Mock Final Exam III Flashcards
Which legal principle holds that healthcare providers owe a duty to warn identifiable third parties about specific threats made by their patients?
A) Informed consent doctrine
B) Duty to warn/protect
C) Respondeat superior
D) Best interests standard
B) Duty to warn/protect
The legal concept that allows for negligence to be inferred when an injury wouldn’t occur without negligence and the defendant had exclusive control over the cause is known as:
A) Res ipsa loquitur
B) Negligence per se
C) Corporate negligence
D) Comparative negligence
A) Res ipsa loquitur
Under which standard would a physician be required to disclose information that a reasonable patient would consider material to their treatment decision?
A) Professional community standard
B) Subjective patient standard
C) Reasonable patient standard
D) Medical custom standard
C) Reasonable patient standard
What legal doctrine makes hospitals liable for negligent acts of their employees performed within the scope of employment?
A) Corporate negligence
B) Respondeat superior
C) Ostensible agency
D) Strict liability
B) Respondeat superior
Which of the following best describes “apparent agency” in healthcare liability?
A) When a physician explicitly represents themselves as a hospital agent
B) When a patient reasonably believes a provider is a hospital employee
C) When a hospital formally designates a physician as an agent
D) When a physician serves on hospital committees
B) When a patient reasonably believes a provider is a hospital employee
Which federal law requires hospitals receiving Medicare funding to provide emergency screening and stabilizing treatment regardless of ability to pay?
A) HIPAA
B) EMTALA
C) ACA
D) HCQIA
B) EMTALA
Under the doctrine of corporate negligence, hospitals have a direct duty to:
A) Pay for all patient treatments deemed necessary by physicians
B) Monitor and supervise all medical staff who practice at the facility
C) Prevent physicians from refusing to treat patients
D) Ensure all patients receive identical care regardless of insurance
B) Monitor and supervise all medical staff who practice at the facility
Which legal standard is used to determine what decision an incompetent patient would have made if competent?
A) Best interests standard
B) Substituted judgment standard
C) Reasonable person standard
D) Professional judgment standard
B) Substituted judgment standard
What term describes the legal document that allows a person to designate someone to make healthcare decisions if they become incapacitated?
A) Living will
B) Healthcare power of attorney
C) DNR order
D) POLST form
B) Healthcare power of attorney
Under EMTALA, what constitutes an “appropriate medical screening examination”?
A) Any examination a hospital chooses to provide
B) Identical screening to that provided to other patients with similar symptoms
C) Only the minimal screening needed to identify emergency conditions
D) Screening by a board-certified emergency physician
B) Identical screening to that provided to other patients with similar symptoms
What legal principle prevents a plaintiff from bringing the same claim against the same defendant after it has been decided by a court?
A) Stare decisis
B) Res judicata
C) Collateral estoppel
D) Substantive due process
B) Res judicata
Which of the following is an example of “informed refusal” in healthcare?
A) A physician declining to treat a non-compliant patient
B) A hospital refusing to provide experimental treatment
C) A patient declining treatment after being informed of the risks of non-treatment
D) An insurance company denying coverage for a procedure
C) A patient declining treatment after being informed of the risks of non-treatment
What legal doctrine protects healthcare providers engaged in peer review activities from civil liability if certain standards are met?
A) HCQIA immunity
B) Charitable immunity
C) Governmental immunity
D) Good Samaritan immunity
A) HCQIA immunity
The doctrine that allows courts to find negligence when a healthcare provider violates a statute designed to protect patients is:
A) Vicarious liability
B) Negligence per se
C) Breach of warranty
D) Absolute liability
B) Negligence per se
What term describes medical interventions considered futile because they would not provide a meaningful benefit to the patient?
A) Non-beneficial treatment
B) Experimental therapy
C) Palliative care
D) Negligent treatment
A) Non-beneficial treatment
What legal standard requires hospitals to stabilize emergency medical conditions before transferring patients to other facilities?
A) Stabilization requirement under EMTALA
B) Community standard of care
C) Reasonable physician standard
D) Due process requirement
A) Stabilization requirement under EMTALA
Which doctrine has been largely abandoned in favor of recognizing that various healthcare providers have their own responsibilities in a team approach?
A) Respondeat superior
B) Corporate negligence
C) Captain-of-the-ship doctrine
D) Apparent agency
C) Captain-of-the-ship doctrine
When a physician provides treatment without patient consent in a life-threatening emergency where consent cannot be obtained, this is justified under:
A) Therapeutic privilege
B) Emergency exception to informed consent
C) Implied consent doctrine
D) Good Samaritan immunity
B) Emergency exception to informed consent
Which of the following best describes the “locality rule” in medical malpractice?
A) Physicians are judged against the standard of care in their specific geographic area
B) Lawsuits must be filed in the jurisdiction where treatment occurred
C) Damages are determined based on local economic conditions
D) Physicians must practice within the geographic area where they’re licensed
A) Physicians are judged against the standard of care in their specific geographic area
What legal principle allows courts to follow precedent from previous similar cases?
A) Res judicata
B) Stare decisis
C) Substantive due process
D) Judicial review
B) Stare decisis
Under comparative negligence, if a patient is found 40% responsible for their injury:
A) The patient cannot recover any damages
B) The patient’s recovery is reduced by 40%
C) The healthcare provider is fully liable
D) The patient must pay 40% of the provider’s legal fees
B) The patient’s recovery is reduced by 40%
Which legal theory applies when a healthcare provider makes a specific promise about results that isn’t achieved?
A) Negligence
B) Breach of warranty
C) Fraud
D) Strict liability
B) Breach of warranty
What standard of proof is typically required in medical malpractice cases?
A) Beyond a reasonable doubt
B) Clear and convincing evidence
C) Preponderance of evidence
D) Substantial evidence
C) Preponderance of evidence
The “loss of a chance” doctrine applies when:
A) A provider loses a patient’s medical records
B) A provider’s negligence reduces an already compromised chance of recovery
C) A patient loses the opportunity to try experimental treatment
D) A patient loses income due to a medical procedure
B) A provider’s negligence reduces an already compromised chance of recovery
Which of the following is NOT typically an element of an “appropriate” transfer under EMTALA?
A) The receiving facility has available space and qualified personnel
B) The transferring hospital provides necessary medical records
C) The transfer is approved by the patient’s insurance company
D) The patient is stabilized to the extent possible before transfer
C) The transfer is approved by the patient’s insurance company
A 72-year-old patient with advanced Parkinson’s disease was admitted to Memorial Hospital with pneumonia. During his stay, his physician, Dr. Roberts (a hospital employee), prescribed medication that caused severe adverse reactions because she failed to check his medication allergies in his chart. A nurse employed by the hospital administered the medication without verifying allergies, contrary to hospital policy.
When the patient experienced difficulty breathing, the nursing supervisor called Dr. Chen, a pulmonologist with privileges at Memorial but not a hospital employee. Dr. Chen was listed as “on call” that day. Dr. Chen advised over the phone that the patient should be given oxygen and monitored, but did not come to examine the patient. The patient’s condition deteriorated, resulting in permanent brain damage. Investigation revealed that the hospital’s credentialing committee had previously received three complaints about Dr. Roberts’ medication errors but took no action.
Analyze all potential theories of liability against:
1) Dr. Roberts
2) The nurse
3) Dr. Chen
4) Memorial Hospital
For each party, identify the applicable legal doctrines, elements that must be proven, potential defenses, and how courts would likely analyze each claim. Discuss how the hospital’s corporate liability differs from its potential vicarious liability, and explain what policies might have prevented this outcome.
A 72-year-old patient with advanced Parkinson’s disease was admitted to Memorial Hospital with pneumonia. During his stay, his physician, Dr. Roberts (a hospital employee), prescribed medication that caused severe adverse reactions because she failed to check his medication allergies in his chart. A nurse employed by the hospital administered the medication without verifying allergies, contrary to hospital policy.
When the patient experienced difficulty breathing, the nursing supervisor called Dr. Chen, a pulmonologist with privileges at Memorial but not a hospital employee. Dr. Chen was listed as “on call” that day. Dr. Chen advised over the phone that the patient should be given oxygen and monitored, but did not come to examine the patient. The patient’s condition deteriorated, resulting in permanent brain damage. Investigation revealed that the hospital’s credentialing committee had previously received three complaints about Dr. Roberts’ medication errors but took no action.
Analyze all potential theories of liability against:
1) Dr. Roberts
2) The nurse
3) Dr. Chen
4) Memorial Hospital
For each party, identify the applicable legal doctrines, elements that must be proven, potential defenses, and how courts would likely analyze each claim. Discuss how the hospital’s corporate liability differs from its potential vicarious liability, and explain what policies might have prevented this outcome.
Memorial Medical Center experienced a ransomware attack that encrypted patient records, including medication orders and test results. Unable to access critical information, several patients received incorrect medications or delayed treatments.
Patient A, who had a documented penicillin allergy in her inaccessible electronic record, received amoxicillin, resulting in anaphylactic shock. The hospital had a paper backup system but had not maintained it properly. The IT department had warned administration about cybersecurity vulnerabilities six months earlier, but budget constraints delayed security upgrades.
Patient B had a scheduled cardiac catheterization delayed because his previous test results were inaccessible. During the delay, he suffered a heart attack. Investigation revealed the hospital had no functional downtime procedures for accessing essential information during system outages.
Thoroughly analyze the legal and regulatory issues presented by this scenario, including:
1) Theories of liability against the hospital for both patients
2) How standards of care apply to electronic health records and cybersecurity
3) The hospital’s obligations under relevant healthcare regulations
4) How the hospital’s prior knowledge of vulnerabilities affects liability analysis
5) Risk management strategies that could have prevented these incidents
Support your analysis with relevant legal principles and standards, identifying where courts might differ in their approaches to these emerging issues.
1) Liability theories:
- Negligence: Hospital breached duty to maintain accessible medical records; clear causation for Patient A (allergy reaction); potentially more complex causation for Patient B (delayed procedure)
- Corporate liability: Direct hospital duties to maintain adequate systems and safety procedures
- Potential breach of implied contract to provide reasonably safe care including information access
2) EHR standards of care:
- Industry standards include NIST Cybersecurity Framework, HIPAA Security Rule, and Joint Commission requirements
- Reasonable hospital standard requires functioning backup systems and downtime procedures
- Failure to maintain paper backups represents clear departure from standard practice
3) Regulatory obligations:
- HIPAA Security Rule violations: Risk analysis, contingency planning, and evaluation requirements
- Medicare Conditions of Participation: Medical records, quality assessment, and patient safety
- Potential state-specific EHR and data breach regulations
4) Prior knowledge impact:
- IT warnings establish clear foreseeability, creating heightened duty
- Budget constraints unlikely as viable defense given known critical risks
- Documentation trail strengthens plaintiffs’ cases and may support punitive damages
5) Preventive measures:
- Technical: Comprehensive security framework, redundant storage, network segmentation
- Administrative: Regular downtime drills, formal risk assessment process
- Hybrid approach: Maintaining critical information in multiple accessible formats
- Governance: Clinical/IT oversight committee prioritizing safety investments
Jurisdictional variations may exist in recognition of cybersecurity standards as establishing duty of care and causation requirements between system failures and patient harm.
Westside Hospital implemented a new policy requiring all medical staff with admitting privileges to take emergency department call. Dr. Harris, a neurosurgeon with privileges at Westside for 15 years, refused to participate in the call schedule, citing his age (67) and that his practice focuses on elective procedures. The hospital medical executive committee voted to terminate his privileges based on this refusal.
Upon learning of the termination, Dr. Harris filed suit against the hospital alleging:
1) The hospital breached its bylaws which don’t explicitly require ED call
2) The termination was based on age discrimination
3) The decision constitutes an antitrust violation as it was influenced by younger neurosurgeons seeking to eliminate competition
The hospital’s peer review records show committee members expressed concerns about Dr. Harris’s recent cases having higher complication rates, though this wasn’t part of the official termination decision.
Analyze the legal issues presented in this case, including:
1) The hospital’s authority to implement call requirements
2) Proper procedure for privilege termination
3) Dr. Harris’s potential claims and their likelihood of success
4) The role of HCQIA immunity in this dispute
5) How courts balance medical staff autonomy against hospital administrative authority
Provide analysis of both sides’ strongest arguments and explain how courts typically approach these conflicts.
1) Hospital authority: Hospitals can generally establish reasonable requirements for staff privileges, including ED call participation. Courts typically defer to hospitals on operational requirements when reasonably related to patient care needs. The new policy must be uniformly applied to avoid discrimination claims.
2) Procedural requirements: Privilege termination requires:
- Following medical staff bylaws procedures
- Providing adequate notice and hearing opportunity
- Basing decisions on reasonable quality-of-care factors
- Proper documentation of process and rationale
3) Dr. Harris’s claims:
- Bylaws breach: May succeed if bylaws explicitly limit termination grounds or require bylaws amendment for new requirements
- Age discrimination: Difficult to prove without evidence that younger physicians received exemptions or that age was discussed
- Antitrust: Unlikely to succeed without evidence of conspiracy or market power abuse
4) HCQIA immunity applies if:
- Action taken with reasonable belief it furthered quality healthcare
- Reasonable investigation of facts occurred
- Adequate notice and hearing procedures were followed
- Committee acted with reasonable belief that action was warranted
5) Hospital vs. staff autonomy:
- Courts balance hospital’s need to ensure continuous care against physicians’ practice autonomy
- The undisclosed quality concerns complicate the case as the actual vs. stated rationale differs
- Medical staff governance varies by state law and individual bylaws
Key to resolution: Whether termination followed proper procedure, whether the call requirement was reasonable and uniformly applied, and whether actual quality concerns were properly addressed through appropriate channels.
Community General Hospital’s emergency department was overwhelmed by a multiple-casualty accident. Sandra Jones, 35 weeks pregnant, arrived by private car with complaints of decreased fetal movement. The triage nurse noted her stable vital signs and placed her in the waiting room. After 90 minutes without assessment, Jones experienced severe abdominal pain and vaginal bleeding. When finally examined, placental abruption was diagnosed, requiring emergency C-section. The baby suffered permanent neurological damage from oxygen deprivation.
Hospital records show:
1) Jones registered but received no medical screening examination for 90 minutes
2) The ED was operating under mass casualty protocols due to a bus accident
3) No obstetrical staff was consulted during initial triage
4) Hospital policy required pregnant patients ≥24 weeks with concerning symptoms to receive expedited assessment
Analyze:
1) The hospital’s potential EMTALA violations
2) Medical malpractice liability for the hospital and staff
3) How the mass casualty situation affects liability analysis
4) Whether the hospital’s triage protocol constitutes an appropriate screening examination
5) Damages considerations in maternal-fetal injury cases
Discuss how courts balance emergency department resource constraints against patient safety obligations in determining liability.
1) EMTALA analysis:
- Potential violation for failing to provide appropriate medical screening examination
- Pregnant patient with decreased fetal movement requires prompt assessment
- Triage alone doesn’t constitute appropriate medical screening
- Mass casualty situation doesn’t exempt hospital from EMTALA obligations toward all patients
2) Malpractice considerations:
- Breach of standard of care: Failure to follow hospital’s own protocol for pregnant patients
- Causation: 90-minute delay likely contributed to negative outcome
- Hospital liability: Direct corporate negligence for inadequate triage protocols and vicarious liability for staff actions
- Staff liability: Triage nurse potentially liable for improper assessment/prioritization
3) Mass casualty impact:
- Doesn’t eliminate duty but may modify standard of care expectations
- Resource allocation must still follow appropriate medical prioritization
- Failure to involve obstetrical staff suggests improper triage decision, even amid mass casualty
4) Screening examination adequacy:
- Courts look at whether patient received same screening other similar patients would receive
- Hospital’s own policy establishes baseline standard which wasn’t met
- Without any actual medical assessment beyond initial vital signs, screening likely inadequate
5) Damages considerations:
- Both maternal and fetal injuries compensable
- Neurological damage to infant creates significant long-term damages
- Some jurisdictions limit non-economic damages in malpractice cases
Courts consider resource constraints but typically hold that proper triage based on medical need rather than time of arrival is fundamental to emergency care. The violation of hospital’s own policy significantly weakens defense arguments based on resource limitations.
Lakeside Retirement Community, a continuing care facility with independent living, assisted living, and skilled nursing units, implemented a new advance directive policy. The policy requires all residents to complete a POLST (Physician Orders for Life-Sustaining Treatment) form upon admission, explicitly choosing or declining various life-sustaining treatments. Residents who decline to complete the form are placed in a “full code” status by default.
Mr. Wilson, an 83-year-old with early dementia, moved into the assisted living section. His daughter, who holds healthcare power of attorney, refused to complete the POLST, stating her father previously expressed wishes to avoid aggressive interventions but never completed formal documentation. The facility administrator informed her that without a completed POLST, they would perform all life-sustaining measures, including CPR, regardless of her instructions as healthcare agent.
One month later, Mr. Wilson suffered cardiac arrest. Despite the daughter’s objections, staff performed CPR, resulting in broken ribs and prolonged hospitalization. He ultimately survived but with decreased quality of life and significant pain from complications.
Analyze:
1) The legal validity of the facility’s mandatory POLST policy
2) The authority of a healthcare agent under a valid power of attorney
3) Potential liability for battery and negligence claims
4) How state laws regarding advance directives affect this scenario
5) The competing interests in end-of-life decision policies for residential facilities
1) Mandatory POLST policy validity:
- Facilities can require advance care planning discussions but typically cannot mandate specific directive completion
- POLST forms should document existing treatment preferences, not create new requirements
- Default “full code” status for non-participants likely violates patient autonomy principles
2) Healthcare agent authority:
- Valid healthcare power of attorney grants the agent legal authority to make decisions consistent with patient’s known wishes
- This authority generally supersedes institutional policies
- Facilities must honor decisions of legally authorized surrogates absent court intervention
- Agent’s decisions should be given same weight as patient’s own statements
3) Liability analysis:
- Battery claim: Performing CPR against authorized agent’s express instructions may constitute unconsented touching
- Negligence claim: Disregarding valid healthcare POA breaches standard of care
- Facility policy of disregarding agent instructions likely creates direct corporate liability
- Damages include physical injury, pain and suffering, and medical expenses
4) State law variations:
- Surrogate decision-making laws vary by state but generally prioritize designated healthcare agents
- Some states have specific POLST legislation defining their legal status
- Statutory hierarchy of surrogates typically places appointed agents above facility policies
5) Competing interests:
- Facility interest in clear documentation vs. patient/family autonomy
- Risk management strategies shouldn’t override patient rights
- Facilities have legitimate need for emergency guidance but must respect existing legal documents
The strongest position is that the facility violated the legal authority of the healthcare agent and committed battery by performing unwanted treatment. The policy of disregarding agent instructions without court intervention likely violates established healthcare law principles regarding surrogate decision-making.
Midwest Regional Hospital contracted with Medtech Innovations to implement a new artificial intelligence system that analyzes radiology images and flags potential abnormalities. The system is intended as a “second check” but hospital policy requires radiologists to review all images independently.
Dr. Garcia, a radiologist, reviewed chest X-rays for patient Robert Thompson but failed to identify a small lung nodule. The AI system flagged the nodule with 83% confidence, but this alert wasn’t included in the final report due to a software integration error that Medtech had previously identified but hadn’t yet fixed. Six months later, Thompson was diagnosed with advanced lung cancer. Further investigation revealed:
1) The hospital didn’t verify the AI system was functioning properly after implementation
2) Medtech knew about the integration error but classified it as “low priority”
3) Hospital policy didn’t specify how AI alerts should be documented or addressed
4) The radiology department received no training on AI system limitations
Analyze:
1) Liability theories against the hospital, Dr. Garcia, and Medtech
2) How standards of care apply to AI-assisted medical diagnosis
3) Causation challenges in delayed diagnosis cases
4) The impact of the software integration error on various defendants’ liability
5) How courts might approach this novel intersection of medical malpractice and technology liability
1) Liability theories:
- Hospital: Corporate negligence for inadequate implementation, verification, and training; vicarious liability for employee errors
- Dr. Garcia: Medical malpractice for failure to identify nodule below standard of care
- Medtech: Product liability for defective software; negligence for failing to address known error; potential breach of warranty
2) AI and standard of care:
- Emerging standard likely requires proper implementation, training, and verification protocols
- AI serves as adjunct not replacement for professional judgment
- Hospital policies regarding AI usage help establish applicable standard
- Failure to ensure proper integration constitutes systemic negligence
3) Causation analysis:
- Plaintiff must establish earlier detection would have changed outcome
- Six-month delay likely material to cancer progression and treatment options
- “Loss of chance” doctrine may apply in jurisdictions recognizing reduced survival probability as compensable
4) Software error implications:
- Creates direct liability for Medtech who knew but didn’t fix or adequately warn
- Hospital liable for failing to verify system functionality
- Shared responsibility between technology provider and healthcare facility
- Documentation of known error significantly weakens defendants’ positions
5) Novel legal approaches:
- Courts may apply hybrid of medical malpractice and product liability principles
- AI as supplement vs. replacement affects liability distribution
- Duty to monitor technology performance increasingly recognized
- Evolving standards for disclosure of AI limitations to patients
This case represents the complex liability landscape emerging at the intersection of healthcare and AI. The strongest claims center on system implementation failures and improper response to known errors rather than AI performance itself. The hospital’s failure to establish clear policies on AI integration likely constitutes independent corporate negligence beyond physician error.
