Unit 1 Exam Flashcards
What is a vital aspect of evaluating health law and policy?
Quality Assessment
What is health defined in?
Its relation to illness.
Who may dispute illness?
Health Insurance Payors
What was the case of Katskee v. BlueCross BlueShield of Nebraska?
In this case, the health insurance payor refused to pay for surgery because they had deemed it not medically necessary.
What did the court rule in the case of Katskee v. BlueCross BlueShield Nebraska?
In this case, the court ruled that an ambiguous health insurance policy will be constructed in favor of the insured.
What is something that one must be aware of when assessing the quality of healthcare?
It is vital to understand what is and is not medical care, to realize that there is not always the best treatment option, and that more medical care is not always desirable than less.
What is known as physician-induced disease?
Iatrogenesis
What does quality in healthcare reflect?
The performance of medical professionals.
What is quality healthcare expected to do?
Maximize patient welfare.
What are the 3 indicators in assessing the quality of healthcare?
1.) Structure -> Resources
2.) Process -> Documentation
3.) Outcome -> Patient Satisfaction
What are secondary ways in which the quality of healthcare can be measured?
1.) Hospital mortality and morbidity rates.
2.) Adverse events that impact patient care.
3.) Effectiveness of compliance policy.
What is important to remember about quality improvement?
This aspect is continuous and a driving force in healthcare.
What is a driving source of iatrogenesis?
Medical Error
Medical errors that cause harm to patients also impose costs on who else?
Health insurance carriers, payors, other injured patients, health systems, and society.
Why is healthcare prone to errors?
Because it is delivered by humans.
What is a problem regarding medical education that reinforces the notion of infallible physicians?
This method of teaching future healthcare professionals does not encourage the disclosure of mistakes and thus fails to prevent future avoidance.
What is the Aviation Model?
This is the idea that error must always be anticipated, thus institutionalizing safety.
What was the Medical Model not based on?
Accident Prevention
What are hospital systems coping through the means of?
Discovery, prevention, training, and error-proofing.
What does the Institute of Medicine acknowledge regarding medical errors?
This organization says, “To Err is to Human.”
Who supported the Institute of Medicine’s report on human error?
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
What is the purpose of the JCAHO?
This organization is authorized by the state and federal government to accredit hospitals and requires the reporting of adverse events.
What is required by the Center for Medicare and Medicaid Services (CMS)?
The development of quality assessment.
What does CMS state that quality can be improved through?
1.) Professional ethics and socialization.
2.) The market mechanism by providing information and empowering consumers of healthcare.
3.) Self-regulation of medical professionals based on: accreditation, medical staff privileges, and medical licensing.
What are the 5 strategies of healthcare regulation?
1.) Command and Control - This imposes standards backed by criminal sanctions. Example: Regulations against fraud and abuse.
2.) Legalism - This refers to the production of complex rules, which may lead to over regulation.
3.) Market Controls - To prevent monopoly and encourage competition.
4.) Inventive-based methods to induce desirable behavior.
5.) Self-regulation - This involves standards set by professionals in the industry. There is also enforced self-regulation, which occurs when self-regulation is subject to some form of government oversight or scrutiny.
What entity provides licensing to medical professionals?
States
Who implements state law regarding medical licensing and what is it subjected to?
Boards (Agencies) and their actions are subjected to administrative and judicial review.
What is the National Practitioner Data Bank?
This organization was established by Congress and was created to prevent doctors disciplined in one state from traveling to another state to continue their practice.
What are the two legal issues raised by Alternative and Complimentary Medicine?
1.) Did it harm patients?
2.) Did it benefit patients?
What did the Administrative Hearing Commission decide following the case of the State Board of Registration For The Healing Arts v. McDonagh?
The AHC determined that the physician being charged did not require discipline due to his use of chelation therapy, as a treatment for vascular disease, not causing harm.
What was the matter in the case of the State Board of Nursing and State Board of Healing Arts v. Ruebke?
In this case, various nursing and medical groups sought an injunction against Ruebke for the alleged practice of lay midwifery.
What did the court rule in the case of the State Board of Nursing and State Board of Healing Arts v. Ruebke?
In this case, the court found that midwifery did not constitute the practice of nursing and medicine. This is because the scope of practice regulations sets the boundary between the professions.
What did the court rule in the case of Sermchief?
In this case, the court found that a nurse may perform certain medical procedures without having engaged in unauthorized practice of medicine.
What was the matter in the case of Mauceri v. Chassin?
In this case, the plaintiff, Mauceri, operated a business from her home, which consisted of providing patients with referrals to home health aides.
What did the court rule in the case of Mauceri v. Chassin?
In this case, the court ruled that providing names of home health aides constitutes the arranging of home health care services.
How do states regulate healthcare facilities?
Police Power: The ability of the state that allows them to pass and enforce laws and regulations pertaining to isolation, quarantine, health, and inspection.
What are the three areas of the regulatory process (police power)?
1.) Standard Setting
2.) Survey and Inspection
3.) Sanctions
What did the court rule in the case of Re: The Estate of Michael Patrick Smith?
In this case, court ruled that the Dept. of HHS must enforce compliance of the Medicaid Act through focusing on patient care, allowing for inspections, violations, and citations to remain a major approach to regulation.
What are the two claims within medical liability?
1.) Medical Negligence
2.) Lack of Informed Consent
In medical negligence and malpractice lawsuits, what is the theory of claim?
In these types of lawsuits, the theory of claim derives from tort for malpractice.
What is needed when establishing a medical malpractice action?
Physician-Patient Relationship
What was the matter in the case of Hiser v. Randolph?
In this case, Dr. Randolph, the on-call ER physician, refused to treat a patient who later passed away.
What did the court decide in the case of Hiser v. Randolph?
In this case, the court decided that Dr. Randolph’s refusal was medically unjustifiable due to his agreement with the hospital bylaws as well as his acceptance of payment as an on-call ER physician.
What does the Restatement (Second) of Torts Section 299 A - Undertaking in Profession or Trade establish?
Standard of Care
What does the Standard of Care state?
When one undertakes to render services in the practice of a profession or trade is required to exercise the skill and knowledge normally possessed by members of that profession or trade in good standing in similar communities.
What was the matter in the case of Shilkret v. Annapolis Emergency Hospital Association?
In this case, Shilkret, an infant, was born at the AAGH but needed to be continuously hospitalized due to intracranial bleeding-induced brain damage. The infant’s delivery was believed to be done negligently, causing the condition.
What did the court decide in the case of Shilkret v. Annapolis Emergency Hospital Association?
In this case, the court issued a directed verdict in favor of the AEHA.
When the case of Shilkret v. Annapolis Emergency Hospital Association was appealed, what did the Maryland Court of Appeals decide?
In this case, the appellate court reversed the original verdict, stating that the physicians did not meet the national standard of medical care.
What was the decision in the case of Hall v. Hilburn
In this case, the court ruled that a physician’s duty of care was to be judged by national, not local, standards.
What was the matter in the case of Wickline v. State?
In this case, the patient was discharged sooner than her doctor had believed appropriate because of the health insurance payor’s refusal to cover further hospitalization. The patient later suffered a blood clot in her leg, leading to amputation.
What did the court rule in the case of Wickline v. State?
In this case, the court ruled that health insurance payors cannot be held responsible for discharge decisions.
What is the key to using scientific medical evidence in the courtroom?
Expert medical opinion and the ability for said expert(s) to turn complex technical evidence into material that can be absorbed by a judge or jury.
What was the matter in the case of Johns Hopkins v. Genda?
In this case, doctors, who were performing surgery on a child with a congenital heart defect to remove a blockage, left a broken needle fragment inside the patient out of fear of causing more harm.
What did the court decide in the case of Johns Hopkins v. Genda?
In this case, the judge rejected Johns Hopkins motion for a directed verdict, and the jury ordered the defendants to pay the family affected in damages.
What did the Maryland Court of Appeals decide regarding the case of Johns Hopkins v. Genda?
In this case, the appellate court decided that there was insufficient evidence to prove medical negligence.
What does Res Ipsa Loquitur mean?
“The injury speaks for itself.”
What was the matter in the case of Ravi v. Williams?
In this case, Dr.Ravi had been attending a hysterectomy for a woman experiencing genital bleeding and pelvic pain. While the scrub nurse and circulating nurse claimed all sponges used were accounted for, one ended up remaining inside of the plaintiff after surgery.
The plaintiff in Ravi v. Williams pursued matters related to the case outside Dr. Ravi. What did those entail?
Prior to Dr. Ravi going on trial, she sued two doctors, one of which was found liable. This was then followed by a settlement with the hospital.
What did the court decide in the case of Ravi v. Williams?
In this case, the court found Dr. Ravi liable for failing to remove a sponge prior to closing an incision. This was deemed negligence per se.
What was the matter in the case of Horner v. Northern PAC?
In this case, a woman undergoing surgery had her right arm extended on a board and injected with a muscle relaxant, while her left arm remained at her side with a blood pressure cuff. Following the surgery, the patient was left with paralysis in her right arm for four years.
What did the court decide in the case of Horner v. Northern PAC?
In this case, the jury found the hospital liable.
What did the appellate court decide when the hospital appealed the decision in Horner v. Northern PAC?
In this case, the appellate court reaffirmed the previous decision as there was evidence the jury could use to infer medical negligence.
The court found that the doctrine of res ipsa loquitur applied in the case of Horner v. Northern PAC because of what three characteristics?
1.) The accident or occurrence producing the injury was of a kind that ordinarily did not happen in the absence of someone’s negligence.
2.) The injuries were caused by an agency or instrumentality within the exclusive control of the hospital.
3.) The injury-causing accident or occurrence was not due to any voluntary actions or contribution by the patient.
What are the Federal Rules of Evidence (701-706) used in medical malpractice cases?
701: Opinion Testimony by Lay Witnesses
702: Testimony by Expert
703: Bases of Opinions by Experts
704: Opinions on Ultimate Issue
705: Disclosure of facts or data underlying expert opinion.
706: Court-Appointed Experts
What is negligence treated as if it causes harm to the patient?
In this instance, it is treated as the sole cause.
What was the matter in the case of Evers v. Dollinger?
In this case, a patient expressed concern to her doctor when she found a lump on her breast. Her doctor told her not to worry, only for that lump increase in size and be discovered as a tumor, rendering the patient terminally ill.
What did the court decide in the case of Evers v. Dollinger?
In this case, the court initially ruled in favor of the defendant due to a perceived lack of evidence. However, that decision was overturned by the Supreme Court of New Jersey in favor of the plaintiff.
What precedent did the case of Chumbler v. Mclure establish?
In this case, the precedent established outlined that something is not considered to be medical malpractice if it deviates from the majority consensus, so long as it does not harm the patient.
What was the matter of the case of Brook v. St. John’s Hickey Mem. Hosp?
In this case, the radiologist injected a contrast medium in the plaintiff’s calves, which was considered to be an unusual spot.
What did the court rule in the case of Brook v. St. John’s Hickey Mem. Hosp?
In this case, the court ruled that a physician is not permitted to conduct an experiment on a patient, unless they have a reasonable basis for doing so.
What is a defense that is commonly exhibited in medical malpractice cases?
In medical malpractice cases, the defense will often raise the contributory fault of the plaintiff in question.
What are the Good Samaritan Statutes?
These laws, found in most states, protect medical professionals when providing emergency assistance in situations where there is no duty to act. However, they cannot abandon someone in need after beginning to assist them.
What is the Joint Tortfeasor Doctrine?
In this doctrine, if parties act together, or separately, but their actions unite to cause a single injury, the multiple defendants are considered to be joint tortfeasors.
What could the court do if several defendants are possible offenders, but the court cannot find which one?
In this instance, res ipsa can be applied.
What is the process in which parties in healthcare lawsuits seek out information?
Discovery
What may the use of the discovery process entail?
The obtainment of electronically stored information pertaining to a patient’s health record.
What is it called when seeking a patient’s electronic health information?
E-Discovery
What are the two issues associated with electronically stored information (ESI)?
(a) The need to preserve ESI.
(b) The existence of meta data (data about data).
Meta data refers to unseen or hidden information in computer files that can indicate what?
(a) When a document was created, viewed, or revised.
(b) Can contain edits, notes, or other private data.
What problem does meta data pose?
Accidental or unintentional release of data.
What would the court use meta data for when there are conflicting versions of the patient’s health records?
(a) If the electronic health record was altered, and
(b) If so, by whom?
Why is the concept of meta data important for health information managers?
It assists them in the process of fulfilling requests for audit trails of electronic health records.
What is an audit trail?
This is a record or catalog that shows a sequence of user activity of a computer system.
What information is in an audit trail?
(a) Who assessed the data.
(b) When such access occurred.
(c) Whether and what changes were made.
What requires the creating and reviewing audit trails?
The Security Rule of the Health Insurance Portability and Accountability Act.
