PPT Lecture Flashcards
How many legal systems are there in the US?
- 1 federal system + 50 state systems
True or false: medical licensing and regulations are come from federal laws.
FALSE- they come from state laws
What are the 3 branches of the federal government?
Executive- president/cabinet/agencies.
Legislative- house and senate
Judicial- US sepreme court/court of appeals/US district courts/special courts
What is the highest court in the federal level?
US Supreme court
What is the highest court in the state level?
Supreme court
What is the first level appellate court in the federal level?
US courts of appeal
What is the first level appellate court in PA?
Superior and Commonwealth
What are the trial courts (general jurisdiction) in the federal level?
US District courts
What are the trial courts (general jurisdiction) in PA?
Courts of common pleas
What are the 3 sources of laws?
- Consitutions (federal and states)
- Statutory laws (write it/committees/both houses/confrence committiees)
- Common law/case law
What is the source of law for state medical boards?
Statutory law
What is the “stare decisis” under common/case law?
That courts abide by prior decisions
like Roe v. Wade and crap like that
Who does private law concern differences/problems?
Between individuals. Judge judy!
What is a form of civil law where $ damages are sought to compensate for a loss or harm?
Torts.
Judge Judy style!
What are the 2 forms of torts?
unintention and intentional
What type of law provides remedies if promises are not fulfilled under private law?
Contract law
Between who does public law concern?
Between the government and individuals (criminal law)
Tommy presents to the office with a deep laceration to the right knee. It’s 4:55pm and just before office closing time. The doc quickly looks at it puts a bandaid on it and skips suturing because he wants to make his 5:30 tee-off time. A week later the knee becomes horribly infected and necrotic and now is being questioned for amputation. What type of unintentional tort did the doctor perform?
Negligence
What are the 4 elements of a negligence action?
duty, breach, causation proximate and damages.
What is the name for the unintentional tort when a healthcare professional has a duty to act but fails to act in a reasonable, competent manner, thus harming the patient?
Professional negligence (malpractice)
What are the components too negligent misrepresentation?
Statement—oral or written (yes, texts count)
That maker knows will be relied upon
Whose truth the maker is careless in verifying
That turns out to be untrue
That is in fact relied upon by a party
And the party is injured due to reliance on the statement
Assault, battery, false imprisonment, defamation/slander, invasion of privacy, and fraud are examples of what type of tort?
Intentional tort
Procedures without consent are an example of what type of intentional tort?
battery
What are the 4 ESSENTIAL elements to form a valid and enforceable contract?
Offer
Acceptance
Consideration
Meeting of the minds/legal commitment
What are the 3 types of contracts?
written, oral, quasi (equitable estoppel)
What happens to the contract between a doc and a patient if there is patient abandonment?
IT IS VIOLATED OH GOD.
What are the 3 components of the contract for services with a physician?
- an agreement to pay for services for as logn as they are received by the pt
- truthful disclosure of conditions by the pt
- an agreement to provide services by the physician
“People v.” and “US v.” are example of what type of law? Criminal or Administrative?
Criminal
State licensing and regulations, CME’s, discipline, Administrative Law Judge hearing are examples of what type of law? Criminal or Administrative?
Administrative
These 6 items are part of what concept? Judicial Venue Initiation Discovery Standard of Proof Goal for Defence
Judicial Keys
What is jurisdiction?
subject matter and personal
What is initiation?
grand jury/preliminary hearing vs summons and complaint
What is discovery/rule 26?
No surprises, subpoenas key (witnesses and evidence must be disclosed)
What is standard of proof?
basically proving it: somethings that beyond resonable doubt (criminal), clear and convincing (civil), preponderance of evidence (most civil), substantial evidence in the recor (some federal administrative law cases)
What is the key focus in every state for medical practice acts?
Patient safety
Define: a physician must provide information to a pt that a reasonable, prudent person would want before he/she makes a decision about treatment.
Prudent Person rule (aka the reasonable person standard)
What things do you need to tell patients before you treat them?
diagnosis, risks, expected benefits, alternative treatments, costs (including pain)
What is informed consent?
When the pt must understand AND agree to the procedure.
True or False: Informed consent only has to be obtained where there is serious risk of harm to the patient.
FALSE. You need it for ANY procedure with more than a slight risk of harm to the pt.
What is the key duty of the physician, even prior to the enactment of HIPAA?
Confidentiality
What is the “Respondeat Superior?”
How physicians are responsible for those who work under their supervision for acts that occur within scope of employment
True or False: Physicians must enforce state scope of practice rules for allied health professionals.
True
Define: this is a practice to control or minimize the incidence of problem behavior that can lead to injury to patients and employees.
Risk management
What are the goals of risk management?
to reduce risk of liability for the physician/employer and to identify problems and formulate plans to eliminate them
When should you use incidence reports?
To document an unusual occurrence (fall, medication error, needle stick) and make changes to prevent occurrance
What are the 5 components to an incident report?
SDFWK
Sign Date Factual 5 W's (who what where when and WHY) Keep confidential
What must physicans have to get eligible for Medicare/caid?
EMR’s
Since Managed Care Organizations are on the rise from cost containment, who plays the biggest role of the gatekeeper?
Primary care physicians
Who is responsible for the actions in a partnership form of practice?
each partners is responsible for the actions of all other partners, includoing partnership debts and legal actions.
In an S corporation, how does the income pass?
through to owners and the owners pay the income tax
In a C corporation, how does the tax get paid?
The corportation pays the tax and then dividend is paid to the shareholders. The shareholders then pay taxes on income (so theyre taxed twice)
True or False: a physician cannot choose which patients he/she treats.
False- he/she can refuse to take someone on as a new pt but cannot refuse if it’s an emergency
44,000-98,000 people are killed each year in the US from what?
Medical mistakes
What is the most serious complication for post-surgery?
Sepsis
A 16 year old girl arrives to the doctors office alone asking about birth control and the possibility of STD’s. Are you allowed to treat this patient even though she’s a minor?
Yes, you can treat here if she’s considered a “mature minor” and can understand the diagnosis and treatments.
True or False: Emancipated minors (from court order, marriage or military) between the ages of 15-18 can be treated without parental consent.
True
What does a living will do?
sets forth in advance treatment and care requests in the event of catastrophic situation where the pt may be incompetent to voice wishes concerning medical treatment.
What is a durable power of attorney?
allows the pt to select a representative to act on their behalf. may be to make healthcare decisions only.
What is the #1 cause for malpractice?
Breakdown of physician-pt communication
What is the range for the statute of limitations for medical malpractice in the states?
1-3 years
What causes compensatory damages for malpractice?
For actual loss of income, and emotional pain and suffering, injury: future included
What causes punitive damages for malpractice?
for someone harmed in a particularly malicious or willful way; to serve as punishment
What causes nominal damages for malpractice?
slight payment to show that plantiff’s rights were violated.
What is a borrowed servant malpractice defense?
employer not liable for the actions of employee when employee was under the service of a temporary employer
What is a contributory negligence in malpractice defense?
plantiff’s conduct contibuted to the cause of injury
What is a comparative negligence in malpractice defense?
plantiff’s conduct also contributed, but court assigns fault and damages
Maintaining good communications with patients, having them be active participants in their care, following up, anticipating emergencies, scrutinizing lab/test results, and being sensitive to time limitations are all ways of preventing what?
Malpractice claims
Define: this is a deliberate concealment from another facts for unlawful or unfair gain.
Fraud
Who is the main target for payers in fraud cases?
Government payers (medicare/caid)
Who enforces federal laws for fraud?
HHS/OIG
Phantom billing, patient bribery, upcoding, unbundling, equipment, HIV injection scams, and phantom employees are types of what?
Fraud and abuse
What are practice limitations?
acting within the scope of your practice/soecialty or expertise
Situation: Bobby comes in for a cough to the doctors office. His physician just had a negligence lawsuit a few months ago and wants to be more careful and defensive when treating patients. The physican orders a CBC, CXR, CT, broncoscopy and spinal tap for Bobby to rule out certain diseases. Is the physician practicing good medicine? Why?
No. Ordering unnecessary tests causes unneccesary harm/time/cost for the patient. He should think for the best course of action for the pt.
A doc has a duty to report what in births?
a birth certificate
What things must the doc report within 24-72 hours of a death?
date, cause, treatment, pregnancy, autopsy
Is a doc required to tell a patients partner about a + HIV test if the pt refuses to tell the partner?
Generally, yes. Many states require notifying known parties at risk
Is a doc required to report abuse, whether it’s child, elder, spousal, substance?
Yes. Must be in good faith.
Is a doc required to report refusal of parents to allow treatment of children?
Yes
What is the doc required to do when handling evidence in an abuse case?
Document/describe Take samples Arrange lab tests Save clothing Save foreign objects Photograph with permission Maintain chain of custody
Which agencies oversee and enforce OTC and prescription drug sales and ensures they are safe for the public?
FDA and HHS
Which agency controls drugs with a potential for addiction or abuse?
DEA
What measures must you take with controlled substances to keep them controlled?
Register with the DEA, know the 5 schedules, maintain a closed system/inventory, make reports to state data banks, keep good records, form 222.
Up to 10% of thje workforce is addicted to what?
Alcohol
Physicans have an ethical duty to do what if they get addicted to drugs?
Abstain and report. every state has a program for physicians
Hazardous chemical information are located on what sheets?
MSDS
Yes or No: you can not hire someone cuz they’re ugly.
NO
Where do antidiscrimination laws come from?
Title VII and state FEP laws
What are the 2 areas of possible “accommodations” for discrimination?
Religion and disability
Can you ask about religious preferences ina job interview?
NO
How can you manage a hiring fairly and keep anti-discrimintory?
Key in on education, skills and experience that are job related and consistent with business necessity.
What is an “at will” employee?
A typical employee- takes place at the will of both the employer or the employee, so employment may be terminated “at will” without notice or reason. SCREW IT IM LEAVING
This provides protection for the qualified disabled, those perceived disabled, or those having a record of disability, including AIDS
Americans with Disabilities Act (ADA)
This provides protection for those over 40, where only top execs and safety sensitive employees may be “retired”
Age Discrimination in Employment Act (ADEA)
What does Title VII enforce?
That you can’t discriminate on the basis of race, color, creed, sex or national origin.
Say an employee is discriminated based on race, color, sex, religion, or national origin. Under what act can they sue for compensatory and punitive damages?
Civil Rights Act of 1991
What does the Employee Retirement Income Security Act (ERISA) enforce?
regulates employee benefits and pension plans so u cant abuse them, where a retirement plan is vested after a certain # of years and only after then can u receive benefits from the plan
This act governs the provision of health insurance by an employer after the employee is no longer working for the employer, which is ~18months after the employee leaves.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
THis act set up federal minimum wage, requires payment of overtime, set maximum hours worked per week, affects only hourly employees.
Fair Labor Standards Act (FLSA)
This act allows for unpaid time off for employee due to illness, military, injury or birth.
Family and Medical leave Act (FLMA)
How long can u take an absence under FLMA?
Up to 12 weeks a year
What does the National Labor Relations Act (NRLA) cover?
Protects concerted activity (PCA) and unions
What does OSHA protect?
it’s an omnibus safety law
Say a female co-worker gets preggers. Under what law is she protected from discrimination?
Pregnancy Discrimination Act (PDA)
Which act was a precursor to the ADA and prohibits employment discrimination of handicapped by any institution that received federal assistance?
Rehabilitation Act of 1973
What are state run programs where employers pay into plan that covers employees who lose their jobs through no fault of the employees?
Unemployment compensation
Which act causes employers pay into a fund to help cover costs for an injured employ hurt in the course of employment?
Workers compensation act
Which law protects employee from whistelblowers, anti-retaliation, undercuts at will employment doctrine, and requires “just cause” and progressive discipline?
wrongful discharge common law
True or False: the medical record for a patient is only the completed SOAP noted from the physician.
FALSE. it is ALL written or electronically recorded info about the pt
Thor v. Boska reminds us of what NOT to do a patients record?
Destroy it in any way
People v. Smithtown reminds us of what NOT to do a patients record?
Alter it in any way
What are the 6 C’s for the medical record?
clear, complete, concise, consistent credible and current
Can u take pics of the patient at any time? why or why not?
NO. it’s an invasion of privacy
Who is the only 1 allowed to permanently add or change an EMR?
The attending physician
Who owns the pt’s records?
The oweners of the healthcare facility
What is the doctrine of Professional Discretion?
a physician can determine if patient viewing of medical records would be harmful
What are the state retention laws for FL and PA?
FL-5 yrs, PA-7 yrs
Which act concerns materials stored in a system of records by the federal executive branch and limits the amt of pt into that federal agencies collect or maintain?
Privacy act of 1974
Which set of laws say that medical records are generally exempt from disclosure to the public except when the public interest outweighs an individual’s confidentiality interest?
State Open Record laws
Which act provides protection for records of patients receiving treatment for drug or alcohol abuse?
Public health services act
Which act is designed to protect the privacy of personal/protected health information (PHI) and how it’s used, transmitted, and disclosed?
HIPAA
Who enforces HIPAA?
HHS
What are the fines/penalties for violating HIPAA?
100-250k and 10 yrs in prision
When was HIPAA enacted?
1996
What are fraud alerts?
they’re alerts from the inspector general of the HHS concerning suspicious practices to alert providers and the public about the potential for medical privacy abuse
Who collects reports and disclosures of actions taken against healthcare practitioners, providers, and vendors for noncompliance and fraudulent activities?
Healthcare Integrity and Protection Data Bank
What are the 3 things under the HIPAA privacy rule?
- protects individuals medical records
- sets limits and conditions on the uses and disclosures allowed without pt authorization
- gives pts rights conceritn the examinationa nd copying of their health records and request corrections
What is the 1 thing that falls under the HIPAA security role?
it protects individuals EMR information
When can u breach to disclose to a 3rd party without consent or legal obligation?
public health, hazard avoidance (inability to drive), child/elder abuse/abandonment
What act covers the privacy of genetic information?
Genetic Information Nondiscrimination Act (GINA)
What are the 8 things that makes data “protected health information (PHI)?”
Name Address Numbers – phone/SSN/Health Plan Vehicle identifiers (e.g. license plate #) URL’s/IP Biometric identifiers (e.g. fingerprints) Photos “Catch all”
What are the 3 main components of the HIPAA Standards?
- Electronic transaction standards (e.g. certain formats and code sets in electronic transmissions)
- Privacy standards (enforcing the privacy rule)
- Security standards (for electronically receiving, storing and using PHI, etc.).
What is an employer identification number (EIN)?
a federal employers tax ID that is used by healthcare providers for electronic transmisisons
What are the 3 types of entities that HIPPA covers?
covered entity (CE)
- healthcare providers
- healthcare insurers
- healthcare clearinghouses (like billing services)
A covered entity must hand the patient a _____ of the CE’s privacy practices prior to the first treatment?
notice
True or False: a pt can restrict the use of PHI
True
True or False: a pt cannot access and copy their own PHI.
False. They can access and copy it from 30 days on site/60 days off site
True or False: a pt can amend their own PHI
true
True or false: a patient can receive an accounting of uses/disclosures of PHI up to 10 years back.
False! only up to 6 years past
True or False: under HIPAA CE obligations, there must be a privacy officer in each healthcare facility.
True
What are the 2 disclosures that are required by HIPAA?
For the US HHS and to honor patient requests.
Ready access to treatment, efficient payment for healthcare, and healthcare operations (TPO) all require use of what?
PHI
True or False: The Privacy Rule permits a CE to use and disclose PHI for the purposes of TPO without patient authorization.
True!
True or False: you are not allowed to give PHI to law enforcement purposes unless you have patient authorization.
FALSE. Law enforcement is an exception to disclosure with authorization.
The HIPAA Privacy Rule permits, but doesnt require, a CE to obtain patient _______ for uses and disclosures of PHI for treatment, payment, and healthcare operations (TPO).
consent
What is required by the Privacy Rule for uses and disclosures of PHI not otherwise allowed by the Rule?
Authorization
True or False: As long as you are using the patients PHI for reaseach for the greater public good, you do not need authorization for the use of PHI.
FALSE. You need authorization for each patient
What are the 3 ways of getting authorization for the patient for research?
- from the compliant patient
- a waiver of authorization from an institutional review board
- waiver from a privacy board
When does HIPAA not preempt state laws?
- The purpose of the state law differs (e.g. controlled substances; fraud; insurance regulation);
- State law deals with reporting/prevention of disease or abuse;
- Sate law deals with audits or licensure; or
- State law deals with PHI but is more stringent
What are medical informatics?
the application of communication and information to medical practice, research, and education. An example is a hospital pharmacy computerized medication ordering system
What is telemedicine?
the use of communication and information technologies to provide healthcare services to people at a distance. Can assist homebound and rural patients
This act from 2009 promotes the adopting and meaningful use of health information technology.
Health Information Technology for Economic and Clinical Health (HITECH) Act
What does subtitle D under HITECH address?
the privacy and security concerns associated with the electronic transmission of health information
What is the #1 thing u must ensure a patient has under HIPAA/HITECH?
Their notice of privacy practices.
I remember getting this at my docs office and being like omg who the F cares. but apparently it’s the law to do it.
