Tapering Meds/Legal status

[Guest guest]

All,

 

I am not a lawyer and cannot answer this question authoritatively.

 

However, some of what I am reading in this discussion seems to me a little

dangerous. Even in a general commercial liability case (e.g.: selling herbs

over the counter) a waiver signed by anyone who is not a a legally

constituted corporation and without representation by counsel is not

defensible in a legal action. It might protect you from damages based on

negligence; it might establish absence of criminal intent, however, it would

not limit your liability and, in my lay opinion, would probably not protect

you even from the negligence aspect of a malpractice case.

 

U.S. law will consider such a waiver to be signed under implicit duress.

That is, the plaintiff's attorney, (whether for the individual or for their

survivors), would argue that the meds were for legally diagnosed conditions

and that the patient could not possibly have signed any waiver independent

of their fear of losing access to the treatments you offered. They would

further introduce into evidence the unsupported claims made in herbal

advertisements and the absence of support for any drug tapering in the

clinical literature. I frankly doubt your assets would survive the case.

 

Case notes in liability cases constitute a claim of standard practice. In other

words, the purpose of the case notes is to establish that the defending

practitioner performed at least as well as the standard of care for the

condition. That would be defined by the appropriate diagnostic standards

manuals and the testimony of experts recognized by the court (physicians).

I would be very surprised if the simple absence of the primary care

physician's order for the tapering in their case record would not be

sufficient to bring the case to court. The expense of the trial alone would

bankrupt anyone not covered by the appropriate insurance.

 

One of my colleagues treated many orthopedic and muscular problems for

professional athletes and other performers who were surrounded by agents

and teams of lawyers. In instances where he felt his therapy might impact

the dose of a prescribed drug, he would write the primary care physician a

letter establishing the therapeutic measures he was following (e.g. range of

motion, or a pain scale) and what he expected the course of acupuncture

therapy to achieve. He would note the med doses that might be effected and

follow-up that initial letter with progress reports and copies of his charts.

 

This approach had two advantages. First, it establishes the primary care

physician's responsibility by getting the therapy into the case record.

Second, doctors are human and curious and often enough follow the case,

including keeping track of whatever diagnostic test results indicated the

meds in the first place. In my friend's case, after local orthopeds saw the

tests improve (even the plebeian ones), they not only supported the

acupuncture, but began to refer other patients.

 

While it is certainly true that you might lose a patient to a inflexible

physician's demands, those are exactly circumstances where you will find

yourself in court, it is also true that you could engender a valuable referral

source.

 

Bob

 

bob Paradigm Publications

www.paradigm-pubs.com 44 Linden Street

Robert L. Felt Brookline MA 02445

617-738-4664

[Guest guest]

U.S. law will consider such a waiver to be signed under implicit duress

>>>There is such a thing as AMA form to cover your ass is such situations

Alon

 

-

Robert L. Felt

Thursday, November 15, 2001 3:08 PM

Tapering Meds/Legal status

All,I am not a lawyer and cannot answer this question authoritatively. However, some of what I am reading in this discussion seems to me a little dangerous. Even in a general commercial liability case (e.g.: selling herbs over the counter) a waiver signed by anyone who is not a a legally constituted corporation and without representation by counsel is not defensible in a legal action. It might protect you from damages based on negligence; it might establish absence of criminal intent, however, it would not limit your liability and, in my lay opinion, would probably not protect you even from the negligence aspect of a malpractice case.U.S. law will consider such a waiver to be signed under implicit duress. That is, the plaintiff's attorney, (whether for the individual or for their survivors), would argue that the meds were for legally diagnosed conditions and that the patient could not possibly have signed any waiver independent of their fear of losing access to the treatments you offered. They would further introduce into evidence the unsupported claims made in herbal advertisements and the absence of support for any drug tapering in the clinical literature. I frankly doubt your assets would survive the case.Case notes in liability cases constitute a claim of standard practice. In other words, the purpose of the case notes is to establish that the defending practitioner performed at least as well as the standard of care for the condition. That would be defined by the appropriate diagnostic standards manuals and the testimony of experts recognized by the court (physicians).I would be very surprised if the simple absence of the primary care physician's order for the tapering in their case record would not be sufficient to bring the case to court. The expense of the trial alone would bankrupt anyone not covered by the appropriate insurance.One of my colleagues treated many orthopedic and muscular problems for professional athletes and other performers who were surrounded by agents and teams of lawyers. In instances where he felt his therapy might impact the dose of a prescribed drug, he would write the primary care physician a letter establishing the therapeutic measures he was following (e.g. range of motion, or a pain scale) and what he expected the course of acupuncture therapy to achieve. He would note the med doses that might be effected and follow-up that initial letter with progress reports and copies of his charts. This approach had two advantages. First, it establishes the primary care physician's responsibility by getting the therapy into the case record. Second, doctors are human and curious and often enough follow the case, including keeping track of whatever diagnostic test results indicated the meds in the first place. In my friend's case, after local orthopeds saw the tests improve (even the plebeian ones), they not only supported the acupuncture, but began to refer other patients.While it is certainly true that you might lose a patient to a inflexible physician's demands, those are exactly circumstances where you will find yourself in court, it is also true that you could engender a valuable referral source.Bobbob Paradigm Publicationswww.paradigm-pubs.com 44 Linden StreetRobert L. Felt Brookline MA 02445617-738-4664Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

First, it establishes the primary care physician's responsibility by getting the therapy into the case record.

>>>>This is always a good idea and best way to build a practice

Alon

 

-

Robert L. Felt

Thursday, November 15, 2001 3:08 PM

Tapering Meds/Legal status

All,I am not a lawyer and cannot answer this question authoritatively. However, some of what I am reading in this discussion seems to me a little dangerous. Even in a general commercial liability case (e.g.: selling herbs over the counter) a waiver signed by anyone who is not a a legally constituted corporation and without representation by counsel is not defensible in a legal action. It might protect you from damages based on negligence; it might establish absence of criminal intent, however, it would not limit your liability and, in my lay opinion, would probably not protect you even from the negligence aspect of a malpractice case.U.S. law will consider such a waiver to be signed under implicit duress. That is, the plaintiff's attorney, (whether for the individual or for their survivors), would argue that the meds were for legally diagnosed conditions and that the patient could not possibly have signed any waiver independent of their fear of losing access to the treatments you offered. They would further introduce into evidence the unsupported claims made in herbal advertisements and the absence of support for any drug tapering in the clinical literature. I frankly doubt your assets would survive the case.Case notes in liability cases constitute a claim of standard practice. In other words, the purpose of the case notes is to establish that the defending practitioner performed at least as well as the standard of care for the condition. That would be defined by the appropriate diagnostic standards manuals and the testimony of experts recognized by the court (physicians).I would be very surprised if the simple absence of the primary care physician's order for the tapering in their case record would not be sufficient to bring the case to court. The expense of the trial alone would bankrupt anyone not covered by the appropriate insurance.One of my colleagues treated many orthopedic and muscular problems for professional athletes and other performers who were surrounded by agents and teams of lawyers. In instances where he felt his therapy might impact the dose of a prescribed drug, he would write the primary care physician a letter establishing the therapeutic measures he was following (e.g. range of motion, or a pain scale) and what he expected the course of acupuncture therapy to achieve. He would note the med doses that might be effected and follow-up that initial letter with progress reports and copies of his charts. This approach had two advantages. First, it establishes the primary care physician's responsibility by getting the therapy into the case record. Second, doctors are human and curious and often enough follow the case, including keeping track of whatever diagnostic test results indicated the meds in the first place. In my friend's case, after local orthopeds saw the tests improve (even the plebeian ones), they not only supported the acupuncture, but began to refer other patients.While it is certainly true that you might lose a patient to a inflexible physician's demands, those are exactly circumstances where you will find yourself in court, it is also true that you could engender a valuable referral source.Bobbob Paradigm Publicationswww.paradigm-pubs.com 44 Linden StreetRobert L. Felt Brookline MA 02445617-738-4664Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

What is an AMA form?

 

-Jason

 

 

 

ALON MARCUS

[alonmarcus]

Thursday, November 15, 2001

6:07 PM

To:

 

Re:

Tapering Meds/Legal status

 

 

U.S. law will consider such a waiver to be signed

under implicit duress

 

 

>>>There is such a thing as AMA form to

cover your ass is such situations

 

 

Alon

 

 

 

-

 

 

Robert L.

Felt

 

 

 

 

 

 

Thursday, November

15, 2001 3:08 PM

 

 

Subject:

Tapering Meds/Legal status

 

 

 

 

All,

 

I am not a lawyer and cannot answer this

question authoritatively.

 

However, some of what I am reading in this

discussion seems to me a little

dangerous. Even in a general commercial

liability case (e.g.: selling herbs

over the counter) a waiver signed by anyone who is

not a a legally

constituted corporation and without representation

by counsel is not

defensible in a legal action. It might

protect you from damages based on

negligence; it might establish absence of criminal

intent, however, it would

not limit your liability and, in my lay opinion,

would probably not protect

you even from the negligence aspect of a

malpractice case.

 

U.S. law will consider such a waiver to be signed

under implicit duress.

That is, the plaintiff's attorney, (whether for

the individual or for their

survivors), would argue that the meds were for

legally diagnosed conditions

and that the patient could not possibly have

signed any waiver independent

of their fear of losing access to the treatments

you offered. They would

further introduce into evidence the unsupported

claims made in herbal

advertisements and the absence of support for any

drug tapering in the

clinical literature. I frankly doubt your

assets would survive the case.

 

Case notes in liability cases constitute a claim

of standard practice. In other

words, the purpose of the case notes is to

establish that the defending

practitioner performed at least as well as the

standard of care for the

condition. That would be defined by the

appropriate diagnostic standards

manuals and the testimony of experts recognized by

the court (physicians).

I would be very surprised if the simple absence of

the primary care

physician's order for the tapering in their case

record would not be

sufficient to bring the case to court. The

expense of the trial alone would

bankrupt anyone not covered by the appropriate

insurance.

 

One of my colleagues treated many orthopedic and

muscular problems for

professional athletes and other performers who

were surrounded by agents

and teams of lawyers. In instances where he

felt his therapy might impact

the dose of a prescribed drug, he would write the

primary care physician a

letter establishing the therapeutic measures he

was following (e.g. range of

motion, or a pain scale) and what he expected the

course of acupuncture

therapy to achieve. He would note the med

doses that might be effected and

follow-up that initial letter with progress

reports and copies of his charts.

 

This approach had two advantages. First, it

establishes the primary care

physician's responsibility by getting the therapy

into the case record.

Second, doctors are human and curious and often

enough follow the case,

including keeping track of whatever diagnostic

test results indicated the

meds in the first place. In my friend's

case, after local orthopeds saw the

tests improve (even the plebeian ones), they

not only supported the

acupuncture, but began to refer other patients.

 

While it is certainly true that you might lose a

patient to a inflexible

physician's demands, those are exactly

circumstances where you will find

yourself in court, it is also true that you could

engender a valuable referral

source.

 

Bob

 

bob

Paradigm Publications

www.paradigm-pubs.com

44 Linden Street

Robert L.

Felt

Brookline MA 02445

617-738-4664

 

 

 

 

The Chinese

Herb Academy, a voluntary organization of licensed healthcare practitioners,

matriculated students and postgraduate academics specializing in Chinese Herbal

Medicine, provides a variety of professional services, including board approved

online continuing education.

 

 

 

 

Your use of

is subject to the

Terms of Service.

 

 

 

 

Chinese Herbal Medicine, a

voluntary organization of licensed healthcare practitioners, matriculated

students and postgraduate academics specializing in Chinese Herbal Medicine,

provides a variety of professional services, including board approved online continuing

education.

 

 

 

 

Your use of

is subject to the

Terms of Service.

[Guest guest]

, " " <@o...> wrote:

> What is an AMA form?

>

> -Jason

>

Jason:

 

I know Alon will reply to this, but AMA means " against medical

advice " . My only experience with them is on the sidelines when a

patient in the hospital says " I'm otta here! " when the standard of

care calls for further hospitalization. To cover themselves the

physician and hospital have the patient sign an AMA form acknowleding

that he (she) is rejecting their advice.

 

What I wanted to add was that I have an attorney who is a patient and

we discussed this issue briefly. He indicated that if his client were

damaged he would seek to demonstrate that the practitioner, being

the " expert " did not provide appropriate care or guidance. Even if it

is the patients idea and desire to discontinue medications, I believe

we would be held to a higher standard and " should know better " (i.e.

stay within the scope of our practice and refer to those within who's

scope of practice an issue falls).

 

As Bob suggests, the stakes are extremely high and nothing completely

insulates us from the litigeous nature of our society. Even when you

give people exactly what they ask for, if results are untoward, they

won't be happy and some will be looking to collect damages.

 

Michael

[Guest guest]

What is an AMA form?

>>>>Against medical advise

Alon

 

-

 

Thursday, November 15, 2001 6:29 PM

RE: Tapering Meds/Legal status

 

 

What is an AMA form?

 

-Jason

 

 

ALON MARCUS [alonmarcus] Thursday, November 15, 2001 6:07 PM Subject: Re: Tapering Meds/Legal status

 

 

U.S. law will consider such a waiver to be signed under implicit duress

 

>>>There is such a thing as AMA form to cover your ass is such situations

 

Alon

 

 

-

 

Robert L. Felt

 

 

Thursday, November 15, 2001 3:08 PM

 

Tapering Meds/Legal status

 

 

All,I am not a lawyer and cannot answer this question authoritatively. However, some of what I am reading in this discussion seems to me a little dangerous. Even in a general commercial liability case (e.g.: selling herbs over the counter) a waiver signed by anyone who is not a a legally constituted corporation and without representation by counsel is not defensible in a legal action. It might protect you from damages based on negligence; it might establish absence of criminal intent, however, it would not limit your liability and, in my lay opinion, would probably not protect you even from the negligence aspect of a malpractice case.U.S. law will consider such a waiver to be signed under implicit duress. That is, the plaintiff's attorney, (whether for the individual or for their survivors), would argue that the meds were for legally diagnosed conditions and that the patient could not possibly have signed any waiver independent of their fear of losing access to the treatments you offered. They would further introduce into evidence the unsupported claims made in herbal advertisements and the absence of support for any drug tapering in the clinical literature. I frankly doubt your assets would survive the case.Case notes in liability cases constitute a claim of standard practice. In other words, the purpose of the case notes is to establish that the defending practitioner performed at least as well as the standard of care for the condition. That would be defined by the appropriate diagnostic standards manuals and the testimony of experts recognized by the court (physicians).I would be very surprised if the simple absence of the primary care physician's order for the tapering in their case record would not be sufficient to bring the case to court. The expense of the trial alone would bankrupt anyone not covered by the appropriate insurance.One of my colleagues treated many orthopedic and muscular problems for professional athletes and other performers who were surrounded by agents and teams of lawyers. In instances where he felt his therapy might impact the dose of a prescribed drug, he would write the primary care physician a letter establishing the therapeutic measures he was following (e.g. range of motion, or a pain scale) and what he expected the course of acupuncture therapy to achieve. He would note the med doses that might be effected and follow-up that initial letter with progress reports and copies of his charts. This approach had two advantages. First, it establishes the primary care physician's responsibility by getting the therapy into the case record. Second, doctors are human and curious and often enough follow the case, including keeping track of whatever diagnostic test results indicated the meds in the first place. In my friend's case, after local orthopeds saw the tests improve (even the plebeian ones), they not only supported the acupuncture, but began to refer other patients.While it is certainly true that you might lose a patient to a inflexible physician's demands, those are exactly circumstances where you will find yourself in court, it is also true that you could engender a valuable referral source.Bobbob Paradigm Publicationswww.paradigm-pubs.com 44 Linden StreetRobert L. Felt Brookline MA 02445617-738-4664Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

I believe we would be held to a higher standard and "should know better" (i.e. stay within the scope of our practice and refer to those within who's scope of practice an issue falls). >>>>>One should never try something he does not understand, including using TCM in a patients. The key is having the patient sign and also document that you are not the one suggesting that tcm can take the place of drugs, and that you are not the one suggesting cutting drugs. And you should only agree to participate if you understand all possible complications (again that is true for tcm as well). Refusing to treat a patient is also legally liable

Alon

 

-

mbuyze

Friday, November 16, 2001 8:12 AM

Re: Tapering Meds/Legal status

, "" <@o...> wrote:> What is an AMA form?> > -Jason> Jason:I know Alon will reply to this, but AMA means "against medical advice". My only experience with them is on the sidelines when a patient in the hospital says "I'm otta here!" when the standard of care calls for further hospitalization. To cover themselves the physician and hospital have the patient sign an AMA form acknowleding that he (she) is rejecting their advice.What I wanted to add was that I have an attorney who is a patient and we discussed this issue briefly. He indicated that if his client were damaged he would seek to demonstrate that the practitioner, being the "expert" did not provide appropriate care or guidance. Even if it is the patients idea and desire to discontinue medications, I believe we would be held to a higher standard and "should know better" (i.e. stay within the scope of our practice and refer to those within who's scope of practice an issue falls). As Bob suggests, the stakes are extremely high and nothing completely insulates us from the litigeous nature of our society. Even when you give people exactly what they ask for, if results are untoward, they won't be happy and some will be looking to collect damages.MichaelChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.