COT Medical Ethics, Legal and Regulatory Issues 3 — Questions and Answers
Question 1: A COT suspects that an elderly patient's unexplained bilateral periorbital bruising may be the result of physical abuse. The patient insists it was accidental and begs the technician not to tell anyone. What is the COT's legal obligation?
- Respect the patient's wishes and maintain confidentiality
- Document the suspicion and report it to the supervising ophthalmologist immediately (Correct answer)
- Contact law enforcement directly without informing the ophthalmologist
- Note the concern in the chart but take no further action unless the patient consents
Correct answer: Document the suspicion and report it to the supervising ophthalmologist immediately
Mandatory elder abuse reporting laws supersede patient confidentiality. The COT must document the suspicion and bring it to the supervising ophthalmologist, who is ultimately responsible for making the mandatory report to the appropriate authorities. COTs do not typically file reports independently but must escalate through the proper clinical chain.
Question 2: A pharmaceutical representative offers the ophthalmology practice free samples of a new glaucoma drop and requests that the practice track and report patient outcomes. Which ethical concern does this arrangement most directly raise?
- Violation of OSHA hazardous material regulations
- Breach of Medicare anti-kickback statutes
- Conflict of interest that may influence prescribing decisions (Correct answer)
- Violation of FDA drug approval protocols
Correct answer: Conflict of interest that may influence prescribing decisions
Accepting free samples contingent on tracking patient outcomes for a pharmaceutical company creates a conflict of interest. The physician's prescribing decisions could be influenced by the relationship with the rep rather than by what is medically best for the patient. This arrangement must be evaluated carefully under ethical guidelines for physician-industry relationships.
Question 3: A patient's employer calls the ophthalmic practice requesting the results of a recent visual acuity exam, stating it is needed to determine whether the patient can continue working as a truck driver. How should the COT handle this request?
- Release only the visual acuity result since it is not a diagnosis
- Provide the information because occupational safety is a HIPAA exception
- Decline to release any information without a signed patient authorization or court order (Correct answer)
- Transfer the call to the ophthalmologist who can release information verbally
Correct answer: Decline to release any information without a signed patient authorization or court order
Under HIPAA, a patient's employer is not automatically authorized to receive protected health information. Even occupational relevance does not override this requirement. A signed patient authorization or a legally valid court order or subpoena is required before any PHI can be released to an employer.
Question 4: During a busy clinic day, an ophthalmologist instructs the COT to instill a topical anesthetic and then perform a Goldmann applanation tonometry measurement independently, without the physician present. Which principle applies to this situation?
- The COT may proceed because tonometry is a standard technician task
- The COT must refuse because instilling drops is outside all technician scope of practice
- The COT should act only within the legally defined scope of practice for the state and ensure physician supervision as required (Correct answer)
- The COT can proceed provided the patient gives verbal consent
Correct answer: The COT should act only within the legally defined scope of practice for the state and ensure physician supervision as required
Scope of practice for ophthalmic technicians varies by state law. In many states, COTs can instill drops and perform tonometry under physician supervision or pursuant to a standing order. The COT must know the specific state regulations and ensure the level of supervision required by law is met — patient consent alone does not override scope-of-practice rules.
Question 5: A patient who is hard of hearing arrives for an exam and requests a qualified sign language interpreter. The practice declines, saying the patient can bring a family member. Under which law is this most likely a violation?
- HIPAA Privacy Rule
- Americans with Disabilities Act (ADA) (Correct answer)
- Occupational Safety and Health Act (OSHA)
- Medicare Conditions of Participation
Correct answer: Americans with Disabilities Act (ADA)
The Americans with Disabilities Act requires healthcare providers to provide effective communication for patients with disabilities, which may include providing a qualified sign language interpreter. Requiring a patient to bring their own family member as interpreter is generally not considered adequate under the ADA and may compromise informed consent and patient confidentiality.
Question 6: A COT discovers that a co-worker has been logging into the EHR and viewing the records of a well-known local celebrity patient out of curiosity, without any clinical reason. What is the most appropriate first action?
- Warn the co-worker privately and document the warning
- Ignore it since no information was shared outside the practice
- Report the behavior to the practice's privacy officer or compliance department (Correct answer)
- Ask the celebrity patient whether they mind before escalating
Correct answer: Report the behavior to the practice's privacy officer or compliance department
Accessing patient records without a legitimate clinical purpose is a HIPAA violation regardless of whether the information was shared externally. The COT is obligated to report the breach to the practice's privacy officer or compliance department. Ignoring it or handling it informally does not satisfy legal and ethical obligations and could expose the practice to significant liability.
COT Medical Ethics, Legal and Regulatory Issues 3
A COT suspects that an elderly patient's unexplained bilateral periorbital bruising may be the result of physical abuse.
The patient insists it was accidental and begs the technician not to tell anyone.
What is the COT's legal obligation?