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Q&A: Legal Issues with Safety & Testing
Panelists answer the questions physicians asked related to safety and testing during our webinar, “Medico-legal Concerns for the Private Practice During COVID-19.”
COVID-19 Safety
Q: Randy, one thing that came up in Florida is there is a valved N95 mask and that does not prevent you from giving it to someone. This has been in the press in Florida and caused us to ensure we don't use valved N95 masks in our office treating patients.
Randolph Waldman, M.D., Facial Plastic Surgeon, Editorial Advisor, Aesthetic Authority, Founder and Director of the annual multi-specialty Global Aesthetics Conference: Yes, we are not using the valved mask even though they are more comfortable to wear.
Q: Is KN 95 as good as the N95?
Dr. Waldman: I don't think so.
Q: How are you having patients text? Are you just having them text someone's personal phone or have you found a way to get professional texting?
Dr. Waldman: We are using a system called Weave, which is a system that is like having an iPhone and patients can text our system and vice versa.
Q: How does one address concerns with employees who are making travel plans that include airfare and/or traveling by car across state lines this summer and early fall?
Dr. Waldman: We are still asking them to quarantine away from us through the month of June if they have traveled by plane, but we expect that to change in the next month or two.
Q: If one of the staff members becomes positive, and the physician was exposed (mask or no mask), does the physician need to quarantine for 2 weeks?
Dr. Waldman: Great question and will need to be something every physician must decide for themselves. I think testing and temp checks will allow the physician to stay in the office as it would other office staff.
Q: Should we have patients apply shoe covers/booties when entering the office?
Dr. Waldman: Masks suffice in our practice.
Q: How will you handle post op care/visits if the patient has developed COVID infection post procedure?
Dr. Waldman: Virtual [visits] where possible and with caution in an isolated area of the office if not possible.
Q: If we are presuming all patients are presymptomatic, could an argument be made that we should all being wearing N95 masks if we see patients?
Jeff Segal, M.D., JD, Founder, Medical Justice Services: N95 masks (and eyewear/face shields/gowns/gloves) are limited to being around (a) patients with active symptoms; or (b) aerosolizing procedures – intubation/drilling/or arguably working on open mouth or nose. For being around “pre-symptomatic” people (assuming no exposure to aerosolizing procedures or exposure to open mouth), surgical mask and hand washing should be adequate.
Q: What PPE is absolutely required to provide our staff for a practice that does injectables?
Dr. Segal: If you are in front of the patient’s face and patient is breathing right on you as you do the injections – would recommend N95 mask, eyewear/face shields/gowns/gloves. Alternatively, one can be creative and have plexiglass barrier between patient and injector. This assumes you can work around the barrier comfortably. If so, then surgical mask and eyewear may be adequate.
Q: What type of PPE is needed for staff in offices not doing aerosolizing procedures? The panel is using N95s, but these are scarce.
Dr. Segal: If staff is not in front of patient’s open mouth, surgical mask and eyewear may be adequate. See answer above.
Q: How does one address concerns with employees who are making travel plans that include airfare and/or traveling by car across state lines this summer and early fall?
Dr. Segal: Hard to say. It depends whether there’s a second wave. Whether they are traveling to hot spots. I know most airlines are trying to be flexible to get people back on planes.
Q: What is your responsibility if you share an office?
Alex Thiersch, JD, Partner, Salveo Capital; CEO, AmSpa:Businesses in a shared office space or with shared common space should coordinate to implement effective infection controls and sterilization procedures that apply to the entire office. An any health information obtained about an employee must be kept in separate confidential files, however. You are responsible under OSHA to provide a workplace free from recognized hazards, but this does not extend to non-employees. Nevertheless, a common plan and protocol should be implemented.
COVID-19 Testing
Q: Do practices that are already open have a COVID-19 Exposure Plan (i.e., processes in place in case staff/patients test)?
Dr. Waldman: Yes, I think most do and we have taken the extra step of having both an OSHA officer (which we have had) and also a COVID director.
Q: If one of my staff members becomes ill and then tests positive for COVID-19, do I contact the patients that we saw from several days prior and alert them that they may have been exposed?
Thiersch: There is no legal requirement to do so, particularly if you are following recommended protocols such as social distancing, wearing masks, wash hands and screening patients before they arrive. However, this is an individual decision that each business must make given that this is a sensitive topic with PR implications. Certainly, some screening will need to be done to see who the employee came into contact with, were they showing any symptoms (they shouldn’t be because that would require them to avoid work), were any other employees showing symptoms, etc. So, while not legally required, depending on the circumstances there may be wisdom in doing so.