Review Course Flashcards
1
Q
What is necessary for a podiatrist to admit a patient?
A
Podiatry patients must be co-admitted by another physician with the podiatrist.
2
Q
When a physician delegates a medical act to any qualified and properly trained individual acting under their supervision, who is responsible for the act?
A
The supervising physician.
3
Q
What are the medical practice restrictions for MDs infected with HIV, Hep B or are HBeAg positive?
A
Generally may not perform an exposure procedure
- May perform such a procedure only after seeking counsel with an expert review panel, the hospital develops guidelines, and the physician notifies and obtains the patient’s consent, unless the patient is unable to consent.
- If a physician practices medicine that does not involve exposure-prone procedures, then their practice won’t be restricted
4
Q
Do telemedicine physicians have to take the Texas JP Exam?
A
Yes.
5
Q
What are the exceptions to the special telemedicine license?
A
- A physician licensed in Texas receives episodic consultation from another physician in the same specialty who resides in another state.
- A physician in a state contiguous with the state of Texas who is the treating physician of a patient and orders home health or hospice services.
- A physician in another state who provides medical consultations to a medical school or other educational institution.
6
Q
How much CME does the Texas Board require per year?
A
24 hours
12 are formal
12 are informal
1 hour of medical ethics
7
Q
What crime is committed if a physician practices medicine without a license or valid registration?
A
Third Degree Felony
8
Q
Must a physician notify the board if they do not have malpractice insurance?
A
No they do not have to notify the Board
9
Q
Who can initiate disciplinary action against a physician?
A
Anyone or the Board when relevant information exists that a physician poses a threat to the community and/or has violated the MPA
10
Q
If a physician is suspended or receives criminal sanction in another state what must the TMB do?
A
The TMB has a duty to report it.
11
Q
What does the physician need to do if he receives a Class B misdemeanor with deferred adjudication?
A
Report to the TMB in a similar manner as if there were not deferred adjudication.
12
Q
How many lawsuits must a physician have to trigger the Board to review the license like a complaint?
A
3 lawsuits in 5 years.
13
Q
Who does the TMB require to report physicians who pose a continuing threat to public welfare?
A
Licensed physicians
Medical peer review committees
Medical Students
PAs
14
Q
When might the Board temporarily suspend a license without notice or hearing?
A
When the physician’s practice is found by the Board to constitute an immediate danger to the public.
15
Q
If a license is revoked, how soon can it be reinstated?
A
No earlier than one year.
16
Q
What sort of crime is violation of the MPA or Board decision?
A
Class A misdemeanor
17
Q
What would happen if a physician solicits patients or receives remuneration for referrals?
A
If found guilty, it is a Class Misdemeanor a civil penalty of no more than $10,000 may be imposed.
18
Q
How long must restriction of clinical privileges occur in order to be reportable to the board?
A
longer than 30 days
19
Q
What must a plaintiff prove for medical malpractice?
A
A duty existed Breach of duty Failure was the cause of the injury Patient sustained recognizable injury Plaintiff must prove claim by a preponderance of evindence
20
Q
What are the major causes of medical malpractice?
A
Poor record-keeping Criticism of other physicians Self-criticism Ghost surgery - surgery performed by another provider without the patient's consent Poor communication and bedside manner
21
Q
What must a plaintiff do prior to a lawsuit?
A
File a letter of intent to sue the physician 60 days prior to lawsuit
22
Q
What is the statue of limitations regarding malpractice suits?
A
A two-year statute limitation exists from the occurrence of the breach for health care claims.
23
Q
How long doe the intent to sue suspend the statute of limitations?
A
75 days
24
Q
What is the discovery rule exception?
A
A suit may be filed within two years from the date the plaintiff should have discovered that the negligent act took place.
25
What is the venue?
The District Court in which the alleged injurious act occurred.
26
How soon may either party in a medical malpractice suit expect to receive the patient's medical records?
Within 45 days of a written request
27
What are the three levels of proof of law?
1. Beyond reasonable doubt (criminal case)
2. Preponderance of the evidence (civil casze)
3. Clear and convincing evidence (intermediate proof when beyond reasonable doubt is not plausible)
28
What are the discovery phase events?
Pretrial preparation begins
Don't discuss the case
Don't send the original records to the plaintiff's attorney
Don't alter the medical records
29
When must the Expert Report be filed?
within 120 days of filing the claim
30
What are expert qualification requirements for a malpractice suit?
Currently practicing medicine
Knowledge of accepted standards of care
Qualified on the basis of training to offer opinion.
31
Who establishes standard of care in a malpractice lawsuit?
Standard of care must be established by expert testimony of the same specialty and locality
32
What is Res ipsa loquitur
Means the thing speaks for itself. Shifts burden of proof to the physician when the injury occurs in a situation where such injury usually does not occur absent negligence (e.g. retained sponges).
33
What is the non-economic damages cap from Chapter 74?
250,000 per claiment if single or multiple physicians
- $500,000 per claimant if multiple hospitals or institutions involved
- $500,000 for wrongful death
34
What are exemplary damages?
These are punitive damages and are generally not covered by malpractice insurance policies.
35
What is Stowers doctrine?
Liability insurance company has a duty to exercise the same care and thoroughness for the insurer as if managing his or her own business.
36
Regarding joint and several liability: What is proportionate responsibility?
Percentage of responsibility is determined for each defendant and the claimant
37
Regarding joint and several liability: What is the Texas Comparative Negligence Act?
The jury must determine the percentage for which each defendant is liable when each defendant is liable for than less than 50%
38
Regarding joint and several liability: Can a claimant recover damages if their percentage of responsibility is greater than 50%?
No.
39
Regarding joint and several liability: what happens if one defendant is responsible for greater than 50% of the liability?
He or she is responsible for the entire amount and must sue the other physician(s) for his liability amount to recoup their share.
40
When may a physician break patient confidentiality?
Information authorized by law or probability of imminent danger to the patient or others.
41
If a patient is a danger to himself, to the treating physician or others, can the physician warn potential victims in Texas?
No. Bu the physician may warn medical or law enforcement authorities.
42
What is the single major cause of lost malpractice suits?
Inappropriate and inadequate medical record keeping.
43
Can a physician refuse to give a patient copies of his/her record?
Yes if it would be deleterious to the patient.
Physicians cannot withhold the release of information for purposes of emergency care or for payment for past due accounts.
44
If a physician receives a non-emergent request for medical records, what can he expect in exchange for the release of the requested information?
A reasonable, cost-based fee
45
How would you describe a Schedule I drug?
No accepted medical use (e.g. heroin)
46
How many refills can a patient be written for for scheduled II drugs?
None
47
What are the refill limits for schedule III-V class drugs?
Cannot be refilled more than 5 times or more than six months from the issue date
48
How must the prescription for a schedule II drug be written?
Numerically followed by the number written as a word.
49
When can a DEA registration be suspended?
Fraudulent information
Suspended Controlled Substance Registration
Convicted of any felony
Suspended license
Failed to maintain effective controls against diversion
Failed to maintain records
50
What is the dangerous drug act?
Regulation of drugs no included in Schedule I - V (steroids, tranquilizers).
51
Who may prescribe Laetrile and why?
A licensed physician for treatment of cancer despite no scientific benefit of its use.
52
Who may prescrive or administer DMSO?
Dimethyl sulfoxide as long as it is approved human use by the FDA.
53
If a patient has immediate needs, may an urban practitioner dispense medications?
Yes but may not charge.
54
If a patient has immediate needs, may a rural practitioner dispense medications?
Yes and may charge if outside 15 mile range of a pharmacy.
55
What are the requirements on the part of the physician in order to dispense free pharmaceutical samples?
Left in company package
Not repackaged by physician
Physician keeps records of the sample
56
What does the Intractable Pain and Treatment Act do?
It protects physicians who prescribe narcotics for pain relief for a generally accepted medical condition.
57
What department gives a license to a physician for handling, producing or transporting hazardous chemicals or radioactive materials?
Department of State Health Services
58
Can pharmacists dispense a medication refill without physician approval?
Yes if the pharmacist cannot reach the provider after reasonable effort. A 72 hour quantity is allowed.
59
What is the Healing Arts Identification Act?
Requires health care providers to identify their branches in advertising sources.
60
What type of physician is a D.P.M.?
Doctor of Podiatric Medicine
61
According to the Healing Arts ID act, what must an M.D. or D.O. put after their degree?
Nothing if they so choose but they may place their board specialty after it.
62
When can a physician write Board Eligible in advertising?
Never
63
What ad media does the board prohibit?
The board may not prohibit the use of a particular ad medium.
64
What are the limits on the size or duration of a physician's advertisement?
None. The board may not restrict these.
65
What are the advertising restrictions surrounding a physician's trade name?
There are no restrictions.
66
What are the advertising restrictions involving the use of a person's voice?
There are none.
67
What are the advertising restriction involving use of the term "Board Certified"?
The complete name of the board must be used. No exceptions.
68
What must a lab disclose to the patient in order for a physician to make payments for the patients?
- Net amount charged for each test must be on bill
- Name and address of the performing lab
- Net amount paid available upon written request by the patient or third-party payers.
69
What is a fiduciary duty?
A duty of trust owed by persons with superior knowledge to patients.
70
Describe the consensual quality of a patient-physician relationship?
No physician is required to accept a patient other than in an emergency situation.
71
When does the patient-physician relationship begin?
With any act of diagnosis or treatment directly with the patient.
72
How many full-time PAs may a supervising physician oversee?
Up to 5.
73
According to the omnibus health care rescue act, when is physician supervision adequate?
MD must receive daily report
MD must visit clinic at least once every 10 business days
MD must be reachable by phone
MD must be responsible for standing order and protocols
74
What does the phrase respondeat superior refer to?
A physician is responsible for the actions of his/her employees.
A hospital is held liable for the negligent actions and medical care provided by their nurses.
75
Are hospitals liable for the negligent acts of their physicians?
Generally no, but recent rulings have held some hospitals responsible for their physician's negligence.
76
Who can bill as a surgical assistant?
Only a licensed surgical assistant may directly bill a patient or third-party insurer for services.
77
When is good samaritan protection lost?
When a fee charged or received or if gross negligence occurs.
78
Does good samaritan protection extend to physician's with a pre-existing duty to treat or is responsible for the emergency?
No.
79
What is EMTALA?
Emergency Medical Treatment and Active Labor Act?
80
Does EMTALA require screenings to be performed by a physician?
No.
81
What sort of patients does EMTALA require hospitals to provide emergency treatment and stabilization?
Emergent Condition
| Active Labor
82
If a hospital does not have the capability to provide necessary treatment, what does EMTALA allow?
Transfer to a facility that does have the capability.
83
When does EMTALA allow transfer of an unstable patient?
Patient requests transfer and understands risks
| Physician must sign a written summary representing that the benefits outweigh the risks.
84
When can a receiving hospital offering the necessary services and capabilities refuse to admit a patient from an under-equipped facility?
Never.
85
What are the types of violations of EMTALA?
1. Reckless violation-->if permanent injury or death results it becomes a Class A misdemeanor
2. Intentional violation-->if death results it becomes a felony
86
What are the punishments for an EMTALA violation?
- Hospital or physician: fine <= 50,000
- Termination of provider agreement with CMS
- Only hospitals are subject to civil liability, physicians are not.
87
Who does HIPAA permit disclosure for HIV results?
```
Local health authority
TDSHS
CDC if required by federal law
Ordering physician and the patient
Treating HCP
Spouse of patient
Partner notification program
Emergency medical personnel exposed to HIV virus
```
88
What are patient rights?
Right to participate in his or her plan of care
Right make informed decisions regarding care
Right to be informed of his or her own care
Right to request or refuse treatment
Right to formulate advance directives
Right to personal privacy
Right for records to be confidential
89
What may constitute the tort of battery?
Unwanted touching of the patient without consent
90
When may physicians be liable for assault?
For performing medical treatment or surgery without a patient's express or implied consent.
91
What is simple consent?
Required by patients by expressing or implying consent for treatment
92
What is informed consent?
Explains the risks and benefits of the procedure
93
What is the standard for informed consent?
Reasonable Patient Standard: What a reasonable patient would want to know in making an informed decision before a procedure.
94
What is the implied consent doctrine?
Applies to emergency circumstances in which consent is not necessary.
95
What duty does the referring doctor have to obtain consent for surgery?
None. That is the surgeon's duty.
96
What is the only basis for recovery for failure to obtain consent?
Negligence in failing to disclose risks and benefits that would have influenced a reasonable person in making a medical decision.
97
If a person is arrested for operating a vehicle under the influence, what sort of consent is required for the taking of a blood specimen?
They are automatically deemed to have consented to the taking of a blood specimen.
98
When is consent for the treatment of children not required?
In an emergency or when there is a reasonable suspicion for abuse.
99
When may children may consent for treatment without parental notification?
1. Active military duty
2. Older than 16 residing separately from parents and managing own financial affairs
3. For purposes of diagnosing and treating an infectious or communicable disease
4. For treatment of drug or chemical addition
5. For pregnancy related treatment (unmarried, pregnant female children) with the exception of abortion
6. For sexual abuse or suicide prevention treatments
100
What is the order of consent of minors?
Natural mother
Father
Adoptive mother or father
Parent or guardian who is managing conservator
101
If parents are not present who may provide consent for minors?
Adult sibling
Grandparents
Adult aunt/uncle
if none of the above available, then adult with written authorization
102
Who are the surrogate decision makes for elective procedures for comatose or mentally incapacitated patients?
Spouse
Adult child who has consent of other adult children
Majority decision of available adult children
Patient's parents
Individual with power of attorney
Nearest living relative
Member of clergy
103
What treatments can a surrogate NOT consent to?
Abortion
Inpatient mental health services
Convulsive treatment
Psychosurgery
104
What sort of violation is intentional alteration of a directive?
Class A misdemeanor
105
Who may not serve as a patient's Power of Attorney?
Treating physician
Employee of treating physician
Residential care provider
Employee of the patient's residence
106
When are blood tests for HIV, syphilis and Hepatitis B administered to pregnant women?
1st pregnancy exam and at birth and physician must provide information about treatment in the instance of positive test results.
107
What are the rules surrounding PKU/Thyroid tests of a newborn?
Needs parental consent. Physician not liable if parents object due to religious beliefs.
108
Can a 15 year old minor get an abortion in Texas?
Yes if parents are notified and consent, the minor has a court order, or is needed to avoid serious injury to include death.
109
What eye drops must a physician give a newborn and what happens if he/she fails to do so?
A physician must use eye prophylaxis drops to prevent ophthalmia neonatorum and failure to do so is a Class B misdemeanor
110
What must a physician provide a newborn?
Eye prophylaxis drops
Offer a newborn hearing exam
Check for PKU, hypothyroidism, sickle cell, HIV, and other inheritable diseases
111
When must birth reports be filed?
within 5 days
112
Who is responsible for filing a birth report if the birth occurs outside a hospital?
The parents.
113
When must a child's death be filed with JOP or ME?
When the child is under 6 years of age and the cause of death is unknown.
114
What is a wrongful pregnancy?
A preconception tort where ineffective sterilization resulted in normal pregnancy
115
What is a wrongful birth?
Preconception tort brought on by the delivery of a child with birth defects where the physician failed to provide genetic counseling so the mother missed an opportunity for an abortion.
116
What is a post-conception tort?
Applies to injuries incurred during delivery
117
If a husband signs consent for artificial insemination of his wife, who is the child's legitimate parents?
Both father and mother
118
What happens if a physician fails to report child abuse?
Class B Misdemeanor with jail <= $1000.
119
How soon does a certificate of death be filed?
Within 10 days
120
What is the charge for failure to comply with state regulations regarding the proper documentation for birth and death certificates?
Class C Misdemeanor
121
When must deaths be immediately reported to the medical examiner?
When they are unexpected and suspicious
122
May a physician promote a suicide?
No, it it is a class C misdemeanor and if it results in death or serious injury then it is a felony.
123
What is the order of priority for consent for an autopsy?
```
Spouse
Adult child
Authorized Guardian
Parent
Next of kin
```
124
If nothing in writing exists regarding an anatomic gift, who can elect to have remains donated?
```
Spouse
Adult child
Either parent
Adult sibling
If no family cannot be contacted within 4 hours, then the ME may decide
```
125
Who can execute a directive for the withholding of life-sustaining procedures?
Any competent person unless they are pregnant.
126
What is required for a valid directive under the natural death act?
- Can't be pregnant
- Must be signed with two witness who are neither related to the patient nor entitled to any inheritance
- Does not include feeding or medications
127
When must a physician report a drug overdose?
Only when it involves penalty group 1 drugs.
128
What happens if a physician fails to report elderly abuse outside of a nursing home?
Class A misdemeanor
129
What happens if a physician maliciously reports elderly abuse?
Class B misdemeanor
130
What happens if a physician fails to report elderly abuse inside a nursing home?
Class A misdemeanor
131
What happens if a physician maliciously or fraudulently reports elderly abuse inside a nursing home?
Class A misdemeanor
132
What should a physician do if a child less than 14 years old presents with pregnancy related issues or requesting a pregnancy test?
Trigger a report of possible child abuse
133
When must non-professionals report child abuse?
Immediately
134
When must professionals report child abuse?
Within 48 hours
135
What sort of crime is knowingly making a false report of child abuse?
Felony carrying liability for civil fines up to $1000
136
What gunshot wounds do not need to be reported to local police?
All need to be reported.
137
Are local health officer records confidential?
Yes and may not be released unless for epidemiological purposes or to protect the health of the named party.
138
A provider who requires HIV testing without consent as provided by law commits what crime?
Class A Misdemeanor
139
To whom does the phrase "mental illness" refer?
```
Those with impaired mental health but excluding those with:
Epilepsy
Dementia
MR
Alcoholism
```
140
What is a physician's responsibility if he learns of consensual sexual relations between a mental patient and their provider?
He must report it and failure to report is a class C misdemeanor.
141
What does the illegal remuneration act address?
It forbids kickbacks for referrals to mental hospitals.
142
What does the corporate practice of medicine forbid?
Forbids businesses owned by non-physicians to profit from the practice of medicine.
143
Is the following business model allowed: Non-profit owned corporations jointly owned by physicians and non-physicians.
Yes, it is legal.
144
Is the following business model allowed: Limited liability association or company jointly owned by physicians and podiatrists and optometrists.
Yes, it is legal
145
Is the following business model allowed: Nonprofit corporations owned by non-physicians.
Yes, it is legal.
146
Is the following business model allowed: Partnership practice of husband and non-physician wife?
No, is it illegal.
147
What is the Stark Law?
Prohibits physician referrals of Medicare patients for designated services that are reimbursed under CMS to which the physician has a financial relationship.
