Please stop by and visit us at our booths. Meet the new EPIC committee members as well as some of the EPIC and EMPSF staff. Our ACEP schedule of events has been noted on the EPIC Intranet calendar on the home page.
Contact the Emergency Medicine Patient Safety Foundation
EMPSF
11760 Atwood Road, Suite 5
Auburn, CA 95603
Tel 530-889-9328
Fax 530-889-8742
www.empsf.org
Graham Billingham, MD, FACEP
Chairman & Medical Director
gbillingham@empsf.org
Dianne Vass
Executive Vice President & COO
dvass@empsf.org
Vanessa Smith
Director of Operations
vsmith@empsf.org
Your Comments and Questions Are Welcome
The EMPSF Newsletter will be published quarterly. Future issues will include:
Periodically, it will contain lessons learned from claims experience and educational case studies.
Please feel free to suggest topics for discussion, submit questions, or submit practical tips or articles for publication in the newsletter. We are particularly interested in your experiences, and we are open to feedback and any ideas you have to help us continually improve the newsletter and the service of the Foundation. Please send materials in electronic format to rbitterman@empsf.org.
The EMPSF Newsletter
The EMPSF Newsletter is published quarterly by the Emergency Medicine Patient Safety Foundation (EMPSF) for its members. Letters to the editor and articles, to be edited and published at the editor’s discretion, are welcome. Views expressed in letters to the editor are those of the writer and do not necessarily reflect the opinion or official policy of EMPSF. Please sign letters and address them to the editor or send them via email to rbitterman@empsf.org.
Publisher: Emergency Medicine Patient Safety Foundation
Editor: Robert A. Bitterman, MD, JD, FACEP
Managing Editor: Dana Cooper
Art Director: Shawn Mountcastle
Web Master: Jason Fontaine
The Emergency Medicine Patient Safety Foundation (EMPSF) publishes The EMPSF Newsletter quarterly to inform EMPSF members on issues pertinent to emergency medicine and professional liability insurance. Any recommendations found in the newsletter are intended as guidelines, not standards of care, and do not ensure successful outcomes. Any guidelines address principles of the practice of emergency medicine, and are not inclusive of all proper methods of care nor exclusive of other appropriate methods. Treatment decisions must be made by individual healthcare providers within the context of specific situations and in accordance with the laws of the jurisdiction in which the care is provided.
© 2005, Emergency Medicine Patient Safety Foundation.
All rights reserved. Printed in the USA.
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