COT Medical Ethics, Legal and Regulatory Issues 4 — Questions and Answers
Question 1: An ophthalmologist asks a COT to independently diagnose a patient's condition and prescribe treatment while the physician steps out. Which of the following is the most appropriate response?
- Perform the diagnosis and prescribe as instructed since the physician delegated the task
- Decline, as diagnosis and prescribing are outside the COT's legal scope of practice (Correct answer)
- Attempt the diagnosis but document that the physician was unavailable
- Ask the patient to wait and proceed only if the physician does not return within 30 minutes
Correct answer: Decline, as diagnosis and prescribing are outside the COT's legal scope of practice
Diagnosis and prescribing are outside the legal scope of practice for a COT. Even when delegated by a physician, a COT cannot perform tasks that require a medical license. Performing such tasks exposes both the technician and the practice to legal liability.
Question 2: Under OSHA's Bloodborne Pathogen Standard, which of the following is the ophthalmic practice's PRIMARY obligation following a needlestick injury to a COT?
- File an incident report within 30 days and offer the employee optional HIV testing
- Immediately document the exposure and provide the employee with a confidential medical evaluation at no cost (Correct answer)
- Notify the state health department within 24 hours and quarantine the exposed area
- Require the employee to cover the cost of post-exposure prophylaxis from their health insurance
Correct answer: Immediately document the exposure and provide the employee with a confidential medical evaluation at no cost
OSHA's Bloodborne Pathogen Standard requires employers to immediately document the exposure incident and provide the affected employee with a confidential medical evaluation and follow-up at no cost to the employee. This includes testing, counseling, and post-exposure prophylaxis if indicated.
Question 3: A pharmaceutical representative offers a COT free sports tickets in exchange for recommending their eye drops to patients. Accepting this gift would most likely violate:
- The Americans with Disabilities Act (ADA)
- The federal Anti-Kickback Statute (Correct answer)
- HIPAA's minimum necessary standard
- OSHA's workplace safety regulations
Correct answer: The federal Anti-Kickback Statute
The federal Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals or recommendations of items or services covered by federal healthcare programs. Accepting gifts in exchange for recommending specific products violates this law.
Question 4: A patient with glaucoma is being seen regularly at your clinic. Due to a scheduling dispute, the ophthalmologist informs the patient they are dismissed from the practice effective immediately, with no referral or transition plan provided. This situation best describes:
- Informed refusal
- Therapeutic privilege
- Patient abandonment (Correct answer)
- Contributory negligence
Correct answer: Patient abandonment
Patient abandonment occurs when a provider unilaterally terminates the physician-patient relationship without giving the patient adequate notice, time to find alternative care, or a referral — particularly when the patient still has an ongoing medical need. This is an ethical and legal violation.
Question 5: A COT is reviewing a patient's chart and notices the ophthalmologist documented a procedure that the COT knows was never performed. What is the most appropriate course of action?
- Correct the documentation yourself to reflect what actually occurred
- Ignore it, since the physician is responsible for their own charting
- Report the discrepancy through the practice's internal compliance or reporting mechanism (Correct answer)
- Inform the patient directly that the documentation is inaccurate
Correct answer: Report the discrepancy through the practice's internal compliance or reporting mechanism
Falsifying medical records is fraud. The appropriate action for a COT who identifies a documentation discrepancy is to report it through the practice's internal compliance channel or to a supervisor — not to alter records themselves or ignore the issue. Altering another provider's documentation without authorization is also a violation.
Question 6: A parent calls requesting the complete medical records of their 17-year-old child who was treated for a sexually transmitted infection. Under most state laws and HIPAA, the practice should:
- Release all records immediately since the parent is the legal guardian
- Release only the records unrelated to the STI, as minors may have confidential rights for certain sensitive treatments (Correct answer)
- Refuse to release any records until the patient turns 18
- Release the records only if the physician personally reviews them first
Correct answer: Release only the records unrelated to the STI, as minors may have confidential rights for certain sensitive treatments
Under HIPAA and most state laws, minors can have the right to consent to and control records related to certain sensitive services — including STI treatment — without parental involvement. In such cases, the practice should release only the records for which the parent has legal access, protecting the minor's confidential information.
COT Medical Ethics, Legal and Regulatory Issues 4
An ophthalmologist asks a COT to independently diagnose a patient's condition and prescribe treatment while the physician steps out.
Which of the following is the most appropriate response?