Comlex Ethics Level 2 Actual questions with 100% correct answers (GUARANTEED SUCCESS)

What is respondeat superior or vicarious liability?

it is when an employer is responsible for the actions of their employees. Both terms essentially mean the same thing.

what is res ipsa loquitur?

it is when a physician acts negligently to lead to an accident.

the thing speaks for itself

Example is if a physician prescribes the wrong medication leading to injury or leaves a scalpel inside someone .

What is contributory negligence?

it is when a patient voluntary neglects to follow advice leading to injury.

What is the payment system known as capitation? What form of insurance is it seen in?

Capitation is when a patient is paid the same amount regardless of what kind of services the patient needs. Think of it as the insurance putting a cap on the amount you can make. It is seen in HMO

How is the physicians mistake judged against?

it's based on what a reasonably prudent physician would exercise the same scenario under similar circumstances.

in what case is a child considered emancipated?

Emancipated minor

-married or military

- living alone or homeless

- parent (16 yo mom)

- financially independent

- High school graduate

when is it considered battery on a patient with a physician?

intentional act that leads to harm or offensive contact.

An example is when a physician goes in to remove a tumor and sees another one so he removes it without the patient's permission.

what is one requirement of negligence?

it leads to injury

If a patient asks you about your experience before you perform a procedure what must you say?

You must state your years of experience. You must fully answer every patient's question regarding consent.

If doctors are talking about a patient then when are they considered violating HIPAA?

If they mention the state then they are not in violation of the law. However, if they mention the city then they are screwed.

when is a patient found liable based on the strict liability of tort?

it requires a hazardous act.

If a patient comes in to the ER with emergency symptoms and they request to be examined or in need of care what must you do even if the insurance denies pay?

if the insurance denies pay and the patient has emergency symptoms then they are required to be screened. If it turns out they have an emergency medical situation then you must treat them until they can be transferred to another facility.

This is EMTALA (emergency medical treatment and labor act)

If you have a patient with an STD and you try to convince them to tell their partner and they repeatedly refuse, what is it your duty to do?

It is your duty to warn an endangered third party if you try to convince someone that they should report their STD and use protection and they refuse.

what is paternalism, nonmalificence, due care?

paternalism- ignores patient's autonomy

nonmalificence- do no harm

due care- provide care to the patient.

When does a doctors duty to exercise reasonable care to a 1st time patient arise?

It arises when the doctor actually provides medical treatment, even if the doctor gives a treatment without physically contacting the patient.

What agencies must be contacted in the case of child abuse?

a doctor may contact local law enforcement first before submitting a written report to child protective services or department of children and family services.

In what patient population is a physician required to report abuse? When is a doctor not required to report abuse?

They are required to report abuse of children and elderly, even if the patients request nothing be said. If a spouse if being abused they are NOT required to report it because the spouse may get beaten more.

What is the rule regarding patient confidentiality?

The doctor is required to maintain patient confidentiality even when it involves third party payers. So if an insurance company asks for the patients file you gotta ask the patient.

When can a doctor break confidentiality?

A doctor can break confidentiality if they feel a patient will harm their own body, certain infectious diseases, & patients with epilepsy to the DMV.

When is a hospital not forced to follow EMTALA?

When a patient comes into an ER asking for nonmedical emergency services like a shot or gathering criminal law cases. However, they must comply if they seek a medical screening exam.

What is implied consent used for?

implied consent is used for when a patient is incapacitated; they pass out. When a patient comes into an urgent care facility it's implied that they are going to get TX so if they pass out then you should treat them.

When a caretaker verbally insults, insults, or threatens harm what type of abuse is this?

it's psychological abuse.

What is 'violation of basic rights' and how is it different from active neglect?

violation of basic rights: deprives the basic rights that are protected under state and federal law like the right of privacy to freedom of religion.

Active abuse- when the caregiver intentionally doesn't provide care to the patient like not giving food or meds.

what is passive type of abuse?

passive abuse is when the caregiver unintentionally doesn't provide care because they are overloaded with work.

If a patient has a genetic condition and a family member is at risk of developing and decides to sue, are you supposed to warn the relative or not?

A physician has a duty to warn those who are established to be at a risk for inheriting the genetically susceptible.

If a patient writes in his/her will that they have chosen a power of attorney and they are not married or the parents want to take control, who has the final say in the patient's outcome?

no matter what, once a power of attorney is declared (whoever it be) they are the decision maker.

What does EMTALA say about patients who come in to the ER but want to leave?

EMTALA says that examination should be offered to each ER patient that requests an examination or looks to have emergency medical condition.

But if a patient refuses then you have to make sure the refusal is written in writing and that the patient knows about the benefits or treatment and the risks about not getting treated.

Rights of minors / when do they NOT need parental consent

Minors do NOT need parental consent for... and any wishes to not involved parents MUST be followed.

1. Contraception

2. STD testing

3. Substance abuse treatment

4. Pregnancy

who do you report failure of medical equipment to?

FDA first!

what needs to happen first in a rape victim?

Rape → 1st = sexual assault FORENSIC exam → HIV/STI PPX

medicare criteria?

Medicare Criteria

1. All > 65

2. Medical disability > 2 years

3. CRenalF or ALS

medicare part A covers?

hospital care, inpatient

SNF, nursing home

hospice, home health

medicare part B covers?

medically needed services and supplies

outpatient care (doc appt)

PT/OT

medicare part C covers?

combo of part A and b, C is coverage through PRIVATE insurance companies such as HMO

medicare part D? issues with it?

drug coverage

donut hole (max 3,750 covered, then out of pocket before)

Tarasoff vs. Regent of University of California

Mental health professionals have a duty to protet individuals being threatened by a patient

Public Health Service Act

HHS covers public health and medical response (emergency assistance, housing, human service). Allows government to respond to public emergencies

Cruzan Vs. Director Missouri Dep of Health

Pts have the right to refuse life sustaining tx

Schloendrff vs. society of NY hospital

Informed consent and respondeant superior were established

Patient self determination act

Hospitals/nursing home/home health/hospice/HMOs/health care institutions:

1) ask if have advance directive

2) inform patient of right to accept/refuse tx

3) incorporate advance directive into medical record

individual physicians don't need to

Intern can't work more than...

80 hrs and 16 hr shifts

Minor requests contraceptives, what do you do?

Try to convince them to get parental involvement

Good samaritan law

1) Tx must be rendered in true emergency

2) tx must be outside hospital

3)tx must NOT be reimbursed

What do you do if a pt refuses tx?

Assess capacity

When should physician breach pt confidentiality to parent?

If pt health is at risk

Double effect

Action that has negative and positive consequences may be ethically justified if intention is to achieve positive effect

Gross negligence

Carelessness with intent to cause harm

Volenti non fit injuria

Person who knowingly puts himself at risk for danger cannot sue

Stark Law

Prohibits physician self-referral, specifically referring medicare/medicaid patients to a service that the physician/physician's family member has a financial relationship with

Johnson v. Kokemoor

You must divulge the full extent of your experience if patient asks specifically about it.

Otherwise consent is not fully informed

Safer v. Pack

established the rule that a physician has a duty to take reasonable steps to warn those known to be at risk of avoidable harm from a genetically transmissible condition

Physician Impairment

-inability to practice due to substance abuse

-must report to the physician health program or state board

-confidential assessment and remediation of potentially impaired colleague.

-required to have a long-term contingency contract involving random drug tests and treatment groups

Define primary prevention of disease, and list some examples.

Prevent onset of disease

(ex. vaccinations, diet/exercise)

Define secondary prevention of disease, and list some examples.

Prevent progression of disease

(ex. screening tests, HTN meds)

Define tertiary prevention of disease, and list some examples.

Prevent complications of disease

(ex. surgery, rehabilitation)

What are the reportable disease in most US states?

HepA

HepB

Syphilis

Gonorrhea

Mumps

Measles

Rubella

Tuberculosis

Salmonellosis

Shigellosis

E.Coli (think food outbreaks)

AIDS (yes, and HIV)

Varicella

Meningitis

***easily spread and/or dangerous diseases need to be reported

True or False: Parents can refuse to have their child receive Chemotherapy

False- if parents refuse consent for treatment for a non-emergent, but fatal medical condition the physical should obtain a court order

In terms of consent, if both parents (who are divorced) have custody of a child, do both need to give consent for the child to be treated?

No- only one parent needs to consent for treatment

How long does a physician have to release records when requested by a patient?

30 days

What is the difference between competency and capacity?

Competency= legal definition

Capacity= medical definition

--ability to make decisions on their own

What is the Hospice Model?

focus on quality of life (not life prolongation)

-symptomatic control (i.e. pain, N/V, anxiety, depression)

-interdisciplinary team (medical, nursing, psychosocial, spiritual, bereavement care)

-services provided at home, assisted living, or dedicated facility

-requires a survival prognosis of <6mo

What are the 2 components of an advance directive?

1. Living will

2. Durable power of attorney

What happens if a durable power of attorney disagrees with the patients living will?

(the living will must ultimately be honored)

1st Step= meet with family and discuss situation (while providing supportive care) and review living will

2nd Step=if conflicts arise- consult hospital's ethics committee.

What is the most common cause of medical errors?

Miscommunication between providers

True or False? A physician can respond to an employers request for health information if given verbal permission by the patient?

True- physicians can respond to an employers request for health information either by a verbal or written consent.

Is it legal/ethical for students to practice medical procedures on recently deceased patients?

Yes- the attending physician must obtain permission from the family (or patient prior to death) before a student can perform procedures. The training must be a structured training sequence and performed under close supervision.

True or False? A pregnant mother who has the capacity to chose has the right to refuse treatment even if it places her unborn child at risk.

True

Autonomy

Autonomy is the right or capacity to make one's own rational decisions, using one's own value system, and act on those decisions, without undue coercion from other people or influences. Thus autonomy requires an adequate degree of freedom of thought and action.

Beneficence

One should act in such a way that it produces beneficial results. Usually in health care, beneficence is interpreted as a health care professional's duty to act in a manner that in their best judgement will benefit the patient.

Euthanasia

Euthanasia is intentionally causing the death of a person, the motive being to benefit that person, honor his/her wishes, or protect him/her from further suffering. If the motive is other than the interests of the patient, then it does not qualify as euthanasia (i.e. cost-cutting, triage, etc.).

Active Euthanasia

Active is providing or doing something that directly causes the patient's death. (i.e. giving lethal medication, withdrawing a ventilator when the patient is still paralyzed from medication, delivering carbon monoxide, etc.).

Passive Euthanasia

Passive is when one has a treatment with a good chance of preventing or delaying a patient's death and does not use it (i.e. withdrawing or withholding a ventilator in a patient with an underlying condition that makes it difficult or impossible to breathe without assistance, withdrawing or withholding medication necessary to keep the patient's blood pressure up, not treating pneumonia in a patient with PVS, etc.).

Fidelity

Fidelity (loyalty and/or promise-keeping) - In some cases this term is used to describe a duty to be loyal. In other instances it is used to refer to the duty to keep one's promises. With managed care contracts and the increase in institutional affiliations, more health care professionals are finding themselves in situations where they have to choose between honoring a contractual obligation or doing what they believe is in the patient's best interests. They may also find that their obligations to different third parties conflict

Nonmaleficence (Primum Non Nocere)

"Above all, do no harm."

1. A health care professional has a duty to avoid harming his/her patient.

2. A health care professional has a duty to prevent any harm to the patient

Paternalism

Acting like a parent towards another. Paternalism is where person A decides to treat Person B in accordance with what Person A believes to be in Person B's best interests, regardless of Person B's wishes. This is done out of beneficent motives for Person B. Person A assumes that he/she knows what is best for person B. Paternalism weighs patient well-being more highly than patient autonomy. Furthermore, it does not recognize the subjectivity of well-being and individual values.

Doctor Assisted Suicide

Assisted Suicide - Assisted suicide involves helping a person kill him or herself. The main difference between this and euthanasia is that in assisted suicide the patient is in complete control of the process that leads to death because he/she is the person who performs the act of suicide. The other person simply helps (for example, providing the means for carrying out the action).

What is the Federal Anti-Kickback statue?

made with intention to prohibit the practice of paying medical professionals solely to endorse and promote the use of certain medical devices and supplies.

-you must disclose any financial relationship you have with a product (i.e. getting royalties for a new device you helped invent)

Medicare

"care for the elderly"- funded by social security taxes and is not need-based. Designed for 65+ year olds, people with certain disabilities, and people with end stage disease

Medicaid

intended for low income coverage; it is also available for personas who are aged, blind, disabled, or certain people in families with dependent children regardless of financial burden.

What are the 3 types of torts?

There are basically three types of torts:

-intentional torts

-negligence

-strict liability

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions amend the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to require group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated.

EMTALA

Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay,

What are the requirements of EMTALA?

1.Any individual who comes and requests must receive a medical screening examination to determine whether an emergency medical condition exists. Examination and treatment cannot be delayed to inquire about methods of payment or insurance coverage. Emergency departments also must post signs that notify patients and visitors of their rights to a medical screening examination and treatment.

2.If an emergency medical condition exists, treatment must be provided until the emergency medical condition is resolved or stabilized. If the hospital does not have the capability to treat the emergency medical condition, an "appropriate" transfer of the patient to another hospital must be done in accordance with the EMTALA provisions.

3.Hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack the capability to treat unstable emergency medial conditions.

A hospital must report to CMS or the state survey agency any time it has reason to believe it may have received an individual who has been transferred in an unstable emergency medical condition from another hospital in violation of EMTALA.

ERISA

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.

NMHPA

Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth. In general, group health plans and health insurance issuers that are subject to NMHPA may NOT restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section

Res ipsa loquitur

Res ipsa loquitur often arises in the "scalpel left behind" variety of case. For example, a person goes to a doctor with abdominal pains after having his appendix removed. X-rays show the patient has a metal object the size and shape of a scalpel in his abdomen. It requires no further explanation to show the surgeon who removed the appendix was negligent, as there is no legitimate reason for a doctor to leave a scalpel in a body at the end of an appendectomy.

Respondeat superior

Respondeat superior (Latin: "let the master answer"; plural: respondeant superiores) is a legal doctrine which states that, in many circumstances, an employer is responsible for the actions of employees performed within the course of their employment.[1] This rule is also called the master-servant rule, recognized in both common law and civil law jurisdictions.[2]

In a broader scope, respondeat superior is based upon the concept of vicarious liability.

Drug Trials

Phase I safety

Phase II involves subjects with disease

Phase III large scale testing

Phase IV post release surveillance

Phase V compares data found during the clinical trial with clinical data collected over several years following the release of the drug

Healthcare Integrity and Protection Data Bank (HIPDB)

United States Government program that the collects and discloses authorized users negative information on health care practitioners, including malpractice awards, loss of license or exclusion from participation in Medicare or Medicaid.

--primary goals of improving health care quality, protecting the public and reducing health care fraud and abuse

JCAHO

The Joint Commission (TJC) is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 20,000 health care organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement

National Committee for Quality Assurance (NCQA)

non-profit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The private, nonprofit organization operates on a formula of measure, analyze, and improve. And it aims to build consensus across the industry by working with policymakers, employers, doctors, and patients, as well as health plans.

Parts of Medicare

Part A (Hospital Insurance) covers most medically necessary hospital, skilled nursing facility, home health and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years); you will pay a monthly premium if you have worked and paid taxes for less time.

Part B (Medical Insurance) covers most medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.

Part C is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage plan instead of Original Medicare.

Medicare Part D (outpatient Prescription Drug Insurance) is the part of Medicare that provides outpatient prescription drug coverage. Part D is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government (like Original Medicare is).

The Patient Safety and Quality Improvement Act of 2005

established a system of patient safety organizations and a national patient safety database. To encourage reporting and broad discussion of adverse events, near misses, and dangerous conditions, it also established privilege and confidentiality protections for Patient Safety Work Product

Health Maintenance Organization (HMO)

A health maintenance organization (HMO) is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the United States and acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis.

Preferred Provider Organization (PPO)

PPO plans, or "Preferred Provider Organization" plans, are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.

True or False: A physician must provide documentation to patients in at least 30 days before his retirement.

True-abandonment is a breach of contract and negligence and must provide written information so that the patients can have time to find a new provider

What are the elements of an informed consent?

-Diagnosis

-Risks and Benefits

-Alternative Treatments

What are the elements of "tort of negligence"?

"4 D's"

-Duty owed

-Duty Breached

-Damage to patient

-Direct causation