TEXAS LPC JURISPRUDENCE EXAM AND STUDY GUIDE, Exams of Nursing

Download TEXAS LPC JURISPRUDENCE EXAM AND STUDY GUIDE and more Exams Nursing in PDF only on Docsity! 1 | P a g e TEXAS LPC JURISPRUDENCE EXAM AND STUDY GUIDE WITH ACTUAL REAL QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST |GUARANTEED PASS |LATEST UPDATE If a physician is treating a patient suffering from chronic pain with extended drug therapy, and enters into a written pain management agreement with a patient, which of the following is not required to be included in the agreement? C. the patient agrees to see a mental health professional If a physician is going to treat a patient with an alternative treatment instead of the standard of care, the treatment plan must: D. All of the above Which of the following is true regarding the corporate practice of medicine in Texas? B. Corporate practice of medicine is prohibited If patient medical records are requested in an emergency, you may still charge the patient. B. False Dr. K's sister asks her to prescribe antibiotics to her minor child. Dr. K does not believe that antibiotics are indications... is insistent so Dr. K writes the prescription. Is this a violation of the Medical Practice Act or Board rules? A? Texas law requires that when a physician dispenses a controlled substance, they must maintain prescribing records under the Controlled Substances Act be kept for a minimum of how many years? C. 2 years and any other minimum required by federal law After your Texas License is issued to you by the Medical Board, you must: C. Register 2 | P a g e A physician who has just completed residency in any specialty may advertise as being "board eligible" in that specialty. B. False Patient Sally requests her medical records from Dr. P. However, Dr.P's staff person who copies is on maternity leave. How long does Dr.P have to comply with the patient's request? C. 15 business days The Medical Board will notify you by mail at least 30 days before your registration permit expires. B. False 60 days Dangerous drugs or devices are those that are unsafe for self-medication and that are not classified as controlled substances under the Texas Controlled Substances Act. A. True A licensed physician who suffers from an impairment that affects their ability to actively practice medicine must report this impairment to the Medical Board at the time they renew their license. A. True A physician is required to notify the Medical Board within 30 days of the following events except: C. Obtaining board certification You have been practicing in Texas for a couple of years when you realize that your registration has been expired for 24 days. Which is the best course of action? B. Go online and renew In Texas, a pregnant minor is emancipated for all purposes. B. False Is a free standing clinic owned by a hospital considered a facility-based practice for the purposes of supervising a PA or APRN? No Generally, a physician may only delegate prescribing authority to how many physician assistants or advanced practice registered nurses combined? C.7 Medical Board complaints filed at the State Office of Administrative Hearings against a physician are disclosed in the physician's public profile. B. False The definition of "dangerous drug" includes scheduled narcotics. B. False 5 | P a g e A physician or surgeon may not accept or agree to accept any payment, fee, reward or anything of value for soliciting patients or patronage for any physician or surgeon. A violation constitutes a Class A misdemeanor and each payment, reward, or fee or agreement to accept a reward or fee is a separate offense. You are the clerkship director for pediatrics at a Texas medical school. A physician you know from residency contacts you and asks if he can teach in the pediatric clerkship program. The physician has recently had his license suspended by the Medical Board. Can you allow the physician to teach at the medical school? If the treatment plan for chronic pain included extended drug therapy, the physician should consider signing a written pain management agreement between the physician and he patient outlining patient responsibilities. Can you cease to hold face-to-face meetings with an APRN to whom you have delegated prescriptive authority after the physician/delegate relationship has been firmly established and still allow the delegate to continue prescribing to patients? A controlled substance is described as: Minimum score to pass? 75% viable answers if given the choice? "all of the above" "which of the following is not" Texas Occupations & Administrative Codes that involve time periods answers are usually? when in doubt, choose 30 How much time to report child abuse/neglect? 48 hours Issuing a birth certificate you have how much time? 5 days using a death certificate you have how much time? 10 days How much time do you have to report most communicable diseases? 7 days How much time do you have to report tuberculosis and pertussis? 1 day how much time to supply medical records 6 | P a g e 15 days What does TMB stand for? Texas Medical Board TMB composes of how many people? 19 How many physicians in TMB 12 How many laypersons on the TMB 7 TMB are appointed by the Governor for how long? 6 year terms What else does the TMB have authority over? granting licensure and taking them away (disciplinary actions) What does MPA stand for? Texas Medical Practice Act all doctors must adhere to what when practicing medicine in Texas? MPA Laws covered by MPA ONLY apply to? Texas-licensed physicians while practicing in Texas ALSO- non instant physicians providing services to patience in Texas. Who does the MPA NOT apply to? other healthcare providers like: nurses, medical students and other doctors which include dentist, podiatrists, optometrists Non-compensated emergency care does not apply to? MPA What are the Texas Medical Licensure requirements? #1 complete college (60 credit hours) What are the Texas Medical Licensure requirements? #2 MD or DO 7 | P a g e What are the Texas Medical Licensure requirements? #3 pass USMLE steps 1-3 (within 7 years) an Texas JP exam What are the Texas Medical Licensure requirements? #4 complete your intern (PGYL) year Texas Medical License states that... Any US- trained grad finished with the step exam can apply for their full Texas Medical Licensure after completing their internship corollary #1 for Texas medical licensure states that... if you quit your residency after internship, you can still practice as a fully licensed physician in Texas ( but not certified in specialty) Corollary #2 for Texas Medical Licensure states that.. Naturopathic doctors, podiatrists, optometrist, chiropractors, dentist, and any other doctors are thus not licensed as physicians by the TMB If you quit your residency what can you still do in the state of Texas? practice as a fully licensed physician but without a certification or specialty. Who's not licensed by the TMB as physicians in Texas? Naturopathic doctors, podiatrists, optometrist, chiropractors, dentist, and any other doctors (they have their own governing bodies and rules) How often do you have renew your license? every 2 years (after initial license period) * which means you have between 12-24 months to renew license without being fined Will you receive a fine if your license is expired less than 30 days? No You will be fined $75 if your licensed is not renewed before how many days? 90 days You will be fined $145 if your licensed is not renewed before how many days? 365 days If you haven't renewed your license in a year what are the consequences? you must reapply for license and handover entire processing fee. If you wait longer than 2 years to renew your Texas license what happens? 10 | P a g e good standing in another state, board - certified in your specialty and to not physically practice in the state of TX. States that the TX telemedicine licensure are contiguous with are? Oklahoma, Arizona, Louisiana, and New Mexico What can these contiguous states do? can order home heath and hospice services for patients in Texas without a special telemedicine license. Non-direct patient care states... DO NOT need license or special permit to provide your expert opinion to other physicians or for any educational services within or across state lines. Non-direct patient care states that you can teach when? at your local medical school before you pass JP exam Do you need an additional license to produce, use and transport radioactive material? yes Who does radioactive material license generally apply to? radiologist practicing nuclear medicine, interventional oncology, or radiation oncologist. what is workers compensation? is a no-fault no-lawsuit statutory system for the payment of work-related injuries. Worker Compensation states... the employee gets money for an injury regardless of who's at fault and who caused it. Worker compensation states that any doctor can.. perform an initial visit Worker compensation says that the doctor performing the initial visit must be approved by whom? Texas Department of Insurance (TDI) list to evaluate workers comp visits and get paid. What do residents practice under that's institution specific? physician-in-training permit (PIT) what does PIT stand for? physician-in-training what happens if you change residency? apply for new PIT permit 90 days before switching 11 | P a g e Does TMB offer reciprocity for other state licensure NO podiatrist ______ admit patients can not TMB and MPA are _____ physician-centric Podiatrists may be doctors, but ____ they cannot admit patients to a hospital independlty Podiatrist patients must be admitted under an _____ MD or DO physician Physicians can delegate any task (medical act) they want to___ anyone acting under their supervision ex: nurses, techs, medical student and midlevel practitioners who can prescribe controlled substances (schedule III and IV) under the license of their supervising physician? NPs and PAs Who's responsible for any delegated action and their consequences? supervising physician Various Liability any delegated action and consequences are the supervising physicians responsibility Do midlevels purchase their own liability insurance? and why? no, because if one messes up the physician or hospital that pays is liable Standing orders do not require using any independent______ medical judgment Why does the ER department use EKG and CXRs for pregnancy test for women under 50 and when patients have concern of chest pains? Because standing orders do not require using any independent medical judgment Midlevels (PA) physician assistants APRN 12 | P a g e Advanced Practical Registered Nurse APN advanced practice nurse NP nurse practitioner Physicians do not have a limit to how many ___________ they can supervise midlevels Physicians can delegate outpatient prescriptive authority to how many full-time and part-time midlevels total? full-time: 7; part time 14 How many max clinical hours can midlevels have a week? total 350 The TMB runs an online ____________, which needs to be used when applicable supervision and prescription delegation registration system ____________ and __________ care facilities have no limit on midlevels hospitals and long-term care facilities Hospital's delegating physicians can be? 1. medical director 2. chief of medical staff 3. chair of credentialing committee 4. department chair 5. physician who consents to being the delegate at request of the medical director lon-term facility delegating physician is? medical director facility-based delegation can only delegate to_______ midlevels at one hospital or up to two long-term care facilities free-standing clinics and ERs do not qualify as ______ "facility- based practices", for the purpose of superseding the 7 FTE rule 7 FTE rule is waived when supervising a rural/medically underserved population 15 | P a g e Readily visible notice must be posted for patients to see at each site of health care delivery in what language(s)? English and Spanish Signs that must be displayed prominently and in the same verbiage in every bill, registration and ______ must also be in Spanish and English. contract TMB website will have information about your degrees, experience and felonies and misdemeanors from any state. TMB will remove records of ___________ and ________ investigations due to the 3 claims in 5 years rules formal complaints, malpractice The 3 claims in 5 years rules state? after 5 years if the claim did not amount to anything and no actions were taken against physician, the TMB will remove record of complaints Can a patient successfully sue a doctor if there is no physician-patient relationship? No If there is no prior physician-patient relationship, are you legally obliged to respond to a call from a patient for treatment? No Does being on call give rise to a physician-patient relationship? No How can one terminate a physician-patient relationship, without abandonment if there is ongoing treatment? 30 days written notice; must provide for emergency Does a physician's duty extend to the unborn child or potential victims of an ill patient? Yes What is "proximate cause"? Prove that negligence caused harm and that the cause was not too remote; what is required to hold a defendant liable in a civil lawsuit What are the two components of proximate cause? Cause-in-fact (but-for test) and foreseeability 16 | P a g e Does an expert witness have to be actively practicing medicine? Yes Does an expert witness have to know standards of care? Yes Does an expert witness have to have enough training to express an opinion on whether standard of care was provided? Yes Does an expert witness have to be board certified? No, board certified or eqivalent In a medical malpractice case, are expert witnesses required? Yes, with two exceptions In a medical malpractice setting, what 2 instances do not need expert testimony? Res ipsa loquitur (e.g., amputation of wrong leg) and negligence per se (a law was broken) What are "exemplary damages"? Damages above compensatory designed to punish the defendant and deter the behavior Is there a cap to noneconomic damages? How much? $250,000 for physicians, $500,000 for hospitals Does the cap on noneconomic damage depend on the number of defendants or claimants? No What is "proportional responsibility"? Percentage of liability apportioned according to percentage of fault Can the claimant have part of the proportional responsibility? Yes If the claimant's proportionate responsibility is more than what %, he/she may not recover damages? If > 50%, no damages awarded How long is the statute of limitations for adults? For minors? 2 years; for minors 2 years after becoming 18 years of age By how much can the statute of limitations be extended and how? File complaint—extra 60-day, notice letter extends statute by 75 days 17 | P a g e What is the statute of limitations for wrongful death? 2 years What is the discovery rule? Give examples. Statute does not begin until damage is discovered. For example, a retained sponge that is found 3 years post-op Is there immunity from civil action in emergency cases? Yes, except gross negligence Is there immunity from civil action in volunteer care? Yes, except gross negligence When can a physician be charged with "assault and battery"? Un-consented surgery or examination or when exceeding the scope of the consent When can a physician be charged with patient abandonment? Unilateral cessation of treatment when continued treatment is necessary What is "strict liability"? Liability that does not depend on actual negligence, but that is based on a breach of a duty to make something safe. This often applies to product liability Are hospitals liable for the actions of a physician? No, unless the hospital employs the physician Who determines in a criminal case if the medical records of a patient should be released? Judge by inspection How many days do you have to release medical records to an attorney? 45 days Can medical records be admitted as evidence in court? What are the requirements? Yes, but only with affidavit What are schedule 1, 2, 3, 4, 5 drugs? Schedule 1—no known use (e.g., heroin); schedule 2—very addictive (morphine, cocaine); schedule 3- 5—less addictive What are dangerous drugs? Prescription drugs other than schedule 1-5 How many DEA registrations do you need if you prescribe drugs? dispense drugs? 20 | P a g e To give anesthesia, how often do you have to register with the board? Every 2 years What life support competency do surgeons and anesthesiologists need? ACLS, PALS, or board-approved course How many and what competency levels of healthcare providers do you need in all settings? At least 2 physicians with advanced competency How many days do you have to report office-based anesthesia-related complications? 15 days What is considered an anesthesia-related complication? Admission to hospital within 24 hours or death within 72 hours What is considered intractable pain? Pain where cause of pain cannot be removed and where relief or cure has not been found Can a hospital forbid a physician to give dangerous drugs or controlled substances for treatment of intractable pain? No Can the board take disciplinary action against a physician for giving dangerous or controlled substances to a patient with intractable pain? No What must the physician document prior to treatment of intractable pain? Understanding between physician and patient about treatment; dose, type, frequency of medication; consultation with psychologist, psychiatrist, addictions expert Can you guarantee that a drug will work? No Who can be part of a confidential communication? Persons involved, furthering interest of the patient, and those participating in diagnosis or treatment, e.g., patients, doctors, translators, nurses, etc Is the billing record confidential? No, billing record is NOT part of medical record In a criminal proceeding, is the physician-patient privilege communication confidential? NO (except for mental health records); judicial ruling should be obtained 21 | P a g e In a criminal proceeding, are records of alcohol and drug abuse confidential? Yes Does the physician confidentiality apply to court or administrative proceedings brought by the patient against a physician? No Can the physician violate confidentiality if he/she thinks he or someone else is in danger? Yes, must report that to law enforcement agency (NOT for mental health) What information must a release of medical records include? Type of records, reason, and person to whom to release How many days (hospital) or business days (physician) does a hospital/physician have to provide medical records when they are requested? Physician has 15 business days, hospital has 15 days What is "therapeutic privilege," when can it be used, who has access to the information, and what is the protocol the physician must follow? If physician thinks that information would be harmful to the patient, it can be withheld; in writing, copy in the chart; films or tests must be released to patient representative Can the physician charge for medical records and films? For an affidavit? Does he have to give the information if the patient does not pay? What does he do if the patient does not pay? Yes, can charge $25 for first 20 pages, then 15¢ per page plus postage; notarization $15, films $8; patient MUST pay to get records, 10-day notice Can you charge a patient requesting records in order to apply for disability or public aid? How many copies are patients entitled to? Can you charge if federal agency is requesting records? No; one copy; no How many years does a physician MD have to keep records for adults? for minors? How many years do hospitals have to keep records for adults? For minors? 7 years for adults, 7 years or until age 21; hospital 10 years Can a physician or hospital get rid of records after the required years if these records might be part of a litigation? No Can you relate information without patient consent for treatment? Billing? To report abuse? To law enforcement? For funeral directions? For worker's comp? Yes, all of the above 22 | P a g e What is the "minimum necessary standard" for a medical release? It protects health care information unless it is required to be released (investigation, law enforcement, authorized release, participating care providers, HIPAA compliant release) Does a patient have the right to see his/her own record? Can he/she ask for amendments to the records? Yes; yes, they can request amendments What is the Texas medical record privacy act? Is it like HIPAA? It is the state equivalent of HIPAA Within how many days must a hospital send an itemized bill to patients? Is this mandatory? Or done by request? When must the hospital inform patients of this option? Upon request, within 30 business days; hospital must inform patient of availability of itemized bill Can medical records be obtained with a subpoena? Does this include substance-abuse records? Yes; no Are substance abuse records admissible during criminal proceedings? No, unless the crime is EXTREMELY serious Is HIV information confidential? Yes Can you "break" confidentiality in order to tell a spouse that his/her spouse is HIV positive? Yes Can you break confidentiality to tell a partner about notification program?. Yes Are blood bank records confidential? Yes If a blood bank finds a donor with an infectious disease, can they call other blood banks and tell them the name of donor and the disease?Edition. They can tell name of donor, NOT disease If a blood bank finds that blood outbound to hospitals is HIV positive, can they call the hospitals and give name of donor? Type of disease? They can tell name of disease, NOT donor For statistical purposes, can a blood bank give out medical records? Names? 25 | P a g e If applicant is under prosecution, investigation, or has restrictions on license in another state How many days does the program director have to tell the board that somebody with a physician-in- training license did not show up, was suspended, etc.? 30 days What is a temporary postgraduate training permit? License for residents and fellows pending the physician in training permit What is a telemedicine license? Do you have to be board certified to have it? Do you have to pass the jurisprudence exam? A license to do consulting work through internet, etc., in Texas; cannot physically see or treat patients; board certification is required; JP exam required How often do you register your license? Do you need an updated physician profile? Every 2 years; yes How many days prior to the expiration of your license does the TMB notify you? 30 How many days after a license expires are you considered to be practicing without a license? 30 day grace period. License expired < 90 days—penalty is? $75 License expired 91-364 days—penalty is? $150 License expired > 364 days—penalty is? Cancellation Do you have to retake JP exam if your license is canceled? Only if the license is canceled for more than 2 years. How can you get another license if it is lost/destroyed? Get affidavit of lost or destroyed document and pay fee to board How many category 1 CMEs yearly? 12 How many CMEs per year? 24 26 | P a g e How many category 1 CMEs yearly must be in ethics? 1 How many category 2 CMEs can be from volunteer work? 6 How many CMEs can a license carry forward? And for how many registration periods? 48; only once How many CMEs can be applied retroactively? 24; only once How many CMEs do you need if you become "board certified" within 36 months? 24 If you practice pain management, how many CMEs in pain management are required? None, but they are recommended Who can initiate a complaint to the board? Anyone What is the "health professions council"? Council of various professionals that establishes a central telephone complaint system (800-number) Does the TMB have to notify a physician when a complaint is filed? Are there exceptions? How often do the parties get updated on proceedings? Yes, within 30 days, except if it would interfere with the investigation; updates are quarterly When does the TMB release complaint information to the hospital? Upon written request Who investigates issues of "medical competency"? An expert physician panel appointed by the board consisting of physicians ONLY What do medical malpractice carriers have to report to the TMB regarding malpractice? Within what time limit? Who punishes them if they do not report? What does a physician without insurance have to report and when? Is there a difference for NPDB/HCQIA? Within 30 days from a complaint being filed in a lawsuit, settlement; noninsured MDs have to self-report within 30 days; any payment must be reported to NPDB by HCQIA requirements Restrictive action by the TMB: Within what time limit must the board tell the hospital? Tell Medicare? Tell the secretary of health & professional societies & complainant? 27 | P a g e Next working day for hospitals; in writing for all within 30 days. Restrictive action by the TMB: How often must the board make public notices about disciplinary orders? 2 times per year. Restrictive action by the TMB: Must the board report crimes found during investigations? Yes, to the law enforcement. Restrictive action by the TMB: Within how many days must the board report to the NPDB? 30 days. Restrictive action by the TMB: Within how many days must a court report to the board about convictions, felonies, and misdemeanors and addiction issues be filed? 30 days. Are TMB reports confidential? Yes Who can the NPDB give info to? How about to patients? How about statistical data? Hospitals, self-requesting physicians, board, other state or federal agencies, attorneys; for statistical purposes if no identity disclosed When is it not illegal to perform a third-trimester abortion? To prevent mother's death, if unborn has severe irreversible brain damage When is it not illegal to perform an abortion on a minor? In emergency and with court order Is sexual contact between a physician and patient OK if the patient consents? NO, the disparity of power does not allow consent Why is it unprofessional to initially prescribe drugs over the Internet? Did not verify identity of patient, no physician coverage or follow-up guaranteed How can you terminate care to a patient? 30 day notice, certified letter, available for emergencies during that time, give alternative physicians What prescriptions does a physician need to keep records on? Dangerous drugs? Controlled substances? Samples? Samples and dangerous drugs as part of medical record; for schedule 3-5 records and log; for schedule 2 separate log and records; keep record for 2 years; do inventory on schedule drugs every 2 years Can the board administer monetary penalties? 30 | P a g e What is a standing delegation order? What are the requirements? Physician order for patient or population; signed, dated, in writing Who can a physician delegate to? Any qualified and properly trained person Who can the physician delegate to administer dangerous drugs? Any qualified and trained person Can a physician delegate to a midwife? Yes (e.g., eye prophylaxis) Is a physician liable for the actions of a NP or PA? No, unless vicariously liable due to employment What kind of name identification do PAs need? Name tag identifying themselves as a physician assistant What requirements exist for prescription for PAs and NPs? No schedule 2; maximum 90 days, no refills unless consultation with physician Which drug schedules can PAs and NPs prescribe? How many days? Can they give refills? Can they treat children? What ages? Schedules 3-5, 90 days, refill after consultation with physician; Yes, but children less than 2 years only after consultation with physician How many PA and NP equivalent FTEs can a physician supervise at maximum? 3 FTEs Can CRNAs give all anesthetic drugs? Are they restricted to a particular MD? Yes; no, any MD What authority do pharmacists have? Can they give immunizations? Where does the supervising physician have to be located geographically? Getting histories, ordering drug therapy-related tests, procedures, modifying drug therapy; yes; physician has to be able to be physically present daily What can optometrists prescribe? Eye ointments Can anybody be a surgical assistant? Do they need a license? Yes; yes, if they identify themselves as licensed, otherwise, no 31 | P a g e Can a physician delegate the taking of X-rays to noncertified technicians? Yes Can they do bone density? Nuclear tests? CT? Skull X-ray? Bone density, skull, spine, extremities, abdomen, chest; NOT CT, nuclear test, etc Do they need to be licensed or registered by the boards? Yes, they need registration What is the difference between a partnership and a limited liability partnership? The limited liability partnership can limit individual liability white partner A is liable for the acts of partner B Who can incorporate in Texas? Can physicians practice through corporations? Dentists, PT but NOT MD; MD cannot practice through corporation Are there any corporations that can employ physicians? Yes, Certified Nonprofit Healthcare Corporation Who can grant a title of Certified Nonprofit Healthcare Corporation? TMB What are 5 important characteristics of Certified Nonprofit Healthcare Corporations? Must conduct scientific research, support education, improve capabilities to study and teach, deliver health care to the public, instruct public in medical science, public health Can hospitals provide "physician guarantees"? How do the finances work? Physicians can contract with hospitals but are not employees; guarantees paid for availability, billing, etc Are there federal anti-kickback laws? Yes What does the health care insurance portability and accountability act do to federal anti-kickback provisions? Applies to all federal health care insurances = all insurances Do the anti-kickback laws apply only to Medicare and Medicaid? No Does federal anti-kickback law apply only to patient referrals? 32 | P a g e No Does this law apply only to giving money as a kickback? Who is punished, giver or taker? No, any money or monetary value; both are punished What kind of crime is a violation of anti-kickback law, and what is the penalty for physicians and hospitals? Felony; up to $250,000 for individuals and $500,000 for institutions What are safe harbors in anti-kickback law? Give examples. Acts NOT in violation of anti-kickback regulation; e.g., space and equipment rental, sale of practice, discounts, etc Are STARK laws federal? Yes What is a STARK law? Can you refer to family? Anti-self-referral law; no What is the difference between STARK 1 and STARK 2? Stark 1 applies to laboratories, Stark 2 to PT, OT services, etc What is the CIVIL FALSE CLAIMS act? Is it state or federal? How long has it been around? What does it prohibit? Submitting false claims to government for payment; federal law since War Between the States Does Texas prohibit remuneration in exchange for referral volume? Yes, prohibition on the solicitation of patients What kind of crime is it to tamper with Texas Medical Board documents? Class A Misdemeanor Barratry—what is it? Is it illegal? Contacting prospective patients in attempts to solicit them; it is illegal Who can be part of a medical peer review committee? Physicians, health care workers, anybody in the hospital Does physician competency include membership in societies, participation in education, participation in group plans? No Who makes rules (by laws) for hospitals? 35 | P a g e No; no Who is responsible to review a child's immunization record? Any physician; failure to do so has no consequence What happens if a physician does not review a child's immunization record? Nothing Do you need to consent to inform the authorities if you suspect child abuse or neglect? No In what instance can a child give consent? If on active duty, when restrictions of minor removed, for communicable disease, if pregnant for counseling, and addiction treatment Does the Consent to Medical Treatment Act apply to "incapacitated" individuals? Does it apply to psychiatry patients? Yes; yes, but not for patients in FREE-STANDING psychiatric hospitals Who can be a surrogate decision maker? What are the requirements? Spouse, adult child, majority of children, parents, or a person identified by patient before becoming incapacitated Can surrogate decision maker consent to voluntary inpatient psych treatment? ECT treatment? Appoint another surrogate decision maker? Not psych treatment, not ECT, cannot appoint another decision maker What are 3 examples of "advanced directive"? Directive to physician, out-of-hospital DNR, medical power of attorney How many witnesses do you need, and what are the witness requirements for advanced directives? 2 witnesses, one cannot be related, beneficiary, attending physician or hospital employee Can a directive to a physician be oral or must it be in writing? Can be verbal and must be documented in chart with names of witnesses Does an advanced directive have to be notarized? No How many witnesses for an oral directive? 2 How long is a directive good for? 36 | P a g e No limit, until revoked What are the 3 ways to revoke an advance directive? Written, oral, or VOID across the pages When a directive is orally revoked, what should the physician do with it? Destroy or write note on verbal revocation or write VOID across pages What happens if a physician disagrees with the directive given to him? Does not have to follow; can request ethics or medical committee with 48-hour notification for all parties What is the transfer registry? Directory of physicians or hospitals willing to accept patients in transfer who have advanced directives Is "mercy killing" allowed in Texas? No Who must sign an "out-of-hospital DNR"? Can it be verbal? Are witnesses needed? Attending physician, patient, and two witnesses; yes/no; yes/no What is the effect of an "out-of-hospital DNR"? Legally binding; patient's wishes written as a physician order If a patient's family disagrees with a patient's decision, what can they do? Must apply for temporary guardianship under Texas probate code If you see a DNR device on a patient but have not seen the form, is that enough not to give treatment? Yes, DNR device is enough Can an incompetent patient revoke their DNR? Yes Should this form accompany patients on transfers? Yes What kind of treatment can the power of attorney NOT consent to? Admission to mental health institution, ECT, psychosurgery, abortion, neglect of minimal treatment (nutrition, hydration, comfort measures) Does the power of attorney have an expiration date? No, unless specified 37 | P a g e What happens if on the expiration date the patient is incompetent? It is continued until patient becomes competent again, then expires Who cannot be the power of attorney? Principal health care provider or residential care provider or employee of those Does the power of attorney have access to the patient's medical records? Yes When can you withhold treatment to an infant? If chronically and irreversibly comatose or terminally ill and further treatment would be futile Can you withhold nutrition/hydration from a terminally ill infant? No Is the mental health directive an advanced directive act? Yes, but with differences What are the requirements for mental health directive? What are requirements for witnesses? Age 18 or not a legal minor, not incapacitated; 2 witnesses both of who cannot be related, beneficiaries, attending physician, or employees of hospital Does a mental health directive have an expiration date? Yes, 3 years or until revoked What happens if on the expiration date of a mental health directive, the patient is incapacitated? It continues until competent When can you use restraints? When can you use behavioral measures? If there is danger of harm to self or others and other measures have failed; never Does the donor have rights of a parent in artificial insemination? Does the husband? Donor NO, husband YES What prenatal maternal tests must a physician check? HIV, hepB, syphilis How many times must a physician check prenatal maternal tests? Twice; upon first examination and on admission for delivery Are prenatal maternal tests confidential and anonymous? Confidential; anonymous upon request 40 | P a g e Every physician Until when must insurance pay for immunizations? Up to age 6 Who must submit the birth certificate? Physician, midwife, or person attending birth How many days do you have to submit the birth certificate? 5 days What kind of crime is it if you don't submit a birth certificate? Misdemeanor What kind of crime is it if you submit false data on a birth certificate? Felony 3rd degree How old or young must a baby be in order for a care provider to be able to take possession of an abandoned baby? 60 days Can any money transaction be done during an adoption? Yes; only to cover expenses When is a person considered dead? Cardiac and respiratory functions cease to exist When is a ventilated person considered dead? Irreversible cessation of brain function What is the time of death for ventilated people? At time of determined brain death For your ventilated person, do you pronounce death before or after you turn off ventilator? Before Who can pronounce somebody dead? MD, PA, NP, RN Who must file the death certificate? Person in charge of interment How many days does the physician have to fill it out once it is given to him/her? 41 | P a g e 5 days for MD to fill out medical portion, 10 days to send in death certificate Do fetuses require death certificates? If 350 grams or more or 20 weeks or older Sudden infant death syndrome (SIDS) applies to children ages or younger 1 year In SIDS, is an autopsy required? Yes To whom and how fast must you report SIDS? To a justice of the peace, medical examiner, or other proper official immediately Who pays for autopsy in SIDS? State If at the time of death the physician knows that the patient had a communicable disease, what must be done to the body? Report to TDSHS and tag body to indicate caution required due to communicable disease The death of a child under ____ years must be reported. 6 years Whom do you report it to? Medical examiner or justice of the peace What must the medical examiner do for the death of a child under 6 years? Hold inquest How many days must have passed since the person was last seen in order to issue a "certificate of death by catastrophe"? 10 days Can you issue a certificate of death by catastrophe for a minor? Yes, with affidavit What is the difference between an inquest and an autopsy? Inquest is investigation only into causes of death, autopsy is postmortem body examination Who does the inquest after the death of a child under 6 years old? Medical examiner or justice of the peace 42 | P a g e Who has rights to consent to autopsy? In what order? Spouse, child, court or guardian, parent, next of kin, any person assuming custody If a person higher in hierarchy is not available, can the next person down consent to autopsy? No If a member of a class (1 out of 4 children) consents to autopsy but the other 3 do not agree, can they still do the autopsy? Yes, only one needs to consent What kind of crime is it if you assist in suicide and patient does not die? What if patient dies? Class C misdemeanor, if patient dies felony How many witnesses do you need to donate an organ if there is no will? 2 witnesses, signed Who has the power to donate the organ of a dead person? Spouse, child, parent, siblings, guardian, any authorized person How can you revoke an organ gift? Do you have to tell the donee? Yes; no Can you pronounce the death and transplant an organ in the same patient? Physician who determines death CANNOT participate in transplantation At what age and how can a mentally retarded person donate a kidney? Age 12, by petitioning the district court Can a blood bank pay for blood? How? After how many days? Yes, by mailed check, 15 days after donation What is the duty of a medical professional when treating an adult with family violence? What languages to use? Duty to treat and provide information (and document that information was provided) in English and Spanish; no need to report Does the physician have to call the police in cases of adult family violence? No, just inform victim of options What is the difference between a professional and a medical professional? Medical professional = MD; professional = anybody else, e.g., teacher Reporting of child abuse? By whom? How fast? Can it be delayed? To whom (3 entities)? 45 | P a g e Physician, dentist, veterinarian, chiropractor What sort of situations must be reported? Documented or suspected infection, exotic diseases, outbreaks Can an employee in the office do the reporting? Yes, if designated by physician If a physician reports a communicable disease, does the hospital also have to report it? Yes, both If you treat a patient with a communicable disease that dies, what are your 2 responsibilities and within what time frame? Report death immediately and put toe tag on What kind of crime is nonreporting communicable disease? Class B misdemeanor If you are a police officer, firefighter, etc., can you make somebody have an HIV test if you think you might have been exposed? Who do you call? Yes, request TDH Is the police officer, etc., required to be tested himself/herself? No If an employee is exposed, can the hospital check if the person is harboring an infective agent? Yes, to HepB, C, HIV What diseases must they test for? Hep B, C, HIV Do they need the patient's consent? No Who must report occupational exposure? Does that include labs? Physicians, labs, health care workers; labs must report abnormal lead levels What occupational exposure must be reported? Asbestosis, silicosis Do you have to report birth defects? Yes 46 | P a g e Which diseases have to be reported immediately? Diphtheria, measles, anthrax, pertussis, hemophilus, plague, rabies, SARS, smallpox, yellow fever, etc Which diseases must microbiology labs report immediately? Vancomycin-resistant staph, VRE, HIV, neisseria meningitis Can you make somebody have HIV test? What are the 4 exceptions? No, unless during pregnancy, criminal proceedings, accidental exposure, consented What kind of crime is it if you force somebody to take an HIV test? Misdemeanor A Does HIV testing consent have to be written? No Do you have to sign an HIV consent if you have signed a consent for treatment? No Do you need consent for lab testing after accidental exposure? No Does a physician have to contact the partner notification program if a patient is HIV positive and the physician suspects sexual activity? Yes Can a health care worker with exudative lesions or weeping dermatitis participate in direct patient care or handling of medical equipment? No If you are a health care worker that has HIV or hepB or HbeAg, can you perform invasive procedures that are "exposure-prone"? What are the 2 requirements? No, unless patient has been educated and has sought expert panel What if you do invasive procedures that are not exposure-prone, and you are positive for HIV, HepB or HbeAg? Do you need to inform? No need to inform Can you force rapists to undergo HIV and HepC tests? Yes Which neoplasm must be reported to the cancer registry? All 47 | P a g e Which traumatic injuries must be reported? To whom? Who is responsible to report? Spinal cord, traumatic brain, anoxia including near-drowning; to TDH; physician Do you have to report overdosing and gunshot wounds? How fast? Who are the 2 people who can report that? Yes; immediately; by physician or hospital administrator or official What kind of offense is nonreporting of traumatic injuries, overdoses or gunshot wounds? Misdemeanor What is a "commitment order"? Court order for involuntary mental health admission Who is considered an "adult" in order to proceed with voluntary psych admission? 16 and over OR anybody who has ever been legally married What are the 3 types of involuntary psych admissions? Who can order them? Emergency or temporary detention, protective custody; they are court ordered Does being on ETOH, senile, mental retardation, epilepsy constitute grounds to deny voluntary psych admission? No When you are admitted involuntarily, when can a patient be forced to take psychoactive mediations (3 cases)? (1) a medication-related emergency, (2) under a court order, (3) patient is a ward and guardian consents Do you need a separate court order to give psychoactive medications in addition to the court order for involuntary admission? Yes, you need 2 separate court orders Do you need a physician order to put patient in restraints? Yes When should you consider prescribing psychoactive medications? Medication emergency—threat to self or others ECT may not be used in people less than ___ years of age. Any exceptions? 16, no 50 | P a g e How many years must you keep records of patient transfers? 5 years Do hospitals need to keep on-call lists? Yes Can you do elective surgery when you are on call? Yes Can on-call physician refuse to show up? No, only in circumstances beyond his control What are the 3 penalties for hospitals and physicians for violation of EMTALA? What is the maximum damage? Civil money penalties, termination of provider agreement, civil action. Up to $50,000 per violation ($25,000 for < 100 beds) Can a patient initiate his/her own transfer? Yes How many people on the Texas Medical board? 19 How many MDs on the TMB? 12 How many layperson on the TMB? 7 How often does the police run a check on physicians? Monthly How often does the TMB put out reports on physicians? Every 6 months How many years of postgraduate training to apply for full license? 1 If a resident does not show up to begin his training, how many days does the program director have to report that to the board? 30 51 | P a g e Institutional permit: how many months for initial license? How many renewals? How many months for each renewal? 14 months; 7; 12 months Physician-in-training permit: how many months for initial license? How many renewals? How many months for each renewal? 18 months; 6; 18 months How often do you register your license with the TMB? Every 2 years How many days prior to expiration of your license does the board notify you? 30 How many days after expiration are you considered practicing without a license? 30 How many days after expiration is license canceled? 365 How many category 1 CMEs per year? 12 How many ethics CME credits? 1 yearly How many CME credits can be from volunteering? 6 How many CMEs can you carry forward? 48 How often must the board give update to all participants in a complaint? Every 3 months (quarterly) How much time do insurances have to report malpractice to the board? 30 days If disciplinary action is taken by the board, how much time to report to the hospital verbally? In writing? To the NPDB? Verbally immediately to hospitals on first working day; in writing to all hospitals and agencies within 30 days. 52 | P a g e How much time to report court reports to the board? 30 days How many malpractice claims in what time frame to trigger board investigation? 3 within 5 years How many people from the board to emergency suspend license? 3 How many days does a physician have to file appeal to a board decision? Which county? 30 days; Travis county How soon and how often can you file for reinstatement of a license? After one year; once a year. Maximum administrative penalty by board? By attorney general? $5000 per violation; $1000 per violation. How much time to pay an administrative penalty by the board? 30 days. How many days can NPs and PAs prescribe? How many refills? For patients how old? 30 days, no refills; older than 2 years. How many PA equivalents can an MD supervise? 3 full-time employees What percentage of random charts of the PA must the physician review? 10% How far can secondary practice sites be located from primary? 60 miles How many days does board have to give information to requesting hospitals? 15 days How many days do you have to correct changes in your TMB profile? 30 days How many days do you get to review your data the FIRST time the board releases it? 15 business days. How often does a physician have to resubmit his core data if there were no changes? 55 | P a g e How long can a mother + newborn stay in the hospital paid by insurance after birth with vaginal delivery/cesarean section? 48 hrs/96 hrs Until when must an insurance pay for hearing screening? Follow-up hearing screening? 30 days; 2 years How many days do you have to submit birth certificate? 5 days. After what age can you take possession of an abandoned baby? 60 days or less How many days does the funeral director have to file death certificate? 10 days How many days does the physician have to fill out death certificate? 5 days. Over what weight must a death certificate be filled out for a fetus? 350 grams. If weight is not known, over what gestational age? 20 weeks. SIDS is for children of less than what age? 12 months. When do you have to report SIDS? Immediately. Death of a child of what age or younger must be reported to the medical examiner? Within what time frame? 6 years; immediately How many days after catastrophe to get "certificate of death by catastrophe"?Xlibris. Kindle Edition. 10 days. If a patient dies within how many hours of admission must an inquest be ordered? 24 hours. A mentally retarded person of what age can donate a kidney if the guardian petitions the court? 56 | P a g e 12 years. After how many days can a blood bank pay for blood donation? 15 days. A person older than what age can voluntarily commit self to psychiatry? 16 years How often do private psychiatry hospitals file reports? Yearly. What age do you have to be to get ECT? 16 How often do you renew DEA license? DPS license? Every 3 years; yearly. How many days to you have to inform the DPS of change in information? 7. How many days of pills can a patient get of schedule 2-5 when discharged from the hospital? 7. How many days to send written prescription to pharmacy of schedule 2 drug? 7. How long is a schedule 2 script valid? How many refills? Schedule 3-5 valid? Refills? Dangerous drugs valid? Refills? 7 days; no refills; 6 months; 5 refills; unlimited; unlimited. How often do you need to do inventory on your drugs? Every 2 years. How often do you have to register with the board and pay a fee to administer anesthesia? Every 2 years. How many days do you have to report an office-based anesthesia complication? 15 days. How much time do you have to report a death from communicable disease? Immediately. How much time to report a gunshot wound? 57 | P a g e Immediately. What is the monetary penalty for violation of anti-kickback laws for physicians? Hospitals? $25,000-$250,000 / $50,000-$500,000. How much time does a physician have to report child abuse? Immediately; 48 hours in writing. How much time does a professional (not medical professional) have to report child abuse? 48 hours. How much time do professionals/physicians have to report death of a child secondary to abuse? 48 hours. How much time do you have to report nursing home abuse verbally? In writing? Immediately; 5 days. If a nursing home resident dies after transfer to a hospital, within what time frame must be reported? 24 hours. How much time does the nursing home have to report elderly death? 10 days after the end of the month of death. What are the age limits to consider abuse a criminal offense? 14 or younger, 65 or older; older than 14 and disabled.