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DOT exam corrections

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I just wanted a few other opinions regarding this situation.

Pt had a DOT exam with a different provider and came in to make some corrections. His HR wanted it to be corrected from Federal to State instead which would require filling out the State long form and a new DOT card. I advised the patient that as I was not the examining provider, the correction would need to be made and the form and card signed by the examining provider. I gave them the date the provider was next in office. 

My employer is telling me I should have just signed off on the new forms as it was a completed exam. I disagree. It wasn't in pending status where I could complete the remainder, it was a completed physical. 

Does anyone know the legality of this? 

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I don't know the legality of this question...

However I do not it is acceptable to sign off on a DOT Examination performed by another provider in your office (assuming this is a medical provider that is competent and you trust).  

I believe if it was a simple error, (Federal checked off instead of State) there is nothing wrong with copying the information over, and backdating it to the day the examination was completed, and resubmitting it.

 

Whether or not you want to sign off on someone else's examination, that is a entirely different issue...

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I suppose if it's technically legal to sign off on someone else's physical, I'm still uncomfortable with the liability should he be involved in a medically related accident. I will have to make it a personal rule that they either have to repeat the physical with me or just see the provider who performed the physical.

If anyone can provide any insight to the legality aspect too, I would greatly appreciate it!

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If you sign the form, then you are stating he is qualified to drive.  You are basing this on another provider's medical exam.  Should the driver get into an accident, your the provider who signed the form.  So, you really shouldn't sign a new form making it look like you did the exam because you are then liable should it be called into question that he was not eligible for clearance.  

On a side note...How easy is it really to be held liable should a driver get into an accident so long as you followed the guidelines?  As long as you don't pass someone that should have been disqualified or needed to complete the recommended waiting time.  Anyone ever been involved in any litigation with DOT exams or know of any cases? 

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14 minutes ago, DizzyJ said:

On a side note...How easy is it really to be held liable should a driver get into an accident so long as you followed the guidelines?  As long as you don't pass someone that should have been disqualified or needed to complete the recommended waiting time.  Anyone ever been involved in any litigation with DOT exams or know of any cases?

If the guidelines are followed and documented appropriately, the liability should be zero (I say "should" because we all know the legal system).  But, that doesn't stop someone from filing a lawsuit that haunts you for years, and follows you to future employers and malpractice coverage.

 

Early in my career I made the decision to NEVER sign off on another provider's in any way other than providing a sick note to a patient.  I don't care who they are, I am not willing to accept any form of liability (theoretical or otherwise) for something I did NOT do.  I am happy to perform my own exam or the patient can wait for the original provider to return.  It has gotten so bad that I actually have it stated in my current employer contract that I am NOT required to ever sign off on another provider's work.

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It should go back to the original examiner - keeps the chain intact.

And state requirements are often a bit different than federal and the provider should review the content to ensure it is correct, accurate and qualifies under state.

I don't sign other providers' forms.

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If the guidelines are followed and documented appropriately, the liability should be zero (I say "should" because we all know the legal system).  But, that doesn't stop someone from filing a lawsuit that haunts you for years, and follows you to future employers and malpractice coverage.
 
Early in my career I made the decision to NEVER sign off on another provider's in any way other than providing a sick note to a patient.  I don't care who they are, I am not willing to accept any form of liability (theoretical or otherwise) for something I did NOT do.  I am happy to perform my own exam or the patient can wait for the original provider to return.  It has gotten so bad that I actually have it stated in my current employer contract that I am NOT required to ever sign off on another provider's work.
This is awesome. In my new practice family medicine I am sending out a lot of medications that patients are requesting via telephone, and i definitely feel that should things get litigious I could be putting myself in a questionable position. Ethically however I need to balance that fear with providing patients the best care I can, and consistent access to long term maintenance medications is important especially in this fragmented medical system. I wish my practice had a better way of dealing with it, but whenever I'm in an ethical conundrum regarding refilling a med or not, I tend to take a conservative route.

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No way, No how would I ever sign someone else's DOT.  NO FREAKING WAY.

Zero liability?  Good grief.  You are literally putting yourself in the hands of the other provider.  If that driver goes out and takes out a school bus full of kids....guess what the very first thing their 30 lawyers will do?  Pull the DOT card with your signature on it.  Then you get to explain the physical you didn't do and your signature.  Good grief.  No way.

Let me guess...you are in Urgent Care?  I have been asked this exact same question several times in Urgent Care and the answer is always...No way.

p.s. I have performed >1000 DOT physicals over the last 26 years.  I'm no stranger to these.

Edited by Cideous

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12 hours ago, DarwinStarwin said:

 Ethically however I need to balance that fear with providing patients the best care I can, and consistent access to long term maintenance medications is important especially in this fragmented medical system.

Not quite the same thing. In a DOT medical exam, your client is "society", and the person in front of you is not your patient, but your exam subject.  That exam subject pays you, sure, but the certification is a specific legal process with specific expectations.  Having said that, I try and benefit the person I'm examining as much as possible, but the thing to remember is: they're not the patient.

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7 hours ago, Cideous said:

p.s. I have performed >1000 DOT physicals over the last 26 years.  I'm no stranger to these.

Ugh.  I'm right at about 100 over the last 4, and if I never have to do another hernia check in my entire career, I'd be just fine with that.

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I do 10-20 a day!!!  but I am only covering the urgent care side till another provider gets hired.....

 

a few issues (most already identified)

you didn't do the exam

the patient was no available to you to examine

you can't just "pencil whip" (sign all the papers with out ever seeing the patient)

The company likely has a contract and/or wants to provide good service which would entail handling the situation for the client

There are times in the DOT world, if they do not get their DOT card in by a certain date they LOOSE their CDL an have to jump through a lot (and I mean A LOT) of hoops to get it back 

It would be totally unfair to force a loss of license onto the client over the prior provider checking wrong box

 

 

So how to handle????

 

I have been in very similar situations and I figure the cost of another visit (eaten by the company and provided to the client immediately) is the way to go.

See the patient, do the exam, sign the papers and everyone (but your employer who wanted you to do it with out seeing the patient and assume undue liability got to pay your salary with out gaining more income) is happy.  And if the employer makes a stink about you not just signing it then politely point out the option was for you to flatly decline, sending the client away, and that is an even worse situation.

 

This is one of those cases (few) where if you put your foot down, provide a clear resolution that is medical/legal defensible, and you do you job you should be fine.....

 

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1 hour ago, ventana said:

I do 10-20 a day!!!  but I am only covering the urgent care side till another provider gets hired.....

 

a few issues (most already identified)

you didn't do the exam

the patient was no available to you to examine

you can't just "pencil whip" (sign all the papers with out ever seeing the patient)

The company likely has a contract and/or wants to provide good service which would entail handling the situation for the client

There are times in the DOT world, if they do not get their DOT card in by a certain date they LOOSE their CDL an have to jump through a lot (and I mean A LOT) of hoops to get it back 

It would be totally unfair to force a loss of license onto the client over the prior provider checking wrong box

 

 

So how to handle????

 

I have been in very similar situations and I figure the cost of another visit (eaten by the company and provided to the client immediately) is the way to go.

See the patient, do the exam, sign the papers and everyone (but your employer who wanted you to do it with out seeing the patient and assume undue liability got to pay your salary with out gaining more income) is happy.  And if the employer makes a stink about you not just signing it then politely point out the option was for you to flatly decline, sending the client away, and that is an even worse situation.

 

This is one of those cases (few) where if you put your foot down, provide a clear resolution that is medical/legal defensible, and you do you job you should be fine.....

 

That is exactly correct and what I would do.  Tell them that if they need it before the other provider shows up again that the exam would need to be repeated.  If the corporate overlord admins want it so bad, they can just do a no charge.  The DOT exam is not complicated, so as long as it's clean (good BP, no DM etc) then it's not a big deal.

The problem often occurs with trucking companies where the patient/driver lives out of state, but again...not your fault.

Here is the take away...I have been asked dozens of times in UC to do things that put me at risk and are virtually indefensible if things go bad and it's not the admins who have to face the music...it's you, and it's just not worth it.

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I always told them before the present day certification requirement that the exam was not for the benefit of the driver but instead to protect the general public from a driver that didn’t meet qualifications. I would then offer a tragic example from years back here in N. Texas.

 

I NEVER would’ve signed off on someone else’s exam, regardless of DOT, school athletic PE, camp PE, etc.

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