Legal Considerations for the MCAINVESTIGATIONS AND COMPLAINT RESOLUTION

The views and comments in this presentation are the opinions of the presenters only. They should not be considered as official opinions of the Attorney General and do not necessarily reflect the views of the Attorney

General.

Also, none of the views and comments in this presentation should be considered legal advice.

What to do?

You receive a complaint that a paramedic is diverting drugs. What next?

The PSRO investigates the complaint and concludes that the paramedic’s medical control should be suspended in the MCA. Now what?

The Important Role of the MCA

Front line of defense 60 medical control authorities Nearly 30,00 EMS licensees

Department designates MCAs to supervise and coordinate emergency medical services Establish protocols for EMS providers Enforce protocols

Required Protocols Protocols defining the process, actions, and sanctions a

medical control authority may use in holding a life support agency or personnel accountable. (MCL 333.20919(1)(d))

Protocols to ensure that if the medical control authority determines that an immediate threat to the public health, safety, or welfare exists, appropriate action to remove medical control can immediately be taken until the medical control authority has had the opportunity to review the matter at a medical control authority hearing. The protocols must require that the hearing is held within 3 business days after the medical control authority’s determination. (MCL 333.20919(1)(e))

Required Protocols Protocols to ensure that if medical control has been removed

from a participant in an emergency medical services system, the participant does not provide prehospital care until medical control is reinstated, and that the medical control authority that removed the medical control notifies the department within 1 business day of the removal. (MCL 333.20919(1)(f))

Protocols to ensure that a quality improvement program is in place within a medical control authority and provides data protection as provided in 1967 PA 270, MCL 331.531 to 331.534. (MCL 333.20919(1)(g))

Protocols to ensure that an appropriate appeals process is in place. (MCL 333.20919(1)(h))

Protocols are Important MCAs have authority to exercise discipline for “noncompliance

with protocols” “suspension, limitation, or removal of medical control for the life support

agency or its personnel to provide emergency medical services”

Disregarding protocols could expose PSRO records MCA ≠ PSRO necessarily

Department may revoke or suspend an MCA designation Fails to perform in accordance with its approved protocols Has failed to develop protocols required by the Code to protect public

health

What is a PSRO? Entity to review:

Necessity, appropriateness, or quality of health care rendered; OR Qualifications, competence, or performance of a healthcare provider

The review entity is made of: A health facility or agency licensed under article 17 of the public health

code A health care network, a health care organization, or a health care

delivery system . . . composed of health facilities licensed under article 17 of the public health code

An organization . . . that collects and verifies the authenticity of documents and other data concerning the qualifications, competence, or performance of licensed health care professionals

PSRO Records Generally

General Rule: PSRO records are confidential, not public records, and not discoverable

PSRO may release PSRO reports, findings, and conclusions in certain circumstances

The identity of a person whose condition or treatment has been reviewed is confidential and shall be removed

Releasing PSRO Records

Records, reports, findings, and conclusions of the PSRO may be released for the following reason: To advance health care research or health care education To maintain the standards of the health care profession To provide evidence relating to the ethics or discipline of a

health care provider, entity, or practitioner.

Remove identity of person receiving treatment

Release may cause the records to be discoverable

Liability of MCA (and Members)? No liability for implementing and enforcing the MCA’s

department-approved protocols Medical director, members of the board, advisory body, or

committees, and employees of MCA Exception: Gross negligence or willful misconduct

No liability for releasing reports, findings or conclusions of PSRO Exception: Acting with malice

Acting with knowledge of the falsity, or with reckless disregard of the truth or falsity, of information. Feyz v Mercy Mem Hosp, 475 Mich 663 (2006).

Questions?

Carl J. Hammaker, IIIAssistant Attorney GeneralCorporate Oversight Division(517) 373-1160HammakerC@Michigan.gov

Mark A. GabrielseAssistant Attorney GeneralCorporate Oversight Division(517) 373-1160GabrielseM@Michigan.gov