COT Medical Ethics, Legal and Regulatory Issues 5

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?

Accepted Answer

Report the suspected abuse to the supervising physician and follow mandatory reporting protocols

Answer

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?

Accepted Answer

Decline to discuss risks and direct the patient to the principal investigator or study coordinator

Answer

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?

Accepted Answer

Notify the physician immediately and follow the established DNR order per facility policy

Answer

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?

Accepted Answer

This is known as upcoding — a form of Medicare fraud; the technician should report it to the compliance officer or appropriate authority

Answer

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?

Accepted Answer

Honor the patient's refusal and use all available bloodless medical alternatives while respecting the signed refusal

Answer

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.

COT - Certified Ophthalmic Technician Practice Test

COT - Certified Ophthalmic Technician Practice Test

COT Medical Ethics, Legal and Regulatory Issues 5