Please answer the following questions on the word document, All answers found on the power points.

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Please answer the following questions on the word document, All answers found on the power points.

Jessica Zuniga
HSHA 434
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Chapter 8 & 9 Assignment
Describe the organization, responsibilities, duties, and legal risks of a governing body.
List some of the major provisions of SOX
Describe the meaning of the legal doctrine respondeat superior.
Describe the term corporate negligence.
Why is the Darling case described as a benchmark case?
Does the legal doctrine respondeat superior apply to an independent contractor?
Explain your answer.
1. Discuss importance of delineating clinical privileges.
2. Why is it important that the governing body approve the appointment and
reappointment of physicians to the medical staff?
3. What, if any, sanctions should be imposed upon an on-call physician who fails to
respond to such call when requested? Discuss your answer.
4. Describe what options a hospital has in disciplining a disruptive physician. What effect
can a physician’s behavior have on patient care?
5. When two physicians have opposing views as to care, what course of action should the
patient’s attending physician follow?
6. 6. Describe malpractice risks for radiologists and attending physicians.
7. 7. Is a poor outcome always an indication of a negligent act? Explain.
8. 8. When is a physician considered to have abandoned his or her patient?
Chapter 8
Corporate Structure
and Legal Issues
LEARNING OBJECTIVES
• Explain express, implied, and corporate
authority.
• Discuss corporate organization and committee
structure.
• Describe the Sarbanes–Oxley Act.
• Explain the terms respondeat superior and
corporate negligence.
Authority of Corporations
• Express
– Authority designated by statute . . . .
• Implied
– Authority not expressed by written words
• Ultra Vires Acts
– Acting beyond scope of authority
CORPORATE COMMITTEES
Executive Committee
• Liaison between management & full board.
• Review & make recommendations on
management proposals.
• Performing special assignments as may be
delegated by full board.
• Business transacted should be reported at regular
sessions of the governing body & ratified.
• Committee generally has all the powers of the
governing body.
Bylaws Committee
• Reviews & recommend bylaw changes to the
governing body.
• Bylaws generally are amended or rescinded by
a majority vote of the governing body.
Finance Committee
• Overseeing financial affairs of the organization
• Direct & review preparation of financial
statements, operating budgets, major capital
requests . . . .
Nominating Committee
• Develop & recommend criteria for governing
body membership.
• Recommend appt’s for new board members.
Planning Committee – I
• Periodic review of org’s mission & vision
statements.
• Conduct of community health needs
assessments.
• Develop strategic plans & ongoing monitoring.
• Develop of short-term & long-range goals.
• Maintenance of the organization’s physical
facilities.
Planning Committee – II




Preparation of capital budgets.
Oversight of expansion programs.
Acquisition of major equipment.
Addition of new services based on identified
community need.
• Downsizing & closing services.
• Planning progress reports to the full board.
• Program development.
Patient Care Committee





Corporate development.
Identify patient & family needs & expectations.
Determine methodology for reviewing data.
Identify patterns of concern.
Forward information to those responsible for
implementing change in the org.
• Review, evaluate, & implement plans for
improving organizational performance.
Audit & Regulatory
Compliance Committee – I
• Develop corporate auditing policies &
procedures.
• Recommend independent auditors (IA).
• Review credentials of IAs & facilitating change
in auditors as appropriate.
• Review with IAs scope & extent of their audit
duties & responsibilities.
• Review scope & results of annual audit
• Set, oversee, review, & act on
recommendations of internal audit staff.
Audit Committee Responsibilities – II
• Review internal accounting practices of
corporation.
• Reviewing & evaluate financial statements.
• Promote prevent, detect, deter, & report fraud.
• Review means for safeguarding assets.
• Ensure financial reporting functions comply with
accepted accounting principles.
• Review reliability & integrity of financial &
operating information.
Organizational Ethics
• Describes ethics of an organization & how it
responds to internal or external circumstances
affecting the organization’s mission and values
Sarbanes-Oxley Act
• Sarbanes-Oxley Act (SOX) was signed into law
by President Bush on July 30, 2002 in response
to the Enron debacle & high profile cases of
corporate mismanagement.
• Act contains 11 titles, or sections, ranging from
additional Corporate Board responsibilities to
criminal penalties, & requires Securities &
Exchange Commission to implement rulings on
requirements to comply with SOX.
Major provisions of SOX – I




Certification of Financial Reports
Ban on Personal Loans
Accelerated Reporting of Trades by Insiders
Prohibition: Insider Trades during Pension
Fund Blackout Periods
• Public Reporting of Compensation & Profits
• Inside Audit
Major Provisions of SOX – II




Criminal & Civil Penalties
Internal Audit Certified by External Auditors
Increased Criminal Penalties
Code of Ethics & Standards of Conduct
Sarbanes-Oxley Act of 2002
Promoting Due Diligence
• SOX is about self-regulation:
– Selecting leader with morals & core values
– Examining incentives
– Monitoring organization’s culture
– Building a strong knowledgeable governing
body
– Searching for conflicts of interest
– Focusing attention on the right things
– Having courage to speak out
Corporate Compliance Program
• Internal mechanisms for preventing,
detecting, and reporting criminal conduct.
Corporate Negligence
• Doctrine under which hospital is liable if it fails
to uphold required standard of care
• Corporation treated no differently than
individual
• Liability to injured party

Benchmark Case Facts – I
Darling v. Charleston Comm. Mem. Hosp.







18 Yr. Old Football Player injured
Fracture of tibia & fibula
Leg casted by General Practitioner in ED
Patient complains of pain
No specialist called for consultation
Two weeks later – student transferred
Eventually leg amputated
Benchmark Case Trial – II
• No expert testimony presented
• Documentary Evidence included
– Medical records
– Hospital’s bylaws, rules & regulations
– Illinois Hospital Licensing Act
– JCAHO standards
Benchmark Case – III
• Hospital, as a corporate entity, liable for:
– Negligent act of nurses
– Negligent acts of physicians
Benchmark Case Lessons:
Provide Competent Staff






Verify licensure, as appropriate
Verify training & experience
Provide procedures for credential & privileging
Monitor quality of care
Require consultations
Alert supervisor of care concerns
Respondeat Superior – I
• “let the master respond”
• Legal doctrine holding employers liable for the
wrongful acts of their employees.
• Also referred to as vicarious liability, whereby
an employer is answerable for the torts
committed by employees.
Respondeat Superior – II
• To impute liability to the employer:
– Master-servant relationship between employer &
employee must exist.
– Wrongful act of employee must occur within
scope of employment.
Independent Contractors
• Responsible for their own negligent acts.
• Principal must not have right to control
agent’s work.
Corporate Duties – I
• Appoint CEO
• Comply with the laws & regulations
• Comply with Joint Commission standards
– When accredited by the JC
• Provide timely treatment
• Avoid self-dealing & conflict of interest situations
• Provide adequate staff
• Provide adequate insurance
Corporate Duties – II




Be financially scrupulous
Require competitive bidding
Provide appropriate supplies & equipment
Provide a safe environment
– Fire Safety
– Prevent Falls
• Safeguard patient valuables
• Appoint a CEO
– Code of Ethics
Medical Staff: Responsible for…








medical staff bylaws
application requirements for privileges
process for granting emergency staff privileges
requirements for medical staff consultations
peer-review process
process auditing medical records
process for addressing disruptive physicians
process for disciplinary action
Corporate Reorganization
• Due to lewer revenues from traditional
sources (3rd party payors) have restructured to
set-up related business enterprises in order to
increase revenues to support patient care
operations.
• Legal pressures present substantial
impediments.
Regulatory Pressures





Taxation
Third-party reimbursement
Certificate of need
Financing
Certificate of Need
Review Questions – I
1. Describe the organization, responsibilities, duties,
and legal risks of a governing body.
2. List some of the major provisions of SOX
3. Describe the meaning of the legal doctrine
respondeat superior.
4. Describe the term corporate negligence.
5. Why is the Darling case described as a benchmark
case?
6. Does the legal doctrine respondeat superior apply
to an independent contractor? Explain your answer.
Chapter 9
Medical Staff Organization
and Physician Liability
LEARNING OBJECTIVES
• Describe medical staff organization and
committee structure.
• Describe the credentialing and privileging
process.
• Discuss the purpose of physician supervision and
monitoring.
• List and discuss common medical errors.
• Explain how the physician–patient relationship
can be improved.
Medical Staff Committees
Executive Committee




Recommends medical staff structure.
Develops a process for reviewing credentials.
Recommends appointments to the medical staff.
Develops processes for delineating clinical
privileges.
• Performance improvement activities.
• Conducts peer review.
• Review & act on reports of medical staff
departmental chairpersons & medical staff
committees.
Bylaws Committee
• Organization of the medical staff is described in
its bylaws, rules, & regulations.
• Bylaws must be approved by the governing body.
• Bylaws must be kept current & the governing
body must approve recommended changes.
• Bylaws describe various membership categories
of the medical staff (e.g., active, courtesy,
consultative).
Blood & Transfusion Committee
• Develops blood usage p & p
• Monitors transfusion services
• Monitors
– indications for transfusions
– blood ordering practices
– each transfusion episode
– transfusion reactions
Credentials Committee
• Oversees application process for medical staff
applicants, requests for clinical privileges, &
reappointments to the medical staff.
• Makes its recommendations to the medical
executive committee.
Infection Control Committee
• The infection control committee is generally
responsible for the development of policies &
procedures for investigating, controlling, &
preventing infections.
Medical Records Committee
Develops Policies & Procedures




Release, security, & storage
Determining the format of medical records
Monitoring records for accuracy
Completeness, legibility, & timely completion
& clinical pertinence
• Ensures records reflect condition & progress
of the patient, including results of all tests &
therapy given & makes recommendations for
disciplinary action as necessary.
Pharmacy & Therapeutics Committee
• Policies & procedures (e.g., selection,
procurement, distribution, handling, use, &
safe administration of drugs, biologicals, &
diagnostic testing material).
• Oversees development & maintenance of
formulary.
• Evaluates & approves protocols for the use of
investigational or experimental drugs.
Pharmacy & Therapeutics Committee
Oversees
• tracking of medication errors
• adverse drug reactions
• management, control, effective & safe use of
medications through monitoring & evaluation
• monitoring of problem-prone, high-risk, &
high-volume medications
Tissue Committee
• Surgical case reviews including
– justification & indications for surgical
procedures
Utilization Review Committee – I
• Monitors & evaluates utilization issues such as
medical necessity and appropriateness of
admission & continued stay, as well as delay in
the provision of diagnostic, therapeutic, &
supportive services.
• Ensures each patient is treated at appropriate
level of care.
Utilization Review Committee – II
• Objectives of the committee include:
– transfer of patients requiring alternate levels of
care
– promotion of efficient & effective use of resources
– adherence to quality utilization standards of thirdparty payers
– maintenance of high-quality, cost-effective care
– identification of opportunities for improvement
MEDICAL DIRECTOR
• Serves as a liaison between medical staff &
organization’s governing body & management.
Medical Staff Privileges –
Screening Process









Application
Medial Staff Bylaws
Physical & Mental Status
Consent for Release of Information
Certificate of Insurance
State Licensure
National Practitioner Data Bank
References
Interview Process
Medical Staff Privileges – II




Delineation of Clinical Privileges
Governing Body & Final Action
Appeal Process
Reappointments
Medical Staff Privileges – III




Screening for Competency
Physician Supervision and Monitoring
Practicing Outside Field Of Competence
Misrepresentation of Credentials
Disruptive Physicians
• Negative impact on an organization’s staff and
ultimately affect the quality of patient care.
• Physician’s inability to work with other
members org staff can be sufficient grounds to
deny staff privileges
Disruptive Physicians
Rage in the O.R.
• Experts say that doctor’s bad behavior is not
merely unpleasant; it also has a corrosive
effect on morale And poses a significant threat
to patient safety.
—Sandra G. Boodman, The Washington Post, March 5, 2013
Emergency Calls – Failure to
Respond
• Physicians on call expected to respond to
requests for emergency assistance.
• Failure to respond is grounds for negligence
should a patient suffer injury.
Emergency Calls – II
• Gynecologist’s Refusal to Treat
– Patient’s Death
• Dillon v. Silver
Misdiagnosing Accident Victim – I
• A police department physician examined an
unconscious man who had been struck by an
automobile.
• The physician concluded that the patient’s
insensibility was a result of alcohol
intoxication, not the accident, & ordered the
police to remove him to jail instead of the
hospital.
Misdiagnosing Accident Victim – I
• The man, to the physician’s knowledge,
remained semiconscious for several days &
finally was taken to the hospital at the
insistence of his family.
• The patient subsequently died.
• An he autopsy revealed massive skull
fractures.
• Did the physician commit malpractice?
YES!
• Although a physician does not ensure the
correctness of the diagnosis or treatment, a
patient is entitled to such thorough & careful
examination as his or her condition and
attending circumstances permit, with such
diligence and methods of diagnosis as usually
are approved and practiced by medical people
of ordinary or average learning, judgment, and
skill in the community or similar localities.
HISTORY & PHYSICAL
• Inadequate H & P Exam
– Failure to obtain an adequate family history
& perform an adequate H & P violates a
standard of care owed to the patient.
• Cursory Exam Fails to Reveal Head Injury
DELAY IN TREATMENT
• Lung Cancer
– Plaintiff/Patient awarded damages
– Blackmon v. Langley
– failure of the examining physician to inform
patient in a timely manner that a chest Xray showed a lesion in his lung.
MEDICAL RECORD – I
Tool for Communications
• Patients Records
– tool for gathering patient information
– means of communication between
caregivers
• Critical information lost in the record
MEDICAL RECORD – II
• Failure to Use Information
• Failure to read the record can lead to an
action in malpractice
– Patient Allergy Communication Breakdown
– Physician Fails to Read Nursing Notes
MEDICAL RECORD – III
Lack of Documentation
• Value of maintaining records of treatment.
– Important for patient’s on-going care
– Important for family member care
– It may be many years after a patient has
been treated before litigation is initiated.
• Jury could consider failure to document as
sufficient evidence for finding a physician
guilty of negligence.
DIAGNOSTIC TESTS – I
• Failure to Order
– Standard practice to order specific
diagnostic tests based on H & P
– Physician failed to use the test
• failed to diagnose patient’s illness.
– Patient suffered injury
DIAGNOSTIC TESTS – II





Failure to Order Appropriate X-Rays
CT Misinterpretation Leads to Death
Failure to Review Lab Tests
Surgeon Fails to Read X-ray Report
Failure to Consult with a Radiologist
DIAGNOSTIC TESTS – III




Delay in Reporting Critical Tests
Failure to Communicate X-Ray Results
Failure to Timely Diagnose
Patient’s Failure to Follow-up
CONSULTATIONS – I
2nd Opinions
• Physicians should practice discretion when
treating patients outside their area of
expertise
• Standard of care required
– specialty in which a physician is practicing
– whether or not the physician has been
credentialed in that specialty
CONSULTATIONS – II
2nd Opinions




Failure to Refer
Untimely Referral
Failure to Advise Patient’s Need for a Specialist
Discounting Consulting Physicians’ Advice
DIAGNOSIS – I
• Failure to Diagnose
– Physician can be liable for reducing
patient’s chances for survival
• Timely diagnosis
– important as the need to accurately
diagnose a patient’s injury or disease
– failure to do so can result in malpractice
DIAGNOSIS – II
• Most frequently cited injury.
• Misdiagnosis will not in and of itself impose
liability.
– unless there is a departure from the
standard of care & injury results.
DIAGNOSIS – III
• Pathologist Misdiagnoses Cancer
• Radiologist: Loss of Chance to Survive
• Physician Fails to Follow-Up: Lost Chance to
Survive
• Possibility of Survival Destroyed
• Failure to Form a Differential Diagnosis
DIAGNOSIS – IV
• Choice of Treatment: Differing Opinions
– Two Schools of Thought Doctrine
• Physician not liable for medical malpractice
if he or she follows a course of treatment
supported by reputable, respected, &
reasonable medical experts.
• Use of unprecedented procedures that
create an untoward result may cause a
physician to be found negligent.
MEDICATION ERRORS
• Wrong Dosage
• Abuse in Prescribing Medications
• Excessive Drug Dosage Leads to Death
INFORMED CONSENT
• Physicians must inform patients of known
benefits, risks, & alternatives to procedures.
• Case: Failure to Advise Patient of Treatment
Alternatives
INVASIVE PROCEDURES – I
Surgery Mix-Ups Surprisingly Common
• Unthinkable errors by doctors and surgeons—such as
amputating the wrong leg or removing organs from
the wrong patient—occur more frequently than
previously believed, a new study suggests.
• Over a period of 6.5 years, doctors in Colorado alone
operated on the wrong patient at least 25 times and
on the wrong part of the body in another 107
patients, according to the study, which appears in
the Archives of Surgery.
—Amanda Gardner, Health.com, 2011
INVASIVE PROCEDURES – II







Wrong Surgical Procedure
Catheter Fractured
Wrong Patient
Wrong Site: Colon
Wrong Site: Herniated Disk
Wrong Site Cover-up: Kidney
Foreign Objects Left In Patients
– Needle fragment
• Improper Performance of a Procedure
ANESTHESIA – I
• Longview Regional, Surgeon Part of $1.9 million
Civil Lawsuit Verdict
• Evidence before the jury showed a breathing tube
was not inserted when Ross was put under
anesthesia.
• When Ross began to retch during the procedure, his
anesthetized body could not prevent the stomach
contents from spilling into his lungs.
—Glenn Evans, newa-journal.com, November 9, 2012
ANESTHESIA – II
• Untimely Insertion of Breathing Tube
• Failure to Maintain Adequate Airway
• Improper Positioning of Arm
AGGRAVATION
OF PRE-EXISTING CONDITION
• May cause a physician to be liable for
malpractice.
– if original injury is aggravated, liability will be
imposed for the aggravation
– rather than for both the original injury & its
aggravation
PREMATURE DISCHARGE
• Premature discharge of a patient is risky business.
• Intent of discharging patients more expeditiously is
often due a need to reduce costs.
• Dr. Nelson, an obstetrician & board member of the
American Medical Association
• Discharge “should be based on medical factors &
ought not be relegated to bean counters.“
– Anita Manning, AMA Calls Drive-Thru Birth Risky,
USA TODAY, June 21, 1995, at 1.
FAILURE TO FOLLOW-UP
• Failure to provide follow-up care can result in
a lawsuit if such failure results in injury to a
patient.
INFECTIONS





Leading cause of injury
2 Million patients annually get infections.
Infections a Recognized Risk
Preventing Spread of Infection
Poor Infection-Control Technique
DENTISTRY
• Practicing Outside the Scope of Practice 2
• Drill Bit Left in Tooth Preventing Spread of
Infection
• Anesthesia Abuse and CEO Dilemma
OBSTETRICS
• C-Section Delay Causes Injury
• Failure to Perform C-Section
• Failure to Attend Delivery
– Fetus Decapitated
• Failure to Perform Timely C-Section
• Wrongful Death of Unborn Fetus
PSYCHIATRY
• Commitment
– Commitment Upheld
• Duty to Warn
– Exceptions to Duty to Warn
• Suicidal Patients
• Failure to Provide Appropriate Evaluation
ABANDONMENT
• Elements Necessary to Recover Damages
– Medical care unreasonably discontinued
– Discontinuance against patient’s will
– Failure to assure follow-up care for patient
– Foresight – failure could result in patient
injury
– Actual harm was suffered by patient
Physician-Patient Relationship – I







Personalize treatment
Conduct thorough assessment
Develop comprehensive treatment plan
Take time to get to know your patient
Request consultations when needed
Closely Monitor your patient’s progress
Maintain complete, legible, & accurate records
Physician-Patient Relationship – II





Do not guarantee treatment outcomes
Provide coverage when off-duty
Do not overextend your practice
Limit telephone orders
Do not become careless because you know
the patient
• Seek advice of counsel should you suspect a
legal action
REVIEW QUESTIONS – I
1. Discuss importance of delineating clinical privileges.
2. Why is it important that the governing body
approve the appointment and reappointment of
physicians to the medical staff?
3. What, if any, sanctions should be imposed upon an
on-call physician who fails to respond to such call
when requested? Discuss your answer.
4. Describe what options a hospital has in disciplining
a disruptive physician. What effect can a physician’s
behavior have on patient care?
REVIEW QUESTIONS – II
5. When two physicians have opposing views as to care,
what course of action should the patient’s attending
physician follow?
6. Describe malpractice risks for radiologists and
attending physicians.
7. Is a poor outcome always an indication of a negligent
act? Explain.
8. When is a physician considered to have abandoned
his or her patient?

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