Graduate Medical Education
GME Trainee Manual and Benefits Guide (updated
March 2009)
This Graduate Medical Education (GME) Trainee Manual is provided as a guide to and summary of the various policies, benefits, and services available and applicable to GME Trainees (Residents and Fellows) as of the date published. It also summarizes the rights and responsibilities of the GME Trainees. The policies, benefits, and services described in this guide may be changed or discontinued. Documents summarizing various policies, benefits, and services are issued, amended, and revised from time to time with or without prior notice.
Trainees are encouraged to consult the various booklets, summaries, and/or governing documents as appropriate, and to contact the Office of Graduate Medical Education for more detailed information and up-to-date descriptions at http://www.dmc.org/gme.
Except as provided in the applicable grievance or dispute procedure, information contained in any handbook, guide, manual, or document prepared for or relating to GME Trainees is for informational purposes only and shall not be construed as a contract. Agreement to the terms of the applicable grievance or dispute resolution procedure, as may be periodically amended and which is available upon request from the Office of Graduate Medical Education, is a condition of employment/training.
This guide is to acquaint you with policies from DMC GME and DMC hospitals at which you will be rotating. It is important to note that as stated in your Graduate Medical Education Agreement of Appointment (contract), you are governed by the policies of any hospital at which you rotate. If you wish to have additional information regarding anything addressed in this guide, please feel free to contact the Office of Graduate Medical Education at (313) 745-5146.
Please note that pertinent DMC GME policies and procedures are also available for viewing on the Office of GME website at http://www.dmc.org/gme.
Office of Graduate Medical Education
Detroit Medical Center
Graduate Medical Education
4201 St. Antoine, 9C UHC
Detroit, Michigan 48201
(313) 745-5146
Office Hours: Monday – Friday 8:00 am to 5:00 pm
Academic Calendar
July 1 – June 30
Dear DMC Graduate Trainees:
The Office of Graduate Medical Education prepared the GME Trainee Manual and Benefits Guide for you. This guide provides a summary of benefits, policies, and services that are available to you as a member of the DMC House Staff. Additional policies, procedures, and requirements may be found in your program residency manual.
Should you have any questions or needs, do not hesitate to visit or contact The Office of Graduate Medical Education. We are here to assist and serve you.
Sincerely,
M. Safwan Badr, MD
Designated Institutional Official
Executive Vice President and Chief Medical Officer
Detroit Medical Center
Table of
Contents
Section I – DMC Graduate Medical
Education History
Section II –
Graduate Medical Education (GME)
Section III
– Graduate Medical Education Trainee Benefits
Changes in Personal Information
Changes in Tax Withholding and/or
Payroll Deductions
Health, Dental, and Vision
Insurance
Life Insurance and Accidental Death
& Dismemberment Coverage
Professional Liability Coverage
Section IV –
GME Policies and Procedures
ACGME and AOA Outcome Project:
American with Disabilities Act
(ADA)
Appointment/ Employment
Requirements
Corrective Action and Hearing
Procedures (Disciplinary Action)
Duty Hours and Working Environment
ECFMG Certificate (International
Medical Graduates Only)
Electronic Medical Records (EMR)
Fingerprint/Background Check
Requirement
GMEC Approved Complement of
Trainees in Program
I-9 Procedure for Appointment to
Residency
Malpractice Coverage during
Rotations to and from Non-DMC Sites
DMC
residents while outside DMC
Non-DMC
residents rotating through DMC hospitals
Moonlighting/Temporary Special
Medical Activity (TSMA)
National Practitioner Data Bank
New Training Program Establishment
Procedures
Observership Policy and Application
Outside Professional Activities
2006 Professional Expectations
(formally conduct and general work rules)
Standards of
Conduct and Performance for Graduate Medical Trainees:
Program Closure and/or Reduction in
Size
Program Director Role in Internal
Review
Program Information Forms (PIF)
Submission to GME
Program Probation or Adverse Action
by ACGME
Promotion/Reappointment/Graduation
Proof of Identity and US Employment
Eligibility (I-9)
Recruitment and
Selection/Non-Discrimination
New
Appointment Paperwork Processing Time.
National
Resident Matching Program Appointments.
Resident
Transfer / Verification of Previous Residency
Supervision of Postgraduate
Trainees
Section V –
DMC Hospital Policies and Procedures
Blood and Body Fluid Exposure
(BBFE) (needle stick exposure)
Patient’s Rights and
Responsibilities
Pharmaceutical and Vendor
Interactions / DMC Ethics of Business Conduct
Section VII
– Program Specific Policies:
1) 2009 Flexible Benefits Enrollment Guide
2) DMC 403B Plan Features & Highlights
3) DMC Long Term Disability Insurance for House Officers
Section I – DMC Graduate Medical Education History
Facilities
The largest health care provider in southeast Michigan, the DMC operates eight hospitals (Children's Hospital of Michigan, Detroit Receiving Hospital, Harper University Hospital, Huron Valley-Sinai Hospital, Hutzel Women’s Hospital, DMC Surgery Hospital, the Rehabilitation Institute of Michigan and Sinai-Grace Hospital), two nursing centers and more than 100 outpatient facilities throughout southeast Michigan. The DMC is also affiliated with the Barbara Ann Karmanos Cancer Institute and Hospital and the Veterans Administration Medical Center Detroit.
As a nonprofit corporation established in 1985, the DMC is the largest nongovernmental employer in Detroit. The system has more than 2,000 licensed beds, 3,000 affiliated physicians and serves as the teaching and clinical research site for Wayne State University, the nation's third largest medical school. Many DMC physicians are recognized by colleagues as leaders in their field of medicine.
DMC Organizational Profile
The DMC’s record of service has provided medical excellence throughout the history of the Metropolitan Detroit area. From the founding of Children’s Hospital in 1886, to the creation of the first mechanical heart at Harper Hospital 50 years ago, to our compassion for the underserved, our legacy of caring is unmatched.
Our medical experts are nationally recognized and each year, hundreds of DMC doctors are included in the list of America’s Best Doctors™. A reputation for excellence draws patients to world-class programs in oncology, organ transplant, cardiology, women’s services, neurosciences, stroke treatment, optometry, pediatrics and rehabilitation.
We are the leading academically integrated delivery system in metropolitan Detroit and the largest health care provider in southeast Michigan. The DMC has more than 2,000 licensed beds, 3,000 affiliated physicians, and is the teaching and clinical research site for Wayne State University School of Medicine, the nation’s fourth largest medical school. DMC facilities employ best practices and conduct business in an atmosphere of respect and professionalism. Our volunteer efforts in health education and disease prevention represent an ongoing commitment to the health and well-being of the communities we serve.
The DMC continues to meet the health care needs of a growing community, offering the best in medical research and development, advanced technology and optimum clinical services.
DMC Facilities
Children’s Hospital of Michigan – an international leader in pediatric neurology and neurosurgery, cardiology, oncology, diagnostic services including Positron Emission Tomography and MRI. Southeast Michigan’s only pediatric Level One Trauma Center. Experts in pediatric critical care, rehabilitation and neonatal and perinatal medicine care for thousands of children every year.
Detroit Receiving Hospital – Michigan’s first Level One Trauma Center. Areas of expertise include a burn center, hyperbaric medicine, emergency psychiatry, medical and surgical emergencies, and traumatic brain surgery. Detroit Receiving trains nearly 60 percent of Michigan’s emergency department physicians.
Harper University Hospital – known for its specialty services such as bariatric (gastric bypass surgery) cardiology, vascular procedures, neurosurgery, neurology and kidney and pancreas transplants. As the hospital with the first mechanical heart, Harper has always been a leader in state-of-the-art technology. Today, Harper continues that trend with Michigan’s only iMRI machine, non-invasive cardiac procedures, and new advances in stroke prevention and neuromuscular diseases like Parkinson’s and multiple sclerosis.
Huron
Valley-Sinai Hospital – Oakland County's newest hospital and among the top hospitals in
the area and nation in patient satisfaction. The hospital features the
Harris Birthing Center with all private birthing suites, a regional specialty
center, the Charach Cancer Center, a part of the Barbara Ann Karmanos Cancer
Institute, the Krieger Center for Senior Adults, state-of-the art surgical
suites; cardiac services, complete inpatient and outpatient diagnostic care as
well as an emergency department ranked among the highest in the United States
for patient satisfaction.
Hutzel Women’s Hospital – nationally recognized for cutting-edge research in high-risk obstetrics, infertility, reproductive genetics, gynecology and neonatology. Hutzel has been ranked as the number one hospital in research grants in the United States, for its Obstetrics and Gynecology physicians who are affiliated with Wayne State University School of Medicine.
Karmanos Cancer
Institute/The Cancer Hospital – the only center in
Michigan that specializes in cancer. The Hospital and Institute provides a
highly effective, multi-disciplinary approach to patient care in which teams of
physicians from diverse specialties and caregivers discuss and present the best
treatment options for patients.
Kresge Eye Institute – internationally known for its contributions to ophthalmology and considered a leading center for the preservation of sight, implant surgery, cornea transplantation, retina disease and treatment of vision problems.
DMC Surgery Hospital – located in Madison Heights, is the only regional hospital focused exclusively on orthopaedic services. This specialty hospital provides patients access to comprehensive orthopaedic services and our expert team of physicians and caregivers recognized as among the best in the United States for orthopaedic care.
Rehabilitation Institute of Michigan – one of the nation's largest hospitals dedicated to rehabilitation medicine and research. The institute serves as a center of excellence for the treatment of persons with spinal cord and brain injuries.
Sinai-Grace Hospital – located in northwest Detroit, is a full-service community hospital, offering expertise in emergency medicine, obstetrics/gynecology, gerontology and bariatric surgery. Sinai Grace’s orthopaedic surgery program features total joint replacement surgery, including a revolutionary minimally-invasive knee replacement procedure. Sinai-Grace operates 21 ambulatory sites and surgery centers, including the Oakland Virtual Medical Center.
Section II – Graduate Medical Education (GME)
GME & OGME Mission Statement
GME Administration
M. Safwan Badr, M.D., DIO, Vice President and Chief Medical Officer, DMC
(313) 745-2566; mbadr@dmc.org
Deborah Kellogg, Executive
Director, Medical & Academic Affairs, Graduate Medical Education, DMC
(313) 745-3456; dkellogg@dmc.org
Dianne Mitchell, Executive Secretary, Graduate Medical Education, DMC
(313) 745-3456; dmitchel4@dmc.org
GME Staff
OFFICE:
Main Telephone Number: (313) 745-5146 or (313) 745-5147
Main Fax Number: (313) 966-0880/Alternate Fax Number: (313) 745-7844
BENEFITS:
Sandie Krach, Benefits Data Assistant
(313) 745-3799; skrach@dmc.org
OPERATIONS:
Lydia Pingilley, GME Operations Coordinator
(313) 745-5146; lpingill@dmc.org
PAYROLL:
Greg Czentnar, Financial Coordinator, GME
(313) 745-5149; gczentna@dmc.org
VERIFICATION LETTERS A-L:
Kim Canady; GME
Associate
(313) 993-0931; kcanady@dmc.org
VERIFICATION LETTERS M-Z:
Tracy Davis; GME Associate
(313) 993-0034; tdavis9@dmc.org
VISAS:
Connie Williams, GME Assistant
(313) 993-2573; cwilliam@dmc.org
Osteopathic GME Staff
William G. Anderson, DO FACOS – Vice President of Academic Affairs, DMC
(313) 966-3223; wanderso2@dmc.org
Angela Cole – Residency Program Manager
(313) 966-3223; acole@dmc.org
Sonya L. Williams – Medical Student Program Manager
(313) 966-3223; slwilliams@dmc.org
Tanya E. Thomas – Office Assistant
(313) 966-3223; tthomas5@dmc.org
GMEC Committee Members
|
Anderson, William |
DO |
VP Academic Affairs Osteopathic ME |
|
Appel, Joel |
MD |
Section Chief, Hematology/Oncology |
|
Badr, Safwan |
MD |
EVP & CMO, DIO |
|
Bailey, Craig |
MD |
PGY-1-TY-Vice President, Resident Council |
|
Bang, Hyun |
MD |
PGY-1-TY |
|
Belen, Jack |
DO |
Internal Medicine |
|
Bergsman, Kenneth |
MD |
Program Director, Transitional |
|
Blasier, Ralph |
MD |
Chief, Orthopedics |
|
Bonbrisco, Daniel |
MD |
Assist. VP Med Affairs |
|
Bourne, Ayinde |
DO |
PGY-2-IM |
|
Buck, Joseph |
MD |
Chief, Surgery |
|
Butler, Monique |
MD |
PGY-3-IM-President, Resident Council |
|
Carter, Ben |
|
EVP, COO |
|
Chidiac, Elie |
MD |
Vice-Chair for Education-Dept. of Anesthesia |
|
Dobbs, Kathleen |
PA-C,MS |
Administrative Director, Adult Clinical Services |
|
Dziuba, John |
MD |
Chief, Psychiatry |
|
Feldman, Marc |
MD |
Associate Program Director, IM |
|
Gheraibeh, Petra |
MD |
PGY-3-Orthopaedics |
|
Glass, Marvin H. |
DO |
Chairman & Program Director, Anesthesia |
|
Haapaniemi, John |
DO |
Chief of Staff |
|
Kellogg, Debi |
|
Executive Director, Medical & Academic Affairs |
|
Lemos, Stephen |
MD, PhD |
Program Director, Ortho Sports Medicine |
|
Lim, Kenneth |
DO |
Program Director, Urological Services |
|
MacDonald, Lawrence |
MD |
Associate Program Director, Transitional |
|
Madgy, David N. |
DO |
Program Director, Otolaryngology (ENT)-HVSH |
|
Mallett, Conrad, Hon. |
|
President SGH |
|
Munasinghe, Rajika |
MD |
Associcate
Program Director, IM |
|
Sealey, John |
DO |
Associate PD, General Surgery |
|
Seman, Susan |
DO |
Program Director, General Surgery |
|
Shade, George |
MD |
Vice-President Medical Affairs |
|
Shah, Mahendra |
MD |
Section Chief of CT/Ultrasound |
|
Siddique, Mohamed |
MD |
Program Director, IM |
|
Wolf, Bruce |
DO |
Program Director, Radiology - HVSH |
|
|
|
|
Section III – Graduate Medical Education Trainee Benefits
Athletic Facilities
The Rehabilitation Institute of
Michigan's Brasza Outpatient Center is pleased to offer a state-of-the-art
health and wellness facility to the valued employees and patients of the DMC.
Access to this facility is available to residents for an annual fee of $120.
Please take some time to look over
the website and learn about the many programs and services available at the
Brasza Outpatient Center.
http://intraweb/default.aspx?ifsrc=/main_dmcinfo/rim_fitness
Beepers
A DMC beeper will be issued to you, in most cases, when you begin in the training program. Should the beeper malfunction or break, it should be returned to the GME office for replacement. There will be a replacement fee of $100.00 should the beeper be lost or stolen.
Bereavement Leave
In the event of the death of a close relative, trainees will be allowed time off with pay. A trainee will receive up to three (3) days paid time off for the funeral of a close relative. Two (2) additional days may be provided if the funeral site is equal to, or exceeds, 300 miles from the trainee’s residence and the trainee attends the funeral. Bereavement time off must be approved by the Program Director prior to usage. (Governed by DMC Policy HR 304)
Changes in Personal Information
Any change in your name or address must be immediately reported to the GME Office as well as your program office, in order to ensure no delay in receipt of important payroll information and/or documentation.
If you hold a Permanent Michigan License you must also notify the State Licensing Board of the change, in writing to:
State of Michigan
Board of Medicine
P.O. Box 30912
Lansing, Michigan 48909
Foreign Nationals – Specific Notice:
Federal regulations require all foreign nationals to notify INS (in addition to ECFMG) of any change in your residential address. Go to www.ins.usdoj.gov to obtain FORM AR-11 to submit your address change to INS.
Changes in Tax Withholding and/or Payroll Deductions
Based on the forms you completed upon your employment at the DMC, federal, state, and Social Security deductions are taken from your paycheck. Theses deductions appear on your bi-weekly paycheck stub. To change your tax withholding, you will need to submit a new Federal W-4 form or MI-4 form to the Office of Graduate Medical Education.
Counseling
Employee Assistance
Program (EAP)
The DMC offers an Employee Assistance Program (EAP) to all postgraduate trainees. The EAP is designed to help you with problems such as anxiety or depression, alcohol or substance abuse, marital or family problems, legal or financial matters. The EAP telephone number is (313) 745-1900 or (877) 789-3271
Discounts
The DMC EAC Discount Directory explains who and what the EAC is and what it does for you. It also lists every discount available to you as a DMC employee or physician.
Link: DMC Intraweb - look under: "For Our Employees" and then click on Discount Directory
Health, Dental, and Vision Insurance
(Also see Attachment 1: Flexible Spending Accounts)
SUMMARY OF BENEFITS - POSTGRADUATE TRAINEES
All of the benefits listed below are provided to postgraduate trainees who are on the DMC payroll. DMC reserves the right to add, delete or otherwise change benefits without advance notice at DMC's discretion and as DMC deems appropriate.
HEALTH INSURANCE: The DMC offers trainees the choice between two health insurance providers, DMC Care Basic or DMC Care Plus PPOM. (Coverage is effective on the date of your appointment)
PLEASE NOTE THAT YOU ARE RESPONSIBLE FOR REPORTING ANY CHANGE IN YOUR FAMILY'S STATUS (E.G. MARRIAGE, DIVORCE ETC.) TO THE GME OFFICE IN PERSON WITHIN 30 DAYS OF THE OCCURRENCE. YOU HAVE 90 DAYS TO REPORT THE BIRTH OF A CHILD BUT IT IS RECOMMENDED TO ADD THE CHILD TO YOUR INSURANCE AS SOON AS POSSIBLE. If you do not report such changes within the required period of time, it will not be possible to obtain coverage for that individual until the annual Open Enrollment which takes place near the end of each year, with coverage taking effect January 1.
SPONSORED DEPENDENTS (e.g. Parents) can be enrolled if you pay the full premium participation cost and the following requirements are met: Must be related by blood or marriage, must have been claimed as a dependent on the prior year or will be claimed as a dependent on the current year federal tax return (the IRS 1040 Form which verifies the individual is dependent upon you for 50% or more of his support as stated in the IRS dependent code), dependents who are not U.S. citizens must reside within the United States for a minimum of six consecutive months prior to becoming eligible to enroll in the plan and must have a social security number. The postgraduate trainee must provide a copy of the Medicare card, if applicable, complete the Certification of Dependent Eligibility form and complete the IRS 4506-T Form (Request for Transcript of Tax Return). This form allows the DMC to obtain a transcript of your most recent income tax return.
DENTAL INSURANCE: Dental insurance is available at a nominal cost per pay to all trainees. YOU ARE RESPONSIBLE FOR REPORTING ANY CHANGE IN THE STATUS OF YOU OR YOUR FAMILY TO THE G.M.E. OFFICE IN PERSON WITHIN 30 DAYS OF THE OCCURRENCE. Sponsored dependents are not eligible for coverage under dental insurance.
VISION COVERAGE: Vision coverage, through Heritage Full-Network vision plan or Kresge Eye Institute Vision Plus plan, is available at a nominal cost per pay. Children over 19 are not eligible and Sponsored Dependents are not eligible for Vision coverage.
Housing
Information packets regarding housing are available through the GME Office. Housing for any outside rotation is the responsibility of the resident’s program.
Leaves of Absence
FAMILY LEAVE OF ABSENCE:
An unpaid family leave of absence is a conditional privilege of postgraduate training. Such time off will be provided in accord with DMC policy in order to accommodate specific family care needs.
Under the Family Medical Leave Act (FMLA), you may be eligible to take up to 12 weeks of leave in order to care for a spouse, parent or child who has a serious health condition, or to care for a new child or newly adopted child. (If both parents are employed by the DMC, the combined maximum time off for care of a child is 12 weeks between the two parents). You must be employed by DMC for 1 full year to qualify for FMLA.
A FMLA Certification form must be completed and submitted to the GME office via the Program Director prior to date of requested leave.
A trainee taking time off in order to care for a family member may use paid vacation time; he/she cannot use paid sick time since sick time only covers time off due to trainee’s own illness. If vacation time is exhausted, the leave shall be unpaid.
Health and dental insurance coverage will be paid by the DMC for 12 weeks.
Depending on the length of the leave and individual board requirements training time may need to be extended as determined by your Program Director.
PERSONAL LEAVE OF ABSENCE:
Approval of personal leaves of absence may be granted at the discretion of the DMC Program Director for up to 90 calendar days. Personal leaves of absence shall be unpaid. The DMC will continue to provide insurance premium payment for 30 days; after 30 days, the postgraduate trainee will be provided the opportunity to continue insurance coverage in accordance with the provisions of current law (COBRA).
Depending on the length of the leave and individual board requirements training time may need to be extended as determined by your Program Director.
SHORT - TERM ILLNESS:
Trainees will receive payment of stipend for verifiable illness for up to 180 days as follows: 1-90 days at 100%; 91-180 days at 75%. Program Directors will notify the GME office when a trainee is out ill for more than 3 calendar days. For absences in excess of 3 calendar days, physician verification may be required. Illness time does not accumulate.
The DMC Graduate Medical Education Program does not have a separate policy for maternity leave; time off for pregnancy and delivery is provided for under Short Term Illness.
Depending on the length of the leave and individual board requirements training time may need to be extended as determined by your Program Director.
LONG - TERM DISABILITY:
A long-term disability plan underwritten by Unam Corporation is provided to all trainees on the DMC payroll. The plan provides 60% of salary to a maximum benefit of $2500 per month. Long-term disability benefits are payable after 180 consecutive days of disability and are payable as long as the disability continues (maximum to age 65 benefit period). For a detailed description visit www.flynnbenefits.com.
An optional supplemental policy is available at your own expense up to a maximum of $1000 per month. For a supplemental application, contact our disability representative Patrick Flynn at (313) 745-4935, (248) 649-4100, or pflynn@flynnbenefits.com.
Depending on the length of the leave and individual board requirements training time may need to be extended as determined by your Program Director.
Life Insurance and Accidental Death & Dismemberment Coverage
Postgraduate
trainees receiving a stipend through DMC have a term life insurance policy and
accidental death and dismemberment coverage available to you effective on the
date of your appointment. Life
insurance benefit is two times your annual stipend. After initial enrollment, any change in beneficiary must be
reported to the GME office in person.
Meals for In-House Night Call
Meals and/or access to food/beverage service is provided to all residents during In-House Night Call. For further information, contact your program to receive meal tickets, or other resources in order to receive meals for In-House Night Call.
Payroll Procedures
The postgraduate trainees receiving a stipend through the DMC are paid bi-weekly. You have the option of having your stipend check mailed to your home, directly deposited to your bank account or of picking it up directly from the GME office. Check distribution forms are available in the GME Office. Please note that if you elect to have your check mailed to your home, the GME Office cannot be responsible for delays in delivery due to holidays, etc.
Trainees receiving a stipend through a non-DMC source should contact the office responsible for issuing their check regarding their procedures.
Professional Liability Coverage
Your professional liability coverage is through the DMC Insurance Company, Limited. Your policy is a limited claims made policy with extended reporting endorsement (tail coverage).
This coverage does not extend beyond the resident/fellow’s role as trainees. For example, if a resident/fellow wanted to moonlight outside of the training program, the insurance would not extend to cover the moonlighting activities. It would be the resident/fellow’s responsibility to obtain insurance coverage for these types of exposures.
The insurance for the current policy year is as follows:
Insurance Company: DMC Insurance Co., Ltd.
Policy Number: DMC 4108-1
Limit of Liability: $5,000,000 per claim
Effective Dates: April 1, 2009 to April 1, 2010
Retirement Plans
TAX SHELTERED ANNUITY (TSA) PROGRAM: This Program can help you reduce your current taxes and increase your retirement savings by saving pre-tax dollars. You have a choice of fixed annuity contracts, as well as variable annuity (mutual fund) investment options within an annuity contract(s).
Security and Safety
Postgraduate trainees must comply with security and safety policies and procedures at DMC Hospitals. DMC hospitals require that identification badges be worn at all times. DMC hospitals will not assume responsibilities for theft or damage for personal property. All DMC postgraduate trainees and personnel are required to complete safety training through DMC Corporate Quality and GME Orientation.
Student Loans
Student loans are the responsibility of the postgraduate trainee. For more information, please contact your lender and access your loan information and requirements for student loan reduction of payment or other information as needed. Verification of training may be sought from the Office of Graduate Medical Education at (313) 745-5146.
Vacation
First year trainees are eligible for two weeks of vacation per contract year. All other residents and fellows are eligible for three weeks of vacation per year. All vacation time must be approved in advance by your Program Director. Vacation time does not accumulate.
Section IV – GME Policies and Procedures
ACGME and AOA Outcome Project:
Minimum Program Requirements
Language
Approved by the ACGME and the AOA
Educational Program
The residency program must require its residents to obtain competencies in the 6 areas below to the level expected of a new practitioner. Toward this end, programs must define the specific knowledge, skills, and attitudes required and provide educational experiences as needed in order for their residents to demonstrate:
- Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
- Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
- Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
- Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
- Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
- Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
In addition to these 6 competencies the AOA accredited residency must require its residents to adhere to an additional competency to the level expected of a new practitioner.
- Osteopathic Principles and Practices (OPP) which residents are expected to recognize and treat each patient as a whole person integrating body, mind, and spirit; and, use the relationship between structure and function to help the body move toward wellness.
ACLS\BLS\PALS Certification
The Office of Graduate Medical Education requires proof of BLS certification for all house staff and ACLS/ATLS/PALS is program dependent. House Staff must be certified when they arrive at DMC and must re-certify every two years. Upon completion of the re-certification courses, the House Staff trainee must provide a copy of the life support cards to the GME Office.
Advanced Standing
The stipend level of a trainee must be in accord with the level of the trainee recognized by the Residency Review Committee (RRC) of the specialty the trainee is entering. For example, a trainee transferring from Internal Medicine who will not receive any credit from the Surgery RRC must be appointed at the PGY I level.
Trainees who spend time in a DMC Residency or Fellowship Program sponsored research activity can receive advanced standing for stipend purposes.
American with Disabilities Act (ADA)
The DMC is committed to the fair and equal employment of
people with disabilities. The DMC will
provide a reasonable accommodation that is not an undue hardship where such an
accommodation will allow the disabled person to perform the essential functions
of the job.
This
policy applies to all employees of the DMC and its subsidiaries, medical and
house staff, and applicants (excluding joint ventures / affiliates and other
DMC entities as may from time to time be deemed appropriate).
Employees
covered by a union contract should refer to the collective bargaining
agreement. This policy applies to union
employees except to the extent the policy conflicts with the applicable
collective bargaining agreement, in which case the provisions of the collective
bargaining agreement on that subject will control.
1.
Disability:
A disability or handicap is a physical or mental impairment that
substantially limits a major life activity, a history of such impairment, or
the perception of such impairment.
2. Qualified
Individual with a Disability: A
person who meets legitimate skill, experience, education, or other requirements
of an employment position that she/he holds or seeks, and who can perform the
essential functions of the position with or without reasonable
accommodation. Requiring the ability to
perform “essential” functions assures that an individual with a disability will
not be considered unqualified simply because of inability to perform marginal
or incidental job functions.
3. Impairment: Is a physiological disorder affecting one or more of a number of
body systems or a mental or psychological disorder.
4. Reasonable Accommodation: Any
adjustment or modification to the work situation, which allows an individual
with a disability to perform the essential functions of a job or enjoy the
benefits and privileges of employment.
A reasonable accommodation may
include, but is not limited to:
·
Making
existing facilities used by employees readily accessible to and usable by
individuals with disabilities.
·
Acquiring
or modifying equipment or devices, modifying training materials, and providing qualified readers or interpreters.
·
Job
restructuring, modifying work schedules or reassignment to a vacant position.
5.
Undue Hardship: An action requiring
significant difficulty or expense when considered in light of factors such as
an employer’s size, financial resources and the nature and structure of its
operation.
6.
HR
Representative: The DMC will assign this role to a
designated Human Resources staff member who will take a lead in reviewing,
assessing and evaluating the accommodation on an individual case.
It is the policy of the DMC to reasonably accommodate
qualified individuals with disabilities unless the accommodation would impose
an undue hardship. In accordance with the Michigan Persons with Disabilities
Civil Rights Act #220 and the Americans with Disabilities Act of 1990,
accommodations will be provided to qualified individuals with disabilities when
such accommodations are directly related to performing the essential functions
of a job, competing for a job, or to enjoy equal benefits and privileges of
employment. The DMC will comply with all
applicable provisions of the Americans with Disabilities Act (ADA) and Michigan
Persons with Disabilities Civil Rights Act (MPDCRA) by providing full and equal
employment and educational opportunities to all disabled individuals.
1. Employees Seeking Accommodations
a. The DMC will communicate to department
heads, supervisors, and employees both the existence of this policy and the
procedures for implementation.
b. An employee shall
file a written request for an accommodation with their supervisor or the HR
Representative. Upon receiving the
written request the supervisor or HR Representative should also have the
medical authorization form signed by the employee at that time so the
appropriate medical information can be obtained.
c. The supervisor or
the HR Representative may require medical documentation of the employee’s
disability and related information. Any
medical documentation must be collected and maintained in Occupational
Health. Information regarding a
disability and access to medical information will be restricted to those with a
legitimate business need for such information, persons with the written
authorization of the employee, or as otherwise required by state and/or federal
laws.
d. When a qualified
individual with a disability has requested an accommodation, the Department
management shall, in consultation with the employee and the HR Representative:
1. Discuss the essential functions of the
particular job involved. Completion of a step-by-step job analysis may be
necessary.
2.
Determine
the precise job-related limitation, notify Human Resources of requests for
accommodation and participate in evaluation of accommodation requests.
3. Identify the potential accommodation(s) and
assess the effectiveness each would have in allowing the employee to perform
the essential functions of the job. The
accommodation chosen need not be the “best” one or the one preferred by the
employee; it need only be reasonable.
4. Select and
implement the accommodation that is the most appropriate for both the employee
and the employer and one that will not cause an
undue hardship on the employer.
While an employee’s preference will be given consideration, the DMC is
free to choose among any reasonable accommodations.
e.
A
meeting will be held with the Department management, the HR Representative and
the employee to discuss the requested accommodation. The HR Representative will work with the employee to obtain
technical assistance, as needed.
f. The Department
management in consultation with the HR Representative will provide a written
decision regarding the accommodation request to the employee within a reasonable
amount of time.
2. Funding Accommodations
In order for the accommodation to be
funded it must be approved by management within the department in consultation
with the HR Representative. The
employee, the department or the operating unit will pay for the accommodation
unless alternative funding sources are secured.
3. Refusal to Accept
Accommodation
Any employee or applicant who refuses a reasonable accommodation may no
longer be a qualified individual with a disability and may be subject to
corrective action, up to and including termination for failing to perform his
or her job functions.
4. Appeals
An Employee who
disagrees with management’s decision shall present an appeal through the
Employee Problem Solving/Appeals Process.
5. Retaliation
DMC will not tolerate discrimination, retaliation, or reprisals
against any individual who is protected under provisions of the Americans With
Disabilities Act or its state counterpart.
All persons who are found to have discriminated against or retaliated
against any individual who is protected under the provisions of this policy or
the applicable law will be subject to disciplinary action up to and including
termination.
6. Job Applicants
a. The job applicant
shall file a written request of the need for an accommodation with the
appropriate Employment representative of the DMC. The Department management and
the HR Representative will discuss the needed accommodation and possible
alternatives with the applicant.
b. The Department
management and the HR Representative in conjunction with the appropriate
Employment representative of the DMC will make a decision regarding the request
for accommodation, determine if there will be an undue hardship and, if
approved, take the necessary steps to see that the accommodation is
provided.
7.
Administrative Responsibilities:
Department
management will provide for assessment and evaluation of requests for
accommodation and provide for reasonable accommodation as is determined appropriate.
a. Human Resources will assign this role to a designated Human
Resources Generalist who will take a lead in reviewing, assessing and
evaluating the accommodation on an individual
case.
b. Communicate to
department heads, supervisors and all employees both the existence of this
policy and the procedures for implementation.
c. Advises applicants of the DMC's policy
regarding non-discrimination and accommodation.
d.
Make
current employees aware of the existence of their sites ADA Policy, Affirmative
Action Plan and the benefits available to them though posting the policy and
the Invitation to Self Identify. The DMC
will post, in conspicuous places on its premises, ADA (Americans with Disabilities Act) and MPDCRA (Michigan Persons with Disabilities Civil Rights Act)
notices setting forth the pertinent provisions of both acts and information
pertinent to the filing of a complaint.
e. Develop any
administrative procedures and forms as necessary in order to ensure compliance
with provisions of this policy.
f.
Assesses
requests for accommodation and communicates the results to the requesting
party.
g.
For
employees or applicants covered by a collective bargaining agreement, Human
Resources will inform the respective union of any proposed reasonable
accommodation.
Requests for
exceptions to this policy are to be submitted to the senior executive of the
appropriate operating unit for decision.
This person will confer with the Corporate Vice President of Human
Resources (or designee) as necessary.
THERE MAY BE NO
EXCEPTION TO THIS POLICY WHERE SUCH EXCEPTION IS A VIOLATION OF LAW
This
policy may be revised or revoked at any time by the DMC without prior notice to
employees.
Appointment/ Employment Requirements
Prior to appointment/employment all trainees must complete the following:
1. A completed Application for Appointment
Programs can accept any type of application form for review purposes, however, all appointment paperwork must be accompanied by a DMC graduate medical education application or ERAS (Electronic Residency Application System) form.
2. A minimum of three (3) House Staff reference forms to be completed by physicians who have worked with you, observed your professional performance, and are able to provide reliable information regarding your clinical competence, judgment, character, ability to work with others and health status as it relates to the privileges you are requesting.
a) A minimum of three letters of recommendation. Letters of recommendation are to be maintained in the applicant's program file; do not submit to the GME Office.
b) Of the three letters of recommendation one must include a Letter from Dean of applicant's medical school.
or,
c) If applicant is currently in a training program or has completed a training program, letter of recommendation from current/previous Program Director.
3. Proof of legal employment status, (i.e. birth certificate, passport, naturalization papers, valid visa, etc.).
4. If the trainee is an international medical school graduate, an original, current, and valid ECFMG certificate.
5. Obtain and maintain a valid license to practice medicine that complies with the applicable provisions of the laws pertaining to licensure in the state of Michigan and provide documentation of valid license to GME office by date required annually.
6. Acquire and maintain life support certification(s) ACLS, BLS, and PALS as prescribed by program, and/or DMC.
7. A signed Graduate Medical Education Agreement of Appointment
8. Submit to a health examination and supplementary test(s), which includes tests for drug and/or alcohol abuse, and receive the required immunizations in compliance with the Medical Center’s policy and all applicable federal, state, and local laws and regulations. It must be determined the trainee is in sufficient physical and mental condition to perform the essential functions of appointment. The results of all examinations shall be provided to the Hospital’s Employee Occupational Health Services (OHS).
Further information that the GME Office may request in connection with the trainee’s credentials, includes but is not limited to, Criminal Background Check (State of Michigan Public House Act 27, 28, and 29) and clearance from the National Practitioner Data Bank.
Any document not printed in English must be accompanied by an acceptable original English translation performed by a qualified translator. Each translation must be accompanied by an affidavit of accuracy acceptable to DMC.
Successful passage of Institutional Net Learning Modules required for Employment.
ELIGIBILITY:
Applicants must be one of the following in order to be eligible for appointment:
- Graduate of medical school in U.S. and Canada accredited by the Liaison Committee on Medical Education (LCME).
- Graduate of college of osteopathic medicine in the U.S. accredited by the American Osteopathic Association (AOA).
- Graduates of medical schools outside of the U.S. and Canada must possess a currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) and an ECFMG Certificate number.
Applicants selected for appointment must provide:
- Original certified transcript from medical school - to be maintained in the applicant's program file; do not submit to GME Office.
- Medical School Diploma – copy to be submitted to GME Office with appointment notification.
PERSONAL INTERVIEW:
Personal interviews should be arranged by the residency program office.
EXAMINATIONS:
To obtain an educational limited license in the State of Michigan, a passing score is required for USMLE Step I and II CK & CS, therefore DMC requires the same.
APPROPRIATE FORMS FOR HIRE:
Non-U.S. Citizen International Medical Graduates
- ALL OF THE ABOVE, PLUS THE FOLLOWING:
- Proof of current visa status
- If currently on or applying for Exchange Visitor Visa (J-1), must also provide:
- Curriculum Vitae
- Ministry of Health Letter from home government
Compliance
The DMC Corporate requires compliance for all employees. This compliance includes
seven elements:
1. Policies and Procedures to guide our compliance.
2. A Compliance Officer to oversee the program.
3. Training and education for employees on compliance issues.
4. Monitoring for unlawful activities within the DMC.
5. Reporting mechanisms for unlawful activities.
6. Written guidelines for dealing with employees who engage in unlawful activities.
7. Responding to detected offenses.
Compliance Hot Line: call toll-free (888) 484-9200
The DMC provides the hotline as a
service to its affiliates, contractors, employees, patients, vendors and others
who want to assist in improving the DMC. Calls made to the hotline are answered
7 days a week/24 hours a day by an out-of-state professional hotline service.
All callers will remain anonymous, unless callers choose to identify
themselves. The hotline allows you to call without revealing your identity and
without fearing retaliation, if you suspect the following:
- Inaccurate billing practices and documentation
- Activities resulting in harm to the environment
- conflicts of interest
- Inappropriate business deals
- Harassment
- Misuse of DMC Property
- Fraud, waste and abuse
- Violation of privacy and confidentiality of patient information
Confidentiality
The use and disclosure of PHI, as well as any given
individual’s right with respect to his/her own PHI will be limited to that
which is allowable under HIPAA. Information, which is de-identified as defined
under the terms of HIPAA regulations, is not subject to this policy.
Call Rooms
DMC will provide adequate
institutional call room space for Graduate Medical Trainees who are required to
do in-house call.
Compensation
It is the policy of DMC, (regardless of other less restrictive policies), all graduate medical trainees within the DMC residency training system, sponsored by the ACGME, receive equal compensation according to graduate medical education training level. Any exceptions must be approved by the GMEC and confirmed by the Executive Committee of the Medical Staff.
Corrective Action and Hearing Procedures (Disciplinary Action)
This document describes the procedures to be followed when a resident
(“Resident”) is subject to corrective action, as provided by the Residency
Agreement between Detroit Medical Center Graduate Medical Education Program
(DMC) and the Resident.
1. GENERAL PROVISIONS
1.1. Corrective Action. As used in this document, “corrective
action” includes the following actions:
1.1.1. Suspension. This action involves the temporary removal from the
residency program (“Program”) for a definite period of time. It does not
include a summary suspension, as discussed in Paragraph 3 below.
1.1.2. Reappointment Without Advancement. This action
involves reappointment to the Program without advancement to the next training
level.
1.1.3. Decision Not To Reappoint. This action involves a decision not to
reappoint a Resident following the expiration of the term of his or her current
contract.
1.1.4. Termination. This action involves immediate and permanent
dismissal from the Program.
1.1.5. Other. Other corrective action includes, but is not limited to,
the following:
(a)
Placing the Resident on probationary status.
i.
Probation status shall not exceed one year. If the
probation exceeds six months, the probation shall include at least one interim
review at the approximate midpoint of the probation.
ii.
Probation is imposed in accordance with 2.13 and 2.14.
(b)
Issuing the Resident a letter of warning, admonition or
reprimand which documents the cause for concern and becomes part of the
Resident’s permanent record.
1.2. Criteria for Initiation. Corrective action may be based upon the
following criteria:
1.2.1. Failure of the Resident to fulfill each and
every obligation imposed by the Residency Agreement.
1.2.2. Any action, conduct or health status of the
Resident that is adverse to the best interests of patient care or the
institutions to which the Resident is assigned.
1.3. Examples. The criteria described in Paragraph 1.2 include,
but are not limited to, the following examples:
1.3.1. Breach of professional ethics;
1.3.2. Misrepresentation of research results;
1.3.3. Violation of the rules of the Program, of the
institution to which the Resident is assigned or of the law; and
1.3.4. Inadequate medical knowledge, deficient
application of medical knowledge to either patient care or research, deficient
technical skills or any other deficiency that adversely affects the Resident’s
performance.
1.4. Parties Who May Initiate Corrective Action. Any of the
following parties may initiate corrective action:
1.4.1. Any DMC Hospital or other hospital to which
the Resident is or has been assigned, or in which duties under the Residency
Agreement are otherwise performed;
1.4.2. DMC GME;
1.4.3. The Department or Section Chief to which the
Resident is assigned;
or
1.4.4. The Program Director.
1.5.
Separate
Action by DMC Hospitals or Other Hospitals. In addition to the corrective actions
described in this document, any DMC Hospital or other hospital to which the
Resident is assigned may, in accordance with the policies of such hospital,
limit, restrict or suspend, summarily or otherwise, the Resident’s
participation in the Program at such hospital. The Hospital shall first consult
with the CMO, the Chair of the GMEC, the DMC counsel or appropriate Program
Director regarding such action. Such action by a Hospital shall not require the
initiation of corrective action under this policy.
1.6.
Notice. Any notice
required by this document shall be deemed sufficient if the notice provisions
of the Residency Agreement are satisfied.
2. CORRECTIVE ACTION PROCEDURE
2.1.
All requests for the corrective actions described above in
Paragraphs 1.1.1. through 1.1.4. shall be in writing, submitted to the
Coordinator of DMC, and supported by reference to the specific activity,
conduct, deficiency or other basis constituting the grounds for the request.
The procedures described below in Paragraphs 2.2. through 2.12. shall be
followed for such corrective actions, and the procedure described below in
Paragraph 2.13. and 2.14. shall be followed for all other corrective actions.
2.2.
DMC shall investigate the request for corrective action in
the manner and to the extent it deems appropriate. The investigative procedure
may include consultation with the Resident and/or other parties, as determined
in the sole discretion of DMC, and shall be completed no later than thirty days
following receipt of the request.
2.3.
The Chair of the DMC Graduate Medical Education Program
(“GMEC”) shall appoint a Committee of not less than three members of the GME
Council. The Chair of the GMEC Council shall not serve as a member of the
Committee, nor shall the Department or Section Chief of the Department to which
the Resident is assigned or the individual initiating the corrective action.
2.4.
Upon completion of the investigation, DMC shall forward the
request and a written report of its investigation and recommendations to the
members of the Committee. A copy of the request shall also be sent to the
Resident, along with a copy of the Corrective Action Procedures then in effect,
and a notice that he or she may request an appearance before the Committee.
2.5.
The Resident shall have ten days following the date of the
notice described in Paragraph 2.4. above to file a written request for an
appearance before the Committee. This request may include the Resident’s
written response to the request for corrective action. The request is to be
made to the Chair of the GMEC Council. The request for an appearance shall
specify:
2.5.1.
The name of the single physician, if any, who will
accompany and represent the Resident;
2.5.2.
The Resident’s request to be represented by an attorney
(although such a request shall be denied in such circumstances as may be
determined solely by the Committee). The Chair of the GMEC Council shall notify
the Resident within ten days of the request for appearance if the request to be
represented by an attorney will be granted; and
2.5.3.
The names of any witnesses the Resident intends to call.
2.5.4.
The rights to representation by a physician, to request
representation by an attorney, and/or to call witnesses shall be deemed waived
if the request for an appearance fails to specify the information described in
Paragraphs 2.5.1. through 2.5.3.
2.6.
If the Resident fails to request an appearance within the
applicable time period:
2.6.1.
He or she waives any right to such appearance and to any
further appellate procedures to which he or she might otherwise have been
entitled; and
2.6.2.
He or she will be deemed to have accepted an adverse
decision by the Committee, which decision shall thereupon become the final
decision and shall be implemented.
2.7.
The Committee shall consider and decide upon the request
for corrective action at its next meeting or as soon thereafter as may be
practicable. The following procedures shall be applicable if the Resident has
requested an appearance in accordance with the provisions of Paragraph 2.5.
above.
2.7.1.
The Resident shall be provided fifteen days notice of the
time, place and date of the meeting;
2.7.2.
The Resident may present witnesses named pursuant to
Paragraph 2.5.3.;
2.7.3.
DMC may present witnesses;
2.7.4.
Either party may cross-examine any witness appearing
in-person;
2.7.5.
Any party may present evidence of a type on which
reasonable persons customarily rely in the conduct of serious affairs,
regardless of the admissibility of such evidence in a court of law; and
2.7.6.
The Committee shall record its evidentiary proceedings.
Deliberations of the Committee shall not be recorded.
2.8.
The Resident shall be deemed to have waived his or her
rights to appear as well as any appeal rights if, having requested an
appearance, he or she fails without good cause to attend the meeting.
2.9.
Following the appearance of the Resident and the
presentation and examination of all witnesses and evidence, the Committee shall
deliberate to determine appropriate action. The Committee may take either the
action sought in the initial request for corrective action or such other action
that the Committee determines to be warranted.
2.10.
The Committee shall notify the Resident and the GMEC
Council of its findings and corrective action decision no later than fifteen
days following the meeting.
2.11.
The Resident may submit a written request for
reconsideration by the CMO of the decision of the Committee within ten days of
the date of notice of such decision. The CMO, in his or her sole discretion,
may affirm, modify or reverse the decision of the Committee, or return the case
for consideration by the full GMEC Council. The CMO shall notify the Resident
of his or her decision within fifteen days of the receipt of such request for
consideration. The CMO’s decision shall be final and binding. except as
described below in Paragraph 2.12.
2.12.
To the extent there are procedures established by DMC for
appeal of an adverse reconsideration decision by the CMO to the DMC President,
the Resident may appeal to the DMC President in accordance with such
procedures.
2.13.
The procedures described in Paragraphs 2.1. through 2.12.
above shall not apply to the other corrective action that is provided for above
by Paragraph 1.1.5. The Resident shall have the opportunity, however, to
informally discuss the pertinent circumstances with his or her Program Director
in the event that the Resident is subjected to such other corrective action.
The Resident shall be entitled to present such information or provide such
explanation that may be relevant, but the Program Director’s determination of
the action to be taken, if any, shall be final and binding.
2.14.
If the Program Director determines that the Resident should
be placed on probation, the Program Director shall provide the Resident with
the following information in writing:
(a) The length of the probationary period, which shall not exceed one year.
(b) The academic or professional deficiency or conduct, or other basis giving rise to the probation.
(c) The criteria which the Resident must meet in order to satisfy the terms of the probation.
(d) The approximate date or dates on which the Resident’s probationary status will be reviewed.
A copy of such written probation notice, including the
information provided to the Resident, shall be submitted to the Graduate
Medical Education Office. If the Program Director fails to provide such
information, the Resident may request review by the Committee as set forth in
paragraphs 2.1 through 2.12.
3. SUMMARY SUSPENSION
3.1.
Description. The Resident
may be summarily suspended from the Program, based on the criteria listed about
in Paragraph 1.2., and such suspension shall become effective immediately upon
imposition. In the event any corrective action described in Paragraphs 1.1.1.
through 1.1.4. is also recommended, summary suspension shall continue pending
completion of the corrective action proceedings described in Paragraph 2 above.
If no such corrective action is recommended within ten days, or if any
corrective action described in Paragraph 1.1.5. is taken, the summary
suspension shall terminate upon expiration of the ten-day period or upon the
taking of such corrective action.
3.2.
Parties
Who May Initiate. Summary suspension, as described above in Paragraph 3.1.,
may be initiated by any of the parties described in Paragraph 1.4.2. through
1.4.4. above.
3.3.
Action
by DMC Hospitals or Other Hospitals. As provided in Paragraph 1.5. above, a
DMC Hospital or other hospital to which the Resident is assigned may summarily
suspend the Resident from participating in the Program at such hospital, in
accordance with that hospital’s procedures. Such action may be taken
independent of and in addition to any action taken pursuant to in Paragraph
3.1.
DEA Numbers
An individual DEA number is only available upon acquiring a permanent license.
A prescription for a controlled substance must be dated and signed on the date when issued. The prescription must include the patient’s full name and address, and the practitioner’s full name, address, and DEA registration number. The prescription must also include:
1. drug name
2. strength
3. dosage form
4. quantity prescribed
5. directions for use
6. number of refills (if any) authorized
A prescription for a controlled
substance must be written in ink or indelible pencil or typewritten and must be
manually signed by the practitioner on the date when issued. An individual
(secretary or nurse) may be designated by the practitioner to prepare
prescriptions for the practitioner’s signature. The practitioner is responsible
for ensuring that the prescription conforms to all requirements of the law and
regulations, both federal and state.
Disaster Response Policy
In the
event of a disaster impacting the graduate medical education programs sponsored
by DMC, the GMEC establishes this policy to protect the well being, safety and
educational experience of residents enrolled in our training programs.
The
definition of disaster will be determined by ACGME as defined in their
published policies and procedures. Following declaration of a disaster, the DIO
and other sponsoring institution leadership will strive to restructure or
reconstitute the educational experience as quickly as possible following the
disaster.
In
order to maximize the likelihood that residents will be able to complete
program requirements within the standard time required for certification in
that specialty, the DIO will, as soon as possible, make the determination that
transfer to another program is necessary.
Once
the DIO determines that the sponsoring institution can no longer provide an
adequate educational experience for its residents, the sponsoring institution
will, to the best of its ability, arrange for the temporary transfer of the
residents to programs at other sponsoring institutions until such a time as the
DMC is able to resume providing the experience. Residents who transfer to other
programs as a result of a disaster will be provided by their Program Directors
an estimated time that relocation to another program will be necessary. Should
that initial time estimate need to be extended, the resident will be notified
by their Program Director using written or electronic means identifying the
estimated time of the extension.
It
will be the intent of DMC to provide the appropriate administrative support, to
the extent possible, to re-establish a permanent educational experience which
meets the standards of the ACGME as quickly as possible. If this cannot be
achieved within a reasonable amount of time following the disaster, DMC will
take appropriate steps to arrange permanent transfers of residents to other
accredited programs.
The
DIO will be the primary institutional contact with the ACGME and Institutional
Review Committee Executive Director regarding disaster plan implementation and
needs within the sponsoring institution.
The DIO within 10 days of declaring a disaster will contact the ACGME to
discuss due dates that the ACGME will establish for the programs including but
not limited to program reconfigurations and resident transfer decisions. Program Directors and Residents/Fellows will
contact the appropriate Review Committee Executive Director with information
and/or requests.
In the event of a disaster affecting other sponsoring
institutions of graduate medical education programs, the program leadership at DMC
will work collaboratively with the DIO who will coordinate on behalf of the
medical center the ability to accept transfer residents from other
institutions. This will include the process to request complement increases
with the ACGME that may be required to accept additional residents for
training. Programs currently under a proposed or actual adverse accreditation
decision by the ACGME will not be eligible to participate in accepting transfer
residents.
Disciplinary Action
See Corrective Action.
Dress Code
All trainees are expected to use good judgment in the selection of clothing and maintenance of personal cleanliness.
Drug-Free Workplace
Drug use in the workplace is all too common. The cost of drug use to industry has been estimated at over 100 billion dollars per year.
Drug use in the workplace endangers coworkers, the company, customers, and the public. It affects the quality of service delivery and of products. Coworkers may often have to cover up for an affected employee by making excuses or redoing poor quality workmanship.
Drug-using workers have a greater frequency of sick days, use of healthcare benefits, and of work-related injury.
Supervisors need to be educated about the signs of drug abuse and coworkers should report concerns or suspicious behavior to the supervisor. Keeping quiet enables the affected person to get sicker, expose others to increasing risk, and not be held responsible for his or her own behavior.
Some Signs Of Drug
Use In The Workplace Include:
· decreasing quality of work
· mood swings and irritability
· unpredictable behavior
· frequently ill, absent, or late
· desire to work alone
· frequent trips to bathroom
· not letting briefcase or purse out of sight
· decreased ability to tolerate usual workload and
· change in hygiene and/or dress
Obvious Signs of Drug
Use in the Workplace include:
· alcohol on breath
· odor of marijuana or
· caught using or selling drugs
Employees have a right to a safe, drug-free workplace. Utilize the Employee
Assistance Program if needed.
Duty Hours and Working Environment
On June 27, 2007, the GMEC approved the DMC Graduate
Medical Education Postgraduate Trainee Duty Hours and Working Environment
Policy. This policy incorporates the ACGME and AOA duty hour requirements and includes
requirements that programs carefully monitor moonlighting activities (if
allowed and approved prior to actual duty by the program director) and that
program-specific policies be developed and distributed to each trainee. On an
ongoing basis the GMEC has discussed at length the mechanisms for monitoring
program compliance with duty hours, supervision, and moonlighting.
The following policy has been adopted by the GMEC for all House Staff in
Graduate Medical Education.
1. Duty hours are defined as all clinical and academic activities related to the training program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
2. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
3. Trainees must be provided with one (1) day in 7 free from all educational and clinical responsibilities, averaged over a four week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
4. Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call.
Oversight
The GMEC reviews and monitors working conditions, Residents/Fellows supervision, duty hours for Residents/Fellows, and ancillary support, and Residents/Fellows participation in department scholarly activity as set forth in the ACGME and AOA Institutional, Common and applicable Specialty Program Requirements.
The GMEC reviews and approves any proposal to substantially alter the working conditions for Residents/Fellows including benefits before they are enacted.
1. Each DMC program must have written policies and procedures consistent with this policy and the ACGME and AOA Program Requirements for trainee duty hours and the working environment. These policies must be distributed to the trainees and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service.
2. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create trainee fatigue sufficient to jeopardize patient care.
3.
If the complainant is a
resident, a member of the teaching staff, or other internal personnel in the
program or institution in question, the following options should be taken
before submitting a complaint to the ACGME or AOA:
a. Contact the Program Director to discuss the problem.
b.
If the issue either involves
the Program Director or is not resolved by meeting with the Program Director,
contact the institutional GME committee or similar oversight body, the DIO of
the sponsoring institution, the GME office identified on the ACGME website
(under Accredited Programs and Sponsors, ADS), or the resident representative
on any of these oversight groups.
4. If the efforts above do not resolve the issue, contact the
ACGME or AOA Complaint Officer to discuss submitting a formal complaint. If the
complainant is someone outside the institution, the ACGME or AOA Complaint
Officer may be contacted as the first option in the process.
5. For further information on filing a complaint directly with
the ACGME please reference their website at: www.acgme.org
or www.osteopathic.org.
Requests for Exception
A program wishing to request an exception to the Duty Hours limitation (up to a maximum of 88 hours), must submit a written proposal describing the educational rationale for the request to the GMEC.
An RRC may grant exceptions for up to 10 % of the 80-hour limit, to individual programs based on a sound educational rationale. However, prior permission of the GMEC is required.
Process:
1. Exceptions to the above standards for reasons of sound educational rationale may be submitted to the GMEC for consideration, approval and/or denial. If approved, the exception request will then be forwarded on to the appropriate Residency Review Committee (RRC). Exceptions approved by GMEC will not be effective until direct notification to the DIO from the RRC that it was accepted.
2. All duty hour concerns by trainees will be directed to the GMEC for consideration, investigation, and action for approval and/or denial.
Monitoring Requirements
Compliance with duty hour requirements is monitored as identified below. Follow-up and resolution of problems identified are the responsibility of the GMEC and DIO.
ACGME and AOA Resident Survey: The ACGME and AOA surveys the residents about their clinical and education experiences. This survey is not administered in conjunction with a program's site visit, although the information gathered will be used at the time of the program's site visit.
Compliance Hotline: Trainees are encouraged to contact the DMC Compliance Hotline ((888) 484-9200) to report violations of the Duty Hour requirements.
Internal Audit: Each year various programs are selected to be audited by personnel from the DMC Internal Audit department.
Internal Review: Questionnaire includes specific questions regarding program policies on duty hours and compliance with requirements. Internal Review Committee members meet with trainees and ask for their confidential assessment of program compliance with requirements.
Program Policies: Copies of program specific policies and procedures are maintained in the GME Office.
Periodic Review of Program Procedures: On a semi-annual basis, program directors are requested to report on the procedures they have in place to insure that duty hour requirements are being met.
Web Survey: Trainees are asked to complete a confidential (only program is identified) web based survey. Included in the survey are questions about program compliance with duty hours and other work environment issues.
ECFMG Certificate (International Medical Graduates Only)
The Educational Commission
for Foreign Medical Graduates (ECFMG) certificate is required for admission to
any residency training program at DMC.
See also Recruitment & Selection/Non Discrimination.
E-mail is available through the DMC. To obtain an e-mail address contact, the GME office.
Electronic Medical Records (EMR)
The DMC is in the process of training, developing and distribution of electronic medical records. Check with your program for requirements of the EMR training.
Evaluations
It is critically important that postgraduate trainees are made aware of performance expectations. A program must be able to document that the goals and objectives of the training program and individual rotations have been provided to the trainee at the beginning of his/her training and prior to each rotation.
A formal written evaluation integrated with the ACGME or AOA general and/or core competencies, must be completed for each postgraduate trainee on at least a semi-annual basis or as required by the specialty RRC or other accrediting body. The evaluation must be provided to the trainee in a face to face session with the Program Director or his/her designee. It is important that the program maintain documentation of the evaluation and counseling sessions for each postgraduate trainee.
Prior to the start of each rotation, the goals and objectives of the rotation must be clearly delineated in writing and provided to the postgraduate trainee. The trainee must receive an evaluation of his/her performance at the end of each rotation. Adequate documentation of the evaluations must be maintained by the program and reviewed through multiple reporting methods including GMEC internal review.
Fingerprint/Background Check Requirement
Effective October 1, 2008, all applicants
for a health profession license or registration in Michigan are required to
submit fingerprints and undergo a criminal background check. The Michigan Board
is not able to accept fingerprints that have been obtained for any other
purpose. Your license or registration will not be issued until this process is
complete.
Please see the following link for instructions on completing fingerprint/background check requirement and locations
http://www.michigan.gov/documents/cis_fhs_bhser_mdedlmtpkt_74971_7.pdf
Fire Alarms and Evacuation
The active
support of all employees and medical staff is essential to effectively control
an emergency situation and minimize or prevent injury to patients, visitors and
employees.
a. General
Personnel Procedures
· In the
event of a fire, hospital personnel are expected to exhibit an immediate,
coordinated, trained response to the emergency in order to minimize the risk or
occurrence of injury.
b. Reporting
a Fire
· In the
event of a suspected fire employees should immediately investigate and locate
the source of suspicion.
· Any person
in immediate danger should be moved to safety beyond at least one set of fire
doors.
· Report the
fire by pulling the fire alarm box lever straight down.
· Remove all
equipment from hallways.
A hospital safety control officer
is located in each facility; check www.dmc.org
for specific locations.
Gifts and Gratuities
We follow DMC policies regarding gifts and gratuities. At no time will an employee, medical staff, fellow, resident, student or contractor accept gifts or other entertainment from anyone at anytime.
GMEC Approved Complement of Trainees in Program
In order to comply with the ACGME requirement that the number of approved residents does not exceed the number of active residents, the GMEC will review on a semiannual basis the status of each program. Programs that exceed the number of approved residents will be required to submit an explanation to DIO and the GMEC.
Grievance for GME Trainees
The purpose of this policy is to define the usual process at DMC for residents to communicate substantive issues and concerns to the programs and institution’s administration. It also defines the mechanisms for an official, impartial hearing of concerns that are not resolved through usual, initial communications with administration. The intent is to provide the due process and an appeal mechanism in instances where this is needed.
1. Residents who have concerns or issues related to the interpretation, application, or breach of any policy, practice, or procedure in their educational program, or GME in general should:
a) first discuss them with their program director,
b) if reasonable discussion with the program director does not lead to resolution of the concern the resident(s) should bring the issue to the attention of the GME office,
c) if reasonable discussion with the DIO does not resolve the issue, a formal grievance may be sent in written form to the GMEC.
2. Resident(s) wishing to resolve a specific grievance will forward their complaint in writing (addressed to the GMEC), to the DIO. The resident(s) concerned, or their colleagues representing them - such as the chief resident(s), will then be scheduled to present a summary of the complaint to the GMEC at its next meeting. Legal representatives will not participate in or be present during GMEC or subcommittee deliberations.
3. Upon hearing the summary of the complaint, the GMEC will nominate a subcommittee to review that specific complaint. The subcommittee must be made up of GMEC members and include:
- two residents
- two faculty (one from the program from which the complaint emanated and one not)
- a chairperson who cannot also simultaneously fill one of the above positions
- a non-voting administrative resource person
The chairperson will be nominated and elected by the GMEC.
4. The Grievance Subcommittee will meet within two weeks to consider resolution for the complaint. Residents, program directors, and the DIO will submit documentation they feel is important to the subcommittee secretary prior to the first meeting. The subcommittee chairperson may request additional documentation, as they or the subcommittee feels necessary.
5. The subcommittee will, at the designated time and place, hear the resident(s) concerned present the details of their complaint and their proposed solutions in full. Other concerned parties may also present their views on the issues to the subcommittees at that time. Having heard the resident(s) and other parties concerned, they will then be excused from the meeting.
6. The subcommittee will then immediately deliberate behind closed doors, without interference or participation by anyone other than subcommittee members.
7. The subcommittee will have the fiduciary responsibility to make a final recommendation regarding resolution of the complaint. This will be expected at the time of the first meeting. In rare circumstances, at the chairperson’s discretion, the subcommittee may elect to obtain additional information and meet again in one week to finalize their recommendation(s) for resolution of the complaint.
8. The final recommendation(s) of the Grievance Subcommittee will be distributed by the chairperson to the GMEC, the resident(s) concerned, and the DIO within 3 work days.
9. The subcommittee’s final recommendation(s) for resolution of the complaint are not necessarily final and binding:
- Those recommendations requiring financial remuneration are subject to review and approval by DMC. This review will be executed by DMC administration within two weeks of the subcommittee’s recommendations.
- Resident(s) concerned with the complaint may choose to appeal the subcommittee’s recommendation(s). The appeals process is outlined below.
- In all other cases, the subcommittee’s recommendations are final and binding, and the GMEC will effect the recommendations of the subcommittee or direct the DIO to do so.
10. If the resident(s) appeal the subcommittee’s recommendations, they will submit in writing their appeal to the GMEC, including specific reasons why the feel an appeal is necessary despite the Grievance Subcommittee’s deliberations. The GMEC will consider this request for appeal and vote to:
a) Retain the subcommittee’s recommendations, or
b) Nominate a Grievance Appeals Committee.
11. If the GMEC votes to retain the subcommittee’s recommendations, they are final and binding.
12. In case of appeal, if the GMEC elects to nominate an Appeals Subcommittee, the constituents will be from the same groups as outlined for the Grievance Subcommittee, but new persons will be nominated first from the GMEC. If an appropriate member is not available from the GMEC, nonmembers will be nominated. In addition to the constituents outlined for the Grievance Subcommittee, an administrator from DMC will be nominated to the Appeals Subcommittee, as will a program director or leader from an outside institution.
13. The Appeals subcommittee will follow the same process as outlined above for the Grievance Subcommittee. The Grievance Appeals Subcommittee recommendations for resolution of the complaint are final and binding on all parties.
Harassment
It is the DMC’s policy to maintain a work environment free of sexual and discriminatory harassment on the basis of race, color, religion, gender, national origin, sexual preference, height, weight, age or disability/handicap. All trainees are expected to conduct themselves so as to maintain a work environment free of harassment. No retaliation or reprisals will be tolerated against any individual who complains of, reports or participates in the investigation of any incident of alleged harassment.
Sexual harassment is defined as unwelcome sexual advances, requests for sexual favors, and other verbal and/or physical conduct of a sexual nature when: (a) submission to such conduct or communication is made a term or condition, either explicitly or implicitly, to obtain or retain employment or enrollment in a GME program; (b) submission to, or rejection of, such conduct or communication by an individual as a factor in any work related (employment) decision affecting such individual; (c) such conduct or communication has the purpose or effect of unreasonably interfering with a person’s work performance or creating an intimidating, hostile, or offensive work environment.
Discriminatory harassment is defined as verbal or physical conduct including written statements or displayed materials by agents, supervisory employees, co-workers or non-employees directed against any person on the basis of that person’s race, color, religion, gender, national origin, sexual preference, height, weight, age or disability/handicap, or that person’s relatives, friends or associates when such conduct has a purpose or effect of interfering with the person’s work environment, or affecting an individual’s work related (employment) opportunities or causing or aggravating tension or animosity between different racial, ethnic, gender or religious groups.
Situations involving behavior described above should be reported immediately to your Program Director or the DIO at (313)745-5146.
I-9 Procedure for Appointment to Residency
GME will run a monthly report identifying any Visa or Work
agreements that will expire in the next 180 days on a monthly basis. Program Directors will be notified of any
Resident appearing on this report. The
attached memorandum will be issued to the Resident warning of the need to
provide their original required documents to assure compliance with immigration
law and other regulatory requirement.
Failure to provide the required documentation for a new
appointment or renewal documentation by the expiration date will result in the
resident being suspended pending investigation of the Visa or Work
Authorization card.
New Residents will not be allowed to start their rotation
programs without Medical Licensure or immigration documentation.
ID Badge
Identification badges are issued when you begin in the training program. Replacements for lost badges can be obtained in the Parking and Badges office with $10.00 cash replacement fee. Also new hires are required to pay a $10.00 cash fee.
Impairment
It is the policy of the DMC to provide a drug-free workplace by prohibiting the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance or alcohol.
A postgraduate trainee will be required to undergo a drug and alcohol test any time a supervisor has a suspicion (based on abnormal speech, appearance, odor, attendance, behavior or conduct, etc.) that a postgraduate trainee’s behavior is unusual/impaired as a result of the use of drugs and/or alcohol. Postgraduate trainees who refuse to be tested for drugs and/or alcohol will be considered to be insubordinate and will be subject to disciplinary action up to and including termination.
When a postgraduate trainee has been identified, either through the DMC Drug-Free Workplace policy or through voluntary recognition, as having a substance abuse or dependency problem, the trainee will be referred to the Employee Assistance Program for counseling and assistance in the mandatory reporting to the Michigan Health Professional Recovery Program (HPRP). The trainee will be removed from work pending evaluation and recommendations from the HPRP.
The HPRP will recommend a treatment plan and will require the trainee to sign a contract stipulating the conditions under which the trainee can return to the program and care for patients in the State of Michigan. Prior to returning to work, the postgraduate trainee must provide a copy of the HPRP treatment plan recommendation and signed contract to the DIO. In addition, the trainee may be required to sign an agreement supplemental to the Residency Agreement which outlines conditions under which he/she may continue in the training program and any other matters specific to the individual trainee’s circumstances.
The trainee must agree to submit to an alcohol or drug screening test, as appropriate to the impairment, anytime at the request of the DIO or the Program Director.
International Graduates
Travel and Re-Entry from Abroad
J-1/J-2 visa holders who need to renew their visa must have a valid SEVIS DS-2019. ECFMG urges you to review current requirements prior to making travel plans to assure that you have the appropriate documents and vacation time to allow for processing procedures. See www.travel.state.gov/links.html for additional information.
Sponsorship Renewal
1. Please contact the GME Office in March to begin the processing of your ECFMG sponsorship renewal.
2. If you have a dependent that requires renewal of their work authorization you will need to allow the INS Office at least 3 months to process the request once you submit your new DS2019.
3. If your "No Objection Certification Letter" is date restricted, or does not include your sub-specialty, please let the GME Office know so that you can obtain a new letter of offer to submit to the Ministry of Health.
Jury Duty
DMC policy enables you to
fulfill your civic responsibility of serving on juries or appearing as a
subpoenaed witness without loss of pay or benefits. All Graduate Medical
Trainees are eligible for this benefit. When you receive a summons, subpoena,
or other legal notice for appearance, you should notify your supervisor
promptly. In the case of jury duty, your supervisor will approve the absence
and consider it an "authorized absence with full pay." When you
return to work, you must submit proof of appearance, including complete dates
of service. In those instances when your continued presence is crucial to the
operation of the department, your supervisor is authorized to furnish a letter
(addressed to the presiding judge) requesting that you be excused and providing
a full explanation for that request. Your absence will not be counted as sick
pay or vacation regardless of the duration of your jury service.
Legal Aid and Legal Actions
Legal aid is available to all DMC Graduate
Medical Trainees in connection with any circumstances involving a hospital
patient(s). Any development of a medical legal nature must be handled through
the Risk Management Office. If legal papers relating to a patient are served on
a Trainee, contact Risk Management at (313) 966-0820.
Malpractice Coverage during Rotations to and from Non-DMC Sites
DMC residents while at DMC
Coverage is
provided automatically. Limit:
$5M/claim.
DMC residents while outside DMC
Outside of area:
coverage determined on a case by case basis.
Requires the completion of the off-site rotation form. Limit up to $5M/claim.
At area
hospitals: coverage determined by an affiliation agreement between DMC and the
other institution and/or on a case by case basis. Typically, we will cover the
residents while they are rotating through our facilities and other institutions
will cover the residents while rotating through their facilities. The highest limit we can offer is $5M/claim
although the affiliation agreement may mandate a lower limit of liability, like
200/600.
Non-DMC residents rotating through DMC hospitals
At area hospitals: coverage determined by an affiliation agreement between DMC and the other institution and/or on a case by case basis. Typically, we will cover the residents while they are rotating through our facilities and other institutions will cover the residents while rotating through their facilities. The highest limit we can offer is $5M/claim although the affiliation agreement may mandate a lower limit of liability, like 200/600.
A completed Application for Rotation into a DMC Hospital must be submitted to the GME Office at least four weeks prior to the start of the rotation.
Observership
All trainees interested in an observership with a DMC program must apply at a minimum of 30 days prior to the start of the rotation. See Observership policy for more information.
Medical Licensure
DMC Postgraduate Trainees must possess a valid Michigan medical license. The GME Office will assist a trainee in obtaining and/or renewing of medical licenses, however, it is the trainee’s responsibility to ensure that his/her medical license is valid at all times.
You are allowed to have a Michigan Limited Educational License for a period of six (6) years. After that time you must apply for a permanent medical license. To obtain an application contact the GME office.
Military Duty
Military leaves of absences, and any extensions, will be administered in relation to the specific circumstances and applicable laws. The trainee must provide written proof of the active duty requirement.
Military leaves of absence will be unpaid. The trainee requesting a leave to fulfill military requirements will be eligible to continue paying for his/her health and dental benefits as defined in accordance with the provisions of the current COBRA laws.
Depending on the length of the leave and individual board requirements, training time may need to be extended as determined by the Program Director.
Moonlighting/Temporary Special Medical Activity (TSMA)
DMC does not require moonlighting, however if a resident/fellow would like to moonlight they must meet the below requirements:
1. Because trainee education is a full-time endeavor, the program director must ensure that moonlighting does not interfere with the ability of the trainee to achieve the goals and objectives of the educational program.
2. The program director must comply with the DMC written policy regarding moonlighting.
3. The resident must receive prior written approval from the Program Director and the Chief of the Department or Section. The Program Director and/or the Chief of the Department or Section may withhold or withdraw his or her consent at any time, as he or she, in his or her sole discretion, deems appropriate.
4. Moonlighting that occurs within a DMC health care facility (internal moonlighting), must be counted toward the 80-hour weekly limit on duty hours.
DMC Training Programs must have a written policy regarding moonlighting that:
- Identifies whether or not the program allows trainees to moonlight
If program allows moonlighting, policy must also:
- Describe eligibility for moonlighting
- Set parameters, e.g., maintenance of acceptable performance, hours, location, etc. Note: Moonlighting time spent in DMC facilities must be counted toward the 80-hour limit.
- Describe consequences of not complying with policy
The policy must be distributed to each trainee. A copy of the policy signed by each trainee acknowledging receipt must be maintained in the trainee’s program file.
A copy of the program’s moonlighting policy must be provided to the Graduate Medical Education Office.
Liability coverage for moonlighting activities is not provided through DMC Graduate Medical Education. It is the responsibility of the trainee to ensure that appropriate liability coverage is in place for his/her moonlighting activities.
Resident Request of Moonlighting Activities
In order for a DMC resident or fellow to moonlight in a DMC-owned hospital or practice, the following criteria must be met:
I. All moonlighting activities MUST be approved by the trainees Program Director in order to make sure duty hour requirements are met.
2. Under current ECFMG regulations, J-l visa holders are NOT eligible to moonlight under any circumstances. Moonlighting is considered extracurricular activity that is not part of the training program curriculum and is compensated for. Therefore, any activities performed outside of the scope of the program would be considered moonlighting and J-l visa holders would not be eligible.
3. Under current USClS regulations, H-l B visa holders ARE eligible to moonlight as long as they receive compensation from the employer that has petitioned for their current H-l B visa. DMC is the employer on the H-l B petition so compensation must be paid by the DMC.
4. Moonlighting candidates MUST possess a Permanent Michigan License. An Educational Limited License is NOT valid for moonlighting activities.
5. Malpractice coverage must be provided for moonlighting activities. The GME policy does not cover moonlighting activities. Trainees that will be moonlighting must have the appropriate DMC Insurance Program request forms sent by their supervisor to:
DMC Insurance Program
Attention: Pamela Jones
Fax: (313) 966-5124
This
will provide notification to the DMC Professional Liability Office of the
extracurricular activities that will be performed by the trainees so coverage
can be provided.
In order for a DMC resident or fellow to moonlight in a non-DMC-owned hospital or practice, the following criteria must be met:
I. All moonlighting activities MUST be approved by the trainee's program director in order to make sure duty hour requirements are met.
2. Under current ECFMG regulations J-1 visa holders are NOT eligible for moonlighting under any circumstances. Moonlighting is considered any extracurricular activity that is not part of the training program curriculum that is compensated for. Therefore, any activity performed outside of the scope of the program would be considered moonlighting and J-1 visa holders would not be eligible.
3. Under current USCIS regulations, H-I B visa holders ARE eligible to moonlight, however, if the employer is a hospital or practice other than the DMC, the trainee MUST apply for a dual H-I B with that employer. The H-I B visa that the trainee has for the DMC is not valid for any other employer. The trainee would need to contact an attorney to process this request and will be responsible to pay all of the fees associated with it. It is the responsibility of the trainee to verify with the attorney that if they will be exempt from the H-I B cap based on the employer.
4. Moonlighting candidates MUST possess a Permanent Michigan License. An Educational Limited License is NOT valid for moonlighting activities.
5. Malpractice coverage must be provided for moonlighting activities must provided by the employer, other than DMC. Trainees moonlighting for WSUPG will receive coverage through a WSUPG policy provided by DMC once the Corporate Director of Employee Benefits notify the DMC Insurance Program Office of the trainees' activities. If the employer is not DMC or WSUPG, then the employer would provide the coverage independently.
National Practitioner Data Bank
There will be a check made to identify and
discipline incompetent physicians who engage in unprofessional behavior and to
restrict their ability to move from state to state without disclosure or
discovery of previous damaging or incompetent performance. The NPDB collects
information on actions relating to the professional competence or professional
conduct of physicians. The check will be conducted on all new applicants to the
medical health professional affiliate staff. The departments should notify
applicants that employment is contingent on the satisfactory results of these
checks.
New Training Program Establishment Procedures
The GMEC will evaluate proposals to establish a new DMC fellowship program based primarily on whether or not there is evidence of:
· The existence of a body of scientific medical knowledge underlying the subspecialty—knowledge that is in large part distinct from, or more detailed than that of, other areas in which accreditation is already offered.
· The existence of a sufficiently large group of physicians concentrating their practice in the proposed subspecialty area. Information should include the number of physicians, the annual rate of increase in the past decade, and their present geographic distribution.
· The existence of national societies with a principal interest in the proposed subspecialty area. Information should include the number of journals published in the subspecialty area as well as how many national and regional meetings are held annually.
· The existence, number, and geographic location of medical school and hospital departments, divisions, or other units, in which the principal educational effort is devoted to the proposed subspecialty area.
In addition to the above, proposals must include:
· Statement identifying the funding source for the fellow’s stipend and fringe benefits.
· Description of the impact the fellow’s activities will have on the educational and clinical experience of the programs’ residents, if applicable.
· A formal letter addressed to the DIO must be signed by both the Program Director and the Chair of the Department.
Non-Renewal of Appointment
DMC Graduate Medical Education will provide a postgraduate trainee with written notice of intent not to renew a trainee’s Residency Agreement no later than four months prior to the end of the trainee’s current agreement, except in instances where the primary reason for non-renewal occurs within the four months prior to the end of the agreement. In all cases, including those where more than or less than four months notice is given, trainees must be accorded due process as described in the DMC Corrective Action Procedures (a copy of which is available at the GME website http://www.dmc.org/gme).
When non-reappointment is based on reasons other than the Trainee’s performance or his/her compliance with the terms of the Graduate Medical Education Agreement of Appointment (Hospital or Program Closure, reduction or discontinuance) it shall be final and not subject to further appeal or review and shall not be grievable under the Hospital’s grievance procedure.
In this event all Trainees shall be entitled to the following:
· Notification of non-reappointment as soon as practical after the decision to close is made;
· Reasonable assistance in finding appointment to another training program;
· Fiscal resources permitting, payment of stipend and benefits up until the conclusion of the term of this Agreement
Observership Policy and Application
What Is The Role Of An
Observer?
Observers
may watch procedures, surgeries, patient histories and physicals. Observers may
attend patient rounds, teaching conferences and utilize the medical library.
Observers may not participate in any patient care activities or research as
they are not covered under DMC liability insurance, are not licensed in the
State of Michigan and are often on a visitor visa which would preclude any
activity beyond observation. In essence, you may not question, examine, or
scrub in on surgical cases of any patient.
What
Is The Process For Becoming An Observer?
The
Office of Graduate Medical Education (as well as individual staff physicians)
receives hundreds of requests for observer rotations each year. In order to
ensure an observer request does not conflict with other training in a
department, applications for all Observerships should be forwarded to the
Office of Graduate Medical Education. The request will be recorded in our
database and forwarded to the program director in the department the rotation
is being requested. After we have reviewed your credentials and other training
commitments (the number of rotators and medical students, etc), the program
director will apprise the Office of Graduate Medical Education of their ability
to accommodate the request.
This
can be a rather lengthy process- please do
not call repeatedly to check your status; GME will notify you if your request
cannot be accommodated or send a letter of appointment for the rotation once it
has appropriate approval. The approval process takes approximately 6-8
weeks.
What
Qualifications Do I Need To Become An Observer?
To
ensure all Observers meet a basic level of medical and clinical science
knowledge, only applicants with valid ECFMG certification are eligible for
appointment. This allows the experience to be of value to the observer and
ensures the observer meets the basic qualifications to apply for residency
training in the U.S.
How
Long Is An Observership?
Rotations
are 4 weeks (1 month) in duration. Due to the number of observership requests
GME receives annually, a limit of two one-month rotations per person has been
set.
How
Do I Apply For An Observership?
Simply
complete the Observer application (found at http://www.dmc.org/gme)
and send to GME with the following: A copy of your valid ECFMG Certificate, CV,
USMLE score report, and Medical School Diploma (as well as translation if not
in English) to:
Attention:
Observership Application
Office
of Graduate Medical Education
4201
St. Antoine, 9C – University Health Center
Detroit, Michigan 48201
On-Call Activities
The objective of on-call activities is to provide trainees with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when trainees are required to be immediately available in the assigned institution.
1. In-house call must occur no more frequently than every third night, averaged over a four-week period.
2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Trainees may remain on duty for up to 6 additional hours to participate in didactic activities, maintain continuity of medical and surgical care, transfer care of patients, or conduct outpatient continuity clinics.
3. No new patients may be accepted after 24 hours of continuous duty, except in outpatient continuity clinics. A new patient is defined as any patient for whom the trainee has not previously provided care.
4. At-home call (page call) is defined as call taken from outside the assigned institution.
a. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each trainee. Trainees taking at-home call must be provided with one (1) day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.
b. When trainees are called into the hospital from home, the hours trainees spend in-house are counted toward the 80-hour limit.
c. The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.
Outside Professional Activities
Resident shall devote all of his or her professional efforts to the performance of Resident's obligations under this Agreement, and shall not participate or engage in any outside professional work of any kind or nature whatsoever; (i) unless and until Resident has obtained a permanent license to practice medicine in Michigan; (ii) unless and until Resident has presented his/her Program Director with evidence of professional liability insurance in such amounts as DMC, in its sole discretion, deems appropriate, insuring Resident against any malpractice liability, and Resident has agreed to indemnify and hold harmless DMC, WSU, the DMC Hospitals, all other hospitals to which Resident is assigned and the officers, directors, employees and agents of each of the foregoing, from any and all losses and expenses resulting from or caused by such activities; and (iii) unless and until Resident receives the written approval of the Program Director and the Chief of the Department or Section to which Resident is assigned, it being understood that the Program Director and the Chief of the Department or Section to which Resident is assigned may withhold or withdraw his or her consent at any time, as he or she, in his or her sole discretion, deems appropriate. Resident hereby acknowledges that while engaging in any activities other than those required to performed under this Agreement, Resident is not acting as an employee or agent of DMC, WSU, any DMC Hospital or other hospital to which Resident is assigned and that Resident is therefore not covered by the insurance or self-insurance programs of any such entity. Resident further acknowledges that he or she shall be expected to perform all duties as assigned even in the event consent is given to engaging in other activities, and if Resident is unable to perform his or her duties as assigned or otherwise violates the terms of this Paragraph 5 Resident will be subject to corrective action including dismissal.
Parking
The postgraduate trainee must park in the designated lot at the hospital in which they are rotating. Information regarding trainee parking locations is distributed to new trainees at the time of appointment. Additional information regarding parking is available in the Office of Graduate Medical Education. The parking office has final say in any parking related issues.
|
DMC FACILITY |
PARKING ASSIGNMENTS |
|
Children’s Hospital |
Children’s Hospital Parking Deck (enter from Beaubien) Accessible 24 hours/day IMPORTANT NOTE: PARK ONLY AT THE 5TH LEVEL OR ABOVE |
|
Detroit Receiving Hospital |
North Deck (enter from John R) Accessible 24 hours/day DRH underground (enter from St. Antoine) Accessible only between 4:30pm and 5:00am Monday-Friday; all day weekends and holidays |
|
Harper Hospital |
North Deck (enter from John R) Accessible 24 hours/day Fellows Only–Center Deck (enter from John R) |
|
Hutzel Hospital |
Hutzel Parking Deck (enter from St. Antoine) Accessible 24 hours/day IMPORTANT NOTE: PARK ONLY AT THE 3RD LEVEL OR ABOVE |
|
Rehabilitation Institute |
PM&R Residents ONLY – CHM Mack Deck (enter from Brady) |
|
University Health Center |
North Deck (enter from John R) Accessible 24 hours/day DRH underground (enter from St. Antoine) Accessible only between 4:30 pm and 5:00 am Monday-Friday; all day weekends and holidays |
2006 Professional Expectations (formally conduct and general work rules)
Purpose: Successful
participation in graduate medical education depends upon many factors, central
to which are ACGME and AOA core competencies: Patient Care, Medical Knowledge,
Practice Based Learning and Improvement, Interpersonal and Communication
Skills, Professionalism and Systems Based Practice, Osteopathic Philosophy and
Osteopathic Manipulative Medicine (AOA only). These are similar to DMC Service
Standards: Health and Safety, Courtesy and Respect, Efficiency and
Effectiveness, Continuous Learning and Improvement.
Professionalism includes a
variety of behaviors and attitudes consistent with and understanding of, and
commitment to institutional policies and procedures, Departmental, Divisional
and Program-specific expectations. This includes treating everyone (colleagues,
faculty, students, patients, families, staff, and guests) with respect and
demonstrating integrity and honesty.
This information, “professional
expectations” is intended to provide written guidelines which outline
expectations and potential disciplinary consequences for activities, practices,
or behaviors, of graduate medical trainees of DMC which are consistent with
professional behavior.
Resources and techniques
dedicated to developing a greater understanding of these expectations and
supporting successful performance include but are not limited to:
·
New Graduate Medical Trainee
orientation
·
DMC GME Trainee Manual
·
Office of Graduate Medical
Education web page (www.dmc.org/gme)
·
Office of Graduate Medical
Education staff
·
Elected House Staff member to
Medical Executive Committee of the Medical Staff
·
Required Web modules
·
Policies and procedures for
using DMC owned equipment, property and resources
·
Policies and procedures
regarding attendance and time away from work
We expect trainees to:
·
Treat everyone (colleagues,
faculty, students, patients, families, guests) with respect as well as
demonstrate integrity and honesty
·
Ensure patient safety
·
Regularly review your
performance evaluations with your program director
Resources:
·
The Office of Human
Resources; DMC
·
The Exercise Facility
·
The Disability Office
·
Personal Assistance Program,
which promote and support emotional and physical well being and provide
strategies to prevent impairment.
·
Faculty/Attending/Peer
Feedback
Standards of Conduct and
Performance:
General standards of conduct and
performance apply throughout the DMC Enterprise and affiliated educational
sites. Violation and/or failure to adhere to these standards may result in
warning (oral or written) corrective action and suspension, and include
termination.
These
standards are minimum guidelines for graduate medical education trainees. They
describe, though not all inclusive, issues of conduct and work performance.
These conditions may be supplemented by additional regulations when graduate
medical trainees are subject to professional accreditation and/or state
regulations and/or and licensure.
The following are guidelines for
professional code of conduct. These are examples of potential violations, but
not limited to these only.
Professional Expectations:
Key: Recommended Disciplinary
Action
O: Oral Warning (written
documentation filed in the training record)
W: Written Warning
CA/S: Automatic corrective
action including suspension
T: Termination
Standards of Conduct and Performance for Graduate Medical Trainees:
|
STANDARD |
Example of a VIOLATION |
1st event |
2nd event |
3rd event |
4th event |
|
1. Performance |
|||||
|
1.1 Perform assigned
tasks safely, competently to maximize patient health and safety and according
to performance expectations. |
1.1a Failure to
perform task(s) adequately as requested, either because of unwillingness to
perform the task or carelessness in carrying out the assignment |
O |
W |
CA/S |
T |
|
1.2 Demonstrate
commitment to excellence and ongoing, continuous learning, improvement
and professional development |
1.2a Being in an
unfit condition to perform the duties of the job, including working under, or
suspected of working under, the influence of drugs or alcohol |
O or W |
T |
|
|
|
2. Compliance with Policies & Procedures |
|||||
|
2.1 Understand and
comply with all University, Hospital, or affiliated premises, policies and
procedures, i.e. Clinical, Administrative, and Safety policies |
2.1a Failure to
complete required safety training |
W |
CA/S |
T |
|
|
|
2.1b Failure to
complete required HIPAA training |
W |
CA/S |
T |
|
|
|
2.1c Failure to
maintain current BLS, ACLS |
W |
CA/S |
T |
|
|
|
2.1d Failure to
maintain current NALS, PALS, ATLS (when indicated) |
W |
CA/S |
T |
|
|
|
2.1e Failure to
complete required ACGME or AOA competency modules |
W |
CA/S |
T |
|
|
|
2.1f Engaging
in unapproved “moonlighting” activities |
CA/S |
T |
|
|
|
|
2.1g Failure to have
an annual PPD with results recorded at OHS |
O |
W |
CA/S |
|
|
2.2 Comply with all
federal & state and accreditation standards regulating the
provision of professional services |
2.2a Failure to
maintain on file with the Office of GME a valid MI medical license |
CA/S |
T |
|
|
|
|
2.2b Any activity
which violates federal or state standards regulating the provision of
professional services, or violations of regulations affecting continued
licensure, commissioning or certification in a profession |
T |
|
|
|
|
|
2.2c Boundary
violations and/or sexual relationships with patients |
T |
|
|
|
|
|
2.2d Self prescribing
or prescribing for family members in violation of policy of the MI
Medical Board |
W |
CA/S |
T |
|
|
|
2.2e Report to the
Office of Graduate Medical Education and cooperate with the Michigan Medical
Board any investigation or correspondence regarding issues which may impact
state licensure |
T |
|
|
|
|
2.3 Maintain duty
hours in compliance with Institutional, ACGME, AOA and RRC policies |
2.3a Work in excess
of 80 hours per week averaged over 4 week period; work in excess of call more
frequently than 1 night in 3 averaged over a 4 week period; lack of having
one 24 hour period in 7 days away from the hospital averaged over a 4 week
period |
W |
CA/S |
T |
|
|
2.4 Protect
confidentiality of sensitive information. Such information should not
be repeated, discussed or removed from the work area, except for legitimate
and authorized work reasons |
2.4a Use of another's
computer sign-on or computer access code or providing the use of an
individual's sign-on code without proper authorization to gain unauthorized
access to confidential or privileged information |
W |
CA/S |
T |
|
|
|
2.4b Behavior which
compromises another's safety or privacy, or discloses confidential DMC information,
including access to medical records based upon curiosity and not a medical
“need to know” due to participation in the patient's medical care, or
designated QI or educational function |
CA/S vs. T depends on whether curiosity or malicious
intent |
|
|
|
|
2.5 Demonstrate
honesty and integrity |
2.5a Falsifying DMC,
Hospital, or affiliated records, including intentional failure to accurately
record time records, or medical records |
T |
|
|
|
|
|
2.5b Failure to
demonstrate commitment to ethical principles |
CA/S |
T |
|
|
|
|
2.5c Failure to
appropriately disclose relationship/gifts from industry including
pharmaceutical representative in order to avoid real or perceived undue
influence |
W |
CA/S |
T |
|
|
3. Availability for Work |
|||||
|
3.1 Attend work as
assigned; arrive on time fully prepared to begin work. Remain throughout the
work period and until work is completed (patients seen, notes written or
dictated, messages completed). Request authorization for time away from
work according to established procedures if there is a need to leave the
workplace |
3.1a Violation of
attendance policy involving unscheduled absence or tardiness for whatever
reason, including failure to report to work or leaving work prior to
conclusion of the work period, and absences which exhibit an unprofessional
pattern or trend. Absences may render a graduate medical trainee
unable to complete a program within the training contract and may result in a
trainee being ineligible to sit for boards, depending on specific rules of
the relevant RRC |
O |
W |
CA/S |
T |
|
3.2 Notify the
supervisor well in advance of any unscheduled absence in accordance with
departmental guidelines. |
3.2a Failure to
inform supervisor when leaving duty or failure to report back |
W |
CA/S |
T |
|
|
|
3.2b Absence without
notice provided in accordance with program procedures for 3 consecutive
workdays constitutes voluntary resignation |
T |
|
|
|
|
3.3 Arrange coverage
for patient follow-up when absent. |
3.3a Failure to
arrange patient coverage when absent |
O |
W |
CA/S |
T |
|
3.4 Answer pages and
respond to emails in timely fashion. |
3.4a Failure to
respond to pages promptly (typically within 15minutes); email within 24
hours, when on duty and on call. |
O |
W |
CA/S |
T |
|
|
3.4b Failure to use
available systems to designate vacations, time away, etc. |
O |
W |
CA/S |
T |
|
4. Teamwork & Workplace Behavior |
|||||
|
4.1 Communicate
effectively and demonstrate caring and respectful behaviors when interacting
with patients, families, staff and colleagues; Work collaboratively with all
co- workers including those from other disciplines to provide patient-focused
care |
4.1a Inappropriate
behavior and/or use of profane, abusive or loud/boisterous language directed
toward patients, families, staff, supervisor or co-workers |
W |
CA/S |
T |
|
|
|
4.1b Threatening or
endangering any person's life or health, deliberately or through carelessness |
CA/S |
T |
|
|
|
4.2 Demonstrate respect
and courtesy toward fellow staff members, faculty, students, patients and
visitors; demonstrate sensitivity and responsiveness to patients and co
workers' culture, age, gender, and/or disabilities |
4.2a Failure to
appropriately interact with anyone on DMC, Hospital, or affiliated premises
(including patients, their families, students, visitors or other employees) |
CA/S |
T |
|
|
|
|
4.2b Violating
another's privacy or dignity, including sexual harassment or insensitivity to
culture, age, gender and/or disabilities |
CA/S |
T |
|
|
|
|
4.2c Sexual
relationship with anyone with whom one has supervisory or educational
evaluative responsibilities |
CA/S |
T |
|
|
|
4.3 Be productive and
use all available time to accomplish expected work tasks. Personal
business should be accomplished outside of work times and/or in scheduled
time-off |
4.3a Failure to
complete work assignments in a timely fashion. Allowing personal
activities to interfere with professional responsibilities. |
O |
W |
CA/S |
T |
|
4.4 Use available
resources to resolve work related problems |
|
O |
W |
CA/S |
T |
|
4.5 Facilitate
learning of students and other health professionals |
4.5a Failure to treat
others with dignity and respect and maintaining appropriate relationships
which are conducive to equitable, balanced evaluations |
O |
W |
CA/S |
T |
|
4.6 Present at all
times a proper and professional appearance. Dress for work according to
the department's workplace attire guidelines, including the appropriate
display of the DMC identification badge. |
4.6a Failure to
conform to departmental uniform or dress code policy, including the wearing
of identification badges |
O |
W |
CA/S |
T |
|
4.7 Give, accept and
ask for balanced feedback on a regular basis |
|
O |
W |
CA/S |
T |
|
5. Work Requests & Assignments |
|||||
|
5.1 Complete all
medical records in a timely fashion |
5.1a Failure to
complete medical records within Hospital/Department designated time frame |
W |
CA/S |
T |
|
|
6. Safety & Respect |
|||||
|
6.1 Respect and
safeguard the property of others and DMC. Use WSU or DMC property only for
legitimate work purposes (email, facsimile machines, computers, copiers, cell
phones, tools, vehicles and other work related equipment) |
|
CA/S |
T |
|
|
|
6.2 Use only WSU or
DMC email system for DMC information |
6.2a Conducting a
personal business from a DMC email address |
W |
CA/S |
T |
|
|
6.3 Report
immediately any accident on University, Hospital or affiliated premises
involving an on the job injury or property damage |
|
W |
CA/S |
T |
|
|
6.4 Obey and abide by
all civil, state, and federal laws and University regulations. |
6.4a Commission of any
crime on University, Hospital, or affiliated premises such as theft,
unauthorized removal of or willful damage to property |
T |
|
|
|
|
|
6.4b Unauthorized
possession of alcohol, weapons, explosives or being in possession of illegal
drugs |
T |
|
|
|
|
|
6.4c Charging
personal long distance phone calls to the University, Hospital or affiliates
authorization |
T |
|
|
|
|
|
6.4d Gambling on
University, Hospital or affiliates' premises |
T |
|
|
|
|
|
6.4e Commission of a
work related crime while off campus |
T |
|
|
|
Program Closure and/or Reduction in Size
The DMC is committed to insuring that trainees enrolled in the DMC Graduate Medical Educations are provided the opportunity to complete their training at a DMC institution.
The sponsoring institution must either allow residents already in the program(s) to complete their education or assist the residents in enrolling in an ACGME-accredited program(s) in which they can continue their education.
Program Director Role in Internal Review
As part of the GME Faculty Development initiative, Program Directors with upcoming site visits or Internal Reviews are encouraged to participate as a reviewer for another program’s Internal Review.
Program Information Forms (PIF) Submission to GME
PIFs
must be submitted to the DIO 30 days prior to ACGME deadline thus allowing time
for review by DIO, Program Director revisions, and final signature. In the
absence of the DIO, the Executive Director Medical & Academic Affairs will
review and cosign all program information forms and any documents and/or
correspondence submitted to the ACGME by program directors.
Program Probation or Adverse Action by ACGME
· If a
program receives ACGME notification of:
1. withhold accreditation
2. probationary accreditation
3. withdrawal after probationary accreditation
4. expedited withdrawal of accreditation
· The
following actions must occur:
1. The Program Director must submit an immediate response to the DIO and prepare a written report addressing all citations that will be presented at the GMEC. This GMEC meeting may occur ad hoc (if a response is required prior to the next GMEC meeting) or at the next regularly scheduled GMEC meeting.
2. Further, any program remaining on probation or in an adverse action category must submit a monthly written and oral report of their performance improvement plan progress to the GMEC.
· Citations
on Procedures/Cases – Programs not on Probation:
Any programs receiving citations regarding procedures (e.g., inadequate volume, inequitable distribution of cases among residents, lack of appropriate resources prohibiting procedural compliance, etc.) must submit a six-month written and oral progress report to the GMEC (will remain a standing agenda item until resolved).
This report must include a specific performance improvement plan, the National Data Report Case Log and a summative procedure log (per resident) at year end. Data on each individual resident is not required.
Manual: procedural citations will be discussed regularly semi-annually at the GMEC.
GMEC Agenda: Semi-annual report to GMEC
(standing agenda item)
Promotion/Reappointment/Graduation
Programs must clearly delineate, in writing, requirements for promotion/graduation of postgraduate trainees.
In addition to specialty specific RRC requirements, programs are encouraged to require passage of USMLE I and II by the end of postgraduate year I and passage of Part III prior to graduation. Exception to requirement of passage of USMLE part III may be made for those International Medical Graduates who are returning to their home country immediately after graduation.
Re-appointment and/or promotion to the next level of training is conditional upon; 1) satisfactory completion of all training components as mandated by the Program and the Institution, 2) the availability of a position, 3) satisfactory performance evaluations and documentation of passage of appropriate licensing examinations, 4) full compliance with the terms of this Agreement, 5) the continuation of the Hospitals’ and Program’s accreditation by the ACGME and/or AOA, 6) the Hospitals’ financial ability, and 7) furtherance of the Hospitals’/University’s objectives.
Upon completion of the DMC program, the graduate will be able to practice competently and independently of the training program if all requirements for graduation have been met including integration (where required) of the six ACGME and seven AOA general/core competencies and appropriate outcome measures. Completion of medical records and clearing of any financial obligations to the DMC must be included as a prerequisite for graduation from a DMC training program.
Proof of Identity and US Employment Eligibility (I-9)
The Graduate Medical Trainee will complete Section 1 of the I-9 form and the GME Office must complete section 2. When a Graduate Medical Trainee registers he/she is required to complete an I-9 Form. The trainee is to bring original documentation with them so their GME representative can make copies and attach them to the I-9 form. The trainee will not be able to attend Orientation unless this and all other forms are complete.
Recruitment and Selection/Non-Discrimination
It is the purpose of this DMC Policy to set forth the respective roles and responsibilities of the Office of Equal Opportunity and the executive officers of the DMC in the investigation and resolution of complaints filed internally alleging violations of the DMC’s policies against unlawful discrimination and harassment.
Programs must not discriminate with regard to sex, race, age, religion, color, national origin, disability or any other applicable legally protected status.
Additionally:
Successful applicants must exhibit strong qualifications for the specialty they wish to pursue. Candidates should possess the following qualities:
· Critical thinking skills
· Sound judgment
· Emotional Stability and maturity
· Empathy for others
· Physical and mental stamina
· Ability to learn and function in a variety of settings
DMC Medical and surgical residencies and fellowships are open to U.S. citizens, permanent U.S. immigrants and international applicants as follows:
· Graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME)
· Graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA).
· Graduates of medical schools outside the United States and Canada who meet one of the following qualifications:
1. Have a currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG).
2. Have successfully completed a Fifth Pathway program provided by an LCME-accredited medical school.
· Applicants who are not citizens of the United States must apply for an ECFMG-sponsored J-1 visa or have an INS issued employment authorization. More detailed information on the visa requirements and application procedures may be obtained from the Office of International Affairs at (313) 577-3422.
· All applicable medical license issues must be fulfilled prior to starting a training program.
· Prospective residents must pass a criminal background check.
New Appointment Paperwork Processing Time
In order to facilitate the processing of new appointment paperwork and avoid unnecessary confusion regarding the start dates for new trainees, the GME Office will be strictly adhering to the following time frames effective September 25, 2006.
National Resident Matching Program
Appointments
NOTE: PLEASE DO NOT WAIT FOR RETURN OF LETTERS OF OFFER BEFORE SUBMITTING PAPERWORK TO THE GME OFFICE.
DEADLINES: US Citizens & Permanent Residents 2 weeks after Match Day
J-1 Visa 10 days after Match Day
Non-Match Appointments:
U.S. Citizens & Permanent Residents who do not possess a Michigan Medical License
Minimum processing time = 6 weeks
New & Transfer J-1 trainees entering A.C.G.M.E. accredited program
Minimum processing time = 10 weeks
New & Transfer J-1 trainees
entering non-accredited program
Minimum
processing time = 12 weeks
Renewal of work authorization cards
Minimum processing time = 12 weeks
H-1 appointments - Please note that DMC does not sponsor H-1 appointments except under the following circumstances: The applicant already possesses an H-1 visa and is in an accredited program elsewhere OR is enrolling in a DMC unaccredited program
New H-1 trainees
Minimum processing time = 16 weeks
Transfer H-1 trainees
Minimum processing time = 12 weeks
Resident Probation
Program Directors must adhere to the following protocol for Resident
Probation:
1. The Program Resident Education Committee (or equivalent) identifies a resident performance deficit that requires probation.
2. The Program Resident Education Committee must define the probationary terms, timeline, and conditions including behavioral based outcomes and expectations.
3. The Program Director must notify a Resident of probationary status in writing. The Resident must review the probation terms and sign the letter acknowledging receipt.
4. Documentation of the probation (including the signed letter and all supporting evidence) must be submitted to the Program Chair and DIO.
5. Resident failure to meet the defined terms of probation may result in the implementation of corrective action procedures. The probationary status must not exceed one year; violations considered egregious in nature may result in earlier corrective action implementation.
6. At the time of probation, the resident must be given a copy of the program and institutions’ corrective actions policies and procedures.
Resident Transfer /
Verification of Previous Residency
Residents are considered as transferring residents under several conditions which include:
· When moving from one program to another within the same or different sponsoring institution;
· When entering a PGY-2 program requiring a preliminary year even if the resident was simultaneously accepted into the prelim PGY 1 program and the PGY 2 program as part of the match (e.g. accepted to both programs right out of medical school)
Before accepting a transferring resident, the “receiving program” director must obtain written or electronic verification of prior education from the current program director. Verification includes:
· Evaluations
· Rotations completed
· Procedural/operative experience
· Summative competency-based performance evaluation.
A resident transfer form must be obtained from the DMC GME Office for programs to utilize that includes the following elements:
· Verification of training
· List and duration of rotations
· Professional liability
· Summative competency based performance evaluation
· Procedural / Surgical Experience
· Final recommendation status
Risk Management
The process that identifies objectively assesses and attempts to prevent events that are inconsistent with accepted standards of medical practice, in the delivery of health care services, which could result in potential harm to patients, physicians or other health care providers.
Safe Medical Devices Act
The Safe Medical Devices Act requires that the institution report to the manufacturer and/or to the FDA certain incidents involving the malfunction or failure of medical devices (1) in which a patient sustained serious injury or death, or (2) intervention was required to prevent serious injury or death. If your patient is involved in an incident that might be reportable, immediately isolate the equipment without changing any settings and contact Engineering, Maintenance or call Risk Management. Graduate Medical Education Trainees should not return such equipment to the company or attempt to repair it by themselves.
Smoking
The DMC is a smoke-free environment; therefore, smoking is prohibited in all areas of DMC hospitals including private offices, bathrooms, conference rooms, locker rooms, etc.
Supervision of Postgraduate Trainees
The GMEC
1. All patient care must be supervised by qualified faculty. The program director must ensure, direct, and document adequate supervision of trainees at all times. Trainees must be provided with rapid, reliable systems for communicating with supervising faculty.
2. Faculty schedules must be structured to provide trainees with continuous supervision and consultation.
3. Faculty and trainees must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.
Uniforms
Uniforms are provided through individual departments. Please see your coordinator and/or director for information.
Visa Policy
The decision to offer an H-1B visa to applicants will be made at the Program Director’s discretion. The visa application will be processed by the GME office when the following requirements are met:
Acceptable
Citizenship or Visa Statuses
The following are acceptable work statuses for enrollment:
1. J-1
2. Work authorization
3. Permanent resident
4. F-1/OPT
5. H-1B
H-1B Visa
To qualify for consideration and before the H-1B application can be filed, a prospective trainee (resident) must:
1.
Complete and pass USMLE
Step 3 prior to Match results (No Exceptions)
2. Provide proof that he/she has obtained a Michigan Medical License
*Trainees that require a visa to enter the program, but do not have proof of passage of Step 3 when the match results are posted will be required to enter the program on another visa.
F-1/OPT Visa:
1. Trainees that enter the program on an F-1/OPT visa will need to convert this visa to either a J-1 or H-1 during their first year of training.
2. Passage of USMLE Step 3 is required before the trainee can convert the F-1/OPT to an H-1B.
Current Residents
Residents who currently hold an H-1B visa and are enrolled in a training program:
1. Residents enrolled in a clinical training program: This policy DOES NOT apply to trainees who are currently enrolled in a clinical training program and hold an H-1B visa.
2. Residents enrolled in a research program: This policy WILL apply since they are required to pass Step 3 before converting to a clinical H1-B visa.
Section V – DMC Hospital Policies and Procedures
Advance Directive
An Advance Directive, as used in this policy, is a written document in which a person specifies what type of medical treatment he or she wants or does not want, in the event that the person loses the ability to make decisions. An Advance Directive may include a patient's designation of another person to affect medical care decisions regarding the patient in the event that the patient becomes unable to do so.
All capable adult patients, upon their inpatient
admission, will be informed of the DMC's policy of accepting and utilizing
Advance Directives. The information regarding Advance Directives will be
reasonably communicated in a clearly understood manner. Patients will be asked if they have Advance
Directives which they wish to be followed during the course of their inpatient
stay if they (the patient) become incapable of making decisions during his/her
stay.
1.
Patients
have the right to self-determine the level and type of treatment which they
undergo as patients at the DMC's hospital and Outpatient Ambulatory
facilities. Consistent with applicable
laws, the DMC's standards of practice, and with related administrative
policies, the patient's expression of treatment choices or limitations shall be
honored.
2.
At
the time of admission into the DMC Ambulatory/Outpatient system, each patient
should be made aware of the availability of Advanced Directives and encouraged
to seek additional information and determine whether or not to enter into, and
submit, properly executed Advance Directive to their Ambulatory/Outpatient
physician.
3.
At
the time of an inpatient admission or as soon thereafter as may be practicable
in individual circumstances, inpatient admittees shall be asked if they have
prepared an Advance Directive to be included in their medical records. Copies of all Advance Directives presented
by inpatients shall be included in the patient's medical chart so that
appropriate personnel may review it, and otherwise have access to its
requirements. The essence of the
patient’s directive will be determined and documented in the progress notes if
a copy is not available.
4.
Physicians
and other caregivers shall consult the Advance Directive for guidance regarding
treatment decisions, provided that the patient is medically determined to be
then unable to participate in treatment decisions.
5. The only Advance Directive which is currently recognized as being singularly legally binding is a properly executed Durable Power of Attorney for Healthcare. However, a Living Will is not prohibited by law and does provide evidence of the patient's treatment preferences.
6. A person who has agreed to act as the Patient Advocate by a written document signed by the patient and which meets the statutory requirement for a Durable Power of Attorney shall be entitled to make healthcare decisions on behalf of the patient who granted this authority. The powers of a Patient Advocate become valid when the attending physician, together with at least one other physician (or licensed psychologist), declares that the patient is incapable or otherwise unable to understand and personally participate in the course of treatment. Review of this determination should occur from time to time, upon changes in the patient's condition. Immediately upon the patient's resumption of capability the patient, and not the advocate, shall be the sole person permitted to grant and withhold consents and to otherwise direct the course of treatment.
7. A properly designated Patient Advocate shall have the authority to make treatment decisions calculated solely to forego life-sustaining treatment only if the express grant of that authority is incorporated into the patient's Durable Power of Authority; and, with the concurrence of the attending physician in the reasonableness and ethical appropriateness of the undertaking of such directions.
8. The Hospital Ethics Committee may be consulted to advise about issues associated with a patient's advance directive.
9. No Advance Directive shall displace the necessity for physicians and others to adhere to the dictates of related administrative policies, and, as well, to the general policies, practices, and protocols of the DMC facility at which the patient is being treated to the same extent as would be required in absence of such Directive.
10. The DMC shall undertake activities to assure that members of the general public as well as DMC hospital's patients are aware of the Advance Directive options available to them under Michigan Law.
A. Adults who present themselves for inpatient admission will be offered written information concerning their right to adopt advance directives.
B. Hospital staff personnel, including social workers, nurses and the Patient Relations and Spiritual Care staff are available for consults with patients who request additional educational information regarding Advance Directives.
C. Additional educational activities shall be implemented from time to time by such means as may be deemed effective, so as to insure that patients and citizens of our community are made aware of their ability to execute an Advance Directive and to fully exercise their rights as a patient at the DMC.
Affirmative Action
The DMC provides and promotes equal employment
opportunity to all persons, without regard to race, color, sex, age, religion,
national origin, weight, height, marital status, disability, status as a
Vietnam-era or special disabled veteran or sexual preference. Within the provisions of applicable laws,
equal employment opportunity will be provided in all employment practices as
well as all other terms and conditions of employment. Employees of the DMC are prohibited from engaging in any
employment practices that are prohibited by law and are contrary to the intent
of this policy.
The
definitions and procedures enumerated previously shall apply unless such
procedure is specified in a contract to which a covered operating unit is a
signatory. In such cases, the terms of
the contract shall govern for employees covered by that contract and such terms
will take precedence over this policy.
Anatomical Gifts
Wayne State University is one of three in the state of Michigan that is part of the will donor program. Michigan State University and University of Michigan are the other two.
Animal Subjects in Research
A federal law, the Animal Welfare Act, sets forth standards for the care and treatment of laboratory animals, including housing, feeding, cleanliness, ventilation and veterinary care. (Currently, AWA regulations do not cover rats and mice bred specifically for research.) All facilities using laboratory animals covered under the AWA must register with and be inspected by the United States Department of Agriculture's enforcement arm, the Animal and Plant Health Inspection Service (APHIS). It is the responsibility of APHIS – through random, unannounced inspections – to ensure that institutions are complying with all USDA regulations.
Anonymous Hotline
1.
The
DMC will establish and maintain a telephone hotline that employees may use to
report problems and concerns either anonymously or in confidence.
2. Employees who report problems and concerns via the hotline in good faith will be protected from any form of retaliation or retribution. (See DMC Tier I Administrative Policy Manual, Non-retaliation/Non-retribution Policy, Policy No. CG-01 1.)
3. All those who are employed in the hotline operation are expected to act with utmost discretion and integrity in assuring that information received is acted upon in a reasonable and proper manner.
4.
The Corporate Audit
& Compliance Department is responsible for the daily operation of the
employee hotline.
5.
If the efforts above do
not resolve the issue, contact the ACGME Complaint Officer to discuss
submitting a formal complaint; ACGME Complaint Officer
– (312) 755-5041, log on to www.osteopathic.org for the AOA Compliant Officer Information.
Autopsies
Autopsies will be performed in an effective and timely manner when requested by the attending physician and when the provisions are met. Autopsies are performed between 0800 and 1400 Monday through Friday, and 0800 to 1200 weekends and holidays. A diener is required to safely perform an autopsy.
Biological Safety
To assure that all Hospital implants have been exposed to an appropriate sterilization process and those biological indicators are used to assure this.
Blood and Body Fluid Exposure (BBFE) (needle stick exposure)
|
BBFE Administrative
Guidelines/ Procedure: Central Region Operating Units |
A. Blood and Body Fluid Exposures
1. Occupational blood and body fluid exposure (BBFE) is considered an urgent medical event that requires timely post-exposure management (CDC MMWR June 29, 2001 / 50 (RR11); 1-42).
2. The optimal time for chemoprophylaxis is within four (4) hours of the BBFE exposure; therefore the exposed individual must present for evaluation and management as soon as possible, ideally within one (1) hour of exposure, whether or not a source patient is identified.
3. A paper incident report and the web-based incident should both be completed.
4. Note: Patient consent for HIV and hepatitis testing, in the event of a BBFE, has already been obtained for all DMC registered patients, and thus does not need to be secured again at the time of the event.
B. Exposed Healthcare Worker’s (HCW) Response
1. Following a blood/body fluid exposure, the HCW must immediately report the event to his/her immediate supervisor and present for medical evaluation and management.
2. If the BBFE occurs on a nursing unit, notify the charge nurse of the event.
3. Notify the Nursing Administrative Supervisor/designee:
a. CHM 313 966-5342 or 313 966-5343
b. DRH #9860 or 313 745-3234
c. HUH #00152 (days M-F), all other times #9512
d. Hutzel #00125 (days M-F), all other times #9326
e. KCI #9548 or 313 576-8444
f. RIM #6345 or 313 745-1215
4. Complete Employee incident report (32257097). If the form is not available locally, forms are available in OHS or the ED.
5. Obtain a patient label to identify source patient, or otherwise document the identity of the source patient.
6. Take completed incident report form and source patient identifiers to OHS or the DRH Emergency Department.
OHS 4K (UHC) Monday – Friday 6:30 AM to 4:00 PM
DRH Emergency Department All other times
7. On arrival in OHS or ED advise the staff that you are presenting for BBFE evaluation.
C. Supervisor’s Response (for non-patient care
employees)
1. Upon notification, release the employee from his/her work assignment
2. Ensure completion of Employee Injury/Illness Report (32257097)
3. Form will be provided in OHS or the ED if not available on the unit
4. Direct employee to OHS or the DRH ED. If not already notified, contact the Nursing Administrative Supervisor for BBFE’s involving or occurring on an inpatient unit.
1. The charge nurse will identify the source patient and facilitate drawing of source patient’s blood.
2. Provide exposed individual with source patient label or identifying information to take with him/her to OHS or ED.
3. If not already notified, contact the Nursing Administrative Supervisor/designee.
a. CHM 313 966-5342 or 313 966-5343
b. DRH #9860 or 313 745-3234
c. HUH #00152 (days M-F), all other times #9512
d. Hutzel #00125 (days M-F), all other times #9326
e. KCI #9548 or 313 576-8444
f. RIM #6345 or 313 745-1215
Immediately draw source patient’s blood (1 red top and 1 purple top), and
Enter a CIS laboratory order (“BBFE Source Blood Exposure”) as a “per protocol” order under the source patient’s attending physician’s name AND
Complete CIS Downtime Laboratory Requisition form
a. Send specimen, lab requisition slip and CIS Downtime Laboratory Requisition form to your site’s specimen processing lab. Do not mark any test boxes, instead write in the Miscellaneous Tests section “SEH12, and SEHEPA.”
b. Call Core Lab Client Services 745-4100 and tell them that a specimen has been sent to your site’s lab for “BBFE Protocol.” Provide call back number for Nursing Administrative Supervisor.
E. Nursing Administrative Supervisor’s Response
1. Nursing Administrative Supervisor/designee collaborates with the employee’s supervisor and charge nurse to ensure that the employee reports to OHS or the DRH ED and that the source patient’s blood specimen is drawn and sent for processing.
2. In collaboration with the Charge Nurse ensures that they following activities occur:
Immediate drawing of source patient’s blood (1 red top and 1 purple top)
CIS laboratory order (“BBFE source blood exposure”) is entered into CIS system AND
CIS Downtime Laboratory Requisition form is correctly completed
Source patient’s blood specimens, lab requisition slip and CIS Downtime Laboratory Requisition are immediately sent to your site’s specimen processing lab.
Core Lab Client Services (745-4100) has been called and advised that a BBFE source patient’s specimen has been sent to the site’s lab for BBFE protocol.
Accurate call back number for Nursing Administrative Supervisor is provided.
3. Follow-Up Activities
a. Thirty (30) minutes after the specimen is drawn and sent the Nursing Administrative Supervisor will call Client Services 745-4100 to confirm receipt.
b. If the specimen has not been received within one (1) hour it may be necessary to obtain a new specimen and requisition and hand carry them to the site’s lab.
4. Contact OHS (745-4522) or DRH ED Clinical Coordinator (966-0705) for questions/concerns.
1. Notify immediate supervisor
2. Supervisor will contact OHS (745-4522) or DRH ED (966-0705) for further instructions
OHS 4K (UHC) Monday – Friday 6:30 AM to 4:00 PM
DRH Emergency Department All other times
3. Do not allow source patient to leave before source patient’s blood is drawn, or a decision not to draw source patient’s blood is made by OHS or DRH ED.
G. Emergency Department and Operating Room
Services
1. Notify immediate supervisor
2. Supervisor will contact OHS (745-4522) or DRH ED (966-0705) for further instructions
OHS 4K (UHC) Monday – Friday 6:30 AM to 4:00 PM
DRH Emergency Department All other times
3. Do not allow source patient to leave before source patient’s blood is drawn, or a decision not to draw source patient’s blood is made by OHS or DRH ED.
(Refer to the Tier 1 policy on
the Intraweb 1 CLN 010 Post Exposure Prophylaxis for further information on
needle sticks)
Computer Usage
1) All users of the DMC computer system must behave in an ethical, legal, and morally responsible fashion while using the system. Individuals are responsible for their behavior and actions when accessing the system and the internet.
2) Use of the systems, and in particular patient information, internet service, and E-mail, is provided for the support and improvement of the DMC's business objectives. Access is a privilege, given or withheld by DMC sponsoring institution, as it determines.
3) All use of DMC computers, the internet, and E-mail, is subject to observation and monitoring by the DMC to verify that the use of services is in accordance with DMC policy. There shall be no privacy from the DMC in any individual's use of any DMC system, computer, E-mail message, or related device.
4) The sponsoring institution reserves the right to collect, monitor, examine, copy, store, transmit, print, and use any and all information entering, leaving, residing in, or processed by any and all information systems and components used in the corporate setting, for any and all purposes that the DMC so selects or determines, at its sole discretion.
Electronic Communication
1. DMC will take necessary steps to accommodate reasonable requests by patients to receive confidential communications of PHI.
2. DMC will provide confidential communications by alternative means or at alternative locations.
Ethics
The DMC is committed to the
highest ethical principles in its conduct of business, patient care, research
and education. In pursuit of this goal,
the DMC Board of Trustees has established this statement of organizational
ethics. All members of the DMC
community—Trustees, administrators, medical staff, employees, and volunteers –
are expected to act in accordance with this organizational statement and its
supporting policies.
Human Subjects in Research
To assure
that all clinical researchers understand their responsibility to protect the welfare
of their research subjects, the NIH requires that researchers be “certified” in
human subjects' protection before releasing research funds. This requirement
has been in place since October, 2000.
Institutional
Review Board – a specially constituted review body established or designated by
an entity to protect the welfare of human subjects recruited to participate in
biomedical or behavioral research.
Nepotism
Nepotism, as defined by this policy, shall not be permitted in the DMC. An employee shall not permanently work under the supervision (direct or indirect) of a relative. Related employees will not be allowed to work permanently in the same department unless they can be assigned to different supervisors, work areas or shifts.
Patient’s Rights and Responsibilities
Each health care facility within the DMC has the responsibility to ensure the rights of all patients and, if applicable, their parents/guardians, to participate in decisions regarding their medical care. Patient rights and responsibilities shall be posted.
Pharmaceutical and Vendor Interactions / DMC Ethics of Business Conduct
The relationship and contact between vendors and The DMC must demonstrate the highest professional and ethical standards. Because there is room to misinterpret the relationship of charitable contributions with the business relationship between the vendor and The DMC, it is essential that charitable solicitations be conducted in the most professional and ethical manner so that even any appearance of impropriety is avoided.
All residency programs will be aware and follow the vendor interaction policies of the DMC or wherever the resident/fellow is rotating. All programs should develop an educational module to instruct residents on the ethical and legal obligations governing physician-vendor relationships. The DMC policy is stated below.
Revised Ethics of Business Conduct Policy (1 CG 015)
Executive Summary - January 2009
The DMC Ethics of Business Conduct policy governs the
actions of persons affiliated with the DMC, including employees, board members,
volunteers and contractors, vendors and members of their household(s) As governing bodies and legal requirements
change, leading to changes in codes of ethics which provide more transparency,
it is essential that the DMC also modify the way that it has conducted business
in the past in order to avoid any appearance of impropriety on the part of key
personnel in decision-making positions.
As such, effective as of January 1, 2009, The DMC will no
longer permit, on its premises, its affiliated persons to solicit or accept
gifts or other inducements, even those of nominal value, such as prescription
pads and ink pens, from vendors who either currently do business or who are
soliciting a business relationship with the DMC. This prohibition on the acceptance of gifts includes any food
brought on the premises by a vendor.
Items which provide some educational value, such as textbooks,
may be accepted if approved by the appropriate department chair or
director. The receipt of samples
offered on a trial basis in order to evaluate a product which may provide value
to the DMC is also acceptable.
The change in the Ethics of Business Conduct Policy is just
another example of the DMC’s continuing commitment to provide quality services
in an environment free from undue influence of outside forces and to maintain
an environment of the utmost corporate integrity.
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Title: |
Ethics of Business Conduct |
Page 62
of 1 |
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Policy
No: |
1 CG 015 |
Effective
Date: January 1, 2009 |
OBJECTIVE
To outline guidelines/rules for conducting business
and delivering healthcare in accordance with high ethical standards and
compliance with laws and regulations.
To protect corporate integrity and welfare by providing guidelines/rules
for disclosing violations or potential violations of this policy.
The provisions set forth in this policy contain
specific guidelines on certain conduct or activities. The provisions are a non-exhaustive list of
guidelines for use in further development of conduct expectations by employees
and for situations not specifically covered in the policy. Based upon the guidelines set forth within
this policy, employees should refrain from conduct similar to that which is
prohibited or discouraged by this policy.
SCOPE
All DMC: Employees, Board Members, Vendors, Medical Staff, Contractors, Students and Volunteers.
DEFINITIONS
1.
Contractor:
a.
Any
individual (other than an employee), organization or employee of an
organization who is associated with a covered operating unit, through contract
or otherwise, and whom acts on behalf of such covered operating unit (e.g.
Wayne State University faculty and contract physicians and managers when they
function as contractors who are responsible for the operation of a covered
operating unit department).
b.
A
contractor is subject to the provisions of policies to the same extent as is an
"employee" in any section specifically, during those periods of time
when the contractor is conducting activities as a representative of a covered
operating unit.
2.
Covered
Person: All DMC
employees, contractors, board members, medical staff, students, volunteers and
vendors.
3.
Covered
Operating Unit: The
DMC parent corporation and its wholly owned operating units.
4.
Employee(s):
All employees of The Detroit Medical Center (NOTE: Members of the Board
of Trustee are subject to this policy, except that disclosure obligations
described in this policy are covered by and superseded by the policy on
“Disclosure of Interest of Members of the Board of Trustees", 1 CG 002).
5. Household: Any covered person’s current or former spouse, parents, children,
siblings, grandparents, grandchildren, in-laws, aunts, uncles, cousins, nieces,
nephews, step-family, and/or legal guardians wherever they reside; as well as any person(s) sharing the
same living quarters with an employee or who interacts with an employee in an
intimate and personal relationship that could have an adverse affect on the
objective of this policy.
6. Vendor: An individual or organization that conducts business with the DMC
or that indicates an interest in doing so.
Each covered person is expected to conduct his/her
duties in a manner that meets the highest legal and ethical standards. An employee who participates in any activity
that violates legal standards, or which could adversely impact corporate
integrity and welfare, will be subject to disciplinary action, up to and
including discharge, prosecution, or both.
A violation of legal standards or DMC policy by a
contractor may constitute a breach of contract resulting in the termination of
such contractor’s services.
No action that would otherwise be suspect or
discouraged under this policy is permissible simply because it is
customary. A prohibited action is not
excused simply because the action was taken with the knowledge, or at the
discretion, of a supervisor.
PROVISIONS
1. Gifts or Inducements: Covered persons and
members of their household may not solicit or accept anything of value, from
vendors, or any other persons whom they contact or who contacts them on behalf
of a covered operating unit, including, but not limited to; monetary gifts,
awards, bribes, incentives, inducements, trips, discounts or other tangible
benefits that would suggest or create any obligation,. Such gifts or inducements, if received, must
be returned to the donor/vendor.
Whenever an offer of a gift, entertainment, or other gratuity is made
because of the employee's position with the DMC, the employee shall question
the propriety of accepting such an offer and refer to this policy and/or their
supervisor for guidance.
a. Covered persons may not solicit or accept
non-monetary gifts from vendors.
b. Covered persons may not accept loans offered
by a vendor. This does not include those loans which are granted by lending
institutions in the ordinary course of business of such institutions.
c. Assets of a covered operating unit shall not
be used to provide gifts, personal favors or benefits to others, except for
lawful and reasonable business-related expenses. Any expenditure for lawful and reasonable business related
expenses shall be properly entered on the corporate records of the covered
operating unit.
d. No food of any kind will be directly
supplied to covered persons by vendors.
e. Covered persons shall not accept and vendors
shall not distribute, post, or leave, any type of promotional items (including
pens, penlights, paper pads or prescription pads)
f. Covered persons shall not accept from
vendors, cash or other personal gifts or items of any kind.
g. Textbooks and items of educational value may
be accepted on behalf of a covered operating unit if approved by the department
chair/director and consistent with this policy.
2. Travel
and Lodging: Travel and/or lodging for a covered person may not be accepted
from, or be reimbursed by, a vendor or provider of a service to a covered
operating unit unless such travel or lodging is for educational or consultative
purposes, and is approved in advance by the appropriate Senior Vice President.
All other business travel will be reimbursed, if appropriate, at the expense of
a covered operating unit and according to its established business travel
practices. Under no circumstances may a
covered person accept travel or lodging from a vendor for a household member
without prior approval of the appropriate Senior Vice President.
a. Unless charged and paying a fair market
price, a covered person may not utilize, for his/her personal use, living
quarters, a cabin, lodge, apartment, vehicle, office, or retreat facility owned
or supplied by vendors, suppliers, contractors, or agencies.
b. Infrequent exceptions may be made for events
such as supplier-sponsored seminars, or trips outside of the continental limits
of the United States and/or to non-traditional business sites upon advance
written approval by the Senior Vice President of a covered operating unit.
(NOTE: Blanket approval may be given for recurring,
industry-wide practices that are in compliance with law and regulations and
applicable industry ethical standards.)
3. Employee
Discounts: The only approved employee
discounts are those listed in an "Employee Discount" or similar
policy of a covered operating unit. The
giving of any other merchandise or service discount by a covered person within
a covered operating unit is a violation of this policy.
4. Direct
Purchase from Vendors: For Personal
Use: Purchases from vendors (and
discounts associated with such purchases) that are for personal use shall be
permitted only when they are available expressly to all employees. A covered operating unit shall communicate
the existence of such special purchase arrangements to its employees.
5. Bribes: No funds or other property of a covered
operating unit shall be used to bribe, or attempt to bribe; any decision,
action or inaction by any public official, covered person, agency, or
organization. Any covered person who believes that there has been an attempt at
bribery is obligated to report the suspicion to his/ her supervisor, one of the
covered operating unit's Senior Vice President, the Corporate Vice President,
Chief Compliance and Governance Officer, or to call the DMC Fraud and Ethics
Hotline (1-888-484-9200).
6. Political Contributions: No covered person may make any agreement to contribute any money, property, or services of any covered person at a covered operating unit’s expense to any political candidate, party, organization, committee, or individual in violation of applicable law, or in a manner that may jeopardize the tax exempt status of a covered operating unit. Employees may personally participate in and contribute to political organizations or campaigns, but they must do so clearly as individuals not representing a covered operating unit, and they must use their own funds and do so on their own time.
7. Receipt
of Samples and/or Free Goods: While
receipt of free goods and samples from vendors is discouraged, it is recognized
that it may be necessary to receive sample products from a vendor for trial and
evaluation. Free samples obtained for
purposes of trial and evaluation must be obtained from the vendor via
established Tier 2 MRMPRO Policy Number 604, “Processing of Purchase
Requisitions – Manual and Electronic,” to ensure appropriate receipt, usage,
disposal and return of samples. A “no
charge” Purchase Order will be issued to the vendor. Such procedures for obtaining samples will be consistent with the
provisions and philosophy of this policy.
8. Promotions/Contest:
Participation with a vendor in a promotion or contest, which results in
personal gain/loss, is not permitted.
9. Offsite
Meals and Entertainment:
a. Covered persons may accept meals at a
vendor's expense, if appropriate and in connection with the covered person's
job and duties. Excessive meals and
entertainment, and excessively frequent acceptances of elaborate arrangements
are prohibited. At the appropriate
opportunity, a reciprocal business-related invitation should be offered to a
vendor. The covered person’s supervisor
or the appropriate Senior Vice President must approve, in writing,
participation of the covered person in meals and entertainment.
b. Occasional attendance at a theater, sporting
event, or similar entertainment at vendor's expense, may be accepted by a
covered person. Regularly involved
business representative of the vendor must be in attendance with the covered
person. The covered person’s supervisor
or the appropriate Senior Vice President must approve, in writing,
participation of the covered person in such entertainment.
c. Employees may not solicit meals, theater,
sporting events, or other entertainment from any person affiliated or doing
business with the DMC, including vendors.
10. Honoraria
for Speeches and Articles: Honoraria
opportunities for DMC employees must be conducted on an individual's own time
and must not conflict with an individual's job responsibilities. Each honorarium opportunity for an employee
will be considered on an individual basis and must have the documented, advance
approval of the Senior Vice President of the covered operating unit. Honoraria for speeches and articles given or
prepared by employees of the DMC may be retained by him/her unless:
a.
His/her
speech or article is prepared at a specific direction of a covered operating
unit,
OR
b.
There
is an agreement to the contrary with the DMC employee. In such a case, any honorarium will belong
to the covered operating unit.
(NOTE: Wayne State University faculty members are
subject to this provision, with respect to their DMC employment and also are
subject to the Wayne State University rules of governance regarding this
matter).
11. Confidentiality: Unless authorized by Federal or State
statute, a covered person will not disclose confidential or material information,
to any outside or unauthorized persons, which relates to a covered operating
unit, an employee, or a patient. Within
a covered operating unit, confidential or material information should only be
revealed to those covered persons who are authorized to receive such
information and have a need for such information in connection with their
duties. This requirement continues
after termination of employment.
12. False
or Misleading Information: No covered person shall make any false or misleading
statements to others related to patients, persons, or entities doing business
or competing with a covered operating unit, nor shall an covered person make
false or misleading statements about the products or services of such a covered
operating unit, DMC parent corporation, persons, patients, or business entities
in relation to DMC.
13. Commitment
to detecting and reducing fraud, waste and abuse: every covered person vendor and contractor will be provided with
information concerning the DMC’s commitment to detecting and reducing fraud,
waste and abuse in the health care setting through the DMC Code of Conduct,
this and other policies, as well as through educational sessions about the DMC
Compliance Program. Written material
and training sessions will cover the Federal False Claims Act and the Michigan
Medicaid False Claims Act and other federal and state laws designed to detect
and prevent fraud, waste & abuse.
14.
Compliance with Laws: A covered person is required to comply with all
laws affecting the operation of covered operating units. A covered person will not knowingly:
a. Participate on the behalf of a covered
operating unit or use corporate assets, to carry out any unlawful action,
scheme (regardless of past practice) or permit such practice to continue in a
department under the covered person's supervision.
b. Receive money, favors, goods, services, or
property, directly or indirectly, with an understanding that a covered
operating unit will pay rebates or refunds.
A
covered person is not expected to have full knowledge of all laws affecting the
operations of a covered operating unit.
However, it is expected that every covered person will have a general
knowledge of prohibited activities involved in his or her work. An covered
person shall seek guidance from his/her supervisor, Senior Vice President, or the Corporate Audit and Compliance
Department regarding any matter on which he/she has a question and shall
participate in continuing education at the system as appropriate to the covered
person's job duties.
15.
Outside
Employment and/or Consulting Opportunities ("Moonlighting"): Outside employment and/or consulting
opportunities for all employees must be conducted on an individual's own time
and must not conflict with an individual's job responsibilities. Each "moonlighting" opportunity
being considered by a covered person must be disclosed on the "DMC
Employee Disclosure/Moonlighting Form" contained in this policy
(Attachment 1). Covered persons must have the advance written approval of their
supervisor or manager. If the
supervisor or manager denies approval, the supervisor or manager shall check
the “denied” box on the Disclosure Form, send a copy of the form to the
Corporate Audit and Compliance Department, give the original form back to the
employee, and refer the employee to the Employee Problem Solving Policy (Tier I
Policy HR 505) for guidance regarding the employee appeal process.
a.
Covered
persons are prohibited from working at a business where: (1) such activities
conflict with the covered person’s ability to perform his/her job at a covered
operating unit; and/or (2) the employee is in any way soliciting business for
the other employer while working for the covered operating unit.
b.
All
names, addresses, and other identification of employees, affiliated persons,
customers, suppliers, and contractors of a covered operating unit are the
property of the covered operating unit and shall not be used or disclosed to
any other person, except in the regular course of employment.
c.
Those
covered persons who held a position elsewhere prior to accepting employment
with the DMC, or who began a "moonlighting" opportunity without prior
written approval, are required to inform their supervisor of such
"moonlighting", the nature of the moonlighting, and the name of the
outside employer.
d.
With
the exception of expense reimbursement, no covered person is to be paid any
form of remuneration by a covered operating unit, other than through the
employee's regular payroll account.
e.
No
covered person of a covered operating unit, or group of such persons, may
operate on the property of any covered operating unit, any enterprise for
personal profit, such as vending machines, rental service, cleaning, etc. An exception is a contractual relationship
to provide services on behalf of, to, or at the DMC for delivery of goods or
services to the DMC.
(NOTE: Faculty are subject to this policy when such
faculty members are acting in a DMC capacity (i.e. on the DMC payroll system as
a teaching physician).
f. No covered person
shall render his/her services, outside of the normal course of his/her
employment, to any competitor of a covered operating unit, or to anyone that
does business with or seeks to do business with the covered operating unit,
without the written approval of the Senior Vice President of the covered
operating unit. Nor shall any such
covered person be a director, officer, or consultant of such an organization,
nor permit his/her name to be used in any fashion that would indicate a
business relationship with such an organization.
16. Dealings
with Current or Former Employees or Trustees:
Caution shall be used when consideration is given to entering into any
financial arrangement with a current or former Trustee, current or former
employee, or an employer or any entity in which they hold a business interest.
Preferential treatment is prohibited. The nature of any such proposed
arrangement shall be fully disclosed to the appropriate covered operating unit
Vice President, or Senior Vice President.
Full disclosure is required.
17. Conflict
of Interest: All covered persons shall
regulate their activities so as to avoid conflicts of interest, actual
impropriety, and/or the appearance of impropriety. Covered persons are required
to disclose conflicts of interest, an actual impropriety, and/or appearances of
an impropriety. Procedures for
disclosure and the necessary forms are included in this policy.
a. While not all inclusive, the following will
serve to guide covered persons in evaluating the potential for a conflict of
interest, and the appropriateness of activities or behaviors with vendors,
providers, contractors, third-party payors, and government entities. The
potential for a conflict of interest may exist where:
1) An covered person or members of their
household have an ownership interest in, or are employed by or a party to a
contract with, any outside business that provides products or services to a
covered operating unit. This does not
apply to stock or other investments held in a publicly held corporation,
provided the value of that stock or investment does not exceed five percent of
such covered person's net worth.
2) A covered person or members of their
household, conduct personal business with any vendor, supplier, contractor,
third-party payor, or government entity.
3) A covered person or members of their
household, attempt to represent a covered operating unit in any transaction in
which he or she, or a household member, has a substantial personal interest.
4)
A
covered person or members of their household disclose or use confidential,
special, or inside information pertaining to a covered operating unit, for
personal gain or to benefit a household member or any other persons.
5) A covered person or members of their
household, compete, directly or indirectly, with the interest of a covered
operating unit, in the purchase, sale, or ownership of property or property
rights, or business investment opportunities.
b.
Disclosure
by Employees and Contractors (Including Members of the Medical Staff):
1)
All
employees and contractors have a continuous obligation to disclose conflicts of
interest, an actual impropriety, and/or an appearance of an impropriety.
2)
Each
employee and contractor is required to disclose such activities on the
"DMC Employee Disclosure/Moonlighting Form" (Attachment 1) contained
in this policy. The form shall be
submitted to the employee’s immediate supervisor or in the case of a contractor
to the Material Management Department.
All disclosed information shall be confidential, except to the extent
necessary for the protection of the interests of the DMC.
3)
The
Corporate Audit and Compliance Department will make a determination regarding
the existence of a conflict. If it is
determined that a conflict does in fact exist, the employee/contractor will be
notified and will be given the option to either immediately discontinue all
activities surrounding the said conflict or seek a waiver and written approval
from the affected DMC President/Chief Executive Officer, or.
c.
Disclosure
by Vendors
1)
Vendors
are required to continuously disclose to the DMC all conflicts of interest,
gifts, honoraria, trips, equipment, and all remuneration given to the DMC and
its physicians, and Wayne State University Medical School.
2)
Vendors
will be required to complete the "DMC Vendor Disclosure Form"
(Attachment 2) contained in this policy,
at the request of DMC. The form
shall be submitted to the Corporate Audit and Compliance Department. All disclosed information shall be
confidential, except to the extent necessary for the protection of the
interests of the DMC.
3)
The
DMC reserves the right to discontinue or decline to do business with those
vendors who refuse to complete the disclosure form or whose disclosure forms
raise concerns about the vendor's compliance with DMC policy.
d.
Participation
on Boards of Directors/Trustees:
1)
An
employee must obtain written approval from his/her Senior Vice President prior
to serving as a member of the Board Of Directors/Trustees of any organization
whose interests may conflict with those of the DMC or its operating units.
2) An employee who is asked, or who seeks, to
serve on the Board of Directors/Trustees of an organization whose interests
would not impact the DMC or its operating units (e.g. civic [non-governmental],
charitable, fraternal and so forth), will not be required to obtain the
approval of the Senior Vice President.
3) All fees/compensation (other than
reimbursement for expenses arising from Board participation) that are received
for Board services provided at the request of the DMC and during normal work
time shall be paid directly to the covered operating unit where the employee is
employed.
4) The DMC retains the right to prohibit
membership on any Board of Directors/Trustees where such membership might conflict
with the interests of the DMC or any of its operating units.
5) Questions regarding whether or not Board
participation might represent a conflict of interest should be discussed with
an employee's Senior Vice President, or designee.
e.
Any
proposed transaction involving a covered operating unit and an covered person,
or household member of a covered person, or any individual or entity associated
with an covered person or member of their household must have the prior written
approval of the DMC President/Chief Executive Officer and of the Board of
Trustees/Directors, or a duly
authorized committee of the covered operating unit(s).
f.
If a
conflict of interest situation arises and the Senior Vice President of the
covered operating unit cannot resolve it, it shall be referred to a DMC
Executive Vice President or the Vice President of Corporate Audit and
Compliance.
18. DMC Code of Conduct:
Each covered person will be provided with a copy of the DMC Code of
Conduct ("The Code"). Each
covered person will receive corporate compliance training and education. The provisions of the Code are to be read,
and adhered to, by each covered person.
Covered persons may contact the Corporate Audit and Compliance
Department for interpretation of any of the Code provisions. Each covered person shall acknowledge
receipt of the Code of Conduct, make a commitment to abide by the provisions of
the Code, and sign the "My Commitment" form, which is included in
this policy.
19. Policy
Violations: Covered persons have a duty to report any situation that violates
or may violate DMC policies and procedures, the Code of Conduct, or applicable
laws and regulations. Reports of such
violations or potential violations are to be reported to the covered person's
supervisor, Senior Vice President, or designee, or via the DMC Fraud and Ethics
Hotline.
a. Incidents of alleged policy violations will
be treated as follows:
1)
The
Corporate Audit and Compliance Department will determine whether interviews
and/or an investigation are necessary with respect to allegations of policy
violation. Investigations may be
assigned to one or more of the following departments: Corporate Audit and
Compliance, Security, Legal Affairs, and/or Human Resources.
2)
The
President of the covered operating unit will ensure that all data necessary to
conduct an investigation is made available for review. Subsequent interviews, of person(s)
determined to have knowledge or information relative to the investigation, will
be conducted with the consent and approval of the DMC department that conducted
the initial interviews and/or investigation.
3) Further investigation will be conducted if
advisable, based on the results of the interviews. Facts will be assembled and reviewed with the covered
person's Supervisor/Department Head, at the discretion of the DMC department
that initiated the investigation process and the Senior Vice President of the
covered operating unit. This group will
determine if any further action is necessary.
b. The investigation and resolution of suspected
policy violations must be given priority over other responsibilities of
management involved.
c.
In the
event that disciplinary action is required, such action will be administered in
accordance with the provisions of the progressive discipline policy/program of
the DMC.
d.
An
employee who disagrees with a decision pertaining to disciplinary action may
submit the matter for review in accordance with the employee grievance/problem
solving policy/program of the DMC.
20.
In any
provision of this policy, where the President or Executive of a covered
operating unit is the covered person, approvals/disclosures are to be secured
from, or made to, the Chairman of the Board of Trustees of the DMC and the
President/Chief Executive Officer of the DMC or designee.
ADMINISTRATIVE RESPONSIBILITY
The President/CEO has overall administrative
responsibility for this policy. The
Executive Vice President/COO and the Vice President, Corporate Audit and
Compliance, have overall operational responsibility for this policy. The Senior Administrator of each covered
operating unit has operational day-to-day responsibility for policy
administration and audit for policy compliance. Should an exception to the policy be required, individuals in the
positions designated below may make such exception. In instances where an exception to this policy has been made,
such exception is to be documented in writing and a copy filed with both the
Senior Administrator of the covered operating unit and the President/Chief
Executive Officer, or designate, of the DMC.
The DMC President/Chief Executive Officer will review all policy
exceptions and will consult with the appropriate Board Chairman to reassess the
organizational necessity of an exception when such an exception may be
considered to be inconsistent with the objective/purpose of this policy.
Authorization for policy exceptions:
·
The
DMC President/Chief Executive Officer; OR
·
Executive
Vice President/Chief Operating Officer in consultation with the Senior
Administrator of a covered unit under his/her direct supervision; OR
·
Presidents
in a covered operating unit, other than the DMC, in consultation with the
appropriate DMC Executive Vice President and with the concurrence of the
Chairman of the Board of Trustees.
Any decision or judgment to be exercised pursuant to
this policy shall be at the sole discretion of the management of the DMC and/or
its wholly owned operating units.
If any
provision(s) of this policy is, at any time during the life of this policy, in
conflict with any applicable valid state federal or local law, such
provision(s) shall continue in effect only to the extent permitted by such
law. If any provision(s) of this policy
is or becomes invalid or unenforceable, such invalidity or unenforceability
shall not affect or impair any other provision of this policy.
SUPERSEDES: February
29, 2004; February 14, 2000; September 9, 2004; January 1, 2007
Pharmacy
All pharmacy department areas containing medications will be locked at all times. Only pharmacy personnel and designated others shall have access to these areas. If the department does not have 24-hour pharmacy staffing, a policy and procedure will be in place to address medication needs when the pharmacy is closed. Procedures are in place in the event of an immediate threat.
Quality Assurance
The DMC is committed to continuous improvement, prevention of pollution and compliance with relevant environmental and quality regulations and other requirements. To support this commitment, the DMC has appointed Michelle Schreiber, MD as Senior Vice President for Corporate Quality that includes quality safety and environment.
Safety
All DMCUL employees and trainees shall complete the Net Learning modules and quizzes provided by the DMC on the intranet. If the employee does not have access to the intranet, the employee is to review the appropriate documents and take a written quiz. All DMCUL technical employees and trainees shall review the document and take the quiz on “Chemical Safety Measures, Spills and Disposal. All DMCUL technical employees and trainees are to review the documents and take the quiz on “Compressed Gas Cylinders” and “The OSHA Formaldehyde Standard” if applicable. All DMCUL employees and trainees that package regulated medical waste or sign the regulated medical waste manifests are to be trained in the DOT regulated medical waste regulations. All DMCUL employees and trainees are to view the VHS film “Fight or Flight”. The completion of the above safety programs is required for compliance with regulatory or accrediting agencies.
Scrubs
1. All personnel will manage scrub attire consistent with this policy, infection control standards, and regulatory and safety requirements.
2. Departments approved for hospital issued sea foam green scrub attire include Operating Room Services, Labor and Delivery, NICU, Hemodialysis units, Central Sterile Processing, Angiography and Cardiac Catheterization and other site designated areas.
3. If clothing becomes soiled with blood and/or body fluids while providing care, hospital issue scrub attire may be provided to other patient care providers for the remainder of their workday.
PROVISIONS
Departments Approved for Hospital Issue Scrubs
1.
Employees
in departments approved for wearing hospital provided scrub attire are provided
with a copy of this policy and are required to sign a responsibility memo. An original of the memo is retained in the
employee's personnel file and a copy provided to the employee as a Security
pass.
2.
Scrub
attire should be removed at the end of the day and/or shift and disposed of in
hospital soiled laundry hamper.
3.
Scrub
attire that becomes soiled with blood and body fluids is changed as soon as
possible.
4.
If
scrub attire is worn home, it must be with the written pre-authorization from
management. Upon request, the employee will provide Security with a copy of the
authorization.
Severe Weather
In the event of severe weather conditions, “Code Gray” will be handled according to the definitions and provisions listed in the DMC policy.
Smoking Policy
The DMC recognizes both the
health hazards associated with the inhalation of tobacco smoke by smokers and
non-smokers as well as its obligation to adhere to laws pertaining to smoking.
Therefore, the DMC prohibits the smoking of tobacco products of any kind in all
of its facilities in accordance with the State of Michigan Clean Indoor Air
Act.
The following provisions are consistent with the Human Resources Tier I policy and support its intent.
All staff members, including physicians, students, contracted employees and volunteers are expected to comply with the prohibitions within this policy and to actively enforce the policy with patients and visitors in a manner consistent with established hospitality guidelines. Visitors and contractors are expected to observe and cooperate with this policy and its provisions.
Worker’s Compensation
All workers compensation
claims are managed and processed according to the State of Michigan Workers
With Disabilities Compensation Act of 1982.
Section VII – Program Specific Policies:
Section VIII – Attachments:
1) 2009 Flexible Benefits Enrollment Guide
2) DMC 403B Plan Features & Highlights
3) DMC Long Term Disability Insurance for House Officers