Mismanagement 2 year probation

[warrenr]

This physician received 2 year probation for anticoagulation mismanagement.
This is from the Arizona Medical Board

Wednesday, February 7, 2007
CALL TO ORDER
The meeting was called to order at 9:30 a.m.
ROLL CALL
The following Board Members were present: Patrick N. Connell, M.D., Robert P. Goldfarb, M.D., Patricia R.J. Griffen, Becky Jordan, Ram R. Krishna, M.D., Douglas D. Lee, M.D., Lorraine Mackstaller, M.D., William R. Martin, III, M.D., Sharon B. Megdal, Ph.D., Dona Pardo, Ph.D, R.N., Paul M. Petelin, Sr. and Amy Schneider, M.D.
CALL TO PUBLIC
Statements issued during the call to the public appear beneath the case referenced.
FORMAL INTERVIEWS
NO.
CASE NO.
COMPLAINANT v PHYSICIAN
LIC. #
RESOLUTION
1.
MD-06-0277A
C.P.
JOE T. HAYASHI, M.D.
12865
Draft Findings of Fact, Conclusions of Law and Order for a Decree of Censure for failure to recognize the importance of adequately maintaining an adequate INR in face of multiple other risk factors for increase hypocoaguability and for failure to properly supervise a medical assistant. Two year Probation to include a PACE evaluation for general and internal medicine within 60 days and comply with any recommendations made by PACE. Board Staff shall conduct random chart reviews. The Probationary term shall not terminate upon completion of the PACE evaluation.
CP was present and spoke during the call to the public on behalf of her mother, the patient of Dr. Hayashi. CP said Dr. Hayashi?s medical records were inadequate and he failed to properly manage her mother?s care when 10 out of 13 laboratory reports showed her mother had subtherapeutic INRs. CP also noted Dr. Hayashi had a significant prior Board history.
Joe Hayashi, M.D. was present with counsel, Mr. Rick Delo.
Kelly Sems, M.D., Internal Medical Consultant summarized the case for the Board. Staff found Dr. Hayashi failed to properly monitor anticoagulation status for the patient, failed to maintain adequate medial records and failed to properly supervise his medical assistant.
Dr. Hayahsi said he did not feel it was necessary to micromanage the INRs as they were in the therapeutic range initially. Dr. Hayashi said his Medical Assistant (MA) did not notify him that the patient?s last protime was low. Dr. Hayashi said he learned of this when he reviewed the chart a few days later on a Friday and he recommended the patient return to the office on Monday morning. However, the patient experienced a stroke over the weekend.
Lorraine Mackstaller, M.D. led the questioning. Dr. Mackstaller questioned Dr. Hayashi regarding the patient?s subtherapeutic INRs and Dr. Hayashi said he thought they were just aberrations at first. Dr. Hayashi said he has since made changes in his office so that MAs cannot directly report labs or x-ray results to patients, but the results must be given instead to him. Robert P. Goldfarb, M.D. opined that Dr. Hayahsi should have had the patient present to his office on the Friday when he discovered the low protime. Dr. Goldfarb found Dr. Hayashi should have re-checked the patient?s INR at that point instead of telling the patient to present on Monday.
William R. Martin, III, M.D. noted Dr. Hayashi had a prior Board history for a similar set of facts as in this case. Dr. Hayashi said this case was different because it demonstrated an administrative error in his office and was not due to medical negligence on his part.
Mr. Delo said there were not 10 subtherapeutic INRs in this case as even the Board?s Medical Consultant found that many of the INR?s for this patient were close to normal range. Dr. Hayashi refutes all of the allegations in this case.
Dr. Mackstaller said the patient had two mechanical valves, was in atrial fibrillation and because of such, it required the patient have an INR of 2.5 to 3.5. Dr. Mackstaller found Dr. Hayashi should prescribed Aspirin for the patient when her INR fell to 1.6. Dr. Mackstaller also was concerned that Dr. Hayashi had the patient on hormones that increased the patient?s risk for clotting. Dr. Mackstaller found actual harm in this case in that the patient suffered a cerebrovascular accident as a result of Dr. Hayashi?s care.
MOTION: Lorraine Mackstaller, M.D. moved for a finding of Unprofessional Conduct in violation of A.R.S. §32-1401(27)(q)- Any conduct or practice that is or might be harmful or dangerous to the health of the patient or the public, A.R.S. §32-1401(27)(ii) - Lack of or inappropriate direction, collaboration or direct supervision of a medical assistant or a licensed, certified or registered health care provider employed by, supervised by or assigned to the physician and A.R.S. §32-1401 (27)(ll)- Conduct that the board determines is gross negligence, repeated negligence or negligence resulting in harm to or the death of a patient.
SECONDED: Ram R. Krishna, M.D.
VOTE: 12-yay, 0-nay, 0-abstain, 0-recuse, 0-absent
MOTION PASSED.
MOTION: Lorraine Mackstaller, M.D. moved to Draft Finding of Fact, Conclusions of Law and Order for a Decree of Censure for failure to recognize the importance of adequately maintaing an adequate INR in the face of multiple other risk factors for increased hypocoagulation and for failure to adequately monitor office staff.
SECONDED: Ram R. Krishna, M.D.
Draft Minutes for the February 7-8, 2007 Board Meeting
Page 9 of 21
Dr. Megdal suggested adding a Continuing Medical Education (CME) requirement to the Order along with a two year Probation for records review and without early termination of the Order. Dr. Goldfarb said he concerned about Dr. Hayashi?s medical decision as evidenced in this case and noted Dr. Hayahsi testified he was currently monitoring 60 patients on Coumadin.
MOTION: Lorraine Mackstaller, M.D. moved to amend the motion to Draft Findings of Fact, Conclusions of Law and Order for a Decree of Censure for failure to recognize the importance of adequately maintaining an adequate INR in face of multiple other risk factors for increase hypocoaguability and for failure to properly supervise a medical assistant. Two year Probation to include a PACE evaluation for general and internal medicine within 60 days and comply with any recommendations made by PACE. Board Staff shall conduct random chart reviews. The Probationary term shall not terminate upon completion of the PACE evaluation.
SECONDED: Ram R. Krishna, M.D.
ROLL CALL VOTE: Roll call vote was taken and the following Board Members voted in favor of the motion: Patrick N. Connell, M.D., Robert P. Goldfarb, M.D., Patricia R.J. Griffen, Becky Jordan, Ram R. Krishna, M.D., Douglas D. Lee, M.D., Lorraine Mackstaller, M.D., William R. Martin, III, M.D., Sharon B. Megdal, Ph.D., Dona Pardo, Ph.D, R.N., Paul M. Petelin, Sr. and Amy J. Schneider, M.D.
VOTE: 12-yay, 0-nay, 0-abstain, 0-recuse, 0-absent
MOTION PASSED.

 

[Mary]

The report says the doctor realized the level was below the theraputic range on Friday and had the patient make an appointment for MONDAY???
That alone speaks volumes to his ability to continue managing his 60 patients who are receiving anticoagulation.
His CEU completion needs to come from attendance at one of Al's seminars.

 

[catwoman]

I agree with Mary.

Warren: What's the status of the action against your dad's doctors?

 

[Ross]

Dr. Hayashi said he has since made changes in his office so that MAs cannot directly report labs or x-ray results to patients, but the results must be given instead to him.

I would find this way too easy to abuse. Interested in what some of you others think. I honestly think we should know before they do.

 

[warrenr]

still ongoing

still ongoing

I agree with Mary.

Warren: What's the status of the action against your dad's doctors?

It is still ongoing with a new trial date of 10/22/07.

 

[Blanche]

Not the first time

Not the first time

I hang my head...I live in Arizona. This internist practices in SunCity West, which is a retirement community. This is not the first time he was investigated for a patient who was in jeopardy of a stroke because of his lack of attention and action. I also noted that the doc in question has been practicing for almost 30 years. Good Grief!!!!

What this says to me is that we all have to be vigilant when it comes to our medical practitioners. Here in Arizona we have a Board of Examiners who list docs and their records. I always use it before visiting a new doctor. When I needed surgery for ovary removal, I checked one Gyn surgeon and found that he had more than several serious concerns in past. I think I dodged a bullet on that one.

Here is the addy for Az site. http://www.azmd.gov/

Thanks for posting this, Warren.

Blanche

 

[Guest]

If he had not prescribed aspirin for atrial fibrillation and a mechanical valve and had the patient take a double dose of warfarin on the Friday, the patient may not have had a stroke. At least the doctor would probably not been guilty of negligence because he would have taken a step in the right direction.

It also illustrates that IV draws and lab testing is accurate but it makes little difference if the abnormal lab value is not acted upon. If the doctor had a finger-stick tester, there would have been immediate action because the patient would have still been there.

 

[lance]

Sobering food for thought

Sobering food for thought

If he had not prescribed aspirin for atrial fibrillation and a mechanical valve and had the patient take a double dose of warfarin on the Friday, the patient may not have had a stroke. At least the doctor would probably not been guilty of negligence because he would have taken a step in the right direction.

It also illustrates that IV draws and lab testing is accurate but it makes little difference if the abnormal lab value is not acted upon. If the doctor had a finger-stick tester, there would have been immediate action because the patient would have still been there.

There's a lesson there for doctor's opposed to the use of INR patient self-monitoring. It makes a good case for the use of INR finger-stick method of care.

 

[Rich]

Warren,

Warren,

It sounds like this doctor got off with a slap on the wrist, he deserved a lot more.
A similar thing happened to my wife's sister in Florida. Because of it she suffered a major stroke and died a few weeks later. Whether or not my brother-in-law is pursuing this, I don't know.
Ross,
I get my blood checks at the hospital lab every month, the old-fashioned way if you will. Up until about six months ago I was told by the lab to call the lab myself if I so desired. I did this on multiple occasions when the my doctor's office was closed for holidays, weekends, etc.
Then about six months ago the hospital started a new privacy policy, and patients can no longer obtain their results themselves.
This really infuriated me and I sent the director of the hospital a VERY strongly worded letter. I told him this was ridiculous, I certainly don't give a damn if everyone in this world knows what my INR is !! I also told him about my sister-in-law's case, and warned him if something like that happened to me they could face a lawsuit. But of course it did no good when fighting a beuracratic nightmare like that.
Now my doctor's office and I have an agreement that when I have a blood test, I call them right after and they contact the lab to get me my results the same day. So far so good.
Rich
PS: I did tell my doctor that all I need from him is the prescription for the tests, other than that I can manage my INR myself thanks to Al and this great forum. He didn't like that a lot but that's too bad.
Hopefully it woke him up.

 

[Ross]

Rich you'd think with the Hippa law, they'd have no choice but to tell you. They are part of your records. Sometimes I think this thing works against you rather then for you.

 

[jeffp]

Then about six months ago the hospital started a new privacy policy, and patients can no longer obtain their results themselves..

Let me see if I have this right ... to protect your privacy, they can't tell you your results. Do they also blindfold the lab techs? How about the records clerks? This is a very typical example of HIPAAmania. Very few administrators have actually read and understand the regulations, especially the intent of the rules. It's been 4 years now, and still they can't get it right.

Just smile and do what you have to do to look after your own best interests. Sorry, I didn't mean to hijack the thread.

 

[Marty]

Health Connect

Health Connect

1.The Maryland physician I posted about a couple of years ago did have his license lifted and will be on probation if he gets it back.
2. Mid Atlantic Kaiser recently rolled out a computer system called " health connect" where patients have immediate access to all their lab work results. This is a good thing and seems to be working well. Also, all physicians get the reports immediately on opening their computers and can no longer say they were not notified of important lab and X-ray findings.

 

[Rich]

Jeff,
I don't get it but as you said we just have to do what is best for us.
I can understand a little, where maybe a patient has some communicable disease. This might protect them from an employer finding this out, etc.
But for patients like us it is ridiculous, as I said if the whole world knows my INR results, that's just fine with me. Delays in getting test results can be(and have been) life threatning. Now I notify my doctor's office right after my blood test so they can look for it.
Marty,
That sounds like what I would like to see.
In this case the doctor's office though has to go look for the test results, it just doesn't pop up for them.

 

[Marty]

Rich, I am told all medical records will be computerized in the next few years.
Lets hope sooner rather than later- and patient privacy will be maintained.