Safeguarding our Healthcare Heroes with Legislation on Workplace Violence Prevention

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The stories are not new, but they become more frequent every year. Nurses assaulted in the emergency room by a patient being evaluated for treatment, surgeons shot to death in their clinics, dental staff threatened by patients over wait times, hospital employees shot to death by coworkers in hospital stairwell, and countless others. While possible everywhere, emergency departments and behavioral health facilities are at the most risk for an incident to occur. According to the World Health Organization, it is estimated that between 8% and 38% of healthcare workers suffer physical violence at some point in their careers. Additionally, per the US Bureau of Labor Statistics, healthcare and social service workers were victims of 76% of all nonfatal injuries from workplace violence in 2020.

What is Workplace Violence?

The Occupational Safety and Health Administration (OSHA) defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. Workplace violence ranges from threats and verbal abuse to physical assaults and even homicide. Patients are the largest, but not the only source of violence as family members, visitors, intruders, or even coworkers are also potential instigators. Most incidents are created by systemic factors such as overcrowded areas, staff shortages, long wait times, inflexible visiting hours, and differences of language and culture. When healthcare workers require treatment or miss work because of an injury, employers’ workers’ compensation insurance (whether private or self-insured) will typically bear the expense of continuing to compensate the injured provider while away from work. Non-economic costs include provider stress, fatigue, burnout, and turnover, all of which have been shown to relate to decreased patient satisfaction and an increased risk of error.

Workplace Violence Prevention for Healthcare and Social Service Workers Act

On April 18, 2023, both the Senate and the House reintroduced the Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 2663 and S 1176) that was previously considered in 2021 and 2019. It has been sent by both houses for committee review. The new legislation would require the Secretary of Labor to issue a standard requiring healthcare providers to write and implement a workplace violence prevention plan. If it becomes law, it will apply to many healthcare settings, including hospitals, psychiatric treatment facilities, and substance use disorder treatment centers. The requirements include unit-specific assessments and implementations of prevention measures, including:

  • physical changes to the environment
  • staffing for patient care and security
  • hands-on training
  • robust record-keeping requirements
  • protections for employees to report workplace violence to their employer and law enforcement

Additionally, the Safety from Violence for Healthcare Employees Act, introduced in September, would make assaulting healthcare workers in hospitals a federal crime with enhanced penalties for assaults resulting in serious bodily injury.

Many states are also passing legislation surrounding workplace violence prevention in healthcare, including Virginia, which recently required every hospital to implement a heightened security plan with staffing of at least one off-duty police officer at all times, absent a waiver. Additionally, The Joint Commission revised workplace violence prevention requirements effective January 1, 2022. The increase in legislation and attention around workplace violence in healthcare recognizes that identifying risk factors and providing education can help to prevent or minimize incidents from occurring.

Hancock Daniel’s Security, Workplace Violence, and Crisis Management Team provides assistance in assessing or creating a compliant program for your organization. Our team provides the full continuum of services from risk assessment to crisis management as well as handling the legal, regulatory, and operational aspects resulting from safety related events occurring in the healthcare setting.

via Hancock Daniel.  Click here for a full PDF version of the advisory.
The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel & Johnson, P.C., is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel & Johnson, P.C. be liable for any direct, indirect, or consequential damages resulting from the use of this material.

The MSV Installs President Alice Coombs, MD, MPA, FCCP at 2023 Annual Meeting

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Alice Coombs, MD, MPA, FCCP of Richmond, Virginia was installed as the fourth female and first black president of the Medical Society of Virginia (MSV) at the organization’s Annual Meeting on October 14, 2023, at Hilton Norfolk The Main. Dr. Coombs is a Board-certified Critical Care Specialist, Anesthesiologist, and Internist. She has been actively practicing medicine for more than 35 years in both Private and Academic settings.

In her inaugural speech, Dr. Coombs spoke of her experiences as a physician, the importance of the patient-physician relationship, advocating for effective and solution-focused healthcare policy, and her passion for the profession and her fellow physicians and PAs.

“Don’t miss your moment. Each of us is given finite time on this earth, to care for patients, to impact families and to care for our own families and for ourselves.

We are made of a unique fabric some silk, some wool, but the fibers of our lives have been woven into experiences that make us uniquely positioned to leave our mark. Don’t miss your moment!”

Her agenda for her presidency includes a focus on physician and PA mental health and wellness, developing and supporting new programs designed to better the lives of physicians and patients, and to uphold MSV’s overall goal to make Virginia the best place to practice medicine and receive care.

Dr. Coombs completed her medical training at the Massachusetts General Hospital in Internal Medicine and Anesthesiology and completed a MGH Critical Care Medicine fellowship and Tufts University Cardiothoracic fellowship.

Dr. Coombs is a Past President of the Massachusetts Medical Society. She is a Virginia Delegate to the American Medical Association (AMA) House of Delegates and currently serves on the AMA Council on Medical Services. She has served 2 terms as a commissioner on the Medicare Payment Advisory Commission, the body that makes recommendations to Congress annually regarding payment for Medicare beneficiaries.

Impact of a Federal Government Shutdown on Health Programs

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The fall season brings with it the potential for government shutdown on October 1. We are seeing this play out this week as Congress has yet to pass any of the 12 FY2024 appropriations bills or a short-term spending bill (i.e., Continuing Resolution, or CR) to keep the government funded while Congress continues to work on a broader spending package. The Senate is expected to vote by Saturday on a CR that would fund the government until November 17. There are two CR proposals in the House—one to fund the government for 30 days and the other until January 11—but a vote has not been scheduled and may not be by the October 1 deadline.

Below are some highlights of the impact on key health policy areas in the event Congress does not pass a CR by midnight Saturday, September 30, and there is a government shutdown.

Congress

  1. Congressional offices will remain open.

Medicare and Medicaid

  1. The Centers for Medicare & Medicaid Services (CMS) will continue to process claims.
  2. Physicians would not have to hold claims until the CR passes, but there could be a delay in payment if the shutdown is prolonged and funding to Medicare Administrative Contractors is delayed.
  3. If the shutdown is prolonged, it is possible that the release of the Medicare physician fee schedule final rule, outpatient prospective payment system final rule, and other major regulations could be delayed.
  4. Medicare benefits will not be affected.
  5. Medicaid has full funding for the next three months.
  6. Approximately half of CMS employees would be deemed essential and continue to work, although many would be unpaid until the shutdown ends.
  7. CMS staffing levels may not be sufficient to respond to physicians’ questions about Medicare policies or scores under the Merit-based Incentive Payment System (MIPS).
  8. Center for Medicare and Medicaid Innovation (CMMI) staff may continue to develop new alternative payment models, but any new model that CMMI plans to formally announce would likely be delayed.

Department of Health and Human Services (HHS)

  1. HHS will use its authority under the Antideficiency Act (ADA) to maintain existing HHS activities, including research and vaccine and therapeutic development.
  2. CMS will maintain the staff necessary to make payments to eligible states for the Children’s Health Insurance Program (CHIP).
  3. CMS will continue Federal Exchange activities, such as eligibility verification, using Federal Exchange user fee carryover.
  4. The Substance Abuse and Mental Health Services Administration (SAMHSA) will continue substance abuse and mental health programs, including those that provide critical behavioral health resources in the event of a natural   or human-caused disaster such as Disaster Behavioral Health response teams, the 24/7 365 day-a-year Disaster Distress Helpline that provides crisis counseling to people experiencing emotional distress after a disaster, and the 988/Suicide Lifeline to connect people in crisis with life-saving resources.
  5. The Administration for Strategic Preparedness and Response (ASPR) will maintain the minimal readiness for all hazards, including COVID-19, pandemic flu, and hurricane responses.
  6. The National Institutes of Health (NIH) will continue research and clinical activities.
  7. The Food and Drug Administration (FDA) will continue to support drug and medical device reviews, as well as emergency use authorizations and countermeasures to fight the COVID-19 pandemic. FDA will also continue core functions to handle and respond to emergencies, such as monitoring for and quickly responding to outbreaks related to foodborne illness and the flu, supporting food and medical product recalls when products endanger consumers and patients, pursuing criminal and certain civil investigations when the public health is at risk, and screening the food and medical products that are imported to the U.S.
  8. HHS will continue to protect human life and property, such as monitoring for disease outbreaks conducted by the Centers for Disease Control and Prevention (CDC).
  9. CMS regulations and guidance related to the No Surprises Act, including the Independent Dispute Resolution process, could be delayed.
  10. The Health Resources and Services Administration (HRSA) will continue to oversee many direct health services and other activities funded through carryover balances, such as the Ryan White HIV/AIDS program – Parts A and B and Ending the HIV Epidemic.
  11. The Agency for Healthcare Research and Quality (AHRQ) will continue activities funded through the Patient-Centered Outcomes Research Trust Fund (PCORTF).
  12. Advanced Research Projects Agency for Health (ARPA-H) is under a three-year appropriation; all of ARPA-H activities would continue during a lapse of appropriation.
  13. The Indian Health Service (IHS) is under advance appropriations for FY 2024; the majority of IHS-funded programs will remain funded and operational in the event of a lapse of appropriation.

Miscellaneous

  1. Supplemental Nutrition Assistance Program (SNAP) will continue at least through October.
  2. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) could begin an immediate reduction in benefits a few days after the shutdown starts, although some states may be able to use extra funding to maintain funding for a week or two.
  3. Student loan payments: The beginning of a government shutdown could coincide with the restart of federal student loan payments in the U.S. on Oct. 1, but borrowers will still have to make payments to their loan service providers.

2023 Nominating Committee Report

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The Nominating Committee met on July 31st to consider all eligible candidates for the upcoming term of office. The committee recommends the following slate for consideration by the society membership.

MSV Board of Directors
Term 2023-2024/2025

Officers (Elected for 1-year term)

President-Elect | Joel Bundy, MD

Speaker | Michele Nedelka, MD

Vice Speaker | Atul Marathe, MD

 

Directors (Elected for 2-year term)

District 1 | Bobbie Sperry, MD

District 3 | Carolyn Burns, MD

District 3 | Mark Townsend, MD

District 5 | Gary Miller, MD

District 7 | Peter Netland, MD

District 7 | Karen Rheuban, MD

District 9 | Jan Willcox, DO

MSV Foundation | José Morey, MD

Academic | Arturo Saavedra, MD (VCU)

 

Directors (Elected for 1-year term)

Resident | Pooja Gajulapalli, MD (VCU Peds)

Medical Student | Shreya Mandava (UVA)

 

Associate Directors (Elected for 2-year term)

District 1 | Andreya Risser, MD

District 3 | Sidney Jones, MD

District 5 | Jacqueline Fogarty, MD

District 7 | John Mason, MD

District 9 | Stephen Combs, MD

Academic | Lindsay Robbins, MD (EVMS)

 

Associate Directors (Elected for 1-year term)

Resident | Matthew Adsit, MD (VCU Ortho)

Medical Student | Elizabeth Ransone (VCU)

Virginia Delegation to the American Medical Association
Term 2024-2025

Elected for 2-year calendar year term
Delegates

Alice Coombs, MD

Claudette Dalton, MD

Cliff Deal, III, MD

Bhushan Pandya, MD

Cynthia Romero, MD

Sterling Ransone, MD

 

Alternate Delegates

Sandy Chung, MD

Mark Townsend, MD

Jan Willcox, DO

2023-2024 Nominating Committee

 

District 1 Sterling Ransone, MD

District 2 Stuart Mackler, MD

District 3 Hazle Konerding, MD

District 5 Bushan Pandya, MD

District 6 Cynda Johnson, MD

District 7 Claudette Dalton, MD

District 8 Carol Shapiro, MD

District 9 John Knarr, MD

District 10 William Hutchens, MD

Academic Cynthia Romero, MD (EVMS) (Chair)

AMA Advisor (Chair of the Virginia Delegation) Tom Eppes, MD

2021-2022 Former President Advisor | Mohit Nanda, MD

2022-2023 Former President Advisor | Harry Gewanter, MD

National Physician Suicide Awareness Day underscores urgent need to support physician wellness

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National Physician Suicide Awareness Day (NPSA)—on Sept. 17—is a sobering reminder for physicians and others to ensure that we advocate for programs and initiatives to support physician health and wellness. Supporting physician wellness and reducing physician burnout are key elements of the AMA Recovery Plan for America’s Physicians.

Physicians have higher rates of death by suicide than the general population, and medical residents and students also experience depression at rates greater than the general population, according to the American Foundation for Suicide Prevention.

“AMA advocacy is focused on eliminating barriers that prevent physicians and medical students from seeking care for their own mental health,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “National Physician Suicide Awareness Day is an important reminder of the tragedies in our profession—it is time, however, for licensing boards, health systems and credentialing organizations to take additional actions to ensure that we can support our physicians’ health and wellness and help prevent our colleagues from dying by suicide.”

Part of the AMA’s advocacy to support physician wellness has been direct engagement with state medical boards, hospitals and health systems to remove stigmatizing questions on applications related to mental health and substance use disorders. The AMA has worked with several dozen medical boards, hospitals and health systems alongside the Dr. Lorna Breen Heroes’ Foundation (PDF) and the Federation of State Medical Boards to urge boards and others to review, revise and/or remove all questions that may deter physicians from seeking treatment for mental illness or substance use disorder. In addition, the AMA has worked closely with the Medical Society of Virginia and Virginia Healthcare and Hospital Association to challenge all Virginia hospitals to ensure their credentialing applications are consistent with recommendations from the AMA, Federation of State Medical Boards and Dr. Lorna Breen Heroes’ Foundation…

Read the Full Article

Virginia Department of Health Declares Statewide Outbreak of Meningococcal Disease

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via VDH

Dear Colleague:

The Virginia Department of Health (VDH) is declaring a statewide outbreak of meningococcal disease caused by the bacterium Neisseria meningitidis serogroup Y. The sequence type associated with this outbreak was first identified in eastern Virginia in September 2022 and has since been detected in central and southwest Virginia. This letter provides an update to the most recent notice to clinicians that was issued in March 2023.

Meningococcal disease is a rare, but very serious illness. From June 2022 to August 2023, there have been 27 cases of meningococcal disease caused by Neisseria meningitidis serogroup Y reported in Virginia, with most cases (20) occurring in the eastern region. All isolates available for sequencing (22 out of 27) were found to be highly genetically related. This strain is susceptible to ciprofloxacin and penicillin, unlike other serogroup Y strains previously detected in Maryland and northern Virginia, and is known to be circulating more widely across the United States.

Five case-patients associated with this outbreak have died from complications of meningococcal disease, indicating that this strain might have a higher case fatality rate (19% CFR) than is commonly observed in serogroup Y cases (source). The majority of case-patients (18) developed septicemia, and not meningitis, with common symptoms including fever, nausea, vomiting, and muscle aches.

VDH has not yet identified a common risk factor among the cases. The majority of cases have occurred in Black or African American adults between 30-60 years of age. Twenty-six case-patients were unvaccinated for serogroup Y.

Early identification and prompt public health follow up remain key to preventing further transmission. VDH responds to reports of suspected meningococcal disease by rapidly identifying close contacts for whom short-term antibiotics are recommended for post-exposure prophylaxis. VDH is dedicated to increasing access to meningococcal conjugate vaccine (MenACWY), which provides protection against serogroup Y. In areas that have reported an outbreak-associated case, MenACWY vaccine is being made available through the local health departments for people at increased risk of meningococcal disease due to certain medical conditions and residents of localized areas with increased transmission. Additionally, VDH is offering vaccine to outbreak-associated close contacts in an effort to vaccinate individuals who may be part of an unknown social network at increased risk for meningococcal disease serogroup Y.

Please consider the following actions:

  • Maintain a high index of suspicion for meningococcal disease while this outbreak continues. The majority of case-patients have presented with symptoms of septicemia; several case-patients presented with meningitis, citing neck stiffness and photophobia. A petechial rash with pink macules might also be observed. This rash may appear purple, dark brown, or black on darker skin tones.
  • Immediately notify your local health department (LHD) if meningococcal disease is suspected based on clinical findings or laboratory results of gram-negative diplococci or Neisseria meningitidis from a normally sterile site. Please coordinate with your LHD to send specimens/isolates for newly identified cases to Virginia’s state public health lab, the Department of General Services Division of Consolidated Laboratory Services (DCLS), for serotyping.
  • Ensure that all patients who are at increased risk for meningococcal disease are up to date on MenACWY vaccine. People at increased risk include: people with HIV, those whose spleen is damaged or removed, people with sickle cell disease, anyone with a rare immune condition called “complement deficiency” or people taking “complement inhibitors.” A MenACWY booster is recommended every five years for people with increased risk due to medical conditions.
  • Continue to encourage routine administration of MenACWY vaccine in adolescents. As a reminder, a dose of MenACWY vaccine is required for students enrolled prior to 7th and 12th grade.

Thank you for your attention and cooperation.

Sincerely,

Karen Shelton, MD
State Health Commissioner

Quality Insights Announces 50th Anniversary Grant Program Winners

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Quality Insights, a healthcare organization committed to improving healthcare and promoting health equity, recently celebrated its 50th anniversary by launching a grant program aimed at supporting innovative projects. After reviewing submissions, Quality Insights selected six winners who will collectively receive more than $100,000.

Quality Insights CEO, Sven T. Berg, M.D., expressed his gratitude to all applicants while congratulating the winners and looking forward to the successful implementation of their grants.

“We were impressed with the quality of all the applicants. These decisions were difficult to make, but we are thrilled to support these innovative programs that will make a significant difference in health and healthcare,” said Berg.

The winners of the grant program include:

  • Lori’s Hands Charm City Scholars Initiative, Baltimore, MD, will create specialized, stipend internships for black, indigenous, people of color (BIPOC), low-income, and/or first-generation college students who are pursuing careers in healthcare. Interns will advance Lori’s Hands’ unique community health service learning model that provides instrumental and social support to community members.
  • The Medical Society of Virginia Foundation, SafeHaven™ Coaching Network, Richmond, VA, will bolster the health and wellness coaching resources available to the healthcare community, building a foundation of peer health and wellness coaches for and increasing access to confidential and protected well-being coaching services.
  • Literacy Delaware, Demystifying the Healthcare Journey, Wilmington, DE, will develop a health literacy education program for dialysis patients and their families to close the health equity gap.
  • Think Kids, West Virginia Wraparound Intensive Support in Enrollment (WV WISE), Charleston, WV, will create a model of person-centered benefits enrollment assistance that overcomes stigma and galvanizes local programs to address health disparities.
  • Grassroots Health, College Athlete Health Education Program for Middle School Students, Baltimore, MD/Philadelphia, PA, will recruit and train 100 college athletes to deliver weekly sports-based health education modules in under-resourced middle schools, an investment in both preventive health education for middle school youth and volunteer/peer training in a health-related field for college student volunteer program facilitators.
  • West Virginia Osteopathic School of Medicine, Women Interested in Staying Healthy (WISH), Lewisburg, WV, will provide support, encouragement, nutrition education, and exercise opportunities for women in Greenbrier County, incorporating a professional dietician, a professional strength trainer/exercise physiologist, and physician counseling on weight loss and healthy lifestyle.

The grant program is part of Quality Insights’ commitment to improving healthcare and closing the health equity gap. The organization believes that by investing in innovative programs, it can make a significant impact in the lives of individuals and communities.

About Quality Insights

Founded in 1973, Quality Insights is celebrating 50 years of using quality improvement science, education and collaboration to develop and bring best practices to healthcare settings and communities. Learn more at www.qualityinsights.org.

Support for Maui Wildfire Relief

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The Medical Society of Virginia and its members’ hearts go out to the families and communities affected by the Maui Wildfires. Many of our members are asking how they can support the many communities impacted. Below is information, resources, and ways you can currently support.

The Hawaii Medical Association (HMA) has been doing regular updates on the situation, here.

Other Resources:

The MSV will update this page as we learn more.

4 Big Ways Medical Students Benefit from Membership with MSV

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By Jenny Young, Associate Vice President of Membership and Engagement

When entering medical school, your first few weeks of orientation are packed with lectures and activities from the dozens of clubs and organizations you’ve been given the opportunity to join; each with a unique value proposition and list of benefits.  Most clubs are clearly understood from their title such as the pediatric student interest group, yoga club, and women in medicine.  You know what you’re signing up for.

Then you come across The Medical Society of Virginia (MSV), and its joint membership package with The American Medical Association (AMA), which fall into the category of organized medicine.  You’ve probably heard of AMA in the news while reading how physicians were managing the COVID-19 pandemic.  But what does becoming a member of MSV and AMA mean?  And how can you take advantage of your membership to strengthen your medical school career?

The AMA represents physicians, medical students and patients on a national scope, lobbying Congress, while the MSV represents physicians, medical students and patients on a state scope, lobbying the Virginia General Assembly. The MSV and AMA are both led by their members: physicians, residents, and medical students. All policies, advocacy efforts, and organizational goals are debated and voted on by members – and medical students have a powerful voice and vote!

As a medical student member, you can take advantage of a combined membership with MSV and AMA for the duration of your medical school career.  You get to decide how you’ll use your membership.  Regardless of how engaged you become, the fact that you’re a member makes an impact in MSV and AMA’s advocacy work.  More members equal greater influence in achieving important goals such as increasing access to care for our most vulnerable populations, or ensuring physicians can do what’s best for their patients without legislators or regulators dictating how care should be provided.

For medical students looking for more from their membership, medical students can have a major impact on changing healthcare through AMA and MSV.

Crafting Policy

Virginia medical students have been successful in crafting state and national policy through authoring resolutions. Several examples include:

Access to Healthcare Influencers

Attending MSV and AMA meetings and events grant you with direct access to healthcare influencers and legislators.

  • MSV and AMA hold lobby days for you to meet with your state legislators in Richmond, Virginia (MSV) and federal legislators in DC (AMA)
  • Past speakers and attendees that students have met with at AMA and MSV conferences include leaders such as: national specialty society presidents, The Surgeon General, The Governor of Virginia, Virginia’s Health Commissioner and CEOs and Chief Medical Officers of hospitals and health tech companies.

Leadership Positions

Medical Student Members are given the opportunity to hold leadership positions through MSV and AMA. The leadership opportunities include:

  • Leading your school’s AMA/MSV chapter
  • Serving on a state or national medical student section (MSS) committee:
    • MSV has standing committees on advocacy, community outreach, and member engagement
    • AMA has committees focusing on topics such as bioethics and humanities, economics and quality in medicine, and minority issues. Take a look at the full list of AMA medical student standing committees
  • Leading the MSV MSS on the MSS Executive Committee
  • Joining AMA MSS’s Region 6 Leadership Board, leading medical students from VA, DC, MD, NJ, and PA
  • Representing medical students on one of MSV’s Boards: MSV Board of Directors, MSV Foundation Board of Directors, or MSV Political Action Committee Board of Directors

Connect with Students and Physicians

Woven throughout all MSV and AMA events and leadership opportunities is the opportunity to connect with passionate medical students seeking to positively impact healthcare at your school, throughout Virginia, and throughout the nation. The friendships and professional relationships formed will have a lasting impact!  The community powerfully galvanizes around doing what is right for patients and physicians.

You’ve earned the opportunity to join the hundreds of thousands of physicians and medical students who are members of AMA and MSV.  Take advantage of a joint MSV + AMA membership to support our efforts to make Virginia and America the best place to practice medicine and receive healthcare!

Important Message for DEA-Registered Practitioners

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As you may be aware, the new MATE law requires DEA-registered practitioners who are renewing their license or any first-time registrants to complete eight hours of training on the treatment and management of patients with opioid or other substance use disorders. 

The University of Virginia is pleased to provide an 8-hour training course that meets these requirements to Virginia-based providers at no cost.  This course, titled “Substance Misuse and Opioid Use Disorders – A National Problem: An Interprofessional Solution” will be available beginning July 31 on the UVA Continuing Education website at CMEVillage.com.  Participants may complete some or all of the eight (8) modules, based on their interests and needs.  Credit will be awarded based on participation, with one content hour per module.

This course is designed for Physicians, Advanced Practice Providers, Nurses, Psychologists, Social Workers, Pharmacists and other healthcare professionals who care for patients with substance abuse disorders.  

For more information on this course, including accreditation details and the MATE law requirements, please review the attached announcement for the course or contact [email protected].