Mock Final Exam I

Question 1

What are the four primary sources of law in the U.S. healthcare system?

Answer 1

1. Common Law (judicial decisions based on precedent)
2. Statutory Law (enacted by legislative bodies)
3. Constitutional Law (federal and state constitutions)
4. Administrative/Regulatory Law (rules created by executive agencies)

Question 2

In the hierarchy of law, which of the following has the highest authority?
A) Federal regulations
B) State statutes
C) US Constitution
D) Local ordinances

Answer 2

C) US Constitution

Question 3

Which court serves as the final interpreter of the Constitution?
A) Circuit Courts of Appeal
B) Supreme Court
C) District Courts
D) State Supreme Courts

Answer 3

B) Supreme Court

Question 4

Which of the following is NOT a basis for federal question jurisdiction?
A) Cases involving federal laws
B) Cases involving the Constitution
C) Cases involving treaties
D) Cases between citizens of different states with less than $75,000 in dispute

Answer 4

D) Cases between citizens of different states with less than $75,000 in dispute (This describes diversity jurisdiction, and it requires at least $75,000 in controversy)

Question 5

Which of the following is NOT a component of the civil litigation process?
A) Filing a complaint
B) Discovery
C) Sentencing
D) Pre-trial motions

Answer 5

C) Sentencing (Sentencing is part of criminal proceedings, not civil litigation)

Question 6

What are the four elements required to establish a medical malpractice claim?

Answer 6

1. Duty (provider-patient relationship established standard of care)
2. Breach (failure to meet standard of care)
3. Causation (breach directly caused injury)
4. Damages (patient suffered actual harm)

Question 7

Which legal principle refers to courts following precedent from previous similar cases?
A) Res judicata
B) Stare decisis
C) Due process
D) Res ipsa loquitur

Answer 7

B) Stare decisis

Question 8

Which of the following is the standard of proof in most civil cases?
A) Beyond a reasonable doubt
B) Clear and convincing evidence
C) Preponderance of evidence
D) Substantial evidence

Answer 8

C) Preponderance of evidence

Question 9

In the case Helling v. Carey, the court ruled that:
A) The locality rule should always be applied in malpractice cases
B) The medical profession’s standard of care was inadequate
C) Expert witnesses are always required in medical malpractice cases
D) Physicians should never be held liable for following professional standards

Answer 9

B) The medical profession’s standard of care was inadequate (The court found that reasonable prudence required testing patients under 40 for glaucoma despite the profession’s standard practice)

Question 10

What federal law established Medicare and Medicaid in 1965?
A) Social Security Act Amendments
B) Hill-Burton Act
C) Affordable Care Act
D) EMTALA

Answer 10

A) Social Security Act Amendments

Question 11

Analyze how the Hill-Burton Act impacted hospital obligations regarding indigent care and community service. How have these obligations evolved in modern healthcare?

Answer 11

The Hill-Burton Act provided federal funding for hospital construction with two key obligations:
1) uncompensated care for those unable to pay, and
2) making facilities available to all community members.

Initially, the Act allowed “separate but equal” facilities, though this was declared unconstitutional by 1963. These obligations created a framework for hospital community responsibility that influenced later developments like EMTALA.

Modern healthcare has expanded these concepts through requirements for community needs assessments, broader non-discrimination protections, and financial assistance policies under the ACA, though the direct Hill-Burton obligations continue for facilities that received this funding.

Question 12

What Supreme Court decision made Medicaid expansion under the Affordable Care Act optional for states?
A) King v. Burwell
B) NFIB v. Sebelius
C) Cruzan v. Director, Missouri Department of Health
D) Roe v. Wade

Answer 12

B) NFIB v. Sebelius

Question 13

Under EMTALA, which of the following is NOT required of Medicare-participating hospitals?
A) Provide an appropriate medical screening examination
B) Stabilize emergency medical conditions before transfer
C) Accept all transfers from other facilities
D) Avoid delaying examination to inquire about payment method

Answer 13

C) Accept all transfers from other facilities (EMTALA requires appropriate transfers but doesn’t mandate accepting all transfers)

Question 14

Which of the following cases established that the transfer of unstable patients could violate EMTALA even without proof of an improper motive?
A) Baber v. Hospital Corporation of America
B) Roberts v. Galen of Virginia
C) Summers v. Baptist Medical Center
D) Arrington v. Wong

Answer 14

B) Roberts v. Galen of Virginia

Question 15

What was the key issue in the Wickline v. State case regarding third-party payers and physician liability?

Answer 15

Wickline established that physicians who comply without protest with third-party payer limitations, when their medical judgment dictates otherwise, cannot avoid ultimate responsibility for patient care. The physician cannot use the healthcare payer as a liability scapegoat when negative consequences result from the physician’s own determinative medical decisions.

Question 16

What legal doctrine allows an inference of negligence without specific proof of negligent acts, when certain conditions are met?
A) Res ipsa loquitur
B) Respondeat superior
C) Strict liability
D) Assumption of risk

Answer 16

A) Res ipsa loquitur

Question 17

In Darling v. Charleston Community Memorial Hospital, what new form of liability did the court establish for hospitals?
A) Strict liability for all medical malpractice
B) Corporate liability for quality of care
C) Vicarious liability only for employed physicians
D) Liability only for administrative failures

Answer 17

B) Corporate liability for quality of care

Question 18

Explain the difference between respondeat superior and corporate liability in the hospital setting, citing relevant cases that established these doctrines.

Answer 18

Respondeat superior makes hospitals liable for negligence of employees acting within the scope of employment, based on control relationships rather than employment status alone. Corporate liability, established in Darling v. Charleston Community Memorial Hospital, creates direct hospital liability for negligence in maintaining equipment, selecting staff, and establishing adequate rules and systems.

Thompson v. Nason Hospital expanded corporate liability to include duties to:
1) maintain safe facilities,
2) select and retain competent physicians,
3) oversee all patient care, and
4) formulate and enforce rules/policies ensuring quality care.

While respondeat superior requires employee negligence, corporate liability holds the institution directly responsible for its own negligence independent of individual providers.

Question 19

The Health Care Quality Improvement Act (HCQIA) provides immunity for peer review activities if:
A) The hospital has received written consent from the physician under review
B) The actions were taken in reasonable belief of furthering quality healthcare
C) The physician was represented by legal counsel during all proceedings
D) The physician’s privileges were not ultimately revoked

Answer 19

B) The actions were taken in reasonable belief of furthering quality healthcare

Question 20

Which federal law created the National Practitioner Data Bank?
A) HIPAA
B) EMTALA
C) Health Care Quality Improvement Act
D) Affordable Care Act

Answer 20

C) Health Care Quality Improvement Act

Question 21

Which of the following best describes “economic credentialing”?
A) Granting privileges based on a physician’s financial contribution to the hospital
B) Requiring physicians to have malpractice insurance before granting privileges
C) Using economic criteria in determining qualifications for privileges
D) Limiting privileges based on a physician’s past malpractice claims

Answer 21

C) Using economic criteria in determining qualifications for privileges

Question 22

Which Supreme Court case established that competent adults have a constitutionally protected liberty interest in refusing unwanted medical treatment?
A) In re Quinlan
B) Canterbury v. Spence
C) Cruzan v. Director, Missouri Department of Health
D) Roe v. Wade

Answer 22

C) Cruzan v. Director, Missouri Department of Health

Question 23

Which of the following is NOT a type of advance directive?
A) Living will
B) Healthcare power of attorney
C) Do-not-resuscitate order
D) Medical loss ratio form

Answer 23

D) Medical loss ratio form (This is related to insurance, not advance directives)

Question 24

In Canterbury v. Spence, the court established which standard for informed consent?
A) Professional standard (what a reasonable doctor would disclose)
B) Reasonable patient standard (what a reasonable patient would want to know)
C) Subjective patient standard (what this specific patient would want to know)
D) Customary practice standard (what is commonly disclosed in the community)

Answer 24

B) Reasonable patient standard (what a reasonable patient would want to know)

Question 25

Based on the Canterbury v. Spence decision, what factors should physicians consider when determining if a risk is "material" enough to disclose to patients? What criticism has been made of this standard?

Answer 25

When determining materiality, physicians should consider: 1) the severity of potential harm, 2) the probability of occurrence, and 3) the availability of alternative treatments with different risks. A risk is material if a reasonable person would likely attach significance to it when deciding whether to consent to treatment. Critics argue this standard creates uncertainty for physicians who cannot predict what a hypothetical "reasonable patient" would want to know, potentially encouraging defensive medicine through excessive disclosures. The standard also doesn't account for individual patient preferences and values, which may vary widely.

Question 26

Under the Emergency Medical Treatment and Labor Act (EMTALA), what constitutes "coming to the emergency department"? A) Only physically entering the emergency department B) Arriving anywhere on hospital property seeking emergency care C) Calling the hospital to request emergency services D) Being referred by another physician

Answer 26

B) Arriving anywhere on hospital property seeking emergency care

Question 27

In the case In re Baby K, the court ruled that: A) Hospitals may withhold "futile" treatment if multiple physicians agree B) EMTALA requires treatment of emergency conditions even for anencephalic infants C) Parents cannot demand treatment contrary to physicians' recommendations D) State law determines what constitutes appropriate emergency treatment

Answer 27

B) EMTALA requires treatment of emergency conditions even for anencephalic infants

Question 28

Which of the following statements about exculpatory contracts in healthcare is TRUE? A) They are generally enforceable if the patient is properly informed B) They are valid for experimental procedures but not standard care C) They are generally invalidated as contrary to public policy in healthcare settings D) They are enforceable only for cosmetic procedures

Answer 28

C) They are generally invalidated as contrary to public policy in healthcare settings

Question 29

In Bush v. Schiavo, what was the central legal issue? A) Whether life support could be withdrawn without an advance directive B) Whether a feeding tube constitutes medical treatment C) Whether the legislation violated separation of powers D) Whether the spouse or parents had decision-making authority

Answer 29

C) Whether the legislation violated separation of powers

Question 30

What is the "therapeutic privilege" exception to informed consent? A) Permission to withhold information if disclosure would cause psychological harm B) Authority to provide treatment without consent in emergencies C) Right to treat minors without parental consent D) Permission to use experimental treatments when standard therapies fail

Answer 30

A) Permission to withhold information if disclosure would cause psychological harm

Question 31

In wrongful birth cases, the plaintiffs are: A) Children claiming they should not have been born B) Parents claiming negligence that led to the birth of a child with disabilities C) Women claiming forced sterilization D) Physicians claiming they were not responsible for birth defects

Answer 31

B) Parents claiming negligence that led to the birth of a child with disabilities

Question 32

Which of the following statements about physician-assisted dying is TRUE based on Supreme Court rulings? A) There is no constitutional right to physician-assisted suicide B) States may not prohibit physician-assisted suicide C) The federal government has exclusive authority to regulate the practice D) Physicians have a constitutional right to provide assisted dying

Answer 32

A) There is no constitutional right to physician-assisted suicide

Question 33

What legal doctrine makes employers responsible for employees' negligence within the scope of employment? A) Corporate liability B) Respondeat superior C) Vicarious liability D) Both B and C

Answer 33

D) Both B and C (Respondeat superior is a form of vicarious liability)

Question 34

Which landmark case established that hospitals have a duty to exercise reasonable care in reviewing credentials and granting staff privileges? A) Darling v. Charleston Community Memorial Hospital B) Johnson v. Misericordia Community Hospital C) Kadlec Medical Center v. Lakeview Anesthesia Associates D) Thompson v. Nason Hospital

Answer 34

B) Johnson v. Misericordia Community Hospital

Question 35

Analyze how Kadlec Medical Center v. Lakeview Anesthesia Associates impacts hospital credentialing practices and disclosure obligations. What duties exist when providing references for former medical staff?

Answer 35

Kadlec established that healthcare entities providing references for former medical staff must avoid material misrepresentations. The court found that while no affirmative duty exists to disclose all negative information, references cannot be materially misleading. This impacts credentialing by: 1) encouraging more thorough background checks, 2) highlighting the risks of accepting vague reference letters, and 3) creating potential liability for providing incomplete information. The case demonstrated that healthcare facilities face competing obligations between protecting future patients at other facilities and avoiding defamation claims from former staff. Best practices now include more comprehensive information sharing through robust credentialing procedures, carefully documented impaired provider policies, and specific language in references.

Question 36

Under the Affordable Care Act, ACOs are designed to: A) Maximize fee-for-service reimbursement B) Coordinate care to improve quality and reduce costs C) Replace traditional Medicare D) Reduce hospital liability for physician negligence

Answer 36

B) Coordinate care to improve quality and reduce costs

Question 37

In Thompson v. Nason Hospital, what duties were established under corporate liability? A) Duty to provide emergency care only B) Duty to maintain facilities, select competent staff, oversee patient care, and formulate policies C) Duty to employ only physicians who carry malpractice insurance D) Duty to accept all transfer patients regardless of capacity

Answer 37

B) Duty to maintain facilities, select competent staff, oversee patient care, and formulate policies

Question 38

Which federal law often preempts state law claims against managed care organizations for coverage decisions? A) HIPAA B) ERISA C) EMTALA D) ACA

Answer 38

B) ERISA

Question 39

What is the "borrowed servant" doctrine in healthcare liability? A) When hospital employees temporarily become servants of a surgeon B) When physicians borrow equipment from the hospital C) When one hospital temporarily lends staff to another hospital D) When patients authorize substitute physicians to provide care

Answer 39

A) When hospital employees temporarily become servants of a surgeon

Question 40

What was the significance of the "captain-of-the-ship" doctrine, and why has it been largely abandoned?

Answer 40

The "captain-of-the-ship" doctrine held that surgeons were responsible for all actions in the operating room, regardless of who committed the error. This doctrine has been largely abandoned because it doesn't reflect the modern team approach to healthcare where various providers have independent responsibilities and specialized training. Courts now recognize that nurses, anesthesiologists, and other professionals aren't merely subordinates following surgeon orders but have their own professional standards, duties, and judgments. The doctrine unfairly placed liability on surgeons for errors they couldn't reasonably control or prevent.

Question 41

Which of the following is NOT one of the four duties established in the Thompson v. Nason Hospital case? A) Duty to maintain safe and adequate facilities B) Duty to select and retain only competent physicians C) Duty to oversee all persons who practice medicine within the hospital D) Duty to provide malpractice insurance for all independent contractors

Answer 41

D) Duty to provide malpractice insurance for all independent contractors

Question 42

In the context of hospital liability, what is "apparent agency" or "ostensible agency"? A) When a hospital explicitly designates a physician as its agent B) When a patient reasonably believes a provider is the hospital's employee C) When a physician appears to be more qualified than they actually are D) When the government designates a hospital as a public agency

Answer 42

B) When a patient reasonably believes a provider is the hospital's employee

Question 43

Which statement about charitable immunity in healthcare is TRUE? A) It remains the standard in most states B) It was a former doctrine that protected charitable hospitals from tort liability C) It applies only to religious hospitals D) It was established by the Supreme Court in the 1980s

Answer 43

B) It was a former doctrine that protected charitable hospitals from tort liability

Question 44

Regarding loss of a chance doctrine, which statement is most accurate? A) It applies only when a patient had at least a 50% chance of recovery B) It allows recovery if negligence reduced an already compromised chance of recovery C) It provides damages equal to 100% of what would be recovered for wrongful death D) It has been universally accepted by all state courts

Answer 44

B) It allows recovery if negligence reduced an already compromised chance of recovery

Question 45

Compare and contrast the "reasonable doctor" standard versus the "reasonable patient" standard in informed consent cases. Using Canterbury v. Spence and Cobbs v. Grant, explain which approach better protects patient autonomy.

Answer 45

The reasonable doctor standard measures disclosure by what a reasonable physician would disclose in similar circumstances, while the reasonable patient standard focuses on what information would be material to a reasonable patient's decision. Canterbury v. Spence rejected the professional standard, stating that respecting patient self-determination requires making patients aware of material risks, as "true consent is the informed exercise of choice." Cobbs v. Grant similarly held that patients' right to self-decision requires adequate information. The reasonable patient standard better protects autonomy by: 1) centered on patient informational needs rather than professional custom, 2) recognizing patients as decision-makers rather than passive recipients, and 3) reducing physician paternalism by not allowing the profession to set its own disclosure standards.

Question 46

In the context of damages for medical malpractice, what are "special damages"? A) Punitive damages intended to punish the defendant B) Economic damages like medical costs and lost earnings C) Non-economic damages like pain and suffering D) Damages for loss of consortium

Answer 46

B) Economic damages like medical costs and lost earnings

Question 47

Under EMTALA, what is the standard for an "appropriate medical screening examination"? A) Whatever screening a reasonable physician would provide B) Same screening provided to any patient with similar symptoms regardless of payment ability C) A comprehensive examination that diagnoses all conditions D) Screening that follows nationally established protocols

Answer 47

B) Same screening provided to any patient with similar symptoms regardless of payment ability

Question 48

What is unique about the liability of government hospitals for negligence? A) They are always immune from all liability B) They can only be sued in federal court C) They may have sovereign immunity that has been partially waived D) They are held to a higher standard of care than private hospitals

Answer 48

C) They may have sovereign immunity that has been partially waived

Question 49

Examine the evolution of jurisprudence regarding patient dumping that led to EMTALA. How did cases like Guerrero v. Copper Queen Hospital and Hill v. Ohio County influence this legislation?

Answer 49

Prior to EMTALA, cases like Hill v. Ohio County (1968) upheld the traditional view that private hospitals could refuse non-emergency admission. However, Guerrero v. Copper Queen Hospital marked a shift by ruling that licensed private hospitals with emergency departments must provide care regardless of ability to pay. These and similar cases highlighted a systemic problem of hospitals "dumping" uninsured patients, transferring them without stabilization, or refusing care outright. The courts' inconsistent approaches to these cases eventually led Congress to pass EMTALA in 1986, establishing uniform federal requirements for emergency screening, stabilization before transfer, and prohibiting transfers for economic reasons. This evolution represents a move from viewing healthcare as a purely private contractual relationship to recognizing certain public obligations of healthcare providers.

Question 50

What case established that a physician who complies without protest with limitations imposed by a third-party payer "cannot avoid his ultimate responsibility for patient care"? A) Wickline v. State B) Darling v. Charleston Community Memorial Hospital C) Johnson v. Misericordia Community Hospital D) Aetna Health, Inc. v. Davila

Answer 50

A) Wickline v. State

Question 51

In the context of end-of-life decision making, what is a POLST form? A) Power of Life Support Treatment B) Physician Orders for Life-Sustaining Treatment C) Patient Option for Long-term Specialized Treatment D) Palliative Order for Limited Support Therapy

Answer 51

B) Physician Orders for Life-Sustaining Treatment

Question 52

What is the difference between express consent and implied consent in healthcare? A) Express consent is written while implied consent is only verbal B) Express consent is given in words while implied consent is manifested by actions C) Express consent is for surgery while implied consent is for medication D) Express consent is for adults while implied consent applies to minors

Answer 52

B) Express consent is given in words while implied consent is manifested by actions

Question 53

Analyze how the Helling v. Carey decision impacts the relationship between professional custom and legal standards of care. What implications does this have for healthcare administrators?

Answer 53

Helling v. Carey established that courts can find a profession's own standards inadequate when reasonable prudence requires more. The court ruled that ophthalmologists should have tested patients under 40 for glaucoma despite professional guidelines not recommending this. This decision demonstrates that: 1) following professional custom doesn't guarantee immunity from liability, 2) courts can establish standards of care "as a matter of law" based on risk-benefit analysis, and 3) reasonableness rather than custom is the ultimate test. For healthcare administrators, this means: developing systems to identify emerging standards before they become legal requirements, ensuring policies keep pace with technological advances, implementing proactive risk management rather than simply following industry norms, and creating mechanisms to evaluate customary practices against patient safety considerations.

Question 54

When may a physician legally withdraw from treating a patient? A) Only with the patient's consent B) Only after completing the agreed-upon course of treatment C) After giving reasonable notice allowing time to find another provider D) Only after receiving approval from the hospital where the patient is being treated

Answer 54

C) After giving reasonable notice allowing time to find another provider

Question 55

What standard of decision-making applies when making medical decisions for incompetent patients who never expressed their wishes? A) Substituted judgment B) Best interests standard C) Reasonable person standard D) Professional judgment standard

Answer 55

B) Best interests standard

Question 56

What was the key issue in Washington v. Washington Hospital Center regarding standard of care?

Answer 56

The key issue was whether carbon dioxide monitors had become standard equipment for tertiary care hospitals during anesthesia, representing the standard of care. The court determined that evidence of use by other institutions could be evaluated by a lay jury even without extensive expert testimony, and found that the hospital's failure to use available monitoring technology fell below the standard of care.

Question 57

How did Planned Parenthood v. Casey (1992) modify the Roe v. Wade decision? A) It overturned Roe completely B) It replaced the trimester framework with an "undue burden" standard C) It prohibited all state regulation of abortion D) It eliminated viability as a consideration

Answer 57

B) It replaced the trimester framework with an "undue burden" standard

Question 58

Analyze how the "undue burden" standard established in Planned Parenthood v. Casey was applied in subsequent cases like Whole Woman's Health v. Hellerstedt. What factors do courts consider when determining if an abortion regulation constitutes an undue burden?

Answer 58

The "undue burden" standard from Casey prohibits regulations that place a substantial obstacle in the path of women seeking pre-viability abortions. In Whole Woman's Health v. Hellerstedt (2016), the Court clarified that courts must balance the burdens a law imposes against its benefits. Factors courts consider include: 1) whether regulations have a legitimate health benefit proportional to the burden imposed, 2) the actual rather than hypothetical impact on abortion access (including facility closures, increased travel distances, and wait times), 3) the cumulative effect of multiple regulations rather than examining each in isolation, 4) whether regulations are reasonably related to legitimate state interests, and 5) the availability of less restrictive alternatives. This analysis requires courts to examine empirical evidence rather than defer uncritically to legislative findings, representing a more rigorous application of the undue burden standard than some lower courts had previously employed.