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About Sarah Macdissi

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So far Sarah Macdissi has created 27 blog entries.

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13 Aug, 2015

August Reflections on the “July Effect”

2018-04-23T23:52:19-06:00August 13th, 2015|Midwest Medical Legal Advisor|

Now that we are safely in mid August, I feel comfortable addressing the so called “July effect” without causing a mass exodus of hospital patients from their hospital beds.  What is the July effect you ask?  It’s the alleged rise in medical mistakes that coincidentally (or not) coincides with the increase of new medical residents at teaching hospitals starting July 1. While there is some research that mortality rates increase [...]

15 Apr, 2014

Mandatory Vaccinations?

2018-04-23T23:52:19-06:00April 15th, 2014|Midwest Medical Legal Advisor|

Vaccinations or rather, the lack thereof - has been a hot topic in the news lately. The media is reporting increased outbreaks of communicable diseases with the finger pointed at those individuals who choose to not vaccinate out of a fear, amongst others, that vaccinations cause autism. Studies conducted in the scientific community have largely discredited any association between vaccinations and autism.  Most recently, a March 2013 study published in [...]

17 Feb, 2014

The Doctor’s White Coat Days Are Likely Numbered

2018-04-23T23:52:19-06:00February 17th, 2014|Health Care Law, Midwest Medical Legal Advisor, Risk Management|

What is thought to be one of the most common vehicles for spreading germs in a hospital?  The answer might surprise you: the white lab coat.  Also ranking high are neck ties and wrist watches worn by health care practitioners. The Society for Healthcare Epidemiology of America has released new guidelines  suggesting that the white lab coat be eliminated altogether or hung on an outside hook prior to entering a patient’s [...]

22 Jan, 2014

A Dose of Perspective on Doctor Tardiness

2018-04-23T23:52:19-06:00January 22nd, 2014|Midwest Medical Legal Advisor|

There is a blog being circulated right now that addresses frustrations over doctor tardiness.  The woman who writes the blog is married to a pediatric physician and wants everyone to remember the reason why a physician might be running late to a dinner /next appointment/ anniversary date night / sporting event.  There is always an appointment before our own.  She writes: “We may never know what struggles the child and [...]

20 Nov, 2013

How Was Your Day? Combating Physician Burnout

2018-04-23T23:52:19-06:00November 20th, 2013|Midwest Medical Legal Advisor|

My husband, a local hospitalist in town, came home from work a few nights ago very tired. During his 14 hour work day, he had seen and treated quite a few sick patients and I could tell several of the sickest were still on his mind.  Sensing he needed to unwind, I sat quietly on the couch with him for a few minutes – both of us deep in our [...]

1 Nov, 2013

Rocky Rollout for the Affordable Healthcare Act

2018-04-23T23:52:19-06:00November 1st, 2013|Health Care Law, Midwest Medical Legal Advisor|

Six people.  That's the number of people who registered with the new healthcare website on Day 1 of its unveiling.  Documents released yesterday by the House of Representatives showed this number modestly increased to 248 individuals successfully enrolled on Day 2 of the rollout. These numbers shine a light on the rocky introduction of President Obama's health care legislation to the American people.  Criticisms of the new healthcare law include the [...]

11 Oct, 2013

The 411 on the Government Shut Down and the Healthcare Industry

2018-04-23T23:52:19-06:00October 11th, 2013|Health Care Law, Midwest Medical Legal Advisor|

The obvious and immediate impacts of the government shut down are visible before everyone’s eyes – the closing of the national parks, federally owned museums, IRS call centers advising taxpayers and offices handling federal grants, and the furloughing of thousands of federal employees. What’s not so visible is the impact on America’s already vulnerable healthcare system.  No, I am not talking about the hot button topic of Obamacare here.  What [...]

1 Oct, 2013

Living in a Post Antibiotic Era? Part II

2018-04-23T23:52:19-06:00October 1st, 2013|Health Care Law, Midwest Medical Legal Advisor|

Diagram published by the CDC. Last week I discussed a report issued by the Centers for Diseases Control (“CDC”) that addressed the ever increasing prevalence of antibiotic resistance.  One author, commenting on the potential demise of antibiotics, went as far as to compare a modern post antibiotic era to the plight of our ancestors during the “Black Death.”  Piling on, the CDC declared antimicrobial resistance to be “one [...]

20 Sep, 2013

Living in a Post Antibiotic Era?

2018-04-23T23:52:19-06:00September 20th, 2013|Midwest Medical Legal Advisor|

This week, the Centers for Disease Control (“CDC”) issued a report that addressed, in detail, the threat of antibiotic-resistant organisms to our world.  Dr. Todd Friedman, the director of the CDC, cautioned that, “[i]f we are not careful, we will soon be in a post antibiotic era.”  Antibiotic-resistant organisms account for 2,049,442 illnesses and 23,000 deaths each year.  The estimated cost to society?  $20 billion in additional healthcare spending and $35 [...]

30 Aug, 2013

Physician Reimbursement for End of Life Discussions

2018-04-23T23:52:19-06:00August 30th, 2013|Midwest Medical Legal Advisor|

Representative Earl Blumenauer from Oregon has introduced into legislation the “Personalize Your Care Act of 2013” that would provide Medicare and Medicaid coverage for end of life discussions.  Mr. Blumenaur has been dubbed “the death panel guy” for his continued role in introducing bills that tackle end of life care.   In 2009, he wrote it was “perverse” that Medicare pays for most medical procedures but does not reimburse physicians “for having a [...]

20 Aug, 2013

HHS Releases $67 Million for Health Care Navigators

2018-04-23T23:52:19-06:00August 20th, 2013|Midwest Medical Legal Advisor|

This past Wednesday, the Department of Health and Human Services released $67 million dollars to fund health care "navigators," intended, as the name states, to navigate uninsureds and other individuals through the new health care law. In total, 105 organizations received grant funds to assist with coverage in states where the government is running exchange programs.  Navigators will receive 20 to 30 hours of training and are subject to prosecution [...]

9 Aug, 2013

Covenants Not to Compete and Physician Employment Agreements

2018-04-23T23:52:20-06:00August 9th, 2013|Midwest Medical Legal Advisor, Risk Management|

Covenants not to compete are common in physician employment agreements but are they enforceable?  The American Medical Association (AMA) has taken the position that physician non-compete agreements impact negatively on health care and are not in the public interest. Stopping short of completely prohibiting covenants not to compete, the AMA strongly discourages them.  In line with the AMA, Colorado, Massachusetts, and Delaware have passed laws invalidating contractual provisions restricting a [...]

19 Jul, 2013

Prescribing of Controlled Substances Under Nebraska Law

2018-04-23T23:52:20-06:00July 19th, 2013|Litigation Tips, Midwest Medical Legal Advisor, Risk Management|

Under Nebraska law, it is unprofessional conduct to prescribe controlled substances to oneself, a spouse, child, parent, sibling, or “any person living in the same household as the prescriber.”  The only exception to this prohibition is in times of medical emergency.  The phrase "medical emergency" is not defined under the statutes - although it would presumably entail situations in which a family member would not have sufficient time to seek treatment elsewhere. The way [...]

9 Jul, 2013

Should I Stay or Should I Go Now (to the E.R.)?

2018-04-23T23:52:20-06:00July 9th, 2013|Midwest Medical Legal Advisor|

America's healthcare system has been no stranger to controversy over the years.  A large piece of the current debate pertains to the cost of healthcare – with the finger often pointed at the rising expense of emergency medicine and unnecessary treatments.  One of the goals of the new healthcare overhaul is to lessen this burden with more access to primary care physicians.  Another proposed solution is to make patients front the [...]

28 Jun, 2013

Is this the end or just the beginning?

2018-04-23T23:52:20-06:00June 28th, 2013|Health Care Law, Midwest Medical Legal Advisor|

Today marks my husband’s last day of residency.  As he walks out of his last call shift, he says a bittersweet farewell to not only his on call pager (the sound of which will likely trigger a nervous twitch for many years to come) - but to an army of mentors and a group of colleagues bonded through three years of work with little sleep.  The topic of residency has [...]

18 Jun, 2013

Protecting Emergency Services Providers from Communicable Diseases

2018-04-23T23:52:20-06:00June 18th, 2013|Health Care Law, Midwest Medical Legal Advisor, Risk Management|

It’s a scene straight from a movie – someone is injured and you rush to render aid.  Of course, there’s blood – and with blood comes the potential exposure to communicable diseases.  So, what should you do if you do not know whether the person you have been assisting may have placed you at risk? The Nebraska statutes and regulations provide some protection to emergency services providers (including individuals rendering [...]

7 Jun, 2013

Doctors-in-Training Have Only 8 Minutes Per Patient

2018-04-23T23:52:20-06:00June 7th, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor|

How much time should a physician spend with their patient? In an ideal world, the answer would be as much time as needed.  Yet, according to a new study conducted by researchers from the John Hopkins University and the University of Maryland, gone are the days where new physicians had the time to truly get to know the individuals they treat.   This new study found that physicians-in-training spend about eight minutes per day [...]

28 May, 2013

Going Gently Into that Good Night: Physician Distrust on End of Life Care and a Few Musings from the Wife of a Resident Physician

2018-04-23T23:52:20-06:00May 28th, 2013|Midwest Medical Legal Advisor|

My husband - Tony (left) with his twin brother Adam. Both are internal medicine residents at the University Nebraska Medical Center. A backyard bar-b-q this Memorial Day weekend with two third year resident physicians - one being my husband and another my brother-in-law (twins who coincidentally (or by design?) have chosen the same career path - see inset picture) prompted a somewhat unique although not unusual conversation considering the company involved: [...]

17 May, 2013

Monetary Value of Malpractice Claims is Steadily Declining

2018-04-23T23:52:20-06:00May 17th, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor, Tort Reform|

Last week I discussed a new study published by the journal BMJ Quality and Safety that analyzed malpractice claims since 1986 and found errors in diagnosis to be the worst offender for malpractice claims.  This week, my discussion centers on a similar analysis performed by Diedrich Healthcare.  Analyzing data gathered by the National Practitioner Data Bank, Diedrich Healthcare found that out of the $3.6 billion paid out for malpractice lawsuits in [...]

7 May, 2013

Diagnostic Errors Account for the Most Malpractice Claims

2018-04-23T23:52:20-06:00May 7th, 2013|Midwest Medical Legal Advisor|

A new study published by the Journal BMJ Quality and Safety sought to characterize the frequency, health outcomes, and economic consequences of medical malpractice claims within the United States.  The study’s authors analyzed closed, paid malpractice claims from the National Practitioner Bank, with claims dating back to 1986.  In total, 350,706 paid claims were analyzed.  Errors in diagnosis accounted for the most medical malpractice claims with 28.6% of paid medical [...]

26 Apr, 2013

The Debate Over Work Hour Restrictions for Doctors in Training

2018-04-23T23:52:20-06:00April 26th, 2013|Health Care Law, Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

Time magazine recently published an article highlighting the controversy surrounding work hour restrictions placed upon doctors in training.  Work hour restrictions were initially enacted by the state of New York in 1987 in response to the death of an 18 year old female, caused by a medication prescribing error made by a resident in the middle of a 30 hour work shift.   As a result of the 18 year old’s death, [...]

16 Apr, 2013

Nebraska’s Good Samaritan Law and the Duty to Rescue

2018-04-23T23:52:20-06:00April 16th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor|

Does anyone remember the last episode from Seinfeld where Jerry, Elaine, George and Kramer end up in jail for failing to help an individual being held up at gunpoint? The arresting police officer cites the town’s “Good Samaritan” law as grounds for the arrest, which purports to impose upon citizens a duty to rescue. Unlike this fictionalized episode from Seinfeld, laws generally do not impose a duty to rescue.  In [...]

5 Apr, 2013

Understanding Physician Liability Under Nebraska’s So Called “Captain of the Ship” Doctrine

2018-04-23T23:52:20-06:00April 5th, 2013|Midwest Medical Legal Advisor|

With all of the recent cruise ship debacles, I was reminded of a doctrine often applied in malpractice cases informally referred to as the "Captain of the Ship" doctrine.  This doctrine suggests that a surgeon has the ultimate responsibility for the care of the patient, and has a non-delegable duty to ensure that proper care is given while in the operating room.  Simply put, the physician is the captain of the ship during the operation being performed [...]

26 Mar, 2013

Expanding Physician-Patient Confidentiality

2018-04-23T23:52:20-06:00March 26th, 2013|HIPAA, Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

On December 20, 2012, the Florida Supreme Court expanded the already far reaching scope of doctor-patient confidentiality.  In the case of Hasan v. Garvar, 2012 WL 6619334 (Fla.), a patient sued a dentist (referred to as Dentist #1 for purposes of this post) after the dentist failed to diagnose and treat a dental condition resulting in a bone infection. The patient subsequently sought treatment from a second dentist.  (Dentist #2).  Dentist [...]

8 Mar, 2013

Overtreatment and MRI’s

2018-04-23T23:52:20-06:00March 8th, 2013|Health Care Law, Midwest Medical Legal Advisor|

The Omaha World Herald published a thought provoking article on the topic of overtreatment and the use of MRI’s in last week’s paper, written by World Herald Columnist Matthew Hansen.  In it, Dr. Thomas Tape from the University Nebraska Medical Center discusses how the health system in this country pushes people into hospitals, rather than out, with unnecessary medical tests, including the overuse of MRI’s, becoming the norm.  According to [...]

5 Mar, 2013

A Few Do’s and Dont’s of Prescribing Medicine

2018-04-23T23:52:20-06:00March 5th, 2013|Health Care Law, Midwest Medical Legal Advisor, Risk Management|

This topic hits close to home.  I am married to a third year resident who is starting his career as a hospitalist in August.  Friends and family frequently ask my husband to write them a prescription for various ailments rather than visit their primary care physician.  His response? "Sorry, unless you come visit me in my clinic and we establish a physician - patient relationship, the Statutes and Regulations in [...]

22 Feb, 2013

The Failure to Pass Board Examinations as Evidence in a Medical Malpractice Trial

2018-04-23T23:52:20-06:00February 22nd, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor|

So, you didn't pass your medical boards?  Or you didn't pass your medical boards on your first try?  Worried how it might affect your career as a physician?  Well, you can rest easy when it comes to malpractice suits.  Generally, a defendant physician's failure to pass board certifications is not admissible as to whether a physician complied with the standard of care.  While performance on a board certifying examination might [...]