Download Texas Jurisprudence Exam (Chap 1-4) With Correct Answers. and more Exams Nursing in PDF only on Docsity!
(Chap 1- 4 )
With Correct Answers.
Can a patient successfully sue a doctor if there is no physician-patient relationship? - Answer No If there is no prior physician-patient relationship, are you legally obliged to respond to a call from a patient for treatment? - Answer No Does being on call give rise to a physician-patient relationship? - Answer No How can one terminate a physician-patient relationship, without abandonment if there is ongoing treatment? - Answer 30 days written notice; must provide for emergency Does a physician's duty extend to the unborn child or potential victims of an ill patient? - Answer Yes What is "proximate cause"? - Answer Prove that negligence caused harm and that the cause was not too remote; what is required to hold a defendant liable in a civil lawsuit What are the two components of proximate cause? - Answer Cause-in-fact (but-for test) and foreseeability Does an expert witness have to be actively practicing medicine? - Answer Yes Does an expert witness have to know standards of care? - Answer Yes Does an expert witness have to have enough training to express an opinion on whether standard of care was provided? - Answer Yes Does an expert witness have to be board certified? - Answer No, board certified or eqivalent In a medical malpractice case, are expert witnesses required? - Answer Yes, with two exceptions In a medical malpractice setting, what 2 instances do not need expert testimony? - Answer Res ipsa loquitur (e.g., amputation of wrong leg) and negligence per se (a law was broken) What are "exemplary damages"? - Answer Damages above compensatory designed to punish the defendant and deter the behavior Is there a cap to noneconomic damages? How much? - Answer $250,000 for physicians, $500,000 for hospitals
(Chap 1- 4 )
With Correct Answers.
Does the cap on noneconomic damage depend on the number of defendants or claimants? - Answer No What is "proportional responsibility"? - Answer Percentage of liability apportioned according to percentage of fault Can the claimant have part of the proportional responsibility? - Answer Yes If the claimant's proportionate responsibility is more than what %, he/she may not recover damages? - Answer If > 50%, no damages awarded How long is the statute of limitations for adults? For minors? - Answer 2 years; for minors 2 years after becoming 18 years of age By how much can the statute of limitations be extended and how? - Answer File complaint—extra 60-day, notice letter extends statute by 75 days What is the statute of limitations for wrongful death? - Answer 2 years What is the discovery rule? Give examples. - Answer Statute does not begin until damage is discovered. For example, a retained sponge that is found 3 years post-op Is there immunity from civil action in emergency cases? - Answer Yes, except gross negligence Is there immunity from civil action in volunteer care? - Answer Yes, except gross negligence When can a physician be charged with "assault and battery"? - Answer Un- consented surgery or examination or when exceeding the scope of the consent When can a physician be charged with patient abandonment? - Answer Unilateral cessation of treatment when continued treatment is necessary What is "strict liability"? - Answer Liability that does not depend on actual negligence, but that is based on a breach of a duty to make something safe. This often applies to product liability Are hospitals liable for the actions of a physician? - Answer No, unless the hospital employs the physician Who determines in a criminal case if the medical records of a patient should be released? - Answer Judge by inspection How many days do you have to release medical records to an attorney? - Answer 45 days
(Chap 1- 4 )
With Correct Answers.
How many days does the physician have to mail the schedule's emergency prescription to the pharmacy? - Answer 7 days How many days does the patient have to fill schedule 2 prescriptions? - Answer 7 days Can you refill a schedule 2 prescription? How about schedule 3-5? - Answer No for schedule 2. Max 5 refills for schedules 3-5. Who can call in prescription from a physician's office? - Answer Any qualified DESIGNATED person Can they call in schedule 2? - Answer Only physician in emergencies Can a physician prohibit substitutions for generics? - Answer Yes From whom and how do you order schedule 2? Schedules 3-5? - Answer Schedule 2 on triplicate order form from distributor; schedules 3-5 regular form from wholesaler What drugs do you need to keep records on? How are the records kept? How often do you need to do inventory? Do you need to submit the records? How long do you have to keep the last inventory list? - Answer If dispensed in office, then all dangerous drugs, schedule drugs and samples; separate records for schedule 1+2; inventory every 2 years; records are not submitted; keep records for 2 years Who can inspect your drugs? - Answer TMB, DPS, attorney general for the DEA What is the method of ordering and accounting for drug samples? - Answer Written and signed request by physician; must keep inventory and drug logs Can you repackage samples? - Answer No Do you need to keep records on samples? - Answer Yes, just like other meds Can a physician buy and rebottle? Any exceptions? - Answer No, except for rural areas (less than 5000 population of town or 2500 of municipality, closest pharmacy > 15 miles) To give anesthesia, how often do you have to register with the board? - Answer Every 2 years What life support competency do surgeons and anesthesiologists need? - Answer ACLS, PALS, or board-approved course
(Chap 1- 4 )
With Correct Answers.
How many and what competency levels of healthcare providers do you need in all settings? - Answer At least 2 physicians with advanced competency How many days do you have to report office-based anesthesia-related complications? - Answer 15 days What is considered an anesthesia-related complication? - Answer Admission to hospital within 24 hours or death within 72 hours What is considered intractable pain? - Answer Pain where cause of pain cannot be removed and where relief or cure has not been found Can a hospital forbid a physician to give dangerous drugs or controlled substances for treatment of intractable pain? - Answer No Can the board take disciplinary action against a physician for giving dangerous or controlled substances to a patient with intractable pain? - Answer No What must the physician document prior to treatment of intractable pain? - Answer Understanding between physician and patient about treatment; dose, type, frequency of medication; consultation with psychologist, psychiatrist, addictions expert Can you guarantee that a drug will work? - Answer No Who can be part of a confidential communication? - Answer Persons involved, furthering interest of the patient, and those participating in diagnosis or treatment, e.g., patients, doctors, translators, nurses, etc Is the billing record confidential? - Answer No, billing record is NOT part of medical record In a criminal proceeding, is the physician-patient privilege communication confidential? - Answer NO (except for mental health records); judicial ruling should be obtained In a criminal proceeding, are records of alcohol and drug abuse confidential? - Answer Yes Does the physician confidentiality apply to court or administrative proceedings brought by the patient against a physician? - Answer No Can the physician violate confidentiality if he/she thinks he or someone else is in danger? - Answer Yes, must report that to law enforcement agency (NOT for mental health)
(Chap 1- 4 )
With Correct Answers.
option? - Answer Upon request, within 30 business days; hospital must inform patient of availability of itemized bill Can medical records be obtained with a subpoena? Does this include substance- abuse records? - Answer Yes; no Are substance abuse records admissible during criminal proceedings? - Answer No, unless the crime is EXTREMELY serious Is HIV information confidential? - Answer Yes Can you "break" confidentiality in order to tell a spouse that his/her spouse is HIV positive? - Answer Yes Can you break confidentiality to tell a partner about notification program?. - Answer Yes Are blood bank records confidential? - Answer Yes If a blood bank finds a donor with an infectious disease, can they call other blood banks and tell them the name of donor and the disease?Edition. - Answer They can tell name of donor, NOT disease If a blood bank finds that blood outbound to hospitals is HIV positive, can they call the hospitals and give name of donor? Type of disease? - Answer They can tell name of disease, NOT donor For statistical purposes, can a blood bank give out medical records? Names? - Answer Yes, but not names or other identifying information Is genetic information confidential? - Answer Yes Can patients have access to the results of their genetic testing? - Answer Yes What kind of crime is the unauthorized release of records? - Answer Misdemeanor Can the Texas Medical Board (TMB) show preference to a specific school of medicine such as medicine v. osteopathy? - Answer No What does the Medical Practice Act (MPA) regulate? - Answer The practice of medicine Who does the MPA apply to? - Answer Physicians (MD, DO), PAs, and acupuncturists
(Chap 1- 4 )
With Correct Answers.
Does the MPA apply to the armed forces and federal public health? Can they moonlight? - Answer It does NOT apply to a federal job, they can NOT moonlight outside the federal setting Does the MPA apply to emergency assistance if there is NO charge of money? If there is money charged or billed? - Answer NO if no charge; YES if money is charged Are medical students in "board-approved schools" subject to the MPA? - Answer No Does the MPA prohibit self-care? - Answer No Does the MPA apply to physicians in contiguous states? - Answer NO (physicians from nearby states can only order care for patients in hospice or nursing homes) How many people are on the TMB? Who appoints them? Who must confirm them? - Answer 19 members, appointed by the governor, confirmed by the senate Can the board subpoena people and records? Who can serve a subpoena? - Answer YES, subpoenas can be served by board investigator or sent by certified mail How often does the Department of Public Safety (DPS; state police) check on physicians and report to the board? - Answer Quarterly What are acceptable methods to tell the public on how to register a complaint to the TMB? In what languages? Where can a physician include this info? - Answer By phone (direct number and 1-800 number) or by mail; posted sign, on registration forms or bill; in English and Spanish How often must the TMB disseminate updated information? What info is included? - Answer 2 times per year; info includes disciplinary action, board activities and functions, changes to the MPA and attorney general opinions Are disciplinary orders private or public? - Answer Public Are the following included in the physician profile?
- ethnic origin
- CME
- years in practice
- Medicaid participation
- misdemeanors
- felonies
- malpractice claims
- tax ID or social security numbers - Answer Everything except for tax ID/soc. security
(Chap 1- 4 )
With Correct Answers.
How can you get another license if it is lost/destroyed? - Answer Get affidavit of lost or destroyed document and pay fee to board How many category 1 CMEs yearly? - Answer 12 How many CMEs per year? - Answer 24 How many category 1 CMEs yearly must be in ethics? - Answer 1 How many category 2 CMEs can be from volunteer work? - Answer 6 How many CMEs can a license carry forward? And for how many registration periods? - Answer 48; only once How many CMEs can be applied retroactively? - Answer 24; only once How many CMEs do you need if you become "board certified" within 36 months? - Answer 24 If you practice pain management, how many CMEs in pain management are required? - Answer None, but they are recommended Who can initiate a complaint to the board? - Answer Anyone What is the "health professions council"? - Answer Council of various professionals that establishes a central telephone complaint system (800-number) Does the TMB have to notify a physician when a complaint is filed? Are there exceptions? How often do the parties get updated on proceedings? - Answer Yes, within 30 days, except if it would interfere with the investigation; updates are quarterly When does the TMB release complaint information to the hospital? - Answer Upon written request Who investigates issues of "medical competency"? - Answer An expert physician panel appointed by the board consisting of physicians ONLY What do medical malpractice carriers have to report to the TMB regarding malpractice? Within what time limit? Who punishes them if they do not report? What does a physician without insurance have to report and when? Is there a difference for NPDB/HCQIA? - Answer Within 30 days from a complaint being filed in a lawsuit, settlement; noninsured MDs have to self-report within 30 days; any payment must be reported to NPDB by HCQIA requirements
(Chap 1- 4 )
With Correct Answers.
Restrictive action by the TMB: Within what time limit must the board tell the hospital? Tell Medicare? Tell the secretary of health & professional societies & complainant? - Answer Next working day for hospitals; in writing for all within 30 days. Restrictive action by the TMB: How often must the board make public notices about disciplinary orders? - Answer 2 times per year. Restrictive action by the TMB: Must the board report crimes found during investigations? - Answer Yes, to the law enforcement. Restrictive action by the TMB: Within how many days must the board report to the NPDB? - Answer 30 days. Restrictive action by the TMB: Within how many days must a court report to the board about convictions, felonies, and misdemeanors and addiction issues be filed?
- Answer 30 days. Are TMB reports confidential? - Answer Yes Who can the NPDB give info to? How about to patients? How about statistical data?
- Answer Hospitals, self-requesting physicians, board, other state or federal agencies, attorneys; for statistical purposes if no identity disclosed When is it not illegal to perform a third-trimester abortion? - Answer To prevent mother's death, if unborn has severe irreversible brain damage When is it not illegal to perform an abortion on a minor? - Answer In emergency and with court order Is sexual contact between a physician and patient OK if the patient consents? - Answer NO, the disparity of power does not allow consent Why is it unprofessional to initially prescribe drugs over the Internet? - Answer Did not verify identity of patient, no physician coverage or follow-up guaranteed How can you terminate care to a patient? - Answer 30 day notice, certified letter, available for emergencies during that time, give alternative physicians What prescriptions does a physician need to keep records on? Dangerous drugs? Controlled substances? Samples? - Answer Samples and dangerous drugs as part of medical record; for schedule 3-5 records and log; for schedule 2 separate log and records; keep record for 2 years; do inventory on schedule drugs every 2 years Can the board administer monetary penalties? - Answer Yes
(Chap 1- 4 )
With Correct Answers.
If you surrender your license voluntarily, whose burden is it to show competence if you want it back? - Answer The physician who surrendered the license How often and how soon can you reapply to have your license reinstated if it has been canceled/suspended, etc.? - Answer Once a year What is the maximum administrative penalty? How long do you have to pay it? - Answer $5000 per violation; 30 days What is the maximum penalty for an action for civil penalty by the attorney general? How long do you have to pay it? - Answer $1000 per penalty, 30 days What kind of offense is a violation of the MPA? What kind offense is it to practice medicine in violation of the MPA? To practice medicine with financial harm? - Answer Misdemeanor class A; felony; jail felony May you perform emergent surgery while drunk? - Answer No; emergency MIGHT be an exception If you have a contract with an impaired physician, can you avoid reporting him/her? - Answer No Can the board regulate advertising? - Answer No, except to prohibit false, misleading, or deceptive practice Are "testimonials" allowable advertising? - Answer No Is it permitted to advertise board certification? Board eligibility? - Answer Certification, yes; not eligibility What is a standing medical order? - Answer Physician order to institution, e.g., nursing home What is a standing delegation order? What are the requirements? - Answer Physician order for patient or population; signed, dated, in writing Who can a physician delegate to? - Answer Any qualified and properly trained person Who can the physician delegate to administer dangerous drugs? - Answer Any qualified and trained person Can a physician delegate to a midwife? - Answer Yes (e.g., eye prophylaxis) Is a physician liable for the actions of a NP or PA? - Answer No, unless vicariously liable due to employment
(Chap 1- 4 )
With Correct Answers.
What kind of name identification do PAs need? - Answer Name tag identifying themselves as a physician assistant What requirements exist for prescription for PAs and NPs? - Answer No schedule 2; maximum 90 days, no refills unless consultation with physician Which drug schedules can PAs and NPs prescribe? How many days? Can they give refills? Can they treat children? What ages? - Answer Schedules 3-5, 90 days, refill after consultation with physician; Yes, but children less than 2 years only after consultation with physician How many PA and NP equivalent FTEs can a physician supervise at maximum? - Answer 3 FTEs Can CRNAs give all anesthetic drugs? Are they restricted to a particular MD? - Answer Yes; no, any MD What authority do pharmacists have? Can they give immunizations? Where does the supervising physician have to be located geographically? - Answer Getting histories, ordering drug therapy-related tests, procedures, modifying drug therapy; yes; physician has to be able to be physically present daily What can optometrists prescribe? - Answer Eye ointments Can anybody be a surgical assistant? Do they need a license? - Answer Yes; yes, if they identify themselves as licensed, otherwise, no Can a physician delegate the taking of X-rays to noncertified technicians? - Answer Yes Can they do bone density? Nuclear tests? CT? Skull X-ray? - Answer Bone density, skull, spine, extremities, abdomen, chest; NOT CT, nuclear test, etc Do they need to be licensed or registered by the boards? - Answer Yes, they need registration What is the difference between a partnership and a limited liability partnership? - Answer The limited liability partnership can limit individual liability white partner A is liable for the acts of partner B Who can incorporate in Texas? Can physicians practice through corporations? - Answer Dentists, PT but NOT MD; MD cannot practice through corporation Are there any corporations that can employ physicians? - Answer Yes, Certified Nonprofit Healthcare Corporation
(Chap 1- 4 )
With Correct Answers.
What kind of crime is it to tamper with Texas Medical Board documents? - Answer Class A Misdemeanor Barratry—what is it? Is it illegal? - Answer Contacting prospective patients in attempts to solicit them; it is illegal Who can be part of a medical peer review committee? - Answer Physicians, health care workers, anybody in the hospital Does physician competency include membership in societies, participation in education, participation in group plans? - Answer No Who makes rules (by laws) for hospitals? - Answer The governing body Can a hospital reject an orthopedist because he is a DO and not an MD? - Answer No Can a hospital deny you privileges because you don't accept HMOs? Participate in other hospitals? - Answer No Who makes the final decision in a hospital to grant or deny privileges to a physician?
- Answer Governing body Does the hospital have to get a report from the NPDB about physicians prior to granting privileges? - Answer Yes, initially and every 2 years; if they don't, they are liable How many days does the board have to give data to a hospital requesting it? - Answer 15 days How often must a physician update his core credentials? How many days does he have to provide corrections? - Answer Yearly; corrections within 30 days Prior to the "first release" of his information, how many days does a physician have to review it? - Answer 15 business days If a physician's privileges will be suspended, does he/she have the right to due process? - Answer Yes How many days prior to hearing of due process must the hospital give the physician notification? - Answer 30 days Do hospitals have to accept NPs and PAs? - Answer No
(Chap 1- 4 )
With Correct Answers.
If accepting NPs and PAs, what are the hospital's responsibilities? - Answer Due process, fairness, appeal Is the peer review file confidential? - Answer Yes, EXCEPT for possible civil rights violation and possible anti-trust violation When must a hospital's medical peer review report actions taken against physicians to the TMB? to the HCQIA? to the NPDB? - Answer If action affects privileges for longer than 30 days or if physician surrenders privileges or if it affects membership; never, the TMB reports to NPDB How much time does the committee have to report to the TMB? - Answer 15 days Is it good enough to get the signature for informed consent? - Answer No, actual informed consent must be achieved Which procedures need "full disclosure" of LIST A and LIST B? - Answer Only List A Which procedures need additional "statutory consent"? - Answer Hysterectomy, radiation therapy, ECT Is it the duty of the hospital or the physician to get consent? - Answer Physician Which particular aspects of an informed consent if neglected can be grounds for a suit? Do you need to suffer damages to sue? - Answer Nondisclosure of risks, benefits, alternatives; yes Is express consent required in an emergency? - Answer No, consent is implied If arrested and suspected to be drunk, do the police need consent to check blood? - Answer No, consent is deemed to have been made, but consent can be expressly denied If anyone died in an accident, is consent needed to check blood? - Answer No Who is a minor in Texas? - Answer Anybody less than 18 years of age who has not been emancipated When can a minor petition the court NOT to be a minor? - Answer Age 16 when living independently and supporting self, age 17 when supporting self, managing conservator or guardian, Texas resident Can an uncle consent for a minor? - Answer Yes Can an educational institution consent for a minor? - Answer Yes (boarding school for example)
(Chap 1- 4 )
With Correct Answers.
What are the 3 ways to revoke an advance directive? - Answer Written, oral, or VOID across the pages When a directive is orally revoked, what should the physician do with it? - Answer Destroy or write note on verbal revocation or write VOID across pages What happens if a physician disagrees with the directive given to him? - Answer Does not have to follow; can request ethics or medical committee with 48-hour notification for all parties What is the transfer registry? - Answer Directory of physicians or hospitals willing to accept patients in transfer who have advanced directives Is "mercy killing" allowed in Texas? - Answer No Who must sign an "out-of-hospital DNR"? Can it be verbal? Are witnesses needed? - Answer Attending physician, patient, and two witnesses; yes/no; yes/no What is the effect of an "out-of-hospital DNR"? - Answer Legally binding; patient's wishes written as a physician order If a patient's family disagrees with a patient's decision, what can they do? - Answer Must apply for temporary guardianship under Texas probate code If you see a DNR device on a patient but have not seen the form, is that enough not to give treatment? - Answer Yes, DNR device is enough Can an incompetent patient revoke their DNR? - Answer Yes Should this form accompany patients on transfers? - Answer Yes What kind of treatment can the power of attorney NOT consent to? - Answer Admission to mental health institution, ECT, psychosurgery, abortion, neglect of minimal treatment (nutrition, hydration, comfort measures) Does the power of attorney have an expiration date? - Answer No, unless specified What happens if on the expiration date the patient is incompetent? - Answer It is continued until patient becomes competent again, then expires Who cannot be the power of attorney? - Answer Principal health care provider or residential care provider or employee of those Does the power of attorney have access to the patient's medical records? - Answer Yes
(Chap 1- 4 )
With Correct Answers.
When can you withhold treatment to an infant? - Answer If chronically and irreversibly comatose or terminally ill and further treatment would be futile Can you withhold nutrition/hydration from a terminally ill infant? - Answer No Is the mental health directive an advanced directive act? - Answer Yes, but with differences What are the requirements for mental health directive? What are requirements for witnesses? - Answer Age 18 or not a legal minor, not incapacitated; 2 witnesses both of who cannot be related, beneficiaries, attending physician, or employees of hospital Does a mental health directive have an expiration date? - Answer Yes, 3 years or until revoked What happens if on the expiration date of a mental health directive, the patient is incapacitated? - Answer It continues until competent When can you use restraints? When can you use behavioral measures? - Answer If there is danger of harm to self or others and other measures have failed; never Does the donor have rights of a parent in artificial insemination? Does the husband?
- Answer Donor NO, husband YES What prenatal maternal tests must a physician check? - Answer HIV, hepB, syphilis How many times must a physician check prenatal maternal tests? - Answer Twice; upon first examination and on admission for delivery Are prenatal maternal tests confidential and anonymous? - Answer Confidential; anonymous upon request Does the physician have to tell the mother that he/she will do prenatal maternal tests? What if she wants anonymous testing? - Answer Yes, must inform but not specifically consent; if anonymous is wanted must refer patient to anonymous testing center; patient can refuse If prenatal maternal tests are positive, what must the physician do? - Answer Refer for treatment, provide counseling, and provide information about diseases How long does a physician have to keep prenatal maternal test results? - Answer For 9 months What institutions do not need licensing for birthing centers? - Answer Licensed hospitals, nursing homes, and ambulatory surgery centers
