Texas Jurisprudence Exam: Comprehensive Guide to Medical Laws and Regulations, Exams of Nursing

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Can a patient successfully sue a doctor if there is no physician-patient relationship?

• CORRECT ANSWERS No If there is no prior physician-patient relationship, are you legally obliged to respond to a call from a patient for treatment? - CORRECT ANSWERS No Does being on call give rise to a physician-patient relationship? - CORRECT ANSWERS No How can one terminate a physician-patient relationship, without abandonment if there is ongoing treatment? - CORRECT ANSWERS 30 days written notice; must provide for emergency Does a physician's duty extend to the unborn child or potential victims of an ill patient? - CORRECT ANSWERS Yes What is "proximate cause"? - CORRECT ANSWERS Prove that negligence caused harm and that the cause was not too remote; what is required to hold a defendant liable in a civil lawsuit What are the two components of proximate cause? - CORRECT ANSWERS Cause-in-fact (but-for test) and foreseeability Does an expert witness have to be actively practicing medicine? - CORRECT ANSWERS Yes Does an expert witness have to know standards of care? - CORRECT ANSWERS Yes Does an expert witness have to have enough training to express an opinion on whether standard of care was provided? - CORRECT ANSWERS Yes

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Does an expert witness have to be board certified? - CORRECT ANSWERS No, board certified or eqivalent In a medical malpractice case, are expert witnesses required? - CORRECT ANSWERS Yes, with two exceptions In a medical malpractice setting, what 2 instances do not need expert testimony? - CORRECT ANSWERS Res ipsa loquitur (e.g., amputation of wrong leg) and negligence per se (a law was broken) What are "exemplary damages"? - CORRECT ANSWERS Damages above compensatory designed to punish the defendant and deter the behavior Is there a cap to noneconomic damages? How much? - CORRECT ANSWERS $250,000 for physicians, $500,000 for hospitals Does the cap on noneconomic damage depend on the number of defendants or claimants? - CORRECT ANSWERS No What is "proportional responsibility"? - CORRECT ANSWERS Percentage of liability apportioned according to percentage of fault Can the claimant have part of the proportional responsibility? - CORRECT ANSWERS Yes If the claimant's proportionate responsibility is more than what %, he/she may not recover damages? - CORRECT ANSWERS If > 50%, no damages awarded How long is the statute of limitations for adults? For minors? - CORRECT ANSWERS 2 years; for minors 2 years after becoming 18 years of age

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By how much can the statute of limitations be extended and how? - CORRECT ANSWERS File complaint—extra 60-day, notice letter extends statute by 75 days What is the statute of limitations for wrongful death? - CORRECT ANSWERS 2 years What is the discovery rule? Give examples. - CORRECT ANSWERS Statute does not begin until damage is discovered. For example, a retained sponge that is found 3 years post-op Is there immunity from civil action in emergency cases? - CORRECT ANSWERS Yes, except gross negligence Is there immunity from civil action in volunteer care? - CORRECT ANSWERS Yes, except gross negligence When can a physician be charged with "assault and battery"? - CORRECT ANSWERS Un-consented surgery or examination or when exceeding the scope of the consent When can a physician be charged with patient abandonment? - CORRECT ANSWERS Unilateral cessation of treatment when continued treatment is necessary What is "strict liability"? - CORRECT ANSWERS Liability that does not depend on actual negligence, but that is based on a breach of a duty to make something safe. This often applies to product liability Are hospitals liable for the actions of a physician? - CORRECT ANSWERS No, unless the hospital employs the physician Who determines in a criminal case if the medical records of a patient should be released? - CORRECT ANSWERS Judge by inspection

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How many days do you have to release medical records to an attorney? - CORRECT ANSWERS 45 days Can medical records be admitted as evidence in court? What are the requirements?

• CORRECT ANSWERS Yes, but only with affidavit What are schedule 1, 2, 3, 4, 5 drugs? - CORRECT ANSWERS Schedule 1—no known use (e.g., heroin); schedule 2—very addictive (morphine, cocaine); schedule 3-5—less addictive What are dangerous drugs? - CORRECT ANSWERS Prescription drugs other than schedule 1- How many DEA registrations do you need if you prescribe drugs? dispense drugs? - CORRECT ANSWERS One to prescribe; a separate registration for each location where you dispense How often do you renew your DEA license? - CORRECT ANSWERS Every 3 years Can you move your office location and then change your DEA? - CORRECT ANSWERS No, need to change BEFORE move Is a DEA registration sufficient to prescribe drugs in Texas? - CORRECT ANSWERS No, also need Department of Public Safety Bureau of Narcotics and Dangerous Drug registration How often do you renew a DPS license? - CORRECT ANSWERS Yearly Do you have to display the DEA and DPS licenses? - CORRECT ANSWERS Not required by any statute.

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How many days do you have to notify the DPS of any change in your information (name, address, tel., etc.)? - CORRECT ANSWERS 7 days Can you have your DPS suspended and keep your DEA or vice versa? - CORRECT ANSWERS No, they are interconnected For schedules 2-5 drugs, can you just put the number of pills on prescription? - CORRECT ANSWERS No, number and number spelled out Do you have to put intended use on prescription? - CORRECT ANSWERS Yes With how many days of a schedule 2-5 drug can a patient be discharged from the hospital? - CORRECT ANSWERS 7 days; only if the drug was already rx in the hospital What kind of prescription pad do you need for schedule 2 drugs? Can you use stickers? - CORRECT ANSWERS Official DPS form; no stickers Can a physician prescribe schedule 2 over the phone? - CORRECT ANSWERS Yes, for emergencies, and only for the duration of emergency How many days does the physician have to mail the schedule's emergency prescription to the pharmacy? - CORRECT ANSWERS 7 days How many days does the patient have to fill schedule 2 prescriptions? - CORRECT ANSWERS 7 days Can you refill a schedule 2 prescription? How about schedule 3-5? - CORRECT ANSWERS No for schedule 2. Max 5 refills for schedules 3-5. Who can call in prescription from a physician's office? - CORRECT ANSWERS Any qualified DESIGNATED person

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Can they call in schedule 2? - CORRECT ANSWERS Only physician in emergencies Can a physician prohibit substitutions for generics? - CORRECT ANSWERS Yes From whom and how do you order schedule 2? Schedules 3-5? - CORRECT ANSWERS Schedule 2 on triplicate order form from distributor; schedules 3- regular form from wholesaler What drugs do you need to keep records on? How are the records kept? How often do you need to do inventory? Do you need to submit the records? How long do you have to keep the last inventory list? - CORRECT ANSWERS If dispensed in office, then all dangerous drugs, schedule drugs and samples; separate records for schedule 1+2; inventory every 2 years; records are not submitted; keep records for 2 years Who can inspect your drugs? - CORRECT ANSWERS TMB, DPS, attorney general for the DEA What is the method of ordering and accounting for drug samples? - CORRECT ANSWERS Written and signed request by physician; must keep inventory and drug logs Can you repackage samples? - CORRECT ANSWERS No Do you need to keep records on samples? - CORRECT ANSWERS Yes, just like other meds Can a physician buy and rebottle? Any exceptions? - CORRECT ANSWERS No, except for rural areas (less than 5000 population of town or 2500 of municipality, closest pharmacy > 15 miles)

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To give anesthesia, how often do you have to register with the board? - CORRECT ANSWERS Every 2 years What life support competency do surgeons and anesthesiologists need? - CORRECT ANSWERS ACLS, PALS, or board-approved course How many and what competency levels of healthcare providers do you need in all settings? - CORRECT ANSWERS At least 2 physicians with advanced competency How many days do you have to report office-based anesthesia-related complications? - CORRECT ANSWERS 15 days What is considered an anesthesia-related complication? - CORRECT ANSWERS Admission to hospital within 24 hours or death within 72 hours What is considered intractable pain? - CORRECT ANSWERS Pain where cause of pain cannot be removed and where relief or cure has not been found Can a hospital forbid a physician to give dangerous drugs or controlled substances for treatment of intractable pain? - CORRECT ANSWERS No Can the board take disciplinary action against a physician for giving dangerous or controlled substances to a patient with intractable pain? - CORRECT ANSWERS No What must the physician document prior to treatment of intractable pain? - CORRECT ANSWERS Understanding between physician and patient about treatment; dose, type, frequency of medication; consultation with psychologist, psychiatrist, addictions expert Can you guarantee that a drug will work? - CORRECT ANSWERS No

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Who can be part of a confidential communication? - CORRECT ANSWERS Persons involved, furthering interest of the patient, and those participating in diagnosis or treatment, e.g., patients, doctors, translators, nurses, etc Is the billing record confidential? - CORRECT ANSWERS No, billing record is NOT part of medical record In a criminal proceeding, is the physician-patient privilege communication confidential? - CORRECT ANSWERS NO (except for mental health records); judicial ruling should be obtained In a criminal proceeding, are records of alcohol and drug abuse confidential? - CORRECT ANSWERS Yes Does the physician confidentiality apply to court or administrative proceedings brought by the patient against a physician? - CORRECT ANSWERS No Can the physician violate confidentiality if he/she thinks he or someone else is in danger? - CORRECT ANSWERS Yes, must report that to law enforcement agency (NOT for mental health) What information must a release of medical records include? - CORRECT ANSWERS Type of records, reason, and person to whom to release How many days (hospital) or business days (physician) does a hospital/physician have to provide medical records when they are requested? - CORRECT ANSWERS Physician has 15 business days, hospital has 15 days What is "therapeutic privilege," when can it be used, who has access to the information, and what is the protocol the physician must follow? - CORRECT ANSWERS If physician thinks that information would be harmful to the patient, it can be withheld; in writing, copy in the chart; films or tests must be released to patient representative

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Can the physician charge for medical records and films? For an affidavit? Does he have to give the information if the patient does not pay? What does he do if the patient does not pay? - CORRECT ANSWERS Yes, can charge $25 for first 20 pages, then 15¢ per page plus postage; notarization $15, films $8; patient MUST pay to get records, 10-day notice Can you charge a patient requesting records in order to apply for disability or public aid? How many copies are patients entitled to? Can you charge if federal agency is requesting records? - CORRECT ANSWERS No; one copy; no How many years does a physician MD have to keep records for adults? for minors? How many years do hospitals have to keep records for adults? For minors? - CORRECT ANSWERS 7 years for adults, 7 years or until age 21; hospital 10 years Can a physician or hospital get rid of records after the required years if these records might be part of a litigation? - CORRECT ANSWERS No Can you relate information without patient consent for treatment? Billing? To report abuse? To law enforcement? For funeral directions? For worker's comp? - CORRECT ANSWERS Yes, all of the above What is the "minimum necessary standard" for a medical release? - CORRECT ANSWERS It protects health care information unless it is required to be released (investigation, law enforcement, authorized release, participating care providers, HIPAA compliant release) Does a patient have the right to see his/her own record? Can he/she ask for amendments to the records? - CORRECT ANSWERS Yes; yes, they can request amendments What is the Texas medical record privacy act? Is it like HIPAA? - CORRECT ANSWERS It is the state equivalent of HIPAA

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Within how many days must a hospital send an itemized bill to patients? Is this mandatory? Or done by request? When must the hospital inform patients of this option? - CORRECT ANSWERS Upon request, within 30 business days; hospital must inform patient of availability of itemized bill Can medical records be obtained with a subpoena? Does this include substance- abuse records? - CORRECT ANSWERS Yes; no Are substance abuse records admissible during criminal proceedings? - CORRECT ANSWERS No, unless the crime is EXTREMELY serious Is HIV information confidential? - CORRECT ANSWERS Yes Can you "break" confidentiality in order to tell a spouse that his/her spouse is HIV positive? - CORRECT ANSWERS Yes Can you break confidentiality to tell a partner about notification program?. - CORRECT ANSWERS Yes Are blood bank records confidential? - CORRECT ANSWERS Yes If a blood bank finds a donor with an infectious disease, can they call other blood banks and tell them the name of donor and the disease?Edition. - CORRECT ANSWERS They can tell name of donor, NOT disease If a blood bank finds that blood outbound to hospitals is HIV positive, can they call the hospitals and give name of donor? Type of disease? - CORRECT ANSWERS They can tell name of disease, NOT donor For statistical purposes, can a blood bank give out medical records? Names? - CORRECT ANSWERS Yes, but not names or other identifying information Is genetic information confidential? - CORRECT ANSWERS Yes

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Can patients have access to the results of their genetic testing? - CORRECT ANSWERS Yes What kind of crime is the unauthorized release of records? - CORRECT ANSWERS Misdemeanor Can the Texas Medical Board (TMB) show preference to a specific school of medicine such as medicine v. osteopathy? - CORRECT ANSWERS No What does the Medical Practice Act (MPA) regulate? - CORRECT ANSWERS The practice of medicine Who does the MPA apply to? - CORRECT ANSWERS Physicians (MD, DO), PAs, and acupuncturists Does the MPA apply to the armed forces and federal public health? Can they moonlight? - CORRECT ANSWERS It does NOT apply to a federal job, they can NOT moonlight outside the federal setting Does the MPA apply to emergency assistance if there is NO charge of money? If there is money charged or billed? - CORRECT ANSWERS NO if no charge; YES if money is charged Are medical students in "board-approved schools" subject to the MPA? - CORRECT ANSWERS No Does the MPA prohibit self-care? - CORRECT ANSWERS No Does the MPA apply to physicians in contiguous states? - CORRECT ANSWERS NO (physicians from nearby states can only order care for patients in hospice or nursing homes)

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How many people are on the TMB? Who appoints them? Who must confirm them? - CORRECT ANSWERS 19 members, appointed by the governor, confirmed by the senate Can the board subpoena people and records? Who can serve a subpoena? - CORRECT ANSWERS YES, subpoenas can be served by board investigator or sent by certified mail How often does the Department of Public Safety (DPS; state police) check on physicians and report to the board? - CORRECT ANSWERS Quarterly What are acceptable methods to tell the public on how to register a complaint to the TMB? In what languages? Where can a physician include this info? - CORRECT ANSWERS By phone (direct number and 1-800 number) or by mail; posted sign, on registration forms or bill; in English and Spanish How often must the TMB disseminate updated information? What info is included? - CORRECT ANSWERS 2 times per year; info includes disciplinary action, board activities and functions, changes to the MPA and attorney general opinions Are disciplinary orders private or public? - CORRECT ANSWERS Public Are the following included in the physician profile?

1. ethnic origin
2. CME
3. years in practice
4. Medicaid participation
5. misdemeanors
6. felonies
7. malpractice claims
8. tax ID or social security numbers - CORRECT ANSWERS Everything except for tax ID/soc. security

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Which malpractice claims should be included? - CORRECT ANSWERS Any jury awards, liabilities—NOT settlements What happens if you don't give this info? - CORRECT ANSWERS License is not renewed How many years of postgraduate training do you need to be eligible for licensure? - CORRECT ANSWERS One Who can get a limited license? - CORRECT ANSWERS Applicant who is recommended by dean, president, or chief administrator from Texas medical school Do you need the jurisprudence exam for a limited license? - CORRECT ANSWERS Yes Who is not eligible for licensure? - CORRECT ANSWERS If applicant is under prosecution, investigation, or has restrictions on license in another state How many days does the program director have to tell the board that somebody with a physician-in-training license did not show up, was suspended, etc.? - CORRECT ANSWERS 30 days What is a temporary postgraduate training permit? - CORRECT ANSWERS License for residents and fellows pending the physician in training permit What is a telemedicine license? Do you have to be board certified to have it? Do you have to pass the jurisprudence exam? - CORRECT ANSWERS A license to do consulting work through internet, etc., in Texas; cannot physically see or treat patients; board certification is required; JP exam required How often do you register your license? Do you need an updated physician profile? - CORRECT ANSWERS Every 2 years; yes

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How many days prior to the expiration of your license does the TMB notify you? - CORRECT ANSWERS 30 How many days after a license expires are you considered to be practicing without a license? - CORRECT ANSWERS 30 day grace period. License expired < 90 days—penalty is? - CORRECT ANSWERS $ License expired 91-364 days—penalty is? - CORRECT ANSWERS $ License expired > 364 days—penalty is? - CORRECT ANSWERS Cancellation Do you have to retake JP exam if your license is canceled? - CORRECT ANSWERS Only if the license is canceled for more than 2 years. How can you get another license if it is lost/destroyed? - CORRECT ANSWERS Get affidavit of lost or destroyed document and pay fee to board How many category 1 CMEs yearly? - CORRECT ANSWERS 12 How many CMEs per year? - CORRECT ANSWERS 24 How many category 1 CMEs yearly must be in ethics? - CORRECT ANSWERS 1 How many category 2 CMEs can be from volunteer work? - CORRECT ANSWERS 6 How many CMEs can a license carry forward? And for how many registration periods? - CORRECT ANSWERS 48; only once

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How many CMEs can be applied retroactively? - CORRECT ANSWERS 24; only once How many CMEs do you need if you become "board certified" within 36 months? - CORRECT ANSWERS 24 If you practice pain management, how many CMEs in pain management are required? - CORRECT ANSWERS None, but they are recommended Who can initiate a complaint to the board? - CORRECT ANSWERS Anyone What is the "health professions council"? - CORRECT ANSWERS Council of various professionals that establishes a central telephone complaint system (800- number) Does the TMB have to notify a physician when a complaint is filed? Are there exceptions? How often do the parties get updated on proceedings? - CORRECT ANSWERS Yes, within 30 days, except if it would interfere with the investigation; updates are quarterly When does the TMB release complaint information to the hospital? - CORRECT ANSWERS Upon written request Who investigates issues of "medical competency"? - CORRECT ANSWERS An expert physician panel appointed by the board consisting of physicians ONLY What do medical malpractice carriers have to report to the TMB regarding malpractice? Within what time limit? Who punishes them if they do not report? What does a physician without insurance have to report and when? Is there a difference for NPDB/HCQIA? - CORRECT ANSWERS Within 30 days from a complaint being filed in a lawsuit, settlement; noninsured MDs have to self-report within 30 days; any payment must be reported to NPDB by HCQIA requirements

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Restrictive action by the TMB: Within what time limit must the board tell the hospital? Tell Medicare? Tell the secretary of health & professional societies & complainant? - CORRECT ANSWERS Next working day for hospitals; in writing for all within 30 days. Restrictive action by the TMB: How often must the board make public notices about disciplinary orders? - CORRECT ANSWERS 2 times per year. Restrictive action by the TMB: Must the board report crimes found during investigations? - CORRECT ANSWERS Yes, to the law enforcement. Restrictive action by the TMB: Within how many days must the board report to the NPDB? - CORRECT ANSWERS 30 days. Restrictive action by the TMB: Within how many days must a court report to the board about convictions, felonies, and misdemeanors and addiction issues be filed?

• CORRECT ANSWERS 30 days. Are TMB reports confidential? - CORRECT ANSWERS Yes Who can the NPDB give info to? How about to patients? How about statistical data? - CORRECT ANSWERS Hospitals, self-requesting physicians, board, other state or federal agencies, attorneys; for statistical purposes if no identity disclosed When is it not illegal to perform a third-trimester abortion? - CORRECT ANSWERS To prevent mother's death, if unborn has severe irreversible brain damage When is it not illegal to perform an abortion on a minor? - CORRECT ANSWERS In emergency and with court order Is sexual contact between a physician and patient OK if the patient consents? - CORRECT ANSWERS NO, the disparity of power does not allow consent

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Why is it unprofessional to initially prescribe drugs over the Internet? - CORRECT ANSWERS Did not verify identity of patient, no physician coverage or follow- up guaranteed How can you terminate care to a patient? - CORRECT ANSWERS 30 day notice, certified letter, available for emergencies during that time, give alternative physicians What prescriptions does a physician need to keep records on? Dangerous drugs? Controlled substances? Samples? - CORRECT ANSWERS Samples and dangerous drugs as part of medical record; for schedule 3-5 records and log; for schedule 2 separate log and records; keep record for 2 years; do inventory on schedule drugs every 2 years Can the board administer monetary penalties? - CORRECT ANSWERS Yes What happens to his/her license if a physician goes to prison? - CORRECT ANSWERS TMB is required to suspend How many malpractice claims within what time period automatically open a board investigation? - CORRECT ANSWERS 3 within 5 years How many people from the TMB are necessary to temporarily suspend a license? - CORRECT ANSWERS President appoints a 3-member panel; can be done by phone Is self-reporting addiction a disciplinary action? Is a rehabilitation order a disciplinary order? - CORRECT ANSWERS No; no, it is the only nondisciplinary order Is probation a disciplinary order? Who cannot be put on probation? - CORRECT ANSWERS Yes; sex offenders, felons, prisoners, or if the physician is a threat to public

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Can the TMB make a physician give a refund? What is the maximum amount of refund? - CORRECT ANSWERS Yes; cannot be more than the amount paid What is monitoring? - CORRECT ANSWERS Continued oversight of the board for subjects on disciplinary orders Who is part of an informal hearing and what is it? - CORRECT ANSWERS Members of the board, at least one of whom is a public member, physician, his/her attorney; a means to settle a case without an administrative hearing When do you go to formal hearings? What is the SOAH? Is it part of the TMB? Who holds the hearings? Who is participating? Must the TMB follow the ruling of the administrative law judge? - CORRECT ANSWERS If no settlement reached after informal hearing; state office of administrative hearing; no; board members, physician, attorneys, and administrative law judge; NO, they do not have to follow the judge's ruling Where can a physician file an appeal? Within what time period? Can he practice in the interim? - CORRECT ANSWERS Circuit court Travis county, within 30 days after final board decision; physician cannot practice in interim Can the TMB panel serve a subpoena to a physician? - CORRECT ANSWERS Yes Can the physician get his file? - CORRECT ANSWERS Yes, with written request, within 30 days Can you voluntarily surrender your license? - CORRECT ANSWERS Yes, but board does not have to accept it If you surrender your license to avoid disciplinary action, can you reapply for it? - CORRECT ANSWERS Yes, if there is no prohibitive circumstance

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If you surrender your license voluntarily, whose burden is it to show competence if you want it back? - CORRECT ANSWERS The physician who surrendered the license How often and how soon can you reapply to have your license reinstated if it has been canceled/suspended, etc.? - CORRECT ANSWERS Once a year What is the maximum administrative penalty? How long do you have to pay it? - CORRECT ANSWERS $5000 per violation; 30 days What is the maximum penalty for an action for civil penalty by the attorney general? How long do you have to pay it? - CORRECT ANSWERS $1000 per penalty, 30 days What kind of offense is a violation of the MPA? What kind offense is it to practice medicine in violation of the MPA? To practice medicine with financial harm? - CORRECT ANSWERS Misdemeanor class A; felony; jail felony May you perform emergent surgery while drunk? - CORRECT ANSWERS No; emergency MIGHT be an exception If you have a contract with an impaired physician, can you avoid reporting him/her?

• CORRECT ANSWERS No Can the board regulate advertising? - CORRECT ANSWERS No, except to prohibit false, misleading, or deceptive practice Are "testimonials" allowable advertising? - CORRECT ANSWERS No Is it permitted to advertise board certification? Board eligibility? - CORRECT ANSWERS Certification, yes; not eligibility

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What is a standing medical order? - CORRECT ANSWERS Physician order to institution, e.g., nursing home What is a standing delegation order? What are the requirements? - CORRECT ANSWERS Physician order for patient or population; signed, dated, in writing Who can a physician delegate to? - CORRECT ANSWERS Any qualified and properly trained person Who can the physician delegate to administer dangerous drugs? - CORRECT ANSWERS Any qualified and trained person Can a physician delegate to a midwife? - CORRECT ANSWERS Yes (e.g., eye prophylaxis) Is a physician liable for the actions of a NP or PA? - CORRECT ANSWERS No, unless vicariously liable due to employment What kind of name identification do PAs need? - CORRECT ANSWERS Name tag identifying themselves as a physician assistant What requirements exist for prescription for PAs and NPs? - CORRECT ANSWERS No schedule 2; maximum 90 days, no refills unless consultation with physician Which drug schedules can PAs and NPs prescribe? How many days? Can they give refills? Can they treat children? What ages? - CORRECT ANSWERS Schedules 3-5, 90 days, refill after consultation with physician; Yes, but children less than 2 years only after consultation with physician How many PA and NP equivalent FTEs can a physician supervise at maximum? - CORRECT ANSWERS 3 FTEs

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Can CRNAs give all anesthetic drugs? Are they restricted to a particular MD? - CORRECT ANSWERS Yes; no, any MD What authority do pharmacists have? Can they give immunizations? Where does the supervising physician have to be located geographically? - CORRECT ANSWERS Getting histories, ordering drug therapy-related tests, procedures, modifying drug therapy; yes; physician has to be able to be physically present daily What can optometrists prescribe? - CORRECT ANSWERS Eye ointments Can anybody be a surgical assistant? Do they need a license? - CORRECT ANSWERS Yes; yes, if they identify themselves as licensed, otherwise, no Can a physician delegate the taking of X-rays to noncertified technicians? - CORRECT ANSWERS Yes Can they do bone density? Nuclear tests? CT? Skull X-ray? - CORRECT ANSWERS Bone density, skull, spine, extremities, abdomen, chest; NOT CT, nuclear test, etc Do they need to be licensed or registered by the boards? - CORRECT ANSWERS Yes, they need registration What is the difference between a partnership and a limited liability partnership? - CORRECT ANSWERS The limited liability partnership can limit individual liability white partner A is liable for the acts of partner B Who can incorporate in Texas? Can physicians practice through corporations? - CORRECT ANSWERS Dentists, PT but NOT MD; MD cannot practice through corporation Are there any corporations that can employ physicians? - CORRECT ANSWERS Yes, Certified Nonprofit Healthcare Corporation

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Who can grant a title of Certified Nonprofit Healthcare Corporation? - CORRECT ANSWERS TMB What are 5 important characteristics of Certified Nonprofit Healthcare Corporations?

• CORRECT ANSWERS Must conduct scientific research, support education, improve capabilities to study and teach, deliver health care to the public, instruct public in medical science, public health Can hospitals provide "physician guarantees"? How do the finances work? - CORRECT ANSWERS Physicians can contract with hospitals but are not employees; guarantees paid for availability, billing, etc Are there federal anti-kickback laws? - CORRECT ANSWERS Yes What does the health care insurance portability and accountability act do to federal anti-kickback provisions? - CORRECT ANSWERS Applies to all federal health care insurances = all insurances Do the anti-kickback laws apply only to Medicare and Medicaid? - CORRECT ANSWERS No Does federal anti-kickback law apply only to patient referrals? - CORRECT ANSWERS No Does this law apply only to giving money as a kickback? Who is punished, giver or taker? - CORRECT ANSWERS No, any money or monetary value; both are punished What kind of crime is a violation of anti-kickback law, and what is the penalty for physicians and hospitals? - CORRECT ANSWERS Felony; up to $250,000 for individuals and $500,000 for institutions

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What are safe harbors in anti-kickback law? Give examples. - CORRECT ANSWERS Acts NOT in violation of anti-kickback regulation; e.g., space and equipment rental, sale of practice, discounts, etc Are STARK laws federal? - CORRECT ANSWERS Yes What is a STARK law? Can you refer to family? - CORRECT ANSWERS Anti-self- referral law; no What is the difference between STARK 1 and STARK 2? - CORRECT ANSWERS Stark 1 applies to laboratories, Stark 2 to PT, OT services, etc What is the CIVIL FALSE CLAIMS act? Is it state or federal? How long has it been around? What does it prohibit? - CORRECT ANSWERS Submitting false claims to government for payment; federal law since War Between the States Does Texas prohibit remuneration in exchange for referral volume? - CORRECT ANSWERS Yes, prohibition on the solicitation of patients What kind of crime is it to tamper with Texas Medical Board documents? - CORRECT ANSWERS Class A Misdemeanor Barratry—what is it? Is it illegal? - CORRECT ANSWERS Contacting prospective patients in attempts to solicit them; it is illegal Who can be part of a medical peer review committee? - CORRECT ANSWERS Physicians, health care workers, anybody in the hospital Does physician competency include membership in societies, participation in education, participation in group plans? - CORRECT ANSWERS No Who makes rules (by laws) for hospitals? - CORRECT ANSWERS The governing body

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Can a hospital reject an orthopedist because he is a DO and not an MD? - CORRECT ANSWERS No Can a hospital deny you privileges because you don't accept HMOs? Participate in other hospitals? - CORRECT ANSWERS No Who makes the final decision in a hospital to grant or deny privileges to a physician? - CORRECT ANSWERS Governing body Does the hospital have to get a report from the NPDB about physicians prior to granting privileges? - CORRECT ANSWERS Yes, initially and every 2 years; if they don't, they are liable How many days does the board have to give data to a hospital requesting it? - CORRECT ANSWERS 15 days How often must a physician update his core credentials? How many days does he have to provide corrections? - CORRECT ANSWERS Yearly; corrections within 30 days Prior to the "first release" of his information, how many days does a physician have to review it? - CORRECT ANSWERS 15 business days If a physician's privileges will be suspended, does he/she have the right to due process? - CORRECT ANSWERS Yes How many days prior to hearing of due process must the hospital give the physician notification? - CORRECT ANSWERS 30 days Do hospitals have to accept NPs and PAs? - CORRECT ANSWERS No

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If accepting NPs and PAs, what are the hospital's responsibilities? - CORRECT ANSWERS Due process, fairness, appeal Is the peer review file confidential? - CORRECT ANSWERS Yes, EXCEPT for possible civil rights violation and possible anti-trust violation When must a hospital's medical peer review report actions taken against physicians to the TMB? to the HCQIA? to the NPDB? - CORRECT ANSWERS If action affects privileges for longer than 30 days or if physician surrenders privileges or if it affects membership; never, the TMB reports to NPDB How much time does the committee have to report to the TMB? - CORRECT ANSWERS 15 days Is it good enough to get the signature for informed consent? - CORRECT ANSWERS No, actual informed consent must be achieved Which procedures need "full disclosure" of LIST A and LIST B? - CORRECT ANSWERS Only List A Which procedures need additional "statutory consent"? - CORRECT ANSWERS Hysterectomy, radiation therapy, ECT Is it the duty of the hospital or the physician to get consent? - CORRECT ANSWERS Physician Which particular aspects of an informed consent if neglected can be grounds for a suit? Do you need to suffer damages to sue? - CORRECT ANSWERS Nondisclosure of risks, benefits, alternatives; yes Is express consent required in an emergency? - CORRECT ANSWERS No, consent is implied