TEXAS JURISPRUDENCE FINAL EXAM Questions and Answers Latest Updates 2024 GRADED A+, Exams of Nursing

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TEXAS JURISPRUDENCE FINAL EXAM Questions and Answers Latest Updates 2024 GRADED A+ Can a patient successfully sue a doctor if there is no physician-patient relationship? - No If there is no prior physician-patient relationship, are you legally obliged to respond to a call from a patient for treatment? - No Does being on call give rise to a physician-patient relationship? - No How can one terminate a physician-patient relationship, without abandonment if there is ongoing treatment? - 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? - Yes What is "proximate cause"? - 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? - Cause-in-fact (but-for test) and foreseeability Does an expert witness have to be actively practicing medicine? - Yes Does an expert witness have to know standards of care? - Yes Does an expert witness have to have enough training to express an opinion on whether standard of care was provided? - Yes Does an expert witness have to be board certified? - No, board certified or eqivalent In a medical malpractice case, are expert witnesses required? - Yes, with two exceptions In a medical malpractice setting, what 2 instances do not need expert testimony? - Res ipsa loquitur (e.g., amputation of wrong leg) and negligence per se (a law was broken) What are "exemplary damages"? - Damages above compensatory designed to punish the defendant and deter the behavior Is there a cap to noneconomic damages? How much? - $250,000 for physicians, $500,000 for hospitals Does the cap on noneconomic damage depend on the number of defendants or claimants? - No What is "proportional responsibility"? - Percentage of liability apportioned according to percentage of fault Can the claimant have part of the proportional responsibility? - Yes If the claimant's proportionate responsibility is more than what %, he/she may not recover damages? - If > 50%, no damages awarded How long is the statute of limitations for adults? For minors? - 2 years; for minors 2 years after becoming 18 years of age By how much can the statute of limitations be extended and how? - File complaint —extra 60-day, notice letter extends statute by 75 days How many days does the physician have to mail the schedule's emergency prescription to the pharmacy? - 7 days How many days does the patient have to fill schedule 2 prescriptions? - 7 days Can you refill a schedule 2 prescription? How about schedule 3-5? - No for schedule 2. Max 5 refills for schedules 3-5. Who can call in prescription from a physician's office? - Any qualified DESIGNATED person Can they call in schedule 2? - Only physician in emergencies Can a physician prohibit substitutions for generics? - Yes From whom and how do you order schedule 2? Schedules 3-5? - Schedule 2 on triplicate order form from distributor; schedules 3-5 regular form from wholesaler What drugs do you need to keep records on? How are the records kept? How often do you need to do inventory? Do you need to submit the records? How long do you have to keep the last inventory list? - 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? - TMB, DPS, attorney general for the DEA What is the method of ordering and accounting for drug samples? - Written and signed request by physician; must keep inventory and drug logs Can you repackage samples? - No Do you need to keep records on samples? - Yes, just like other meds Can a physician buy and rebottle? Any exceptions? - No, except for rural areas (less than 5000 population of town or 2500 of municipality, closest pharmacy > 15 miles) To give anesthesia, how often do you have to register with the board? - Every 2 years What life support competency do surgeons and anesthesiologists need? - ACLS, PALS, or board-approved course How many and what competency levels of healthcare providers do you need in all settings? - At least 2 physicians with advanced competency How many days do you have to report office-based anesthesia-related complications? - 15 days What is considered an anesthesia-related complication? - Admission to hospital within 24 hours or death within 72 hours What is considered intractable pain? - 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? - No Can the board take disciplinary action against a physician for giving dangerous or controlled substances to a patient with intractable pain? - No What must the physician document prior to treatment of intractable pain? - 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? - No Who can be part of a confidential communication? - 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? - No, billing record is NOT part of medical record In a criminal proceeding, is the physician-patient privilege communication confidential? - NO (except for mental health records); judicial ruling should be obtained In a criminal proceeding, are records of alcohol and drug abuse confidential? - Yes Does the physician confidentiality apply to court or administrative proceedings brought by the patient against a physician? - No Can the physician violate confidentiality if he/she thinks he or someone else is in danger? - Yes, must report that to law enforcement agency (NOT for mental health) What information must a release of medical records include? - 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? - 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? - 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 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? - 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 billed? - NO if no charge; YES if money is charged Are medical students in "board-approved schools" subject to the MPA? - No Does the MPA prohibit self-care? - No Does the MPA apply to physicians in contiguous states? - NO (physicians from nearby states can only order care for patients in hospice or nursing homes) How many people are on the TMB? Who appoints them? Who must confirm them? - 19 members, appointed by the governor, confirmed by the senate Can the board subpoena people and records? Who can serve a subpoena? - 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? - 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? - 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? - 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? - Public Are the following included in the physician profile? ethnic origin CME years in practice Medicaid participation misdemeanors felonies malpractice claims tax ID or social security numbers - Everything except for tax ID/soc. security Which malpractice claims should be included? - Any jury awards, liabilities—NOT settlements What happens if you don't give this info? - License is not renewed How many years of postgraduate training do you need to be eligible for licensure? - One Who can get a limited license? - Applicant who is recommended by dean, president, or chief administrator from Texas medical school Do you need the jurisprudence exam for a limited license? - Yes Who is not eligible for licensure? - 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.? - 30 days What is a temporary postgraduate training permit? - 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? - 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? - Every 2 years; yes How many days prior to the expiration of your license does the TMB notify you? - 30 How many days after a license expires are you considered to be practicing without a license? - 30 day grace period. License expired < 90 days—penalty is? - $75 License expired 91-364 days—penalty is? - $150 License expired > 364 days—penalty is? - Cancellation Do you have to retake JP exam if your license is canceled? - Only if the license is canceled for more than 2 years. How can you get another license if it is lost/destroyed? - Get affidavit of lost or destroyed document and pay fee to board How many category 1 CMEs yearly? - 12 How many CMEs per year? - 24 How many category 1 CMEs yearly must be in ethics? - 1 How many category 2 CMEs can be from volunteer work? - 6 How many CMEs can a license carry forward? And for how many registration periods? - 48; only once How many CMEs can be applied retroactively? - 24; only once How many people from the TMB are necessary to temporarily suspend a license? - 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? - No; no, it is the only nondisciplinary order Is probation a disciplinary order? Who cannot be put on probation? - Yes; sex offenders, felons, prisoners, or if the physician is a threat to public Can the TMB make a physician give a refund? What is the maximum amount of refund? - Yes; cannot be more than the amount paid What is monitoring? - Continued oversight of the board for subjects on disciplinary orders Who is part of an informal hearing and what is it? - 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? - 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? - 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? - Yes Can the physician get his file? - Yes, with written request, within 30 days Can you voluntarily surrender your license? - Yes, but board does not have to accept it If you surrender your license to avoid disciplinary action, can you reapply for it? - Yes, if there is no prohibitive circumstance If you surrender your license voluntarily, whose burden is it to show competence if you want it back? - 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.? - Once a year What is the maximum administrative penalty? How long do you have to pay it? - $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? - $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? - Misdemeanor class A; felony; jail felony May you perform emergent surgery while drunk? - No; emergency MIGHT be an exception If you have a contract with an impaired physician, can you avoid reporting him/her? - No Can the board regulate advertising? - No, except to prohibit false, misleading, or deceptive practice Are "testimonials" allowable advertising? - No Is it permitted to advertise board certification? Board eligibility? - Certification, yes; not eligibility What is a standing medical order? - Physician order to institution, e.g., nursing home What is a standing delegation order? What are the requirements? - Physician order for patient or population; signed, dated, in writing Who can a physician delegate to? - Any qualified and properly trained person Who can the physician delegate to administer dangerous drugs? - Any qualified and trained person Can a physician delegate to a midwife? - Yes (e.g., eye prophylaxis) Is a physician liable for the actions of a NP or PA? - No, unless vicariously liable due to employment What kind of name identification do PAs need? - Name tag identifying themselves as a physician assistant What requirements exist for prescription for PAs and NPs? - 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? - 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? - 3 FTEs Can CRNAs give all anesthetic drugs? Are they restricted to a particular MD? - Yes; no, any MD What authority do pharmacists have? Can they give immunizations? Where does the supervising physician have to be located geographically? - 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? - Eye ointments Can anybody be a surgical assistant? Do they need a license? - Yes; yes, if they identify themselves as licensed, otherwise, no Can a physician delegate the taking of X-rays to noncertified technicians? - Yes Can they do bone density? Nuclear tests? CT? Skull X-ray? - Bone density, skull, spine, extremities, abdomen, chest; NOT CT, nuclear test, etc Can a hospital deny you privileges because you don't accept HMOs? Participate in other hospitals? - No Who makes the final decision in a hospital to grant or deny privileges to a physician? - Governing body Does the hospital have to get a report from the NPDB about physicians prior to granting privileges? - 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? - 15 days How often must a physician update his core credentials? How many days does he have to provide corrections? - Yearly; corrections within 30 days Prior to the "first release" of his information, how many days does a physician have to review it? - 15 business days If a physician's privileges will be suspended, does he/she have the right to due process? - Yes How many days prior to hearing of due process must the hospital give the physician notification? - 30 days Do hospitals have to accept NPs and PAs? - No If accepting NPs and PAs, what are the hospital's responsibilities? - Due process, fairness, appeal Is the peer review file confidential? - 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? - 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? - 15 days Is it good enough to get the signature for informed consent? - No, actual informed consent must be achieved Which procedures need "full disclosure" of LIST A and LIST B? - Only List A Which procedures need additional "statutory consent"? - Hysterectomy, radiation therapy, ECT Is it the duty of the hospital or the physician to get consent? - Physician Which particular aspects of an informed consent if neglected can be grounds for a suit? Do you need to suffer damages to sue? - Nondisclosure of risks, benefits, alternatives; yes Is express consent required in an emergency? - No, consent is implied If arrested and suspected to be drunk, do the police need consent to check blood? - No, consent is deemed to have been made, but consent can be expressly denied If anyone died in an accident, is consent needed to check blood? - No Who is a minor in Texas? - Anybody less than 18 years of age who has not been emancipated When can a minor petition the court NOT to be a minor? - Age 16 when living independently and supporting self, age 17 when supporting self, managing conservator or guardian, Texas resident Can an uncle consent for a minor? - Yes Can an educational institution consent for a minor? - Yes (boarding school for example) Vaccinations: Is physician liable for damages by a required vaccination? Is physician liable for damages done by a disease that the parents denied vaccination for? - No; no Who is responsible to review a child's immunization record? - Any physician; failure to do so has no consequence What happens if a physician does not review a child's immunization record? - Nothing Do you need to consent to inform the authorities if you suspect child abuse or neglect? - No In what instance can a child give consent? - If on active duty, when restrictions of minor removed, for communicable disease, if pregnant for counseling, and addiction treatment Does the Consent to Medical Treatment Act apply to "incapacitated" individuals? Does it apply to psychiatry patients? - Yes; yes, but not for patients in FREE- STANDING psychiatric hospitals Who can be a surrogate decision maker? What are the requirements? - Spouse, adult child, majority of children, parents, or a person identified by patient before becoming incapacitated Can surrogate decision maker consent to voluntary inpatient psych treatment? ECT treatment? Appoint another surrogate decision maker? - Not psych treatment, not ECT, cannot appoint another decision maker What are 3 examples of "advanced directive"? - Directive to physician, out-of- hospital DNR, medical power of attorney How many witnesses do you need, and what are the witness requirements for advanced directives? - 2 witnesses, one cannot be related, beneficiary, attending physician or hospital employee Can a directive to a physician be oral or must it be in writing? - Can be verbal and must be documented in chart with names of witnesses Does an advanced directive have to be notarized? - No How many witnesses for an oral directive? - 2 How long is a directive good for? - No limit, until revoked Are prenatal maternal tests confidential and anonymous? - Confidential; anonymous upon request Does the physician have to tell the mother that he/she will do prenatal maternal tests? What if she wants anonymous testing? - Yes, must inform but not specifically consent; if anonymous is wanted must refer patient to anonymous testing center; patient can refuse If prenatal maternal tests are positive, what must the physician do? - Refer for treatment, provide counseling, and provide information about diseases How long does a physician have to keep prenatal maternal test results? - For 9 months What institutions do not need licensing for birthing centers? - Licensed hospitals, nursing homes, and ambulatory surgery centers What does the federal case Roe v. Wade say about abortion? - Abortions are legal Under what circumstance can you perform a third trimester abortion in Texas? - In emergency to save mother's life or if fetus has severe irreversible abnormality After third-trimester abortion, how many days does the physician have to notify the Department of Health? - 30 days What is the cut-off gestational age to do an abortion in the office? - 16 weeks What specific health risk must you inform the patient about during consent for abortion (4 categories)? - Infection, hemorrhage, infertility, breast cancer What specific economic-related issues must you talk about during consent for abortion? Do you need to document in writing that you talked about these issues? - Medical assistance, father's liability for support; yes How long before the abortion must you tell patients about risks and economic issues? - 24 hours When can you perform an abortion on a minor? Can you do it without calling the parents? - To save mother's life, court order, consent of parents; yes, only court ordered How much time prior to an abortion on a minor must you give notification to parents? If they agree, can you do it earlier? - 48 hours; yes What happens if you cannot find a parent to notify of abortion? - Mail certified letter 48 hours prior Is there any way for a minor to have abortion without notifying the parents? - Yes, can petition court if minor is mature, informed and notification may be harmful (abuse) To perform emergency abortion on a minor, what must you do? What kind of form to fill out? - Assure that it is necessary; notify TDDHS on prepared form What facility must be licensed to do abortions in Texas? - If they do > 50/year How often do abortion facilities have to report to the DPH? - Yearly Do abortion facilities' reports include the physician and patient names? - No, neither Can you force a physician to perform an abortion? - No With what and for what do you have to treat all newborns? - Ophthalmia neonatorum, tetracycline, erythromycin, or silver nitrate ophthalmic solution What genetic test must you do on all newborns? How many times? Who can do them? Can the parents object? - PKU, galactose-1-phosphate uridyltransferase deficiency, sickling hemoglobinopathies, congenital adrenal hyperplasia, hypothyroidism; twice (at birth, 2 weeks later); physician or person attending birth; parents can object on religious grounds Do hospitals have to give hearing test to all newborns? - Yes Within what time period does insurance have to pay for newborn hearing screen? When do they have to pay for follow-up care with regard to hearing? - From birth until 30 days; up to 2 years of age For what time period must an insurance cover a mother + newborn? - 48 hours normal delivery, 96 hours C-section; longer for complicated delivery Who must review immunization history? - Every physician Until when must insurance pay for immunizations? - Up to age 6 Who must submit the birth certificate? - Physician, midwife, or person attending birth How many days do you have to submit the birth certificate? - 5 days What kind of crime is it if you don't submit a birth certificate? - Misdemeanor What kind of crime is it if you submit false data on a birth certificate? - Felony 3rd degree How old or young must a baby be in order for a care provider to be able to take possession of an abandoned baby? - 60 days Can any money transaction be done during an adoption? - Yes; only to cover expenses When is a person considered dead? - Cardiac and respiratory functions cease to exist When is a ventilated person considered dead? - Irreversible cessation of brain function What is the time of death for ventilated people? - At time of determined brain death For your ventilated person, do you pronounce death before or after you turn off ventilator? - Before Who can pronounce somebody dead? - MD, PA, NP, RN Who must file the death certificate? - Person in charge of interment How many days does the physician have to fill it out once it is given to him/her? - 5 days for MD to fill out medical portion, 10 days to send in death certificate Do fetuses require death certificates? - If 350 grams or more or 20 weeks or older What is the duty of a medical professional when treating an adult with family violence? What languages to use? - Duty to treat and provide information (and document that information was provided) in English and Spanish; no need to report Does the physician have to call the police in cases of adult family violence? - No, just inform victim of options What is the difference between a professional and a medical professional? - Medical professional = MD; professional = anybody else, e.g., teacher Reporting of child abuse? By whom? How fast? Can it be delayed? To whom (3 entities)? - Report immediately but MUST be within 48 hours, cannot be delegated; to Texas Department of Protective and Regulatory Services, any law enforcement, Texas Youth Commission Will the TDPRS act on anonymous calls regarding child abuse? Does it satisfy a professional duty to report? - Yes, they will be acted upon but DO NOT satisfy duty to report How much time do professionals and medical professionals have to report the death of a child secondary to suspected abuse? - 48 hours What kind of crime is lying in a report on child abuse? Not submitting a report? - State jail felony, misdemeanor class B Who must report nursing home abuse? - Any person Is the report of nursing home abuse verbal or written? - Immediately verbally, written within 5 days What kind of offense is it NOT to report nursing home abuse? - Misdemeanor class A Can the institution retaliate against a whistle-blower in cases of nursing home abuse? - No When and within what time limit must nursing homes report resident deaths? - Within 10 working days Within what time period must nursing home deaths be reported if the resident just transferred to hospital within 24 hours and died? - 10 working days Who is considered a child, elderly, or disabled person when talking about a criminal offense for injury of the above? - 14 year or younger, 65 or older or disabled older than 14 Who is considered "elderly" when living at home? - 65 or older What kind of offense is it if you do not report elderly abuse? - Misdemeanor class A; false information class B Can a volunteer report abuse in a hospital, etc.? - Yes Who is considered a mental health worker? Does that include priests? - Social worker, addiction counselor, counselor, marriage therapist, clergy member, physician, psychologist; yes Give definitions for 4 types of sexual contact - Touching, deviate acts, intercourse, request for or suggestion of What is sexual exploitation? - Pattern for purposes of sexual gratification What is therapeutic deception? - Making patient believe it is part of treatment What of the above questions is cause for action? - All-contact, exploitation, deception Is an employer liable for the sexual misconduct of a current or previous worker with a current or discharged or ex-patient? - Yes, if employer has knowledge of past sexual exploitation or fails to inquire over the last five years of employment What is considered "emotional dependence"? - Lack of emotional dependence of the patient on the therapist is a defense that can be raised in an action brought by a former patient Is it a defense that the sexual misconduct was consented? Off the premises? Outside treatment sessions? - No, no, no Who are the 2 agencies that should receive a report in cases of sexual misconduct? - State licensing board and prosecuting attorney of the county where the alleged offense occurred When to report sexual misconduct? What offense is failure to report? - Within 30 days; misdemeanor If you are examining a patient with a communicable disease, what is your duty? - Duty to instruct on prevention of reinfection, spread, and necessity to treat Who has to report communicable diseases? - Physician, dentist, veterinarian, chiropractor What sort of situations must be reported? - Documented or suspected infection, exotic diseases, outbreaks Can an employee in the office do the reporting? - Yes, if designated by physician If a physician reports a communicable disease, does the hospital also have to report it? - Yes, both If you treat a patient with a communicable disease that dies, what are your 2 responsibilities and within what time frame? - Report death immediately and put toe tag on What kind of crime is nonreporting communicable disease? - Class B misdemeanor If you are a police officer, firefighter, etc., can you make somebody have an HIV test if you think you might have been exposed? Who do you call? - Yes, request TDH Is the police officer, etc., required to be tested himself/herself? - No If an employee is exposed, can the hospital check if the person is harboring an infective agent? - Yes, to HepB, C, HIV What diseases must they test for? - Hep B, C, HIV What are the 3 types of involuntary psych admissions? Who can order them? - Emergency or temporary detention, protective custody; they are court ordered Does being on ETOH, senile, mental retardation, epilepsy constitute grounds to deny voluntary psych admission? - No When you are admitted involuntarily, when can a patient be forced to take psychoactive mediations (3 cases)? - (1) a medication-related emergency, (2) under a court order, (3) patient is a ward and guardian consents Do you need a separate court order to give psychoactive medications in addition to the court order for involuntary admission? - Yes, you need 2 separate court orders Do you need a physician order to put patient in restraints? - Yes When should you consider prescribing psychoactive medications? - Medication emergency—threat to self or others ECT may not be used in people less than years of age. Any exceptions? - 16, no Can anyone, including courts, force somebody to have ECT without their written consent? - No, ECT cannot be court ordered How often do you need consent for ECT? - Before each treatment How about people > 65 years of age, who must sign for ECT? - Patient and 2 physicians Can psychiatry hospitals employees' pay be based on # of admissions, length of stay, calls to referring sources? - No Can psychiatry hospitals "guarantee" a cure on advertising? - No Can psychiatry hospitals solicit information about patients' confidential records to solicit them for services? - No Can a physician send a patient directly to psychiatry hospital? Do they have to first get insurance approval? - Yes; no How long is a mental health directive valid for? - 3 years or earlier if revoked Does a mental health directive suffice to allow ECT treatment? - Yes, it is considered a prior consent Does Texas have "duty to warn" for mentally-ill patients? Is this breach of confidentiality - Texas does NOT have duty to warn, it IS a breach of confidentiality Can patient refuse mental health treatment after admission? - If they are voluntarily admitted, yes; if involuntarily, no, with court order Who does EMTALA apply to? - Hospitals participating in Medicare What is considered "campus"? - 250 yards from ER What 4 places constitute "coming" to the ER? - In hospital-owned ambulance or air transport, or patient is in ER or in hospital requesting ER consultation If an ambulance despite being told that the hospital is on diversion comes to the ER, can you send them away? - No, patient HAS TO BE SEEN Is pregnancy a medical emergency? - No, except for complications and labor Under EMTALA, what MUST a hospital provide? - Medical screening Is it enough to log in or triage the patient? - No Can you delay treatment in order to check insurance? Get pre-approval? - No Can you provide different levels of care based on insurance? - No Can a PA or NP provide the EMTALA required screening? - Yes Does admitting the patient for treatment satisfy EMTALA requirements? - No If patient refuses treatment, does that satisfy EMTALA? What is the appropriate protocol? - Yes; has to be informed of potential dangers If a physician is not available to determine if transfer is necessary, who else can do it? What is required? - PA, NP, RN, other qualified person after consultation with MD Do you have to send medical records when transferring from an ER? - Yes Can you transfer because on-call physician did not show up? What must you do? - Yes; record name and address of physician who did not show up Can a specialized hospital (e.g., burn unit) refuse a transfer because "they are full"? - No, if they have EVER accepted patients before and made room for them How many years must you keep records of patient transfers? - 5 years Do hospitals need to keep on-call lists? - Yes Can you do elective surgery when you are on call? - Yes Can on-call physician refuse to show up? - No, only in circumstances beyond his control What are the 3 penalties for hospitals and physicians for violation of EMTALA? What is the maximum damage? - Civil money penalties, termination of provider agreement, civil action. Up to $50,000 per violation ($25,000 for < 100 beds) violation. How much time to pay an administrative penalty by the board? - 30 days. How many days can NPs and PAs prescribe? How many refills? For patients how old? - 30 days, no refills; older than 2 years. How many PA equivalents can an MD supervise? - 3 full-time employees What percentage of random charts of the PA must the physician review? - 10% How far can secondary practice sites be located from primary? - 60 miles How many days does board have to give information to requesting hospitals? - 15 days How many days do you have to correct changes in your TMB profile? - 30 days How many days do you get to review your data the FIRST time the board releases it? - 15 business days. How often does a physician have to resubmit his core data if there were no changes? - Once a year. How many days before hospital hearing must a physician be notified? - 30 days. A suspension in the hospital must be reported if it lasts for how long? Within what time must it be reported? - More than 30 days; 15 days. Until what age is one considered a minor? - 18 years How many witnesses do you need for advanced directive? For verbal directive to physician? For out-of- hospital DNR? - 2; 2; 2 How many witnesses for a mental health directive? - 2 How long until mental health directive expires? How long until medical directives expire? - 3 years; no limit. How many days does a physician have to give records to patient? Hospital? Attorney? - 15 business days; 15 business days; 45 days. How many days does patient have to pay fees for requested records? - 10 days. What are the fees for copied records? Postage or not? - $25 for first 20 pages, then 15¢ per page plus postage. How many years must a physician keep records for adults? For minors? From what age? - 7 years; 7 years or age 21. How many years must hospitals keep records for adults? For minors? From what age? - 10 years; 10 years or 20th birthday. How many days does a hospital have to send itemized bill if requested? - 30 business days. What is the economic cap on noneconomic damages in Texas per defendant/claimant? - $250,000 How long is the statute of limitations for adults? Minors? - 2 years; 2 years from age 18. When must a claimant send a letter, and by how long can he/she extend the statute of limitations? - Within 60 days; extends by 75 days. How many yards from ER is considered campus? - 250 yards. How many years must you keep records of transferred patients? - 5 years. What is the maximum monetary penalty for a hospital violating EMTALA? - $50,000, $25,000 if < 100 beds. How long do physicians have to keep screening test records from the first visit of a pregnant woman? - 9 months. How many days does a physician have to notify the DPS of a third trimester abortion? - 30 days. What is the cut-off gestational age for office-based abortions? - 16 weeks. How long prior to abortion must you give the woman information on abortion (verbal/written)? - 24 hours. How much time prior to abortion must parents of a minor be notified? - 48 hours. How long is a schedule 2 script valid? How many refills? Schedule 3-5 valid? Refills? Dangerous drugs valid? Refills? - 7 days; no refills; 6 months; 5 refills; unlimited; unlimited. How often do you need to do inventory on your drugs? - Every 2 years. How often do you have to register with the board and pay a fee to administer anesthesia? - Every 2 years. How many days do you have to report an office-based anesthesia complication? - 15 days. How much time do you have to report a death from communicable disease? - Immediately. How much time to report a gunshot wound? - Immediately. What is the monetary penalty for violation of anti-kickback laws for physicians? Hospitals? - $25,000- $250,000 / $50,000-$500,000. How much time does a physician have to report child abuse? - Immediately; 48 hours in writing. How much time does a professional (not medical professional) have to report child abuse? - 48 hours. How much time do professionals/physicians have to report death of a child secondary to abuse? - 48 hours. How much time do you have to report nursing home abuse verbally? In writing? - Immediately; 5 days. If a nursing home resident dies after transfer to a hospital, within what time frame must be reported? - 24 hours. How much time does the nursing home have to report elderly death? - 10 days after the end of the month of death. What are the age limits to consider abuse a criminal offense? - 14 or younger, 65 or older; older than 14 and disabled.