question

applied ethics

answer

the practical application of moral standards to the conduct of individuals involved in organizations that are meant to benefit the patient, such as medical ethics

question

bioethics

answer

a branch of applied ethics, is a field resulting from modern medical advances and research

question

litigious

answer

an excessive inclination to sue

question

laws

answer

rules or actions prescribed by an authority such as the federal government and the court system that have a binding legal force

question

medical practice acts

answer

laws established in all 50 states that define the practice of medicine as well as requirements and methods for licensure in a particular state

question

precedent

answer

the decision of the court case acts as a model for any future cases in which the facts are the same

question

ethics

answer

branch of philosophy related to morals, moral principles, and moral judgments

question

morality

answer

the quality of being virtuous or practicing the right conduct

question

amoral

answer

lacking or indifferent to moral standards

question

medical ethics

answer

concerns questions related specifically to the practice of medicine

question

utilitarianism

answer

an ethical theory based on the principle of what is the greatest good for the greatest number of people

question

cost/benefit analysis

answer

justifies the means of achieving a goal

question

indigent

answer

a person who is impoverished and without funds

question

rights-based ethics

answer

a natural rights ethical theory, places the primary emphasis on a person's individual rights

question

duty-based ethics

answer

based on absolute moral rules; focuses on performing one's duty to various people and institutions such as parents, employers, employees, and customers (patients)

question

justice-based ethics

answer

based on an important moral restraint called "the veil of ignorance"; fair distribution of benefits and burdens

question

virtue-based ethics

answer

based on the belief that we have a duty or responsibility to others; an emphasis on persons and not necessarily on the decisions or principles that are involved

question

fidelity

answer

loyalty and faithfulness to others

question

sanctity of life

answer

the sacredness of human life

question

tolerance

answer

a respect for those whose opinions, practices, race, religion, and nationality differ from our own

question

integrity

answer

the unwavering adherence to one's principles

question

empathy

answer

the ability to understand the feelings of others without actually experiencing their pain or distress

question

sympathy

answer

feeling sorry for or pitying someone else

question

compassion

answer

the ability to have a gentle, caring attitude toward patients and fellow employees

question

due process

answer

the entitlement of employees of the government and public companies to have certain procedures followed when they believe their rights are in jeopardy; the Fourteenth and Fifth Amendments provide for due process

question

sexual harassment or gender harassment

answer

unwelcome sexual advances or requests for sexual favors as defined in the Equal Employment Opportunity Commission guidelines, which are part of the Title VII of the Amended Civil Rights Act of 1964

question

comparable worth

answer

known as pay equity, is a theory that extends equal pay requirements to all persons who are doing equal work

question

principle of autonomy

answer

the principle that people have the right to make decisions about their own life; includes the concept of "informed consent", whereas consent is granted by a person after the patient has received knowledge and understanding of potential risks and benefits

question

principle of beneficence

answer

the principle of doing good

question

principle of nonmalfeasance

answer

means "First, do no harm."

question

principle of justice

answer

warns us that equals must be treated equally

question

bioethicists

answer

specialists in the field of bioethics, give thought to ethical concerns that often examine the more abstract dimensions of ethical issues and dilemmas

question

quality assurance (QA)

answer

gathering and evaluating information about the services provided, as well as the results achieved, and comparing this information with an accepted standard

question

medical etiquette

answer

standards of professional behavior that physicians practice in their relationship and conduct with patients and other physicians

question

Federalism

answer

1 Large Government- Federal Government Many smaller local governments

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Executive Branch

answer

President and his cabinet Has Veto power Enforcing Laws

question

Judicial Branch

answer

Judges- Supreme Court (Justices) Interpret Laws Constitutionality

question

Legislative Branch

answer

Congress- Senate- House of Representatives Make Laws Amend Laws 2/3 majority vote can override a veto

question

Burden of Proof

answer

Plaintiff has BOP in Civil cases State/Prosecutor has BOP in Criminal cases BOP is proving propondence of evidence in civil beyond a reasonable doubt in criminal

question

Statutory Law

answer

(Statutes) Laws written by the legislative branch

question

Regulatory Law

answer

(Regulations) Laws written by agencies

question

Examples of intentional torts

answer

Assault, Battery, False Imprisonment

question

Battery

answer

Actual unconsented physical contact

question

Assault

answer

Threat of bodily harm, placing someone in apprehension of imminent harm

question

Class Action Lawsuit

answer

A lawsuit filed by one or more people on behalf of a larger group of people who are all affected by the same situation

question

Constitutional Law

answer

Set up our system of government Bill Of Rights- Freedoms- Prevents governments from interferring with our individual rights

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Defamation Of Character

answer

Harm to a person's reputation False statements about a person

question

Embezzlement

answer

Taking money of or property that has been entrusted to you

question

Expressed Contract

answer

An agreement that clearly states all the terms

question

Fraud

answer

Decieving another person, usually for personal gain

question

Implied Contract

answer

Understood through actions

question

Lible

answer

Written/printed defamation

question

Subpoena

answer

A written command from the court for a person to appear in court

question

"Stare Decisis"

answer

"Let the decision stand"

question

Slander

answer

Spoken defamation

question

Intentional Tort

answer

When a person has been intentionally or deliberately injured by another

question

Unintentional Tort

answer

Negligence- Medical Malpractice Duty of care- Fail to exercise reasonable care that results in harm

question

Tort

answer

Civil injury or wrongful act that results in harm

question

False Imprisonment

answer

Confining someone against their will

question

Invasion Of Privacy

answer

Unauthorized publication of private information

question

Contract

answer

Agreement between two or more people

question

Subpoena "Duces Tecum"

answer

A court order requiring a witness to appear in court and to bring certain records/documents

question

Regulations

answer

Rules or laws made by agencies

question

Statutes

answer

Laws enacted by state and federal legislatures

question

Plaintiff

answer

A person on group of people suing another person or group; the person who instigates the lawsuit

question

Defendant

answer

Person or group of people sued civilly or prosecuted criminally in a court of law

question

Criminal Laws

answer

Set up to protect the public from the handful acts of others

question

Case Law

answer

Also known as Common Law Based on decisions made by judges

question

Contract Law

answer

Division of law that includes enforceable promises and agreements between two or more persons to do or not to do a particular thing

question

Common Law

answer

Also known as Case Law Based on decisions made by judges

question

Civil Law

answer

Relationships between individuals or between individuals and the government, which are not criminal

question

Administrative Law

answer

Branch of law that covers regulations set by government agencies

question

Breach Of Contract

answer

The failure, without legal excuse, to perform any promise or to carry out any of the terms of an agreement; failure to perform a contractual duty

question

Breach

answer

Neglect of an understanding between two parties; failing to perform a legal duty

question

Beyond A Reasonable Doubt

answer

Evidence that is almost an absolute certainty that a person did commit a crime 99.9%

question

Checks And Balances

answer

Separation between the three branches

question

Preponderance Of Evidence

answer

Evidence showing that more likely than not the incident occured

question

Accreditation p. 60

answer

a voluntary process in which an agency is requested to officially review healthcare institutions, such as hospitals, nursing homes, and educational institutions, to determine compliance.

question

Bonding p. 67

answer

a special type of insurance that covers employees who handle financial statements, records, and cash.

question

Confidentiality p. 62

answer

refers to keeping private all information about a person (patient) and not disclosing it to a third party without the patient's written consent.

question

Discovery p. 63

answer

rule legal theory that provides that the statute of limitations begins to run at the time the injury is discovered or when the patient should have known of the injury.

question

Endorsement p. 59

answer

an approval or sanction.A state may grant a license by endorsement to applicants who have successfully passed the NBME exam.

question

Good Samaritan laws p. 64

answer

state laws that help protect healthcare professionals from liability while giving emergency care to accident victims.

question

Guardian ad litem p. 63

answer

court-appointed guardian to represent a minor or unborn child in litigation.

question

Incident report p. 68

answer

a means of documenting problem areas within a hospital or other medical facility.

question

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) p. 60

answer

an agency that oversees accreditation standards for: • all types of hospitals (medical, psychiatric, long-term care, etc.) • managed care oranizations (like HMOs) • VNAs (visiting nurse associations) • clinical laboratores

question

Prudent person rule p. 62

answer

also called the responsible person standard, means the healthcare professional must provide the information that a prudent, reasonable person would want before making a decision about treatment or refusal of treatment. This would include: • the diagnosis • the risks and potential consequences of treatment • the expected benefits of the treatment or procedure • potential alternative treatments • prognosis if no treatment is received • that an acceptable standard of care is followed • the costs, including the amount of expected pain

question

Reciprocity p. 59

answer

the cooperation of one state in granting a license to practice medicine to a physician already licensed in another state. Reciprocity can be applied to other licensed professionals, such as nurses and pharmacists.

question

Respondeat superior p. 64

answer

Latin phrase meaning "let the master answer" means the employer is responsible for the actions of the employee.

question

Revoke p. 60

answer

take away, as in revoke a license.

question

Risk management p. 67

answer

a practice to minimize the incidence of problem behavior that might result in injury to the patient and liability for the organization.

question

Scope of practice p. 66

answer

the activities a healthcare professional is allowed to perform as indicated in their license, certification, and/or training.

question

Standard of care p. 61

answer

the ordinary skill and care that medical practitioners use and that is commonly used by other medical practitioners in the same locality when caring for patients; what another medical professional would consider appropriate care in similar circumstances.

question

Statute of limitations p. 63

answer

the period of time that a patient has to file a lawsuit; typically 1 to 3 years. The time period begins when the problem is discovered or should have been discovered.

question

Tolling p. 63

answer

also known as running of the statute of limitations, means the time has expired.

question

List the four basic characteristics of state medical practice acts. p. 57

answer

• Establish the baseline for the practice of medicine in that state. • Determine the prerequisites for licensure. • Forbid the practice of medicine without a license. • Specify the conditions for license renewal, suspension, and revocation.

question

Describe the three methods by which a state grants a license to practice medicine. p. 58-59

answer

• Examination—Each state offers its own examination for licensure. • Endorsement—This is an approval or sanction granting a license by endorsement to applicants who have successfully passed the National Board of Medical Examination. • Reciprocity—A license to practice medicine may be granted by a state that accepts a medical license granted by another state.

question

Discuss conduct that may result in a physician's loss of license to practice medicine. p. 60

answer

Conduct that could result in the loss of a physician's license includes Medicare/ Medicaid fraud, rape, murder, larceny, narcotics conviction, and the inappropriate use of drugs and alcohol.

question

Identify the difference between licensure and certification.

answer

A license is granted by a state or federal entity. This provides the legal right for a professional, such as a physician, to practice. Certification is granted by a certification board and means that a person has met the special requirements, such as additional education and training, of the certifying board.

question

Discuss what the term standard of care means for a physician and what it means for someone in your profession (or your planned profession).

answer

Standard of care, as it relates to the physician, is the ordinary skill and care that medical practitioners use and that is commonly used by other medical practitioners in the same locality when caring for patients. It is the care that another professional would find appropriate in similar circumstances.

question

Describe the importance of the discovery rule as it relates to the statute of limitations.

answer

The discovery rule is the legal theory that provides that the statute of limitations begins to run at the time the injury is discovered or when the patient should have known of the injury.

question

Discuss the importance of the phrase respondeat superior as it relates to the physician.

answer

This translates to "let the master answer." It means that the employer (physician) is responsible for the actions of the employee.

question

Medi Tips Chapter 3

answer

p. 57 - Every state has a board set up to handle issues relating to physician registration. p. 60 - If a physician continues to practice medicine without renewal of his or her license, under the law it is considered practicing medicine without a license. p. 61 - The term "reasonable" is a broad, flexible word to make sure the decision is based on the facts of a particular situation rather than on abstract legal principles. It can mean fair, rational, or moderate. Reasonable care has been defined as "that degree of care a person of ordinary prudence would exercise in similar circumstances". p. 63 - Do not discuss anything relating to a patient within earshot of others. p. 63 - The statute of limitations is a state law that varies by state. p. 64 - The Good Samaritan laws do not protect physicians or their employees from liability while practicing their profession in their work environment. The laws are meant to encourage medical professionals to assist with emergencies outside of the work setting. Always check the coverage of the Good Samaritan Law in your own state. p. 65 - Even though the doctrine of respondeat superior mainly refers to the employer, in all states both the physician and the employee may be liable. p. 66 - Healthcare workers have a duty to be assertive and question those orders that they believe are erroneous or appear to be harmful to the patient. They also have a duty to refuse to carry out orders that violate their own practice acts. p. 67 - All employees must understand that there are limits to their authority when it comes to healthcare decisions. The ultimate decision always rests with the physician, provided it does not violate their professional practice. p. 68 - Everyone in a healthcare institution - not just the risk manager - is responsible for risk management.

question

Medical Practice Acts p. 57

answer

Statues that govern the practice of medicine in that state. They establish: • requirements for licensure • duties of the licensed physician • grounds on which the license may be revoked • reports that must be made to the government • define penalties for practicing without a license

question

Federal Licensing Examination (FLEX) p. 58

answer

The official U.S. medical licensing exam.

question

National Board of Medical Examiners (NBME) p. 58

answer

...

question

U.S. Medical Licensing Examination (USMLSE) p. 58

answer

...

question

Registration p. 59

answer

Periodic (annual or biannual) renewal of a medical license. Requirements include: • fee • continuing medical education, measured in CME units (typically 75 hours in a 3 year period). This can be done through workshops, courses, seminars, self-instruction modules, teaching, reading approved medical literature.

question

Commission on Accreditation of Allied Health Education Programs (CAAHEP) p. 61

answer

provides accreditation for programs such as medical assisting, emergency medical technicians (EMTs), physician assistants, and respiratory therapists, among others.

question

Employee's Duty to Carry Out Orders p. 66

answer

Healthcare workers have a duty to be assertive and question those orders that they believe are erroneous or appear to be harmful to the patient. They also have a duty to refuse to carry out orders that violate their own practice acts.

question

Employer's Duty to Employees p. 67

answer

...

question

Incident Report p. 68

answer

...

question

Medical Patient Rights Act p. 62

answer

Law passed by Congress that says all patients have the right to have their personal privacy respected and their medical records handled with confidentiality. • no information can be shared without the patient's consent • no information can be given over the phone without consent • no records an be given to another person or physician without the patient's written permission (unless subpoenaed). • information should be shared only on a need-to-know basis

question

Medical Licensure Exams p. 58

answer

NBME - National Board of Medical Examiners FLEX - Federal Licensing Examination USMLE - U.S. Medical Licensing Examination

question

Exceptions to State Medical License Requirement p. 59

answer

• physician employed by a federal medical facility (must be licensed but not necessarily by the state they are practicing in) • a out-of-state physician providing emergency care • physician waiting to qualify for residency • research physician who does not practice patient-based medicine • military physicians at military hospitals

question

Licensure

answer

A license is granted by a state or federal entity. This provides the legal right for a professional, such as a physician, to practice.

question

Certification

answer

Certification is granted by a certification board and means that a person has met the special requirements, such as additional education and training,of the certifying board.

question

administer a drug

answer

To introduce a drug into the body of a client

question

appellant

answer

One who appeals a court decision to a higher court

question

arraignment

answer

The procedure of calling someone before a court to answer a charge

question

civil case

answer

Court action between private parties, corporations, government bodies, or other organizations. Compensation is usually monetary. Recovery of private rights is sought.

question

closing arguments

answer

Summary and last statements made by opposing attorneys at a hearing or trial

question

Controlled Substances Act

answer

Federal law regulating the administration, dispensing, and prescription of particular substances that are categorized in five schedules.

question

court of appeals

answer

Court that reviews decisions made by a lower court; may reverse, remand, modify, or affirm lower court decision.

question

court order

answer

An order issued only by a judge to appear or to request certain records. The release of any records requested in a court order does not require the client's permission.

question

criminal case

answer

Court action brought by the state against individual(s) or groups of people accused of committing a crime; punishment usually imprisonment or a fine; recovery of rights of society.

question

cross-examination

answer

Examination of a witness by an opposing attorney at a hearing or trial.

question

defendant

answer

The person or group accused in a court action.

question

deposition

answer

A written record of oral testimony made before a public officer for use in a lawsuit.

question

direct examination

answer

Examination of a witness by the attorney calling the witness at a hearing or trial.

question

dispense a drug

answer

To deliver controlled substances in a bottle, box, or some other container to the client. Under the Controlled Substances Act, the definition also includes the administering of controlled substances.

question

examination of witness

answer

Questioning of a witness by attorneys during a court action.

question

expert witness (medical)

answer

Person trained in medicine who can testify in a court of law as to what the professional standard of care is in the same or similar communities.

question

felony

answer

A serious crime such as murder, larceny, assault, or rape. The punishment is usually severe.

question

higher (superior) court

answer

The court to which appeals of trial court decisions can be made; a court with broader judicial authority than a lower or inferior court.

question

judge

answer

A public official who directs court proceedings, instructs the jury on the law governing the case, and pronounces sentence.

question

jury

answer

Six to 12 individuals, usually randomly selected, who are administered an oath and serve in court proceedings to reach a fair verdict on the basis of the evidence presented.

question

law

answer

Rule or regulation that is advisable or obligatory to observe.

question

litigation

answer

A lawsuit; a contest in court.

question

lower (inferior) court

answer

Usually the court in which a case is first presented to the trial court; a court with limited judicial authority.

question

misdemeanor

answer

Type of crime less serious than a felony.

question

opening statements

answer

Statements made by opposing attorneys at the beginning of a court action to outline what they hope to establish in the trial.

question

plaintiff

answer

The person or group initiating the action in litigation.

question

prescribe a drug

answer

To issue a drug order for a client.

question

probate (estate) court

answer

State court that handles wills and settles estates.

question

sentencing

answer

Imposition of punishment in a criminal proceeding.

question

small claims court

answer

Special court intended to simplify and expedite the handling of small claims or debts.

question

subpoena

answer

An order to appear in court under penalty for failure to do so.

question

subpoena duces tecum

answer

A court order requiring a witness to appear and bring certain records or tangible items to a trial or deposition.

question

summons

answer

An order, in a civil case, from the court directing the sheriff or other appropriate official to notify the defendant where and when to appear.

question

verdict

answer

Findings or decision of a jury.

question

Human Dignity

answer

A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.

question

Honesty

answer

A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception

question

Responsibility to Society

answer

A physician shall respect the law and recognize a responsibility to seek changes in those requirements that are contrary to the best interests of the patient.

question

Confidentiality

answer

A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidence within the constraints of the law.

question

Continued Study

answer

A physician shall continue to study, apply, and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals as needed.

question

Freedom of Choice

answer

A physician shall, in the provision of appropriate health care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide service.

question

Responsibility to Improved Community

answer

A physician shall recognize a responsibility to participate in activities contributing to an improved community.

question

Responsiblity to Patient

answer

Responsiblity to patient is paramount

question

Patient Access to Medical Care

answer

Must support access to medical care for all people.

question

Accepting Gifts

answer

Gifts to physicians from medical companies can be accetped only if they relate to the physician's medical practice. However, drug samples from pharmaceutical companies can be accepted for patient use.

question

Conflict of interest

answer

Physicians should not place their own financial interests above the patient's welfare.

question

Professional Courtesy

answer

Historically, there is an unwritten practice among many physicians taht they would not charge each toher for professional services. However, this practice has lost favor because many physicians are concerned about the lack of documentation when seeing a fellow physician free of charge.

question

Reporting Unethical Conduct

answer

A physician should report any unethical conduct by other physicians.

question

Second Opinions

answer

Physicians should recommened that patients seek a second opinion whenever necessary.

question

Sexual Conduct

answer

It is unethical for the physician to engage in sexual conduct with a patient during the physician-patient relationship.

question

Treating Family Members

answer

Physicians should not treat members of their families except in an emergency.

question

Dumping Crisis

answer

When a private hospital emergency room sends an indigent patient to a public hospital emergency room.

question

The Comprehensive Omnibus Budget Reconciliation Act (COBRA)

answer

contains an amendment that prohibits "dumping" patients from on facility to another. It is now a federal offense to do this. This amendment does not mandate treatment, but it does require a hospital to stabilize a patient during an emergency situation.

question

Abandonment

answer

withdrawing emdical care from a patient without providing sufficient notice to the patient. Considered to be a civil wrong or tort and condsidered to be a breach of contract and even negligence.

question

Certified Mail - Abandonment

answer

Sending a letter by certified mail is the best method physicians can use to protect themseleves from a charge of abandoment when they have to sever a relationship with a patient.

question

Against Medical Advice (AMA)

answer

when a noncompliant patient leaves a hospital without physician's permission

question

Acquired Immunodeficiency Syndrome (AIDS)

answer

is a diease resulting in infections that occur as a result of exposure to the human immunodeficiency virus (HIV), which causes the immune system to break down. First documented in the US in 1980.

question

Americans with Disabilites Act (ADA)

answer

A federal law, protects HIV and AIDS patients from discrimination.

question

Prognosis

answer

Prediction for the course of their disease

question

Medical Patients Rights Act

answer

provides that all patients have the right to have their personal privacy respected and their medical records handled with confidentiality.

question

Privileged Communication

answer

refers to confidential information that has been told to a physician (or attorney) by the patient.

question

Patient's Bill of Rights

answer

descrbies the physician-patient relationship

question

Self-Determination Documents or Advance Directives

answer

States the patinet's intentions for healthcare-related decisions and in some cases name another person as proxy to make decisons for the patient.

question

Proxy or Agent

answer

a person who acts on behalf of another person

question

Proxy Statement

answer

is the written authorization given by a person so that a second person can act for him or her.

question

Advance Directive

answer

is a written statement in which people state the type and amount of care they wish to receive during a terminal illness and as death approaches.

question

Living Will

answer

Document that a person drafts before becoming incompetent orunable to make heathcare decisions.

question

Durable Power of Attorney for Healthcare

answer

A legal doucment that empowers another person (proxy) to make healthcare decisions for an incompetent patient. It goes into effect after the person beomces incompetent and only pertains to healthcare decisons.

question

Uniform Anatomical Gift Act

answer

All states have some form of this law. It allows persons 18 years or older and of sound mind to make a gift of any part of their body for purposes of medical research or transplantation.

question

Do not Resuscitate (DNR) Order

answer

This is an order placed into a person's medical chart or medical record. It indicates taht the person does not wish to be resuscitated if breathing stops.

question

Modified Rights of Terminally Ill Act

answer

which states that the person must be terminally ill and/or in a state of permanent unconsciousness. The patient must be in a state that is irreversible, untreatable, and incurable with the prospect of imminent death.

question

Patient Self-Determination Act (PSDA)

answer

was passed in 1991 and states that congress has stongly supported a person's right to self-determination before beoming incompetent.

question

Minor

answer

is a person who has not reached the age of maturity, which in most states is 18.

question

In loco parentis

answer

consent of the parents or someone standing in for the parents

question

principle of parens patriae authority

answer

occurs when the state takes responsiblity from the parents for the care and custody of minors under the age of 18.

question

mature minor

answer

a person judged to be mature enought to understand teh physician's instructions. Such a minor may seek medical care for treatment of drug or alcohol abuse, contraception, venereal disease, and pregnancy.

question

Emancipated Minor

answer

a person between the ages of 15 and 18 who is either married, in the military, or self-supporting and no longer lives under teh care of a parent. Parental consent for medical care is not required. Proof of emancipation should be included in the medical record.

question

Consent

answer

is the voluntary agreement that a patient gives to allow a medically trained person the permission to touch, examine, and perform a treatment.

question

Informed or Expressed Consent

answer

means taht the patient agrees to the proposed course of treatment after having been told about the possible consequences of having or not having certain procedures and treatments. The patients's signature on the consent form indicates that the patient understands the limits or risks involved in the pending treatment or surgery as explained by the physician.

question

Affirmative defense p. 143

answer

allows the defendant (usually physician or hospital) to present evidence that the patient's condition was the result of factors other than the defendant's negligence. • Denial (the most frequently used defense) • Assumption of risk • Contributory negligence • Comparative negligence • Borrowed servant • Statute of limitations • Good Samaritan laws

question

Alternative dispute resolution (ADR) p. 150

answer

methods for resolving a civil dispute that do not involve going to court. Using arbitration, mediation or a combination (med-arb) for deciding a civil case can same time and money.

question

Arbitration p. 50

answer

submitting a dispute for resolution to a person other than a judge. this can be time consuming because both parties must agree on the choice of arbitrator. Then both parties must agree to abide by the arbitrator's decision.

question

Arbitrator p. 150

answer

a person chosen to decide a disagreement between two parties.

question

Assumption of risk p. 143

answer

a legal defense that prevents a plaintiff from recovering damages if the plaintiff voluntarily accepts a risk associated with the activity. Patients should be asked to sign an authorization for all procedures indicating that they understand the risks involved, accept those risks, and give their consent for treatment.

question

Borrowed servant doctrine p. 144

answer

a special application of respondeat superior in which an employer lends an employee to someone else. The employer is not liable for any negligence caused by the employee while in the service of the temporary employer.

question

Cap p. 138

answer

limit. In some states, where there is no cap, malpractice insurance have risen to a point where some physicians have had to leave their practices.

question

Claims-made insurance p. 149

answer

liability insurance that covers the insured party for only the claims made during the time period the policy is in effect (or policy year). It is important with this type of insurance to file reports in a timely manner, especially by the time of the policy's year end.

question

Comparative negligence p. 144

answer

a defense, similar to contributory negligence, that the plaintiff's own negligence helped cause the injury; not a complete bar to recovery of damages but only damages based on the amount of the plaintiff's fault.

question

Compensatory damages p. 138

answer

an amount of money awarded by the court to make up for loss of income or emotional pain and suffering. Payment for the actual loss of income, emotional pain and suffering, or injury suffered. The losses are past, current, and future and include lost wages and profits.

question

Contributory negligence p. 144

answer

conduct on the part of the plaintiff that is a contributing cause of injuries; a complete bar to recovery of damages.

question

Damages p. 136 & 138

answer

any injuries caused by the defendant; usually a monetary award is given as compensation. Patients seek recovery, or compensation, for a variety of damages: • Permanent physical disability • Permanent mental disability • Loss of enjoyment of life • Personal injuries • Past and future loss of earnings • Medical and hospital expenses • Pain and suffering

question

Defensive medicine p. 149-150

answer

ordering more tests and procedures and referring to specialists more often than necessary in order to protect oneself from a lawsuit. The result is patients have to undergo additional tests and procedures and the cost of healthcare increases. The over use of specialist can negatively impact the relationship with the PCP. Defensive medicine becomes problematic if a physician becomes reluctant to attempt more risky, but potentially effective procedure for fear of a lawsuit. Studies show that physicians with good bedside manner (talking unhurriedly, sitting on the bedside, holding the patient's hand) were much less likely to be sued (regardless of skill). This extends to all healthcare professionals and is why physicians hire employees who project a warm and caring attitude toward the patients.

question

Dereliction p. 136

answer

neglect, as in neglect of duty.

question

Direct cause (or proximate cause) p. 136 & 137

answer

the continuous sequence of events, unbroken by any intervening cause, that produces an injury and without which the injury would not have occurred. Proximate cause means there were no intervening forces between the defendant's action(s) and the plaintiff's injury -- hence, a cause-and-effect relationship. Proximate cause refers to the last negligent act that contributed to a patient's injury, without which the injury would not have resulted.

question

Duty p. 136

answer

obligation or responsibility.

question

Feasance p. 135

answer

doing an act or performing a duty.

question

Federal Rules of Evidence p. 147

answer

rules that govern the admissibility of evidence into federal court.

question

Fraud p. 139

answer

the deliberate concealment of the facts from another person for unlawful or unfair gain. Illegal billing, referral kickbacks, dishonesty when conducting medical research, embezzlement, and the illegal sale of drugs are all forms of fraud. Frequently cited areas of medical related fraud are on p. 141.

question

Law of agency p. 147

answer

the legal relationship formed between two people when one person agrees to perform work for another person. (This does not apply to pharmacists since they are not hired by the physicians.) In order to protect the physician/employer from liability for negligence under the doctrine of respondeat superior, the healthcare professional should: • Have a written job description that clearly defines the responsibilities, duties and skills necessary for the job. • Use extreme care when performing his or her job • Carry out only those procedures for which he or she is trained • Be honest about any errors or inability to perform a procedure

question

Liable p. 145

answer

legal responsibility for one's own actions.

question

Malfeasance p. 135

answer

performing an illegal act. Medical personnel must be especially aware of malfeasance when they offer advice such as "Try giving your child aspirin to bring down the fever."

question

Malpractice p. 134

answer

professional misconduct or demonstration of an unreasonable lack of skill with the result of injury, loss, or damage to the patient. A physician is held to a different but not higher standard of care than a nurse, medical assistant, physician assistant, or phlebotomist. Medication errors are one of the leading types of medical errors.

question

Mediation p. 150

answer

using the opinion of a third party to resolve a civil dispute in a nonbinding decision. The mediator lists to both sides of the dispute and assists the parties in finding a solution.

question

Misfeasance p. 135

answer

the improper performance of an otherwise proper or lawful act. Occurs when poor technique is used; such as when a phlebotomist performs veinipuncture and the patient suffers nerve damage.

question

Negligence p. 134

answer

an unintentional action that occurs when a person either performs or fails to perform an action that a "reasonable person" would or would not have committed in a similar situation.

question

Nominal damages p. 139

answer

a slight or token payment awarded by the court.

question

Nonfeasance p. 135

answer

the failure to perform an action when it is necessary. An example would be when a patient collapses in the office and a nurse trained in CPR fails to administer it.

question

Occurrence insurance p. 149

answer

also called claims-incurred insurance, liability insurance that covers the insured party for all injuries and incidents that occurred while the policy was in effect (policy year), regardless of when they are reported to the insurer or when the claim is made. With this type of insurance it is important to clearly documetn when an event took place.

question

Proximate p. 137

answer

the injury was closely (proximately) related to the defendant's negligence.

question

Punitive damages or exemplary damages p. 139

answer

also called exemplary damages, monetary award by a court to a person who has been harmed in an especially malicious and willful way; meant to punish the offender.

question

Res judicata

answer

Latin phrase meaning "the thing has been decided."

question

Rider p. 149

answer

additional component to an insurance policy.

question

Settlement p. 147

answer

the act of determining the outcome of a case outside a courtroom; settling a case is not an indication of legal wrongdoing. It usually means the defendant believes that he or she cannot with the lawsuit. (Poor charting techniques are sometimes the cause.)

question

Med Tips

answer

p. 133 - All healthcare workers are responsible for their actions even though the doctrine of respondent superior states that an employer is also liable for injury to a patient. p. 134 - When a person is injured they are sue under tort law ("a wrongful act against another person"). The unintentional tort of negligence is the most often cause of lawsuits for healthcare professionals. p. 134 - Not everyone will perform reasonable skill in the same way. However, unreasonable lack of skill is unacceptable because it shows lack of skill or carelessness. p. 135 - The best solution is to avoid errors is to always double-check all orders and healthcare decisions that physicians and other healthcare professionals make. Electronic prescriptions has eliminated many medication errors. Most important, never perform a procedure for which you are not trained. p. 135 - You can be sued even if you are right. Patients can be injured though no fault of the medical personnel. p. 136 - The determination of duty in the court room is the responsibility of the judge, not the jury. p. 137 - Proximate cause refers to the last negligent act that contributed to a patient's injury, without which the injury would not have resulted. p. 137 - To have preponderance of evidence to find in favor of the plaintiff, the jury believes that it is at least 51 percent likely that the defendant caused the injury. p. 141 - Filing a false claim for programs such as Medicare or Medicaid is a federal crime. The employee's physician could be severely fined and even lose his or her license for this type of fraudulent act. p. 142 - Every person has the right to say "no" when asked to perform an activity that is unethical, illegal, or against his or her own value system. p. 143 - It is easier to prevent negligence that to defend it. p. 144 - The physician is solely responsible for explaining the risks of treatment or procedure. If a they delegate this function to a nurse, medical assistant, or physician assistant, the physician still retains overall responsibility. p. 144 - Instructions given to the patient should always be noted in the patient's record. p. 145 - Healthcare professionals should have an understanding of what is right and wrong under the law. Arguing that a negligent act was unintentional is not a defense, nor is ignorance of the law. p. 146 - Medical personnel must listen to and respect the patient's wishes. p. 146 - Every staff remember must take responsibility for reporting and correcting defects (to the physical condition of the premises) that could cause injury. p. 147 - Be alert for indications of drug use among coworkers. Reporting abuse is necessary in order to get help for the abuser and to protect patients and the reputation of the facility. p. 147 - A comment made to a patient such as "I'm sure you will be fine." could be taken as a verbal contract. p. 148 - Never completely obliterate any notation on a chart. If a note is placed in the wrong chart, cross through the notation with one line and write "Incorrect Chart" and you name. p. 148 - Never alter a medical record p. 150 - There is no law that states, " If you didn't document it, you didn't do it," however, it is difficult to defend a practice that is not documented. p. 152 - Medical assistants can be named and prosecuted in lawsuits. p. 152 - The public often assumes anyone in a white uniform is a nurse. Unless they are an R.N. the healthcare professional must correct the patient. p. 154 - Healthcare professionals must only practice within the scope of their training. There are times when a healthcare professional must refuse to perform a task.

question

The Tort of Negligence p. 135

answer

Both actions and inactions (omissions) can be considered negligence.

question

Professional liability malpractice claims p. 135

answer

Three classifications: • malfeasance • misfeasance • nonfeasance

question

The Four Ds of Negligence p. 136

answer

In order to obtain a judgement of negligence against a physician (defendant), the patient (plaintiff) must be able to show all four of the Ds. Duty - takes place when there is an obligation established between the physician and the patient Dereliction of duty - the physician or healthcare provider failed to provide a correct standard of care to the patient and therefore, has not met the duty. Direct or proximate cause - the dereliction or breach of duty was the direct cause of the patient's injury Damages - injuries caused by the defendant for which compensation (financial or otherwise) is due.

question

Preponderance of Evidence p. 137

answer

One side of a case must demonstrate a greater weight of evidence than the other side. The plaintiff must prove that it is more likely than not that the defendant, (physician), has caused the injury. The burden of proof is on the plaintiff.

question

Res Ipsa Loquitur (also called Res ipsa loquitur or RIL) p. 137

answer

This doctrine means "the thing speaks for itself" and refers to situations where the breach of duty is so obvious that it doesn't need further explanation. Under res ipsa, an exception to the burden of proof rule occurs, and the burden of proof now falls to the defendant. A judge decides if a case can be tried under ris ipsa; to do so three conditions must be present: 1. The injury could not have occurred without negligence. 2. The defendant had total and direct control over the cause of the injury, and the duty was within the scope of the duty owed to the patient or injured party. 3. The patient did not, and could not, contribute to the cause of injury. In order to have a civil malpractice lawsuit, the plaintiff (patient) must show that: 1. A relationship had been established 2. The relationship established a duty of the physician to the patient. 3. The duty required the physician to perform at a particular standard of care. 4. The duty was breached by the physician. 5. The patient received an injury as a result of the physician's breach of duty. 6. The physician's breach of duty was the proximate cause of injury to the patient.

question

Types of Compensatory Damages p. 138-139

answer

• Compensatory • Special compensatory or exemplary damages • Punitive • Nominal

question

Special compensatory or exemplary damages p. 138

answer

Refers to a monetary award to compensate the patient for losses that were not directly cased by the negligence. (Such as PT needed for atrophy that was a result of the injury.) Non-economic reasons include disfigurement, disability, loss of consortium.

question

Wrongful-death statutes p. 139

answer

If a patient's death has been caused by the physician's negligence, the deceased person's dependents and heirs may sue for wrongful death. A plaintiff in a wrongful-death suit does not have to prove that he or she was completely dependent on the deceased person for support. The plaintiff must prove that the defendant's actions were the "proximate," or immediate cause of death.

question

Notes

answer

p. 139 - There are no federal malpractice laws.

question

Office of the inspector general (OIG) p. 141

answer

The OIG is one of the major players in the war against healthcare fraud. This office was created to protect programs under the Department of Health and Human Services (HHS) such as Medicare and Medicaid. The OIG reports problems to the Secretary of State and Congress makes recommendations on how to correct them.

question

The Office of Counsel to the Inspector General p. 141

answer

• Provides legal services to the OIG • Represents the OIG in civil cases tried under the False Claims Act. • Imposes money penalties on healthcare providers found guilty of fraud. • Issues fraud alerts

question

Federal statutes to avoid waste, fraud, and abuse in healthcare p. 141

answer

Major areas of concern are: 1. Additional costs to federal healthcare programs 2. Quality of patient care 3. Access to care 4. Freedom of choice 5. Competition 6. Healthcare provider's abuse of professional judgement

question

Violation of Statues p. 142

answer

Ex: In some states a "poison" label is required by law (statute)

question

False Claims p. 142

answer

• A claim for payment for services or supplies that were never provided • A claim using a diagnosis code other than the true diagnosis code to obtain reimbursement for services • A claim indicating a higher level of service that that which was provided. • A claim for a service that the provider knew was not necessary • A claim for services provided by an unlicensed individual

question

Immunity for Charitable Organizations p. 143

answer

Almost all states now reject immunity for charitable organizations on the basis that immunity encourages neglect and irresponsibility.

question

Defense to Malpractice Suits p. 143

answer

...

question

Denial Defense p. 143

answer

The most common kind of defense; the physician denies he or she performed the procedure.

question

Statue of Limitations p. 145

answer

The rule of discovery does not "run" if fraud was involved to cover the infraction.

question

Res Judicata p. 145

answer

This means "the thing that is decided." If a court decides a case, the plaintiff cannot bring a new lawsuit on the same subject against the same defendant.

question

Fear of Lawsuits (under Civil Liability Cases) p. 145

answer

Fear of lawsuits has influenced the practice of medicine. Some hospitals or physicians are reluctant to withdraw or withhold treatment at the specific directive of a patient or family.

question

Physical conditions of the Premises p. 146

answer

An institution may be liable when an accident occurs as the result of not following regulatory standards for maintaining a safe environment for patients. Lawsuits involving the physical condition of medical facilities have involved cases such as broken steps, malfunctioning elevators and doors, and defective carpets.

question

Illegal Sale of Drugs p. 146

answer

In healthcare settings were access to controlled substances is present, proper security measures must be taken. Failure to do so can result in loss of license, severe, penalty, and even prison for the offender.

question

Promise to Cure p. 147

answer

A promise to cure a patient with a certain procedure or form of treatment is considered under contract law rather than civil law. A comment made to a patient such as "I'm sure you will be fine." could be taken as a verbal contract.

question

Uniform Business Records Act p. 147

answer

...

question

Altered Medical Records p. 147

answer

Any time that a medical record has the appearance of being altered or changed, it causes suspicion about the defendant's motives. Never completely obliterate any notation on a chart. If a note is placed in the wrong chart, cross through the notation with one line and write "Incorrect Chart" and you name. It is poor technique to leave spaces on the chart so that another person can add statements later. Deliberate attempts to alter or hide a chart can result in losing a negligence case, even weeks after the case is over (if the chart has been changed since last checked.)

question

Who is Liable? p. 148

answer

The employer is liable for the consequences of the employee's actions, no matter how well trained the employee is. However, a patient can sue both the physician and the employee. If both parties are found liable by the court the plaintiff may collect from either party, but not both. The employer, if not at fault, but forced to pay the plaintiff, can then sue the employee.

question

Liability Insurance p. 149

answer

Many insurance plans are contingent on the insured person practicing good safety habits and providing a safe environment. There are two major types of liability insurance: • Claims-made insurance • Occurrence (or claims-incurred) insurance

question

Malpractice Insurance p. 149

answer

All licensed medical professionals should cary malpractice insurance. Unlicensed healthcare personnel, such as medical assistants, are usually covered under their employer's policy, but many also carry their own.

question

narrative documentation p. 150

answer

traditional method for recording that uses storylike format to document information specific to client conditions and nursing care. When done once per shift, does not always convey exactly what was done for the patient. To a judge, it may appear as "lack of monitoring." It is different to defend a practice that is not documented.

question

Liability of other Health Care Professionals p. 151-

answer

• Medical employees who make repeated errors are not only liable for their errors, but are also subject to discharge. • When nurses exceed their scope of practice, they violate their nursing license. • Nursing supervisors have been found negligent for not establishing procedures for the nursing staff that are designed to protect patients. • Most states have statutes that provide civil immunity for paramedics who provide emergency life-saving care. • All healthcare professionals are required to report unusual situations to their supervisors. • It is wise to talk to risk management about the need to complete an incident report whenever an unusual situation occurs. The report accurately reflects the time, date, and facts of the situation. It can be subpoenaed by the court in the even of a lawsuit.

question

Tort Reform (or Malpractice Reform) p. 154

answer

According to the National Conference of State Legislatures, 32 states have passed reforms that limit an injured person's ability to sue. In some states there is a cap on damage awards.

question

Malpractice Prevention p. 154-

answer

You have a duty not to inflict harm on the patient. Take everything you do seriously, even when you think it is not an issue. Always be careful what you say in front of a patient. • Follow safety practices and OSHA guidelines • Communicate clearly and within HIPAA • Document accurately and completely

question

Tips for Writing Effective Cover Letters p. 157

answer

• Don't duplicate the wording in your resume • Be positive • Write clearly and concisely • Don't use overblown or empty words to describe your abilities • Be truthful • Emphasize your skills as a team player • Incorporate specialized terminology • Research the organization • Read the letter aloud

question

Show Off Your Writing Skills p. 58

answer

Demonstrate business writing skills. Be concise, articulate, and convincing. See p. 158

question

Steps to correct an error in a medical record and why is it important to do it correctly?

answer

Draw a line through error so it is still legible, write above or below the correct information, note why the correction was made, date, time and initial, and have another witness the correction and add initials if possible - It's important because it may appear to be due to falsification or cover up of entries, could be interpreted as evidence of guilt in a medical malpractice case.

question

Ownership of the "Physical Medical Record"

answer

Is owned by the entity that created it, physicians office, clinic, hospital

question

Ownership of the "Content" of the record

answer

Is owned by the patient.

question

What should the clinic employee do when requsted to release records to a third party?

answer

Need written consent from the patient, Only the information requested should be released, check the specific dates and or time spans, check/verify name, check for authorization of release.

question

Medical Record

answer

A collection of data recorded when a patient seeks medical treatment.

question

5 C's of Charting

answer

1)Concise. 2) Complete/Objective 3) Clear/Legibly written 4)Correct 5)Chronologically Ordered.

question

Doctrine of professional discretion

answer

A physician can exercise a judgement as to whether to show patients who are being treated for mental or emotional conditions their recors; whether in the physicians judgement, it would do more harm than good.

question

Retention and Storage

answer

Records should be kept until the statute of limitations has elapsed. - usually ranges from two to seven years. - in some cases this involves keeping the records of minors for a specified length of time after they reach legal age.

question

Confidentiality of Alcohol and Drug Abuse, Patient Records

answer

A federal statute that protects patients with histories of substance abuse regarding the release of information about treatment.

question

Consent

answer

Permission from a person either expressed or implied for something to be done by another

question

Doctrine of informed consent

answer

The legal basis for informed consent, usually outlined in a state's medical practice acts.

question

Informed Consent

answer

Implies that the patient understands - proposed modes of treatment, why the treatment is necessary, risks involved in the proposed treatment, available alternative modes of treatment, risks involved if treatment is refused. Important to have patient sign a consent form.

question

EXCEPTiONS who cannot give informed consent include:

answer

Minors, Persons who are mentally incompetent, Persons who speak limited or no english.

question

Good Samaritan acts

answer

Sate laws protecting physicials and sometimes other health care practitionners and laypersons from charges of negligence or abandonment if they stop to help the victim of an accident or other emergency. Consent is Unnecessary in emergency situations.

question

HIT - Health Information Technology

answer

The application of information processing, involving both computer hardware and software, that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.

question

HIPAA - Health Insurance Portability Accountibility Act

answer

mandates certain procedures and standards for the electronic transmission and storage of health care information.

question

HHS - Health and Human Services

answer

results of HHS projects include: X-Rays over the internet, Lab results can be sent electronically, prescriptions can be sent eletronically.

question

EHR - Electronic Health Record -

answer

Contains the same information as any medical record, but in electronic form.

question

Affirmative action programs p. 196

answer

to remedy discriminating practices in hiring minority group members. Also covered under Title VII. Courts may mandate that affirmative action programs be implemented if there is evidence that an employer has intentionally discriminated against a particular minority group.

question

Age Discrimination in Employment Act (ADEA) of 1967 p. 197

answer

protects persons 40 years or older against employment discrimination because of age. • Applies to employers who have 20 or more employees. • Does not apply if the older employee does not have the ability to perform the job • The employer must be able to show in writing why the younger job applicant was hired over the older one. • Mandatory retirement is prohibited under this law except for certain exempt executives. • People over 40 are protected by ADEA and Title VII.

question

Americans with Disabilities Act (ADA) of 1973 p. 198

answer

prohibits employers who have more than 15 employees from discriminating against disabled individuals. • There are 43 million disabled persons in the U.S. • Persons with AIDS are also covered under this act. • Employers must make reasonable accommodations to make the work environment accessible to their disabled employees. • Exceptions occur if making the accommodations would put undue hardship for the employer. • The vagueness of term "undue hardship" has caused problems interpreting this law. • Employers have a 2 years to implement the accommodations. • Patients are also protected under this statute.

question

Autonomy p. 190

answer

independence. As long as a person is competent, he or she has the right to make their own decisions. Bioethical and legal issues arise when a person is called upon to make decisions based upon his or her own religious beliefs, for another person such as a child or incompetent adult. Guardianship may have to be established by the courts so the best interested of the patient are observed.

question

Bias p. 189

answer

unfair dislike or preference for something.

question

Bloodborne pathogens p. 200

answer

disease-producing microorganisms transmitted by means of blood and body fluids containing blood.

question

Civil Rights Act of 1991 p. 191 & 196

answer

permits the court to award both compensatory damages and punitive damages to mistreated employees. • Prior to this amendment only compensatory damages were awarded • Wrongful discharge suits fall under this law. • Hospitals cannot discriminate against employees and employees cannot discriminate against patients.

question

Clinical Laboratory Improvement Act (CLIA) p. 202

answer

established minimum quality standards for laboratories. • The federal government requires all clinical laboratories that test human specimens must be controlled. • 1992 - mandate written policies and procedures for a comprehensive quality assurance program • most tests are regulated except simple ones that would not negatively impact a patient if the result were erroneous • The FDA is responsible for categorizing the tests and allowing the waiver of testing • Tests performed at home are general waived but the manufacturer must request the waiver • Tests that use a microscope, calculations, or a judgement call are not waived • A complete list of waived tests is on hcfa.gov/medicaid/clia and www.cola.org

question

Consolidated Omnibus Budget Reconciliation Act (COBRA) p. 203

answer

offers government financing for health insurance coverage continuation after an employee has been laid off a job. • This is an important act because it has helped decrease the number of uninsured Americans. • A company with 25 or more employees must provide extended healthcare insurance to terminated employees for up to 18 months - usually at the employee's expense. • COBRA also contains an amendment called EMTALA which prohibits "patient dumping"

question

Creditor p. 209

answer

person or institution to whom a debt is owed.

question

Debtor p. 209

answer

person who owes money to another person.

question

Discrimination p. 195

answer

unfair or unequal treatment.

question

Drug Free Workplace Act of 1988 p. 203

answer

employers contracting to provide goods or services federal government must certify that they maintain a drug free workplace. • Drug-using employees are expensive in terms of decreased productivity, workplace, accidents, and increased healthcare costs. • To prevent abuse some organizations require drug testing as a condition of employment.

question

Emergency Medical Treatment and Active Labor Act (EMTALA) p. 207

answer

a section of COBRA dealing with patient dumping. • Patients must be stabilized before transfer or sent to a regional trauma center if they cannot be stabilized • A person reporting patient dumping may not be peanalized • Hospitals can be fined or have their Medicare agreements dropped • The patient can sue the hospital • A physician can be penalized if he/she misrepresents a patient's condition • EMTALA does not apply to HMOs, private clinics, or private phusician's offices.

question

Employee Retirement Income Security Act (ERISA) p. 194 & 206

answer

regulates employee benefits and pension plans. • ERISA requires employers to earmark money that can only be used to pay future benefits. • Guarantees vesting of pension plans • Under ERISA, employees who stay with a company for 10 years are entitled to 50 percent of the employer's retirement plan even if they leave the company and take another job. • The employee is entitled to 100% of the employer's pension contribution after fifteen years of employment when he or she becomes fully vested. • ERISA protects employees from being laid off just before they become vested.

question

Employment-at-will p. 195

answer

a common-law doctrine of employment that takes place at either the will of the employer or the employee when a contract is not present. Employment may be terminated at will, without notice, at any time,and without a reason. An employee may quit at any time. The only protection is that employees cannot be fired for an illegal reason (race, religion, etc.) This does not apply if there is a contract between the employer and employee that defines the duration of the employment. This concept is beginning to lose favor as wrongful-discharge lawsuits rise.

question

Equal Credit Opportunity Act of 1975 p. 207

answer

prohibits businesses (including hospitals) from granting credit based on race and gender—unfair treatment is referred to as discrimination.

question

Equal Employment Opportunity Act (EEOA) of 1972 p. 193 & 197

answer

authorizes the EEOC to sue employers in federal court on behalf of people whose rights have been violated under Title VII.

question

Equal Employment Opportunity Commission (EEOC) p. 193

answer

monitors Title VII of the Civil Rights Act. It has strict guidelines on the types of questions that can be asked during a job interview. • EEOC monitors Title VII and the Justice Department enforces the statute.

question

Equal Pay Act of 1963 p. 204

answer

Makes it illegal for an employer to discriminate on the basis of gender in the payment of men and women who are doing the same job.

question

Ethnocentric p. 189

answer

a belief that one's cultural background is better than any other

question

Fair Credit Reporting Act of 1971 p. 207

answer

establishes guidelines for use of an individual's credit information • If a patient is denied credit based on a poor credit rating from a credit agency, the patient must be notified of this fact and given the name and address of the reporting agency. • The agency must disclose the information to the consumer and correct any outdated or erroneous information.

question

Fair Debt Collection Practices Act of 1987 p. 208

answer

prohibits unfair collection practices by creditors. • The FCC issued guidelines for specific times that credit collection phone calls can be made (8 a.m. - 9 p.m.) • It prohibits harassment and threats • Guidelines on page 209 • Billing and collections personnel must have a full understanding of the laws regulating the collection process

question

Fair Labor Standards Act (FLSA) p. 205

answer

establishes the minimum wage, requires payment for overtime work, and sets the maximum hours employees covered by the act may work. • This is the main statute regulating employee benefits. • Over time must be provided at time and a half if over 40 hours are worked each week • Hospitals are an exception when they make an agreement with their employed to establish a work period of 14 days. Overtime then starts at 80 hours. • This law affects only full-time, hourly employees. • Salaried, management, part-timers, and time-sharers usually do not benefit from this law.

question

Family and Medical Leave Act (FMLA) of 1994 p. 206

answer

allows both the mother and the father to take a leave of absence for up to 12 weeks, in any 12-month period, when a baby is born. • The employees job, or an equivalent position, must be held. • In most cases the leave is without pay. • FMLA also allows an employee to take 12 weeks for a family members medical situation (birth, death, adoption). • The employees heath coverage must be maintained • Accumulated employee benefits cannot be lost

question

Federal Insurance Contribution Act (FICA) of 1935 p. 205

answer

requires employers to contribute to Social Security for employees. • The oldest act relating to compensation. • Employers are required to contribute to Social Security plans for their employees. • Severe fines ensue if the employer does not pay on time. • Detailed documentation of the employer's payments are necessary

question

Federal Wage Garnishment Law p. 209

answer

restricts the amount of the paycheck that can be garnished to pay off a debt.

question

Garnishment p. 209

answer

court order that requires an employer to pay a portion of an employee's paycheck to one of the employee's creditors until the debt is resolved.

question

Just cause p. 195

answer

legal reason.

question

National Labor Relations Act of 1935 or The Wagner Act p. 199

answer

prohibits employer actions, such as attempting to force employees to stay out of unions, and labels these actions as "unfair labor practices."

question

Occupational Safety and Health Act (OSHA) of 1970 p. 200

answer

requires an employer to provide a safe and healthy work environment; the employer must protect the worker against hazards. • OSHA regulations preempt all other state and local regulations regarding employee safety and health, meaning that states may not pass any laws concerning the working environment. • Right-to-know laws • Employers and office managers should become familiar with OSHA regulations as they apply to their specific fields. This protects employees and avoids fines for OSHA violations which can be severe. • Poor publicity from OSHA violations can damage an office or company's reputation. • It is better to err on the side of being to cautious when implementing OSHA regulations.

question

Parenteral p. 200

answer

medication route other than the alimentary canal (oral and rectal), including subcutaneous, intravenous, and intramuscular routes.

question

Patient dumping p. 207

answer

a slang term for transferring patients from one hospital to another if the patient is unable to pay for services.

question

Preempt p. 194

answer

overrule.

question

Pregnancy Discrimination Act of 1978 p. 197

answer

employers must treat pregnant women as they would any other employee, providing they can still do the job. • An employer cannot force a woman to quit her job because she is pregnant • A woman cannot be refused a job because she has had an abortion • The employer's medical plan must cover pregnancy the same way it covers medical conditions. • The woman is entitled to sick leave the same as other employees

question

Rehabilitation Act of 1973 p. 198

answer

prohibits employers from discriminating against the handicapped. • This act prohibits discrimination based on disability in any institution that receives federal financial assistance. (e.g., a hospital that receives Medicare or Medicaid reimbursement must comply with this law). • This act had a major influence on the Americans with Disabilities Act of 1990 because it included a broad definition of "handicapped" (people with physical or mental impalement) • This act give legal basis for claims challenging denial for employment because of physical or mental reasons.

question

Social Security Act of 1935 p. 203

answer

federal law that covers all private and most public sector employees. • This act laid the groundwork for unemployment compensation in the United States. • Social Security is paid by the employer and the employee in equal payroll taxes and Medicare participant premiums. • Social Security is composed of different but related programs: - retirement - disability - dependent - survivor's - Medicare health benefits • The amount paid to the beneficiary is calculated based on the worker's average wages earned during his/her working lifetime.

question

Stereotyping p. 189

answer

negative generalities concerning specific characteristics about a group are applied to an entire population.

question

Title VII of the Civil Rights Act p. 195

answer

prohibits discrimination in employment based on five criteria: race, color, religion, gender, or national origin. • This proposal from the Kennedy administration is considered one of the most important pieces of all legislation. • This act applies to all organizations that have 20 or more employees working 20 or more weeks a year. • Some of the most frequent violations in the healthcare employment field are related to Title VII issues. • Title VII also makes sexual harassment a form of unlawful sex discrimination.

question

Truth in Lending Act (Regulation Z) of 1969 or Regulation Z of the Consumer Protection Act p. 207

answer

requires a full written disclosure about interest rates or finance charges concerning the payment of any fee that will be collected in more than four installments. • Installment payments are often used for orthodontia, obstetrical care, and surgical treatment. • It is legal to include a finance charge, however, few physicians and dentists require the charge.

question

Unemployment Compensation p. 205

answer

provides for temporary weekly payments for the unemployed worker who lose their job through no fault of their own. • In order to receive unemployment insurance, the employee must have worked for an employer who has paid, or was required to pay, unemployment compensation taxes. • Exemptions apply for religious, educational, or charitable organizations. • Employees who are fired for a good cause cannot collect unemployment benefits.

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Vesting p. 206

answer

a point in time, such as after 10 years of employment, when an employee has the right to receive benefits from a retirement plan.

question

Worker's Compensation Act p. 205

answer

protects workers and their families from financial problems resulting from unemployment related injury, disease, and death. • Employers typically pay into a fund to help cover costs when a worker is hurt during the course of employment. • The goal of worker's compensation is to get the worker pack to work as soon as possible. • COBRA may allow for a retraining opportunity if the injury results in permanent inability to work the same job • If the employee has only worked at the job a few months, the former employer may have to pay worker's compensation. • Some medical practices specialize in worker's compensation cases • Worker's Compensation is completely administered at the state level • The employee must submit written notice of the injury to the employer • Worker's Compensation pays a fraction of the normal salary, such as 2/3. • Available even if the employee is at fault for the injury, except employees who violate hospital policy • An employee who is injured by a nonemployee can collect Workman's Compensation and sue the nonemployee for damages.

question

Wrongful discharge p. 195

answer

lawsuit in which the employee believes the employer does not have a just cause, or legal reason, for the firing.

question

Discuss the regulations concerning equal employment opportunity and employment discrimination.

answer

Occupational Safety and Health Act (OSHA) of 1970—Under OSHA, an employer is required by law to provide a safe and healthy work environment. The employer must protect the worker against hazards. Clinical Laboratory and Improvement Act (CLIA) of 1988, 1992—The federal government now requires that all clinical laboratories that test human specimens must be controlled. These standards mandate written policies and procedures for a comprehensive quality assurance program to evaluate the overall quality of the laboratory testing process. Health Maintenance Organization (HMO) Act of 1973—This act requires any company with at least 25 employees to provide an HMO alternative to regular group insurance for their employees if an HMO is available in the area. Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985—Under COBRA, a company with 20 or more employees must provide extended healthcare insurance to terminated employees for as long as 18 months—usually, but not always, at the employee's expense. Drug-Free Workplace Act of 1988—Under this act, employers contracting to provide goods or services to the federal government must certify that they maintain a drug-free workplace.

question

Discuss the regulations affecting employee compensation and benefits.

answer

Social Security Act of 1935—This federal law covers all private and most public sector employees. It laid the groundwork for unemployment compensation in the United States. Social Security is paid by the employer and the employee in equal payroll taxes and Medicare participant premiums. Fair Labor Standards Act (FLSA) of 1938—This is the main statute regulating benefits. It establishes the minimum wage, requires payment for overtime work, and sets the maximum hours employees covered by the act may work. Equal Pay Act of 1963—This act makes it illegal for an employer to discriminate on the basis of gender in the payment to men and women who are performing the same job. Unemployment Compensation—The unemployment compensation laws provide for temporary weekly payments for the unemployed worker. Federal Insurance Contribution Act (FICA) of 1935—Under this law, employers are required to contribute to Social Security plans for their employees. Workers' Compensation Act—This statute protects workers and their families from financial problems resulting from employment-related injury, disease, and even death. Employee Retirement Income Security Act (ERISA) of 1974—ERISA regulates employee benefits and pension plans. Family and Medical Leave Act (FMLA) of 1994—This law allows both parents to take a leave of absence of up to 12 weeks in any 12-month period when a baby is born. The employees' jobs, or equivalent ones, must be available when both return to work. The FMLA also requires employers to provide unpaid leave for up to 12 weeks to employees who request leave for their own or a family member's medical or family-related situation, such as birth, death, or adoption.

question

Give examples of regulations affecting consumer protection and collection practices

answer

• Emergency Medical Treatment and Active Labor Act (EMTALA)—A section of the Consolidated Omnibus Budget Reconciliation Act (COBRA) dealing with "patient dumping." • Fair Credit Reporting Act of 1971—This act establishes guidelines for use of an individual's credit information. • Equal Credit Opportunity Act of 1975—This act prohibits businesses, including hospitals and medical offices, from denying credit based on the applicant's race or gender—an unfair treatment referred to as discrimination. • Truth in Lending Act (Regulation Z) of 1969—This act requires a full written disclosure about interest rates or finance charges concerning the payment of any fee that will be collected in more than four installments. • Fair Debt Collection Practices Act of 1978—This act prohibits unfair collection practices by creditors. • Federal Wage Garnishment Law—This law restricts the amount of the employee's paycheck that can be used to pay off a debt (garnishment).

question

Describe accommodations that can be made in the workplace for persons with disabilities.

answer

• Parking spaces, marked for the handicapped, near an accessible doorway • Inclined ramps into buildings and over curbs in parking lots • Elevator floor numbers accessible to wheelchair-bound persons • Handicapped accessible bathrooms with handrails • Hallways with 36 inches of clearance for a wheelchair • Desks and counters that accommodate a wheelchair • Telephone adapters for the hearing impaired

question

List several questions that may be legally asked during an employment interview

answer

Legal questions a. Age—Only legal to ask if he or she is between 17 and 70; if the person's age falls outside this boundary, then it is legal to ask only the birth date. b. Birthplace—Legal, but inadvisable to ask where the applicants, their parents, spouse, or children were born. It is illegal to ask about their national heritage or nationality or that of their spouse. c. Address—Legal to ask, along with how long applicant has lived there. d. Married/Maiden Name—Legal, but inadvisable. e. Citizenship—Legal to ask, "Are you a citizen of the United States?" f. Organizations person belongs to—Legal to ask if applicant belongs to any organizations. g. Languages—Legal to ask what language a person can speak and write, but can be perceived as discriminatory and a method to determine a person's national origin. h. Military experience—Legal to ask if person was a member of the armed forces and when he or she was discharged. Cannot ask what type of discharge was received. i. If ever convicted of a crime—legal. Illegal questions a. Age—Cannot ask for the applicant's specific age if it falls between 17 and 70. b. National heritage or that of applicant's spouse. c. If applicant rents or owns home. d. If applicant has children. e. Height and weight. f. Race or color. g. Religion or creed. h. If applicant has ever been arrested. i. Any handicaps. j. Memberships in any specific organizations. k. What type of military discharge.

question

Recommendations for Good Hiring Practices p. 191-192

answer

a. Develop clear policies and procedures on hiring, discipline, and termination of employees. b. Effectively screen backgrounds. c. State in writing that the employee handbook is not a contract. d. Use a two-tier interview screening process. e. Carefully assess the applicant's skill level. f. Develop an application form that provides accurate information about the applicant's qualifications. g. Provide a job description for every position. h. Develop a progressive disciplinary procedure and make this policy known to all employees and supervisors. i. Provide in-service training to supervisors on how to conduct job interviews and how to motivate and discipline employees. j. Become familiar with the legal and illegal employment interview questions.

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Professionalism in the Workplace p. 187

answer

...

question

Med Tips

answer

p. 188 - Efficiency is getting the job done; effectiveness is doing the job right! p. Employees should receive a 30 minute lunch break and 2 two 15 minute breaks during each 8-hour work day. The exact policy is established by individual states by the Department of Labor.

question

Discrimination in the Workplace p. 188

answer

...

question

Privacy and the Workplace p. 188-189

answer

Opening a patient's medical file should always be on a "need to know" basis. Any other reason may constitute an illegal action.

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Cultural Considerations p. 189

answer

• Hygiene Practices Keep one's opinions about he use of deodorants, clean clothing, and frequent bathing to oneself, unless the patient's health is suffering as a result of poor hygiene conditions. • Communication Communication is a challenge for non-English speakers. The nods for "yes" and "no" may be switched.Non-English-speaking-patients need brochures, and handouts in their own language. An interpreter must be available when explaining important information.

question

Tips for Avoiding the Negative Behaviors of Stereotyping, Bias, and Ethnocentrism p. 189

answer

• Be aware of your coworker's and patients' beliefs • Learn as much as you can about other cultures, races, and nationalities. • Be sensitive to the feelings of others • Evaluate all information before accepting it as belief • Always avoid ethnic jokes. Walk away if a co-worker is telling ethnic or disrespectful joke • Be open to differences in other people

question

Religious Considerations p. 190

answer

• Advance directives, consent to treatment, and the use of birth control devices are often influenced by a person's religious beliefs. In some cases, it may mean rejecting medical interventions such as blood transfusions or it may mean a patient rejects all medical care. • Bioethical and legal issues arise when a person is called upon to make decisions based upon his or her own religious beliefs, for another person such as a child or incompetent adult. • Guardianship may have to be established by the courts so the best interested of the patient are observed. • It is never appropriate to judge, either with verbal or nonverbal criticism, another person's religious customs and beliefs. A exception occurs when there is evidence of abuse as a result of a religious practice. • There are some beliefs that do not allow a person to receive a blood transfusion. When the patient is a child, a court order is needed for the transfusion to proceed against the objections of the parents. • Employers has a legal obligation under the Civil rights Act to make accommodations so that employees can practice their religious observations.

question

Effective Hiring Practices p. 191

answer

• Employee handbooks should clearly state that they are not contracts and should be carefully examined for any erroneous or misleading statements. • Employees should be allowed to see, comment on, or copy anything affecting them in written review and personnel file memos.

question

Federal Regulations Affecting the Medical Professional p. 194

answer

• Both state and federal laws regulate the employer and employee relationship. • Healthcare facilities must remain current on regulations affecting employment practices such as health, safety, compensations, worker's compensation, unions, and discrimination laws. • In general federal law usually applies to organizations that employ a declared number of employees and who work a minimum number of weeks in the year. • Usually, federal law preempts state laws. An exceptions occur when: - there is no federal law on the topic - the state law does not conflict with the federal law - Congress prohibits states from regulating a certain law by complete preemption

question

Major categories of federal laws regulating the employer-employee relationship

answer

• equal employment opportunity and employment discrimination • employee health and safety • compensation and benefits regulations • consumer protection and collection practices • federal labor acts

question

Equal Employment Opportunity and Employment Discrimination p. 194

answer

The government regulates the employment relationship, including laws affecting: • recruitment • placement • pay plans • benefits • penalties • termination The basis of the law is that people must be judged primarily by their job performance. Employment-at-Will Concept

question

Equal Employment Opportunity and Employment Discrimination Laws p. 195

answer

Table 8.3

question

Quid pro quo p. 196

answer

a Latin term meaning "something for something".

question

Who is an Employee Under Title VII? p. 196

answer

If an employer witholds employment taxes from a person's income, than that person is considered an employee.

question

Who Is an Employer Under Title VII? p. 196

answer

A person who employs the services of another and provides payment for those services is considered an employer. The employer has the right to control the physical conduct of the employee in performing the service. The statute does not apply to independent contractors. Parent companies are not liable under Title VII.

question

Basic accommodations that can be made for persons with disabilities include: p. 199

answer

...

question

National Labor Relations Board (NLRB)

answer

Enforces the National Labor Relations Act

question

National Employee Health and Safety Laws p. 200

answer

Table 8.4

question

Employee Health and Safety p. 200

answer

Both state and federal laws regulate issues affecting an employee's health and safety. State law can be stricter than the federal law, it cannot be more lenient.

question

Right-to-know laws p. 200

answer

laws that give employees access to workplace safety information.

question

OSHA Occupational Exposure to Bloodborne Pathogens Standards P. 200

answer

• Fines up to $7,000 per violation • All healthcare workers have occupational exposure • OSHA standards mandate that each employee with occupational exposure must be offered the hepatitis B vaccination at the expense of the employer. An employee may decline, in writing, to receive the vaccine. • The OSHA standard refer to urine, stool, sputum, nasal secretions, vomitus, adn sweat only if there is visible evidence of blood. • OSHA compliance checklist for medical facilities includes: - eyewash stations - fire extingishers - first-aid kits - written training programs - labels for chemical and hazardous waste - sharps containers - exit signs - spill kits - accident report forms - chemical inventory lists • OSHA guidelines are available from the U.S. Department of Labor, Washington, D.C.

question

Occupational Exposure p. 200

answer

a reasonable anticipation that the employee's duties will result in skin, mucous membrane, eye, or parental contact with bloodborne pathogens or other potentially infectious material.

question

List of Potentially Infectious Materials p. 201

answer

Table 8.5

question

Hazard Communication Standard (HCS) p. 201

answer

• An OSHA standard meant to reduce injuries and illnesses in the workforce by alerting healthcare employees to potential dangers and risks when using hazardous chemicals and materials. • MSDS must be posted wherever hazardous materials are used. • Employees are instructed to read the sheets and know how to handle the materials.

question

Material Safely Data Sheets p. 201

answer

...

question

List of CLIA Laboratory Requirements p. 201

answer

Table 8.6

question

Health Maintenance Organization Act (HMO) of 1973 p. 202

answer

requires any company with at least 25 employees to provide an HMO alternative to regular group insurance for their employees if an HMO is available in the area

question

Compensation and Benefits Regulations p. 204

answer

Table 8.7 These laws influence the compensation (salary) and benefits provided to employees.

question

Paid Sick Days p. 204

answer

• Employees "earn" a certain number of paid sick days per year based on the number of hours worked. • These can be saved up and used when the employee has to take time off for an illness or surgery. • Sick days are not part of earned vacation days. They cannot be used except for sickness.

question

Consumer Protection and Collection Practices p. 206-207

answer

Table 8.8

question

Guidelines for Collection Efforts p. 209

answer

Table 8.9

question

Bankruptcy p. 209

answer

is a legal method for providing some protection to individual debtors who owe money by establishing a fair method of distribution of the debtor's assets to all the creditors. • Once a debtor files for bankruptcy, a creditor (such as a physician who is owed an outstanding debt) may no longer seek payment from the patient, but must instead file a claim in bankruptcy court at a later date. • A creditor who fails to comply with bankruptcy laws, such as harassing the debtor, can be cited for contempt of court.

question

Claims against Estates p. 210

answer

• When a patient dies, a bill should be sent to the estate of the deceased. • Follow up with bill collection to avoid the impression that the physician was at fault in the patient's death • The probate department of the superior court in the county that is handling the estate can provide information on the time limits and also name the administrator of the estate.

question

The Statue of Limitations p. 210

answer

This statute defines how long a medical practice has to file suit to collect on a past-due account. • The time limit varies from state to state • Consult with an attorney • If an aging account is more than three years old, the creditior should investigate the state's statute of limitations before investing time, effort , and money to collect the debt. • Avoid issues by collecting debts as soon as possible

question

medical record

answer

All of the written documentation relating to the patient. It includes past history information, current diagnosis and treatment, and correspondence relating to the patient.

question

Problem-Oriented Medical Record (POMR)

answer

Medical charting that includes the chronological record of each visit.

question

SOAP

answer

Subjective, objective, assessment plan. Subjective statements of the patient. Objective data such as lab reports, vital signs, etc. Assessment or diagnosis. Plan of treatment.

question

timeliness of documentation

answer

All entries should be made as they occur or as soon as possible afterward. Federal reimbursement guidelines mandate that all medical records should be completed within 30 days following the patient's discharge from a hospital.

question

credible

answer

Believable or worthy of belief, trustworthy, and reliable.

question

credibility gap

answer

An apparent disparity between what is said or written and the actual facts.

question

privileged communication

answer

Confidential information that has been told to a physician (or attorney) by the patient.

question

doctrine of professional discretion

answer

That a physician may determine, based on his or her best judgment, if the patient with mental or emotional problems should view the medical record.

question

Privacy Act of 1974

answer

Federal agencies and government contractors may maintain only information relevant to its authorized purpose. Citizens have the right to gain access to records and to copy records if necessary.

question

open-record laws

answer

State freedom of information laws that grant public access to records maintained by state agencies.

question

disclosed

answer

Made known.

question

Public Health Services Act

answer

Protects patients who are receiving treatment for drug and alcohol abuse.

question

electronic media record (EMR)

answer

Fully computerized method of record-keeping of all patient-related data.

question

encryptions

answer

Scrambling and encoding information before sending it electronically.

question

firewalls

answer

Software to prevent unauthorized users.

question

microfiche

answer

Miniaturized photographs of records.

question

improper disclosure

answer

Healthcare providers and institutions may face civil and criminal liability for releasing medical records without proper patient authorization.

question

Privacy Rule

answer

all covered entities must be in compliance

question

WLANs

answer

wireless systems to send and receive data

question

HIPAA

answer

Health Insurance Portability and Accountability Act of 1996

question

EIN

answer

number assigned to to an employer

question

clearinghouse

answer

a billing service

question

healthcare plan

answer

individual or group that provides or pays for medical care

question

PHI

answer

individually identifiable information

question

telemedicine

answer

use of information technologies to treat people at a distance

question

employer identifier standard

answer

based on employer's tax ID or on their EIN

question

HHS

answer

Department of Health and Human Services

question

The Privacy Rule is meant to ensure

answer

a and b only (standardization of health data and standardization fo financial data

question

An example of a clearing house is

answer

a billing service

question

The government organization that investigaes a violation of a patient's medical privacy is called

answer

OCR

question

A network of wireless communication systems used to access patient record is

answer

WLANs

question

The privacy law

answer

does not apply to most police and fire departments

question

A violation of HIPAA

answer

is a criminal offense

question

When implementing HIPAA, physicians and physician groups should

answer

all of the above (hire a privacy officer, implement a notice of privacy practices, retain signed authorizations for at least six years, and enter into written agreements with nonemployee service providers)

question

Covered entities include all of the following except

answer

police departments

question

Patients' rights under HIPAA include the ability to

answer

a, b, and c (examine their medical record, have a full copy of their medical record, and complain to the HHS if they believe their is a violation of privacy

question

When patient information is requested via a subpoena, you must

answer

provide all PHI that is requested in the subpoena

question

Synopsis

answer

The study of healthcare ethics is an applied ethics, which means that it is more than just a study of theory. Students need to understand the role of ethics in the practice of their medical discipline. A critical-thinking approach to ethics requires the student to look for a solution that includes fairness to patients, respect for society, and a concern for the future implications of the decision. This must be a decision in which the dignity of the individual is always respected. This chapter includes a brief history of ethics, codes of ethics, and a discussion of ethics committees. Bioethical issues such as transplant rationing, biomedical research, and conflicts of interest are included. Three models for examining ethical dilemmas are included in Chapter 1.

question

Allege p. 266

answer

to assert or declare without proof.

question

Censure p. 266

answer

—to find fault with, criticize, or condemn. • Physicians accused of unethical behavior can be issued a warning or censure by the AMA.

question

Chromosome p. 279

answer

—threadlike structures within the nucleus (center) of a cell that transmit genetic information.

question

Clone

answer

—a group of identical matching cells that come from a single common cell.

question

Control group p. 275

answer

—research subjects who receive no treatment.

question

Double-blind test p. 278

answer

—a research design in which neither the experimenter nor the patient knows who is getting the research treatment.

question

Euthanasia p. 275

answer

—the administration of a lethal agent by another person to a patient for the purpose of relieving intolerable and incurable suffering.

question

Expulsion p. 266

answer

—the act of forcing out.

question

Gene markers p. 279

answer

—list of genes that are responsible for disease.

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Gene therapy p. 281

answer

—the replacement of a defective or malfunctioning gene.

question

Genetics

answer

—a science that describes the biological influence that parents have on their offspring.

question

Harvest p. 272

answer

—remove organs or embryos.

question

Human genome p. 278

answer

—the complete set of genes within the 23 pairs of human chromosomes.

question

Human Genome Project p. 278

answer

—a research program funded by the federal government to "map" and sequence the total number of genes with the 23 pairs, or 46 chromosomes.

question

Institutional Review Board (IRB) p. 275

answer

—a hospital or university board of members who oversee any human research in that facility.

question

National Organ Transplant Law of 1984 p. 273

answer

—federal law that forbids the sale of organs in interstate commerce.

question

Nontherapeutic research p. 275

answer

—research conducted that will not directly benefit the research subject.

question

Posthumous p. 272

answer

—after death.

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Revocation p. 266

answer

—the act of taking away or recalling, such as taking away a license to practice medicine.

question

Social utility method of allocation p. 272

answer

—a method of determining the allocation of organs by giving them to people who will benefit the most.

question

Stem cells p. 281

answer

—master cells in the body that can generate specialized cells.

question

Therapeutic research p. 275

answer

—a form of medical research that might directly benefit the research subject.

question

United Network for Organ Sharing (UNOS) p. 271

answer

—the legal entity in the United States responsible for allocating organs for transplantation.

question

List and discuss at least ten bioethical issues the modern physician and healthcare professional faces. Answers may include:

answer

abortion allocation of scarce health resources determination of death euthanasia: active and passive fetal tissue research genetic counseling harvesting of embryos HIV, AIDS, and ARC in-vitro fertilization organ donation and transplantation quality-of-life issues random clinical trials stem cell research sterilization surrogate parenthood withdrawing treatment withholding lifesaving treatment

question

Describe how an ethical decision-making model can be used when confronted with difficult ethical dilemmas.

answer

An ethical model, such as the seven-step model, can help when confronted with an ethical dilemma, to problem solve instead of following a gut reaction. Furthermore, it requires that one examine all the facts and look at alternative solutions before coming to a conclusion.

question

Discuss ethical issues relating to genetic testing.

answer

...

question

Describe the advances in human stem cell research.

answer

New information is coming out about stem cell research almost weekly. These master body cells can generate specialized cells that can grow into any cells or tissue in the body. It is believed that the use of stem cells will eventually allow the body to heal itself from diseases such as Parkinson's, diabetes, stroke, and Alzheimer's.

question

Summarize the ethical issues of organ transplantation.

answer

The ethical concerns for this issue are wide-ranging but include determining who receives a scarce organ, the expense of a transplant, and the sale of organs.

question

Discuss the importance of codes of ethics such as the Nuremberg Code and the Declaration of Helsinki.

answer

These codes were developed as a direct response to atrocities that occurred during wartime, especially in response to the medical experimentation in Nazi concentration camps during World War II. These codes express concern for the human subject in medical experimentation.

question

Introduction p. 265

answer

• Healthcare ethics, bioethics and medical law are intertwined. • Ethics (a branch of philosophy) in healthcare are applied ethics. • Ethics requires critical-thinking approach that examines important considerations such as fairness for all consumers, the impact on society, and future implications of the decision. • The dignity of the individual, whether it is the patient, employee,or physician must always be of paramount concern when discussing ethics and bioethics. • Bioethics concerns ethical issues discussed in the context of advanced medical technology. • An illegal act is almost always unethical. However, an unethical act may not be illegal.

question

Early History p. 265

answer

• The Hippocratic Oath reminds students of the importance of their profession, the need to teach others, and the obligation to never knowingly harm a patient or divulge a confidence. • The same principles are found in the AMA's code of ethics.

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Ethical Standards and Behaviors p. 266

answer

• According to the AMA, ethical behavior refers to moral principles or practices, the customs of the medical profession, and matters of medical policy. • Physicians accused of unethical behavior can be issued a warning or censure by the AMA. • The AMA Board of Examiners may recommend the expulsion or suspension of a physician from the AMA, but it does not have authority to bring legal action against a physician. • The AMA is required to report to the state licensing board or governmental agency if someone alleges that a physician has committed a criminal act. • Violation and conviction may result in a fine, imprisonment, or revocation of the physician's license. • Serious cases of fraud require the loss of a physician's license.

question

Codes of Ethics p. 267

answer

• People's behavior must match their set of values. • Codes of Ethics or statements of intent are developed by professional organizations to summarize the the principles of behavior they expect of their practitioners. • The Nuremberg Code was developed in response to a wartime medical ethic atrocities; it outlines the basic ethical principles that must be followed when conducting medical research • The first AMA Code of Ethics was developed in 1847. Since then the AMA has taken a leadership role in setting such standards. • Know the code of ethics that relates to your professional practice. Many healthcare professionals keep a framed copy near their place of work to remind them of this responsibility.

question

American Medical Association (AMA) Principles of Medical Ethics p. 267

answer

The AMA Principles of Medical Ethics discuss • Human dignity • Honesty • Responsibility to society • Confidentiality • The need for continued study • Patient autonomy • Responsibility of the physician to improve the community • Responsibility to the patient • Access to medical care Every healthcare professional who interacts with patients (even medical receptionists) must be familiar with the Principles of the AMA.

question

Judicial Council Opinions of the AMA p. 267

answer

• The Council on Ethical and Judicial Affairs of the AMA is compromised of nine members who interpret the Principles of Medical Ethics. Issues include: • Abuse • Accepting patients • Allocations of health resources • Confidential care of minors • Euthanasia • Fee splitting • Financial incentives for organ donation • Gene therapy • Ghost surgery • HIV testing • Mandatory parental consent to abortion • Physician-assisted suicide • Quality of life • Withholding or withdrawing life-prolonging treatment

question

Codes of Ethics for Other Medical Professionals p. 269

answer

ANA - American Nurses Association AAMA - American Association of Medical Assistants ADA - American Dietetic Association AHIMA - American health Information Management Association ASMT - American Society for Medical Technology ASRT - American Society of Radiologic Technologitst

question

Nurses' Code of Ethics p. 269

answer

The American Nurses Association (ANA) has developed a code for nurses.

question

Code of Ethics for the American Association of Medical Assistants (AAMA) p. 269

answer

...

question

Bioethical Issues p. 269

answer

New bioethical issues arise almost daily due to advances in medical technology.

question

Organ and Tissue Donation p. 271

answer

In the United States people may voluntarily donate their organs and tissues to others. They can indicate this desire in their advance directive or on their driver's license (in some states). • The most commonly donated are corneas, heart, kidneys, skin, bone marrow, blood, liver, and lungs. The long bones of the body (tibia, fibula, femur, humerus, radius, and ulna) can also be transplanted. • Some organs and tissues can be donated by a living person, such as, blood, bone marrow, and kidneys. • A U.S. law prohibits the sale of organs. Payment to cover the medical cost for the donor is allowed. • UNOS contains a database relating to every organ donation and transplant in the U.S. since 1986. • UNOS uses a formula that gives half the weight to considerations of medical untility or need and half to considerations of justice. • An estimated 400,000 people are waiting for transplant in the U.S. • There are 106,000 people listed on the UNOS waiting list (many are for kidneys) • Severe shortages of organs leaves patients to take desperate measures to find organs on their own

question

The Ethics of Transplant Rationing p. 272

answer

• Transplant rationing is one of the most discussed bioethic issues • One issue is the extreme expense involved for the procedure and continued immune suppression therapy • The criteria for rationing are controversial. • The United States and Great Britain are committed to the donation model for organs; organs may be harvested only with the consent of the donor or the donor's surrogate representative. • All U.S. states have adopted the Uniform Anatomical Gift Act, permits competent adults to either allow or forbid the posthumous use of their organs though some type of written document, including a donor card. • The social utility method of allocation determines the allocation of organs based on who will benefit the most through careful matching and estimated survival rate. • Another approach is the justice method, which gives everyone an equal change at the available organs. • Other methods include seniority (first come, first serve) basis and the lottery method. Both of these methods cause concern because they may result in a person in lesser need receiving an organ first. The lottery method may result in a patient with little chance of recovery, receiving a scarce organ. • Other selection criteria, such as age, social status, projected ability to give back to the community raise concerns that this is not a just system for all persons. • A combination approach using medical suitability first and then seniority basis second is the most often used method. • National Organ Transplant Law of 1984 forbids the sale of organs and addresses the matter of finding donor organs close to recipients locations. • Financial incentives for cadavers is generally frowned upon • Medicare has been expanded to fully fund kidney transplants and most insurance will cover heart transplants. • Lessons learned from the Oregon case are: - Medical resources are limited in all states - The need for acute care, such as for transplants, is more visible than preventative care, such as prenatal care - New medical discoveries and treatments, with their enormous costs, are likely targets for cost containment rather than older, more basic medical treatments. - For new treatments to be funded, they must replace older, ineffective treatments

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Information about Organ Transplants p. 274

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Table 11.3

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Ethical Issues and Personal Choice p. 274

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• Healthcare professionals may have personal, religious, or ethical reasons for not wishing to be involved in a particular procedure. • The preference should be stated before hiring takes place. • If the healthcare providers reasons jeopardize the health and safety of the patient it may be necessary for them to resign. • The ethics of the employer must be in agreement with the ethics of the healthcare professional.

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The Ethics of Biomedical Research p. 275

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• Aims of healthcare include: - the relief of pain and suffering - the restoration of body functions and health - the prevention of disability and death • Human experimentation is considered necessary for medical progress to occur • Medical research carries some degree of risk and patients must be willing, informed participants, especially in nontherapeutic research • The justification for all research is that the benefits must outweigh the risks. • This utilitarian (benefit/cost) approach is considered a good model for research. • Increasing knowledge is not considered justification for risking human life • Medical researches must abide by the code of ethics established by their professional organizations • HHS implements government standards for research. They require all institutions that receive federal research funds to establish an Institutional Review Board (IRB) to oversee any human research.

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Consent p. 275

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• Informed consent is necessary in therapeutic research • Patients must be informed about the risks and they type of research design that is used. Such as: - Control group - Randomized study in which the subjects is assigned at random to either the control or experimental treatment group - Placebo group in which an inactive substance or an alternative type of treatment is given

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Placebo group p. 275

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...

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When Research Can Resolve Debate over the Best Treatment p. 276

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• Ethics becomes a concern when research results prove that the type of treatment subjects have been receiving has actually harmed patients. • Research can help determine the which course of treatment is best • Physicians are responsible for explaining the risks involved in a research project, however, other healthcare professionals have a duty to covey information the patient tells them to the doctor.

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Conflict of Interest p. 277

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• A conflict of interest can arise in research if the researcher's interests are put above the patients'. As when a researchers falsifies data so they continue to receive funding. • Physicians should not engage in drug trials for drugs made by companies that they own stock in. •

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Department of Clinical Bioethics p. 277

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at the National Institute of Health Clinical Center

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Dear Doctor Letter p. 278

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...

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Ethics of Randomized Test Trials p. 278

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• Many ethicsists believe that control groups are unethical because that group cannot benefit form the experimental drug • Race based control groups create another ethical dilemma because people of a certain race may not receive treatment • However, race based control groups are necessary when researching a condition that only affects that particular race

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Problems with the Double-Blind Test p. 278

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Considered to be an objective means of gathering test data because it eliminates bias, an ethical question still arises. Is the process of informed consent adequate when the patient does not know if they are receiving treatment or not.

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Human Genome Project p. 278

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The goal of the Human Genome Project is to provide a map of where each gene is located on the 23 pairs, or 46 chromosomes.

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Genetic Engineering p. 279

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The ability to alter the basic structure of life to correct a malfunction is the goal of genetic engineering. Moral and ethical concerns are raised by critics who say that manipulation the human genetic code is akin to playing God.

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Cloning p. 279

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• Researches claim that a major reason for developing cloning in animals is to permit the study of genetic development and genetic diseases. • Arguments against human cloning is the effect it might have on human dignity.If we control the creation of human beings, then we can eliminate the creation of imperfect human beings. • Three more oppositions to cloning are: - health risks from mutated genes - emotional risks - the risk of abusing technology • Also,since therapeutic cloning destroys a 4-d-ay-old embryo, many anti-abortionists are against it.

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Gene Therapy p. 280

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A needed gene is spliced onto the DNA of a body of cells to control the production of a particular substance. • This could cure some diseases but there are unanswered questions such as: - Should gene therapy be used to create healthier fetuses? - Should companies develop tests to predict mental illness? - Could gene therapies, designed to save lives, end up being a way to choose the traits we want our children to have?

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Human Stem Cell Research p. 281

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• Stem cells can be used to treat Parkinson's disease, Alzheimer's, disease, stroke, and diabetes. • The controversy revolves around the moral implications of using human embryos to obtain stem cells. • Embryos are grown in the lab, in-vitro fertilization left overs and from abortions. • Congress has banned all federal funding of stem cell research • The FDA has little jurisdiction over embryonic research • States have widely opposing views • The ban on stem cell research was lifted in 2009 • Research using stem cells from sources other than embryos is less controversial. • Some fear there are dangers of starting a practice that is ethically questionable

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Induced Pluripotent Stem Cells

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Somatic cells that are genetically reprogrammed to differentiate differently

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Whistleblowing p. 282

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►Occurs when employees publicly report a potentially dangerous situation in their organization to authorities who can take corrective action. The employee must: • Exhaust all other channels for correcting the situation within the organization • Have documented evidence that would convince an impartial and reasonable observer. • Have a good reason to believe that by "blowing the whistle" and going public the necessary changes will be made to prevent harm and injury. ► Anonymous complaints can be made to reulatory agencies like the EPA or OSHA. ►The Occupational Safety and Health Act of 1970, the Solid Waste Disposal Act and the FDA prohibits retaliation against an employee who files a complaint with them. Federal workers are protected from losing their jobs. ►Whisteblowing is used as a last resort when all other methods for warning about a dangerous situation have failed.

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Healthcare Reform p. 282

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• An estimated 50 million Americans are without healthcare • Illness has been linked to 50 percent of all personal bankruptcies in the U.S. Often the person starts out owning a home and having health insurance, but once they get sick and can no longer work, they lose their health insurance and then their homes. With out a law to protect them, they may be denied new insurance because of their preexisting condition. • Physicians no longer provide as much free care as they used to. • Medical office personnel must treat all patients with the same consideration for the patient's dignity no matter what their ability to pay. • Another cause of rising medical cost is the physicians need to practice defensive medicine to avoid potential lawsuits. • Rationing of medical resources to keep costs down but often makes patients unhappy

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Patient Protection and Affordable Care Act Health Reform 3590 p. 284

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The House passed H.R. 3590 on March 21, 2010 and was approved by the Senate on December 24, 2009. Major components include: • A provision that allows individuals who already have healthcare coverage to retain their coverage if desired • A provision also applies to employers who currently offer coverage. • Patients who are not eligible under Medicare and Medicaid will be required to maintain minimum coverage beginning after 2013. There will be a fine for failing to retain coverage. • A tax credit and reduced cost sharing, on a sliding scale, for qualified individuals. • An expansion of Medicaid • The act does not require employers to provide healthcare coverage, However, if they do not, they may be liable for an additional tax. • Hospitals would be required to conduct periodic community health needs assessments.

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slippery slope

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predicting (without justification) that one step in a process will lead unavoidably to a second, generally undesirable step

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Utility Method

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Organs are given to patients who would benefit the most

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Justice Method

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All patients have an equal chance of receiving an organ.

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Medical suitabitliy

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Measures the medical need and medical benefit to determine organ allocation.

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embryo

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Unborn child in the stage of development between the second and twelfth week after conception.

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fetus

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Unborn child from the third month after conception to birth.

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gestational period

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Time before birth during which the fetus is developing, usually around nine months (40 weeks).

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artificial insemination

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The injection into the female's vagina of seminal fluid that contains male sperm by some means other than sexual intercourse.

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artificial insemination donor

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A man who donates his semen for insemination of a woman who is not his wife.

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artificial insemination husband

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A procedure in which sperm from the woman's husband or partner is used.

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in-vitro fertilization

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The process of combining ovum and sperm outside of a woman's body.

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surrogate mother

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A woman who agrees to bear a child for another couple. The husband's sperm is implanted into the woman's uterus.

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preimplantation genetic diagnosis

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Genetic testing on embryos for genes that cause untreatable or severe diseases.

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contraception

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Any action taken to prevent pregnancy from occurring.

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sterilization

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The process of medically altering reproductive organs so as to terminate the ability to produce offspring.

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therapeutic sterilization

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Sterilization undertaken to save the mother's life or protect her health.

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eugenic (involuntary) sterilization

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Sterilization of certain categories of persons, such as the insane, in order to prevent them from passing on defective genes to their children.

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eugenics

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The science that studies methods for controlling certain characteristics in offspring.

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viable

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Able to survive outside the uterus.

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spontaneous abortion

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An abortion that occurs naturally without interference.

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induced abortion

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An abortion that is caused by artificial means such as medications or surgical procedures.

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Unborn Victims of Violence Act

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A law designed to provide legal penalties for any harm that is done to an unborn child at federal facilities such as military bases or in crimes that cross state lines.

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Child Abuse Prevention and Treatment Act

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(of 1987) Prohibited withholding of medical treatment solely because the infant is disabled.

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amniocentesis

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The physician uses a needle to withdraw a small amount of amniotic fluid that surrounds the fetus, which is tested for the presence of genetic defects (e.g. Tay-Sachs disease and Down Syndrome).

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Safe Haven Laws

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Allows a parent to voluntarily give up custody of an infant thirty-one days or younger to a hospital ER, or police or fire station.

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proxy

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a person authorized to act for another

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expired

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died

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mercy killing

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Euthanasia

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comatose

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vegetative condition

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rigor mortis

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stiffness that occurs in death

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hypothermia

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body temperature below normal

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stages of dying

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Kubler-Ross; reflection on the dying process

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cardiac death

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legal definition of death

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brain death

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vegetative condition

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active euthanasia

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legal term for killing a patient

Chapter 1-13 Medical Law & Ethics – Flashcards

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