Legal & Ethical Standards in Healthcare Flashcards

Which landmark 1965 case established that a hospital can be held directly liable for failing to monitor the quality of care provided by its medical staff?

Answer: Darling v. Charleston Community Memorial Hospital

Darling established the doctrine of corporate negligence, making hospitals responsible for overseeing physician care.

In Johnson v. Misericordia Community Hospital (1981), the hospital was found liable primarily because it:

Answer: Failed to properly investigate a surgeon's credentials before granting privileges

Misericordia is the leading negligent credentialing case, holding the hospital liable for not verifying the surgeon's background.

Under the Health Care Quality Improvement Act (HCQIA), what is the primary benefit granted to peer review participants who meet the Act's standards?

Answer: Immunity from monetary damages in suits arising from the professional review action

HCQIA grants qualified immunity from money damages, not from injunctive relief or civil rights claims.

A hospital restricts a physician's clinical privileges for 45 days due to professional competence concerns. Within how many days must the action be reported to the NPDB?

Answer: 15 days

Adverse privileging actions lasting more than 30 days must be reported to the NPDB within 15 days of the action.

Which federal list must be checked to confirm a practitioner is not excluded from participating in Medicare and Medicaid?

Answer: The OIG List of Excluded Individuals/Entities (LEIE)

The OIG LEIE identifies individuals and entities excluded from federally funded health care programs.

A credentialing specialist shares a physician's peer review file with a friend at a competing hospital without authorization. This primarily violates:

Answer: Confidentiality obligations protecting peer review and credentialing records

Credentialing and peer review files are confidential and often protected by state peer review privilege statutes.

Which situation would most likely expose a hospital to an antitrust claim during credentialing?

Answer: Denying privileges to reduce competition for existing staff physicians

Using credentialing to exclude competitors rather than for quality reasons can violate the Sherman Antitrust Act.