Quiz 3 Key Terms Flashcards
What is the definition of “privileging” according to The Joint Commission?
The process whereby the specific scope and content of patient care (clinical) services are authorized for a healthcare practitioner by a healthcare organization on the basis of evaluation of the individual’s credentials and performance.
What is “credentialing”?
A process for establishing the qualifications and competence of medical staff applicants through review of their training, licensure, and practice history.
What is the primary purpose of the HCQIA (Health Care Quality Improvement Act)?
To improve the quality of medical care by encouraging physicians to identify and discipline physicians who are incompetent or who engage in unprofessional conduct, while providing immunity from lawsuits for those who participate in peer review activities.
Who has the ultimate responsibility for approving medical staff privileges?
The hospital’s governing board (board of directors/trustees) has the ultimate responsibility for the overall quality of care and for approving medical staff privileges, though they typically rely on the medical staff’s recommendations.
What does “peer review” refer to in a hospital setting?
A process where physicians evaluate the quality of work done by their colleagues to maintain standards of care and improve quality, often conducted through confidentiality-protected committee proceedings.
What are the four requirements for immunity under HCQIA?
1) Reasonable belief that the action was in furtherance of quality healthcare; 2) Reasonable effort to obtain the facts; 3) Adequate notice and hearing procedures; 4) Reasonable belief that the action was warranted by the facts known.
What is a “professional review action” under HCQIA?
An action or recommendation taken by a professional review body based on a physician’s competence or professional conduct that affects or may affect the physician’s clinical privileges or medical staff membership.
What is the National Practitioner Data Bank (NPDB)?
A federal database created by HCQIA that collects and releases information on adverse actions taken against healthcare practitioners, including medical malpractice payments and certain professional review actions.
What is “economic credentialing”?
The use of economic criteria unrelated to quality of care or professional competence in determining a physician’s qualifications for initial or continuing hospital medical staff membership or privileges.
What is the doctrine established in Johnson v. Misericordia Community Hospital?
A hospital has a duty to exercise due care in the selection of its medical staff and can be liable for negligent credentialing if it fails to verify the accuracy and completeness of information in a physician’s application for privileges.
In the Poliner case, what did the court establish about HCQIA immunity?
That HCQIA immunity applies when temporary restrictions on a physician’s privileges are imposed to protect patients during an investigation, and that courts should not second-guess peer review decisions if the statutory requirements are met.
What lesson does the Kadlec case teach about reporting requirements?
Healthcare entities have an obligation to be truthful when providing information about former staff members to other facilities, and can be held liable for fraudulent misrepresentations that conceal dangerous conduct.
What is an Accountable Care Organization (ACO)?
A group of healthcare providers who work together to manage and coordinate care for Medicare fee-for-service beneficiaries, with goals of improving quality, coordinating care, and reducing unnecessary costs.
What is a “complementary and alternative medicine” (CAM) practitioner?
A healthcare provider who uses practices outside of conventional medicine, such as acupuncture, Eastern medicine, naturopathy, massage therapy, or herbal medicine, often as part of an integrative approach to healthcare.
What is the duty of a hospital regarding the clinical competence of its medical staff?
A hospital has a duty to ensure that its medical staff is qualified and competent, which includes proper credentialing, periodic review of clinical performance, and taking action when issues arise.
What is a “licensed independent practitioner” according to The Joint Commission?
Any individual permitted by law and by the organization to provide care, treatment, and services without direction or supervision.
What is the “substituted judgment doctrine” in medical staff issues?
Not typically applied in medical staff issues, but in patient consent contexts it refers to making decisions for incompetent patients based on what they would have decided if competent.
What is an exclusive contract in a hospital setting?
An arrangement where a hospital grants exclusive rights to a physician or physician group to provide certain clinical services (like radiology, anesthesiology, or emergency medicine) within the facility.
What is the “corporate practice of medicine” doctrine?
A legal doctrine prohibiting corporations from practicing medicine or employing physicians to provide professional medical services, though many states have exceptions for hospitals and other healthcare organizations.
What are The Joint Commission’s general competency areas for credentialing?
1) Patient care, 2) Medical/clinical knowledge, 3) Practice-based learning and improvement, 4) Interpersonal and communication skills, 5) Professionalism, and 6) Systems-based practice.
What was the doctrine of “charitable immunity”?
A now largely abandoned legal doctrine that protected charitable organizations, including hospitals, from tort liability on the basis that their assets were held in trust for charitable purposes or that beneficiaries implicitly waived their right to sue.
What is “respondeat superior”?
A legal doctrine meaning “let the master answer” that holds an employer liable for the negligent acts of employees performed within the scope of their employment.
What is the distinction between an employee and an independent contractor in healthcare liability?
An employee works under the hospital’s control regarding means and methods, making the hospital liable under respondeat superior; an independent contractor controls their own work methods, theoretically shielding the hospital from liability.
What is “apparent agency” or “agency by estoppel”?
Legal doctrines that make a hospital liable for the acts of independent contractors (like physicians) when patients reasonably believe these individuals are hospital employees based on the hospital’s representations or conduct.
What was the significance of Bing v. Thunig (1957)?
It eliminated the distinction between administrative and medical acts of hospital employees, establishing that hospitals are responsible for the negligent acts of their employees regardless of whether those acts require professional skill.
What is the “captain-of-the-ship” doctrine?
A now largely eroded doctrine that held the surgeon responsible for the negligence of all personnel in the operating room, based on the theory that the surgeon was in complete control like a ship’s captain.
What is the “borrowed servant” doctrine?
A doctrine that shifts liability from a hospital to a physician when a hospital employee is temporarily under the direct supervision and control of the physician, especially during surgery.
What is “corporate liability” in healthcare?
A doctrine holding that a hospital has direct, non-delegable duties to patients independent of its employees’ actions, including duties to maintain proper facilities, establish safety protocols, and properly select and supervise medical staff.
What was established in the Darling v. Charleston Community Memorial Hospital case?
That a hospital has a direct duty to patients to review and supervise the quality of care provided by its medical staff, and that hospital accreditation standards and bylaws can be used as evidence of the standard of care.
What is a managed care organization (MCO)?
An organization that manages healthcare delivery to control costs through mechanisms like provider networks, utilization review, preauthorization requirements, and financial incentives for efficient care.
What is ERISA (Employee Retirement Income Security Act) preemption?
A provision stating that ERISA supersedes state laws relating to employee benefit plans, often preventing state-law claims against employer-provided health plans and limiting remedies to those available under federal law.
What was established in Aetna Health, Inc. v. Davila (2004)?
The Supreme Court ruled that ERISA preempts state laws allowing patients to sue health plans for coverage decisions, limiting patient remedies to those specified in ERISA, which does not include compensatory damages for injuries.
What is utilization review (UR)?
A systematic process used by managed care organizations to evaluate the medical necessity, appropriateness, and efficiency of healthcare services and procedures according to established criteria or guidelines.
What is utilization management (UM)?
Proactive techniques to improve efficiency and control healthcare costs by influencing providers’ medical decision-making through peer review processes, often used by managed care organizations.
What is “patient dumping”?
The practice of refusing to treat or transferring patients (usually uninsured or underinsured) who cannot pay for medical care from private to public hospitals, which prompted the passage of EMTALA.
What is the significance of Johnson v. Misericordia Community Hospital (1981)?
It established that hospitals have a duty to exercise reasonable care in the selection and retention of medical staff and can be liable for negligent credentialing if they fail to properly verify a physician’s qualifications.
What is the standard for a hospital’s duty regarding medical equipment?
Hospitals have a duty to properly maintain, inspect, and ensure the proper use of equipment, to have equipment customarily available for the services they provide, and to train staff in the proper use of equipment.
What is the hospital’s responsibility regarding rules and regulations?
Hospitals must adopt and follow reasonable rules to ensure patient safety and quality care, and failure to follow established rules can be evidence of negligence in a lawsuit.
What was the impact of Roberts v. Galen of Virginia on ERISA preemption?
The Supreme Court ruled that a health plan’s improper motive (like cost-saving) is not required to bring a claim under EMTALA, clarifying that all patients are protected from improper transfers regardless of insurance status.
What is “corporate responsibility for the quality of medical care”?
The principle that hospitals and their governing bodies are responsible for the overall quality of patient care delivered in their facilities, including monitoring physician competence and ensuring proper policies and procedures.
What is the difference between express consent and implied consent?
Express consent is given in words (spoken or written), while implied consent is manifested by action showing the patient agrees to treatment, but both require that the person be legally competent and reasonably informed.
What are the elements of information required for informed consent?
Diagnosis, proposed treatment, risks and benefits, alternative treatments and their risks/benefits, prognosis with and without treatment, probable course of recovery, and consequences of not consenting.
What is the standard for consent in a medical emergency?
In a true emergency where the patient is unable to consent and delaying treatment would increase risk of death or serious harm, consent is implied by law and treatment can proceed without explicit consent.
What is the “reasonable doctor” standard for informed consent?
A standard holding that a physician must disclose risks that a reasonable doctor would disclose under similar circumstances, based on professional medical standards and practices.
What is the “reasonable patient” standard for informed consent?
A standard holding that a physician must disclose all information that would be material to a reasonable patient’s decision about treatment, regardless of what other physicians typically disclose.
What is the significance of Cobbs v. Grant for informed consent law?
It established that a physician’s duty to disclose is not governed by community standard practice but is a duty imposed by law, and that patients have the right to information necessary to make an intelligent decision about treatment.
What is “informed refusal” as established in Truman v. Thomas?
The principle that patients must be informed of the risks of refusing recommended treatment or tests, similar to how they must be informed of risks of accepting treatment.
What is a “persistent vegetative state” (PVS)?
A condition where a patient is alive and appears awake but has no detectable awareness, resulting from prolonged brain anoxia and characterized by absence of higher brain functions with only reflexive responses to stimuli.
What is the “substituted judgment doctrine”?
A standard for making decisions for incompetent patients by attempting to determine what the patient would have decided if competent, rather than what the guardian thinks is in the patient’s best interests.
What was established in the Quinlan case regarding end-of-life decisions?
That a guardian could authorize removal of life support for a patient in a persistent vegetative state based on the patient’s right to privacy, using the substituted judgment standard.
What was the significance of Cruzan v. Director, Missouri Department of Health?
The Supreme Court’s first case on right-to-die issues, holding that states may require “clear and convincing evidence” of an incompetent person’s wishes before allowing withdrawal of life-sustaining treatment.
What is a living will?
A document that allows individuals to state their wishes regarding life-sustaining treatments if they become terminally ill and unable to communicate their decisions.
What is a durable power of attorney for healthcare?
A legal document that appoints an agent to make healthcare decisions on behalf of the principal if they become incapacitated, with the power remaining effective even during incapacity.
What is the Patient Self-Determination Act (PSDA)?
A federal law requiring healthcare facilities receiving federal funding to inform patients of their rights to make medical decisions, to ask about advance directives, and to document any such directives in the medical record.
What is the POLST (Physician Orders for Life-Sustaining Treatment) form?
A medical order form that documents a patient’s wishes regarding life-sustaining treatments, designed for those with serious illness or frailty to communicate treatment preferences across healthcare settings.
What is the “mature minor” doctrine?
A common law doctrine that allows minors who demonstrate sufficient understanding and judgment to consent to or refuse medical treatment without parental involvement.
What constitutes a valid defense to a battery claim in medical treatment?
Valid informed consent, emergency situation where consent cannot be obtained, or therapeutic privilege (rarely valid) where disclosure would harm the patient.
What are the rules regarding parental consent for treatment of minors?
Generally, parents or legal guardians must consent to medical treatment for minors, with exceptions for emergencies, emancipated minors, mature minors in some states, and certain sensitive services (e.g., reproductive health).
What is “aid in dying” or “death with dignity”?
Laws in certain states that allow terminally ill patients to request and receive prescription medication from their physician to hasten death in a peaceful manner, with specific safeguards and requirements.
What is the difference between “aid in dying” and euthanasia?
Aid in dying involves the patient self-administering medication to end their life, while euthanasia involves a physician directly administering lethal medication to the patient. Only aid in dying is legal in some U.S. states.
What is the Emergency Medical Treatment and Labor Act (EMTALA)?
A federal law requiring hospitals that accept Medicare funding to provide emergency medical screening to anyone who comes to the emergency department, and to stabilize emergency conditions before transferring or discharging patients, regardless of ability to pay.
What constitutes an “emergency medical condition” under EMTALA?
A condition manifesting acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: placing the individual’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
What is an “appropriate medical screening examination” under EMTALA?
A screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available, to determine whether an emergency medical condition exists. Courts have held it must be comparable to what other patients with similar symptoms would receive.
What is the “comes to the emergency department” language in EMTALA?
This refers to when a person has presented at the hospital seeking emergency care. Regulations define this as including the main hospital campus, within 250 yards of the main building, and in some cases, a person in an ambulance owned by the hospital or in the process of being transported to the hospital.
What is considered “stabilizing” treatment under EMTALA?
Treatment necessary to ensure that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or delivery in the case of a pregnant woman having contractions.
What are appropriate reasons for transferring a patient under EMTALA?
A patient may be transferred if: 1) they are stabilized; 2) they request transfer in writing; or 3) a physician certifies that the medical benefits of transfer outweigh the risks and the receiving facility has available space and qualified personnel and has agreed to accept the transfer.
What is “patient dumping”?
The practice of refusing to treat or transferring patients (typically those who are uninsured or underinsured) to other hospitals for economic rather than medical reasons. EMTALA was enacted specifically to prevent this practice.
What does the “common law rule” state about the duty to aid strangers?
Under traditional common law, there is no legal duty to aid a stranger in distress, even in an emergency, unless there is a preexisting relationship that creates such a duty.
What was established in Childs v. Weis regarding emergency medical care?
This case illustrated the traditional common law rule that a physician had no duty to treat a patient with whom he had no preexisting relationship, even in an emergency situation.
What developments changed the common law’s approach to emergency care?
Courts gradually established a duty for hospitals with emergency departments to provide care to those in genuine emergency situations, and eventually EMTALA codified this duty at the federal level for hospitals receiving Medicare funding.
What is a “Good Samaritan law”?
A state statute that provides immunity from civil liability for ordinary negligence to persons who provide emergency medical assistance, encouraging people to help others in emergency situations without fear of lawsuit.
Does EMTALA require a hospital to prove that a patient was transferred for a non-economic reason?
No. As established in cases like Roberts v. Galen of Virginia, EMTALA does not require proof of an improper motive (like inability to pay) for a claim to succeed. The focus is on whether the hospital provided appropriate screening and stabilizing treatment.
What was established in Moses v. Providence Hospital regarding behavioral health patients?
The court ruled that EMTALA’s stabilization requirement applies to psychiatric emergencies as well as physical ones, and that a hospital may be liable if it discharges a patient with a psychiatric emergency condition that has not been stabilized.
What was established in Beller v. Health and Hospital Corp. regarding ambulances?
Ambulance services operated by municipal corporations or government entities have limited immunity from liability.
When ambulance personnel fail to meet the professional standard of care expected of similarly trained emergency medical technicians in similar circumstances, they can be held liable for negligence despite their governmental affiliation.
Once emergency services are undertaken, providers have a duty to render care in accordance with established professional standards.
What makes a transfer “appropriate” under EMTALA?
An appropriate transfer requires: 1) providing treatment to minimize transfer risks, 2) sending medical records, 3) arranging for qualified personnel and equipment during transfer, 4) securing acceptance from the receiving hospital, and 5) ensuring the receiving facility has the capability and capacity to provide necessary treatment.
When does a hospital’s duty begin under EMTALA?
The duty begins when a person “comes to the emergency department” which includes arriving on hospital property or, as interpreted by courts, when a person is in the process of being brought to the hospital in some circumstances.
What is the hospital’s obligation to screen patients under EMTALA?
The hospital must provide an appropriate medical screening examination to any person who comes to the emergency department and requests examination or treatment, to determine if an emergency medical condition exists.
What is the relationship between EMTALA and medical malpractice law?
EMTALA is not intended to be a federal medical malpractice statute. Courts have held that negligent screening that fails to identify an emergency condition is not an EMTALA violation unless there was disparate treatment compared to other similar patients.
What are the penalties for violating EMTALA?
Hospitals can face civil monetary penalties up to $50,000 per violation (or $25,000 for hospitals with fewer than 100 beds), termination from Medicare, and civil liability to individuals harmed by the violation. Physicians can also face civil penalties.
What is the significance of Buck v. Bell in sterilization law?
A 1927 Supreme Court case that upheld the constitutionality of a Virginia law allowing compulsory sterilization of the “feebleminded” for eugenic purposes, with Justice Holmes infamously writing “three generations of imbeciles are enough.” Though never explicitly overruled, it is no longer considered valid precedent.
What is the significance of Skinner v. Oklahoma in reproductive rights?
A 1942 Supreme Court case that struck down an Oklahoma law allowing sterilization of “habitual criminals,” recognizing procreation as a fundamental right and establishing that laws affecting this right are subject to strict scrutiny under the Equal Protection Clause.
What is the significance of Griswold v. Connecticut in reproductive rights?
A 1965 Supreme Court case that struck down a Connecticut law prohibiting contraception use, establishing a constitutional right to privacy within marriage that protected reproductive decisions from government interference.
What is “wrongful birth”?
A legal action brought by parents claiming that negligent medical treatment or advice deprived them of the opportunity to avoid conception or terminate a pregnancy, usually when a child is born with disabilities that would have been detected with proper care.
What is “wrongful life”?
A legal action brought on behalf of a child born with disabilities, claiming that negligent medical care deprived the child’s parents of information that would have led them to avoid conception or terminate the pregnancy, thus claiming the child’s very existence as the injury.
What is the primary difference between “wrongful birth” and “wrongful life” lawsuits?
In wrongful birth, the parents sue claiming they were deprived of the choice to avoid or terminate a pregnancy; in wrongful life, the claim is brought on the child’s behalf, arguing that but for the negligence, the child would not have been born to suffer.
What damages are typically allowed in wrongful birth cases?
Most courts allow recovery for pregnancy and childbirth expenses, and many also allow extraordinary costs associated with raising a disabled child (beyond normal child-rearing costs). Some courts also allow damages for emotional distress.
Why do most courts reject wrongful life claims?
Most courts reject these claims because: 1) life, even with disabilities, is not considered a legal injury; 2) the physician’s negligence did not cause the disability; and 3) damages comparing existence to non-existence cannot be calculated.
What is assisted reproductive technology (ART)?
Medical procedures used to address infertility, including in vitro fertilization (IVF), gamete intrafallopian transfer, zygote intrafallopian transfer, and intracytoplasmic sperm injection, which involve handling both eggs and sperm outside the body.
What is a “gestational surrogate”?
A woman who carries and delivers a baby for another person or couple, where the surrogate is not genetically related to the child because the embryo was created using another woman’s egg or a donor egg.
What legal issues arose in the Baby M case?
The New Jersey Supreme Court ruled that surrogacy contracts were invalid and unenforceable as against public policy, determining that the genetic father and surrogate mother both had parental rights, with custody determined by the child’s best interests.
What is the Uniform Parentage Act (UPA)?
A model law first promulgated in 1973 and revised in 2002 and 2017, designed to establish legal parentage regardless of marital status, including provisions for children conceived through assisted reproduction and surrogacy agreements.
What was established in Roe v. Wade regarding abortion?
The 1973 Supreme Court decision recognized a constitutional right to abortion based on the right to privacy, establishing a trimester framework where states could not restrict abortion in the first trimester, could regulate to protect maternal health in the second, and could prohibit abortion after viability except when necessary for the woman’s health.
How did Planned Parenthood v. Casey modify abortion law?
The 1992 decision upheld the essential holding of Roe that women have a right to abortion before viability, but replaced the trimester framework with an “undue burden” standard, allowing more state regulation throughout pregnancy as long as it didn’t create a substantial obstacle to abortion access.
What is the “undue burden” standard for abortion regulations?
A standard established in Casey that allows state regulation of abortion as long as it does not place a substantial obstacle in the path of a woman seeking an abortion before viability; the purpose or effect cannot be to hinder the right to choose.
What was established in Whole Woman’s Health v. Hellerstedt?
The 2016 Supreme Court decision clarified that the “undue burden” standard requires courts to weigh the health benefits of abortion restrictions against the burdens they impose, striking down Texas requirements for admitting privileges and surgical-center standards that closed many clinics.
What is a “conscience clause” in healthcare law?
A statutory provision that permits healthcare providers and institutions to refuse to perform or participate in certain procedures, such as abortion or sterilization, based on religious or moral objections.
What is the Hyde Amendment?
A legislative provision first passed in 1976 and renewed annually that prohibits the use of federal funds to pay for abortion except to save the woman’s life or in cases of rape or incest. It primarily affects Medicaid coverage of abortion.
What is the legal status of stem cell research?
Federally funded research on existing embryonic stem cell lines is permitted, while the creation of new lines from embryos specifically for research purposes has been politically controversial. Adult stem cells and induced pluripotent stem cells face fewer restrictions.
