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Restrictive, Non-Solicitation Covenants Are Valid

Enforceability of covenants depends on whether they are necessary to protect interest of practice

MONDAY, Aug. 25, 2014 (HealthDay News) -- Restrictive and non-solicitation covenants are valid and can be enforced, according to an article published Aug. 5 inMedical Economics.

Some physicians and their employers perceive that restrictive and non-solicitation covenants are not enforceable. However, according to Medical Economics, enforceability depends on whether the covenants are necessary to protect the interests of the medical practice or hospital.

A restrictive covenant prevents physicians from practicing medicine during the term of employment and for a period after termination. The covenant should encompass the period of physician employment and may continue for up to two years after termination. A covenant generally must relate to the area from which the practice or hospital draws most of its patients. Non-solicitation covenants prohibit physicians from soliciting patients or other employees of the employer. These covenants are usually in force for the same length as restrictive covenants. Other issues that should be discussed between physician and employer include waiving of covenants if an employer doesn't renew a physician's employment agreement; whether the employer should include liquidated damage; and exceptions to the scope of the covenants.

"While courts may be reluctant to enforce such covenants and will try to limit their scope, properly drafted restrictive and non-solicitation covenants are valid," according to the article.

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U.S. to Tighten Access to Certain Narcotic Painkillers

Drugs containing hydrocodone, which include Vicodin, would be affected

FRIDAY, Aug. 22, 2014 (HealthDay News) -- The U.S. Drug Enforcement Administration (DEA) is going ahead with tough new controls on painkillers containing hydrocodone, which has been tied to a surge in dangerous addictions across the United States.

The new restrictions would cover prescription narcotic drugs such as Vicodin, Lortab, and their generic equivalents, putting them in the same regulatory class as painkillers such as Oxycontin, Percocet, and codeine. Patients will now only have access to a three-month supply of the drug and will have to see a doctor to get any refills.

The new rules, posted online by the DEA on Thursday, come more than 18 months after a U.S. Food and Drug Administration advisory panel met to discuss the fate of painkillers containing hydrocodone. That 2013 meeting followed the DEA's request for an FDA panel review on the issue. The painkillers were previously classified as Schedule III drugs, but the DEA wanted them placed under the more restrictive Schedule II designation.

"Almost seven million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents," DEA Administrator Michele Leonhart said Thursday in a news release. "Today's action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available."

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Hospitals Should Follow CDC Recommendations for Ebola Care

Exceeding CDC recommendations may increase risk of transmission, anxiety, and costs

TUESDAY, Aug. 26, 2014 (HealthDay News) -- Hospital and health care providers should follow the U.S. Centers for Disease Control and Prevention's recommendations for care of patients with Ebola, according to an ideas and opinions piece published online Aug. 21 in the Annals of Internal Medicine.

Michael Klompas, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues discuss the need to reconcile official CDC guidance for Ebola with the temptation to maximize precautions that exceed CDC recommendations.

The authors note that the CDC recommendations include placing patients with suspected or confirmed Ebola in a single-patient room and instituting contact and droplet precautions. These recommendations are evidence-based, established by experience with control and prevention of Ebola in other outbreaks. In spite of this guidance, many hospitals are planning to place patients in negative-pressure rooms and compel personnel to wear hazardous material suits. However, Ebola is transmitted via direct contact with patients' bodily fluids; sharing airspace with an infected patient is not a risk factor. Exceeding CDC recommendations may increase transmission risk due to the possibility of self-contamination during the removal of unfamiliar protective equipment. In addition, extra gear increases anxiety levels in patients and caregivers, increases costs, and wastes resources.

"As health care professionals, we strive to provide evidence-based care driven by science rather than by the media or mass hysteria," the authors write. "We need to apply these principles to planning for Ebola as well."

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In Case You Missed It: Week of August 29, 2014


“In Case You Missed It” is a weekly roundup of popular healthcare headlines.

Adventures of a Floating Physician: Hello from Pennsylvania! Things have been reallyMcGann busy at EmCare’s North division this year.  We have had several new contracts, and an important part of my position as a Regional Float is to help open these contracts and provide much needed transitional staffing.  One of the personal challenges I face is being ... read more

Get to Know our Clinician of the Month: Ginger Wirth: EmCare has more than 10,000 clinicians serving communities across the country and we want to share their stories with you more

The Real Reason We're All Shocked by Robin Williams' Death. The world was stunned this week to learn of the death of one of the most beloved comedians and entertainers of our time. Robin Williams, the talented and versatile actor who entertained us and made us laugh for decades was found dead of an apparent suicide. I think Williams passing stands out more >>

STUDY: Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead. Read this study in full at 



Have you encountered patients who share their Fitbit data? "Guess what? Doctors don’t care about your Fitbit data" 

Join us at these upcoming events!

emcare eventsWEBINAR. How Integrated Clinical Services and Technologies are Making Healthcare Work Better. Register now for this webinar presented by Dr. Kirk B. Jensen and Mark Hamm, to discover the benefits of hospital-wide integration. Wednesday, September 17, 2014 | 1:00 PM - 2:00 PM CDT. Register at now!

CAREER. 12 Hospitals. 1 All-Expense Paid Trip. Register Now for EmCare's Hiring Conference! September 25-26. Click here to find out how you can pre-qualify

CME Course. Emergency Medicine Mistakes Even Smart Providers Make and How to Avoid Them. Learn basic emergency medicine skills and earn CME credits at the Essential Procedures in Emergency Medicine Simulation Course. Click here for details.

CME Course. 2nd Pediatric Emergency Medicine Simulation Course. This 1-day course focuses on the recognition of subtle and common presentations of kids who can be very ill, and management updates on these conditions. Learn more and RSVP here! 

View all upcoming events!



Adventures of a Floating Physician: Hello from Northeast Pennsylvania!


Things have been really busy at EmCare’s North division this year.  We have had several newphysician contracts, and an important part of my position as a Regional Float is to help open these contracts and provide much needed transitional staffing.  One of the personal challenges I face is being one of the first physicians through the doors of a new contract, and helping the staff and administration acclimate to the new ER group that will be helping to care for their community.

To many, the idea of having repeated “first days” at work would be intimidating, I enjoy meeting new people and getting to know them, work next to and with them, and caring for patients in different communities.  While the patients’ chief complaints tend to be similar from hospital to hospital, it is the person that you are treating that is unique.  Discovering these regional differences among my patients is quite refreshing.

The Regional Float position is a unique one for EmCare.  It’s true that it is a demanding position because of what it entails, but the rewards are many.  Several of our long-time floats have decided to return to full-time positions at one institution, but the decision was made easier by the experiences they gained from floating through the facility they chose.  They were much more at ease with their decision because they knew the institution quite well before accepting the position.  Talk about a smooth transition! 

 I am not encouraging becoming a float for the sole purpose of searching for your next full-time post; I am encouraging floating because it is a unique experience that has the potential of showing you a side of Emergency Medicine that many do not see during their training or early careers.

Next for me, I have a new contract to open beginning soon.  This one is in eastern Ohio and I am looking forward to it.  First Days always brings the challenges of new names and faces, but, I embrace it.  With easy access to Pittsburgh, Youngstown, and Cleveland, I’m seeing several baseball games in my near future!  Wish me luck at my new hospital!

McGannDr. McGann is a regular contributor for EmCare’s blog. He is a Board certified physician in Emergency Medicine.  He began working as a regional float physician for the North Division of EmCare almost 10 years ago, and still operates in that capacity today.  He is licensed in 12 states, with one more currently pending approval.  He is poised and ready to fill in where necessary to assure that EmCare-contracted shifts are always covered. Connect with Kevin on LinkedIn!



Register now: How Integrated Clinical Services and Technologies are Impacting Healthcare


As healthcare continues to evolve, the focus on efficiency, cost effectiveness, quality andjensen hamm patient experience has put coordination and collaboration at center stage. Visionary healthcare organizations are realizing that integration of services and care requires the support of technology to manage processes, facilitate communication and achieve better outcomes at lower cost.

Join us for a webinar, in conjunction with Becker's Hospital Review, presented by two experts in clinical and operational integration.

Kirk Jensen, MD is author of the recently published “Hospital Executive’s Guide to E.D. Management” and is CMO of Best Practices. Mark Hamm is CEO of EmCare Hospital Medicine and a frequent speaker at industry events. 

You will learn:
• The benefits of hospital-wide integration
• Case examples of emergency medicine and hospital medicine integration
• Innovations and case studies

September 17, 2014
1:00 - 2:00 pm CDT

Click here to register:





Get to Know our Clinician of the Month: Ginger Wirth


EmCare has more than 10,000 clinicians serving communities across the country and we want to share their stories with you. Beginning in August, you can get to know these hard-working, difference-makers right here with our monthly “Clinician of the Month” blog post. Do you know a clinician who should be featured? Email!

Ginger Wirth joined EmCare in 2013 as a Divisional Director of Clinical Services for the SouthGinger Wirth Division with the strong belief that she could continue to make positive changes within healthcare by helping others focus on quality, excellence and the overall patient experience.

She regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20+ year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

Get to know Ginger!

  1. Proudest moment during your career? I actually took care of a young mother who was recently post-partum and having severe complications.  I took care of her for several hours prior to having to go back to surgery (over 5 hours) and to this day she still sends me a Christmas card with pictures of her family and how it has grown over the years.  She says that I was “her angel” and without my care she would not have been alive to raise her son and now her 2 other children.  She has even gone to the trouble of making sure she had my address when I moved from California to South Carolina.  It is amazing to see her children grow up (in pictures) and to see her family so blessed!
  2. I hope my patients remember me as: a nurse that was caring, compassionate and made a difference in their lives.
  3. The one piece of healthcare advice I wish everyone would follow is: in order to make a difference in patients’ lives, you have to take care of yourself~ personally, professionally and physically!
  4. What are the most promising tools, technologies, processes that you think will drive the future of healthcare?  I believe that the biggest driver for healthcare today will be making sure that we never forget to go back to the basics.  Make sure we are not getting caught up in technology, and forget the humanity of healthcare!
  5. Describe your best day on the job.  Being able to take care of patients that really need help makes every day a “best” day!  I also feel very lucky to be working at EmCare and to be able to go into client hospitals and share best practices, provide consultations on flow and processes and to be able to take home some of their “wins” and connect with others all over the country. 


I was a victim of violence in the E.D. Here's my story. Pt. 1

I was a victim of violence in the E.D. Here's my story. Pt. 2 

The Reason We're All Shocked by Robin Williams' Death.


depressionThe world was stunned this week to learn of the death of one of the most beloved comedians and entertainers of our time. Robin Williams, the talented and versatile actor who entertained us and made us laugh for decades was found dead of an apparent suicide.

I think Williams passing stands out among other celebrity deaths for several reasons.  Robin Williams was such a talented and versatile actor that most of us found some way to connect with him through his entertainment. Whether it was his stand up comedy, his voice acting, his dramatic portrayals, or his charitable work, the breath and intensity of Williams career touched the vast majority of Americans.

The term “genius” is thrown around pretty loosely these days but I can think of few people that it applies to more that Robin Williams. He was a Julliard-trained actor who burst onto our TVs as Mork and went on to find unbelievable success in just about every genre that he attempted. 

What I think bothers so many people about Williams passing is his manner of death.   The concept that the man often considered to be the funniest people in the world could be suffering from such crippling depression that eventually led to his suicide does not seem intuitive at all.

I think that the apparent juxtaposition between Williams’ comic genius and his addiction, depression, and ultimate suicide should prompt us to highlight both the reality of mental illness as well as the evolving faces of depression and suicide.

Not only is suicide shockingly common in the U.S., the demographics have changed over the past decade or so. In 2011, 38,519 people took their own life in the U.S.  Though suicide has traditionally been considered more common in the fairly young and the elderly, the percentage of 45 to 64 year olds who ended their own life increased 40% between 1999 and 2011. 

I’m hopeful that the media attention that is being focused on Williams, his mental health problems, and his suicide will go a long way towards removing the stigma associated with psychiatric disorders. Depression, bipolar disorder, and other mental diseases are common, real, and should be thought of as mental illnesses as opposed to character flaws. 

We should feel for and support our friends, family, co-workers, and patients with mental illness in the same way that we would if they had a medical or surgical disorder.  In healthcare, we should make sure that our patients feel comfortable talking about their mental health problems and concerns without fear of judgment. 

Robin Williams did an excellent job of not only being open and honest about his mental health and addiction struggles, he did it with dignity and by using his talent for comedy.  I hope that the rest of society can follow his lead and continue to push the flywheel so that we all see mental illness for what it is – a medical problem.


CorleyAdam Corley, MD, FAAEM, FACEP, is a Regional Medical Director for EmCare and practices at Brazosport Regional Health Center in Houston, TX. Follow Dr. Corley on Twitter:


10 Sure-Fire Tips to Success in the E.R. from Someone Who's Been There

Reduced Nicotine Cigarettes Don't Up Smoking Intensity

Little evidence of compensatory increase in smoking; no change in smoking urges, nicotine dependence

FRIDAY, Aug. 22, 2014 (HealthDay News) -- Reduced nicotine cigarettes are not associated with increased smoking intensity versus usual brand cigarettes, according to a study published online Aug. 22 in Cancer Epidemiology, Biomarkers & Prevention.

David Hammond, Ph.D., from the University of Waterloo in Canada, and Richard J. O'Connor, Ph.D., from the Roswell Park Cancer Institute in Buffalo, N.Y., examined changes in consumer behavior and exposure in response to reduced nicotine cigarettes. Data were included for 72 adult smokers who completed an unblinded trial of reduced nicotine cigarettes. Participants completed a seven-day baseline period, during which they smoked their usual brand of cigarettes, followed by seven-day periods smoking cigarettes with progressively lower nicotine levels (0.6, 0.3, and 0.05 mg emission cigarettes).

The researchers found that compared with usual brand smoking (~1.2 mg nicotine) there were significant reductions in nicotine intake for 0.3 and 0.05 mg nicotine emission cigarettes, but not for the 0.6 mg nicotine emission cigarettes. There was little evidence of compensatory smoking for reduced nicotine cigarettes. Across study periods there were no increases in exhaled breath carbon monoxide levels, smoking intensity, or levels of 1-hydroxypyrene. There were no significant differences in smoking urges or measures of nicotine dependence.

"The study adds to the evidence that cigarettes with markedly reduced nicotine content are not associated with increased smoking intensity or exposure to smoke toxicants," the authors write.

O'Connor has provided expert testimony for the U.S. Food and Drug Administration.

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Low Complication Rate for Peds Laparoscopic Cholecystectomy

Zero common bile duct injuries; 4.5 percent have post-op complications; median hospital stay one day

FRIDAY, Aug. 15, 2014 (HealthDay News) -- For pediatric patients, laparoscopic cholecystectomy is associated with low complication rates and short postoperative hospital stays, according to research published in the June issue of Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.

Moiz M. Zeidan, M.B.B.S., from the Mayo Clinic in Rochester, Minn., and colleagues performed a retrospective chart review of children (aged younger than 18 years) who underwent laparoscopic cholecystectomy at a single institution between 1990 and 2010. The authors sought to better understand the complications and outcomes associated with this procedure in the pediatric population.

The researchers identified 325 cases of cholecystectomy, of which 62.2 percent were performed laparoscopically. Symptomatic cholelithiasis was the primary indication for surgery (45.5 percent). In 12.4 percent of patients, preoperative endoscopic retrograde cholangiopancreatography was performed. In 22.3 percent of patients there were variations in anatomy and technical difficulties. In 9.9 percent of patients, intraoperative cholangiogram was performed, and concomitant splenectomy was performed in 7.9 percent. A lack of clarity resulted in an open approach in 4 percent of cases. Zero common bile duct injuries were reported, but spillage of bile was observed in 5.9 percent of patients. In 4.5 percent of patients there were postoperative complications, including wound infection, retained stones, abdominal abscess, and biloma. There was a one-day median postoperative hospital stay. Recurrence of abdominal pain without associated pathology occurred in 9.4 percent of patients.

"Laparoscopic cholecystectomy in the pediatric population results in short postoperative hospital stay and has low complication rates," the authors write.

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