coordinated - Uniformed Services University of the Health Sciences

A Legal Primer
Marcy Auclair
BUMED Attorney Advisor for Health Care Law
October 23, 2013
Fundamental Principles
• Patient Safety
• Quality Assurance / Risk
• Compliance with requirements of
The Joint Commission
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Implementing Regulations
• DoD Level:
DOD Instruction 6025.13 (17 Feb 11)
Medical Quality Assurance (MQA) in the
Military Health System (MHS)
DOD 6025.13-R – MHS CQA Program
Regulation (being reissued as a Manual)
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Implementing Regulations
• Service Level:
• Navy
BUMEDINST 6320.66E, “Credentials Review
and Privileging Program”
BUMEDINST 6320.67A, Ch1, “Adverse
Privileging Actions, Peer Review Panel
Procedures, and Health Care Provider
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Implementing Regulations
• Air Force
AFI 44-119, “Medical Quality Operations”
• Army
AR 40-68, “Clinical Quality Management”
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• Credentials: Documents that constitute
evidence of appropriate education, licensure,
experience, and expertise of health care
• Clinical Privileges: Permission to provide
medical and other patient care services in the
granting institution, within defined limits, based
on an individual’s education, professional license,
experience, competence, ability, health, and
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• Adverse Privileging Action: Denying,
suspending, restricting, reducing, or revocation of
clinical privileges based upon misconduct,
impairment, or lack of professional competence.
• Adverse Practice Action: Restricting, reducing,
or revoking the clinical practice of a nonprivileged healthcare provider based upon
professional misconduct, impairment, or lack of
professional competence.
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Disciplinary Actions
• Misconduct:
Military: Violations of the Uniform Code of Military Justice
(UCMJ); allegations handled through Non-Judicial
Punishment, Courts-Martial, and/or Administrative Separation
Civilians: Allegations of lying, stealing, assault, etc. will be
investigated and actions coordinated with HRO (i.e.
suspensions, termination, etc.)
Contractors: Similar to civilians; allegations need to be
investigated and actions coordinated with contracting officer
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Disciplinary Actions
• If misconduct is not related to patient safety or the
delivery of a health care item or service, no further
professional action is required.
• If misconduct is related to patient safety or the
delivery of a health care item or service then
consideration must be given to initiating an adverse
privileging action (if privileged provider),notifying the
state licensing board (if not privileged provider), and
reporting to the National Practitioner Data Bank.
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Disciplinary Actions
• DoD requires the Surgeons General to report UCMJ
actions, adverse civilian personnel actions, and
contract terminations for default of any healthcare
provider, supplier or practitioner where the acts or
omissions were related to the delivery of a
healthcare item or service.
• Anyone involved in patient care can be reported to
the NPDB; it is not limited to licensed healthcare
practitioners (i.e. dental techs, corpsmen can be
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Disciplinary Actions
• Misconduct reports were formally made
to the Healthcare Integrity and
Protection Data Bank (HIPDB); however,
in May 2013, the HIPDB merged with the
National Practitioner Data Bank (NPDB).
The requirements to report provider
misconduct remain in effect.
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Final actions resulting in the denial, suspension,
restriction, reduction, or revocation of a provider’s
clinical privileges are reported to the National
Practitioner Data Bank, state(s) of licensure, Federation
of State Medical Boards, professional organizations, and
DoD Health Affairs.
Final actions resulting in the restriction, reduction, or
revocation of a non-privileged healthcare provider’s
clinical practice, are reported to state(s) of licensure,
professional organizations, and DoD Health Affairs.
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Reporting of adverse
professional/clinical information to
outside entities and licensing bodies is
performed by the Surgeons General
Headquarters staff; local reporting in
not authorized.
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Questions ???
• Contact Info:
Marcy Auclair
Phone: (703) 681-8972
DSN: 761-8972
Email: [email protected]
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