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The Three Strikes Law in Florida
1.
The Three Strikes Law
in © FBOG-SIP 2015
2.
CONTINUING EDUCATION There was
no commercial support for this education. There are no off-labeled uses of medications discussed in this module. There are no alternative therapeutic modalities discussed in this module. © 2015 Florida Board of Governors Self-Insurance Program. All rights reserved. Approved by the Florida Board of Medicine as satisfying the 1 hour Medical Error Prevention licensure requirement. Expiration date is - June 30, 2018. To obtain contact hours for the education, you must complete the entire module, including the questions and evaluation. © FBOG-SIP 2015
3.
OBJECTIVES Cite the Constitutional
and statutory provisions of the Florida Three Strikes Law. Explain the three key concepts of the Florida Three Strikes Law. Recognize the types of results from medical malpractice trials, arbitration, and agency actions that may result in a strike. Define the term “physician” as used in the Three Strikes Law. Define and discuss the terms, “medical malpractice” and “standard of care”. Identify and contrast a single incident of medical malpractice that may lead to a single strike and multiple incidents of medical malpractice that may lead to more than one strike. Discuss the “clear and convincing evidence” standard necessary for an agency board to determine if the physician will receive a strike. Relate the practical implications of the Three Strike Law based upon its history. © FBOG-SIP 2015
4.
Florida Three Strikes Amendment Overview © FBOG-SIP
2015
5.
THREE STRIKES LANGUAGE
APPROVED The Constitutional Provision No person who has been found to have committed three or more incidents of medical malpractice shall be licensed or continue to be licensed by the State of Florida to provide health care services as a medical doctor. Art X, Sec. 26, Fla. Constitution Prohibition of Medical License After Repeated Medical Malpractice © FBOG-SIP 2015
6.
Key Concepts of
the Three Strikes Law Found to have committed Three or more “incidents” Medical malpractice © FBOG-SIP 2015
7.
“Found to Have
Committed” Malpractice Defined “Found to have committed” malpractice as determined by: © FBOG-SIP 2015
8.
A Strike May
Include Presuit Voluntary Binding Arbitration The Medical Malpractice Act provides an alternative to litigation. The parties can agree to submit their dispute to a panel of arbitrators. The defendant must admit liability in exchange for limits on damage awards. Physicians who agree to this arbitration process are subject to a strike. © FBOG-SIP 2015
9.
Is a Settlement Before an Adverse Verdict
a Strike? As a general rule, a settlement is not a Strike. Settlements in Florida are reported to the Florida Office of Insurance Regulation. The Florida Office of Insurance Regulation database is public record and available to the medical/osteopathic licensing boards. A licensure investigation could be initiated that could result in the board’s determination that the licensure investigation produced clear and convincing evidence of medical negligence on the part of the physician. © FBOG-SIP 2015
10.
“Medical Malpractice” AND
The Long Arm of the Law “Medical Malpractice” Failure to practice medicine in Florida with that level of care, skill, and treatment recognized in general law related to healthcare providers’ licensure AND Any similar wrongful act, neglect, or default in other states or countries, which, if committed in Florida, would have been considered medical malpractice © FBOG-SIP 2015
11.
The Florida Legislature
Passed a Law to Help Define the Three Strikes Amendment “Medical doctor” “Incident of medical malpractice” “Level of care, skill, and treatment recognized under general law related to health care licensure” Standard of proof “Final administrative decision” Provides specificity and some clarification of the Constitutional terms: The Florida Legislature’s enabling legislation implements the constitutional amendment: Fla. Stat. sec. 456.50 (2) © FBOG-SIP 2015
12.
Who is a Medical
Doctor? Licensed under Florida Statutes Chapter 458 (MD) Licensed under Florida Statutes Chapter 459 (DO) A physician: © FBOG-SIP 2015
13.
What is Medical
Malpractice? The Breach of the Prevailing Professional Standard of Care Bad outcomes alone do not constitute a breach of the professional standard of care, except for: Retained foreign body cases – res ipsa loquitor ACT or OMISSION © FBOG-SIP 2015
14.
“The Level Of Care,
Skill, And Treatment Recognized in General Law Related To Health Care Licensure” This concept is also referred to as the Prevailing Professional Standard of Care (Standard of Care) The Standard of Care is established under sec. 766.102 of Florida Statutes “The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment, which, in light of all relevant surrounding circumstances is recognized as acceptable and appropriate by reasonably prudent similar healthcare providers.” © FBOG-SIP 2015
15.
Expert opinion is
required to assess the standard of care of a medical doctor during the care and treatment of the patient Recently, the Legislature has mandated that standard of care opinions relating to the care and treatment of a specialist must be rendered only by experts of the same specialty What is REQUIRED to Establish the Standard of Care Was Met? © FBOG-SIP 2015
16.
The wrongful act
or occurrence from which the medical malpractice arises, regardless of the number of claimants or the findings of the court, arbitrators, or Board. What is an “Incident” of Medical Malpractice? © FBOG-SIP 2015
17.
A single act,
regardless of the number of claimants is counted as only one (1) “incident” Multiple findings of medical malpractice arising from the same wrongful act or series of wrongful acts associated with the treatment of the same patient counts as only one (1) incident. A Single Wrongful Act vs. Multiple Wrongful Acts © FBOG-SIP 2015
18.
Comparison of Standards
of Proof in Legal Cases Preponderance of the Evidence – a low threshold of proof applicable to findings of medical malpractice by juries in a lawsuit or by arbitrators in an arbitration proceeding. Proof Beyond a Reasonable Doubt – a very high threshold of proof required to convict a defendant in a criminal case. Not used in medical malpractice cases. Clear and Convincing Evidence – A higher threshold of proof than preponderance of the evidence standard but lower than the beyond a reasonable doubt standard. “More likely than not” Witness testimony must be precise and lack confusion. The evidence as a whole is sufficient so that a trier of fact (e.g., a judge, jury, arbitration panel) would have a firm conviction, without hesitation, regarding the truth of the allegations of medical negligence. What is the Standard of Proof of Medical Malpractice Required for a Strike? © FBOG-SIP 2015
19.
The appropriate Board
determines if an incident is one of medical malpractice rising to the level of a strike. The Board must determine if the strike was due to medical negligence and was proven to a higher standard than the preponderance of evidence standard applied in a medical malpractice lawsuit or medical malpractice arbitration. Clear and convincing evidence is the standard that is applied by the Board. If the court, the arbitrators, or licensing Board used a lower standard, then the appropriate Board must review the proceedings to determine if the acts or omissions of the medical doctor demonstrate medical negligence by the higher standard of clear and convincing evidence. What Standard of Proof of Medical Mal- practice IS Required for a Strike? © FBOG-SIP 2015
20.
A strike is: AND Determined
by the Board that the evidence during trial, an arbitration hearing, or a board proceeding proved medical malpractice by clear and convincing evidence. A single strike may consist of one act of negligence regardless of the number of claimants or multiple acts of negligence involving a single claimant. An incident of medical negligence involving a breach of the prevailing professional standard of care Determined by a result of a: Lawsuit; Arbitration proceeding; or Board administrative process Wrapping Up the Legal Aspects © FBOG-SIP 2015
21.
Very few strikes During
the first six years from the passing of the Three-Strikes Rule amendment to the constitution and enabling legislation only three physicians were deemed by the Board of Medicine to have a strike.* Boards of Medicine and Osteopathic Medicine have their own statutory authority outside of the Three-Strikes law to suspend or revoke a physician’s license for medical malpractice, even if the physician had only one incident of medical malpractice. *Chaires, G, Three Strikes Rule: It has been almost six years: Is there any discernable impact of its passage, Risk Rx, Vol.7, No.4, 2010 The Three Strike Law in Practice © FBOG-SIP 2015
22.
PROGRAM CREDITS Narration: Glenn Rickards,
WUFT-FM Gainesville, FL © FBOG-SIP 2015
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