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Physician absent during labor until heart rate crashed
A 22-year-old mother was admitted to the hospital for induction after passing her due date. Within 4 hours the fetal heart monitor showed repetitive variable decelerations, which stopped when oxytocin was halted. The attending obstetrician ordered the restart of oxytocin after an epidural. No physician saw the patient prior to the restart of oxytocin, although an obstetrical resident and the attending were on the floor during the entire labor.
During delivery, the monitor showed that the fetal heart became nonreactive, but the delivery nurse did not notify anyone. About 3.5 hours later the fetal heart monitor showed persistent late decelerations, and again the delivery nurse did not notify anyone. Two hours later the fetal heart rate decreased to 60 bpm. An emergency cesarean section was performed and the infant was delivered within 10 minutes. The Apgar scores were 3 at 1 minute and 9 at 5 minutes. The baby was diagnosed with cerebral palsy and mental retardation at 3 months of age.
In suing, the mother claimed that no physician examined her during the 12 hours of labor until the fetal heart rate crashed. The hospital contended that the infant’s brain damage occurred prior to the mother being admitted to the hospital.
- The parties settled for $2.3 million.
A 22-year-old mother was admitted to the hospital for induction after passing her due date. Within 4 hours the fetal heart monitor showed repetitive variable decelerations, which stopped when oxytocin was halted. The attending obstetrician ordered the restart of oxytocin after an epidural. No physician saw the patient prior to the restart of oxytocin, although an obstetrical resident and the attending were on the floor during the entire labor.
During delivery, the monitor showed that the fetal heart became nonreactive, but the delivery nurse did not notify anyone. About 3.5 hours later the fetal heart monitor showed persistent late decelerations, and again the delivery nurse did not notify anyone. Two hours later the fetal heart rate decreased to 60 bpm. An emergency cesarean section was performed and the infant was delivered within 10 minutes. The Apgar scores were 3 at 1 minute and 9 at 5 minutes. The baby was diagnosed with cerebral palsy and mental retardation at 3 months of age.
In suing, the mother claimed that no physician examined her during the 12 hours of labor until the fetal heart rate crashed. The hospital contended that the infant’s brain damage occurred prior to the mother being admitted to the hospital.
- The parties settled for $2.3 million.
A 22-year-old mother was admitted to the hospital for induction after passing her due date. Within 4 hours the fetal heart monitor showed repetitive variable decelerations, which stopped when oxytocin was halted. The attending obstetrician ordered the restart of oxytocin after an epidural. No physician saw the patient prior to the restart of oxytocin, although an obstetrical resident and the attending were on the floor during the entire labor.
During delivery, the monitor showed that the fetal heart became nonreactive, but the delivery nurse did not notify anyone. About 3.5 hours later the fetal heart monitor showed persistent late decelerations, and again the delivery nurse did not notify anyone. Two hours later the fetal heart rate decreased to 60 bpm. An emergency cesarean section was performed and the infant was delivered within 10 minutes. The Apgar scores were 3 at 1 minute and 9 at 5 minutes. The baby was diagnosed with cerebral palsy and mental retardation at 3 months of age.
In suing, the mother claimed that no physician examined her during the 12 hours of labor until the fetal heart rate crashed. The hospital contended that the infant’s brain damage occurred prior to the mother being admitted to the hospital.
- The parties settled for $2.3 million.
Brain damage detected after surprise birth
A 15-year-old girl with no history of prenatal care and no diagnosis of pregnancy presented to the hospital complaining of abdominal pain. The girl gave birth 3 hours later; 27 hours later the infant had a seizure. The infant was later diagnosed with severe brain damage and microcephaly and now has an IQ of 55.
In suing, the mother claimed fetal heart rate monitoring strips showed severe decelerations prior to delivery and that the physician failed to expedite delivery.
- A defense verdict was returned.
A 15-year-old girl with no history of prenatal care and no diagnosis of pregnancy presented to the hospital complaining of abdominal pain. The girl gave birth 3 hours later; 27 hours later the infant had a seizure. The infant was later diagnosed with severe brain damage and microcephaly and now has an IQ of 55.
In suing, the mother claimed fetal heart rate monitoring strips showed severe decelerations prior to delivery and that the physician failed to expedite delivery.
- A defense verdict was returned.
A 15-year-old girl with no history of prenatal care and no diagnosis of pregnancy presented to the hospital complaining of abdominal pain. The girl gave birth 3 hours later; 27 hours later the infant had a seizure. The infant was later diagnosed with severe brain damage and microcephaly and now has an IQ of 55.
In suing, the mother claimed fetal heart rate monitoring strips showed severe decelerations prior to delivery and that the physician failed to expedite delivery.
- A defense verdict was returned.
Laparotomy leads to massive blood loss
An 18-year-old woman with a history of chronic pelvic pain and heavy menstrual periods was referred to a gynecologist for a laparoscopy. Abnormal internal bleeding that could not be controlled was encountered soon after the procedure began. An exploratory laparotomy was then performed. Injuries were found in 4 separate intra-abdominal structures: the iliac vein was lacerated, the small intestine had perforations in 2 separate locations, and a mesenteric blood vessel was also lacerated.
The woman asserted that the trocar was not inserted correctly and that she sustained motor and sensory impairments as well as cognitive deficits due to the large volume of blood lost during the procedure. She also claimed lack of informed consent in that she was not told the injuries were known risks of the surgery. She also claimed that despite losing 60% of her blood volume, she did not receive a blood transfusion.
The physician contended that the trocar and protective sheath might not have retracted properly and that the injuries sustained were a known risk of the procedure.
- The jury returned a defense verdict.
An 18-year-old woman with a history of chronic pelvic pain and heavy menstrual periods was referred to a gynecologist for a laparoscopy. Abnormal internal bleeding that could not be controlled was encountered soon after the procedure began. An exploratory laparotomy was then performed. Injuries were found in 4 separate intra-abdominal structures: the iliac vein was lacerated, the small intestine had perforations in 2 separate locations, and a mesenteric blood vessel was also lacerated.
The woman asserted that the trocar was not inserted correctly and that she sustained motor and sensory impairments as well as cognitive deficits due to the large volume of blood lost during the procedure. She also claimed lack of informed consent in that she was not told the injuries were known risks of the surgery. She also claimed that despite losing 60% of her blood volume, she did not receive a blood transfusion.
The physician contended that the trocar and protective sheath might not have retracted properly and that the injuries sustained were a known risk of the procedure.
- The jury returned a defense verdict.
An 18-year-old woman with a history of chronic pelvic pain and heavy menstrual periods was referred to a gynecologist for a laparoscopy. Abnormal internal bleeding that could not be controlled was encountered soon after the procedure began. An exploratory laparotomy was then performed. Injuries were found in 4 separate intra-abdominal structures: the iliac vein was lacerated, the small intestine had perforations in 2 separate locations, and a mesenteric blood vessel was also lacerated.
The woman asserted that the trocar was not inserted correctly and that she sustained motor and sensory impairments as well as cognitive deficits due to the large volume of blood lost during the procedure. She also claimed lack of informed consent in that she was not told the injuries were known risks of the surgery. She also claimed that despite losing 60% of her blood volume, she did not receive a blood transfusion.
The physician contended that the trocar and protective sheath might not have retracted properly and that the injuries sustained were a known risk of the procedure.
- The jury returned a defense verdict.
Did prolapsed cord cause injuries?
A pregnant woman who was under care of her family practitioner, who had provided her prenatal care, was admitted to a hospital for childbirth. The membranes were artificially ruptured and within 1 to 2 minutes the fetal heart strip showed a prolonged deceleration from a baseline of 150 bpm to 60 bpm, lasting 4.5 minutes.
The physician conducted a vaginal examination at the time of this deceleration and discovered a loop of cord along the left side of the infant’s head, which was described in the records as a prolapsed umbilical cord. He manually elevated the infant’s head, reducing the cord. He then instructed the mother to push, allowing labor for a half hour. During this time several instances of fetal distress were noted, with the fetal heart rate ranging from 60 to 120 bpm.
At some point the physician attempted to call the primary and back-up obstetricians on-call, but the primary was busy with a procedure at another hospital and the back-up OB was 45 minutes away.
The infant, born with the umbilical cord along the left side of the head, had severe brain damage due to profound anoxia. He also had a fractured right humerus and a small subdural bleed with a corresponding intracerebral contusion. He has limited cognition, is fed through a PEG tube, has a tracheostomy, and requires 24-hour care in a nursing home.
In suing, the woman asserted that a cesarean section should have been performed when the prolapsed cord was diagnosed and that the hospital’s policy regarding the on-call obstetrician was inadequate, as it allowed both of the obstetricians to be unavailable.
The physician contended that he did not diagnose a prolapsed cord prior to delivery but that the records were written later and were not a comment on what he knew at the time of delivery. The hospital claimed that its on-call policy was appropriate for a community hospital. Both the hospital and the physician contended that the child’s injuries were not due to anoxia from a prolapsed umbilical cord.
- A $10.95 million settlement was reached.
A pregnant woman who was under care of her family practitioner, who had provided her prenatal care, was admitted to a hospital for childbirth. The membranes were artificially ruptured and within 1 to 2 minutes the fetal heart strip showed a prolonged deceleration from a baseline of 150 bpm to 60 bpm, lasting 4.5 minutes.
The physician conducted a vaginal examination at the time of this deceleration and discovered a loop of cord along the left side of the infant’s head, which was described in the records as a prolapsed umbilical cord. He manually elevated the infant’s head, reducing the cord. He then instructed the mother to push, allowing labor for a half hour. During this time several instances of fetal distress were noted, with the fetal heart rate ranging from 60 to 120 bpm.
At some point the physician attempted to call the primary and back-up obstetricians on-call, but the primary was busy with a procedure at another hospital and the back-up OB was 45 minutes away.
The infant, born with the umbilical cord along the left side of the head, had severe brain damage due to profound anoxia. He also had a fractured right humerus and a small subdural bleed with a corresponding intracerebral contusion. He has limited cognition, is fed through a PEG tube, has a tracheostomy, and requires 24-hour care in a nursing home.
In suing, the woman asserted that a cesarean section should have been performed when the prolapsed cord was diagnosed and that the hospital’s policy regarding the on-call obstetrician was inadequate, as it allowed both of the obstetricians to be unavailable.
The physician contended that he did not diagnose a prolapsed cord prior to delivery but that the records were written later and were not a comment on what he knew at the time of delivery. The hospital claimed that its on-call policy was appropriate for a community hospital. Both the hospital and the physician contended that the child’s injuries were not due to anoxia from a prolapsed umbilical cord.
- A $10.95 million settlement was reached.
A pregnant woman who was under care of her family practitioner, who had provided her prenatal care, was admitted to a hospital for childbirth. The membranes were artificially ruptured and within 1 to 2 minutes the fetal heart strip showed a prolonged deceleration from a baseline of 150 bpm to 60 bpm, lasting 4.5 minutes.
The physician conducted a vaginal examination at the time of this deceleration and discovered a loop of cord along the left side of the infant’s head, which was described in the records as a prolapsed umbilical cord. He manually elevated the infant’s head, reducing the cord. He then instructed the mother to push, allowing labor for a half hour. During this time several instances of fetal distress were noted, with the fetal heart rate ranging from 60 to 120 bpm.
At some point the physician attempted to call the primary and back-up obstetricians on-call, but the primary was busy with a procedure at another hospital and the back-up OB was 45 minutes away.
The infant, born with the umbilical cord along the left side of the head, had severe brain damage due to profound anoxia. He also had a fractured right humerus and a small subdural bleed with a corresponding intracerebral contusion. He has limited cognition, is fed through a PEG tube, has a tracheostomy, and requires 24-hour care in a nursing home.
In suing, the woman asserted that a cesarean section should have been performed when the prolapsed cord was diagnosed and that the hospital’s policy regarding the on-call obstetrician was inadequate, as it allowed both of the obstetricians to be unavailable.
The physician contended that he did not diagnose a prolapsed cord prior to delivery but that the records were written later and were not a comment on what he knew at the time of delivery. The hospital claimed that its on-call policy was appropriate for a community hospital. Both the hospital and the physician contended that the child’s injuries were not due to anoxia from a prolapsed umbilical cord.
- A $10.95 million settlement was reached.
Pregnancy state affects CMV test code
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Can nurse-midwife bill for prolonged physician services?
To report these codes, the typical time included in the base inpatient service you are billing for must be exceeded by 30 minutes. For instance, code 99222 (initial hospital care, requiring a comprehensive history; a comprehensive exam and medical decision making of moderate complexity) has a typical time of 50 minutes. Since in your example the CNM spent only 1 hour face-to-face with the patient on the admission day, the criterion for reporting prolonged services has not been met and code 99356 cannot be billed in addition to 99222.
On the second day, however, prolonged services can be billed. Let’s use the example of 6 hours and assume the subsequent hospital care code billed on that day was 99233 (subsequent hospital care, requiring high complexity of medical decision making and a detailed history or exam). The typical time for this code is 35 minutes.
To determine billable prolonged service time, subtract typical time from the total face-to-face time (in this case 360 minutes), then subtract 30 because the first 30 minutes of prolonged time is not reported (360–35–30=295). Thus on day 2 you could bill 99233, plus 99356×1 for the first hour of prolonged service, and 99357×8 for the 8 remaining half-hour increments of prolonged time.
Two caveats, however. First, CPT nomenclature for the prolonged services codes indicate “physician service,” which means that some payers may not reimburse for prolonged services unless provided by a physician.
Second, if the CNM is unable to bill for the global service, but instead must itemize the services provided by billing separately for antepartum care (eg, 59426, antepartum care only; 7 or more visits) and postpartum care (59430, postpartum care only [separate procedure]), some payers may include the time spent with the laboring patient as part of the antepartum services. Check with the individual payer to see if they have a written policy regarding this situation.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
To report these codes, the typical time included in the base inpatient service you are billing for must be exceeded by 30 minutes. For instance, code 99222 (initial hospital care, requiring a comprehensive history; a comprehensive exam and medical decision making of moderate complexity) has a typical time of 50 minutes. Since in your example the CNM spent only 1 hour face-to-face with the patient on the admission day, the criterion for reporting prolonged services has not been met and code 99356 cannot be billed in addition to 99222.
On the second day, however, prolonged services can be billed. Let’s use the example of 6 hours and assume the subsequent hospital care code billed on that day was 99233 (subsequent hospital care, requiring high complexity of medical decision making and a detailed history or exam). The typical time for this code is 35 minutes.
To determine billable prolonged service time, subtract typical time from the total face-to-face time (in this case 360 minutes), then subtract 30 because the first 30 minutes of prolonged time is not reported (360–35–30=295). Thus on day 2 you could bill 99233, plus 99356×1 for the first hour of prolonged service, and 99357×8 for the 8 remaining half-hour increments of prolonged time.
Two caveats, however. First, CPT nomenclature for the prolonged services codes indicate “physician service,” which means that some payers may not reimburse for prolonged services unless provided by a physician.
Second, if the CNM is unable to bill for the global service, but instead must itemize the services provided by billing separately for antepartum care (eg, 59426, antepartum care only; 7 or more visits) and postpartum care (59430, postpartum care only [separate procedure]), some payers may include the time spent with the laboring patient as part of the antepartum services. Check with the individual payer to see if they have a written policy regarding this situation.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
To report these codes, the typical time included in the base inpatient service you are billing for must be exceeded by 30 minutes. For instance, code 99222 (initial hospital care, requiring a comprehensive history; a comprehensive exam and medical decision making of moderate complexity) has a typical time of 50 minutes. Since in your example the CNM spent only 1 hour face-to-face with the patient on the admission day, the criterion for reporting prolonged services has not been met and code 99356 cannot be billed in addition to 99222.
On the second day, however, prolonged services can be billed. Let’s use the example of 6 hours and assume the subsequent hospital care code billed on that day was 99233 (subsequent hospital care, requiring high complexity of medical decision making and a detailed history or exam). The typical time for this code is 35 minutes.
To determine billable prolonged service time, subtract typical time from the total face-to-face time (in this case 360 minutes), then subtract 30 because the first 30 minutes of prolonged time is not reported (360–35–30=295). Thus on day 2 you could bill 99233, plus 99356×1 for the first hour of prolonged service, and 99357×8 for the 8 remaining half-hour increments of prolonged time.
Two caveats, however. First, CPT nomenclature for the prolonged services codes indicate “physician service,” which means that some payers may not reimburse for prolonged services unless provided by a physician.
Second, if the CNM is unable to bill for the global service, but instead must itemize the services provided by billing separately for antepartum care (eg, 59426, antepartum care only; 7 or more visits) and postpartum care (59430, postpartum care only [separate procedure]), some payers may include the time spent with the laboring patient as part of the antepartum services. Check with the individual payer to see if they have a written policy regarding this situation.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Is discount unfair for outpatient ablation?
In the office setting the practice expense portion of the relative value assigned to a procedure is higher than when the procedure is performed in an outpatient setting, which does not incur the expense of supplies, treatment room, anesthesia, and equipment. The physician is still reimbursed the same for the physician work and malpractice elements of the procedure’s relative value, but the total RVU is less because the practice expense portion is less.
A physician would be paid at the lower RVU level for a facility setting, for performing a procedure in a hospital outpatient department, under Medicare rules, since the outpatient facility has incurred the expenses of staffing the procedure as well as the expensive disposable equipment.
The only exception to this rule is when a procedure performed in this setting does not appear on the ambulatory surgical center (ASC) list of procedures. In that case, the higher nonfacility fee allowance would be reimbursed. Unfortunately, both codes for an endometrial ablation—58353 (endometrial ablation, thermal, without hysteroscopic guidance) and 58563 (hysteroscopy surgical; with endometrial ablation)—appear on the ASC list.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
In the office setting the practice expense portion of the relative value assigned to a procedure is higher than when the procedure is performed in an outpatient setting, which does not incur the expense of supplies, treatment room, anesthesia, and equipment. The physician is still reimbursed the same for the physician work and malpractice elements of the procedure’s relative value, but the total RVU is less because the practice expense portion is less.
A physician would be paid at the lower RVU level for a facility setting, for performing a procedure in a hospital outpatient department, under Medicare rules, since the outpatient facility has incurred the expenses of staffing the procedure as well as the expensive disposable equipment.
The only exception to this rule is when a procedure performed in this setting does not appear on the ambulatory surgical center (ASC) list of procedures. In that case, the higher nonfacility fee allowance would be reimbursed. Unfortunately, both codes for an endometrial ablation—58353 (endometrial ablation, thermal, without hysteroscopic guidance) and 58563 (hysteroscopy surgical; with endometrial ablation)—appear on the ASC list.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
In the office setting the practice expense portion of the relative value assigned to a procedure is higher than when the procedure is performed in an outpatient setting, which does not incur the expense of supplies, treatment room, anesthesia, and equipment. The physician is still reimbursed the same for the physician work and malpractice elements of the procedure’s relative value, but the total RVU is less because the practice expense portion is less.
A physician would be paid at the lower RVU level for a facility setting, for performing a procedure in a hospital outpatient department, under Medicare rules, since the outpatient facility has incurred the expenses of staffing the procedure as well as the expensive disposable equipment.
The only exception to this rule is when a procedure performed in this setting does not appear on the ambulatory surgical center (ASC) list of procedures. In that case, the higher nonfacility fee allowance would be reimbursed. Unfortunately, both codes for an endometrial ablation—58353 (endometrial ablation, thermal, without hysteroscopic guidance) and 58563 (hysteroscopy surgical; with endometrial ablation)—appear on the ASC list.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Medical Records: What to Keep—Part II
Last month I listed the various options for storing your old medical records, and made the case for keeping them indefinitely. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com
Once you've found a permanent home for your medical records, what about all those other records, business documents of all kinds, that are probably gathering dust in boxes, taking up expensive space?
Before you can decide what to keep, of course, you have to determine what you have. So get out all those boxes and have an employee sort everything into identifiable categories, by date.
Now comes the hard part. As a recovering “pack rat” myself, my instinct is to keep everything, but that's impractical and usually unnecessary. While your corporate minutes book must be maintained and updated perpetually, and a few important documents—which I will point out as we get to them—should be preserved for the duration, most records have no value after varying periods of time or the information they contain is readily available elsewhere, so they can be safely destroyed.
Of course, these are only suggestions. You should check your state and local laws for any statutorily mandated time limits, and your individual circumstances may dictate longer—or shorter—retention times for some documents than those suggested here. When in doubt, consult your practice lawyer.
Among standard business records, experts say day sheets, patient billing slips, and other original entry items can be discarded after 7 years. Ditto for year-end financial and management reports; third-party insurance explanation of benefits forms, correspondence, and other records; and paid invoices and other bills. (The Internal Revenue Service cannot normally go back further than 7 years, but audited files can be reopened at any time, so keep any receipts and papers related to an audit forever.) Internal monthly summaries and financial data need only be kept for 3 years.
Routine business correspondence should also be preserved for 3 years, but keep anything really important (particularly if related to litigation or major purchases) indefinitely. Expired insurance policies can be discarded after 3 years, but hang on to your malpractice policies, as well as insurance payout records, claims reports, and related documentation.
Keep bank deposit slips and monthly bank statements for 1 year. Canceled checks can be tossed after 7 years, except those for taxes, major asset purchases, and similar important transactions. Those should be filed permanently with the papers related to the corresponding transactions.
Personnel records, including original employment applications, should be kept for 3 years after the employee has left. Employee time clock records as well as payroll records and summaries, including payroll tax forms, should be kept a minimum of 7 years.
Tax returns should be kept at least 7 years, along with worksheets, lists, schedules, and other supporting items, though some tax lawyers recommend keeping the returns themselves indefinitely. Important legal documents such as deeds, mortgages, and bills of sale of major items should be kept permanently. Keep partnership agreements, corporate shareholder agreements, corporate minute books, and charter bylaws for 7 years after you cease being a shareholder or partner.
Finally, there are a few documents which should never be kept, even for a day. Unsolicited resumes, for example, pose legal risks that you have no need to take. Unsolicited resumes should be returned to senders immediately, accompanied by a note to the effect that you have “a strict policy on such submissions: Without exception, they are returned without review. But thanks for your interest.”
Last month I listed the various options for storing your old medical records, and made the case for keeping them indefinitely. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com
Once you've found a permanent home for your medical records, what about all those other records, business documents of all kinds, that are probably gathering dust in boxes, taking up expensive space?
Before you can decide what to keep, of course, you have to determine what you have. So get out all those boxes and have an employee sort everything into identifiable categories, by date.
Now comes the hard part. As a recovering “pack rat” myself, my instinct is to keep everything, but that's impractical and usually unnecessary. While your corporate minutes book must be maintained and updated perpetually, and a few important documents—which I will point out as we get to them—should be preserved for the duration, most records have no value after varying periods of time or the information they contain is readily available elsewhere, so they can be safely destroyed.
Of course, these are only suggestions. You should check your state and local laws for any statutorily mandated time limits, and your individual circumstances may dictate longer—or shorter—retention times for some documents than those suggested here. When in doubt, consult your practice lawyer.
Among standard business records, experts say day sheets, patient billing slips, and other original entry items can be discarded after 7 years. Ditto for year-end financial and management reports; third-party insurance explanation of benefits forms, correspondence, and other records; and paid invoices and other bills. (The Internal Revenue Service cannot normally go back further than 7 years, but audited files can be reopened at any time, so keep any receipts and papers related to an audit forever.) Internal monthly summaries and financial data need only be kept for 3 years.
Routine business correspondence should also be preserved for 3 years, but keep anything really important (particularly if related to litigation or major purchases) indefinitely. Expired insurance policies can be discarded after 3 years, but hang on to your malpractice policies, as well as insurance payout records, claims reports, and related documentation.
Keep bank deposit slips and monthly bank statements for 1 year. Canceled checks can be tossed after 7 years, except those for taxes, major asset purchases, and similar important transactions. Those should be filed permanently with the papers related to the corresponding transactions.
Personnel records, including original employment applications, should be kept for 3 years after the employee has left. Employee time clock records as well as payroll records and summaries, including payroll tax forms, should be kept a minimum of 7 years.
Tax returns should be kept at least 7 years, along with worksheets, lists, schedules, and other supporting items, though some tax lawyers recommend keeping the returns themselves indefinitely. Important legal documents such as deeds, mortgages, and bills of sale of major items should be kept permanently. Keep partnership agreements, corporate shareholder agreements, corporate minute books, and charter bylaws for 7 years after you cease being a shareholder or partner.
Finally, there are a few documents which should never be kept, even for a day. Unsolicited resumes, for example, pose legal risks that you have no need to take. Unsolicited resumes should be returned to senders immediately, accompanied by a note to the effect that you have “a strict policy on such submissions: Without exception, they are returned without review. But thanks for your interest.”
Last month I listed the various options for storing your old medical records, and made the case for keeping them indefinitely. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com
Once you've found a permanent home for your medical records, what about all those other records, business documents of all kinds, that are probably gathering dust in boxes, taking up expensive space?
Before you can decide what to keep, of course, you have to determine what you have. So get out all those boxes and have an employee sort everything into identifiable categories, by date.
Now comes the hard part. As a recovering “pack rat” myself, my instinct is to keep everything, but that's impractical and usually unnecessary. While your corporate minutes book must be maintained and updated perpetually, and a few important documents—which I will point out as we get to them—should be preserved for the duration, most records have no value after varying periods of time or the information they contain is readily available elsewhere, so they can be safely destroyed.
Of course, these are only suggestions. You should check your state and local laws for any statutorily mandated time limits, and your individual circumstances may dictate longer—or shorter—retention times for some documents than those suggested here. When in doubt, consult your practice lawyer.
Among standard business records, experts say day sheets, patient billing slips, and other original entry items can be discarded after 7 years. Ditto for year-end financial and management reports; third-party insurance explanation of benefits forms, correspondence, and other records; and paid invoices and other bills. (The Internal Revenue Service cannot normally go back further than 7 years, but audited files can be reopened at any time, so keep any receipts and papers related to an audit forever.) Internal monthly summaries and financial data need only be kept for 3 years.
Routine business correspondence should also be preserved for 3 years, but keep anything really important (particularly if related to litigation or major purchases) indefinitely. Expired insurance policies can be discarded after 3 years, but hang on to your malpractice policies, as well as insurance payout records, claims reports, and related documentation.
Keep bank deposit slips and monthly bank statements for 1 year. Canceled checks can be tossed after 7 years, except those for taxes, major asset purchases, and similar important transactions. Those should be filed permanently with the papers related to the corresponding transactions.
Personnel records, including original employment applications, should be kept for 3 years after the employee has left. Employee time clock records as well as payroll records and summaries, including payroll tax forms, should be kept a minimum of 7 years.
Tax returns should be kept at least 7 years, along with worksheets, lists, schedules, and other supporting items, though some tax lawyers recommend keeping the returns themselves indefinitely. Important legal documents such as deeds, mortgages, and bills of sale of major items should be kept permanently. Keep partnership agreements, corporate shareholder agreements, corporate minute books, and charter bylaws for 7 years after you cease being a shareholder or partner.
Finally, there are a few documents which should never be kept, even for a day. Unsolicited resumes, for example, pose legal risks that you have no need to take. Unsolicited resumes should be returned to senders immediately, accompanied by a note to the effect that you have “a strict policy on such submissions: Without exception, they are returned without review. But thanks for your interest.”
Should episiotomy have been performed?
A 28-year-old woman undergoing a vaginal delivery had a perineal tear. In suing, she claimed the resident allowed the perineum to tear before an episiotomy was performed, failed to control expulsion of the fetal head, and failed to support the perineum after episiotomy, leading to a 4th degree perineal laceration extending to the rectum.
The woman noted that she has permanent scarring at the posterior fourchette of the vagina and pain during intercourse, and said the ObGyn left a sponge inside the vagina for a month after repair of the perineum.
The defense contended that tears cannot be predicted with accuracy and that tears/extensions of episiotomies do occur without a breach of the standard of care.
- The jury awarded the plaintiff $526,745 against the ObGyn and his group, the resident, and the university.
- The hospital settled for $75,000.
A 28-year-old woman undergoing a vaginal delivery had a perineal tear. In suing, she claimed the resident allowed the perineum to tear before an episiotomy was performed, failed to control expulsion of the fetal head, and failed to support the perineum after episiotomy, leading to a 4th degree perineal laceration extending to the rectum.
The woman noted that she has permanent scarring at the posterior fourchette of the vagina and pain during intercourse, and said the ObGyn left a sponge inside the vagina for a month after repair of the perineum.
The defense contended that tears cannot be predicted with accuracy and that tears/extensions of episiotomies do occur without a breach of the standard of care.
- The jury awarded the plaintiff $526,745 against the ObGyn and his group, the resident, and the university.
- The hospital settled for $75,000.
A 28-year-old woman undergoing a vaginal delivery had a perineal tear. In suing, she claimed the resident allowed the perineum to tear before an episiotomy was performed, failed to control expulsion of the fetal head, and failed to support the perineum after episiotomy, leading to a 4th degree perineal laceration extending to the rectum.
The woman noted that she has permanent scarring at the posterior fourchette of the vagina and pain during intercourse, and said the ObGyn left a sponge inside the vagina for a month after repair of the perineum.
The defense contended that tears cannot be predicted with accuracy and that tears/extensions of episiotomies do occur without a breach of the standard of care.
- The jury awarded the plaintiff $526,745 against the ObGyn and his group, the resident, and the university.
- The hospital settled for $75,000.
$32 million award for catastrophic injuries
A woman delivered a baby who sustained hypoxic ischemic encephalopathy during delivery. The child, now 7 years old, has cerebral palsy, cortical blindness, seizure disorder, scoliosis, multiple contractures throughout the body, and spasticity. The child is incapable of participating in any activities of daily life.
In suing on behalf of the child, the plaintiff claimed the hospital nursing staff failed to inform the physician of rising maternal blood pressure and uterine hyperstimulation during labor; failed to decrease oxytocin in the presence of that hyperstimulation; and failed to investigate a lack of urine output for 7.5 hours before delivery.
The plaintiff also claimed the physician failed to take action on those developments; failed to recognize nonreassuring fetal heart tones; failed to order a cesarean section because of the distress signs; improperly removed the intrauterine pressure catheter; and improperly ordered a vaginal delivery.
The physician denied being informed of adverse conditions and claimed her decision to proceed with vaginal delivery under the circumstances was appropriate.
- The jury awarded the plaintiff $32.036 million.
A woman delivered a baby who sustained hypoxic ischemic encephalopathy during delivery. The child, now 7 years old, has cerebral palsy, cortical blindness, seizure disorder, scoliosis, multiple contractures throughout the body, and spasticity. The child is incapable of participating in any activities of daily life.
In suing on behalf of the child, the plaintiff claimed the hospital nursing staff failed to inform the physician of rising maternal blood pressure and uterine hyperstimulation during labor; failed to decrease oxytocin in the presence of that hyperstimulation; and failed to investigate a lack of urine output for 7.5 hours before delivery.
The plaintiff also claimed the physician failed to take action on those developments; failed to recognize nonreassuring fetal heart tones; failed to order a cesarean section because of the distress signs; improperly removed the intrauterine pressure catheter; and improperly ordered a vaginal delivery.
The physician denied being informed of adverse conditions and claimed her decision to proceed with vaginal delivery under the circumstances was appropriate.
- The jury awarded the plaintiff $32.036 million.
A woman delivered a baby who sustained hypoxic ischemic encephalopathy during delivery. The child, now 7 years old, has cerebral palsy, cortical blindness, seizure disorder, scoliosis, multiple contractures throughout the body, and spasticity. The child is incapable of participating in any activities of daily life.
In suing on behalf of the child, the plaintiff claimed the hospital nursing staff failed to inform the physician of rising maternal blood pressure and uterine hyperstimulation during labor; failed to decrease oxytocin in the presence of that hyperstimulation; and failed to investigate a lack of urine output for 7.5 hours before delivery.
The plaintiff also claimed the physician failed to take action on those developments; failed to recognize nonreassuring fetal heart tones; failed to order a cesarean section because of the distress signs; improperly removed the intrauterine pressure catheter; and improperly ordered a vaginal delivery.
The physician denied being informed of adverse conditions and claimed her decision to proceed with vaginal delivery under the circumstances was appropriate.
- The jury awarded the plaintiff $32.036 million.