Final Review Slides Flashcards
3 branches of government
Legislative branch
Executive branch
Judicial branch
Lawmaking body
Legislative branch
Congress
Creates rules (more specific laws) to enforce the law
President
Executive branch
Interpret law
Supreme court
Judicial branch
Legal cases for violation of the law are brought and heard in
State and federal trial courts
Outcomes of state and federal trials are known as ___ and documented as ___
Rulings
Judicial opinions
Judicial opinions are
Interpretation of the law
Explanation given by a judge for the reasoning and president of a court’s decision
Judicial opinions
Courts apply general principles of law (statutes or common law) to specific situations brought before the court which in effect
Interpret the law through their decisions
___ have the force of law in that jurisdiction
Opinions
Traditional principles of law not typically written in statues
Common law
Common law examples
Tort law
Contract law
Highest court in the federal system
Supreme court
Nine justices meeting in washington DC
Supreme court
Appeals jurisdiction through certiorari process
Supreme court
Limited original jurisdiction over some cases
Supreme court
Intermediate level in the federal system
Courts of appeal
12 regional circuit courts, including DC circuit
Court of appeal
No original jurisdiction; strictly appellate
Court of appeals
Lowest level in the federal system
District courts
94 judicial districts in 50 states and territories
District courts
No appellate jurisdiciton
District courts
Original jurisdiction over most cases
District courts
Wrongful act committed against another person or property, resulting in harm
Elements of a tort
The plaintiff must suffer a mental or physical injury caused by the defendant
Harm
This harm to the plaintiff must be caused by the wrongful act of the defendant
Causation
Person intentionally or deliberately injured by another
Intentional torts
Unlawful touching of another
Battery
Lacking consent
Battery
Forcing a patient to do anything against their wishes or without their knowledge
Battery
Still taken place due to the invasion of the patient’s right to provide consent and in the interest of the patient’s right to be free from anxiety and humiliation that it took place
Battery
Threat of bodily harm to another
Does not have to be actual touch
Assault
Patient agrees to the proposed course of treatment after having been told about the possible consequences of having or not having certain procedures and treatment
Informed/expressed consent
Indicates that the patient understands the limits or risks involved in the pending treatment
Signature
Goals of informed/expressed consent
Protect patient’s rights to decide for themselves about their own treatment
Disclose information to the patient so that they can make a reasoned decision
Mohr v Williams
Informed/expressed consent
The unauthorized publicity of information about a patient
Invasion of privacy
Inherent duty to maintain patient confidentiality
Invasion of privacy
Estate of Berhiaume v Pratt
Invasion of privacy
Violation of the personal liability of another person through unlawful restraint
False imprisonment
Takes action to confine a patient
False imprisonment
Patient not allowed to leave a room or building and had no reasonable means of escape
False imprisonment
Deliberate concealment of facts from another person for unlawful or unfair gain
Fraud
Illegal billing for services that may or may not have rendered
Fraud
Dishonesty when conducting medical research
Fraud
Illegal sale of drugs
Fraud
Negligence by a healthcare professional is considered to be
Malpractice
Unintentional tort
Negligence - malpractice
Person performs or fails to perform an action that a reasonable professional person would or would not have performed in a similar situation
Negligence malpractice
Both action and inaction (omissions) can be considered
Negligence
Every mistake or error is NOT
Malpractice
When a treatment or diagnosis does not turn out well, the provider is not necessarily
Negligent
4 elements of negligence
Provider owes a duty of care
Breach in the applicable standard for carrying out duty
A compensable injury was the proximate cause of the breach of duty
Compensable damages or injury to the patient
Responsibility established by the provider-patient relationship
Duty
The obligations the provider has to the patient
Duty
Patient/plaintiff has to prove that a relationship has been established
Duty
Duty is assessed based on the
Reasonable person standard
Chiropractors and other healthcare professionals must act within the ___ appropriate for their profession, with attention to their special field or their particular level of practice
Standard of care
All providers are held to the same
Standard of care in their field of practice
The test for standard of care is
Reasonable person standard
Continuous sequence of events, unbroken by any intervening cause that produces an injury and without which the injury would not have occurred
Direct or proximate cause
The injury was proximately or closely related to the provider/defendant’s negligence
Direct or proximate cause
There was no intervening forces between the defendant’s action and the plaintiff’s patient injury
Direct or proximate cause
The last negligent act that contributed to a patient’s injury, without which the injury would have resulted
Direct or proximate cause
The thing speaks for itself
Res ipsa loquitur
Breach is so obvious that it does not need further explanation
Res ipsa loquitur
Injury would not have occurred wihout the negligence of someone
Res ipsa loquitur
Injuries caused by the defendant
Damages
Plaintiff seeks recovery/compensation for damages
Permanent physical disability Permanent mental disability Loss of enjoyment of life Personal injuries Past and future loss of earnings Medical and hospital expenses Pain and suffering
Defendant present evidence that the patient’s condition was the result of factors other than the defendants negligence
Affirmative defense
Undesirable side effects; informed consent documents
Assumption of risk
Patient was fully or in par at fault for the injury; plaintiff will recover nothing
Contributory negligence
Plaintiff can recover based on the percent of the damage caused by the defendant
Comparative negligence
Limits the time frame for a lawsuit to be filed
Statute of limitations
Exception to statute of limitations - rule of discovery
Statutes does not begin to run until the injury is discovered
Professional liability
Conditions of the premises
Respondeat superior
Exercise the standard of care of any other business owner
Conditions of the premises - professional liability
Conditions of the premises examples
Broken steps
Malfunctioning elevators or doors
Defective carpets
Safety
Employer is liable for the consequences of the employee’s action committed in the scope of employment
Respondeat superior
Does not necessarily require wrong directly by employer
Respondeat superior
A legal entity that requires no state filing to create it
Sole proprietorship
Simply one person operating a business for profit
Sole proprietorship
Person has unlimited personal liability for the business
Can have employees
Sole proprietorship
Individual ownership is the simplest and most basic business structure and appeals to a person who wants to be independent and free from the laws that govern other legal entities
Sole proprietorship
Two or more people who combine their work, money, and talents to achieve a common goal
Partnership
Many states require a document or registration that serves as notice to the public notice an announcement that the ____ members are doing business together
Partnership
In conducting the affairs of a partnership
All partners are bound by the acts of others
Legal entity, created by one or more individuals or other legal entities to further a common goal and to create ground rules for matters such as ownership, profit distribution, liability, taxes, and control
LLC
LLC
Limited liability company
Individuals who have an interest in an LLC are usually referred to as
Members
Most states have laws that govern
LLC
Protection from being held personally liable
LLC
Physicians, lawyers, architects, and accountants
Professional limited liability company. - PLLC
Limits of liability may only be applied to certain aspects of the business such as creditors
PLLC
Managed care contracts with doctors, hospitals, clinics, and other health care providers to create provider networks
Managed care organizations
An in-network physican or health care facility is part of a MCO’s network if there is a preexisting agreement between
The MCO and the health care provider
MCO
Managed care organizations
The agreement dictates the protocols for patient care and the
MCO
Compensation system
Physician or health care facility that does not have an agreement with the MCO
Out-of-network provider
To discourage the use of out-of-network providers, a patient’s reimbursement for services provided by that provider is not compensated at the same level as an
In-network provider
Networks of health care providers or facilities who have agreed to predetermined protocols and compensation
PCPs
Who coordinate all of patient’s health care
Preauthorization for specific treatments
Limited reimbursement for out-of-network providers
Claim filing assigned to the provider rather than the patient
Tiered coverage of prescription drugs
Managed care focuses on various aspects of health care and can include these characteristics
Employers are not allowed to ask interview qeustions involved
Race
Religion
Age
Whether a woman is pregnant
Employers are allowed to test potential employees as part of the hiring process but such tests must be
Carefully constructed, usually by experts, to ensure that they only measure the skills anad abilities necessary to do the job
The opportunity to do so cannot be denied employees on the basis of race, color, religion, sex, or national origin
Civil rights act of 1964
A physical or mental impairment that substantially limits one or more of the major life activities of an individual, or a record of such impairment, or being regarded as having such an impairment
Disability
Prohibits employment discrimination and places the burden on an employer to prove that the requirements of a specific job could not be changed to accomodate a disabled applicant
Title I of americans with disabilities act
Guarantee the disabled access to the workplace. Professional offices of health care providers are in the public sector and as such require an employer make reasonable modifications for the disabled to gain access
Titles ii and III of the americans with disabilities act
Conditions that are not impairments
Pregnancy
Physical characteristics like hair or eye color
Common personality traits
Normal devisiations in height or weight
Federal minimum wage, madates extra pay for overtime work, regulates the employment of children, and is administered by the department of labor
Fair labor standards act (FLSA)
FLSA
Fair labor standards act
A voluntary agreement between two or more parties that establishes a legally enforceable obligation
Contract
Contracts can be
Oral or written
Parties enter into a contractual relationship by mutual agreement, also referred to as
Assent or
Meeting of the minds
A clear, definitive agreement between two or more parties
Express contract
An actual agreement between the parties, the terms of which are openly stated in distinct and explicit language either orally or in writing
Express contract
An agreement not indicated by direct words but evident from the conduct of the parties
Implied contract
Gives rise to contractual obligations by some action or inaction without specifically stating the terms orally or in writing
Implied contract
The foundation of medical practice
Patient-physician relationship
Types of contracts
Patient-physical relationship Insurance companies Office or medical supplies Lease office space Employment Other health care facilities Clinical laboratories services Medical record software Medical equipment lease or purchase
Elements of a contract
Offer
Acceptance
Consideration
A proposal to perform or refrain from a certain action
Offer
An agreement to the terms of an offer
Acceptance
Something promised that results in making an agreement a lawful, enforceable contract
Consideration
To form a contract there must be a clear understanding between parties
Mutual agreement
Assent
Meeting of the minds
Legal duties and obligations exist once a ___ exists, so it is important ot udnerstand when the relationship begins and ends
Patient-physician relationship
St. John v Pope
Mutual agreement
Wax v Johnson
Mutual agreement
One of the parties does not keep a promise - by not performing, not paying for services, not keeping to schedule, or not doing the procedure as had been agreed
Breach of contract
Occurs when one party prevents the other party from performing
Breach of contract
Examples of breach
Patient does not pay bill
When a physician makes a warranty that the physicain will cure the patient but fails to do so
An agreed-upon addition signed by all parties to the original contract
Amendment
Details the specific terms, clauses, sections and definitions to be changed in the original contract but otherwise leaves it in full force and effect
Amendment
The goal when writing a contract amendment is
To only change the parts that all parties want to change while not creating any loopholes or unintended consequences in the agreement as it stands in writing
Including an additional document in the already existing one
Addendum
