THE TEXAS

MEDICAL JURISPRUDENCEEXAMINATION

A SELF-STUDY GUIDE

byWilliam J. Winslade, Ph.D., J.D.

James Wade Rockwell Professor of Philosophy in Medicine

Amy L. McGuire, J.D.

Jennifer S. Bard, J.D., M.P.H.Cheryl Erwin, J.D., Ph.D.

Institute for the Medical HumanitiesThe University of Texas Medical Branch

Galveston, Texas

Copyright © 1986, 1987, 1988, 1989, 1990, 1992, 1994, 1997,2000,2002 byThe University of Texas Medical Branch at Galveston

TABLE OF CONTENTSACKNOWLEDGEMENTS i

INTRODUCTION x

HUMAN RESOURCES LAW _ 1SECTION 1: ADULT AND CHILD CARE 1

Child Care Facilities and Placement of Children 1Adult Day Health Care 4

SECTION 2: ASSISTANCE FOR NEEDY AND ELDERLY PERSONS............................................................................................... 5

Rights of the Elderly 5Reports of Abuse, Neglect, or Exploitation of Elderly and Disabled

Persons 8Medical Assistance to Needy Persons 10Protective Services for the Elderly II

SECTION 3: NURSING HOME RESIDENTS 13Rights of Nursing Home Residents 13Abuse and Neglect Reporting Requirements for Nursing Homes 14Information Required from the Person Reporting Abuse and Neglect

............................................................................................... 15Inspections and Medical Examination 16

FAMILY LAW 16SECTION 4: ABUSE AND NEGLECT OF CHILDREN 17

Persons Required to Report 17Matters to Report; Appropriate Agency; Contents of Report 17Confidentiality and Disclosure ofInformation 18Immunities 18Failure to Report 18Examination of Abused or Neglected Children 18Abused or Neglected Children May Have Medical Records Released

............................................................................................... 19Abandoned Newborns 19Sale or Purchase of Child 21Sterilization (Minors and Mentally Incompetent Persons) 22Female Genital Mutilation 22

SECTION 5: CHRONICALLY ILL AND DISABLED CHILDREN 23Chronically III and Disabled Children's Services Act 23

SECTION 6: VARIOUS AFFIRMATIVE DUTIES TO NEWBORNS .... 24

11

Protecting the Eyes of Newborns 24Newborn Screening for Phenylketornuria, Other Heritable Diseases,

and Hypothyroidism 25Testing for Hearing Loss in Newborns and Children 25

SECTION 7: ABORTION 26Background 26Right Not to Perform Abortions 27Rights of a Living Child After an Abortion or Premature Birth 27Termination of Parent-Child Relationship After Abortion 27Living Child After Abortion 28Provisions of More Than 300 Abortions Requires Licensure as an

Abortion Facility 28Parental Notification of Abortion 28

MENTAL HEALTH LAW 33SECTION 8: MENTAL HEALTH LAW 34

Definitions 34Voluntary Inpatient Mental Health Services 34Involuntary Mental Health Services 39Court-Ordered Extended Mental Health Services 53Rights of Patients 53Right to Mental Health Record 55Request by Patient to View Mental Health Record 56Minor Patient Bill of Rights 56Independent Evaluation 57Administration of Psychoactive Medication 58Electroconvulsive Therapy 60Authorized Disclosure of Confidential Information Other Than in

Judicial or Administrative Proceeding 62Authorized Disclosure of Confidential Information in a Judicial or

Administrative Proceeding 63Revocation of Consent 64Transporting Mentally III Persons Under Emergency Detention

Without a Protective Custody Order 64Transportation of Mental Health Patients After Detention 65Authority to Have Escaped Mental Health Patient Taken Into

Custody and Returned 66Consent to Treatment for Intermediate Care Facilities for Mentally

Retarded Patients 67Disputes Involving a Patient's Declaration for Mental Health

Treatment 71Miscellaneous 72

SECTION 9: CHEMICAL DEPENDENCy 73Commitment of Chemically Dependent Persons 73

iii

State Hospitals/Chemical Dependency Treatment 75Protective Custody Pending a Commitment Hearing 75Prohibition Against Illegal Remuneration 75

SECTION 10: ABUSE AND NEGLECT OF MENTAL HEALTH PATIENTS............................................................................................... 76

Reports of Abuse and Neglect or of Illegal, Unprofessional orUnethical Conduct ,.. 76

Sexual Exploitation Cause of Action 76Sexual Exploitation by Mental Health Services Provider 77

DRUG LAW 78SECTION II: DRUG LAW 80

Food, Drug, and Cosmetic Act 80Laetrile 86Dimethyl Sulfoxide 86Controlled Substances Act 87Official Prescription Form 95Use of Federal Drug Enforcement Number and Liability for Misuse

............................................................................................... 97Texas Pharmacy Act 97Drug Treatment Program-Narcotics 99Authority to Supply Drugs 99Donation of Unused Prescription Drugs to Charitable Medical Clinics

............................................................................................... 99Notice of Employee Drug Testing Policies 100Reporting Drug Overdoses 100

PUBLIC HEALTH LAW 10 ISECTION 12: AUTOPSIES AND INQUESTS ON DEAD BODIES 102

Autopsies 102Inquests 104Reporting the Death of a Child 12 Months Old or Younger .105

SECTION 13: COMMUNICABLE DISEASE PREVENTION AND CONTROL............................................................................................... 106

Definitions 106Reporting and Treatment of Sexually Transmitted Diseases 106Duty to Instruct 107Reporting of Communicable Diseases-Generally 107Confidentiality 107Contagious Disease Exposure (Emergency Medical Personnel,

Fire Fighters, Peace Officers) 110Rabies 110Tuberculosis 110Cancer 110

iv

SECTION 14: HlV, AIDS, AND HEPATITIS IIITesting for AIDS and Related Disorders IIIInformed Consent for HIV Testing 113Testing for Accidental Exposure to Hepatitis B or Hepatitis C 114Counseling Requirements for Positive HlV Test Results 115Prenatal Testing 115Confidentiality 117Penalty for Breaching Confidentiality of HIV Test Results 119Partner Notification Program for HIV Infection 120HIV-Infected Health Care Workers 121Blood-borne Pathogen Control 124

SECTION 15: VARIOUS REPORTING REQUIREMENTS ANDAFFIRMATIVE DUTIES 125Gunshot Wounds 125Spinal Cord Injuries 125Birth Defects 125Epidemiological or Toxicologic Investigations 126Use of Automated External Defibrillators 126

SECTION 16: IMMUNIZATIONS 128Requirements in Texas Elementary and Secondary Schools and

Institutions of Higher Education 128Immunization Requirements for Nursing Homes 130

SECTION 17: ANATOMICAL GIFfS 131Persons Who May Execute an Anatomical Gift 131Persons Who May Become Donees and Purposes for which Anatomical

Gifts May be Made 132Requirements for Gift or Donation 132Time of Death 133Liability 133Eye Tissue 133Kidney Donation by a Mentally Retarded Person 134Donated Organs Offered to Texas First 135

SECTION 18: ASSISTED REPRODUCTION 136Artificial Insemination 136Oocyte Donation 136Embryo Donation 137

SECTION 19: VITAL STATISTICS 137Birth Certificates 137Death Certificates 138Penalties 138

v

MEDICAL DECISION-MAKING 139SECTION 20: CONSENT FOR MEDICAL TREATMENT 140

Consent for Medical Treatment 140Consent for Emergency Care 140Incapacitated Patients and Surrogate Decision-Making 141Exceptions 142Surrogate Consent for Medical Treatment 142Prerequisites for Surrogate Consent 143Liability for the Cost of Medical Treatment Provided as a Result of

Surrogate Consent 144Limitations on Surrogate Liability 144

SECTION 21: END OF LIFE DECISION MAKING 144Defining Death 145Patient Self-Determination Act of 1990 146Suicide and Assisted Suicide 148Advance Directives: General Provisions 148Directive to Physicians 154Out-of-Hospital Do Not Resuscitate Orders 163Medical Power of Attorney 176

SECTION 22: CONSENT FOR MINORS 182Who May Consent to Medical Treatment of a Minor 182Who May Give Informed Consent for Immunization of a Minor 184Consent for Minors' Admission to a Mental Hospital 185Consent to Chemical Dependency Treatment for Minors

("1oJo's Law") 185

MEDICAL RECORDS CONFIDENTIALITY 187SECTION 23: PROTECTED HEALTH INFORMATION 187

Definitions 187Exemptions 188Compliance with Federal Regulations-HIPAA 188Permitted Disclosures 189Prohibited Acts 191Enforcement and Penalties 192

SECTION 24: OTHER CONFIDENTIALITY PROVISIONS 192Emergency Management Information is Confidential 192Patients' Medical Disclosure Authorization to Hospital Must be

Separate from Medical Consent 192Access to a Child's Medical Records by Non-parent 193

MEDICAL PRACTICE 193SECTION 25: TEXAS MEDICAL PRACTICE ACT 195

vi

Findings and Purposes 195Definitions 196Texas State Board of Medical Examiners 197Construction .. 198Licensure of Physicians 199Grounds for Denial of License or Disciplinary Action 208Unlawful Practices and Penalties 212Reporting by Medical Peer Review Committee or Physicians 213Peer Review Confidentiality 215Report of Convictions 217Reports and Data From Insurers 217Disciplinary Action 218Physician Profiles Made Available to the Public 221Physician Credentialing 222Continuing Medical Education 225Regulation of Out-of-State Physicians 227Regulation of Anesthesia in Certain Outpatient Settings 227PhysicianlPatient Communication 229The Physician's Duty to Release Medical Records 233

SECTION 26: MEDICAL EDUCATION AND RURAL HEALTH CARE............................................................................................... 234

State Medical Education Board 234State Rural Medical Education Board 234Rural Communities Health Care Investment Program 234

SECTION 27: MEDICAL PROFESSION GENERALLy 235Revocation and Suspension of License for Drug-Related Felony

Conviction 235Suspension or Loss of License for Failure to Pay Child Support 235Soliciting Patients 236Restriction on Bidding and Advertising 236Deceptive Advertising 237Time Frame for Submitting Provider Bills 238Billing Information 238Isolated Billing Errors 239Statute of Limitations for Civil Fraud and Breach of Fiduciary Duty

............................................................................................... 239Certain Volunteer Health Care Providers Immune from Civil Liability

............................................................................................... 239Referrals to Occupational Therapists Permitted 241Use of Surgical Assistants 241

MEDICAL BUSINESS LAW 242SECTION 28: FORM OF PRACTICE 243

Medical Business Law 243

vii

Health Maintenance Organization (HMO) 244Health Maintenance Organization-Patient Protection Rules 247Preferred Provider Organization (PPO) 250Use of Osteopathic Hospital by Health Maintenance and Preferred

Provider Organizations 25 IJointly Owned Entities Formed by Physicians and Podiatrists 251Physicians May Form Certain Business Associations with Optometrists

................................................................................... 252Business Entities Consisting of Mental Health Professionals and

Non-Physicians 252

SECTION 29: BUSINESS AGREEMENTS 254Disclosure of Agreements for Payment of Laboratory Tests 254Physician Covenants Not to Compete 254

SECTION 30: HEALING ART IDENTIFICATION ACT 255Purpose 255Exception 255Definition 255Identification 255Violation 257Non-applicability 258

INSURANCE LAW 258SECTION 31: MEDICAL LIABILITY AND INSURANCE IMPROVEMENT

ACT 259Malpractice Claims 259Informed Consent 262Insurance Claim Fraud 264Physician Expert Witness May be Licensed Anywhere in the U.S .

............................................................................................... 267

SECTION 32: PATIENT CARE AND INSURANCE 267Adverse Utilization Review Determinations Must Include Notice of

Right of Appeal 267Health Maintenance Organization Appeals and Complaints 268Confidentiality of Utilization Review Concerning Mental Health

Records 269

SECTION 33: BUSINESS ASPECTS OF INSURANCE 269Silent PPOs are Prohibited 269Joint Negotiation by Physicians with Health Benefit Plans 270

CRIMINAL LAW 275SECTION 34: CRIMINAL LAW 276

Vlll

Misdemeanors 276Felonies 277

WORKERS' COMPENSATION 277SECTION 35: WORKERS' COMPENSATION 278

Definitions 278Medical Services 279Approved Doctors 280Employment of a Medical Advisor and Confidential Information 280Sanctions 282Selection of Doctor 282Required Reports and Records by Health Care Provider 283Payment of Health Care Provider 284Required Medical Examinations 284Notice of Injury to Employer 285

MISCELLANEOUS 285SECTION 36: MISCELLANEOUS 286

Blood Alcohol in the Case of an Arrested Motor Vehicle Driver. 286Physician Prescribing Alcohol 287Hospital Emergency Services 289Emergency Medical Services (EMS) 290Social Security Number of Licensee or Applicant Kept Confidential

.............................................................................................. 293Appointment of a Third Party as Guardian for Incapacitated Persons

............................................................................................... 293

SELF-STUDY QUESTIONS 295

SUGGESTED FURTHER READINGS 360

ix