Mock Final Exam III Flashcards

Question

Which of the following is NOT typically an element of an "appropriate" transfer under EMTALA? A) The receiving facility has available space and qualified personnel B) The transferring hospital provides necessary medical records C) The transfer is approved by the patient's insurance company D) The patient is stabilized to the extent possible before transfer

Answer 1

C) The transfer is approved by the patient's insurance company

Answer 2

A 72-year-old patient with advanced Parkinson's disease was admitted to Memorial Hospital with pneumonia. During his stay, his physician, Dr. Roberts (a hospital employee), prescribed medication that caused severe adverse reactions because she failed to check his medication allergies in his chart. A nurse employed by the hospital administered the medication without verifying allergies, contrary to hospital policy. When the patient experienced difficulty breathing, the nursing supervisor called Dr. Chen, a pulmonologist with privileges at Memorial but not a hospital employee. Dr. Chen was listed as "on call" that day. Dr. Chen advised over the phone that the patient should be given oxygen and monitored, but did not come to examine the patient. The patient's condition deteriorated, resulting in permanent brain damage. Investigation revealed that the hospital's credentialing committee had previously received three complaints about Dr. Roberts' medication errors but took no action. Analyze all potential theories of liability against: 1) Dr. Roberts 2) The nurse 3) Dr. Chen 4) Memorial Hospital For each party, identify the applicable legal doctrines, elements that must be proven, potential defenses, and how courts would likely analyze each claim. Discuss how the hospital's corporate liability differs from its potential vicarious liability, and explain what policies might have prevented this outcome.

Answer 3

1) Liability theories: - Negligence: Hospital breached duty to maintain accessible medical records; clear causation for Patient A (allergy reaction); potentially more complex causation for Patient B (delayed procedure) - Corporate liability: Direct hospital duties to maintain adequate systems and safety procedures - Potential breach of implied contract to provide reasonably safe care including information access 2) EHR standards of care: - Industry standards include NIST Cybersecurity Framework, HIPAA Security Rule, and Joint Commission requirements - Reasonable hospital standard requires functioning backup systems and downtime procedures - Failure to maintain paper backups represents clear departure from standard practice 3) Regulatory obligations: - HIPAA Security Rule violations: Risk analysis, contingency planning, and evaluation requirements - Medicare Conditions of Participation: Medical records, quality assessment, and patient safety - Potential state-specific EHR and data breach regulations 4) Prior knowledge impact: - IT warnings establish clear foreseeability, creating heightened duty - Budget constraints unlikely as viable defense given known critical risks - Documentation trail strengthens plaintiffs' cases and may support punitive damages 5) Preventive measures: - Technical: Comprehensive security framework, redundant storage, network segmentation - Administrative: Regular downtime drills, formal risk assessment process - Hybrid approach: Maintaining critical information in multiple accessible formats - Governance: Clinical/IT oversight committee prioritizing safety investments Jurisdictional variations may exist in recognition of cybersecurity standards as establishing duty of care and causation requirements between system failures and patient harm.

Answer 4

1) Hospital authority: Hospitals can generally establish reasonable requirements for staff privileges, including ED call participation. Courts typically defer to hospitals on operational requirements when reasonably related to patient care needs. The new policy must be uniformly applied to avoid discrimination claims. 2) Procedural requirements: Privilege termination requires: - Following medical staff bylaws procedures - Providing adequate notice and hearing opportunity - Basing decisions on reasonable quality-of-care factors - Proper documentation of process and rationale 3) Dr. Harris's claims: - Bylaws breach: May succeed if bylaws explicitly limit termination grounds or require bylaws amendment for new requirements - Age discrimination: Difficult to prove without evidence that younger physicians received exemptions or that age was discussed - Antitrust: Unlikely to succeed without evidence of conspiracy or market power abuse 4) HCQIA immunity applies if: - Action taken with reasonable belief it furthered quality healthcare - Reasonable investigation of facts occurred - Adequate notice and hearing procedures were followed - Committee acted with reasonable belief that action was warranted 5) Hospital vs. staff autonomy: - Courts balance hospital's need to ensure continuous care against physicians' practice autonomy - The undisclosed quality concerns complicate the case as the actual vs. stated rationale differs - Medical staff governance varies by state law and individual bylaws Key to resolution: Whether termination followed proper procedure, whether the call requirement was reasonable and uniformly applied, and whether actual quality concerns were properly addressed through appropriate channels.

Answer 5

1) EMTALA analysis: - Potential violation for failing to provide appropriate medical screening examination - Pregnant patient with decreased fetal movement requires prompt assessment - Triage alone doesn't constitute appropriate medical screening - Mass casualty situation doesn't exempt hospital from EMTALA obligations toward all patients 2) Malpractice considerations: - Breach of standard of care: Failure to follow hospital's own protocol for pregnant patients - Causation: 90-minute delay likely contributed to negative outcome - Hospital liability: Direct corporate negligence for inadequate triage protocols and vicarious liability for staff actions - Staff liability: Triage nurse potentially liable for improper assessment/prioritization 3) Mass casualty impact: - Doesn't eliminate duty but may modify standard of care expectations - Resource allocation must still follow appropriate medical prioritization - Failure to involve obstetrical staff suggests improper triage decision, even amid mass casualty 4) Screening examination adequacy: - Courts look at whether patient received same screening other similar patients would receive - Hospital's own policy establishes baseline standard which wasn't met - Without any actual medical assessment beyond initial vital signs, screening likely inadequate 5) Damages considerations: - Both maternal and fetal injuries compensable - Neurological damage to infant creates significant long-term damages - Some jurisdictions limit non-economic damages in malpractice cases Courts consider resource constraints but typically hold that proper triage based on medical need rather than time of arrival is fundamental to emergency care. The violation of hospital's own policy significantly weakens defense arguments based on resource limitations.

Answer 6

1) Mandatory POLST policy validity: - Facilities can require advance care planning discussions but typically cannot mandate specific directive completion - POLST forms should document existing treatment preferences, not create new requirements - Default "full code" status for non-participants likely violates patient autonomy principles 2) Healthcare agent authority: - Valid healthcare power of attorney grants the agent legal authority to make decisions consistent with patient's known wishes - This authority generally supersedes institutional policies - Facilities must honor decisions of legally authorized surrogates absent court intervention - Agent's decisions should be given same weight as patient's own statements 3) Liability analysis: - Battery claim: Performing CPR against authorized agent's express instructions may constitute unconsented touching - Negligence claim: Disregarding valid healthcare POA breaches standard of care - Facility policy of disregarding agent instructions likely creates direct corporate liability - Damages include physical injury, pain and suffering, and medical expenses 4) State law variations: - Surrogate decision-making laws vary by state but generally prioritize designated healthcare agents - Some states have specific POLST legislation defining their legal status - Statutory hierarchy of surrogates typically places appointed agents above facility policies 5) Competing interests: - Facility interest in clear documentation vs. patient/family autonomy - Risk management strategies shouldn't override patient rights - Facilities have legitimate need for emergency guidance but must respect existing legal documents The strongest position is that the facility violated the legal authority of the healthcare agent and committed battery by performing unwanted treatment. The policy of disregarding agent instructions without court intervention likely violates established healthcare law principles regarding surrogate decision-making.

Answer 7

1) Liability theories: - Hospital: Corporate negligence for inadequate implementation, verification, and training; vicarious liability for employee errors - Dr. Garcia: Medical malpractice for failure to identify nodule below standard of care - Medtech: Product liability for defective software; negligence for failing to address known error; potential breach of warranty 2) AI and standard of care: - Emerging standard likely requires proper implementation, training, and verification protocols - AI serves as adjunct not replacement for professional judgment - Hospital policies regarding AI usage help establish applicable standard - Failure to ensure proper integration constitutes systemic negligence 3) Causation analysis: - Plaintiff must establish earlier detection would have changed outcome - Six-month delay likely material to cancer progression and treatment options - "Loss of chance" doctrine may apply in jurisdictions recognizing reduced survival probability as compensable 4) Software error implications: - Creates direct liability for Medtech who knew but didn't fix or adequately warn - Hospital liable for failing to verify system functionality - Shared responsibility between technology provider and healthcare facility - Documentation of known error significantly weakens defendants' positions 5) Novel legal approaches: - Courts may apply hybrid of medical malpractice and product liability principles - AI as supplement vs. replacement affects liability distribution - Duty to monitor technology performance increasingly recognized - Evolving standards for disclosure of AI limitations to patients This case represents the complex liability landscape emerging at the intersection of healthcare and AI. The strongest claims center on system implementation failures and improper response to known errors rather than AI performance itself. The hospital's failure to establish clear policies on AI integration likely constitutes independent corporate negligence beyond physician error.