The 2015 Annual California Society for Healthcare Risk Management Conference. Juggling our Resources: Finding Balance in the Chaos. Conference Program

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1 The 2015 Annual California Society for Healthcare Risk Management Conference Juggling our Resources: Finding Balance in the Chaos Conference Program March 4-6, 2015 Napa Valley Marriott and Spa 3425 Solano Ave., Napa, California

2 The Board of Directors of CSHRM proudly welcomes you back to the 2015 Annual Educational Conference here in beautiful Napa Valley. We hope that you find this to be an interactive Conference that provides you with an exciting and distinctive blend of informative panel discussions and intellectual presentations along with useful networking and socializing opportunities. This Conference represents the full spectrum of the healthcare risk management industry and provides a unique opportunity for professionals to openly exchange information and ideas that truly allow you to connect with risk management professionals, claims representatives, attorneys and other healthcare related personnel. The CSHRM s Board of Directors and our Speakers promise that you find the 2015 Conference to be a rewarding and worthwhile event CSHRM Board of Directors PRESIDENT Gregg Timmons COMMUNICATIONS & GOLF TOURNAMENT CHAIR AND PRESIDENT ELECT Jon Corr PAST-PRESIDENT Kirsten Padgett LEGISLATIVE & CONFER- ENCE SPONSORSHIP CHAIR Lashonda Griffin MEMBERSHIP CHAIR Mike Ball SECRETARY Denise Curry TREASURER Pamela Brotherton- Sedano BOARD MEMBER Regina Richard SPONSORSHIP COMMITTEE Richard Salinas SPONSORSHIP COMMITTEE Tascha Haut BOARD MEMBER Linda Robertson BOARD MEMBER Daniel Wainwright BOARD MEMBER Sheetal Shah BOARD MEMBER Dirk Paloutzian

3 CSHRM is pleased to Announce the presentation of The 34th Annual Conference of the California Society for Healthcare Risk Management Wednesday - Friday, March 4-6, 2015 Napa Valley Marriott and Spa Napa, California Juggling our Resources: Finding Balance in the Chaos

4 Conference Schedule of Speakers, Topics and Events 7:00-1:00 p.m. Eagle Vine 1:00-1:15 p.m. 1:15-2:15 p.m. Day One Wednesday, March 4, th Annual Golf Tournament - Generously Sponsored by Welcome to the Conference Introductory Remarks Gregg Timmons, CSHRM President Lengthy Difficult Patient Discharges: Juggling Capacity Concerns on Both Sides of the Equation Gena Peyton, Sutter Health Jeremy Harris, Sutter Health Kat Todd, Esq., Schuering Zimmerman & Doyle, LLP The increasingly lengthy efforts of discharging of patients with capacity issues, especially those due to psychiatric conditions, organic causes, or developmental disabilities continue to drain medical facility resources at alarming rates. This session will elevate the audience s awareness to the juggling act that must be performed on a daily basis by Emergency Department staff, Case Management folks, and health care providers in general when attempting to safely discharge or transfer these patients in order to stay within the requirements of the law. The presenters will go over the spectrum of difficult discharge issues but will focus the main discussion on what actions and responsibilities are required for compliance with state and federal regulations. 2:15-3:15 p.m. Working with Patients and Medical Staff in Ethical Conflicts Regarding Ineffective and Inappropriate Interventions Ryan F. Holmes, MA, PhD(c), Markkula Center for Applied Ethics at Santa Clara University. Conflicts between patients, their families and the medical staff regarding the course of treatment can be problematic, sometimes turning into significant legal and media issues. Finding ways to come to consensus between all the parties involved while managing all the legal, ethical and moral concerns is a real challenge to providers. In this presentation, Ryan F. Holmes, MA, PhD(c), a consultant and ethicist working with several Bay Area hospitals, will discuss ways to find the consensus among these sometimes disparate interests and parties. He will review the philosophy behind common sense interventions risk managers can use to help resolve these dilemmas. 3:15-3:30 p.m. Grand Foyer Afternoon Break - Snack Generously Sponsored by Enjoy an Afternoon Snack and Visit our Sponsors and Exhibitors

5 Day One Schedule Continued 3:30-4:30 p.m. When Patient Satisfaction Overrides Professional Judgment: What Can We Do About It? Matson Sewell, MS MPH CPHRM, Matson Sewell Consulting Patient Satisfaction monitoring (and relating its measurement to reimbursement) is here to stay, despite the current political rhetoric about challenging the Affordable Care Act. As with most attempts to improve patient care, unintended consequences of initiatives often go unrecognized and unaddressed. In the case of prioritizing patient satisfaction, clinicians are, with increasing frequency, foregoing recognized standards of care in order to comply with patient wishes. The effects of this pressured compliance with patient preference range from ill-advised use of antibiotics and overprescribing of opioids to the overuse of imaging technology and indefensible surgical approaches. Risk Managers are likely the only professionals currently in healthcare who are in a position to provide both the perspective and expertise to counter the risk of undue influence on professional standards. This presentation will focus on how we can help clinicians take practical steps to encourage adherence to care standards while remaining therapeutically aligned with the patient. 4:30-5:30 p.m. Case Studies on Behavioral Health Risks in the Non-Psychiatric Setting: Violence, Suicide and Firearms Jonathan D Rubin, Esq., Kaufman Borgeest & Ryan LLP Gregg Timmons, RN MA JD CPHRM The influx of psychiatric patients into acute care emergency departments, inpatient units, and clinics causes overcrowding and heightened risk of suicide and aggressive episodes. This taxes already overburdened settings with heretofore unforeseen patient management challenges and environmental issues. Using a case study format, this session will explore some of the unique risks acute care settings face from psychiatric patients. Scenarios derived from actual claims and real life examples will be discussed to illustrate risk management implications that address these challenges. Included will be the importance of following facility policies, adequately assessing risk and the duty to warn identified third parties of impending harm. Specific actions to address risks posed by psychiatric patients will be reviewed, such as environmental, assessment, staffing and training initiatives in various settings. Finally, legal implications of treating this population will be explored, including duty to warn and the ownership or possession of firearms by psychiatric patients. 5:30-6:30 p.m. Newcomer s Reception - Sponsored - by Courtyard CSHRM invites all new and/or first time attendees first time attendees to meet and to meet socialize and with each other socialize and with the CSRHM each other Board. and the CSHRM Board.

6 7:00-8:00 a.m. Continental Breakfast Day Two Thursday, March 5, :00-8:30 a.m. 8:30-9:30 a.m. Day Two Welcome and Opening Remarks Gregg Timmons, CSHRM President Hala Y. Helm, Member ASHRM Board Member Working with CDPH: Avoiding and Managing Immediate Jeopardy and Citation and Fine Situations Cyrus A. Tabari, Esq., Sheuerman Martini Tabari Zenere & Garvin Working with the surveyors of the California Department of Public Health (CDPH) in a way that is collegial, productive and in the best interest of patients is something all healthcare organizations should strive for, but in certain situations can be a challenge. In this session, a seasoned attorney will discuss two recent cases this year in which he represented local hospitals that challenged fines and citations levied by the CDPH. Both were cases of regulatory violations that the hospitals did not believe fit the facts. In one case the hospital took CDPH to court. In the other case the hospital was given a finding of Immediate Jeopardy and responded. This program will discuss various regulatory issues and how to avoid challenging situations with CDPH without having to take such extreme measures. 9:30-11:00 a.m. Navigating the Challenges of Burnout in the Risk Management Community Ron Holfeldt, MD, Wellness Development Group Recent studies indicate that burnout is pervasive in physicians, nurses and other direct healthcare providers. Not only is burnout a concern that impacts patient safety, but the overall health of the providers is an important factor that affects the quality of patient care. Slowly, health and wellness programs are being developed to address this vital concern among clinicians. Too frequently overlooked is the impact of stress on a key segment of the healthcare team- the Risk Manager. The intrinsic stress of medicine along with the escalation of demands placed on Risk Managers make for a unique set of challenges that impact their health and wellbeing. This presentation addresses the impact of stress and burnout on Risk Managers. Attend this interactive discussion that explores the specific stressors that impact Risk Managers and participate in an exploration of the mitigating factors that promote resilience. Join your colleagues in discovering tips to prolong your career and enhance the joy of your work. 11:00-11:15 a.m. Grand Foyer 11:15-12:15 p.m. Morning Break Enjoy a late morning snack, mingle with colleagues and visit our Sponsors/Exhibitors Addressing Chaos in Work and Improving Patient Safety Using the SEIPS Model Theresa Frei, R.N., BSN, MBA, Sutter Medical Foundation In this engaging session, Theresa Frei, a healthcare executive active with the California Patient Safety Action Coalition, will discuss the opportunities provided by the System Engineering Initiative for Patient Safety, or SEIPS. The SEIPS model of work system design was developed by the University of Wisconsin School of Industrial Engineering and is used to improve the structures, processes and outcomes that affect patient safety in healthcare. Ms. Frei will highlight the potential healthcare organizations have to improve physician and nursing satisfaction with the work environment using the SEIPS model. 12:15-1:15 p.m. Pool Patio CSHRM Business Meeting & Lunch - Generously sponsored by Attend CSHRM s 2015 Annual Business Lunch

7 Day Two Schedule Continued 1:30-2:30 p.m South Napa Earthquake: Lessons Learned for Hospital Disaster Planning and Response Kathy Flossman, Queen of the Valley Hospital, Napa Lois Husted, Queen of the Valley Hospital, Napa Hospitals all across California have disaster plans and response protocols in case of a serious earthquake. But since a quarter of a century has elapsed since a major earthquake, most do not know exactly how effectively and efficiently their organizations would respond if the worst case scenario hit. At 3:20 am on August 24, 2014, a 6.0 earthquake now known as the South Napa Earthquake struck Queen of the Valley Medical Center in Napa, California. In this program, risk management and disaster management professionals from that facility will share their experiences on that day and in the immediate aftermath. They will discuss specific successes and opportunities for improvement from which all healthcare organizations can benefit. Keynote Address 2:30-4:00 p.m. Crossing the Patient Safety Medical Liability Chasm Timothy McDonald, MD, JD, Sidra Medical and Research Center CSHRM is pleased to have Timothy B. McDonald, an internationally known advocate for patient safety, as our keynote speaker. Dr. McDonald is the inaugural Service Chief for Anesthesiology and Medical Director of Quality and Safety at Sidra Medical and Research Center. Prior to joining Sidra, Dr. McDonald was Chief Safety and Risk Officer for Health Affairs at the University of Illinois, Professor of Anesthesiology and Pediatrics at the University of Illinois College of Medicine at Chicago and Adjunct Professor of Law at Loyola University School of Law. Dr. McDonald gained his medical degree from Indiana University School of Medicine and his law degree from Loyola University School of Law. After completing an internship and junior residency in pediatrics at Boston Children s Hospital, Dr. McDonald was a registrar in pediatrics at St Mary s Hospital, London, UK. He then returned to complete a senior residency in pediatrics at Boston Children s Hospital before undertaking a residency in anesthesia at Brigham and Women s Hospital. 4:00-4:15 p.m. Grand Foyer 4:15-5:15 p.m. Afternoon Break Enjoy an afternoon snack and visit our Sponsors/Exhibitors Current Trends in Managing Patient and Staff Health Risks during Healthcare Construction Projects John Martinelli, Forensic Analytical Consulting Services It seems as though, in addition to death and taxes, construction in hospitals has become a constant. Along with the construction are actual and perceived health risks and an increased public awareness of healthcare acquired infections and the potential role these construction projects may play. In addition to health risks, are the increased risk of litigation related to claims of infection or compromised care as a result of construction activities. To best protect the public and the owners risk, as well as comply with regulatory requirements, using a proactive pre-construction risk assessment process that engages a multi-disciplinary team to identify risks, assign and monitor the effectiveness of risk mitigation measures and document all activities is the current industry standard. This session will examine examples of tools that can be used to guide the risk assessment process; list the key participants and the unique role of each; and discuss various monitoring methods including environmental sampling, their values and limitations, and when (and when not) they are best employed to prove effectiveness of control measures.

8 Day Two Schedule Continued 6:00-8:00 p.m. President s Reception - Generously sponsored by Pool Patio 7:00-8:00 a.m. Grand Foyer 8:00-8:15 a.m. 8:15-9:15 a.m. Day Three Friday, March 6, 2015 Full Breakfast - Generously sponsored by Day Three Opening Remarks Gregg Timmons, CSHRM President Electronic Healthcare Communication by the Book: Keeping It Under Control and Within the Rules Paul Anderson, ECRI Institute Effective communication is the crux of safe healthcare. When technology helps providers get the right information faster, whether test results, changes in a patient s condition, or even clinical news and education, it can have a direct effect on patient outcomes. But when providers use to complain about colleagues, go on social media to badmouth patients, or text orders to the wrong number, the consequences can be significant. To make matters more complicated, the National Labor Relations Board (NLRB), the Joint Commission, and other regulatory and accreditation agencies have sometimes confusing rules regarding how much employers can control what their employees say and do online. This session will look at the balancing act risk managers and compliance officers have to do to protect the organization s interests without violating employees rights. Case examples will show some of the ways online communication has gone wrong and what organizations and managers can do within the bounds of NLRB s rules to help providers take advantage of the best technology has to offer without putting patient safety or their own jobs and professional reputations in jeopardy. 9:15-10:15 a.m. Engaging Emergency Physicians and Hospitalists as Allies in Patient Safety During ED Transitions of Care Richard Bernard, BS CPA (inactive Status) CPHRM and Mark J. Spiro MD, FACEP, Medical Director, The Mutual RRG, Inc. The role of communication for transitions in care is seen as fundamental for patient safety in the Emergency Department (ED). Both emergency physicians (EPs) and hospitalists can take particular specific actions to protect patients from avoidable harm during these transitions. In this presentation, we will review patient safety issues unique to transitioning patients from the emergency department to the hospitalist service in a case study format for the betterment of the patient. We will also explore effective approaches to promoting patient safety awareness among physicians, including ways to obtain physician buy-in on these initiatives. 10:15-10:30 a.m. Grand Foyer Morning Break Enjoy another cup of coffee or tea and make a last visit to our Sponsors

9 Day Three Schedule Continued 10:30-11:30 p.m. Out from Under the Rug: Creating a Culture of Transparency Warren Browner, MD, California Pacific Medical Center Often too many healthcare organizations deal with serious medical events by "sweeping them under the rug" through failing to be aware of events or failing to disclose them, among other means. However, these failures keep organizations from developing a fair, transparent culture. In this presentation, Dr. Warren Browner, CEO of Sutter Health CPMC in San Francisco, will discuss the processes by which organizations can establish to create a culture that ensures transparent, safe, quality health care. Dr. Browner will describe organizational systems that provide transparent solutions designed to effectively and efficiently address significant events. Other principles to be addressed will also include effective disclosure, resistance to change, and ensuring a fair and just response to an event. 11:30-12:30 p.m. Legislative Update Susan Penney, UCSF Medical Center This annual update summarizes recent new laws and regulations of particular interest or importance for healthcare risk managers. New trends or contemporary issues of interest to healthcare risk managers are also tracked. 12:30-12:45 p.m. Final Remarks, Thanks and Adjournment of Conference Gregg Timmons, CSHRM President The CSHRM Board of Directors Thank You for attending our 2015 Annual Conference. Please drive home safe, have a wonderful remainder of 2015 and let s meet again next year at CSHRM s 2016 Conference.

10 CONFERENCE SPONSORS The Board of Directors of CSHRM wish to thank those who have graciously and generously sponsored the 2015 Conference. Without the support of our sponsor s this wonderful Conference at this amazing location would have never occurred. As such, the Board offers its utmost appreciation for the financial backing it has received for this year s Conference from the following sponsors: President s Reception Sponsor NORCAL Mutual Insurance Company was formed by physicians in 1975 to provide the highest quality medical professional liability insurance products and services to its policyholder-owners. NORCAL Mutual insurers nearly 20,000 physicians and other healthcare professionals in solo practice, medical groups, hospitals, clinics and allied healthcare facilities in California, Alaska and Rhode Island. Golf Tournament Sponsor Founded in 1965, La Follette, Johnson, DeHaas, Fesler & Ames is a statewide litigation firm of 55 attorneys specializing in defense of healthcare providers. The Firm serves clients all over Northern and Southern California, including San Diego, through its five offices. La Follette, Johnson represents many hospitals in Northern California in major exposure medical negligence cases. The state s largest insurers, self-insured entities, and healthcare organizations call upon La Follette, Johnson to defend their most serious claims.

11 Business Lunch Sponsor Franco Signor is passionate about the Liability and W o r k e r s C o m p e n s a t i o n industry groups we serve. We are the nation's recognized leader in Medicare Secondary Payer Compliance and the largest provider of Medicare Reporting Services in the United States. Additionally, we offer outstanding Medicare Set-Aside Services, Conditional Payment Resolution Services and Mandatory Insurance Reporting Services. Franco Signor is dedicated to leading the evolution of the marketplace with our innovation and oversight. For more information, visit Newcomer s Reception Sponsor Medical Malpractice defense is what Weiss Martin Salinas & Hearst is best known for it s what they do. When a health care professional or institution is faced with allegations that care and treatment resulted in injury or death, Weiss Martin Salinas & Hearst can help. With established expertise and decades of experience, they are prepared to provide an aggressive defense. They are expert at handling all phases of malpractice litigation, from the initial pleadings through jury trial. If you are facing allegations of medical malpractice, elder or dependent adult abuse or related claims, get Weiss Martin Salinas & Hearst on your side. The attorneys at Weiss Martin Salinas & Hearst have been successfully defending physicians, allied health professionals and medical institutions for well over 30 years. Platinum Level Sponsors McCormick Barstow LLP is a Martindale-Hubbell AV Preeminent Peer Review Rated firm committed to providing the highest level of legal representation to its clients. This commitment has helped make McCormick Barstow a pre-eminent and respected law firm in each of our locations and practice areas. It is with great pride and dedication that McCormick Barstow has grown to more than 100 attorneys on staff, a wide array of practice areas, and six offices in five states. McCormick Barstow is capable of handling virtually all of your legal needs in California, Colorado, Nevada, Ohio, Washington and beyond. McCormick Barstow s Professional Liability Practice Group specializes in representing professionals in a wide variety of matters involving errors and omissions, licensing, and disciplinary proceedings. The Practice Group s diverse clientele includes physicians, hospitals, psychologists, psychiatrists, chiropractors, podiatrists, dentists, and other healthcare professionals. For more information see:

12 Platinum Level Sponsors (continued) Porter Scott s healthcare attorneys are well-versed in the issues currently facing public and private hospitals, nursing homes, convalescent facilities, surgical centers, surgeons, physicians, physician assistants, nursing staff, nurse midwives, dentists, hygienists, and other healthcare practitioners. The firm s attorneys are experienced in cutting-edge legal issues relevant to elder abuse, dependent adult abuse, medical malpractice, regulatory compliance, credentialing, licensing, labor and employment and related matters. Since its inception over 30 years ago, Porter Scott has provided the highest quality litigation representation to Northern California s healthcare industry in cases of medical negligence with catastrophic injury. The firm s full spectrum of services includes pre-litigation advice and counseling, training and education of the medical staff, pre-lawsuit investigation and aggressive advocacy when it becomes necessary. In addition to its healthcare practice, the firm offers a wide variety of complex litigation services in many other fields including professional liability, employment, products liability, construction, civil rights and public entity, real estate, environmental law, general business litigation and alternative dispute resolution, including mediation and arbitration. For further information regarding the wide spectrum of services offered and information regarding Porter Scott Attorneys, please visit our website at BETA Healthcare Group (BETA) is the largest insurer of hospital professional liability coverage in California, serving more than 150 hospitals and healthcare facilities. As the leading choice of liability insurers for California hospitals, BETA s long-established commitment to California physicians continues to grow with more than 5,000 insured physicians and over 50 medical groups. Whether its hospitals, medical groups, clinics or hospices, BETA has earned a reputation for financial strength, rate stability, quality service and breadth of coverage that is unparalleled in the industry As the world's leading insurance broker and risk advisor, Marsh is devoted to finding the opportunity in risk. With 24,000 employees and annual revenues approaching $5 billion, Marsh serves more clients in more industries worldwide than any firm in our industry. Our HealthCare Practice comprises more than 500 colleagues who provide risk management, risk consulting, risk financing, and technological solutions to organizations across the health care continuum. Our clients include for-profit and not-for profit hospitals; academic medical and research centers; managed care providers including HMOs and pharmacy benefit managers; senior housing services composed of assisted and independent living centers and long-term care residences; and more than 195 health care captives. With more than forty-five years of experience in service to the legal and insurance industries, Quest Discovery Services (QDS) is uniquely qualified to provide you with the litigation support you need to be successful. We have the people, resources, alliances, and professional expertise to meet your needs quickly, accurately, and cost-effectively. No longer will you have to juggle missed deadlines and multiple vendors. QDS offers a full-range of services, including subpoena preparation, service of process, electronic records, x-ray duplication and large volume reproductions. Trust QDS to provide you with a single source for all your litigation support needs. The Quality of our product is achieved through our belief in Uniformity, commitment to Excellence, pride in our Service, and strength through Teamwork.

13 Platinum Sponsors (Continued) Baker Manock & Jensen is one of Central California s largest law firms. In operation since 1903, we are located in Fresno yet some of our specialty practices are statewide. We have a long and proud tradition of representing health care providers in a variety of matters, both in and out of the courtroom. We are also known for our expertise in industries other than healthcare, such as agriculture, food processing and manufacturing, and in certain disciplines such as water, tax, trusts and estates Stammer, McKnight, Barnum & Bailey LLP has served clients primarily throughout California s Central Valley and Central Coast since Its areas of expertise include the defense of medical malpractice actions for hospitals and doctors, staff privilege hearings, employment law, business litigation, agricultural law, and general personal injury law. The firm is the recipient of Martindale- Hubbell s AV Peer Rating. Two of the partners are members of the American Board of Trial Advocates, and two are members of the California Medical Legal Committee. The firm works up its cases for trial in consultation with its clients so it is ready to go to trial if necessary, but with the recognition that not every expense necessary to take the case to trial need be incurred at the outset. Safety National is a versatile alternative market insurance provider that offers a broad range of risk funding products through insurance agents and brokers. Founded in 1942, Safety National is the leading provider of excess workers compensation coverage to self-insured employers and groups nationwide, and has provided that type of coverage longer than any other company in the United States. The company is licensed to provide workers compensation insurance in all 50 states, the District of Columbia and Canada. Safety National is a member of the Tokio Marine Group and is rated A (Excellent), Financial Size Category XI, by A.M. Best.

14 Gold Level Sponsors AIG has a 40 year history serving the volatile liability healthcare market. Our underwriting, claims and risk management expertise provides brokers and policyholders with a distinct knowledge advantage in managing healthcare risks. AIG provides security, flexibility and quality with each insurance policy. Hinshaw, Marsh, Still & Hinshaw, LLP has been protecting and defending the rights of healthcare professionals in medical malpractice and administrative law cases for over four decades. We have a reputation for diligent preparation, uncompromising advocacy and success at trial. While justifiably proud of our record at trial, we work to achieve our clients goals efficiently and effectively through aggressive discovery, pretrial motion practice and alternative methods of dispute resolution. We strive to provide proactive, cost effective defense strategies to our clients and claims specialists. This approach that has earned our law firm a reputation as a leader in healthcare defense in Northern California. The Cooperative of American Physicians, Inc. was established in 1975 by a group of California physicians to manage the escalating cost of medical professional liability coverage. Two years later, CAP formed the Mutual Protection Trust, which today provides protection to nearly 12,000 of California's finest physicians, and which has earned an A+ (Superior) rating from A.M. Best since CAP also offers medical professional liability protection to physicians practicing in large groups through the Cooperative of American Physicians Insurance Company, Inc., a risk retention group. CAPIC-RRG is rated A- (Excellent) by A.M. Best. For more information, visit Milliman is among the world's largest providers of actuarial and related products and services. The firm has consulting practices in healthcare, property & casualty insurance, life insurance and financial services, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. For further information, visit RL Solutions designs innovative healthcare software for patient feedback, incident reporting and risk management, infection surveillance and claims management. At RL Solutions, nurturing long-lasting relationships with our clients is what we do best. We have over 1500 clients, including healthcare networks, hospitals, long-term care facilities and more. RL Solutions is a global company with offices in Canada, the United States, Australia and United Kingdom.


16 Resort Map & Event Locations Grand Foyer - Sponsors/Exhibitors & Food/Beverage Display 3/5/15 Business Lunch & President s Reception - All General Sessions 3/4/15 Newcomer s Reception The 2015 Annual California Society for Healthcare Risk Management Conference Juggling our Resources: Finding Balance in the Chaos