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May 14 15

Answers to Nursing Quiz:

by Suzanne Daniluk, RN

1.  The minimum requirement to become a registered nurse in the U.S. is:
A. Certification
B. Bachelor’s degree
C. Associate’s degree
D. Master’s degree

Answer: C – An associate’s degree in nursing (ADN) is currently the minimum required RN education, although it may change to a bachelor’s degree in the future.

 

2. The percentage of male nurses in the U.S. is:
A. 2%
B. 4%
C. 10%
D. 15%

Answer: C – About 10% of nurses in the U.S. are male. However, their numbers are higher in speciality areas. For example, about 40% of nurse-anesthetists are male.
 

3.  More nurses go on to medical school than to graduate-level nursing programs. True or false?

Answer: False – About 100 times more nurses continue on to graduate-level nursing programs than to medical school.

 
4.  Nurses are responsible for coordinating care of which of the following providers:
A. Social workers
B. X-ray technicians
C. Physical therapists
D. All of the above
E. None of the above

Answer: D – All of the above.

 

5.  Wal-Mart employees have a higher turnover rate than nurses. True or false?
Answer: True – The turnover rate for nurses is about 16%, with a 44% turnover rate for Wal-Mart employees, which is typical in retail.

 

6.  Which of the following is outside the scope of nursing practice?
A. Drawing blood for lab work
B. Emergency department triage
C. Ordering x-rays
D. Physical assessment
E. Removing sutures

Answer: C – Ordering x-rays, except for advanced-practice nurses; otherwise, all are nursing duties. Removing sutures can be done with a physician’s order.

 
7. Nurses, not doctors, supervise nurses. True or false?

Answer: True – Only nurses are the boss of other nurses.

 
Bonus question – You know you’re a nurse if:
A. You wash your hands before using the restroom.
B. You tuck in your sheet corners like they do in the hospital.
C. You check out other customers’ veins in grocery store lines.
D. You can only tell time with a 24-hour clock.
E. Discussing bodily fluids over a gourmet meal seems perfectly normal to you.
F. Any and/or all of the above.

Answer: F – Happy Nurses’ Week!

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May 11 15

Celebrating Nurses’ Week: Nursing Specialties!

by Suzanne Daniluk, RN

The list of specialties in nursing is long, with a plethora of opportunities familiar to most, such as:  surgical nurse, school nurse, forensic nurse, etc.

But here are some specialty areas you may not have considered – until now!

 

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May 8 15

Bridging the Health Data Privacy and Security Gap

by Suchi Pahi, JD

On April 30, 2015, Senator Patrick Leahy (Vt.) a longstanding Senator Leahysupporter of consumer privacy and data protection, introduced the Consumer Privacy Protection Act of 2015 (CPPA) to protect personal data.[1] Though it does not provide a private cause of action, it does hold companies accountable for their handling of personal information and seeks to keep consumers informed.

 

But I thought health information was protected!

Not so fast- health information handled by Covered Entities (healthcare providers) and Business Associates (handling health information for healthcare providers) is protected under HIPAA. But HIPAA does not regulate data held by anyone else, such as data about sleep schedules, dietary intake, weight, height, or any other personally identifiable information.

If a non-HIPAA covered company experiences a data breach, the company does not have responsibilities about the health information or other personal data unless there is identity theft or financial harm to the consumers.

mobile-phone-426559_64010% of Americans have fitness trackers such as FitBit, and many more use apps to track sleeping, eating, workouts and chronic health conditions, among other pieces of personal information.[2] None of this data is protected despite being “health” information, simply because it is outside of the Covered Entity and Business Associate interactions. Over 90% of the respondents in a survey conducted by the California Institute of Technology wanted information about health and physical activity anonymized, consistent with the Pew Research Center’s report that 86% their respondents about online behavior were attempting to mask or remove their digital data.[3]

This means that to date, it is really difficult to know when your information is compromised and it is even more difficult for companies to be held responsible for lax data privacy and security standards.

What does the CPPA do?

Subtitle A of the CPPA requires covered entities handling Sensitive Personally Identifiable Information (SPII) of 10,000 individuals during any 12-month period to maintain a comprehensive Consumer Privacy and Data Security Program in which they:

  • Conduct risk assessments and implement risk management and control measures;
  • Train employees for consumer privacy and data security;
  • Conduct Vulnerability Testing;
  • Assess and modernize data security, and
  • Require any associates handling SPII on their behalf to do the same.

The CPPA adopts a broad definition of SPII that specifically includes “an individual’s first and last name or first initial and last name in combination with any information that relates to the individual’s past, present, or future physical or mental health or condition, or to the provision of healthcare to or diagnosis of the individual.”

This would cover mobile apps, fitness trackers, diet logs, and any of those that could potentially link a user account and health data.

Enforcement

The legislation does not introduce a new regulatory body, but leaves enforcement with the Attorney General of the United States, Federal Trade Commission, and state attorneys general. Civil penalties are limited to $16,500 times the number of individuals whose SPII is placed at risk, with a maximum of $5,000,000 unless the covered entity was willful and wanton or intentional in violating the CPPA.

xl-2015-ftc-1

Federal Trade Commission

Under this draft of the bill, the state attorneys general must provide notice to the Attorney General of the United States and the FTC. The Attorney General and FTC will have the right to stay the action until Federal actions are taken.

Importantly, preemption of state laws has been limited. The CPPA preempts all federal and state laws that are less stringent than the CPPA. As the slew of proposed legislation in late 2014 and early 2015 indicate, data privacy and security laws outside of the health and financial sectors are state by state hodgepodge of requirements. Some states have stringent data security laws, such as California, and others have none at all, such as Alabama.

Data Breach Notification

After a breach, Subtitle B requires a covered entity to notify any resident of the United States whose SPII has been or is reasonably believed to have been accessed or acquired:

  • Third parties are obligated to notify covered entities;
  • Only the covered entity must notify the residents affected;
  • Service providers are obligated to notify covered entities; and
  • A reasonable delay in notification is 30 days following the discovery of the breach unless the problem is exempted.

The CPPA builds in a Safe Harbor for reasonable determination that the SPII is for all intents and purposes unusable or unidentifiable using methodology accepted by experts in the information security field and there is not a reasonable likelihood the security breach has resulted in or will result in the misuse of data.

The covered entity also has to notify the FTC and the Credit Reporting Agencies if there are more than 5000 individuals’ information involved that can be used for financial fraud or identity theft and a Federal Government Entity (to be designated).

The penalties under the data breach notification requirements are limited in the same manner penalties in Subtitle A for lack compliance with the Consumer Privacy and Security Program requirements. Each lack of notice to an individual is a separate violation times $16,500.

Enforcement is retained again by the Attorney General of the United States, FTC, FCC and state attorneys general.

Where to next?

The CPPA has immense potential to protect health information that has been left floating by the various sector-based data privacy and security laws. Even if the CPPA does not make it through to become the law, the conversation on filling the gap for consumer data has started an especially important conversation for health data protection.

 

[1] The bill is cosponsored by Al Franken (Minn.), Elizabeth Warren (Mass.), Richard Blumenthal (Conn.), Ron Wyden (Ore.), and Edward Markey (Mass.)

[2] MyFitnessPal, Fitocracy, Argus, MapMyFitness, Noom Coach, Allergy FT to name a few.

[3] More recently, Truste’s U.S. Consumer Confidence Index showed that 92% of US Internet users worry about their online privacy. Global Research Business Network (GRBN) reported 45% of U.S. respondents were highly concerned about safety of their personal data- and 74% of the data considered personal included healthcare data.

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May 7 15

Quiz: Do You Know Nursing?

by Suzanne Daniluk, RN

Nurses WeekNurses are 2.7 million strong in the U.S., compared to 1.2 million workers at Wal-Mart – the largest employer in Texas and 19 other states. Nurses outnumber doctors by 4 to 1. Our ranks will have increased by over a half million in 2022. During the celebration of National Nurses’ Week, test your knowledge of nursing (and thank a nurse prn).

1.  The minimum requirement to become a registered nurse in the U.S. is:
A. Certification
B. Bachelor’s degree
C. Associate’s degree
D. Master’s degree

2. The percentage of male nurses in the U.S. is:
A. 2%
B. 4%
C. 10%
D. 15%

3.  More nurses go on to medical school than to graduate-level nursing programs. True or false?

4.  Nurses are responsible for coordinating care of which of the following providers:
A. Social workers
B. X-ray technicians
C. Physical therapists
D. All of the above
E. None of the above

5.  Wal-Mart employees have a higher turnover rate than nurses. True or false?

6.  Which of the following is outside the scope of nursing practice?
A. Drawing blood for lab work
B. Emergency department triage
C. Ordering x-rays
D. Physical assessment
E. Removing sutures

7. Nurses, not doctors, supervise nurses. True or false?

Bonus question – You know you’re a nurse if:
A. You wash your hands before using the restroom.
B. You tuck in your sheet corners like they do in the hospital.
C. You check out other customers’ veins in grocery store lines.
D. You can only tell time with a 24-hour clock.
E. Discussing bodily fluids over a gourmet meal seems perfectly normal to you.
F. Any and/or all of the above.

Check back next week for answers.

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May 1 15

Case Update: Slip & Falls are not Chapter 74 Health Care Liability Claims in Texas

by E. Dale Burrus, JD, LLM

On May 1, 2015, the Texas Supreme Court addressed the much debated issue of how far Chapter 74 reaches. In Ross v. St. Luke’s Episcopal Hospital the Court held that a hospital visitor’s slip-and-fall claim is not a Chapter 74 health care liability claim (HCLC).

Lezla Ross, a visitor to St. Luke’s Episcopal Hospital, sued the hospital on a premises liability theory after she slipped and fell near the lobby exit doors. The trial court and court of appeals concluded Ross’s claim was an HCLC subject to Chapter 74’s expert report requirement. The Court disagreed holding Ross did not assert an HCLC because the record did not demonstrate a relationship between the safety standards Ross alleged the hospital breached—standards for maintaining the floor inside the lobby exit doors—and the provision of health care, other than the location of the occurrence and the hospital’s status as a health care provider.

Relying on the Court’s decision in Texas West Oaks v. Williams the hospital asserted Ross’s claim was an HCLC and moved for dismissal because she failed to serve a Chapter 74 expert report. The trial court agreed and dismissed Ross’s slip-and-fall claim. On appeal, the Fourteenth Court of Appeals concluded that under Williams it is not necessary for any connection to exist between health care and the safety standard on which a claim is based in order for the claim to come within Chapter 74.

The pivotal issue in a safety standards-based liability claim is whether the standards on which the claim is based implicate the defendant’s duties as a health care provider, including its duties to provide for patient safety. To determine whether Ross’s safety standards-based claim was an HCLC, the Court conducted a seven-prong analysis:

  1.  Did the alleged negligence of the defendant occur in the course of the defendant’s performing tasks with the purpose of protecting patients from harm;
  2. Did the injuries occur in a place where patients might be during the time they were receiving care, so that the obligation of the provider to protect persons who require special, medical care was implicated;
  3. At the time of the injury was the claimant in the process of seeking or receiving health care;
  4. At the time of the injury was the claimant providing or assisting in providing health care;
  5. Is the alleged negligence based on safety standards arising from professional duties owed by the health care provider;
  6. If an instrumentality was involved in the defendant’s alleged negligence, was it a type used in providing health care; or
  7. Did the alleged negligence occur in the course of the defendant’s taking action or failing to take action necessary to comply with safety-related requirements set for health care providers by governmental or accrediting agencies?

The Court’s answer to all seven questions was “no.” The record did not show that the cleaning and buffing of the floor near the exit doors was for the purpose of protecting patients. Nor did the record reflect that the area where Ross fell was one where patients might be during their treatment so that the hospital’s obligation to protect patients was implicated by the condition of the floor at that location. Ross was not seeking or receiving health care, nor was she a health care provider or assisting in providing health care at the time she fell. There was no evidence the negligence alleged by Ross was based on safety standards arising from professional duties owed by the hospital as a health care provider. There was also no evidence that the equipment or materials used to clean and buff the floor were particularly suited to providing for the safety of patients, nor did the record demonstrate that the cleaning and buffing of the floor near the exit doors was to comply with a safety-related requirement set for health care providers by a governmental or accrediting authority.

 The Court decided Ross’s claim was based on safety standards that had no substantive relationship to the hospital’s providing of health care so it was not an HCLC. Because her claim was not an HCLC she was not required to serve an expert report to avoid dismissal of her suit. The Court reversed and remanded.

Over the past few years, the scope of claims falling within Chapter 74 has significantly broadened. The Ross decision demonstrates the Court is clarifying the types of claims that are and are not HCLCs.

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Apr 30 15

Case Update: Slip & Falls as Chapter 74 Healthcare Liability Claims in Texas

by Marsha Bradley, JD, LLM

If a hospital visitor slips and falls, is it a Chapter 74 health care liability claim? The Texas Supreme Court is currently considering this question. On November 15, 2014, the Court heard oral argument in Ross v. St. Luke’s Episcopal Hospital. Additionally, the court requested briefing on the merits in another five slip-and-fall cases: Doctor’s Hospital v. Mejia, CHRISTUS St. Elizabeth Hospital v. Guillory, Northeast Methodist Hospital v. Dewey, Reddic v. East Texas Medical Center, and Galvan v. Memorial Hermann Hospital. The court also requested briefing in Baylor University Medical Center v. Lawton, a case considering whether a hospital employee’s toxic inhalation injury claim is a health care liability claim.

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Apr 1 15

Health Care Management

by Kroger Burrus

On March 14, 2015, Partners Edward Kroger and Dale Burrus graduated from Rice University’s Graduate Certificate Program in Health Care Management. The five month program is offered through Rice University’s Jesse H. Jones Graduate School of Business, and addresses topics such as Strategy Formulation, Competitive Analysis, Strategic Marketing, Patient Management, Health Care Process Mapping and Quality Improvement.

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Mar 30 15

Understanding Legal Issues in Geriatric Ophthalmology

by Kroger Burrus

On February 14, 2015, Managing Partner Edward J. Kroger spoke about Medicolegal Issues in Geriatric Ophthalmology at the 4th Annual Symposium on Enhancing Geriatric Understanding and Education (SEGUE) at the Houston Methodist Research Institute.

For four years in a row SEGUE has provided quality education for non-geriatricians regarding geriatric care. The aim of the symposium is to prepare healthcare providers for aging patient populations. Physicians and nurses receive professional education credits from attending the symposium and participating in various activities.

Dr. Kroger covered a variety of legal issues in geriatric ophthalmology and emphasized best practices for healthcare providers.

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Mar 18 15

Medicine and the Movies

by Suzanne Daniluk, RN

Recently, we wrote about a USC-affiliated program that gives out free, factual medical information to Hollywood scriptwriters. Still, there appears to be some who may have failed to consult the experts. Test your knowledge of medical facts and fiction in the movies.

Fact or fiction?
1. In the classic James Bond film Goldfinger, a character dies from “skin suffocation” after being completely covered in gold paint. Mr. Bond explains in the film that if a square at the spine have been left unpainted, the character would have lived. Pulp Fiction

2. In a memorable scene from Pulp Fiction, Vincent Vega (played by John Travolta) rescues Mrs. Wallace (Uma Thurman) from an impending drug overdose with an injection of adrenalin directly into her heart – a standard procedure in emergency rooms.

3. Electroconvulsive therapy (ECT), or “shock treatment”, as depicted in One Flew Over the Cuckoo’s Nest, is a procedure still used today.

4. In the movie The Firm, starring Tom Cruise, the Gene Hackman character states he can’t fly within 24 hours of scuba diving during a trip to the Cayman Islands. A medical basis for this statement exists; it wasn’t just made up by the screenwriters as a plot device.

5. In the Godfather, a nurse caring for the Don, who is recovering from an assassination attempt, helps Michael Corleone wheel the Don’s bed into another hospital room for security reasons. This is something that a nurse would readily do when requested.

Check back next week for answers.

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Mar 17 15

Junior Partner Lauren M. Nelson Named as a 2015 Texas Rising Star

by Kroger Burrus

Lauren M. Nelson 216x216Kroger | Burrus is pleased to announce that Lauren M. Nelson, JD has been selected as a 2015 Texas Rising Star. Ms. Nelson was previously selected in 2012, 2013 and 2014. Lawyers who are 40 years old or younger are eligible for peer nomination. The selection process includes a review of credentials and experience. Ultimately, less than 2.5% of the state’s younger lawyers are recognized for this award.

Ms. Nelson is a graduate of Baylor University and South Texas College of Law. She is currently pursuing her MBA at Baylor University. She practices in the areas of medical malpractice defense and health law, representing health care providers across Texas.

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Dec 17 14

Hollywood Calling Medical Experts!

by Suzanne Daniluk, RN
James Bond could have learned that painting someone gold is not really fatal.

James Bond could have learned that painting someone gold is not really fatal.

Did you ever wonder where TV shows get their medical information? One source is Beverly Hills-based Hollywood, Health, and Society, an affiliate of the University of Southern California. Funded in part by the Centers for Disease Control and Prevention, and free of charge to callers, the program serves as a reference center for TV producers and writers who wish to provide shows with medically-accurate storylines.

The company’s staff consults with medical experts around the country to obtain the right information. Some experts will even go where the writers are, taking them on field trips such as to the county morgue, to enhance the reality of their scripts. While drama may be a priority, putting out accurate medical storylines can be a public health service without anyone ever knowing it, said Hollywood, Health, and Society board member/ED physician and producer of Grey’s Anatomy, Dr. Zoanne Clack.

Now if they would only call us – we’d let them know nurses do a lot more than pass pills, shuffle papers, and gossip at the nurses’ station, as Hollywood often portrays!

To read more:
http://hollywoodhealthandsociety.org/
http://www.medscape.com/viewarticle/831934
http://www.truthaboutnursing.org
(advocating accurate images of nursing in the media)

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Oct 28 14

Edward J. Kroger and E. Dale Burrus Selected as 2014 Texas Super Lawyers

by Kroger Burrus

Edward J. Kroger, MD, JD and E. Dale Burrus, JD, LLM have been selected by their peers as 2014 Texas Super Lawyers. Dr. Kroger and Ms. Burrus practice in the areas of health law and medical malpractice defense. Their clients include health care facilities and medical professionals across Texas.

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Aug 15 14

Medical Quiz: Disease Names – Answers

by Suzanne Daniluk, RN

Match diseases with names:

  1. Amyotrophic Lateral Sclerosis
A.   Mary Mallon
  1. Neurofibromatosis
B.   Fredrick Daniel von Recklinghausen
  1. Salmonella typhi
C.  Lou Gehrig
  1. Leprosy
D.   Hans C. J. Reiter
  1. Chronic lymphocytic thyroiditis
E.   Hakaru Hashimoto
  1. Reactive arthritis
F.   Gerhard Hansen

ANSWERS:

  1. Amyotrophic Lateral Sclerosis – (C) The neurodegenerative disease is also named after baseball hall of famer Lou Gehrig (1903-1941).
  2. Neurofibromatosis – (B) Von Recklinghausen disease or neurofibromatosis, a nerve tumor disorder, is named for the pathologist who first described it in 1882. Englishman Joseph Merrick (1862-1890) was the famous “Elephant Man” thought to have had the disease.
  3. Salmonella typhi – (A) Mary Mallon, a/k/a “Typhoid Mary”, as called in the Journal of the American Medical Association in 1908, was the first known carrier of Salmonella typhi which causes Typhoid Fever. She worked as a cook, thereby spreading the disease to dozens until she was eventually apprehended and quarantined for the rest of her life on an island in New York City’s East River. Salmonella is named after a veterinary pathologist, Daniel Elmer Salmon, although a man named “Smith” actually discovered the bacteria. See the quarantine island today:
    http://curbed.com/archives/2014/05/08/come-tour-nycs-eerie-overgrown-north-brother-island.php
  4. Leprosy – (F) Leprosy is also known as Hansen’s disease, for the Norwegian physician who identified causative bacteria Mycobacterium leprae.

  5. Chronic lymphocytic thyroiditis – (E) Hashimoto’s thyroiditis, or chronic lymphocytic thyroiditis, is an autoimmune disorder of the thyroid gland and the most common cause of hypothyroidism in parts of the world without sufficient iodine levels. It was named after Japanese surgeon Hakaru Hashimoto (1881 – 1934).
  6. Reactive arthritis – (D) Another autoimmune disorder, reactive arthritis, was formerly known as Reiter’s Syndrome for German physician Hans C. J. Reiter, until his Nazi past was revealed.

 

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Aug 12 14

Compassionate Use and the Ebola Virus Epidemic

by Leah Greene, JD, LLM

ebola

On August 8, 2014, the World Health Organization declared the Ebola virus a Public Health Emergency of International Concern (PHIEC). Specific information regarding the signs and symptoms of, history and current status of the Ebola virus epidemic can be found here. The mortality rate ranges from 50 to 70%. There is no proven treatment or vaccine for the Ebola virus.

By now, most have heard of Dr. Kent Brantly and Nancy Writebol, missionaries who contracted the Ebola virus in Africa and are being treated at Emory University Hospital in Atlanta. Their condition is reportedly improving and has been attributed to ZMapp, an experimental drug that has been tested only on monkeys. Dr. Brantly and Mrs. Writebol were allowed access to the drug through the “compassionate use” program of the Food and Drug Administration (FDA). The FDA considers requests for access to experimental drugs to people outside clinical trials if a patient meets the following criteria: (1) the disease or condition is serious or immediately life-threatening; (2) no comparable or satisfactory therapeutic alternatives exist; (3) the drug manufacturer and the patient’s doctor make arrangements to obtain the drug for the patient; and (4) the FDA authorizes these arrangements.

A request for the exemption may not result in access to it. Drug companies may balk at providing an experimental drug out of concern for bad publicity if the recipient dies or develops life-threatening side effects. A physician may not agree to the use of the drug out of fear of liability or exposing the patient to significant health risks.

The FDA warns patients seeking access of the following: the treatment may not work; the drug may have unknown health risks; and obtaining approval from the FDA may take some time, as there is no deadline for the FDA to respond to these requests. If access is granted, the drug manufacturer may charge the patient for the drug, which is typically expensive, and not paid for by insurance. After the initial cost of the drug, there may be associated costs for monitoring the drug’s effect.

According to the Center for Disease Control, however, ZMapp’s manufacturer has a limited supply of the drug. In addition, it has not started Phase 1 (of 4) of the clinical trial to determine its safety and effectiveness. On August 9, Reuters reported that The Centers for Innovation in Advanced Development and Manufacturing, which were set up by the US Department of Health and Human Services to partner with private industry to respond to any major public health threat, expressed willingness to assist with making experimental drugs to treat Ebola. We will continue to monitor whether this organization is asked to manufacture any experimental drugs for the Ebola epidemic in Africa.

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Aug 11 14

Edward Kroger Named as a Top Houston Lawyer by H Texas Magazine

by Kroger Burrus

Congratulations to Managing Partner Edward J. Kroger, MD, JD for being selected by H Texas Magazine as one of Houston’s Top Lawyers in 2014.

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