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[CLE 115] Medical law & Ethics > Final Exam Review (Ch. 1-10) > Flashcards

Final Exam Review (Ch. 1-10) Flashcards

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1
Q

Ethics

A
  • Branch of philosophy related to morals, moral principles, and moral judgement
  • Morality is being virtuous: practicing right conduct
  • Uses reason and logic to analyze problems and find solutions
  • Concerned with actions and practices that improve welfare of people in a moral way
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2
Q

Utilitarianism

A
  • Utiliarianism is the greatest good for the greatest number
  • Impact of actions on welfare of society as a whole, rather than merely the individual
  • EX: Medicare
  • Weakness
    • The rights of some people, such as the poor or ill, may be ignored
    • Can be result in biased allocations
    • The vulnerable may be ignored
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3
Q

Utilitarianism Weakness

A
  • The rights of some people, such as the poor or ill, may be ignored
  • Can be result in biased allocations
  • The vulnerable may be ignored
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4
Q

Rights-based Ethics

A
  • Emphasis on individuals’ rights
  • Rights belong to all people
  • Weakness
    - May result in individualist, selfish behavior—even anarchy
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5
Q

Rights-based Ethics Weakness

A

May result in individualist, selfish behavior—even anarchy

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6
Q

Justice-based Ethics

A
  • Based on a “veil of ignorance” to allow decision-makers to be impartial in their decisions
  • Weaknesses
    - Unfair for the healthy to subsidize the unhealthy
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7
Q

Justice-based Ethics Weakness

A

Unfair for the healthy to subsidize the unhealthy

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8
Q

Duty-based Ethics

A
  • Focuses on performing duty
  • Explores depending on professional role
  • Weakness
    • Difficult to know who determines one’s duty
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9
Q

Duty-based Ethics Weakness

A
  • Difficult to know who determines one’s duty
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10
Q

Virtue-based Ethics

A
  • Emphasis on people, not decisions or principles involved
    • Based on character traits such as integrity
    • Virtues are good habits
      • EX: fairness, honesty, courage, and justice
    • Weakness
      • A person may become too trusting and complacent
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11
Q

Virtue-based Ethics Weakness

A

A person may become too trusting and complacent

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12
Q

Medical Ethics

A
  • Concerns issues related to practice of medicine
    • Explores and promotes principles guiding conduct of healthcare professionals
    • Involves the welfare and consideration of others in deciding how to act
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13
Q

Why Study Law, Ethics, and Bioethics?

A
  • Illegal is almost always unethical
    - EX: Although marches during the Civil Rights were illegal, they were certainly not unethical
    • Basic understanding of law as it applies to medical practice is essential
    • It helps to protect patients from poor medical care
    • Helps protect employee and employer from lawsuits
    • Assists medical professional in making decisions based on reason and logic rather than on just emotion
    • We live in a litigious society
      • unreasonably prone to go to law to settle disputes
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14
Q

Medical Law

A
  • Addresses legal rights and obligations that affect patients and protect individual rights, including rights of health care employees
    • Provides yardstick to measure of judge actions
    • Punishes unlawful actions
    • Laws are rules or actions prescribed by a government authority that have a binding legal force
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15
Q

Quality Assurance

A
  • Gather and evaluate information about services
    • Examine results
    • Compare information against a standard
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16
Q

Felony

A
  • Serious crime such as practicing medicine without a license
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17
Q

Misdemeanor

A
  • Less serious crime such as a traffic violation
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18
Q

Medical Practice Acts

A
  • Establish state medical boards
    • Provide baseline for practice of medicine
    • Determine prerequisites for licensure
    • Forbid practice of medicine without a licensure
    • Specify conditions for renewal, suspension, and revocation of licenses
    • Vary from state to state
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19
Q

Managed Care Organization (MCO)

A
  • Gatekeeper— Primary physician
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20
Q

Health Maintenance Organization (HMO)

A
  • Offers a wide range of services to members for a predetermined fee by a limited group of providers
    - Capitation rate
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21
Q

Preferred Provider Organization (PPO)

A
  • Patient must use a medical provider who is under contract with the insurer for an agreed-upon fee
    - Copayment
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22
Q

Exclusive Provider Organization (EPO)

A
  • Combines the concepts of HMO and PPO
    • Fee for service (FFS)
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23
Q

Types of Medical Practice

A
  • Solo Practice
    - Sole Partnership
    • Partnership
      • Share responsibility for financial and legal matters
    • Associate practice
      • Share facility, but not accounting or legal responsibility
    • Group practice
      • Three or more physicians
      • Share same facility
      • Practice medicine together
      • Can be designated as HMO or IPA
    • Professional corporations
      • Managed by board of directors
      • Shareholders
      • Protection of individual assets and liability
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24
Q

Solo Practice

A
  • Sole Partnership
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25
Q

Partnership

A
  • Share responsibility for financial and legal matters
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26
Q

Associate practice

A
  • Share facility, but not accounting or legal responsibility
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27
Q

Group practice

A
  • Three or more physicians
    • Share same facility
    • Practice medicine together
    • Can be designated as HMO or IPA
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28
Q

Professional corporations

A
  • Managed by board of directors
    • Shareholders
    • Protection of individual assets and liability
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29
Q

Fee splitting

A
  • One physician offers to pay another for referral (unethical and illegal)
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30
Q

Franchise

A
  • Business run by individual to whom franchisor grants exclusive right to market product or service in certain market area (ethical)
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31
Q

Franchisees

A
  • Persons or companies that hold a franchise
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32
Q

Physician’s Rights

A
  • Right to select patients
    • Right to refuse service to patients
    • Right to determine type of services provided
    • Right to be paid for services rendered
    • Right to withdraw from relationship
    • Right to vacation and time off
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33
Q

Physician’s Responsibilities

A
  • Be professionally competent
    • Treat all patients equally
    • Not to take “kickbacks” of money or other benefits in exchange for referrals
    • Follow AMA code of ethics
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34
Q

Physicians’ Duties

A
  • Patient welfare above financial interests
    • Professional courtesy
    • Report any unethical conduct by other physicians
    • Recommend second opinions when necessary
    • Do not engage in sexual conduct with a patient during the physician-patient relationship
    • Do not treat family members except in emergencies
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35
Q

Duty to Treat Patients with AIDS

A
  • Unethical to refuse to treat, work with, or provide housing for person who is HIV positive or has AIDS
  • Physician, by law, must make full report to state about any patient who is HIV positive or has AIDS
    • Ethical dilemma
    • Report required regardless of consequence
  • Ethical considerations
    • Persuade patient to inform his or her partner
    • Notify authorities if concerned that patient will not inform others
    • As last resort, notify patients partner
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36
Q

Minor

A
  • Person under the age of maturity (18 is most states)
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37
Q

In loco parentis

A
  • Person assigned by court to stand in place of parents
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38
Q

Parents patriae

A
  • State takes over care for minor
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39
Q

Mature minor

A
  • Person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent
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40
Q

Emancipated minor

A
  • Person in mid to late teens who legally lives outside parents’ or guardian’s control
    • Proof should be included in medical record
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41
Q

Duty to Treat Indigent Patients

A
  • “Dumping crisis”
    - EMTALA
    - Require patient stabilization in an emergency
    • Physician has right to select which patients to treat
    • Physician does not have right to drop or abandon patients once treatment is agreed upon
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42
Q

Professional Negligence and Medical Malpractice

A
  • Professional misconduct or demonstration of an unreasonable lack of skill with the result of injury, loss, or damage to the patient
    • Negligence
      • Unintentional action that occurs when a person performs or fails to perform an action that a reasonable person would or would not have committed in a similar situation
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43
Q

Feasance:

A

Performing an act or duty

44
Q

Malfeasance

A
  • Performing a wrong or illegal act
45
Q

Misfeasance

A
  • Improperly performing on otherwise proper or lawful act
46
Q

Nonfeasance

A
  • Failure to perform a necessary action
47
Q

Four D’s of Negligence

A
  • Duty
    - Responsibility established by physician-patient relationship
    • Dereliction
      • Neglect of duty
    • Direct to proximate cause
      • Continuous sequence of events, unbroken by an intervening cause, that produced injury and without which injury would not have occurred
    • Damages
      • Injuries caused by the defendant
48
Q

Duty

A
  • Responsibility established by physician-patient relationship
49
Q

Dereliction

A
  • Neglect of duty
50
Q

Direct to proximate cause

A
  • Continuous sequence of events, unbroken by an intervening cause, that produced injury and without which injury would not have occurred
51
Q

Damages

A
  • Injuries caused by the defendant
52
Q

Affirmative defense

A
  • Denial, assumption of risk, contributory negligence, comparative negligence, borrowed servant, statute of limitations, and res judicata
    • Allows defendant to present evidence that patient’s condition was the result of factors other than negligence
53
Q

Denial defense

A
  • Plaintiff must prove defendant did wrongful or negligent act
    • Most common defense
    • Jury must determine if defendant caused injury
    • May bring in expert witness
54
Q

Assumption of risk

A
  • Prevents plaintiff from recovering damages if plaintiff voluntarily accepts a risk associated with the activity
    • Plaintiff must know and understand risk involved, and choice to accept risk must be voluntary
    • Should have signature to document that patient authorizes procedure, understands the risks, and consents to treatment
55
Q

Public Health Records and Vital Statistics

A
  • Important events in person’s life
    • Used by government to determine population trends and needs
    • Mortality rate: Death rate ratio of the number of deaths to population in a given location
    • Morbidity rate- The number of sick people or cases of ds. in relationship to a specific population
    • Public duty of physicians to report vital events
56
Q

Birth

A
  • Physicians must sign certificate of live birth
    • Certificate is filed at county clerk’s office in state birth took place
57
Q

Death

A
  • Date and time of death
    • Cause of death
    • How long deceased was treated before dying
    • Presence of absence of pregnancy
    • Whether autopsy took place
    • Death certificate
      • Usually must be signed within 24 to 72 hours of death
      • Proof that a death has occurred
      • Often required to confirm information
        • Settling an estate
58
Q

Coroner

A
  • Public health officer holds inquest if death from unknown or violent cause
59
Q

Medical examiner

A
  • Physician (Pathologist) who investigates unexplained deaths and can perform autopsy
60
Q

Autopsy

A
  • Examination after death to determine cause of death by examining the organs and tissue
61
Q

Certain deaths require a coroner’s signature:

A
  • No physician present at time of death
    • Violent in nature
      • Homicide, suicide, accident
    • Death as result of criminal action
    • An unlawful death
      • Assisted suicide
    • Result of undetermined causes
    • Caused by electrical, radiation, or chemical injury
    • Caused by criminal abortion
      • Includes self-induced
    • Occurring less than 24 hours after hospital admission
    • Of a person who had no physician in attendance within 36 hours of death
    • Occuring outside a hospital or licensed health care facility
    • Suspicious death
      • Fall
    • Of a person whose body is not claimed by friend or relative
    • Of a person of unknown identity
    • Of a child underage of two if death is from unknown cause
    • Of a person in jail or prison
62
Q

Duty to Report AIDS, HIV, and ARC Cases

A
  • All states require reports of these cases to local or state department of health
    • Who shall report the case varies from state to state (attending physician, laboratory, etc.)
    • Many states have confidentiality statutes
63
Q

Disclosure to Patients of Health Workers’ HIV Status

A
  • Health care workers consider disclosure an invasion of privacy
    • All blood and tissue donors tested
    • Patients have desire to know if they are at risk of HIV infection
64
Q

Child Abuse

A
  • Child Abuse Prevention and Treatment Act: Requires reporting of all child abuse cases
    • All abuse must be reported by teachers, health professionals, law enforcement and day care personnel, and social service workers
      • Probable cause: A reasonable belief that something improper has happened
    • Physicians have been held liable for not reporting cases
    • Persons reporting is protected by law from being sued by parents and others
    • Battered child syndrome— Describes a series of injuries, fractures, bruises, and burns. Signs of neglect, malnutrition, poor growth, poor hygiene
    • Parental neglect
      • States generally refrain from involvement
      • State may have to intervene when a child is not receiving proper medical care
65
Q

Elder Abuse

A
  • Older American Act (1987)
    • Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older
    • Protects residents of nursing home facilities
    • Protects against financial abuse or exploitation
66
Q

Spousal Abuse

A
  • Laws governing the reporting vary by state
    • Local police may have to become involved when spousal abuse is suspected
    • Court may issue restraining or protective order prohibiting abuser from contact with victim
67
Q

Signs of Abuse

A
  • Repeated injuries
    • Bruises and unexplained swelling
    • Signs of inadequate nutrition
    • Unexplained fractures
    • Bite marks
    • Unusual marks
    • Bruising or swelling in genital area
    • Venereal disease and genital abrasions
    • Makeup to hide bruises
    • Sunglasses worn inside to hide blackened eyes
68
Q

Substance Abuse

A
  • Abuse of prescription drugs is reportable immediately according to law
    • Violation of controlled substances laws is a criminal offense
69
Q

Food and Drug Administration (FDA):

A

An agency within the Department of Health and Human Services that ultimately oversees and enforces laws regarding drug sales and distribution

70
Q

Controlled Substances Act of 1970:

A

A federal statute that regulates the manufacture and distribution of drugs that are capable of causing dependency

71
Q

Medical examiner:

A

A physician, usually a pathologist, who can investigate an unexplained death and perform autopsies

72
Q

Cultural Considerations

A
  • Background and experience heavily influence personal beliefs
    • Stereotyping: Negative generalities concerning specific characteristics about a group are applied to an entire population
    • Bias: Unfair dislike or preference against someone, can prevent a health care professional from making an impartial judgement
    • Do not judge a person
    • Different cultures have their own practices for personal hygiene
    • Ethnocentric people: Tend to believe that their way of viewing and experiencing the world is superior to other’s views
    • Communication can be a challenge for many people who do not understand English
    • Non-English-speaking patients need brochures and handouts in their own language
    • Cultural restrictions can pose difficult situations
73
Q

Religious Considerations

A
  • Patient autonomy
    • Conditions can result in confusion for the medical professional
    • Guardianship may have to be established
    • It is never appropriate to judge another person’s customs or beliefs
    • Employer has a legal obligation to accommodate religious practices
74
Q

Equal Employment Opportunity and Employment Discrimination

A
  • Laws that affect recruitment, placement, pay plans, benefits, penalties, and termination
    • People must be judged primarily by job performance
75
Q

Employment-At-Will Concept

A
  • Employment-at-will: The employment takes place at either the will of the employer or the employee
    • Employment takes place at will of either employer or employee
    • Employment may be terminated at will at any time for no reason
    • Employee may quit at any time
    • Exception for a specific employment contract in which employment cannot be terminated during contract period
76
Q

Equal Credit Opportunity Act:

A

Prohibits businesses (including hospitals) from denying or granting credit based on race and gender, referred to as discrimination

77
Q

Equal Employment Opportunity Act (EEOA):

A

Authorizes the EEOC to sue employers in federal court on behalf of people whose rights have been violated under Title VII

78
Q

Title VII of the Civil Rights Act of 1964

A
  • Prohibits discrimination, or unfair treatment based on race, color, religion, gender, or national origin
    • Forbids discrimination in all aspects of patient care in institutions that receive federal financial assistance
    • Makes sexual harassment a form of unlawful sex discrimination
    • Equal Employment Opportunity Commission (EEOC)
      • Equal Employment Opportunity Commision (EEOC): The group that monitors Title VII of the Civil Rights Act
      • Sexual harassment is a form of unlawful sex discrimination
      • Quid pro quo: Something for something (Ex: Sexual favor in exchange for job advancement)
    • Affirmative action programs: To remedy discrimination practices in hiring minority group members. Also covered under Title VII
79
Q

Age Discrimination in Employment Act (ADEA):

A
  • Protects persons forty years or older against employment discrimination because of age
  • Protects persons 40 and older against discrimination
  • Applies to employers with 20 or more employees
  • Mandatory retirement prohibited except for certain exempt executives
80
Q

Americans with Disabilities Act (ADA):

A
  • Prohibits employers who have more than fifteen employees from discriminating against disabled individuals
  • Americans with Disabilities Act of 2008 (ADAAA): Broadened and clarified the definition of “disability”
  • Americans with Disabilities Act (ADA) of 1990, Amended in 2008
    • Prohibits employers who have more than 15 employees from discriminating against individual with disability
    • Employer must make reasonable accommodations
    • Exception if undue hardship for employer to make accommodations
    • AIDS patients protected under this statute
81
Q

National Labor Relations Act (NLRA):

A
  • Prohibits employer actions, such as attempting to force employees to stay out of unions, and labels these actions as “unfair labor practices.”
  • National Labor Relations Act (NLRA) of 1935, Amended in 1947
    • Gives employees right to form and join unions, to bargain collectively, and to strike for better benefits and working conditions
    • Purpose of law is to protect employees
  • National Labor Relations Act (NLRA) of 1935
    • Establishes rights for both employees and employers, and defines some prohibitive acts by employers, called unfair labor practices
    • Also called the Wagner Act
82
Q

Occupational Safety and Health Act (OSHA):

A
  • Requires an employer to provide a safe and healthy work environment; the employer must protect the worker against hazards
  • Occupational Safety and Health Act (OSHA) of 1970
    • Employer required by law to provide safe and healthy work environment
    • Must protect worker against hazards
    • Occupational Exposure to Bloodborne Pathogens Standards
    • Standards refer to urine, stool, sputum, nasal secretions, vomitus, and sweat if there is visible evidence of blood
83
Q

Health Maintenance Organization (HMO) Act of 1973, Amended in 1996

A
  • Requires company with 25 or more employees to provide HMO alternative to regular group insurance if HMO is available in area
    • Under HMO, patient has limited choice of doctors
    • Patient may have to get a second opinion and permission from HMO for major procedures
84
Q

Consolidated Omnibus Budget Reconciliation Act (COBRA):

A
  • Offers government financing for health insurance coverage continuation after an employee has been laid off their job
    • Company with 25 or more employees must provide extended health care insurance to terminated employees for as long as 18 months
    • Usually at employee’s expense
85
Q

Equal Pay Act:

A
  • Makes it illegal for an employer to discriminate on the basis of gender in payment to men and woman who are performing the same job
  • Equal Pay Act of 1963
    • Amendment to Fair Labor Standards Act (FLSA)
    • Illegal for employer to discriminate on basis of gender if performing same job
86
Q

Worker’s Compensation Act

A
  • Protects workers and families from financial problems resulting from employment-related injury, disease, or death
    • Employers pay into a fund to help cover costs when employee has work-related injury or disease
    • Goal to get employee back to work as soon as possible
87
Q

Medical record:

A
  • All the written and computer generated documentation relating to a patient
    - Also called the health record
    - All written documentation relating to patient, including:
    - Past history
    - Current diagnosis and treatment
    - Correspondence relating to patient
    - A legal document
    - May be subpoenaed
88
Q

Purpose of the Medical Record

A
  • Record of patient from birth to death
    • Document for continual management of patient’s health
      care
    • Provides data and statistics
    • Tracks ongoing patterns of patient’s health
89
Q

Contents of the Medical Record

A
  • Personal information about patient
    • Clinical data or information
      • Records of medical examinations
      • X-rays
      • Lab reports
      • Consent forms
      • Referrals: PT/OT
      • Prescriptions and refills
      • Admitting diagnosis
      • Evidence of a physician examination
        • Not more than seven days before admission or 48
          hours after admission to a hospital
      • Documentation of any complications
      • Signed consent forms
      • Consultation reports
      • Physicians’ and health care professionals’ notes
      • Discharge summary, with follow-up care
      • Should never contain irrelevant material
90
Q

Corrections and Alterations

A
  • Errors require correction
    • Nothing should be deleted
      • Note in the margin of the record why the change was
        made
      • Use black or blue ink
      • Draw one line through error
      • Write correction above error
      • Date and initial change
      • Do not erase or use correction fluid
    • Electronic health record (EHR) corrections
    • Falsification of medical records is grounds for criminal indictment
91
Q

Timeliness of Documentation

A
  • Medical records must be accurate and timely
    • All entries must be made as care occurs or as soon as
      possible afterward
    • Should be completed by physician within 30 days following patient’s discharge from hospital
92
Q

Completeness of Entries

A
  • Medical records document type and amount of patient care that was given
    • In eyes of court, “if it’s not documented, it wasn’t done”
93
Q

Reporting and Disclosure

A
  • State laws require disclosure of some confidential medical record information without patient’s consent
    • Reporting and disclosure are duties of the physician
94
Q

Improper Disclosure

A
  • Health care providers and institutions may face civil and criminal liability for releasing medical records without proper patient authorization
95
Q

Subpoena Duces Tecum

A
  • Written order requiring person to appear in court, give testimony, and bring information described in subpoena
96
Q

Electronic medical record (EMR):

A

Fully computerized method of record-keeping

97
Q

Corrections and Alterations

A
  • Errors require correction
    • Nothing should be deleted
      • Note in the margin of the record why the change was
        made
      • Use black or blue ink
      • Draw one line through error
      • Write correction above error
      • Date and initial change
      • Do not erase or use correction fluid
    • Electronic health record (EHR) corrections
    • Falsification of medical records is grounds for criminal indictment
98
Q

HIPAA’s Five Titles

A
  • Title I: Protects health insurance coverage for workers and their families when they change or lose their jobs
    • Title II: Known as the Administrative Simplification provisions
      • Requires national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
    • Title III: Sets guidelines for pre-tax medical spending accounts
    • Title IV: Sets guidelines for group health plans
    • Title V: Governs company-owned life insurance policies
99
Q

Who is affected by HIPPA

A
  • Public health authorities
    - Health care clearinghouses
    - Self-insured employers
    - Private insurers
    - Information systems vendors
    - Various service organizations
    - Universities
    - Health care plans
    - Treatment, payment, and health care operations (TPO)
100
Q

Protected health information (PHI):

A

Any individually identifiable information that relates to the physical or mental condition or the provision of healthcare to an individual

101
Q

Can Protected Health Information (PHI) Be Deidentified?

A
  • To “deidentify” patient information, remove:
    - Patient’s name
    - Address, including e-mail
    - Telephone and fax numbers
    - All dates, including birth (except year), admission, discharge, and death
    - Social security number
    - Medical records numbers
    - Health care insurance numbers
    - License numbers
    - Facial photos
    - Other identifying numbers or characteristics
    - E-mail and website address
    - Motor vehicle registration numbers
    - Facial photographs, such as found on driver’s license
102
Q

Title I:

A

Protects health insurance coverage for workers and their families when they change or lose their jobs

103
Q

Title II:

A

Known as the Administrative Simplification provisions
- Requires national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers

104
Q

Title III:

A

Sets guidelines for pre-tax medical spending accounts

105
Q

Title IV:

A

Sets guidelines for group health plans

106
Q

Title V:

A

Governs company-owned life insurance policy

[CLE 115] Medical law & Ethics (12 decks)

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