CPHRM Legal Issues 3 — Questions and Answers
Question 1: Which element is NOT required to establish a claim of medical malpractice?
- Duty of care owed to the patient
- Breach of the standard of care
- Proof of intentional misconduct (Correct answer)
- Causation linking the breach to the harm
Correct answer: Proof of intentional misconduct
Medical malpractice is a negligence claim requiring duty, breach, causation, and damages — intentional misconduct is not required and would constitute a separate tort.
Question 2: The Health Insurance Portability and Accountability Act (HIPAA) permits disclosure of protected health information without patient authorization for:
- Marketing purposes with patient opt-out
- Treatment, payment, and healthcare operations (Correct answer)
- Employment decisions by the patient's employer
- Research conducted by non-covered entities without IRB approval
Correct answer: Treatment, payment, and healthcare operations
HIPAA's TPO exception permits disclosure of PHI without authorization for treatment, payment, and healthcare operations activities.
Question 3: A risk manager reviewing a case notices a nurse's note was altered after an adverse event without documentation of the correction. This situation presents a risk of:
- Only a HIPAA violation
- Spoliation of evidence and potential fraud claims (Correct answer)
- A minor documentation deficiency only
- An administrative sanction from The Joint Commission
Correct answer: Spoliation of evidence and potential fraud claims
Altering medical records after an adverse event without proper correction notation can constitute spoliation of evidence, obstruction of justice, and fraud, dramatically increasing litigation risk.
Question 4: Under the False Claims Act, a qui tam relator is best described as:
- A federal investigator assigned to healthcare fraud cases
- A private individual who files a lawsuit on behalf of the government alleging fraud (Correct answer)
- A hospital compliance officer
- A state attorney general representative
Correct answer: A private individual who files a lawsuit on behalf of the government alleging fraud
The False Claims Act's qui tam provision allows private citizens (whistleblowers) to file suit on behalf of the government and share in any recovery for reporting fraudulent claims.
Question 5: A patient who lacks decision-making capacity requires emergency surgery and no surrogate is available. The ethically and legally appropriate action is to:
- Delay surgery until a surrogate is located
- Proceed with surgery under the emergency exception to informed consent (Correct answer)
- Obtain a court order before proceeding
- Contact the nearest family member listed in the record
Correct answer: Proceed with surgery under the emergency exception to informed consent
In a true emergency where treatment cannot be delayed, the law recognizes an exception to informed consent, allowing providers to act in the patient's best interest.
Question 6: The 'locality rule' in medical malpractice standards of care has largely been replaced by:
- A national standard of care reflecting what a reasonably competent physician would do (Correct answer)
- A state-by-state statutory standard
- The CMS Conditions of Participation standard
- An evidence-based standard set by specialty boards
Correct answer: A national standard of care reflecting what a reasonably competent physician would do
Modern malpractice law generally applies a national standard of care — what a reasonably competent physician in the same specialty would do — rather than the outdated locality-based standard.
Question 7: A hospital is vicariously liable for the negligent acts of an employed physician under the doctrine of:
- Ostensible agency
- Respondeat superior (Correct answer)
- Corporate negligence
- Charitable immunity
Correct answer: Respondeat superior
Respondeat superior holds employers liable for the negligent acts of employees committed within the scope of their employment.
CPHRM Legal Issues 3
Which element is NOT required to establish a claim of medical malpractice?