Chuck Shabino, MD has agreed to serve as WHA’s Medical Affairs Advisor effective immediately. Shabino, a recent WHA Chair, will handle an array of responsibilities including staffing the Wisconsin Council on Medical Education and Workforce, co-staffing the Council on Medical and Professional Affairs, and providing leadership support for the evolution of WHA’s clinical quality and patient safety initiatives.

"Chuck’s interest in working with WHA staff and members by advancing our physician workforce agenda and helping evolve current and future public reporting initiatives is terrific news," said WHA President Steve Brenton. "Chuck has a well deserved statewide reputation as a visionary physician leader, and his willingness to be part of our fine team sets the stage for WHA’s continued leadership role in both of these important endeavors."

Shabino had previously announced his intention to retire from his full-time responsibilities as president/CEO of Aspirus Health System in Wausau. The WHA engagement is part-time and reports to Brenton.

"I’m pleased to have the opportunity to continue working with friends, colleagues and talented WHA staff on issues that are important to me and to the patients we serve," Shabino noted. "Wisconsin is a recognized leader in promoting bold initiatives designed to measure and report quality and safety indicators. I’m eager to help shape the evolution of these programs and help our community hospitals and physician partners maintain that national leadership position."

On December 30, the Supreme Court of Wisconsin issued another disappointing opinion in a medical malpractice case. The issue before the Court was whether the statute of limitations barred the case of a developmentally disabled child against his health care providers filed more than 11 years after the alleged act of medical malpractice. The Court held that there is no statute of limitations for claims against health care providers alleging injury to a developmentally disabled child.

The plaintiffs (the child and his parents) allege that the child’s developmental disability is the result of the child being denied oxygen just before and after his birth. After the plaintiffs filed their action, the defendants moved for summary judgment arguing that the plaintiffs’ action was barred by the applicable statute of limitations. The Court of Appeals concluded that the statute of limitations that applies to minor children in medical malpractice actions does not apply to developmentally disabled children, but that the general statute of limitations does apply, thus barring the plaintiffs’ action.

The Supreme Court agreed with the Court of Appeals that, based on the language of the statute, the statute applicable to minor’s medical malpractice actions does not apply, but found that the general statute of limitations also does not apply. The Court determined that the Legislature has not provided a statute of limitations for claims against health care providers alleging injury to a developmentally disabled child, writing that the Court "cannot act in their stead."

Without a statute of limitation, one would expect to see an increase in the number of medical malpractice cases filed, increasing the cost of the medical liability system. This decision, with the loss of the cap on non-economic damages, is creating an unfavorable medical liability environment that is making it difficult to recruit health care providers to Wisconsin, reducing access to health care.

"The Court notes that a plaintiff’s claim can still be time barred if there is unreasonable delay," observed WHA General Counsel Laura Leitch. "The decision, however, adds uncertainty to the system and uncertainty destabilizes the system and increases costs. We are disappointed."

As in Ferdon in which the Court found the cap on non-economic damages in medical malpractice actions unconstitutional, the Court was split 4-3 in this case with Justices Bradley, Abrahamson, Butler, and Crooks in the majority.

In his dissenting opinion, Justice Prosser wrote, "This case exposes an obvious legislative mistake, which renders the legislature’s blueprint for certain litigants ambiguous. Under the circumstances, this court is required to devise a response that will carry forward the legislative intent." Justice Prosser concluded, "[The majority opinion] is not judicial restraint because it disregards completely the purpose of the statute of limitation in medical malpractice actions. Excising unconstitutional language from an obviously defective statute is the common sense solution and is no more problematic than removing a ruptured appendix from an otherwise healthy body."

"We are obviously very disappointed with the Court’s decision, the latest in a string of decisions over the past six months have turned Wisconsin’s once envied health care liability system on its head," said WHA’s Eric Borgerding. "We are working to address this situation, but make no mistake — whether Wisconsin is able to restore that once envied environment is a decision that is in no one’s hands but the Legislature’s and Governor Doyle’s. They need to come together and enact a meaningful cap before the current session ends. We can continue speculating about what may or may not be constitutional until the last neurosurgeon leaves the state, but that is a moot discussion until there is a new cap, signed into law, for the Court to consider."

The case is Haferman v. St. Clare Healthcare Foundation, which can be viewed on WHA’s website.

Mary Starmann-Harrison, president/CEO of SSM Health Care of Wisconsin, assumed her role as 2006 WHA Chair on January 1. Starmann-Harrison has served in many leadership positions at WHA. She has been a member of the Board of Directors since 2000, chaired the Public Policy Council from 2001-2004 and is still a member of that Council, served on the Property Committee in 2003-2004, was a member of the Political Action Committee in 2001, joined the Executive Committee in 2003, and served on the Nominating and Awards Committee in 2002. She is also a member of the American Hospital Association Regional Policy Board 5.

Starmann-Harrison joined SSM in September 1998 and has worked in the health care field for the past 24 years. SSMHC/WI owns and operates St. Marys Hospital Medical Center in Madison, St. Clare Hospital & Health Services in Baraboo, and two nursing homes. SSMHC/WI also manages Boscobel Area Health Care and is affiliated with Upland Hills Health Care, Inc. in Dodgeville, Columbus Community Hospital, and Stoughton Hospital Association. SSMHC/WI is a member of SSM Health Care located in St. Louis, Missouri.

A graduate of Arizona State University, Starmann-Harrison holds a master’s degree in health service administration, a bachelor’s degree in nursing and is a Fellow of the American College of Healthcare Executives. (See Starmann-Harrison’s guest column in this issue of The Valued Voice.)

Bob Fale, president/CEO, Agnesian HealthCare, Fond du Lac, is WHA’s 2006 chair-elect and will serve as chair in 2007. Fale has served in many leadership positions at WHA. Currently, he chairs the WHA Community Benefits Task Force. In addition, he served on the Finance Council, 1997-2002; chaired the Workforce Development Council in 2004; chaired the HFS 124 Task Force, 2001-2003; has served on the WHA Board since 1999; and he serves on the Executive Committee.

Prior to joining Agnesian HealthCare, Fale served as president and CEO of facilities sponsored by Catholic Health Initiatives, one of the largest non-profit health care systems in the country. After receiving his bachelor’s degree in nursing from the University of Wisconsin-Oshkosh, he went on to receive his masters in health administration from Washington University in St. Louis, Missouri.

WHA 2006 past chair is Ned Wolf, president of Lakeview Medical Center in Rice Lake. Wolf has also served in many leadership positions at WHA. He has been a member of the Board of Directors since 2000, chaired the Council on Finance and Payment in 2003, served on the Council on Governance from 1996-1997, joined the Executive Committee in 2003, served on the Nominating and Awards Committee in 1999 and 2000, and chaired the Medicaid Task Force in 2004 and 2005. He is currently a member of the Community Benefits Task Force and the Council on Finance and Payment, and will chair the Nominating and Awards Committee and Advocacy Committee in 2006.

A diplomat in the American College of Healthcare Executives, Wolf received his bachelor’s degree in biology and master’s degree in public health from the University of Missouri-Columbia. He served as vice chair of the Wisconsin State Trauma Council in 1999 and is on both the board and executive search committee for the VHA-Upper Midwest.

For a complete list of the 2006 WHA Board, Council and Committee members, go to www.wha.org/about/councils_boards_regions.aspx.

Happy New Year. And special thanks to Ned Wolf for his year of service as WHA Board Chair. I’m looking forward to working with staff, members and our collaborating partners over the course of 2006.

Here’s my take on our issue/program priorities as we begin the New Year:

• We need to restore Wisconsin’s previous status as a state that welcomes physicians with a favorable medical malpractice environment that includes limits on non-economic damage awards. To accomplish this goal we must take advantage of bipartisan support for a legislative "fix" early in the new year. Governor Doyle’s disappointing veto of legislation last month creates a challenge...but it’s a challenge that’s far from overwhelming given the broad public support for fixing the problem before it becomes a crisis.
  
• We must support the recommendations of WHA’s Task Force on Community Benefits and implement a statewide public reporting system by mid year. Such an initiative will allow us to tell our stories of service to our communities and can provide convincing evidence of how.... as nonprofit organizations...we are living our missions daily.
  
• Wisconsin is a recognized national leader when it comes to private sector initiatives that measure, report and improve patient safety and quality care. We’ve earned that distinction…but we now need to further evolve our public reporting programs in ways that empower our caregivers and benefit our patients. In addition to enhancing CheckPoint and PricePoint, I’d like to see WHA implement a voluntary ADVERSE EVENTS REPORTING initiative in 2006.
  
• Health care costs continue to be a major issue of concern to the business community, lawmakers and the public. In 2003 WHA led a major effort to educate the public about cost "drivers" and promote initiatives that reduce the growth of spending increases. While we’ve made measurable progress on that front, we need to "dust off" our public policy initiative (Healthier Choices), update it, and in partnership with others lead discussion that identifies meaningful solutions for what is a complicated but highly charged issue.
  
• While the fall elections will likely preclude serious legislative discussion of increasing the TOBACCO TAX, we must position WHA to be a leading voice supporting such an initiative in 2007. Why? I can think of at least three good reasons: 1) Funding for our ambitious Medicaid downpayment plan; 2) Funding for tobacco control programs; and 3) Higher cigarette prices discourage teen smoking.

These five issue priorities, along with necessary attention to workforce issues, legal advocacy and "surprise" challenges that will unexpectedly emerge this year, present a weighty "to do" list. But WHA has demonstrated in recent years that we can accomplish much. And with your support, we can effectively deal with these important 2006 priorities!

Mary Starmann-Harrison
WHA Chair

On December 15, 2005, the Governor signed 2005 Act 56 into law relating to the donation of newborn umbilical cord blood. The law requires that the principal prenatal health care provider (usually a physician or nurse midwife) of a woman who is known to be pregnant to provide to that woman, before the woman’s 35th week of pregnancy, information on options to donate, to an accepting and accredited cord blood bank, blood bank, blood center or plasma center, blood extracted from the umbilical cord of her newborn child. The requirement only applies if the donation may be made without monetary expense for the collection or storage to the woman, to any 3rd party payor of health care coverage for the woman, or to the hospital in which the delivery occurs. The law also provides that no person may be held civilly liable for failure to comply or for complying with the new requirement.

Some hospitals have reported that even prior to the passage of this new law, pregnant women have inquired about donating umbilical cord blood. However, there are currently no blood cord donation centers in Wisconsin. The nearest ones are in St. Louis or Minnesota. So in Wisconsin, until a center starts a donation process, even if a mom wants to donate the cord blood, there is no place to either collect it or store it.

Additional information regarding cord blood donation can be found at www.marrow.org/DONOR/cord_blood_faqs.html. A copy of the law can be found at www.legis.state.wi.us/2005/data/acts/05Act56.pdf. If you have questions, contact Jodi Bloch at jbloch@wha.org.

Worker’s Compensation and Liability Protection for Volunteer Providing Services During a Disaster

On January 4, 2006, the Governor signed into law 2005 Act 96 that allows health care providers to be designated as a state agent when they volunteer to provide services in a public health emergency, protecting the volunteer provider by making the state liable for any worker’s compensation claims and providing liability protections for claims made against them.

Under the new law, health care providers, behavioral health providers, pupil services providers, and substance abuse prevention providers including physicians, physicians assistants, registered nurses, licensed practical nurses, nursing assistants, nurse-midwives, pharmacists, podiatrists, dentists, respiratory care practitioners, veterinarians, and psychologists, can be designated as state agents for purposes of worker’s compensation benefits and state liability protections upon an appropriate declaration of a state of emergency in Wisconsin. The worker’s compensation benefits and liability protections only apply to such providers who:

1. Have held the required license, certification or registration to provide care in Wisconsin at some time during the 10 years prior to the declared state of emergency;
2. Have not had their license, certification or registration revoked, limited, suspended, or denied and are not listed in the state nursing assistant abuse registry; and,
3. Are providing volunteer, unpaid health care services on behalf of a health care facility during a declared state of emergency, except that the health care provider may accept reimbursement for travel, lodging, and meals.

If these requirements are met, the volunteer health care provider may be covered under the state’s worker’s compensation coverage and may be prohibited from making a claim in tort against the health care facility that accepted the volunteer health care provider’s services. Furthermore, as a state agent, such volunteer health care provider may also be eligible to receive state liability protections including being defended by the attorney general and limited liability for acts performed during the lawful course of duties. The law also excepts such volunteer health care providers from the prohibitions on practicing or attempting to practice without a license or certificate and from the prohibitions on holding themselves out, without a license or certificate, as trained, certified, or licensed for performance of health care services.

WHA members can once again choose from a wide variety of WHA educational offerings in 2006, ranging from billing and coding education to workforce-related topics. The full 2006 Education Calendar is included in this week’s packet. Also included in the calendar are dates for WHA’s important annual events.

As member needs change, so will the WHA educational offerings. The calendar includes all planned events as of January 6, 2006, but continue to watch for information on additional educational programming throughout 2006.

Specific event brochures and registration information are distributed approximately eight weeks prior to the event dates via direct mailing and WHA’s weekly newsletter and packet. The same information will also be available on the web site at www.wha.org. Remember that you can register online for most 2006 programs.

Upon the recommendation of WHA’s Council on Medical & Professional Affairs, WHA is offering its first "Physician Leadership Development Conference" in 2006. This new education offering, for both new and potential physician leaders, will be held at The American Club in Kohler, Wisconsin. The one-and-a-half day conference is scheduled for Friday, March 24, through noon on Saturday, March 25, 2006.

A successful physician leader represents both clinical and managerial interests, requiring the leader to obtain and balance the trust and respect of both groups. Those new to the leadership role are often challenged by the need to move beyond their traditional clinical training and take a new approach for decision-making, problem solving, communication and negotiation. Presented by American College of Physician Executives (ACPE) faculty, this new conference is designed to assist physicians who have recently assumed a leadership or management role, and those who have the potential to be future leaders, to make that leap.

Any physician who is fairly new to his/her leadership role or who has leadership or management potential should mark his/her calendar and plan to attend this conference. Also, chiefs of staff, medical directors, medical presidents, chief medical officers, clinical department chairs, and committee chairs are encouraged to attend or designate a physician with leadership potential to attend, as part of your organization’s succession planning.

A discounted "early bird" registration fee is available to those registering by February 15, as well as a group discount to those registering early. Additionally, a "host" registration option, which includes all meals, is available to those hospital representatives who would like to accompany their attending physicians to the conference.

ACPE is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The American College of Medical Education designates this educational activity for a maximum of 11 category 1 credits toward the American Medical Association’s Physician Recognition Award. Each physician should declare only those credits that he/she actually spent in the activity. Additionally, these programs are part of the ACPE and CCMM requirements toward a graduate degree or certification in medical management.

There will be an important pandemic influenza Web cast on January 11, 2006, from 1-2 pm, hosted by the State’s Hospital Disaster Preparedness Program. Web cast information and presentation will be presented live via your computer at Media Site Live. (See below for information on accessing this site.) The presentation will be archived on the DHFS website for viewing at a later date for those who cannot participate. The target audiences for this event are hospital disaster preparedness personnel, emergency department clinicians, infection control personnel, and physicians.

Web cast information will be provided by Thomas Haupt, respiratory infection epidemiologist at the Wisconsin Division of Public Health, and Marilyn Michels, ICP at Gundersen Lutheran Hospital. The agenda will include an overview of the National Pandemic Influenza Plan and the State of Wisconsin plan. In addition, an overview of two template policies on pandemic and avian flu for hospitals will be discussed. (Both these template policies can be accessed on the WHA website in preparation for the Web cast. Go to www.wha.org/qualityAndPatientSAfety/influenza.aspx and click on hospital policies on pandemic and avian influenza.)

You may either use this hotlink to access this site or you may copy/paste this link to your address bar on your browser.

It is suggested that you visit the Department of Health and Family Services (DHFS) main catalog located at http://dhfs.wi.gov/webcast and test your PC’s capability of receiving the Media Site Live Web cast by selecting one of the previous Web cast sessions for test viewing to ensure that your audio/video software will work properly prior for this scheduled event on January 11.

This link, http://dhfs.wi.gov/webcast/help.htm, will provide the information you need to configure your PC to receive this Web cast.

If you will be viewing this Web cast with a group of people at your hospital, it is suggested that you have an amplification system such as a microphone that you can place close to your laptop/PC to amplify the sound so that all can hear.

You will also be able to email questions at the time of the Web cast by clicking the "ASK" button. You can then type in your question and your question will then be answered "live" during the Web cast. Since time will be limited for questions, you can also send any questions and comments to gatesac@dhfs.state.wi.us. All questions will be answered in a timely manner and both the questions and answers will be sent to email groups that include all hospitals (this email will come from your Regional HRSA Hospital Board) and all ICPs (this email will come form the Wisconsin Division of Public Health, Bureau of Communicable Disease).

On December 30, 2005, the Centers for Disease Control and Prevention (CDC) issued updated guidelines for preventing the transmission of tuberculosis in health care settings. The report updates recommendations issued in 1994 to reflect shifts in the epidemiology of the disease, advances in scientific understanding and changes in health care practice. The AHA provided input on the guidelines and is pleased with many of the overall changes, including the simplification of risk assessment determinations, said Roslyne Schulman, AHA senior associate director for policy. The association was disappointed with the continued recommendation for N95 respirators since the evidence for preventing transmission is not conclusive, but was pleased the agency recommends only periodic respirator fit-testing based on specific criteria, and not annual fit-testing, she said. The guidelines note that TB transmission in health care settings continues to decrease due to implementation of infection-control measures and reductions in community rates of TB.

The Centers for Medicare & Medicaid Services implemented its 2006 Medicare payment rules on January 1 as scheduled, but in a "fact sheet" issued earlier this week (available at www.cms.hhs.gov/apps/media/press/release.asp?Counter=1746), CMS states that they stand ready to make all appropriate payment changes once Congress takes final action on the budget reconciliation bill. The bill must go back to the House due to minor technical changes made by the Senate on December 21, before the President signs it. CMS expects the bill to be taken up soon after Congress reconvenes. "At such time, CMS will be ready to make all appropriate payment changes in the least burdensome manner possible," the Agency said. In the meantime, Medicare payment changes contained in the bill — including changes to keep physician payment rates from being reduced and to extend the outpatient hold harmless provision for small rural hospitals — would not take effect, CMS said.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established an 18-member Physician Engagement Advisory Group. This group will advise the Joint Commission in its efforts to expand physician participation in the accreditation process and to broaden physician engagement in quality of care and patient safety initiatives.

Members of the group include physician quality directors and educators, chief medical officers, private practice physicians and other physician leaders. In addition to representing a variety of medical specialties, the newly formed Joint Commission Physician Engagement Advisory Group includes a geographic mix of representatives from urban and rural areas. The advisory group, which held its first meeting in December in Chicago, is being chaired by William E. Jacott, MD, special advisor for professional relations, Joint Commission.

One Wisconsin doctor is a member of the Advisory Group — Kevin Flaherty, MD, from Eye Clinics of Wisconsin in Wausau.

In recent years, the Joint Commission’s Board of Commissioners has identified enhancing physician engagement in accreditation and other quality improvement initiatives as one of its top strategic priorities.

"Physician leadership and involvement are critically important to the success of patient care and patient safety improvement efforts," says Jacott. "The Physician Engagement Advisory Group will assist the Joint Commission in identifying opportunities to work with physicians and physician groups on specific initiatives that will improve the quality and safety of patient care."

Top