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Treatment for breast cancer
Health & Safety Code §109275(a)-(c)
requires physicians and surgeons who treat patients for any form of breast cancer to inform patients in writing of the alternative "efficacious methods" of treatment that may be medically indicated including, surgical, radiological, or chemotherapeutic treatments, or combinations thereof. Failure to advise patients of available treatments by means of a standardized summary, written in lay terms and developed by the Department of Health Services, constitutes unprofessional conduct.
Failure to advise patients of available treatments may also result in a fine not to exceed $10,000, and/or imprisonment in a county jail for a period of no more than one year.
[Health & Safety Code §109370]
Physicians may obtain the Department of Health Services written summary/brochure entitled, "A Woman's Guide to Breast Cancer Diagnosis and Treatment," by contacting the Medical Board of California's Program Support Unit at 916/ 263-2389. Prior to performing a biopsy, the physician or surgeon must note in the medical record that he/she has given the patient the Department of Health Services' brochure.
[Health & Safety Code §109275(d)]
"Every person or entity who owns or operates a health facility or a clinic, or who is licensed as a physician or surgeon and rents or owns the premises where his or her practice is located, shall cause a
sign or notice to be posted where a physician and surgeon performs breast cancer screening or biopsy as an outpatient service, or in a reasonably proximate area to where breast cancer screening or biopsy is performed. A sign or notice posted at the patient registration area...shall constitute compliance..."
[Health & Safety Code §109277(a)]
The sign must be at least 8 ½ x 11 inches in size and posted in a conspicuous place. The words "BE INFORMED" must be no less than one-half inch in height and centered on a single line without any other text. The rest of the notice shall read,
"If you are a patient being treated for any form of breast cancer, or prior to performance of a biopsy for breast cancer, your physician and surgeon is required to provide you with a written summary of alternative efficacious methods of treatment, pursuant to Section 109275 of the California Health and Safety Code. The information about methods of treatment was developed by the State Department of Health Services to inform patients of the advantages, disadvantages, risks and descriptions of procedures."
The message must be displayed in English, Spanish, and Chinese. [Health & Safety Code §109277(b)-(c)]
Diagnosis of gynecological cancer
In accordance with Health & Safety Code §109278, medical care providers who are "primarily responsible for providing" annual gynecological examinations must give patients, as part of the examination, a standardized summary about gynecological cancers. The written summary must be in layperson's language and describe the "symptoms and appropriate methods of diagnoses for gynecological cancers." Publications developed by nationally recognized cancer organizations can be distributed.
California's Department of Health Services (DHS) developed a pamphlet in English and Spanish entitled, "Gynecologic Cancers: What Women Need to Know." Physicians can download the brochure from DHS's website at
www.dhs.ca.gov/director/owh or request copies of the pamphlet from the Medical Board of California (MBC). Fax your request for the "Gynecologic Cancers" pamphlet to the MBC at 916/ 263-2479.
Diagnosis of prostate cancer
Business and Professions Code §2248
requires a physician or surgeon who has examined a patient's prostate gland to inform the patient of the availability of appropriate diagnostic procedures, including, but not limited to the prostate-specific antigen (PSA) test. For this requirement to apply, any of the following criteria must be met: (1) The patient is over 50 years of age; (2) The patient manifests clinical symptomatology; (3) The patient is at increased risk of prostate cancer; or (4) It is the physician or surgeon's opinion that provision of the information is medically necessary. Failure to inform applicable patients is unprofessional conduct.
Prostate cancer treatment
"A standardized written summary in layman's language and in a language understood by patients shall be developed by the department [DHS] on the recommendation of the Cancer Advisory Council and printed and made available by the Medical Board of California to physicians and surgeons, concerning the advantages, disadvantages, risks, and descriptions, of procedures with regard to medically viable and efficacious alternative methods of treatment of prostate cancer."
[Health & Safety Code §109280] To date, the DHS has not produced a pamphlet about prostate cancer.
The law does not require physicians and surgeons to provide a written summary, but they are encouraged to make a summary available to patients when appropriate. The National Institute of Health and the National Cancer Institute have developed a helpful brochure entitled, "What You Need to Know About Prostate Cancer." For information, physicians can call the National Cancer Institute at 800/ 4CANCER or visit the Cancer Institute's websites at
www.nci.nih.gov and http://cancernet.nci.nih.gov/health.htm.
Health & Safety Code §109282(a) mandates that every person or entity who owns or operates a health facility or a clinic, or who is licensed as a physician or surgeon and rents or owns the premises where his or her practice is located, shall cause a
sign or notice to be posted where a physician and surgeon performs prostate cancer screening or provides treatment, or in a reasonably proximate area to where prostate cancer screening or treatment is performed. A sign or notice posted at the patient registration area constitutes compliance.
The sign must be at least 8 ½ x 11 inches in size and posted in a noticeable place. The words "BE INFORMED" must be no less than one-half inch in height and centered on a single line without any other text. The rest of the notice shall read,
"If you are a patient being treated for any form of prostate cancer, or prior to performance of a biopsy for prostate cancer, your physician and surgeon is urged to provide you with a written summary of alternative efficacious methods of treatment, pursuant to Section 109280 of the California Health and Safety Code. The information about methods of treatment was developed by the State Department of Health Services to inform patients of the advantages, disadvantages, risks and descriptions of procedures."
The message must be displayed in English, Spanish, and Chinese.
[Health & Safety Code §109280(b)-(c)]
MIEC recommendations
MIEC's Loss Prevention specialists have found that patient education is an effective deterrent to litigation. Many malpractice claims can be traced to patient error which is attributed to a lack of information. In some cases, the information the patient does not have is about the nature and extent of an illness or disease. In other cases, the patient may be uninformed about treatment options, their risks and efficacy; the proper use of medications; the limitations on activities and diet; or the purpose and need for
follow-up treatment.
Oral instruction may not suffice: Most physicians do speak with their patients and try to explain the nature of various types of cancer, but oral communication is simply not enough in many instances. The subject matter may be too complex for the patient to remember. Some patients listen, but do not hear what the doctor says because they are frightened, concerned, or for other reasons are unable to absorb all of the information the doctor is giving orally.
Some patients may not understand a technical discussion about treatment options, or may be unable to remember what the doctor said, and would benefit from having written material they can read and review as often as they wish. Providing written material for patients also serves to educate their spouses, or adult children who may be 'advising' their parents about their medical care. For these reasons, MIEC recommends that physicians rely more on printed educational material to supplement, but
not replace, their oral discussions.
Document educational efforts: Whether a patient is given educational materials required by law, or helpful materials written by the physician, whenever educational materials are dispensed, a note should be made in the patient's chart. If a simple numbering system is used (e.g., "PI #5" for Patient Information sheet #5), only the code need be documented to indicate that: (a) the patient received the item; (b) the patient was told to read the sheet or pamphlet; (c) the patient was told to ask questions if he or she did not understand the material. Similarly, the doctor should document oral discussions aimed at educating the patient about the scope and limitation of their illness, treatments, options, and directions for the use of prescribed medications.
To reach MIEC
Ask for the CLAIMS DEPARTMENT . . .
- If you have received a legal document, such as a request for records, a notice of intent to sue, a letter from a patient threatening to sue, a subpoena, an attorney's request for a meeting or a report, a deposition notice, a summons and complaint, a notice from an agency such as the state medical board of examiners, a request for pre-litigation screening, or a demand for arbitration of a claim;
- If you want to know the status of a claim;
- If you want to report a claim, a potential or threatened claim, a patient-specific incident, or an untoward result; or,
- If you have a patient-specific question.
Ask for the LOSS PREVENTION DEPARTMENT. . .
If you want to speak with someone about:
- how to close your practice;
- how long to keep medical records;
- informed consent or informed refusal;
- medical chart documentation;
- patient education and patient education materials;
- forms and brochures for medical offices; and
- surveys and seminars.
Ask for the UNDERWRITING DEPARTMENT. . .
If you want someone to answer these, or similar, questions:
- Am I covered for ... (doing a surgery, prescribing an off-label drug, participating in an experimental protocol, etc.)?
- I'm retiring; should I get tail coverage?
- I just hired a nurse practitioner; is she covered under my policy?
- If I serve on my hospital's Board of Directors, will my malpractice insurance cover me if I'm sued as a member of that group?
Ask for the ACCOUNTING DEPARTMENT. . .
- If you want to know:
- if your premium statement has been sent to you;
- how much you owe for your premium; or
- if we have received your premium payment.
We hope this helps you understand how MIEC's various departments can help you. If your question does not fit easily into the categories listed above, we will do our best to find the department and the person who is most likely to be able to help you. We appreciate your patience.
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