Page 16
style of collaboration and partnership with patients”. The National Quality Forum developed Safe Practices in 2003; the 2006 revision, Safe Practices for Better Healthcare, listed 30 practices. The 2009 update contains 34 practices, which are organized under seven functional categories. The first of these categories is “Promoting a Culture of Safety”. Healthcare has a history of a movement away from the paternalistic, provider-centered treatment that has been the prevailing practice methods for many years, to one in which the healthcare consumer and the provider work in partnership to plan and implement the best treatment and care for that particular individual or family. While some professional disciplines and some individual professionals have been more open to this kind of interaction with patients, others struggle with such relationships.A collaborative partnership for healthcare between patients and providers requires that the provider must make communicating with the patient a priority. Good lines of communication between patient and provider improves the healthcare relationship. Such open communication, particularly good listening skills on the part of the provider, also facilitates education of the patient and encourages the patient to consult more actively with the provider. Improving provider patient communication has been highlighted as a method for reducing medical errors. A controversial intervention, recommended by the IOM (2006), is that healthcare providers must be more forthcoming when a medical error occurs, and to clearly explain what consequences, if any, have resulted from the error. There are opposing viewpoints about disclosing medical errors to patients and family members. Risk managers, healthcare administrators and attorneys may not share this perspective. The National Patient Safety Foundation (2009) has instituted a Universal Patient Compact. This Compact expands on principles contained in the Consumer Bill of Rights to describe a mutual covenant between healthcare providers and their patients. Utilizing this Compact as a guide to practice helps to promote a healthcare partnership between patient and provider. Because they often spend more time with patients than do other members of the healthcare team, nurses are in a unique position to be able to promote the Principles for Partnership contained in Universal Patient Contact. These Principles are not inconsistent with nurses ethical responsibilities outlined in the Code for Nurses (ANA, 2001). This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead ofaddressing legal concerns. Last Update: October 2005 EXPERT WITNESS FEES State law is ambiguous as to how much physicians may charge to testify as expert witnesses. According to state law, as an expert witness in a civil action, a physician may be allowed an expert witness fee “in an amount agreed to by the parties.” Section 92.231(2), Florida Statutes. The fee for ordinary witnesses is only $5 per day, plus six cents per mile for the actual distance covered to and from the court. Section 92.142(1), Florida Statutes. Of course, most courts hold that a physician testifying as an expert is entitled to much greater compensation, and the physician may request any "reasonable" amount. Judges routinely award $250-300/hour to family and primary care physicians and greater amounts to those with more specialized expertise. In Workers' Compensation cases, however, deposition fees are limited to $200/hour for treating physicians and $200/day for physicians that do not provide direct professional services but merely review medical records and provide an expert opinion. Section 440.13(10), Florida Statutes. Regardless, the physician's charge should be confirmed in writing by the person employing the physician. If a physician is to render expert testimony on behalf of a defendant or the defendant's attorney, he or she should obtain, in advance, a written confirmation of the fee. The physician expert witness should also consider requiring that a portion of the fee be prepaid. Furthermore, such a fee should not be based on the outcome of the case for according to the AMA, "it is unethical for a physician to accept compensation which is contingent upon the outcome of litigation." Opinion 9.07, AMA Council on Ethical and Judicial Affairs. A physician expert witness should be prepared at trial or during deposition to estimate the amount of time they spend testifying in such cases as well as their remuneration for such services. Moreover a physician expert witness should note that attorneys and other legal representatives are allowed to be present during an independent medical examination in a Workers' Compensation case. Prepayment of Deposition Fees As mentioned above, physicians may attempt to receive payment of deposition fees from plaintiff attorneys. While this practice is legal, it must be noted that a physician may not require the prepayment of such fees in advance if the physician has received a valid subpoena. Having received a valid subpoena, a physician must participate in a deposition regardless of whether the physician has received a prepayment of deposition fees. Failure to do so could result in a contempt citation against the physician. Should the attorney not pay the fees after a reasonable length of time subsequent to the deposition, the physician may then petition the court, which can order the attorney to pay the fees at the risk of a contempt citation against the attorney. This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: February 2013 FAMILY AND MEDICAL LEAVE ACT OF 1993 The “Family and Medical Leave Act of 1993", 29 U.S.C. §§2601 - 2654. (FMLA) requires that covered employers provide up to 12 weeks of unpaid, job protected leave to eligible employees for certain family and medical reasons during any 12-month period. 29 U.S.C. §2612(a)(1). One of the most common misperceptions regarding the law is that it applies to all employers and employees, regardless of the size of the business. In actuality, the law only applies to those employers with 50 or more employees for at least 20 workweeks in the current or preceding calendar year within a 75 mile radius and only to those employees who have worked for the employer for over one year, during which they have worked at least 1,250 hours. 29 U.S.C. §2611. Assuming, however, that the employer and employee are covered by the FMLA, the employee still must comply with several requirements before he is eligible to take the leave. First, employees must give at least 30 days notice of their leave when such leave is foreseeable. If the need to take leave requires less than 30-days’ notice, the employee must give notice “as is practicable.” This generally means at least one or two business days of learning the leave is necessary. 29 U.S.C. §2612(e)(1). The FMLA provides that the employer may require medical certification to support the request for leave. 29 U.S.C. §2613. Moreover, the request for leave must be for valid reasons, such as the care of an employee's child after birth, or placement for adoption or foster care, care for the employee's spouse, child, or parent who has a serious health condition, or for a serious health condition that makes the employee unable to perform his/her duties. 29 U.S.C. §2612(a)(1). Finally, even if an employee is covered and takes the applicable leave, the employee is not guaranteed his exact position upon returning to work. In