COT Medical Ethics, Legal and Regulatory Issues 5 — Questions and Answers
Question 1: A patient presents with signs of physical abuse, including multiple bruises in various stages of healing. The patient asks the ophthalmic technician to keep this information confidential. What is the technician's legal obligation?
- Honor the patient's request for confidentiality and document only the eye findings
- Report the suspected abuse to the supervising physician and follow mandatory reporting protocols (Correct answer)
- Discuss the situation with other staff members to gather more opinions before acting
- Refer the patient to social services without informing the physician
Correct answer: Report the suspected abuse to the supervising physician and follow mandatory reporting protocols
Healthcare workers, including ophthalmic technicians, are mandated reporters under state laws. Suspected abuse must be reported to the supervising physician and appropriate authorities regardless of a patient's request for confidentiality. Mandatory reporting laws supersede general patient confidentiality rules in cases of suspected abuse.
Question 2: A patient enrolled in a clinical research trial asks the ophthalmic technician to explain the risks of the experimental treatment. The technician is not a co-investigator on the study. What is the most appropriate response?
- Explain the risks as best as possible using the informed consent form the patient has
- Decline to discuss risks and direct the patient to the principal investigator or study coordinator (Correct answer)
- Tell the patient that risks are minimal since the study was IRB-approved
- Review the patient's chart and summarize the risks documented there
Correct answer: Decline to discuss risks and direct the patient to the principal investigator or study coordinator
Detailed discussion of research risks and benefits must be conducted by the principal investigator or a designated co-investigator. An ophthalmic technician who is not part of the research team is outside their scope of practice if they attempt to counsel patients about experimental treatment risks. The appropriate action is to direct the patient to the proper research personnel.
Question 3: A patient has a valid advance directive stating they do not want resuscitation (DNR). While undergoing a minor ophthalmic procedure, the patient becomes unresponsive. What should the technician do?
- Immediately begin CPR since the procedure environment overrides advance directives
- Do nothing and wait for the patient to recover on their own
- Notify the physician immediately and follow the established DNR order per facility policy (Correct answer)
- Call 911 and begin CPR while waiting for emergency services
Correct answer: Notify the physician immediately and follow the established DNR order per facility policy
A valid advance directive legally guides care decisions. The technician should immediately notify the physician and follow the DNR order in accordance with facility policy and state law. Overriding a valid DNR without physician authorization violates patient autonomy and legal directives. The physician is responsible for directing the response within the parameters of the advance directive.
Question 4: An ophthalmic technician notices that the billing department has been routinely coding a brief patient history and visual acuity measurement as a comprehensive eye examination to receive higher reimbursement from Medicare. What is this practice called and what should the technician do?
- This is known as upcoding — a form of Medicare fraud; the technician should report it to the compliance officer or appropriate authority (Correct answer)
- This is standard practice called code bundling and does not require any action
- This is called downcoding and the technician should inform the physician to bill at an even higher level
- This is an administrative error and should be corrected only if Medicare audits the practice
Correct answer: This is known as upcoding — a form of Medicare fraud; the technician should report it to the compliance officer or appropriate authority
Billing for a higher level of service than was actually provided is called 'upcoding' and constitutes Medicare fraud under the False Claims Act. Healthcare workers who become aware of fraudulent billing have an ethical and legal obligation to report it through internal compliance channels or, if necessary, to external authorities such as the OIG. Failure to report known fraud can also carry legal consequences.
Question 5: A Jehovah's Witness patient scheduled for ocular surgery that may require a blood transfusion has signed a form refusing blood products. During surgery, the patient loses a significant amount of blood and the surgeon believes a transfusion is necessary to save the patient's life. What is the correct course of action?
- Administer the transfusion immediately since preserving life overrides religious objections
- Contact the patient's family to obtain surrogate consent for the transfusion
- Honor the patient's refusal and use all available bloodless medical alternatives while respecting the signed refusal (Correct answer)
- Delay the surgery and obtain a court order to authorize the transfusion
Correct answer: Honor the patient's refusal and use all available bloodless medical alternatives while respecting the signed refusal
A competent adult patient's right to refuse medical treatment, including blood transfusions, is a fundamental legal and ethical principle rooted in patient autonomy. A signed informed refusal is legally binding. The care team must honor the refusal and use all available bloodless alternatives (such as volume expanders, controlled hypotension, or blood salvage techniques). Overriding a competent patient's informed refusal constitutes battery, even in life-threatening situations.
Question 6: An ophthalmic technician is asked by a pharmaceutical sales representative to provide a list of patients who use a competing eye drop medication so that the company can send them promotional materials. How should the technician respond?
- Provide only de-identified patient data since it does not technically violate HIPAA
- Agree to share the list only if the representative signs a confidentiality agreement
- Decline, as sharing patient medication information with pharmaceutical companies violates HIPAA (Correct answer)
- Check with the office manager before sharing since it may be an approved marketing partnership
Correct answer: Decline, as sharing patient medication information with pharmaceutical companies violates HIPAA
Patient medication information is Protected Health Information (PHI) under HIPAA. Disclosing PHI to pharmaceutical companies for marketing purposes — without explicit patient authorization — is prohibited regardless of whether the data appears de-identified or whether a confidentiality agreement is signed. Such disclosure could result in significant civil and criminal penalties for the technician and the practice. The correct response is to immediately decline and, if appropriate, report the solicitation to the compliance officer.
COT Medical Ethics, Legal and Regulatory Issues 5
A patient presents with signs of physical abuse, including multiple bruises in various stages of healing.
The patient asks the ophthalmic technician to keep this information confidential.
What is the technician's legal obligation?