Test bank & Solution Manual for Applied Law and Ethics in Health Care 1E by Wendy Mia Pardew

TEST BANK & SOLUTION MANUAL

2023

COMPLETE Elaborated Test Bank & Solution Manual for

Applied Law and Ethics in Health Care 1st Edition Wendy Mia Pardew 2023

Applied Law and Ethics in Health Care 1st Edition by Wendy Mia Pardew

ISBN-10 0357623878 ISBN-13 978-0357623879

Test Bank and Solution Manual for Applied Law and Ethics in Health Care 1st Edition by Wendy Mia Pardew

ISBN-10 0357623878 ISBN-13 978-0357623879 THIS IS NOT THE ACTUAL BOOK. YOU ARE BUYING it is the Official Test Bank in e-version INSTANTDOWNLOAD >The test bank is what most professors use as a template when making exams for their students, which means there’s a very high chance that you will see the exact questions in the tests! >The file is either in.pdf, excel, or zipped in the package and can easily be read on PCs and Macs. >Delivery is INSTANT. You can download the files IMMEDIATELY once payment is done.

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TABLE OF CONTENTS

Chapter:1. The Big Business of Health Care and You. Chapter:2. Laws and Regulations You Will Encounter.

Chapter:3. From the Constitution to the Courtroom.

Chapter:4. Criminal Acts and Intentional Torts.

Chapter:5. What Makes a Contract.

Chapter:6. Medical Malpractice and Other Lawsuits.

Chapter:7. The Health Record.

Chapter:8. Introduction to Ethics.

Chapter:9. Laws and Ethics of Patient Confidentiality.

Chapter:10. Professional Ethics and the Living.

Chapter:11. Reproductive Issues and Early Life.

Chapter:12. Death and Dying.

W.Docs Chapter:1. The Big Business of Health Care and You.

TB-Applied Law & Ethics in Health Care[1E,Pardew]

True / False 1. In addition to protecting patients, laws also operate to protect the public. a. True b. False ANSWER: True 2. Physicians are not vicariously liable for the behavior of their employees. a. True b. False ANSWER: False 3. Most medical office employees are not licensed to practice medicine. a. True b. False ANSWER: True 4. Dividends are the net worth of a corporation. a. True b. False ANSWER: False 5. In managed care, the actual care a patient receives is influenced by the policies and procedures of the managed care plan. a. True b. False ANSWER: True Multiple Choice 6. If you are not certain that an assigned task is within your scope of practice, what should you do? a. Leave the position and seek a job that does not stretch professional boundaries. b. Contact regulatory authorities. c. Tell the provider that you are not prepared or skilled to do the task. d. Raise the concern with the employer and discuss until it is resolved.

ANSWER: d 7. The standard of care for a certified health care professional is a. highly developed and dictated by the state b. not as well defined as it is for licensed professionals c. based on the employer’s definition d. dependent on the employee’s ethical preference ANSWER: b

.

8. Which is a legal business entity? a. Stockholder b. Partnership Page 1

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c. Agent d. Conglomerate ANSWER: b 9. Identify the true statement about sole proprietorships. a. It is a two-person entity. b. The sole proprietor does not have to pay taxes. c. The sole proprietor benefits from profits. d. The sole proprietor cannot hire employees.

ANSWER: c 10. Which of the following statements is true? a. A medical assistant is held to a lower standard of care than is a layperson. b. A medical assistant is held to the reasonable person standard. c. A medical assistant, working as an agent under the physician’s direction, may be held to the same standard of care as a physician. d. A medical assistant is only held to the same standard of care as a physician when dispensing medical advice.

ANSWER: c 11. Personal protection means: a. protecting yourself from needless co-worker criticism b. protecting the facility from loss of revenue c. protecting yourself from loss of earning power d. protecting the provider from loss of reputation ANSWER: c 12. Licensure laws: a. protect physicians and medical office staff. b. protect the public and serve patients’ interests. c. are set by the federal government. d. signify exceptional qualifications for the occupation.

ANSWER: b 13. Why is it important for medical assistants to understand and work within the parameters of the laws that apply to a medical office? a. Doing so protects themselves and their employer. b. Doing so protects the patient. c. Doing so protects the physician. d. Doing so protects the pharmacist and the physician.

ANSWER: a 14. In today’s medical office, the certified health care professional is permitted to do which of the following? a. Act independently to care for patients b. Communicate directly with patients c. Give medical advice d. Diagnose and treat patients Page 2

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ANSWER: b 15. Which of the following is a type of legal entity in which one person operates a business for profit and has unlimited personal liability for the business? a. solo practice b. sole proprietorship c. conglomerate d. limited liability company ANSWER: b 16. A Patient Bill of Rights offered by many hospitals and other health care facilities are: a. always required by law. b. standard among all health care facilities. c. may differ for each health care facility. d. required by law in all federal facilities.

ANSWER: c 17. Which is true about a Limited Liability Company (LLC)? a. An LLC’s ground rules are decided by the government. b. An LLC is owned by a single individual who wants full responsibility for profit and losses. c. An LLC can be owned by an individual or group. d. An LLC does not require tax reporting.

ANSWER: c 18. Most medical office professionals are not licensed to practice medicine and . a. must do anything required to assist the patient b. must carry out their responsibilities without making medical decisions or acting outside the areas of their expertise c. may sometimes dispense medical advice d. must carry out their responsibilities without making medical decisions or acting outside the areas of their expertise and may sometimes dispense medical advice ANSWER: b 19. Locum tenens means: a. a physician or other professional who is temporarily performing the duties of another. b. a certification. c. a legal action pursuant to federal law. d. scope of practice.

ANSWER: a 20. A Patient Bill of Rights: a. provides billing information related to current treatment. b. acknowledges a patient’s right to choose, consent to, and to refuse treatment. c. explains legal and ethical rights. d. explains legal and ethical rights, and acknowledges a patient’s right to choose, consent to, and to refuse treatment.

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ANSWER: d 21. Which is a feature of the Affordable Care Act (ACA)? a. Health plans must cover preventive care. b. The No Surprises Act is part of ACA c. Eliminates coverage for pre-existing conditions. d. Eliminates standards for health insurance plans.

ANSWER: a 22. Which indicates the holder has completed education, experience and has basic minimum qualifications required by state law to perform certain procedures for a specific occupation? a. Degree b. Being hired to work in a physician’s office c. A license d. Being hired to work in a physician’s office and a degree ANSWER: c 23. What will you receive once you have attained a minimum level of education and training and passed an examination required by an accredited certifying organization? a. Degree b. Certification c. Professionalism d. License ANSWER: b 24. What federal law requires every health plan and provider to maintain reasonable and appropriate safeguards to ensure the confidentiality of health information? a. HITECH b. FMLA c. ACA d. HIPAA ANSWER: d 25. What is the name of profits of a corporation that are distributed to stockholders? a. Shares b. Dividends c. Gifts d. Stocks ANSWER: b 26. Which is a feature of Managed Care? a. Delivering health care with lower costs and increased quality. b. Allowing health care services without restrictions. c. Eliminating premiums. d. Brand name prescription access.

ANSWER: a Page 4

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27. As a member of society, one is expected to carry out interpersonal relationships in a responsible manner that will not cause harm. This is known legally as holding an individual to what kind of standard? a. Standard of care b. Reasonable person c. Guardian ad litem d. Respondeat superior ANSWER: b 28. What type of MCO does not use primary care physicians as gatekeepers and seeks to improve health care and reduce costs by using groups of physicians, hospitals, and other health care providers to coordinate cost-effective, quality health care and to reward positive patient outcomes by sharing cost-savings with providers? a. HMO b. POS c. ACO d. LCO ANSWER: c 29. What is the name of a legal entity that is an association of two or more individuals who act as co-owners of a business venture? a. Corporation b. Limited Liability Company c. Proprietor d. Partnership ANSWER: d 30. Legal entities include sole proprietorships, partnerships, professional associations, limited liability partnership, and limited liability companies. What is another type of legal entity? a. Corporation b. Stockholder c. Group d. Dividend ANSWER: a Subjective Short Answer 31. Why should health care professionals understand their legal professional responsibility?

ANSWER: Ignorance of the law does not protect the professional from being guilty of a violation or the consequences of a violation. Therefore, health care professionals have the responsibility to understand the laws and regulations about their chosen career.

32. Describe how the medical office personnel are the link between the patient and the doctor.

ANSWER: They arrange office visits, laboratory tests, therapeutic appointments, and hospital admissions.

33. Describe fee-for-service.

ANSWER: Fee-for-service is payment per service, sometimes that service is per hour sometimes per service item.

34. When is telemedicine used?

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ANSWER: Telemedicine is a health care delivery system used when the patient is in one location and the treating physician is in another, possibly thousands of miles away.

35. Describe the implications for “respondeat superior” as it applies to employee protection while working within their scope of employment.

ANSWER: Respondeat superior (“let the master answer”) means that physicians are vicariously liable for the behavior of their employees (such as medical assistants or nurses) while the employees are working within the scope of their employment.

36. Name two forms of Prepaid Group Practices (PGPs).

ANSWER: Staff model and group model 37. Define negligence.

ANSWER: Negligence is not using reasonable and prudent care within the circumstance.

38. Describe the differences among a sole proprietorship, partnership, and corporation.

ANSWER: Answers should include: Sole Proprietor is a single physician, therapist, or other licensed health care profession operating a business alone. A partnership is two or more people who combine their work, money, and talents to do what one could not do alone. A corporation is a group of people banding together and creating an artificial being, or entity, that can do something that the members of the group could not do individually.

39. Identify two types of Health Maintenance Organizations (HMOs) provider payment structures.

ANSWER: Answers should include: Prepaid Group Practice (PGP) are a group of physicians who agree to provide comprehensive health care services for a fixed prospective per capita payment to a definite population.

Individual Practice Associations (IPAs) are groups of physicians who join together into an agreement with other organizations to provide medical services to a defined population.

40. Define the term managed care.

ANSWER: Answers should include: Managed Care is a term used to describe a system of integration of the financing and delivery of health care to provide comprehensive services to an identified segment of the population.

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W.Docs Chapter:2. Laws and Regulations You Will Encounter.

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True / False 1. Permitting unlicensed personnel to perform medical procedures within the physician’s scope of practice is not grounds for the revocation or suspension of a medical license. a. True b. False ANSWER: False 2. Controlled substances acts restrict the distribution, classification, sale, and use of certain drugs. a. True b. False ANSWER: True 3. Employment policies that appear to treat all employees equally but have an adverse impact on a particular protected group can result in a disparate impact. a. True b. False ANSWER: True 4. The Federal Age Discrimination Act (FADA) protects the rights of workers under the age of 40. a. True b. False ANSWER: False 5. The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers from using genetic information when hiring, firing, training, or promoting employees. a. True b. False ANSWER: True Multiple Choice 6. Licensing boards can a. revoke; reprimand b. refuse; reinstate c. censure; relinquish d. provide; pursue ANSWER: a

licenses and

medical providers for working outside of their scope of practice.

7. In many states, failure to report specific injuries or deaths can result in a. lawsuits b. misdemeanor charges c. loss of license d. action against the hospital ANSWER: b

.

8. As a mandatory reporter, what should a nurse do if there is suspected abuse or neglect when caring for a patient?

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a. not get involved in the issue b. notify a physician, supervisor, and law enforcement c. wait for another nurse to report it d. confront the abuser ANSWER: b 9. What does the EEOC stand for? a. Employing Equally Out of College b. Equal Employment Opportunity Commission c. Employment Equals Outstanding Colleagues d. Elder Equal Opportunities Commission ANSWER: b 10. Which federal act establishes a federal minimum wage, mandates extra pay for overtime work, regulates the employment of children, and is administered by the Department of Labor. a. Family and Medical Leave Act (FMLA) b. Fair Labor Standards Act (FLSA) c. Equal Pay Act d. Employee Retirement Income Security Act ANSWER: b 11. State legislatures establish medical boards with the authority to a. protect physicians and medical office staff. b. control health care provider licensing. c. require drug testing of all health care professionals. d. set standards in patient care.

ANSWER: b 12. What does the procedures manual describe? a. job responsibilities b. required skills c. how to perform responsibilities d. personnel policies ANSWER: c 13. Physicians are required to submit reports on a regular basis to various governmental agencies. Which of these should be reported? a. non-communicable diseases b. accidents c. births, deaths, and communicable diseases d. patient load ANSWER: c 14. Elder abuse is governed at the a. state b. federal and state

level.

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c. federal d. state and local ANSWER: b 15. Under law, employers are not allowed to ask interview questions concerning race, religion, age, or whether a woman is pregnant. a. Equal employment b. FLMA c. Discrimination d. Employment ANSWER: c 16. Social Security includes what related but different programs? a. retirement, disability, and dependent’s/survivor’s benefits b. OSHA and HIPAA c. Fair Labor Standards d. Family and Medical Leave ANSWER: a 17. Most people 65 years of age or older, rich or poor, are eligible for coverage. individuals and is obtainable through local social services or welfare departments. a. Medicare; Medicaid b. Medicaid; Medicare c. retirement; Medicaid d. retirement; Medicare ANSWER: a

is provided for low-income

18. Which statement best describes the regulations for blood-borne pathogens? a. Regulations cover clinical aspects of practice. b. Regulations do not require universal precautions. c. Regulations cover both administrative and clinical aspects of practice. d. Regulations require employees to get vaccinations from employers only.

ANSWER: c 19. People join unions for many reasons, but primarily because they: a. like organizations. b. are dissatisfied with their job description. c. are dissatisfied with wages, benefits, or working conditions. d. are content with their job responsibilities.

ANSWER: c 20. A job description describes: a. how specific tasks of a job should be carried out. b. the responsibility required of each employee. c. guidelines for performing procedures. d. an action for product liability.

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ANSWER: b 21. What is a procedural attempt to achieve collective agreements between an employer and accredited representative of a group of employees to improve conditions of employment? a. risk management b. bargaining unit c. quality assurance d. collective bargaining ANSWER: d 22.

legislatures establish medical boards with the authority to control health care provider licensing. a. Federal b. International c. State d. Governmental ANSWER: c

23. The licensing board has the power to within the provider’s scope of practice. a. renew b. revoke c. grant d. inform ANSWER: b

a license for reasons such as performing procedures that are not

24. One ground for of a medical license is permitting unlicensed personnel to perform medical procedures within the scope of practice of physicians. a. issuance b. granting c. revocation d. renewal ANSWER: c 25. Controlled substances acts restrict the a. manufacturing, allocation, and licensing b. chemicals, foods, and sale c. licensing, classification, and chemicals d. distribution, classification, and sale ANSWER: d

,

, and

of certain drugs.

26. Are employers allowed to test potential employees as part of the hiring process? a. No, never. b. Yes, if agreed by employee and signed in advance. c. Yes, when tests are carefully constructed to ensure it measures skills necessary to do the job. d. No, except for when discrimination is suspected.

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27. Illegal discrimination may be shown by either disparate treatment or a. the number of prior lawsuits b. the number of employee complaints c. disparate impact d. interstate commerce ANSWER: c 28. An EEOC Charge of Discrimination must be filed within an exception that extends the period to days. a. 300; 180 b. 60; 300 c. 180; 300 d. 90; 180 ANSWER: c

.

days following the incident, unless the facts warrant

29. If a health care professional has knowledge of abuse to a child and fails to report the abuse, then this can result in a. federal assistance. b. the prosecution of the health care professional c. reporter protection d. no discipline of the health care professional.

ANSWER: b 30. The OSHA rules and regulations are intended to prevent a. job safety; injuries b. discrimination; equality c. injuries; job safety d. blood borne pathogens; hand washing ANSWER: c

and promote

.

Subjective Short Answer 31. Name the three federal acts that seek to protect various forms of elder abuse.

ANSWER: The Elder Justice Act of 2009, The Older Americans Act, and The Elder Abuse Victims Act of 2009.

32. Who administers workers’ compensation laws?

ANSWER: Workers’ compensation laws are administered by state governments.

33. What are medical practice laws?

ANSWER: Medical practice laws control the practice of medicine.

34. What does Title I of the Americans with Disabilities Act (ADA) do?

ANSWER: Title I of the ADA prohibits employment discrimination and places the burden on an employer to prove that the requirements of a specific job could not be changed to accommodate a disabled applicant.

35. What do Titles II and III of the ADA guarantee for the disabled?

ANSWER: Titles II and III of the ADA guarantee the disabled access to the workplace.

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36. Why does the government control the manufacture, storage, and distribution of drugs or chemicals through the controlled substances acts?

ANSWER: The government controls a drug or chemical because of its potential for misuse or abuse.

37. What is a procedures manual?

ANSWER: A procedures manual describes how a task in the job description should be carried out.

38. What is Medicare?

ANSWER: Medicare is a federal insurance program for people who are entitled to Medicare from their Social Security contributions and payment of premiums.

39. In what situations can discrimination occur during the hiring process?

ANSWER: The answer should include preemployment testing, drug testing, and interviewing.

40. What is Medicaid?

ANSWER: Medicaid provides for low-income individuals and is obtainable from local social services or welfare departments.

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W.Docs Chapter:3. From the Constitution to the Courtroom.

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True / False 1. The Preamble and the Amendments make up the Constitution. a. True b. False ANSWER: False 2. Congress has 535 voting members, including 100 Representatives and 435 Senators. a. True b. False ANSWER: False 3. The first thing an experienced medical malpractice lawyer will do is try to obtain a copy of the patient’s medical records. a. True b. False ANSWER: True 4. The three branches of government are the administrative, the legislative, and the judiciary. a. True b. False ANSWER: False 5. You should only release a copy of a patient’s medical records after verifying that a signed authorization form is in the patient’s chart. a. True b. False ANSWER: True Multiple Choice 6. Who passes legislation? a. The President b. Congress c. The President’s Cabinet d. The Judiciary ANSWER: b 7. What clause tells us that federal law will govern when there is a conflict between federal and state law? a. The Supremacy Clause b. The Interstate Commerce Clause c. The Commerce Clause d. The Necessary and Proper Clause ANSWER: a 8. Negligent acts fall under which category of law? a. Civil Law Page 1

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b. Criminal Law c. Common Law d. Administrative Law ANSWER: a 9. What occurs at the end of the second phase when the discovery is complete, and the judge declares the case is ready for trial? a. Pretrial conference b. Depositions c. Negotiations d. Examination ANSWER: a 10. The determines whether federal or state law is applicable and enforceable. a. administration b. legislative branch c. president d. Constitution ANSWER: d 11. Which of the following falls under the responsibilities of administrative agencies? a. adjudication b. legislation c. arbitration d. mediation ANSWER: a means “let the decision stand.” a. Respondeat superior b. Stare decisis c. Writ of certiorari d. Cert. denied ANSWER: b

12.

13. During Phase II, consists of depositions, interrogatories, motions, and witness identification. a. arbitration b. discovery c. pretrial conference d. testimony ANSWER: b 14. Once a complaint has been filed, the patient officially becomes the . a. defendant/plaintiff b. plaintiff/defendant c. prosecutor/respondent

and the provider officially becomes the

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d. respondent/prosecutor ANSWER: b 15. Testimony is: a. a motion. b. a writ of certiorari. c. evidence. d. confidential.

ANSWER: c 16. Ninety percent of cases settle out of court. Cases are settled out of court in several ways, including: a. arbitration and/or mediation. b. plea bargaining and/or testimony. c. incident reports and/or agreement. d. mediation and/or discovery.

ANSWER: a 17. The Clause states that Congress is authorized to “make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof.” a. Necessary and Proper b. Supremacy c. Enumerated Powers d. Interstate Commerce ANSWER: a 18. In a bench trial, the: a. jury makes the decision. b. negotiation process is continued. c. judge serves as both judge and jury. d. jury declares a mistrial.

ANSWER: c 19. When preparing a testimony, a witness: a. should be subjective b. can provide false statements c. should offer additional information when possible d. must pay attention in all legal proceedings ANSWER: d 20. In a medical malpractice case, who is the plaintiff? a. The patient b. The physician c. The attorney d. The defendant ANSWER: a Page 3

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21. A deposition is: a. a constitutional right. b. the final settlement of a case. c. monetary compensation for loss or injury. d. sworn verbal statement in response to questions.

ANSWER: d 22. Perjury is: a. a false statement during a deposition. b. a false statement made to your attorney. c. a false statement made to the physician during a patient office visit. d. a false statement during negotiations.

ANSWER: a 23. The stages of the federal appellate process are: a. federal district court, U.S. Court of Appeals, U.S. Supreme Court b. federal district court, superior district court, U.S. Supreme Court c. superior district court, U.S. Court of Appeals, U.S. Supreme Court d. appellate court, federal district court, U.S. Supreme Court ANSWER: a 24. In a criminal case, “beyond a reasonable doubt” is: a. the standard of guilt b. the standard of proof. c. the burden of guilt. d. the burden of proof.

ANSWER: b 25. A person charged with a crime is the a. plaintiff b. defendant c. prosecution d. guilty party ANSWER: b

.

26. A misdemeanor is a crime punishable by imprisonment in jail for less than a. three months b. five years c. one year d. six months ANSWER: c

or a fine.

27. Which of the following can be used to settle a lawsuit? a. reformation b. mediation Page 4

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c. deposition d. discovery ANSWER: b 28. Who makes up the executive branch of government? a. The president b. The president and the president’s cabinet c. senators d. Judges ANSWER: b 29. The objective of the federal judicial branch of government is, in part, to interpret whether laws are a. rational b. fair c. legal d. constitutional ANSWER: d

.

Multiple Response 30. Which of the following is court-made law that arises from judges’ interpretation of statutory or regulatory law? a. Administrative Law b. Common Law c. Criminal Law d. Civil Law ANSWER: b Subjective Short Answer 31. In which division of law will the defendant be found liable or not liable?

ANSWER: Civil law 32. What is filed in Phase II of a medical malpractice case that causes the patient to officially become the plaintiff?

ANSWER: A complaint 33. When is a copy of the patient’s medical records authorized for release?

ANSWER: A copy of the patient’s medical records should only be released after verifying that a signed release form is in the patient’s chart.

34. During a trial, who determines what laws are involved in the case?

ANSWER: The judge 35. Who can appeal a decision in Phase IV of a medical malpractice lawsuit?

ANSWER: Either party can appeal a decision, but usually, the losing party appeals.

36. What authority does Congress delegate to administrative agencies?

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ANSWER: Answer should include how administrative agencies make rules and regulations pertaining to their specialty, and how agencies are empowered to adjudicate disputes.

37. What happens in Phase III of a medical malpractice lawsuit?

ANSWER: In Phase III, the case goes to trial to settle the dispute between two parties.

38. What is common law?

ANSWER: Common law is court-made law that arises from judges’ interpretation of statutory or regulatory law.

39. Who will receive the plaintiff’s medical records when a medical malpractice lawsuit is filed?

ANSWER: The plaintiff’s medical records will be given to the defendant, their attorney, and experts.

40. The preparation of the attorney and the witnesses is crucial to winning a lawsuit. What should a witness consider when preparing for testimony?

ANSWER: Answer should include looking at both sides, seeing where the witness fits into the total picture, trying to anticipate what defense the other side will offer, trying to be objective about strong points and weak arguments, and following the instructions given to you by your attorney.

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True / False 1. A felony is defined as a crime of grave or more serious nature than those designated as misdemeanors. Under federal law and many state statutes, it is any offense punishable by imprisonment for a term exceeding 1 year or death. a. True b. False ANSWER: True 2. A misdemeanor is a crime punishable by imprisonment in jail for less than one year or a fine. a. True b. False ANSWER: True 3. Physicians are considered mandated reporters of child abuse according to most state statutes. a. True b. False ANSWER: True 4. A husband who threatens to harm his wife is committing domestic violence. a. True b. False ANSWER: True 5. “Renting patients” means that patients are recruited and paid for procedures they do not need and is considered fraud. a. True b. False ANSWER: True Multiple Choice 6. When reporting suspected child abuse to the child protective services agency (CPS) in your state, what is the most crucial next step taken by CPS before referring the report to the district attorney? a. Monitor the child in their environment b. Question the family, caretakers, or foster home c. Confirming and substantiating the reported abuse d. View any historical records related to the child ANSWER: c 7. After observing an illegal activity in the health care setting, which of the following is most important to do next? a. Follow office protocol and contact the appropriate person or department b. Call the state authorities c. Fill out the designated incident report form d. Gather health information for the affected patient in their medical records, as it will be needed for reporting ANSWER: a 8. What type of elder abuse is suspected in the following example? George, an 87-year-old man, is found unconscious in his home by his son following a phone call from his physician’s office after missing several of his scheduled Page 1

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appointments. George shows signs of starvation, and his home is disheveled. George’s caretaker is arrested on suspicion of abuse. a. Financial abuse b. Unintentional abuse c. Psychological abuse d. Intentional abuse ANSWER: d 9. In what instance can the confidentiality of the patient-provider relationship be broken? a. An adult patient discusses their disease with their physician. b. A parent is charged with child abuse. c. A 17-year-old female discusses their sexual history with their physician. d. A family member expresses concern for the health of their elderly parent.

ANSWER: b 10. You are reporting an illegal activity you witnessed while working in your health clinic. Which of the following should be included in the reporting process? a. Your suspicions of how long the activity has occurred b. Detailed information about the activity with facts and the people involved c. Relevant information from the patient’s chart, regardless of patient privacy statutes or rules d. Your state’s district attorney information ANSWER: b 11. The most common civil claim in medical law is an action known as a tort. Tort liability is classified as: a. intentional, negligent, or liability without fault. b. intentional, negligent, or malpractice. c. intentional, malpractice, or strict liability. d. negligent, malpractice, or strict liability.

ANSWER: a 12. The standard of proof required to find a defendant guilty in a criminal case is: a. beyond a reasonable doubt. b. clear and convincing evidence. c. preponderance of evidence. d. reasonable suspicion.

ANSWER: a 13. Which of the following is considered a civil cause of action? a. Manslaughter b. Malpractice c. Murder d. Misdemeanor ANSWER: b 14. Manslaughter is defined as: a. the unlawful killing of another intentionally.

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b. the unlawful killing of another accidentally. c. the unlawful killing of another negligently. d. unlawful killing of another without malice.

ANSWER: d 15. Conspiracy occurs when two or more persons: a. are joined together for a common purpose. b. come reasonably close to committing a crime. c. commit an unlawful or criminal act. d. are negligent together.

ANSWER: c 16. Larceny would occur if you took a lawnmower from your neighbor: a. without permission, and you had no intent to return it. b. and you pretend you don’t know who owns it when questioned. c. with your neighbor’s permission, and then you returned it. d. and you forgot to return it.

ANSWER: a 17. These types of abuse have mandatory reporting statutes governed by state law. a. Child abuse b. Domestic abuse c. Verbal abuse of an adult d. Adult drug abuse ANSWER: a 18. Which of the following statements is true regarding reporting child abuse and penalties for failure to report abuse? a. All states have the same hotline for reporting abuse. b. All states require complaints to be directed to child protective agencies. c. All states have the same reporting and penalties. d. All states have reporting laws.

ANSWER: d 19. Clara, a 4-year-old child, was brought into the clinic by her parents after reporting that she fell down the stairs. What physical indicators could indicate possible child abuse? a. Hyperactivity when being asked to remain still for the examination b. Wincing when touched by the health care provider c. Wearing a diaper and wetting herself during the examination d. Evidence of a skull fracture on X-ray and bruises along her arms ANSWER: d 20. Elder abuse is divided into a. three b. four c. five d. six

classifications.

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ANSWER: b 21. What crime is committed when a physician does not practice in good faith, uses a form of treatment not generally accepted in medical science, or practices under the influence of drugs or alcohol, causing death to a patient? a. Murder b. Conspiracy c. Manslaughter d. Negligence ANSWER: c 22. What is an intentional action or lack of action causing the merciful death of someone suffering from a terminal illness? a. Euthanasia b. Manslaughter c. Malpractice d. Suicide ANSWER: a 23. One of the classifications of elder abuse is abuse. Examples of this type of abuse are elderly patients with lapsed and unfilled prescriptions, unbrushed and unwashed hair, general unkempt appearance, and not eating well. a. unintentional b. physical c. intentional d. financial ANSWER: a 24. Insurance abuse includes a. discussing b. discussing procedures for c. billing for d. charging excessively for ANSWER: d

services that have been provided.

25. If you suspect Medicaid fraud has occurred in the hospital where you work, where can you report the illegal activity? a. Local law enforcement office b. The CEO of the hospital c. To the patient(s) affected d. Medicaidfraudhotline.com ANSWER: d 26. A penalty will be imposed on someone who knowingly receives a bribe for referring a patient in order to be paid by Medicare or Medicaid. a. civil b. judiciary c. criminal d. monetary Page 4

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ANSWER: c 27. Not all states require medical professionals to report a. rape of a minor b. births and deaths c. treating an adult rape victim d. physical abuse of a minor ANSWER: c

.

28. When an individual working in a medical office breaks a law, the individual’s difference as to whether the behavior is labeled criminal or civil. a. intent b. authority c. behavior d. state of mind ANSWER: a 29. The importance of intentional torts for patients and plaintiffs lies in the ability of the victims to receive their injuries. a. a refund b. damages c. a sentence d. an award ANSWER: b

makes the

for

30. A tort is a private wrong or injury, other than a breach of contract, for which the court will provide a remedy. Which of the following is classified as an intentional tort against a person? a. Battery b. Negligence c. Conspiracy d. Liability ANSWER: a Subjective Short Answer 31. What information is needed when reporting suspected child abuse?

ANSWER: The reporter will be asked to provide as much information about the child’s situation as they can, including the names and addresses of the child and the child’s parents or other persons responsible for the child’s care, the child’s age, conditions in the child’s home environment, the nature and extent of the child’s injuries, and information about other children in the same environment.

32. Briefly explain the purpose of the Violence Against Women Act (VAWA).

ANSWER: The purpose of the Violence Against Women Act (VAWA) is to address the right of women to be free from domestic violence.

33. Explain the Fourth Amendment of the U.S. Constitution.

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ANSWER: The Fourth Amendment protects an individual against unreasonable search of person, house, office, or vehicle and unreasonable seizure of person, papers, and effects. The police may not enter a person’s home without a search warrant.

34. Define assault and battery.

ANSWER: The answer should include this being any willful attempt or threat to injure another person or nonconsensual touching.

35. The Department of Justice civil fraud section follows provisions of this Act, to recover funds in the health care area.

What is the name of this Act? ANSWER: The False Claims Act (FCA), 31 U.S.C. § 3729.

36. What is a misdemeanor?

ANSWER: A misdemeanor is an offense classified lower than a felony and generally punishable by a fine or imprisonment other than in a penitentiary.

37. Describe the difference between robbery and theft.

ANSWER: Robbery is the forcible stealing of the personal property of another either from their person or in the immediate presence of the victim. Theft is the taking property without the property owner's consent. An individual is guilty of robbery if, while carrying out theft, the victim is physically injured or has been threatened and put in fear of bodily injury.

38. What three things are required to be proven beyond reasonable doubt to find a defendant guilty of conspiracy?

ANSWER: (1) The defendant joined in an agreement or plan, (2) with the purpose to do something unlawful, and (3) the defendant joined the conspiracy knowing of the unlawful plan and intending to help carry it out.

39. What are the behavioral indicators of child abuse?

ANSWER: The child is overly compliant or passive or extremely aggressive; the child is demanding; there is a rolereversal of “parental” behavior; or the child is lagging in development.

40. Identify five forms of fraud in the medical office.

ANSWER: (1) “Upcoding” procedures to something more expensive, (2) kickbacks for referrals, (3) filing false information, (4) billing for services not provided, and (5) “renting” patients.

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W.Docs Chapter:5. What Makes a Contract.

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1. The patient-provider relationship is the keystone of medical practice but is not necessarily contractual in nature. a. True b. False ANSWER: False 2. Parties enter into a contractual relationship by mutual assent. a. True b. False ANSWER: True 3. Third-party collection agencies that pursue past due health care debt are governed by the Fair Debt Collections Practice Act (FDCPA). a. True b. False ANSWER: True 4. A minor has the capacity to sue in court and is dependent on the parent to file lawsuits before the age of majority. a. True b. False ANSWER: False 5. A contract can be written or oral. a. True b. False ANSWER: True 6. Written instructions about a person’s future medical care is called a. breach of contract b. advanced directive c. termination of contract d. duty ANSWER: b

.

7. The majority of states require that one or more parents be advised of, or consent to a minor’s a. emancipation b. abortion c. conservator d. undue influence ANSWER: b

.

8. A(n) is any person under the federal age of majority in the United States. a. agent b. principal c. guardian d. minor ANSWER: d Page 1

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9. Health care providers and facilities each have protocols in place for Collections Practice Act. a. past due b. bad check c. termination of contract d. injunctive relief ANSWER: a

accounts that abide by the Fair Debt

10. When a person agrees to work for, and under the direction of another, a principal–agent relationship is created. In the medical office, the health care provider is the and the medical assistant is the . a. principal; agent b. offer; acceptance c. agent; principal d. acceptance; offer ANSWER: a 11. A breach of contract occurs when: a. the patient fails to pay their account. b. one party does not prevent the other from performing. c. the promised cure does take place. d. the patient pays their account in full.

ANSWER: a 12. To form a contract, there must be a clear understanding between the parties, known as of the minds. a. warranty b. agency c. implied d. mutual agreement ANSWER: d

, assent, or meeting

13. A patient and health care provider voluntarily agree on a surgical procedure the patient requires. This is an example of a(n) . a. abandonment b. undue influence c. contract d. mutual assent ANSWER: c 14. If a patient and health care provider cannot agree on a treatment plan. They can both mutually agree to a. terminate the contract b. patient abandonment c. breach of contract d. statute of limitations ANSWER: a

.

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15. What is an actual agreement between the parties, the terms of which are openly stated in distinct and explicit language, either verbally or in writing? a. An implied contract b. A warranty c. An express contract d. A health care proxy ANSWER: c 16. Minors, incompetent persons, and individuals under the influence of a drug that alters their mental state are considered: a. emancipated. b. statutory adults. c. legally disabled. d. mentally competent.

ANSWER: c 17. Which statement best describes the statute of limitations? a. The length of time to mutually agree on a contract b. The length of time after injury a plaintiff has before they may no longer file a suit c. The length of time it takes a patient to reach the age of majority d. The length of time it takes to withdraw from treating a patient ANSWER: b 18. The physician tells a patient that she will be cured after a procedure. If after the procedure, the patient is not cured.

The physician could now be liable for . a. breach of contract b. undue influence c. negligence d. durable power of attorney ANSWER: a 19. Generally, neither a minor nor a minor’s parents may consent to sterilization, transplants, experimental medical care, or refusal or withholding of treatment without what? a. A court order b. Agreement from the physician c. Agreement from the minor d. Agreement from the parents and the physician ANSWER: a 20. Examples of are the living will and health care power of attorney. a. implied contract b. consideration c. express contract d. advance directives ANSWER: d

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21. A person with cannot enter into a contract, and must have a legally appointed guardian that does this on their behalf. a. mutual agreement b. full cognitive ability c. an emancipated minor d. mental incompetence ANSWER: d 22. What is the legal relationship between physician and patient? a. Consensual b. Contractual c. Fee for service d. Principal and agent ANSWER: b 23. A(n) is a non-emancipated minor in mid- to late-teens who has the intelligence and emotional maturity to be able to grasp the information necessary to make an informed decision. a. mature minor b. agent c. guardian d. conservator ANSWER: a 24. The employee answering a health care provider’s phone is working under the a. contract b. injunctive relief c. law of agency d. specific performance ANSWER: c

.

25. To a patient means that the physician gives up completely—deserts the patient—and indicates that the physician intends to terminate the contractual relationship? a. proxy b. unduly influence c. abandon d. contract with ANSWER: c 26. What is a proposal to perform a certain action or pay a specified amount? a. Consideration b. Acceptance c. Offer d. Mutual assent ANSWER: c 27. Special rules called the

governs the relationship between the principal and agent.

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a. warranty b. law of agency c. duress d. conservator ANSWER: b 28. What type of minor is someone under the age of majority who is deemed to be completely self-supporting and able to enter into contracts? a. Emancipated b. Guardian c. Mature d. Conservator ANSWER: a 29. What is the name for a court-appointed person given authority to manage only the financial affairs of an incompetent person? a. A mature minor b. A guardian c. A parent d. A conservator ANSWER: d 30. A medical assistant prepares an injection, and a patient rolls up his or her shirt sleeve to receive the injection. What type of contract is this? a. Express b. Implied c. Written d. Mutual ANSWER: b 31. Provide examples of what an advanced health care directive can include within it.

ANSWER: A health care advance directive can include choices regarding organ and tissue donation, as well as other instructions. The advanced health care directive involves the acceptance or refusal of medical or surgical treatment the patient wishes to receive. It also requires documentation of the patient’s receipt of this information in the medical record, as well as whether a patient has executed an advance directive.

32. Describe various ways in which a patient or provider can terminate a contract.

ANSWER: A contract between a health care provider and a patient can be terminated in several ways. The most satisfactory outcome is that the health care provider treats the patient, the patient pays the health care provider the required fee or copayment, both parties are satisfied, and the contract concludes. The parties can mutually agree to terminate the relationship. A health care provider’s termination of a patient should be provided by written notice sent by certified mail, return receipt requested, and filed in the patient’s chart.

33. What are examples of advance directives?

ANSWER: The living will, the durable power of attorney, and the health care proxy are all advance directives.

34. What are the differences between implied and express contracts?

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ANSWER: An express contract is an explicit agreement between two or more parties. Whereas, an implied contract is an agreement not indicated by direct words but evident from the conduct of the parties.

35. What does it mean to be an agent?

ANSWER: An agent is someone who has the authority to act for another under specific conditions.

36. What are the four elements that make up a contract?

ANSWER: Offer, acceptance, consideration, and mutual assent 37. What constitutes a contract for employment?

ANSWER: The contract states that the individual is employed, at what rate, what the job consists of, and any other terms are that are necessary to define the framework of employment. Health care providers and professionals may have employment contracts that state that they are employed, at what rate, what the job consists of, and whatever other terms are necessary to define the frame-work of employment. If there is no employment contract, the employee is deemed to be an employee-at-will, which means that the employer can dismiss the employee at any time, without warning, and for any nondiscriminatory reason.

38. Describe who cannot legally form a contract.

ANSWER: Minors, incompetent persons, and individuals under the undue influence of a drug that alters their mental state cannot legally form a contract. A person with a legal disability cannot form a contract because a contract cannot be made by or enforced against a person who does not have the legal capacity for mutual agreement. Minors, incompetent persons, and individuals under the undue influence of a drug that alters their mental state are among those who are considered legally disabled for the purpose of forming a contract.

39. Explain and give an example of common law rule in the treatment of minors.

ANSWER: A minor is incapable of giving effective consent for the administration of medical treatment. Therefore, without the consent of the parents or guardian, medical practitioners are liable for assault and battery.

Exceptions to the rule are made in medical emergencies and for mature and emancipated minors.

40. Describe the two main elements, consideration and mutual agreement, necessary to make a contract.

ANSWER: To form a contract, there must be a clear understanding between the parties, known as mutual agreement, assent, or meeting of the minds. A contract comes into being when one party makes an offer, the other party accepts, and some form of consideration passes between them. All contracts have some form of consideration. Without consideration, a contract is not enforceable.

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W.Docs Chapter:6. Medical Malpractice and Other Lawsuits.

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True / False 1. Malpractice is defined as not doing something that a reasonable person would do or doing something that a reasonable person would not do. a. True b. False ANSWER: False 2. Negligence is defined as failing to act with reasonable and prudent care given the circumstances. a. True b. False ANSWER: True 3. Premise liability is a theory used in product liability cases in which the seller is liable for any and all defective or hazardous products that unduly threaten a consumer's personal safety. a. True b. False ANSWER: False 4. Health care professionals often work under the direct supervision of the health care provider; therefore, they are often covered by the health care provider’s malpractice insurance. a. True b. False ANSWER: True 5. A health care professional stops at the scene of an accident to assist the injured person. The health care professional leaves the scene of the accident before any other adequate help responds. The health care professional could be charged with medical malpractice. a. True b. False ANSWER: True Multiple Choice 6.

can be addressed in office staff meetings and training sessions to help employees support each other. a. Defensive medicine b. Burnout c. Negligence d. Peer reviews ANSWER: b

7.

results as a direct consequence and without which the injury result would not have happened. a. Breach of duty b. Proximate cause c. Expert witness d. Standard of care ANSWER: b Page 1

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8. The statute of limitation of medical malpractice lawsuits usually gives the patient as long as depending on the state and the injury incurred. a. 5 years, 10 years b. 2 years, 10 years c. 1 year, 10 years d. 10 years, 15 years ANSWER: b

to sue for damages but can be

9. Sometimes the breach of duty is so obvious, it is not necessary to prove causation, demonstrating that the thing speaks for itself and is defined as . a. standard of care b. causation c. injury d. res ipsa loquitur ANSWER: d 10. A patient may withdraw a. duty b. standard of care c. informed consent d. agency ANSWER: c

at any time, even after the authorized treatment has begun.

11. Which of the following can disprove a medical malpractice lawsuit? a. The health care provider’s breach was the proximate cause of the patient’s injury. b. The duty had not been upheld at the professional standard of care. c. There was no patient-provider relationship. d. The patient had a resulting injury.

ANSWER: c 12. Which of the below is a defense to a medical malpractice cause of action lawsuit? a. Peer-reviews b. Defensive medicine c. Non-verbal communication d. Assumption of risk ANSWER: d 13.

is a term used to describe voluntary acceptance of a known danger. a. Contributory negligence b. Comparative negligence c. Assumption of risk d. Affirmative duty ANSWER: c

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b. informed consent c. product liability d. strict liability ANSWER: c 15. Which statement best describes some of the ethical and moral implications regarding informed consent? a. Some patients want to hear bad news. b. Most patients always remember what the physician tells them. c. A patient may selectively remember comments by the health care provider. d. The sicker the patient is, the more accurate the patient’s memory for details becomes.

ANSWER: c 16. One of the negative consequences of so many medical malpractice lawsuits is that physicians: a. primarily treat obstetric and orthopedic cases. b. stay away from the treatment of difficult cases. c. apply for emergency room duty to regain their confidence. d. attempt new procedures or employ new drugs.

ANSWER: b 17. Burnout happens when health care professionals: a. are sued for medical malpractice. b. enjoy serving the public. c. are exhausted from overwork. d. specialize in a particular field of medicine.

ANSWER: c 18. Risk management measures a health care professional can take to avoid lawsuits include: a. maintaining an unfriendly relationship with patients. b. becoming burnout. c. ensuring the patient understands the information provided. d. practicing defensive medicine.

ANSWER: c 19. A licensee enters a property with a. illegal intent b. implied permission c. affirmative duty d. product liability ANSWER: b 20. Affirmative duty: a. does not require inspection of the property. b. does not require reasonable care. c. does not necessarily make the premises safe. d. is to protect the invitee.

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21. Nonverbal communication is best defined as: a. enunciation. b. using body language. c. voice projection. d. text messaging.

ANSWER: b 22. Indicate which of the following products could be part of a product liability case. a. Building b. Heart pacemaker c. Medical clinic d. Laboratory ANSWER: b 23. Who is legally responsible for obtaining informed consent from a patient? a. Medical assistant b. Janitor c. Receptionist d. Physician ANSWER: d 24. is any professional misconduct and implies a greater duty of care to the injured person than the reasonable person standard. a. Negligence b. Malpractice c. Standard of care d. Intentional tort ANSWER: b 25. A(n) a. conservator b. attorney c. adversary d. guardian ad litem ANSWER: c 26. The healthcare provider’s a. res ipsa loquitur b. breach of duty c. relationship d. defensive medicine ANSWER: b

is a person who is working against an individual or party, an opponent, not an ally.

must be the cause of the injury.

27. There are (conforming to professionally proper behavior) and moral implications in informed consent, especially when a drug or procedure is in the research phase and physicians are experimenting on patients.

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a. professional b. medical c. malpractice d. ethical ANSWER: d 28. Select which of the following are defenses available to the defendant of a medical malpractice lawsuit. a. statute of limitations b. risk management c. defensive medicine d. peer-reviewed ANSWER: a 29. What is the first element of a malpractice case that must be proven? a. There was a patient-provider relationship. b. There was a duty owed. c. There was a breach of duty. d. There are damages.

ANSWER: a 30. A malpractice cause of action usually arises from two factors: the factor, which is the injury suffered by the patient; and the factor, which is the alienation, anxiety, frustration, and potential anger in the patient. a. subjective; objective b. objective; subjective c. damages; breach of duty d. damages; subjective ANSWER: b Subjective Short Answer 31. Define what an expert witness is and why they are important in a medical malpractice lawsuit.

ANSWER: A person whose education, profession, or specialized experience qualifies them to testify about their area of expertise as it relates to the lawsuit. An expert witness is someone who will testify about their professional opinion and whether they believe the standard of care was met.

32. Explain the statute of limitations.

ANSWER: In medical malpractice actions, the statute of limitations is specified in each state’s medical malpractice law. Statutes of limitations are necessary because as the years go by, evidence vanishes, witnesses’ memories dim, and witnesses die. By setting a time frame within which a lawsuit may be initiated, there is assurance that relevant evidence is available for the fact finders and the parties.

33. Define strict liability in tort.

ANSWER: Strict liability is a theory used in product liability cases in which the seller is liable for any and all defective or hazardous products that threaten the consumer’s safety.

34. List elements of a medical malpractice lawsuit.

ANSWER: To have a medical malpractice lawsuit, the patient must prove the following: Page 5

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1. There was a patient–provider relationship.

2. This relationship established the duty owed by the health care provider to the patient.

3. The duty had not been upheld at a professional standard of care.

4. The health care provider breached the duty to the patient.

5. The patient had a resulting injury.

6. The health care provider’s breach was the proximate cause of the patient’s injury.

35. Describe reasonable care in a medical setting.

ANSWER: Reasonable care indicates that the patient is cared for in a safe manner that does not place the patient at any unforeseeable risk, and the pain levels are low.

36. Why is it important to get an informed consent form signed by the patient before a procedure?

ANSWER: Legally the patient must be adequately informed about the potential outcomes, risks, and any adverse effects associated with the procedure before performing a procedure. The signed consent form is a legal document that indicates the patient has been informed and has an adequate level of understanding of the procedure.

This form can help the defense in a medical malpractice lawsuit.

37. What is contributory negligence?

ANSWER: Contributory negligence is a term used to describe any unreasonable behavior on the part of the patient that contributed to the cause of injury.

38. Explain the Good Samaritan law and how it relates to a health care professional stopping to assist a person who has been injured.

ANSWER: If a helper stops and assists, he or she will be held to a standard of care appropriate to the individual’s training and experience.

39. What are some common patient choice litigation factors?

ANSWER: Patient injury, patient anxiety, patient alienation, patient frustration, patient anger, and poor provider communication. A malpractice lawsuit usually arises from two factors: the objective factor, which is the patient’s injury, and the subjective factor, which is the patient’s alienation, anxiety, frustration, and potential anger. Although medical malpractice as a legal concept requires both injury and negligence, the injury alone does not usually bring about the intense hostility that a lawsuit expresses. Many malpractice suits are brought because of the health care provider's poor communication.

40. Office emergencies usually do not fall under the protection of Good Samaritan laws. Explain why.

ANSWER: Office emergencies usually do not fall under the protection of Good Samaritan laws. In a medical office, a patient–physician relationship already exists: the doctor is offering services, and the patient is seeking services.

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W.Docs Chapter:7. The Health Record.

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True / False 1. While maintaining perfect records should always be the goal, incorrect entries may happen. When an error occurs with a paper chart, cross out the mistake, initial and date it, and then write the correct information. a. True b. False ANSWER: True 2. In certain states, legislators have given the patient, the patient’s physician, and/or the authorized agent the right to examine or copy health records. a. True b. False ANSWER: True 3. Credibility of a health record refers to whether the information recorded is believable. a. True b. False ANSWER: True 4. If changes are made to health records beyond a reasonable period of time following discharge, particularly after a physician or hospital is on notice of a potential lawsuit, changes in the health record are almost always serious and raise red flags. a. True b. False ANSWER: True 5. Most EHR systems track each entry by user, date, and time. So, if a mistake is made and the record needs to be changed, the original error will remain, but there will be an addendum with the correct information. a. True b. False ANSWER: True Multiple Choice 6. What determines who owns a patient’s health record? a. The Health Information Technology for Economic and Clinical Health Act (HITECH) b. The Health Insurance Portability and Accountability Act (HIPAA) c. The Health Maintenance Organization (HMO) d. State Law ANSWER: d 7. What requires that patients have the right to see their records, to obtain copies, and to make corrections in them? a. The Health Information Technology for Economic and Clinical Health Act (HITECH) b. Health Insurance Portability and Accountability Act (HIPAA) c. The Cures Act d. State laws ANSWER: b Copyright Cengage Learning. Powered by Cognero.

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8. What includes both computer hardware and software systems to store patient information? a. Electronic Health Record (EHR) b. Application Programming Interfaces (API) c. Protected Health Information (PHI) d. Paper chart ANSWER: a 9. Which of the following is a written order to produce documents? a. Subpoena b. Subpoena Cum Laude c. Subpoena Duces Tecum d. Property Right ANSWER: c 10. Who is responsible for keeping health records accurate? a. The employer b. The record keeper c. The patient d. The insurance company ANSWER: b 11. Provisions within the further the interoperability of health care information between insurance companies, providers, patients, and technology vendors. a. Cures Act b. Health Insurance Portability and Accountability Act (HIPAA) c. Electronic Health Record (EHR) d. Health Information Technology for Economic and Clinical Health Act (HITECH) ANSWER: a 12. Which statement best describes the ownership of health records? a. Ownership can be exclusively exercised. b. Ownership does not belong to the physician or medical facility. c. Ownership carries with it the right and power to exercise authority over the property. d. Ownership does prevent others from the right to see the record.

ANSWER: c 13. When may changes to a patient’s record be accepted as rewritten or amended? a. After the patient is discharged b. After notice of a potential lawsuit c. While patient is under treatment d. At any given time ANSWER: c 14. In what situation would a patient implicitly consent to sending a truthful health record to a third party? a. When the patient is submitting a third-party payment claim. b. When the patient submits to a physical examination for the purpose of life insurance benefits.

Copyright Cengage Learning. Powered by Cognero.

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c. When the record could be used in litigation against the third party. d. When the patient is mentally ill.

ANSWER: b 15. Which statement best describes HIPAA requirements regarding patients’ rights to their health records? a. Patients have the right to see their health records when participating in a research study. b. Patients have the right to make corrections in their health records. c. Inmates are authorized copies of their health records. d. Patients are only authorized copies of their health records when filing a complaint.

ANSWER: b 16. Hospitals and health care providers should have a written policy on file detailing the procedures for releasing patient information. The policy must reflect: a. local and state law. b. federal law and HIPAA regulations. c. state and federal law. d. state law.

ANSWER: c 17. When in doubt about releasing medical information, you should: a. get oral authorization from the patient. b. send the information via the physician’s cell phone or PDA and let the patient know after the transmission. c. err by not disclosing rather than disclosing. d. remember that the owner of the privilege to keep information confidential is the physician.

ANSWER: c 18. Who may release health records of a deceased patient? a. Immediate family members b. The health care provider c. The next of kin d. A personal representative ANSWER: d 19.

allows patients to see their records and make corrections in them. a. Subpoena duces tecum b. HIPAA c. Privileged communication d. Federal rules of evidence ANSWER: b

20. To correct an entry in a hard copy health record, you should: a. cross out the mistake, initial and date it, then write in the correct information. b. write the correct information, change the date and the time, and sign it in the side margin. c. remove the erroneous entry and prepare a new entry indicating the erroneous entry has been removed. d. use correction fluid to hide the mistake, write the correct information, date and sign the entry.

ANSWER: a Copyright Cengage Learning. Powered by Cognero.

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21. What is a recorded collection of data on a patient? a. Health record b. Family history c. Test results d. PHI ANSWER: a 22. Which of the following established incentives for the use of EHRs and penalties for not using them? a. The Health Information Technology for Economic and Clinical Health Act (HITECH) b. The Health Insurance Portability and Accountability Act (HIPAA) c. The Cures Act d. Federal Law ANSWER: a 23. With an integrated health record, the patient is represented by a inpatient activity. a. single b. massive c. double d. multi-folder ANSWER: a

record that includes all outpatient and

24. Who can consent to the release of health records? a. Patient at the age of majority b. Incompetent person c. Conservator d. Physician ANSWER: a 25. Which of the following is a sufficient method for a patient to authorize the release of health records? a. Oral request b. Over the phone c. In writing d. Patients are not authorized to release health records ANSWER: c 26. Minor patients are typically unable to consent to the release of their health records. Who of the following has authority to release the minor patient’s records? a. Immediate family members b. Parent c. Conservator d. Attorneys ANSWER: b 27. Under which of the following circumstances would minors be authorized to release their health records?

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a. When diagnosed with a sexually transmitted disease. b. When they are receiving a physical exam to participate in school athletics. c. When they receive a subpoena. d. Minors are never authorized to release their health records.

ANSWER: a 28. In time-sensitive circumstances, which of the following is an appropriate method to deliver medical information? a. By mail b. Over the phone c. Secure email d. Video conference ANSWER: c 29. When can health records be withheld if payment of the patient’s bill is pending? a. When the amount owed is less than $100 b. When the amount owed is more than $100 c. In all circumstances d. Never ANSWER: d 30. HITECH stands for: a. The Health Impact Technology for Ergonomic and Climacteric Health Act. b. The Health Insiders Technology for Economic and Customers’ Health Act. c. The Health Information Technology for Economic and Clinical Health Act. d. The Human Information Technology for Economic and Clinicians Health Act. ANSWER: c Subjective Short Answer 31. What ethical obligations does a physician have in the management of medical records?

ANSWER: Obligation encompasses managing the records of current patients, retaining old records against possible future need, and providing copies or transferring records to a third party as requested by the patient or the patient’s authorized representative.

32. Who should be notified when an error is found in a health record?

ANSWER: When authorized by the patient to examine them for use in possible litigation against the health care provider or a third party.

33. Under what circumstances is the credibility of record-keeping subject to questioning?

ANSWER: Delayed filing of laboratory tests, incomplete files, illegible records, altered or fabricated records, or the loss or concealment of information.

34. What is the difference between a subpoena and a subpoena duces tecum?

ANSWER: A subpoena is a command to appear at a specified time and place to testify. A subpoena duces tecum is when the court commands a witness to produce at trial a certain pertinent document the witness holds.

35. What issues may occur with integrated health records?

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ANSWER: Answer can include the following: (1) Cross-indexing of the hospital and outside office records is very limited and usually represented by a copy of the discharge summary from the hospital chart in the office record of the attending health care provider; (2) the hospital record seldom carries any direct report of medical office visits unless the medical office is part of the hospital; and (3) the technologies of a hospital and one of its practices may not be compatible.

36. When would a third party be required to review errors in record-keeping?

ANSWER: When the record keeper is in dispute with the health care provider, the facts should be reviewed by a neutral third party.

37. What should be included in requests to release health records?

ANSWER: The request should have time limits, identify the purposes for which the records will be used, and identify the particular information requested.

38. What must accompany the requested information when it is disclosed?

ANSWER: When information requested is disclosed, it must be accompanied by instructions that forbid its re-disclosure to others who are not authorized to receive it.

39. What is the difference between the ownership of jewelry and the ownership of medical records?

ANSWER: Ownership usually carries with it the exclusive right and power to exercise authority and control over the use of the property. In the case of the health record, the owner cannot control the record exclusively.

40. When are office records and hospital records subject to inspection by an attorney?

ANSWER: When authorized by the patient to examine them for use in possible litigation against the health care provider or a third party.

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True / False 1. Bioethics studies the ethical dilemmas and issues of biological research as it relates to medicine. a. True b. False ANSWER: True 2. Behavior that does not take moral principles into consideration is known as amoral. a. True b. False ANSWER: True 3. Philosophy is the viewpoint of a value system. A philosophy can be from an individual or community’s perspective. a. True b. False ANSWER: True 4. Deontological theories of ethics are concerned with the outcomes and consequences of ethical decisions. a. True b. False ANSWER: False 5. Since there is no single approach to make ethical decisions, a person may look to cultural values, moral upbringing, present circumstances, society’s expectations, and a multitude of other variables. a. True b. False ANSWER: True Multiple Choice 6. Working under a code of ethics can be a challenge for health care professionals because: a. the principles are unclear. b. they face difficult decisions while interacting with patients and families. c. codes of ethics are only for one specialty of professional. d. developing a code of ethics is a difficult task and therefore flawed.

ANSWER: b 7. Medical ethics includes: a. theories of how ethics generally develop. b. studies of technology and patient care. c. questions involving modern medical technology. d. legal enforcement of medicine.

ANSWER: c 8. Morals are developed throughout our lifetime by experiences with: a. medical technologies. b. definite paths of immoral conduct.

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c. careful studies of Kohlberg and Piaget. d. family, friends, and culture.

ANSWER: d 9. Ethical theories are: a. overwhelming academics. b. ethical dilemmas. c. decision-making frameworks. d. complete answers to dilemmas ANSWER: c 10. Two groups of western ethical theories are: a. virtue and duty. b. Kohlberg and Piaget. c. right and wrong. d. deontological and teleological.

ANSWER: d 11. The study of ethics is grounded theoretically in behavior. a. etiquette b. technology c. philosophy d. medicine ANSWER: c

, which helps create standards of right and wrong

12. When making an ethical decision, the first step should be: a. provide reasons for actions. b. implement the action. c. identify the parties that have an interest in the matter. d. identify the dilemma and the values.

ANSWER: d 13. When there is an ethical dilemma, what is a source that health care professionals usually turn to in order to solve the question? a. Law or organization’s policy b. Deontological theories c. Teleological theories d. Virtue based theories ANSWER: a 14. Values are developed by: a. growing up. b. professional societies. c. codes of ethics. d. requirements by law.

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ANSWER: a 15. Etiquette is: a. a demonstration of politeness, professionalism, and courtesy. b. outlined in policy and procedure manuals. c. defined as one physician giving courtesy or preference to another physician. d. the same as medical ethics.

ANSWER: a 16. Health care professionals need to understand their own ethics and how they may conflict with the ethics of the workplace because: a. an educated professional should study the various ethical theories. b. it is inappropriate to discuss personal morality and ethics during an ethical dilemma. c. an entire inventory of a person’s own beliefs is required to be a health care professional. d. arguing about ethics with a supervisor may cause dismissal.

ANSWER: b 17. What is the difference between personal and professional ethics? a. Personal ethics are defined by the employer, and professional ethics are defined by religious belief. b. Professional ethics are defined by personal needs, and personal ethics are based upon patient need. c. Personal ethics reflect values that the individual person lives by day to day. Professional ethics reflect values established in the workplace. d. Personal and professional ethics are not different; they are the same.

ANSWER: c 18. Breaking codes results in the disapproval of at least a segment of society but breaking results in penalties enforced by the law. a. legal; ethical b. legal; moral c. ethical; legal d. moral; legal ANSWER: c

codes

19. Kohlberg developed a theory about how people develop values which includes: a. four stages based on age. b. three levels based on thought process. c. two levels based on self-evidence. d. two levels based on experience.

ANSWER: b 20. Personal ethics are: a. a person’s level of compliance at work. b. a person’s values and beliefs. c. the results of a person’s decisions. d. a person’s usual actions at work.

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21. Common principles within most people’s personal ethics would include: a. individuality and success. b. duty and professionalism. c. honesty and respect. d. faith and choice of religion.

ANSWER: c 22. The study of a. biology b. medicine c. ethics d. law ANSWER: c

is grounded theoretically in philosophy.

23. What are collections of principles about what is right? a. Morals b. Etiquette c. Ethics d. Bioethics ANSWER: a 24. A moral principle that guides choices and conduct is: a. a moral. b. a philosophy. c. an ethic. d. a virtue.

ANSWER: c 25. Which statement describes Utilitarianism? a. Decisions are based on virtue. b. Decisions are based on duty. c. Decisions are based on the greatest good. d. Decisions are based on business success.

ANSWER: c 26. A school nurse updating a student’s record indicating that a vaccine was administered when there was no vaccine administered is an example of: a. professional conduct. b. immoral conduct. c. amoral conduct. d. right moral conduct.

ANSWER: b 27. Which is a tenet of the AMA’s Code of Ethics for physicians? a. A physician shall support medical care for all people.

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b. A physician shall strive for accuracy above all. c. A physician shall not consult with colleagues. d. A physician shall never report another physician for misconduct.

ANSWER: a 28. What type of problem does each individual approach from their own perspective, which includes cultural values, moral upbringing, present circumstances, society’s expectations, and a multitude of other variables? a. Etiquette b. Professional c. Bioethics d. Ethics ANSWER: d 29. Professional ethics are formed by: a. religious belief. b. family upbringing. c. accrediting authorities. d. academics.

ANSWER: c 30. Values are: a. prescribed codes of courteous social behavior. b. ethical issues surrounding biological research. c. principles of thought and conduct that are considered desirable. d. situations where a challenging decision must be made between two or more options.

ANSWER: c Subjective Short Answer 31. Describe a situation where professional and personal ethics may conflict.

ANSWER: Possible answers: 1-The health professional does not ethically support the patient's chosen treatment. 2-The medication or treatment is tested on animals, and the health professional is ethically opposed to animal testing.

32. What are the differences between a violation of the law and a violation of ethics?

ANSWER: A violation of the law, negligent act, or a breach of contract, for example, may result in prison, fines, or monetary damages, among others. A code of ethics violation in health care may result in license suspension or revocation, or other negative repercussions from your employer, colleagues, patients, family, or friends.

33. What are some groups that may be the ultimate decision maker in ethical dilemmas?

ANSWER: Possible answers: ethics committee, a hospital’s risk department, or a panel composed of different disciplines, providers, other health care providers, a lawyer, the courts, the patient (or their family), medical ethicists, or medical office personnel.

34. What care should a health care professional take in regard to conflicts between personal and professional ethics?

ANSWER: Health care professionals should identify and evaluate their own personal ethics, identify any that may conflict with ethics in the workplace, and address strategies on how to manage potential ethical dilemma situations before they encounter intense, pressure-filled, decision-making moments.

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35. Describe the consequences of a health care provider not having a clear understanding of their own personal ethics and how they coincide or conflict with professional ethics.

ANSWER: Possible answers: 1- Providers could refuse to treat patients because of their personal ethics about the patient’s choice of care. 2- The provider's credibility or trustworthiness could be damaged.

36. Explain the difference between personal ethics and professional ethics.

ANSWER: Personal ethics pertains to a person’s values in all aspects of their personal lives, which is influenced by their experiences, family, faith, and community, while professional ethics pertains to a person’s values within the workplace and is influenced by the employer, the nature of the business, regulation, compliance and accreditation standards.

37. What would be an acceptable response to an ethical issue?

ANSWER: Considering the issue and then using the eight steps toward facing an ethical dilemma realizing the options of different theories.

38. What would be a strategy for separating personal and professional ethics in the workplace?

ANSWER: Determining the ultimate decision maker in the situation may help to identify what ethical position should be taken.

39. Why is it essential that a health care professional have an understanding of ethics and ethical decision-making?

ANSWER: In order to respond quickly to ethical dilemmas, health care professionals need to understand ethics and processes of ethical decision-making.

40. Summarize the difference between duty-based and virtue-based ethical theories.

ANSWER: Answer can include the following: The duty-based theory requires identifying the professional’s duty in the situation regardless of outcome, and the morally correct action is based on the required duty. The virtuebased theory requires identifying an action that a virtuous person would take, and the morally correct action is based on how virtuous the action was.

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W.Docs Chapter:9. Laws and Ethics of Patient Confidentiality.

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True / False 1. HIPAA’s privacy rules and regulations affect all health care facilities and personnel. a. True b. False ANSWER: True 2. Included in matters of privacy is the right to be left alone and to make personal choices for others. a. True b. False ANSWER: False 3. Patient-provider privilege is a legal doctrine that protects communications between a patient and a provider from disclosure in court. a. True b. False ANSWER: True 4. It is routine procedure for a patient to receive a Notice of Privacy Practices (NPP) once a year while checking in for an appointment as part of HIPAA compliance. a. True b. False ANSWER: True 5. A pregnant woman decides she wants to find out the sex of the fetus and share this with her husband, who could not come to the appointment. When she shares this information with her husband, this is a violation of HIPAA. a. True b. False ANSWER: False Multiple Choice 6. When was signed into law in 1996, there was no Federal Privacy Act for medical records prior. a. confidentiality b. privacy c. HIPAA d. privileged communication ANSWER: c 7. Patient health information (PHI) files and filing systems, as well as electronic systems that manage electronic PHI, are built with high levels of security and cybersecurity. These are examples of ensuring HIPAA . a. violation b. compliance c. security d. breach ANSWER: b

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8. who has reason to believe that a covered entity or business associate violated HIPAA’s Privacy, Security, or Breach Notification Rules may file a complaint with the Office of Civil Rights (OCR). a. A physician b. A patient c. A family member d. Anyone ANSWER: d 9. Use of in health care creates an increasing number of ways that patient confidentiality can be compromised, incurring a HIPPA violation. a. technology b. locked cabinets c. protected passwords d. disclosures ANSWER: a 10. OCR issues penalties for civil violations of HIPAA Rules and considers several factors when assessing penalties, including the of time the violation existed, the of people affected, and the of PHI disclosed. a. length; number; type b. inaccurate; largest; electronic c. accurate; smallest; files d. accurate; moderate; system ANSWER: a 11. To is the act of giving up a claim, privilege, or right. a. practice b. abandon c. waive d. protect ANSWER: c 12. Under HIPAA requirements, those found guilty of wrongfully disclosing private health information face in jail and a fine. a. 5; $100,000 b. 5; $250,000 c. 10; $100,000 d. 10; $250,000 ANSWER: d

years

13. HIPAA is the abbreviation for: a. Health Information Portability and Accountability Act b. Health Insurance Protection and Accountability Act c. Health Information Protection and Accountability Act d. Health Insurance Portability and Accountability Act ANSWER: d

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14. In what year was HIPAA signed into law? a. 1993 b. 1996 c. 1997 d. 2003 ANSWER: b 15. A method for maintaining PHI security and confidentiality in a medical facility is: a. opening up an email from an unknown sender. b. browsing unknown websites on your work computer. c. strictly complying with all computer security policies. d. sharing your password with your colleague.

ANSWER: c 16. Disclosure of PHI, not otherwise authorized by HIPAA, must be authorized in a. a phone call; patient b. a phone call; spouse c. verbatim; spouse d. writing; patient ANSWER: d

by the

.

17. What legal agency is responsible for enforcing HIPAA? a. City/local government b. State government c. Federal government d. U.S. Military ANSWER: c 18.

is when information is not disclosed to those who are not authorized to receive it. a. Protected b. Private c. Confidentiality d. Waived ANSWER: c

19. Roe v. Wade, 410 U.S. 113 (1973), the U.S. Supreme Court held that the patient–provider relationship is protected by constitutional rights of . a. security b. privacy c. protection d. shared ANSWER: b 20. Covered entities are required to establish administrative, physical, and technical safeguards, to review their security risks to ensure compliance with the Rule, and to record all security compliance measures undertaken. a. Administrative Copyright Cengage Learning. Powered by Cognero.

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b. Security c. Complex d. Specialist ANSWER: b 21. is information held by a covered entity related to the patient’s health status, their health care, or payment for their health care. a. Private health information b. Protected health information c. Privileged health information d. Confidential health information ANSWER: b 22. There are many ways to violate HIPAA, and a violation may be a. accidental; waived b. intentional; shared c. secret; confidential d. intentional; accidental ANSWER: d

or

.

23. Covered entities are required to establish administrative, physical, and technical safeguards, to review their security risks to ensure with the Security Rule. a. compliance b. enforcement c. breach d. waiver ANSWER: a 24. An older man is brought into the emergency room unconscious. The man’s son accompanies him and provides detailed health history to the health care providers on his behalf. This is an example of when disclosure of health information is and . a. illegal; unnecessary b. breach; shared c. private; waived d. legal; necessary ANSWER: d 25. Two challenges to maintaining patient confidentiality include: a. usage of appropriate forms and technology safeguards. b. technology and high-profile patients. c. locked filing cabinets and protective computer screen coverings. d. proper disclosure of medical information and password-protected filing system.

ANSWER: b 26. There are a. two

tiers of HIPAA violations and penalties.

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b. three c. four d. ten ANSWER: c 27. Hospitals and medical offices have strict HIPAA policies against a. accepting b. disclosing c. utilizing d. collecting ANSWER: b

patient information.

28. What is a patient’s expectation of privacy known as in the patient-provider relationship? a. Privilege b. Etiquette c. Ethics d. Confidentiality ANSWER: d 29. Which of the following is true about the confidentiality of medical information? a. Any family member asks for test results, and you print them off from the medical office database. b. As a medical office professional, you can view the health record of anyone who comes into the office. c. It is permissible to discuss a patient’s medical information at home, provided your family knows it is confidential. d. A patient may disclose their own health information to whomever they choose.

ANSWER: d 30. Before HIPAA’s enactment, what type of law was the privacy of patient records subject to? a. Federal b. County c. State d. Judicial ANSWER: c Subjective Short Answer 31. Explain the patient-provider privilege.

ANSWER: A provider may not reveal in court confidential information obtained during treatment unless the patient voluntarily waives his or her privilege against disclosure.

32. Who can discipline a health care professional or facility for HIPAA violations?

ANSWER: Only the government can discipline a health care professional or facility for HIPAA violations.

33. A health care provider requests a patient’s notes, labs, and x-rays from their recent emergency room visit. Is this disclosure of health information legally necessary; why or why not?

ANSWER: Yes, it is necessary. The health information being requested is legally necessary for continuity of care for the patient for their follow-up visit to determine the next course of action.

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34. List the three kinds of information protected under HIPAA. ANSWER: (1) Electronic media; (2) written documents; (3) the spoken word 35. Define the three major purposes of HIPAA. ANSWER: Answers should include the following: (1) To protect and enhance the rights of consumers by providing them access to their health information and controlling the inappropriate use of that information; (2) to improve the quality of health care in the U.S. by restoring trust in the health care system among consumers, health care professionals, and the multitude of organizations and individuals committed to the delivery of care; (3) to improve the efficiency and effectiveness of health care delivery by creating a national framework for health privacy protection that builds on efforts by states, health systems, and individual organizations and individuals.

36. A local hospital’s health information system is hacked by an unknown party, and the private health information of over 15,000 patients is compromised. Describe what the hospital must do according to HIPAA’s Breach Notification Rule.

ANSWER: HIPAA’s Breach Notification Rule requires that covered entities and their business associates provide notice after a breach of unsecured protected health information. Unsecured protected health information is PHI that has not been protected from disclosure to unauthorized persons. The notice must be sent to the affected individuals and the U.S. Department of Health and Human Services’ Secretary. Where a breach affects more than 500 residents of a state, covered entities are also required to provide notice to the media. The rule requires that business associates notify the hiring covered entities if a breach occurs.

37. List two conditions that allow patient information to be disclosed.

ANSWER: (1) When a patient voluntarily waives (gives up) his or her privilege against disclosure, and (2) when a patient files a medical malpractice cause of action. In a typical patient–provider privilege, a provider cannot reveal confidential patient information in a legal proceeding unless the patient waives their privilege against disclosure. The patient–provider privilege belongs to the patient, not the provider. So, a provider may not waive the privilege. When a patient files a medical malpractice lawsuit, for example, the nature of the case requires that medical records be available, and the patient–provider privilege is implicitly waived.

38. A HIPAA Privacy Rule violation occurs when a member of the health care provider’s staff improperly discloses the simple fact that the President is a patient of their practice. Explain how this is a violation of HIPAA and why they cannot share this information.

ANSWER: It would be a violation of HIPAA for a health care professional to disclose any confidential information about the President. Health care providers are required to keep the information of all patients confidential per HIPPA. The media is always interested in gathering confidential information about public figures largely because the public is interested in hearing about it. Health care providers are required to keep the information of all patients confidential, even if the patient is the most popular Hollywood actor, the latest internet celebrity, the highest-paid athlete, or the local politician.

39. Discuss the challenges that media face in maintaining confidentiality.

ANSWER: Answer should include the following: printing of nonfactual information, libel, lawsuits, slander, etc.

40. Discuss and provide at least two examples of a situation in which privacy could be violated.

ANSWER: Examples could include: the simple clerical matter of sending a “checkup reminder,” loudly projecting why a patient is coming for an office visit, making copies of patients’ records, providing information to non-related individuals without consent. Other examples are possible.

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True / False 1. When patients travel domestically or internationally to seek medical care that is priced lower, or not available locally, they are participating in medical tourism. a. True b. False ANSWER: True 2. The subjects of the Tuskegee study were offered proper treatment to cure their illness. a. True b. False ANSWER: False 3. The first successful human-to-human organ transplant was a liver transplant, and now it is the most commonly transplanted organ. a. True b. False ANSWER: False 4. The COVID-19 pandemic produced a dilemma of more patients that needed an ICU bed than there were ICU beds available across the country; this is an example of the ethical issue of allocation of resources. a. True b. False ANSWER: True 5. One ethical question that arises from “community-based” research is the potential conflict of interest between the researcher’s best interest and the pharmaceutical company’s demands. a. True b. False ANSWER: False Multiple Choice 6. The halting of the clinical trial for remdesivir, an antiviral drug used to treat COVID-19, during mid-research, provided an example of: a. poor drug manufacturing. b. undeniable drug benefits. c. complications in medical research. d. incomplete study data.

ANSWER: b 7. Those administering health care are obligated to take actions that benefit patients, even if those actions interfere with or neglect the patient’s . a. autonomy b. paternalism c. standards d. well-being ANSWER: a Copyright Cengage Learning. Powered by Cognero.

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8. Which of the following is a problem presented to the provider due to the use of organs from the living? a. The level of benefit to the patient b. The complicated surgery involved c. The infliction of pain on one person for another’s benefit d. The low demand for organs ANSWER: c 9. Providing for people’s needs yet giving them no responsibility or control over their destiny is the definition of what? a. Autonomy b. Allocation c. Preferentiality d. Paternalism ANSWER: d 10. is the objective of eradicating or slowing the spread of a disease that occurs when a high enough percentage of the population is immune to the disease, and it can no longer spread. a. Recovery from illness b. Herd immunity c. Acquired immunity d. Eradication ANSWER: b 11. In managed care, control access to specialists. a. pharmacists b. accountants c. primary care physicians d. case workers ANSWER: c

act as gatekeepers to control the cost-effectiveness of services offered to members and

12. According to this chapter, managed care is a response to which of the following? a. The need to allocate limited health care resources. b. Increased patient costs for preventative medicine. c. Adequate choice of providers. d. High health care costs.

ANSWER: a 13. According to The Uniform Anatomical Gift Act, in the absence of a gift by the deceased, who of the following has the power to give the body or any of its contents? a. Attending physician b. Coworker of the deceased c. Spouse d. Case manager ANSWER: c 14. In 2005,

transplants began in France.

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a. heart b. face c. corneal d. lung ANSWER: b 15. In which year did the first human kidney transplant occur? a. 1940 b. 1954 c. 1964 d. 1974 ANSWER: b 16. In which year was the first human heart transplant attempted? a. 1964 b. 1965 c. 1974 d. 1975 ANSWER: a 17. As a result of the Nuremberg Code, research on human subjects is carefully reviewed and regulated due to the . a. potential for a cure b. age of the participants c. nature of the experiment d. potential for harm ANSWER: d 18. Any individual of sound mind and eighteen years of age or more may give all or any part of their body; the gift to take effect upon death. This is one of the provisions of the: a. Uniform Anatomical Gift Act. b. Donate Life Act. c. Nuremberg Code. d. Clinical Trials Act. ANSWER: a 19. Medical transplants are divided into three categories, depending on the tissue used. A transplant procedure from one person to another person is known as a: a. homograft. b. autograft. c. biograft. d. heterograft.

ANSWER: a 20. The transplant of animal tissue into a human is known as a: a. autograft.

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b. biograft. c. homograft. d. heterograft.

ANSWER: d 21. Select the year in which the Uniform Anatomical Gift Act was passed. a. 1960 b. 1962 c. 1964 d. 1968 ANSWER: d 22. What is medical tourism? a. A vacation to visit and inspect hospitals in other countries. b. A trip to a location away from your home to have a medical procedure performed. c. A vacation to a place where there is a medical crisis. d. A trip to give medication to family members living in other countries.

ANSWER: b 23. Which of the following statements about transplants is accurate? a. There is a low demand for donor organs. b. All states use some form of The Uniform Anatomical Gift Act, and many allow individuals to indicate their choice to donate on their drivers’ licenses. c. Using live donors to obtain organs presents a few problems. d. The trafficking of human organs for profit is unfavored but regulated.

ANSWER: b 24. Which of the following statements is true regarding conducting “community-based” research in a private medical office versus clinical trials in an academic medical center? a. The costs of “community-based” research are much less than the same trials in an academic medical center. b. Results are produced much slower than in an academic medical center. c. The trend to move research away from academic medical centers and into “community-based” research started in the 1970s. d. This trend does not raise ethical questions about the objectivity of the research.

ANSWER: a 25. Paternalism is defined as: a. a means of independence and self-reliance. b. not interfering with a person’s independence. c. working hand in hand with the concept of autonomy. d. in conflict with the concept of autonomy.

ANSWER: d 26. What are the two primary reasons for medical tourism? a. Lower-priced medical care and a vacation b. The procedure is not available locally and newer hospitals Copyright Cengage Learning. Powered by Cognero.

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c. Newer hospitals and more physicians who perform the procedure d. Lower-priced medical care and the procedure is not available locally ANSWER: d 27. The Tuskegee Experiment caused a public uproar that led to the creation of an Ad Hoc Advisory Panel to review the experiment. The panel found that the men had agreed freely to be examined and treated, but there was no evidence that researchers had informed them of the study or its real purpose. This is an example of . a. informed consent b. autonomy c. a lack of informed consent d. medical research ANSWER: c 28. What is the Nuremberg Code? a. A set of numbers used to access Nuremberg’s prisons b. An experiment performed on human subjects c. A language used in experimental research d. A set of guidelines for experimental medical research on human subjects ANSWER: d 29. What is the name of transplantation of a person’s own tissue from one part of the body to another? a. Autograft b. Homograft c. Heterograft d. Humograft ANSWER: a 30. If there is a shortage of ICU beds, patients in the unit usually have surplus. a. a shorter b. a longer c. the same d. an unpleasant ANSWER: a

length of stay than when there is a

Subjective Short Answer 31. Why was the Nuremberg Code developed?

ANSWER: Society has developed guidelines to deal with experimental medical research. As a result of the medical atrocities conducted by Nazi German doctors on prisoners during World War II, the Nuremberg Code was drafted.

32. Why is there a conflict of interest for a physician when entering into an experimental protocol with a drug company?

ANSWER: On one side is the best interest of the patient; on the other, the pharmaceutical demands for protocol fulfillment. Ethical questions arise regarding the motives of privately practicing providers largely because they follow clinical plans designed by the pharmaceutical company rather than their own medical judgment.

There is an inherent conflict of interest when faced with balancing the best interest of the patient against satisfying the pharmaceutical company’s demands and the need to be paid for the experiments.

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33. What are some of the concerns with data collected in drug trials conducted outside of the United States?

ANSWER: As a result, conducting drug trials in locations outside the United States with weak or no regulation has resulted in scrutiny of the data collected. Varying standards of medical care, issues of translation, inadequately trained researchers, and fraud are some of the factors that raise concerns about data collected outside the United States.

34. Define autonomy.

ANSWER: Autonomy means allowing individuals control over themselves.

35. Explain organ trafficking.

ANSWER: Organ trafficking is a broad concept that includes several illegal activities, of which the main goal is to profit from human organs and tissue, for the sole purpose of transplantation. These activities include trafficking of human beings for the purpose of organ removal, transplant tourism, and trafficking in organs and tissues.

36. List three ethical conflicts created by managed care as discussed in this chapter.

ANSWER: Answers can include the following: (1) From the patient’s perspective, the single greatest threat posed by this shift is the potential for managed care systems to cut needed care to save health care dollars; (2) MCOs can dictate the specific brands and types of medication prescribed under a certain plan, protocol for diagnostic evaluations, as well as specific providers; (3) because the health care industry is determined to cut costs, MCOs emphasize drug treatment over counseling; (4) health care providers, who are paid on a capitation basis, who realize bonuses for fiscal restraint or who have portions of their salary withheld to control costs, make less money with a seriously ill patient; (5) many MCOs have adopted authorization requirements, where the MCO must approve certain procedures before the PCP orders them.

37. List some of the ethical issues surrounding the topic of transplants discussed in this chapter.

ANSWER: Answers can include the following: (1) Using live donors; (2) inflicting pain on one person for another’s benefit; (3) organ demand has increased; (4) selling organs is illegal, but organ trafficking has increased; (5) There are also strict protocols that govern organ harvesting, which do not always provide the needed protection for the prospective donor.

38. List and discuss some of the ethical issues surrounding funding in health care.

ANSWER: Answers can include the following: (1) Financial resources for health care are limited. (2) What is an adequate level of health care? (3) Should everyone have the opportunity to get a transplant, if needed? (4) Should everyone have the opportunity to get proper nutrition, exercise, and inoculations to prevent disease?

(5) On the one hand, it is costly to fund transplant operations; on the other hand, it is costly to fund school lunch programs for undernourished children. Values and ethics become involved in this discussion. Because society does not have unlimited funds for health care, ethical choices dictate the outcome.

39. List three benefits of conducting “community-based” research as opposed to clinical trials in an academic medical setting.

ANSWER: The costs of conducting “community-based” research is less than the same trials in an academic medical center. In addition, the research organizations conducting the trials for the pharmaceutical companies are able to produce results more quickly than an academic medical center. Additional benefits are (1) adding a level of continuity and personal contact to the process; (2) providing an enormous pool of potential research subjects; and (3) allowing patients and their health care providers access to current and scientifically advanced therapies.

40. What was the Tuskegee Experiment?

ANSWER: The Tuskegee Experiment was a study that involved poor, Black men. It was conducted without the benefit of patients’ informed consent. Researchers told the men they were being treated for “bad blood,” a term used to describe several ailments, including syphilis, anemia, and fatigue. They did not receive the proper Copyright Cengage Learning. Powered by Cognero.

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treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. The outrage over this study prompted the creation of rules and regulations that govern experiments using human subjects.

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True / False 1. Amniocentesis allows a physician to perform genetic testing on premature babies to look for defects. a. True b. False ANSWER: False 2. In experiments with monkeys, transplanting fetal tissue into the brain of an animal with symptoms similar to Parkinson’s disease has successfully controlled the symptoms. a. True b. False ANSWER: True 3. Today’s technology has reached the point where a fertilized egg can be cloned and implanted for incubation until birth. a. True b. False ANSWER: True 4. Tay-Sachs disease is a genetically defective enzyme that causes a blood disorder and early death in 1 of 3,500 persons of Greek ancestry. a. True b. False ANSWER: False 5. There are several thousand human genetic diseases, 500 of which are linked to a defect in a single gene. a. True b. False ANSWER: True Multiple Choice 6. Which of the following describes a procedure in which a sperm sample is taken from a donor who is not the partner of the woman seeking to become pregnant? a. Homologous artificial insemination b. Heterologous artificial insemination c. Amniocentesis d. In vitro fertilization ANSWER: b 7. In the event of wrongful death of a fetus, which of the following may recover a stillborn child’s estate? a. Survival action b. The Unborn Victims of Violence Act c. Baby Doe law d. Federal law ANSWER: a 8. Which genetic disorder often causes fatal chronic lung problems?

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a. Cystic fibrosis b. Sickle cell anemia c. Hemophilia d. Tay-Sachs disease ANSWER: a 9. Which of the following is used to identify whether a parent’s known genetic defect is present in an embryo produced by in vitro fertilization? a. Amniocentesis b. Preimplantation genetic diagnosis c. DNA sampling d. Embryonic stem cell research ANSWER: b 10. What prevents withholding of medical care from an infant with noncongenital anomalies? a. Baby Doe law b. State law c. The Constitution d. Hospital policy ANSWER: a 11. During the separation of marital property, which court case determined that the surviving embryos would be discarded in accordance with the terms of the in vitro fertilization agreement? a. Roe v. Wade b. Roman v. Roman c. Griswold v. Connecticut d. Katz v. United States ANSWER: b 12. Which of the following holds genetic information responsible for the development and performance of an organism? a. DNA b. Genes c. Embryonic stem cells d. Fetal tissue ANSWER: a 13. Wrongful death is death caused by a. malpractice b. negligence c. parens patriae d. sanctity ANSWER: b

.

14. Investigating an individual’s genetic makeup may be used for purposes, such as treatments. a. inappropriate; valuable Copyright Cengage Learning. Powered by Cognero.

purposes, such as discrimination or for

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b. right; wrong c. ethical; moral d. individual; global ANSWER: a 15. What key element is often the reason for debate surrounding the use of embryonic stem cells for research? a. Religion b. Political views c. Culture d. Federal and state regulations ANSWER: a 16. What argument best describes an advocate’s perspective of embryonic stem cell research? a. Embryonic research does not tamper with the natural progression of fetal development b. Embryonic research may aid in developing more efficient treatments for severe diseases c. Embryonic research is more ethical than somatic research d. Embryonic research aligns with most religious beliefs ANSWER: b 17. What religion does not support embryonic stem cell research under the belief that “the moment of conception is also the beginning of the entity of the human person?” a. Judaism b. Buddhism c. Catholicism d. Protestant ANSWER: c 18. Select the type of samples necessary for genetic testing. a. Solid tissue, blood, skin, saliva b. Solid tissue, nucleated cells, urine, blood c. Solid tissue, hair, saliva d. Solid tissue, nucleated cells, saliva, blood ANSWER: d 19. Which of the following is an example of genetic testing? a. IVF b. Autografts c. DNA d. Amniocentesis ANSWER: d 20. Which of the following can be used to choose a child’s sex? a. Amniocentesis b. Preimplantation genetic diagnosis c. Cloning d. In vitro fertilization Copyright Cengage Learning. Powered by Cognero.

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ANSWER: b 21. The United States is pluralistic. What does this mean in the context of this chapter? a. It restrains debate. b. It allows for multiple positions on ethical issues. c. It allows for a single position on ethical issues. d. It allows for healthy debate.

ANSWER: b 22. Reproductive involves identically duplicating an organism. a. in-vitro fertilization b. insemination c. cloning d. amniocentesis ANSWER: c 23. The human right to a. abortion b. privacy c. conceive d. life ANSWER: b

is grounded in the basic moral tenet that each individual has an incalculable worth.

24. Which of the following statements about human reproductive cloning is true? a. There are no federal regulations related to human reproductive cloning. b. There are federal regulations related to human reproductive cloning. c. All states have laws that prohibit human reproductive cloning. d. Human reproductive cloning is legal in all U.S. states.

ANSWER: a 25. Children may be conceived by parents for their assistance in the treatment of another family member with a serious illness. What are these children called? a. Siblings b. Savior babies c. Anencephalic babies d. Tay-Sachs babies ANSWER: b 26. One debate regarding is that an individual’s incalculable worth extends to the fetus. a. cloning b. embryonic stem cell research c. preimplantation genetic diagnosis d. abortion ANSWER: d 27. What type of claim will plaintiffs typically file when they sue for the loss of a frozen embryo?

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a. Wrongful death b. Survival action c. Medical malpractice d. Property damage ANSWER: d 28. Which of the following are derived from human embryos or fetal tissues and are self-replicating? a. DNA b. Embryonic stem cells c. Genes d. Molecules ANSWER: b 29. In the Roe v. Wade Supreme Court decision, what was the deciding factor? a. A woman may seek an abortion only if she has the permission of her spouse (or parents, if the woman is a minor). b. States may decide how to regulate all abortions. c. Women have a right to privacy in a first-trimester abortion. d. Abortions are only legal in the first trimester.

ANSWER: c 30. The debate over the use of embryonic stem cells for research emanates from the fact that the definition of unclear. a. a fetus b. a life c. morals d. personhood ANSWER: d

is

Subjective Short Answer 31. What options are available to a couple when a diagnosis confirms that the man does not have enough active sperm to fertilize the woman’s egg?

ANSWER: 1) Adoption; 2) homologous artificial insemination; or 3) Heterologous artificial insemination.

32. What are genetic data banks used for?

ANSWER: Genetic data banks are usually developed for clinical research and public health programs.

33. Describe the dilemma of sanctity versus quality of life.

ANSWER: This is an ethical dilemma that considers whether living with the disease or disorder is better or worse than living without one.

34. What type of artificial insemination procedure involves a sperm sample from a woman’s partner?

ANSWER: This is called homologous artificial insemination.

35. What is the Unborn Victims of Violence Act?

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ANSWER: It is a federal law that makes it a crime to harm a fetus while assaulting a pregnant woman during the commission of a federal crime.

36. The Society for Assisted Reproductive Technology justifies preimplantation diagnosis under what circumstances?

ANSWER: The Society for Assisted Reproductive Technology, whose members provide preimplantation diagnosis, says it is “ethically justified” to prevent serious adult diseases for which “no safe, effective interventions are available.”

37. What court case settled a custody dispute under the decision that frozen embryos were considered property and not human life?

ANSWER: In the Roman v. Roman case, the appellate court ultimately upheld the terms of the written IVF consent agreement that included a provision to discard the embryos should the parties divorce.

38. What ethical questions should be considered in relation to in vitro fertilization?

ANSWER: 1) Should in vitro fertilization be offered to only those who can afford it? 2) Is it ethical to allow anyone regardless of age to undergo in vitro fertilization?

39. When using assisted reproductive technology to conceive, what options may a woman have to consider if her partner dies and the first attempt to conceive is unsuccessful?

ANSWER: 1) Continue artificial implantation with the remaining embryos; 2) Impregnate a surrogate; or 3) Discard the embryos 40. What options may a couple have to consider when the woman is unable to conceive but has healthy eggs?

ANSWER: 1) Implant an embryo in a family member to carry a child to term; or 2) Implant the couple’s embryo in a stranger to carry a child to term for a fee

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True / False 1. A variety of influences shape our thoughts and feelings about death and dying, including family, religion or spirituality, the media, society, and life experiences. a. True b. False ANSWER: True 2. A living will is intended to extend the right to refuse specific treatments in the future event where the individual becomes incompetent. a. True b. False ANSWER: True 3. The only way a health care proxy can be revoked is if the patient notifies the agent or health care provider verbally. a. True b. False ANSWER: False 4. A DNR order only works if the health care provider knows it exists. a. True b. False ANSWER: True 5. A health care proxy asserts an individual’s right to accept or refuse treatment and gives direction to relatives, friends, and medical professionals. a. True b. False ANSWER: False Multiple Choice 6. Recently, the criteria for considering a person dead under the Uniform Determination of Death Act (UDDA) has been reconsidered. What criteria are being reviewed? a. Who should determine whether a person is dead or not. b. Whether a person is dead at the cessation of brain function. c. Whether a person is dead at the cessation of circulatory function. d. Whether biological criteria should be the only criteria in determining death.

ANSWER: d 7. In which situation is it crucial to have a clear determination of death? a. Family relation issues b. Tax issues c. Life insurance issues d. Cultural issues ANSWER: c

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8. Palliative care is best defined by: a. a patient’s right to die being documented. b. compassionate care for all patients. c. appointing a caregiver in a case of incompetency. d. care in keeping a terminally ill patient comfortable.

ANSWER: d 9. A health care proxy can be referred to as which of the following? a. Power of attorney b. Executor of will c. Living will d. Surrogate ANSWER: d 10. A patient is declared never to regain consciousness. They are continuing to be fed by artificial means. There is family and state conflict, as well as public debate about whether or not the feeding tubes and protocol should be stopped. What is the ethical dilemma? a. Right to life versus right to death b. Obligation to uphold life versus obligation to prevent suffering c. Obligation to serve the patient versus obligation to serve the family’s wishes d. Duty to feed people who need artificial feeding versus patient autonomy ANSWER: b 11. Which of the following is the definition of cardiopulmonary arrest? a. Cessation of normal functioning of the breathing and lungs b. Cessation of normal functioning of the cognitive thinking and lungs c. Cessation of normal functioning of the heart and lungs d. Cessation of normal functioning of the kidneys and lungs ANSWER: c 12. Which of the following is an advance directive? a. Assisted suicide b. Patient Self Determination Act c. Hospice care plan d. Living will ANSWER: d 13. A document signifying a principal to delegate to another person the authority to act on the principal’s behalf is known as: a. health care proxy. b. durable living will attorney. c. durable power of attorney. d. advance directive.

ANSWER: c

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14. After treating a patient who suffered the traditional signs of a death have appeared. a. terminal illness b. cardiopulmonary arrest c. brain injury d. AIDS ANSWER: b 15. Assisted suicide laws fall under the jurisdiction of a. state law b. federal law c. contract law d. euthanasia statutes ANSWER: a

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using CPR, patients may be literally brought back to life after

.

16. The number of states that recognize some version of the durable power of attorney is a. 35 b. 40 c. 45 d. 50 ANSWER: d

.

17. The term for actively assisting someone to terminate their life at their request is which of the following? a. Suicide b. Death with dignity c. Euthanasia d. Removing life support ANSWER: c 18. In terms of patients being fed artificially, the Vatican’s position is: a. feeding should continue or discontinue at the patient’s explicit wishes. b. feeding should discontinue or continue at the family’s explicit wishes. c. feeding should discontinue due to potential suffering. d. feeding should continue; a person in a vegetative state has fundamental human dignity.

ANSWER: d 19. The Uniform Determination of Death Act attempts to define when a person: a. has ceased circulation. b. may die. c. is considered dead. d. has spiritual death.

ANSWER: c 20. Living wills are: a. created by living people for themselves. b. created by living people for their family members.

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c. executed by living people for themselves. d. executed by living people for their health care providers.

ANSWER: a 21. Hospitals must provide written information to patients upon admission, informing them of their rights under state law to executive advance directives. This is a provision of which act? a. HIPAA b. PSDA c. Uniform Probate Codes d. Uniform Power of Attorney Act ANSWER: b 22. Termination of life support systems is considered: a. an individual decision. b. an intentional act. c. an advance directive. d. death with dignity.

ANSWER: b 23. What does a DNR order do? a. It halts only feeding by artificial means. b. It halts all treatment. c. It gives a family member control of the patient’s affairs if the patient cannot. d. It halts cardiopulmonary resuscitation.

ANSWER: d 24. Which is a provision of the PSDA? a. Hospitals must provide verbal information to patients upon admission, informing them of their rights to executive advance directives. b. Hospitals must provide verbal information about how to carry out advance directives. c. Hospitals should not document whether an advance directive exists for a patient due to privacy. d. Hospitals must educate their staff and community on advance directives.

ANSWER: d 25. A person who is fatally ill with a condition for which there is no reliable cure is considered a. extremely b. terminally c. living d. euthanasia ANSWER: b

ill.

26. What is an advance directive? a. One person making a decision for another. b. Written instructions about a person’s future medical care. c. A promise that specifically named results will occur.

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d. A prior sworn statement by a witness to be used in court as testimony taken under oath and subject to crossexamination.

ANSWER: b 27. Under the PSDA, each entity is required to maintain policies and procedures concerning advance directives and provide information to patients at the time of admission or enrollment. a. verbal and written b. written c. verbal or written d. verbal ANSWER: b 28. Euthanasia is also known as: a. the right to die. b. physician-assisted suicide. c. a good death. d. a mercy killing.

ANSWER: d 29. A purist is a person who: a. follows a patient’s preferences. b. follows a family’s preferences. c. follows rules above all else. d. cares for patients.

ANSWER: c 30. In order to meet the criteria for an adult to accelerate their death under a death with dignity act, they must have: a. a terminal illness. b. a serious illness. c. chronic pain. d. a genetic disorder.

ANSWER: a Subjective Short Answer 31. Who accepts living wills as the right to refuse artificial life-sustaining procedures?

ANSWER: Living wills are accepted by courts, health care providers, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, and lawyers.

32. When was the PSDA implemented?

ANSWER: The PSDA was implemented in 1990.

33. What criteria must an individual meet in order to execute a living will?

ANSWER: To execute a living will, a person must be competent.

34. What is the definition of assisted suicide?

ANSWER: Assisted suicide occurs when one person makes it possible for another person to commit suicide.

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35. What is the ethical dilemma related to the decision to keep or remove life support?

ANSWER: The ethical conflict in these cases is the tension between the obligation to prevent death and the obligation to prevent suffering.

36. List one reason why ethical issues arise around the definition of “brain death.”

ANSWER: Answer should include: There may be a personal religious belief component in death. These beliefs may be in conflict with the Uniform Determination of Death Act (UDDA) definition of brain death, which leads to questions concerning the ethical implications of following science when it conflicts with religious beliefs.

The student may cite the case of Nayim Carter, whose parents’ religious beliefs were that he could recover from his condition.

37. What are some of the arguments made against euthanasia?

ANSWER: Answers can include the following: (1) mistake in diagnosis; (2) difficulty in determining if euthanasia is voluntary, for example, when there is an undue influence exerted on the patient by a member of the family or beneficiary of a will for financial reasons; (3) slippery slope argument, for example, with the growth of managed care there may be more pressure to hasten death for those who are elderly, uneducated, on welfare, or disabled; (4) altering the role of physicians to include the practice of killing patients would bring about a psychological upheaval in the doctor–patient relationship, and patients would become less trustful of their physician’s role as healer.

38. The Death with Dignity Act has been a source of debate for many years. Name five states that have implemented the act.

ANSWER: Answers will be among: California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington 39. List the situations in which the determination of death is crucial.

ANSWER: Answers should include: executing wills and distributing estates, life insurance, tort lawsuits, organ donation, and criminal matters involving death.

40. List three types of advance directives discussed in this chapter.

ANSWER: There are three major forms of advance directives: living will, durable power of attorney, and health care proxy.

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SOLUTION MANUAL

SOLUTION MANUAL

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 1, The Big Business of Health Care and You

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 1, The Big Business of Health Care and You

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

Frontline health care professionals can help prevent medical malpractice lawsuits by: • Representing themselves and their employers in a professional manner.

• Know the applicable laws and regulations.

• Understand their scope of practice.

• Maintain positive patient interactions.

• Minimize the nonmedical and nonlegal variables involved in malpractice.

• Abide by HIPAA's regulations regarding patient confidentiality.

The owner of a sole proprietorship has unlimited personal liability and does not have the tax advantages of an LLC or a corporation. There is no legal separation between you and your business in a sole proprietorship.

Unlike a partnership, a person’s interest in a corporation is represented by stock, and the risk for the corporation’s debt does not extend past the amount invested; except for very rare situations (called piercing the corporate veil), the personal assets of a corporation’s shareholder are not at risk to cover corporate liability.

A provider may be tempted to achieve maximum financial reward by not ordering tests or procedures or prescribing medicine.

Personal health information has become a lucrative target for illegal actions on the internet. Health care companies have more liability than just HIPAA violations, and they now need to be stalwart defenders of their technologies' security.

2.

3.

4.

5.

Cases For Discussion 1.

The Central Texas Medical Foundation and Brackenridge Hospital should be held vicariously liable for Dr. Villafani’s treatment of the plaintiff. The Foundation and Brackenridge Hospital had control over the details of Dr. Villafani’s work, so the court concluded he was the Foundation’s “borrowed employee” when he treated plaintiff. Consequently, St. Joseph’s could not be vicariously liable under the theory of respondeat superior, in part, because St. Joseph’s had no control over Dr. Villafani’s work at Brackenridge.

St. Joseph Hosp. v. Wolff, 94 S.W.3d 513 (Tex., 2002).

Parkview may be held vicariously liable for Christian's misconduct even if the actions in question ran directly counter to Parkview rules or policies, such as the Confidentiality Agreement and the Acknowledgment Regarding Access to Patient Information. The employee’s conduct was likely incidental to her duties at work because it was "of the same general nature" as her authorized job duties, which included use of the electronical medical records, management of schedules and communication, and other tasks that required access to patients' charts. While this case was settled before trial, it is likely Parkview should be found vicariously liable given the facts in this case. SoderVick v. Parkview Health Sys., 148 N.E.3d 1124 (Ind. App. 2020).

2.

© 2022

1

Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 2, Laws and Regulations You Will Encounter Laws and Regulations You Will Encounter

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 2, Laws and Regulations You Will Encounter

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

2.

Responses will vary.

While it may not be a discriminatory question, it is ill advised as there is a lot of room for follow up questions that may be discriminatory. Instead, it is better to be clear during the interview as to the company policy. For example, you can mention that vaccination or a viable medical excuse is a requirement of employment.

The Family Medical Leave Act. If a health care professional receives a needle stick at work, they should follow procedures in the office procedures/protocol manual. In addition, providers and their staff must comply with OSHA’s Bloodborne Pathogens regulation (29 CFR 1910.1030), which establishes standards for exposure incidents involving bloodborne pathogens.

3.

4.

Cases For Discussion 1.

The issue in this case is whether material written in a personnel manual may constrain an employer’s power to terminate an employment relationship that would otherwise be terminable at will. When the chief executive officer testified that Leikvold was terminated because of her requested transfer to a subordinate position, Leikvold argued that the employees’ handbook was part of her employment contract and that she could not be fired unless for a reason listed. Applying for a subordinate position was not listed as a cause for discharge.

The court agreed with Leikvold and returned the matter to a lower court for trial on the facts.

The court stated: “If an employer does choose to issue a policy statement in a manual or otherwise, and by its language or by the employer’s actions, encourages reliance thereon: the employer cannot be free to only selectively abide by it. Having announced a policy, the employer may not treat it as illusory.” Leikvold v. Valley View Community Hospital, 688 P.2d 170 (Az. 1984).

Markus' behavior would likely be deemed sexual harassment, which is unwelcome sexual attention at an employee's workplace that establishes a hostile work environment, negatively affects the employee's ability to do their job, or which results in a detrimental change in their job responsibilities. When Markus continued his conduct after his advances were declined, his conduct became harassment.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 3, From the Constitution to the Courtroom

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 3, From the Constitution to the Courtroom

Table of Contents Study Questions ....................................................................................................................................................... 1

Study Questions 1.

The Supremacy Clause ensures that the federal government can legislate certain matters that fall under one of its enumerated powers, including interstate commerce and foreign relations. Consequently, when there is a conflict between federal and state law, the Constitution Supremacy Clause tells us that federal law will govern. There are, however, exceptions to this rule.

The three branches of government are the executive, the legislative, and the judiciary. There are checks and balances, so no one branch can gain too much power.

The three levels of the judiciary are the trial court, the mid-level appellate court, and the highest-level appellate court. The name of the highest court in the United States is the Supreme Court.

Federal agencies can make their own rules and prosecute those who violate the rules, provided Congress gives them this power.

The major distinction between criminal and civil law is that criminal law involves the prosecution of cases by the state against a defendant who has been charged with violating a specific criminal statute, and, if found guilty, the defendant may face time in prison. Civil law generally involves a dispute between individuals or legal entities such as corporations, and even though the state (or federal government) can be a party in a civil lawsuit, the defendant in a civil lawsuit will not face the possibility of prison.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 4, Criminal Acts and Intentional Torts Laws and Regulations You Will Encounter

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 4, Criminal Acts and Intentional Torts

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

The element of intent differentiates murder from euthanasia. Often courts are more lenient with people charged with euthanasia if the objective of the killing was to spare a terminally ill person additional pain.

Statutes and regulations on child and elder abuse affect the medical office because the reporting of suspected child or elder abuse is mandatory.

The difference between robbery and larceny, both of which involve the theft of another's property, is that robbery involves the victim being physically injured or being put in fear of bodily injury. Larceny is a theft that does not involve the use of force.

The patient can file a complaint against the hospital for a claim of false imprisonment.

Which ae examples of insurance fraud and which are examples of insurance abuse: a. Insurance Fraud

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Cases For Discussion 1.

In most states, each one of the hypothetical situations would be identified as child abuse and should be reported.

If it can be proven that the provider had an intent to defraud for purposes of collecting additional billings or other unsound or unprofessional reasons, the patient would likely be successful in a civil fraud suit.

Such fraud can also be criminal. The important facts are that there was intent and that the purpose was to obtain payment.

Venner was found guilty of possession of marijuana with an intent to distribute. In this case, the police did not confront or even see Venner at the hospital. There was nothing in the record to suggest that when the nurses, in the normal routine, took the bedpans from Venner’s bed to the place for disposition of their contents that it was a place where Venner had a constitutionally protected right of privacy. Nor was there anything to suggest that Venner exercised or attempted to exercise any right of possession or control over the balloons. They were abandoned by Venner, and their subsequent retrieval on behalf of the police was lawful. Venner v. State, 30 Md. App. 599. 354 A.2d 483 (1976).

The court held against the defendant surgeon and stated that it could not be concluded that the article was written solely for scientific purposes stating that “even a scientific publication may be nothing more than someone’s advertisement in disguise.” Griffin v. Medical Society of New York, 11 N.Y.S.2d 109 (N.Y. 1939).

The court ruled against the provider. The provider’s refusal to correct or retract his error and the injury

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 4, Criminal Acts and Intentional Torts Laws and Regulations You Will Encounter

that it inflicted on the patient were considered sufficient for the jury to award substantial damages. Vigil v. Rice, 397 P.2d 719 (N.M. 1964).

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 5, What Makes a Contract Laws and Regulations You Will Encounter

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 5, What Makes a Contract

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

Implied: rolling up a sleeve to accept an injection; taking a pill given to you; following instructions during an examination; describing symptoms and history. Express: completing admission documentation or an informed consent form; verbally saying “yes” to a provider’s recommended course of treatment.

Without an express contract, providers typically do not warrant the results of their work. An express contract can be written or oral. If the patient’s comments were inaccurate and the results of the surgery not as described, the patient would feel as if the provider did not do what he or she stated. Here, it would be worthwhile to discuss the patient’s understanding of what the provider stated and make any needed corrections. Such a situation should be noted in the patient’s chart.

Generally, parents are responsible for the financial needs of their minor children. In this case, the issue of confidentiality must be addressed. Because the minor was pregnant, she is able to consent to medical care, which implicitly suggests the parents do not know about the pregnancy. A provider may be deemed to have breached the patient’s confidentiality by seeking payment from the parents. A provider may dismiss a patient for nonpayment of fees, but you must do so in a way that allows the patient to obtain other care. In addition, depending on the facts, the patient–provider relationship established during the first pregnancy may be deemed concluded, so at the time the patient requested an appointment the provider could have refused to accept her as a new patient. If after the first pregnancy, the provider chose to terminate the patient, they should send detailed letter to the patient confirming discharge using certified mail and allowing time for the patient to find a new provider.

A conservator is a person appointed to care for another’s financial matters. A legal guardian would be appointed to make health care decisions for someone who did not have the legal capacity to contract.

Because the woman is a conservator, rather than a legal guardian, she would not be able to consent to medical treatment on behalf of the minor. I would explain the difference between the two and help the woman identify the appropriate person to consent to medical treatment.

The federal Fair Debt Collections Practice Act (FDCPA) governs collections practices. The FDCPA prohibits many different collection practices—for example, threats of violence, use of abusive language when trying to collect the debt, harassment by means of phone calls, and deception and unfair methods of collection (e.g., threatening to deposit a postdated check before the date of the check, intentionally causing the debtor’s other checks to be dishonored).

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Cases For Discussion 1.

The gynecologist was right to refuse to enter into a contract to perform the abortion. The court would not require the 16-year-old female have an abortion and would likely consider the teenager a mature minor, who is legally capable of making such decisions for herself. As a result, the teenager had the legal capacity to choose not to enter into a contract for abortion. In making this determination, the court would consider the age of the pregnant teenager, and her emotional maturity, intelligence, and ability to comprehend the decision when making this decision. If the 16-year-old could not be considered a mature minor, it’s likely that a doctor would not perform the abortion without a court order.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 5, What Makes a Contract Laws and Regulations You Will Encounter

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The court would likely agree with the father. When the provider allowed the patient to be admitted to the hospital under his name, the provider established a patient–provider relationship.

The radiologist took the X-rays that were ordered by the provider and likely prepared a report as to the patient’s diagnosis. The radiologist undertook to treat the patient by taking and reading X-rays, so there was a contractual relationship with the patient even though he never saw her.

The court would not find the consultant provider liable for the gauze in the patient’s abdomen. The consultant provider was not present during the surgery, and there was no reason to think he should have known about the gauze left in the patient’s abdomen. It is also possible that there was no consideration, which would allow for a contract to be formed, since the consultant provider was not expecting a fee.

The surgeon would not be liable for breach of contract. Assuming there was informed consent that would have explained that the procedure may not work, the husband’s vasectomy not preventing conception would be a risk.

If the surgeon warranted specific results, he or she would be liable for breach of contract. Here, the surgery was to improve the patient’s appearance, not worsen the appearance, so the surgeon would be liable for breach of contract.

If the surgeon warranted specific results, the surgeon would be liable for breach of contract. Here, the surgery was to sterilize the patient, but one of the fallopian tubes was left intact, so the surgeon would be liable for breach of contract.

No, the provider did not have the right to discharge the patient from the hospital because he could not pay his bill. The provider abandoned the patient when he discharged him too soon after the electroshock treatment. When a provider enters into a patient–provider relationship, the provider is obliged to attend the case as long as it requires attention, unless the patient is given reasonable notice of the provider’s intention to withdraw, or the patient informs the provider that the services are no longer desired.

A contract was formed when the patient scheduled the appointment. The provider’s actions constitute abandonment, and damages should be awarded. If the provider desires to withdraw from the case, the reasonableness of notice becomes an issue that depends on the patient’s condition, the availability of other competent providers, the manner of notice, and, indirectly, the patient’s educational and economic status. Here, it was unreasonable of the provider to refuse treatment based upon the patient’s need for a guide dog. And the provider made no effort to arrange for alternative care for the patient.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 6, Medical Malpractice and Other Lawsuits

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 6, Medical Malpractice and Other Lawsuits

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 3

Study Questions 1.

Examples of negligence: putting a patient’s medical record in the trash; sending a medical record to someone not authorized to receive it; spilling liquid on the floor and not cleaning it, among many others.

Examples of malpractice: not using a new needle for an injection; improperly recording a patient’s vital signs, among others.

An expert witness in a legal action involving a medical assistant who works in a pediatrician’s office should have experience in the field of pediatrics and know what tasks medical assistants perform in such an office and how those tasks are performed.

A patient–provider relationship is required before a patient may claim that a provider owed a duty of care.

To have a medical malpractice lawsuit, the patient must show the following: • There was a patient–provider relationship.

• This relationship established duty by the provider to the patient.

• The duty had been upheld at a professional standard of care.

• The provider breached the duty to the patient.

• The patient had a resulting injury.

• The provider’s breach was the proximate cause of the patient’s injury.

Advise the patient that you can schedule additional time for the patient to speak with the provider and clear up remaining questions. Then, ensure you make a note or inform the provider that the patient seems to have remaining questions about options and, thus, consent.

Common defenses available to a defendant in a medical malpractice cause of action include statute of limitations, contributory negligence, comparative negligence, assumption of risk, and emergency.

• Statute of Limitations - The statute of limitations sets forth a particular number of years within which one person can sue another. Attorneys representing providers who have been sued for malpractice will typically first determine whether the statute of limitations has run out by determining how much time has passed since the time the patient knew or should have known there was an injury and the time the lawsuit was filed. Different causes of action have different statutes of limitations. For example: A patient had pain in her leg which began immediately following surgery on her gallbladder. For several years following surgery she knew that she had phlebitis. She went to another surgeon, who informed her that a vein in her leg had been severed at the time of her gallbladder surgery. She filed a malpractice action against the first surgeon. The court determined that the pain in her leg and other symptoms put her on notice that something was wrong and that she should have filed an action immediately. The surgeon raised the defense of statute of limitations, and the patient’s failure to file a lawsuit within the statutory period eliminated her right to sue.

• Contributory Negligence - Contributory negligence is a term used to describe any unreasonable

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 6, Medical Malpractice and Other Lawsuits

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behavior on the part of the patient that contributed, in part, to the cause of injury. In other words, if a patient does anything that contributes to his or her suffering and constitutes behavior that is non-self-preserving, the patient is contributorily negligent. For example: A patient undergoes surgery and does not follow any of the provider’s post-surgery instructions, including instructions for care of the incision. The patient develops a significant infection and other complications. The patient sues, and the provider raises the defense of contributory negligence since the patient’s failure to follow the provider’s post-surgery instructions was the cause of the infection.

Comparative Negligence - Under comparative negligence, the plaintiff is allowed to recover damages proportionate to the defendant’s fault, at least in a situation in which the plaintiff’s negligence is less than that of the defendant. For example: A patient goes to the hospital and is diagnosed with pneumonia. The provider advises the patient to stay in the hospital but does not warn of the risks of not staying in the hospital. The patient decides to leave against the advice of the provider and develops serious complications. The patient sues, and the provider raises the defense of comparative negligence since the patient’s failure to follow the provider’s advice was, in part, responsible for the injuries. The court may find the patient was 60 percent responsible for his injuries (for failing to follow the advice of the provider), and the provider was 40 percent responsible (for failing to warn of the risks associated with leaving the hospital against medical advice).

Assumption of Risk - Assumption of risk is defined as voluntarily accepting a known danger. The consent to assume risk may be express or implied. This is a defense similar to the doctrine of informed consent in that the only way a patient may assume the risk of a procedure is if the patient is informed of it by the provider. For example: A patient provides informed consent to a surgery knowing that one of the risks of the surgery is blindness. The risk of blindness occurs as a result of surgery, and the patient sues. The provider would have the defense of assumption of risk, as the patient knew that, even with the utmost care, that blindness was a risk of undergoing the surgery.

Emergency - Both common law and Good Samaritan acts protect health care professionals when they respond to an emergency situation. Under common law, the elements of a medical malpractice action are applied to the emergency situation. For example: if a medical assistant witnesses an automobile accident and no one else is available, is the medical assistant liable for what happens to the victim? o Relationship: No contractual relationship exists between the medical assistant and the victim as long as the medical assistant does not stop to give help. As soon as help is offered—merely stopping a car may prevent someone else from coming to the aid of the victim—a relationship is established with the victim. o Duty: As long as the medical assistant passes the accident, he or she has no legal duty to assist the victim. After a medical assistant stops, the victim cannot be abandoned unless care is being provided by someone with comparable or better training, or until the first responders arrive on the scene and assume responsibility for the victim. This reasonable person duty applies whether the Good Samaritan is a health care professional or a layperson. o Standard of care: In an emergency situation, to encourage trained people to stop and assist, states have enacted Good Samaritan statutes to protect the rescuer from liability. The level of training of the Good Samaritan and the standard of care are important to the person being rescued, but the rescuer will only be held liable for reckless behavior. o Breach of duty: If a person passes an accident, no breach of duty exists because no relationship with the victim from which a duty arises has been established. If a helper stops and assists, he or she will be held to a standard of care appropriate to the individual’s training and experience. If the procedures are performed below standard, the usual question of the court is whether the actions increased the injury of the victim.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 6, Medical Malpractice and Other Lawsuits

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Injury: The victim is already injured. The Good Samaritan has a responsibility to help the victim, but for the helper to be held liable for the injury, the helper’s acts must cause a considerable amount of additional harm. o The breach was the cause of the injury: Under negligence law, the victim must prove by a preponderance of the evidence that the help offered caused injury. Since the victim is already injured, the helper’s behavior would have to be grossly negligent to increase the victim’s injuries.

You are under no obligation to assist in an emergency, but once you begin to help you may not stop until first responder help arrives or comparable or better care than you can provide.

Does your malpractice insurance cover a health care professional working in this office?

The medical office landlord knew of the defect in the floor and should have fixed it. At the same time, the injured person may also be partly responsible for not observing a known defect because he was drunk.

If the medical office knew or should have known about the defective chair, it would be liable for any foreseeable injury that flows from it, possibly including pneumonia.

Equipment found in a medical office that could give rise to a product liability claim includes exam tables, hypodermic needles, forceps and other tools, chairs and rolling stools, medical devices and medications, among many others.

Cases For Discussion 1.

Yes. A defendant may be held liable to a person whose existence was not apparent at the time of the act.

The sensitization of the mother’s blood at 13 years of age was a negligent act. At that time, it could be foreseen that the mother would become pregnant and bear a child with incompatible blood, resulting in defects in the child. There is a right to be born free from prenatal injuries. Renslow v. Mennonite Hospital, 67 Ill. 2d 348. 10 Ill. Dec. 484 (1977).

No. When a provider enters into a professional relationship with a patient, the provider is not at liberty to withdraw until replaced by an equally qualified provider. Hospital records revealed that the defendant abandoned the patient before another provider was called in; therefore, there was sufficient evidence for a jury to conclude that the defendant had abandoned the patient. Typically, the informed consent obtained is not specific to one provider and it covers all who might provide care. Ascher v. Gutierrez, 175 U.S. App. D.C. 100. 533 F.2d 1235 (1976).

The court found the hospital liable for the nurse’s negligence and held that a reasonably prudent nurse would have paid closer attention to the patient. The nurse was held to have violated the nursing standard of care. Hiatt v. Groce, 523 P.2d 320 (Kan. 1974).

Expert testimony revealed that the provider’s failure to examine the boy more thoroughly was negligence, but the charges were dismissed because none of the experts could testify that the patient more than probably would have survived such a severe head injury with treatment. Cooper v. Sisters of Charity, 272 N.E.2d 97 (Ohio 1971).

The defendant was not guilty in the manner of operating but was guilty of not informing the patient about the risk of surgery. Because the risk was not explained and the patient was not given the opportunity to decide as to whether he wanted to take the risk, the matter was remanded for a new trial on that issue.

Barnette v. Potenza, 79 Misc. 2d 51. 359 N.Y.S.2d 432 (N.Y. 1974).

Yes. The general rule is that the consent of a parent is necessary for an operation on a minor. There are exceptions, but this case does not fall within an exception. Bonner v. Moran, 75 U.S. App. D.C. 156. 126 F.2d 121 (1941).

Yes. The common-law rule that any extension of an operation without either the patient’s consent or the consent of one with authority to consent for him or her constitutes a battery or trespass. Because of the use of anesthesia, it is impractical to obtain the patient’s consent. Usually, someone else who is in the family or otherwise designated by the patient will make the decision. In situations of abdominal surgery, it is well known that an exact diagnosis cannot be made until the patient is under anesthesia and the incision made. It is better to extend consent to allow the surgeon to extend the operation to remedy any

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 6, Medical Malpractice and Other Lawsuits

diseased condition around the original incision without further consent. Kennedy v. Parrott, 243 N.C. 355.

90 S.E.2d 754. 56 ALR 2d 686 (N.C. 1956).

This is a matter of product failure. The forceps are expected to do the job they were designed to do. The patient, the surgeon, and the hospital depended on the forceps performing a task they were designed to perform. There is nothing extraordinary in their use. Taking all these factors into consideration, the medical supply distributor is liable for furnishing the defective instrument to the hospital under a warranty theory and the manufacturers on a strict liability theory for making a defective product. The surgeon and the hospital were not found liable for this latent defect.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 7, The Health Record

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 7, The Health Record

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

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A health record includes past history, a statement of the current problem and diagnosis, and the treatment procedures used to solve the problem.

The ownership of a health record is not absolute, and it may require that the owner must allow others to access it.

Issues to consider: Who owns the record? What is the office’s policy on allowing patients to take home records, X-rays, etc.? Is there a medical need for the patient to show this information to others?

Seek the provider’s guidance on what can be provided to the patient. Explain to the patient that you will pass along the request to the provider and will follow up shortly. There are circumstances where information in a patient’s record can be withheld by the provider, and the provider should be involved in determining what should be withheld.

When you testify in court, you are under oath and subject to penalties for lying. So, answer all questions truthfully and to the best of your ability.

Determine if there is an office protocol for correcting medical records. If so, follow the protocol. If not, discuss alternative ways with the provider to correct the information that does not raise suspicion, or the appearance, of wrongdoing.

Cases For Discussion 1.

Yes. The plaintiff applied for insurance. He was an insurance broker and was fully aware, when he made the application, that the state of his health prior to issuance of any insurance policy was an important factor. Because he authorized the provider to release information about his past health, he has no case against the insurance company or the provider. The provider did only what the plaintiff authorized him to do. Millsaps v. Bankers Life Co., 342 N.E.2d 329 (1976).

No. The court had adequately protected the 140 patients from disclosure of their identity and the surgeries performed on them. The court did not see how this disclosure in any way impinges on the confidential patient–provider relationship the statute was designed to protect. Schach v. Whalen, 581 E.2d 35 (1978).

Yes. Destruction of records was evidence of negligence. The hospital did not have the right to destroy the records. Carr v. St. Paul Fire and Marine Insurance Co., 384 F. Supp. 821 (Ark. 1974).

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 8, Introduction to Ethics

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 8, Introduction to Ethics

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

Three situations that bring about ethical dilemmas in medicine include when religious beliefs of the provider or patient conflict with the application of best medical practice, when the cost of medical procedure is high and likelihood of success is low, and when the law requires medical action that invades a patient’s privacy. The identification of personal ethics that align with each dilemma will vary greatly amongst students, as will the methods used to separate their personal ethics from the ethical dilemma at hand.

Many patients consider themselves to be at the mercy of providers or at a disadvantage because they rely upon providers for specialized information, so the ethical codes help protect patients’ rights and privacy.

A code of ethics violation in health care may result in license suspension or revocation, or other negative repercussions from your employer, colleagues, patients, family, or friends.

See Table 8-2.

Personal morals develop and evolve throughout our lifetimes. Our family, friends, mentors, religious leaders, teachers, public figures, culture, and society, among others, expressly or through their actions, teach us what is and what is not acceptable behavior. People adopt some values because they appear as self-evident truths. Most values, however, develop as we mature from infancy. There are numerous theories that seek to explain how we develop our values. Lawrence Kohlberg expounded on the theories and research of Jean Piaget, which resulted in one of the more common and controversial theories of value development.

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Responses will vary.

Responses will vary.

Responses will vary.

Responses will vary.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 9, Laws and Ethics of Patient Confidentiality

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 9, Laws and Ethics of Patient Confidentiality

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

While privacy is a right that emanates from the U.S. Constitution and common law, confidentiality is grounded in an ethical duty.

HIPPA’s three main objectives: 1. To protect and enhance the rights of consumers by providing them access to their health information and controlling the inappropriate use of that information.

2. To improve the quality of health care in the U.S. by restoring trust in the health care system among consumers, healthcare professionals, and the multitude of organizations and individuals committed to the delivery of care 3. To improve the efficiency and effectiveness of health care delivery by creating a national framework for health privacy protection that builds on efforts by states, health systems, and individual organizations and individuals.

HIPAA’s Security Rule also requires that covered entities perform risk assessments, which include the identification of potential areas that may result in the disclosure of ePHI in violation of HIPAA’s Rules.

Anyone who has reason to believe that a covered entity or business associate violated HIPAA’s Privacy, Security, or Breach Notification Rules may file a complaint.

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Cases For Discussion 1.

A provider cannot deny you a copy of your records because you have not paid for the services you have received. However, a provider may charge for the reasonable costs for copying and mailing the records.

Yes, there was a HIPAA violation. Yes, it matters. The supervision had no legitimate reason for having the employee's PHI. Yes, an authorization is needed. Revise the authorization to specify what records and/or portions of the files may be disclosed.

Independent medical examinations contain PHI, and the patient is entitled to a copy.

If a patient has requested that a covered entity communicate with them in a specific and confidential manner, such as by requesting calls only at work, the covered entity must accommodate that request, if reasonable No. The hospital failed to comply with the HIPAA Security and Privacy rules such as breach of confidential information of the patients and non-compliance to the standards.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 10, Professional Ethics and the Living

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 10, Professional Ethics and

the Living

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

Consider: Inform the provider of the patient’s sentiments, so the provider and patient can discuss further; collect available written material on the procedure should the provider want to provide to the patient; you can provide empathy simply by letting the patient speak.

Responses will vary.

Ensure (1) that the patient wants you to work with the press; (2) that you have written authorization from the patient (or his parents, in this case) to ensure there are no HIPAA violations and no miscommunication; and (3) that you are clear about what information can be disclosed to the press.

You do not want your employer to be sued for malpractice associated with the abandonment of this patient. Suggest a certified letter explaining the provider's position along with alternative providers, and suggest the patient go to the emergency room, if the infection is severe.

Share with him that the sale of human organs is illegal.

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No. The court denied him the request and stated that transporting him to Colorado for testing and then back later for surgery would require the services of guards and other personnel, which would be expensive to the state. The court also stated that moving a prisoner under a death sentence would be extremely dangerous for the public. Campbell v. Wainwright, 416 F.2d 949 (1969).

Yes. Responses will vary.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 11, Reproductive Issues and Early Life

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 11, Reproductive Issues and Early Life

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

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Responses will vary.

Responses will vary.

Sanctity of life is a philosophy of life that holds living beings are inviolable. The decision not to remove life support from a person in a persistent vegetative state would be a sanctity of life argument.

Quality of life is a philosophy of life that focuses on the standard of health, comfort, and joy experienced by an individual. The decision to remove life support from a person in a persistent vegetative state would be a quality-of-life argument.

The three exceptions to the Baby Doe Law are: 1.

When the infant is chronically and irreversibly comatose.

2.

When treatment would merely prolong dying.

3.

When the treatment would be futile either because the child would not survive, or the treatment would be inhumane.

Responses will vary.

Responses will vary.

Testing for genetic information requires a DNA sample from solid tissues, blood, saliva, or other nucleated cells.

4.

5.

6.

7.

8.

Cases For Discussion 1.

No. There is no cause of action existing for the unintentional infliction of harm to a person in this situation. Although the deciding judge agreed that the provider’s failure to properly advise as to the genetic possibility of the disease and to test for the disease did not actually cause the disease in the newborn, his negligent act may be said to be the proximate cause due to the parents’ statement that abortion would have been sought had they been aware of the child’s abnormality. Howard v. Lecher, 42 N.Y.2d 109, 397 N.Y.S.2d 363 (1977).

Responses will vary.

Yes. The state of New York requires the consent of both parents of a child born in wedlock for an adoption to take place. New York has a strong policy in favor of legitimacy. It is determined that a child born of consensual artificial insemination during a valid marriage is a legitimate child entitled to the rights and privileges of a naturally conceived child of the same marriage. The first husband is the father, and for the second husband to adopt the child, the first husband must consent. In re Adoption of Anonymous, 74 Misc. 2d 99, 345 N.Y.S.2d 430 (1973).

The courts have consistently shown a policy favoring the requirement that a child be provided with a father as well as a mother. In a situation in which there is an anonymous donor, the courts have required that the person who consents to the use of sperm not his own be responsible for fathering the child. In this case, there is a known man who is the donor. There is no husband. If the couple had been married and the husband’s sperm was used artificially, he would be considered the father. The court found that the evidence supported C.M.’s contention that he and C.C. had a long-standing dating relationship and he fully intended to assume the responsibility of parenthood. He has shown a genuine interest in the child.

2.

3.

4.

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 11, Reproductive Issues and Early Life

He is a teacher and educationally able to aid the child’s development and is financially capable of contributing to his support. The court will not deny him the privileges of fatherhood. His motion for the right of visitation is granted. C.M. v. C.C., 152 N.J. Super. 160, 377 A.2d 821 (1977).

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Solution and Answer Guide: Pardew, Applied Law & Ethics in Health care, CY23, 9780357623879, Chapter 12, Death and Dying

Solution and Answer Guide Pardew, Applied Law & Ethics in Health Care, CY23, 9780357623879, Chapter 12, Death and Dying

Table of Contents Study Questions ....................................................................................................................................................... 1 Cases For Discussion ................................................................................................................................................. 1

Study Questions 1.

2.

3.

Responses will vary.

A patient would want a DNR order to ensure the patient’s wishes are known.

Responses will vary..

Cases For Discussion 1.

Death, as required by law, is cessation of life. Death is not merely the cessation of the heartbeat but occurs when the heart stops long enough to result in complete loss of brain function. In light of significant technological advances, the traditional principle must be modified. Brain death occurs when, in the opinion of a licensed provider, there has been a total and irreversible cessation of spontaneous brain functions and further attempts at resuscitation by continued supportive maintenance will not be successful in restoring such functions. Regardless of an ability to artificially maintain the heartbeat of the victim, proof of brain death satisfies beyond a reasonable doubt the element of the death of the victim.

Commonwealth v. Golston, 366 N.E.2d 744 (1977).

No. There is a constitutional right of privacy protecting against state action in this case. There is no compelling interest to justify the state to require the patient to continue existence. The prognosis is that the patient is doomed to the continuance of a mere biological vegetative existence. Such decisions should be controlled within the patient–provider–family relationship. Her father should be appointed as the patient’s guardian, and upon concurrence of the guardian and family of the patient, if the attending providers and hospital ethics committee or a similar body conclude that there is no reasonable possibility of the patient regaining a cognitive, sapient state, her life-support systems may be withdrawn. In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).

The trial court said yes and provided comment that there is more moral warrant for turning off a machine than for never having started it; that is, when the patient has been given the benefit of all known procedures and these prove unsuccessful in restoring health, they need not be uselessly continued. The case was appealed, and the appellate court restricted the medical criteria for activation of the patient’s right to terminate treatment to only those terminally ill who are in a permanent vegetative coma with extremely remote probability of regaining cognitive brain function (Paris, 1980, p. 876).

The Supreme Judicial Court did allow the removal of the tube. The hospital stated that the patient would have to be removed from the facility if the procedure were to be performed. Another hospital in the area accepted the patient and worked with his wife to provide dignity in death for the patient. Brophy v. New England Sinai Hospital, 398 Mass. 417 (1986).

Yes, the court upheld a substitute decision not to continue feeding the patient. The court stated that the primary focus should be the patient’s desires and experience of pain and enjoyment, not the type of treatment involved. In re Conroy, 98 N.J. 321, 486 A.2d 1209 (1985).

2.

3.

4.

5.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 4 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 5 Internet Resources............................................................................................................................................. 5 Appendix ..................................................................................................................................................... 7 Generic Rubrics .................................................................................................................................................. 7 Standard Writing Rubric .................................................................................................................................... 7 Standard Discussion Rubric ............................................................................................................................... 7

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Purpose and Perspective of the Chapter The purpose of this chapter is to give the learner an understanding of their crucial role in the health care system. Chapter 1 advises how understanding legal and ethical responsibility will protect these new health care professionals, their employers, and their patients. The chapter discusses differences among skill sets, scope of practice, and standards of care with information about how to proceed if there is a concern about employer assigned tasks. Patient protections in terms of patient rights and mandatory reporting for public health are addressed. Finally, the chapter reviews types of business entities and health care organizations that a learner may be working in as well as the benefits and challenges of remote health care, telemedicine.

Chapter Objectives The following objectives are addressed in this chapter: 01.01 Recognize the importance of your role on the front lines of the health care industry.

01.02 Differentiate among registration, certification, and licensure for health care providers.

01.03 Identify proper protocol when a health care professional is asked to perform a task outside the scope of practice.

01.04 Summarize what is meant by personal protection and provider protection.

01.05 Compare standard of care for medical assistants and for different health care professionals.

01.06 Summarize laws and standards that protect patients.

01.07 Identify the different types of legal entities.

01.08 List the main types of managed care organizations.

01.09 Explain the risks and rewards of telemedicine.

Key Terms Agent: One who has authority to act on behalf of another.

Bylaws: Regulations adopted by a corporation or association to govern its internal affairs.

Capitation: Payment in a lump sum to providers, HMOs, and health care facilities to deliver health care to a segment of the population.

Certification: Endorsement by an accredited professional organization that the holder has specific expertise as evidenced by passing an examination.

Conglomerate: A corporation diversifying operations by acquiring varied businesses.

Directors: Those elected and terminated by stockholders to manage a corporation.

Dividends: Distributed profits of a corporation.

Fee-for-service: Basis of professional billing, either so much per hour or per identified procedure.

Investment: Expenditure of resources (money, effort, etc.) intended to secure income or profit.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Joint venture: A group of persons together performing some specific business undertaking that is limited in duration or scope.

Legal entity: An individual or organization that has legal capacity to contract, incur and pay debts, and sue and be sued.

Negligence: Failure to act with reasonable and prudent care given the circumstances.

Negotiated fee schedules: The amount an insurance company or other third-party payer will reimburse for a specific medical procedure.

Notice: An announcement of pertinent information to those who have a right or obligation to know.

Officers: Persons holding formal positions of trust in an organization, especially those involved in high levels of management.

Per capita payment: Pay equally according to the number of individuals.

Reasonable person: A prudent person whose behavior would be considered appropriate under the circumstances.

Registration: Recordation and maintenance of professionals’ license related administrative information.

Respondeat superior: Legal theory that holds employers responsible for the behavior of an employee working within the scope of employment.

Scope of practice: The tasks and services that a qualified health care professional is considered competent and allowed to perform pursuant to their license, or, if no license, their education, and experience.

Shares: Units of stock giving the possessor part ownership in a corporation.

Standards of care: The amount of care that a reasonable person in similar circumstances would exercise.

Stockholders: Those who hold an interest in a corporation.

Utilization review: A process by which hospitals review patient progress to efficiently allocate scarce medical resources.

Vicariously liable: Legally obligated for the acts of others who are acting as their agent.

[return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

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New content on certification; scope of practice; vicarious liability; health care delivery systems; surprise billing; HSAs; and technology and medicine, including impact of COVID-19 upon telemedicine and health information on personal electronic devices.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

V.

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Introduction to the Business of Health Care (01.01) a. This section reviews the complexity of the US health care system. It notes the general complexity of the business as well as the new allied health care professional’s potentially dire role as a frontline worker and the heavy responsibility that holds. It mentions the conflicts between care delivery, cost containment and compliance. The competing interests between government, providers, patients, payers, and employers are also raised. Finally, this section discusses competition for cost control, market share and new product innovation with the emergence of Managed Care.

The Front Line Is You (01.01) a. This section discusses that the Allied Health Professional needs to understand that they are on the front line of the health care industry most in contact with patients.

Therefore, these professionals need to be aware of their legal and ethical responsibility and understand how their professional behavior has an impact on the legal and ethical standing of the organization as well as their own careers. b. Study Question #1: 15 minutes: Reviewing what the allied health professional can do to minimize risk of malpractice.

The Importance of Legal Knowledge (01.01, 01.02, 01.03, 01.04, 01.05, 01.06) a. This section introduces concepts of standard of care, licensure, registration, and certification, as well as scope of practice. Personal and provider protection are discussed as well as patient protection and the Patient Bill of Rights. b. Suggested Activity #1: 15 minutes total. Discuss the licenses and certifications that are available in the area and who issues them. c. Cases for Discussion #1: 30 minutes total. Discuss the case of Brackenridge Hospital and Resident Dr. Villafani performed tracheostomy with a breathing tube, which resulted in bleeding and permanent brain damage to the patient. The question is: Who, if anyone, should be held vicariously liable for Dr. Villafani’s treatment of the plaintiff? d. Cases for Discussion #2: 40 minutes total. Discuss the case of Parkview Health System’s OB/GYN case where patient Ms. SoderVick sued under assertion of respondeat superior after an employee violated HIPAA privacy provisions.

The Business Structure: Legal Entities (01.07) a. This section introduces the business structures that can be found in health care, from small structures like a solo practice to the conglomerate and informs about the concept of DBA. b. Suggested Activity #2: 30 minutes total. Find online resources for state corporations and research legal entity registrations with year created and other significant information. c. Study Question #2: 15 minutes: compare and contrast sole proprietorships and partnerships d. Study Question #3: 20 minutes: compare corporations and partnerships.

Health Care Delivery and Compensation System (01.08)

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

a. This section describes fee-for-service as well as managed care entities and features. The description and challenges of fee-for-service are discussed. The Managed Care Organization (MCO) is defined along with associated delivery systems such as HMO, PPO and others. A case study describing Amazon Care is featured illustrating commercial and provider collaboration in managing care. The Affordable Care Act subsection defines the ACA, the purpose, and the features of the law. b. Suggested Activity #3: 45 minutes total. Group discussion about what types of plans individuals may prefer and the variety of health insurance features. c. Study Question #4: 15 minutes total. Identifying the conflicts of MCO bonuses for providers who reduce testing.

Technology and Medicine (01.09) a. This section mentions how the COVID pandemic influenced the increased use of telemedicine and includes an insert that visits this concept in some depth. Here also are mentioned personal electronic devices with health metric monitoring expansion of electronic health records and associated technology. Telemedicine subsection delves into the use of video visits and transmitted monitoring, the development of best practices for remote health care services, and the legal challenges of telemedicine. b. Suggested Activity #4: 30 minutes total. Discussion of group’s experiences with telemedicine and how these services compare to in-person health care. c. Study Question #5: 15 minutes total. Identifying the risks associated with technology in health care.

VI.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Legal entities: U.S. Small Business Administration. (n.d.). Choosing your business structure. In Starting & managing. Retrieved from https://www.sba.gov/business-guide/launch-your-business/choosebusiness-structure

●

Managed care organizations: U.S. Centers for Medicare & Medicaid Services. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more. Retrieved from https://www.healthcare.gov/choose-a-plan/plan-types/

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American Telemedicine Association. Retrieved from https://www.americantelemed.org/

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

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Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 1: The Big Business of Health Care and You

Contribution Quality

Etiquette

© 2022

Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Table of Contents Purpose and Perspective of the Chapter

2

Chapter Objectives

2

Key Terms

2

What's New in This Chapter

3

Chapter Outline

3

Discussion Questions

5

Additional Resources

5

Internet Resources............................................................................................................................................. 5 Appendix

6

Generic Rubrics .................................................................................................................................................. 6 Standard Writing Rubric .................................................................................................................................... 6 Standard Discussion Rubric ............................................................................................................................... 6

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Purpose and Perspective of the Chapter The purpose of this chapter is to explain the many laws that students will encounter in the workplace.

Discrimination is a prominent issue in the hiring and promotion of employees that your students will want to know about. This chapter also addresses sexual harassment, a serious problem in the workforce. Students will learn how the ADA regulates the hiring and promotion of physically and mentally disabled individuals; the FADA protects the rights of older workers; the Equal Pay Act prevents the practice of paying women less than men for the same job; the FLSA establishes a federal minimum wage, mandates extra pay for overtime work, and regulates the employment of children; the ERISA involves pensions; and, the OSHA affects health care workers, particularly with regulations involving right-to-know laws and blood-borne pathogens. Other issues discussed in this chapter are workers’ compensation and social security, which affect every employer and employee. The chapter covers Occupational Safety and Health Act and regulations for blood-borne pathogens. Finally, this chapter makes clear the importance of working conditions by discussing procedure manuals, job descriptions, and employee handbooks, as well as discusses unions and collective bargaining.

Chapter Objectives The following objectives are addressed in this chapter: 02.01 Describe the government’s influence on the practice and licensing of medicine.

02.02 Identify circumstances that require mandatory reporting.

02.03 Describe controlled substance acts.

02.04 Summarize basic workplace discrimination and harassment laws.

02.05 Summarize basic laws impacting employee wages and benefits.

02.06 Summarize Occupational Safety and Health Act (OSHA) regulations for the health care industry.

02.07 Describe the purpose and components of job descriptions, procedures manuals, and employee handbooks.

02.08 Explain the purpose of unions.

Key Terms Bargaining unit: The labor union, or group of employees with similar interests, authorized to conduct negotiations on behalf of the employees who are members of the union or group.

Censure: A formal statement of disapproval.

Collective bargaining: Procedural attempt to achieve collective agreements between an employer and accredited representative of a group of employees to improve the conditions of employment.

Disparate impact: Disproportionate result that seemingly fair practices or policies have upon a protected group.

Disparate treatment: A marked difference between the way two things are handled.

Facially neutral: On the surface the matter appears to be impartial.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Inference: A process of reasoning by which a fact is deduced as a logical consequence of other facts.

Interstate commerce: The movement of goods and services, or services that rely on the movement of goods, which cross state borders within the United States.

Mitigating: Make less severe due to considerations of fairness and mercy.

Negligent per se: Conduct that is not aligned with the applicable standard of care and without more can be deemed negligence.

Probable cause: Having more evidence for than against.

Quality assurance: Procedures and protocols that maintain a stated level of quality of care received by patients.

Risk management: The practice of considering the risk of actions taken and taking steps to minimize the undesired risks of those actions. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content on licensing; scope of practice; medical license revocation or suspension; mandatory reporting; chain of custody, workplace sexual harassment; the Americans with Disabilities Act; Medicare and Medicaid; and unions and health care workers.

●

Expanded “Controlled Substances Acts” section, including information on the Controlled Substances Schedules, Drug Enforcement Agency, and United States Pharmacopeia (USP).

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

© 2022

Introduction to Health Care Laws, Regulations, and Business Protocols (02.01) a. Health care professionals need to be aware of various medical practice laws and regulations, the nature of your employment, discrimination, sexual harassment, health care laws and regulations, and union membership and collective bargaining. Health care professionals are expected to know the laws and regulations that govern the profession, and ignorance of a law, or a regulation, does not excuse a health care professional’s violation.

Medical Practice Laws (02.01) a. Medical practice laws control the practice of medicine. State legislatures create medical boards that control health care provider licensing. These boards have the authority to grant licenses, as well as renew and revoke licenses. Medical boards must allow due process when pending notice of suspension or revocation of a license. A medical license can be revoked or suspended if a health care practitioner is performing procedures outside of their scope of practice.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

III.

IV.

V.

VI.

VII.

VIII.

© 2022

Mandatory Reporting (02.02) a. Health care reporters are required to submit reports to governmental agencies about births, deaths (suspicious or ‘unnatural deaths’), communicable diseases, as well as injuries to children, elderly, and patients due to abuse. Providers, nurses, and other health care professionals are required by most states to report abuse of children, elderly, and patients.

Controlled Substances Acts (02.03) a. A controlled substance is a drug or chemical whose manufacture, storage, distribution, and use are controlled by the government because of its potential for misuse or abuse.

Control substance acts restrict the distribution, classification, sale, handling, storage, prescription, and use of controlled substances. Control substance acts cover criminals to health care providers who hold licenses to write prescriptions as well as drug manufacturers. The Drug Enforcement Agency (DEA) is in charge of enforcing the Controlled Substances Act, including the distribution, classification, sale, handling, storage, prescription, and use of controlled substances.

Employment Law (02.04) a. The federal Employment Law seeks to ensure that employees can work in an environment free from discrimination and harassment. Employment law encompasses laws against discrimination against gender, disabilities, and age. b. Suggested Activity 1: 15 minutes total. Discuss the “#MeToo” movement and what the students learned about harassment that they did not realize was harassment. c. Suggested Activity 3: 10 minutes total. Students are asked if they have ever experienced an inappropriate interview question or faced questions that were discriminatory. d. Study Questions 1: 10 minutes. Students draft interview questions that should be asked and should not be asked during an interview. e. Study Questions 2: 10 minutes. Students need to explain whether it is discriminatory to ask interview questions about COVID-19. f. Cases For Discussion 1: 20 minutes. Students read a case study and discuss the case study to determine if the actions were acceptable or discriminatory practices. g. Cases For Discussion 2: 20 minutes. Students read a case study and determine if the conduct would be considered harassment.

Employee Wages and Benefits (02.05) a. Several federal acts ensure employers provide equal pay for employees regardless of gender, minimum wage, and overtime, as well as leave for employees to care for family members. There are laws pertaining to employee benefits such as worker compensation, social security benefits, Medicare, and Medicaid. b. Study Question 3: 5 minutes total. Students need to reference the act that they would reference for a coworker who asked for time away to care for a child.

Occupational Safety and Health Act (02.06) a. Occupational Safety and Health Act (OSHA) sets rules and regulations intended to prevent injuries and promote job safety. b. Suggested Activity 2: 15 minutes total. Students locate the website for a cleaning product and look for the MSDS information about the product. c. Study Question 4: 10 minutes. Students need to decide what they and the employer should do if they get an accidental needle stick.

Working Conditions (02.07)

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

IX.

a. The working conditions in a health care office should be defined in individual job descriptions, office handbooks, and procedure manuals.

Unions and Health Care Workers (02.08) a. People join unions for many reasons, primarily because of dissatisfaction with wages, benefits, or working conditions. When a union is organized, the employer and the union are obligated to bargain in good faith with one another.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

The DEA website about the Controlled Substances Act https://www.dea.gov/druginformation/csa

●

Sexual harassment: U.S. Equal Opportunity Employment Commission. (n.d.). Sexual harassment.

In Laws, rules, & regulations. Retrieved from https://www.eeoc.gov/sexual-harassment

●

ADA Amendments Act of 2008. Retrieved from https://www.eeoc.gov/statutes/adaamendments-act-2008

●

OSHA. Retrieved from https://www.osha.gov/

●

Social Security. Retrieved from https://www.ssa.gov/

●

Medicare. Retrieved from https://www.medicare.gov/

●

Medicaid. Retrieved from https://www.medicaid.gov/

[return to top]

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

© 2022

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 2: Laws and Regulations You Will Encounter

Contribution Quality

Etiquette

© 2022

Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

7

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Table of Contents Purpose and Perspective of the Chapter

2

Chapter Objectives

2

Key Terms

2

What's New in This Chapter

4

Chapter Outline

4

Discussion Questions

5

Additional Resources

5

Internet Resources............................................................................................................................................. 5 Appendix

7

Generic Rubrics .................................................................................................................................................. 7 Standard Writing Rubric .................................................................................................................................... 7 Standard Discussion Rubric ............................................................................................................................... 7

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Purpose and Perspective of the Chapter All laws in the United States flow from the Constitution. This chapter explains the basis for a federalist system of government: the federal government concurrently existing with state governments. The discussion of the Constitution includes the significance of the Supremacy Clause and other enumerated powers. Also explained in this chapter is the federal government’s division into three branches: the executive, the legislative, and the judiciary. The judicial branch of law, both in the federal and state governments, is responsible for settling legal disputes. Each lawsuit that goes to trial follows certain phases of development. From the time the alleged negligence occurs to the time the case goes to trial, both sides are involved in discovery, which is a form of legal investigation. After the verdict has been announced, either side has the right to an appeal. Finally, this chapter discusses that an individual who is a party or a witness in a trial undertakes extensive preparation. Students will learn that time should be spent with the counsel preparing the questions and answers that the attorney will ask, as well as anticipating those of the other side.

Chapter Objectives The following objectives are addressed in this chapter: 03.01 Explain how the Constitution’s Supremacy Clause supports a federalist government.

03.02 Describe the three branches of government.

03.03 Identify the three levels of the judiciary.

03.04 Differentiate between federal and state law.

03.05 Differentiate between origins of statutory, administrative, and common law.

03.06 Differentiate between criminal and civil law.

03.07 Describe the four phases of a lawsuit.

03.08 Explain how a medical record can be used in a lawsuit.

03.09 Describe techniques that aid in being a good witness.

Key Terms Adjudicate: To decide a disputed matter Arbitration: A hearing held between two or more parties who disagree on an issue but agree in advance to abide by the decision of an impartial third party Assault: Any intentional act, attempt, or threat to inflict bodily injury on another person with the apparent ability to do so Battery: Intentional touching of another person without permission Beyond a reasonable doubt: Evidence so strong and credible that it leaves no more than a remote possibility that there is another explanation for what happened Civil: The system of law concerned with disputes between individuals or, where the case does not relate to the violation of a criminal statute, between an individual and the state

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Common law: Law created as a result of judicial decisions Concurrent: Two or more events happening at the same time Contingency: Something that may occur but is dependent on a different and uncertain future event to happen first Criminal: The system of law concerned with offenses prosecuted by and deemed prohibited by state or federal law, or a person who has been proven guilty of such an offense Cross-examination: Attorney’s interrogation of a witness by the other party’s attorney Defendant: A person or party against whom a civil plaintiff has initiated a lawsuit to settle a dispute; in a criminal matter, a person or party that has been charged with a crime and who is being prosecuted Deposition: A sworn verbal statement given out of court in response to questions posed by attorneys involved in the case and transcribed by a court reporter Deterrence: Punishment used to discourage crime Direct examination: Attorney’s interrogation of a witness by the party for whom the witness has been called Enumerate: To list a number of things Interrogatory: Written questions about a case addressed to one party or witness by another party Judgment: A court’s decision regarding the rights and obligations of the parties in a lawsuit Mediation: A neutral party meets with parties to a dispute with the intent of persuading them to settle their dispute Motion: The application made to a judge to take a specific action in a case Negligent act: Failure to take reasonable precaution to protect others from the risk of harm Negotiation: Exchange and consideration of offers with the objective of reaching an agreement Perjury: A false statement under oath Plaintiff: A person or party who brings a civil court action against a person or party with whom they have a dispute Preponderance of evidence: The greater weight of the evidence that is more likely than not Pretrial conference: A meeting of the parties and the judge to discuss the readiness for and details of trial process Reformation: The rehabilitation of a criminal Restraint: Restriction of personal liberty Retribution: Something given or demanded as a punishment for criminal wrongdoing Standard of proof: Level of proof required, which is established by considering all evidence and witnesses

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Strict liability: Responsibility of a seller or manufacturer for a defective product that causes injury Tort: A wrong or injury, other than breach of contract, for which a court will provide a remedy

[return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content on common law and the phases of a lawsuit.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

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It All Starts with the Constitution (03.01) a. The American government and legal systems flow from the Constitution, which determines whether federal or state law is applicable and enforceable. The first three Articles of the Constitution address the separation of powers into three distinct branches: the executive, the legislative, and the judicial. This allows for a system of “checks and balances,” which prevents abuse of power from any one branch. The Constitution also addresses federalism and the enumerated powers of the federal government. b. Study Question#1: 5 minutes total. Students will describe the purpose of the Supremacy Clause and how it is tied to the federalist system of government.

Three Branches of Government (03.02) a. The federal government is divided into three branches: the executive, the legislative, and the judiciary. b. Suggested Activity #1: 10 minutes total. Students will watch “I’m Just a Bill” by Schoolhouse Rock and summarize the law-making process in an unforgettable way. c. Study Question #2: 5 minutes total. Students will list the three branches of government and describe why it is necessary to separate the government in this manner. d. Study Question #3: 5 minutes total. Students will list the three levels of the judiciary and name the highest court in the United States.

Health Care: Federal or State Law? (03.04) a. The Constitution does not contain any express federal powers or rights related to health care. The enumerated powers have played a part in allowing the federal government to legislate health care. The federal and state governments have become increasingly intertwined in health care funding, regulation, and administration.

Administrative and Common Law (03.05) a. Administrative law governs the activities of administrative agencies of government. In carrying out their responsibilities, agencies usually perform one or more of the following: rule making, adjudication, prosecution, advising, supervision, and investigation. Common law is court-made law that arises from judges’ interpretation of

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

statutory or regulatory law. Judicial decisions from the past with similar underlying facts or issues require that current judicial decisions adhere to the prior conclusion. b. Study Question #4: 5 minutes total. Students will determine if federal agencies are authorized to make their own rules and prosecute those who violate them.

The Distinction Between Criminal and Civil Law (03.06) a. A crime is defined as the performance of an act forbidden by law, or the omission of an act required by law. In a criminal case, the defendant is found guilty or not guilty. In a civil case, the defendant is found liable or not liable. In a criminal case, the standard of proof is beyond a reasonable doubt. In a civil case, the standard of proof is preponderance of the evidence. The most common civil lawsuit in health care is tort and is based on intentional acts, negligent acts, or strict liability. b. Study Question #5: 5 minutes total. Students will differentiate between criminal and civil law.

What Happens During a Lawsuit (03.07) a. Less than 10 percent of medical malpractice lawsuits go to trial. The rest are settled out of court by agreement, arbitration, or mediation. Cases that do go to trial will go through four phases.

You As a Witness (03.09) a. When considering a testimony, witnesses should look at both sides to see how they fit in, anticipate defense remarks, be objective, and follow the instructions of the attorney.

Other suggestions include paying attention, behaving in a professional manner, answering the question asked and only the question asked, cooperating with the attorney, and being honest. b. Suggested Activity #2: 130 minutes total. Students will watch The Verdict. c. Suggested Activity #3: 30 minutes total. Students will discuss the witnesses in The Verdict and rate them as excellent, adequate, or poor based on their attention span, their mannerisms, how they answered questions, and whether they were cooperative or not. d. Suggested Activity #4: 90 minutes total. Students will role-play a recent court case. Roles will include the witness, plaintiff’s attorney, and the defendant’s attorney.

V.

VI.

VII.

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Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Constitution. Retrieved from https://www.archives.gov/founding-docs/constitution

●

Supreme Court. Retrieved from https://www.supremecourt.gov

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

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Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 3: From the Constitution to the Courtroom

Contribution Quality

Etiquette

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Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 5 Internet Resources............................................................................................................................................. 5 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Purpose and Perspective of the Chapter The purpose of this chapter is to explain the differences between misdemeanor and felony crimes, and that intent is the factor as to whether the behavior is labeled criminal or civil, intentional or negligent, based on the level of malice or premeditation involved. The statutes made by local, state, and federal legislatures drive the appropriate response to each criminal or misdemeanor activity. Additionally, child, elder, and domestic abuse will be discussed. The student will learn how to identify each, what abuses require mandatory reporting versus other reporting or filing a complaint in regard to their state’s legal responses.

It will also be important for students to understand fraud, the many forms it takes, how it differs from abuse, the legislative response involved, how to report fraudulent activity, and what acts and governmental offices are dedicated to reducing this from occurring. Finally, students will learn about the types of intentional torts and the defenses available to defendants accused of intentionally injuring patients.

Chapter Objectives The following objectives are addressed in this chapter: 04.01 Summarize types of felonies.

04.02 Identify and define types of abuse that mandate reporting.

04.03 Recognize some of the indicators of an abused child or older adult.

04.04 Explain the steps involved in mandatory reporting, following federal and state guidelines.

04.05 Determine proper protocol for reporting an illegal activity in the health care setting.

04.06 Describe types of fraud in the health care industry.

04.07 Distinguish between criminal and civil causes of action.

04.08 Summarize types of intentional torts.

Key Terms Conspiracy: An agreement among two or more people to undertake an illegal act.

Euthanasia: An intentional action or lack of action causing the merciful death of someone suffering from a terminal illness or incurable condition.

Felony: A crime that is generally punishable by imprisonment for a sentence longer than a year.

Larceny: Taking the personal property of another with the intent to permanently deprive that person of their property.

Malice: An unjust intention to commit an illegal act to injure someone.

Manslaughter: The killing of a person without premeditation.

Misdemeanor: A crime that is generally punishable by a fine or imprisonment of less than a year.

Murder: An act done with intent to kill the victim.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Qui tam lawsuit: A lawsuit alleging fraud and initiated by a whistleblower who receives a share of any recovery as a reward.

Robbery: The forcible stealing of the personal property of another either from their person or in the immediate presence of the victim.

Theft: Taking property without the property owner’s consent.

Wanton: An act done with reckless disregard of another’s rights or needs. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content on classifications of murder; fraud, including false billings, and delegation of duties; and defamation of character.

●

New content on federal and state anti-kickback statutes, including the Stark law.

●

Expanded and revised “Abuse” section, including content on child abuse, elder abuse, domestic violence, and sexual assault.

●

Additional content on reporting illegal activities in the health care setting following proper protocol and completing an incident report related to patient care.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

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Criminal Acts (04.01, 02, 03, 04, 05) a. This section first differentiates between misdemeanors and felonies, defines, and describes the different types of felonies that one can be charged for, and discusses the legislative responses and penalties involved with each. It discusses child, elder, and domestic abuse, teaches the reader how to identify each, and focuses on how to report these instances, whether the reporting is mandatory or compulsory. b. Suggested activity 1: 15 minutes total. Research and describe mandatory reporting procedures for child and older adult abuse in the student’s state of intended practice, as well as federal acts involved. c. Suggested activity 3: 10 minutes total. The student will describe the steps and chain of command involved in reporting an OSHA violation. d. Suggested activity 4: 10 minutes total. Students are asked to read the AMA Code of Medical Ethics Opinion 8.10 and discuss health care providers' role in this. e. Suggested activity 5: 15 minutes total. The student is asked to research gunshot wound reporting obligations in their state and whether or not they would be considered a mandatory reporter or not. f. Study question 1: 10 minutes. Students explain murder versus euthanasia and the court’s response to both.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

II.

III.

IV.

g. Study question 2. 10 minutes. Students describe how the health care industry is affected by statutes and regulations on child and elder abuse. h. Study question 3. 5 minutes. Students must explain the difference between robbery and larceny. i. Cases for discussion 1: 20 minutes. Students read the case studies and determine in each if child abuse should be reported.

Fraud (04.06) a. This section describes the different types of fraud that can be witnessed in the health care setting, the legislative responses to each, the penalties involved, and the defenses available to defendants accused. The Health Insurance Portability and Accountability Act of 1996 is also described. b. Suggested activity 2: 15 minutes total. Create a list of situations where fraud could be committed in light of the COVID-19 pandemic and how a witness would report the fraud. c. Study question 5: 10 minutes total. Out of the five examples listed, the student is asked to identify which are insurance fraud and which are insurance abuse. d. Cases for discussion 2: 20 minutes. After reviewing the proposed case of fraud against a surgeon, the student will discuss if the court will rule in favor of the plaintiff or not. e. Cases for discussion 3: 15 minutes: The student will determine if the illegal drug possession case requires a search warrant.

Other Reporting (04.04, 05, 06) a. This section goes into more detail about the steps involved in mandatory and nonmandatory reporting of illegal or unsafe activities and patient care errors. Emphasis is placed on following state, office, or hospital protocols in place for reporting the witnessed act.

Civil Causes of Action - Intentional Torts (04.04, 07, 08) a. This section discusses civil law of torts and their intentionality. Students will learn about the different types of intentional torts, read case studies, and briefly learn about the defenses available to defendants. b. Study question 4: 10 minutes. A case of false imprisonment of a patient is analyzed, and the student determines if the patient can file charges or not. c. Cases for discussion 4: 10 minutes. The case describes a case of a patient versus a surgeon regarding an invasion of privacy. The student determines if the patient should win the case or not. d. Cases for discussion 5: 15 minutes. The student reads the case of potential libel against a health care provider and determines if the provider has a convincible defense.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

Additional Resources Internet Resources ●

Child Welfare Information Gateway. (2019) Mandatory Reporters of Child Abuse and Neglect.

Retrieved from www.childwelfare.gov/topics/systemwide/laws-policies/statutes/manda/ ●

Child Welfare Information Gateway. (2017). Making and Screening Reports of Child Abuse and Neglect. Child Welfare Information Gateway. Retrieved from www.childwelfare.gov/pubPDFs/repproc.pdf

●

National Council on Aging. (n.d.). (2021, February 23). Get the Facts on Elder Abuse. NCOA. Retrieved from www.ncoa.org/article/get-the-facts-on-elder-abuse

●

The United States Department of Justice. (n.d.). What is domestic violence? Retrieved from www.justice.gov/ovw/domestic-violence

●

National Coalition Against Domestic Violence (2020). Domestic violence. Retrieved from https://assets.speakcdn.com/assets/2497/domestic_violence2020080709350855.pdf?1596811079991

●

Health Insurance Portability and Accountability Act of 1996. Retrieved from https://www.hhs.gov/hipaa/index.html

●

Office of the Attorney General, Eastern District of New York. (2015, November 4). Riverhead physician assistant arrested for conspiracy to illegally prescribe oxycodone. United States Department of Justice. Retrieved from www.justice.gov/usao-edny/pr/riverhead-physicianassistant-arrested-conspiracy-illegally-prescribe-oxycodone

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

© 2022

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 4: Criminal Acts and Intentional Torts

appropriate introduction, content, and conclusion.

Coverage of facts, arguments, and conclusions are logically related and consistent.

10 points

Research

Research

Grammar and Spelling

assignment includes an appropriate introduction, content, and conclusion.

Coverage of facts, arguments, and conclusions are mostly logically related and consistent.

7 points The assignment is based upon The assignment is based upon appropriate and adequate adequate academic literature academic literature, including but does not include peer peer reviewed journals and reviewed journals and other other scholarly work. scholarly work.

5 points 3 points The assignment follows the required citation guidelines.

5 points

The assignment follows some of the required citation guidelines.

3 points The assignment has two or The assignment has three to fewer grammatical and spelling five grammatical and spelling errors. errors.

5 points 3 points

includes an introduction, content, and conclusion, but coverage of facts, arguments, and conclusions are not logically related and consistent.

0 points The assignment is not based upon appropriate and adequate academic literature and does not include peer reviewed journals and other scholarly work.

0 points The assignment does not follow the required citation guidelines.

0 points The assignment is incomplete or unintelligible.

0 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

© 2022

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 4 Chapter Outline .......................................................................................................................................... 4 Discussion Questions .................................................................................................................................. 6 Additional Resources .................................................................................................................................. 6 Internet Resources............................................................................................................................................. 6 Appendix ..................................................................................................................................................... 7 Generic Rubrics .................................................................................................................................................. 7 Standard Writing Rubric .................................................................................................................................... 7 Standard Discussion Rubric ............................................................................................................................... 7

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Purpose and Perspective of the Chapter Contracts govern almost everything we do in modern life and in the workplace. This chapter explains that a contract is a voluntary agreement between two or more parties that creates, modifies, or destroys a legal relationship. Students will learn that to have a contract, there must be an offer, acceptance, and consideration. A contract can be verbal or written, and it can be express or implied. The chapter also discusses that employees are the agents of their employers and, under the law of agency, can contract for the principal; contracts made by an authorized agent are valid and enforceable; and the principal is usually held responsible for any damages. In the contract between physician and patient, the patient may desire to change physicians before treatment has been completed, or the physician may desire to refuse further treatment under the informed consent.

This chapter further explains how the discharged physician should memorialize the circumstances and conditions of the discharge in a certified letter sent to the patient. If a physician terminates the relationship, further provisions must be made for the care of the patient, or the physician can be found to have abandoned the patient. Students will learn that contracts not performed according to agreement are termed breached. A party who sustains a breach of contract is entitled to be made whole by the award of damages. Lastly, discussion of an advanced health care directive and how it applies to the care of the patient are explored.

Chapter Objectives The following objectives are addressed in this chapter: 05.01 Explain the elements necessary to make a contract.

05.02 Differentiate between express and implied contracts.

05.03 Describe the law of agency.

05.04 Identify who can and who cannot be a party to a contract.

05.05 Define advance directives.

05.06 Identify the various ways to terminate a contract.

05.07 Identify situations that would be considered a breach of contract in the health care field.

05.08 Identify the individual responsible for payment of medical fees.

05.09 Describe basic collection protocol for past due accounts.

Key Terms Abandon: To give up or cease doing.

Acceptance: An agreement to the terms of an offer.

Advance directives: Written instructions about a person’s future medical care.

Agent: One who has authority to act on behalf of another.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Age of majority: The age, as determined by state law, at which a person becomes legally able to contract, vote, and join the military.

Breach: To act contrary to a contractual provision or to fail to perform a contractual provision.

Conservator: A court- appointed person given authority to manage the financial affairs of an incompetent person.

Consideration: Something promised that results in making an agreement a lawful, enforceable contract.

Contract: A voluntary agreement, written or unwritten, between two parties that creates an obligation to do or not to do something.

Duress: Being influenced by a threat to do some- thing one would not otherwise do.

Emancipated minors: A person under the age of majority who is deemed to be completely selfsupporting and able to contract.

Express contract: An explicit agreement between two or more parties.

Guardian: A person entrusted to take care of the person, property, and rights of someone too young or otherwise incapable of managing their own affairs.

Implied contract: An agreement not indicated by direct words but evident from the conduct of the parties.

Incompetent persons: Those who lack the necessary qualifications to perform a duty.

Injunctive relief: Remedy preventing or requiring someone to perform or to refrain from performing a particular action.

Legal capacity: A person’s ability to enter into contracts because no legal disabilities exist.

Legal disability: Lack of legal capacity for mutual agreement.

Mature minor: A person under the age of majority who has the mental capacity to make certain medical decisions with- out parental consent.

Mental incompetence: Lack of reasoning faculties needed to enable someone to contract.

Minors: Persons who are under the age of majority as set forth by state law.

Mutual agreement: Common agreement and understanding of all parties to a contract.

Offer: A proposal to perform or refrain from a certain action.

Principal: The employer, or source of authority, of the agent or employee.

Remedies: Ways to make a nonbreaching party whole after a contracting party has breached.

Specific performance: The remedy of requiring a party to a contract to perform the contract as specified.

Undue influence: Any improper persuasion to make someone act differently from his or her own will.

Warranty: A promise that specifically named results will occur.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

[return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Additional content about collections, bankruptcy, and termination of delinquent patients.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

© 2022

Elements of a Contract (05.01) a. Contracts, in general, are reviewed with identification and definitions of the key terms.

Elements needed to make a contract between a patient and health care provider are reviewed and discussed in detail. b. Suggested Activity 3: 10 minutes total. Identify various contracts you encounter in your personal life. What was the last contract you signed? What was the last contract you signed on behalf of someone else (an employer or child, a disabled relative, etc.)? c. Cases for Discussion 2: 15 minutes total. Discussion of whether a patient-provider relationship existed within a medical malpractice case is explored. d. Cases for Discussion 3: 15 minutes total. Discussion of a patient who required x-rays after an automobile accident is explored. The patient did not receive an x-ray of the leg at the first hospital she sought care at; however, the second hospital ordered one and revealed a leg fracture. She sued the first hospital and the radiologist. Does the radiologist, who never saw her, have a contractual relationship with the patient?

Types of Contracts (05.02) a. Differing types of contracts are discussed and explored. Differentiating between express and implied consent is defined and reviewed. Warranty is defined and reviewed with regards to how it relates to a contract. b. Suggested Activity 1: 10 minutes total. What is the age of majority in your state? c. Study Question 1: 10 minutes total. Give examples of implied and express consent to medical treatment in a hospital emergency room situation. d. Study Question 2: 15 minutes total. A patient has just been informed by the health care provider that she must have a hysterectomy and that there is a question of malignancy.

The patient makes a comment that makes the health care professional question whether the patient understands the treatment appropriately. How would you handle this situation? Did the health care provider give the patient a warranty as to the results?

If so, was the warranty express or implied? e. Cases for Discussion 4: 20 minutes total. Exploration of a patient case regarding a piece of gauze being left in them while being operated on is explored. Discussion regarding

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

III.

IV.

V.

VI.

VII.

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whether the consultant health care provider that did not perform the surgery is liable for the gauze in the patient’s abdomen. f. Cases for Discussion 7: 15 minutes total. A patient sterilization case involving the birth of a child that is developmentally disabled is discussed. Review and discussion regarding whether the plaintiff can allege a breach of warranty. Exploration of whether the court should allow them to recover damages under a breach of warranty action is discussed.

Agency (05.03) a. When a person agrees to work for and under the direction or control of another, a principal-agent relationship is created. Agent and principal are defined in greater detail with regards to how they relate to an established contract.

Capacity of the Parties (05.04) a. Legal disability, minors, incompetent persons, duress, guardian majority, age of majority, emancipated minors, mature minors, undue influence, mental incompetence, and conservator are defined and discussed in detail with relation to who can and cannot be a party to a contract. b. Study Question 4: 15 minutes total. Discussion of a minor and their conservator is reviewed regarding whether the conservator has the capacity to approve medical care for the minor. c. Cases for Discussion 1: 15 minutes total. A case regarding a minor who is pregnant and their parent who is requesting an abortion that the minor does not want, is discussed.

The provider refuses to perform the abortion without a court order. Capacity of parties is discussed and reviewed in detail with regards to the case.

Health Care Advance Directives (05.05) a. The Patient Self-Determination Act, enacted in 1990, requires health care facilities to provide written information to each adult admission regarding patient rights under state law to make advanced directives involving the acceptance or refusal of medical or surgical treatment. b. Suggested Activity 2: 10 minutes total. Exploration and completion of a health care directive in the student’s state are discussed.

Termination of Contracts (05.06) a. The termination of a contract between a health care provider and patient is discussed.

Elements of how to terminate a patient-provider contract appropriately and inappropriately are reviewed. b. Study Question 3: 15 minutes total. Review of a minor patient who is pregnant and miscarried without the knowledge of her parents is explored. Discussion and review regarding what the agent of the health care provider should do in this situation, whether the health care provider can terminate the patient-provider relationship due to failure to pay, and if so, how should the relationship be terminated? c. Case for Discussion 8: 20 minutes total. A mental health patient is discussed that could not pay his bill and was discharged. The patient was prescribed a sedative and ignited himself with a cigarette. The patient suffered nearly fatal third-degree burns. Did the provider have the right to discharge the patient upon realizing he could not pay his bill?

Breach of Contracts (05.07) a. A breach of contract occurs when one of the parties does not keep a promise by not performing, not paying for services, not keeping to schedule, or not doing the procedure as had been agreed. Breach of contract also occurs when one party prevents the other

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

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party from performing. Examples are provided on how a patient or provider may breach the contract. b. Cases for Discussion 5: 15 minutes total. Review and discussion regarding a patient who has a failed vasectomy and conceives a child afterward. Discussion regarding whether the surgeon who performed the vasectomy should be liable for breach of contract? c. Cases for Discussion 6. 15 minutes total. A plastic surgery case is discussed when the patient does not obtain the outcome they had anticipated. Breach of contract is discussed in relation to the provider and whether it occurred.

Who Pays? (05.08) a. Information regarding the responsible party for payment to the provider is discussed and reviewed. In general, the patient who receives treatment is responsible for payment even if someone else requests the services. In certain circumstances, such as in the care of minor children and incompetent persons, others are responsible for payment.

Collections (05.09) a. Bankruptcy, bad checks, overdue accounts, collections, and termination of delinquent patients are defined and reviewed with how it relates to the pre-existing patientprovider contract. b. Suggested Activity 4: 15 minutes total. Exploration of the state statute regarding collections in the state the student intends to practice is discussed. c. Study Question 5: 10 minutes. Which federal act governs the collection of past due accounts? What does the act prohibit? d. Cases for Discussion 9: 15 minutes total. A mental illness case is reviewed and discussed with regards to whether the health care provider had the right to discharge the patient from the hospital because he could not pay his bill.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

American Hospital Association. (2022). Fact Sheet Hospital Billing Explained. Retrieved from https://www.aha.org

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Caring Info. (2021). Advance Directive Forms by State. Retrieved from https://www.caringinfo.org/planning/advance-directives/by-state/

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TedTalk. (2015). Advanced Care Directive TedTalk. Retrieved from https://www.youtube.com/watch?v=gqp42LiJOQI

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

© 2022

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 5: What Makes a Contract

Contribution Quality

Etiquette

© 2022

5 points Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

3 points Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 3 What's New in This Chapter ........................................................................................................................ 4 Chapter Outline .......................................................................................................................................... 4 Discussion Questions .................................................................................................................................. 7 Additional Resources .................................................................................................................................. 7 Internet Resources............................................................................................................................................. 7 Appendix ..................................................................................................................................................... 8 Generic Rubrics .................................................................................................................................................. 8 Standard Writing Rubric .................................................................................................................................... 8 Standard Discussion Rubric ............................................................................................................................... 8

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Purpose and Perspective of the Chapter The purpose of this chapter is to review negligence. Negligence is when one person hurts another without intent. The legal cause of action of negligence by a professional is known as malpractice. The difference between negligence and malpractice is the standard of care required of the injuring party.

Students will learn that if the defendant is a layperson who is held to the reasonable person standard, the act (or failure to act) is considered ‘negligence’ and, if the inflicting party is a professional who is held to the standard of a professional with prescribed education, training, and experience, the act (or failure to act) is considered ‘malpractice.’ This chapter enumerates five defenses available to a defendant in a medical malpractice cause of action: tolling of the statute of limitations, contributory negligence, comparative negligence, assumption of risk, and emergency. Medical malpractice insurance is discussed and available to cover monetary awards against a defendant. Medical assistants may or may not be covered under a physician’s insurance. Your students will want to know that insurance is available for the protection of a medical assistant.

Medical assistants are hybrid health care professionals. Delegated responsibilities extend the effectiveness of a physician and are delegated by the employer. Students will learn that many malpractice lawsuits can be avoided simply with better communication. The patient has a right to refuse treatment; therefore, the physician must provide enough information to allow the patient to make an informed decision. Informed consent is reviewed and requires that a physician communicate information to a patient regarding the treatment he or she is about to receive. Only a physician can accept consent from a patient. It is important for students to note that beyond preparing and filing consent forms, they should be listening and observing whether the patient understood and accepted the proposed treatment; alerting the physician when any discrepancies arise is key. Finally, students will learn that different standards of responsibility are required for trespassers, licensees, and invitees. The standard of property maintenance for a trespasser is reasonable care. The standard of maintenance increases for licensees. The highest standard of maintenance is due to invitees and requires affirmative behavior on the part of the landlord or occupier to warn the invitee about dangerous conditions or activities that are known or could be discovered with reasonable effort.

Chapter Objectives The following objectives are addressed in this chapter: 06.01 Distinguish between a cause of action for negligence and one for malpractice.

06.02 List the elements of a medical malpractice lawsuit.

06.03 Identify when there has been a breach of duty to a patient based on an inappropriate standard of care.

06.04 Analyze the legal cause of a patient’s injury and assess accountability of the employee.

06.05 Identify the legal, moral, and ethical aspects of informed consent.

06.06 Describe negative consequences of medical malpractice lawsuits.

06.07 Identify common subjective contributing factors to the patient’s choice to litigate.

06.08 Summarize risk management measures the health care professional can take to avoid lawsuits.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

06.09 Describe defenses available to the defendant in a medical malpractice lawsuit.

06.10 Analyze emergency situations to determine whether the situation is covered by a Good Samaritan statute.

06.11 Identify a product liability case of action.

06.12 Define strict liability in tort.

06.13 Distinguish between the duty of care owed to invitees, licensees, and trespassers for maintenance of equipment and premises.

Key Terms Adversary: An opponent in a dispute or contest.

Affirmative duty: An obligation to do or to not do something.

Assumption of risk: Voluntary acceptance of a known danger.

Burnout: Exhaustion from overwork.

Comparative negligence: Negligence measured by percentage, with the determined damages lessened according to the extent of injury or damage committed by the party proven guilty.

Consumer: A person who uses products or services.

Contributory negligence: Conduct by a plaintiff that is below the standard to which he or she is legally required to conform for his or her own protection.

Defensive medicine: The practice of medicine where the main focus is preventing a lawsuit rather than improving the health of the patient.

Ethical: Conforming to professionally proper conduct.

Expert witness: A person whose education, profession, or specialized experience qualifies them to testify about their area of expertise as it relates to the lawsuit.

Good Samaritan: A person who helps another person in distress even though there is no duty to do so.

Grossly negligent: Deliberately failing to perform a necessary duty in extraordinary disregard of the consequences to the person neglected.

Insurance: A contract binding one party to compensate another for specific losses, damages, or injury in exchange for the payment of premiums.

Invitee: A person who enters another’s property as a result of express or implied invitation.

Licensee: A person who has express or implied permission to enter another’s property.

Nonverbal communication: Body language used to communicate something.

Peer review: Assessment of academic, professional, or scientific work by others who are experts in the same field.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Product liability: A tort making a manufacturer liable for compensation to anyone using its product if damages or injuries occur from defects in that product.

Proximate cause: Results as a direct consequence and without which the result would not have happened.

Reasonable care: The amount of care a rational person would use in similar circumstances.

Res ipsa loquitur: Translated from Latin to “the thing speaks for itself.” Evidence showing that negligence by the defendant may be reasonably inferred from the nature of the injury occurring to the plaintiff.

Sanctioned: Penalized for violating a law or accepted procedure.

Sociological: Pertaining to human social behavior.

Statute of limitations: The law setting a time limit within which one person can sue another.

Statutory guidelines: Legislative laws defining legal rights and responsibilities.

Suit-prone: Likely to sue someone or be sued.

Trespasser: Someone who enters another’s property without express or implied invitation or permission. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

New content on expert witnesses and health care providers’ duty to their patients.

●

Additional content on statute of limitations; causation; informed consent; the impact of medical malpractice suits; and defensive medicine.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

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Negligence or Malpractice? (06.01) a. Health care professionals are introduced into the practice of medicine and the statutory guidelines in place. Precise limitations exist based on each health care professional’s license and are different within each state. It is the responsibility of each health care provider to understand these laws and ensure they are practicing within them at all times when rendering patient care. Health care professionals are taught the difference between negligence and malpractice. b. Study Questions 1: 10 minutes. Describe a situation that might place a health care professional in the area you intend to practice in the position of being negligent.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

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III.

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c. Study Questions 3: 10 minutes. List the possible qualifications for an expert witness in a medical malpractice case involving a nurse who works in a pediatrician’s office. d. Study Questions 4: 10 minutes. What relationship is necessary between a health care provider and patient to establish duty of care for the health care provider?

Elements of a Medical Malpractice Lawsuit (06.02) a. The six elements of a medical malpractice lawsuit are defined and explained in detail.

Each of the six elements are defined and reviewed with regards to how it contributes to a medical malpractice suit. b. Study Questions 2: 10 minutes. Describe a situation that might cause a health care professional to be named as a defendant in a medical malpractice claim. c. Cases for Discussion 1: 20 minutes. Exploration of a negligence action brought by a mother on behalf of a minor, and whether a patient relationship existed with the hospital providing treatment. d. Cases for Discussion 4: 10 minutes. Exploration of a health care provider’s lack of thorough examination on a 16-year-old male patient after an automobile accident. The patient expires thus leading to further discussion regarding appropriate standard of care of a minor and whether the health care provider’s actions, or lack thereof, contributed to the patient expiring. e. Cases for Discussion 3: 10 minutes. A woman delivered before the obstetrician arrived while the nurse ignored requests by the patient and her spouse to call the obstetrician.

The patient is injured during delivery. The discussion of whether the hospital is liable to the patient is discussed.

Informed Consent (06.03) a. The ethical, moral, and legal implications of informed consent are reviewed. Legal responsibility and scope of practice on who collects and reviews an informed consent with the patient are explored. b. Suggested Activity 1: 15 minutes. Play the childhood game of rumors. This will give each player an opportunity to learn about some of the confusion a patient experiences in the informed consent process. c. Cases for Discussion 6: 15 minutes. Informed consent is discussed in relation to care for a minor and who may legally provide the informed consent for the minor patient. d. Cases for Discussion 7: 15 minutes. Discussion of whether a health care provider can extend an operation without consent if they find a secondary issue that wasn’t covered with the patient in the original informed consent. e. Cases for Discussion 2: 20 minutes. A patient suffers disabling brain damage following admission for a procedure. Conflicting evidence regarding whether a provider left the operating room to attend another patient before or after an equally qualified health care provider arrived to provide care. Aspects of informed consent are discussed in depth.

Impact of Medical Malpractice Suits (06.04, 06) a. The impact of medical malpractice suits on a health care provider are explored in depth.

Defensive medicine and the economics of medical malpractice are discussed with regards to the impact of medical malpractice suits. There are many negative consequences of medical malpractice lawsuits including providers becoming bitter and emotional, the practice of defensive medicine, higher health and malpractice insurance, lack of specialists in high verdict areas, and higher health care costs.

Analysis of the Problem (06.05, 07)

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

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a. Objective and subjective factors of a medical malpractice suit are reviewed. Lack of empathy, the suit prone health care provider, and pharmacy are discussed. Subjective and objective factors contributing to a patient’s choice to litigate are defined and reviewed. Understanding the subjective and objective factors a health care professional can implement demonstrates how the usage of these when caring for a patient can greatly reduce a patient’s choice to litigate. b. Suggested Activity 2: 15 minutes. Role play. Show empathy to a patient who has just learned that he has cancer of the larynx. c. Study Questions 6: 15 minutes. A newly diagnosed cancer patient approaches you after being informed of two alternatives for treatment of cancer. This discussion outlines who the appropriate health care professional is to provide medical advice and informed consent. d. Cases for Discussion 5: 15 minutes. A medical case involving a patient that injures their finger and requires surgical care and the outcome is not what the patient had anticipated. Informed consent is discussed with relation to the surgical care provided to the patient by the health care provider.

Risk Management Issues in the Medical Office (06.08) a. Risk management measures to avoid a medical malpractice lawsuit are reviewed in detail. Each measure is defined in detail regarding how each health care professional may utilize this to avoid a medical malpractice lawsuit. b. Suggested Activity 3: 20 minutes. Watch the TedTalk “Doctor Make Mistakes. Can we Talk About That?”

Defenses to a Medical Malpractice Suit (06.09) a. Common defenses available to a defendant in a medical malpractice lawsuit are reviewed. Definitions and examples of each defense contribute to the overall understanding of the defense and how it can be utilized to defend against a malpractice lawsuit. The Good Samaritan Law is explained in detail with regards to how it protects health care professionals when they respond to an emergency situation. b. Study Questions 8: 15 minutes. This case discusses the obligation of a health care professional owed to a patient with regards to the Good Samaritan Law. c. Study Questions 5: 10 minutes. List the elements of a medical malpractice cause of action. d. Study Questions 7: 15 minutes. List, define, and give examples of the five defenses available to a defendant in a medical malpractice suit. e. Study Questions 11: 15 minutes. Explores the possible defenses of a patient that incurs an injury from medical facility property and incurs a secondary injury from failure to comply with medical directions.

Malpractice Insurance (06.10) a. Malpractice insurance is covered in detail with regards to what the insurance covers, why it is important, and the importance of understanding if the health care professional is covered by their place of work with their malpractice insurance. b. Study Questions 9: 10 minutes. Prepare a question for your future employer to determine whether their malpractice insurance covers a health care professional working in their office.

Product Liability (06.11) a. Product liability is reviewed and how it pertains to a medical lawsuit. Common products are reviewed that have been utilized in a product liability lawsuit.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

b. Study Questions 12: 10 minutes. List equipment you might find in a medical office or hospital that could injure a patient and give rise to a product liability claim.

Strict Liability (06.12) a. Strict liability in tort is a theory used in product liability cases in which the seller is liable for any and all defective or hazardous products that unduly threaten a consumer’s personal safety. Strict liability in health care often arises with regard to drug manufacturing. b. Cases for Discussion 8: 15 minutes. The discussion regarding a defective instrument utilized within a surgical case that causes physical injury to the patient is explored.

Discussion on who can be named as a defendant within the case and whether there is a claim for strict liability.

Premises Liability (06.13) a. The responsibility of hospitals, clinics, and individual practitioners are responsible to the public for their offices, laboratories, buildings, and equipment are reviewed.

Classification of people entering onto another’s property are defined and reviewed with regards to the duty of care owed to each. The duty to warn and reasonable care are defined and reviewed. b. Study Questions 10: 15 minutes. Discusses the responsibility of the medical office when an inebriated trespasser comes onto the medical facility property and is injured from a known hazard within the facility.

XII.

XIII.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Health Workforce Technical Assistance. (2022). Health Professions Regulation in the U.S. Retrieved from https://www.healthworkforceta.org

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Goldman, Brian. (2010). Doctors Make Mistakes Can We Talk About That? Retrieved from https://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that? language=en

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National Conference of State Legislatures. (2022). Medical Liability/Malpractice Laws. Retrieved from https://www.ncsl.org

[return to top]

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

© 2022

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 6: Medical Malpractice and Other Lawsuits

Contribution Quality

Etiquette

© 2022

Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

9

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 2 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 5 Internet Resources............................................................................................................................................. 5 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Purpose and Perspective of the Chapter Health records and information regarding patients are subject to privacy laws. State law determines who owns a patient’s health record. Ownership usually carries with it the exclusive right and power to exercise authority and control over the use of property. In the case of the health record, the owner cannot control the record exclusively. The Health Insurance Portability and Accountability Act (HIPAA) allows patients to see their records and make corrections to them. Physicians are required to transfer medical information to other physicians engaged by their patients and to allow attorneys access to their clients’ records. It is crucial for students to understand that the contents of a health record should not be transferred or disclosed without the patient’s authorization. Records are often required in court and can be ordered by the issuance of a subpoena duces tecum. Finally, health records must be credible.

This means that there can be no alterations, fabrications, or concealments in a record. Corrections to a health record should be made with great care.

Chapter Objectives The following objectives are addressed in this chapter: 07.01 Define the Health Information Technology for Economic and Clinical Health (HITECH) Act and Promoting Interoperability.

07.02 List different types of health records.

07.03 Identify the owner of a health record.

07.04 Determine who is allowed access to the health record.

07.05 Identify the procedures necessary for release of information from the health record.

07.06 Define the importance of health record credibility.

07.07 Follow an acceptable method for making corrections to a health record.

Key Terms Data: Pieces of information.

Premises: Physical location, such as an office or building.

Property right: A right of ownership to a certain thing.

Subpoena: A written order to appear at a specified time and place to give sworn testimony.

Subpoena duces tecum: A written order to produce documents or things. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

© 2022

Additional content on electronic health records.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

●

New content on HITECH; goals and benefits of data interoperability; source of privacy rights and the Tarasoff case; patient and family access to health records; release of patient information; and chain of custody.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

V.

© 2022

Introduction (07.01) a. Despite changes in the way a health record is kept, the elements of privacy, accuracy, timeliness, and reliance should be upheld. A health record is a recorded collection of data on a patient. The transition from paper charts to electronic health records (EHR) is one of the most significant changes in health care. The Health Information Technology for Economic and Clinical Health (HITECH) Act was intended to encourage the use of health information technology, provide incentives for the use of the EHR, and penalize health providers who do not use the EHR. b. Study Question #1: 10 minutes total. Students will list information contained in a health record.

Electronic Health Records (07.01) a. The HITECH Act has provided incentives for the promotion of data interoperability. EHR technology includes both computer hardware and software systems that store patient information. Challenges related to EHR include funding and not all EHR forms being able to “talk” to each other.

Types of Health Records (07.02) a. The typical form of a health record has transitioned from a collection of handwritten notes to an electronic file stored on a network. Integrated health records are common in large outpatient settings. Integrated health records represent the patient in a single record that includes all outpatient and inpatient activity. Management of the health record requires the same attention to detail and confidentiality regardless of whether it is in a hospital setting or a private office, it is a paper chart, or an EHR. Ownership of the Health Record (07.03) a. State law determines who owns a patient’s health record. Ownership usually carries with it the exclusive right and power to exercise authority and control over the use of property. In the case of the health record, the owner cannot control the record exclusively. Individuals, professionals, corporations, and courts are authorized to see copies of information within the health record regardless of who owns it. b. Study Question #2: 10 minutes total. Students will describe the difference between ownership of a health record and ownership of other property.

Access to the Health Record (07.04) a. Hospitals and health care providers should have a written policy detailing the procedures for releasing patient information. The policy must reflect federal law and state law, if applicable. There is general authorization for providers to release information to insurance companies when a patient is submitting third-party payment claims. Office and hospital records are subject to inspection by an attorney when

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

VI.

VII.

VIII.

© 2022

authorized by the patient. In other instances, patients implicitly consent to the sending of a health record to a third party. b. Study Question #3: 20 minutes total. Students will role-play a scenario in which they will respond to a patient requesting access to x-rays to show family members. c. Study Question #4: 20 minutes total. Students will discuss how to handle a situation in which a patient requests access to their health record that contains information about telephone calls from the patient’s relatives that will interfere with the family relationship.

Release of Information (07.05) a. Unless otherwise instructed by the law or your employer, you should not disclose information about a patient. Information should not be released unless the request is specific, to include time limits, the purpose and use of the information, and what particular information is needed. b. Suggested Activity #1: 20 minutes total. Students will find a HIPAA-compliant release form on the internet and fill it out. c. Suggested Activity #2: 30 minutes total. Students will draft a letter for a fictitious patient who has requested a copy of their records and include a copy of the release form. d. Case for Discussion #1: 30 minutes total. A plaintiff authorized the release of information to an insurance company following an application for major medical insurance. The health care provider released information regarding the plaintiff’s physical health, mental health, and family life, and indicated that he is a poor insurance risk. Students will discuss if the provider had a right to release the information he provided. e. Case for Discussion #2: 30 minutes total. In a medical malpractice lawsuit, the court ordered a hospital to produce copies of all consultations, operative notes, interpretations of preoperative x-rays, and brain tissue analyses obtained on 140 patients. The hospital refused because consent had not been obtained from any of the patients. Students will discuss if the court should agree with the hospital’s opposition.

Credibility of the Health Record (07.06) a. Credibility of a health record refers to whether the information is believable. If a health record has corrections, amendments, modifications, changes, or misspelled words, it will raise suspicions. The credibility of the health record is crucial during a medical malpractice lawsuit. Credibility is questionable when an investigation reveals delays in filing laboratory test results, incomplete files, illegible records, altered or fabricated records, or the loss or concealment of information. b. Study Question #5: 20 minutes total. Students will discuss how to testify in court as a record keeper when the health provider has removed information from the record. c. Case for Discussion #3: 30 minutes total. A patient visited the emergency room due to chest pains. The nurse refused to call a health care provider and the patient died of myocardial infarction after leaving the hospital. In an attempt to review the records, the widow’s attorney found they were destroyed. Students will discuss if the hospital had a right to destroy the records.

Acceptable Method of Making Changes in Health Records (07.07) a. The goal should always be to maintain a record perfectly. Most EHR systems track entries by user, date, and time. When an error occurs and corrections are made, the original error will remain, and an addendum will be added. When an error occurs with a paper chart, cross out the mistake, initial and date it, and write in the correct

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

information. If changes are made while a patient is under treatment, they may be accepted as rewritten or amended. If changes are made beyond a reasonable period after discharge, they may raise red flags. Record keepers have the responsibility to ensure records are accurate and should bring up any errors to the health provider for corrections. b. Study Question #6: 20 minutes total. Students will discuss how to change a good-faith error in a record that has been subpoenaed when the health care provider requests the record to be deleted and recreated. [return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

HITECH Act. (2017, Jun 16). U.S. Department of Health and Human Resources. Retrieved from https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interimfinal-rule/index.html

●

Public Health Data Interoperability. (2022, Jan 19). Centers for Disease Control and Prevention.

Retrieved from https://www.cdc.gov/datainteroperability/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.c dc.gov%2Fehrmeaningfuluse%2Fintroduction.html

●

HIPAA for Professionals. (2021, May 17). U.S. Department of Health and Human Resources.

Retrieved from https://www.hhs.gov/hipaa/for-professionals/index.html

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria

© 2022

Meets Requirements

Needs Improvement

Incomplete

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 7: The Health Record

Content

Organization and Clarity

Research

Research

Grammar and Spelling

The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

0 points 15 points 8 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

© 2022

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 2 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 4 Internet Resources............................................................................................................................................. 4 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

© 2022

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Purpose and Perspective of the Chapter This chapter introduces the matter of ethics. Students will learn about the distinctions between ethics, morals, and etiquette. In this chapter, definitions are established, and deontological and teleological ethical theories are explored. Students are offered reasoning into the development of ethical principles and the concept of potential for conflicting personal and professional ethics. The process of ethical decision making is outlined. Reasoning tools are discussed for processing ethical dilemmas, and finally, the chapter discusses the concept of the ultimate decision maker.

Chapter Objectives The following objectives are addressed in this chapter: 08.01 Distinguish between ethics, law, morals, and etiquette.

08.02 Describe the importance of ethics codes in professional organizations.

08.03 Describe how individual values and morals are developed.

08.04 Summarize the main concepts of duty-based, utilitarian, and virtue-based ethical theories.

08.05 Develop a thought process for making ethical decisions.

08.06 Demonstrate acceptable responses to ethical issues.

08.07 Distinguish between personal ethics and professional ethics.

08.08 Describe the relationship between personal ethics and professionalism on the job.

08.09 Develop a plan for separating personal and professional ethics in the workplace.

Key Terms Amoral: Without consideration of morals.

Bioethics: Ethical issues and the implications of the application of biological research.

Dilemma: Situation where a challenging decision must be made between two or more options.

Ethics: Moral principles that guide a person or a society’s choices and conduct.

Etiquette: Prescribed code of courteous social behavior.

Immoral: Not moral.

Philosophy: A basic viewpoint of an individual’s or a community’s value system.

Values: Principles of thought and conduct that are considered desirable. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

© 2022

New content on definition of ethics; morals; development of values; and professional etiquette.

2

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

●

New section entitled “Ethical Theories”, including information about deontology, teleology, utilitarianism, and virtue-based ethics.

●

New section entitled “Ethical Decision Making”, explaining common steps in ethical decision making.

●

New section entitled “Personal Ethics in the Workplace”, differentiating personal and professional ethics.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

© 2022

The Difference Between Ethics, Law, Morals, and Etiquette (08.01, 02, 03) a. This section defines dilemmas, ethics, morals, and etiquette and compares these concepts to law. The AMA Code of Conduct is reviewed. Morals are more thoroughly discussed, and the definitions of immoral and amoral are mentioned. This section discusses the development of values and mentions Piaget and Kohlberg’s psychological theories of moral development. Finally, the concept of etiquette is discussed in reference to professional etiquette and its impact on the individual and employer. b. Suggested Activity 4: 45 minutes total. Research news media for examples of ethics, law, morals, and etiquette. Use those stories to help distinguish between the concepts. c. Suggested Activity 2: 60 minutes total. Learners should research a code of ethics for their role or profession and identify the purpose for each tenet. d. Study Question 5: 30 minutes total. Compare morals and values and how they are developed. e. Study Question 2: 20 minutes total. Discuss why ethical codes are important in practicing medicine. f. Case for Discussion 2: 30 minutes total. An orthopedist in Maine disciplined for overutilization, malpractice, and unethical practice who proved that his actions were not illegal, yet was accused of violating ethics codes of the state society. Should the provider lose his license or not?

Ethical Theories (08.04) a. This section defines deontological and teleological philosophical theories of duty, utilitarianism, and value-based concepts of ethical theory. It mentions Kant’s categorical imperative, Jeremy Bentham’s view of utilitarianism, and the early philosophers’ concepts of virtue. Each theory is presented with advantageous aspects as well as weaknesses. b. Study Question 4: 30 minutes total. Compare and contrast the duty-based, utilitarianism, and virtue-based ethical theories. c. Case for Discussion 4: 45 minutes total. Review the details of the case study and apply utilitarian, duty-based and virtue-based theories in an ethical decision-making analysis.

Ethical Decision Making (08.05, 06) a. This section calls the learner to take inventory of their own personal ethics. It offers case studies to discuss and situations to consider aiding that personal inventory.

Acknowledging that there are many ethical theories and guides, this section offers a

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

composite eight step method of identifying the decision-making process of an ethical dilemma. Within the section, the case studies are tabled based on these eight steps and the use of the eight-step process. b. Study Question 3: 20 minutes total. Why is it important to study ethics as a health care professional? c. Suggested Activities 3: 45 minutes total. Independent consideration to inventory personal and professional ethics by creating 10 priorities, tying them to ethics. Then, the learner will review life events and consider how ethical decisions were made using the eight steps in the chapter. d. Case for Discussion 1: 30 minutes. Present the case discussing the rights of the patient and an acceptable response to the ethical issue.

Personal Ethics in the Workplace (08.07, 08, 09) a. This section compounds the ethical inventory of the previous section and discusses the difference between personal and professional ethics. After defining professional ethics, consideration is made toward potential personal versus professional ethical conflicts.

Ultimately, the section presents the concept of determining the ultimate decision maker in an ethical dilemma and the fact that that person or entity must make ethical decisions. The section inspires learners to explore the remaining chapters that offer ethical and legal consideration for special situations found in the health care setting. b. Suggested Activities 1: 30 minutes total. Independent consideration of categories of ethics, potential conflicts with professional ethics, and how one would separate personal and professional ethics if needed. c. Study Question 1: 30 minutes total. Identify three professional ethics and personal ethics that may conflict or align. The learner will describe how they would be separated if needed. d. Case for Discussion 3: 45 minutes total. Discuss the case with these questions in mind: How would you have handled the situation differently? Is there a way in this situation to maintain personal ethics while complying with professional ethics?

IV.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Vermont Ethics Network. (n.d.). Health care ethics: Overview of the basics. In Health Care Ethics.

Retrieved from https://vtethicsnetwork.org/medical-ethics

●

Cleveland Clinic. (n.d.). Dealing with ethical questions in health care. Retrieved from https://my.clevelandclinic.org/health/articles/dealing-with-ethical-questions-in-health-care

© 2022

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

●

Limentani, A. E. (1999). The role of ethical principles in health care and the implications for ethical codes. Journal of Medical Ethics, 25, 394–398. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC479265/pdf/jmedeth00006-0032.pdf

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

© 2022

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 8: Introduction to Ethics

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

© 2022

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion.

0 points criticism in an offensive manner. Provides only negative feedback.

3 points

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 2 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 4 Internet Resources............................................................................................................................................. 4 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

© 2022

1

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Purpose and Perspective of the Chapter The purpose of this chapter is to review privacy, confidentiality, and privileged communication, terms used to define the relationship between medical professionals and their patients and between legal professionals and their clients. HIPAA provides rules about the confidentiality requirements of health care facilities and personnel. This chapter makes clear that all factors must be reviewed when making decisions about breaking patient confidentiality. Students will learn that regardless of the format of the information (electronic, written, verbal), HIPAA governs it. This chapter explains that there are limits to a patient’s right to confidentiality when there is a greater interest in disclosing the information, which creates ethical dilemmas. Students will learn that maintaining confidence often involves ethical conflicts.

Chapter Objectives The following objectives are addressed in this chapter: 09.01 Distinguish between privacy, confidentiality, and privileged communication.

09.02 Summarize the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

09.03 Evaluate health care interactions to determine if they violate HIPAA. 09.04 Summarize consequences for violating HIPAA. 09.05 Perform HIPAA compliance reporting.

09.06 Identify challenges to maintaining patient confidentiality.

09.07 Identify methods of maintaining confidentiality in medical facilities.

09.08 Identify situations in which disclosure of health information is legal and necessary.

Key Terms Confidentiality: Not disclosing information to those who are not authorized to receive it.

Patient-provider privilege: Legal doctrine that protects communications between a patient and a provider from disclosure in court.

Privacy: Being protected from public scrutiny or having your personal information shared without your permission.

Protected health information: Information held by a covered entity related to a patient’s health status, their health care, or payment for health care.

Privileged communication: A communication (written or verbal) that occurs between two or more people that is protected by law from disclosure in court (see also patient–provider privilege).

Waives: The act of giving up a claim, privilege, or right. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition:

© 2022

2

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

●

Additional content differentiating patient confidentiality, privacy, and privileged communication.

●

New content on HIPAA, including the Privacy Rule, the Security.

●

Rule, HIPAA compliance, the Enforcement Rule, the Breach Notification Rule, violations and penalties, and filing a HIPAA complaint.

●

New sections entitled “HIPAA-Authorized PHI Uses and Disclosures” and “Patient-Authorized PHI Uses and Disclosures”.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

© 2022

Patient Confidentiality, Privacy, and Privileged Communication (09.01) a. Discussion and review of patient confidentiality, privacy, privileged communication, and protected health information. b. Study Question 1: 10 minutes total. Privacy means many different things in a medical setting. Distinguish between the patient’s right to privacy and privacy of privileged communication. c. Suggested Activity 1: 10 minutes total. Research methods of maintaining the confidentiality of medical records at a local emergency room or hospital.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) (09.02, 04, 05) a. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is reviewed.

Enforcement, violations, and maintenance of HIPAA are explained in depth. b. Suggested Activity 2: 15 minutes total. Find out and document the procedure and charges to obtain a copy of your own medical record from a health care provider. c. Suggested Activity 3: 20 minutes total. Find three HIPAA compliant Notice of Privacy Practices online. How are they the same? How do they differ? d. Study Question 2: 10 minutes total. Explain HIPAA’s three main objectives. e. Study Question 3: 10 minutes total. Explain how a HIPPA covered entity might identify violations that occurred on its electronic health records system. f. Study Question 4: 10 minutes total. Identify those who are eligible to file a HIPAA complaint.

Challenges to Maintaining Confidentiality (09.03) a. Technologic, high-profile patients, and additional factors that are challenging with regards to maintaining confidentiality are explored. b. Cases for Discussion 5: 15 minutes total. A hospital employee calls a patient’s home and leaves a voicemail that detailed her medical condition and treatment plan that her daughter heard. The patient specified to only utilize her cell phone for voicemails. What are the implications of this? c. Cases for Discussion 6: 15 minutes total. A patient was injured in an unusual sporting accident, and the hospital released their skull x-ray to the local media. The local newspaper then featured it on the front page. Was this a permissible disclosure?

HIPAA-Authorized PHI Uses and Disclosures (09.07)

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

a. The Tarasoff case is reviewed with regards to the implementation of HIPAA. In some circumstances, there are interests that outweigh a patient’s right to confidentiality, and HIPAA recognizes and identifies those circumstances. b. Case for Discussion 2: 20 minutes total. A patient, who was also an employee of the hospital, alleged that their PHI was impermissibly disclosed to their supervisor. Was this a HIPAA violation? Why or why not?

Patient-Authorized PHI Uses and Disclosures (09.06, 08) a. Mandatory elements of PHI and HIPAA that must be included in the disclosures are reviewed. b. Cases for Discussion 1: 15 minutes total. A private practice provider denied a patient access to her medical records because she had an outstanding balance for services. Is this permissible under HIPAA? Why or why not? c. Cases for Discussion 3: 20 minutes total. An HMO sent a patient’s entire medical record to a disability insurance company without proper authorization. The authorization form used by the HMO did not comply with HIPAA’s requirements. Is an authorization needed in this instance? What should the investigating compliance officer recommend? d. Cases for Discussion 4: 20 minutes total. As part of a negotiation settlement a patient sustained from a car accident, the defendant’s insurance company requested the plaintiff undergo an independent medical exam (IME). The patient is denied a copy of the medical record related to the IME. Is the plaintiff entitled to a copy of their record of the exam?

Confidentiality as an Ethical Dilemma a. In addition to the consequences of violating HIPAA, intentionally disclosing confidential PHI raises issues as to what is ethically right or wrong given the circumstances. There are many situations in which protecting or releasing protected health information can cause ethical questions or dilemmas, but compliance with the law and profession’s code of ethics is essential.

V.

IV.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Center for Disease Control and Prevention. (2022). Health Insurance Portability and Accountability Act of 1996. Retrieved from https://www.cdc.gov/phlp/publications/topic/hipaa.html

●

TedTalk. (2019). Privacy and Consent. Retrieved from https://www.ted.com/talks/fred_cate_privacy_and_consent

© 2022

4

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

●

U.S. Department of Health and Human Services. (2022). Summary of the HIPAA Security Role.

Retrieved from https://www.hhs.gov/hipaa/for-professionals/security/lawsregulations/index.html

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

© 2022

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 9: Laws and Ethics of Patient Confidentiality

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

© 2022

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion.

0 points criticism in an offensive manner. Provides only negative feedback.

3 points

6

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 4 Additional Resources .................................................................................................................................. 5 Internet Resources............................................................................................................................................. 5 Appendix ..................................................................................................................................................... 6 Generic Rubrics .................................................................................................................................................. 6 Standard Writing Rubric .................................................................................................................................... 6 Standard Discussion Rubric ............................................................................................................................... 6

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Purpose and Perspective of the Chapter The purpose of this chapter is to prepare the student to face ethical issues related to the allocation of resources as a future health care provider. Resources such as time, the scarcity of organs for transplant, the limitation of funds for health care delivery systems, ICU beds, and even COVID-19 vaccines all fall into the allocation of resources. Managed care organizations also are discussed and raise issues of the conflict between cost savings and providing the best patient care.

Additionally, this chapter contains a discussion of the ethics of human and medical experimentation, including the Tuskegee Study and the Nuremberg Code. Medical transplants, their types, the growth in popularity of medical tourism, and the ethical dilemmas that arise from these topics are important for the student to understand. Finally, this chapter explains that a professional’s desire to save a life sometimes conflicts with an individual’s desire to be autonomous and make informed decisions.

Chapter Objectives The following objectives are addressed in this chapter: 10.01 Identify ethical issues faced by medical professionals in allocating scarce resources.

10.02 Explain ethical questions associated with medical research and experimentation.

10.03 Summarize the Tuskegee Study.

10.04 Summarize the terms of the Nuremberg Code.

10.05 Summarize the pros and cons of community-based research.

10.06 Describe what the first transplant operations were and when they occurred.

10.07 Identify the three categories of transplants.

10.08 Define the Uniform Anatomical Gift Act. 10.09 Identify ethical issues related to organ transplants.

10.10 Explain the importance of balancing autonomy and paternalism in patient care.

10.11 Explain the reasons for and consequences of medical tourism.

10.12 Explain ethical dilemmas associated with patient confidentiality.

Key Terms Allocation: The act of distributing something.

Autonomy: Allowing individuals control over themselves.

Herd immunity: The eradication or slowing of the spread of a disease that occurs when a high enough percentage of the population is immune to the disease and it can no longer spread.

Paternalism: Providing for people’s needs but giving them no responsibility or control over their destiny. [return to top]

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

New content on the allocation of scare resources; the ethics of transplants; and medical tourism.

●

Additional content on clinical trials and autonomy versus paternalism in health care.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

III.

IV.

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Introduction (10.01) a. This introductory section introduces the student to the ethical issues they will face as future health care providers relating to the allocation of scarce resources, medical research, transplants, autonomy, paternalism, and influences upon the patient-provider relationship.

Allocation of Scarce Resources (10.01) a. In this section, students will be introduced to the ethical dilemma of allocating resources in health care. Resources such as scarcity of organs for transplant, limitation of funds for health care delivery systems, ICU beds, and COVID-19 vaccines. Ethical conflicts in the ICU and conflicts created by managed care are also discussed in more detail. b. Suggested Activity 4: 30 minutes total. The student is asked to research a news article on an area of resource allocation related to the pandemic and think about the fairness, helpfulness, and areas of improvement that are applicable. c. Study Question 2: 10 minutes total. The student is asked to think about the similarities and differences between required COVID-19 vaccinations and required child vaccinations for school attendance. d. Cases for Discussion 3: 15 minutes total. In this ethical dilemma, the student is asked to decide and provide rationale for choosing which COVID-19 patient gets an ICU bed, when all three need one.

Ethics in Medical Research (10.02, 03, 04, 05) a. This section discusses the mandates of the Tuskegee Study and the Nuremberg code, created as a result of past unethical behavior in medical research. The ethics, benefits, and conflicts involved in clinical drug trials and private office medical research are also discussed. b. Suggested Activity 1: 120 minutes total. Watch the movie Miss Evers’ Boys, based upon the true story of the Tuskegee Study. c. Suggested Activity 3: 60 minutes total. Watch one of the many documentaries available on the Nuremberg Trials.

Transplants (10.06, 07, 08, 09) a. This section defines the three categories of transplants, reflects on the history of transplant surgery, and explains the creation and provisions involved in The Uniform Anatomical Gift Act. This section also speaks to the scarcity, demand, funding, ethical issues, and illegal sale of organs.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

V.

VI.

VII.

b. Suggested Activity 5: 15 minutes total. Research the Uniform Anatomical Gift Act as it applies to the state in which the student lives or works. c. Suggested Activity 6: 15 minutes total. The student is asked to find a recent example in the news for each of the three categories of transplants. d. Study Question 1: 10 minutes total. After reviewing a patient's situation regarding fear and questioning of a kidney transplant surgery, the student is asked to think about how they would respond. e. Study Question 3: 10 minutes total. The student is asked to think about how they would respond to a patient case regarding the publicity of a liver transplant. f. Study Question 5: 10 minutes total. An ethical dilemma involving the selling of a kidney for financial and patient benefit is discussed, and the student is asked how they would respond to the situation. g. Cases for Discussion 1: 15 minutes total. The student is asked to ponder upon and discuss a situation involving a prisoner sentenced to die and a child needing a kidney.

Autonomy Versus Paternalism (10.10) a. This section discusses the terms autonomy and paternalism and how these issues are in constant conflict with each other in health care. The different perspectives and roles in health-related situations create tension between the two terms. b. Suggested Activity 2: 120 minutes total. Visit a local nursing home (with permission) to listen to what the residents and staff think about autonomy in decision making, and paternalism with older adults. c. Cases for Discussion 2: 15 minutes total. The student reviews a situation involving the forcible removal of a patient from her home to a hospital and is asked to discuss whether she should be released or not.

Medical Tourism (10.11) a. Medical tourism has grown in response to concerns over the cost and availability of health care services. This section discusses the ethical dilemmas that arise between patients, providers, and employers in response to medical tourism. b. Study Question 4: 10 minutes total. The student is asked to respond to a case in which the patient is seeking follow-up care on a knee surgery done abroad, and the provider is refusing to see them.

Influences on the Patient-Provider Relationship (10.01, 12) a. Many resources, such as time and one’s relative power, influence the patient-provider relationship. This section discusses the ethical concerns and considerations that influence this relationship.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Additional Resources Internet Resources ●

Fressin, F., Wen, A., Shukla, S., Mok, K., Chaguturu, S. (2021, July 23). How We Achieved More Equitable Vaccine Distribution: Social Vulnerability Analytics Are Necessary, But Not Sufficient.

Health Affairs. Retrieved from www.healthaffairs.org/do/10.1377/hblog20210721.568098/full/.

●

Tuskegee Study: Centers for Disease Control and Prevention. (2016, December 8). The Tuskegee timeline. Retrieved from https://www.cdc.gov/tuskegee/timeline.htm

●

Nuremberg Code: United States Holocaust Memorial Museum. (n.d.). Nuremberg code.

Retrieved from https://www.ushmm.org/information/exhibitions/online-exhibitions/specialfocus/doctors-trial/nuremberg-code

●

AMA. (n.d.). Medical Tourism: Code of Medical Ethics Opinion 1.2.13. AMA. Retrieved from www.ama-assn.org/delivering-care/ethics/medical-tourism.

[return to top]

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

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Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 10: Professional Ethics and the Living

Contribution Quality

Etiquette

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Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 6 Internet Resources............................................................................................................................................. 6 Appendix ..................................................................................................................................................... 6 Generic Rubrics .................................................................................................................................................. 6 Standard Writing Rubric .................................................................................................................................... 6 Standard Discussion Rubric ............................................................................................................................... 7

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Purpose and Perspective of the Chapter This chapter explores ethical issues involving the rights of embryos, fetuses, birth issues, the neonatal period, and the growing child, which are gaining prominence. Technology makes it possible to exercise more control over birth and the beginning of life by detecting genetic and chromosomal abnormalities.

New techniques for artificial insemination raise questions of surrogate motherhood and paternal responsibility. Questions about fetal rights and maternal legal obligations during pregnancy take on new importance as technology’s ability to intervene during pregnancy advances. And, because of the value of fetal tissue in transplants, society has taken a new look at the need to protect the fetus. Students will learn that society takes steps to control procedures used to care for handicapped newborn infants because of conflicting ethical positions on sanctity versus quality of life.

Chapter Objectives The following objectives are addressed in this chapter: 11.01 Analyze ethical questions associated with artificial insemination and assisted reproductive

technology.

11.02 Summarize the decision of Roman v. Roman.

11.03 Identify examples of genetic disorders.

11.04 Explain how genetic testing is performed.

11.05 Analyze ethical questions surrounding genetic research.

11.06 Identify regulations on cloning.

11.07 Explain the dilemma of sanctity versus quality of life.

11.08 Summarize key legal decisions related to abortion.

11.09 Explain the medicolegal rights of a fetus.

11.10 Explain the medicolegal rights of a newborn.

Key Terms Amniocentesis: Test used during pregnancy to diagnose a fetus’ genetic disorders and other health issues.

Chemotherapy: Drug treatment, most often used in the treatment of cancer, that uses potent chemicals to kills fast-growing cells.

Cloning: Identically duplicating an organism.

DNA: Molecule within cells that holds genetic information responsible for the development and performance of an organism.

Embryonic stem cell: Cells that are derived from human embryos or human fetal tissues that are selfreplicating.

Embryos: Fertilized eggs in the early stages of development.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Fetus: Unborn, developing offspring from the period beginning 8 weeks (when the major structures have formed) after fertilization of an egg by a sperm until the time of birth.

Genetic: Resulting from genes are attributable to them.

Heterologous artificial insemination: An artificial insemination procedure wherein a sperm sample is taken from a donor who is not the partner of the woman seeking to become pregnant.

Homologous artificial insemination: An artificial insemination procedure wherein a sperm sample is taken from a donor who is the partner of the woman seeking to become pregnant.

Pluralistic: Political philosophy wherein people of different beliefs, political parties, and lifestyles coexist and take part equally in the political process.

Preimplantation genetic diagnosis: Genetic testing used to identify whether a parent’s known genetic defect is present in an embryo produced by in vitro fertilization.

Sanctity: The quality of being sacred.

Survival action: A lawsuit related to a death and brought by the decedent’s survivors.

Wrongful death: Death caused by negligence. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Updated content on artificial insemination and assisted reproductive technology; genetic testing before birth; embryonic stem cells for research; cloning and gene editing; and medicolegal rights of the fetus and the newborn.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

Introduction (11.01) a. Due to the United States’ pluralistic society, there is a growing debate surrounding ethical issues associated with reproduction. Medicine, law, and ethics are intertwined when considering the complex ethical issues concerning life’s early stages. Each advance in medicine, technology, and knowledge adds more challenges.

Artificial Insemination and Assisted Reproductive Technology (11.01, 02) a. Prospective parents that have trouble conceiving naturally have other options to have children. One option is artificial insemination. Artificial insemination can be homologous - meaning the sperm donor is the partner of the woman seeking to become pregnant or heterologous - meaning the sperm donor is not the partner of the woman seeking to become pregnant. Another option is in vitro fertilization (IVF), during which a woman’s

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

III.

IV.

V.

eggs are fertilized in a petri dish. Both options require thought and consideration.

Students will learn that in the case of Randy and Augusta Roman, frozen embryos were ultimately discarded after their divorce due to written terms in the IVF consent agreement. Embryos are typically considered property rather than human life. b. Suggested activity 1: 60 minutes total. Students will research three different religions and compare/contrast their positions on artificial insemination. c. Case for discussion 2: 30 minutes total. Discuss the arguments for both a husband and wife who are discussing how to handle frozen embryos during a separation. d. Case for discussion 3: 60 minutes total. Discuss the factors involved when petitioning to adopt a child conceived through artificial insemination after the woman divorces the father and remarries. e. Case for discussion 4: 60 minutes total. Discuss the arguments both for and against visitation rights of a baby conceived through homologous artificial insemination when the couple is not married.

Genetics (11.03, 04, 07) a. There are more than 6,000 known genetic disorders, and at least 500 are linked to a defect in a single gene. They include cystic fibrosis, sickle cell anemia, hemophilia, and Tay-Sachs disease. Investigating genetic makeup is controversial and can have both positive and negative outcomes. On one side, genetic information can be cause for discrimination and can expose family information. However, genetic information can also be used to develop new treatments for disorders and diseases. Testing only requires a DNA sample from tissues, blood, saliva, or nucleated cells. Students will discuss amniocentesis and preimplantation genetic diagnosis and corresponding ethical issues. The sanctity of life versus the quality of life will also be considered. b. Study question 1: 20 minutes total. Discuss the benefits and detriments of genetic testing c. Study question 2: 30 minutes total. Discuss whether you would have an amniocentesis test done if you knew that you or your partner had a family history of a genetic disease.

Discuss what factors you would consider when determining whether to terminate the pregnancy. d. Study question 3: 20 minutes total. Define the sanctity of life and give an example of an ethical decision based on its philosophy. e. Study question 4: 20 minutes total. Define quality of life and give an example of an ethical decision based on its philosophy. f. Study question 8: 10 minutes total. Determine what kind of sample is used for genetic testing and where it can be obtained.

Embryonic Stem Cells for Research (11.05) a. Embryonic stem cell research may aid in the development of new and more efficient treatments for diseases, potentially helping numerous patients. Opponents of embryonic stem cell research argue that potential benefits do not outweigh the harm done to the natural progression of fetal development. Because the beginning of life is defined differently among religions, religious beliefs are often at the core of the debate of what is morally acceptable.

Cloning and Gene Editing (11.06) a. Today’s technology makes it possible for a fertilized egg to be cloned and implanted for human incubation until birth. There are no federal regulations related to human reproductive cloning, but several states have enacted laws that prohibit it. Gene editing

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

VI.

VII.

VIII.

can remove certain DNA mutations that lead to disease. This technology can be used to create a baby with or without desired characteristics.

Abortion and the Right to Be Left Alone (11.08) a. Privacy is the right to be left alone to make personal choices. The human right to privacy is grounded in the moral tenet that each individual has incalculable worth, as reflected in the Fourth Amendment. Some argue that incalculable worth extends to the fetus, while others argue that the woman and what she chooses to do with her body is a high priority. The decision of the U.S. Supreme Court case, Roe v. Wade, protects a woman’s right to privacy during a first-trimester abortion. b. Suggested activity 2: 30 minutes total. Students will research a judicial decision that was made after the Roe v. Wade decision and discuss how it modifies the Roe v. Wade ruling.

Medicolegal Rights of the Fetus (11.09) a. Fetuses are protected from harm under the Unborn Victims of Violence Act. The act made it a crime to harm a fetus while assaulting a pregnant woman during the commission of a federal crime. A stillborn child’s estate can be recovered through a wrongful death and survival action for injuries sustained while in the womb. Students will also discuss the growing interest in transplants using fetal tissue and the ethical questions that may be associated with it. b. Study question 6: 30 minutes total. Discuss what restrictions you might give a pregnant mother in regards to the well-being of the fetus. Discuss whether a pregnant woman’s nutrition should be monitored by the government.

Medicolegal Rights of a Newborn (11.10) a. Newborns are protected from medical negligence under the Baby Doe law. The Baby Doe law is an amendment to the Child Abuse Prevention and Treatment Act and prevents withholding of medical care from an infant with noncongential anomalies.

Ethical considerations that are discussed in this section include the harvesting, freezing, and storing of a baby’s umbilical cord and the use of “savior babies.” b. Study question 5: 15 minutes total. List the three exceptions to the Baby Doe law. c. Study question 7: 60 minutes total. Develop philosophies that advocate for opposing views regarding the life of a baby born with congenital conditions. d. Case for discussion 1: 60 minutes total. Discuss the ethical issues involved in the court case regarding a couple who gave birth to a baby with Tay-Sachs disease.

[return to top]

Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

Additional Resources Internet Resources ●

Goldenring, J.M. (1985, December). The brain-life theory: Towards a consistent biological definition of humanness. Journal of Medical Ethics, 11(4), 198-204. Retrieved from https://pubmed.ncbi.nlm.nih.gov/4078859/

●

BBC. (n.d.). When is the foetus “alive”? BBC. Retrieved from https://www.bbc.co.uk/ethics/abortion/child/alive_1.shtml

[return to top]

Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria Content

Organization and Clarity

Research

Research

Grammar and Spelling

Meets Requirements Needs Improvement Incomplete The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

15 points 8 points 0 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not logically related and related and consistent. and conclusions are mostly consistent.

10 points logically related and consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible.

0 points errors. errors.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 11: Reproductive Issues and Early Life

5 points

3 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

7

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Instructor Manual Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Table of Contents Purpose and Perspective of the Chapter .................................................................................................... 2 Chapter Objectives ..................................................................................................................................... 2 Key Terms ................................................................................................................................................... 2 What's New in This Chapter ........................................................................................................................ 3 Chapter Outline .......................................................................................................................................... 3 Discussion Questions .................................................................................................................................. 5 Additional Resources .................................................................................................................................. 5 Internet Resources ...................................................................................................................................... 5 Appendix ..................................................................................................................................................... 5 Generic Rubrics .................................................................................................................................................. 5 Standard Writing Rubric .................................................................................................................................... 5 Standard Discussion Rubric ............................................................................................................................... 6

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Purpose and Perspective of the Chapter This chapter aims to identify the ethical dilemmas and legal guidelines in relation to death and dying.

This chapter starts by discussing commonalities in perspectives on death and dying. At that point, the learner will review laws such as the UDDA and PSDA to understand some of the legal tools for working in an industry that faces death and dying. Advance Directives, including living wills, durable power of attorney, health care proxy, and do not resuscitate orders, are discussed. Palliative care and death with dignity concepts are explored. Cases including Schiavo, Nayim Carter, and the work of Dr. Kevorkian are reviewed in addition to information from current and ancient resources. Finally, ethical dilemmas surrounding suicide, the right to die, assisted suicide, and euthanasia are identified.

Chapter Objectives The following objectives are addressed in this chapter: 12.01 Identify common influences on an individual’s perspectives on death and dying.

12.02 Summarize the Uniform Determination of Death Act (UDDA).

12.03 Differentiate among advance directives, living wills, durable power of attorney, and health care proxies.

12.04 Summarize the basics of the Patient Self-Determination Act (PSDA) of 1990.

12.05 Define palliative care.

12.06 Identify the states with death with dignity acts.

12.07 Explain the need for a do-not-resuscitate (DNR) order from the patient’s perspective.

12.08 Summarize legal and ethical dilemmas related to the decision to keep or remove life support.

12.09 Summarize legal and ethical arguments for and against euthanasia.

Key Terms Advance directive: A document signed and witnessed according to state statute authorizing one person to make decisions for another, including the authorization or refusal of medical treatment.

Assisted suicide: One person making it possible for another person to commit suicide.

Cardiopulmonary arrest: Cessation of normal functioning of the heart and lungs.

Clear and convincing: Legal standard of proof that requires proof that the allegation or contention is far more likely than not to be true.

Durable power of attorney: A document allowing the principal (the person writing the durable power of attorney) to delegate to another person (the agent) the legal authority to act on the principal’s behalf.

Euthanasia: Ending someone’s life to prevent pain or suffering.

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Health care proxy: Document appointing a specific person to act as a surrogate to make health care decisions for another person under certain circumstances.

Hospice: A medical facility or a home where a terminally ill patient receives palliative care.

Life-sustaining: Helping someone to stay alive with medical intervention.

Living will: A will made by a person in which he or she requests to be allowed to die naturally rather than being kept alive by artificial means in the event there is no probable recovery from mental or physical disability.

Palliative care: Care intended to keep a patient with a serious or terminal illness as comfortable as possible.

Purist: One who believes in and follows all traditional rules.

Sanctity: The quality of being sacred.

Substitute judgment: One person’s decision used to make a decision for another.

Terminally ill: Fatally ill with a condition for which there is no cure. [return to top]

What's New in This Chapter The following elements are improvements in this chapter from the previous edition: ●

Updated content on attitudes toward death; dying and the Uniform Determination of Death Act (UDDA); and the right to die.

[return to top]

Chapter Outline In the outline below, each element includes references (in parentheses) to related content. "CH.##” refers to the chapter objective.

I.

II.

Attitudes Toward Death and Dying (12.01, 02) a. Recognizing that health care professionals will likely encounter death and dying, this section asks the student to consider different attitudes towards death and dying. The ethical issues of health care question the sanctity and quality of life. Laws that help to define when a person is medically dead and a review of situations where this definition is particularly important to clarify are discussed. Consideration is given to ethical dilemmas over whether current criteria and definitions of death are sufficient. b. Suggested Activity 2: 45 minutes total. Research criteria for the pronouncement of death in the student’s state. c. Case for Discussion 1: 30 minutes total. Violent crime results in the victim becoming brain dead and the defendant found guilty of murder. The defendant appealed stating, that “death” never occurred. How should the court rule?

Advance Directives (12.03, 04) a. This section discusses what advance directives are as well as the ethical dilemma case of Terry Schiavo. The section then reviews the Patient Self Determination Act (PSDA) and

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

III.

IV.

the requirements under this ruling. Lastly, the details regarding the advance directives, living wills, durable powers of attorney, and health care proxy are reviewed. b. Suggested Activity 3: 20 minutes total. Research online for an example of living will in the student’s state. c. Suggested Activity 5: 20 minutes total. Research online for durable power of attorney or living will statute in the student’s state. What types of legal protection does the state provide?

The Terminally Ill Patient (12.05) a. This section defines terminally ill and palliative care and uses a case study to highlight the ways that death and dying impact the patient and their family. Hospice care is reviewed as well as its benefits to patients and families at the end of life. b. Suggested Activity 4: 60 minutes total. Listen to the This American Life episode “Death and Taxes” Act One - Death which is Episode 523 (36 minutes). Identify different types of palliative care.

The Right to Die (12.06, 07, 08, 09) a. This section discusses death with dignity statutes, physician-assisted suicide, and the ethical dilemma of promoting life versus reducing suffering. The ethical dilemmas of euthanasia and suicide are highlighted. DNR orders and removal of life support are discussed. Euthanasia is defined and differentiated from suicide and assisted suicide.

The ethical dilemmas surrounding euthanasia are discussed. The ancient philosophy of Hippocrates is cited as well as more current historical cases such as Brittany Maynard.

Finally, this section reviews the trauma of suicide. b. Suggested Activity 1: 60 minutes total. Interview a clergy person or physician and document the standards on life support and its use on the terminally ill. Note the philosophies that lead to their perspectives and ask what could influence their present position. c. Study Question 1: 30 minutes total. Explain your philosophy regarding euthanasia. d. Study Question 2: 15 minutes total. Why would a patient want a DNR order? e. Study Question 3: 30 minutes total. What are the factors you consider when identifying your position on the right to die? f. Case for Discussion 2: 30 minutes total. The patient falls into a long-term coma and is determined to be in a vegetative state. She was put on life support but continued to deteriorate. The father asked for removal of life support; the physician declined because she did not meet the traditional standard for death. If the life support systems are removed, should the physician be subject to civil or criminal liability? g. Case for Discussion 3: 30 minutes total. 83-year-old monk enters hospital for routine surgery and suffers cardiopulmonary arrest. After resuscitation, he was in a chronic vegetative condition. The patient, following his religious beliefs, had clearly stated he did not want any extraordinary measures to prolong his life. His guardian requested removal of the respirator, but the surgeon refused. The guardian went to court. What should the court decide? h. Case for Discussion 4: 30 minutes total. The patient suffered an aneurysm and underwent a craniotomy but never regained consciousness. Life support was initiated as well as feeding by artificial means, and the patient was diagnosed to be in a vegetative state. The patient was not considered terminally ill. The family requested the removal of the feeding tube apparatus, and the hospital declined. The case went to court. What should the court conclude?

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Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

i.

Case for Discussion 5: 30 minutes total. 84-year-old patient with irreversible physical and mental impairments in continuing decline, but the patient was not brain dead, comatose, or vegetative. The family wanted the feeding tube removed. Should the court allow the removal of the feeding tube?

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Discussion Questions Refer to the Cases for Discussion at the end of the chapter. You can assign these cases and questions several ways: in a discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in class. Answers appear in the Solution and Answer Guide. [return to top]

Additional Resources Internet Resources ●

Death and dying: Updike, N. (2014, April 25). Death and taxes. This American Life Podcast.

Podcast retrieved from https://m.thisamericanlife.org/radio-archives/episode/523/death-andtaxes?act=1#act-1

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MedlinePlus. (n.d.). End of life issues. Retrieved from https://medlineplus.gov/endoflifeissues.html

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Physician-assisted suicide: CNN Library. (2016, June 7). Physician-assisted suicide fast facts. CNN. Retrieved from http://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/

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Theresa Schiavo case: Didion, J. (2005, June 9). The case of Theresa Schiavo. The New York Review of Books. Retrieved from http://www.nybooks.com/articles/2005/06/09/the-case-oftheresa-schiavo/

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Appendix Generic Rubrics Providing students with rubrics helps them understand expectations and components of assignments.

Rubrics help students become more aware of their learning process and progress, and they improve students’ work through timely and detailed feedback.

Customize these rubrics as you wish. The writing rubric indicates 40 points and the discussion rubric indicates 30 points.

Standard Writing Rubric Criteria

Meets Requirements

Needs Improvement

Incomplete

5

Instructor Manual: Pardew, Applied Law and Ethics in Health Care, ISBN 9780357623879; Chapter 12: Death and Dying

Content

Organization and Clarity

Research

Research

Grammar and Spelling

The assignment clearly and The assignment partially The assignment does not comprehensively addresses all addresses some or all address the questions in the questions in the assignment. questions in the assignment. assignment.

0 points 15 points 8 points The assignment presents ideas The assignment presents ideas The assignment does not in a clear manner and with in a mostly clear manner and present ideas in a clear manner strong organizational structure. with a mostly strong and with strong organizational The assignment includes an organizational structure. The structure. The assignment appropriate introduction, assignment includes an includes an introduction, content, and conclusion. appropriate introduction, content, and conclusion, but Coverage of facts, arguments, content, and conclusion. coverage of facts, arguments, and conclusions are logically Coverage of facts, arguments, and conclusions are not related and consistent. and conclusions are mostly logically related and 10 points logically related and consistent. consistent.

0 points 7 points The assignment is based upon The assignment is based upon The assignment is not based appropriate and adequate adequate academic literature upon appropriate and academic literature, including but does not include peer adequate academic literature peer reviewed journals and reviewed journals and other and does not include peer other scholarly work. scholarly work. reviewed journals and other 5 points 3 points scholarly work.

0 points The assignment follows the The assignment follows some The assignment does not required citation guidelines. of the required citation follow the required citation 5 points guidelines. guidelines.

3 points 0 points The assignment has two or The assignment has three to The assignment is incomplete fewer grammatical and spelling five grammatical and spelling or unintelligible. errors. errors.

0 points 5 points 3 points

Standard Discussion Rubric Criteria Participation

Contribution Quality

Etiquette

Meets Requirements Submits or participates in discussion by the posted deadlines. Follows all assignment. instructions for initial post and responses.

5 points Comments stay on task.

Comments add value to discussion topic. Comments motivate other students to respond.

20 points Maintains appropriate language. Offers criticism in a constructive manner. Provides both positive and negative feedback.

5 points

Needs Improvement Incomplete Does not participate or submit Does not participate in discussion by the posted discussion. deadlines. Does not follow 0 points instructions for initial post and responses.

3 points Comments may not stay on Does not participate in task. Comments may not add discussion. value to discussion topic.

0 points Comments may not motivate other students to respond.

10 points Does not always maintain Does not participate in appropriate language. Offers discussion. criticism in an offensive 0 points manner. Provides only negative feedback.

3 points

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