Avoiding the Disaster After the Disaster

1
Avoiding the Disaster After the Disaster

• Tuesday, June 21, 2005
• 100 PM - 200PM

2
Thank You

• To all, participating in these calls
• To Bill Bazan and others at WHA
• To WHA and Michael Best and Friedrichs LLP for
  the completion of the Hospitals Guide to Mass
  Casualty Incidents

3
Goal

• To provide specific guidance to hospitals in the
  various topic areas, referenced in the Health Law
  Manual by September 2006

4
Process Step One

• A baseline of existing federal and state
  legislation, pertaining to emergencies has been
  achieved through the Health Law Manual
• However, a quick read of the Manual shows that
  there are many unanswered questions

5
Process Step Two

• WHA Legal Issues Hotline
• MBF to periodically up-date Manual
• Legal Issues Workgroups

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Workgroups

• State Expert Panel on Disaster Reimbursement
• Wisconsin Disaster Credentialing Management
  Council
• 12 Legal Workgroups being established
• HRSA Funding available to support this legal
  research
• Legislative advocacy through WHA

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Workgroups

• Refer to Be Part of the Solution Handout Join
  one or more of the workgroups
• Invite others at your hospital to join
• Send in your questions individually, if you
  cannot join a workgroup
• Invite others at your hospital to send in
  questions individually

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Hospitals Guide to Mass Casualty Incidents

• Share the Manual with key people at your hospital
• Or, at least, share pertinent sections of the
  Manual with key people at your hospital

9
Avoiding the Disaster After the Disaster

• During the incident, all will applaud your
  hospital for its efforts
• Months later, people will tend to forget your
  heroic efforts and may file grievances, based on
  what may have happened to them or their family
  members

10
Sample of Issues

• This is not meant to be a legal commentary or
  analysis
• Rather, it is a review of the various topic areas
  from an administrative perspective

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Need for Additional HCWs

• A mass casualty incident can quickly deplete your
  human resources
• What options are available to add needed staff to
  your hospital?
• HCWs as Volunteers
• HCWs as employees of the requesting hospital
• HCWs as employees of the sending hospital

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Volunteer Issues

• Protections from
• Liability
• Injury
• Disclosure Statements
• Disclosures for in-state HCWs
• Disclosures for out-of-state HCWs
• WI HCWs going out-of-state
• HCWs coming into WI

13
Workers Compensation

• Who is covered and when
• Effect of the incident upon your modification
  factor
• Mitigation by cap on catastrophic claims
• Incident injuries excluded from your experience
  rating
• What coverage is there for HCWs injured at your
  hospital not covered by Workers Comp

14
Contracted Employees

• Union contract to address ability to
• require OT
• allow job transfers
• ability to sub-contract
• hire non-union employees
• Same will apply to contracts with Independent
  Contractors

15
Employee Benefits

• Right of hospital to adjust benefits
• Statement in the Employee Handbook
• Required benefits harder to administer
• FMLA (many will request leave some will simply
  leave)
• Military Leave advance notice precluded by
  necessity (plan for quantifying potential losses)
• Jury Duty proactive plan to exempt HCWs

16
OSHA Compliance

• General Duty clause will apply
• Record keeping and logging of work related
  injuries and illnesses
• Other OSHA standards
• Blood borne pathogens
• PPE
• HAZWOPER

17
Credentialing

• Work now being done by WDC Management Council
• Work being done at national level (ESAR-VHP)
• Disaster credentialing held to same standard as
  day-to-day credentialing
• Emergency credentialing
• Disaster credentialing

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Credentialing

• Process is the easiest part
• Registration and credentialing
• Liability issues are more difficult
• Disclosure Statement
• Question about portability of malpractice
  insurance
• Role of lapsed licensed HCW
• Out-of-state HCWs

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Reimbursement Issues

• State Expert Panel on Disaster Reimbursement
• Payors Medicare, Medicaid, Commercial Insurance,
  HMO, self-funded employers
• Providers hospitals, physicians, EMS
• Associations
• Report due September 2005

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Issues Being Addressed

• Exemptions and Exclusions
• Special Codes for incidents
• Special modifications of payor rules
• Catastrophic Insurance
• Modifications to contracts

21
Coordination of Plans

• Protections for hospitals take effect when plans
  are coordinated with local Emergency Management
  plans
• Hospitals are now being held to a higher standard
  of care based on the need for planning,
  collaboration, and funding availability for
  preparedness
• Why were you not prepared?

22
Alternative Treatment Sites

• Definition of ATS
• Wisconsin plan for ATS
• Hospitals will use non-traditional centers for
  care and treatment
• Triage center apart from hospital
• ER for high acuity patients with lesser acuity
  patients sent to ATS

23
Security

• Limited to no authority for hospital security
  staff
• Ability to control crowds
• Ability to keep people out of the hospital
• Ability to search

24
Quarantine, Isolation, Detention

• Existing statutes provide coverage for avian
  flu/pandemic influenza
• Integration of Q/I/D with public health
• Payment for Q/I/D costs by county government
• Payment for Q/I/D costs, borne by hospital for
  staff, patients and visitors

25
Confidentiality

• Some modifications to existing protocols for
  emergencies are provided
• Need for a policy regarding what modifications
  are allowed in an emergency
• who authorizes this
• who terminates this

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EMTALA

• Standard triage does not satisfy EMTALA
• Plan now is that GREEN (ambulatory) patients
  may be referred out of the hospital to the ATS
• Some limited EMTALA modifications exist during an
  emergency

27
Medical Records

• No present rules to modify existing requirements
  for medical records in an emergency
• Compliance is difficult with surge of patients

28
Property Insurance

• What are the limitations and exclusions?
• What about applicability of this insurance to ATS?

29
Business Continuity Insurance

• Its effects on loss of business due to
  cancellation of admissions and procedures and
  other normal business
• Recovery of costs OT, supplies at higher costs,
  quarantine costs, housing, food, etc.

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Other Insurances

• Exclusions and limitations such as effect of an
  incident upon Life Insurance for employees and
  their family members

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Next Steps

• Read the Health Law Manual
• Share the Manual with Staff
• Join a workgroup
• Identify and report questions and issues

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What Is Next With HRSA?

• Funding award of 8,887,129 expected 9/1/05
• Funding award of 6 7 Million expected 9/1/06
• Project period ends 8/31/07
• Planning and implementation to be completed by
  8/31/07
• Sustainment budget expected thereafter

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Comments and Questions
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Contact Information

• Bill Bazan
• VP Metro Milwaukee
• Wisconsin Hospital Association
• 414-431-0105 bbazan_at_mailbag.com

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Contact Information

• Dennis J. Tomczyk
• Director, Hospital Bioterrorism Preparedness
• Wisconsin Division of Public Health
• 608-266-3128 tomczdj_at_dhfs.state.wi.us