HFD/CMDA Minutes

September 4, 2007

Chair- Cari Levy MD, CMD


Attendees:  Lee Anneberg,  Roger Bermingham,  Wendy Bodwell, Julie Christiansen, Leslie Eber, Fred Feinsod,  Kristy Flodquist, Greg Gahm,  Sheldon Goldberg,  Kerry Hildreth, Chris Horton, Alexander Jacobs, Ron Kennedy, Karyn Leible, Cari Levy,  Jennifer McCants, Alan Miller, William Orr, Kim Santomango, John Schlue, William Soloman, Karen Villalon






  1. Introductions


  1. Review minutes from last meeting


  1. HFD Update (Mr. Roitman)

·         Mr. Roitman provided a brief introduction.  He is currently in his 2nd month with the Health Facilities Division.  He is not a doctor, but lawyer by training and has specialized in regulatory management. 

·         Recently provided an update to the legislative committee that oversees audits; they are generally on schedule for meeting recommendations for the 44 items that came up; some are in place; working to get additional resources (financial and human) for others.

·         Recommendation on audit for conducting criminal background checks at long term care facilities; discussion from HFD staff that there was a need for legislation to require and how to handle when an issue arose over background check; legislative committee did not seem to want to take on proposing legislation for this issue at state level but requested that HFD do some research with the industry as to what is current practice and what they feel is needed.  *Dr. Leible has seen a recently proposed federal bill that deals with this issue.

·         Working to improve accuracy of MDS.

·         Possible education session across facilities related to discharging and receiving patients (long term care, OR, ICU) and MRSA infection rates.

·         Working to balance work load, especially finding resources to conduct initial certification surveys for new facilities; issue becomes that facility can open without the certification, but cannot bill for Medicare; researching possibility of bringing in outside resources on short term contract.



  1.  Community Outreach (Dr. Feinsod)
    • Arkansas Valley Regional Medical Center Grand Rounds

                                                               i.      F TAG 329 - Well received by the multiple physicians, PAs, NPs that attended; positive and supportive of gradual dose reduction; appears there will be more support of interdisciplinary teams at facilities.

                                                             ii.      Cooperation from the physicians in terms of using the minimal number of medications necessary, supporting the IDT in carrying out the mandates in F TAG 329, and in creating an open dialogue on medications.


  1. Policy Issues (Dr. Leible)

·         There has been a recently proposed federal House Bill requiring criminal background checks for non-professionals in long term health care; will update as more information becomes available


  1. Vaccination Update
    • Vaccination Rate Plan – current rate update was provided for facilities since November 2006; numbers represent a “snapshot” of facility’s immunization status at the time of last annual survey.
    • Dr. Gham indicated that there are more doses available and to be liberal in vaccinating patients; since mild season last year, it is expected this year will be worse; the later you can wait to vaccinate, the better since Colorado’s peak is in February and effectiveness decreases with time.
    • Question as to best practice for health care providers – 36% is average rate; more effective to vaccinate employees rather than patients; the more times you are vaccinated, the more resistant you are to a pandemic flu.


  1. Quarterly Educational Seminars for Surveyors (Dr. Levy)
    • Week of October 15th  – Role of the Nurse Practitioner in Long-term Care (Tami Meurer) – Location TBD; HFD will get with Tami to determine exact date; questions will be generated in advance; 1.5 hour session.
    • End-of-Life Care – (Dr. Gottula)  - This topic will be saved for the next seminar in December.


  1. Web site and Library updates (Dr. Levy)
    • Our web address is: www.cmda.gen.co.us or www.cmda.us.
    • Meeting notes and all articles are posted 


  1. Providers meeting summary (Dr. Jacobs)

·         Slide presentations on revised TAG 323 (Accidents) and Paid Feeder Assistance; certain requirements and restriction apply to the hiring of someone to assist in feeding residents; handouts of both presentations will be posted on the website.

·         Plans of Corrections – if not accepted, are sent back to facility for correction/changes sometimes multiple times; occasionally new issues are brought up in succeeding revisions that were not brought up as deficient in previous plans; state can now send a written directed plan of correction if initial plan is not found to be sufficient or adequate; clarification that the directed plan occurs only after plan has been submitted for the 2nd time and still not corrected and only for significant items.

·         Panel discussion on dehydration as a phenomenon of end-of-life does present possible problems; important that possible issues – weight loss, skin issues, etc., be well documented in the beginning when decision is made to hold fluids and nutrition.     


  1. End-of-life Consortium update (Julie Christiansen, Ombudsman)

·         A presentation by Dr. Telatnik re: implementation of a standard form for life-sustaining treatments Physician Orders for Life-sustaining Treatments (POLST) to be presented at next meeting.


  1. Treasurer Update (Dr. Anneberg)
    • Laptop - Thank you to COPIC for the donation of a used laptop computer, which will be used for the financial records.
    • Has updated spreadsheets and financial information to turn over the books to Dr. Birmingham.


  1. Hospice of St. John has an immediate opening available for a medical director
    • Contact Jeanie Youngwerth, MD at jeanie.youngworth@uchsc.edu


  1. Tamper-resistant Prescription Pads (Alan Miller)

·         The Centers for Medicare and Medicaid Services released a guidance statement regarding the Medicaid tamper-resistance prescription pad requirement that will be implemented on October 1, 2007. This new regulation will require all handwritten prescriptions for Medicaid patients to be on tamper-resistant prescription paper, unless they meet an exception that is indicated in the regulation.   

·         The regulation provides an exception for drugs provided in nursing facilities, intermediate care facilities for the mentally retarded, and other specified institutional and clinical settings.

    • The regulation does not apply to dual eligibles---beneficiaries receiving both Medicaid and Medicare.    


  1. Beyond Informed Consent - Ethical Strategies for Shared Decision Making
    • Sept 18th 8-11:30am
    • Denver Community Bioethics Committee 11177 W. 8th Ave, Lakewood
    • Sara Golden – sgolden@totallongtermcare.org



CMDA 2008 Annual Meeting: (Dr. Leible, Dr. Levy)


  1. Speakers  

o        Andy Kramer – quality assurance strategies

o        Dan Sheridan – forensic nurse specialist will speak on identifying abuse and how to do documentation 

o        Jean Pals – communication between nurse and physician – when to call the doctor.

o        Dr. Rubey – psychiatric issues


  1. Date – April 25, 2008


  1. Location - TBD




New Business: (20 min)


  1. Drug Destruction (Mark McMillan and Elaine Daniloff -Disease Control and Environmental Epidemiology Division)

·         Issue of emerging contaminants and human health risk has been discussed in recent months; decided to focus on pharmaceutical disposal; looking at take back programs (one day drop off); drafting a guide for citizens; security around disposing of controlled substance; drop off at approved locations; mailing back to approved locations; bin program at pharmacies; liability issues; cost of and who pays; more information regarding IL-IN (Illinois-Indiana) Sea Grant Resource Kit can be obtain at www.iisgcp.or/unwantedmeds.

·         Best practice does not call for disposal of drugs by flushing and put down the drain; must make sure there is destruction on site to avoid someone “appropriating” unused drugs.

·         "Longmont United Hospital is hosting the first "Pharmaceutical Drop Off Day" on Saturday, September 9, 2007, 8:00 AM - 2:00 PM.



Organized by Boulder County's Environmental Health Division's PACE program (Partners for a Clean Environment) and Longmont United Hospital, this pharmaceutical take back event is the first of its kind in Colorado.  Modeled on similar pharmaceutical take back programs in other states, the initiative clears the regulatory hurdles while protecting the environment by assuring that unused medications and OTC medications are disposed of properly.  In light of the numerous obstacles surrounding medication recycling/reuse, Longmont United Hospital will separate the dropped off pharmaceuticals appropriately into either general hazardous waste or hazardous waste to be incinerated, e.g. inhalers, liquids, patches. 



  1. Regulatory Agency Support for Medical Directors (Dr. Feinsod)

·         Which regulatory agencies are going to support the facility Medical Director in the implementation of F TAG 329?  Physicians question what  authority medical directors have in dealing with recalcitrant physicians re: F TAG 329; failure to report sub-standard care can result in medical director receiving F TAG 501

·         Possible ideas for dealing with this issue – summarizing F TAG 329 in a handout with publications that are available for further education; forming an advisory committee from CMDA to assist with situation before it goes to BME; important to follow the chain of command when dealing with facility that is part of a corporation.


 Old Business:


  1. Establishing “Intent” among the cognitively impaired- (Sharon Haney) 

Tabled until next month.



Educational Moment: (15 min)


Pharmacological Treatment of Geriatric Cachexia: Evidence and Safety in Perspective

J Am Med Direct Assn 2007; 8:363-377.

Tabled until next month.



Next Meeting:  October 2, 2007 – 12:00 noon 

Our educational moment will feature - Hip Protectors: Does brand name matter?