Ch. 21 Ethical/Legal

Question 1

What 4 things are grounds for denial of license and basis for revocation, sanction, and discipline of established license holders?

Answer 1

1. Fraudulent application statements
2. Conviction of a felony
3. Suspension or reduction of hospital privileges
4. Unprofessional or immoral conduct

Question 2

What two components are required for billing?

Answer 2

1. CPT® (Current Procedural Terminology) - the “how” you did something
2. International Classification of Diseases (ICD) codes - the “why” you did something

Question 3

What were the four main components of the Health Insurance Portability and Accountability Act (HIPAA) of 1996?

Answer 3

■ Improve portability and continuity of health insurance coverage.
■ Protect confidential protected health information (PHI).
■ Standardize health information transfers.
■ Require identification numbers for providers, health plans, and employers.

Question 4

What is considered PHI?

Answer 4

includes (but is not limited to)
name, postal address, telephone numbers, e-mail addresses, social security
numbers, medical record numbers, health plan beneficiary numbers, vehicle
identifiers, driver’s licenses, and biometric identifiers such as facial photographs
and fingerprints

Question 5

The Secretary of Health and Human Services imposes civil monetary penalties for violation of any HIPAA requirement, up to $______ per violation.

Answer 5

$50,000

Question 6

What do you call the ethical principle that recognizes a person’s right to make health care decisions?

Answer 6

Autonomy

Question 7

What do you call the ethics principal of acting for the good of the patient?

Answer 7

Beneficence

Question 8

The presumption that information disclosed to the physician will not be revealed to any other person or institution without the
patient’s permission

Answer 8

Confidentiality

Question 9

What does “primum non nocere” mean?

Answer 9

“first, do no harm” aka concept of nonmaleficence

Question 10

What do you call the concept of Acting to
prevent harm and not cause harm?

Answer 10

Nonmaleficence

Question 11

Acting according to one’s own values and moral standards

Answer 11

Personal integrity

Question 12

Acting to provide medical care fairly regarding resources, patient
rights, and legal restrictions

Answer 12

justice

Question 13

What does The Emergency Exception Doctrine define?

Answer 13

the three conditions in which an emergency physician may treat a patient without consent

Question 14

What does the Emergency Exception Doctrine state?

Answer 14

Emergency physicians may treat the patient without consent only if all of the three following conditions are met:
1. The patient is unable to express his or her wishes.
2. The patient has a condition that demands immediate attention.
3. No family or other substitute decision maker is immediately available to consent.

Question 15

What are the 4 components of Decision-making capacity?

Answer 15

the patient be able to:
■ Take in what the physicians are saying.
■ Appreciate his or her medical condition and its consequences.
■ Communicate a choice.
■ Reason about treatment choices (eg, give a reason for choices).

Question 16

Who is considered an emancipated minor?

Answer 16

■ Minors who are legally married or have dependent children
■ Minors living independently and supporting themselves
■ Those with court-approved independence from their parents or guardians
■ Minors serving the US Armed Forces

Question 17

Which 3 categories provide exceptions to the requirement for minors to have parental consent?

Answer 17

■ Reproductive issues (including pregnancy and contraceptives)
■ Communicable diseases
■ Drug abuse

Question 18

Patients who refuse treatment or leave against medical advice should have
which four thing documented in the medical record?

Answer 18

■ Decisional capacity to refuse treatment
■ Understanding of the risks of refusing treatment and explanation of alternative
treatment, if any
■ Discharge instructions
■ Follow-up care options

Question 19

What legal Act mandates that unstable patients cannot be discharged or transferred except for medical necessity?

Answer 19

EMTALA

Question 20

When does a hospital’s EMTALA obligation end?

Answer 20

with hospital admission

Question 21

What is considered an “Emergency Medical Condition” (EMC)?

Answer 21

One in which:
■ A delay in treatment would cause loss of body functions or impairment to
organs or limbs.
■ A pregnant woman is contracting and there isn’t time to transfer her before
she delivers, or the transfer may pose a threat to mother or child. In reality,
if a woman is in active labor in the ED, she should deliver in that hospital.

Question 22

Who can perform an MSE?

Answer 22

Can be performed by anyone the hospital designates as its standard of practice; in practice, this is usually the physician, but the task can be delegated, eg, to a nurse, physician assistant, etc. For example, a nurse on labor and delivery can be delegated this responsibility

Question 23

What elements make up an “appropriate” transfer?

Answer 23

■ The transferring hospital must do all it can to minimize the risks of transfer.
■ The receiving hospital has available space and personnel (capability and
capacity) and has agreed to take the case.
■ The transferring hospital sends copies of records, including the name and
address of any on-call physician who has refused or failed to appear within
a reasonable time to help stabilize the patient.
■ The transfer must use qualified personnel and equipment.
■ Medical records must be maintained by the hospital for a period of 5 years
from the date of transfer.

Question 24

How long does a facility accepting a transfer have to report transfer violations?

Answer 24

72 hours

Question 25

Who enforces EMTALA?

Answer 25

Office of the Inspector General

Question 26

What are the 3 civil penalties for EMTALA violations?

Answer 26

■ A hospital that negligently violates an EMTALA requirement may have to
pay up to $50,000 per violation.
■ The responsible EP and the on-call physician who negligently violate may
also have to pay up to $50,000 per violation. Civil monetary penalties
such as EMTALA are not covered by malpractice insurance.
■ Violation may result in loss of Medicare/Medicaid billing privileges for the
hospital

Question 27

What are the four main elements of malpractice?

Answer 27

1. Duty - defendant had a duty to the plaintiff
2. Breach of duty
3. Damages
4. Causation - that the breach in duty led to the damages

Question 28

In a malpractice suit, what is the standard against which a defendant physician is
judged?

Answer 28

“How would a reasonable emergency physician have performed in the same or similar circumstances?”

Question 29

What types of damages can be awarded in a malpractice suit?

Answer 29

■ Economic damages: Lost income and medical bills
■ Noneconomic damages: Pain and suffering compensation

PLUS
punitive damages
- which can be awarded if the jury feels that the conduct of the defendant was particularly loathsome and unprofessional

Question 30

What are the two types of medical malpractice insurance policies?

Answer 30

1. Occurrence
2. Claims made

Question 31

Which type of medical malpractice insurance provides Coverage for events which occur during the life of the policy,
no matter when the allegation is eventually initiated?

Answer 31

Occurrence insurance policies

Question 32

Which type of medical malpractice insurance provides Coverage only if there is a claim made (or, sometimes, a report of an incident) during the coverage period of that policy or renewal of that policy?

Answer 32

Claims made insurance policies

Question 33

What is Right to approve settlement?

Answer 33

A defendant can ask that the insurer offer policy limits to any plaintiff, but most policies today do not provide for any control
by the physician or group policyholders. Insurers want to be able to make
economic choices about the terms and conditions of a settlement, free of the
visceral and professional concerns driving physician defendants.

Question 34

What is security of coverage?

Answer 34

Domestic insurers are inspected and regulated by state insurance commissioners. Offshore companies can be less secure. Some hospitals insist that staff and contract physicians and physician groups carry US insurance and usually at required minimum amounts.

Question 35

Which communicable and infectious diseases are typically reportable to the state?

Answer 35

■ Sexually transmitted infections, including HIV
■ Community outbreaks, eg, food poisoning
■ Illnesses related to foreign travel, eg, malaria
■ Suspected biological terrorist threats, eg, anthrax

Question 36

What type of relationship must exist for there to be elder abuse?

Answer 36

the abuser must be in a “trust relationship” with the patient, meaning that the patient relies on the abuser for services.