Texas MD Jurisprudence Exam

What are the components of malpractice payments?

*Compensatory damages*: Relates to the injury, medical care, loss of ability to work, etc. Not capped. Texas passed Tort reform in 2003, which limits the *egregious noneconomic* (pain, suffering, shame, etc.) *damages* that you occasionally see in the news elsewhere in the country. Noneconomic damages are capped: - $250,000 total for all involved individuals (physicians and other healthcare providers) - $250,000 from each hospital/facility up to a total of $500,000. This is why patients will usually also sue hospital(s). - $250,000 + $500,000 = $750,000 maximum *Exemplary (punitive) damages:* The fines designed to punish the defendant and deter future similar behaviors. These are capped in Texas to no more than $750,000. These are actually determined by the greater of $200,000 or 2x economic damages + noneconomic damages up to $750k. Exemplary damages for wrongful death are capped at $500,000. *Proportionate responsibility:* The percentage of liability 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 the order of Surrogate consents? At least through the family chain. for minors? for adults?

*For minors:* Parent -> grandparents -> adult sibling -> aunt/uncle -> educational institutions with written authorization -> any adult with written authorization -> court if there is an active suit affecting parent/child relationship -> peace officer who has taken custody *For adults:* Spouse -> adult child who is sole decision maker -> majority of adult children -> parent(s) -> adult sibling -> a person clearly designated by the patient prior to incapacitation -> nearest relative -> clergy A surrogate decision-maker cannot pick a new surrogate. If they are unwilling or unable to make decisions, it passes down the line. *No proxy consent is allowed for abortion, ECT, or psychosurgery.* These require the patient themselves to consent directly; if the patient is unable to then these generally cannot be pursued. Exception is court appointed guardian for ECT in the setting of a patient who typically is no longer able to care for their basic needs or for abortion in the case of unemancipated minors (where the court is able to act as a temporary guardian).

Concept/Definition: What are infractions? Misdemeanors? Felonies? Jail v. Prison?

*Infractions* are what everyone gets, tickets: jaywalking, speeding, illegal parking, etc. These involve small fines, no jail time, and have no effect on your ability to practice medicine. *Misdemeanors* are smallish crimes (e.g. shoplifting, pimping, marijuana possession, DUI without injury) with relatively small fines, less than 1 year of jail time, and no effect on your civil liberties (can still vote, buy a gun, run for public office, etc.). Severity is A > B > C. *Felonies* are more serious (aggravated assault, murder, etc.) with jail time greater than 1 year and complete loss of civil liberties. Severity is 1st > 2nd > 3rd. Though people often talk colloquially about "jail time," jails are generally places run by the county sheriff's department where people go to await trial or to serve short sentences. Prison (either state or federal) is where most convicted criminals serve their sentences. Lastly, a *State Jail Felony* is essentially the lowest form of felony offense in Texas. Think of it as a fourth-degree felony that is served in a state jail instead of a prison (a common state jail felony is the possession of small amounts of cocaine or meth). Confinement: 180 days-2 years, 2-10 years if with a deadly weapon or prior felony conviction.

When are abortions allowed?

- 1st trimester abortions are fine. - 2nd trimester abortions can be limited depending on how many Republicans there are in the state legislature. - 3rd trimester abortions are only permissible to prevent the death or serious physical/mental impairment of the mother, for a nonviable fetus, or for a fetus with a severe abnormality.

Voluntary Psychiatric admission can be done by who?

- A parent/guardian can "volunteer" their child under 16 for "voluntary" admission. *- After 16, the child must also consent to voluntary admission.* - Adults over 18 can obviously admit themselves. - (No consent is required for involuntary admission. That's because it's involuntary.)

How long does an order of protective custody last? What happens next? What can the patient request? After how long can you files for indefinite commitment? Can a patient refuse psychoactive medications?

- A temporary hospitalization under a judge-issued Order of Protective Custody (OPC) lasts up to 30 days, after which one has to file for a 90-day commitment. The patient has the right to request a probable cause hearing within 72 hours to try to get released. - Can file for indefinite commitment after 60 days *- The court orders for involuntary admission and for mandatory psychoactive medications are separate.* A patient can be committed but able to refuse medications, and another can be an outpatient but obliged to take meds.

In what cases/situations can minors consent?

- Active duty military - 16 and "emancipated" (live separate from parents and managing their own affairs) - For STD treatment - addiction treatment - abuse or suicide prevention - for pregnancy treatment except abortion.

What is the statute of limitations? What is a complaint is filed? By when should everyone involved be able to get the patient's medical records?

- Adults: 2 years - Minors: 2 years after becoming 18 - If it would be unreasonable for the patient to discover the wrongdoing within two years, then it essentially *begins when the harm is discovered.* So, amputating the wrong leg would be discovered immediately. Missing an obvious tumor on an x-ray would begin once the cancer is actually found. - Filing a complaint buys the lawyers 60 more days; a notice letter of the impending lawsuit extends the statute by 75 days. Everyone involved should be able to get the patient's medical records within 45 days. - 10 years from the injury is the absolute maximum delay (aka Texas has a "statute of repose").

Who can file for court-ordered treatment of substance-use?

- Any adult can file an application for court-ordered treatment of another person (perhaps for when your family "intervention" fails) - After two physicians examine the patient to assess for chemical dependency, the court then conducts the hearing.

By Law, how long does a mother get in hospital for vaginal birth? C-section? When must birth reports be filed?

- By law, a mother gets 48 hours in the hospital for a vaginal birth and 96 hours for a C-section. - Birth reports must be filed within 5 days.

What criteria is needed for licensure?

- Complete college (60 credit hours) - Have an MD or DO - Pass the USMLE Steps 1-3 (within the past 7 years) and the Texas JP exam - Complete your intern (PGY1) year So, any US-trained grad finished with the Step exams can apply for their full Texas medical license after completing their internship. Ben White. The Texas Medical Jurisprudence Exam - A Concise Review (Kindle Locations 77-81). Kindle Edition.

Common ways to cause harm?

- Failure to diagnose or order appropriate tests (when standard of care) - Failure to follow up on lab results - Negligence during surgery - Failure to disclose risks/benefits (misrepresentations, no informed consent, etc.) that would have caused a patient to change/withhold consent to a procedure. An example would be not telling a patient who agrees to undergo a hysterectomy that they will no longer be able to get pregnant and have children. - Failure to treat condition properly (follow standard of care)

Prenatal and perinatal testing Laws what must be tested for?

- HIV, syphilis, and Hep B must be tested for at the first pregnancy exam visit and again at delivery - The neonatal state screen (55 disorders including PKU/HIV/hypothyroidism/sickle cell), prophylaxis for ophthalmia neonatorum (eye drops/goop), and a hearing exam must be provided after birth (but *do* require parental consent).

A List of things that violates the MPA

- Lying - Drug/alcohol abuse - Felony convictions - Mental incompetence (including psychiatric illness that impairs judgment/ability to practice medicine) - False advertising - Malpractice - Dangerous prescribing (typically of controlled substances) - "Unprofessional or dishonorable" conduct (not specifically defined) - Violating the MPA TMB can punish you for mistakes made in other states / during military

What are your rights when investigated / suspended?

- May be temporarily suspended without notice or hearing if there is concern for a continuing danger to public welfare (though must then be notified immediately, with a formal hearing to follow within 10 days) - Due process (under the law) - 5th amendment protected (you never have to incriminate yourself) - 30 days to appeal

List of a patients rights

- Participate in own care - Make informed decisions - Request or refuse treatment - Make advanced directives - Have privacy - Confidential records

Common ways to increase odds of getting in trouble?

- Poor record keeping (document or it didn't happen) - Criticizing self or colleagues (although contemporary general consensus is that admitting mistakes reduces likelihood of a lawsuit) - Poor communication & bedside manner

If an HIV result is positive, who can you notify?

- Spouse - Partner notification program (which will contact partners identified by the patient without sharing identifying information) - Potentially exposed personnel (health care, law enforcement, firefighters, EMTs, etc.) - Local and state health authorities

To whom can you tell protected health information (PHI)?

- The patient and any doctors, nurses, or other healthcare providers directly involved in the patient's care - Family members only with permission - Patients have the right to know to whom their PHI has been disclosed. - Penalizations/fines for unauthorized disclosures

What is a wrongful pregnancy v. wrongful birth?

- Wrongful pregnancy: pregnancy that occurs after ineffective sterilization - Wrongful birth: where a child with birth defects was not aborted because the mother was not offered genetic counseling - For injuries that occur during delivery

What is needed for a successful malpractice claim?

1. Duty existed (established physician-patient relationship) 2. Duty breached (i.e. negligence) 3. Patient is harmed 4. Breach caused the harm - The harm must have been both foreseeable and directly caused by the act (legally called "proximate cause"). - The negligent act can't be removed from the harm by too much time or too many intermediary steps. - The negligent act actually caused the harm (aka "cause in fact"). - Harm can occur either by omission (not doing something) or commission (doing something wrong or doing the wrong thing). So, several corollaries are true: - You are not obligated to respond to a phone call, give medical advice, or provide care to a patient you have never seen before. - You aren't legally obligated to provide care for a patient you don't know (even if you are "on call"). - Like all important relationships, the physician-patient relationship must be consensual. - If you give someone specific medical advice (even on an elevator), that counts. - You should keep meticulous records. Malpractice suits are civil cases and the plaintiff is going for the less-challenging "preponderance of evidence" meaning they just need to show more evidence of malpractice than not. (as opposed to beyond a reasonable doubt in criminal cases).

When to report death certificate?

10 days

How many people compose the texas medical board? how many MDs? DOs? laypersons? how long is the term?

12 are physicians (9 MD, 3 DO). 7 are laypersons. All are appointed by the governor for 6-year terms.

When supplying medical records by?

15 days

What degree felony / class misdemeanor are the following crimes: Sexual abuse of nursing home or mental institution patient?

2nd deg felony

How many lawsuits triggers a review of your license?

3 lawsuits in 5 years.

When do you need to let the TMB know about conviction for felonies, drug violations, Medicare/Medicaid fraud, or misdemeanors that involve moral turpitude ("moral turpitude" is counter to the standards of decency/conduct/etc.).

30 days

When must you inform the TMB of any name / practice address changes?

30 days. You do not need to notify texas about changing medical malpractice insurance.

What degree felony / class misdemeanor are the following crimes: Practicing medicine without a license?

3rd degree felony

What degree felony / class misdemeanor are the following crimes: Selling child?

3rd degree felony

When must abuse/neglect be reported? What is the crime if you don't?

48 hours Responsibility is non-transferable Failure to report is a Class B misdemeanor (180 days jail time).

How much Continuing medical education CME must you have to renew your license?

48 hours of CME. 1/2 formal 1/2 informal (self reported, volunteering, peer review and 2 hours of medical ethics/professional responsibility

When to report birth certificate?

5 days

Reporting most communicable diseases?

7 days (1 day for TB and pertussis)

How many midlevels can you have in outpatient?

7 full time equivalents (i.e. can have 14 half time) In hospital or medically underserved area, no midlevel limit.

How long do you have to keep charts for?

7 years for adults 7 years for minors or until age 21, whichever is longer - The hospital must hold onto adult inpatient charts for 10 years and keep pediatric inpatient charts for 10 years or age 20, whichever is longer.

What is delegating Authority? Who is responsible? What can NPs or PAs do?

A physician can delegate any task ("medical act") they want to anyone acting under their "supervision" (loosely defined), such as *nurses, techs, medical students, and mid-level practitioners such as NPs or PAs.* NPs and PAs can even prescribe controlled substances (*schedule III and IV*) under the license of their supervising physician. Ultimately, any delegated actions and their consequences are entirely the *responsibility of the supervising physician. *This is known as *vicarious liability.*

Who determines Involuntary mental health admission?

A psychiatrist and the court Cannot be done by proxy

What do you need to practice telemedicine in Texas?

A special texas telemedicine license (required JP exam). A full medical license in good standing in another state. Board certified in speciality. NOT practicing medicine PHYSICALLY in texas.

What is abandonment? How can you do it properly?

Abandonment refers to unilaterally terminating the doctor-patient relationship without 30 days written notice. To legitimately terminate a physician/patient relationship: - Send written notification in mail (use "certified mail receipt" to have proof it was delivered) - State reason - Set termination date - Provide a 30-day grace period of continued treatment until a new doc is found Provide help finding a new doc (can be a simple list, nothing arduous required) - Offer to transfer records Note: there are of course situations in which you can't terminate the physician-patient relationship, including things like during the period of typical postoperative care/follow-up or if you're so rural that there are no alternative physicians available.

What is an advanced directive? Medical Power of Attorney? Are witnesses or a notary needed? How can they be revoked?

Advanced Directives are legal medical "plans" that lay out the desire to receive/withdraw life-sustaining treatment. They include both the out-of-hospital DNR and medical power of attorney (MPOA). *The MPOA* is an individual who has been identified as having the ability to make medical decisions for a patient when the patient is no longer able to make decisions for themselves (temporarily or permanently). Two witnesses are required to make an advanced directive, one of which must have no vested interest (not a relative and not involved in the patient's medical care). Advanced directives can be given verbally to a physician as long as they fulfill the witness requirement and are subsequently documented. Notary services are not required. Advanced directives (including DNR and MPOA) do not expire, they last until they are revoked or supplanted. Revoking is easy. All a patient has to do to revoke an AD is say never mind.

What is a APOWW (Apprehension by a peace officer without warrant)? What are the timelines for evaluation?

An APOWW (Apprehension by a Peace Officer Without Warrant) is filed by the police when there is suspicion for risk of injury to self or others. *A physician must physically evaluate the patient within 12 hours* (unlike 72 hours for a voluntary admission). *A psychiatrist must then clear the APOWW within 48 hours or file for an OPC (order of protective custody)* to be issued by a judge. Emergency detention must only be used if the patient is an imminent risk and it is deemed the least restrictive means for safety.

What must a doctor do to run a rural / medically underserved practice with mid levels?

Be remotely available visit every 10 days Review at least 10% of charts of each midlevel Pt can request supervising physician. Mid levels can prescribe sch III and IV mid levels can prescribe sch II (Norco, morphine, vicodin) with intended stay of 24 hours or greater, in a hospital based (not free standing ER), or for patients in hospice.

Can podiatrists admit patients?

Both the TMB and MPA are physician-centric. Podiatrists may also be doctors, but podiatrists can no longer admit patients to a hospital independently. Podiatry patients must be admitted under an MD or DO physician. Ben White. The Texas Medical Jurisprudence Exam - A Concise Review (Kindle Locations 142-144). Kindle Edition.

Violating the medical practice act is what degree felony/class misdemeanor violation?

Class A misdemeanor

What degree felony / class misdemeanor are the following crimes: Failure to report elder abuse (outside or inside of a nursing home)

Class A misdemeanor

What degree felony / class misdemeanor are the following crimes: Receiving kickbacks for referrals?

Class A misdemeanor

What degree felony / class misdemeanor are the following crimes: Soliciting patients

Class A misdemeanor

What degree felony / class misdemeanor are the following crimes: Violating the medical practice act (such as dangerous prescribing)?

Class A misdemeanor

What degree felony / class misdemeanor are the following crimes: Failure to report child abuse?

Class B misdemeanor (oddly less severe than for old people)

Do you need consent for HIV testing?

Consent for HIV testing is required except when it's necessary (needle stick; person is a suspected rapist; person is getting surgery or is a needle-stick risk and they have high-risk behavior/etc.) In fact, all needle sticks require subsequent testing for HIV, Hep B, and Hep C.

When will the TMB tell your hospital you've been restricted or suspended?

Day 1

When is electroconvulsive therapy available? who can consent?

ECT is always voluntary and available starting at age 16. Only physicians can perform ECT. ECT cannot be performed by court order or against patient wishes. Written consent must be obtained before every session (an extreme legal consent requirement you can thank One Flew Over the Cuckoo's Nest for). The *only exception* to patients being required to consent for ECT themselves is when there is a *court-appointed guardian acting on their behalf (not just a medical power of attorney).*

What is EMTALA?

Emergency Medical Treatment and Active Labor Act The antidumping rule. The ER must: - Screen emergency cases - Stabilize/treat acute conditions prior to discharge - Take care of women in active labor and deliver their babies - Transfer unstable patients only if the benefits outweigh the risks or secondary to patient request - Benefit > Risk examples would include: - Unstable STEMI patient to a facility with a cath lab - Stroke patient to a stroke center - Emergency care is required regardless of ability to pay - Emergency care obviously does not mean "definitive" care. Hence the patients who present to the county ER for "follow-up" of their splinted fractured extremity. - Parent brings kid to the adult ER, which is 100 yards from the pediatric ER entrance. The kid has to be seen and evaluated/stabilized prior to transfer. They can't just be redirected to the right door down the hallway, even if they are extremely clinically stable. - Therefore, when applying EMTALA, don't just use common sense to determine what's best for the patient (that might be wrong!). Apply the actual law, not the spirit of the law.

What is deferred adjudication?

Equivalent of pleading guilty / being found guilty. you still have to report the crime to the TMB even if the crime is eventually waived. You can then petition to have your misdemeanor removed from the TMB website if successfully adjudicated.

What are the exceptions to requiring patient permission for patient health information?

Exceptions to requiring patient permission for PHI disclosure include cases of abuse, neglect, domestic violence, for law enforcement purposes, medical examiners, and funeral directors, and to avert serious harm to self/others. Patient privacy (physician-patient privilege) is waived in the case of criminal proceedings (with the exception of mental health records, which require a court ruling; mental health records are always special). Billing records are not part of the medical record. If a patient sues you, they waive confidentiality (which is obvious if you think about it).

What is an expert witness? When must the expert report be available by?

Expert witness is a physician who is actively practicing medicine who knows the standard of care and has enough training/knowledge to know if the standard of care was provided. Does not technically have to be board certified but must be board eligible. The expert report must be available within 120 days of the claim. There must be an expert witness for a medical malpractice case except in these two dramatic exceptions: - Amputating the wrong leg - If an actual criminal law was broken

What are the penalties for EMTALA violations?

For EMTALA violations: - Up to $50k fine per violation - Can lose Medicare/Medicaid reimbursement - Only hospitals (not individual physicians) have civic liability (i.e. patients harmed by EMTALA failures can only sue the hospital, not the actual physician).

What is the renewal schedule for your texas medical license? Overdue fines? Expiration?

For starters, you renew it every two years (after the initial licensing period, which ranges from 12 to 24 months). If you're late: - No fine if expired < 30 days - $75 if expired < 90 days - $145 if expired < 365 days *- Canceled entirely after 1 year. Must reapply and fork over entire processing fee etc. (ouch!)* *- If you wait longer than 2 years, then you not only have to apply for a new license from scratch but must also retake the JP exam* If you continue practicing with an expired license after 30 days, you are now practicing medicine without a license, which is a third degree felony. Ben White. The Texas Medical Jurisprudence Exam - A Concise Review (Kindle Locations 87-96). Kindle Edition.

What problem can you self-report and keep confidential?

Forced rehab for self-reported drug/alcohol problems or physical/mental illness is confidential/not public (assuming you haven't hurt anyone yet through your impaired practice). This is to incentivize physicians to seek help for substance use and mental health issues. TMB can also privately *reprimand* you for a mistake which is also completely confidential and not in your TMB file. Internal peer review is confidential, but any practice restriction longer than 30 days must be reported to the TMB.

When must the TMB be notified if a hospital takes disciplinary action against a physician (affecting privileges)?

If the restriction lasts more than 30 days.

what is the law on Childhood immunizations

Immunizations are required for school attendance unless a physician signs an affidavit attesting to a significant health risk or a parent opts out for reason of conscience.

What happens if you are indicted for a felony?

License is suspended. If convicted, it is revoked. 3rd degree felony to practice medicine without a license.

What is on List A & B of informed consent? What requires statutory consent?

List A - procedures that require specific risk/hazard disclosures by the person "doing" the treatment (e.g. epidural hematoma and nerve damage for epidural anesthesia) List B - procedures that require no specific risk disclosures (e.g. local anesthesia) Exceptions: emergency, patient declines, risk disclosure would threaten well-being (i.e. invoking therapeutic privilege), blood draws in the setting of a DUI arrest Texas is on the unique side for requiring "statutory consent" for several procedures (e.g. hysterectomy, radiation therapy, electroconvulsive therapy), which means that the informed consent process for these must disclose certain state-standardized risks and utilize a standardized special form.

Do texas physicians need to report an epilepsy patient's inability to drive to the state authorities?

No.

Do you have a duty to report potential harm to a third party?

No. Texas is not a "tarasoff" state. In fact, it is a breach of confidentiality and thus against the law to inform a third party directly. You can however tell law enforcement; this is the permissive element of the statute.

Is an advanced directive legally binding?

Note that an advanced directive does *not legally bind a physician to action*; if there is disagreement, a physician can request an ethics committee review. Once an attending physician signs the patient's out-of-hospital DNR, it *is legally binding.*

What states are contiguous with Texas? and what can these doctors order?

OK, AR, LA, NM Oklahoma, Arkansas, Louisiana, New Mexico They can order home health and hospice services for patients in texas.

Who can bill for being a surgical assistant?

Only *licensed* surgical assistants.

When can an unemancipated minor get an abortion? exceptions?

Only if a parent who is notified 48 hours prior consents 2 exceptions: - Medical emergency to save mother's life or prevent significant disability (with written justification both in the medical record and sent to the Texas Department of Health) - Minor is granted a notification waiver by a judge via court petition. This applies when the patient convinces the judge that it's not in the patient's best interest for a parent to be informed. This is particularly applicable if there is concern that the notification will result in harm/abuse.

When can restraints be used?

Only if there is an immediate danger to self or others. physician must document necessity when using restraints or administering non-consented psychoactive medications (i.e. emergency antipsychotics / sedatives)

Who does the Texas Medical Practice Act apply to?

Only texas licensed doctors practicing in texas. All laws covered by the MPA only apply to Texas-licensed physicians while practicing in Texas (or outside state providers providing telemedicine services to patients in Texas). All other healthcare providers (nurses, medical students, and other "doctors" such as dentists/podiatrist/optometrists) are not included.

What is parental negligence?

Parental negligence includes failing to satisfy basic needs and/or seek, obtain, or follow through with medical care for a child, with the failure resulting in or presenting a risk of death, disfigurement, or functional/developmental injury.

What are midlevels?

Physician assistants, APRN (advance practice registered nurses) and APNs (advanced practice nurses) and nurse practioners

Special restrictions for doctors with blood borne pathogen?

Physicians can't practice "exposure-prone" procedures (like surgery) if they have HIV or Hepatitis B or C, unless approved by an expert review panel and the patient consents. You can, however, do invasive procedures that are not deemed "exposure prone" without any restriction or obligation to inform your patients so long as you use universal precautions.

When do you need to let the TMB know about misdemeanors?

Regular misdemeanors, including those eligible for deferred adjudication, should be reported during the scheduled renewal process. It doesn't matter if the crime happened in another state, the TMB still wants to know.

what is simple consent? Informed consent? What happens if you do not have consent?

SImple consent is patient says yes without hearing full spiel. It can be withdrawn at any time. Informed consent means that the patient has been informed of their condition, the proposed treatment, its risks/benefits, and possible alternative treatments. Their signature on paper is insufficient if their consent was uninformed. Non-disclosed risks/benefits/alternatives can be grounds for a lawsuit. It is the treating physician's responsibility to obtain consent. Unconsented surgery is equivalent to assault and battery. Unwanted touching ia battery.

Generally what degree felony / class misdemeanor if it sounds awful v. if it sounds sketchy but not a huge deal?

Sounds awful: Guess Third degree felony Sketchy but not a huge deal, guess class A misdemeanor

What degree felony / class misdemeanor are the following crimes: Promoting a suicide?

State jail felony if patients hurts/kills themselves It's class C misdemeanor if they don't follow through

What are standing orders?

THey must not require any independent medical judgement. i.e. obtain EKG and CXR for every patient in ER who says "chest pain" or pregnancy test on every female under 50.

Will texas accept other states' licenses?

The TMB reserves the right to accept another state's medical license without requiring additional action but will only consider doing so if you're in good standing (no suspensions, restrictions, or felony charges). Ben White. The Texas Medical Jurisprudence Exam - A Concise Review (Kindle Locations 139-140). Kindle Edition.

When should the father appear on the birth certificate?

The father should appear on the official birth certificate only if the mother is married to the father, if the father signs the certificate agreeing to be the father, or if paternity is established by court order.

The physician in training permit is tied to what?

The institution. If you change residency location, you will need to apply for new PIT permit 90 days before.

What can physicians from other states provide in texas? Not telemedicine / contiguous states

They can provide expert opinion to other physicians or for any educational services within or across state lines (not direct patient care).

When does TMB remove records of formal complaints and malpractice investigations?

They will remove it after 5 years as long as it didn't amount to anything and no action was taken against the physician.

How are you supposed to legally amend a chart/record?

To amend a chart/record, you cross out the mistake with a single line, date, and initial it. Any additions must be clearly marked as an addendum (you can doctor your patients but not your charts!).

All deaths under what age must be reported to a medical examiner or justice of the peace?

Under age of 6

What information should be in a release of medical records? When should the records be sent by? Can you charge for them? What is therapeutic privilege?

When a patient signs a "release of medical records," it must include the *type of records, the reason, and to whom the records should be made available.* You *can charge* patients to provide medical records, but you have to supply them within *15 days* of a request. *Therapeutic privilege:* a physician can withhold medical records if (s)he believes that this information would be harmful to the patient; must document in the chart and notify patient; cannot include raw data like radiology films or lab tests. Can only deny for therapeutic privilege, not for nonpayment or other punitive reasons.

When to report child abuse / neglect?

Within 48 hours

How does worker's comp work in texas? Who can perform the evaluation? Which department is in charge of this?

Worker's compensation is a no-fault no-lawsuit statutory system for the payment of work-related injuries. The employee gets money for an injury regardless of who was at fault or who/what caused it. Any doctor can perform an initial visit, but you need to have a "certificate of registration" and be on the approved Texas Department of Insurance (TDI) list to evaluate worker's comp visits and get paid. Ben White. The Texas Medical Jurisprudence Exam - A Concise Review (Kindle Locations 130-133). Kindle Edition.

Can a delirious patient revoke an advanced directive?

Yes. Medical decision making capacity is needed to make an advanced directive but not to revoke it. A patient can always revoke an advance directive anytime an in any state.

What is the good samaritan law?

You are also exempt from liability when providing on-scene emergency care unless: - You charge or are compensated. - So when you save someone's life on a plane, don't take that upgrade to first class! - You are grossly negligent (hard to do). - You caused the emergency (oops!). - Within your scope of practice at that moment: - Random person keels over in the hospital hallway: not protected. - Random person keels over at the mall: protected.

What are the laws surrounding adoption?

You can't buy or sell children. Which should go without saying. In fact, doing so is a third degree felony. You can, of course, pay for/reimburse any adoption-related medical or legal expenses.

Do you need a license for radioactive materials?

You do need an additional license to produce, use, and transport radioactive materials (usually applies to radiologists practicing nuclear medicine, interventional oncology, or radiation oncologists). Ben White. The Texas Medical Jurisprudence Exam - A Concise Review (Kindle Locations 127-128). Kindle Edition.

Do you need to report colleagues who are impaired?

You have a duty to report colleagues who you think are a "continuing threat to public welfare" to the TMB. There is no precise definition of what a "continuing threat" is, leaving you the physician with some wiggle room. There is no punishment for sounding the alarm for claims made in good faith ("immune from civil liability").

When can a family overrule their loved one's choice to forgo aggressive medical intervention?

You've seen patient's families disagreeing with their medical decisions, particularly when they choose to forgo aggressive medical interventions. In order for a family to overrule their loved one, they must petition a court for and be granted "temporary guardianship." The medical code, particularly in Texas, is biased towards life-sustaining treatment.

When do you have to notify the TMB when you recieve a lawsuit?

insurance will do it for you, but if you don't have insurance you have to tell the TMB in 30 days.

Sexual misconduct

sexual misconduct to ever have sexual contact with a patient (including request and suggestion of it). Even if it's a former patient if the physician uses or exploits trust, knowledge, emotions, or influence derived from the professional relationship.

What can you do when no family member or MPOA is available?

the attending physician may decide along with an uninvolved physician to provide life-sustaining treatment (the "two doc" consent).

What does the TMB website post about you?

usual demographic information (who you are, what school you went to, what state(s) you have a medical license in, etc), but they'll also post felony and most *misdemeanor convictions* *(from any state),* ditto analogous charges with deferred adjudication (until you fulfill the requirements and petition), malpractice claims, formal complaints, and disciplinary action from the medical board *(from any state).*