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

 In a medical malpractice setting, what 2 instances do not need expert testimony?

• Correct answer Res ipsa loquitur (e.g., amputation of wrong leg) and negligence per se (a law was broken)  What are "exemplary damages"? - Correct answer Damages above compensatory designed to punish the defendant and deter the behavior  Is there a cap to noneconomic damages? How much? - Correct answer $250,000 for physicians, $500,000 for hospitals  Does the cap on noneconomic damage depend on the number of defendants or claimants? - Correct answer No  What is "proportional responsibility"? - Correct answer Percentage of liability apportioned according to percentage of fault  Can the claimant have part of the proportional responsibility? - Correct answer Yes  If the claimant's proportionate responsibility is more than what %, he/she may not recover damages? - Correct answer If > 50%, no damages awarded  How long is the statute of limitations for adults? For minors? - Correct answer 2 years; for minors 2 years after becoming 18 years of age  By how much can the statute of limitations be extended and how? - Correct answer File complaint—extra 60-day, notice letter extends statute by 75 days  What is the statute of limitations for wrongful death? - Correct answer 2 years  What is the discovery rule? Give examples. - Correct answer Statute does not begin until damage is discovered. For example, a retained sponge that is found 3 years post-op  Is there immunity from civil action in emergency cases? - Correct answer Yes, except gross negligence  Is there immunity from civil action in volunteer care? - Correct answer Yes, except gross negligence  When can a physician be charged with "assault and battery"? - Correct answer Un-consented surgery or examination or when exceeding the scope of the consent

 When can a physician be charged with patient abandonment? - Correct answer Unilateral cessation of treatment when continued treatment is necessary  What is "strict liability"? - Correct answer Liability that does not depend on actual negligence, but that is based on a breach of a duty to make something safe. This often applies to product liability  Are hospitals liable for the actions of a physician? - Correct answer No, unless the hospital employs the physician  Who determines in a criminal case if the medical records of a patient should be released? - Correct answer Judge by inspection  How many days do you have to release medical records to an attorney? - Correct answer 45 days  Can medical records be admitted as evidence in court? What are the requirements? - Correct answer Yes, but only with affidavit  What are schedule 1, 2, 3, 4, 5 drugs? - Correct answer Schedule 1—no known use (e.g., heroin); schedule 2—very addictive (morphine, cocaine); schedule 3- —less addictive  What are dangerous drugs? - Correct answer Prescription drugs other than schedule 1-  How many DEA registrations do you need if you prescribe drugs? dispense drugs? - Correct answer One to prescribe; a separate registration for each location where you dispense  How often do you renew your DEA license? - Correct answer Every 3 years  Can you move your office location and then change your DEA? - Correct answer No, need to change BEFORE move  Is a DEA registration sufficient to prescribe drugs in Texas? - Correct answer No, also need Department of Public Safety Bureau of Narcotics and Dangerous Drug registration  How often do you renew a DPS license? - Correct answer Yearly  Do you have to display the DEA and DPS licenses? - Correct answer Not required by any statute.  How many days do you have to notify the DPS of any change in your information (name, address, tel., etc.)? - Correct answer 7 days

 Can you have your DPS suspended and keep your DEA or vice versa? - Correct answer No, they are interconnected  For schedules 2-5 drugs, can you just put the number of pills on prescription? - Correct answer No, number and number spelled out  Do you have to put intended use on prescription? - Correct answer Yes  With how many days of a schedule 2-5 drug can a patient be discharged from the hospital? - Correct answer 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 answer Official DPS form; no stickers  Can a physician prescribe schedule 2 over the phone? - Correct answer 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 answer 7 days  How many days does the patient have to fill schedule 2 prescriptions? - Correct answer 7 days  Can you refill a schedule 2 prescription? How about schedule 3-5? - Correct answer No for schedule 2. Max 5 refills for schedules 3-5.  Who can call in prescription from a physician's office? - Correct answer Any qualified DESIGNATED person  Can they call in schedule 2? - Correct answer Only physician in emergencies  Can a physician prohibit substitutions for generics? - Correct answer Yes  From whom and how do you order schedule 2? Schedules 3-5? - Correct answer 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 answer If dispensed in office, then all dangerous drugs, schedule drugs and samples; separate records for schedule 1+2; inventory every 2 years; records are not submitted; keep records for 2 years

 Who can inspect your drugs? - Correct answer TMB, DPS, attorney general for the DEA  What is the method of ordering and accounting for drug samples? - Correct answer Written and signed request by physician; must keep inventory and drug logs  Can you repackage samples? - Correct answer No  Do you need to keep records on samples? - Correct answer Yes, just like other meds  Can a physician buy and rebottle? Any exceptions? - Correct answer No, except for rural areas (less than 5000 population of town or 2500 of municipality, closest pharmacy > 15 miles)  To give anesthesia, how often do you have to register with the board? - Correct answer Every 2 years  What life support competency do surgeons and anesthesiologists need? - Correct answer ACLS, PALS, or board-approved course  How many and what competency levels of healthcare providers do you need in all settings? - Correct answer At least 2 physicians with advanced competency  How many days do you have to report office-based anesthesia-related complications? - Correct answer 15 days  What is considered an anesthesia-related complication? - Correct answer Admission to hospital within 24 hours or death within 72 hours  What is considered intractable pain? - Correct answer Pain where cause of pain cannot be removed and where relief or cure has not been found  Can a hospital forbid a physician to give dangerous drugs or controlled substances for treatment of intractable pain? - Correct answer No  Can the board take disciplinary action against a physician for giving dangerous or controlled substances to a patient with intractable pain? - Correct answer No  What must the physician document prior to treatment of intractable pain? - Correct answer Understanding between physician and patient about treatment; dose, type, frequency of medication; consultation with psychologist, psychiatrist, addictions expert  Can you guarantee that a drug will work? - Correct answer No

 Who can be part of a confidential communication? - Correct answer Persons involved, furthering interest of the patient, and those participating in diagnosis or treatment, e.g., patients, doctors, translators, nurses, etc  Is the billing record confidential? - Correct answer No, billing record is NOT part of medical record  In a criminal proceeding, is the physician-patient privilege communication confidential? - Correct answer NO (except for mental health records); judicial ruling should be obtained  In a criminal proceeding, are records of alcohol and drug abuse confidential? - Correct answer Yes  Does the physician confidentiality apply to court or administrative proceedings brought by the patient against a physician? - Correct answer No  Can the physician violate confidentiality if he/she thinks he or someone else is in danger? - Correct answer Yes, must report that to law enforcement agency (NOT for mental health)  What information must a release of medical records include? - Correct answer 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 answer 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 answer 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? - Correct answer 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 answer 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 answer 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 answer 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 answer Yes, all of the above  What is the "minimum necessary standard" for a medical release? - Correct answer 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 answer Yes; yes, they can request amendments  What is the Texas medical record privacy act? Is it like HIPAA? - Correct answer It is the state equivalent of HIPAA  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 answer Upon request, within 30 business days; hospital must inform patient of availability of itemized bill  Can medical records be obtained with a subpoena? Does this include substance- abuse records? - Correct answer Yes; no  Are substance abuse records admissible during criminal proceedings? - Correct answer No, unless the crime is EXTREMELY serious  Is HIV information confidential? - Correct answer Yes  Can you "break" confidentiality in order to tell a spouse that his/her spouse is HIV positive? - Correct answer Yes  Can you break confidentiality to tell a partner about notification program?. - Correct answer Yes  Are blood bank records confidential? - Correct answer Yes

 If a blood bank finds a donor with an infectious disease, can they call other blood banks and tell them the name of donor and the disease?Edition. - Correct answer They can tell name of donor, NOT disease  If a blood bank finds that blood outbound to hospitals is HIV positive, can they call the hospitals and give name of donor? Type of disease? - Correct answer They can tell name of disease, NOT donor  For statistical purposes, can a blood bank give out medical records? Names? - Correct answer Yes, but not names or other identifying information  Is genetic information confidential? - Correct answer Yes  Can patients have access to the results of their genetic testing? - Correct answer Yes  What kind of crime is the unauthorized release of records? - Correct answer Misdemeanor  Can the Texas Medical Board (TMB) show preference to a specific school of medicine such as medicine v. osteopathy? - Correct answer No  What does the Medical Practice Act (MPA) regulate? - Correct answer The practice of medicine  Who does the MPA apply to? - Correct answer Physicians (MD, DO), PAs, and acupuncturists  Does the MPA apply to the armed forces and federal public health? Can they moonlight? - Correct answer It does NOT apply to a federal job, they can NOT moonlight outside the federal setting  Does the MPA apply to emergency assistance if there is NO charge of money? If there is money charged or billed? - Correct answer NO if no charge; YES if money is charged  Are medical students in "board-approved schools" subject to the MPA? - Correct answer No  Does the MPA prohibit self-care? - Correct answer No  Does the MPA apply to physicians in contiguous states? - Correct answer NO (physicians from nearby states can only order care for patients in hospice or nursing homes)

 How many people are on the TMB? Who appoints them? Who must confirm them? - Correct answer 19 members, appointed by the governor, confirmed by the senate  Can the board subpoena people and records? Who can serve a subpoena? - Correct answer YES, subpoenas can be served by board investigator or sent by certified mail  How often does the Department of Public Safety (DPS; state police) check on physicians and report to the board? - Correct answer Quarterly  What are acceptable methods to tell the public on how to register a complaint to the TMB? In what languages? Where can a physician include this info? - Correct answer By phone (direct number and 1-800 number) or by mail; posted sign, on registration forms or bill; in English and Spanish  How often must the TMB disseminate updated information? What info is included? - Correct answer 2 times per year; info includes disciplinary action, board activities and functions, changes to the MPA and attorney general opinions  Are disciplinary orders private or public? - Correct answer Public  Are the following included in the physician profile?  ethnic origin  CME  years in practice  Medicaid participation  misdemeanors  felonies  malpractice claims  tax ID or social security numbers - Correct answer Everything except for tax ID/soc. security  Which malpractice claims should be included? - Correct answer Any jury awards, liabilities—NOT settlements  What happens if you don't give this info? - Correct answer License is not renewed  How many years of postgraduate training do you need to be eligible for licensure? - Correct answer One  Who can get a limited license? - Correct answer 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 answer Yes

 Who is not eligible for licensure? - Correct answer 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 answer 30 days  What is a temporary postgraduate training permit? - Correct answer 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 answer 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 answer Every 2 years; yes  How many days prior to the expiration of your license does the TMB notify you? - Correct answer 30  How many days after a license expires are you considered to be practicing without a license? - Correct answer 30 day grace period.  License expired < 90 days—penalty is? - Correct answer $  License expired 91-364 days—penalty is? - Correct answer $  License expired > 364 days—penalty is? - Correct answer Cancellation  Do you have to retake JP exam if your license is canceled? - Correct answer Only if the license is canceled for more than 2 years.  How can you get another license if it is lost/destroyed? - Correct answer Get affidavit of lost or destroyed document and pay fee to board  How many category 1 CMEs yearly? - Correct answer 12  How many CMEs per year? - Correct answer 24  How many category 1 CMEs yearly must be in ethics? - Correct answer 1  How many category 2 CMEs can be from volunteer work? - Correct answer 6

 How many CMEs can a license carry forward? And for how many registration periods? - Correct answer 48; only once  How many CMEs can be applied retroactively? - Correct answer 24; only once  How many CMEs do you need if you become "board certified" within 36 months?

• Correct answer 24  If you practice pain management, how many CMEs in pain management are required? - Correct answer None, but they are recommended  Who can initiate a complaint to the board? - Correct answer Anyone  What is the "health professions council"? - Correct answer Council of various professionals that establishes a central telephone complaint system (800- number)  Does the TMB have to notify a physician when a complaint is filed? Are there exceptions? How often do the parties get updated on proceedings? - Correct answer Yes, within 30 days, except if it would interfere with the investigation; updates are quarterly  When does the TMB release complaint information to the hospital? - Correct answer Upon written request  Who investigates issues of "medical competency"? - Correct answer An expert physician panel appointed by the board consisting of physicians ONLY  What do medical malpractice carriers have to report to the TMB regarding malpractice? Within what time limit? Who punishes them if they do not report? What does a physician without insurance have to report and when? Is there a difference for NPDB/HCQIA? - Correct answer Within 30 days from a complaint being filed in a lawsuit, settlement; noninsured MDs have to self-report within 30 days; any payment must be reported to NPDB by HCQIA requirements  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 answer Next working day for hospitals; in writing for all within 30 days.  Restrictive action by the TMB: How often must the board make public notices about disciplinary orders? - Correct answer 2 times per year.  Restrictive action by the TMB: Must the board report crimes found during investigations? - Correct answer Yes, to the law enforcement.

 Restrictive action by the TMB: Within how many days must the board report to the NPDB? - Correct answer 30 days.  Restrictive action by the TMB: Within how many days must a court report to the board about convictions, felonies, and misdemeanors and addiction issues be filed? - Correct answer 30 days.  Are TMB reports confidential? - Correct answer Yes  Who can the NPDB give info to? How about to patients? How about statistical data? - Correct answer Hospitals, self-requesting physicians, board, other state or federal agencies, attorneys; for statistical purposes if no identity disclosed  When is it not illegal to perform a third-trimester abortion? - Correct answer To prevent mother's death, if unborn has severe irreversible brain damage  When is it not illegal to perform an abortion on a minor? - Correct answer In emergency and with court order  Is sexual contact between a physician and patient OK if the patient consents? - Correct answer NO, the disparity of power does not allow consent  Why is it unprofessional to initially prescribe drugs over the Internet? - Correct answer Did not verify identity of patient, no physician coverage or follow-up guaranteed  How can you terminate care to a patient? - Correct answer 30 day notice, certified letter, available for emergencies during that time, give alternative physicians  What prescriptions does a physician need to keep records on? Dangerous drugs? Controlled substances? Samples? - Correct answer Samples and dangerous drugs as part of medical record; for schedule 3-5 records and log; for schedule 2 separate log and records; keep record for 2 years; do inventory on schedule drugs every 2 years  Can the board administer monetary penalties? - Correct answer Yes  What happens to his/her license if a physician goes to prison? - Correct answer TMB is required to suspend  How many malpractice claims within what time period automatically open a board investigation? - Correct answer 3 within 5 years

 How many people from the TMB are necessary to temporarily suspend a license? - Correct answer 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 answer No; no, it is the only nondisciplinary order  Is probation a disciplinary order? Who cannot be put on probation? - Correct answer 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? - Correct answer Yes; cannot be more than the amount paid  What is monitoring? - Correct answer Continued oversight of the board for subjects on disciplinary orders  Who is part of an informal hearing and what is it? - Correct answer 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 answer 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 answer 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 answer Yes  Can the physician get his file? - Correct answer Yes, with written request, within 30 days  Can you voluntarily surrender your license? - Correct answer Yes, but board does not have to accept it  If you surrender your license to avoid disciplinary action, can you reapply for it? - Correct answer 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? - Correct answer The physician who surrendered the license

 How often and how soon can you reapply to have your license reinstated if it has been canceled/suspended, etc.? - Correct answer Once a year  What is the maximum administrative penalty? How long do you have to pay it? - Correct answer $5000 per violation; 30 days  What is the maximum penalty for an action for civil penalty by the attorney general? How long do you have to pay it? - Correct answer $1000 per penalty, 30 days  What kind of offense is a violation of the MPA? What kind offense is it to practice medicine in violation of the MPA? To practice medicine with financial harm? - Correct answer Misdemeanor class A; felony; jail felony  May you perform emergent surgery while drunk? - Correct answer No; emergency MIGHT be an exception  If you have a contract with an impaired physician, can you avoid reporting him/her? - Correct answer No  Can the board regulate advertising? - Correct answer No, except to prohibit false, misleading, or deceptive practice  Are "testimonials" allowable advertising? - Correct answer No  Is it permitted to advertise board certification? Board eligibility? - Correct answer Certification, yes; not eligibility  What is a standing medical order? - Correct answer Physician order to institution, e.g., nursing home  What is a standing delegation order? What are the requirements? - Correct answer Physician order for patient or population; signed, dated, in writing  Who can a physician delegate to? - Correct answer Any qualified and properly trained person  Who can the physician delegate to administer dangerous drugs? - Correct answer Any qualified and trained person  Can a physician delegate to a midwife? - Correct answer Yes (e.g., eye prophylaxis)  Is a physician liable for the actions of a NP or PA? - Correct answer No, unless vicariously liable due to employment

 What kind of name identification do PAs need? - Correct answer Name tag identifying themselves as a physician assistant  What requirements exist for prescription for PAs and NPs? - Correct answer No schedule 2; maximum 90 days, no refills unless consultation with physician  Which drug schedules can PAs and NPs prescribe? How many days? Can they give refills? Can they treat children? What ages? - Correct answer Schedules 3- 5, 90 days, refill after consultation with physician; Yes, but children less than 2 years only after consultation with physician  How many PA and NP equivalent FTEs can a physician supervise at maximum?

• Correct answer 3 FTEs  Can CRNAs give all anesthetic drugs? Are they restricted to a particular MD? - Correct answer Yes; no, any MD  What authority do pharmacists have? Can they give immunizations? Where does the supervising physician have to be located geographically? - Correct answer Getting histories, ordering drug therapy-related tests, procedures, modifying drug therapy; yes; physician has to be able to be physically present daily  What can optometrists prescribe? - Correct answer Eye ointments  Can anybody be a surgical assistant? Do they need a license? - Correct answer Yes; yes, if they identify themselves as licensed, otherwise, no  Can a physician delegate the taking of X-rays to noncertified technicians? - Correct answer Yes  Can they do bone density? Nuclear tests? CT? Skull X-ray? - Correct answer Bone density, skull, spine, extremities, abdomen, chest; NOT CT, nuclear test, etc  Do they need to be licensed or registered by the boards? - Correct answer Yes, they need registration  What is the difference between a partnership and a limited liability partnership? - Correct answer The limited liability partnership can limit individual liability white partner A is liable for the acts of partner B  Who can incorporate in Texas? Can physicians practice through corporations? - Correct answer Dentists, PT but NOT MD; MD cannot practice through corporation

 Are there any corporations that can employ physicians? - Correct answer Yes, Certified Nonprofit Healthcare Corporation  Who can grant a title of Certified Nonprofit Healthcare Corporation? - Correct answer TMB  What are 5 important characteristics of Certified Nonprofit Healthcare Corporations? - Correct answer 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 answer Physicians can contract with hospitals but are not employees; guarantees paid for availability, billing, etc  Are there federal anti-kickback laws? - Correct answer Yes  What does the health care insurance portability and accountability act do to federal anti-kickback provisions? - Correct answer Applies to all federal health care insurances = all insurances  Do the anti-kickback laws apply only to Medicare and Medicaid? - Correct answer No  Does federal anti-kickback law apply only to patient referrals? - Correct answer No  Does this law apply only to giving money as a kickback? Who is punished, giver or taker? - Correct answer 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 answer Felony; up to $250,000 for individuals and $500,000 for institutions  What are safe harbors in anti-kickback law? Give examples. - Correct answer Acts NOT in violation of anti-kickback regulation; e.g., space and equipment rental, sale of practice, discounts, etc  Are STARK laws federal? - Correct answer Yes  What is a STARK law? Can you refer to family? - Correct answer Anti-self- referral law; no  What is the difference between STARK 1 and STARK 2? - Correct answer 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 answer Submitting false claims to government for payment; federal law since War Between the States  Does Texas prohibit remuneration in exchange for referral volume? - Correct answer Yes, prohibition on the solicitation of patients  What kind of crime is it to tamper with Texas Medical Board documents? - Correct answer Class A Misdemeanor  Barratry—what is it? Is it illegal? - Correct answer Contacting prospective patients in attempts to solicit them; it is illegal  Who can be part of a medical peer review committee? - Correct answer Physicians, health care workers, anybody in the hospital  Does physician competency include membership in societies, participation in education, participation in group plans? - Correct answer No  Who makes rules (by laws) for hospitals? - Correct answer The governing body  Can a hospital reject an orthopedist because he is a DO and not an MD? - Correct answer No  Can a hospital deny you privileges because you don't accept HMOs? Participate in other hospitals? - Correct answer No  Who makes the final decision in a hospital to grant or deny privileges to a physician? - Correct answer Governing body  Does the hospital have to get a report from the NPDB about physicians prior to granting privileges? - Correct answer Yes, initially and every 2 years; if they don't, they are liable  How many days does the board have to give data to a hospital requesting it? - Correct answer 15 days  How often must a physician update his core credentials? How many days does he have to provide corrections? - Correct answer Yearly; corrections within 30 days  Prior to the "first release" of his information, how many days does a physician have to review it? - Correct answer 15 business days  If a physician's privileges will be suspended, does he/she have the right to due process? - Correct answer Yes

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

 Who is a minor in Texas? - Correct answer Anybody less than 18 years of age who has not been emancipated  When can a minor petition the court NOT to be a minor? - Correct answer Age 16 when living independently and supporting self, age 17 when supporting self, managing conservator or guardian, Texas resident  Can an uncle consent for a minor? - Correct answer Yes  Can an educational institution consent for a minor? - Correct answer 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? - Correct answer No; no  Who is responsible to review a child's immunization record? - Correct answer Any physician; failure to do so has no consequence  What happens if a physician does not review a child's immunization record? - Correct answer Nothing  Do you need to consent to inform the authorities if you suspect child abuse or neglect? - Correct answer No  In what instance can a child give consent? - Correct answer 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? - Correct answer Yes; yes, but not for patients in FREE-STANDING psychiatric hospitals  Who can be a surrogate decision maker? What are the requirements? - Correct answer 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? - Correct answer Not psych treatment, not ECT, cannot appoint another decision maker  What are 3 examples of "advanced directive"? - Correct answer 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? - Correct answer 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? - Correct answer Can be verbal and must be documented in chart with names of witnesses  Does an advanced directive have to be notarized? - Correct answer No  How many witnesses for an oral directive? - Correct answer 2  How long is a directive good for? - Correct answer No limit, until revoked  What are the 3 ways to revoke an advance directive? - Correct answer Written, oral, or VOID across the pages  When a directive is orally revoked, what should the physician do with it? - Correct answer Destroy or write note on verbal revocation or write VOID across pages  What happens if a physician disagrees with the directive given to him? - Correct answer Does not have to follow; can request ethics or medical committee with 48-hour notification for all parties  What is the transfer registry? - Correct answer Directory of physicians or hospitals willing to accept patients in transfer who have advanced directives  Is "mercy killing" allowed in Texas? - Correct answer No  Who must sign an "out-of-hospital DNR"? Can it be verbal? Are witnesses needed? - Correct answer Attending physician, patient, and two witnesses; yes/no; yes/no  What is the effect of an "out-of-hospital DNR"? - Correct answer Legally binding; patient's wishes written as a physician order  If a patient's family disagrees with a patient's decision, what can they do? - Correct answer Must apply for temporary guardianship under Texas probate code  If you see a DNR device on a patient but have not seen the form, is that enough not to give treatment? - Correct answer Yes, DNR device is enough  Can an incompetent patient revoke their DNR? - Correct answer Yes  Should this form accompany patients on transfers? - Correct answer Yes

 What kind of treatment can the power of attorney NOT consent to? - Correct answer Admission to mental health institution, ECT, psychosurgery, abortion, neglect of minimal treatment (nutrition, hydration, comfort measures)  Does the power of attorney have an expiration date? - Correct answer No, unless specified  What happens if on the expiration date the patient is incompetent? - Correct answer It is continued until patient becomes competent again, then expires  Who cannot be the power of attorney? - Correct answer Principal health care provider or residential care provider or employee of those  Does the power of attorney have access to the patient's medical records? - Correct answer Yes  When can you withhold treatment to an infant? - Correct answer If chronically and irreversibly comatose or terminally ill and further treatment would be futile  Can you withhold nutrition/hydration from a terminally ill infant? - Correct answer No  Is the mental health directive an advanced directive act? - Correct answer Yes, but with differences  What are the requirements for mental health directive? What are requirements for witnesses? - Correct answer Age 18 or not a legal minor, not incapacitated; 2 witnesses both of who cannot be related, beneficiaries, attending physician, or employees of hospital  Does a mental health directive have an expiration date? - Correct answer Yes, 3 years or until revoked  What happens if on the expiration date of a mental health directive, the patient is incapacitated? - Correct answer It continues until competent  When can you use restraints? When can you use behavioral measures? - Correct answer If there is danger of harm to self or others and other measures have failed; never  Does the donor have rights of a parent in artificial insemination? Does the husband? - Correct answer Donor NO, husband YES  What prenatal maternal tests must a physician check? - Correct answer HIV, hepB, syphilis

 How many times must a physician check prenatal maternal tests? - Correct answer Twice; upon first examination and on admission for delivery  Are prenatal maternal tests confidential and anonymous? - Correct answer Confidential; anonymous upon request  Does the physician have to tell the mother that he/she will do prenatal maternal tests? What if she wants anonymous testing? - Correct answer Yes, must inform but not specifically consent; if anonymous is wanted must refer patient to anonymous testing center; patient can refuse  If prenatal maternal tests are positive, what must the physician do? - Correct answer Refer for treatment, provide counseling, and provide information about diseases  How long does a physician have to keep prenatal maternal test results? - Correct answer For 9 months  What institutions do not need licensing for birthing centers? - Correct answer Licensed hospitals, nursing homes, and ambulatory surgery centers  What does the federal case Roe v. Wade say about abortion? - Correct answer Abortions are legal  Under what circumstance can you perform a third trimester abortion in Texas? - Correct answer 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? - Correct answer 30 days  What is the cut-off gestational age to do an abortion in the office? - Correct answer 16 weeks  What specific health risk must you inform the patient about during consent for abortion (4 categories)? - Correct answer 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? - Correct answer Medical assistance, father's liability for support; yes  How long before the abortion must you tell patients about risks and economic issues? - Correct answer 24 hours

 When can you perform an abortion on a minor? Can you do it without calling the parents? - Correct answer 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? - Correct answer 48 hours; yes  What happens if you cannot find a parent to notify of abortion? - Correct answer Mail certified letter 48 hours prior  Is there any way for a minor to have abortion without notifying the parents? - Correct answer 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? - Correct answer Assure that it is necessary; notify TDDHS on prepared form  What facility must be licensed to do abortions in Texas? - Correct answer If they do > 50/year  How often do abortion facilities have to report to the DPH? - Correct answer Yearly  Do abortion facilities' reports include the physician and patient names? - Correct answer No, neither  Can you force a physician to perform an abortion? - Correct answer No  With what and for what do you have to treat all newborns? - Correct answer 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? - Correct answer 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? - Correct answer 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? - Correct answer From birth until 30 days; up to 2 years of age

 For what time period must an insurance cover a mother + newborn? - Correct answer 48 hours normal delivery, 96 hours C-section; longer for complicated delivery  Who must review immunization history? - Correct answer Every physician  Until when must insurance pay for immunizations? - Correct answer Up to age 6  Who must submit the birth certificate? - Correct answer Physician, midwife, or person attending birth  How many days do you have to submit the birth certificate? - Correct answer 5 days  What kind of crime is it if you don't submit a birth certificate? - Correct answer Misdemeanor  What kind of crime is it if you submit false data on a birth certificate? - Correct answer 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? - Correct answer 60 days  Can any money transaction be done during an adoption? - Correct answer Yes; only to cover expenses  When is a person considered dead? - Correct answer Cardiac and respiratory functions cease to exist  When is a ventilated person considered dead? - Correct answer Irreversible cessation of brain function  What is the time of death for ventilated people? - Correct answer At time of determined brain death  For your ventilated person, do you pronounce death before or after you turn off ventilator? - Correct answer Before  Who can pronounce somebody dead? - Correct answer MD, PA, NP, RN  Who must file the death certificate? - Correct answer Person in charge of interment  How many days does the physician have to fill it out once it is given to him/her? - Correct answer 5 days for MD to fill out medical portion, 10 days to send in death certificate

 Do fetuses require death certificates? - Correct answer If 350 grams or more or 20 weeks or older  Sudden infant death syndrome (SIDS) applies to children ages or younger - Correct answer 1 year  In SIDS, is an autopsy required? - Correct answer Yes  To whom and how fast must you report SIDS? - Correct answer To a justice of the peace, medical examiner, or other proper official immediately  Who pays for autopsy in SIDS? - Correct answer State  If at the time of death the physician knows that the patient had a communicable disease, what must be done to the body? - Correct answer Report to TDSHS and tag body to indicate caution required due to communicable disease  The death of a child under ____ years must be reported. - Correct answer 6 years  Whom do you report it to? - Correct answer Medical examiner or justice of the peace  What must the medical examiner do for the death of a child under 6 years? - Correct answer Hold inquest  How many days must have passed since the person was last seen in order to issue a "certificate of death by catastrophe"? - Correct answer 10 days  Can you issue a certificate of death by catastrophe for a minor? - Correct answer Yes, with affidavit  What is the difference between an inquest and an autopsy? - Correct answer Inquest is investigation only into causes of death, autopsy is postmortem body examination  Who does the inquest after the death of a child under 6 years old? - Correct answer Medical examiner or justice of the peace  Who has rights to consent to autopsy? In what order? - Correct answer Spouse, child, court or guardian, parent, next of kin, any person assuming custody  If a person higher in hierarchy is not available, can the next person down consent to autopsy? - Correct answer No