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the use and care of PPE, maintain the quality of the PPE, and consistently review and update the PPE program.“Medical and First Aid Standard”“OSHA requires employers to provide medical and first-aid personnel and supplies commensurate with the hazards of the workplace. The details of a workplace medical and first-aid program are dependent on the circumstances of each workplace and employer.”For a more comprehensive understanding of the Medical and First Aid Standard, please see 29 C.F.R. § 1910.151.Exit Route, Emergency Action Plan and Fire Safety Standards OSHA requires that exit routes are sufficient for the number of employees in a particular area.Additionally, employers must have visible evacuation routes posted.OSHA recommends that employers have an Emergency Action Plan and a Fire Prevention Plan.If required by an OSHA standard, then the formulation of a plan is mandatory.For a more comprehensive understanding of the Medical Exit Route, Emergency Action Plan and Fire Safety Standards, please see 29 C.F.R. § 1910.33 – 1910.39.Other Considerations There are many other hazards that employers should be conscientious of; keep in mind the following additional hazards. Lessen the chance of ergonomic injuries by properly lifting equipment and adjusting patients. Recognize areas prone to slips, trips, and falls as these are among the most prevalent hazards in a health care office. Minimize potential for exposure to tuberculosis and influenza. Finally, remember that all offices must display an OSHA poster in a space easily viewed by employees. The poster can be downloaded for free on the OSHA website.Many other standards apply, to request the full OSHA guidelines, view sample programs or fact sheets please visit www.osha.gov or request information over the phone at (800) 321-OSHA (6742).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 PAPERWORK PREPARATION FEE
There is no statute or administrative code provision that prohibits a physician from charging a fee for filling out paperwork requested by a patient. The FMA currently has a policy on this practice, which states that the FMA favors a policy that mandates that physicians be compensated appropriately for filling out forms that require a physician’s time to review or complete. (HOD 1999; Res. 99-15).The American Medical Association has an ethical guideline that states that "the attending physician should complete without charge the appropriate simplified insurance claim form as a part of service to the patient to enable the patient to receive his/her benefits. The charge for more complex or multiple forms may be made in conformity with local custom." Opinion 6.07, AMA Council on Ethical and Judicial Affairs.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: March 2013 PATIENT-PHYSICIAN RELATIONSHIP dilemma which frequently faces physicians is determining when a patient physician relationship has been established. As most physicians are aware, the establishment of the patient physician relationship requires the physician to continue treating a patient until such time as the treatment is concluded or the patient has had both notice and time to obtain another health care provider. For this reason, many physicians are understandably reluctant to enter into a patient-physician relationship until such time as the physician is comfortable with both the patient and the physician's own ability to render appropriate care.Case law throughout the country consistently states that a patient-physician relationship is not created until such time as both parties have entered into an actual or implied contractual relationship in which the physician agrees to render care to the patient. See, Opinion 9.12, AMA Council on Ethical and Judicial Affairs. As with any contract, this relationship requires both an offer and acceptance in order to be valid. Therefore, the creation of an appointment for a physician to examine a patient does not, in and of itself, create a patient-physician relationship. If, however, the physician agrees to "treat" a patient for a specific condition, the patient-physician relationship has been established.Because of the state of the law, physicians and their office staff must be careful when scheduling appointments with new patients. Instead of stating that the physician will treat a new patient, office staff should only tell the new patient that the physician will see the patient to determine if the physician will undertake the case. Just as importantly, should the physician determine that he does not wish to treat the patient, he must make that decision known to the patient immediately, so that the patient does not assume that an implied contract has been reached. A physician, however, may not refuse to accept a person as a patient because of race, color, religion, national origin, or any other basis that would constitute “invidious discrimination.” Opinion 9.12, AMA Council on Ethical and Judicial Affairs. In addition, a physician may not refuse to accept a patient because of a known disability of the patient or of a person with whom the patient is known to associate. Such an action would be in violation of the American with Disabilities Act, 42 U.S.C. §12182(a).The creation of a patient-physician relationship is one which creates a series of important obligations for the physician, and is not a relationship to be entered into lightly. It is for this reason that a physician should take care to ensure that steps, such as those mentioned above, are taken to prevent the creation of such a relationship when the physician is not able or willing to honor each of the attached responsibilities.As discussed above, once a patient-physician relationship is established, the physician is under an ethical duty to continue that relationship until it is properly terminated by giving the patient adequate notice. Opinion 8.115, AMA Council on Ethical and Judicial Affairs. A physician may terminate the patient-physician relationship at any time and is not required to communicate the reason for termination to the patient. The FMA suggests the following guidelines for terminating a patient:(1) Notify patient by certified letter of the intent to withdraw care.(2) Include the date at which the physician will no longer be available to provide care to the patient (the FMA recommends at least a two (2) week notification period).(3) State in the letter that the physician will be available during the notification period to provide care on an emergency basis only.(4) If the patient’s condition requires continued treatment, the letter must state this fact and inform the patient of the importance of locating a new physician as soon as possible.(5) The physician should notify the patient that copies of the patient’s medical records will be made available (as required by law) to the patient or the patient’s new treating physician.(6) A copy of the termination letter should be placed in the patient’s file.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
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