November 2012 Newsletter 
President's Report
Hello CHRMS Members:
Holiday decorations, cold breezes and snowflakes are just around the corner; yet it seems like only yesterday that Chicago’s Leading Lady set sail. On August 22nd, approximately 100 CHRMS members enjoyed a relaxed evening while viewing the Chicago cityscape on a perfect summer night. Thank you to the Membership Committee, led by Matt Downs and Anne Barrett, for organizing a great event! Members were already asking about next year’s annual boat cruise.
On October 7-10th, I had the opportunity to represent CHRMS at the 2012 ASHRM Conference in Washington D.C., National Harbor. This year’s theme was “Getting to Zero through the Power of One.” This is a goal to eliminate preventable serious safety events one person, one leader, one organization at a time. However, this is more than just a theme. This goal involves our internal compass and is questioning how the job is done. It requires the collaboration and support from all, from the Board Room to the Boiler Room. At the conference, it was announced that ASHRM has revamped its Strategic Plan. Discussions ensued regarding the impact of change on Risk Management; the importance of presenting an approach that demonstrates the value of the risk management process to our organizations; and the need to advance enterprise risk management practices having an awareness of organizations as a whole. The need to engage and empower the work force was stressed; as was the fact that when the work force is stretched too thin, it will affect safety. I attended the chapter workshop and enjoyed meeting and conversing with chapter leaders from across the country. The conference highlighted more than 60 individual sessions and keynote presentations focused on topics such as: reducing safety risks, cyber security, EMR, tracking trends in medical malpractice, regulatory requirements and compliance with the Patient Protection and Affordable Health Care Acts. Over 100 vendors were present to display products and services. ASHRM has approximately 6,000 members; 1,868 with CPHRM status. Before departing the conference, CHRMS members were invited to an informal networking breakfast at the Pienza Restaurant, in the Gaylord National Resort Hotel. Twenty-four (tired?) members came by to enjoy the morning.
On October 18th, Colin Gainer from SmithAmundsen presented the first webinar in the 2012-2013 CHRMS webinar series. The topic was “Handling Electronic Medical Records & Other Types of PHI Under HIPAA and HITECH.” Thank you to Colin for an informational presentation! Remember, if you do not have the opportunity to participate in the webinars, the programs are archived and available to members on the CHRMS website under Programs for 90 days.
With fall and CHRMS activities in full swing, I hope you enjoyed 2012-2013 Law Day, on Friday, November 16th 8:00 a.m. - 3:30 p.m., at the Allegro Hotel. Don't forget to save the date for the Half-Day program on January 25, 2013. CHRMS continues to be an organization that “Gives Back.” Last year’s Law Day program successfully collected food for the Greater Chicago Food Depository. This year, CHRMS invited members to participate in a children’s book drive benefiting the Centro de Salud Esperanza Clinic and Health Center in Southwest Chicago.
CHRMS is indeed a very active organization with approximately 290 members. It is only through the dedication and contributions of our members and sponsors that we can provide quality programming and awesome networking events. We appreciate your ideas, suggestions and encourage your participation. I close this message in amazement that it is nearly time to wish you all a wonderful holiday season and a prosperous 2013.
Regard to All,
Martha Winter
Past Event(s)
Law Day 2012
Law Day 2012 was a tremendous success with 101 members gathering at the Hotel Allegro on November 16, 2012 for a full day of Legal Developments in Healthcare. The presentations included an Illinois Case Law and Legislative Update by Lawrence R. Stolberg of Alholm, Monahan, Klauke, Hay & Oldenburg; a presentaion on Discoverability of Hospital-Acquired Infections by Matt Johnson of Johnson & Bell; an Update on Medicare Non-Reimbursements for Hospital Readmissions by Jim Bream& Lee Williams of Lowis & Gellen; a presentation on Litigation and the Use of Structured Settlements in The New Economy by Paulette Jacobsmeier of CSSC-EPS Settlements Group; and a presentation on Give and Take: The ACA and Medicaid Expansion in Illinois by Jennifer Stuart of Smith Amundsen.
CHRMS would like to thank all of the presenters and organizers who contributed to the success of the event.
Upcoming Events
Don't forget about these upcoming CHRMS Events!
Thursday, December 6, 2012
12:00 - 1:00 pm
Free to CHRMS members!
CHRMS 2012-2013 Lecture Series Webinar #2:
ACOs: What They Are & Their Liability Exposures
As part of CHRMS' mission to provide the membership with topical risk management-related information, the second of the webinar lecture series for 2012-13 year will be presented on Thursday, December 6, 2012, from 12:00 to 1:00 pm.
We are pleased to announce our speaker for this session:
• Alice Johansson, Senior Vice President and Product Manager, Iron Health
Alice will be discussing the evolution ACOs from health reform legislation, as well as reviewing the different kinds of ACOs, their goals, and their associated liability exposures.
Cost:
Members: Free
Non-Members / Guests: $25.00
Save the Date- Half Day Program on Jan. 25th, 2013
Watch your e-mail for more details
Member News
Members on the Move
Here are some recent job changes for CHRMS members
Pauline Jakubiec, formerly Director, Risk Management of Presence Health (formerly Resurrection Health Care) to Risk Management Consultant at The Horton Group, Orland Park, IL.
Laura Zehner has been named Director of Research at Clarity Partners Trial Consulting
Starr Lander from Claims Administrator, Centegra Health System to Senior Claims Analyst with Allied World National Assurance Company
If you have recently changed positions and would like us to announce your move, please send an e-mail to Dave Zehner at [email protected]
Feature Article
We will be following how juror questioning under Supreme Court Rule 243 is impacting medical malpractice trials throughout the year. This is our second article in a series. We are looking for your experiences with juror questions for a continuation of this series. Please send any anecdotes (both positive and negative) about how juror questions have impacted your trials to [email protected].
Navigating the Benefits and Potential Pitfalls of Juror Questions
Under Illinois Supreme Court Rule 243
(By: Anne Scrivner Kuban and Krista R. Frick, Barker & Castro LLC
If you have any questions or comments, they can be reached
at [email protected] and [email protected])
On April 3, 2012 when the Illinois Supreme Court adopted Illinois Supreme Court Rule 243 which allowed jurors in civil cases to submit written questions directed to witnesses at trial, the collective groans you heard in the Chicagoland area were from both Plaintiff’s counsel and the defense bar. As expected, most if not all of the lawyers who were going to try these cases were less than elated. Being reluctant to change, most attorneys assumed that this new rule would interfere with how cases are litigated.
Rule 243 became effective on July 1, 2012 and is currently being applied in courts throughout the State of Illinois. Based on the Supreme Court Rules Committee comments the reasoning behind the Supreme Court’s implementation of this new rule seemed to be a belief that by allowing jurors to ask questions, they would have an improved comprehension of the case, they would pay better attention and they would achieve a greater satisfaction with jury service. The rule gives the trial judge discretion whether or not to allow questions and permits the judge to discuss with the trial attorneys whether the procedure will be helpful but the decision whether or not to allow questions rests solely with the trial judge. The rule specifies some of the procedures the trial judge must follow, but it leaves other details to the trial judge’s discretion.
A recent trial provided us with the opportunity to see the new rule in practice. Admittedly, we were part of the group that was apprehensive about the new rule and quite frankly were opposed to having to use it during a trial. That being said, after having experienced Rule 243 in our recent trial, we are now converts and have eagerly accepted the new rule. One caveat to note is that we won the trial and were very fortunate to have an intelligent judge who applied and implemented the rule in a judicious fashion.
Under Supreme Court Rule 243, once the court has determined that the jury will be allowed to question the witness, jurors submit written questions to the court at the conclusion of questioning by counsel. There is no limit to the number of questions a juror may submit nor is a juror required to pose a question. The jurors are admonished not to discuss potential questions among themselves. Once the jury indicates that they are ready, the sheriff collects the questions and presents them to the judge. The questions are marked as exhibits and made a part of the record.
Outside the presence of the jury and the witness, the judge reads the question to all counsel and allows counsel to see the written question. Counsels are given an opportunity to object to the question and the court determines whether the question will be admitted, modified, or excluded accordingly. Once the court rules on each question, the jury and the witness are brought back into the courtroom and the court instructs the witness to answer only the question presented and not to exceed the scope of the question. The court will ask each question and then provides all counsel with an opportunity to ask follow-up questions limited to the scope of the new testimony. At some point, the court advises the jurors that they shall not concern themselves with the reason for the exclusion or modification of any question submitted and that the court as opposed to the attorneys made the determination regarding whether or not a question was posed.
For the most part, Illinois trial attorneys were apprehensive about the new rule because there was a belief that allowing jurors to ask questions would prolong the trial and trial strategy would be impacted particularly with regard to Supreme Court Rule 213 issues. At the start of our trial, we had the same concerns. We wanted to present our case in a certain way and we wanted to control the evidence and how it was presented as best one could in a trial. By allowing jurors to ask questions, we feared running the risk of a juror posing a question that we did not want answered. It was our belief that our opposing counsel’s case was not as strong as ours and we wondered whether or not the jurors would think to ask questions that he had not during discovery and/or would not think of at trial.
We were pleasantly surprised. Rule 243 was far less troublesome than we had anticipated. In fact, we found it to be extremely helpful. Rather than prolong the trial, we determined that it helped streamline the case. Based upon the jurors’ questions, we knew what their concerns were so we were able to highlight the testimony and evidence that addressed those concerns and we knew what “holes” we had to fill.
The length of time spent on jurors’ questions will vary significantly based upon the nature and complexity of a particular case, the witnesses’ testimony, and the extent of argument each individual judge will allow by counsel for each party. As in our case, there may be witnesses for whom the jury has no questions. In our case, allowing jurors to pose questions did not significantly delay the trial or interfere with our presentation of the case. At most, the entire procedure added anywhere from 15-30 minutes which included the trial court’s review of the questions, attorney arguments and rulings based upon objections by counsel.
Similar to other attorneys we were concerned that this new Rule would lead to an opening of the flood gates where Supreme Court Rule 213 was concerned. What if the jurors asked questions that would violate Rule 213 and the judge allowed those questions to be answered? Were our motions in limine all for nothing? Since Rule 243 was new and was only being implemented since July, 2012 there is very little guidance from a reviewing court. Fortunately, we had a very intelligent judge who abided by Rule 213 and his previous rulings regarding our motions in limine so he did not allow jurors’ questions to become a free for all.
Pursuant to the new rule, the trial judge must rule on any objection made in relation to specific juror questions. The objections made by counsel, like other trial objections, must be offered with a specific basis. The trial court then rules upon the objection under the basis offered by the objecting party. In instances of a Rule 213 objection, the trial court will employ the same analysis as it would, had the objection been raised prior to the jury’s question. In other words, if an issue was not properly disclosed under Rule 213, the same rules, case law and analysis under Rule 213 applies in relation to the trial court’s ruling on the submitted juror question.
Trials in and of themselves can be unpredictable. You think a witness is going to testify one way and he/she does not. You have a specific plan regarding how the evidence is going to come in and your plan goes array. So you can imagine our concern about the prospect of jurors asking questions. They would pose questions that would be beyond the scope of questions that the trial attorneys had carefully and purposefully crafted.
Since Rule 243 is relatively new, the Supreme Court has not had a chance to identify whether questions posed by jurors are considered direct or cross examinations, nor has the Court had an opportunity to determine whether juror questions are subject to the limitations of scope of examination. Fortunately, we did not run into this situation because most of our jurors’ questions did not go beyond the scope of the direct or cross examinations and those that did, our judge upheld objections unless he determined that there was some relevancy to the question(s). However, for those who do encounter this issue, if a juror does pose a question that is not related to an issue that was raised during any parties’ examination of the witness, a beyond the scope objection should be posed, together with any other appropriate objections for the court to consider and rule upon.
We found many of the jurors’ questions to be helpful insight into what they believed was a “missing piece” or an important element to be considered in light of the other evidence. This allowed us to see what information that the jury believed that they needed and decide how best to present that evidence. For example, in our case, the issue at hand was the timing and appropriateness of various surgical procedures. The jury had heard evidence about how a specific consultant had become involved in the care and treatment of the patient but they had questions about when the patient first presented to the hospital. This allowed us to determine which witness was the most appropriate to present this type of evidence to the jury and which facts we should elicit from that witness.
As for our concerns about potential violations of motions in limine, depending upon your opposing counsel, you run that risk throughout the entire trial. Who has not been sitting at counsel’s table when the opposing counsel has violated the court’s rulings regarding motions in limine during his/her opening statement, closing argument or during direct or cross examination? In our case, it was not the jurors’ questions that raised the risk of potential violations of motions in limine but our opposing counsel during his questioning of witnesses!
In those instances where a juror’s question would violate previous rulings on motions in limine, the opposing party must raise a specific objection and the trial court will rule. We anticipate that these types of objections will be the most common because most motions in limine involve barring relevant but potentially highly prejudicial facts. The basis of the objection should be that the fact or issue was appropriately limited or barred by the trial court due to a motion in limine and the issue does not change simply because a juror asked the question.
Another concern was that jurors’ questions would interfere with trial strategy. Specifically, certain facts and/or evidence were intentionally not presented to the jury because the information was not particularly helpful. However, we found a positive element to the jurors’ questions. The questions gave us insight into where the jury’s focus was and what they thought was important and/or irrelevant. This allowed us to decide whether or not to call particular witnesses and/or to present certain facts to the jury. Information that we had thought was particularly important, our jury did not and information that we may have glossed over, became crucial to the jury. This allowed us to tailor our examinations of experts to highlight those issues that the jury found to be important and focus on specific aspects of the case during closing argument.
Due to the recent inception of Rule 243, the trial courts have no appellate court guidance regarding jurors’ questions. Accordingly, many trial courts will be faced with situations in which the rulings will be based solely on the trial judge’s discretion. If you have an intelligent and fair judge like we did, there should not be too much trouble during the course of the trial. If on the other hand you are not as lucky, we are cognizant of the fact of the potential pitfalls the trial attorney may face----some of our initial concerns and preconceived ideas may in fact become reality. However, based upon the language of the Supreme Court Rule, we believe that any assertion of error raised by a party will be reviewed by the appellate court under an abuse of discretion standard.
Ultimately, Illinois Supreme Court Rule 243 may provide trial attorneys with an opportunity that we have not had in the past. Specifically, the chance to know and consider issues and specific facts which the jury finds significant. Based upon our positive experience, we believe that potential benefits under the new rule include insight into how jurors perceived the witness and are processing the case and the evidence, as a whole. As the Supreme Court Rules Committee predicted, knowing that they are entitled to ask questions, the jurors may pay closer attention which may help reduce the potential for jurors to rely upon improper inferences.
Our experience with Rule 243 was positive. This is not to say that everyone will have the same experience. However, based upon our recent trial experience, we believe that Rule 243 need not be feared nor should it be approached with significant apprehension. We recognize that due to the relatively untested waters of this new rule, there is no guidance from the appellate courts. Accordingly, it is reasonable to assume that there will be “growing pains” as application of the rule increases. Overall, however, we found the rule to be an insightful tool that can be beneficial and utilized by both sides of the trial bar.
Featured Spotlight Member
Featured Spotlight Member
Phyllis Rosebrook
Risk Manager
Northwestern Lake Forest Hospital
- 1. How did you get into health care?
I think a fascination of biology and the physiologic process in combination with my love of people was a natural fit for a career in nursing. I spent 10 years as a labor and delivery nurse, and 2.5 years as unit manager. Prior to nursing I’ve had experience in cost accounting in a manufacturing environment which gave me insights into implementing process improvements. All roles have been incredible experiences in themselves and served me well in preparation for my new role in Risk Management.
- 2. What do you enjoy most about your job?
I enjoy engaging the relationships I’ve built and skills I’ve refined as nurse and manager to improve patient safety for the organization as a whole.
- 3. What have you enjoyed most about being a member of CHRMS?
Honestly I’ve been a CHRMS member for nearly a month. I am grateful for the resources I am able to access on line and educational programs. I am excited to attend Law Day this year.
- 4. What benefits do you hope to obtain from your CHRMS Membership?
CHRMS will be a great forum to further my Risk education and meet others in the industry.
- 5. Would you consider volunteering on a CHRMS Committee?
As I am fully integrated into my new position, I’m hopeful to volunteer in the future.
New Members
The following have joined or rejoined CHRMS in the last three months.
Thanks you for your support!
Ryan Asmus, Karla Koop, Tanya Springman, Linda Gunn, Michael Faddah, Mary, Jakstavich, Pam Kasbohm, Lee Williams, Phyllis Rosebrook, Melinda Malecki, Scott McMahon, Mehreen Sherwani, Sangeeta Relan, John P. Sullivan, Susan Conner, Michelle Walker, James Stewart, Lisa Smola, Benjamin Beringer, Adam Snyder, Donna Socol, Ana Cazacu, Melissa Giannini, Andrea Kott
2012-2013 Sponsors
CHRMS acknowledges its 2012 - 2013 Sponsors
Gold Level - CNA HealthPro; Lowis & Gellen, LLP; SmithAmundsen
Silver Level - Alholm, Monahan, Klauke, Hay & Oldenburg, LLC; Allied World Healthcare; Anderson, Rasor, & Partners, LLP; Barker & Castro, LLC; Foran, Glennon, Palandech, Ponzi & Rudloff, PC; Ironshore; Johnson & Bell, Ltd.; Ruff Weidenaar & Reidy, Ltd.; U.S. Legal Support
CHRMS Newsletter Submissions
Call for Presentations
CHRMS invites you and your colleagues to submit your application for consideration as a Content Expert and/or Speaker! CHRMS Content Expert Database seeks to compile content experts in the following categories:
Risk Management, Patient Safety, Quality & Operations, Accreditation & Regulatory Compliance, Claims & Litigation, Risk Financing, Insurance, Health Information & Technology, and Lessons Learned.
CHRMS programs and webinars provide a great venue/opportunity for you to represent your employer, disseminate your lessons learned, and network with local healthcare professionals in the risk management field. Please share this colleagues!
Additional information and the applicaiton is available on our website, Quick Links tab, Connections.