Ch. 21 Ethical/Legal Flashcards
(36 cards)
What 4 things are grounds for denial of license and basis for revocation, sanction, and discipline of established license holders?
- Fraudulent application statements
- Conviction of a felony
- Suspension or reduction of hospital privileges
- Unprofessional or immoral conduct
What two components are required for billing?
- CPT® (Current Procedural Terminology) - the “how” you did something
- International Classification of Diseases (ICD) codes - the “why” you did something
What were the four main components of the Health Insurance Portability and Accountability Act (HIPAA) of 1996?
■ Improve portability and continuity of health insurance coverage.
■ Protect confidential protected health information (PHI).
■ Standardize health information transfers.
■ Require identification numbers for providers, health plans, and employers.
What is considered PHI?
includes (but is not limited to)
name, postal address, telephone numbers, e-mail addresses, social security
numbers, medical record numbers, health plan beneficiary numbers, vehicle
identifiers, driver’s licenses, and biometric identifiers such as facial photographs
and fingerprints
The Secretary of Health and Human Services imposes civil monetary penalties for violation of any HIPAA requirement, up to $______ per violation.
$50,000
What do you call the ethical principle that recognizes a person’s right to make health care decisions?
Autonomy
What do you call the ethics principal of acting for the good of the patient?
Beneficence
The presumption that information disclosed to the physician will not be revealed to any other person or institution without the
patient’s permission
Confidentiality
What does “primum non nocere” mean?
“first, do no harm” aka concept of nonmaleficence
What do you call the concept of Acting to
prevent harm and not cause harm?
Nonmaleficence
Acting according to one’s own values and moral standards
Personal integrity
Acting to provide medical care fairly regarding resources, patient
rights, and legal restrictions
justice
What does The Emergency Exception Doctrine define?
the three conditions in which an emergency physician may treat a patient without consent
What does the Emergency Exception Doctrine state?
Emergency physicians may treat the patient without consent only if all of the three following conditions are met:
1. The patient is unable to express his or her wishes.
2. The patient has a condition that demands immediate attention.
3. No family or other substitute decision maker is immediately available to consent.
What are the 4 components of Decision-making capacity?
the patient be able to:
■ Take in what the physicians are saying.
■ Appreciate his or her medical condition and its consequences.
■ Communicate a choice.
■ Reason about treatment choices (eg, give a reason for choices).
Who is considered an emancipated minor?
■ Minors who are legally married or have dependent children
■ Minors living independently and supporting themselves
■ Those with court-approved independence from their parents or guardians
■ Minors serving the US Armed Forces
Which 3 categories provide exceptions to the requirement for minors to have parental consent?
■ Reproductive issues (including pregnancy and contraceptives)
■ Communicable diseases
■ Drug abuse
Patients who refuse treatment or leave against medical advice should have
which four thing documented in the medical record?
■ Decisional capacity to refuse treatment
■ Understanding of the risks of refusing treatment and explanation of alternative
treatment, if any
■ Discharge instructions
■ Follow-up care options
What legal Act mandates that unstable patients cannot be discharged or transferred except for medical necessity?
EMTALA
When does a hospital’s EMTALA obligation end?
with hospital admission
What is considered an “Emergency Medical Condition” (EMC)?
One in which:
■ A delay in treatment would cause loss of body functions or impairment to
organs or limbs.
■ A pregnant woman is contracting and there isn’t time to transfer her before
she delivers, or the transfer may pose a threat to mother or child. In reality,
if a woman is in active labor in the ED, she should deliver in that hospital.
Who can perform an MSE?
Can be performed by anyone the hospital designates as its standard of practice; in practice, this is usually the physician, but the task can be delegated, eg, to a nurse, physician assistant, etc. For example, a nurse on labor and delivery can be delegated this responsibility
What elements make up an “appropriate” transfer?
■ The transferring hospital must do all it can to minimize the risks of transfer.
■ The receiving hospital has available space and personnel (capability and
capacity) and has agreed to take the case.
■ The transferring hospital sends copies of records, including the name and
address of any on-call physician who has refused or failed to appear within
a reasonable time to help stabilize the patient.
■ The transfer must use qualified personnel and equipment.
■ Medical records must be maintained by the hospital for a period of 5 years
from the date of transfer.
How long does a facility accepting a transfer have to report transfer violations?
72 hours
