JP Exam

For delegation purposes you can only delegate to midlevels at how many hospitals and long term care facilities

1 hospital or 2 long term care facilities.

What are the 4 compenents of licensure criteria

1. Complete college (60 credit hours) 2. Have a MD or DO 3. Pass USMLE steps 1-3 within the past 7 years and pass the JP exam 4. Complete PGY 1 year

What 4 things need to be made against a doctor for a negligence suit?

1. Duty existed (Established relationship) 2. Duty Breached (Negligence) 3. Patient is harmed 4. Breach caused the harm - harm must have been both foreseeble and directly caused by the act (Proximate cause) - Negligent act caused the harm - Harm could be doing something or not doing something.

What are the components of a telemedicien license?

1. License is in good standing in another state 2. Board certified in your specialy 3. Not physically practicing in the state of Texas

What are your rights when investigated/Suspended?

1. May be temporarily suspended without notice or hearing if there is concern for continuing danger to public welfare (though must then be notified immediately, with a formal hearing to follow within 10 days) 2. Due process 3. 5th amendment protected 4. 30 days to appeal

Elements of a prescriptive authority agreement? (7)

1. Name, address, and all professional license numbers of all parties to the agreement 2. State the nature of the practice, practice location, or practice settings. 3. Identify the types of categories or drugs or devices that may be prescribed OR the types or categories of drugs or devices that may not be prescribed. 4. Provide a general plan for addressing consultations and referrals 5. Provide a plan for addressing patient emergencies. 6. State the general process for communication and sharing information related to the care and treatment of patients. 7. Describe a quality assurance and improvement plan and how it will be implemented. The plan must include plans for chart reviews and periodic face to face meetings.

What are some counterproductive affects of the Emergency medical treatment and active labor act?

1. Parents brings kid to the adult ER, which is 100 yards fro pediatric ER. The kid has to be seen and evaluated/stabalized prior to transfer.

What are 3 ways of increasing your risk of getting in trouble?

1. Poor record keeping 2. Criticizing self or collegues 3. Poor Communication and bedside manner

6 things needed for legitimately terminating a physician/patient relationship?

1. Send written notification in mail 2. State reason 3. Set Termination date 4. Provide a 30 day grace period of continued treatment until a new doc is found 5. Provide help finding a new doc 6. Offer to transfer records. Only time this doesn't hold true is post op care or if you are rural and there are no alternatives.

Issuing a death certificate time

10 days

Length of time an export report must be available within?

120 days of the claim

Supplying medical records

15 days

How many people are on the texas medical boards

19 people 12 physicians (9 MD/3DO) 7 are laypersons

When did texas pass Tort Reform?

2003, which limits the egregious noneconomic (pain, suffering, shame, etc) damages that you occasionally see in the news elsewhere in the country

Amount of CME credit per year and breakdown

24 hours per year or 48 hours every 2 years. 1/2 formal 1/2 informal: I read a journal, or volunteering in a medically underserved area, doing peer review Must include 2 hours of formal medical ethics/professional responsibility.

What is the cap for noneconomic damages for Tort Reform?

250k total for all involved individuals 250k from each hospital/facility up to 500k. Max: 750k

Sexual abuse of nursing hoe or mental institutional patient is what degree of offense

2nd degree felony

Sexual abuse of nursing home or mental institution patient what degree of offense

2nd degree felony

How many lawsuits within a certain amount of time automatically generates an official review of your license?

3

Any practice restriction should be reported to the TMB by how long?

30 days

How long do you have to let the TMB know about a conviction for felonies, drug violations, medicare/medicaid fraud, or misdemeanors that involve moral turpitude?

30 days

Time perior to inform the board of any name and practice address changes. They want to know who you are and where to find you

30 days

What is the time fram for abandonment?

30 days written notice

If you recieve a lawsuit but don't have insurance how long do you have to tell the TMB?

30 days, if you have insurance they will do it for you.

If a governing body of a hospital is forced to take disciplinary action against a physician that affects privileges for longer than how long, the TMB must be notified?

30 days.

Degree of offense for practicing without a medical license

3rd degree felony

Selling a child is what kind of offense

3rd degree felony

What is the law bihind practicing without a license?

3rd degree felony

Time to report child abuse/neglet

48 hours

Issueing brith certificate time

5 days

What is the cap for damages for wrongful death?

500k

Medical board member appointed time perior

6 years

Reporting most communicable disease and what is the exception

7 days Exception is TB or pertussis

How long do you have to apply for a PIT permit?

90 days

Fines for not renewing your license?

< 30 days: no fine < 90 days: 75 dollars < 1 year: 145 dillars Canceled entirely after 1 year and have to fork over entire processing fee. > 2 years: Apply for a new license from scratch but must also retake the JP exam. If you practice without a license after 30 days it is a felony.

What is the delegating authority for physicians

A physician can delegate any taks they want to anyone acting under their "supervision" such as nurses, techs, medical students, and midlevel practitioners such as NPs or PAs. All actions and responsibilities reside on the supervising physician: Vicarious liability

Consequences of Misdemeanor

A: < 1 year and 4k fine B: < 180 days and 2K fine C: 500 dollar fine

What is the statute of limitations?

Adults: 2 years Minors: 2 years after becoming 18. ***It essentially begins when the harm is discovered.

When do formal complaints and malpractive infestigations removed?

After 5 years

What is on file for your personal TMB page?

All felony and most misdemeanor convictions (from each state), ditto analogous charges with deferred adjudication. Malpractice claims Formal complaints Disciplinary action from the medical board.

THere must be an expert witness for a medical malpractice case except in these two dramatic exceptions?

Amputation of the wrong leg If an actual criminal law was broken

Who can do workers comp work?

Any doctor can perform the initial visit, but you need to have a "certificate of registartion" and be on the approved Texas department of insurance list to evaluate workers comp visists and get paid

Who can file a complaint with the board and generate potential disciplinary action?

Anyone and it is all public information

Face to Face supervision meetins must occur when after entering into a prescriptive authority agreement, followed by quarterly thereafter?

At least monghtly for the first 3 years Quarterly after 3 years with teleconference meetings montly in between.

Felony Consequences 1 thorugh 3

Capital: Life in prison 1st degree: Life or 5-99 years: 10K fine 2nd degree: 2-20 years: 10K fine 3rd degree: 2-10 years: 10k Fine * State jail felony is the lowest form of felony offense: served in a state jail instead of prison (ex is possession of small amounts of cocaine or meth) with confinement of 180 days - 2 years, 2-10 years if with a deadly weapon or prior felony conviction.

What is the exmplary punitive damages cap for defendents?

Capped in Texas at 750k These are actually determined by the greater of 200k or 2x economic damages + noneconomic damages up to 750k.

Are malpractice lawsuits civil or criminal?

Civil: So malpractice plaintiff attorney is going for the less challenging "preponderance of evidence", fun word describing a greater number, quantity, or importance.

Failure to report elder abuse what degree of offense

Class A Misdemeanor

Recieving kickbacks for referrels of what degree of offense

Class A Misdemeanor

Soliciting patients is what degree of offense

Class A Misdemeanor

Violating the Medical practice act (dangerous prescribing) what degree of offense

Class A misdemeanor

What class misdemeanor is considred violation of the medical practice act?

Class A misdemeanor. - Dangerous prescribing - Getting caught twice makes it a 3rd degree felony

Failure to report child abuse what degree of offense

Class B Misdemeanor

What is the only thing that is relevent to hospital credentialing?

Competency: ability to take care of patients

Want can cause you to lose you license?

Drug/alcohol abuse Felony convictions Mental incompetence (Including psychiatric illness impairing ones judgement/ability to practice medicine) False advertising Malpractice Dangerous prescribing (Typically of controlled substances) Unproffesional or dishonorable conduct Violating the MPA Can be denied licensure, reprimanded, have your license suspended or revoked, or forced to do public service.

When should regular misdemeanors, including those eligible for deferred adjudication?

During each reneval process. Doens't matter if it happened in another state, the TMB still wants to know.

What is the Texas medical Practice Act:

Eerything that a doctor must adhere to to practice medicine in Texas. Also covers out of state providers covering telemedicine services to patients in texas. Does not include nurses, studentes, or any other doctors. Non-compensated emergency care is also exempt covered by the Good Samaritan Law

What is Deferred Adjudication? for a crime

Equivalent to pleading/being found guilty; the only difference is that its presence on your record is temporary assuming you fulfill the requirements to have your crime "adjudicated". *You still have to report the crime to the TMB even if it is eventually waved which you can then petition to have the misdemeanor removed from the website.

How often do you have to renew your license

Every 2 years, initial licensing period ranges from 12-24 months.

Name some common ways to cause harm?

Failure to diagnose or order appropriate tests Failure to follow up on lab results Negligence during surgery Failure to disclose risks/benefits that would have caused a patient to change/withhold consent to a procedure. Failure to treat a condition properly

Lawyers can extend the statute of limitations

Filing complaint extends 60 days Impending lawsuit extends 75 days. Everyone involved should be able to get the patient's medical records within 45 days. 10 years from injury is the absolute max delay.

What qualifies as a facility based delegation/

Hospital Long term Care Free standing clinics and ERs (even when owned by a hospital) are still just regular clinicls and don't abide by the 7 FTE rule. Also waived when supervising a rural/medically underserved population.

Difference between jail and prison

Jail is run by county sheriff department where people go to await trial or to serve short sentences. Prison: is where most convicted criminal serve their sentences.

TMB handles what two situations

Licensing Disciplinary actions

Who is the typical delegating physician in a hospital?

Medical director Chief of medical staff, Chair of the credentialing committee Department chair Physician who consents to being the delegate

Who is the delegating physician in a long term facility

Medical director.

Do you need a medical license or special permit to provide expert opinion to other physicians or for any educations services within or across state lines?

NO - You can teach at medical schools even before passing a JP exam.

Are you legally obligated to provide care for a patient you don't know?

No

Are you obligated to respond to a phone call, give medical advice, or provide care to a pteint you have never seen before?

No

Does the TMB offer reciprocity for other state licensees?

No

Is there midlevel limit in hospital or long term care facility?

No

Are there requirements for how much a supervising physician must be physically present at a designee's practice location or what fraction of charts are reviewed?

No The law basically says that supervision must be "adequite" without spelling out what adequacy entails. *In the past the numbers were 10% physical time and 10% charts reviews. * TBM does suggeest that the length of the time the APRN or PA has been in practice and the complexity of their patients " should be given consideration when determining the details of prescriptive authority.

Do you have to inform the board of changing your medical malpractice insurance?

No because you do not need malpractice insurance.

Is there a limit of how many midlevels you supervise?

No, but you can delegate outpatient prescriptive authority to only 7 full time equivalents (or 14 half time) = 350 total clinicl hours per week or 50h/wk/FTE. The TMB runs an online supervision and perscription delegation registration system, an you need to use it when applicable.

When can Midlevels prescribe schedule II meds?

Norco, Vicodin, Morphine: in limited circumstances: in the hospital with an intended length of stay of 24 hours of greater, in a hospital based ER ( not free standing) or for patients on hospice.

What states can order hoem health and hospice services for patients in Texas?

Oklahoma Arkansas Lousiana New Mexico

Who can admit patients to a hospital

Only MD or DO, podiatrist cannot

What is considered a midlevel

PA, Advanced practice registered nurses APRN which encompeses NP and advanced practice nurses APN.

APRNs and PAs must consult with the delagating physician for conotrlled substances when?

Perscription refills after the initial 90 day supply, for substances for children under the age of 2 years old. Which must be documented in the patients medical record.

What has to be on a notice to patients for complaints?

Readily visible in both english and spanish on signs Prominently displayed and the same verbiage in every bill, registration form, application and contract.

What is compensatory damages?

Relates to work injury, medical care, loss of ability to work. NOT capped

What is the PIT permit?

Residents in training, institutional specific. So if you change residency you have to apply for a new PIT permit

What is a Felonie?

Serious: aggravated assault, murder with jail time greater than 1 year and complete loss of civil liberteries. Severity: 1 > 2 > 3

What is a misdemeanors?

Small crimes: shoplifting, pimping, marijuana possession, dUI. With relatively small fines, less than 1 year of jail time, and no effect on your civil liberties. Severity A > B > C

What kind of license do you need for telemedicine?

Special texas telemedicine license - You need to take the JP exam still.

Promoting a suicide is what degree of offense

State jail felony if the patient hurts/kills themselves. It's a class C misdemeanor if they don't follow through.

What happens to your license of you are indicted for a felony?

Suspended if you are indicted.....Revoked if you are convicted and it is gone for good.

Antidumpting rule for the ER

The ER must: 1. Screen emergency cases 2. Stabilize/treat acute conditions prior to discharge 3. Take care of women in active labor and deliver their babies. 4. Transfer unstable patients only if the benefits outweigh the risks or secondary to patient requests. Benefit > Risks including unstable STEMI patient to a facility with a cath lab or stork patient. 5. Emergency care is required regardless of ability to pay. 6. Emergency care obviously does not mean definitive care. Hence the patients who present ot he couty ER for follow up of their splinted fracture.

What is proportionate responsibilities?

The percentage of liablity each individual carries due to his or her percentage of fault/wrongdoing. The patient can also be at fault, but so long as their proportion is less than 50% they can still be awarded damages.

What is an infractions?

Tickets: Speeding, jaywalking, illegal parking etc. Small fines with no jail time, and have no effect on your ability to practice

What is abandonment?

Unilateral termination of the doctor-patient relationship.

When do you need additional licensing?

When transporting, producing or using radioactive materials - Radiologists - Nuclear medicine - IR IO - Radiation oncologists.

Can the TMB punish you for mistakes made in other states or military?

Yes

Does a patient have the right to request the supervising physician?

Yes

If you give someone specific medical advice even randomly on an elevator, does this count for negligence?

Yes

Can PAs prescribe controlled substances?

Yes schedule III and IV under the license of their supervising physician.

Can surgical assistants bill for their services?

Yes they bill directly

If you quit residency after internship can you still practice medicine?

Yes, but you will not be board certified in a specialty

What is the good samaritan law?

You are exempt from liability when providing on scene emergency care unless: You are charged or are compensated (Plane flights) You are grossly negligent You caused the emergency Within your scope of practice at that moment: Not protected in hospital

Drug rehab is confidential as long as what?

You never endangered a patient/ violated standard of care while impaired. Can be self reported or ordered. *The TMB can also privately REPRIMAND you for a mistake, which is then not released to the public and does not go into your TMB file.