Nutrition 560 K Module IV Instructor Oscar Coetzee

Nutrition 560 K – Module IV Instructor - Oscar Coetzee

“House” of Virtual Clinic

Practice Legally Check with your State http: //nutritionadvocacy. org/ For example, New York defines practice of medicine as: “diagnosing, treating, operating, or prescribing for any human disease, pain, injury, deformity or physical condition”.

Student Project - Advocacy Student needs to go on: www. nutritionadvocacy. org find their state and provide an update on their states legal requirements, the student also needs to find an adjacent state and compare. Grading Rubric: Student needs to provide a one page summary of their findings

Legal Unless you are a licensed health care professional, do not use the following 7 words in conjunction with your practice: • 1. Diagnosis • 2. Patient • 3. Prescribe • 4. Treat • 5. Prevention • 6. Advise • 7. Cure These words can imply the practice of medicine

Legal Never diagnose • If they present with a diagnosis from a licensed physician, its acceptable to use it and you can then explain what it involves • If you suspect anything, refer back to their physician • It may even be a problem to identify an organ on their body. • Instead use your body as an example and point to your abdomen say, this where your liver is.

Legal They are not your patients • A patient is a person who is under medical care or treatment • Unless you are licensed, don’t call them patients • They are clients, customers, people, persons, individuals, but not patients

Legal Don’t prescribe • That’s like giving someone a prescription and that implies a pharmaceutical drug • Technically, we should not even be telling someone to take supplements • The safest way is to simply say, “This is what I would do if I had your condition. ” – I even had pads printed with those words on it • That implies that they are then deciding for themselves

Legal Treat • • • That implies “medical treatment” We don’t treat anyone, unless it’s to dinner or a movie We can help people promote health within themselves We can promote restoring balance We can possibly promote enhanced immune function etc.

Legal Prevention • We can’t legally prevent anything • We may be able to reduce the risk for some general health issues

Legal Advise • We don’t advise anyone • The only advice we can give our clients is to check with their physician • Everything else is just our opinion

Legal Cure • • • We are technically not allow to cure anything Only the doctors are allowed to cure Never use the word cure, it could be your ticket to jail Maybe we make suggestions in the healing process Stay within your scope of practice. Remember: your duty is to refer

Legal Always use a release form • Stating that practitioner is not a medical doctor, and does not diagnosis and treat disease. • In event of a serious illness contact a licensed physician. • If licensed, state what you are actually licensed to perform • Never make claims or promises • Minimize the risk that a client’s inflated expectations may lead to misunderstandings • Maintain confidentiality

Legal Careful to word your • Ads • Business cards • Articles • Lectures • Website

Legal Malpractice is defined as unskillful practice that fails to conform to a standard of care in the profession and results in injury to the patient. Generally: a practitioner of complementary and alternative medicine is held to a standard of care appropriate to the profession. Example: an acupuncturist is held to the same standard as other acupuncturists. Consider some sort of mal practice insurance (Professional Liability Insurance) - HPSO

Legal What about dosages – supplements: • Dosages are not one size fits all and what is indicated on the label is usually a maintenance dose designed for healthy persons, and it may not necessary be a therapeutic dose. • You can start with the manufacturer’s recommendation (usually considered a maintenance dose) and then titrate up to therapeutic levels for individual clients.

Legal What about Meds? • Often nutritional therapy can improve many conditions, and this can make pharmaceutical drugs too potent. • However, clients should be told to never stop taking or reduce any medications on their own, without first checking with their physician • Stopping meds drugs abruptly may produce a re-bound effect and worsen the condition • Know your drug/nutrient interactions and contraindications • Often nutritional therapy can improve many conditions, and this can make pharmaceutical drugs too potent. Especially anti-hypertensive & diabetic meds However, clients should be told never to stop taking or reduce any medications on their own, without first checking with their physicians.

Legal Send a note to Client’s Physician • Introduce yourself & give your credentials • Explain you are providing nutritional support • Brief outline of nutritional protocol • Offer to provide additional information • Mention you will be pleased to work with other patients INCLUDE YOUR BUSINESS CARDS • Write a ROF (Report of findings) • Develop strategic partnerships with other nutritionists & health care professionals. Referrals should go in both directions • Find physicians you can refer clients to for certain lab tests that other MDs won’t do

Legal Business Cards • State your services • State your credentials (M. S. ) & certifications Eg: CNS • If not certified see if in your state you can call yourself: Nutritionist, Clinical Nutritionist, Nutritional Consultant, Nutritional Counselor, etc. • Good to indicate: “Non-Medical”

The Medical Record and Documentation of Nutrition Care - Legal

Legal - Nutritional Care Record • Written documentation of the nutritional care process, including the interventions and activities used to meet the nutritional objectives • “If it’s not documented, it didn’t happen. ” • Medical record is a legal document.

Parts of the Medical Record • • Demographics/legal information Medical history Medical encounters Orders Progress notes Test results Other information

Progress Notes • Daily updates entered into the medical record documenting clinical changes, new information, results of tests • May be in SOAP, narrative, or other formats • Generally entered by all members of the health care team (doctors, nurses, physical therapists, dietitians, pharmacists) • Kept in chronological order

What if I get Sued • Malpractice falls under the Laws of Tort – which means “injuries” • Professional negligence implies that the injury was unintentional – but the professional’s conduct or judgment falls below the standard of care

Lawsuit Law of Torts must prove 4 things: 1. There is a relationship of duty by defendant toward injured person 2. There is a breach of duty to injured person 3. The injury was caused by the breach of duty (thus cause and effect) 4. There is an actual injury

Lawsuit Duty: Simply put a duty exists once you have agreed to care for, or begun to care for, or possibly even established a rapport with patient

Lawsuit Breach of Duty: Proving that nutritionist did something other than “recognized standard of care” “How similarly qualified professionals would have managed patient’s care under the same or similar circumstnaces”

Lawsuit Damages 1. • 2. • Personal: Loss of life, physical injury or disability, deterioration of quality of life Emotional: Physical and emotional pain, suffering, emotional distress, mental anguish, disfigurement, loss of enjoyment, loss of companionship 3. Economic: • Loss of wages, future earning potential, present and future medical expenses, special equipment, other consequences of injury

Lawsuit • • Causation The plaintiff will be responsible for showing that the injury suffered was caused by the actions of the defendant. No other act contributed to the injury Failure to follow std. of care Failure to communicate Failure to document Failure to assess and monitor Failure to act as patient advocate Failure to use supplements or protocols in a responsible manner

Lawsuit Informed Consent • Negligence issues can normally be evaluated by informed consent or lack thereof. • One of the central communication issues in malpractice is that of informed consent • The elements of the informed consent include disclosure of information, competence, understanding, voluntariness and decision making

Student Project - IC Student needs to review readings provided on this topic, also three Informed Consent Docs will be provided and students need to critically assess them Grading Rubric: A multiple choice question exam will follow this part of the course

Anatomy of a Lawsuit • Most top medical experts agree that just about everybody gets sued at least once – especially if they are extremely know for their craft. • Might start with a disgruntled patient • Contact your insurance company immediately • You will have to provide them with a written description of event • Your patient is now plaintiff, cut all communications OFF PERIOD! • See them as an adversarial quality • There are statutes of limitations

Lawsuit Reviewing the Case • Insurance company will want to see all records • Treatments, times , dates, email, protocols, phone consult dates, follow ups, cancellations (both ways), summaries of all records, and recollections of unrecorded conversations • Do NOT discuss this case with anyone not connected to insurance carrier • Avoid conversations with colleagues, acquaintances, associates not involved in law suit

Lawsuit Nutritionist as Defendant • • • Keep a positive attitude Meet your lawyer and prepare a narrative summary for the case before Know the weaknesses of your case and be prepared to deal and admit them Have your CV for your lawyer Review material produced by plaintiff Record and review all records of your patient Never alter medical record, website or anything once you get wind of a lawsuit Consider diagrams, graphs and EBN research in your testimony Know your scope, ethics of practice Become aware of plaintiffs witnesses by attending depositions

Lawsuit Decision • The insurance company may not decide to defend your case • You may have a voice in decision • If the other party is going ahead with proceedings the defendant will receive a “writ of summons (or complaint) • Meaning a legal document has been filed – it is now official – you are being sued • There might be a pleading stage – remember a law suit can be settled at any time

Lawsuit Discovery • • This is a fact finding mission – process used by lawyers Oral deposition (this is more preferred because of credibility as witness) Written deposition – interrogatories (generally in admit or deny format) Potential witnesses include: plaintiff, defendant, office personnel, other healthcare professionals, expert witnesses, family members of plaintiff and plaintiff’s employer

Lawsuit Oral Deposition • • • Last a couple of days Dress professionally – show up early Do not chit chat at water fountain Listen attentively to all questions and respond honestly Answer only what is asked If you do not understand a question do not guess at the meaning. Rephrase Don’t rush or allow yourself to be interrupted Be polite without being overly friendly – addressing people as Sir etc. Keep your head if they try to intimidate, silence or belittle your competence or credentials, non-verbal tactics, facial expressions, mocking etc.

Lawsuit Nutritionist in Deposition • • • Know your field and your case intimately Listen carefully to questions Be direct and to the point Use your patient records Disregard theatrics Be consistent Don’t babble – state facts and wait for next question Be cautious of guided questions like “let me summarize…is it a fair assessment to say…” Firm, credible, professional and courteous

Lawsuit Subpoenas • They are written orders requiring that a person or documents be brought to a specific place and a certain time • Items like medical records, office diaries, or prescribed eating plans

Lawsuit Privileged Information • Not all information is admissible • Legal privilege in client-lawyer privilege is protected from discovery • Conversations with your spouse, personal physician, psychotherapist, clergyman, risk manager, and liability insurance representative are also protected from discovery

Lawsuit The Trial Can be tried before a jury or judge Trail: 1. 2. 3. 4. 5. 6. 7. Jury selection if chosen Opening statements Presentation of evidence Closing statements Verdict Judgment Settlement

Lawsuit Settlement Malpractice lawsuits are not published in law journals unless the case reaches the court of appeals

Arbitration/Mediation Alternatives to law suits • Arbitrator: usually retired judge or experienced lawyer • Mediation: settlement conference conducted by a disinterested party

Lawsuit Expert Witnesses Clarifying performance is an “expert witness” Experts cannot: 1. Assign guilt or innocence 2. Attempt to determine if a law was broken 3. Testify beyond their scope of practice 4. Discuss the case with anyone without the permission of lawyers or court 5. Get compensated for their time