D050 UNIT 3

You are a licensed psychiatrist who was recently treating a mentally ill patient in your office. The patient has paranoid schizophrenia and falsely believes that his neighbor is plotting against him. The patient states that he plans to burn down his neighbor's house to kill him that evening. You have already contacted the police and had the patient involuntarily committed to psychiatric hospital care. Your state does not have a formal Duty to Warn law, but your supervisor recently told you that regardless of this, some clinicians are being found liable in court for not conducting Duty to Warn. Which of the following now also applies?

Duty to warn the patient's neighbor of the threats of violence and arson

The parents of a young child with autism are afraid that they will not be able to afford the education and behavioral intervention their child will need to succeed in life. They are told that the child is guaranteed free services in a public school. Which piece of legislation provides this guarantee?

Education for All Handicapped Children Act

What did the law created by the Consolidated Omnibus Budget Reconciliation Act (COBRA) ensure?

Employees are able to keep their health insurance for a period of time after losing their job.

Nancy Beth Cruzan sustained severe brain injury from a motor vehicle accident, and after a long legal battle, died of starvation 11 days after her feeding tube was removed. Cruzan did not have an advanced directive. How did this impact legislative change in several states regarding healthcare?

Most states require patients to be properly nourished and hydrated during any treatment.

Which is true regarding advance directives?

Most states restrict family members from serving as an agent or proxy for an advance directive.

Which case introduced the issue of prolonged suffering and starvation?

Nancy Beth Cruzan

In 1976...

New Jersey Supreme Court validated advanced directives at the state level

What was the result of Karen Ann Quinlan's drug and alcohol overdose?

Persistent vegetative state

State Medical Licensing Board

Prescribe medications

Who signed COBRA into law?

President Ronald Reagan

What are 2 HIPAA rules governing patient medical records?

Privacy Rule and Security Rule

What was the first major piece of healthcare-related legislation of the 20th Century

Pure Food & Drug Act of 1906

What was the major policy accomplishment of the Health Maintenance Organization Act of 1973?

Removed existing state laws prohibiting HMOs.

Each time an LGBTQ person is a victim of physical or verbal harassment or abuse, they become 2.5x more likely to hurt themselves.

False

Suicide takes the lives of over 28,000 Americans every year.

False

The passing of the National Treatment Act introduced civil rights for patients and significantly reduced experiments.

False. The passing of the National Mental Health Act introduced civil rights for patients and significantly reduced experiments.

In 1984, laws were established requiring the use of IRB's to review propose U.S. scientific studies on human subjects after a study has been conducted.

False:In 1974, the US government established laws that required the use of IRBs to review proposed scientific studies on human subjects before a study is conducted.

Mandatory fees are funding elements that are generated through small and large-scale donations.

False:Mandatory fees are fixed fees for medical services that are linked to market rates. Requested models are funding elements that are generated through small and large-scale donations.

Medicare FFS are government funded insurance programs that require patients to submit bills for reimbursements.

False:Medicare FFS is a government funded insurance program that is offered to the elderly and/or disabled. The treating providers bill insurance companies. With this model patients are not responsible for submitting bills for reimbursement. FFS health plans require patients to submit bills for reimbursements.

Immediate warning signs that someone may be in a suicidal crisis include all except

Feelings of hopelessness or desperation Insomnia Panic attacks Social isolation Irritability X Feelings of misguided love and affection Rage Feelings of being a burden

What federal agency was established by the Food & Drug Act of 1906?

Food & Drug Administration

What is an "adulterated" food or drug under the provisions of the Pure Food & Drug Act of 1906?

Food or drugs mixed with toxic substances),

What was the first major healthcare services program provided by the government to U.S. citizens?

Freedman's Bureau

Which act provides funding for youth suicide preventions programs?

Garrett Lee Smith Memorial Act

State Board of Nursing

Give injections or insert IVs

What is the biggest risk factor for committing suicide?

Having previously attempted to kill oneself

Centers for Medicare and Medicaid Services (CMS)

Headquartered in Washington, DC, this agency administers the Medicare and Medicaid federal insurance programs. CMS also sets clinical diagnostic standards, maintains standardized billing codes (also referred to as ICD codes), and sets national policy standards for the majority of healthcare reimbursement rules, health information technology regulations (such as the security of healthcare records data), and electronic medical records (EMRs).

A healthcare coordinator witnesses a nurse force an older adult patient to take a bite of food. The healthcare coordinator files a report on the nurse for abuse. Which act was created to offer provisions to protect the healthcare coordinator and other whistleblowers?

Health Information Technology for Economic and Clinical Health Act

Which of the following statements describes an IRB?

IRBs are made up of a variety of professionals with backgrounds in science, medicine, ethics, and law.

Dorothea Dix

In 1870, a jail nurse, noted that many incarcerated offenders were diagnosed with mental illness. These offenders were often mistreated and suffered from malnutrition, and that there was a lack of mental health care. Dix worked with government officials and jail staff to divert mental health offenders from jail systems to community-based treatment facilities. This led to numerous legal mandates about incarceration based behavioral treatment and significantly reduced inhumane jails/prisons.

mental health commitment

In 1920, these laws were established to oversee institutional admissions. Prior to these laws, patients were committed to mental institutions as children and were never released from state hospital systems. The eventual creation of community-based treatment systems was a result of these commitment laws. The major asset of the law is the statute that patients must be treated in the least restrictive treatment environment.

Clifford Bears

In the early 1900s, a mental health patient, and businessman documented his experience during an insane asylum placement following a nervous breakdown in his text "A Mind That Found Its Self." Bears spoke out about inhumane treatments such as sexual assault, starvation, and medication overdosing/underdosing, along with violence in state hospital systems. Bears' testament also led to laws which eventually resulted in mass deinstitutionalization (the removal of large populations of patients from state hospitals to community placement), and in the development of disciplinary systems to punish staff who were abusive to patients. Bears' work led to the creation of the National Mental Health Association.

National Mental Health Act

Institutionalized patients with mental illness were wards of the state and often subjected to inhumane experimental treatments (such as lobotomy brain surgeries) that reduced their ability to function and even sometimes resulted in death. The passing of the National Mental Health Act introduced civil rights for patients and significantly reduced these experiments.

What is a role of the Office of Inspector General (OIG) in the Department of Health and Human Services (HHS)?

Investigating Medicare fraud and abuse

Suicide is the _______ leading cause of death in the US for all ages

10th

When did Medicare and Medicaid first become established by law in the United States

1965

When did Medicare become available to disabled people and those with kidney disease?

1972

When was Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) enacted?

1985

When was HIPAA enacted?

1996

When did Medicare begin to offer a prescription drug plan? (Medicare Part d)

2003

At what age do non-disabled people become eligible for Medicare?

65

Karen Ann Quinlan

A 1976 case involving a 22-year-old female who became comatose following a drug and alcohol overdose. Karen required the use of a respirator due to a persistent vegetative state. Her family fought for years with medical staff to remove her breathing tube based on Karen's wishes (she had previously informed her parents of her advanced directives); however medical professionals were fearful of the legalities and kept her on life support. The battle lasted 10 years in which Karen never regained consciousness but remained in a persistent vegetative state and was sustained by feeding tubes.

Nancy Beth Cruzan

A 1983 case involving a 33-year-old female who sustained major brain injuries following a car accident. Nancy's family request removal of her feeding tubes after doctors ruled that consciousness was not possible. Following seven years of legal battles, Nancy's life support was disconnected. However, another controversy arose when it took 11 days for Nancy to pass—her feeding tubes were removed on December 15, and she died on December 27. This introduced the issue of prolonged suffering and starvation.

Theresa (Terri) Maria Schiavo

A media driven case in 1990 involving a 26-year-old married female who collapsed at home as a result of a proposed potassium imbalance. The incident left Terri without the ability to function (walk, talk, sit, or eat) and requiring a feeding tube. Terri's husband and parents became involved in a long and brutal battle regarding her case. Terri's parents wanted her to maintain the life support system, but after 10 years her husband pursued removal. Terri's feeding tubes were removed almost 15 years after her original injury.

TRICARE

Active-duty military service members in the United States typically receive healthcare treatment via their military branch, which is paid for by the military health insurance system, TRICARE. This agency sets its own rules and regulations for the provision and payment of healthcare to active-duty military personnel and employs its own internal physician/nurse/clinician force.

Office for Civil Rights (OCR)

Assess whether low-income minority children were unlawfully denied access to medical care

What law created the State Children's Health Insurance Program (S-CHIP)?

Balanced Budget Act of 1997

CMS (Centers for Medicare and Medicaid Services)

List clinical criteria for a specific disease diagnosis or treatment for reimbursement

You are a licensed clinical social worker in a state which does not have Duty to Warn laws. A patient tells you that she doesn't like her co-worker because the co-worker's loud voice gets on her nerves. On the other hand, the patient sometimes fantasizes about going out on dates with the co-worker, which the patient later regrets. Both the patient and the co-worker are adults. Which of the following applies?

Maintain patient confidentiality

FDA (Food and Drug Administration)

Manufacture and/or sell prescription drugs or medical devices

What is a healthcare coverage type required by the Affordable Care Act for all healthcare plans to include?

Maternity (pregnancy) coverage

You are an emergency-room physician operating in a U.S. state. Late one night a young couple brings in an infant for treatment of a broken arm. You notice that in addition to the broken arm, the infant is covered in bruises. When you confront the young couple about how these injuries occurred, they shrug their shoulders and say they "don't know." Which of the following applies?

Duty to report to law enforcement/child protection services about possible child abuse

What law established Medicare Part D (Medicare prescription drug coverage)?

Medicare Prescription Drug, Improvement and Modernization Act of 2003. Tier 1: Patient pays the first $250 per year in prescription drug costs ("deductible"). Tier 2: Prescription drug costs between $250 and $2,250 per year are split: 75% paid for by Medicare and 25% paid for by patients. Tier 3: After costs hit $2,250 for the year, patients are responsible for 100% of costs (also known as the "donut hole"). Tier 4: After costs hit $5,100 for the year, Medicare once again covers 95% of out-of-pocket drug costs.

Clifford Beers had three siblings who were institutionalized. He was later institutionalized for three years. Upon his release, he wrote a book entitled, A Mind That Found Itself. The book brought awareness of the need to change mental healthcare. How was mental healthcare impacted as a result?

The Mental Hygiene Movement was founded.

Gabriel was institutionalized in 1943 and was given lobotomies and other experimental treatments. Which act created the National Institute of Mental Health as a result of inhumane experimental treatments of institutionalized patients like Gabriel?

The National Mental Health Act

In 1991...

The Patient Self-Determination Act was enacted

Why did the court fail approve Michael Martin's tube removal?

The absence of a written advance directive

Olmstead v. LC

The case also found that moving a patient from the community to a more restricted setting must be medically justified, and also approved by a court on an individual basis.

Public Health Surveillance

The constant collection of data and monitoring. This involves monitoring communities to look for patterns of disease and occurrence.

What is a popular name for Tier 3 of Medicare Part D, where patients must cover 100% costs between $2,250 and $5,100 annually?

The donut hole

In 1968...

The first living will was introduced to the House

Early 1900s...

The local, state, and the Supreme Court begins to hear testimony on advanced directives violations

Controversy over Vaccines

The marketing point of vaccines is disease prevention; however public concern has significantly changed the acceptance and compliance rates of vaccinations. The side effects of many vaccines often lead to chronic or long-term neurodevelopmental impairment. When vaccinations are applied to the epidemiologic triangle, sometimes the vaccine is identified as the agent (since it carries disease), people are the hosts, and the environment spreads the disease. Immunizations have some great values, such as strengthening the immune system and building defenses against chronic diseases. However, the side effects should not be ignored.

A patient who has a terminal illness has requested physician-assisted suicide. Which situation would prevent the patient's wishes from being fulfilled?

The patient is unable to self-administer the life-ending medication.

Physician-assisted death/dying

The practice of a physician providing patients access to life-ending drugs and monitoring the dying process.

Physician-hastened death/dying

The practice of providing life-ending medicine and/or reducing patient dependence on machines to promote death. This practice has created controversy due to the idea of undue pain being placed on the patient.

Linkages

The process of filling in the gaps and checking to determine if the evaluation successfully addresses the public health surveillance issue and introducing additional clarity on the impact of any intervention. This task also ignites involvement in research to further the study and help create disease prevention/control strategies on a larger scale.

Rogers v. Okin

This case helped established the right to informed consent as well as the right to refuse treatment by mental health patients which have not been declared legally incompetent and do not pose a danger to themselves to others—even if they are physically confined to a mental hospital.

What was the name of the legislative amendment which established Medicaid?

Title XIX of the Social Security Act. provided public health coverage to poor families receiving Aid to Families with Dependent Children (AFDC).

What was the name of the legislative amendment which established Medicare Parts A & B?

Title XVIII of the Social Security Act. Established Medicare Part A and Part B, which covered hospitalization and doctors' visits for persons age 65 and older, with some limited coverage for post-hospitalization skilled nursing care.

Medically serious attempts at suicide are 4x more likely among LGBTQ youth than other young people.

True

The hybrid approach is a blend of the other fee-for-service models.

True:The hybrid approach is a blend of the other fee-for-service models.

Where did most of the physicians hired by the Freedmen's Bureau work before working there?

U.S. military

What agencies set standards for defining standards of strength, quality, and purity of drugs in the US?

United States Pharmacopoeia and the National Formulary

Veterans Administration (VA)

Veterans may access government-administered healthcare via the Veterans Administration (VA). The VA also sets its own rules and regulations for the provision and payment of healthcare to veterans and employs its own internal physician/nurse/clinician force.

The highest suicide rates in the US are among

Whites

Who frequently provided healthcare to families before doctors and hospitals became widespread?

Wives and mothers

Illegal kickback

a financial incentive a healthcare provider might receive for directing a patient to receive a specific service, often unnecessary, from a specific provider.

Autism Spectrum

a group of developmental disabilities (autism, pervasive disorder, and Asperger syndrome). Risk factors include having a sibling with a developmental disorder, children born to older parents, and drug and/or alcohol use during pregnancy. Genetic and chromosomal conditions are also risk factors. Epidemiology issues were raised following the results of the Study to Explore Early Development (SEED) which revealed environmental and behavioral factors, as well as genetics to be possible risk factors.

The Joint Commission (JC)

a private nonprofit governance organization overseeing hospitals, healthcare organizations, and other institutions that provide inpatient and outpatient healthcare. Through its accreditation and certification standards, the Joint Commission inspects hospitals and healthcare facilities to ensure that they provide safe and effective care that meets minimum nationally accepted performance standards (accreditation). Most hospitals cannot operate or receive Medicare/Medicaid or private insurance payments if they do not meet minimum Joint Commission accreditation standards.

Analytic Studies

Comparison studies that focus on the design, conduct, analysis, interpretation, and communication findings of a project.

Office of the Inspector General (OIG)

Determine whether a hospital or physician has committed Medicare fraud

Which historical figure helped jail staff to divert mental health offenders from jails to community-based treatment facilities?

Dorothea Dix

Joint Commission

Open or re-accredit a hospital

Under what circumstances could patients use COBRA benefits under its original provisions

After involuntary job loss or while on medical leave

Which of the following agencies develops and administers federal metrics and scoring systems (Quality Performance Measures), such as those used in the CMS Value-Based Purchasing Program?

Agency for Healthcare Research & Quality (AHRQ)

A mentally competent adult with a terminal illness has a confirmed prognosis of six or fewer months to live. The Death with Dignity Act would allow the individual to voluntarily request a prescription medication to hasten death since the outcome is inevitable. In which state does the patient have this medical option?

California

A licensed psychiatrist is treating a patient with schizophrenia. The patient believes her coworker is plotting against her and states that she plans on meeting her for lunch and killing her. The provider has called the police and had the patient committed to a psychiatric hospital. The healthcare coordinator recognizes that the psychiatrist must perform which additional action to adhere to the duty to warn law?

Call the coworker and alert the individual of threats of violence.

_______% of trans adults said they had attempted suicide, in one study.

None of the above; 41%

Which is an example of a behavioral health condition?

Obesity

What became illegal after the Food & Drug Act of 1906?

Selling mislabeled and spoiled food & medications

Under what earlier law did the amendments establishing Medicare and Medicaid fall?

Social Security Act of 1935

What novel helped bring about the Pure Food & Drug Act of 1906?

THE JUNGLE, by Upton Sinclair

What is the health insurance plan offered to active-duty military personnel and their families?

TRICARE

Field Investigations

Taking the results of public health surveillance and identifying unreported/unrecognized issues that might continue the spread of diseases. This helps to identify risk factors.

Evaluation

The use of studies to help determine the problem, proposed resolutions, and effective prevention strategies.

Suicide Prevention and Awareness

There are several environmental and social risk factors associated with suicide including substance abuse, psychological disorders, and psychosocial issues (homelessness, unemployment, etc.). These risks significantly increase when support systems are inaccurate or absent. According to the Centers for Disease Control (CDC) the general statistics for suicide and suicide prevention are astounding: There are more than 105 daily suicide victims A person dies every 12.3 seconds Suicide is the 10th leading cause of death

State Medical Licensing Boards

These agencies determine who is qualified to practice medicine (physician) in their given states, usually by regulating medical schools, managing licensing exams, and setting practice standards.

State Department(s) of Insurance

These agencies license and accredit private insurance companies permitted to do business in a given state. These agencies may regulate all types of insurance (health, auto, property, etc.) or only a specific insurance type.

State Department(s) of Medicaid Administration & State and Local Departments of Public Health.

These state and local agencies work in partnership with the CDC to inspect healthcare and food-delivery facilities, to prevent the spread of disease, and to monitor/report local disease activity.

Michael Martin

This 1987 case involved a 35-year-old male who suffer major brain injury following a car-train accident. Following the accident Michael was unable to walk or talk, was severely mentally impaired, and was dependent on feeding tubes. Michael's condition was severe, but he was not in a vegetated state due to him regaining some movements and having the ability to recognize faces. Five years following the accident, Michael condition did not improve and his wife requested the removal of the feeding tubes. However, Michael's sister and mother filed a lawsuit to maintain treatment. Michael's wife and colleagues reported that he verbally acknowledged no interest in being on life support. The court was unable to approve tube removal due to the absence of a written advance directive.

Agency for Healthcare Research and Quality (AHRQ; often pronounced "arc")

This agency governs the regulation of the safety, quality, and efficacy of healthcare provided in the United States. AHRQ also establishes and administers federal metrics and scoring systems (performance measures), such as the CMS Value-Based Purchasing Program, which applies the best available clinical evidence to medical practice to help prevent unnecessary costs associated with preventable illness and re-hospitalizations.

Centers for Disease Control and Prevention (CDC)

This agency is a component of the U.S. Public Health Service and is headquartered in Atlanta, Georgia. This agency issues policy standards surrounding the control, detection, and prevention of communicable diseases, while also responding to public health emergencies. The CDC monitors disease activity on a national basis (epidemiology), tracks and reports national disease statistics, and provides overall public health leadership, research, and disease control standards which are implemented across the country.

Food and Drug Administration (FDA)

This agency regulates the safety, quality, and efficacy of food and drugs made available for human consumption. The FDA also governs the manufacture of drugs and medical devices, including ensuring manufacturing facilities, pharmacies, and drug distributors maintain a predetermined level of safety and prevent contaminated, spoiled, or dangerous drugs, devices, or foods from entering the U.S. marketplace. Finally, the FDA regulates advertising and product labeling for foods, drugs, and medical devices to ensure that members of the public receive accurate safety and clinical effectiveness information about the drugs and foods that they may wish to purchase or use.

Office of Inspector General (OIG)

This agency serves as the internal "watchdog" for all programs and services operating under the HHS. It investigates allegations of wrongdoing, mismanagement, and/or criminal activity within HHS programs, and works with federal and state law-enforcement agencies to prosecute individuals or organizations which have violated federal health regulations and/or misappropriated taxpayer funds (e.g. Medicare/Medicaid fraud).

Health Information Technology for Economic and Clinical Health Act (HITECH)

enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA). -Tightened regulations around HIPAA healthcare privacy enforcement, IT security regulations in healthcare, and related penalties for violations. -Mandated the use of electronic medical records by all U.S. healthcare providers by 2015; those providers out of compliance after 2015 would face penalties. -Increased penalties and fines for healthcare providers who repeatedly violated HIPAA privacy protections. -Offered provisions to protect whistleblowers that report healthcare fraud (e.g. overcharging for care, charging for services not provided, illegal kickbacks) to law enforcement, while also offering financial incentives to those who report wrongdoing.

Office for Civil Rights (OCR)

ensures that all individuals receiving services from HHS-administered systems or programs are not subject to unlawful discrimination. The OCR also enforces laws, rules, and regulations that protect individuals receiving HHS services or who are enrolled in HHS programs, so that they may freely exercise their conscience rights (including the right to refuse care) and personal/religious freedoms. Lastly, the OCR enforces rules and regulations surrounding the privacy and safety of individuals' health information as well as investigate instances where patients' privacy rights may have been violated.

Henrietta Lacks

in 1951, an impoverished African American's bodily cells were collected during a routine cancer biopsy and then used in scientific research experiments for decades without the patient's informed consent or shared monetary benefit

The Fernald State School Experiment

in which disabled children were injected with radioactive minerals to study the effects of radiation sickness

The Tuskegee Syphilis Experiment

in which illiterate, poor African American patients during the segregation era (1932-1972) were injected with syphilis without their knowledge, and then left untreated despite the existence of effective medicines. This study was conducted so physicians could observe how syphilis (a dangerous sexually transmitted disease) progressed without treatment

State Boards of Nursing

these agencies determine who is qualified to practice nursing (e.g. registered nurses, licensed practical nurses, nursing assistants) in their given states, usually by regulating nursing schools, managing licensing exams, and setting practice standards.

Welsch v. Likins

was brought in 1972 on behalf of numerous mentally disabled persons confined to Minnesota state hospitals. This case led to stricter legal requirements for establishing medical justification in a court of law for forcibly confining patients, while also requiring that inpatient care for the mentally incompetent and disabled be humane