Source: https://healthlawmonitor.jacksonkelly.com/other/
Timestamp: 2019-04-25 19:58:38+00:00

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The West Virginia Legislature recently amended the Medical Professional Liability Act, W.Va. Code 55-7B-1, et seq. (“MPLA”) through Senate Bill 6. These amendments accomplished several things including broadening the statutory definitions of “health care provider” and “health care” to encompass a wider range of health care professionals, health care related activities, and provide MPLA protections to entities related to health care providers. Statutory prerequisites for expert testimony were also strengthened. Senate Bill 6 was, at least in part, the Legislature’s response to a series of decisions of the Supreme Court of Appeals of West Virginia which narrowly interpreted the MPLA, creating a class of claims against health care providers falling outside the MPLA, most notably Manor Care v. Douglas. In Manor Care, the West Virginia Supreme Court of Appeals affirmed a jury verdict apportioning an award against a nursing home between “ordinary” and “medical” negligence, and then applying the MPLA only to the portion for “medical” negligence. Below is a summary of a few of the changes to the MPLA occasioned by Senate Bill 6.
Senate Bill 6 also amended section 55-7B-2(g) by adding pharmacists and certified nursing assistants to the definition of “health care provider.” It also adds “any person supervised by or acting under the direction of a licensed professional in a health care facility” in an effort to ensure that persons who carry out orders are subject to the MPLA.
These changes expand (and are intended to expand) the definition of health care and medical professional liability to ensure the MPLA applies to services typically provided to patients in hospitals and nursing homes as part of the overall plan of care, but which could be considered “ordinary” negligence under Manor Care v. Douglas. In Manor Care, the plaintiffs’ claims included understaffing and failure to provide adequate nutrition and hydration. Lawyers for the Douglas family argued these services were not “health care” but rather “ordinary negligence.” They argued that there was evidence as to how non-healthcare decisions like staffing and budgets affected Ms. Douglas’s care. The jury was then allowed to apportion by percentage between “medical” and “ordinary” negligence, with the MPLA applying only to the percentage of the award of noneconomic loss that was “medical” negligence.
(f) "Health care facility" means any clinic, hospital, nursing home or assisted living facility, including personal care home, residential care community and residential board and care home, or behavioral health care facility or comprehensive community mental health/mental retardation center, in and licensed by the State of West Virginia and any state-operated institution or clinic providing health care and any related entity to the health care facility.
These changes are important to nursing homes, which have individual buildings or facilities which are generally owned by parent entities, and have certain services provided by separate corporations, such as budgeting and management services. These changes can also be important to hospitals as they will ensure the MPLA applies to related entities in a hospital system, or which are designed to provide services to several hospitals, and more particularly to entities set up to employ physicians. The changes reflect the evolving way of providing health care services and provide the MPLA is applicable.
Senate Bill 6 also created new rebuttable presumptions (§55-7B-7a)against the introduction of certain information “unless it applies specifically to the injured person or it involves substantially similar conduct that occurred within one year of the particular incident involved….” This section is intended to stop the introduction of state and federal investigative reports, disciplinary actions, accreditation reports or assessment of penalties unless they apply to the injured person or substantially similar conduct within one year of the incident involved. It prohibits the introduction of evidence about staffing levels if state staffing requirements are met. Finally, even if the evidence satisfies these provisions, it may only be admitted if there is a final order which is otherwise admissible under the West Virginia Rules of Evidence.
Senate Bill 6 is an extremely important bill, particularly for hospitals and long-term care facilities and requires close examination. How it will be interpreted and whether all of the changes will pass constitutional muster in the courts remains to be seen.
On June 5, 2013, the West Virginia Supreme Court of Appeals issued a new opinion which expands the power of the West Virginia Attorney General and in so doing overruled more than thirty years of precedent. This case is very significant to any health care entity facing potential actions by the West Virginia Attorney General because it signals that he has more power to institute actions than under prior law.
State ex rel Discover Financial v. Nibert held the West Virginia Attorney General has common law powers, which include the power to retain and pay private outside counsel. In a nutshell, the Court overruled a thirty year old case, Manchin v. Browning, 170 W. Va. 779, 296 S.E.2d 909 (1982), where it held the Attorney General had only those powers specifically prescribed by statute. Thus, even though the Court in State ex rel Discover Financial found there was no statutory authority for the Attorney General to retain private counsel, it held the retention was proper because of the Attorney General’s common law powers. The Court also found no statutory prohibition against the Attorney General retaining and paying counsel, and refused to limit payments.
The Court concluded “[i]n the final analysis, the authority of the Office of Attorney General ‘comes from three sources–the constitution of this state; the legislature; and the common law, from which emanates some of its so-called inherent power.’ State ex rel. McGraw v. Telecheck Servs., Inc., 213 W. Va. 438, 443, 582 S.E.2d 885, 890 (2003).” Thus, the Attorney General, according to the Court, has common law power to retain counsel.
Insofar as W. Va. Code § 5-3-3 does not expressly prohibit the Attorney General from making alternative fee arrangements with special assistant attorneys general, we now hold that the Attorney General has common law authority to provide for compensation to be paid to special assistant attorneys general through a court-approved award of attorney’s fees taken directly from the losing opponent in the litigation.
However, we wish to make clear that we are not addressing the appropriateness of awarding attorney’s fees to special assistant attorneys general directly from any actual monetary judgment award to the State because such a contingent fee agreement is not at issue in this case. We also note that the Legislature attempted to address the issue of contingency fee payment to special assistant attorneys general during the 2013 Regular Session of the West Virginia Legislature, but such proposals failed to be approved.
The recognition of common law powers in the Attorney General’s office is significant, and will hamper arguments that attack whether the Attorney General has statutory authority to bring actions, etc. Common law powers will undoubtedly be used to shore up arguments that the Attorney General can act when allowed by statute, but perhaps more significantly, when not prohibited by statute. Like Pandora, this opinion sets the Attorney General free from the Manchin v. Browning box and may have implications far beyond whether the Attorney General can retain counsel. It opens the door for litigation by the Attorney General even absent statutory authority. West Virginia is not alone, as there was a similar recent ruling in the United States District Court for the Eastern District of Kentucky in Merck Sharp and Dome v. Conway, here.
If a covered entity receives financial remuneration in exchange for disclosing PHI to a third party, that transaction is a sale of PHI.
The original HIPAA Privacy Rule required covered entities to obtain an individual’s authorization before using or disclosing the individual’s PHI for marketing purposes (defined as making communications about a product or service to encourage individuals to purchase or use the product or service). However, there were several broad exceptions to the definition of marketing, including exceptions for communications that describe a product or service provided by the covered entity or that recommend alternative treatments. The effect was that covered entities could use PHI for various purposes that would seem, from a plain-language perspective, to be marketing.
The Final Rule modifies the definition of marketing as required by Section 13406(a) of the Health Information Technology for Economic Clinical Health (HITECH) Act. Marketing now includes any treatment or health care operations communications to individuals about health-related products or services, if the covered entity or its business associate (BA) receives financial remuneration in exchange for making the communication from or on behalf of the third party whose product or service is being described.
The Final Rule defines financial remuneration as “direct or indirect payment from or on behalf of a third party whose product or service is being described.” The commentary to the Final Rule verifies that non-financial benefits, such as in-kind benefits provided to a covered entity in exchange for making a communication about a product or service, are not financial remuneration.
HHS retains existing exceptions to the authorization requirement for communications that are made face-to-face by the covered entity to the individual and for promotional gifts of nominal value provided by the covered entity. There are other limited exceptions, including for communications related to currently prescribed drugs (e.g., refill reminders, communications about generic substitutes or instructions for taking the drug), as long as any remuneration is reasonably related to the covered entity’s cost of making the communications.
In sum, authorization is required for any covered entity or BA receiving financial remuneration from a third party in exchange for making a communication about a product or service, with the exceptions noted above. The authorization must disclose that remuneration is received from a third party and state that the individual may revoke the authorization at any time.
The final rule prohibits the sale of PHI absent an individual’s written authorization. The authorization must state that the disclosure will result in remuneration to the covered entity.
For any other purposes permitted by and in accordance with the applicable requirements of the Privacy Rule, where the only remuneration received by the covered entity is a reasonable, cost-based fee to cover the cost to prepare and transmit the PHI for such purpose, or a fee otherwise expressly permitted by other law.
It is recommended that covered entities review and update their Notices of Privacy Practices to advise individuals about changes imposed by the Final Rule, including the prohibition on the sale of PHI without express written authorization.
 78 Fed. Reg. 5566 (Jan. 25, 2013).
 78 Fed. Reg. at 5593.
 78 Fed. Reg. at 5596.
 45 C.F.R. §§ 164.502(a)(5)(ii), 164.508(a)(4).
 78 Fed. Reg. 5607 (Jan. 25, 2013).

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