Posted March 26, 2001
Adversarial matters in health care are unfortunately becoming more numerous and frequent, from patient or employee related claims or litigation to administrative law proceedings based upon facility investigations by government regulators. At Garlo Ward, P.C., we strive to assist our clients to address and resolve such legal matters in the most expeditious and cost-effective manner possible. For that reason, this article explores the ways in which clients can work closely with us to make that happen.
- SEND EVERYTHING TO YOUR ATTORNEY. Everything has a deadline. Any time you receive anything by fax or mail from TDHS or HCFA, let your attorney know immediately. Unless it is a very large document, we will want you to fax it to us no later than the end of that day. This is especially true of certified mail, where your receipt of it is officially recorded. Sometimes official communications look similar and it takes a careful reading to see that what looks like a form letter contains something significantly different than a prior one. That is an attorney’s job to determine; yours is to make sure we get the letter or document. If it is a large document, call your attorney or paralegal upon receipt so we can discuss what it is and whether fax, overnight mail or regular first class mail is best. Any delay in sharing information and delivering materials can result in a lost opportunity to minimize a problem, loss of penalty reductions or even loss of appeal or hearing rights to challenge findings or sanctions.
- Make yourself available. Give specific times to the paralegal and attorney when you can be reached. It costs you more money for a paralegal or attorney to try and track you down and leave repeated messages. Garlo Ward, P.C. wants to work closely with you and needs your involvement in your legal matter. Our attorneys know the law and want to educate you about what is going on so you know what to look for and how to help us help you. You know more about the facts and circumstances than anyone, and the attorney must rely on getting that information from you.
- Batch all your questions. Create a list of questions for your attorney or paralegal and get them all covered with one phone call. One ten-minute phone call will be more cost- and time-effective than three or four five-minute calls. Attorneys do the same thing so they can cover as much as possible in one discussion.
- Use your paralegal. If your question is procedural or does not require legal advice, speak to the paralegal. If you are in doubt about that, try the paralegal first anyway. You may get the answer you need right away and, if not, the paralegal can often convey your question and get an answer from the attorney without incurring a great deal of attorney time, thereby saving you in legal fees. The attorney and paralegal can determine whether a call back from the attorney is needed. If you want to speak with the attorney directly, please do say so. We tend to utilize our paralegals in an effort to save you in fees, not to avoid talking to you!
- Return phone calls promptly. You are charged a fee every time a paralegal or attorney has to pick up the phone to contact you. Attorneys call with important information they need to share or to obtain. Having prompt contact with you allows the attorney to move your case along. If you are not available and an attorney or paralegal has to put the matter aside and move on to another case, it takes additional time to get back to your file, review notes for a discussion and so on. That is avoided if we can reach you or hear back from you quickly.
- Provide documents as quickly as possible. Thoroughly comply with requests and instructions for documents; having to repeatedly ask for important documents costs time and money. When you speak with your attorney and/or paralegal, make notes about what is being requested and make sure you are clear about the names of documents and what they look like. If you are not sure, ask. Your attorney will advise you as fully as need be so that you can identify the documents we are asking for and get them to us. Different facilities sometimes have different names and filing systems for similar information. We may be asking for specific information or content rather than just a name of a document. If you have something that meets our need for information or content, tell us what you call those records in your facility so we can speak the same language and get the information you already carefully collect and file.
- Obtain written instructions and lists from your paralegal or attorney. You already have a lot on your mind. It will be much easier to get everything done correctly if you can work from written directions. If our requests are confusing to you, or you don’t have time to make notes on all the things we ask for, feel free to ask us to create a checklist for you. Your attorney may already have forms for document requests that we can send and you can check off as you gather the information in a packet to return to us.
- Designate a point person and a contact team in your facility. Designate a “point person” for decision-making and who can delegate tasks needed to respond to requests from our office. Your attorney needs to know who will be the official decision maker with whom we can discuss strategy and the direction to go in handling a case. It is additionally helpful if you create a team of no more than two additional staffers who can work with you during this process. Inform your attorney of who these people are and how they will assist you (who can identify people with knowledge of an event, who is good at finding records or documentation, and so on). Your attorney can then rely on them to gather information and documents or get questions answered. Be sure to meet with them regularly or set up a system for communications between you so conversations with our office can be easily relayed among you. Having more than one person up to speed on the status of the legal matter will make it easier for us to move forward smoothly.
- Don’t fax a document at 4:30 p.m. and then send it for overnight delivery. This is a waste of money. Plan ahead or contact our office if you have questions about the best manner of delivery or how much to send by fax. In any event, there is not much an attorney can do with a document that arrives late in the day, especially if some action is needed on it that same day. Be sure to look at your mail and deliveries early in the day so you can take action on something that comes in if need be.
- Keep your records in order. Often, attorneys have less than 10 days to draft an Informal Dispute Resolution or other response, or to respond to Discovery requests. These responses cannot be completed without relevant resident records or other facility documents that you or your staff will have to find for us quickly.
- Organize documents by categorizing them. Clearly label binders and file folders. Keep surveys, Plans of Correction and similar documents together in chronological order. Be sure to keep an administrative record in chronological order of patient, family or employee concerns, complaints, disruptions and so on that may not be appropriate to file in a patient or employee file. Evidence of repeated problems that affect patient care or employee performance may be important to developing a defense and we need to be able to draw on records you have kept of such occurrences.
- Keep facility policies, protocols & manuals in order. It is not unusual to need these items from as far back as five years. Keep active records in your office and carefully archive and store older records in a way that they are easily retrievable.
- Keep all in-service training records in a 3-ring binder, organized by date and time. Make sure the forms you use have a record of the title(s) of the in-service, a description of the content covered, the names of all persons who attended, and who conducted the training. If the same training is given at different times, days or shifts make sure you mark the records with the time and that the attendance roster is accurate as to which session employees or management staff actually attended. Knowing the actual whereabouts of a given individual long after an event can be important in addition to just being sure that individual actually received certain information or education. If a policy change or some other document is discussed, be sure to keep a copy of that document with the training records as evidence of the version of the document discussed.
- If possible, have a witness present during any surveyor interviews. Often the foundation of many disputes is a difference of opinion or of interpretation of an event or communication. Witnesses can serve as an additional observer and can also assist the party being interviewed to be less nervous about the process. When in doubt about how to handle a surveyor interview, check with your attorney and receive guidance up front. That is much easier and more cost-effective in the long run than having to try to un-do a mis-stated or mis-interpreted and potentially damaging comment.
- Do not have your staff write statements for surveyors or your own investigations without any input from an attorney. It is important for the attorney to direct what is recorded so that information is not missed and is accurate, and most importantly so that any information that may be confidential or privileged can be properly protected in accordance with what the law allows.
- Pay bills promptly in order to take advantage of available discount. Some attorneys will discount fees of current invoices if payment is received on or before a certain day and no other amounts are past due. Garlo Ward, P.C. has such a discount program, so be sure to inquire and make sure you know how it works.
We want to enjoy a long-term professional relationship with our clients. We feel we can best achieve that if we can provide high quality services, include you in and educate you about the process, utilize your expertise to assist us and create communication and work systems to resolve your legal matters in the most expeditious and cost effective way possible. Please let us know if you have questions or suggestions to help us improve on these goals.
All information in this article is informational only and is not legal advice. Should you have any questions or a situation requiring advice, please contact an attorney.
Copyright 2004 by Garlo Ward, P.C., all rights reserved
Austin, Texas 78752-3714 USA