Recently, I was at an interdisciplinary team (IDT) meeting as medical director for a hospice. During the meeting, one of the nurses reported that one of her patients had a severe sore throat. She also relayed the information that her primary care physician (PCP) had declined continuing as her PCP once she became enrolled in hospice. By default, then, I was her PCP. Fortunately, I had time between the end of the meeting and my next appointment to stop by her house, which was not particularly out of the way. The patient was an elderly woman on hospice with end-stage chronic obstructive pulmonary disease.

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“What do you do?” This is often the question used to spark a conversation in a new acquaintance, to get to know who they are. But aren’t you more than what you do for a job? And isn’t it more interesting to know what a person is passionate about, not necessarily what they spend their 9 to 5 doing? I think this common question highlights the fact that our identities often are interwoven into our job titles. But is this really healthy? Is it truly the whole story of who we are? And, more importantly, in our example as physicians, do our patients really want us to simply be a doctor?

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The legal landscape for non-compete restrictions has been undergoing change. Legislatures and courts have been taking a renewed look at these restrictions, and in some cases aggressively limiting the type and scope of non-competes including those for physicians. While limitations are springing up, non-competes continue to be valid in most states. As a result, physicians must still be mindful and strategic when entering into contracts containing non-compete clauses. 

 

What is a non-compete?

 

Non-competes are a type of contract provision known as a restrictive covenant which can apply during employment and after employment ends.1 Non-competes are designed to restrict physicians from competing by precluding them from working for a competitor, or setting up a competing medical practice, usually for a specified time period after employment ends within a designated geographic area.

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A Federal law enacted nearly six decades ago to combat interstate organized crime has become the latest weapon in the government’s arsenal against healthcare fraud. The Travel Act, signed by President John F. Kennedy in 1961, prohibits interstate or foreign travel, or use of the mails or any facility in interstate or foreign commerce, for the purpose of distributing the proceeds of an unlawful activity, committing a crime of violence in furtherance of an unlawful activity, or to promote, manage, establish, or carry on an unlawful activity. It makes travel or the use of the mails or other interstate facilities in furtherance of a state or federal crime a separate federal offense.

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“From Pittsburgh to the World” is the message on a banner at the Global Links headquarters in Green Tree. Surrounding the banner is detailed pottery from Cuba, lucky ekekos from Bolivia and beautifully painted feathers from Nicaragua. Adjacent to these mementos of thanks from communities around the world is a window that sits eye-level with I-376 West and the rapid traffic and massive semi-trucks that come with it. The colorful art and the grey interstate form a striking dichotomy … and a striking partnership. Those massive semi-trucks that pass by may just have left Global Links filled with medical surplus such as life-saving sutures, hospital beds, wheelchairs, breathing machines, blood pressure cuffs and oto-ophthalmoscopes.

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Catherine A. Chappell, MD, MSc
Debra L. Bogen, MD, FAAP, FABM

One of the most significant consequences of the opioid crisis is the increasing prevalence of hepatitis c virus (HCV) infection among young persons, including pregnant women. In 2015, the Centers for Disease Control (CDC) reported a 364% increase in HCV infection among persons less than 30 years of age.1 Now in Pennsylvania, young persons outnumber the “Baby Boomers” (persons born between 1945 to 1965) with HCV infection.2 Currently, recommendations are to universally screen all Baby Boomers for HCV.3 However, there are conflicting guidelines regarding HCV screening during pregnancy. While the Infectious Disease Society of America (IDSA) recommends universal antenatal HCV screening, the American College of Obstetrics and Gynecology (ACOG) recommends risk-based screening.

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The Pennsylvania Commonwealth Court, on remand from the Pennsylvania Supreme Court, has again decided that the previously agreed termination date of the access provisions contained in the UPMC/Highmark Consent Decrees, i.e. June 30, 2019, is not a term subject to the modification provisions of those Consent Decrees, and is definite. The adjudication of the Commonwealth Court, attached hereto, discusses the history of the negotiation of the terms, especially the termination date, and confirms the Consent Decrees will expire on June 30, 2019.

PA vs. UPMC 6-14-19 Adjudication

The Pennsylvania Supreme Court decided Mitchell v. Shikora in favor of Pennsylvania’s physicians. 

All seven justices agreed and held that evidence regarding risks and complications of a surgical procedure may be admissible in medical negligence actions to assist in establishing the standard of care. In a dissenting/concurring opinion, however, two of the justices essentially opined that risks and complications evidence is not always germane and should be considered on a case-by-case basis.

PAMED action: On Dec. 1, 2017, the Pennsylvania Medical Society (PAMED) Executive Committee approved the filing of an amicus curiae brief with the American Medical Association (AMA) in the state Supreme Court case Mitchell v.

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This is the first installment of a four-part series.

Part I: Introduction

Medical malpractice is an unfortunate issue that all physicians are forced to confront from time to time. My background for this topic includes the following: I am a retired diagnostic radiologist who is certified by the American Board of Radiology. My principle areas of interest are musculoskeletal (MSK) disorders and trauma imaging, with special interest and expertise in spine injuries. My academic career included faculty positions at the University of Louisville, Duke University, Drexel University and Temple University (during my 30 years at Allegheny General Hospital). I was an expert witness and legal consultant in diagnostic radiology for 35 years.

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Since former U.S. President Richard Nixon redeemed his legacy by defrosting and strengthening the relationship between the United States and China, China has rapidly advanced in terms of technology, economic power and manufacturing capability to become a superpower in its own right. Our recent news is filled with worries of U.S. debt to China, trade wars with China, industrial and perhaps political espionage perpetrated by China and the like. At the same time, it has become fashionable amongst Americans to visit China and take pictures along the Great Wall of China or before the famous Stone Soldiers to cross these off one’s bucket list.

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