ethics chapter 8 a

Massachusetts

in __________________, 245 CMR 2.00 governs the licensure and practice of nursing home administrators and establishes the standards of conduct for the practice of nursing home administrators, which include a written examination

Jesse Bravo v. White Memorial hospital, et al.

42 CFR section 482.61 (c)(1) mandates that physicians develop or lead hte development of hte patient's treatmetn plan; Dr. Hernandez signed one of Mr. Bravo's treatment plans on March 4, 2011, well ater Mr. Bravo's discharge on Februrary 11, and never signed the other; if Dr. Hernandez contributed to Mr. Bravo's treatment plans, he would have signed them at the time; accordingly, his failure to participate

maintain moral integrity

Hoffman states that: because blatantly unethical conduct should never be condoned or promoted, it is the more frequent suble compromises with dubious dimensions that permit otherwise ethical practitioners to rationalize their acquiesence; in the shadow of these compromises, we find a personal need for job security and loyalty trumping ethical behavior

Business Ethics in Healthcare Beyond Compliance

Leonard J. Weber wrote in ________________- that: helathcare ethics is not just about decisions made in executive offices and in boardrooms; ____________________ offers prosepctives that can assist healthcare managers achieve the higehst ethical standards as they face thier roles as healthcare providers, employers, and community service organizations 215

maintain moral integrity

Weber suggests guideliens nad criteria based on the understannding that hte healthcare organization is committed to patient's rights, to careful stewardship of reosurces, to just working conditions for employees, and to service to the community Paul B. Hoffman writes that if a person succumbs to organizational pressures and ultimately suppresses long-held beliefs, values and principles, he or she turns into what Webster and Baylis have described as a moral chamelon, thereby becoming sensitized to wrongdoing, willing to tolerate morally questionable or morally impermissble actions

Alaska Statutes

_______________ for example, require licensing of a nursing home administrators: SEC 08.70.080; license required; only a licensed nursing home administrator may manage, supervise, or be generally in charge of a nursing home; the care provided by a nursing home or a licensed hospital providing nuring home care through the use of skilled nursing beds or intermediate care beds shall be supervised by a licensed nursing home administrator or by a person exepmted from licensure requirements under this section 213

healthcare corperations

_______________ governmental, charitable, or proprietary have certain powers expressly or implicitly granted to them by state statutes; generally, the authority of a _______________ is expressed in the law under which the ___________ is chartered and in the _______________'s articles of incorporation; the existence of this authority creates certain duties and liabilities for governing bodies and their individual members

independent contractors

________________ are responsible for thier own negligent acts; the ______________ relationship is established when the principal has no right of control over the manner in which the agent's work is to be performed; however, some cases indicate that a norganization can be held liable for an independent contractor's negligence

false advertising

________________ by healthcare entitites continues to confuse and mislead the public in the search for high-quality care; hospitals, for example, at a time when the Joint Commission provided hospitals with numerical scores advertized their perfect or nearly perfect accrediation scores; scores as high as 100 were often posted on billboards and/or in local newspapers; the intent of such advertisements was to associate high scores with a higher quality of care compared to care in hospitals receiving lwoer scores; following numerosu complaints by healthcare organizations and surveyors, numerical scoring was discontinued, arbuably due in part to the musue of scores for advertising purposes; some hospitals seemed to be mroe concenred with scores than complying with the standards required for accreditation purposes; from both an ethical and legal poitn of view, healthcare organizations should not ___________________ to encoruage public confidence in the quality of care provided by one organization over than of another

ultra vires

________________ is a latin term meaning beyong hte powers; _________________ acts are those acts conducted by a corporation that lies beyond its scope of authority to perform; a governing body can be held liable for acting beyond its scope of authority, which is either expressed (e.g. in its articles of incorporation) or implied in law; the governing body acts on behalf of the corporation; if any action is in violation of a statute or regulation, it is illegal; an example of an illegal act would be the known employment of an unlicnesed person in a position that by law requires a license; the state, through its attorney general, has hte power to prenet the performacne of an ____________________ by mans of an injunction 206

credentialing

________________ is a process for validating the background of healthcare professionals and assessing their qualifications to rovide healthcare services; the process is an objective evaluation of a professional's current licensure, training, or experience; competenc;e and ability to perofrm the services or procedures requested; _________________ occurs during both the inital appointment and reappointment process;

corporate boards

________________ must act in best interests of the healethcare entities they represent and the communitites they serve; their fiduciary responsibilities include: corporate finances; providing quality care and a safe work environment for staff, patients, and visitors; and periodically assessing the organization's progress, programs, and services; trustees must be fully informed by the CEO prior to making business decisions; they must abide by applicable laws, rules, and regulations and standards that regulate hospital operations; trustees must be objective in the decision-making process and free from the pressures and hte all too often challenging demands and influences from within (e.g. professional staff requests designed to improve pesronal economic gain) and outside the organization; _______________ members must be free of conflicts of interests when discussing and making policy and financial deciions; conflicts of interest statements for trustees and staff should disclose on an annual basis kown financial interest with any business entity that transacts business with the corporation or its subsidiary businesses, when applicable; boarad members can be held liable for their actions or inactions when carrying ot their fiduciary duties and responsibilities 205

hospital scores

________________ were eventually discontinued in the accreditation process becuase of criticism on numerous occasions from both its own surveyors and accredited hospitals; because of the competition among hospitals, the surveyors were pressured to provide high scores by the organization's surveyed 228

trust and integrity

_________________ cannot always be presumed; organizations must encourage patients to as questions and seek second opinions both for peace of mind and to aid in determining the best course of treatment; as noted, some healthcare providers consider their financial intersts more important than the welfare of their patients

concealing mistakes

_________________ in medicine are common occurrences that oftne result in extended hospital stas, higher costs, injury, disability, or death; the Joint Commission in its accreditation process requires that patientes be informed when a mistake has been made; 22. the leincsed indepdent practitioner responsible for managing the patient's care, treatment, and services, or his or her designee, informs the patient about unanticipated outcomes of care, treatment, and services related to sentinel events when the patient is not already aware of the occurrence or when further discussio nis needed unfortunately for patients, organizations sometimes _______________________ 209

code of ethics for organizations

_________________ include: 1. employees and staff members will comply with the ______________ which includes compassionate care; an understanding and acceptance of hte organization's mission, vision, and values; and adherence to one's professional code of conduct 2. ethics training will be provided as required training for all employees 3. ethics competencies will be reviewed at the time of each employee's inital ethics training and scheduled evaluation 4. the organization will be honest and fair in dealings with employees 5. the organization will develop and maintain an environment that fosters the highest ethicla nad legal standards 6. corporate officers, managers, and employees will be impartial when personal interests conflict with hose of the organization and fellow employees 7. employees will be free to speak up without fear of retribution or retaliation 8. a compliance officer will be available to protect employees who wish to speak up as to unprofessional practices he or she observes in the organization; the compliance officer will be held accountable for maintaining the confidentiality of the employee's identity; failure to do so will result in the immediate termination of the compliance officer 9. the pitfalls of groupthink will not be acceptable conduct in the organization; the preservation of harmony will not become more important than the critical evaluation of ideas by all employees 10. employees and patients will be provided with a safe environment (e.g. freedom from sexual harassment) within which to work 11. the drive to increase revenues will not be tied to unethical activities, such as workforce cutbacks as a means to discharge employees when they are encouraged to speak up and then blacklisted because of their honesty 12. employees will avoid conflict-of-interest situations by not favoring one's own inetersts over thse of others, including the organization 13. patients will be provided with care that is of the highest quality regardless of the setting 14. all patientes will be treated with honesty, dignity, respect, and courtsey 15. patients will be informed as to the risks, benefits, and alternatives to care 16. patients wil lbe treated in a manner that preserves their rights, dignity, autonomy, self esteem, privacy, and involvement in thier care 17. each paitent's culture, religion, and heritage will be respected and addressed as appropriate 18. the organization will provide for a patient advocay program 19. the organization will provide appropriate support services for those with physical diabilities (e.g. those with language barriers and those who are hearing or seeing-impaired_ 20. patients will be provided with a patient's bill of rights and responsibilities on admission to the hospital 21. each patient's right to execute advance directives will be honored 207

corporate negligence

_________________ is a doctrine under which the hospital is liable if it fails to uphold the proper standard of care owed the patient, which is to ensure the patient's safety and well-being while at the hospital; this theory of liability creates a nondelegable duty which the hospital owes directly to a patient; therefore, an injured party does not have to rely on and establish the negligence of a third party 210

express corporate authority

_________________ is authority specifically delegated by statute; healthcare corporations derive authority to an act from the laws of the state in which they are incorporated; the articles of incorporation set forth the purposes of each corporation's existence and the powers that hte corporation is authorized to exercise to carry out its purposes 206

organizational ethics

__________________ describes the ethics of an organization in terms of how it responds to internal or eexternal circumstances affecting the organization's mission and values; ethical behavior in an organization can be enhanced by providing staff members with a written code of ethics; providing training and education to improve each staff member's knowledge base, skills, and competencies; providing easy access to professional sources to assist in resolving ethical issues in the workplace; and providing systems for confidential reporting of breaches in ethical conduct within and outside the organization; althouugh most healthcare organizations have published their mission, vision, and values statements, policy nad practice continue to be distant relatives; committment to __________________ begins with hte organization's leadership

implied corporate authority

__________________ is the authority to perform any and all acts necessary to exercise a corporation's expressly conferred authority adn to accomplissh hte purposes for which it was created; generally, ____________________ arises where there is a need for corporate powers not specifically granted in the articles of incorporation; a governing body, at its own discretion, may enact new bylaws, rules, and regulations; purchase or mortgage property; borrow money; purchase equipment; select personnel; adopt corporate resolutions that delineate decision making responsibilies; and so forth; these powers can be enumerated in the articles of incorporation and, in such cases, would be categorized as express rather than ____________________

corporate negligence

__________________ occurs whe na corporation fails to perform those duties it owes directly to a patient or to anyone else wto whom a duty may extend; if such a duty is breached and a patient is injured as a result of the breach, the organization can be held culpable under the theory of ____________________

code of ethics for organizations

__________________ progide guidelines for behavior that help carry out an organization's mission, vision, and values; ________________ build trust, increase awareness of ethical issues, guide decision making, and encourage staff to seek advice and report misconduct when appropriate

respondeat superior

__________________, (let the master respond) is a legal doctrine holding employers liable, in certain cases, for the wrongful acts of hteir agents (emplyees); this doctrine has also been referred to as vicarious liability, whereby an employer is answerable for the torts committed by employees; in the health care setting, an organization, for example, is liable for the negligent acts of its employees, even though there has been no wrongful conduct on the part of hte organization; hospitals are vicariously liable for the negligent of an independent contractor emergency-room physicain where hte patient enters hte emergency room seeking treatmetn from the hospital rather than a specific physicain of hte paitent's own choosing 212

unprofessional conduct

___________________ continues to plague the healthcare system; complex healthcare fraud schemes, for example, resulting in losses of pillions of dollars annually impede advances in medicine and deny high-quality health care to the people; enfocring and bringing to justice the number of individuals and organizations that defraud the government simply add to the losses; ________________ include lack of trust and integrity, false advertising, failure to disclose financial incentives, and concealing mistakes 208

board members

____________________ (trustees, directors) are not always fully aware of thier fiduciary responsibilities and legal risks when serving on a corporate board; although it is an honor to be a member of a hospital _______, ______________ must be fully knowledgable as to their legal liability risks in their positions of trust and service to the organization

national accrediting agencies

_____________________ include: the joint Commission on Accreditation of Healthcare Organizations, the National Committee for Qaulity Assurance, the American Medical Accreditation Program, the American Accreditation Helath Care Commission/Utilization Review Accreditation Commission, and the Accreditation Association for Ambulatory Health Care; in addition, the Foundation for Accountability and the agency for healthcare reserach and quality play important roles in ensuring the quality of healthcare; each of the ___________________ bodies is unique in terms of their mission, activities, compositiosn of their boards, and organizational histories, and each develops their own accredition process and programs and sets their own accreditation standards; for this reason, certain _________________ are better suited than others to perform accreditation for a specific area in the healthcare delivery system; the trend toward outcomes research is noted as a clear shift from the structural and process measures historically used by accrediting agencies; ________________ has been generally viewed as a desirable process to establish standards and work toward achieving higher quality care, but it is not withot limitations; whet accrediting organizations are truly ensuring high quality healthcare across the US is a question that remains to be answered 226

Darling v. Charleston Community Memorial Hospital

______________________ has had a major impact on the liability of healthcare organizations for patietn injuries suffered within thier walls; the immunity status of nonprofit hospitals was no longer an acceptable defense against a plaintiff's negligence claims 210

Magnolias Nursing and Convalescent Center v. Department of Health and Rehabilitation Services

a $5,00 fine was impsoed on a nursing facility for operting without a licensed administrator for 54 days in ______________________; the statute prohibiting operation of a nursing home without a licensed administrator was not considered vague, ambiguous, or unconstitutional 214

Jesse Bravo v. White Memorial hospital, et al.

a complaint for damages and a demand for jury trial was filed by the plaintiff, __________________ with the Superior court of California, County of Los Angeles on Februrary 3, 2012; Damages were sought for elder abuse and neglect, breach of fiduciary duty, intention of infliction of emtional distress, false imprionsment, negligence per se, professional negligence, and hospital negligence

Taylor v. Kennestone Hospital

a hospital nad its governing body were determined to be immune form liability under the federal Health Care quality Improvement Act of 1986 in ______________, for claims arising out of their decision to deny a physician's application to renew his medical staff privileges; a peer review board found that reasonable investigation had adduced evidence demonstrating that the physician had a history of sexual misconduct toward both nurses and patients; he admitted that he had sexual harassment problems that he stopped seeing patients at the hospital, and that he sought psychiatric treatment; he admitted that he filed to comply fully with his own psychiatrist's plan of care before he resumed seeing patients in the hospital; hte evidence established taht the peer reviewers cold reasonable believe their actions furthered the quality of healthcare 219

fiduiciary

a person who has a relationship of trust or confidence with another is called a ___________________; a _______________ relationship with an organization is one-sided, meaning that hte relationship is designed to meet only the needs of the organization and the _________________ must act without regard to his or her own needs; in hospitals and systems, board embers are ________________ because ther have been entrusted with overseeing the fulfillment of the organization's mission; they must be principally concerned about hte performance of hte nonprofit and that its interests are pursued faithfully 205

comply with accreditation standards

accredited hospitals are responsible for ___________________ (e.g. the Joint Commission); the CMS approves nad recognizes national accrediting organizations such as hte Joint Commission's accreditation standards as meeting or exceeding Medicare's requirements, or Conditions of participation required to be viewed during the accreditation process, with qualifying healthcare entities must be in complience in order to be accredited for federal funding; the accrediting body is teh ngranted what is termed deemed status which recognizes the accrediting body as having the athority to conduct hospital accrediation surveys for standards compliance, which is necessary before receiving federal funding 226

screen job applicants

all _________________ must be closely screened prior to employment, regardless of the responsibilities for whic hthey are seeking employment; the screenign process is generalyl the responsibility of the human resources department and hospital managers 217

responsibilities

along with corporate authority that is granted to the governing body, duties are attached to its individual members; these _________________ are considered duties because they are imposed by law and can be enforced in lega lproceedings; governing body members are considered by law to have the highest measure of accountability; they have a fiduciary duty that requries acting primarily for hte benefit of the corporation; the general duties of a governing body are both implied and express; failure of a governing body to perform its duties may consittute mismanagemetn to such a degree that the appointment of a receiver to manage the affiars of the corporation could be warranted 212

corporation

although healthcare organizations may operate as sole propriteriorships or partnerships, most function as ______________; thus, an important source of law applicable to governing boards and to the duties and responsibilities of their members is state law regarding _______________; an incorporated healthcare organization is a legal person with recognized rights, duties, powers, and responsiblities; because hte legal person is in reality a fictitious person, there is a requirement that certain people are designated to exercise the __________ powers and that they are held accountable for corporate decision making

CEO responsibilities

although the ________________- cannot assume the functions of hte professional staff, he or she must ensure that proper admission and discharge policies and procedures ar eformulated and carried out; hte ________________ must cooperate with the professional staff in maintaining satisfactory standards of medical care; the ______________ is responsible to keep current as to regulatory changes that affect organizational operations; periodic meetings should be conducted to informr the staff of regulatory changes affecting their duties and responsibilities; the _______________ should designate a representative for administrative coverage during those hours he or she is absent form the organization; this individual should be capable of dealing with administraive matters and albe to contact the ______________ when major problems arise

disciplining members

although the govenring body has ultimate responsibility for _________________ of the professional staff (e.g. disruptive behavior, incompetence, psychological problems, substance abuse), responsibility for disciplinary actions is generally delegated to the administrator and various department directors and managers; depending on the seriousness of alleged miscondut, disciplinary action may require board involvement for resolution 218

Insinga v. LaBella

an action was brought against Canton (who was masquerading as a phyiscian, Dr. LaBella), the hospital and others in _________________ for hte wrongful death of a 68 year old woman whom Canton had admitted; the patient died while she was in the hospital; Canton was found to be a fugitive from justice in Canada, where he was under the indictment for hte manufacture and sale of illegal drugs; he fraudulently obtained a medical license from teh state of Florida and staff privileges at the hospital by using the name of LaBella, a deceased physician; Canton was extradited to Canada witht being served processes; the US district court for the sourthern district of Florida directed a verdict in favor of the hospital; on appeal, the Flordia supreme court held that the corporate negligence doctrine imposes on hospitals an implied duty to patietns to select competent physicians who, although they are independent practitioners, would be providing in-hospital care to their patients through staff privileges; hospitals are in the best position to protect their patients and consequently have an independent duty to select competent independent physicians 218

corporate compliance program

an effective __________________ should include the following elements: 1. appointment of a corporate compliance officer to oversee the __________________ 2. development of standards of conduct, policies, procedures, and processes to help reduce the risk of criminal conduct 3. assignment of duties, authority, and responsibility to employees with high integrity 4. communication and education of all employees and agents as to the organization's corporate compliance standards; this can be accomplished through required educational programs, computer training modules, and disseminating publications that describe the organization's complaince program 5. utilizatio nof monitoring and auditing systems designed to detect criminal conduct by employees and agents; this should include a program for publicizing a reporting system whereby emploeyees and other agens are easily able to report criminal conduct by others within the organization without fear of retribution; a hotline number should be available to receive and review complaints; procedures should be implemented to protect the autonomy of complaintants from retaliation 6. policies must be consistently enforced through appropriate disciplinary mechanisms; suspected illegal conduct should be handled through the corporate compliance officer 7. the organization msut take all reasonable steps to repond appropriately to any offense in order to prevent similar offenses 8. an audit of the organization's corporate comliance program should be conducted annnually; policies, procedures, and processes should be redesigned as necessary; it is important that hte corporate board participate in the review and evaluation processes 9. the integrity and effectiveness of a compliance program will hold up only as long as there is trust in management on all levels within the organization

conflict of interest

clearly, the banking industry, food industry, and healthcare industry all share one major disturbing characteristic: there is a _______________________ between the inspecting agencies nadd the entities they are inspecting; the quesetion often arises, Which matter dose the accreding agency serve more easily? the pople who use an organization's serivices or the organization? The answer is both. But, however, it is not easy to serve two masters well 228

quality of patient care

even so, the accreditation process for hospitals is working well in many ways, as noted by Pamela R. Knecht, CEO of Accord Limited; in her article "Zero Harm: an Achievable Goal" she describes how some organizations have been successful in imporovising the _____________________ Memorial Herman Health System, Houston, collaborated with the Joint Commissio Center for Transforming Healthcare on the center's hand hygieen project; the results dramatic, as the average complaince across all of MHHS's hospitals improved from 58 to 96%; in addition, one hospital received the systems Certified Zero Award for having no CLABSI infections for 12 months; anf five hospitals had no cases of VAP during that same year 229

safe practices

failure to follow _________________ identified in accreditation standards can result in patient injuries, where patient equipment was disconnected because alarms were annoying to staff who became desensitized to hte alarms- often as a result of frequent false alarms 226

respondeat superior

for ________________, the question of liaiblity frequently rests on whether persons treating a patient are independent agents (responsible for their own acts) or employees of hte organization; the answer to this depends on whether the organization can exercise control over the particular act that was the proximate cause of the injury; the basic rationale for imposing liablity on an employer deceloped becuase of hte employer's right to control teh physical acts of its employees; it is not necessary that employer actually exercise control, only that it posses the right, power, and authority to do so 212

respondeat superior

for liability to be imputed to the employer under ________________: a master-servation relationship must exist between the employer and the employee and 2. the wrongful act of hte employee must have occurred within the scope of his or her employment 212

ensure competency

healcare entities have a responsibility to take reasonable steps to ensure that physicians are qualified for the privileges granted; failur eto screen a medical staff pplicant's credentials properly can lead to liability for injuries sufferred by patietns as a reuslt of the omission; hospitals msut adhere to procedures established under both their own bylaws and state statutes; the measure of quality and the degree of uqality control exercised in a hospital are hte direct responsibilities of the medical staff; supervision of hte manner of appointment of physicians to its staff is mandatory not optional

Hoxie v. Ohio State Med. Bd.

in ___________________, it was determined that a physician had made false statemetns concerning his criminal history when he stated in a deposition that he had never been arrested; there was sufficent evidence presented to support permanet revocation of his licenseto practice medicine; certified records held by th estate of California indicated that the physician had been arrested or detained by the LAPD multiple times in the 1970s and 1980s for possessing marijuana and PCP, for driving under hte influence of alcohol and/or drugs; for driving under the influence of alcohol and/or drugs, and for driving with a suspended license; although the physician asserted that docuemntatio nof his criminal past had been fabricated by police and was not credible, law enforcement investigation reports are generally admissible; the physicain himself added to the reliability by verifying all significant identfiying information contained within the docuemnts and records

Mehlman v. Powell

in ___________________, the court held that a hospital could be found vicariously liable for the legligence of an emergency deparment physician who was not a hospital employee but who worked in the emergency department in the capacity of an independent contractor; the court reasoned that hte hospital maintained control over billing procedures, maintained an emergency department, and represented to the patient that the members of the emergency department staff were its employees, which mihgt have caused the patient to rely on the skill and competence of hte staff 212

allocate scare resources

it is the responsibility of hte governing body, and not the legal system, to provide appropriate staffing and privde adequate supplies and equipment for patients; although the courts do not overlook the importance of maintaining adequate levels of patient care, it is not the job of hte courts to referee disagreements; for example, a disagreement between the governing body and the local community as to how to ____________ is not a question for the courts to settle; questions of this sort often involve ethical principles nad values; how to spend ___________ that provide good for the many is a value judgement, not a legal decision; hospitals are in the business of serving patients with many kinds of illnesses and disabilities; recognizing that the medical community is best equipped to conduct the balancing that medical resource allocations inevitably require, Congress has declined to give courts a mandate to arbitrate allocation disputes

Thompson v. Nason Hospital

liabilit extends to nonemployees who act as a hospital's ostensible agents; for example in, ________________, a Pennsylvania court recognized that hospitals are more than mere conuits through which healthcare professionas are brought into contact with patients; hospitals owe some nondelegable duties directly to their patients independent of hte negligence of their employees, such as duties to use reasonable care of their employees, such as duties to use reasonable care in the maintenance of safe and adequate facilities nad equipment; select and retain only competent physicians; oversee all persons who practice medicine wihtin their walls as to patient care; and forumlate, adopt, and enforce adequate rules and policies to ensure the best care for their patients

New York state requirements

licensure requirements include higher education, such as _____________, which require that applicants: must document that they hold a Bacheolor's or higher level degree form an accredited educational institution; the degree must have included or be supplemented by successful completion of 15 credit hours of course wokr at an accredited educational institution in the following five areas: nursing hoem administration health care financial managmeent legal issues in health care gerontology personnel management an accredited educational institution is one that is listed in the US department of education's database of accredited postsecondary institutions and programs as having its degree program accredited by a regional or nationally recognized accrediting agency 213

CEO responsibilities

major ________________ that appply to CEOs include the following: uphold the organization's and one's professional code of ethics show support and respect to all physicains and staff, knowing that as a team tehy are the ones who provide bedside care make daily ronds in the organization; fix the things they can and find a way t ofix the things they think tehy cannot develop friendships and supporters who can help the organization to meet those extraordinary goals implement community outreach programs; reach out, teach, and educate members of the community on preventative care not be influenced by power brokers simply because of their position; _____________ and managers must do the right ting, all the time- not in a vacuum, but as a team show respect to all persons; treat consultants, accrediation representatives, and inspectors on all levels (e.g., federal, state, local, and private) with respect, knowing that they ar eall there to help hte organization become better in its delivery of patient care 214

loss of accreditation

noncompliance with accreditation standards can lead to an organization's ___________________, which in turn would provide grounds for third party reimburesement agencies (e.g. Medicare) to deny payment for treatment 226

CEO responsibilities

the ____________ must implement as well as interpret hte policies of hte governing body; appropriate action must be taken where noncompliance wiht rules and regulations occurs; the CEO is responsible for making periodic reports to the governing body regarding policy implementation 214

Jesse Bravo v. White Memorial hospital, et al.

other than administering multiple prescriptions of psychotropic medications, defendants provided little care and treatment for him and fialed to stabilize his acute psychiatric condition that led to his admission to the hospital emergency department; the defendants ignored the fact that Mr. Bravo was a married man who resided with his family and instead treated him as if he were a homeless person by unilaterally deciding to discharge him from the medical center to a shelter that cares for homeless people; the patient per hospital policy should have been observed 24 hours before any transfer; less than 12 hours after being admitted to the emergency department, the patient was transferred to the shelter; among other statutes, the hospital violated federal statutes and CMS regulations by not engaging the patient assessment or treatment planning wihtin hte meaning of 42 CFR section 482.61

administratiors to be licensed

states that require ________________ provide penalties ranging from fines to imprisonment for those adminsitrators functioning without a license; the Alaska statutes provide that a person convicted of violating a provision of this chapter is guilty of a class B misdemeanor

maintain moral integrity

the CEO must reflect ________________- in fulfilling the duties and responsibilities of his or her position

Comprehensive Accrediation Manual for Hospitals

the Joint commission responded to complaints of disruptive physician behavior that can place patient care at risk and increase medical errors; the JC in its 2018 ____________________ in its leadership standards sttes: leaders create and maintain a culture of safety and quality through the hospital; the rationale for this standard further states that "leaders must address such behavior in individuals workign at all levels of the hospital, including management, clinical and administartive staff, licensed independent practitioners, and governing body members"; the standards made it mandatory for hospitals to establish written policies designed to address behavior that is demeaning, aggressive, uncivil, or hostile in the patient care setting; the disruptive behavior as a style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care or adversely affects the health care team's ability to work efficiently

governing body

the _______________ must ensure that there are adequate supplies and equipment on hand in eahc of its facilities; if hte board is unable to provide hte necessary supplies and equipment, it must consider finding the funds necessary to fulfill its mission or scailing back operations and, if necessary, consider other options, such as filing for bankruptcy or selling the organization's assets to a competing organization

CEO responsibilities

the _________________ is responsible for hte supervision of hte adminsitrative staff and managers who assist in the daily operations of hte organization; the _____________ derives authority from the owner of hte governing body; the _______________- of an organization owned and operated by a governmental agency may be an appointed publilc official; the ______________ is responsible to lead and oversee the implementation of hte company's long- and short-term plans in accordance with its strategy 214

American College of Healthcare Executives (ACHE)

the __________________ is the primere professional organization offering a CEO certification process; the ___________________ is an international professional scoeity of 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations; _____________'s mission is to advance its membeers and healthcare management excellence; ______________ offers its prestigious FACHE credential, signifying board certification in healthcare management 213

delineation of clniical privileges

the __________________ is the process by which the medical staff determines precisely what procedures a physician is authorized to perform; this determination is based on the credentials necessary to completely perform the privileges requested

food inspection process

the ___________________ is remarkably similar to the hospital accreditaiton surveys: food makers often know when inspectors will audit their facilities, and they vigorously prepare for those inspectors; this was also true with hospitals until the Joint Commission, for example, decided to conduct unnanounced surveys; this change occurred mostly because of the criticism from surveyors, the CMS, the public, and some of the surveyed organizations; but the wheels of change move slowly, more than a decade passed before the Joint Commission submitted to the long overdue change most food makers score high in their inspectiosn and still have recalls and outbreaks as with hospitals, the food companies typically pay for industry inspectors, creating a conflict of interest for inspectosr who might fear they will lose business it they do not hand out high raitings 228

accreditaiton process

the ______________________ of a healthcare organization is a major event in its day to day operations; organizatiosn are expected to maintain a culture that supports patient safety and an environment that fosters respect, honesty, and compassionate care; the accreditation process is one of many tools that help ensure that high-quality care is being provided 227

provide quality patient care

the __________________________ begins form the time of admission and continues to the time of discharge; it involves adopting and following best practices in the treatment of patients in line with both legal and ethical duteis and responsibilities

National Association of Long Term Care Adminsitrator Bords

the __________________________ offers the nursing home administrator examination; the NAB as of July 2017 has transitioned its examinations to a new structure: examinees will need to pass a 100 item Core Knowledge exam and a 50 item line of service exam 213

Jesse Bravo v. White Memorial hospital, et al.

the complaint states that the actions of hte defendants constituted reprehensible and despicable conduct and subjected Mr. Bravo to crue and unjust hardship and consciosu regard for his rights the plaintiff claimed that the conduct by the defendants was outrageous, intentional, and malicious and was done with reckless disregard of the probability of causing the plaintiff to suffer humiliation, mental anguish, and emotional distress

Jesse Bravo v. White Memorial hospital, et al.

the defendants were claimed to have discharged the plaintiff in an unstable, paranoid schizophrenic and heavily sedated state without his consent and then physically restrained him and transported him to the unfamilar location agaisnt his will, abandoming him on a sidewalk withotu the ability to return home

corporate compliance program

the duties and responibilities of the __________________ can be compromised when the corporation pays the salary of the _________________; as they say in the world of finance, follow hte money, and they you will know where loyalties lie 208

supervise and manage

the duty to ___________________ is applicable to the trustees as it is to the managers of any other business corporation; in both instances, there is a duty to act as a reasonably prudent person would act under similar circumstances; the governing body must act prudently in administering the affairs of the organization and exercise its powers in good faith 212

corporate compliance program

the federal government's intitiative to investigate nad prosecute healthcare organizations for criminal wrongdoing, coupled with strong sactions impsoed after conviction, has resulted in healthcare organizations establishing _________________________; these programs establish internal mechanisms for preventing, detecting, and reporting criminal conduct; sentencing incentives are in place for organizations that establish such programs; an effective _________________ should include hte design, implementation, and enforcement of program polciies, procedures, and processes to facilitiate the prevention and detection of criminal conduct 207

CEO code of ethics

the following is the preamble to the ______________ for the ACHE: the purpose of the ______________ of the ACHE is to serve as a standard of conduct for members; it contains standards of ethical behavior for health care executives in their professional relationships; these relationships include colleagues, patients, or others served; members of the health care executive's organization and otherorganizations, the community, and society as a whole the ______________ also incorprates standards of ethical behavior governing individual behavior, particularly when that conduct directly relates to hte role and identifiy of the health care executive the fundamental objectives of the health care management profession are to maintain or enhance the overall quality of life, dignity, and well being of every individual needing health care service and to create a more equitable, accessible, effective, and efficient health care system health care executives have an obligation to act in ways that will merit the trust, confidence, and respect of health care professionals and the general public; therefore, health care executives should lead lives that embody an exemplary system of values and ethics 215

governing body

the general duty of a ________________________ is to exercise due care and diligence in supervising and managing the organization; this duty does not cease with the selection of a CEO; a governing body can become liable if the level of patietn care becomes inadequate because of hte governing body's failure to supervise properly the management of the organization; CEOs, like obard members, cna be persionally liable for their own acts of negligence that injure others 213

complying with rules and regulations

the governing body in general and its agents are responsible for ____________________ regarding the operation of the organization; depending on the scopeof the wrong committed and the intent of the governing body, failure to comply could subject board members and/or their agents to civil liability and, in some instances, to criminal prosecution 225

appointment of a CEO

the governing body is resposnible for _________________ to act as its agent in the management of the organization; athe CEO is responsible for the day-to-day operations; the CEO plans, directs, and coordinates hte operational activities of the organization; the individual selected as CEO must possess the competence nad the character necessary to maintain satisfactory standards of patient care 213

credentialing, appointment, privileging, and discipline

the governing body is ultimately responsbile for the ________________________________ process of the organization's professional staff; the duty to select members of hte professional staff is legally vested in the governing body charged with managing the organization; although cognizant of the improtance of professional staff membership, the governing body must meet its obligation to maintain high standards of practice and fairness; the governing body of all healthcare entities must therefore be given the latitude necessary when prescirbing the necessary qualificatiosn for potential applicants; no court should substitute its evaluation of professional competency for that of the board, a court's review should be limited to ensuring that the qualifications imposde by a board are reasonably related to the operation of the organization and fairly administered; moreover, courts are generally reluctant to get involved with the internal affairs of hospitals or pforessional societies unless any sanctinso they impose violate public policy 217

provide adequate staff

the governing body msut also be involved in the decision-making process when staffing shortages and long work hours stress caregivers; the governing body should require that hte CEO report and discuss with the board at their monthly board meetings as to how management is addressing operating issues that include supply, equipment, and staffing issues and how they are being addressed i nthe organization; ________________ issues in particualr continue to plague the healthcare industry 220

maintain moral integrity

the governing body of an organization should also on an annual basis evaluate its own effectivness, as far up the ladder to board members and, yes, as high up the ladder as the board's chair; no individual in any organization is exempt from the need to be upright and loyal to the mission, vision, and values of the organization based on well-accepted values 215

maintain moral integrity

the governing body, as best it can, must appoint a CEO who has demonstrated _______________ during his/her career path; pointed questions should be made during interviews with prospective CEOs that involve management style, ability to adapt to new employment environments, ability to relate to an organization's mission and values, willingness to be forthcoming with the board; acceptance of the responsibility for decisions made (both the good and questionable); willingness to practice open communications that include both listening and a capacity to accept suggestions for resolving organizational challenges; openness to ideas taht drive innovation; ability to recognize the best in others and give credit to where credit is due; and ability to demonstrate that he or she has a plan for his or her career, including describing what steps he/she has taken to achieve his or her personal goals and how he or she can be fulfilled in the leardership in the organization for which he or she is being interviewed 215

Jesse Bravo v. White Memorial hospital, et al.

the hospital was obligated to develop, implement, and follow policies that address the post-discharrge needs of patients to help prevent adverse health consequences following discharge; the California Health and Safety Code section 1262.5 provides, in part: each hospital shall have a written discharge planning policy and process

governing body

the medical staff is responsible to the ______________ for the quality of care rendered by members of the medical staff; the hospital's _______________ has a duty to ensure that a mechanism is in place for hte medical staff to evaluate, counsel, and when necessary take disciplianry action against physicians who pose an unreasonable risk of harm to patients 218

accrediting bodies

the mission of _________ is to improve the quality of care rendered in the nation's hospitals through the survey process; _____________________ depend upon the hospitals they survey to reimbure them for the costs of those surveys; the obligates the ________________ to maintain satisfied clients, and in so doing, a conflict of interests arises; how credible can a survey be when the ________________ is dependent upon satisfied customers for financial survival; further, hospitals evaluate the performance of the surveyors; surveyors are expected to score an organization's perfomance knowing that organizations often chalenge a sureveyor's findings, which can lead to character assassination in the worst-case scenario and/or a poor performance review of the surveyor by the organization; conflicting interests here encourage surveyors/inspectors to be cautious about what they score becuase of fear of retaliation by both the organizations surveyed and the accrediting body that may side with the organization; because of the financial implications for both the __________________ and the surveyed organization, surveys are far from effective in protecting the consumer from human errors that result in more than 100,000 deaths and injuries annually in the nation's hospitals 228

Jesse Bravo v. White Memorial hospital, et al.

the patient should havea been stabilized in hte hospital emergency department prior to discharge; this in fact did not occur; patient reports do not show that any consideration was given to where the patietn coudl be safely placed nor where there arrangements made with the shelter to receive the patient; the policy required by subdivision a shsall require that appropriate arrangements for post hospital care, inclduing, but not limited to, care at home, skilled nursing or intermedite care facility, or from a hospitce, are made prior to discharge if tehre is no adequate discharge planning; if the hospital determiens taht hte patient and family members or interested persons need to be counseled to prepare them for post hospital care, teh hospital shall provide for that counseling

Casey v. Woodruff

the principles of coroproations were outlined in the 1944 New York Superior Court case ____________________ and reiterated in 1996 by the US Court of Appeals in FDIC v. Sthal: the directors are entrusted wit hhte management of the affiars of the railroad; if in the course of management they arrive at a decision for which there is reasonable basis, and they acted in good faith, as the result of their independent judgement, and uninfluenced by any consideration other than what they honestly believe to be for the best interests of the railroad, it is not the function of hte court to say that it would have acted differently and to charge the directors for any loss or expenditures incurred; courts have properly decided to give directors a wide latitude in the management of th eaffairs of a corporation provided always that judgement and that means an honest, unbiased judgement, is reasoanble exercised by them

organizational ethics

the purpose of ________________ in the healthcare setting is to promote responsible behavior in the decision-making progess; recent interest in _______________ is, in part, the result of concerns of government regulations (e.g. Sarbanes-oxley act, emergency medical treatment and active labor act) and accrediting agencies taht certain unethical practices continue to plague the industry; these practices include billing scams, false advertising and marketing, and patietn care issues (e.g. inappropriate patient transfers based on ability to pay, transferring patients before they have been clinically stabilized); commitment to ____________________ must begin with the organization's leadership

appointment of a CEO

the responsibilities and authority of the CEO should be expressed in an appropriate job description, as well as in any formal agreement or contract that hte organization has with the CEO; some state health code describe the responsibilities of administators in broad terms; they generally provide that the CEO/ administrator shall be responsible for the overall management of hte organization; enforcement of any applicable federal, state, and local regulations, as well as the organization's bylaws, policies, and procedures; appointment of, wit hthe approval of the governing body body, a qualified medical director; liaison between the governing body and medical staff; and appointment of an adminsitrative supervisor to act during the CEO's absence form the organization 213

corporation

the typical healthcare organization is incoporated under state law as a freestanding for profit or not-for-profit ___________, the ______________ has a governing body that has ultimate responsibility for the decisions made in the organization; the existence of htis authority creates certain duties and liabilities; the governing body, having ultimate responsibility for hte operation and management of the organization, generally delegates responsilibity for the day-to-day operations of the organization to hte organizations chief executive officer

CEO licensure

there are no formal licensing requirements for hospital administrators, although there are common educational career paths to follow when seeking executive positiosn in hospitals; a mater's degree in health services administration or a related field is often required; hospital adminsitrators may also earn voluntary professional certification

CEO responsibilities

there may be occasions when the CEO believes that following a direction of hte governing body may create a danger to the patients or others; if hte CEO knows or should have known, as a reasonably prudent person, of a danger or unreasonable risk or harm that will be created by certain directed activity but nevertheless proceeds as directed, he or she could become personally liable for any resulting injury; the ____________ therefore, must take appropriate steps to notify the governing body of any policies that create dangers or unreasonable risks 214

federal requirements

to comply with _________________, the various states have incorporated licensing rquirements in thier regulations; administrators are licensed under hte laws of their individual states; statutes generalyl provide that the administrator of a nursing facility be licensed in accordance with state law

Jesse Bravo v. White Memorial hospital, et al.

ultimately the defendants negligently managed, cared for, treated, discharged, abandoned, adn dumped Mr. Bravo during the relevant period, causing him to suffer injuries the hospitial ultimately had a common law duty to use reasonable diligence in safeguarding a patient committed to its charge- if that duty is measured by the patient's capacity to care for himself, htere was no reasonable effort to assess the plaintiff's joint capacity for self-care ethis and the law are in accord here, the defenandt's actiosn violate every standard of professional conduct; by failing to care for and then releasing a mentally ill, unstable, paranoid, and schizophrenic man and abandoning him on the street in an unfamailar and dangerous area 225

provide adequate staff

various state and federal regulations address _______________; however, they do not adequately address the problems associated with poor and the plethora of regulations that require documentation by caregivers, detracting from the need for hands-on bedside care, thus to the detriment of patient care; because the quality of care provided by nursing facilities is subject to substantial scrutiny, American families face difficlt decisions about wheter to move a loved one into such a settting; under federal law, nursing facilities must have sufficient nursing staff to provide nursing and related services adequate to attain and maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individal plans of care; as nursing facilities are increasingly filled with older, disabled residents with complex care needs, the demands for highly educated and trained nursing personnel continue to grow

respondeat superior

when filing a lawsuit for_____________, the plaintiff's attorney generally names both the employer and employee; this occurs because the employer is generally in a better financial condition to cover the judgement; the employer is not without remedy if liaiblity has been impsoe dagainst the organization due to an emplyee's negligent act; the employer can seek indemnification from the employee; although it would be highly unlikely for a hospital to seek recovery from an employee, the ever-cinreasing number of emplyed physicains could give rise to a hospital seeking indemnification from a physcian who si the cause of a negligent injury and carries his own malpractice insurance policy 212