Texas Jurisprudence Exam 2022 Questions and Answers

Can a patient successfully sue a doctor if there is no physician-patient relationship? – ANSWER No If there is no prior physician-patient relationship, are you legally obliged to respond to a call from a patient for treatment? – ANSWER No Does being on call give rise to a physician-patient relationship? – ANSWER No How can one terminate a physician-patient relationship, without abandonment if there is ongoing treatment? – ANSWER 30 days written notice; must provide for emergency Does a physician's duty extend to the unborn child or potential victims of an ill patient? – ANSWER Yes What is "proximate cause"? – ANSWER Prove that negligence caused harm and that the cause was not too remote; what is required to hold a defendant liable in a civil lawsuit What are the two components of proximate cause? – ANSWER Cause-in-fact (but-for test) and foreseeability Does an expert witness have to be actively practicing medicine? - ANSWER Yes Does an expert witness have to know standards of care? – ANSWER Yes Does an expert witness have to have enough training to express an opinion on whether standard of care was provided? – ANSWER Yes Does an expert witness have to be board certified? – ANSWER No, board certified or equivalent In a medical malpractice case, are expert witnesses required? – ANSWER Yes, with two exceptions In a medical malpractice setting, what 2 instances do not need expert testimony? – ANSWER Res ipsa loquitur (e.g., amputation of wrong leg) and negligence per se (a law was broken) What are "exemplary damages"? – ANSWER Damages above compensatory designed to punish the defendant and deter the behavior Is there a cap to noneconomic damages? How much? – ANSWER $250,000 for physicians, $500,000 for hospitals Does the cap on noneconomic damage depend on the number of defendants or claimants? – ANSWER No What is "proportional responsibility"? – ANSWER Percentage of liability apportioned according to percentage of fault Can the claimant have part of the proportional responsibility? – ANSWER Yes If the claimant's proportionate responsibility is more than what %, he/she may not recover damages? – ANSWER If 50%, no damages awarded How long is the statute of limitations for adults? For minors? – ANSWER 2 years; for minors 2 years after becoming 18 years of age By how much can the statute of limitations be extended and how? - ANSWER File complaint—extra 60-day, notice letter extends statute by 75 days What is the statute of limitations for wrongful death? – ANSWER 2 years What is the discovery rule? Give examples. – ANSWER Statute does not begin until damage is discovered. For example, a retained sponge that is found 3 years post-op Is there immunity from civil action in emergency cases? – ANSWER Yes, except gross negligence Is there immunity from civil action in volunteer care? – ANSWER Yes, except gross negligence When can a physician be charged with "assault and battery"? – ANSWER Un-consented surgery or examination or when exceeding the scope of the consent When can a physician be charged with patient abandonment? – ANSWER Unilateral cessation of treatment when continued treatment is necessary What is "strict liability"? – ANSWER Liability that does not depend on actual negligence, but that is based on a breach of a duty to make something safe. This often applies to product liability Are hospitals liable for the actions of a physician? – ANSWER No, unless the hospital employs the physician Who determines in a criminal case if the medical records of a patient should be released? – ANSWER Judge by inspection How many days do you have to release medical records to an attorney? - ANSWER 45 days Can medical records be admitted as evidence in court? What are the requirements? – ANSWER Yes, but only with affidavit What are schedule 1, 2, 3, 4, 5 drugs? – ANSWER Schedule 1—no known use (e.g., heroin); schedule 2—very addictive (morphine, cocaine); schedule 3-5—less addictive What are dangerous drugs? – ANSWER Prescription drugs other than schedule 1-5 How many DEA registrations do you need if you prescribe drugs? dispense drugs? – ANSWER One to prescribe; a separate registration for each location where you dispense How often do you renew your DEA license? – ANSWER Every 3 years Can you move your office location and then change your DEA? – ANSWER No, need to change BEFORE move Is a DEA registration sufficient to prescribe drugs in Texas? – ANSWER No, also need Department of Public Safety Bureau of Narcotics and Dangerous Drug registration How often do you renew a DPS license? – ANSWER Yearly Do you have to display the DEA and DPS licenses? – ANSWER Not required by any statute. How many days do you have to notify the DPS of any change in your information (name, address, tel., etc.)? – ANSWER 7 days Can you have your DPS suspended and keep your DEA or vice versa? - ANSWER No, they are interconnected For schedules 2-5 drugs, can you just put the number of pills on prescription? – ANSWER No, number and number spelled out Do you have to put intended use on prescription? – ANSWER Yes With how many days of a schedule 2-5 drug can a patient be discharged from the hospital? – ANSWER 7 days; only if the drug was already rx in the hospital What kind of prescription pad do you need for schedule 2 drugs? Can you use stickers? – ANSWER Official DPS form; no stickers Can a physician prescribe schedule 2 over the phone? – ANSWER Yes, for emergencies, and only for the duration of emergency How many days does the physician have to mail the schedule's emergency prescription to the pharmacy? – ANSWER 7 days How many days does the patient have to fill schedule 2 prescriptions? - ANSWER 7 days Can you refill a schedule 2 prescription? How about schedule 3-5? - ANSWER No for schedule 2. Max 5 refills for schedules 3-5. Who can call in prescription from a physician's office? – ANSWER Any qualified DESIGNATED person Can they call in schedule 2? – ANSWER Only physician in emergencies Can a physician prohibit substitutions for generics? – ANSWER Yes From whom and how do you order schedule 2? Schedules 3-5? – ANSWER Schedule 2 on triplicate order form from distributor; schedules 3-5 regular form from wholesaler What drugs do you need to keep records on? How are the records kept? How often do you need to do inventory? Do you need to submit the records? How long do you have to keep the last inventory list? – ANSWER If dispensed in office, then all dangerous drugs, schedule drugs and samples; separate records for schedule 1+2; inventory every 2 years; records are not submitted; keep records for 2 years Who can inspect your drugs? – ANSWER TMB, DPS, attorney general for the DEA What is the method of ordering and accounting for drug samples? - ANSWER Written and signed request by physician; must keep inventory and drug logs Can you repackage samples? – ANSWER No Do you need to keep records on samples? – ANSWER Yes, just like other meds Can a physician buy and rebottle? Any exceptions? – ANSWER No, except for rural areas (less than 5000 population of town or 2500 of municipality, closest pharmacy 15 miles) To give anesthesia, how often do you have to register with the board? - ANSWER Every 2 years What life support competency do surgeons and anesthesiologists need? - ANSWER ACLS, PALS, or board-approved course How many and what competency levels of healthcare providers do you need in all settings? – ANSWER At least 2 physicians with advanced competency How many days do you have to report office-based anesthesia-related complications? - ANSWER 15 days What is considered an anesthesia-related complication? – ANSWER Admission to hospital within 24 hours or death within 72 hours What is considered intractable pain? – ANSWER Pain where cause of pain cannot be removed and where relief or cure has not been found Can a hospital forbid a physician to give dangerous drugs or controlled substances for treatment of intractable pain? – ANSWER No Can the board take disciplinary action against a physician for giving dangerous or controlled substances to a patient with intractable pain? - ANSWER No What must the physician document prior to treatment of intractable pain? - ANSWER Understanding between physician and patient about treatment; dose, type, frequency of medication; consultation with psychologist, psychiatrist, addictions expert Can you guarantee that a drug will work? – ANSWER No Who can be part of a confidential communication? – ANSWER Persons involved, furthering interest of the patient, and those participating in diagnosis or treatment, e.g., patients, doctors, translators, nurses, etc Is the billing record confidential? – ANSWER No, billing record is NOT part of medical record In a criminal proceeding, is the physician-patient privilege communication confidential? – ANSWER NO (except for mental health records); judicial ruling should be obtained In a criminal proceeding, are records of alcohol and drug abuse confidential? – ANSWER Yes Does the physician confidentiality apply to court or administrative proceedings brought by the patient against a physician? – ANSWER No Can the physician violate confidentiality if he/she thinks he or someone else is in danger? – ANSWER Yes, must report that to law enforcement agency (NOT for mental health) What information must a release of medical records include? – ANSWER Type of records, reason, and person to whom to release How many days (hospital) or business days (physician) does a hospital/physician have to provide medical records when they are requested? – ANSWER Physician has 15 business days, hospital has 15 days What is "therapeutic privilege," when can it be used, who has access to the information, and what is the protocol the physician must follow? – ANSWER If physician thinks that information would be harmful to the patient, it can be withheld; in writing, copy in the chart; films or tests must be released to patient representative Can the physician charge for medical records and films? For an affidavit? Does he have to give the information if the patient does not pay? What does he do if the patient does not pay? – ANSWER Yes, can charge $25 for first 20 pages, then 15¢ per page plus postage; notarization $15, films $8; patient MUST pay to get records, 10-day notice Can you charge a patient requesting records in order to apply for disability or public aid? How many copies are patients entitled to? Can you charge if federal agency is requesting records? – ANSWER No; one copy; no How many years does a physician MD have to keep records for adults? for minors? How many years do hospitals have to keep records for adults? For minors? – ANSWER 7 years for adults, 7 years or until age 21; hospital 10 years Can a physician or hospital get rid of records after the required years if these records might be part of a litigation? – ANSWER No Can you relate information without patient consent for treatment? Billing? To report abuse? To law enforcement? For funeral directions? For worker's comp? – ANSWER Yes, all of the above What is the "minimum necessary standard" for a medical release? - ANSWER It protects health care information unless it is required to be released (investigation, law enforcement, authorized release, participating care providers, HIPAA compliant release) Does a patient have the right to see his/her own record? Can he/she ask for amendments to the records? – ANSWER Yes; yes, they can request amendments What is the Texas medical record privacy act? Is it like HIPAA? – ANSWER It is the state equivalent of HIPAA Within how many days must a hospital send an itemized bill to patients? Is this mandatory? Or done by request? When must the hospital inform patients of this option? – ANSWER Upon request, within 30 business days; hospital must inform patient of availability of itemized bill Can medical records be obtained with a subpoena? Does this include substance-abuse records? – ANSWER Yes; no Are substance abuse records admissible during criminal proceedings? - ANSWER No, unless the crime is EXTREMELY serious Is HIV information confidential? – ANSWER Yes Can you "break" confidentiality in order to tell a spouse that his/her spouse is HIV positive? – ANSWER Yes Can you break confidentiality to tell a partner about notification program? - ANSWER Yes Are blood bank records confidential? – ANSWER Yes If a blood bank finds a donor with an infectious disease, can they call other blood banks and tell them the name of donor and the disease?Edition. - ANSWER They can tell name of donor, NOT disease If a blood bank finds that blood outbound to hospitals is HIV positive, can they call the hospitals and give name of donor? Type of disease? - ANSWER They can tell name of disease, NOT donor For statistical purposes, can a blood bank give out medical records? Names? – ANSWER Yes, but not names or other identifying information Is genetic information confidential? – ANSWER Yes Can patients have access to the results of their genetic testing? – ANSWER Yes What kind of crime is the unauthorized release of records? – ANSWER Misdemeanor Can the Texas Medical Board (TMB) show preference to a specific school of medicine such as medicine v. osteopathy? – ANSWER No What does the Medical Practice Act (MPA) regulate? – ANSWER The practice of medicine Who does the MPA apply to? – ANSWER Physicians (MD, DO), PAs, and acupuncturists Does the MPA apply to the armed forces and federal public health? Can they moonlight? – ANSWER It does NOT apply to a federal job, they can NOT moonlight outside the federal setting Does the MPA apply to emergency assistance if there is NO charge of money? If there is money charged or billed? – ANSWER NO if no charge; YES if money is charged Are medical students in "board-approved schools" subject to the MPA? - ANSWER No Does the MPA prohibit self-care? – ANSWER No Does the MPA apply to physicians in contiguous states? – ANSWER NO (physicians from nearby states can only order care for patients in hospice or nursing homes) How many people are on the TMB? Who appoints them? Who must confirm them? – ANSWER 19 members, appointed by the governor, confirmed by the senate Can the board subpoena people and records? Who can serve a subpoena? - ANSWER YES, subpoenas can be served by board investigator or sent by certified mail How often does the Department of Public Safety (DPS; state police) check on physicians and report to the board? – ANSWER Quarterly What are acceptable methods to tell the public on how to register a complaint to the TMB? In what languages? Where can a physician include this info? – ANSWER By phone (direct number and 1-800 number) or by mail; posted sign, on registration forms or bill; in English and Spanish How often must the TMB disseminate updated information? What info is included? – ANSWER 2 times per year; info includes disciplinary action, board activities and functions, changes to the MPA and attorney general opinions Are disciplinary orders private or public? – ANSWER Public Are the following included in the physician profile? 1. ethnic origin 2. CME 3. years in practice 4. Medicaid participation 5. misdemeanors 6. felonies 7. malpractice claims 8. tax ID or social security numbers – ANSWER Everything except for tax ID/soc. security Which malpractice claims should be included? – ANSWER Any jury awards, liabilities—NOT settlements What happens if you don't give this info? – ANSWER License is not renewed How many years of postgraduate training do you need to be eligible for licensure? – ANSWER One Who can get a limited license? – ANSWER Applicant who is recommended by dean, president, or chief administrator from Texas medical school Do you need the jurisprudence exam for a limited license? – ANSWER Yes Who is not eligible for licensure? – ANSWER If applicant is under prosecution, investigation, or has restrictions on license in another state How many days does the program director have to tell the board that somebody with a physician-in-training license did not show up, was suspended, etc.? – ANSWER 30 days What is a temporary postgraduate training permit? – ANSWER License for residents and fellows pending the physician in training permit What is a telemedicine license? Do you have to be board certified to have it? Do you have to pass the jurisprudence exam? – ANSWER A license to do consulting work through internet, etc., in Texas; cannot physically see or treat patients; board certification is required; JP exam required How often do you register your license? Do you need an updated physician profile? – ANSWER Every 2 years; yes How many days prior to the expiration of your license does the TMB notify you? – ANSWER 30 How many days after a license expires are you considered to be practicing without a license? – ANSWER 30 day grace period. License expired 90 days—penalty is? – ANSWER $75 License expired 91-364 days—penalty is? – ANSWER $150 License expired 364 days—penalty is? – ANSWER Cancellation Do you have to retake JP exam if your license is canceled? – ANSWER Only if the license is canceled for more than 2 years. How can you get another license if it is lost/destroyed? – ANSWER Get affidavit of lost or destroyed document and pay fee to board How many category 1 CMEs yearly? – ANSWER 12 How many CMEs per year? – ANSWER 24 How many category 1 CMEs yearly must be in ethics? – ANSWER 1 How many category 2 CMEs can be from volunteer work? – ANSWER 6 How many CMEs can a license carry forward? And for how many registration periods? – ANSWER 48; only once How many CMEs can be applied retroactively? – ANSWER 24; only once How many CMEs do you need if you become "board certified" within 36 months? – ANSWER 24 If you practice pain management, how many CMEs in pain management are required? – ANSWER None, but they are recommended Who can initiate a complaint to the board? – ANSWER Anyone What is the "health professions council"? – ANSWER Council of various professionals that establishes a central telephone complaint system (800-number) Does the TMB have to notify a physician when a complaint is filed? Are there exceptions? How often do the parties get updated on proceedings? - ANSWER Yes, within 30 days, except if it would interfere with the investigation; updates are quarterly When does the TMB release complaint information to the hospital? - ANSWER Upon written request Who investigates issues of "medical competency"? – ANSWER An expert physician panel appointed by the board consisting of physicians ONLY What do medical malpractice carriers have to report to the TMB regarding malpractice? Within what time limit? Who punishes them if they do not report? What does a physician without insurance have to report and when? Is there a difference for NPDB/HCQIA? – ANSWER Within 30 days from a complaint being filed in a lawsuit, settlement; noninsured MDs have to self-report within 30 days; any payment must be reported to NPDB by HCQIA requirements Restrictive action by the TMB: Within what time limit must the board tell the hospital? Tell Medicare? Tell the secretary of health & professional societies & complainant? – ANSWER Next working day for hospitals; in writing for all within 30 days. Restrictive action by the TMB: How often must the board make public notices about disciplinary orders? – ANSWER 2 times per year. Restrictive action by the TMB: Must the board report crimes found during investigations? – ANSWER Yes, to the law enforcement. Restrictive action by the TMB: Within how many days must the board report to the NPDB? – ANSWER 30 days. Restrictive action by the TMB: Within how many days must a court report to the board about convictions, felonies, and misdemeanors and addiction issues be filed? – ANSWER 30 days. Are TMB reports confidential? – ANSWER Yes Who can the NPDB give info to? How about to patients? How about statistical data? – ANSWER Hospitals, self-requesting physicians, board, other state or federal agencies, attorneys; for statistical purposes if no identity disclosed When is it not illegal to perform a third-trimester abortion? – ANSWER To prevent mother's death, if unborn has severe irreversible brain damage