CPCS Certification Test - Legal Cases

Question 1

Ophthalmologist did not disclose all prior hospital affiliations on application. Hospitals summary suspension upheld. Key: Failure to disclose

Answer 1

Oskooi V. Fountain Valley Regional Hospital

Question 2

Physician refused to authorize ROI from prior hospital. New hospital denied application. Court held for hospital. Key: Duty to credential reasonable app requirements. Burden of Proof

Answer 2

Webman V. Little Company of Mary Hospital

Question 3

Physician taken off call panel for failing to accept a patient. Board overturned hearing committee’s recommendation to reinstate. Call panel membership due to lack of substantial evidence. Key: Governing body is the ultimate authority

Answer 3

Hongsathavij V. Queen of the Angels Hollywood Presbyterian Hospital

Question 4

Hospital can revoke otherwise competent physicians privileges when physicians disruptive behavior may adversely affect patient care. Key: Disruptive Behavior

Answer 4

Mahmoodian V. United Hospital Center

Question 5

Committee including competitors found substandard care. Outside consultant agreed. Surgeon challenged summary judgement. HCQIA presumption of good faith upheld. Key: HCQIA burden on physician to prove bad faith review.

Answer 5

Matthews V. Lancaster General Hospital

Question 6

Hospital liable for physicians actions due to failure to request data from other hospital regarding basis for summary suspension. No deficiencies had occurred at Sharp Cabrillo. Key: Negligence in reappt. Negligent Credentialing

Answer 6

Bell V. Sharp Cabrillo Hospital

Question 7

Physicians conducted peer review for anti – competitive reasons. Liable for violating federal anti–trust laws. Key: Anti–competitive peer review. HCQIA. Violations of federal anti–trust laws.

Answer 7

Patrick V. Burget

Question 8

IPA–type HMO advertised as providing medical care. Held liable for member MD’s negligence. Key: Ostensible agency. MCO liable for practitioner’s action

Answer 8

Boyd V. Albert Einstein Medical Center

Question 9

Hospital liable for negligent treatment resulting in amputation of a teenager’s leg. Nurses failed to monitor. A physician failed to consult. Hospital claimed Charitable Immunity Doctrine limited damage to its insurance. Key: Fail to provide proper supervision

Answer 9

Darling V. Charleston Memorial Community Hospital

Question 10

MCO liable provider’s action. Key: Duty to select and monitor patients. Negligent credentialing. Ostensible agency.

Answer 10

McClellan V. Health Maintenance Organizations of PA

Question 11

Patient consulted a pcp who referred her to urological surgeon. Ruled in 1989 that an HMO owes a duty to the pt. to conduct a reasonable investigation of a physician’s credentials and reputation in the community. State law granted immunity to non–profit plans. MCO not liable for negligent credentialing. Key: Negligent credentialing. Failure to credential.

Answer 11

Harrell V. Total Health Care

Question 12

Denial of application based on inability to work w/ others, no quality care problems. Key: Disruptive behavior must be pt. care related.

Answer 12

Miller V. Eisenhower Medical Center

Question 13

MD brought anti–trust suit when denied privileges. Hospital denied privs due to a lack of OR space, unfavorable recommendation, failure to be published in 7 other staffs & because he was not likely to contribute to hospital’s teaching program. Key: Hospitals may determine proper limit on company. Must adhere to bylaws. Denial is not a restraint of trade.

Answer 13

Robinson V. Mgovern

Question 14

Hospital liable for DPM negligence due to failing to obtain malpractice claims data. Although the medical records dept. was aware of claims. Key: negligent credentialing

Answer 14

Elam V. College Park Hospital

Question 15

Hospital liable to pt. injured by physician who failed to disclose pending malpractice cases. Lied about privs at other hospitals. The hospital should have verified information. Key: Negligent credentialing Failure of initial credentialing process.

Answer 15

Johnson V. Misericorida Community Hospital

Question 16

Hospital denied privs to MD after receiving reports from other hospitals on termination/restriction of privileges, substandard work & emotional instability. Key: Disruptive behavior. Personality may be considered if it affects ability to practice or hospital operations.

Answer 16

Rao V. Auburn General Hospital

Question 17

Hospital granted privs to Anesthesiologist whose negligence severely injured a pt. Resulting in a suit against hospital physicians previous employer and the hospital he worked for failed to disclose his history of drug abuse & performance issues. Court found that letters from employer false & found liable. Court originally held previous employer liable but later dropped stating not misleading & didn’t have duty to disclose its investigation or knowledge of drugs.

Answer 17

Kadlec V. Lakeview Anesthesia Associates & Lakeview Medical Center

Question 18

Pt. alleged that Podiatrist was negligent performing bunionectomy on an ulcerated foot resulted in amputation of the foot. DPM did not meet criteria for levell II surgical privs but was granted them. No grandfathering acceptable. Pt. claimed hospital’s breach of duty caused her amputation. Jury agreed and awarded $7.75 million. Key: Doctrine of corporate negligence. Negligent credentialing. Breach of duty.

Answer 18

Frigo V. Silver Cross Hospital