electronic health records- Christensen Law

Meaningful Use Stage 2 Electronic Health Records

Meaningful Use Objectives For Stage 2 Electronic Health Records

Sharing electronic health records is always a matter of security. It’s all about making sure someone’s medical history is protected as it’s transferred and stored in the digital space. Christensen Law shares this article of a few things that go into securing your electronic health records.

Written By: S.Sandy Sanbar, MD, PhD, JD, Blake Christensen, DO, D. Wade Christensen, JD, J.Clay Christensen, JD, L. Nazette Zuhdi, JD, LLM, Adam W. Christensen, JD, MBA, Oklahoma City

On Jan 1, 2014, Meaningful Use Stage 2 began for eligible professionals (EPs). Physicians must develop strategies for meeting each of the following five Meaningful Use Objectives, and talk to their vendors about plans and timelines for getting their electronic health record (EHRs) certified and upgraded.

(1) Develop Web Portals for Patients. Physicians should sign up their patients to participate in a web portal linked to EHR’s that give more than 50% of patients seen during the reporting period timely online access (within 4 business days of a visit) to their health records and allows them to message the physician securely. And, more than 5% of patients seen in that party their health information. EPs will also have to demonstrate Meaningful Use for the entire calendar year, not just for the 90-day period required in Stage 1. Secure messaging might be built into the EHR. One may use an external messaging service like RelayHealth, which offers a certified EHR that includes patient-messaging features. Kryptiq is another external messaging service. Patients may also set up their own personal health record (PHR) on an external “platform” such as Microsoft Health Vault, which allows users of some EHRs to upload clinical data to patients’ PHRs with their permission.

(2) Exchanging Clinical Summaries. EHRs should be capable of generating a summary in a specific and mandatory format known as the Consolidated CDA, which can be shared with other physicians who use EHRs when exchanging clinical summaries with other providers during transitions of care, such as referrals and consultations. Some EHRs can currently create a similar summary known as the Continuity of Care Document (CCD). In Stage 2, EPs must provide a summary-of-care record for more than 50% of transitions of care and referrals. In 10% of those transitions, the summary must be transmitted electronically using certified EHRs. EPs have to exchange a summary at least once with a recipient who uses a different EHR from that of the sender, or conduct a successful exchange with one of the Centers for Medicare & Medicaid Services-designed test EHR. Some healthcare organizations and physician groups are acquiring internal health information exchanges (HIEs) that allow providers to send clinical messages and document attachments to one another. Other organizations may allow independent practices to join their HIEs. Alternatively, a private practice could join a community or regional HIE if one is available. Direct Secure Messaging (DSM) protocol, created by a public-private consortium, specifies how a clinical message can be transmitted from one trusted party to another. Companies known as health information service providers (HISP) route the messages, maintain provider directories, and guarantee the authenticity of senders and receivers of information. DSM could provide independent physicians a cost-effective way to exchange summaries.

(3) Laboratory Orders. Physicians should place laboratory orders themselves. More than 30% of laboratory and imaging test orders must be done electronically in Stage 2. Laboratories are expected to offer a two-way interface before 2014 in order to keep its customers. Physician groups should analyze workflow and figure out how best to pace lab orders electronically, e.g. customizing template orders for annual exams that might include a blood panel, ECG, and bone density test.

(4) Medication Reconciliation. More than 60% of medication orders must be done electronically in Stage 2, compared with just 30% or prescription drug orders in Stage 1. When a patient is transferred to the care of an EP, the physician must use his EHR to reconcile the patient’s medications in 50% of these care transitions. Vendors must build in the capability. Staffers will have to ask patients about their medications and capture that data in structured fields, and Surescripts medication histories can help as well.

(5) Preventive Care reminders. An EHR must have some kind of registry function that can identify patients who are due for preventative/follow-up care for more than 10% of patients with two or more office visits in the previous 2 years. The EHR must have a method of automating those alerts to patients; the office staff does not have to call or mail reminders. Third-party solutions do exist that help solve this problem if an EHR cannot do it.

Electronic health records make the transfer of important patient information easier to do between doctors and other health professionals, but its convenience can be abused if not properly secured. Christensen Law hopes that this has been informative for readers and if you have any questions regarding medical law, don’t hesitate to give our professional lawyers in OKC a call!

CRNA- Christensen Law

CRNA: Liability And Responsibility

Certified Registered Nurse Anesthetics (CRNA)

Anesthesia lets medical practitioners perform precise surgery with little worry of unexpected patient reactions, However; accidents can happen with this very precise part of the medical process. Liability is a complicated term in the medical field, but Christensen Law provides this article to help clarify some of the uncertainties involving liability of certified registered nurse anesthetists (CRNAs).

Written By: Blake D. Christensen, DO, Adam W. Christensen, JD, MBA, and S. Sandy Sanbar, MD, PhD, JD

Certified registered nurse anesthetists (CRNAs) have different educational and training requirements than anesthesiologists or anesthesia assistants. This article focuses on CRNAs, anesthesiologists, and surgeons. In Oklahoma, when a CRNA administers anesthesia, who is liable for CRNA negligent acts; the CRNA, anesthesiologist, or the surgeon?

For the CRNA, the practices of nursing and medicine overlap. CRNAs had been required to practice under direct supervision until 2001, when federal laws enabled states to determine if supervision was or was not required.* Effective Nov. 1, 2011, the OKLAHOMA NURSING PRACTICE ACT (ONA) states that “[a] Certified Registered Nurse Anesthetist, under the supervision of a [doctor], … , and under conditions in which timely, on-site consultation by such [doctor], … , shall be authorized, pursuant to rules adopted by the Oklahoma Board of Nursing, to order, select, obtain and administer legend drugs, … only when engaged in the preanesthetic preparation and evaluation; anesthesia induction, maintenance and emergence; and postanesthesia care.”**

The ONA does not limit the definition of a supervising physician to only an anesthesiologist. The CRNA “supervisor” is any individual licensed to practice as a physician who supervises the CRNA and who is not in training as an intern, resident, or fellow. Furthermore, the ONA requires the supervising practitioner to provide timely onsite consultation with the CRNA as warranted by medical conditions and circumstances. In this respect, medical professionals, in the exercise of his or her professional judgment, may establish what constitutes “timely onsite consultation.”***

Specialties in medicine have nearly caused the “Captain of the Ship Doctrine” to fall by the wayside and be replaced by vicarious liability. This doctrine was originally created to hold surgeons liable because injured patients could not sue hospitals under the old “Charitable Immunity Doctrine.”*^ This doctrine aids in finding a supervising surgeon directly responsible for an alleged error or act of alleged negligence by an assistant despite the assistant’s position as a hospital employee. Standard of care for the supervising physician is established by determining whether he or she needs to be physically present for the onsite timely consultation, and has been required in Oklahoma for nearly 60 years.

In 1995, the Oklahoma Supreme Court held in Jackson v. Oklahoma Memorial Hospital*^^ that the supervising physician owes the patient a duty of reasonable care in that supervision. Among factors affecting the supervising physician’s standard of care:

  •  The complexity of the medical or surgical procedure being carried out
  • The level of training, skill, and knowledge of the health professional
  • Any written guidelines and procedures prescribed by the healthcare facility.

A supervising physician may be liable for negligence of a CRNA under of vicarious liability, which is based on agency or contract law. The supervising surgeon may be liable for an anesthesia-related injury if the surgeon (a) abandons an unstable patient, (b) overtly directs the anesthetic plan, or (c) utilizes an unqualified anesthesia provider.

Physicians Liability Insurance Co. and other carriers calculate medical malpractice premiums by specialty and do not increase or decrease depending on supervision.*^^^ If an anesthesia mishap does occur, most courts will rightfully be able to delineate the difference in roles between the anesthesia provider and the surgeon.

The majority of mishaps occur due to reasons directly related to the underlying medical conditions or the surgical procedure. The degree of control over the delivery of the anesthetic will ultimately determine the liability. Liability should not be imputed on the surgeon for simply requesting a patient be asleep during a procedure but the law must be followed to ensure patient safety.

* Centers for Medicare & Medicaid Services, HHS. 42 CFR Ch. IV (10–1–11 Edition)
** Okla. Stat. Ann. tit. 59, § 567.3 (West)
*** 2012 WL 6560752 (Okl.A.G.)
*^ Walker, James Smith. Hospital Liability. Law Journal Press. 1985. 10(74-80)
*^^ 909 P.2d 765,774 (Okla.1995)
*^^^ Physician’s Liability Insurance Company. Physicians Professional Liability Insurance Policy (Claims – Made and reported). 2008

There are still many other facets about liability. Should you need assistance, the lawyers at Christensen Law in OKC can help to answer any questions involving this complicated term.

Accountable Care Organizations- Christensen Law

Accountable Care Organizations

Christensen Law Explains Accountable Care Organizations

Accountable Care Organizations are a part of the Affordable Care Act that’s designed to give doctors incentives to keep people healthy and out of the hospital. Christensen Law explains this new denomination of healthcare in the article below.

Written By: D. Wade Christensen, JD^ , J. Clay Christensen, JD^^ , L. Nazette Zuhdi, JD, LLM^^^, Adam W. Christensen^* , JD, MBA, Blake Christensen, DO, and S. Sandy Sanbar, MD, PhD, JD^**

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama on March 23, 2010. It created the Medicare Shared Savings (MSS) program*. The MSS program promotes accountability for a patient population, coordinates items and services under part A and B; and encourages investment in infrastructure and redesigned care processes for the purpose of providing high quality and efficient service delivery.

In 2011, the Centers for Medicare & Medicaid Services (CMS), which is one of the HHS agencies, issued the rule that established Accountable Care Organizations (ACOs)** . The ACO initiative is a doctor-hospital partnership which heavily emphasizes integration through technology. The goals or benchmarks of ACOs are the provision of good quality care to Medicare beneficiaries, the reduction of waste when rendering medical services, and ultimately the containment of health care cost.

The doctors and hospitals will jointly be accountable for the health of their patients. They are expected to utilize, meaningfully, the use of electronic medical records and to effectively coordinate care among all providers, and are discouraged from repeating tests on patients. The Accountable Care Organizations providers contractually agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. They are given strong incentives to cooperate and save money by avoiding unnecessary tests and procedures.

They will get paid more in bonuses for keeping their patients healthy and out of the hospital. On the other hand, the ACOs may have to pay a penalty if they do not meet performance and savings benchmarks. And patients in Accountable Care Organizations would still be free to see doctors of their choice outside the network without paying more. In this regard, ACOs differ from HMOs (Health Maintenance Organizations) where patients do not have that choice. In an attempt to become integrated systems, U.S. hospital systems have been buying up physician practices in hopes of becoming ACOs that directly employ the majority of their physicians.

The novel idea of the ACO doctor-hospital partnership has raised some important legal concerns, including:

(1) anti-trust and anti-fraud laws

(2) novel contracts between doctors and hospitals

(3) direct liability of ACOs for integrated system failure or improper integration of care, failure to properly credential and re-credential physicians, and failure to properly train or oversee personnel, vicarious liability extending to both old and new duties which are based on general corporate and agency law principles

(4) liability for independent contractors under the theory of apparent authority, or ostensible agency

(5) liability of primary care physicians for any system breakdown, even at a third-party level

(6) ACO liability caused by self-insurance which protects physicians as long as the system remains financially stable

(7) malpractice claims resulting from incentivizing physicians to not repeat tests or not to refer patients for needed treatment, delay some admissions or discharge patients prematurely

(8) the standard of care for ACOs may be higher than the prevailing standard because the physician may have to explain why he or she did not follow the ACO application, assessment and individualized care plan

(9) when providing informed consent, physicians should ascertain that the patient comprehends the alternative therapies presented and their risks in order to make an informed choice; patient understanding is pivotal in the informed consent process.

An ACO should put the beneficiary and family at the center of all its activities, honor individual preferences, values, backgrounds, resources, and skills, and should thoroughly engage people in shared decision-making about diagnostic and therapeutic options. This is referred to as patient engagement, which allows the patient to assess the merits of various treatment options in the context of his or her values and convictions. The ACO standards may indeed be stricter than the prevailing informed consent standards. Physicians may be liable for lack of informed choice for failure on the part of the physician to demonstrate that a patient understood all reasonable alternatives and made decisions accordingly.

^ First Gentleman of Oklahoma; Owner, Christensen and Associates; ^^ Owner and Managing Director, Christensen Law Group ^^^ Chair, Health Law Section, Christensen Law Group ^* Attorney, Health Law Section, Christensen Law Group ^** Of Counsel, Health Law Section, Christensen Law Group Address for all: 210 Park Avenue Suite 700, Oklahoma City, OK 73102.



Don’t forget, the lawyers at Christensen Law can answer any other questions you have on Accountable Care Organizations.

medical Law

Obama Care: A Pyrrhic Victory in Medical Law

Christensen Law Reviews Changes In Medical Law

In this post, Christensen Law reviews how medical law has changed due to how healthcare has evolved overtime. The Obama Care medical law has been the center of controversy ever since its inception. The idea of universal healthcare is an idea many would favor, but its practicality has always been debated.

Compiled by: D. Wade Christensen, JD, J. Clay Christensen, JD, Blake D. Christensen, DO, L. Nazette Zuhdi, JD, LLM, Adam W. Christensen, JD, MBA, and S. Sandy Sanbar, MD, PhD, JD

President Ronald Reagan was deeply opposed to the creation of Medicare, which he viewed as the sun setting on America’s future. In 1965 under the Presidency of Lyndon B. Johnson, Congress had created Medicare under Title XVII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.

Approximately 19 million people received Medicare in 1966. Before Medicare’s creation, only half of older adults had health insurance, with coverage either unavailable or unaffordable to the other half. Medicare was expanded in 1972 and again in 2001. In 2010, 48 million Americans received healthcare through Medicare. The Affordable Care Act (ACA) of 2010 is the most significant healthcare legislation since the creation of Medicare.

Beginning in 2014, the ACA requires most Americans under age 65 years to have health insurance or face financial penalties. On June 28, 2012, the U.S. Supreme Court declared the ACA in toto as constitutional, including the individual mandate which was permissible under the taxation powers of Congress as defined by the Constitution. President Obama, himself a constitutional scholar, and the Democrats in Congress were relieved, pleased, and gratified by the favorable Supreme Court decision, especially that the majority of the Justices (five) are appointees of Republican Presidents. But the Republicans in Congress have vowed to continue to “fight the battle” to repeal the ACA.

Is the Supreme Court ACA landmark decision a Pyrrhic victory for President Obama’s signature piece of legislation?

One can say that the President’s victory comes “with such a devastating cost that it carries the implication that another such victory will ultimately lead to defeat. Someone who wins a ‘Pyrrhic victory’ has been victorious in some way; however, the heavy toll and/or the detrimental consequences negate any sense of achievement or profit. There is, therefore, no reason to celebrate.” If the President is victorious in one more major and “politically destructive” and “financially costly and debilitating” battle with the Republicans, will he be utterly ruined?

In 280 BC, the army of King Pyrrhus of Epirus, an ancient Greek state, suffered irreplaceable casualties in defeating the Romans in two battles during the Pyrrhic War. Instead of being joyful of his victory, he allegedly stated that one more such victory would utterly undo him or another such victory and I come back to Epirus alone. He had lost a great part of the Greek forces, commanders and friends that he brought with him, with no recruits in sight. In contrast, the Roman camp was quickly and plentifully filled up with fresh men, not at all abating in courage for the loss they sustained, but even from their very anger gaining new force and resolution to go on with the war.

The ACA will, among other things, help over 40 million Americans without health insurance, do away with inequities of pre-existing conditions, and encourage medical students to choose primary care specialties. The ACA will impact physicians who serve uninsured and lower-income patients. It may also calm political and economic anxiety among the broader population of physicians who are unwilling or undecided about undertaking difficult and costly practice transformations to better coordinate care for patients. To some, the ACA is a step toward assuring the availability of health care to all as a universal goal. Health care, to others, is a right and not a privilege. Regardless, it must be provided in a way that is financially responsible. ‰

Select References: http://www.larrydewitt.net/Essays/Reagan.htm The Patient Protection and Affordable Care Act – Public Law 111-148. 124 Stat. 119 through 124 Stat. 1025 (906 pages) http://www.whitehouse.gov/blog/2012/06/28/supreme-court-upholdspresident-obamas-health-care-reform

Reflecting on this article, one may see that medical law is a complicated area of law that’s only getting more complicated with each passing year. If you are in need of assistance with matters pertaining to healthcare law , the lawyers at Christensen Law would be happy to help you. Please click here to contact us.

Worker's Compensation- Christensen Law

Oklahoma Workers’ Compensation Act 2011

Recent Changes To Workers’ Compensation In Oklahoma

Recently, there were some pretty big changes in the way workers’ compensation is processed and handled in Oklahoma. Christensen Law is here to provide the most important changes regarding these law changes.

Written by: D. Wade Christensen, JD*, J. Clay Christensen, JD**, L. Nazette Zuhdi, JD, LLM***, Adam W. Christensen****, JD, MBA, and S.Sandy Sanbar, MD, PhD, JD*****

On May 24, 2011, Governor Mary Fallin Christensen signed the new and extensively modified Workers’ Compensation Act (WCA), which took effect on November 1, 2011, and directed the administrator of the workers compensation court to reduce the fee schedule by 5 percent.*^ The following summarizes most of the new provisions of the WCA:

  • The Court will consist of 10 judges, no more than seven will be assigned to Oklahoma City and no fewer than three will be assigned to Tulsa. The WCA will not apply to certain employees including volunteers; sole proprietors, persons  providing services in a medical care or social services program; persons who employ relatives; persons employed by employers who are liable under certain Acts of Congress; persons employed in agriculture who have certain gross annual payrolls; real estate brokers; persons employed by youth sports league; owner-operators, and drive-away owner-operator.
  • Injuries that do not occur during the employment relationship or in the course of employment are excluded, as are some injuries which occur from certain willful acts, willful failure to act, drug use, and horseplay.
  • The time period a worker can file a claim is shortened from two years to 90 days;
  • Public state entities are required to provide workers’ compensation benefits, paid out of their respective funds, to employees and certain elected officials and to insure against liability for workers’ compensation with CompSource Oklahoma.
  • Voluntary mediation is available to any party to a claim, and the Court may also order mediation in any case.
  • The employer is required to provide an injured employee with medical care within seven days of actual knowledge of an injury, without admission of compensability. The physician selected by the employer will become the treating physician. If the employer fails to do so, or in the case of an emergency, the injured employee may select a physician at the expense of the employer. f there has been a previous contract with a certified workplace medical plan, the employer will select a treating physician from within the network of such plan and the claimant may apply for a change of physician as set out in the plan. Where the employee is not covered by the plan, the employee may be granted one change of treating physician for any affected body part. A maximum of two changes of physician are allowed in a claim.
  • A new Workers’ Compensation Medical Fee Schedule will be established in January 2012 with maximum rates that medical providers are permitted to be reimbursed for.
  • The Court will create and maintain a list of licensed physicians to serve as independent medical examiners and, at any time, may appoint an independent medical examiner to assist in determining any issue before the Court. After receiving a medical examiners report, the Court is required to submit reasons if it does not follow the opinion of the medical examiner.
  • The WCA established the use of nationally recognized treatment guidelines for injured workers. The Court will determine permanent impairment or disability and must be supported by medical testimony. The physician’s opinion of the nature and extent of permanent partial impairment must be based on the “American Medical Association’s Guides to Evaluation of Permanent Impairment.”
  • The WCA encouraged early return to work by utilizing rehabilitation. Injured employees will be entitled to physical rehabilitation. Injured employees will be entitled to physical rehabilitation. Injured employees will be entitled to physical rehabilitation services and Vocational Rehabilitation Director to help injured workers return to work. No person will be adjudicated to be permanently and totally disabled, unless first having obtained an evaluation through vocational rehabilitation services, which are limited to 52 weeks and may be extended in certain circumstances.
  • And, a formula will be established that limits claims for legal services based on the type of case and disability.

*First Gentleman of Oklahoma; Owner, Christensen and Associates;

**Owner and Managing Director, Christensen Law Group

***Chair, Health Law Section, Christensen Law Group

****Attorney, Health Law Section, Christensen Law Group

*****Of Counsel, Health Law Section, Christensen Law Group Address for all: 210 Park Avenue Suite 700, Oklahoma City, OK 73102.


Additional Resources: http://www.workerscompensationok.com/ and http://www.owcc.state.ok.us/

Workers’ compensation allows your employees to get back to work for you faster. Let the lawyers at Christensen Law in OKC answer any of your questions. Click here to get into contact with us.

Pain Management

Chronic Pain Management: Legal And Medical Aspects With Prescription Drug Abuse Prevention

Prescription Drug Abuse Prevention

Prescription Drug Abuse has different effects depending on the severity of the abuse. As such, prescription drug abuse prevention needs to be flexible to deal with this changing severity. Christensen Law is well-versed in healthcare laws of Oklahoma and the history behind chronic pain management. Here’s an article we wrote to explain a little more about this tricky subject.

Written by: Blake Christensen, DO, Adam W. Christensen, JD, MBA, S. Sandy Sanbar, MD, PhD, JD, D. Wade Christensen, JD, J. Clay Christensen, JD, L. Nazette Zuhdi, JD, LLM, Oklahoma City

Controlled substances prescription abuse has been reported to be the fastest growing drug problem in the United States. Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined.* And, for every unintentional overdose death related to an opioid analgesic, nine persons are admitted for substance abuse treatment. In 1914, the Harrison Narcotic Tax Act was the first narcotics law that prohibited doctors from prescribing opioids to addicts. In 1970, the Controlled Substances Act replaced the Harrison Act as the federal U.S. drug policy under which manufacture, importation, possession, use and distribution of certain substances is regulated. In 2005, President George Bush promoted quality pain relief with accountability by signing NASPER (National All Schedules Prescription Electronic Reporting) into law. NASPER was designed to improve patient access and prevent “doctor shopping” and drug diversion.**

In 2007, the Food and Drug Administration Amendments of 2007 gave the FDA the authority to require a Risk Evaluation and Mitigation Strategy (REMS) from manufacturers to ensure the benefits of a drug outweighed its risks through education of providers and the public. In 2009, the FDA announced a “Safe Use Initiative,” a program aimed at decreasing the likelihood of preventable harm from medication use. Finally, in 2011, President Barack Obama’s administration unveiled a Prescription Drug Abuse Prevention Plan, which focuses on four major areas: education, monitoring, enforcement, and disposal. There are also state laws, rules, policies and guidelines that address proper pain management.

The means of narcotic control is found within the federal and state laws currently in place, together with a three step-wise methodological approach to treatment from providers according to their trained skill set.***

1. The first modality is via prevention, patient education and screening. Primary care physicians and other interdisciplinary care providers play a vital role in effective treatment of chronic pain. The chronic-pain patients receiving treatment in this modality are typically the least physically and psychologically impaired. The physician should follow all existing regulations and evidence-based guidelines while having an individualized treatment plan for each patient. This level is typically the most cost-effective modality of treatment for the patient. It is also the modality where most of the laws governing controlled substances apply.

2. The second modality involves physicians who are board-certified in interventional pain management. The patients in this category are complex and display little or no progress using more conservative treatment. Interventional pain procedures can involve high-risk procedures and should only be provided by designated board-certified specialists when stringent objective medical criteria are met. These patients will often require an interdisciplinary care team and manager. They may need the help of a board-certified surgical specialist.

3. The third modality of treatment involves patients with the most physical and psychological impairment. It requires an interdisciplinary team. Psychiatric counseling may be beneficial. The patient should understand all facets of the ailment, have the support of family and friends, and have an established care team manager and interdisciplinary care team. Families need to be good reporters about the patient.

Treatment should focus on ways to manage the disease. The practice of medicine and pain management is based on patient care within the confines of the law. The law protects society from the dangers of narcotic abuse. Public policy exists to protect the public. The crux of the patient, physician, lawmaker, and public interests lies in the efficacy of information exchange. By having a well informed society, effective pain management may be achieved and laws may be understood and followed. Through information exchange of all modalities and the public, a balance may be found between drug control and drug availability.

Prescription drug abuse prevention is the frontline tactic versus the fastest growing drug problem in America. If you have any questions about the legal side of prescription drug abuse, the lawyers at Christensen Law in OKC can help.

* http://www.cdc.gov/nchs/nvss.htm


*** http://www.healthleadersmedia.com/HOM-75466-4625/Tiered-approachto-chronic-pain-targets-suffering

Christensen Law-Telemedicine Law and Medicine

Telemedicine: Law and Medicine

Telemedicine: Medical-Legal Aspects

Telemedicine article written by: Adam W. Christensen, JD, MBA, Blake D. Christensen, DO, Nazette Zuhdi, JD, LLM, Jonathon M. Miles, JD, Adrian Maurer, MD, S. Sandy Sanbar, MD, PhD, JD

Of all the professions one could think of to associate with the word precise many would probably list medicine and law among their top associations. It’s important to know what you’re talking about when it comes to these professions, doubly so when the two professions meet. To show that the lawyers at Christensen Law in OKC know their stuff, below we have an article on telemedicine written by Adam W. Christensen for Bulletin.

Telemedicine has come of age both nationally and internationally. In 1997, the Oklahoma Telemedicine Act (OTA) was passed. The OTA states that all health care service plans, disability insurer programs, workers’ compensation programs, or state Medicaid managed care program contracts are to include coverage for telemedicine services, where appropriate, as determined by a health care provider*.

Telemedicine is broadly defined under the OTA as the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education by means of audio, video, or data communications**. It encompasses such issues as emails, physician-patient communications and transfer of patient medical information from clinic to clinic and facility to facility. Telemedicine has demonstrated its potential to offer widespread access to medical care while at the same time reducing health care costs. Doctors can conduct video consultations with others in the same state, in other states and abroad. Telemedicine, however, does not include consultations provided by telephone or fax machine. There is no universal law of telemedicine. States take significantly different approaches to regulating it. Indeed there are many regulatory and legal issues to consider when developing a mobile app that involves exchange of healthcare information, an online health and wellness platform involving healthcare data, or another telemedicine or telehealth project. Regulatory and legal issues include:

• Privacy and Confidentiality

Informed Consent

Malpractice Due To Equipment Failure and General Liability Principles

Jurisdiction and Registration, Jurisdiction and Liability

Malpractice Liability, Negligence, Duty of Care, Standard of Care, and Negligence for Not Using Telemedicine Regulation of Telemedicine and Telehealth by State, Licensing, and Professional Disciplines

Ethical Constraints in a Given Profession (such as medicine, psychology, psychiatry, or counseling)

Insurance Issues Including Insurance Fraud, Billing and Coding, Medicare and Medicaid Fraud/Abuse, FeeSplitting, Kickback Law and Stark, and Healthcare Fraud.

Giving information on the Internet regarding generic health care conditions is legally permissible. However, giving information tailored to a specific patient, considered as diagnosis and treatment of a medical condition, is controlled by the medical licensing statutes. Telemedicine providers who don’t recognize the differences may run afoul of current law and regulation.

In Oklahoma, the health care practitioner who is in physical contact with the patient has the ultimate authority over the care of the patient and needs to obtain informed consent from the patient. If the patient wishes to utilize telemedicine, a detailed explanation of the risks and benefits and potential privacy concerns must be discussed. Telemedicine in Oklahoma is not centralized, but primarily offered through collaborative telemedicine networks and individual providers. Oklahoma supports telemedicine through the state’s high speed intrastate network, OneNet.

One thing is for certain: telemedicine is evolving and will enhance the physician’s ability to deliver medical care. Rural hospitals, not-for-profit hospitals, public health departments, correctional and military facilities and people involved in emergency response situations like the May 20, 2013, tornado, all have need for the utilization of telemedicine.

A fully developed and sophisticated communications infrastructure is needed to transport telemedicine information. However, this infrastructure is absent in many of the area’s most in need. Perhaps in the future, there will be ways to fund the telecommunications infrastructure and site equipment. The good news is the technology is here. Perhaps political forces will team up to find ways to fund the use of telemedicine and eliminate the barriers that are stunting its growth.

Telemedicine can be a powerful tool, but the restrictions on its use are currently governed state-to-state. If you’re in Oklahoma and have any questions about how your state regulates telemedicines; the lawyers at Christensen Law in OKC can help you get the most out of this powerful tool.

*§36-6803. Added by Laws 1997, c. 209, §1, eff. July 1, 1997
** §36-6802. Added by Laws 1997, c. 209, §1, eff. July 1, 1997

Christensen Law- Physicians

Physicians : Plan Well. Live Well.

5 Factors Of Retirement For Physicians 

Doctors are a certainly very special breed. They work long hours, get very little sleep, and endure heartbreaking loss. Doctors spend their entire careers helping others and saving lives, therefore; whenever one retires we know they very well earned it. When one retires, what they may not realize is that there are a few things, in addition to the normal pitfalls, that can hamstring their retirement needs. Christensen Law is here to give some advice on what some of these pitfalls are and what doctors should do. Let’s start with an example:

Dr. Hood is 55 years of age with dreams of retiring when he is 65 and switching from practicing medicine to enjoying golf full-time. Will he be able to fulfill his dream? What issues must Dr. Hood consider now to be able to retire in ten years?

Nearly half of practicing physicians are older than 50 and approaching retirement. Unlike most other professionals, physicians should consider additional factors when planning for retirement. These five main factors are:

1. Retirement Number. Has the physician accumulated sufficient liquid savings to reach his or her proverbial retirement “number”? The “number” is the amount of savings a physician needs to maintain a desired standard of living in retirement. The proper time to set up a plan is as early as possible to capture the benefits of compounding in tax deferred accounts. If Dr. Hood does not already have a plan in place, now is the time to set up a comprehensive investment plan to reach that retirement number.

2. Succession Planning. Physicians must consider their practice exit strategy and plan their transition into retirement with the best chance of success for their patients and themselves. Strategies will differ between physicians based upon personal preferences and whether a physician is a solo practitioner or a member of a group of physicians.

3. Asset Protection. Physicians are subject to claims of malpractice and ensuing lawsuits. Asset protection is critically important. Physicians should seek advice from a licensed attorney regarding the proper use of LLCs, PLLCs, family limited partnerships, irrevocable trusts, offshore trusts, etc. These business vehicles are also useful when transferring ownership of a professional practice.

4. Accident Planning. This begins with sufficient malpractice insurance. There are two major types of malpractice coverage: occurrence-based and claims made. Occurrence-based policies protect a physician while the policy is in effect, no matter when the claim is made. Claims-made policies cover only claims made during the term of the policy and require tail coverage when the policy ends. Other insurance considerations include life and disability insurance and an adequate umbrella policy.

5. Tax Considerations. This over-arching factor should be considered concurrently with the previous four factors and requires the advice of a tax savvy CPA and/or attorney. Successful financial planning for life events and retirement requires not only the accumulation of assets, but also the protection of assets earned during the course of a physician’s career.

It is never too early to examine and implement the five factors presented in this article. The physician’s team should consist of a financial advisor for factors one, two, and possibly three and four; an attorney for factors two and three; a licensed insurance broker for factor four; and, a CPA or tax attorney for factor five. It is important for the advisor, attorney and CPA to work together to ensure all recommendations are consistent with the physician’s personal goals and objectives.

If you’re a doctor looking to retire soon, let the lawyers at Christensen Law in OKC help make sure you have everything on order.


State Question 777: A Compelling Reason To Vote YES

Why Vote Yes For SQ 777

There are many reasons to vote in November, including one of the least understood, but most crucial pieces of legislation relating to Oklahoma’s agriculture: State Question 777.  It is important to know that this proposed constitutional amendment was drafted by rural Oklahomans for the benefit of ALL Oklahomans and the land we call home. YOUR elected representatives, both Urban and Rural Senators and Representatives, overwhelming passed this proposal by a vote of 124-13.  This is a non-partisan, non-political proposal where the sole interest is to protect Oklahoma’s agriculture.  It is about making sure that Oklahoma encourages and protects all Oklahoma farmers and ranchers while enabling them to continue to have the ability to provide for their families in their chosen line of work and deliver quality, safe and affordable food to fellow Oklahomans and those around the world. S.Q. 777 is designed to benefit Oklahoma farmers and ranchers, whether full-time, part-time or even gardeners and hobbyists.

The actual amendment in full states, Section 38. “To protect agriculture as a vital sector of Oklahoma’s economy, which provides food, energy, health benefits, and security and is the foundation and stabilizing force of Oklahoma’s economy, the rights of citizens and lawful residents of Oklahoma to engage in farming and ranching practices shall be forever guaranteed in this state. The Legislature shall pass no law which abridges the right of citizens and lawful residents of Oklahoma to employ agricultural technology and livestock production and ranching practices without a compelling state interest. Nothing in this section shall be construed to modify any provision of common law or statutes relating to trespass, eminent domain, dominance of mineral interests, easements, rights of way or any other property rights. Nothing in this section shall be construed to modify or affect any statute or ordinance enacted by the Legislature or any political subdivision prior to December 31, 2014.”

Through the commercials and speeches, there is often much “political spin.”  Casting politics aside, what does this proposal really do and not do?

This proposal:
1. does NOT open the door to foreign ownership of agricultural land. (Constitutionally prohibited)
2. does NOT de-regulate puppy mills.  (Statutorily regulated)
3. does NOT legalize cock fighting.  (Statutorily prohibited)
4. does NOT change a single law currently in effect.
5. does NOT pollute our water or change a single water law.
6. does NOT prohibit additional laws to protect our water.
7. does NOT give agriculture any new freedoms.
8. does NOT affect county or municipal laws in any way. (legislative specific language)
9. does NOT allow for any anti-agriculture regulation without a compelling state interest, similar to the constitutional protections that rodeo, hunting and fishing currently have in Oklahoma.

This proposal:
1. does continue to provide for freedom of food choice.
2. does still provide for Oklahomans to make sure our food is safe and our water is protected; farmers and ranchers are the original Stewards of the Land.
3. does help to protect Oklahoma jobs, which is vital to our economy.
4. does protect Oklahoma farmers and ranchers from future adverse legislation from out of state special interest groups that do not care about Oklahomans or their values.
5. does help to continue to encourage future generations of agriculturists to become involved in agriculture by protecting Oklahoma rural values.
6. does restrict harmful, unscientific legislation that does not promote a compelling state interest from being passed by either political party.

Everything in this state question is intended to be in the best interest for all Oklahomans. However, this State Question is garnering a great amount of adverse, political publicity from several special interest groups. Oklahomans must remember, this is about Oklahoma, our food source and our farmers and ranchers, not political out-of-state special interest groups.

Vote YES, to support your local farmers, ranchers and all Oklahomans who enjoy a healthy meal.

Wade Christensen is a fourth generation farmer and rancher from Thomas, Oklahoma and managing Director of Christensen Law in Oklahoma City.  He has served as Chairman of the National Governors Spouses Leadership Committee.  While serving as Chairman, his National platform was entitled “America’s Farms: Feeding and Strengthening Communities.” Christensen highlighted the important role farming and ranching play in providing a safe and healthy food source in the U.S and throughout the world.  He also highlighted the importance of the agricultural sector to the U.S. economy, national security and public health. Oklahoman and American culture celebrates farming and ranching as an important part of our history, but sometimes we don’t remember how important it is to our economy and our way of life today. Whether it is childhood obesity or global hunger, farmers and ranchers are helping to address some of the great issues of our times.