COT Medical Ethics, Legal and Regulatory Issues 1 — Questions and Answers
Question 1: A patient scheduled for cataract surgery tells the ophthalmic technician they are unsure whether they want to proceed and have not signed the consent form. The surgeon is ready to begin. What is the most appropriate action for the technician?
- Proceed with pre-operative preparation since the surgeon is waiting
- Notify the surgeon that the patient has not consented and is uncertain (Correct answer)
- Ask the patient to sign the consent form quickly before the surgeon arrives
- Reassure the patient and escort them to the operating room
Correct answer: Notify the surgeon that the patient has not consented and is uncertain
Informed consent must be obtained voluntarily before any procedure. The technician's duty is to halt preparation and notify the surgeon so the patient can have their questions addressed and consent obtained properly. Proceeding without consent violates patient rights and exposes the facility to legal liability.
Question 2: Under HIPAA, which of the following is permissible without obtaining specific patient authorization?
- Sharing a patient's diagnosis with their employer
- Discussing a patient's treatment with another physician directly involved in their care (Correct answer)
- Providing a patient's records to a law firm representing a third party
- Disclosing test results to the patient's spouse without the patient's knowledge
Correct answer: Discussing a patient's treatment with another physician directly involved in their care
HIPAA's Treatment, Payment, and Healthcare Operations (TPO) provisions allow protected health information to be shared among treating providers without additional authorization. The other options require explicit patient authorization or fall outside permitted disclosures.
Question 3: A COT discovers that a colleague has been billing for ancillary tests that were ordered but never actually performed. What is the ethically and legally correct response?
- Ignore it, as billing practices are not the technician's responsibility
- Confront the colleague privately and ask them to stop
- Report the fraudulent billing through appropriate channels, such as a supervisor or compliance officer (Correct answer)
- Document the observation but wait to see if it continues before acting
Correct answer: Report the fraudulent billing through appropriate channels, such as a supervisor or compliance officer
Billing for services not rendered constitutes healthcare fraud under federal law (False Claims Act). COTs have both an ethical and legal obligation to report suspected fraud through proper channels. Ignoring or delaying reporting can make the observer complicit in the fraud.
Question 4: A 16-year-old patient presents alone for a routine vision examination. The parent has signed a general consent for care on file. The technician is asked to perform corneal topography, a test not typically included in a routine exam. What is the best course of action?
- Perform the test since a general consent is on file
- Refuse the test until the patient turns 18
- Contact a parent or guardian to obtain consent for the additional procedure (Correct answer)
- Ask the patient to sign their own consent form for the additional test
Correct answer: Contact a parent or guardian to obtain consent for the additional procedure
A minor generally cannot provide legally binding consent for medical procedures except in specific circumstances (e.g., emancipated minors, emergency care). A general consent on file does not cover additional unanticipated procedures. The appropriate step is to obtain parental or guardian consent before proceeding.
Question 5: Which federal law specifically governs the privacy and security of electronically transmitted patient health information in ophthalmology practices?
- The Americans with Disabilities Act (ADA)
- The Health Insurance Portability and Accountability Act (HIPAA) (Correct answer)
- The Stark Law (Physician Self-Referral Law)
- The Emergency Medical Treatment and Labor Act (EMTALA)
Correct answer: The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA establishes national standards for protecting individually identifiable health information, including electronic health records and transmissions. The HIPAA Privacy and Security Rules directly govern how ophthalmology practices must handle, store, and transmit patient data.
Question 6: A patient requests a copy of their complete medical record, including images from their retinal photography session. The office manager tells the COT to only provide the written notes, not the images, to save copying costs. What should the COT understand about this situation?
- The office manager is correct; images are not considered part of the medical record
- Patients have the right under HIPAA to access their complete designated record set, which includes diagnostic images (Correct answer)
- The practice may legally withhold images until the patient pays an additional imaging fee
- Images may only be released with a court order
Correct answer: Patients have the right under HIPAA to access their complete designated record set, which includes diagnostic images
Under HIPAA, patients have the right to access their 'designated record set,' which includes all records used to make decisions about care, including diagnostic images such as retinal photographs. Withholding portions of the record to reduce costs is not a valid reason for denial and could violate federal patient rights regulations.
COT Medical Ethics, Legal and Regulatory Issues 1
A patient scheduled for cataract surgery tells the ophthalmic technician they are unsure whether they want to proceed and have not signed the consent form.
The surgeon is ready to begin.
What is the most appropriate action for the technician?