CPHRM Legal Issues 2 — Questions and Answers
Question 1: Under EMTALA, a hospital with an emergency department must provide a medical screening examination to:
- Only patients with insurance coverage
- Any individual who presents seeking examination or treatment (Correct answer)
- Only patients who are US citizens
- Patients referred by a physician
Correct answer: Any individual who presents seeking examination or treatment
EMTALA requires hospitals to provide a medical screening exam to any individual who presents to the emergency department, regardless of insurance status or ability to pay.
Question 2: A hospital risk manager learns that a physician has been performing procedures without current privileges for that specific procedure. The FIRST action should be:
- Immediately revoke the physician's medical license
- Notify the state licensing board
- Suspend the physician's ability to perform that procedure and initiate a peer review (Correct answer)
- File a report with the National Practitioner Data Bank
Correct answer: Suspend the physician's ability to perform that procedure and initiate a peer review
The immediate priority is patient safety by stopping the unauthorized procedures, followed by a formal peer review process through the credentialing committee.
Question 3: The legal doctrine of res ipsa loquitur allows a plaintiff to establish negligence without direct proof when:
- The defendant is a licensed professional
- The injury would not ordinarily occur without negligence and the defendant had control (Correct answer)
- The plaintiff has filed a complaint with a licensing board
- The hospital has admitted liability
Correct answer: The injury would not ordinarily occur without negligence and the defendant had control
Res ipsa loquitur applies when the injury speaks for itself — it wouldn't normally occur without negligence and the defendant controlled the instrumentality causing harm.
Question 4: Which federal law requires healthcare organizations to establish and maintain written policies on advance directives for adult patients?
- HIPAA
- The Patient Self-Determination Act (PSDA) (Correct answer)
- The Americans with Disabilities Act
- The Affordable Care Act
Correct answer: The Patient Self-Determination Act (PSDA)
The Patient Self-Determination Act requires Medicare and Medicaid participating facilities to inform patients of their rights to make decisions including advance directives.
Question 5: A nurse overhears a patient threaten to harm a specific person upon discharge. Under the Tarasoff duty, the provider's obligation is to:
- Maintain strict patient confidentiality and take no action
- Warn the identifiable potential victim and notify authorities (Correct answer)
- Only document the threat in the medical record
- Report solely to the hospital ethics committee
Correct answer: Warn the identifiable potential victim and notify authorities
The Tarasoff decision established that mental health professionals have a duty to protect identifiable third parties from credible threats, which may include warning the potential victim and/or notifying law enforcement.
Question 6: In the context of healthcare litigation, 'discovery' refers to:
- A hospital's internal incident investigation
- The pre-trial process of obtaining evidence from the opposing party (Correct answer)
- A physician's duty to disclose diagnoses to patients
- The risk manager's root cause analysis
Correct answer: The pre-trial process of obtaining evidence from the opposing party
Discovery is the pre-trial legal process through which parties exchange information and evidence, including depositions, interrogatories, and document requests.
Question 7: A hospital's quality improvement committee proceedings are most likely protected from discovery under:
- HIPAA Privacy Rule
- State peer review privilege statutes (Correct answer)
- The Joint Commission standards
- Federal tort reform legislation
Correct answer: State peer review privilege statutes
Most states have peer review privilege statutes that protect the confidential proceedings of quality improvement and peer review committees from being used as evidence in malpractice litigation.
CPHRM Legal Issues 2
Under EMTALA, a hospital with an emergency department must provide a medical screening examination to: