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Page 1
Maryland=20 EPIC
Spring=20 2003
1
Maryland=20 ACEP Emergency Physician Interim Communique
www.mdacep.org Maryland
EP=20 C
L
ast = week I was=20 lying on a white
sandy = beach. The=20 warm wind was
gently = blowing;=20 the sky was a clear blue.
I = thought how=20 magnificent the ocean
and all = life=20 around me was. I was bliss-
fully, = and=20 deliberately, unaware of cur-
rent = events,=20 CNN and anything unpleas-
ant = that might=20 intrude on my peaceful
vacation.
And = then I came=20 home.
My = first notice=20 that all was not right
with = the world=20 was when I called my
best = friend to let=20 her know I was home. She informed me that I must
immediately go to=20 Home Depot and purchase duct tape and plastic.
Next I = must head=20 for the grocery store to stock up on bread, milk,
toilet = paper and 2=20 weeks worth of food in preparation for the im-
pending = terrorist=20 attack. I thought she was being her usual alarmist
self, = until I=20 learned that these recommendations were on the front
page of = the=20 Washington Post.
I = thought about=20 getting back on the plane.
On the = way home=20 from the airport, I thought about how could
we, as a = nation,=20 have allowed things to get so bad? How could New
York and = D.C. be=20 under maximum alert for a =E2=80=9Ccredible terrorist
attack=E2=80=9D? What did=20 this mean for me and my fellow emergency
physicians in=20 Maryland, D.C., Virginia and, of course, New York?
I then = began=20 thinking about a State Legislative hearing I had
attended = just=20 before my vacation. It was on HB1, which is an impor-
tant = piece of=20 legislation designed to provide funding for physicians
who care = for=20 trauma victims. Delegate Dan Morhaim, a practicing
emergency=20 physician, had introduced an amendment to include
emergency=20 physicians in this bill. I was to testify as to why we = should
be=20 included.
It was = not one of=20 my finer moments.
The = chair of the=20 committee did not appear at all sympathetic to
the = plight of=20 emergency docs. He asked, somewhat sarcastically, if I
was = aware of the=20 =E2=80=9Cstrike=E2=80=9D by the on-call physicians at one = trauma
center, = and if=20 including E.R. docs would have prevented that. Of
course = I had to=20 answer no. I quickly added that we are not able to go
=E2=80=9Con strike=E2=80=9D.=20 Unlike our on-call colleagues who can practice outside
the = E.R., our job=20 is being the front line of care not only for many of
the 17 = thousand=20 trauma patients, but also the 2 million other patients
who = visited=20 Maryland emergency departments in 2002.
PRESIDENT=E2=80=99S=20 MESSAGE continued on p. 2
He was = not=20 impressed.
Perhaps = if the=20 testimony had been the week after my vacation,
when = the whole=20 area was on terrorist alert, I might have done a
better = job. We=20 will certainly need our surgical colleagues if there are
trauma = injuries,=20 but if, as is more likely, the casualties are due to
biological or=20 chemical warfare, where will they be then? My guess is
at home = with=20 their families, while we, the emergency physicians of
the = state, will=20 be caring for the victims.
To me, = this is=20 not about getting a few, albeit well deserved, extra
dollars. It=E2=80=99s=20 about being recognized for the tremendous contribution
we = make. It=E2=80=99s=20 about acknowledgement that, unlike our on-call
colleagues, we=20 cannot and do not walk away from our role as the
patient = care=20 safety net. We are here 24/7, day and night, whether
the = patient pays=20 us or not. We work unceasingly for those who can
survive, and with=20 compassion for those who cannot.
Several = months=20 ago, Dr. Susan Nedza, National ACEP Board
Member, = wrote an=20 article in the Illinois Epic making reference to a
book = =E2=80=9CAtlas=20 Shrugged=E2=80=9D written by Ayn Rand. In this novel, the = hero
and = heroine=20 battle to maintain a crumbling system. In the end, they
decide = to =E2=80=98give=20 up=E2=80=99 and let the competing forces of the system = destroy
themselves. They=20 figure that it will be easier to rebuild the system
from = zero than to=20 try to fix one so badly broken. They were talking
about = railroads,=20 but the same could be said about our current
healthcare=20 system. Perhaps we should just walk away and let it fall
apart, = not try so=20 hard to repair a system that values the insurance
industry=E2=80=99s=20 corporate profit over the well-being of the patients, = hospi-
tals = and=20 providers. A system that requires all patients that present = to
an = emergency=20 department be seen and treated, but does not require
anyone = to pay for=20 it. A system that fails to provide funding for
preventive care=20 such as smoking cessation, but will spend billions of
dollars on ICU=20 admissions and cancer treatment.
The = funny thing=20 is that over 50% of all health care dollars come
from = government=20 sources which include Medicare, Medicaid and
Champus. Another=20 20% is from patients out-of-pocket. How is it
that = we allow=20 the remaining 30% from private insurance, to reap all
the = profit and=20 pull all the strings?
The = only legal=20 =E2=80=9Cright=E2=80=9D to healthcare in this country is the right = to
be = treated in an=20 emergency department. As emergency physicians, we
are = committed to=20 providing needed care regardless of the patients=E2=80=99
ability to pay.=20 Every year the number of uninsured patients seen by
us = rises. Every=20 year the insurance industry tries to cut our reimburse-
ment. = Every year=20 our malpractice costs increase.
President=E2=80=99s=20 Message
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86
Linda = De Feo,=20 MD, JD, FACEP, President
Linda De = Feo, MD,=20 JD, FACEP
Maryland=20 EPIC
Spring=20 2003
2
Prevention Pays=20 Off
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86
Dr. = Dan K.=20 Morhaim
 I
ntense = debate is=20 under way as to what type of health care pay-
ment = system is=20 best.
Should = it be a=20 single payer/universal coverage system? Or an
expanded=20 employer-based system, with a Medicaid and Medicare
safety = net? Or=20 another alternative?
In = Maryland,=20 health care accounts for 30 percent of the state
budget, = and=20 employers are seeing huge premium increases. Is there
a way = to both=20 save money and help people?
Once = someone has=20 suffered an injury or been diagnosed with a
serious = illness,=20 medical options narrow to two: either treat the person
with = the best=20 medical care available or deny him that care. The only
real = choices=20 exist in preventing or lessening the injury or disease
process = before it=20 occurs.
How can = we do=20 this? The best way to save money in health care
is to=20 aggressively invest in prevention and deal with the =E2=80=9CBig = 7=E2=80=9D main
drivers = of the=20 health care system. They are:
=E2=80=A2 Care at the=20 end of life. Fully 25 percent of health care dollars
spent = in the=20 average American=E2=80=99s life are spent in the last two
weeks = of life,=20 when the likelihood of recovery is minimal or ab-
sent. = This raises=20 complex personal, ethical, spiritual and legal chal-
lenges. = What can=20 be done?
Expand = the use of=20 advanced directives so that people can make
informed=20 decisions about the kind of care they want. Remove
barriers to=20 adequate pain relief. Support medical providers who
work = with dying=20 patients. Help our culture understand that =E2=80=9Cdo-
ing = everything=E2=80=9D=20 may not always be the best thing to do.
=E2=80=A2 Reduce legal=20 addictions, specifically tobacco and alcohol
abuse.=20 Today, our insurance system will pay thousands of dollars
for = lung cancer=20 care, but nothing for smoking cessation. Instead,
we = should help=20 patients change their destructive behaviors and
reward = providers=20 for helping patients do this.
=E2=80=A2 Treat=20 illegal addictions. Addictions cause an estimated 80 = per-
cent of = crimes,=20 80 percent of uncompensated health care costs
and 80 = percent of=20 major trauma care. Addiction treatment works.
For = each dollar=20 spent, $7 is saved. Maryland has made great strides
to = increase=20 funding for and efficiency of addiction treatment
programs. This=20 has yielded positive results, but there is still a long
way to=20 go.
=E2=80=A2 Lifestyle=20 and obesity. Fifty percent of Americans are overweight,
a = cause of=20 diabetes, heart disease, kidney failure, degenerative
joint = disease.=20 Our system does not pay for weight reduction pro-
grams = and does=20 not pay providers to help patients lose weight.
Obesity leads to=20 high prescription drug costs by paying for multiple
medications=20 instead of dealing with the underlying cause. One
example: even a=20 10-pound weight loss can eliminate the need for
blood = pressure=20 medication.
=E2=80=A2 Simple=20 injury prevention. Wearing seat belts and putting chil-
dren = in car=20 seats have proven effective in reducing injuries. = Let=E2=80=99s
expand = this to=20 other well-recognized accident scenarios. It costs
much = less to=20 help safety-proof a senior=E2=80=99s home than it does to = care
for = avoidable=20 injuries like hip fractures.
=E2=80=A2 Mental=20 health. This system is breaking down, with clinics = closing
at an = alarming=20 rate. When patients can=E2=80=99t get mental health ser-
vices, = they=20 deteriorate, stop working (and paying taxes) and end
up in = emergency=20 rooms, state hospitals and the criminal justice
system. Domestic=20 violence and child abuse increase. Modest in-
vestment in=20 mental health services -- especially out-patient care --
pays = back with=20 huge dividends.
=E2=80=A2=20 Environmental impact. Maryland=E2=80=99s cancer, asthma and = allergy
rates = continue=20 to climb. Common sense tells us that a cleaner
environment is=20 better for everyone, especially for the most vulner-
able: = children=20 and seniors. New thinking in design, construction,
manufacturing=20 and technology will allow us to pursue job cre-
ation = and=20 economic development that contribute to ecological
restoration and=20 a vibrant economy.
These = seven=20 categories drive almost all health care expenses, and
no = system of=20 insurance or payment will work unless they are ad-
dressed. Each=20 can be targeted with specific strategies that improve
health = and=20 reduce costs, and if each is addressed, the whole system
benefits.
With a = creative=20 approach, sound management and a clear vision,
we can = build the=20 model for a healthier America here in Maryland.
The = adage =E2=80=9CAn=20 ounce of prevention is worth a pound of cure=E2=80=9D is
truer = now than=20 ever. Let=E2=80=99s live up to it.
Dan = K.=20 Morhaim, an emergency medicine physician, represents
Baltimore=20 County as a Democrat in the House of Delegates.
Originally=20 published in The Sun February 13, = 2003
PRESIDENT=E2=80=99S=20 MESSAGE continued from p. 1
So what = can you=20 do?
1. = Contact your=20 representatives and senators and let them know
who you = are, and=20 what is happening to you and to their con-
stituents at your=20 hospital.
2. Join = with us=20 in Annapolis when there are bills that impact our
practice. We tell=20 the legislators that we are your representa-
tives, = but=20 imagine the impact of 100 emergency physicians
showing = up for a=20 hearing;
3. Be = proactive.=20 Begin thinking about how our healthcare deliv-
ery = system can=20 be redesigned to make it more efficient (for
example, having=20 on-call physicians cover geographic areas at
one = hospital=20 rather than having one on-call for each hospital)
or;
4. You = can just=20 walk away and let whatever happens happen.
As = always, I=20 welcome your comments and ideas. Please visit our
website at=20 www.mdacep.org.
Please see=20 related article by Del. Dan Morhaim = below.
P/U = MedChi=20 Agency =E2=80=9CYou can
Trust = us to Look=20 After Your
Practice=E2=80=9D
1/2 = page ad from=20 last EPIC
The = finest=20 medical coats available.
Better=20 fabrics, better stitching and more attention to detail;
six = large=20 pockets =E2=80=94 3 inside and 3 outside
front flaps=20 are closed =E2=80=94 no more catching on doorknobs
inside pocket=20 zippers available to secure wallets & PDAs
cotton=20 knotted buttons are available on all coats.
Embroidery of=20 names & logos available on site.
Our = coats are=20 manufactured in Baltimore, under the supervision of a
practicing=20 emergency physician & Maryland ACEP=20 member
On = Call=20 Medical Coats
410 = 574-2657=20 fax 410 574-6307
toll free 877=20 355-2898
 www.medicalcoats.com
Maryland=20 EPIC
Spring=20 2003
4
Annapolis,=20 MD =E2=80=93 The 2003 General
Assembly=20 Legislative Session started slowly,
but = the pace is=20 rapidly escalating as we move
into = the second=20 month of the three-month
session. The=20 reconfigured committees and
new = legislators=20 have become more familiar
with = each other=20 and their roles, and are
settling in for=20 the stretch run.
We are = seeing a=20 lot of issues that had
been = dormant for=20 the past few years re-
emerge. One such=20 issue is the possibility of
an all = payor=20 system for hospital-based phy-
sicians. We have,=20 on a few occasions this session, referenced in our
testimony a study=20 that is to be conducted by the Maryland Health
Care = Commission=20 (MHCC) and the Health Services Cost Review
Commission=20 (HSCRC), which among other issues will study health
care = provider=20 reimbursements by commercial insurers and self-pay
patients in the=20 State. The study will also examine the feasibility of
eliminating=20 Maryland=E2=80=99s prohibition on balance billing; look at = the
possibility of=20 establishing a fund to subsidize reimbursements to pro-
viders = that=20 deliver a disproportionate amount of uncompensated
care; = and also=20 explore the feasibility of an all payor system or a
reimbursement=20 system with a ceiling or a floor. A report detailing
the=20 recommendations of the MHCC and HSCRC is due to the
legislature on=20 January 1, 2004.
In = addition to=20 the trauma bills referenced in Dr. Dave Hexter=E2=80=99s
article, there=20 are a number of bills this session of particular interest
to = Maryland ACEP.=20 This includes House Bill 231 =E2=80=93 =E2=80=9CAdvanced
Directives =E2=80=93=20 Medicaid=E2=80=9D introduced by Delegate Dan Morhaim. The
bill = would=20 require that all applicants for the Medicaid program sign
an = advance=20 directive or sign a form stating that they have decided not
to do = so. It is=20 estimated that 25% of health care dollars spent in the
average = American=E2=80=99s life are spent during the last two weeks of = life,
when = the=20 likelihood of recovery is minimal or absent. Requiring
Medicaid=20 applicants to execute an advance directive will result in
more=20 considerate, compassionate care that is patient-directed = and
in = compliance=20 with the letter and spirit of the federal Patient Self
Determination=20 Act.
There = are a=20 number of public safety bills of interest to MD ACEP.
Among = these are=20 bills that relate to: motorcycle helmets and minors
(SB371); HIV=20 testing of health care providers (HB343); handgun
safety = devices=20 (HB583); and approved gear and equipment for youth
baseball=20 (HB746). Please check MD ACEP=E2=80=99s bill profile
(www.bmbassoc.com/mdacep03.html)=20 and be sure to let us know
if = there are any=20 bills of interest that you would like to come and
testify on or=20 that we should pay particular attention to.
Initially tort=20 reform was expected to be a major issue this session.
As it = stands=20 now, it does not appear likely that any major legislation
in = this area=20 will emerge. The key areas of concern are the mainte-
nance = of our cap=20 on non-economic damages, and the contributory
negligence=20 standard. We hope to test the waters in the upcoming
months = by=20 exploring the possibility of expanding the Good Samari-
tan = statute to=20 include emergency physicians. Currently, the statute
provides limited=20 immunity from civil action for a member of a volun-
teer = fire=20 department, ambulance or rescue squad, law enforcement
agency, or ski=20 patrol who meet certain first aid training criteria and
are = licensed or=20 certified as a State emergency medical services pro-
vider.
Also, = we=20 anticipate the Maryland Insurance Commissioner to
issue = his=20 recommendations concerning the sale and conversion of
BlueCross and=20 BlueShield. Our expectation is that he will not ap-
prove = either the=20 sale or the conversion.
We = will continue=20 to promote the ideas and mission of Maryland
ACEP, = and keep=20 you informed of all the latest happenings in An-
napolis. We=20 would also like to recognize the outstanding leadership
of = Maryland=20 ACEP, and the dedication and commitment of the
Public = Policy=20 Committee chair and members. It is because of their
efforts that=20 your voice and presence are as strong as they are.
Barbara = Marx=20 Brocato
New=20 Members
Keri = Bradley,=20 MD
Gail = Cunningham,=20 MD
Jeremy = Michalke,=20 MD
Welcome To New=20 Members
 P
lease = join us in=20 extending a warm welcome to the following individuals who have recently = joined=20 ACEP and the Maryland
Chapter. We=20 encourage you to attend Committee and Board meetings. Get=20 Involved!
 Cancellations 12
Kristin Rigby,=20 MD
Angela = Shepard,=20 MD
Transfer=20 Members
Fred = Bailor, Jr,=20 DO, FACEP
Update = from=20 Annapolis
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86
Barbara Marx=20 Brocato
MD = ACEP=20 Government Relations Consultant
Dickson Cheung,=20 MD
Gregg = Greenough,=20 MD
Gary = Little,=20 MD
Wendie = Williams,=20 MD
Public = Policy=20 Update
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86=20 =E2=97=86
David Hexter,=20 MD, FACEP
 T
here = is=20 something to be said about
being = at the=20 right place at the right
time. = This is=20 especially true of the political
process. Your=20 public policy team, led by Bar-
bara = Brocato,=20 expends a considerable amount
of = time and=20 effort to make sure that Maryland
ACEP = is=20 represented at meetings of interest
to us. = While=20 many meetings and hearings come
and go = without=20 much going on of relevance,
occasionally=20 this =E2=80=9Calways vigilant=E2=80=9D approach
pays=20 dividends.
Such = was the case=20 at a hearing for House Bill 1 (HB1), The
Maryland Trauma=20 System Funding Act. This bill proposes a sur-
charge = on=20 automobile insurance policies to fund the standby costs
and = uncompensated=20 care provided by physicians who care for trauma
patients. The=20 logic is that about half of trauma patients are a result
of = motor vehicle=20 crashes, thus the cost of caring for trauma patients
should = be spread=20 among automobile drivers. Much of the other half
is a = result of=20 the illicit drug trade, which, as you can appreciate,
would = be=20 difficult to tax.
The = motivation=20 behind HB 1 was the temporary closure of the
trauma = center at=20 Washington County Hospital as a result of the
refusal = of their=20 general surgeons to take call. The trauma center at
Peninsula=20 Regional has also threatened closure, and other commu-
nity-based trauma=20 centers face similar issues with uncompensated
care = and on-call=20 costs. Hospitals are not permitted to include physi-
cian = costs as a=20 legitimate expense when their rates are set by the
Health = Services=20 Cost Review Commission (HSCRC); thus they must
spend = profits=20 which are customarily the funds available for upgrade
and = expansion of=20 the physical plant and equipment.
While = the model=20 for trauma care varies, emergency physicians are
generally=20 integral members of the trauma team, and often serve as
team = leaders.=20 This is especially true at our level 2 and level 3 desig-
nated = centers. In=20 fact, at level 3 centers the trauma surgeon is not
required to be in=20 house. Emergency physicians are thus the first to see
the = patient. For=20 these reasons, Maryland ACEP submitted written
and = provided oral=20 testimony in favor of HB 1.
The = hearing on=20 January 30
 th
was = expected to=20 be a routine expres-
sion of = support=20 for HB1 and the role emergency physicians play in
the = trauma=20 system. However, at the hearing, we were blindsided by an
amendment=20 presented by the sponsor that excluded emergency
physicians from=20 the definition of =E2=80=9Ctrauma physician=E2=80=9D. Testimony = was
presented that=20 we emergency physicians have other patients to sub-
sidize = our=20 trauma patients and that we do not have to be lured away
from a = lucrative=20 private practice as a surgeon would.
Fortunately,=20 your public policy team immediately went into ac-
tion = to educate=20 legislators on the important role we play in the care
of = trauma=20 patients. It was all about being at the right place at the
right = time.=20 Otherwise, this amendment might have slipped through
unnoticed.
As of = this=20 writing, HB 1 is stalled in committee over a number of
issues,=20 including ours. Rest assured that your public policy team = will
remain = vigilant=20 to see that our interests are represented and our
legislators are=20 educated about the reality of our practice.
David = Hexter, MD,=20 FACEP
Please = call to=20 register:
1-800-888-3912
Fax=20 us:
1-800-888-3904
E-mail = us:
registration@ahcpub.com
Visit = our Web=20 site:
www.ahcpub.com Infectious Disease Management
Inpatient and=20 Outpatient
Acute = Care: Year=20 2003
An = Antibiotic=20 and Management Update for
Emergency=20 Medicine, Primary Care, and
Hospital-Based=20 Practitioners and Pharmacists
Supported by an=20 unrestricted
educational=20 grant from
Roche=20 Pharmaceuticals
March = 23,=20 2003
Baltimore,=20 MD
8:30 = a.m. -=20 11:30 a.m.
Baltimore=20 Marriott Waterfront
American Health=20 Consultants is accredited by the Accreditation Council for
Continuing=20 Medical Education (ACCME) to provide continuing medical
education for=20 physicians.
American Health=20 Consultants designates this continuing medical education
activity for up=20 to 2 hours in Category 1 of the Physician=E2=80=99s = Recognition
Award = of the=20 American Medical Association.
Have = applied for=20 2 hours of ACEP Category 1 credit.
Free=20 CME
=C2=B7=20
Free Textbook=20
=C2=B7
Free=20 DrugCHOICE
=C2=B7=20
CD-ROM
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86
Dr. = Brian=20 Hancock, president-elect of the College, wants interested
College members=20 to know that the committee interest forms for
College members=20 desiring to volunteer their time can be
accessed and=20 completed on-line at http://www.acep.org/
1,4885,0.html on=20 the College=E2=80=99s web site.
Maryland=20 EPIC
Spring=20 2003
6
=E2=80=9CThe Legal=20 Corner=E2=80=9D includes clinical scenarios which emphasize
some of = Maryland=E2=80=99s pertinent or unique laws and regulations. = These
questions have a=20 clinical focus and are in medical language, not
legal = language.=20 In the Emergency Department I frequently hear
statements spoken=20 with authority and with the assurance that Mary-
land = law requires=20 this or prohibits that, only to find that there is no
such = law or that=20 the regulations being referred to have been hope-
lessly=20 extrapolated to a preposterous extent. This section should
help = everyone in=20 the emergency department perform their daily job.
For = that reason,=20 I am asking anyone who has a question, area of
confusion, or a=20 concern to please submit it for future EPICs. Please
send = your=20 questions or comments to Claire Jefferson at
MDACEP@AOL.COM or=20 to Maryland ACEP, 1211 Cathedral St.,
Baltimore, MD=20 21201 c/o Lawrence S. Linder, MD.
As you = read the=20 questions and answers below, please remember
that = law, like=20 medicine, is =E2=80=9Cnot an exact science.=E2=80=9D Laws are = inter-
preted = by=20 different lawyers in different ways. We have even seen
situations where=20 the same lawyer interprets a law in two different ways
when = asked the=20 same question a month later. Sometimes one law is
in = conflict with=20 another or with a state regulation. At other times
federal = laws are=20 passed which take precedence over state laws. Please
use = these=20 scenarios as a guide but consult with your hospital=E2=80=99s = attor-
ney for = more=20 information. This issue will deal with=20 Confidentiality.
 CONFIDENTIALITY
* = Much of this=20 may change as we adopt the new federal HIPPA=20 law.
1. A = resident=20 rotating through your Emergency Department comes
to you = with a=20 question concerning refusal to consent. The resident
believes the=20 patient=E2=80=99s abdominal pain maybe due to an AAA. The
patient = is=20 refusing CT scan and he is alert and competent. The
resident says he=20 was taught to discuss such issues with a family
member = to see if=20 they are able help persuade the patient to consent.
However, this=20 patient has specifically stated he does not want his
case = discussed=20 with his family. He argues that would be a violation
of his=20 confidentiality. Is he right?
Yes, = the patient=20 is right, we can not speak with the family about
this = without his=20 permission.
2. = Given the same=20 scenario above, if the patient does not specifically
object = to sharing=20 his information, can you discuss it with his spouse or
children without=20 first consulting him? Is their mere presence in the
Emergency=20 Department with the patient implied consent to discuss
the = patient with=20 them?
This is = more of a=20 grey zone. Their presence in the room when you
walk in = is a type=20 of implied consent since the patient could ask them
to = leave.=20 However, legally, unless there is an emergency, it is = always
best to = consult=20 with the patient. If he does not instruct non-disclo-
sure, = then you=20 may speak with them. If you do discuss health care
while = others are=20 in the room, be more discrete then = usual.
3. A = mother=20 brings her 16-year-old daughter to the Emergency=20 De-
The = Legal Corner:=20 Confidentiality
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86
Larry Linder,=20 MD, FACEP
partment for=20 abdominal pain. The mother happens to be out of the
room = during your=20 history and physical. Work up reveals that the
patient has PID.=20 You inform her and she asks you not tell her mother.
Later = her mother=20 wants to know what the cause of the pain was and
why = her child=20 has been given antibiotics. What should you = do?
Minors = have the=20 right to consent to treatment concerning STD=E2=80=99s.
However, it is=20 up to the health care provider to decide whether to
share = the=20 information with the parent.
4. You = are=20 standing near the unit secretary writing orders on a chart
when = you hear=20 her answer the phone. From the context of her
statements you=20 figure out that a friend of one of your patients just
called = and=20 wanted information about the patient. The secretary
told = the friend=20 that the patient was in the emergency department
and = that the=20 patient=E2=80=99s condition was serious. She mentioned the
patient=E2=80=99s=20 current diagnosis and said that the patient was at CT scan
but = would be=20 back soon. Is that permissible?
No. = =E2=80=9CDirectory=20 Information=E2=80=9D may be disclosed about a patient
without their=20 specific consent. Directory information includes the
general=20 condition of the patient and the fact that they are present = in
the = health care=20 facility. Information concerning their diagnosis would
not be = considered directory information and could not be disclosed
without=20 permission. In addition even directory information may be
forbidden if the=20 patient specifically instructs his/her physician in
writing not to=20 disclose that information.
5. Do = the same=20 rules apply in the case above if the patient is in your
Emergency=20 Department with
a) = depression=20 and suicidal ideation?
No. = When=20 patients are being treated for a mental health prob-
lem = you may=20 confirm or deny the patient=E2=80=99s presence in the facility = to
a = parent,=20 guardian, next of kin, or any individual who has a signifi-
cant = interest in=20 the status of the patient, if that individual has filed a
missing persons=20 report. If disclosure is made, it must be=20 documented.
b) In = your=20 Emergency Department for alcohol = intoxication?
No. = Information=20 concerning disclosure of alcohol and drug abuse
information is=20 covered under federal law which supersedes Mary-
land=20 Law.
c) Is = diagnosed=20 with HIV?
No=20 disclosure. Directory information can not be released if = the
patient=20 instructs you not to release it, or if the patient is being = treated
for a = mental=20 health problem, drugs/alcohol, or HIV.
6. You = routinely=20 dictate your patient=E2=80=99s records and for the = patient=E2=80=99s
convenience and=20 improved medical care, you cc a copy of the infor-
mation = to the=20 patient=E2=80=99s primary care physician and specialist. Is = it
legal = to do that=20 without first obtaining the patient=E2=80=99s approval? Can
that = approval be=20 oral or does it have to be written? Would the same
be = true if you=20 gave them lab tests or their EKG?
I have = received=20 several different opinions here. I have been told:
=E2=80=9CThe medical=20 records statute doesn=E2=80=99t require a release, we do it = to
protect=20 ourselves.=E2=80=9D =E2=80=9CIt needs to be in writing if going to=20 someone
LEGAL=20 CORNER:CONFIDENTIALITY continued on p. 7
other = than the=20 patient.=E2=80=9D =E2=80=9CPut a note in the chart that you gave = them
a copy, = but if=20 going to the patient it is their record and you can give
it to=20 them.=E2=80=9D
Maryland statute=20 states that a request must be in writing, dated,
and = signed.=20 However, see question #20.
7. Your = patient=20 obtained a copy of their history and physical from
medical = records=20 and they disagree with some of the report. In the
history = and=20 physical you wrote that the patient was an unrestrained
driver = involved=20 in an MVA at 1222 on February 14
 th
. The=20 patient
returns = stating=20 that she was restrained and she wants the medical
record = changed.=20 In addition she says she was driving for work and
wants = that added=20 to the record because it should be a worker=E2=80=99s
compensation=20 case. What do you do?
The = medical=20 record cannot be legally altered or deleted. In
addition it is=20 specifically illegal to correct, damage, obliterate or oth-
erwise = obscure a=20 medical record in an effort to conceal the informa-
tion = from being=20 used as evidence. However, an addendum with
additions or=20 clarifications can be made. If you refuse to write an
addendum with the=20 correction then the patient is legally entitled to
insert = in the=20 medical record a concise statement with the reasons
they = disagree,=20 and you may insert the reasons you refused to change
the = record. When=20 faced with this request I usually dictate an ad-
dendum = which=20 reads =E2=80=9Cthe patient has asked me to correct the = record
as = follows...=E2=80=9D=20 and I then dictate what the patient requested. This
leaves = the=20 medical record clear as to the initial information I re-
ceived = and the=20 change which was added at the patient=E2=80=99s = request.
a) Now = that you=20 understand you are not permitted to alter or
obliterate the=20 medical record, what should you do if you make a
mistake = in your=20 charting?
Cross = out the=20 error with a single thin line; don=E2=80=99t obliterate, = erase,
or = white out.=20 Chart the correct information and note time, date,
and = your=20 initials. You don=E2=80=99t have to cross it out, though. You can = also
add an = additional=20 note stating what was wrong and why.
8. = Physicians are=20 required to report certain contagious diseases even
if the = patient=20 does not agree to release that information. Which
diseases are=20 reportable?
HIV, = menigococcal=20 meningitis, TB, mononucleosis, viral hepati-
tis = (all forms),=20 diptheria, plague, hemorrhagic fevers, rabies, anthrax,
Lyme = disease,=20 Legionella disease, measles, mumps, rubella, Salmo-
nella, = tetanus=20 malaria, syphilis, and gonorrhea. Some of these can be
reported within=20 forty-eight hours on special forms, others require
immediate phone=20 notification. With the increased threat of terror-
ism, = this list=20 may change.
a) To = whom do=20 these diseases need to be reported?
The = health=20 officer of the county and to first responders, if they
may = have been=20 exposed.
9. You = have just=20 received notice from the hospital that you have
been = named as a=20 defendant in a lawsuit brought by one of your
patients. You can=20 legally give copies of the patient=E2=80=99s records to = your
attorney without=20 the patient=E2=80=99s consent. Are there other instances
when a = patient=E2=80=99s=20 consent is not required to disclose medical=20 records?
Yes, = if=20 submitted to: the provider=E2=80=99s malpractice carrier if = immedi-
ate = disclosures=20 are needed to provide emergency health care; a
tissue = resource=20 bank if the patient is a potential organ donor; records
requested under=20 subpoena or court order; the state or local govern-
ment=20 investigating a case of suspected abuse or neglect; and the
director of a=20 detention or correctional facility if the patient has been
involuntarily=20 committed there.
As = long as the=20 provider acts in good faith, he/she will not be liable
for = disclosure=20 or failure to disclose the medical = record.
10. Is = Chlamydia=20 one of the diseases listed by the state which re-
quires = mandatory=20 reporting?
No.
11. = What other=20 information besides contagious diseases must be
reported even if=20 the patient doesn=E2=80=99t give informed consent to = release
their=20 information?
Animal = bites and=20 gunshot wounds.
12. = Are=20 physicians permitted to charge for copying medical records?
If so, = is there=20 a set rate?
Yes, = as of 2002,=20 charges were $17.40 preparation fee, 57 cents per
page, = and the=20 actual cost of shipping and handling. Records may be
withheld until=20 the fee is paid if requested by the patient=E2=80=99s = family,
lawyer,=20 guardian, etc. However, they may not be withheld in emer-
gency = situations=20 or when requested by the state or by a proper sub-
poena. = This fee=20 is readjusted every July for inflation based on the
consumer price=20 index.
13. = You are=20 treating a patient whose signs/symptoms are suspicious
for = acute MI and=20 you need an old EKG from another local Emer-
gency = Department=20 for comparison. The patient is not able to sign
the = release=20 forms because of their condition and the other institution
will = not release=20 the information. What should you do?
Inform = them that=20 Health General 4-306 (4) and (6) state they
can be = fined=20 $1,000.00 if they willfully and knowingly don=E2=80=99t = give
information in=20 an emergency situation.
14. To = facilitate patient care and communication, your emergency
department has a=20 big board hanging on the wall, which lists the
patient names,=20 room numbers, diagnosis, and treating physician. Is
this a = breach of=20 patient confidentiality since it is visible to any visitor
walking through=20 the emergency department?
Although one=20 might argue that this is an act of good faith and
you = are not=20 willfully and knowingly disclosing information this is
technically a=20 breach. Only directory information is permitted to be
given = out. Also,=20 JCAHO does not look kindly on this. As noted
earlier, the new=20 federal HIPPA standards may preempt any state
statutes which=20 were protecting physicians.
15. = Over the=20 years you have found that it helps reduce your=20 stress
LEGAL=20 CORNER:CONFIDENTIALITY continued on p. 8
LEGAL=20 CORNER:CONFIDENTIALITY continued from p. 4
Maryland=20 EPIC
Spring=20 2003
8
and = improve your=20 ability to be a compassionate doctor when you
discuss = the=20 details of your cases with your spouse when you get home
each = day. Is that=20 a breach of patient confidentiality?
As long = as no=20 identifying information is given (names, etc), then
it is = not a=20 breach of confidentiality.
16. = Your friend=20 is a primary care physician and she tells you about a
patient = she has=20 been helping for two years. She has invested a lot of
time = caring for=20 the patient but has only been paid a tiny percentage
of the=20 outstanding bills. Now the patient is transferring to a new
physician and has=20 requested the old records to be copied and sent to
the new = physician. Your friend decides she will not copy and send
the = records until=20 the bills are reimbursed and the patient pays the
medical = records=20 copying charges approved by the state. Is this good
strategy for your=20 friend?
No, it = is illegal=20 to refuse to disclose medical records because a
patient = has not=20 paid his/her bill.
17. A = friend of=20 yours is in the hospital. You are curious and decide to
read = their=20 record. You act like you are reading the record of one of
your = personal=20 patients, then put the chart back and leave. Besides
the = obvious=20 ethical implications is there a legal prohibition against
this?
You = bet.=20 Requesting or obtaining a medical record under false
pretenses or=20 through deception is subject to a fine up to $100,000.00
and/or=20 imprisonment for up to five years.
18. = Your high=20 school buddy is a lawyer specializing in occupational
injuries. He=20 offers you $11,000.00 for every case you refer to him.
He says = you don=E2=80=99t=20 have to testify and you don=E2=80=99t even have to discuss
it with = the=20 patient. He is willing to pay you just for giving him the
patient=E2=80=99s name=20 and phone number. Is this a good business opportu-
nity?
It may = be a=20 lucrative business opportunity but it is also illegal. A
health = care=20 worker who knowingly and willfully discloses records for
personal gain=20 without appropriate consent may be subject to a fine
up to=20 $250,000.00, imprisonment for up to 10 years, or=20 both.
19. In = an attempt=20 to get medical records faxed to your emergency
department from=20 other hospitals in a more timely manner, a physi-
cian in = your=20 group tells the unit secretary that 4-305 (b)(6) permits
disclosure of a=20 patient=E2=80=99s record without their authorization if = =E2=80=9Cimme-
diate = disclosure=20 is necessary, to provide for the health care needs of
a = patient.=E2=80=9D The=20 physician copies the following portion of Maryland
law for = the unit=20 secretaries and he tells them to tell the medical
records = department that a health care provider may not refuse to
disclose a=20 medical record request and that if they don=E2=80=99t send it = right
away = they are=20 =E2=80=9Cguilty of a misdemeanor and on conviction subject = to
a fine = of=20 exceeding $100.00 for the first offense and not exceeding
$5,000.00 for=20 each subsequent conviction.=E2=80=9D
The = physician is=20 wrong. Maryland statute says that there is no
liability for=20 disclosing or failing to disclose if done in good faith. It
also = says in an=20 emergency that they may disclose the information
without = authorization, not that they must disclose = it.
20. Are = there=20 times when you can refuse to release a portion of the
medical = record?
LEGAL=20 CORNER:CONFIDENTIALITY continued from p. = 7
You = can only=20 refuse to release the record if you find that a portion
of the = record=20 would be injurious to the health of the recipient and
may = only refuse=20 to release that portion you believe might be injuri-
ous; = and you=20 must a) make a written summary of the undisclosed
portion, b)=20 insert a copy of the summary into the medical record, c)
permit = examination and copying of the undisclosed portion by an-
other = health=20 care provider authorized to treat the patient, d) inform
the = patient they=20 have the right to select another health care pro-
vider. = More=20 information on this topic will appear in a future EPIC in
the = section on=20 psychiatry.
21. A = patient=20 who you believe is homicidal has eloped from the
Emergency=20 Department. Are you violating any Maryland laws by
notifying the=20 police and the person who was threatened? Are you
legally required=20 to notify them?
You = must report=20 it. If you don=E2=80=99t, you will have violated the=20 law.
22. A=20 16-year-old girl presents to the emergency department with
her = boyfriend=20 complaining of abdominal pain and vaginal discharge.
She = says she=20 thinks she might have a venereal disease. After your
examination and=20 tests, you determine that her abdominal pain is
caused = by a=20 sexually transmissible disease. She asks you to keep her
information=20 confidential. Since you have read the book = =E2=80=9CEmergency
Medicine and the=20 Law,=E2=80=9D you are aware that minors have the same
capacity as=20 adults to consent to treatment for venereal disease and
you = know that=20 Maryland law requires you to keep their information
confidential.=20 You assure the patient that she does not need to worry
and = that her=20 medical information will be kept confidential. Four
days = later one=20 of the tests you performed comes back from the lab
positive for=20 gonorrhea, a disease reportable to the local county healthy
office. You now=20 feel uneasy as you have assured the patient that her
information=20 would be private. You report the information to the
county = as=20 required and they attempt to find out from whom she
contracted the=20 disease and to whom she may have spread it. As part
of = their=20 investigation they discover 3 other males and 2 other = females
who = now have=20 gonorrhea and who all need to be treated. One of
the = other girls=20 chooses to tell her own parents about the infection
after = she is=20 treated. Those parents tell the parents of the first girl.
Her = parents=20 become irate and press charges for statutory rape against
the = boy who gave=20 their daughter the disease even though the girl
tells = them that=20 she loves the boy and that their sex was consensual.
Three = years=20 later when the girl is no longer a minor both she and the
boy = who was=20 prosecuted for rape sue you for saying that the informa-
tion = would be=20 confidential when it was not. Did you violate the law
by = following it?=20 Was your understanding of the law somehow flawed?
Did = the county=20 violate the law? Was the second set of parents
required to keep=20 the information confidential? What can you do to
avoid = this=20 situation in the future?
First, = a health=20 care provider can tell the parents about STDs.
Also, = you=20 shouldn=E2=80=99t have told the patient it would be = confidential
since = you know=20 the health department will follow up. Also, believe
it or = not, we=20 have been told that in Maryland, to be charged with
statutory rape,=20 the victim must be 4 years younger than the other
person = and must=20 also be under the age of 15. So the parents would
not = have been=20 able to prosecute for statutory rape unless the girl had
been = 14 years=20 old and then only if the boy was over 18.
2003=20 Annual
Educational=20 Conference
and = Annual=20 Meeting
Maryland=20 Chapter
American=20 College of
Emergency=20 Physicians
Overall=20 Objectives
Upon = completion=20 of this one-day educational conference, the
participant=20 should be able to:
=E2=80=A2 discuss recent=20 advances in the areas presented and have im-
proved = facility=20 with the modalities discussed
=E2=80=A2 describe and=20 discuss the interpretation of EMTALA and its
current changes=20 and how it will affect current practice
=E2=80=A2 discuss the=20 current aspects of bioterrorism preparedness and
modern = emergency=20 department response
=E2=80=A2 describe the=20 critical aspects of medical pain management and
its=20 documentation
=E2=80=A2 describe the=20 top ten new drugs and devices introduced this year
and = when to=20 integrate them into your practice
=E2=80=A2 understand=20 the common clinical entity of C-spine injury and its
important=20 diagnostic challenges to the practitioner in daily prac-
tice.
CME=20 Credits
This = activity=20 has been planned and implemented in accordance
with = the=20 Essential Areas and Policies of the Accreditation Council
for = Continuing=20 Medical Education through the joint sponsorship of
ACEP = and the=20 Maryland Chapter ACEP.
The = American=20 College of Emergency Physicians is accredited by
the = ACCME to=20 sponsor continuing medical education for physi-
cians.
The = American=20 College of Emergency Physicians designates this
educational=20 activity for a maximum of 7 Category 1 credits toward
the = AMA=20 Physician=E2=80=99s Recognition Award. Each physician = should
claim = only=20 those hours of credit that he/she actually spent in the
educational=20 activity.
Approved by the=20 American College of Emergency Physicians for
7 = hours of ACEP=20 Category I credit.
Emergency=20 Nurses Association
ENA = Continuing=20 Education Contact Hours have been applied
for.
Conflict of=20 Interest
In = accordance=20 with ACCME Standards and ACEP policy, all
faculty are=20 required to disclose to the program audience any real or
apparent=20 conflict(s) of interest related to the content of their
presentation(s).
Target=20 Audience
Emergency=20 physicians, emergency residents, emergency nurses
and=20 pre-hospital providers practicing in = Maryland.
 EMERGENCY MEDICINE: CURRENT TOPICS
Friday, April=20 25, 2003
Sheraton=20 International Hotel
7032 = Elm=20 Road
BWI = Airport, MD=20 21040
Maryland=20 EPIC
Spring=20 2003
10 Program PPPPPrrrrr ogramogramogramogramogram 8:00-8:15a Welcome
Linda M.=20 DeFeo, MD, JD, FACEP
President,=20 Maryland ACEP
 8:15-9:00a
The = Latest=20 & Greatest:
10 = Top New=20 Drugs and Devices
Presenter:=20 Joe Lex, MD, FACEP
It is = hard to=20 keep up with the new medications and medical
devices that=20 appear on the market each year. Nationally known
speaker Dr. Joe=20 Lex will update you without all the media and
pharmaceutical=20 hype.
 9:00-9:45a
C-Spine=20 Injuries: Pain and Paralysis
or = Pain and=20 Sprain
Presenter:=20 Annie Sadosty, MD
Treatment of=20 cervical spine injuries is one of the most important
tasks = that=20 emergency medical professionals must do. From the
obvious to the=20 subtle, they need to be recognized and properly
treated. Come=20 and hear an internationally known speaker discuss
this = critical=20 topic.
 9:45-10:15a
BREAK = WITH=20 EXHIBITORS
10:15-11:00a
White = House=20 Physician:
What = You Don=E2=80=99t=20 Read in the Paper
Presenter:=20 Robert Darling, MD, FACEP
Dr. = Darling was=20 the first emergency physician to serve as a
personal=20 physician to the President. He has interesting insights you
will = not hear=20 from anyone else. Get an inside look at the man
behind = the=20 office.
11:00a-12:15p=20 High Tech ERs of the=20 Future
Presenter:=20 Craig Feied,=20 MD, FACEP
Dr. = Feied, a nationally known expert on the = application of=20 tech-
nology = in=20 emergency departments, will give you a glimpse of the
practice of=20 emergency medicine in the near future. Prepare to be
even = more=20 excited about your career.
 12:15-1:15p
LUNCH/Board of=20 Directors Meeting
1:15-2:15p
Read = =E2=80=98Em or=20 Weep:
Articles That=20 Will Change Your Practice
Presenter:=20 Deepi Goyal, MD
The = landslide=20 of medical knowledge continues. In the thou-
sands = of=20 articles published annually, there is information that you
will = need to=20 know. Dr. Goyal will help you sort out the germ of
medical=20 knowledge from the chaff.
 2:15-3:00p
EMTALA=20 Update
Presenter:=20 Russ Harris, MD, MMM, FACEP
As an = important=20 aspect of medical life, EMTALA is a two edged
sword = that both=20 helps and hurts current practice. Interpretation of
this = federal=20 law is constantly changing. Do you know how it affects
you = and your=20 consultants?
 3:00-3:15p BREAK 3:15-4:00p
Ouch!!=20 Controversies in Pain
Management Presenter:=20 Robert Suter, DO, MHA, FACEP
Pain = control is=20 a critical aspect of medical management. Evalua-
tion = and=20 treatment of a patient=E2=80=99s pain need to be documented. = How
good = a job do=20 YOU do in treating your patient=E2=80=99s = pain?
 4:00-5:00p
Survival in the=20 Era of Bioterrorism:
Are = You=20 Prepared to be the First Line
Provider? Presenter:=20 Christina Catlett, MD
Dr. = Catlett,=20 Deputy Director of the Johns Hopkins Office of Criti-
cal = Event=20 Preparedness and Response, will discuss some of the most
important=20 elements of healthcare systems disaster preparedness, such
as=20 vulnerability assessment, collaboration and coordination of = re-
sources, surge=20 capacity, communications systems redundancy, disas-
ter = plans, and=20 training.
 5:00-7:00p
EVENING=20 PROGRAM
Dr. Robert=20 Suter, a member of national ACEP=E2=80=99s Board of = Direc-
tors, = will give=20 a presentation that covers the past, present and future
of = emergency=20 medicine, and deals with crises such as healthcare
financing,=20 access to emergency services, the expanding role of the
emergency=20 department and the nursing shortage. How will we thrive
in = the future=E2=80=99s=20 challenging times?
 FFFFacultyacultyacultyaculty Program Committee
PROGRAM=20 COMMITTEE
Larry=20 Linder, MD, FACEP
 Chair
Past = President,=20 MD ACEP
Medical=20 Director, North Arundel Hospital, Baltimore, = MD
Arjun=20 Chanmugam, MD, FACEP
Residency=20 Director, Emergency Medicine
The = Johns=20 Hopkins School of Medicine, Baltimore, = MD
Jon Mark=20 Hirshon, MD, MPH,
FACEP
Assistant=20 Professor
Division of=20 Emergency Medicine, Department of Surgery
Department of=20 Epidemiology and Preventive Medicine
Charles McC.=20 Mathias, Jr., National Study Center for Trauma and EMS
Baltimore,=20 MD
Lawrence=20 Jefferies, RN, CEN
Staff = Nurse,=20 Bowie Health Center, Bowie, MD
Past = President,=20 Maryland State Emergency Nurses = Association
Daniel=20 Kohn, MD, FACEP
Emergency=20 Physician
Harbor and=20 Sinai Hospitals, Baltimore, MD
Diane=20 Liebeskind, RN, CEN
Staff = Nurse
Bowie = Health=20 Center, Bowie, MD
Past = President=20 , Maryland State Emergency Nurses = Association
Amal=20 Mattu, MD, FACEP
Assistant=20 Professor of Surgery
Division of=20 Emergency Medicine
Director of the=20 Combined EM/IM Residency Program
University of=20 Maryland Medicine, Baltimore, MD
 RRRRRegistrationegistrationegistrationegistrationegistr= ation Registration
On = site=20 registration, add $25.00
(Please=20 Print)
Name________________________________________________
MD
DO
RN
PA
EMT Paramedic Other Address_______________________________________ _____________________________________________= City________________________________________________ State__________________=20 Zip____________________ Phone______________________________________________= FAX________________________________________________= Email_______________________________________________ Spouse/Guest___________________________________
The = Educational=20 Symposium includes continental break-
fast, = lunch and=20 two breaks.
 Fees:
Education=20 Course only =E2=80=93 includes course = syllabus
See = below for=20 Annual Meeting Dinner fees
Maryland ACEP=20 members
$125.00
Non-Maryland=20 ACEP members
$145.00
Non-ACEP=20 members
$175.00
Nurses, PAs,=20 EMTs
$75.00
Residents &=20 Students
$30.00
Annual Business=20 Meeting and Reception Fees:
Maryland ACEP=20 member
$40.00 Spouse/Guest $40.00
Make = checks=20 payable and send to:
Maryland=20 ACEP
1211 = Cathedral=20 St.
Baltimore, MD=20 21201
Questions? Call=20 410-727-2237
If = you have any=20 dietary restrictions, call the chapter = office.
Cancellation=20 Fee:
A $50 = administrative fee will be charged for
cancelled=20 registrations. In the event of a course cancellation,
full = tuition=20 will be refunded. No refunds granted after five days
prior = to course=20 date.
Christina=20 Catlett, MD
Deputy = Director,=20 The Johns Hopkins Office of Critical Event Preparedness and Response=20 (CEPAR)
Assistant=20 Professor, Emergency Medicine, The Johns Hopkins Hospital, Baltimore,=20 MD
Robert=20 Darling, MD, FACEP
Commander, US=20 Navy
USAMRIID,=20 Department of Defense, Ft. Detrick, MD
Former = White=20 House Physician
Craig Feied, MD,=20 FACEP
Director,=20 Institute for Medical Informatics, Washington, DC
Director,=20 National Center for Emergency Medicine Informatics
Director,=20 Federal Project ER One
Director of=20 Informatics, MedStar Health/Washington National Medical=20 Center
Deepi=20 Goyal, MD, FACEP
Emergency=20 Physician, Mayo Clinic Emergency Department
Emergency=20 Medicine Faculty, Mayo Clinic, Rochester, = MN
Russell H.=20 Harris, MD, MMM, FACEP
Chair, = Department of Emergency Medicine
Our = Lady of=20 Lourdes Medical Center, Camden, NJ
Health = Policy=20 Fellow, New Jersey Senate Health = Committee
Joseph R.=20 Lex, Jr., MD, FACEP
Attending=20 Physician,
Chestnut Hill=20 Hospital, Philadelphia, PA
Annie T.=20 Sadosty, MD
Associate=20 Program Director
Emergency=20 Medicine Residency Program
Mayo = Clinic,=20 Rochester, MN
Robert=20 Suter, DO, MHA,
FACEP
Associate=20 Professor, Emergency Medicine
Medical College=20 of Georgia
University of=20 Texas, Southwestern
Director of=20 Physician Practice Development
Greater Houston=20 Emergency Physicians
Houston,=20 TX
 FACULTY
Maryland=20 EPIC
Maryland=20 Chapter, ACEP
1211=20 Cathedral St., Baltimore, MD 21201
410-727-2237 =E2=80=A2=20 www.mdacep.org =E2=80=A2 = mdacep@aol.com
Emergency=20 Physician Interim Communique
Maryland=20 EPIC
Spring=20 2003
12
Emergency=20 Physicians Interim Communique:
Maryland=20 EPIC is published by the
Maryland=20 Chapter, American College of
Emergency=20 Physicians and is a member
benefit of MD=20 ACEP. Please direct
inquiries or=20 comments to: MD ACEP, 1211
Cathedral St.,=20 Baltimore, MD 21201, 410-
727-2237, FAX=20 410-649-4131.
The=20 views
expressed in=20 this publication are those of
the = authors and=20 do not necessarily reflect
the = views of the=20 Maryland Chapter of the
American College=20 of Emergency
Physicians or=20 National ACEP.
MD=20 EPIC
accepts=20 advertisements but does not
endorse any=20 product or service.
Non-member=20 subscription: $25/year.
MARYLAND=20 CHAPTER
American College=20 of
Emergency=20 Physicians
 President
Linda = De Feo,=20 MD, JD, FACEP
Vice=20 President
Jon = Mark=20 Hirshon, MD, MPH, FACEP
 Secretary
Richard Alcorta,=20 MD, FACEP
 Treasurer
Kathryn=20 Yamamoto, MD, FACEP
Immediate Past=20 President
Lawrence S.=20 Linder, MD, FACEP
Board = of=20 Directors
Arjun = Chanmugam,=20 MD, FACEP
David = Hexter,=20 MD, FACEP
Amal = Mattu, MD,=20 FACEP
David = Meyers,=20 MD, FACEP
Frederick=20 Thaler, MD, FACEP
Joseph = Twanmoh,=20 MD
Resident=20 Representatives
Michael=20 DiNapoli, MD
Jeremy = Cushman,=20 MD
 Councillors
Arjun = Chanmugam,=20 MD, FACEP
Joseph = Fastow,=20 MD, FACEP
Lawrence S.=20 Linder, MD, FACEP
Susan = Owens, MD,=20 FACEP
J. = Andrew=20 Sumner, MD, FACEP
Alternate=20 Councillors
David = Hexter,=20 MD, FACEP
Jon = Mark=20 Hirshon, MD, MPH, FACEP
Andrew = Milsten,=20 MD, FACEP
David = Meyers,=20 MD, FACEP
Laura = Pimentel,=20 MD
Leigh = Vinocur,=20 MD, FACEP
Michael Weddle,=20 MD, FACEP
EPIC=20 Editors
Claire = Jefferson, Managing Editor
Daniel = E. Kohn,=20 MD, FACEP
Claude = Koprowski, MD, FACEP
EPIC = Design=20 & Production
Virginia=20 Carter
Chapter=20 Executive
Claire = Jefferson
March = 11, 2003,=20 9:30am
Public Policy=20 Meeting
Office of=20 Barbara Brocato
200 = Duke of=20 Gloucester
Annapolis,=20 MD
March = 29, 2003,=20 7:45am
Oral = Board=20 Preparation Course
Sheraton=20 International BWI Airport
Baltimore,=20 MD
April = 25, 2003,=20 7:30am
Maryland ACEP=20 Annual Educational
Conference
Sheraton=20 International, BWI Airport
April = 25, 2003,=20 noon
Board = of=20 Directors
BWI = Sheraton=20 International Hotel
In = conjunction=20 with the Annual
Educational=20 Conference
April = 25, 2003,=20 5:00pm
Business=20 Meeting and Reception
Immediately=20 following the Educational
Conference
Sheraton=20 International, BWI Airport
July = 25, 2003,=20 11:30am
Board = of=20 Directors
Med = Chi,=20 2
 nd
Floor = Board=20 Room
Baltimore,=20 MD
In = This=20 Issue:
Prevention=20 Pays Off
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86
 2
Update from=20 Annapolis
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86
 4
Public=20 Policy Update
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86
 5
The Legal=20 Corner: Confidentiality
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86=20 =E2=97=86
 6
Annual=20 Meeting Program
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86
 9 Education Conference Registration inside
Calendar of=20 Events
=E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86=20 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 =E2=97=86 = =E2=97=86 =E2=97=86 =E2=97=86