Can a patient successfully sue a doctor if there is no physician-patient relationship?
No
If there is no prior physician-patient relationship, are you legally obliged to respond to a call from a patient for treatment?
No
Does being on call give rise to a physician-patient relationship?
No
How can one terminate a physician-patient relationship, without abandonment if there is ongoing treatment?
30 days written notice; must provide for emergency
Does a physician’s duty extend to the unborn child or potential victims of an ill patient?
Yes
What is “proximate cause”?
Prove that negligence caused harm and that the cause was not too remote; what is required to hold a defendant liable in a civil lawsuit
What are the two components of proximate cause?
Cause-in-fact (but-for test) and foreseeability
Does an expert witness have to be actively practicing medicine?
Yes
Does an expert witness have to know standards of care?
Yes
Does an expert witness have to have enough training to express an opinion on whether standard of care was provided?
Yes
Does an expert witness have to be board certified?
No, board certified or eqivalent
In a medical malpractice case, are expert witnesses required?
Yes, with two exceptions
In a medical malpractice setting, what 2 instances do not need expert testimony?
Res ipsa loquitur (e.g., amputation of wrong leg) and negligence per se (a law was broken)
What are “exemplary damages”?
Damages above compensatory designed to punish the defendant and deter the behavior
Is there a cap to noneconomic damages? How much?
$250,000 for physicians, $500,000 for hospitals
Does the cap on noneconomic damage depend on the number of defendants or claimants?
No
What is “proportional responsibility”?
Percentage of liability apportioned according to percentage of fault
Can the claimant have part of the proportional responsibility?
Yes
If the claimant’s proportionate responsibility is more than what %, he/she may not recover damages?
If > 50%, no damages awarded
How long is the statute of limitations for adults? For minors?
2 years; for minors 2 years after becoming 18 years of age
By how much can the statute of limitations be extended and how?
File complaint—extra 60-day, notice letter extends statute by 75 days
What is the statute of limitations for wrongful death?
2 years
What is the discovery rule? Give examples.
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?
Yes, except gross negligence
Is there immunity from civil action in volunteer care?
Yes, except gross negligence
When can a physician be charged with “assault and battery”?
Un-consented surgery or examination or when exceeding the scope of the consent
When can a physician be charged with patient abandonment?
Unilateral cessation of treatment when continued treatment is necessary
What is “strict liability”?
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?
No, unless the hospital employs the physician
Who determines in a criminal case if the medical records of a patient should be released?
Judge by inspection
How many days do you have to release medical records to an attorney?
45 days
Can medical records be admitted as evidence in court? What are the requirements?
Yes, but only with affidavit
What are schedule 1, 2, 3, 4, 5 drugs?
Schedule 1—no known use (e.g., heroin); schedule 2—very addictive (morphine, cocaine); schedule 3-5—less addictive
What are dangerous drugs?
Prescription drugs other than schedule 1-5
How many DEA registrations do you need if you prescribe drugs? dispense drugs?
One to prescribe; a separate registration for each location where you dispense
How often do you renew your DEA license?
Every 3 years
Can you move your office location and then change your DEA?
No, need to change BEFORE move
Is a DEA registration sufficient to prescribe drugs in Texas?
No, also need Department of Public Safety Bureau of Narcotics and Dangerous Drug registration
How often do you renew a DPS license?
Yearly
Do you have to display the DEA and DPS licenses?
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.)?
7 days
Can you have your DPS suspended and keep your DEA or vice versa?
No, they are interconnected
For schedules 2-5 drugs, can you just put the number of pills on prescription?
No, number and number spelled out
Do you have to put intended use on prescription?
Yes
With how many days of a schedule 2-5 drug can a patient be discharged from the hospital?
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?
Official DPS form; no stickers
Can a physician prescribe schedule 2 over the phone?
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?
7 days
How many days does the patient have to fill schedule 2 prescriptions?
7 days
Can you refill a schedule 2 prescription? How about schedule 3-5?
No for schedule 2. Max 5 refills for schedules 3-5.
Who can call in prescription from a physician’s office?
Any qualified DESIGNATED person
Can they call in schedule 2?
Only physician in emergencies
Can a physician prohibit substitutions for generics?
Yes
From whom and how do you order schedule 2? Schedules 3-5?
Schedule 2 on triplicate order form from distributor; schedules 3-5 regular form from wholesaler
What drugs do you need to keep records on? How are the records kept? How often do you need to do inventory? Do you need to submit the records? How long do you have to keep the last inventory list?
If dispensed in office, then all dangerous drugs, schedule drugs and samples; separate records for schedule 1+2; inventory every 2 years; records are not submitted; keep records for 2 years
Who can inspect your drugs?
TMB, DPS, attorney general for the DEA
What is the method of ordering and accounting for drug samples?
Written and signed request by physician; must keep inventory and drug logs
Can you repackage samples?
No
Do you need to keep records on samples?
Yes, just like other meds
Can a physician buy and rebottle? Any exceptions?
No, except for rural areas (less than 5000 population of town or 2500 of municipality, closest pharmacy > 15 miles)
To give anesthesia, how often do you have to register with the board?
Every 2 years
What life support competency do surgeons and anesthesiologists need?
ACLS, PALS, or board-approved course
How many and what competency levels of healthcare providers do you need in all settings?
At least 2 physicians with advanced competency
How many days do you have to report office-based anesthesia-related complications?
15 days
What is considered an anesthesia-related complication?
Admission to hospital within 24 hours or death within 72 hours
What is considered intractable pain?
Pain where cause of pain cannot be removed and where relief or cure has not been found
Can a hospital forbid a physician to give dangerous drugs or controlled substances for treatment of intractable pain?
No
Can the board take disciplinary action against a physician for giving dangerous or controlled substances to a patient with intractable pain?
No
What must the physician document prior to treatment of intractable pain?
Understanding between physician and patient about treatment; dose, type, frequency of medication; consultation with psychologist, psychiatrist, addictions expert
Can you guarantee that a drug will work?
No
Who can be part of a confidential communication?
Persons involved, furthering interest of the patient, and those participating in diagnosis or treatment, e.g., patients, doctors, translators, nurses, etc
Is the billing record confidential?
No, billing record is NOT part of medical record
In a criminal proceeding, is the physician-patient privilege communication confidential?
NO (except for mental health records); judicial ruling should be obtained
In a criminal proceeding, are records of alcohol and drug abuse confidential?
Yes
Does the physician confidentiality apply to court or administrative proceedings brought by the patient against a physician?
No
Can the physician violate confidentiality if he/she thinks he or someone else is in danger?
Yes, must report that to law enforcement agency (NOT for mental health)
What information must a release of medical records include?
Type of records, reason, and person to whom to release
How many days (hospital) or business days (physician) does a hospital/physician have to provide medical records when they are requested?
Physician has 15 business days, hospital has 15 days
What is “therapeutic privilege,” when can it be used, who has access to the information, and what is the protocol the physician must follow?
If physician thinks that information would be harmful to the patient, it can be withheld; in writing, copy in the chart; films or tests must be released to patient representative
Can the physician charge for medical records and films? For an affidavit? Does he have to give the information if the patient does not pay? What does he do if the patient does not pay?
Yes, can charge $25 for first 20 pages, then 15¢ per page plus postage; notarization $15, films $8; patient MUST pay to get records, 10-day notice
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?
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?
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?
No
Can you relate information without patient consent for treatment? Billing? To report abuse? To law enforcement? For funeral directions? For worker’s comp?
Yes, all of the above
What is the “minimum necessary standard” for a medical release?
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?
Yes; yes, they can request amendments
What is the Texas medical record privacy act? Is it like HIPAA?
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?
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?
Yes; no
Are substance abuse records admissible during criminal proceedings?
No, unless the crime is EXTREMELY serious
Is HIV information confidential?
Yes
Can you “break” confidentiality in order to tell a spouse that his/her spouse is HIV positive?
Yes
Can you break confidentiality to tell a partner about notification program?.
Yes
Are blood bank records confidential?
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.
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?
They can tell name of disease, NOT donor
For statistical purposes, can a blood bank give out medical records? Names?
Yes, but not names or other identifying information
Is genetic information confidential?
Yes
Can patients have access to the results of their genetic testing?
Yes
What kind of crime is the unauthorized release of records?
Misdemeanor
Can the Texas Medical Board (TMB) show preference to a specific school of medicine such as medicine v. osteopathy?
No
What does the Medical Practice Act (MPA) regulate?
The practice of medicine
Who does the MPA apply to?
Physicians (MD, DO), PAs, and acupuncturists
Does the MPA apply to the armed forces and federal public health? Can they moonlight?
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?
NO if no charge; YES if money is charged
Are medical students in “board-approved schools” subject to the MPA?
No
Does the MPA prohibit self-care?
No
Does the MPA apply to physicians in contiguous states?
NO (physicians from nearby states can only order care for patients in hospice or nursing homes)
How many people are on the TMB? Who appoints them? Who must confirm them?
19 members, appointed by the governor, confirmed by the senate
Can the board subpoena people and records? Who can serve a subpoena?
YES, subpoenas can be served by board investigator or sent by certified mail
How often does the Department of Public Safety (DPS; state police) check on physicians and report to the board?
Quarterly
What are acceptable methods to tell the public on how to register a complaint to the TMB? In what languages? Where can a physician include this info?
By phone (direct number and 1-800 number) or by mail; posted sign, on registration forms or bill; in English and Spanish
How often must the TMB disseminate updated information? What info is included?
2 times per year; info includes disciplinary action, board activities and functions, changes to the MPA and attorney general opinions
Are disciplinary orders private or public?
Public
Are the following included in the physician profile?
ethnic origin
CME
years in practice
Medicaid participation
misdemeanors
felonies
malpractice claims
tax ID or social security numbers Everything except for tax ID/soc. security
Which malpractice claims should be included?
Any jury awards, liabilities—NOT settlements
What happens if you don’t give this info?
License is not renewed
How many years of postgraduate training do you need to be eligible for licensure?
One
Who can get a limited license?
Applicant who is recommended by dean, president, or chief administrator from Texas medical school
Do you need the jurisprudence exam for a limited license?
Yes
Who is not eligible for licensure?
If applicant is under prosecution, investigation, or has restrictions on license in another state
How many days does the program director have to tell the board that somebody with a physician-in-training license did not show up, was suspended, etc.?
30 days
What is a temporary postgraduate training permit?
License for residents and fellows pending the physician in training permit
What is a telemedicine license? Do you have to be board certified to have it? Do you have to pass the jurisprudence exam?
A license to do consulting work through internet, etc., in Texas; cannot physically see or treat patients; board certification is required; JP exam required
How often do you register your license? Do you need an updated physician profile?
Every 2 years; yes
How many days prior to the expiration of your license does the TMB notify you?
30
How many days after a license expires are you considered to be practicing without a license?
30 day grace period.
License expired < 90 days—penalty is?
$75
License expired 91-364 days—penalty is?
$150
License expired > 364 days—penalty is?
Cancellation
Do you have to retake JP exam if your license is canceled?
Only if the license is canceled for more than 2 years.
How can you get another license if it is lost/destroyed?
Get affidavit of lost or destroyed document and pay fee to board
How many category 1 CMEs yearly?
12
How many CMEs per year?
24
How many category 1 CMEs yearly must be in ethics?
1
How many category 2 CMEs can be from volunteer work?
6
How many CMEs can a license carry forward? And for how many registration periods?
48; only once
How many CMEs can be applied retroactively?
24; only once
How many CMEs do you need if you become “board certified” within 36 months?
24
If you practice pain management, how many CMEs in pain management are required?
None, but they are recommended
Who can initiate a complaint to the board?
Anyone
What is the “health professions council”?
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?
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?
Upon written request
Who investigates issues of “medical competency”?
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?
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?
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?
2 times per year.
Restrictive action by the TMB: Must the board report crimes found during investigations?
Yes, to the law enforcement.
Restrictive action by the TMB: Within how many days must the board report to the NPDB?
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?
30 days.
Are TMB reports confidential?
Yes
Who can the NPDB give info to? How about to patients? How about statistical data?
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?
To prevent mother’s death, if unborn has severe irreversible brain damage
When is it not illegal to perform an abortion on a minor?
In emergency and with court order
Is sexual contact between a physician and patient OK if the patient consents?
NO, the disparity of power does not allow consent
Why is it unprofessional to initially prescribe drugs over the Internet?
Did not verify identity of patient, no physician coverage or follow-up guaranteed
How can you terminate care to a patient?
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?
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?
Yes
What happens to his/her license if a physician goes to prison?
TMB is required to suspend
How many malpractice claims within what time period automatically open a board investigation?
3 within 5 years
How many people from the TMB are necessary to temporarily suspend a license?
President appoints a 3-member panel; can be done by phone
Is self-reporting addiction a disciplinary action? Is a rehabilitation order a disciplinary order?
No; no, it is the only nondisciplinary order
Is probation a disciplinary order? Who cannot be put on probation?
Yes; sex offenders, felons, prisoners, or if the physician is a threat to public
Can the TMB make a physician give a refund? What is the maximum amount of refund?
Yes; cannot be more than the amount paid
What is monitoring?
Continued oversight of the board for subjects on disciplinary orders
Who is part of an informal hearing and what is it?
Members of the board, at least one of whom is a public member, physician, his/her attorney; a means to settle a case without an administrative hearing
When do you go to formal hearings? What is the SOAH? Is it part of the TMB? Who holds the hearings? Who is participating? Must the TMB follow the ruling of the administrative law judge?
If no settlement reached after informal hearing; state office of administrative hearing; no; board members, physician, attorneys, and administrative law judge; NO, they do not have to follow the judge’s ruling
Where can a physician file an appeal? Within what time period? Can he practice in the interim?
Circuit court Travis county, within 30 days after final board decision; physician cannot practice in interim
Can the TMB panel serve a subpoena to a physician?
Yes
Can the physician get his file?
Yes, with written request, within 30 days
Can you voluntarily surrender your license?
Yes, but board does not have to accept it
If you surrender your license to avoid disciplinary action, can you reapply for it?
Yes, if there is no prohibitive circumstance
If you surrender your license voluntarily, whose burden is it to show competence if you want it back?
The physician who surrendered the license
How often and how soon can you reapply to have your license reinstated if it has been canceled/suspended, etc.?
Once a year
What is the maximum administrative penalty? How long do you have to pay it?
$5000 per violation; 30 days
What is the maximum penalty for an action for civil penalty by the attorney general? How long do you have to pay it?
$1000 per penalty, 30 days
What kind of offense is a violation of the MPA? What kind offense is it to practice medicine in violation of the MPA? To practice medicine with financial harm?
Misdemeanor class A; felony; jail felony
May you perform emergent surgery while drunk?
No; emergency MIGHT be an exception
If you have a contract with an impaired physician, can you avoid reporting him/her?
No
Can the board regulate advertising?
No, except to prohibit false, misleading, or deceptive practice
Are “testimonials” allowable advertising?
No
Is it permitted to advertise board certification? Board eligibility?
Certification, yes; not eligibility
What is a standing medical order?
Physician order to institution, e.g., nursing home
What is a standing delegation order? What are the requirements?
Physician order for patient or population; signed, dated, in writing
Who can a physician delegate to?
Any qualified and properly trained person
Who can the physician delegate to administer dangerous drugs?
Any qualified and trained person
Can a physician delegate to a midwife?
Yes (e.g., eye prophylaxis)
Is a physician liable for the actions of a NP or PA?
No, unless vicariously liable due to employment
What kind of name identification do PAs need?
Name tag identifying themselves as a physician assistant
What requirements exist for prescription for PAs and NPs?
No schedule 2; maximum 90 days, no refills unless consultation with physician
Which drug schedules can PAs and NPs prescribe? How many days? Can they give refills? Can they treat children? What ages?
Schedules 3-5, 90 days, refill after consultation with physician; Yes, but children less than 2 years only after consultation with physician
How many PA and NP equivalent FTEs can a physician supervise at maximum?
3 FTEs
Can CRNAs give all anesthetic drugs? Are they restricted to a particular MD?
Yes; no, any MD
What authority do pharmacists have? Can they give immunizations? Where does the supervising physician have to be located geographically?
Getting histories, ordering drug therapy-related tests, procedures, modifying drug therapy; yes; physician has to be able to be physically present daily
What can optometrists prescribe?
Eye ointments
Can anybody be a surgical assistant? Do they need a license?
Yes; yes, if they identify themselves as licensed, otherwise, no
Can a physician delegate the taking of X-rays to noncertified technicians?
Yes
Can they do bone density? Nuclear tests? CT? Skull X-ray?
Bone density, skull, spine, extremities, abdomen, chest; NOT CT, nuclear test, etc
Do they need to be licensed or registered by the boards?
Yes, they need registration
What is the difference between a partnership and a limited liability partnership?
The limited liability partnership can limit individual liability white partner A is liable for the acts of partner B
We have an expert-written solution to this problem!
Who can incorporate in Texas? Can physicians practice through corporations?
Dentists, PT but NOT MD; MD cannot practice through corporation
Are there any corporations that can employ physicians?
Yes, Certified Nonprofit Healthcare Corporation
Who can grant a title of Certified Nonprofit Healthcare Corporation?
TMB
What are 5 important characteristics of Certified Nonprofit Healthcare Corporations?
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?
Physicians can contract with hospitals but are not employees; guarantees paid for availability, billing, etc
Are there federal anti-kickback laws?
Yes
What does the health care insurance portability and accountability act do to federal anti-kickback provisions?
Applies to all federal health care insurances = all insurances
Do the anti-kickback laws apply only to Medicare and Medicaid?
No
Does federal anti-kickback law apply only to patient referrals?
No
Does this law apply only to giving money as a kickback? Who is punished, giver or taker?
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?
Felony; up to $250,000 for individuals and $500,000 for institutions
What are safe harbors in anti-kickback law? Give examples.
Acts NOT in violation of anti-kickback regulation; e.g., space and equipment rental, sale of practice, discounts, etc
Are STARK laws federal?
Yes
What is a STARK law? Can you refer to family?
Anti-self-referral law; no
What is the difference between STARK 1 and STARK 2?
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?
Submitting false claims to government for payment; federal law since War Between the States
Does Texas prohibit remuneration in exchange for referral volume?
Yes, prohibition on the solicitation of patients
What kind of crime is it to tamper with Texas Medical Board documents?
Class A Misdemeanor
Barratry—what is it? Is it illegal?
Contacting prospective patients in attempts to solicit them; it is illegal
Who can be part of a medical peer review committee?
Physicians, health care workers, anybody in the hospital
Does physician competency include membership in societies, participation in education, participation in group plans?
No
Who makes rules (by laws) for hospitals?
The governing body
Can a hospital reject an orthopedist because he is a DO and not an MD?
No
Can a hospital deny you privileges because you don’t accept HMOs? Participate in other hospitals?
No
Who makes the final decision in a hospital to grant or deny privileges to a physician?
Governing body
Does the hospital have to get a report from the NPDB about physicians prior to granting privileges?
Yes, initially and every 2 years; if they don’t, they are liable
How many days does the board have to give data to a hospital requesting it?
15 days
How often must a physician update his core credentials? How many days does he have to provide corrections?
Yearly; corrections within 30 days
Prior to the “first release” of his information, how many days does a physician have to review it?
15 business days
If a physician’s privileges will be suspended, does he/she have the right to due process?
Yes
How many days prior to hearing of due process must the hospital give the physician notification?
30 days
Do hospitals have to accept NPs and PAs?
No
If accepting NPs and PAs, what are the hospital’s responsibilities?
Due process, fairness, appeal
Is the peer review file confidential?
Yes, EXCEPT for possible civil rights violation and possible anti-trust violation
When must a hospital’s medical peer review report actions taken against physicians to the TMB? to the HCQIA? to the NPDB?
If action affects privileges for longer than 30 days or if physician surrenders privileges or if it affects membership; never, the TMB reports to NPDB
How much time does the committee have to report to the TMB?
15 days
Is it good enough to get the signature for informed consent?
No, actual informed consent must be achieved
Which procedures need “full disclosure” of LIST A and LIST B?
Only List A
Which procedures need additional “statutory consent”?
Hysterectomy, radiation therapy, ECT
Is it the duty of the hospital or the physician to get consent?
Physician
Which particular aspects of an informed consent if neglected can be grounds for a suit? Do you need to suffer damages to sue?
Nondisclosure of risks, benefits, alternatives; yes
Is express consent required in an emergency?
No, consent is implied
If arrested and suspected to be drunk, do the police need consent to check blood?
No, consent is deemed to have been made, but consent can be expressly denied
If anyone died in an accident, is consent needed to check blood?
No
Who is a minor in Texas?
Anybody less than 18 years of age who has not been emancipated
When can a minor petition the court NOT to be a minor?
Age 16 when living independently and supporting self, age 17 when supporting self, managing conservator or guardian, Texas resident
Can an uncle consent for a minor?
Yes
Can an educational institution consent for a minor?
Yes (boarding school for example)
Vaccinations: Is physician liable for damages by a required vaccination? Is physician liable for damages done by a disease that the parents denied vaccination for?
No; no
Who is responsible to review a child’s immunization record?
Any physician; failure to do so has no consequence
What happens if a physician does not review a child’s immunization record?
Nothing
Do you need to consent to inform the authorities if you suspect child abuse or neglect?
No
In what instance can a child give consent?
If on active duty, when restrictions of minor removed, for communicable disease, if pregnant for counseling, and addiction treatment
Does the Consent to Medical Treatment Act apply to “incapacitated” individuals? Does it apply to psychiatry patients?
Yes; yes, but not for patients in FREE-STANDING psychiatric hospitals
Who can be a surrogate decision maker? What are the requirements?
Spouse, adult child, majority of children, parents, or a person identified by patient before becoming incapacitated
Can surrogate decision maker consent to voluntary inpatient psych treatment? ECT treatment? Appoint another surrogate decision maker?
Not psych treatment, not ECT, cannot appoint another decision maker
What are 3 examples of “advanced directive”?
Directive to physician, out-of-hospital DNR, medical power of attorney
How many witnesses do you need, and what are the witness requirements for advanced directives?
2 witnesses, one cannot be related, beneficiary, attending physician or hospital employee
Can a directive to a physician be oral or must it be in writing?
Can be verbal and must be documented in chart with names of witnesses
Does an advanced directive have to be notarized?
No
How many witnesses for an oral directive?
2
How long is a directive good for?
No limit, until revoked
What are the 3 ways to revoke an advance directive?
Written, oral, or VOID across the pages
When a directive is orally revoked, what should the physician do with it?
Destroy or write note on verbal revocation or write VOID across pages
What happens if a physician disagrees with the directive given to him?
Does not have to follow; can request ethics or medical committee with 48-hour notification for all parties
What is the transfer registry?
Directory of physicians or hospitals willing to accept patients in transfer who have advanced directives
Is “mercy killing” allowed in Texas?
No
Who must sign an “out-of-hospital DNR”? Can it be verbal? Are witnesses needed?
Attending physician, patient, and two witnesses; yes/no; yes/no
What is the effect of an “out-of-hospital DNR”?
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?
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?
Yes, DNR device is enough
Can an incompetent patient revoke their DNR?
Yes
Should this form accompany patients on transfers?
Yes
What kind of treatment can the power of attorney NOT consent to?
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?
No, unless specified
What happens if on the expiration date the patient is incompetent?
It is continued until patient becomes competent again, then expires
Who cannot be the power of attorney?
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?
Yes
When can you withhold treatment to an infant?
If chronically and irreversibly comatose or terminally ill and further treatment would be futile
Can you withhold nutrition/hydration from a terminally ill infant?
No
Is the mental health directive an advanced directive act?
Yes, but with differences
What are the requirements for mental health directive? What are requirements for witnesses?
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?
Yes, 3 years or until revoked
What happens if on the expiration date of a mental health directive, the patient is incapacitated?
It continues until competent
When can you use restraints? When can you use behavioral measures?
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?
Donor NO, husband YES
What prenatal maternal tests must a physician check?
HIV, hepB, syphilis
How many times must a physician check prenatal maternal tests?
Twice; upon first examination and on admission for delivery
Are prenatal maternal tests confidential and anonymous?
Confidential; anonymous upon request
Does the physician have to tell the mother that he/she will do prenatal maternal tests? What if she wants anonymous testing?
Yes, must inform but not specifically consent; if anonymous is wanted must refer patient to anonymous testing center; patient can refuse
If prenatal maternal tests are positive, what must the physician do?
Refer for treatment, provide counseling, and provide information about diseases
How long does a physician have to keep prenatal maternal test results?
For 9 months
What institutions do not need licensing for birthing centers?
Licensed hospitals, nursing homes, and ambulatory surgery centers
What does the federal case Roe v. Wade say about abortion?
Abortions are legal
Under what circumstance can you perform a third trimester abortion in Texas?
In emergency to save mother’s life or if fetus has severe irreversible abnormality
After third-trimester abortion, how many days does the physician have to notify the Department of Health?
30 days
What is the cut-off gestational age to do an abortion in the office?
16 weeks
What specific health risk must you inform the patient about during consent for abortion (4 categories)?
Infection, hemorrhage, infertility, breast cancer
What specific economic-related issues must you talk about during consent for abortion? Do you need to document in writing that you talked about these issues?
Medical assistance, father’s liability for support; yes
How long before the abortion must you tell patients about risks and economic issues?
24 hours
When can you perform an abortion on a minor? Can you do it without calling the parents?
To save mother’s life, court order, consent of parents; yes, only court ordered
How much time prior to an abortion on a minor must you give notification to parents? If they agree, can you do it earlier?
48 hours; yes
What happens if you cannot find a parent to notify of abortion?
Mail certified letter 48 hours prior
Is there any way for a minor to have abortion without notifying the parents?
Yes, can petition court if minor is mature, informed and notification may be harmful (abuse)
To perform emergency abortion on a minor, what must you do? What kind of form to fill out?
Assure that it is necessary; notify TDDHS on prepared form
What facility must be licensed to do abortions in Texas?
If they do > 50/year
How often do abortion facilities have to report to the DPH?
Yearly
Do abortion facilities’ reports include the physician and patient names?
No, neither
Can you force a physician to perform an abortion?
No
With what and for what do you have to treat all newborns?
Ophthalmia neonatorum, tetracycline, erythromycin, or silver nitrate ophthalmic solution
What genetic test must you do on all newborns? How many times? Who can do them? Can the parents object?
PKU, galactose-1-phosphate uridyltransferase deficiency, sickling hemoglobinopathies, congenital adrenal hyperplasia, hypothyroidism; twice (at birth, 2 weeks later); physician or person attending birth; parents can object on religious grounds
Do hospitals have to give hearing test to all newborns?
Yes
Within what time period does insurance have to pay for newborn hearing screen? When do they have to pay for follow-up care with regard to hearing?
From birth until 30 days; up to 2 years of age
For what time period must an insurance cover a mother + newborn?
48 hours normal delivery, 96 hours C-section; longer for complicated delivery
Who must review immunization history?
Every physician
Until when must insurance pay for immunizations?
Up to age 6
Who must submit the birth certificate?
Physician, midwife, or person attending birth
How many days do you have to submit the birth certificate?
5 days
What kind of crime is it if you don’t submit a birth certificate?
Misdemeanor
What kind of crime is it if you submit false data on a birth certificate?
Felony 3rd degree
How old or young must a baby be in order for a care provider to be able to take possession of an abandoned baby?
60 days
Can any money transaction be done during an adoption?
Yes; only to cover expenses
When is a person considered dead?
Cardiac and respiratory functions cease to exist
When is a ventilated person considered dead?
Irreversible cessation of brain function
What is the time of death for ventilated people?
At time of determined brain death
For your ventilated person, do you pronounce death before or after you turn off ventilator?
Before
Who can pronounce somebody dead?
MD, PA, NP, RN
Who must file the death certificate?
Person in charge of interment
How many days does the physician have to fill it out once it is given to him/her?
5 days for MD to fill out medical portion, 10 days to send in death certificate
Do fetuses require death certificates?
If 350 grams or more or 20 weeks or older
Sudden infant death syndrome (SIDS) applies to children ages or younger
1 year
In SIDS, is an autopsy required?
Yes
To whom and how fast must you report SIDS?
To a justice of the peace, medical examiner, or other proper official immediately
Who pays for autopsy in SIDS?
State
If at the time of death the physician knows that the patient had a communicable disease, what must be done to the body?
Report to TDSHS and tag body to indicate caution required due to communicable disease
The death of a child under __ years must be reported.
6 years
Whom do you report it to?
Medical examiner or justice of the peace
What must the medical examiner do for the death of a child under 6 years?
Hold inquest
How many days must have passed since the person was last seen in order to issue a “certificate of death by catastrophe”?
10 days
Can you issue a certificate of death by catastrophe for a minor?
Yes, with affidavit
What is the difference between an inquest and an autopsy?
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?
Medical examiner or justice of the peace
Who has rights to consent to autopsy? In what order?
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?
No
If a member of a class (1 out of 4 children) consents to autopsy but the other 3 do not agree, can they still do the autopsy?
Yes, only one needs to consent
What kind of crime is it if you assist in suicide and patient does not die? What if patient dies?
Class C misdemeanor, if patient dies felony
How many witnesses do you need to donate an organ if there is no will?
2 witnesses, signed
Who has the power to donate the organ of a dead person?
Spouse, child, parent, siblings, guardian, any authorized person
How can you revoke an organ gift? Do you have to tell the donee?
Yes; no
Can you pronounce the death and transplant an organ in the same patient?
Physician who determines death CANNOT participate in transplantation
At what age and how can a mentally retarded person donate a kidney?
Age 12, by petitioning the district court
Can a blood bank pay for blood? How? After how many days?
Yes, by mailed check, 15 days after donation
What is the duty of a medical professional when treating an adult with family violence? What languages to use?
Duty to treat and provide information (and document that information was provided) in English and Spanish; no need to report
Does the physician have to call the police in cases of adult family violence?
No, just inform victim of options
What is the difference between a professional and a medical professional?
Medical professional = MD; professional = anybody else, e.g., teacher
Reporting of child abuse? By whom? How fast? Can it be delayed? To whom (3 entities)?
Report immediately but MUST be within 48 hours, cannot be delegated; to Texas Department of Protective and Regulatory Services, any law enforcement, Texas Youth Commission
Will the TDPRS act on anonymous calls regarding child abuse? Does it satisfy a professional duty to report?
Yes, they will be acted upon but DO NOT satisfy duty to report
How much time do professionals and medical professionals have to report the death of a child secondary to suspected abuse?
48 hours
What kind of crime is lying in a report on child abuse? Not submitting a report?
State jail felony, misdemeanor class B
Who must report nursing home abuse?
Any person
Is the report of nursing home abuse verbal or written?
Immediately verbally, written within 5 days
What kind of offense is it NOT to report nursing home abuse?
Misdemeanor class A
Can the institution retaliate against a whistle-blower in cases of nursing home abuse?
No
When and within what time limit must nursing homes report resident deaths?
Within 10 working days
Within what time period must nursing home deaths be reported if the resident just transferred to hospital within 24 hours and died?
10 working days
Who is considered a child, elderly, or disabled person when talking about a criminal offense for injury of the above?
14 year or younger, 65 or older or disabled older than 14
Who is considered “elderly” when living at home?
65 or older
What kind of offense is it if you do not report elderly abuse?
Misdemeanor class A; false information class B
Can a volunteer report abuse in a hospital, etc.?
Yes
Who is considered a mental health worker? Does that include priests?
Social worker, addiction counselor, counselor, marriage therapist, clergy member, physician, psychologist; yes
Give definitions for 4 types of sexual contact
Touching, deviate acts, intercourse, request for or suggestion of
What is sexual exploitation?
Pattern for purposes of sexual gratification
What is therapeutic deception?
Making patient believe it is part of treatment
What of the above questions is cause for action?
All-contact, exploitation, deception
Is an employer liable for the sexual misconduct of a current or previous worker with a current or discharged or ex-patient?
Yes, if employer has knowledge of past sexual exploitation or fails to inquire over the last five years of employment
What is considered “emotional dependence”?
Lack of emotional dependence of the patient on the therapist is a defense that can be raised in an action brought by a former patient
Is it a defense that the sexual misconduct was consented? Off the premises? Outside treatment sessions?
No, no, no
Who are the 2 agencies that should receive a report in cases of sexual misconduct?
State licensing board and prosecuting attorney of the county where the alleged offense occurred
When to report sexual misconduct? What offense is failure to report?
Within 30 days; misdemeanor
If you are examining a patient with a communicable disease, what is your duty?
Duty to instruct on prevention of reinfection, spread, and necessity to treat
Who has to report communicable diseases?
Physician, dentist, veterinarian, chiropractor
What sort of situations must be reported?
Documented or suspected infection, exotic diseases, outbreaks
Can an employee in the office do the reporting?
Yes, if designated by physician
If a physician reports a communicable disease, does the hospital also have to report it?
Yes, both
If you treat a patient with a communicable disease that dies, what are your 2 responsibilities and within what time frame?
Report death immediately and put toe tag on
What kind of crime is nonreporting communicable disease?
Class B misdemeanor
If you are a police officer, firefighter, etc., can you make somebody have an HIV test if you think you might have been exposed? Who do you call?
Yes, request TDH
Is the police officer, etc., required to be tested himself/herself?
No
If an employee is exposed, can the hospital check if the person is harboring an infective agent?
Yes, to HepB, C, HIV
What diseases must they test for?
Hep B, C, HIV
Do they need the patient’s consent?
No
Who must report occupational exposure? Does that include labs?
Physicians, labs, health care workers; labs must report abnormal lead levels
Can you make somebody have HIV test? What are the 4 exceptions?
No, unless during pregnancy, criminal proceedings, accidental exposure, consented
What kind of crime is it if you force somebody to take an HIV test?
Misdemeanor A
Does HIV testing consent have to be written?
No
Do you have to sign an HIV consent if you have signed a consent for treatment?
No
Do you need consent for lab testing after accidental exposure?
No
Does a physician have to contact the partner notification program if a patient is HIV positive and the physician suspects sexual activity?
Yes
Can a health care worker with exudative lesions or weeping dermatitis participate in direct patient care or handling of medical equipment?
No
If you are a health care worker that has HIV or hepB or HbeAg, can you perform invasive procedures that are “exposure-prone”? What are the 2 requirements?
No, unless patient has been educated and has sought expert panel
What if you do invasive procedures that are not exposure-prone, and you are positive for HIV, HepB or HbeAg? Do you need to inform?
No need to inform
Can you force rapists to undergo HIV and HepC tests?
Yes
Which neoplasm must be reported to the cancer registry?
All
Which traumatic injuries must be reported? To whom? Who is responsible to report?
Spinal cord, traumatic brain, anoxia including near-drowning; to TDH; physician
Do you have to report overdosing and gunshot wounds? How fast? Who are the 2 people who can report that?
Yes; immediately; by physician or hospital administrator or official
What kind of offense is nonreporting of traumatic injuries, overdoses or gunshot wounds?
Misdemeanor
What is a “commitment order”?
Court order for involuntary mental health admission
Who is considered an “adult” in order to proceed with voluntary psych admission?
16 and over OR anybody who has ever been legally married
What are the 3 types of involuntary psych admissions? Who can order them?
Emergency or temporary detention, protective custody; they are court ordered
Does being on ETOH, senile, mental retardation, epilepsy constitute grounds to deny voluntary psych admission?
No
When you are admitted involuntarily, when can a patient be forced to take psychoactive mediations (3 cases)?
(1) a medication-related emergency, (2) under a court order, (3) patient is a ward and guardian consents
Do you need a separate court order to give psychoactive medications in addition to the court order for involuntary admission?
Yes, you need 2 separate court orders
Do you need a physician order to put patient in restraints?
Yes
When should you consider prescribing psychoactive medications?
Medication emergency—threat to self or others
ECT may not be used in people less than _ years of age. Any exceptions?
16, no
Can anyone, including courts, force somebody to have ECT without their written consent?
No, ECT cannot be court ordered
How often do you need consent for ECT?
Before each treatment
How about people > 65 years of age, who must sign for ECT?
Patient and 2 physicians
Can psychiatry hospitals employees’ pay be based on # of admissions, length of stay, calls to referring sources?
No
Can psychiatry hospitals “guarantee” a cure on advertising?
No
Can psychiatry hospitals solicit information about patients’ confidential records to solicit them for services?
No
Can a physician send a patient directly to psychiatry hospital? Do they have to first get insurance approval?
Yes; no
How long is a mental health directive valid for?
3 years or earlier if revoked
Does a mental health directive suffice to allow ECT treatment?
Yes, it is considered a prior consent
Does Texas have “duty to warn” for mentally-ill patients? Is this breach of confidentiality
Texas does NOT have duty to warn, it IS a breach of confidentiality
Can patient refuse mental health treatment after admission?
If they are voluntarily admitted, yes; if involuntarily, no, with court order
Who does EMTALA apply to?
Hospitals participating in Medicare
What is considered “campus”?
250 yards from ER
What 4 places constitute “coming” to the ER?
In hospital-owned ambulance or air transport, or patient is in ER or in hospital requesting ER consultation
If an ambulance despite being told that the hospital is on diversion comes to the ER, can you send them away?
No, patient HAS TO BE SEEN
Is pregnancy a medical emergency?
No, except for complications and labor
Under EMTALA, what MUST a hospital provide?
Medical screening
Is it enough to log in or triage the patient?
No
Can you delay treatment in order to check insurance? Get pre-approval?
No
Can you provide different levels of care based on insurance?
No
Can a PA or NP provide the EMTALA required screening?
Yes
Does admitting the patient for treatment satisfy EMTALA requirements?
No
If patient refuses treatment, does that satisfy EMTALA? What is the appropriate protocol?
Yes; has to be informed of potential dangers
If a physician is not available to determine if transfer is necessary, who else can do it? What is required?
PA, NP, RN, other qualified person after consultation with MD
Do you have to send medical records when transferring from an ER?
Yes
Can you transfer because on-call physician did not show up? What must you do?
Yes; record name and address of physician who did not show up
Can a specialized hospital (e.g., burn unit) refuse a transfer because “they are full”?
No, if they have EVER accepted patients before and made room for them
How many years must you keep records of patient transfers?
5 years
Do hospitals need to keep on-call lists?
Yes
Can you do elective surgery when you are on call?
Yes
Can on-call physician refuse to show up?
No, only in circumstances beyond his control
What are the 3 penalties for hospitals and physicians for violation of EMTALA? What is the maximum damage?
Civil money penalties, termination of provider agreement, civil action. Up to $50,000 per violation ($25,000 for < 100 beds)
Can a patient initiate his/her own transfer?
Yes
How many people on the Texas Medical board?
19
How many MDs on the TMB?
12
How many layperson on the TMB?
7
How often does the police run a check on physicians?
Monthly
How often does the TMB put out reports on physicians?
Every 6 months
How many years of postgraduate training to apply for full license?
1
If a resident does not show up to begin his training, how many days does the program director have to report that to the board?
30
Institutional permit: how many months for initial license? How many renewals? How many months for each renewal?
14 months; 7; 12 months
Physician-in-training permit: how many months for initial license? How many renewals? How many months for each renewal?
18 months; 6; 18 months
How often do you register your license with the TMB?
Every 2 years
How many days prior to expiration of your license does the board notify you?
30
How many days after expiration are you considered practicing without a license?
30
How many days after expiration is license canceled?
365
How many category 1 CMEs per year?
12
How many ethics CME credits?
1 yearly
How many CME credits can be from volunteering?
6
How many CMEs can you carry forward?
48
How often must the board give update to all participants in a complaint?
Every 3 months (quarterly)
How much time do insurances have to report malpractice to the board?
30 days
If disciplinary action is taken by the board, how much time to report to the hospital verbally? In writing? To the NPDB?
Verbally immediately to hospitals on first working day; in writing to all hospitals and agencies within 30 days.
How much time to report court reports to the board?
30 days
How many malpractice claims in what time frame to trigger board investigation?
3 within 5 years
How many people from the board to emergency suspend license?
3
How many days does a physician have to file appeal to a board decision? Which county?
30 days; Travis county
How soon and how often can you file for reinstatement of a license?
After one year; once a year.
Maximum administrative penalty by board? By attorney general?
$5000 per violation; $1000 per violation.
How much time to pay an administrative penalty by the board?
30 days.
How many days can NPs and PAs prescribe? How many refills? For patients how old?
30 days, no refills; older than 2 years.
How many PA equivalents can an MD supervise?
3 full-time employees
What percentage of random charts of the PA must the physician review?
10%
How far can secondary practice sites be located from primary?
60 miles
How many days does board have to give information to requesting hospitals?
15 days
How many days do you have to correct changes in your TMB profile?
30 days
How many days do you get to review your data the FIRST time the board releases it?
15 business days.
How often does a physician have to resubmit his core data if there were no changes?
Once a year.
How many days before hospital hearing must a physician be notified?
30 days.
A suspension in the hospital must be reported if it lasts for how long? Within what time must it be reported?
More than 30 days; 15 days.
Until what age is one considered a minor?
18 years
How many witnesses do you need for advanced directive? For verbal directive to physician? For out-of-hospital DNR?
2; 2; 2
How many witnesses for a mental health directive?
2
How long until mental health directive expires? How long until medical directives expire?
3 years; no limit.
How many days does a physician have to give records to patient? Hospital? Attorney?
15 business days; 15 business days; 45 days.
How many days does patient have to pay fees for requested records?
10 days.
What are the fees for copied records? Postage or not?
$25 for first 20 pages, then 15¢ per page plus postage.
How many years must a physician keep records for adults? For minors? From what age?
7 years; 7 years or age 21.
How many years must hospitals keep records for adults? For minors? From what age?
10 years; 10 years or 20th birthday.
How many days does a hospital have to send itemized bill if requested?
30 business days.
What is the economic cap on noneconomic damages in Texas per defendant/claimant?
$250,000
How long is the statute of limitations for adults? Minors?
2 years; 2 years from age 18.
When must a claimant send a letter, and by how long can he/she extend the statute of limitations?
Within 60 days; extends by 75 days.
How many yards from ER is considered campus?
250 yards.
How many years must you keep records of transferred patients?
5 years.
What is the maximum monetary penalty for a hospital violating EMTALA?
$50,000, $25,000 if < 100 beds.
How long do physicians have to keep screening test records from the first visit of a pregnant woman?
9 months.
How many days does a physician have to notify the DPS of a third trimester abortion?
30 days.
What is the cut-off gestational age for office-based abortions?
16 weeks.
How long prior to abortion must you give the woman information on abortion (verbal/written)?
24 hours.
How much time prior to abortion must parents of a minor be notified?
48 hours.
How many abortions per year make you an abortion facility that must be licensed?
50.
How often does licensed abortion facility submit records to TSDHS?
Yearly.
How many times must you check newborn for genetic disorders?
2.
How long can a mother + newborn stay in the hospital paid by insurance after birth with vaginal delivery/cesarean section?
48 hrs/96 hrs
Until when must an insurance pay for hearing screening? Follow-up hearing screening?
30 days; 2 years
How many days do you have to submit birth certificate?
5 days.
After what age can you take possession of an abandoned baby?
60 days or less
How many days does the funeral director have to file death certificate?
10 days
How many days does the physician have to fill out death certificate?
5 days.
Over what weight must a death certificate be filled out for a fetus?
350 grams.
If weight is not known, over what gestational age?
20 weeks.
SIDS is for children of less than what age?
12 months.
When do you have to report SIDS?
Immediately.
Death of a child of what age or younger must be reported to the medical examiner? Within what time frame?
6 years; immediately
How many days after catastrophe to get “certificate of death by catastrophe”?Xlibris. Kindle Edition.
10 days.
If a patient dies within how many hours of admission must an inquest be ordered?
24 hours.
A mentally retarded person of what age can donate a kidney if the guardian petitions the court?
12 years.
After how many days can a blood bank pay for blood donation?
15 days.
A person older than what age can voluntarily commit self to psychiatry?
16 years
How often do private psychiatry hospitals file reports?
Yearly.
What age do you have to be to get ECT?
16
How often do you renew DEA license? DPS license?
Every 3 years; yearly.
How many days to you have to inform the DPS of change in information?
7.
How many days of pills can a patient get of schedule 2-5 when discharged from the hospital?
7.
How many days to send written prescription to pharmacy of schedule 2 drug?
7.
How long is a schedule 2 script valid? How many refills? Schedule 3-5 valid? Refills? Dangerous drugs valid? Refills?
7 days; no refills; 6 months; 5 refills; unlimited; unlimited.
How often do you need to do inventory on your drugs?
Every 2 years.
How often do you have to register with the board and pay a fee to administer anesthesia?
Every 2 years.
How many days do you have to report an office-based anesthesia complication?
15 days.
How much time do you have to report a death from communicable disease?
Immediately.
How much time to report a gunshot wound?
Immediately.
What is the monetary penalty for violation of anti-kickback laws for physicians? Hospitals?
$25,000-$250,000 / $50,000-$500,000.
How much time does a physician have to report child abuse?
Immediately; 48 hours in writing.
How much time does a professional (not medical professional) have to report child abuse?
48 hours.
How much time do professionals/physicians have to report death of a child secondary to abuse?
48 hours.
How much time do you have to report nursing home abuse verbally? In writing?
Immediately; 5 days.
If a nursing home resident dies after transfer to a hospital, within what time frame must be reported?
24 hours.
How much time does the nursing home have to report elderly death?
10 days after the end of the month of death.
What are the age limits to consider abuse a criminal offense?
14 or younger, 65 or older; older than 14 and disabled.
How many days do you have to inform the TMB of a case of child abuse/neglect
48 hours
How many days do you have to inform the TMB in issuing a birth certificate
5 days
How many days do you have to inform the TMB of issuing a death certificate?
10 days
How many days do you have to report to the TMB in the case of most communicable diseases?
7 days ( 1 day for TB or pertussis)
How many days do you have to inform the TMB about supplying medical records?
15 days
How many people compose the Texas Medical Board?
19 ( 12 physicians, 9 MD, 3 DO) 7 are laypersons for 6 year terms
The Texas Medical Board is responsible for
Issuing licenses and all the of the disciplinary actions associated with taking them away
What is the Texas Medical Practice Act?
Everything doctors must adhere to hen practicing medicine in Texas. And all laws only apply to Texas licensed physicians while practicing in Texas, or outsiders providing telemedicine services to patients in Texas
What doctors are excluded from the Texas Medical Practice Act
Podiatrists, dentists, optometrists, nurses, or medical students. Non-compensated emergency care is also exempt (covered by the Good Samaritan Law)
What is the license criteria?
Complete college (60 credits), have an MD or DO, Pass the USMLE steps 1-3 (within the past 7 yrs) and the JP exam, complete your intern year
Any U.S. trained graduate finished with the steps an apply for a full Texas medical license after completing their
Internship
Corollary
If you quit your residency after internship, you can still practice s a fully licensed physician in Texas (though not board certified in a specialty)
Corollary 2
Naturopathic doctors, podiatrists, optometrists, chiropractors, dentists, are not licensed by the TMB and have their own governing bodies and rules
2 years
After how many years do you renew your license?
No fine
What happens if you ware late by less than 30 days?
What happens if your license is expired for more than 30 days?
$75 fee
What happens if your license expires after 365 days?
$145
You must reapply and pay the fees again
What happens if your license is expired for more than a year?
You have to reapply for the license and retake the JP exam
What happens if your license is expired for more than 2 years or longer?
You are practicing medicine without a license and committing a third degree felony
What if you still continue practicing 30 days after?
Continuing Medical Education (CME)
Every 24 month period, out need 48 hours of CME’s
What do these CME’s consist of?
1/2 formal, 1/2 informal ( self reported like ” i read a journal,volunteering at an underserved area, must also include 2 hours of education ethics/ professional responsibility
30 days
How many days do you have to let the board know of any name and practice changes?
The ability to take care of patients
What is physician competency measured by?
By a hospital
How can competency be relevant to credentialing ?
DO’s not being MD’s, punishing a physician for working at other hospitals, only accepting certain insurances, ONLY COMPETENCY
A hospital cannot discriminate against
Mid levels (PA’s, NP’s)
Hospitals require credentials from DO’s and MD’s, but hospitals are not required to accept/hire
The TMB
If the governing body of a hospital is forced to take action against a physician that affects the privileges or longer than 30 days, who must be notified?
No, but you do need a special Texas telemedicine license
Do you need a full Texas Medical license to practice telemedicine in Texas?
Taking the JP exam, license is in good standing in another state, board certified in your specialty, not actually physically or acting in the state of Texas
What does the Texas telemedicine license include?
OK,AR, LA, NM can order home health me hospice services for patients in Texas without a special telemedicine license
What are some contiguous states for telemedicine?
Yes (usually applies to radiologists)
Do you need an additional license to transport, produce, use radioactive materials?
No -fault no-lawsuit system for the payment of work related injuries, the employee will get money regardless of whose fault it was, where any doctor can perform a visit be you need a certificate of registration and be on he approved by the Texas Department of Insurance list to be evaluated
What is worker’s comp?
Resident practice under a physician in training (PIT) and institution specific
What is the Pit permit?
Apply or a new PIT permit 90 days before switching
What if you change your residency location (for example, one hospital and advanced position to another you would need to
Yes, only if you are in good standing and having no suspensions, restrictions, or felony charges
Will the TMB accept another state’s medical licensure without requiring additional action?
No, they must be admitted under a DO or MD
Can podiatrists admit patients?
How can one terminate a physician-patient relationship, without abandonment, if there is ongoing treatment?
30 days written notice, must provide for emergency
What is “proximate cause”?
Prove that negligence caused harm and that the cause was not too remote; what is required to a hold a defendant liable in a civil lawsuit
What are the two components of proximate cause?
Cause-in-fact (but-for test) and forseeability
In a medical malpractice setting, what two instances do not need expert testimony?
Res ipsa loquitur (e.g. amputation of wrong leg) and negligence per se (a law was broken)
Is there a cap to noneconomic damages? How much?
250K for physicians, 500K for hospitals
If the claimants proportionate responsibility is more than what %, then he/she may not recover damages?
If >50%, no damages awarded.
How long is the statute of limitations for adults? For minors?
2 years; for minors, 2 years after becoming 18yo
In a criminal proceeding, is the physician-patient privilege communication confidential?
No, except for mental health and substance abuse records; judicial ruling should be obtained.
What is “therapeutic privilege”, when can it be used, who has access to the information, and what is the protocol the physician must follow?
If physician thinks that information would be harmful to the patient, it can be withheld; in writing, copy in the chart; films or tests must be released to patient representative.
How many years does a physician have to keep records for adults? For minors?
7 years for adults; 7 years or until age 21 for minors; hospital must keep 10 years
Are substance abuse records admissible during criminal proceedings?
No, unless the crime is extremely serious.
Is HIV information confidential?
Yes.
Can you “break” confidentiality in order to tell a spouse that his/her spouse is HIV positive?
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?
They can tell the name of donor, not disease.
What kind of crime is the unauthorized release of records?
Misdemeanor.
What does the Medical Practice Act regulate?
The practice of medicine by MD/DOs, PAs, and acupuncturists.
Does the MPA apply to emergency assistance if there is NO charge of money? If there is money charged or billed?
No if no charge, YES if money is charged.
How many people are on the TMB? Who appoints them? Who must confirm them?
19 members, appointed by the governor, confirmed by the Senate.
How often does the Dept of Public Safety check on physicians and report to the board?
Quarterly.
What is included in the physician profile?
Ethnic origin, CME, years in practice, Medicaid participation, misdemeanors, felonies, malpractice claims
Which malpractice claims should be included?
Any jury awards, liabilities – NOT settlements.
How many CMEs per year?
24
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?
Yes, within 30 days, except if it would interfere with the investigation. Updates are quarterly.
When is it not illegal to perform a third-trimester abortion?
To prevent another’s death or if unborn has irreversible brain damage.
When is it not illegal to perform an abortion on a minor?
In emergency and with court order.
What prescriptions does a physician need to keep records on? Dangerous drugs? Controlled substances? Samples?
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.
How many malpractice claims within what time period automatically open a board investigation?
3 within 5 years.
Is a physician liable for the actions of a NP or PA?
No, unless vicariously liable due to employment.
What requirements exist for prescription for PAs and NPs?
No Schedule 2; maximum 90 days, no refills unless consultation with a physician.
Can NPs and PAs treat children?
Yes, but children less than 2 years only after consultation with a physician.
Who can incorporate in Texas? Can physicians practice through corporations?
Dentists, PT but NOT MD; MD cannot practice through corporation.
Are there any corp that can employ physicians?
Yes, certified Nonprofit Healthcare Corporation (certified by TMB)
What are 5 characteristics of a nonprofit healthcare corporation?
1) conduct scientific research
2) support education
3) improve capabilities to study and teach
4) deliver healthcare to the public
5) instruct public in medical science, public health
What is barratry? Is it legal?
Contacting prospective patients in attempts to solicit them. It is not legal.
Facts about the Exam
2 hours long
Must pass with 75%
Minimum of 50 questions
Topics covered on the exam
Nursing Licensure and Regulation in Texas
Nursing Ethics
Nursing Practice
Nursing Peer Review
Disciplinary Action
The Mission of The Board of Nursing
To protect the People of Texas
How does BON fulfill its mission?
Makes sure that RNs are competent
Regulates the practice of nursing and approves of nursing education programs
Makes their mission a priority over anything else pertaining tol nursing
What can BON do?
Represent the people of Texas 2.Ensure that RNs meet the standards of safe practice
What can professional Associations do?
Represent their members in legislative, political, and policy matters
Provide leadership opportunities for members
Can lobby
True or False: The Board of Nursing can lobby in legislation.
FALSE. The BON cannot lobby, but nursing associations can. The Board of Nursing is a resource for nurses but not a representative for nurses.
True or False: The Board of Nursing regulates practice settings and answer questions about employment.
FALSE. The BON does not answer questions about employment , so ask appropriate questions to the correct hospital. The BON also does not regulate practice settings; it regulates nurses through their rules and requirements.
NPA 301.251
You cannot call yourself a nurse or practice in Texas without a license
NPA 217.10
Items required to be on your name badge
1.First name
2.Last name
3.Credentials
Temporary Permit Expires
In 75 days
When you pass or fail NCLEX
For people who are already licensed, temporary licenses expire after 120 days
Benefits of Paperless Licenses
They are safer and more effective. Less likely to have identity fraud.
Continuing Education
RNs must submit verification of 20 hours of CE in the 2 years prior to licensure or reactivation of delinquent license.
How many hours of CE’s must and RN submit?
20 hours within the 2 years prior to licensure or reactivation of delinquent license
True or False: Certification can count towards CE’s.
True; RN’s must maintain or renew their approved national nursing certification
Rule 216
Continuing Competency
NPA 304 and Rule 220
Nurse Licensure Compact
Benefits of Nursing Compact
increases nurse’s mobility and facilitates innovative and cooperative healthcare
Nurse Licensure Compact States
Texas
New Mexico
Arizona
Utah
Colorado
Idaho
Minnesota
North Dakota
South Dakota
Nebraska
Iowa
Wisconsin
Missouri
Arkansas
Mississippi
Tennessee
Kentucky
North Carolina
South Carolina
Virginia
Delaware
Maryland
Rhode Island
New Hampshire
Maine
What does a person need to report about their criminal record?
pending criminal charges or anything beyond a class C misdemeanor
True or False: Falsifying information to BON can be more damaging than the actual criminal behavior.
True; Inform BON of your misconduct instead of hiding it
Categories of Trust
Honesty, Accountability, Trustworthiness, Reliability, and Integrity
Integrity
Taking responsibility for actions and inactions
What is the the highest level of responsibility of the nurse?
duty to the patient
Boundary Violations
Flirtations, selective communications, “You and me against the world”, secretive behavior
