Delayed Breast Cancer Diagnosis after Insufficient Follow-Up
This case study was made available to MIEC through our partnership with CRICO. It was written by Kristin O’Reilly, RN, BSN, MPH, CRICO Description A 38-year-old patient had a delayed diagnosis of breast cancer resulting in an increased tumor size and advanced staging at the time of diagnosis progressing from Stage 1 to Stage 2. Key Lesson Adhering to national standards and internal policies and procedures is imperative to ensuring the timely diagnosis of cancer. Clinical Sequence A 38-year-old presented to her primary care provider (PCP) with concern for a palpable breast lump. The PCP noted the presence of the...
On June 27, following oral arguments in April, the U.S. Supreme Court dismissed the case United States v. Idaho and remanded the case back to the U.S. Court of Appeals. Importantly, the decision also reinstated the prior injunction against Idaho’s prohibition of abortion under the Emergency Medicine and Active Labor Act (EMTALA), meaning that hospitals can once again perform abortion as part of medically necessary stabilizing care for patients presenting with emergent complications of pregnancy. Since the Dobbs decision overturned federal protections on abortion, Idaho is currently one of 14 states with the most restrictive laws prohibiting abortion, except in...
Update on Controlled Substances and Telehealth Prescribing
On June 14th the U.S. Drug Enforcement Agency (DEA) submitted their long-awaited final rule for telehealth prescribing of controlled substances to the White House Office of Management and Budget (OMB) for a final rule before publication. The rules are expected to be published sometime prior to December 2024. As previously reported, in May 2023 the DEA had temporarily extended the COVID-19 telemedicine flexibilities for prescribing controlled substances. By way of background, The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requires prescribers to conduct an in-person examination to evaluate each new patient at least once before prescribing a controlled substance. After...
The Hawaii Legislature and Governor Josh Green, MD, have enacted significant legislation impacting Hawaii physicians. For a broad report on healthcare legislation enacted, see the Hawaii Medical Association 2024 Legislative Report. Provider Orders for Life Sustaining Treatment (POLST) Effective immediately, this measure (SB 2529) amends the definition of “patient’s provider” initiating POLST orders by removing language that requires the provider to “examine” the patient. Entities testifying in support of the amended law noted that this “examination” requirement often resulted in delays in completing and/or updating a patient’s POLST, particularly for patients in hospice care. The amended law recognizes that “POLST...
Three new laws impacting the practice of medicine were recently passed by the Alaska State legislature. Importantly, these laws are expected to be signed by the Governor but are not yet effective at the time of writing this post. Senate Bill 91: Telehealth and Multidisciplinary Care Teams. This new law expands HB 265 that was passed in 2022. The changes now allow out-of-state physicians and multidisciplinary care team members to provide telehealth services when an Alaskan needs to receive ongoing treatment or follow-up care for a suspected or diagnosed life-threatening condition. Senate Bill 45: Direct Healthcare Agreements. This new...