The COVID-19 Era & Common Questions about Treating Trauma Patients

The Advocate

By Steven J. Anglés

March 26, 2020

Covid-19

As we hunker down here at Adler Giersch and temporarily move our practice to a more “virtual” one, we have received many questions from providers on the best ways to continue safely caring for patients who are healing from traumatic injuries.  We wanted to share our answers in the hope that they are helpful to you and your patients. The COVID-19 pandemic has made all of us get more creative in how we do things, both at work and at home. As we all navigate the many changes, it’s important to not lose sight of a patient’s need for continuity of care and communication, whenever possible, and provide it in a safe manner for all involved.

“My patients can’t safely come see me or my staff without putting their health at risk due to COVID-19. Our regular treatment plan has been interrupted. What are some best practices?”

This is the most common thing we have heard: patients and providers whose usual scheduled visits have been interrupted due to safety concerns, transportation problems, or lack of other resources.

Unfortunately, there’s no simple answer. Ideally, providers may continue to find alternate ways to provide services to patients rather than be unable to provide any services at all. For example, many private practice clinics and those part of bigger health care systems have re-invented “non-essential” provider-patient in-office visits with virtual and online meetings for initial consults and ongoing management of trauma related conditions. (See below). At the same time, Emergency Departments remain open for medically critical needs and have separate areas for COVID-19 vs. non-COVID-19 patients.

With the disruption of regular in-office treatment visits, it remains important to document your patient’s file as a way to proactively avoid anticipated arguments concerning “gaps” or interruptions in care.  Remember that these breaks in care can be incorrectly interpreted to mean that a patient is recovered and no more treatment is needed. If you hold virtual or online meetings with patients, it’s also important to document your file appropriately. As we often say, if the information isn’t in your patient file, it doesn’t exist.  If your clinic is closed, we recommend adding a note to the patient’s file indicating that due to the COVID-19 pandemic, treatment visits have been suspended temporarily and that the patient is advised to take additional steps you may have recommended.

Documenting the anticipated gap in treatment is one way to avoid post-COVID-19 arguments from insurers that since the patient went for several weeks without treatment, it means that they really did not “need” the treatment prescribed.  Failing to document this information could lead to problems with insurance payments, cause problems to your patient’s access to treatment and rehabilitation, and resolution of their personal injury claim later on.

“What about virtual or online treatment sessions or consultations?”

Appointments with patients at a distance, when possible, are far better than no appointments at all. Like you, we have seen a sudden and marked increase in telephone and video conferencing consultations between providers and patients. Anything that continues to provide healing to patients is a plus.

Applications that allow you to share computer or phone screens with your patients will help with viewing documents together during appointments. Keep in mind, however, that while companies such as Google are making their videoconferencing applications available for free, you will want to ensure that whichever service you use complies with patient privacy laws.

“Some of my patients are reaching out to us on social media since they don’t have my email on contact information other than the main business phone number. Is that okay?”

Social media is a great way to stay connected with friends and family as we are all being asked to distance ourselves from one another.  But, much like before COVID-19, social media should be used very sparingly when having communications with patients. There is no right to privacy in social media applications.  When it comes to communications with your patients, it’s still best to ensure the highest degree of privacy possible and use an alternate means of communication such as email, particularly encrypted emails.  Some providers have taken time to call their active patients or sent them a private email, an idea we favor.

“Some of my patients are involved in personal injury claims and there are meeting requested, depositions and court hearings. What’s going on with all of that?”

Attorney Meetings: these are the easiest to address. Telephone or video conferences should be sufficient to keep information flowing freely.

Depositions: in-person depositions are not permitted under Governor Inslee’s stay-at-home directive. However, if the attorneys and the provider agree, both telephone and video depositions can be held.

Court Hearings: The Washington Supreme Court has issued an Order to suspend all pending civil trials until at least April 2020. At some point after that, cases will be reset, with the courts giving criminal cases priority over civil cases due to the expected backlog.

Law offices, courts, and insurance companies are all implementing their own ways of distancing themselves socially, while still trying to conduct business, and complying with Governor Inslee’s March 23, 2020 mandatory statewide stay-at-home order. It’s best to contact these businesses and courthouses directly to get the latest updates.

However, we can share what we’ve been experiencing for the past several weeks, some of which are unlikely to change right away. Law offices such as ours that can operate remotely remain open for business. Meetings are not being held in person. Courthouses remain open, but are only providing limited services. For example, as of March 20, 2020, most courts in King County are severely restricting any in- person appearances and are instead conducting business by telephone or by mail. Other counties are taking more strict measures for longer periods of time to reduce the risk of infection to court staff, judges, and jurors. Websites for courthouses and county bar association websites continue to be the best sources of information.

Court-related delays may impact your practice. If you are scheduled to testify at a legal hearing of any kind, you should get in touch with the appropriate attorney in the case for further information. The same holds true if you are scheduled to provide testimony at a deposition. Chances are, in either case, things may be postponed until further notice.

However, don’t automatically assume that a case you or your patient are involved in can’t be resolved, despite COVID-19. We are still actively resolving client cases while working remotely. Resolving these cases is providing much needed relief for clients and providers alike. Other cases may still resolve without the need for any formal legal proceeding in a courthouse, but the process may just be slower.

On the insurance side, we have seen delays, but not as many, due mostly to the fact that so much work can be performed by insurers and claims handlers remotely and without the need for any in-person contact.

As we all work together to get through these tough times, we will continue to roll out information that we think is important to you, your staff, and your patients. Our website already has a number of articles and blog posts written by our attorneys that cover a number of topics involving your practice. They can be found here: https://www.adlergiersch.com/resources/.

We remain easily reachable by telephone, email, texts, Linked In, and Facebook, among other ways. We are continuing to provide complementary consultations to patients who might need our services, or who may just have questions that are worrying them at a time when they don’t need one more thing to worry about. We are set up for online video meetings as well. Send us your questions & concerns, and we will respond quickly with our best advice.

As we all practice responsible social distancing, we continue to wish you and yours good health.