Monday, December 20, 2004

Opinion by WV Supreme Court in Boggs v. Camden Clark Memorial Hospital

The West Virginia Supreme Court of Appeals issued a decision in the Boggs v. Camden Clark case which I orginally reported on back in an October 2004 blog post. As you will recall, this was the first case to be heard by the Court challenging several medical liability reform provisions enacted by the West Virginia Legislature in recent years.

The case involved a plaintiff whose suit was dismissed by a Circuit Court Judge in Wood County when the plaintiff's counsel failed to provide a signed certificate of merit statement from a physician and failed to serve the notice of claim by certified mail. Both the signed certificate of merit and the requirment that the notice be sent by certified mail were requirements put into law under HB 601 which passed on December 1, 2001 after a 5-week special session dealing specifically with our state's liability insurance crisis. These reforms were then followed in 2003 by the passage of HB 2122 which enacted more significant reforms including lowering the caps on damages.

The 4 to 1 decision (Justice Maynard dissenting) found in favor of the plaintiffs . The decision permitted the plaintiff to amend his complaint, and allowed the reinstated complaint to be governed by the Medical Professional Liability Act II (prior to the reduction of the caps of damages).

To read the opinion issued by the court and the dissent issued by Justice Maynard, you may access the Supreme Court's web page by clicking on the link below.

Following is a AP news article from the Clarleston Gazette regarding the decision:

AP - 12/9
Supreme Court revives malpractice lawsuit

CHARLESTON, W.Va. (AP) -- A paperwork error was not serious enough to force the dismissal of a medical malpractice lawsuit filed by the family of a woman who died at a Parkersburg hospital, the state Supreme Court has ruled.

A Wood County judge had tossed out the June 29, 2003, lawsuit filed by the family of Hilda Boggs because a lawyer gave Camden Clark Memorial Hospital written notice 27 days prior to filing the lawsuit, when state law requires 30 days notice.

The high court ruled 4-1 Wednesday to revive the lawsuit. Writing for the majority, Justice Warren McGraw said the hospital had known since February 2002 that the family intended to file a lawsuit.

Boggs' family can seek $1 million in damages for pain and suffering allegedly caused by her 2001 death at Camden Clark.

If the family had to refile the lawsuit, a state law that took effect July 1, 2003, would have capped the non-economic damages at $500,000.

Boggs, a 50-year-old teacher, was hospitalized after breaking her ankle in a fall at Mineral Wells Elementary School.

HHS to Issue Additional HIPAA Rules

According to an article in the December 14, 2004 report from Health Data Management HHS is set to publish four additional HIPAA Rules in the coming months.

The proposed rules include:

  • A rule to set standards for electronic claims attachments, expected in January 2005;
  • A rule to enforce HIPAA administrative simplification provisions, set for February 2005;
  • A rule to establish a national identifier for health plans, set for April 2005; and
  • A rule to regularly revise the HIPAA transactions and codes sets rule, scheduled for June 2005.

These additional regulations will apply to all covered entities who are now complying with the privacy rules which went into effect in 2003. Health care providers will need to monitor these new regulations and the impact they may have on business operations.

Friday, November 05, 2004

Another Blog on HIPAA Issues

I ran across HIPAA Blog covering medical privacy issues involving the Privacy Standards under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other technology and legal tidbits. I have found the content on the blog excellent and look forward to watching developments posted on this blog. The blog is authored by Jeffrey Drummond of Jackson Walker, LLP in Dallas, TX.

Monday, November 01, 2004

Office of West Virginia Attorney General Announces New Prescription Drug Comparision Web Site

I noticed on a couple of articles, including an article by, that the Office of West Virginia Attorney General has created a prescription drug comparison web site. The Associated Press reported that the Attorney General announced the purpose of the website was to educate consumers and help them reduce drug costs.

According to the Associated Press article, the site includes a list of 24 commonly prescribed drugs and their full retail prices at pharmacies across the state. It also features links to state and federal prescription drug discount programs.

It appears that the information is based upon a survey of various pharmacies around the state of West Virginia. You can view a list of the pharmacies that participated in the survey.

Following is the introductory information posted on the new website:

"According to statistics supplied by the Robert C. Byrd Institute for Health Policy Research, on any given day approximately 425,107 West Virginians (40,637 children, 292,599 non-elderly adults, and 91,871 older adults) go without prescription drug coverage. These citizens have to pay the full retail price for medications out of their own pockets. Additionally, there are many West Virginians who do have health insurance but lack adequate coverage for prescription drugs and must buy them at full price. If you are one of these citizens or a caregiver for one of them, this site may be a useful tool that you will find helpful.

On this site, you will find results of surveys of the prices of commonly prescribed prescription drugs at pharmacies in various counties across the state. To find the prescription drug prices at pharmacies surveyed by our office, use the search option on the top or bottom of this page to get started.

This information will show you the value of comparison-shopping among pharmacies to get the best price for your prescription drugs. Remember, this is a voluntary program and we do not have survey results from every pharmacy in the state. Keep in mind that prices change frequently. Always call or visit your pharmacy to find out the price before buying your medication . . ."

Friday, October 29, 2004

WV Launches One Stop Online Business Registration

I was glad to see an announcement last week regarding the a new web portal which allows businesses to register online to operate in West Virginia. The web portal called appears to aggregate the registration process for various West Virginia state agencies, including the forms required by West Virginia Secretary of State Office, West Virginia State Tax Department, Workers' Compensation Commission and Bureau of Employment Programs.

I haven't registered for a Business4WV Account to manage the business filings that I do on behalf of clients so I can't give you a detailed review of how well the new system works -- but I plan to register soon and give it a try. Anything that can make the process easier for businesses in West Virginia and businesses wanting to come to West Virginia to register will be an improvement over the current system which allows limited online filing, requires hard copy filings and does not provide a coordinated system of one-stop registration.

The new system was created by Tygart Technology, Inc. which has provided a summary of how the new e-government system works. The company describes the system as an enterprise-wide Business-to-Government (B2G) Exchange designed to host a large number of e-services (including e-filings) offered by numerous state agencies. Currently the project integrates the filings involving the four state government agencies listed above.

The Business Organization Division of the Secretary of State was typically the place that most attorneys or others start to create and register a new legal entity, authorize an entity to do business in West Virginia, reserve a business name, etc. You then were required to complete the Business Registration Application (WV/BUS-APP) and foward the form to the West Virginia State Tax Department who would establish an account for the new entity and forared the form to other state agencys, such as, Workers' Compensation and Unemployment Compensation. Depending on the type of entity and the business involved you often had to then make additional filings with licensure boards, local/municipal licensing agencies, etc.

Monday, October 25, 2004

AMA News Report on WV Tort Reform Challenge

In today's online version of the American Medical News ( there is an article discussing the challenges in various state courts to recently enacted legislative medical liability tort reform, including the appeal of Boggs v. Camden-Clarke Memorial Hospital, et al. before the West Virginia Supreme Court of Appeals.

If you want to read the individual briefs filed by the Appellant and Appellee in this case you can find them on the West Virginia Supreme Court of Appeals Argument Docket for November 9, 2004.

For those of you interested in the tort reform issues in West Virginia the decision in this case will be interesting to watch.

Friday, October 22, 2004

WV Supreme Court of Appeals Provides Access to Scanned Copies of Briefs

The West Virginia Supreme Court of Appeals has added a new feature to its website. The Court now provides access to scanned PDF copies of the briefs filed in particular matters on appeal with the Court. Links to the briefs filed in a particlar matter appear under the Court Calendar and Docket page. You must pull up the particular month and day of the scheduled arguments to locate the filed briefs. For example, the briefs filed in matters argued before the Court on November 9, 2004 can be found here.

It is great to see the staff at the West Virginia Supreme Court of Appeals take the lead nationally on technology issues in the court system. Now that briefs can be accessed via the web I would suggest that the Court add a wi-fi connection at the Court so that you can access the briefs and other important Court information while you are waiting for your argument on the docket. I suspect that the Clerk of the Court, Rory Perry, who is leading the charge on technology issues for the Court likely has plans to add wi-fi cabability in the future.

I want to thank another West Virginia blogger, Brian Peterson, for bringing this new feature to my attention on his West Virginia Legal Weblog.

Monday, October 18, 2004

New York Times Magazine Article on New Martinsvillle, WV - "Two Americas, Two Restaurants, One Town"

An article appeared in this weekend's New York Times Magazine about my hometown of New Martinsville, West Virginia.

The article contrasts two local eateries, Baristas and Bob Evans, and provides some interesting commentary on the community and West Virginia. I don't necessarily agree with the simplified perspective that the author takes on our community. Like much of what I read in the press these days there is a tendency to over simplify the state of things in America. In this case it is the old West Virginia cliche that West Virginians are just old country folk (or hillbillies) who hit deer with their pick up trucks and need to experience some culture like Baristas. The article portrays the community as black or white on cultural issues -- rather than gray. When I go home to visit with my dad we go to Bob Evans and Baristas (and the Court Restaurant).

Two Americas, Two Restaurants, One Town

October 17, 2004

To call Baristas a restaurant would be a serious understatement. It is a restaurant, but it's also a barbershop. And a coffeehouse. And, of course, a massage parlor. Naturally, it's run by the same guy who turned the funeral home around the corner into a gym, with cardio machines in the viewing room and free weights in the old embalming chamber.

Baristas occupies a huge turn-of-the-century white house in
New Martinsville, W.Va., with steep fire-engine-red steps,
a porch full of rainbow-colored tables and pillars painted
to look like cloudy skies and candy canes. You walk inside
to high ceilings, oak floors, purple walls and one of the owners, Jill Shade, making her famous mocha crushes or hopping around singing an old Cher song she has had stuck in her head for weeks. When I first walked in, Shade pointed to a huge wooden board behind her. ''Menu's up there,'' she told me, ''but if you're craving something you don't see, just holler and I'll try to make it.''

Baristas' menu is not exactly an exercise in overwhelming choice -- a couple of homemade soups, a salad, some appetizers, sandwiches and one dinner special on Friday nights. But ambience is another story. You can eat in the basement pub, with its low oak ceiling and stone walls. You can eat on the patio overlooking the Ohio River, in the garden next to the hibiscus plants or in the cafe surrounded by walls of local art. You can get a haircut or a bona fide Swedish massage while you wait, then sit at a table covered in quotes from Camus or Malcolm X. It's exactly the kind of place I love, and exactly the kind of place I would never expect to find in New Martinsville, where I live part of each year. It's a town of about 5,000 people and 36 churches, a town full of all-you-can-eat buffets, Confederate flags, ''No Trespassing'' signs and folks who still feel the need to point out the local lesbian couple. But then again, I never expected to find Jeff Shade in New Martinsville either.

Shade is a local boy, a 38-year-old former high-school
football star who left West Virginia with dreams of
becoming a minister. But he lost God somewhere in Texas and
got kicked out of seminary, he says, for ''asking too many questions.'' He studied philosophy and theology at Princeton, then went to massage school in Manhattan while serving as the pastor for a New Jersey church where he preached from The New York Times instead of the Bible. A few years later, he headed back to New Martinsville with his wife, Jill, their 2-year-old son, Soren Aabye Shade (as in Soren Aabye Kierkegaard), and degrees in Greek, theology, philosophy and massage. With all that education, he and Jill decided they wanted to expand the minds of the folks back home. The tool they chose was the burger.

The Barista burger is the creation of Tammy Wilson, a
compact, ponytailed whirlwind with tie-dyed flip-flops and
a T-shirt that says ''Save the drama for your mama.''
Wilson is Baristas' main cook, and she works in a kitchen
that looks more like a home than a restaurant. Teenage
girls run in and out asking her questions about prom dates
and haircuts, Jill appears from the garden with a bag of peppers for roasting and Jeff wanders around tasting soups and sauces while cracking jokes about politicians or saying things about Foucault that nobody understands. Wilson spends hours each week pressing fresh garlic and adding it to vats of ground beef for burgers; when she's done, she rolls up her sleeves and plunges her hands into the meat. ''I learned to cook from my hillbilly grandma, and I'm proud of it,'' she told me. ''And if there's one thing I know, it's that burgers only taste right when you mix the spices by hand.''

Clearly, she's onto something. People drive 60 miles up and down the Ohio River for her burger: a juicy half-pound of ground beef with hints of ginger and garlic and soy, some spices, a touch of West Virginia honey and enough sweet smokiness from the grill to make you think she cooked it over fresh mesquite. Mix that with a salad fresh from the garden and hand-cut fries, and you've got a room full of people who simply can't believe anyone wouldn't want to eat at Baristas.

But in fact, a lot of locals can't imagine even walking
into Baristas, let alone eating there. The truth is, most
of them would rather go to Bob Evans.

The first time I drove up to the New Martinsville Bob
Evans, Billy Joel's ''Just the Way You Are'' was echoing through the parking lot from the speakers above the doors. Everything about the place said ''national chain.'' I walked past a red-white-and-blue banner into a world lined with plaid curtains and Old Fashioned things, like copper teakettles and washboards that looked so new they might as well have still had price tags on them. The eggnog- and pecan-pie-scented candles by the cash register overwhelmed any smells from the kitchen. A short woman in black polyester slacks and a white button-up shirt with a Bob Evans logo stitched on it smiled at me, menu in hand, and
said: ''Hi, welcome to Bob Evans. One for dinner?''

Baristas and Bob Evans are less than a mile apart, but they might as well be in different cities. Baristas sits on Main, a quiet tree-lined street with wide sidewalks and a historic courthouse. You're guaranteed to miss it if you don't know to turn toward the river at the BP station. But you can't miss Bob Evans. It has the tallest sign on this strip of Route 2, a highway lined with a Wal-Mart, a McDonald's, a Dairy Queen and a Pizza Hut that could be anywhere in the country.

There is only one Baristas, but there are 576 Bob Evanses,
in 21 states; in 2004, the company rang up $1.2 billion in sales. Bob Evans is part of a giant and fast-growing retail category known as ''full-service family-style dining'' (you know the kind: Cracker Barrel, Denny's, Friendly's); it's a sit-down restaurant that leans more toward down home than fast food, with a serious emphasis on all-day breakfast. Like most Bob Evanses, the one in New Martinsville is in a red-and-white ''farmhouse'' with a sprawling parking lot and a few benches out front.

The goal at every Bob Evans restaurant is to be the same as every other Bob Evans restaurant. ''We want to make sure the experience someone has in New Martinsville is the same as the one they'd have in Orlando, St. Louis or Baltimore,'' said Tammy Roberts Myers, the P.R. director at the Bob Evans headquarters in Columbus, Ohio. The company's guiding principle is simple: consistency, in everything from ambience to the distance between tables to the arrangement of food on your plate.

''Going out to eat is risky,'' said Steve Govey, the Bob
Evans regional manager for the Ohio Valley. ''You never
know what you're going to get. But at Bob Evans, that's not true. Our strategy is being completely predictable, something people know they can count on.''

Bob Evans was packed when I arrived. It was full of
customers of all ages and sizes, with lots of khakis, denim shorts and camouflage hats with pictures of guns or slogans like ''National Wild Turkey Federation.'' There were three women at three different tables wearing identical neon orange T-shirts. I'd just come from Baristas, where people danced at the counter to Ray Charles and talked across the room about how so-and-so woke up with a weird rash yesterday and what John Kerry said at the rally in Wheeling about helping millworkers. At Bob Evans, I sat alone at the counter. The people around me stared at their plates and ate in silence; behind me, people spoke so quietly I could barely hear their murmurs over the clanking silverware.

I ate a raspberry grilled-chicken salad with exactly four slices of strawberries, four chunks of pineapple and a tough sliced chicken breast with raspberry vinaigrette. I followed that with a classic turkey dinner. The stuffing was great, but the rest was just barely edible -- a little dry, too salty, with oily biscuits and mashed potatoes that tasted like fake movie-popcorn butter. Honestly, I didn't get it.

But I went back to Bob Evans the next day, and I kept going back and kept trying things on the menu. I was determined to understand why so many people in town chose this place over Baristas. (The prices at the two restaurants, by the way, are about the same.) I ate a southwestern omelet smothered in jack cheese, and a pork chop dinner that took four people to make. None of the chefs spoke while they cooked; they just threw still-frozen vegetables and meat straight onto the griddle. (They let me watch.) They measured lettuce and arranged the food on my plate so it would look exactly like the instructional diagram hanging on the kitchen wall: pork chop over here, frozen vegetables over there, one sprig of parsley right there.

After a waitress put the whole package down in front of me,
I took a bite and thought, They're right, it is just like grandma used to make. Thing is, my grandmothers couldn't cook. From my New York grandmother, I got burned matzo brei and gefilte fish from a jar. From my southern Illinois grandmother, I got food that tasted just like Bob Evans's: soggy vegetables, rubbery bread and meat so overcooked it crumbled when you bit it.

I'd gone meat shopping a couple of days earlier with Tammy Wilson from Baristas, and I watched her hand-pick every pound of meat from the butcher's counter as he leaned through the window and told her it had just come in fresh. ''He gets most of his meats local,'' she told me. I wanted to find out the same sort of thing about the Bob Evans pork chop, so I called the folks in Columbus. Tammy Roberts Myers said she would be happy to trace my dinner for me, all the way from the animal to the table. But a couple of weeks later, she called to say that someone at headquarters had a change of heart. ''Sorry,'' she said. ''We can't tell you that, because it's proprietary information. What I can tell you is, it was on a farm somewhere at some point.''

I didn't start to understand the appeal of Bob Evans (for
other people, anyway) until I met Daisy and Wally Kendall.
They eat at Bob Evans nearly every day, sometimes more than once. They sit in a maroon vinyl booth giggling and finishing each other's sentences. When I asked why they eat at Bob Evans all the time, Daisy said: ''It's clean, and there are no surprises. I know what I'm going to get.''

Wally shrugged and said: ''People say, 'Why do you only go
to Myrtle Beach for vacation every year? Don't you want to
see somewhere else?' We never know what to say -- we tried
it, we know we like it, why risk spoiling our vacation somewhere new we might not like?''

When I asked other people why they chose Bob Evans over Baristas, most folks just smiled and shook their heads. One young woman told me her father doesn't like her eating at Baristas because ''it's like feeding your money to Satan.'' One regular said he didn't know why he ate at Bob Evans, but he thought it might have something to do with it being so consistent. ''I'm not big on change,'' he told me. ''That's why I'm voting for George W. It's just too dangerous to change stride now. It's best to leave well enough alone.''

One woman lowered her voice and whispered: ''Baristas'
problem is, they try to make fancy food. We're simple
people here. We don't like a lot of spices and stuff. A
little salt and pepper is good enough for us. You have to develop a taste for that fancy stuff, and we don't really want to.''

Another woman pointed to my pork chop dinner and said:
''You've got to remember, this is what we were raised on.
If people want to go into Baristas for a bean-sprout
sandwich, that's fine, but around here, we don't do that
sort of thing.''

In fact, Baristas' menu is full of traditional New
Martinsville food (hamburgers, grilled-cheese sandwiches, steaks, fried green tomatoes), and there isn't a bean-sprout sandwich in sight. But there are a few things on the menu that give some locals the creeps: hummus, pesto, eggplant, feta. The way they see it, Jeff's a local boy, and New Martinsville loves him, but that doesn't mean they're about to eat weird food in a restaurant that sounds as if it might as well be a brothel, what with all the drinking and massaging going on there.

Daisy and Wally have known Jeff Shade since he was a kid.
When I asked them why they'd never gone to Baristas, they looked at each other as if it had never occurred to them. ''We love Jeff,'' Daisy said. ''The only reason we haven't gone there is really just negligence.

''We were going to go there once,'' Daisy went on, ''but a
deer ran into the car.'' Then she paused. ''We really
should go sometime,'' she told Wally.

How about now, I asked. I'll go with you.

''Oh, no,''
they said in unison, then giggled. ''We're expecting a call from Wally's doctor later.''

Daisy and Wally have always been Bob Evans people, but they didn't start going daily until they came down with severe health problems -- lymphoma for Wally and serious respiratory problems for Daisy -- which they attribute to years of breathing in toxins while working at a local chemical plant. They got sick and weak, they couldn't cook and Bob Evans became their life. Daisy looked at me and
whispered: ''You know, the food here is wonderful. We've
never had a bad meal. But really, we don't come for the
food. We come for the people.'' She gestured around the restaurant. ''This is our social life.''

When I walked back into Baristas after a few days of
nothing but Bob Evans, I literally felt as if I had come
home. The walls were the exact shade of purple that I
painted my bedroom when I was a teenager, and these days my kitchen is maroon, just like Baristas' back dining area. One of my favorite Jayhawks songs was playing, and I sat down at the bar next to Gary, a former airplane-engine specialist who lives in an octagonal penthouse he built on top of an old hog barn.

I told him what I'd been doing, and he looked at me as if I were crazy. ''I can't imagine hanging out at Bob Evans every day,'' he said. ''I just find that place so . . . so . . . the same.'' I knew what he meant. I loved talking to Daisy and Wally and a few other regulars at Bob Evans, but I couldn't handle going in there every day. I'm a Baristas person to the bone -- just as Daisy and Wally are pure Bob Evans. The question is: Why? What makes them Bob Evans people and me a Baristas person?

Some of it is simple aesthetics: I think fresh food tastes
a lot better than frozen, and I want herbs instead of salt. Local art on colorful walls makes me happy, and fake old-fashioned teakettles make me sad. Mostly I love Baristas because of the buzz, the energy I feel when I'm in the midst of people who thrive on resisting predictability, like the Catholics who come to Baristas to hear Buddhist monks speak about reincarnation, or the Republicans who came in to meet the Kerry people who stopped by one night to stump.

Maybe I had an idea that I could convert people -- that I
could persuade some Bob Evans folks that they should be
open to change, that the food really was better at
Baristas; and maybe persuade some Baristas people that the
Bob Evans people are interesting and funny and friendly,
too. But in all my time shuttling back and forth between
the two restaurants, I didn't change a single person's
mind. At some point, it hit me: it's not just New
Martinsville. Bob Evans people and Baristas people live together all over the United States. They often go to the same stores and send their kids to the same schools, but try as they might, they simply can't understand why anyone in his right mind wouldn't eat the way they do, think the way they do and vote the way they do. Unfortunately, I'm not sure a burger can change that, not even a really, really good one.

Rebecca Skloot last wrote for the magazine about fish veterinarians. Her first book, ''The Immortal Life of Henrietta Lacks,'' will be published in 2006.

Tuesday, October 12, 2004

HHS-OIG Publishes 2005 Work Plan and 2004 Cost-Saver Handbook

Today the HHS Office of Inspector General posted the Fiscal Year 2005 Work Plan on its website.

The OIG Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. The Work Plan includes projects planned in each of the Department's major entities: the Centers for Medicare & Medicaid Services; the public health agencies; and the Administrations for Children, Families, and Aging.

Also, the OIG added to its website today the 2004 Cost-Saver Handbook, commonly called the Red Book. The Red Book is a compendium of significant OIG cost-saving recommendations that have not been fully implemented. Full implementation of the recommendations in the 2004 edition of the Red Book could produce substantial savings to the Department.

Wednesday, October 06, 2004

GAO Report: First Year Experiences under the Federal Privacy Rule (HIPAA)

The U.S. Government Accountability Office issued Report GAO-04-965 on September 3, 2004, "Health Information: First-Year Experiences under the Federal Privacy Rule" which analyzes the impact of HIPAA Privacy on consumers and the health care industry.

The GAO also issued highlights of the Report. Overall health care providers felt that implementation went relatively smooth and that new privacy related procedures/policies are now standard in the industry. Health care providers cited two areas where they felt that implementation of the Privacy Rule was particularly difficult to implement and problematic. First, the area of accouting for disclosures. Second, the area of requiring business associate agreements for downstream users of protected health information by those defined as business associates.

The report also indicates that consumer groups fell that the general public is not well informed about their particular rights under the Privacy Rule and don't understand the nature and substance of the privacy notices that they receive.

The Report recommends that HHS (1) require that patients be informed of mandatory disclosures
to public health authorities in privacy notices and exempt such disclosures from the accounting
requirement, and (2) conduct a public information campaign to improve patients’ awareness of
their rights. HHS noted that it continues to monitor the public’s experience with the accounting
provision to assess the need to modify the rule and described ongoing efforts to educate consumers. The GAO continued that it remains concerned about the burden of accounting for disclosures to public health authorities and believes it is important that HHS more effectively disseminate information about the Privacy Rule.

If my personal experiences with HIPAA Privacy are like others -- I have not taken the time to indivudually read each Notice of Privacy Practice that I have received from a health care provider. I think there are many parallels between HIPAA Privacy notices to patients and Gramm-Leach Bliley notices to financial and insurance consumers. As an attorney who deals in privacy related issues daily I have not been that concerned about reading the notices, studying the opt out options, etc. The general public is more concerned about issues other than privacy. For example, how much my copay went up this year because my insurance coverage (if the individual is not a part of the growing number of the uninsured) was reduced. Not until you feel your individual privacy rights have been violated by your health care provider will you come forward, read the notice and seek to enforce some of new requirements of HIPAA on the health care provider.

Tuesday, September 28, 2004

Lawsuit by WV Physician Against Trial Lawyer's Association Dismissed by WV Supreme Court of Appeals

Here is a link to another WV legal blog discussing the WV Supreme Court of Appeals decision to not hear the physician's appeal to overturn the dismissal of her case against the West Virginia trial lawyer's assocation.

Sunday, September 19, 2004

Listen to Justice McGraw Ad

Here is a link to a copy of a political ad running in West Virginia regarding Justice Warren McGraw's reelection to the West Virginia Supreme Court of Appeals.

You can also hear Justice McGraw's full speech at the Racine WV Labor Day event courtesy of the WV GOP website.

Friday, September 10, 2004

Privacy Lawsuit filed over Tort Reform Infomercial in Georgia

Saw this article today regarding a recent lawsuit filed against a group of doctors, Doctors for Medical Liability Reform, charging them with invasion of privacy and breach of confidentiality.

Doctors for Medical Liability Reform is a coalition of more than 230,000 medical specialists who support federal legislation to reform medical liability laws. Last July the group began an "aggressive, multimillion-dollar" public relations campaign including a 30-minute infomercial that aired on both network and cable television. The infomercial makes the case for medical liability reform through interviews with doctors who have left their practices -- or left Georgia -- and through interviews with the patients they've left behind.

Friday, September 03, 2004

Favorite HIPAA Web Links

Earlier this week I spoke at a Lorman Education Services Seminar on "Confidentiality & Privacy of Medical Information in West Virginia" in Charleston, West Virginia. Here is a copy of the brochure from the seminar, including the agenda.

The goal of the seminar was to provide health information specialists and other health care providers with a relatively comprehensive summary of privacy law in West Virginia. In addition we addressed the impact of the Privacy and Security Rules of the Health Insurance Portability & Accountability Act of 1996 (HIPAA) on West Virginia privacy law.

A number of the participants asked for a list of website that I find useful for gaining knowledge about, interpreting and understanding the new HIPAA laws. Below are some of my favorite web resources on HIPAA.

1. A complete copy of the Privacy and Security Rules (unofficial version). This is a must for any privacy officer.

2. The Administrative Simplification website at DHHS.

3. The HIPAA Privacy section of the Office for Civil Rights website. The FAQ section of this website provides very practical information on the Privacy Rule. Also the OCR has posted various educational materials.

4. The State of West Virginia HIPAA website. This website includes a copy of the State of West Virginia's preemption analysis of various provisions of the West Virginia Code.

5. The Work Group for Electronic Data Interchange (WEDI) website. In particular I like the white papers section of the WEDI website.

Thursday, September 02, 2004

St. Francis Hospital appeals Thomas Memorial Hospital cardiac catheterization lab certificate of need

An article from today's Charleston Gazette discusses the filing of an appeal to the Circuit Court of Kanwaha County over the certificate of need decision issued by the West Virginia Health Care Authority to allow Thomas Memorial Hospital to construct and operate a $2.5M cath lab.

Below is a copy of the full article:

By John Heys
Staff writer

Administrators at St. Francis Hospital have taken their concerns about a new heart catheterization lab at Thomas Memorial Hospital to Kanawha County Circuit Court.

St. Francis filed an appeal Tuesday of a state Health Care Authority decision, which allowed Thomas Hospital to go forward with a $2.5 million lab to diagnose patient’s heart problems.

Bob Gray, a Thomas vice president, said the South Charleston hospital would continue with plans to open its catheterization lab, currently being built on the first floor of the facility’s new medical office building.

“This is all part of the appeal process,” Gray said. “I feel pretty confident we’ll prevail.”

State regulators approved Thomas’ proposal in February despite the concerns of St. Francis and Charleston Area Medical Center, which already have catheterization labs.

After the authority approved Thomas’ plan, the state’s Office of Judges upheld the decision following an earlier appeal by St. Francis. If the authority’s decision is upheld again, St. Francis can take their case to the state Supreme Court.

The hospital, which is owned by the Hospital Corporation of America, based in Nashville, Tenn., is also challenging the authority’s revised standards for heart catheterization labs.

The appeal calls the new rules “arbitrary and capricious,” saying the authority did not justify allowing larger hospitals like Thomas to apply for labs without taking into account existing providers when calculating the need for a new lab.

Officials from St. Francis and CAMC have argued the area does not need another heart catheterization lab. They said Thomas’ lab would siphon off some of their patients and revenue. CAMC has six such labs. St. Francis has two.

Doctors use catheterization to look at the extent of heart disease in a patient. A thin tube is inserted into the arteries of the heart. Using a television screen, doctors can then see how the heart and blood vessels are working.

Thomas’ 5,000-square-foot lab would only diagnose patients. People will still be sent to labs at CAMC and St. Francis for stents and angioplasties.

Thomas administrators tried three times in the past 16 years to get regulatory approval for their lab. The nonprofit hospital’s fourth request, submitted in January 2003, was helped by the change in state standards.

Sonia Chambers, chairwoman of the Health Care Authority, said on Wednesday the agency’s board members stand behind their decision on both Thomas’s proposal and the revised standards.

Sunday, August 22, 2004

Department of Labor FairPay Rules Go Into Effect on August 23, 2004

Tomorrow the U.S. Department of Labor's new FairPay Rules go into effect regarding the Fair Labor Standards Act. Employers should seek to learn more about the regulations and the impact on their employees and business. For more information go to the FairPay Web site created by the Wage and Hour Division of the U.S. Department of Labor.

According to the website the new regulations strengthen overtime protections for workers. Under the new FairPay rules, workers earning less than $23,660 per year — or $455 per week — are guaranteed overtime protection. This will strengthen overtime rights for 6.7 million American workers, including 1.3 million low-wage workers who were denied overtime under the old rules.

The regulations contain new guidance on the "white collar" overtime exemptions under the regulation. Here is a FairPay Fact Sheet on the exemptions for exective, administrative, professional, computer and outside sales employees under the Fair Labor Standards Act.

Saturday, August 21, 2004

Justice Department Opens Broad Investigation of Hospital Purchasing Activities

According to various news reports the Department of Justice (DOJ) has opened a national investigation of the medical-supply industry to assess whether hospitals and other providers are fraudulently overcharging Medicare and other federal and state health care programs for various goods.

A New York Times article reports that, federal subpoenas have been sent out by the DOJ to a substantial number of medical-supply companies relating to the way that suppliers market products to hospitals, nursing homes, clinics, etc. that serve Medicare and Medicaid patients. The article also indicates that the investigation is likely to expand and will include the investigation of specific hospitals and other health care providers.

First Criminal Conviction under the HIPAA Privacy Rule

A press release issued by the United States Attorney's Office for the
Western District of Washington announced the first criminal convication in the U.S. under the health information privacy provisions of the Health Insurance Portability & Accountablity Act of 1996 (HIPAA).

In US v. Gibson, W.D. Wash. No.CR04-0374RFM, Mr. Gibson admitted that he obtained a cancer patient's name, date of birth and social security number while Gibson was employed at the Seatle Cancer Care Alliance, and that he disclosed that information to get credit cards in the patient's name. He racked up more than $9,000 in debt in the patient's name. The terms of the plea agreement include that Gibson should be sentenced to a term of 16 months in federal prison or nome confinement.

The press release stated: "Too many Americans have experienced identity theft and the nightmare of dealing with bills they never incurred. To be a vulnerable cancer patient, fighting for your life, and having to cope with identity theft is just unconscionable," stated United States Attorney John McKay. "This case should serve as a reminder that misuse of patient information may result in criminal prosecution."

Wednesday, August 18, 2004

OCR Issues Two New Fact Sheets on the HIPAA Privacy Rule

Today the Office for Civil Rights (OCR) in the US Department of Health and Human Services issued two new Fact Sheets discussing the impact of the HIPAA Privacy Rule on health care consumers.

According to the OCR the Fact Sheets are designed to provide an easy-to-understand overview of what the Privacy Rule means to consumers. The Fact Sheets can be accessed from the "What's New" column on the OCR website.

The OCR states that, "[t]he first Fact Sheet, entitled, "Privacy and Your Health Information" is a general overview of the Rule, explaining that the Privacy Rule gives individuals rights over their health information, sets rules and limits on how information can be used and disclosed, and requires covered entities to take steps to protect health information. The second Fact Sheet, entitled, "Your Health Information Privacy Rights," focuses on each of the privacy rights individuals have under the Privacy Rule."

Health care providers who are required to comply with HIPAA should read these Fact Sheets to better understand OCR's perspective on what the HIPAA Privacy Rule requires.

$1.5M Stark and Anti-Kickback Settlement Reached with Pennsylvania Ophthalmologist and Two Hospitals

On August 6, 2004, the U.S. Attorney's Office issued a press release that the U.S. Attorney's Office for the Eastern District of Pennsylvania reached a $1.5 million settlement with an ophthalmologist and the former operators of two hospitals in Pennsylvania based on allegations of improper financial arrangements and referral inducements in violation of the Stark and Anti-Kickback laws.

This matter involved a qui tam action alleging that the hospitals proived free space, equipment, personnel, supplies, excessive medical director fees and other services to the physician who operated a number of eye care centers. The physician was hit for $200K and the hospitals had to pay $1M and $250K respectively.

The settlement highlights the importance of physicians and hospitals understanding and complying with the Stark and Anti-kickback laws, especially in light of the recent clarification of the Stark laws under the Stark II Phase II regulations.

Monday, August 16, 2004

Mississippi Hospital Is First to Settle Unisured Patient Class Action

An electronic article in the August 23, 2004 American Medical News reported that a Mississippi hospital, North Mississippi Health Services, which has 650 beds and more than $1 billion in annual billings, is the first facility to settle a nationwide class action targeting non-profit hospitals and the methods they use for charging the unisured for health related services.

Interestingly, North Mississippi Health Services was not even among the facilities sued in the class action. According to the CEO of the hospital the hospital system agreed to the settlement to avoid the distraction and cost of a potential suit.

The article summarizes the terms of the settlement as follows, "uninsured patients who were being charged higher rates than those with private insurance or Medicare will now pay rates based on the hospital's Medicare charges. The lower an uninsured person's income, the less he or she would be charged."

The settlement has been filed in the U.S. District Court for the Northern District of Mississippi. According to the article, "North Mississippi Health Care Services will give free care to patients making up to 200% of the federal poverty level. It also agreed to discounted prices, which range from 50% of the Medicare rate for people earning between 201% and 250% of the federal poverty level to 85% of the Medicare rate for those making between 301% and 350% of the poverty level. In addition, the hospital agreed that it would not try to collect more than 10% of someone's income in a given year to recoup medical bills."

Nonprofit hospitals were the first to face these class action styled lawsuits in June 2004. However, now for-profit hospitals are being targeted. Earlier this month lawyers in Florida and Nevada filed actions against for-profit hospitals, including Health Management Associates, Universal Health Services and HCA, Inc. Archie Lamb, the Alabama lawyer who helped physicians bring lawsuits against managed care companies for their billing practices, is among the lawyers suing the for-profit facilities.

According to the article, "[t]he lawsuit in Florida alleges that Health Management Associates, a Naples-based hospital chain, billed uninsured patients for amounts far greater than what Medicare and insurance companies would have been charged for the same services. The lawsuit alleges that these higher charges violate Florida's Deceptive and Unfair Trade Practices Act." The article goes on to states that the lawsuits in Nevada Lamb against Universal Health Services and HCA Inc. alleges that the hospital systems violated state anti-racketeering laws.

Having been involved in large class actions filed against hospitals I can certainly understand the position taken and empathize with the CEO of the Mississippi hospital who stated that his hospital wanted to avoid the distraction and cost of a potential suit. The fact that the hospital is willing to settle a potential class action claim before any formal action is filed against the hospital speaks volumes about the power of a "threat" of class action has on business and industry. The mere fact of being drawn into a class action lawsuit, whether or not the action is frivilous or has merit, can be a daunting and distracting undertaking for any business or health care provider.

For more information about the non-profit hospital class action litigation you can visit the website set up by the law firms involved in the case. This website includes a summary of the litigation, documents filed in the action, press releases about the case, law firms and lawyers involved in the case, etc.

Sunday, August 15, 2004

WEDI Issues New HIPAA Security White Paper

On August 3, 2004 WEDI (Workgroup for Electronic Data Interchange) issued a new HIPAA Security Rule risk analysis white paper and a corresponding power point presentation.

The white paper issued addresses the final Security Rule requirement that all HIPAA "covered entities" perform a security "risk analysis." The white paper discusses solutions various covered entities can consider adopting to meet the requirement to complete a risk analysis. In order to begin the Risk Analysis process, one must first review the final Security Rule in general and its guidance regarding HIPAA security implementation.

Tuesday, August 03, 2004

Competition vs. Regulation: Would the Health Care System in West Virginia Benefit from More Competition or Stronger Regulation?

A Charleston Gazette article recently discussed a new report issued by the Department of Justice and Federal Trade Commission addressing and arguing against the need for state regulatory process such as as the certificate of need process in West Virginia. The report argues that state regulatory processes do not control health care costs, provide greater access to health care and instead discourage competition. Officials in West Virginia disagree with this conclusion because it fails to recognize the limited health care resources available in rural states like West Virginia. The positions taken on this issue revolve around the age old question of competition vs. regulation and which is better at serving the needs of the public.

Below is a copy of the Gazette article:

If a hospital in West Virginia wants to add more beds, build a new wing or start offering open-heart surgery, administrators must first get the OK from state regulators. A new report from two federal agencies recommends West Virginia and other states think about scrapping that system.
The report, jointly issued last month by the U.S. Department of Justice and the Federal
Trade Commission, argues that the regulations don't control health-care costs and discourage competition. The state's chief health-care regulator and some local hospital officials disagree. They say the report ignores the limited health-care resources and rural nature of West Virginia, as well as the state's existing rate-review process for hospitals.
"I just think that would be a formula for disaster," said David Ramsey, president and chief executive officer at Charleston Area Medical Center, about the prospect of letting hospitals expand as they wish.
Hospitals often use profits from services that make money - such as outpatient imaging and surgery - to pay for those that don't. Without the state's regulations, some hospital administrators worry specialty facilities will crop up to offer these money-making services,
leaving hospitals no way to recoup their losses.
The report's authors conclude regulations like West Virginia's stifle competition by allowing providers to block others from entering markets. The state's rules allow providers to oppose proposals by competitors. But Sonia Chambers, chairwoman of the state's Health Care Authority, said access to health care is a bigger concern than competition in many
rural parts of the state. "There aren't very many places in West Virginia where you can have
competition in health care," Chambers said.
Steven Summer, president of the West Virginia Hospital Association, said the report does not take into account the high percentage of state residents covered by government insurance programs, such as Medicare and the Public Employees Insurance Agency. These programs pay hospitals less than private insurers.
Steve Dexter, president of Thomas Memorial Hospital, worries that without regulation, specialty hospitals would cherry-pick the few privately insured - and profitable - patients. Hospitals like Thomas would be left to care for the uninsured and those covered by government
insurance programs, Dexter said.
Administrators at the South Charleston hospital waited 15 years through several different applications before state regulators allowed the South Charleston hospital to open a cardiac catheterization lab. But Dexter said he isn't ready to get rid of the state's current review process.
"The state is trying to put a rational system in place," Dexter said. West Virginia's rules, which have existed in some form since 1977, require health-care providers make their case to regulators before making large capital improvements, such as buying new equipment or
expanding services.
Providers must show the services are needed, consistent with the state's
health standards and financially feasible. Chambers said lawmakers and governors have periodically reviewed how the state approves new health-care services and they have yet to change how the authority decides what projects to approve or reject. "I think that every governor and Legislature has determined the [certificate of need] process is working," Chambers said. The release of the 360-page report comes one month after the U.S.
Department of Justice alerted three West Virginia hospitals they were being investigated for possible antitrust violations.
Bluefield Regional Medical Center, Princeton Community Hospital and CAMC learned in June federal officials were investigating the hospitals' partnership to offer open-heart surgery in Bluefield. The state Health Care Authority, which has encouraged hospitals to work
together to offer services, gave its blessing to the hospitals' proposal
in August 2003.
Thirty-five other states and the District of Columbia have some type of
regulatory review when health-care providers wish to expand.

Monday, August 02, 2004

DHHS Announces New Health Information Technology Initiative

Department of Health and Human Services (DHHS) Secretary Tommy G. Thompson July 21 released a press release detailing a report "Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care," which outlines a ten-year plan for implementing the adoption of electronic health records for all Americans. The report cites four major goals in the initiative: (1) bringing information tools to clinical practice; (2) building a healthcare information infrastructure; (3) using health information technology to encourage people to be involved in their healthcare decisions; and (4) expanding public health monitoring, quality of care measurement, and bringing research advances more quickly into medical practice. The new initiative is designed to transform the delivery of healthcare by building a health information infrastructure that will include electronic health records (EHRs) for all Americans and a nationwide network to link health records.

DHHS also issued a fact sheet about the report.

FTC/DOJ Issue Joint Report On Competition In Healthcare Industry

On July 23, 2004 the Federal Trade Commission (FTC) and the Department of Justice (DOJ)
released a joint report examining competition in the healthcare sector and recommending ways to improve performance of the marketplace. The 361-page report, "Improving Health Care: A Dose of Competition," stems from twenty-seven days of hearings on healthcare and competition
held from February through October 2003, an FTC-sponsored workshop in September 2002, and independent research. The report focuses on a number of key areas, including the importance of reliable information on prices and quality, eliminating barriers to competition, and relying on competition when possible.

Communities in Illinois Take Unique Local Approach to Tort Reform

Two small communities in Illinois have taken tort reform to the local level by passing local ordinances which place caps on noneconomic damages that can be awarded in medical malpractice cases. The ordinance also requires that such lawsuits be filed in the county where the alleged malpractice took place.

Carbondale (population 25,000) and Marion (population 16,624) have both passed ordinances and nearby Herrin (population 11,406) passed a resolution supporting Carbondale's action. Another community, Mount Vernon (population 16,486) was considering a local ordinance.

Carbondale and Marion passed their ordinances under Illinois' "home-rule" authority. Under home rule, cities have a broad right to pass laws dealing with issues of particular concern in their communities. Cities with more than 25,000 residents are entitled to home rule automatically. Residents in smaller cities can adopt these powers through a referendum. Carbondale's and Marion's tort reform ordinances cap noneconomic damages at three times the economic damages. Trial lawyers believe that the ordinances are unconstitutional and unfair to injured patients.

You can read more about this story here.

Tuesday, July 20, 2004

West Virginia Native John Chambers, CEO of Cisco Systems, Talks about the Costs of Paper on the Health Care System

A recent USA Today article talks about the impact a paper based health care record system has on the costs to the health care system. Below are excerpts from the article.

John Chambers, CEO of Internet titan Cisco Systems (CSCO) and a native of West Virginia, says that based on tech's impact on other industries, technology could cut health care costs by at least 25% - and improve care. In May, President Bush set the goal for every American to have an electronic medical record, instead of the traditional stuffed manila folder, within 10 years. At the same time, he named David Brailer to the new position of national coordinator of health information technology.

On Wednesday, Brailer is expected to announce government plans to nudge the industry forward. In the past 18 months, lawmakers introduced at least five bills pushing health care tech ideas.

It won't be an easy fix, though. Billions in investments have been lost on health care tech. The reasons are many. Health care is a huge, fragmented industry: 700,000 doctors; 5,700 hospitals. Each piece collects data its own way. Existing systems don't talk to each other. More common standards are needed. Privacy has been a concern.

The biggest reason, though, is economic. Doctors and hospitals bear the cost of new hardware and software. Their productivity suffers when they change decades-old work processes. But those who pay for care, insurers and employers, get the first financial benefit because of increased efficiency and fewer costly errors.

More than 90% of the 30 billion health care transactions done annually occur via phone, fax or paper, says the eHealth Initiative, a non-profit formed to spur tech adoption. While 90% of physicians in Sweden and the Netherlands use electronic patient medical records, fewer than 20% of U.S. primary-care physicians do, the same percentage as Greece, says market researcher Harris Interactive.

Health and Human Services Secretary Tommy Thompson estimates the USA could save $140 billion a year using more tech. That's a lower estimate than Chambers', but about equal to Mexico's '04 federal budget.

Monday, July 19, 2004

CMS Says All Physician Recruiting Contracts Must Comply With Stark Phase II Regulations

In a new Frequently Asked Question, CMS said that all physician recruiting agreements, even those that pre-date the Stark II Phase II regulations, must comply with the regulations effective July 26, 2004. According to the FAQ, the Phase II regulations, including the new exception at § 411.357(e)(4) for certain joint recruitment arrangements, go into effect July 26. Therefore, "a hospital-funded recruitment arrangement in which the recruited physician is subject to a restriction against competing with the group will not comply with the new joint recruiting exception in the Phase II regulations." To read the FAQ, go here

Friday, July 16, 2004

Hospitals and Physicians should analyze the impact of Stark II

The Stark II Phase II regulations were published as an interim final rule on March 26, 2004 and will become effective on July 26, 2004. 
The Stark law (aka federal physician self-referral law) prohibits physicians from referring Medicare patients for certain designated health services (DHS) to an entity with which the physician or a member of the physician's immediate family has a financial relationship--unless an exception applies. Stark was originally enacted under Section 1877 of the Social Security Act  in 1989 and only applied to physician referrals for clinical laboratory services. In 1993 and 1994, Congress expanded the prohibition to ten additional DHS and applied certain aspects of the law to the Medicaid program. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) (Public Law 108-173) further altered section 1877 by establishing an 18-month moratorium on physician ownership of or investment in certain specialty hospitals. The moratorium is in effect from December 8, 2003 through June 7, 2005. The Stark law is typically used in conjunction with the anti-kickback laws to investigate health care providers for reimbursement related actions under Medicare and Medicaid. In addition, Stark is being used more and more as a basis for qui tam related whistleblower actions brought by individuals. 
The new regulations clarify a number of areas of Stark law that have been confusing and uncertain for years. Health lawyers have tried to provide the best advice possible to their clients when looking at Stark related issued -- but because final regulations have been long in coming it has been very difficult to fully understand the complexity of some of the Stark related exceptions. Now that Stark II Phase I and Phase II have been issued many of the gray areas are now much clearer. What will this lead to? More enforcement? More qui tam whistleblower claims which contain Stark related allegations? Only time will tell. Hospital, physicians and other designated health service care providers should take a close look at the impact of the new regulations.

Thursday, July 15, 2004

Interesting law firm websites

Here is a blog that reports on and tracks intriguing websites for law professionals.

Kessel v. Monongalia General Hospital (May 19, 2004)

Following is a description and link to a recent decision by the West Virginia Supreme Court of Appeals which impacts the ability of hospitals in West Virginia to enter into exclusive agreements with physicians.

EMPLOYMENT, CONTRACTS :: Staff privileges in public hospitals
KESSEL, et al. v. MONONGALIA GENERAL HOSPITAL, et al., Nos. 31547 & 31548 (Maynard, J.)(May 19, 2004). Answering the following certified question from the Circuit Court of Monongalia County (as reformulated by the Court): "May a public or quasi-public hospital enter into an exclusive contract with a medical service provider that has the effect of completely excluding physicians who have staff privileges at the hospital from the use of the hospital's medical facilities." Answer by the Court - No. Setting forth guidance regarding interpretation of medical staff bylaws; a physician's right to practice in public hospitals; duties of quasi-public hospitals; and effect of exclusive contracts with medical service providers.

Here is a link to the full text of the decision.

Friday, July 09, 2004

Letter to DHHS Secretary Addresses Privacy Rule & Child/Adult Protective Services

HIPAA Government Information Value Exchange for States (HIPAA GIVES) a collaborative state government focus group created to share information through a clearinghouse highway and provide a forum for state government and county government agencies to discuss and resolve implementation issues concerning the HIPAA Administrative Simplification rules.
On May 5, 2004, HIPAA GIVES sent DHHS Secretary Tommy Thompson a letter regarding the adverse effect the HIPAA Privacy Rule on state and local governments’ Child Protective Services and Adult Protective Services.

Monday, July 05, 2004

HHS OIG Posts Second Hospital Board Member Educational Resource

On July 1, 2004 the HHS Office of Inspector General posted to its website a second
educational resource which was developed jointly with the American Health Lawyers Association to assist health care organizations' boards of directors in carrying out their compliance oversight responsibility. The new resource is titled "An Integrated Approach to Corporate Compliance: A Resource for Health Care Boards of Directors".
Here is an accompanying press release providing details about the guidance resource. This second educational guidance documents supplements a previously released resource called  "Corporate Responsibility and Corporate Compliance: A Resource for Health Care Boards of
 issued in April 2003.