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6
Student: ___________________________________________________________________________
1. A health care practitioner who practices the "four Cs of medical malpractice prevention" finds two
important benefits related to one of the "Cs", that is, improvement in patients' medical condition and
decreased likelihood that they will sue. Which "C" is most likely to provide these benefits?
A. Caring
B. Communication
C. Competence
D. Charting
2. When showing people they care, what would be the best advice for a nurse caring for patients who have
complaints about dissatisfaction with their treating physicians?
A. Listen to the patients and verbally agree with them if indeed the physician is incompetent.
B Ask the patients to describe the physician's behavior and tell them how patient care will be improved
. under the new health care team.
C. Listen carefully to the patient's complaints and remarks and see that the comments reach the treating
physician.
D. Do not allow the patients to speak about their physicians, rather steer the conversation to the present
treatment.
3. Therapeutic communication is key to avoiding medical malpractice lawsuits. Which of the following is a
recommended guideline when communicating with patients?
A. Clearly state that it is not within your scope of practice to make appointments.
B. If adverse events occur, do not report the event immediately until damage is assessed.
C. When adverse events occur, try to avoid or ignore the patients involved.
D. Communicate clearly and ask for confirmation that you have been understood.
4. A physician assistant (PA) is constantly updating his knowledge and skills by attending in-services and
seminars. This PA is practicing which of the "4 Cs of medical malpractice prevention?"
A. Caring
B. Communication
C. Competence
D. Charting
5. For legal purposes, the health care professional should know that if it isn't in writing and explained
completely and accurately, it wasn't done. To which of the following "4 Cs of medical malpractice
prevention" does this statement refer?
A. Caring
B. Communication
C. Competence
D. Charting
6. Administrators of a medical facility are attempting to reduce liability risks in the workplace environment.
Which of the following is a recommended guideline to accomplish this goal?
A. Do not delegate duties to employees.
B. Embark on a therapeutic course immediately.
C. Use the most aggressive treatment first.
D. Have a medical assistant of either sex present during examinations.
7. From a medical/legal standpoint, in an article in the March 2003 issue of Family Practice Management,
Dr. R.J. Roberts of the University of Wisconsin Medical School identified seven common reasons for
medical malpractice lawsuits. Which of the following is not one of these seven identified reasons?
A. Failure to triage emergency department patients
B. Cancer misdiagnosis, wrong diagnosis, or delay in diagnosis
C. Birth injury or negligent maternity care
D. Failure to obtain informed consent
8. The first major study to determine why patients sue hospitals and health care practitioners and what might
prevent an injured patient or his or her family members from filing a lawsuit was conducted in 1992 by
Gerald B. Hickson and others. According to Hickson, which of the following is the most common reason
for patient lawsuits?
A. The plaintiffs recognized a cover-up.
B. The plaintiffs were advised by knowledgeable acquaintances to sue.
C. The plaintiffs recognized their child would have no future.
D. The plaintiffs wanted revenge to protect others from harm.
9. Which of the following was the most highly agreed upon statement of why injured patients sued in the
Charles Vincent et al study?
A. To make the doctor realize how I felt
B. Because my feelings were ignored
C. To receive an explanation
D. To get back at the doctor
10. Just over 41 percent of the respondents in the Vincent study said that certain actions after their injuries
might have prevented litigation. Which of the following is the highest rated action that might prevent
litigation?
A. An explanation and apology
B. Financial compensation
C. An admission of negligence
D. Investigation by the hospital
11. A report by the American Society of Anesthesiologists Committee on Professional Liability stated that
one of the most common reasons patients start legal proceedings is due to which of the following?
A. Financial needs of the injured/family
B. Need for respect and self-worth
C. Cover ups of the adverse events
D. Communication failures between physicians and patients.
12. Which of the following – according to Micalizzi's Suggestions for Things NOT to Say After Medical
Complications – should not be said to the patient or family following an adverse event?
A. "Practices and systems have been changed to prevent a similar event."
B. "These things happen, and you may never know what went wrong."
C. "Your medical bills have been dismissed."
D. "There will be an immediate unbiased investigation with complete disclosure."
13. Using effective interpersonal communication in the physician-patient relationship may help deter
medical malpractice lawsuits. Which of the following is a recommended guideline for therapeutic
communication?
A. Do not use nonverbal communication with patients.
B. Sit rather than stand when interviewing patients.
C. Do not make eye contact with patients.
D. Use defensive body postures to communicate disapproval.
14. Which of the following is a recommended communication technique to prevent medical malpractice
lawsuits?
A. Do not advise patients over the phone.
B. Do not allow patients to participate in the final decision-making process.
C. Avoid statements that could be construed as an admission of fault.
D. Do not insist on a professional consult if the patient is not doing well.
15. Health care practitioners should know that patient records are often used as evidence in medical
malpractice cases, and improper documentation can lose a case. Which of the following does not need to
be documented?
A. Case withdrawals
B. Patient referrals
C. Treatment refusals
D. All non-telephone patient conversations
16. A physician being sued for medical malpractice claims that a patient did not follow the treatment regimen
she prescribed, thereby contributing to his own injury. This physician is using which of the following
defenses?
A. Contributory negligence
B. Denial
C. Comparative negligence
D. Assumption of risk
17. A physician assistant (PA) accused of medical malpractice claims that the charge does not meet all of the
elements of the theory of recovery. Which of the following defenses is being used by the PA?
B. Comparative negligence
C. Denial
18. Many health care professionals use affirmative defenses in medical professional liability suits. With these
defenses, defendants are allowed to present evidence of which of the following?
A. That they are innocent of all wrongdoing
B. That the "4 Ds of negligence" were not met
C. That the charges do not meet the elements of the theory of recovery
D. That the patient's condition was caused by other factors than defendant negligence
19. It was decided in a professional liability suit using the process of comparative negligence that the plaintiff
contributed 30% to the patient injury and the physician contributed 70%. Which of the following would
be the outcome of this case?
A. The patient damage award would be reduced by 30%.
B. No damages would be awarded
C. The patient would be given 30% of the damage award.
D. The patient would be awarded full damages since the percentage is under 50%.
20. In which of the following types of defenses to professional liability suits is informed consent one of the
most important elements?
C. Denial
21. A physician who came to the aid of a person who was injured during an earthquake is being sued by
that person for malpractice. The physician would not be held liable under common law if the defense
established which of the following?
A. An emergency existed that was caused by the plaintiff.
B. The appropriate standard of care was met, given the emergency situation.
C. An emergency existed that was caused by the defendant.
D. The same standard of care was met as would occur in a non-emergency situation.
22. A physician who is named in a malpractice lawsuit uses the defense that the statute of limitations has run
out, and the plaintiff can no longer file charges. This is an example of which of the following types of
defenses?
A. Technical
B. Affirmative
C. Release of tortfeasor
D. Res judicata
23. A victim in a medical malpractice lawsuit receives compensation for all medical expenses from the
defendant. Which of the following would almost always be an absolute defense in this case?
A. Res judicata
B. Release of tortfeasor
C. Statute of limitations
24. A medical malpractice lawsuit has been decided under the doctrine of res judicata. What does this Latin
term mean?
A. "The thing speaks for itself."
B. "The statute of limitations is up."
C. "The tortfeasor has been released."
D. "The thing has been decided."
25. Which of the following accurately describes an element of the doctrine of res judicata?
A If a patient sues a physician for negligence and loses, the patient can still sue the physician for breach
. of contract based on trial evidence.
B If a patient refuses to pay a physician he feels was negligent and the physician sues for money owed
. and wins, the patient can still sue the physician for negligence.
C If a physician has been sued by a nonpaying patient for negligence and does not file a counterclaim for
. the fee during defense, the patient cannot be sued later for unpaid bills.
D. A claim that has been legally resolved cannot be retried between the same parties unless the parties
hire new lawyers.
26. The statute of limitations for filing professional negligence suits varies with states but generally specifies
how many years?
A. 1 to 6 years
B. 2 to 8 years
C. 3 to 5 years
D. 5 to 10 years
27. What is the most common amount of time allowed for filing legal actions, including collections, damages
for child sexual abuse, retaining of medical records, wrongful death claims, medical malpractice, and
many other causes of action?
A. 1 year
B. 2 years
C. 3 years
D. 4 years
28. Establishing when the statute of limitations begins varies with state law, but one of the most common
dates for marking the beginning of the statutory period is which of the following?
A. The day the alleged act was committed
B. One week after the alleged act was committed
C. One month after the injury from the alleged act was discovered
D. The day the physician-patient relationship began
29. The physician who owns a physician's office examines the practices and behaviors of his employees
to determine and eliminate problems that may lead to a malpractice lawsuit. What is the term for this
practice?
A. Credentialing
B. Liability insurance
C. Occurrence insurance
D. Risk management
30. Which of the following is an example of a physician using risk management to reduce the likelihood of a
malpractice lawsuit against his office?
A. Reducing the incidence of telephone conversations with patients
B. Discouraging employees from providing graphic detail in reports
C. Providing written job descriptions for employees
D. Removing standard office procedure manuals from medical offices
31. Methods used to manage risk are considered a part of which of the following?
A. Assumption of risk
B. Quality assurance
D. Telemedicine
32. The employer physician puts a plan in place to ensure that all government regulations are enforced in her
office. What is the term for this plan?
A. Compliance
C. Government contract
D. Credentialing
33. Which of the following would most likely be involved in completing the process of credentialing for
health care institutions and organizations?
A. Similar health care organizations
B. The employees of a health care organization
C. An insurance company
D. An attorney
34. What instrument of risk management is particularly beneficial for following coding and billing
regulations for Medicare, Medicaid, and other government plans?
A. Quality improvement
C. Compliance plan
D. Credentialing
35. A health care clinic begins the process to receive credentialing. Which of the following is the final step
verifying a health care provider's credentials?
A. A credentialing committee reviews the credentials provided
B. A provider presents copies of requested credentials
C. The National Practitioner Data Bank checks sanctions and malpractice history
D. A peer review process approves the credentialing procedure
36. A physician purchases liability insurance to work in a partnership with other physicians. What does this
insurance cover?
A. The cost of any lawsuits incurred against the physician
B. Potential damages incurred as a result of a negligent act
C. Loss of income due to injury in the workplace
D. Supplemental income due to work stoppages
37. Upon which of the following is the cost of a liability premium based?
A. Physician specialty and dollar amount covered by the policy
B. Physician credentials and ability to pay the policy
C. Number of employees and number of incidences that will be covered
D. Government agencies regulating the purchase of liability insurance by all physicians
38. A physician decides his liability insurance coverage is too high and drops the policy. On which of the
following aspects of this physician's employment will this decision have the greatest impact?
A. Attracting new patients
B. Employing competent staff
C. Making health benefit claims
D. Having hospital privileges
39. A physician assistant carries claims-made liability insurance to protect against malpractice suits. Which
of the following describes the coverage this policy would provide for the designated period?
A. The determining factor is when the claim is made, not when the injury occurs.
B. It covers the insured for those claims made and any injury occurring.
C. It covers the insured for all claims regardless of when the claim is made.
D. It extends coverage for malpractice occurring during coverage by an occurrence policy.
40. Which of the following insurance policies covers incidents that occurred before the beginning of the new
insurance relationship but have not yet been brought to the insured's attention as a claim?
A. Occurrence insurance
B. Tail coverage
C. Prior acts insurance coverage
D. Self-insurance coverage
41. A physician who has liability insurance finds that a lawsuit is imminent. Which of the following is a
recommended guideline when this occurs?
A. Wait until a lawsuit is filed to notify the insurance company.
B. Discuss the lawsuit over the phone with the insurance agent.
C. Do not mention the lawsuit in any correspondence.
D. Call a trusted personal attorney for representation in the lawsuit.
42. As medical malpractice insurance premiums have continued to rise, self-insurance coverage has become
an option for health care practitioners in some states. What is one advantage of self-insurance coverage?
A. Guaranteed hospital privileges

B. Lower premiums
C. No fees for managing the plan
D. Higher coverage limits
43. There are three types of insurance that health care practitioners can purchase to extend coverage of a
canceled claims-made policy or for claims-made coverage when the insured switches to a different
insurance carrier. Which of the following is not an extended insurance plan?
B. Tail coverage
C. Prior acts insurance
D. Self-insurance
44. A physician who listens carefully to each patient's remarks about their treatment is protecting himself
against a medical malpractice lawsuit by using one of the "4 Cs of medical malpractice prevention"
known as _________________.
________________________________________
45. Taking telephone messages and relating them accurately involves one of the "4 Cs of medical malpractice
prevention" known as ___________________.
________________________________________
46. A physician assistant who follows the standards of care and appropriate procedures for medical
practitioners in similar practices and in similar communities is practicing one of the "4 Cs of medical
malpractice prevention" known as _______________________.
________________________________________
47. A competent RN would check medications _______________times prior to administering them to
patients.
________________________________________
48. For legal purposes, if it isn't in writing and explained completely and accurately, it wasn't
done. This concept applies to one of the "4 Cs of medical malpractice prevention" known as
____________________.
________________________________________
49. To prevent malpractice litigation, physicians should exhaust all reasonable methods of securing a
______________ before embarking on a therapeutic course.
________________________________________
50. Physicians often diagnose and prescribe medication for new and established patients over the Internet
now that ______________________ has become more commonplace.
________________________________________
51. Except in __________________, male physicians should not examine female patients and female
physicians should not examine male patients unless an assistant, a nurse, or a member of the patient's
family is present.
________________________________________
52. As required by the ________________________________________ employees should have access to
Material Safety Data Sheets (MSDS) for each hazardous chemical in use in the medical facility.
________________________________________
53. According to Dr. R.J. Roberts of the University of Wisconsin Medical School, one of the seven common
reasons for medical malpractice lawsuits is misdiagnosis of, failure to diagnose, or delay in diagnosis of
__________________________.
________________________________________
54. According to Hickson's study, the most common reason patients sue for medical malpractice is the
plaintiff is advised by knowledgeable ______________ to sue.
________________________________________
55. It was agreed that preventing injury from happening to anyone else was one of the top reasons patients
sued for medical malpractice in a study conducted by _____________________ and others.
________________________________________
56. According to the Vincent study, the third most commonly stated action that might have prevented
medical malpractice litigation was ____________________________.
________________________________________
one of the most common reasons patients start legal proceedings is due to __________________ failures
between physicians and patients.
________________________________________
58. In order to show patients she cares, a nurse who is conducting a health interview of a patient should be in
a ___________________position.
________________________________________
59. Patients should be encouraged to ask questions and to participate in the decision-making process. The
best way to keep patients' expectations in line is through ______________________.
________________________________________
60. It is the responsibility of the physician to explain procedures including risks and possible
complications and make sure that all patients or their authorized representatives sign
___________________________forms before undergoing medical and surgical procedures.
________________________________________
61. Physicians should insist on a ______________________ if the patient is not doing well, if he or she is
unhappy and complaining, or if the patient's family expresses dissatisfaction.
________________________________________
62. If a physician is retiring, moving to another location, leaving the practice of medicine, or otherwise
becoming unavailable, patients should be informed, and a copy of a letter of referral, notice of a
physician's intended absence from practice, or letter of _____________________ should be placed in the
patient's record.
________________________________________
63. A patient's decision to decline treatment, evaluation, or testing should be documented in the patient
record. "_________________________" should be obtained with respect to any treatment or procedure
which could have either diagnostic or therapeutic consequences.
________________________________________
64. A nurse is carefully explaining a procedure to a patient. She asks for confirmation from the patient that
her explanation has been understood and gives the patient the opportunity to ask questions, which she
carefully and competently answers. One of the 4 Cs of medical malpractice prevention the nurse is
practicing is__________________.
________________________________________
65. A physician who asserts her innocence as a defense in a professional liability suit is using the
________________defense.
________________________________________
66. When a health care professional presents factual evidence that the patient's condition was caused by some
factor other than his or her negligence, a __________________ defense is being used.
________________________________________
67. A person is injured in a car accident. A nurse is the first person on the scene, and he uses a tourniquet
to stop the victim's arterial bleeding in her leg, thus saving her life. The car accident victim later
claims permanent damage to her leg and sues the nurse for medical malpractice. This nurse is using the
___________________affirmative defense.
________________________________________
68. In a medical malpractice lawsuit, a physician claims that a patient contributed to his own injury by
not maintaining bedrest when ordered to do so. This is an example of the defense claim known as
__________________________________.
________________________________________
69. The court decides that a patient through her own negligence contributed 40% toward the injury and
the physician contributed 60% and awards damages based on these percentages. This is an example of
______________________________.
________________________________________
70. A patient who signs an informed consent for cardiac surgery and experiences an adverse event
sues her surgeon. The surgeon's defense is based on the contention that the patient knew of the
inherent risks before the surgery was performed and agreed to those risks. This surgeon is using the
___________________________defense.
________________________________________
71. ____________________ defenses include those that claim the statute of limitations has run
out, there is insufficient evidence to support the plaintiff's claim of negligence, and the assertion that the
plaintiff has no standing to sue.
________________________________________
72. A physician being sued for a wrongful death claim states that the period of time established by state law
during which a lawsuit may be filed has expired. This physician is using the technical defense known as
________________________________.
________________________________________
73. _________________________involves identifying problem practices or behaviors, then eliminating or
controlling them.
________________________________________
74. Methods used to manage risk are part of quality ____________________or assurance, a program of
practices performed by health care providers and practitioners to uphold the quality of patient care and to
reduce liability risk.
________________________________________
75. A risk management team for a medical facility ensures that all governmental regulations are being
followed by devising a ______________________plan.
________________________________________
76. ___________________ is the process of verifying a health care provider's credentials.
________________________________________
77. Administrators of a medical facility apply for credentialing. In the final step of the process, a
_______________________completes the credentialing procedure.
________________________________________
78. Because costs for defending a medical malpractice lawsuit can be high,
__________________________may be purchased to cover the costs up to the limits of the policy.
________________________________________
79. The cost of liability insurance premiums for a physician is based on the physician's ________________
and the dollar amount covered by the policy.
________________________________________
80. A physician who drops liability insurance may be at risk for losing ______________ privileges.
________________________________________
81. _____________________insurance covers the insured only for those claims made (not for any injury
occurring) while the policy is in force.
________________________________________
82. A physician signs up for a liability insurance policy that covers him for any claims arising from an
incident that occurred, or is alleged to occur when the policy is in force.
This type of insurance is called ______________________insurance.
________________________________________
83. A physician assistant whose claims-made liability insurance policy is discontinued signs up for
___________________coverage to continue coverage for those dates that claims-made coverage was in
effect.
________________________________________
84. ____________________________is another name for tail coverage liability insurance.
________________________________________
85. _________________________covers incidents that occurred before the beginning of the new
insurance relationship but have not yet been brought to the insured's attention as a claim.
________________________________________
86. Another name for prior acts insurance coverage is ______________coverage.
________________________________________
87. A physician and his partners contribute to a trust fund with a specified limit to be
used in paying potential medical malpractice awards. This type of policy is called
______________________________coverage.
________________________________________
88. In a self-insurance liability insurance policy, the _______________________charges fees for managing
the policy.
________________________________________
89. A disadvantage of self-insurance liability policies occurs because hospitals must agree to accept self-
insurance plans for those physicians who apply for _____________________.
________________________________________
90. A physician working in a medical facility applies for self-insurance liability coverage. The major
advantage of this type of insurance is ___________________________.
________________________________________
91. Some insurance contracts mandate that the attorneys of the ______________________ represent the
insured physician.
________________________________________
92. Once a lawsuit seems imminent, the health care practitioner and/or his or her employees should
not mention the suit on the telephone or in correspondence unless the insurance company's
_________________ approves such a reference.
________________________________________
93. A cab driver causes injury to a passenger by causing an accident. The passenger is treated by a physician
who happens to be on the scene. In most states, the driver who caused the accident is liable both for the
victim's injury and for any medical negligence by the physician who treats the injured victim. This is the
basis for the _________________________________defense.
94. Under the doctrine of __________________ "The thing has been decided," a claim cannot be retried
between the same parties if it has already been legally resolved.
6 Key
1. A health care practitioner who practices the "four Cs of medical malpractice prevention" finds two
important benefits related to one of the "Cs", that is, improvement in patients' medical condition and
decreased likelihood that they will sue. Which "C" is most likely to provide these benefits?
A. Caring
B. Communication
C. Competence
D. Charting
There are two important benefits to showing patients a caring attitude. First is improvement in their
medical condition. A secondary benefit is the decreased likelihood that patients will feel the need to
sue if treatment has unsatisfactory results, or if adverse events occur. Of course it is important that the
practitioner be sincere, because others often quickly sense insincerity and may then be distrustful.
Blooms: Understanding
Difficulty: Medium
Judson - Chapter 006 #1
Learning Outcome: 6.1 List and define the four Cs of medical malpractice prevention.
2. When showing people they care, what would be the best advice for a nurse caring for patients who
have complaints about dissatisfaction with their treating physicians?
A. Listen to the patients and verbally agree with them if indeed the physician is incompetent.
B. Ask the patients to describe the physician's behavior and tell them how patient care will be
improved under the new health care team.
C. Listen carefully to the patient's complaints and remarks and see that the comments reach the
treating physician.
D. Do not allow the patients to speak about their physicians, rather steer the conversation to the
present treatment.
Health care practitioners should avoid destructive and unethical criticism of the work of physicians
and/or other health care practitioners. They should not discuss with a patient his or her former
physician. Instead, they should listen carefully to each patient's complaints and remarks about
dissatisfaction with treatment, and see that the comments reach the treating physician.
Blooms: Applying
Difficulty: Medium
3. Therapeutic communication is key to avoiding medical malpractice lawsuits. Which of the following
is a recommended guideline when communicating with patients?
A. Clearly state that it is not within your scope of practice to make appointments.
B. If adverse events occur, do not report the event immediately until damage is assessed.
C. When adverse events occur, try to avoid or ignore the patients involved.
D. Communicate clearly and ask for confirmation that you have been understood.
Health care practitioners who communicate clearly and ask for confirmation that they have
been understood, will be more likely to earn their patients' and colleagues' trust and respect. The
practitioner should offer to make appointments when appropriate, and when adverse events occur, use
correct procedures in reporting the event, and never avoid or ignore any patients involved.
Blooms: Applying
Difficulty: Medium
4. A physician assistant (PA) is constantly updating his knowledge and skills by attending in-services
and seminars. This PA is practicing which of the "4 Cs of medical malpractice prevention?"
A. Caring
B. Communication
C. Competence
D. Charting
In order to be competent, the health care professional should stay informed about general medical and
scientific progress by reading professional journals, attending seminars and professional association
meetings, and fulfilling continuing study requirements.
Blooms: Applying
Difficulty: Medium
5. For legal purposes, the health care professional should know that if it isn't in writing and explained
completely and accurately, it wasn't done. To which of the following "4 Cs of medical malpractice
prevention" does this statement refer?
A. Caring
B. Communication
C. Competence
D. Charting
Documentation is proof. For legal purposes, if it isn't in writing and explained completely and
accurately, it wasn't done. Medical records should include X-rays, test results, progress notes, and
anything else related to the patient's medical treatment.
Blooms: Remembering
Difficulty: Easy
6. Administrators of a medical facility are attempting to reduce liability risks in the workplace
environment. Which of the following is a recommended guideline to accomplish this goal?
A. Do not delegate duties to employees.
B. Embark on a therapeutic course immediately.
C. Use the most aggressive treatment first.
D. Have a medical assistant of either sex present during examinations.
Physicians can protect themselves from unfounded patient charges by having a nurse, physician
assistant, or medical assistant of either sex present during examinations. Physician employers
should carefully select and supervise all employees and should be careful in delegating duties to
them, expecting them to perform only those duties they may reasonably be expected to perform.
Physicians should exhaust all reasonable methods of securing a diagnosis before embarking on a
therapeutic course. Physicians should use conservative and the least dangerous methods of diagnosis
and treatment whenever possible, rather than those that involve highly toxic agents or risky surgical
procedures.
Difficulty: Medium
7. From a medical/legal standpoint, in an article in the March 2003 issue of Family Practice
Management, Dr. R.J. Roberts of the University of Wisconsin Medical School identified seven
common reasons for medical malpractice lawsuits. Which of the following is not one of these seven
identified reasons?
A. Failure to triage emergency department patients
B. Cancer misdiagnosis, wrong diagnosis, or delay in diagnosis
C. Birth injury or negligent maternity care
D. Failure to obtain informed consent
Seven common reasons for medical malpractice lawsuits include: cancer misdiagnosis, failure to
diagnose, or a delay in diagnosis, birth injury or negligent maternity care, failure to obtain informed
consent, wrong diagnosis and misdiagnosis of negligent fracture or trauma, delay in diagnosis or
failure to consult in a timely manner, medication errors or medication malpractice resulting from
negligent drug treatment, and malpractice resulting from a physician's negligent procedures or surgical
errors.
Difficulty: Medium
8. The first major study to determine why patients sue hospitals and health care practitioners and what
might prevent an injured patient or his or her family members from filing a lawsuit was conducted
in 1992 by Gerald B. Hickson and others. According to Hickson, which of the following is the most
common reason for patient lawsuits?
A. The plaintiffs recognized a cover-up.
B. The plaintiffs were advised by knowledgeable acquaintances to sue.
C. The plaintiffs recognized their child would have no future.
D. The plaintiffs wanted revenge to protect others from harm.
Hickson's seven reasons why patients sue in order of frequency are that the plaintiffs: were advised
by knowledgeable acquaintances to sue, recognized a cover-up, needed money, recognized the child
would have no future, needed information about what happened, and wanted revenge to protect others
from harm.
Difficulty: Medium
9. Which of the following was the most highly agreed upon statement of why injured patients sued in the
Charles Vincent et al study?
A. To make the doctor realize how I felt
B. Because my feelings were ignored
C. To receive an explanation
D. To get back at the doctor
91% of participants agreed that people sued to receive an explanation or to prevent injury from
happening to anyone else. 68% agreed that people sued to make doctors realize how they felt and 67%
agreed that people sued because their feelings were ignored. 23% agreed that people sued to get back
at the doctor.
Difficulty: Medium
10. Just over 41 percent of the respondents in the Vincent study said that certain actions after their injuries
might have prevented litigation. Which of the following is the highest rated action that might prevent
litigation?
A. An explanation and apology
B. Financial compensation
C. An admission of negligence
D. Investigation by the hospital
The most agreed upon actions that might prevent litigation in order of frequency are: (1) an
explanation and apology, (2) correction of the mistake, (3) financial compensation, (4) correct
treatment at the time, (5) an admission of negligence, (6) should have been listened to, (7) disciplinary
action against medical personnel involved, (8) honesty, and (9) investigation by the hospital.
Difficulty: Medium
one of the most common reasons patients start legal proceedings is due to which of the following?
A. Financial needs of the injured/family
B. Need for respect and self-worth
C. Cover ups of the adverse events
D. Communication failures between physicians and patients.
A report by the American Society of Anesthesiologists Committee on Professional Liability stated

that one of the most common reasons patients start legal proceedings is due to communication failures
between physicians and patients.
Difficulty: Medium
12. Which of the following – according to Micalizzi's Suggestions for Things NOT to Say After Medical
Complications – should not be said to the patient or family following an adverse event?
A. "Practices and systems have been changed to prevent a similar event."
B. "These things happen, and you may never know what went wrong."
C. "Your medical bills have been dismissed."
D. "There will be an immediate unbiased investigation with complete disclosure."
The statement "These things happen, and you may never know what went wrong" should not be
said following an adverse event. The other statements are things patients and families want and need
following a complication, according to Micalizzi.
Blooms: Applying
Difficulty: Medium
13. Using effective interpersonal communication in the physician-patient relationship may help deter
medical malpractice lawsuits. Which of the following is a recommended guideline for therapeutic
communication?
A. Do not use nonverbal communication with patients.
B. Sit rather than stand when interviewing patients.
C. Do not make eye contact with patients.
D. Use defensive body postures to communicate disapproval.
Health care practitioners should develop good listening skills and nonverbal communication
techniques so that patients feel the time spent with them is not rushed. For example, patients will see a
health care practitioner as caring and interested if he or she sits rather than stands while interviewing
or conversing with the patient. Conversely, lack of eye contact and defensive body postures convey
disinterest to a patient. In short, obey the Golden Rule when communicating with patients.
Blooms: Applying
Difficulty: Medium
14. Which of the following is a recommended communication technique to prevent medical malpractice
lawsuits?
A. Do not advise patients over the phone.
B. Do not allow patients to participate in the final decision-making process.
C. Avoid statements that could be construed as an admission of fault.
D. Do not insist on a professional consult if the patient is not doing well.
Health care professionals should avoid statements that could be construed as an admission of fault
on the physician's part. They should set apart time each day for telephone consultations, allow
patients to participate in the decision-making process, and insist on a professional consult if the
patient is not doing well, if he or she is unhappy and complaining, or if the patient's family expresses
dissatisfaction.
Blooms: Applying
Difficulty: Medium
15. Health care practitioners should know that patient records are often used as evidence in medical
malpractice cases, and improper documentation can lose a case. Which of the following does not need
to be documented?
A. Case withdrawals
B. Patient referrals
C. Treatment refusals
D. All non-telephone patient conversations
Health care professionals should record referrals, missed appointments, dismissals, treatment refusals,
and all other patient contact, such as tests, procedures, and medications prescribed, including refills.
Only pertinent information needs to be recorded for patient conversations.
Blooms: Remembering
Difficulty: Easy
16. A physician being sued for medical malpractice claims that a patient did not follow the treatment
regimen she prescribed, thereby contributing to his own injury. This physician is using which of the
following defenses?
B. Denial
Contributory negligence is an affirmative defense that alleges that the plaintiff, through a lack of care,
caused or contributed to his or her own injury. Denial is a defense that claims innocence of the charges
or that one or more of the four Ds of negligence are lacking. Comparative negligence is an affirmative
defense claimed by the defendant, alleging that the plaintiff contributed to the injury by a certain
degree. Assumption of risk is a defense based on the contention that the patient knew of the inherent
risks before treatment was performed and agreed to those risks.
Blooms: Applying
Difficulty: Medium
Learning Outcome: 6.2 Describe the various defenses to professional liability suits.
17. A physician assistant (PA) accused of medical malpractice claims that the charge does not meet all of
the elements of the theory of recovery. Which of the following defenses is being used by the PA?
C. Denial
Denial of wrongdoing, or the assertion of innocence, may be used as a defense in professional liability
suits. If some of the alleged facts are true, defendants may not claim innocence. Instead, they should
claim that the charge or charges do not meet all of the elements of the theory of recovery. In other
words, the charge may be missing one of the four Ds of negligence.
Blooms: Applying
Difficulty: Medium
18. Many health care professionals use affirmative defenses in medical professional liability suits. With
these defenses, defendants are allowed to present evidence of which of the following?
A. That they are innocent of all wrongdoing
B. That the "4 Ds of negligence" were not met
C. That the charges do not meet the elements of the theory of recovery
D. That the patient's condition was caused by other factors than defendant negligence
Affirmative defenses that may be used by the defendant in a medical professional liability suit allow
the accused to present factual evidence that the patient's condition was caused by some factor other
than the defendant's negligence. Denial of wrongdoing, or the assertion of innocence, may be used as
a defense in professional liability suits. If some of the alleged facts are true, defendants may not claim
innocence. Instead, they should claim that the charge or charges do not meet all of the elements of the
theory of recovery. In other words, the charge may be missing one of the "four Ds of negligence."
Blooms: Remembering
Difficulty: Easy
19. It was decided in a professional liability suit using the process of comparative negligence that the
plaintiff contributed 30% to the patient injury and the physician contributed 70%. Which of the
following would be the outcome of this case?
A. The patient damage award would be reduced by 30%.
B. No damages would be awarded
C. The patient would be given 30% of the damage award.
D. The patient would be awarded full damages since the percentage is under 50%.
In some states, damages are apportioned according to the degree to which a plaintiff contributed to the
injury. This is called comparative negligence. In this instance, the court decided that a patient, through
his or her own negligence, contributed 30 percent toward the injury and the physician contributed 70
percent, therefore, the patient's damage award would be reduced by 30 percent.
Blooms: Applying
Difficulty: Medium
20. In which of the following types of defenses to professional liability suits is informed consent one of
the most important elements?
C. Denial
Assumption of risk is a defense based on the contention that the patient knew of the inherent risks
before treatment was performed and agreed to those risks. Informed consent is vital to this defense,
since the defendant must show that the patient was fully informed of the risks prior to treatment and
that the risks inherent in the treatment were the cause of the patient's injury. Contributory negligence
is an affirmative defense that alleges that the plaintiff, through a lack of care, caused or contributed
to his or her own injury. Comparative negligence is an affirmative defense claimed by the defendant,
alleging that the plaintiff contributed to the injury by a certain degree. Denial is a defense that claims
innocence of the charges or that one or more of the four Ds of negligence are lacking.
Difficulty: Medium
21. A physician who came to the aid of a person who was injured during an earthquake is being sued by
that person for malpractice. The physician would not be held liable under common law if the defense
established which of the following?
A. An emergency existed that was caused by the plaintiff.
B. The appropriate standard of care was met, given the emergency situation.
C. An emergency existed that was caused by the defendant.
D. The same standard of care was met as would occur in a non-emergency situation.
The health care practitioner who comes to the aid of a victim in an emergency would not be held liable
under common law if the defense established that (1) A true emergency situation existed and was
not caused by the defendant, and (2) The appropriate standard of care was met, given the emergency
situation.
Difficulty: Medium
22. A physician who is named in a malpractice lawsuit uses the defense that the statute of limitations
has run out, and the plaintiff can no longer file charges. This is an example of which of the following
types of defenses?
A. Technical
B. Affirmative
C. Release of tortfeasor
D. Res judicata
When defenses to liability suits are based on legal technicalities, instead of on factual evidence, they
are called technical defenses. Technical defenses include those that claim the statute of limitations has
run out, there is insufficient evidence to support the plaintiff's claim of negligence, and the assertion
that the plaintiff has no standing to sue. Affirmative defenses allow the accused to present factual
evidence that the patient's condition was caused by some factor other than the defendant's negligence.
Release of tortfeasor is a technical defense that prohibits a lawsuit against the person who caused
an injury (the tortfeasor) if he or she was expressly released from further liability in the settlement
of a suit. Under the doctrine of res judicata, "The thing has been decided," a claim cannot be retried
Blooms: Applying
Difficulty: Medium
23. A victim in a medical malpractice lawsuit receives compensation for all medical expenses from the
defendant. Which of the following would almost always be an absolute defense in this case?
A. Res judicata
B. Release of tortfeasor
C. Statute of limitations
Release of tortfeasor is a technical defense that prohibits a lawsuit against the person who caused an
injury (the tortfeasor) if he or she was expressly released from further liability in the settlement of a
suit. If the victim's settlement with the tortfeasor provided compensation for all medical expenses,
the release of tortfeasor is usually an absolute defense. Under the doctrine of res judicata, "The thing
has been decided," a claim cannot be retried between the same parties if it has already been legally
resolved. Statute of limitations is that period of time established by state law during which a lawsuit
may be filed. Assumption of risk is a legal defense that holds that the defendant is not guilty of a
negligent act because the plaintiff knew of and accepted beforehand any risks involved.
Difficulty: Medium
24. A medical malpractice lawsuit has been decided under the doctrine of res judicata. What does this
Latin term mean?
A. "The thing speaks for itself."
B. "The statute of limitations is up."
C. "The tortfeasor has been released."
D. "The thing has been decided."
Under the doctrine of res judicata, "The thing has been decided," a claim cannot be retried between
the same parties if it has already been legally resolved. Res ipsa loquitur is Latin for "the thing speaks
for itself." It is also known as the doctrine of common knowledge. It means that the mistake is so
obvious—such as leaving a sponge or surgical instrument inside a patient after surgery or operating on
the wrong body part—that negligence is obvious. Statute of limitations and release of tortfeasor are
separate defenses.
Difficulty: Medium
25. Which of the following accurately describes an element of the doctrine of res judicata?
A If a patient sues a physician for negligence and loses, the patient can still sue the physician for
. breach of contract based on trial evidence.
B If a patient refuses to pay a physician he feels was negligent and the physician sues for money owed
. and wins, the patient can still sue the physician for negligence.
CIf a physician has been sued by a nonpaying patient for negligence and does not file a counterclaim
. for the fee during defense, the patient cannot be sued later for unpaid bills.
D. A claim that has been legally resolved cannot be retried between the same parties unless the parties
hire new lawyers.
Under the doctrine of res judicata,"The thing has been decided," a claim cannot be retried between
the same parties if it has already been legally resolved. If a physician has been sued by a nonpaying
patient for negligence and does not file a counterclaim for the fee while defending the suit, the patient
cannot be sued later for unpaid bills. Also, if a patient sues a physician for negligence and loses, the
patient cannot then sue the physician for breach of contract based on evidence presented in the trial
for negligence. If a patient refuses to pay a physician's fees on the grounds that the physician was
negligent and the physician sues for money owed and wins, the patient cannot then sue the physician
for negligence. However, if the patient fails to respond to the suit (defaults) or does not allege
negligence in his or her defense, then usually he or she may sue the physician for negligence.
Blooms: Analyzing
Difficulty: Difficult
26. The statute of limitations for filing professional negligence suits varies with states but generally
specifies how many years?
A. 1 to 6 years
B. 2 to 8 years
C. 3 to 5 years
D. 5 to 10 years
The statute of limitations is that period of time established by state law during which a lawsuit may be
filed. The statute of limitations for filing professional negligence suits varies with states but generally
specifies one to six years.
Blooms: Remembering
Difficulty: Easy
27. What is the most common amount of time allowed for filing legal actions, including collections,
damages for child sexual abuse, retaining of medical records, wrongful death claims, medical
malpractice, and many other causes of action?
A. 1 year
B. 2 years
C. 3 years
D. 4 years
The statute of limitations for filing professional negligence suits varies with states but generally
specifies one to six years, with two years being most common. In other words, patients may not file
suit for negligence against physicians if the designated length of time has elapsed.
Blooms: Remembering
Difficulty: Easy
28. Establishing when the statute of limitations begins varies with state law, but one of the most common
dates for marking the beginning of the statutory period is which of the following?
A. The day the alleged act was committed
B. One week after the alleged act was committed
C. One month after the injury from the alleged act was discovered
D. The day the physician-patient relationship began
The statute of limitations is usually marked at: (1) the day the alleged negligent act was committed, or
(2) when the injury resulting from the alleged negligence was actually discovered or should have been
discovered by a reasonably alert patient, or (3) the day the physician–patient relationship ended or the
day of the last medical treatment in a series.
Difficulty: Medium
29. The physician who owns a physician's office examines the practices and behaviors of his employees
to determine and eliminate problems that may lead to a malpractice lawsuit. What is the term for this
practice?
A. Credentialing
B. Liability insurance
C. Occurrence insurance
D. Risk management
Risk management is one approach to reducing the likelihood of a malpractice lawsuit. Risk
management involves identifying problem practices or behaviors, then eliminating or controlling
them. Credentialing is the process of verifying a health care provider's credentials. Because costs for
defending a medical malpractice lawsuit can be high, liability insurance may be purchased to cover
the costs up to the limits of the policy. Occurrence insurance covers the insured for any claims arising
from an incident that occurred or is alleged to have occurred while the policy is in force, regardless of
when the claim is made.
Blooms: Applying
Difficulty: Medium
Learning Outcome: 6.3 Explain the purpose of quality improvement and risk management within a health care facility.
30. Which of the following is an example of a physician using risk management to reduce the likelihood
of a malpractice lawsuit against his office?
A. Reducing the incidence of telephone conversations with patients
B. Discouraging employees from providing graphic detail in reports
C. Providing written job descriptions for employees
D. Removing standard office procedure manuals from medical offices
Risk management activities that may help avoid litigation include: providing written job descriptions
for health care practice employees and providing office procedures manuals and employee handbooks
that can help avoid misunderstanding and mistakes that lead to liability risks. Other common health
care facility activities that may affect the likelihood or course of litigation include: medical record
charting, patient scheduling, writing prescriptions, and communicating with patients including
telephone consultations.
Blooms: Applying
Difficulty: Medium
31. Methods used to manage risk are considered a part of which of the following?
A. Assumption of risk
D. Telemedicine
Methods used to manage risk are part of quality improvement (QI)orquality assurance:a program of
practices performed by health care providers and practitioners to uphold the quality of patient care
and to reduce liability risk. Assumption of risk is a legal defense that holds that the defendant is not
guilty of a negligent act because the plaintiff knew of and accepted beforehand any risks involved.
Comparative negligence is an affirmative defense claimed by the defendant, alleging that the plaintiff
contributed to the injury by a certain degree. With telemedicine physicians often diagnose and
prescribe medication for new patients and for established patients over the Internet, which could
potentially lead to liability and be an area of concentration for risk management.
Blooms: Applying
Difficulty: Medium
32. The employer physician puts a plan in place to ensure that all government regulations are enforced in
her office. What is the term for this plan?
A. Compliance
C. Government contract
D. Credentialing
Quality improvement and risk managers may assume responsibility for compliance with federal, state,
and other health care regulatory agencies. A compliance plan is developed to help ensure that all
governmental regulations are followed. Such a plan is especially beneficial for following coding and
billing regulations for Medicare, Medicaid, and other government plans. Credentialing is the process
of verifying a health care provider's credentials.
Blooms: Applying
Difficulty: Medium
33. Which of the following would most likely be involved in completing the process of credentialing for
health care institutions and organizations?
A. Similar health care organizations
B. The employees of a health care organization
C. An insurance company
D. An attorney
Credentialing is the process of verifying a health care provider's credentials. The process may be
performed by an insurance company before a provider is admitted to the network, by medical offices
prior to granting hospital privileges, or by other groups who routinely employ or contract with health
care providers.
Difficulty: Medium
34. What instrument of risk management is particularly beneficial for following coding and billing
regulations for Medicare, Medicaid, and other government plans?
A. Quality improvement
C. Compliance plan
D. Credentialing
A compliance plan is developed to help ensure that all governmental regulations are followed. Such
a plan is especially beneficial for following coding and billing regulations for Medicare, Medicaid,
and other government plans. These plans are one aspect of quality improvement/quality assurance.
Credentialing is the process of verifying a health care provider's credentials.
Blooms: Applying
Difficulty: Medium
35. A health care clinic begins the process to receive credentialing. Which of the following is the final
step verifying a health care provider's credentials?
A. A credentialing committee reviews the credentials provided
B. A provider presents copies of requested credentials
C. The National Practitioner Data Bank checks sanctions and malpractice history
D. A peer review process approves the credentialing procedure
Credentialing usually consists of the following: (1) A provider fills out an application and attaches
copies of his or her medical license, proof of malpractice insurance coverage, and other requested
credentials, (2) The listed sources are asked to verify the information, (3) Medicare and Medicaid
sanctions and malpractice history are checked via the National Practitioner Data Bank, (4) The
findings are presented to a credentialing committee, and (5) A peer review process completes the
credentialing procedure.
Difficulty: Medium
36. A physician purchases liability insurance to work in a partnership with other physicians. What does
this insurance cover?
A. The cost of any lawsuits incurred against the physician
B. Potential damages incurred as a result of a negligent act
C. Loss of income due to injury in the workplace
D. Supplemental income due to work stoppages
Liability insurance is contract coverage for potential damages incurred as a result of a negligent act
and does not cover all lawsuits against an individual or organization. Workman's compensation may
cover an employee for loss of income due to injury, and unemployment insurance may cover loss of
income due to unemployment.
Difficulty: Medium
Learning Outcome: 6.4 Discuss five different types of medical liability insurance.
37. Upon which of the following is the cost of a liability premium based?
A. Physician specialty and dollar amount covered by the policy
B. Physician credentials and ability to pay the policy
C. Number of employees and number of incidences that will be covered
D. Government agencies regulating the purchase of liability insurance by all physicians
The cost of liability insurance premiums for a physician is based on the physician's specialty and the
dollar amount covered by the policy. Insurance for those physicians in the least risky insurance risk
class (for example, family practitioners and specialists who do not perform surgery) is generally less
costly than insurance for those in specialties considered riskier (for example, orthopedic surgeons and
obstetricians).
Difficulty: Medium
38. A physician decides his liability insurance coverage is too high and drops the policy. On which of the
following aspects of this physician's employment will this decision have the greatest impact?
A. Attracting new patients
B. Employing competent staff
C. Making health benefit claims
D. Having hospital privileges
Some physicians drop liability insurance coverage when rates become too high. However, this
can adversely affect a physician's practice, since most hospitals require proof of coverage up to a
predetermined minimum amount to grant hospital privileges. In addition, managed care organizations
require physicians to provide proof of liability insurance coverage as a prerequisite for entering into a
contractual agreement and as a component of their credentialing process.
Blooms: Applying
Difficulty: Medium
39. A physician assistant carries claims-made liability insurance to protect against malpractice suits.
Which of the following describes the coverage this policy would provide for the designated period?
A. The determining factor is when the claim is made, not when the injury occurs.
B. It covers the insured for those claims made and any injury occurring.
C. It covers the insured for all claims regardless of when the claim is made.
D. It extends coverage for malpractice occurring during coverage by an occurrence policy.
Claims-made insurance covers the insured only for those claims made (not for any injury occurring)
while the policy is in force. With this kind of insurance, the determining factor is when the claim is
made, not when the injury occurs. Occurrence insurance(also known as claims-incurred insurance)
covers the insured for any claims arising from an incident that occurred or is alleged to have occurred
while the policy is in force, regardless of when the claim is made. When a claims-made policy is
discontinued, tail coverage is an option available to health care practitioners from their former carriers
to continue coverage for those dates that claims-made coverage was in effect.
Blooms: Applying
Difficulty: Medium
40. Which of the following insurance policies covers incidents that occurred before the beginning of the
new insurance relationship but have not yet been brought to the insured's attention as a claim?
B. Tail coverage
C. Prior acts insurance coverage
D. Self-insurance coverage
Prior acts coverage, also known as "nose" coverage, covers incidents that occurred prior to the
beginning of the new insurance relationship but have not yet been brought to the insured's attention
as a claim. Occurrence insurance covers the insured for any claims arising from an incident that
occurred, or is alleged to have occurred, during the time the policy is in force, regardless of when
the claim is made. When a claims-made policy is discontinued, tail coverage extends coverage for
malpractice claims alleged to have occurred during those dates that claims-made coverage was
in effect. Self-insurance coverage is an insurance coverage option whereby insured subscribers
contribute to a trust fund to be used in paying potential damage awards.
Blooms: Applying
Difficulty: Medium
41. A physician who has liability insurance finds that a lawsuit is imminent. Which of the following is a
recommended guideline when this occurs?
A. Wait until a lawsuit is filed to notify the insurance company.
B. Discuss the lawsuit over the phone with the insurance agent.
C. Do not mention the lawsuit in any correspondence.
D. Call a trusted personal attorney for representation in the lawsuit.
Physicians and other health care practitioners should notify their insurance companies immediately
if advised of the possibility of a malpractice lawsuit. Insurance companies almost always provide
legal representation for covered physicians, and some insurance contracts require that the insurance
company's attorneys represent the insured physician. Once a lawsuit seems imminent, the health
care practitioner and/or his or her employees should not mention the suit on the telephone or in
correspondence unless the insurance company's legal counsel approves such a reference.
Blooms: Applying
Difficulty: Medium
42. As medical malpractice insurance premiums have continued to rise, self-insurance coverage has
become an option for health care practitioners in some states. What is one advantage of self-insurance
coverage?
A. Guaranteed hospital privileges
B. Lower premiums
C. No fees for managing the plan
D. Higher coverage limits
One advantage to self-insurance coverage is that premiums are considerably lower than with
traditional types of medical malpractice insurance. A disadvantage is that state laws regulating
insurance do not always allow such plans, and even in states where such coverage is allowed,
hospitals must agree to accept self-insurance plans for those physicians who apply for hospital
privileges. The insurance company charges fees for managing the fund and coverage limits are
contracted as in other policies.
Blooms: Applying
Difficulty: Medium
43. There are three types of insurance that health care practitioners can purchase to extend coverage of a
canceled claims-made policy or for claims-made coverage when the insured switches to a different
insurance carrier. Which of the following is not an extended insurance plan?
B. Tail coverage
C. Prior acts insurance
D. Self-insurance
Occurrence insurance is a type of liability insurance that covers the insured for any claims arising
from an incident that occurred, or is alleged to have occurred, during the time the policy is in force,
regardless of when the claim is made. The remaining three options are extended insurance plans.
Blooms: Remembering
Difficulty: Easy
44. A physician who listens carefully to each patient's remarks about their treatment is protecting himself
against a medical malpractice lawsuit by using one of the "4 Cs of medical malpractice prevention"
known as _________________.
Caring
There are two important benefits to showing patients care by listening carefully to their remarks about
their treatment. First is improvement in their medical condition. A secondary benefit is the decreased
likelihood that patients will feel the need to sue if treatment has unsatisfactory results, or if adverse
events occur.
Blooms: Applying
Difficulty: Medium
45. Taking telephone messages and relating them accurately involves one of the "4 Cs of medical
malpractice prevention" known as ___________________.
Communication
If health care professionals communicate clearly and ask for confirmation that they have been
understood, they will be more likely to earn patients' and colleagues' trust and respect. If their duties
include taking telephone messages, they should relate them accurately.
Blooms: Remembering
Difficulty: Easy
46. A physician assistant who follows the standards of care and appropriate procedures for medical
practitioners in similar practices and in similar communities is practicing one of the "4 Cs of medical
malpractice prevention" known as _______________________.
Competence
The competent health care practitioner must know his or her professional area well, including
limitations. He or she must follow standards of care and appropriate procedures for medical
practitioners in similar practices and in similar communities, and avoid any action that he or she is not
fully trained or equipped to handle.
Blooms: Applying
Difficulty: Medium
47. A competent RN would check medications _______________times prior to administering them to
patients.
Three
The RN should check each drug three times: once when taking it from the supply cabinet, again
when preparing the dosage, and a third time when returning the container to the shelf. All outdated
medications should be discarded and promptly replaced.
Blooms: Remembering
Difficulty: Easy
48. For legal purposes, if it isn't in writing and explained completely and accurately, it wasn't
done. This concept applies to one of the "4 Cs of medical malpractice prevention" known as
____________________.
Charting
Documentation is proof. For legal purposes, if it isn't in writing and explained completely and
accurately, it wasn't done. Medical records should include X-rays, test results, progress notes, and
anything else related to the patient's medical treatment.
Blooms: Remembering
Difficulty: Easy
49. To prevent malpractice litigation, physicians should exhaust all reasonable methods of securing a
______________ before embarking on a therapeutic course.
Diagnosis
Physicians should exhaust all reasonable methods of securing a diagnosis before embarking on a
therapeutic course. Physicians should also use conservative and the least dangerous methods of
diagnosis and treatment whenever possible, rather than those that involve highly toxic agents or risky
surgical procedures.
Blooms: Remembering
Difficulty: Easy
50. Physicians often diagnose and prescribe medication for new and established patients over the Internet
now that ______________________ has become more commonplace.
Telemedicine
As telemedicine has become more commonplace, physicians often diagnose and prescribe medication
for new patients and for established patients over the Internet. Physicians also prescribe medication
for established patients over the telephone. To avoid malpractice claims, any communication with
the patient, whether over the Internet or by telephone, should be properly documented in the patient's
medical record.
Difficulty: Medium
51. Except in __________________, male physicians should not examine female patients and female
physicians should not examine male patients unless an assistant, a nurse, or a member of the patient's
family is present.
Emergencies
In ideal situations, a female medical assistant or female nurse should be present when a male
physician examines a female patient, and when a female physician examines a male patient, a male
medical assistant or male nurse should be present.
Difficulty: Medium
52. As required by the ________________________________________ employees should have access to
Material Safety Data Sheets (MSDS) for each hazardous chemical in use in the medical facility.
Occupational Safety and Health Administration (OSHA)
Medical assistants and other medical office employees should ensure that when supplies are received,
they are handled according to office policy and that all relevant literature is readily accessible to
physicians. As required by the Occupational Safety and Health Administration (OSHA), employees
should have access to Material Safety Data Sheets (MSDS) for each hazardous chemical in use in the
medical facility.
Difficulty: Medium
53. According to Dr. R.J. Roberts of the University of Wisconsin Medical School, one of the seven
common reasons for medical malpractice lawsuits is misdiagnosis of, failure to diagnose, or delay in
diagnosis of __________________________.
Cancer
From a medical/legal standpoint, in an article in the March 2003 issue of Family Practice
Management, Dr. R.J. Roberts of the University of Wisconsin Medical School identified seven
common reasons for medical malpractice lawsuits, including cancer misdiagnosis, failure to diagnose,
or a delay in diagnosis.
Blooms: Remembering
Difficulty: Easy
54. According to Hickson's study, the most common reason patients sue for medical malpractice is the
plaintiff is advised by knowledgeable ______________ to sue.
Acquaintances
33% of respondents stated that the most common reason patients sue for medical malpractice is the
plaintiff is advised by knowledgeable acquaintances to sue.
Blooms: Remembering
Difficulty: Easy
55. It was agreed that preventing injury from happening to anyone else was one of the top reasons patients
sued for medical malpractice in a study conducted by _____________________ and others.
Charles Vincent
In a separate, equally well-known study, Charles Vincent and others examined why patients and their
relatives sue physicians, and also investigated which actions might have prevented litigation. Study
participants were given a list of 13 statements and asked whether they agreed or disagreed with each
one.
Blooms: Remembering
Difficulty: Easy
56. According to the Vincent study, the third most commonly stated action that might have prevented
medical malpractice litigation was ____________________________.
Financial compensation
Just over 41 percent of the respondents in the Vincent study said that certain actions after their injuries
might have prevented litigation. The third most common answer was financial compensation.
Difficulty: Medium
57. A report by the American Society of Anesthesiologists Committee on Professional Liability stated
that one of the most common reasons patients start legal proceedings is due to __________________
failures between physicians and patients.
Communication
A report by the American Society of Anesthesiologists Committee on Professional Liability stated

that one of the most common reasons patients start legal proceedings is due to communication failures
between physicians and patients. In short, few patients sue health care practitioners they like and trust.
Difficulty: Medium
58. In order to show patients she cares, a nurse who is conducting a health interview of a patient should be
in a ___________________position.
Sitting
Developing good listening skills and nonverbal communication techniques so that patients feel the
time spent with them is not rushed may help prevent medical malpractice lawsuits. For example,
patients will see a health care practitioner as caring and interested if he or she sits rather than stands
while interviewing or conversing with the patient.
Difficulty: Medium
59. Patients should be encouraged to ask questions and to participate in the decision-making process. The
best way to keep patients' expectations in line is through ______________________.
Education
Physicians should thoroughly explain illnesses and treatment options, including risks and possible
complications, in terms the patient can understand. Patients should be encouraged to ask questions
and to participate in the decision-making process. The best way to keep patients' expectations in line
is through education. When dealing with accidents and bad results, a straightforward approach is
desirable.
Difficulty: Medium
60. It is the responsibility of the physician to explain procedures including risks and possible
complications and make sure that all patients or their authorized representatives sign
___________________________forms before undergoing medical and surgical procedures.
Informed consent
Checking to be sure that all patients or their authorized representatives sign informed-consent forms
before they undergo medical and surgical procedures may help to prevent medical malpractice
lawsuits next of kin or designated representatives must also sign informed-consent forms to authorize
autopsies.
Difficulty: Medium
61. Physicians should insist on a ______________________ if the patient is not doing well, if he or she is
unhappy and complaining, or if the patient's family expresses dissatisfaction.
Professional consultation
Physicians should use tact, good judgment and professionalism in handling patients. They
should insist on a professional consult if the patient is not doing well, if he or she is unhappy and
complaining, or if the patient's family expresses dissatisfaction.
Difficulty: Medium
62. If a physician is retiring, moving to another location, leaving the practice of medicine, or otherwise
becoming unavailable, patients should be informed, and a copy of a letter of referral, notice of a
physician's intended absence from practice, or letter of _____________________ should be placed in
the patient's record.
Dismissal
Patients should be advised when their physicians intend to be gone for long periods of time and
physicians should recommend or make available qualified substitutes. The patient must not be
abandoned. If a physician is retiring, moving to another location, leaving the practice of medicine, or
otherwise becoming unavailable, patients should be informed, and a copy of a letter of referral, notice
of a physician's intended absence from practice, or letter of dismissal should be placed in the patient's
record.
Difficulty: Medium
63. A patient's decision to decline treatment, evaluation, or testing should be documented in the patient
record. "_________________________" should be obtained with respect to any treatment or
procedure which could have either diagnostic or therapeutic consequences.
Informed refusal
"Informed refusal" should be obtained in writing or, at the very least, noted in the patient's medical
record.
Difficulty: Medium
64. A nurse is carefully explaining a procedure to a patient. She asks for confirmation from the patient
that her explanation has been understood and gives the patient the opportunity to ask questions, which
she carefully and competently answers. One of the 4 Cs of medical malpractice prevention the nurse is
practicing is__________________.
Communication
If health care professionals communicate clearly and ask for confirmation that they have been
understood, they will be more likely to earn patients' and colleagues' trust and respect.
Blooms: Applying
Difficulty: Medium
65. A physician who asserts her innocence as a defense in a professional liability suit is using the
________________defense.
Denial
Denialof wrongdoing, or the assertion of innocence, may be used as a defense in professional liability
suits. If some of the alleged facts are true, defendants may not claim innocence. Instead, they should
claim that the charge or charges do not meet all of the elements of the theory of recovery. In other
words, the charge may be missing one of the four Ds of negligence.
Blooms: Applying
Difficulty: Medium
66. When a health care professional presents factual evidence that the patient's condition was caused by
some factor other than his or her negligence, a __________________ defense is being used.
Affirmative
Affirmative defenses may be used by the defendant in a medical professional liability suit to allow the
accused to present factual evidence that the patient's condition was caused by some factor other than
the defendant's negligence.
Blooms: Remembering
Difficulty: Easy
67. A person is injured in a car accident. A nurse is the first person on the scene, and he uses a tourniquet
to stop the victim's arterial bleeding in her leg, thus saving her life. The car accident victim later
claims permanent damage to her leg and sues the nurse for medical malpractice. This nurse is using
the ___________________affirmative defense.
Emergency
If services were provided during an emergency, this may also be used as an affirmative defense.
Blooms: Applying
Difficulty: Medium
68. In a medical malpractice lawsuit, a physician claims that a patient contributed to his own injury by
not maintaining bedrest when ordered to do so. This is an example of the defense claim known as
__________________________________.
Contributory negligence
When the defense claims contributory negligence, this alleges that the patient or complaining party,
through a "want of ordinary care," caused or contributed to his or her own injury. The physician may
deny that he or she committed a negligent act and claim the patient was totally responsible for the
damage or injury. Alternatively, the physician may admit negligence but claim that the patient was
also somehow at fault and so contributed to the injury.
Blooms: Applying
Difficulty: Medium
69. The court decides that a patient through her own negligence contributed 40% toward the injury and
the physician contributed 60% and awards damages based on these percentages. This is an example of
______________________________.
Comparative negligence
In some states, damages are apportioned according to the degree to which a plaintiff contributed to the
injury. This is called comparative negligence.
Blooms: Applying
Difficulty: Medium
70. A patient who signs an informed consent for cardiac surgery and experiences an adverse event
sues her surgeon. The surgeon's defense is based on the contention that the patient knew of the
inherent risks before the surgery was performed and agreed to those risks. This surgeon is using the
___________________________defense.
Assumption of risks
Assumption of risk is a defense based on the contention that the patient knew of the inherent risks
before treatment was performed and agreed to those risks. Informed consent is vital to this defense,
since the defendant must show that the patient was fully informed of the risks prior to treatment and
that the risks inherent in the treatment were the cause of the patient's injury.
Blooms: Applying
Difficulty: Medium
71. ____________________ defenses include those that claim the statute of limitations has
that the plaintiff has no standing to sue.
Technical
When defenses to liability suits are based on legal technicalities, instead of on factual evidence, they
are called technical defenses. Technical defenses include those that claim the statute of limitations has
that the plaintiff has no standing to sue.
Blooms: Remembering
Difficulty: Easy
72. A physician being sued for a wrongful death claim states that the period of time established by state
law during which a lawsuit may be filed has expired. This physician is using the technical defense
known as ________________________________.
Statute of limitations
Since statutes of limitations vary with states, health care practitioners must be familiar with specific
laws for their state. Statutory time limits apply to a number of legal actions, including collections,
damages for child sexual abuse, retaining of medical records, wrongful death claims, medical
malpractice, and many other causes of action. The statute of limitations for filing professional
negligence suits varies with states but generally specifies one to six years, with two years being most
common. In other words, patients may not file suit for negligence against physicians if the designated
length of time has elapsed.
Blooms: Applying
Difficulty: Medium
73. _________________________involves identifying problem practices or behaviors, then eliminating
or controlling them.
Risk management
Since liability is a major factor in health care delivery, and since health care delivery systems and
practitioners seek to minimize liability whenever possible, risk management has become a necessary
practice component. Risk management is one approach to reducing the likelihood of a malpractice
lawsuit. Risk management involves identifying problem practices or behaviors, then eliminating or
controlling them.
Blooms: Remembering
Difficulty: Easy
74. Methods used to manage risk are part of quality ____________________or assurance, a program of
practices performed by health care providers and practitioners to uphold the quality of patient care and
to reduce liability risk.
improvement
Methods used to manage risk are part of quality improvement (QI)or quality assurance, a program of
practices performed by health care providers and practitioners to uphold the quality of patient care
and to reduce liability risk. Most health care facilities and plans employ quality improvement and risk
managers to oversee risk and quality issues relating to physicians and support staff.
Blooms: Remembering
Difficulty: Easy
75. A risk management team for a medical facility ensures that all governmental regulations are being
followed by devising a ______________________plan.
Compliance
Quality improvement and risk managers may assume responsibility for compliance with federal, state,
and other health care regulatory agencies. A compliance plan is developed to help ensure that all
governmental regulations are followed. Such a plan is especially beneficial for following coding and
billing regulations for Medicare, Medicaid, and other government plans.
Blooms: Applying
Difficulty: Medium
76. ___________________ is the process of verifying a health care provider's credentials.
Credentialing
Credentialing is the process of verifying a health care provider's credentials. The process may be
performed by an insurance company before a provider is admitted to the network, by medical offices
prior to granting hospital privileges, or by other groups who routinely employ or contract with health
care providers.
Blooms: Remembering
Difficulty: Easy
77. Administrators of a medical facility apply for credentialing. In the final step of the process, a
_______________________completes the credentialing procedure.
Peer review
Credentialing usually consists of the following: (1) A provider fills out an application and attaches
copies of his or her medical license, proof of malpractice insurance coverage, and other requested
credentials, (2) The listed sources are asked to verify the information, (3) Medicare and Medicaid
sanctions and malpractice history are checked via the National Practitioner Data Bank, (4) The
findings are presented to a credentialing committee, and (5) A peer review process completes the
credentialing procedure.
Blooms: Applying
Difficulty: Medium
78. Because costs for defending a medical malpractice lawsuit can be high,
__________________________may be purchased to cover the costs up to the limits of the policy.
Liability insurance
Because costs for defending a medical malpractice lawsuit can be high, liability insurance may be
purchased to cover the costs up to the limits of the policy. Liability insurance is contract coverage for
potential damages incurred as a result of a negligent act.
Blooms: Remembering
Difficulty: Easy
79. The cost of liability insurance premiums for a physician is based on the physician's
________________ and the dollar amount covered by the policy.
Specialty
The cost of liability insurance premiums for a physician is based on the physician's specialty and the
dollar amount covered by the policy. Insurance for those physicians in the least risky insurance risk
class (for example, family practitioners and specialists who do not perform surgery) is generally less
costly than insurance for those in specialties considered riskier (for example, orthopedic surgeons and
obstetricians).
Blooms: Remembering
Difficulty: Easy
80. A physician who drops liability insurance may be at risk for losing ______________ privileges.
Hospital
Some physicians drop liability insurance coverage when rates become too high. However, this
can adversely affect a physician's practice, since most hospitals require proof of coverage up to a
predetermined minimum amount to grant hospital privileges.
Blooms: Remembering
Difficulty: Easy
81. _____________________insurance covers the insured only for those claims made (not for any injury
occurring) while the policy is in force.
Claims-made
Claims-made insurance covers the insured only for those claims made (not for any injury occurring)
while the policy is in force. With this kind of insurance, the determining factor is when the claim is
made, not when the injury occurs.
Blooms: Remembering
Difficulty: Easy
82. A physician signs up for a liability insurance policy that covers him for any claims arising from an
incident that occurred, or is alleged to occur when the policy is in force.
This type of insurance is called ______________________insurance.
Occurrence
Occurrence insurance (also known as claims-incurred insurance) covers the insured for any claims
arising from an incident that occurred or is alleged to have occurred while the policy is in force,
regardless of when the claim is made.
Blooms: Applying
Difficulty: Medium
83. A physician assistant whose claims-made liability insurance policy is discontinued signs up for
___________________coverage to continue coverage for those dates that claims-made coverage was
in effect.
Tail
When a claims-made policy is discontinued, tail coverage is an option available to health care
practitioners from their former carriers to continue coverage for those dates that claims-made coverage
was in effect. Once a claims-made policy is canceled, coverage does not continue in the future for
any claims that might be reported unless tail coverage or prior acts coverage is secured at the time the
policy is canceled.
Blooms: Applying
Difficulty: Medium
84. ____________________________is another name for tail coverage liability insurance.
Reporting endorsement
When a claims-made policy is discontinued, tail coverage (sometimes called a reporting endorsement)
is an option available to health care practitioners from their former carriers to continue coverage for
those dates that claims-made coverage was in effect.
Blooms: Remembering
Difficulty: Easy
85. _________________________covers incidents that occurred before the beginning of the
new insurance relationship but have not yet been brought to the insured's attention as a claim.
Prior acts insurance coverage
Prior acts insurance coverage is a supplement to a claims-made policy that health care practitioners
can purchase from a new carrier when they change carriers. Prior acts coverage covers incidents that
occurred prior to the beginning of the new insurance relationship but have not yet been brought to the
insured's attention as a claim.
Blooms: Remembering
Difficulty: Easy
86. Another name for prior acts insurance coverage is ______________coverage.
Nose
Prior acts coverage, also known as "nose" coverage, covers incidents that occurred prior to the
beginning of the new insurance relationship but have not yet been brought to the insured's attention as
a claim.
Blooms: Remembering
Difficulty: Easy
87. A physician and his partners contribute to a trust fund with a specified limit to be
used in paying potential medical malpractice awards. This type of policy is called
______________________________coverage.
Self-insurance
As medical malpractice insurance premiums have continued to rise, self-insurance coverage has
become an option for health care practitioners in some states. In this type of policy, an insurance
company writes a policy with a limit of $X, and the insured parties contribute to a trust fund up to a
limit of $X to be used in paying potential medical malpractice awards.
Blooms: Applying
Difficulty: Medium
88. In a self-insurance liability insurance policy, the _______________________charges fees for
managing the policy.
Insurance company
In a self-insurance liability policy, the insurance company charges fees for managing the fund.
Blooms: Remembering
Difficulty: Easy
89. A disadvantage of self-insurance liability policies occurs because hospitals must agree to accept self-
insurance plans for those physicians who apply for _____________________.
Hospital privileges
A disadvantage of self-insurance liability policies is that state laws regulating insurance do not always
allow such plans, and even in states where such coverage is allowed, hospitals must agree to accept
self-insurance plans for those physicians who apply for hospital privileges.
Blooms: Remembering
Difficulty: Easy
90. A physician working in a medical facility applies for self-insurance liability coverage. The major
advantage of this type of insurance is ___________________________.
Lower premiums
One advantage to self-insurance coverage is that premiums are considerably lower than with
traditional types of medical malpractice insurance. A disadvantage is that state laws regulating
insurance do not always allow such plans, and even in states where such coverage is allowed,
hospitals must agree to accept self-insurance plans for those physicians who apply for hospital
privileges.
Blooms: Applying
Difficulty: Medium
91. Some insurance contracts mandate that the attorneys of the ______________________ represent the
insured physician.
Insurance company
Physicians and other health care practitioners should notify their insurance companies immediately
if advised of the possibility of a malpractice lawsuit. Insurance companies almost always provide
legal representation for covered physicians, and some insurance contracts require that the insurance
company's attorneys represent the insured physician.
Blooms: Remembering
Difficulty: Easy
92. Once a lawsuit seems imminent, the health care practitioner and/or his or her employees should
not mention the suit on the telephone or in correspondence unless the insurance company's
_________________ approves such a reference.
Legal counsel
The insurance company's legal counsel will advise the physician on legal wording for all
correspondence regarding the lawsuit.
Blooms: Remembering
Difficulty: Easy
93. A cab driver causes injury to a passenger by causing an accident. The passenger is treated by a
physician who happens to be on the scene. In most states, the driver who caused the accident is liable
both for the victim's injury and for any medical negligence by the physician who treats the injured
victim. This is the basis for the _________________________________defense.
Release of tortfeasor
Blooms: Applying
Difficulty: Medium
94. Under the doctrine of __________________ "The thing has been decided," a claim cannot be retried
Res judicata
Blooms: Remembering
Difficulty: Easy
Law and Ethics for the Health Professions 6th Edition Judson Harrison Test Bank
6 Summary
Category # of Questions
Blooms: Analyzing 1
Blooms: Applying 36
Blooms: Remembering 30
Blooms: Understanding 27
Difficulty: Difficult 1
Difficulty: Easy 30
Difficulty: Medium 63
Judson - Chapter 006 94
Learning Outcome: 6.1 List and define the four Cs of medical malpractice prevention. 36
Learning Outcome: 6.2 Describe the various defenses to professional liability suits. 23
Learning Outcome: 6.3 Explain the purpose of quality improvement and risk management within a health care facility 12
.
Learning Outcome: 6.4 Discuss five different types of medical liability insurance. 23
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Amsterdam, 72, 73, 78, 80, 116, 135, 136, 141, 142, 175, 176
Anacostan Indians, 118, 129
Anglican, 99, 115
Anglo-Saxon, 9
Ango, Jean, 32
Annapolis, 126
Appalachian, 20, 193, 194, 196, 197, 203
Arabs, 6, 17
Arabian, 4, 9
Arctic, 28, 67
Argall, Capt. Samuel, 78, 79, 85, 86, 87, 107, 115
Argo, 3
Argonauts, 2, 3, 4
Armada, 80, 82
Armenia, 5
Arthur, Gabriel, 194
Ashley, Edward, 103
Ashley, Lord, 195
Asia, 4, 6, 17, 23, 24, 26, 49
Atlantic (Ocean), vii, 14, 16, 17, 24, 25, 34, 108, 193
Aughwick, 199
Augusta (Maine), 103
Aunay, Charles d’, 111, 112
Avalon (Newfoundland), 114
Ayllon, Lucas Vasquez de, 28, 29
Aztec Empire, 27, 28
B
Babylon, 2
Bacon, Nathaniel, 195
Bagnall, Walter, 104, 105
Baltic Sea, 9, 10, 11, 12, 13, 45
Baltimore, Lord, (first) see George Calvert;
(second) see Cecilius Calvert
Barbadian brandy, 195
Barbados, 196
Barbary pirates, 57
Barrington, Rhode Island, 171
Basque, 25, 37, 39
Battery, 140
Bay of Biscay, 38
Bay Colony, 166, 183
Bay of Fundy, 37, 39, 55, 62, 82, 83, 84, 86, 107, 108, 109, 111
Bay of the Narragansetts, 172
Bay of Santa Maria, 28
Beaver Road Fort, 160
Bergen, 22
Berkeley, Sir William (Governor of Virginia), 193, 195
Beverwyck, 177, 179
Biard, Father Pierre, 85, 86
Biloxi Bay (Mississippi), 192
Black Sea, 4, 9, 14
Block, Capt. Adrien, 78, 166
Block Island, 171
Blommaert, Samuel, 141, 147, 148
Blue Ridge Mountains, 74, 194
Boone, Daniel, 199
Borgia, Lucretia, 14
Bosphorus, 4
Boston (Massachusetts), 78, 98, 156, 168, 171, 173, 176, 180,
183, 189
Boston Bay, 98, 99, 101
Boston Harbor, 95
Braddock, General Edward, 202
Bradford, Governor William, 91, 93, 96, 102, 105, 106
Brazil, 25
Bremen
Canon Adam of, 10, 22
Councillors of, 10
Bretons, 25, 37
Bristol, 24, 25, 184, 200
Britain, 33, 196
British Empire, 59, 201
Brouage, Bay of Biscay, 38
Browne, Richard, 33
Bruges (Flanders), 12, 14
Brule, Etienne, 76, 77
Bry, Theodore de, 53
Burgesses, House of, 118, 125, 127
Butler, John, 130
Buzzard’s Bay, 55, 87
Byrd, William, 195
Byzantium, 4, 9
C
Cabot, John, 24, 25, 27, 37
Cadillac, Antoine de la Mothe, 193
Cahokia, 193
Calvert, Cecilius (second Lord Baltimore), 127, 128, 132, 133,
134, 183
Calvert, George (first Lord Baltimore), 108, 114, 115, 119, 123,
124, 125, 127, 129
Calvert, Leonard, 127, 128, 130, 131, 132, 133
Canada, 30, 31, 33, 34, 39, 42, 43, 61, 73, 75, 76, 77, 83, 104,
114, 126, 128, 129, 133, 188, 193, 201, 203
Cape Breton, 24, 32, 33, 39
Cape Cod, 17, 18, 28, 39, 55, 69, 78, 87, 88, 89, 93, 95, 111, 175,
181
Cape Elizabeth, 104
Cape Fear, 24, 37, 186
Cape of Good Hope, 14
Cape Hatteras, 34, 52
Cape Henlopen, 141, 142, 152
Cape May, 89, 142, 153
Cape Sable, 108, 109, 111
Carantouan, 76, 77
Cardinal de Richelieu, 109
Caribbean Sea, 29, 33, 38, 52
Carolina, 74, 186, 193, 194, 195, 196
Carr, Sir Robert, 185
Cartier, Jacques, 29, 30, 31, 32, 33, 39
Casco Bay, 98
Caspian Sea, 4, 9
Castine, Maine, 103
Catawba Indians, 74
Cathay, 4, 6, 15, 24, 28, 29, 30, 38, 44, 48, 49, 54, 58, 63
Catholic, 47, 82, 85, 114, 115, 124, 148, 159, 187
Cavelier, Robert (Sieur de la Salle), 190, 191, 192, 197
Cayuga Indians, 74
Champlain, Samuel de. See Chapter IV, pp. 37-43, 55, 56, 74, 75,
77, 107, 108, 109, 110, 187
Channing, Edward, 91
Charles I, 110, 114, 124, 125, 126, 180
Charles II, 124, 184
Charles of Spain, 27
Charleston, 196
Charles Towne, 195
Chattahoochee River, 196
Chaucer, 13
Cherokee Indians, 194, 195
Chesapeake Area, 29, 54, 62, 65, 120
Chesapeake Bay, 20, 27, 28, 52, 53, 55, 56, 59, 61, 65, 69, 74, 76,
77, 89
Chew, John, 120
Chickasaw Indians, 196
China, 16, 27, 28, 39, 43, 67, 68, 72, 186
Choctaw Indians, 196
Chouart, Medard, Sieur des Grosseilliers, 188
Christiansen, Hendrick, 73
Christina River, 79
Church, The, 5, 11, 16
Claiborne, William, 119-123, 124, 125, 126, 127, 128, 129, 130,
131, 132, 133
Cloberry, William, 119, 125, 126, 165
Cockatrice (wherry), 131
Codfish Land, 25, 26, 29
Colchis, 3
Columbus, Christopher, 17, 23, 24
Commissioners of the United Colonies, 170, 181
Company of Cathay, 49
Company of London, 165
Company of New France, 109, 110
Connecticut, 170, 171, 172
Connecticut Path, 167, 169
Connecticut River, 40, 66, 74, 78, 87, 113, 137, 165, 166, 167,
168, 169, 172, 180, 182, 184
Constantinople, 14
Cooper, Thomas, 170
Cornwallis, Capt. Thomas, 131
Corssen, Arendt, 144, 153, 160
Council of Foreign Plantations, 184
Coureurs des bois, 191, 193, 197, 201
Cox, William, 157
Cree Indians, 188
Creek Indians, 196
Cresap, Thomas, 200, 201
“Croatan,” 54
Croghan, George, 199, 200, 201
Cromwell, Oliver, 180, 184
Navigation Act of, 182
Croshaw, Raleigh, 118, 120
Crown Point, 202, 203
Crusades, 5, 10
Cugley, Daniel, 120
Curler, Jacob van, 167
Curran, Barney, 199
Cushenoc, 103, 105
D
Dacotah Indians, 187
Damariscotta River, 104
Danes, 12
Dare, Virginia, 54
Dark Ages, 5, 13
Darkness, Region of, 8, 9
Dartmouth, England, 72
D’Aunay, Charles, 111, 112
Davis, Capt. John, 54
Debedeavon, 120
De Bry, Theodore, 53
De Champlain. See Champlain
De Ferrara, Alfonso, 14
DeGuercheville, Madame, 85, 86
Delaware, 150
Delaware Bay, 78, 89, 138, 141, 183
Delaware Indians, 198
Delaware River, 20, 66, 69, 74, 77, 79, 113, 116, 117, 127, 134,
137, 138, 139, 140, 144, 145, 148, 149, 152, 153, 156, 157,
158, 165, 183, 184, 185
De Monts, 39, 41, 84
Department of Commerce, viii
De Razilly, 110, 111
Dermer, Capt. Thomas, 88, 89, 95, 116
De Roberval, 32
Des Grosseilliers, 188
De Tonti, Henri, 191
Detroit, 193
De Vries. See Vries
D’Iberville, Pierre le Moyne, 192
Dieppe, 32
Digby, 83
Dinwiddie, Governor, 201, 202
Dneiper, 9
Donnacona, 30, 31, 52
Dove (pinnace), 128
Drake, Francis, 48
Dublin, 199
Duck Creek, 149
Dupont-Grave, 38, 39, 40, 86
Dutch. See Chapters VII, XIII, XV and pages 12, 13, 36, 41, 45,
66, 82, 86, 87, 88, 89, 92, 102, 104, 116, 117, 119, 120, 134,
147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158,
159, 160, 161, 162, 163, 180, 181, 182, 183, 184, 185, 186,
187, 197
Dutch East India Company, 67, 72, 79, 80
Dutchmen’s Island, 174
Dutch West India Company, 80, 90, 135, 136, 137, 140, 141, 147,
149, 150, 151, 152, 162, 165, 175, 176, 177
DuQuesne, 202
Dvina, 9
E
East India Company, 67, 72, 79, 80
East Indies, 15, 80
Eastern Shore, 115, 116, 120, 126, 131, 195
Edward III, 46
Eelkens, Jacob, 165, 166
Egypt, 2, 60
Elbe, 10
“El Dorado,” 53, 63, 83
Elizabeth I, 47, 48, 49
Elizabeth City, 120
Elizabethan occupation theory, 79, 145, 164
Endicott, Capt. John, 101, 171
England, 11, 12, 13, 23, 24, 25, 26, 27, 37, Chapter V, 58, 62, 63,
64, 72, 79, 83, 88, 91, 92, 93, 94, 95, 96, 101, 103, 105, 106,
110, 112, 114, 117, 125, 127, 130, 132, 133, 136, 140, 145,
161, 163, 165, 169, 174, 180, 182, 183, 184, 186, 187, 189,
196, 198, 200, 202
English, 12, 24, 36, 37, 39, 41, 43, 45, 46, 48, 50, 53, 54, 55, 59,
62, 63, 65, 67, 76, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 89,
90, 91, 92, 93, 94, 95, 97, 98, 101, 102, 104, 107, 108, 109,
110, 111, 112, 113, 115, 117, 118, 119, 122, 123, 124, 135,
136, 139, 143, 144, 145, 146, 149, 150, 152, 153, 154, 155,
157, 161, 163, 164, 165, 166, 167, 168, 171, 172, 173, 174,
175, 176, Chapter XVI, 186, 187, 189, 190, 191, 193, 194,
196, 198, 199, 200, 201, 202, 203
Eratosthenes, 16
Ericson, Leif, 17, 18, 19, 21, 22
Eric the Red (Eric Thorvaldson), 17, 21
Ericson, Thorvald, 18
Erie, 201
Eriwoneck, 145
Eskimos, 22, 49
Ethiopians, 2, 4
Europe, vii, 5, 6, 9, 12, 13, 16, 23, 25, 51, 70, 72, 141, 149, 197,
202
Euxine Sea, 3
Evelin, George, 133
F
Fairfield, 172
Ferrara, Alfonso de, 14
Fendall, Governor, 183
Fenwick, Cuthbert, 131
Ferryland, 108, 114
Finland, 26
Finns, 152
Five Nations, 41, 42, 43, 61, 74, 75, 76, 77, 129, 191, 197
Flanders, 5, 11, 12
Flatey Book, 21
Fleet, Henry, 118, 119, 128, 129, 130
Florida, 27, 29, 33, 52, 82, 124, 194, 203
Forbes, General John, 202
Forked River, 189, 190
Fort Albany, 186
Fort Amstel, 163
Fort Amsterdam, 140, 141, 143, 144, 145, 146, 149, 156, 157,
176, 184, 185
Fort Beversrede, 160
Fort Casimir, 161, 162
Fort Chartres, 192
Fort Christina, 149, 150, 151, 152, 154, 155, 160, 162, 163
Fort Conquest, 133
Fort Crevecouer, 191
Fort DuQuesne, 202, 203
Fort Elfsborg, 155, 156, 161
Fort Frontenac, 190, 203
Fort Good Hope, 137, 166, 167, 168, 181
Fort d’Huiller, 193
Fort Korsholm, 159, 161
Fort Nassau, 73, 74, 75, 76, 77, 137, 138, 141, 143, 144, 145,
146, 149, 152, 155, 156, 160, 161
Fort Necessity, 202
Fort New Gothenborg, 155
Fort Onondaga, 76
Fort Orange, 137, 163, 165, 166, 176, 177, 179, 180, 183, 185,
186
Fort Orleans, 193
Fort Pitt, 203
Fort Rosalie, 192
Fort St. Antoine, 192
Fort St. George, 84
Fort Saybrook, 168, 172, 173
Fort Trinity, 163
Fortune (ship), 95
France, 11, 13, 14, 23, 28, 30, 31, 33, 39, 40, 52, 79, 82, 84, 86,
107, 108, 110, 111, 163, 191, 192, 193, 198, 199, 203
Francis I, 27, 29, 31, 47, 48
Fraser, John, 199, 201
French Canada, 35, 61, 83, 175, 185, 186
French Creek, 201
French, 28, 29, 31, 34, 37, 38, 40, 41, 42, 43, 48, 54, 55, 62, 68,
69, 72, 74, 75, 76, 77, 80, 82, 83, 84, 85, 86, 87, 88, 89, 94,
95, 101, 104, 106, 107, 109, 110, 111, 112, 116, 117, 119,
120, 126, 134, 137, 145, 147, 173, 186, 187, 188, 189, 190,
191, 192, 193, 196, 197, 198, 199, 200, 201 passim, 202, 203
French and Indian War, vii, viii, 187, 202
Freydis, 17, 21
Frobisher, Martin, 48, 49
Fundamental Orders of Connecticut, 170
G
Gaspe, 39
Genoa, 6, 14
German, 5, 9, 10, 11, 12, 193
Gibbons, Ambrose, 104
Gilbert, Bartholomew, 54
Gilbert, Sir Humphrey, 49, 50, 51, 54
Gilbert, Sir John, 51
Girling, Captain, 112
Gloucester, New Jersey, 137
Godfrey of Bouillon, 10
Godyn, Samuel, 141
Golden Fleece, 2, 3, 4, 188
Gomez, Captain Estevan, 69
Gondomar, Ambassador, 124
Gorges, Sir Ferdinando, 83, 84, 88, 93, 98, 99, 104
Gorges, Capt. Robert, 99
Gosnold, Bartholomew, 55, 69, 83
Gothenburg, 148
Gothland, 11
Grave, Francois (Sieur duPont), 38, 39, 40
Great Lakes, 68, 74, 190
Great Meadows, 202
Greece, 3, 4
Greek, 2, 4, 13, 17, 188
Green Bay, 187
Greenland, 17, 18, 19, 21, 22, 23, 24
Greenwich (Connecticut), 126, 173, 181, 182
Grenville, Sir Richard, 53
Gripen (ship), 148, 150, 151
Grosseilliers, Sieur des, 188
Gudrid, 17, 19
Guercheville, Madame de, 85, 86
Guiana, 54, 92
Gulf of Mexico, 190, 191, 192, 193, 196
Gulf of St. Lawrence, 28, 29, 37, 50, 108, 109, 190
Gustavus Adolphus, 146
H
Hakluyt, Richard, 33, 37
Half Moon (ship), 67, 68, 69, 70, 71, 72
Hampton, Virginia, 120
Hansa, 11, 12
Hanseatic League, 11, 12, 22
Hariot, Thomas, 53
Harmar, Charles, 120, 128, 129
Harrisburg, 199
Harris Ferry, 199
Hartford, 137, 166, 168, 170, 181, 182, 183
Harvey, Sir John (Governor of Virginia), 130, 132, 144, 145
Hatteras, 34, 52
Hauk’s Book, 20
Havre, 32
Hawkins, John, 33, 48
Hawley, Jerome, 132
Hendricksen, Cornelis, 78, 79, 89
Henry IV, 38
Henry VIII, 46, 47
Heyn, Admiral Peter, 135
Hindustan, 5
Hochelaga, 30
Holland, 12, 13, 72, 73, 75, 78, 79, 80, 81, 92, 93, 135, 136, 138,
140, 142, 143, 148, 151, 156, 159, 160, 161, 163, 165, 177,
178, 179, 182
Hollanders, 39, 77, 78, 87, 89, 136, 138, 144, 146, 147, 151, 152,
158, 160, 162, 163, 164, 165, 166, 168, 174, 175, 176, 181,
182
Holmes, Capt. William, 168
Holmes, George, 146
Hoorn, 73, 77, 116
Hopkins, Governor Edward, 170
Horne (Hoorn), 116
Hudde, Andries, 159
Hudson Bay, 22, 188, 189
Hudson’s Bay Company, 189, 193
Hudson, Capt. Henry, 40, 67, 68, 69, 70, 71, 72, 73, 77, 78, 79,
88, 102, 164
Hudson River, 20, 27, 28, 66, 70, 72, 73, 74, 75, 77, 78, 81, 86,
93, 102, 113, 116, 117, 137, 138, 165, 166, 173, 175, 176,
177, 178, 180, 181, 183, 184, 186, 197
Huguenots, 82, 85
Hunt, Captain, 95
Huron Indians, 33, 41, 42, 74, 76, 77
Huygen, Hendrick, 150, 152, 158
I
Iberville, Pierre le Moyne d’, 192
Ibn-Batootah, 7, 8
Iceland, 17, 24
Illinois, 203
Illinois Indians, 191, 192, 197
Illinois River, 193
India, 2, 7, 14, 16, 24, 63
Indian, 110, 123, 124, 129, 134, 142, 150, 158, 168, 172, 174,
176, 183, 196, 200, 201, 203
corn, viii, 28, 35, 48, 69, 75, 94, 96
league, 176
policy, 198
trade, 126, 128, 148, 153, 154, 156, 157, 169, 174, 177, 180,
184, 193, 194, 200
village, 131, 169, 174, 195
Indian Ocean, 5, 27, 50, 52, 53
Indians, vii, 25, 29, 30, 32, 33, 35, 53, 54, 55, 58, 59, 60, 63, 64,
68, 69, 70, 71, 73, 75, 77, 79, 80, 84, 85, 87, 89, 94, 97, 100,
102, 105, 109, 115, 117, 119, 128, 129, 130, 133, 136, 137,
139, 143, 148, 149, 150, 152, 153, 154, 158, 159, 160, 161,
165, 167, 169, 170, 171, 172, 173, 175, 180, 181, 188, 191,
196, 197, 198, 199, 200
customs of, 121-122
Indian Sea, 83
Indies, 16
Ingram, David, 33
Ireland, 17, 72
Iroquois Confederacy, 73
Iroquois Indians, 30, 33, 34, 39, 40, 41, 42, 61, 73, 74, 75, 77, 80,
107, 123, 128, 129, 137, 138, 139, 170, 175, 176, 177, 178,
180, 181, 182, 184, 187, 190, 191, 192, 193, 197, 198
customs of, 74
Islam, 5
Italy, 6, 14
Italian merchants, 5, 6, 14
Ivan the Terrible, 12, 44, 45
J
James I, 54, 58, 83, 86, 108, 164
James Bay, 189
James, Duke of York, 184, 186
James River, 20, 28, 29, 59, 82, 83, 85, 87, 89, 115, 116, 118, 120,
124, 125, 195, 196
Jamestown, 57, 58, 60, 62, 69, 82, 89, 115, 116, 117, 118, 127,
143, 144, 150, 195
Jansen, Commissary Jan, 146, 149, 150, 154, 156, 159
Japazaws, 118
Jason, 2, 3, 4 passim, 188
Jesuit priests, 29, 85, 190, 191
Johnson, Dr. Amandus, 151, 157
Joliet, Louis, 190
Julin, 10
Juno, 3
K
Kalmar Nyckel (ship), 148, 150, 151
Karlsefni, Thorfinn, 17, 19, 20, 21, 69
Kaskaskia, 193
Kecoughtan, 115, 120, 126, 146
Kennebec River, 83, 87, 98, 100, 101, 102, 103, 104, 145
Kent Hundred, 127
Kent Island, 126, 127, 128, 130, 131, 132, 133, 134
Kent Islanders, 128, 130, 131
Kentucky, 199, 203
Khan, Kublai, the Great, 6, 7, 13
Kieft, Governor William, 150, 175
King George’s War, 198, 199, 200
Kirke brothers, 109, 126, 128
“Kleynties,” 76
Kling, Lieutenant Mans, 150, 156
Knight, Capt. John, 54
Kublai Khan, 6, 7, 13
L
Labrador, 25
Laconia Company, 104, 156
La Dauphine (ship), 27, 28
Lake Champlain, 41, 74, 104
Lake Chautauqua, 201
Lake Erie, 193, 199, 201
Lake Huron, 193
Lake Michigan, 187
Lake Nipissing, 42
Lake of the Iroquois, 41, 156
Lake Onondaga, 75
Lake Ontario, 42, 75, 190
Lake Superior, 188
Lake Winnipeg, 22
Lake Winnepesaukee, 104, 181
Lamberton, George, 153, 154
Lancaster, 198, 200
Lane, Governor Ralph, 53, 54
La Rochelle, 32, 35, 86
La Salle, Sieur de, 190, 191, 192, 197
La Tour, Charles de, 108, 109, 110, 111
Laud, William (Bishop of London), 124
Lederer, John, 193
Lee, Thomas, 200
Leif, Ericson, 17, 18, 19, 21, 22
Leigh, Capt. Charles, 37, 54
Leipzig, 26
Lenni Lenape Indians, 74, 137, 138, 139, 140, 143, 144, 148, 149
Levett, Christopher, 98
Levy, Franks and Simon, 200
Lewger, John (Secretary of Maryland), 133
Leyden, 92
Lincolnshire, 57
Logan, James, 198
Lok, Michael, 49
London, 37, 45, 48, 55, 63, 64, 83, 95, 119, 132, 164, 165, 184,
189, 200
London Company, 57, 58, 69, 82, 83
Long Island Sound, 18, 78, 87, 102, 153, 165, 171, 173, 183
Long Tayle (pinnace), 130, 131, 132
Lords Commissioners of Plantations, 132
Louis XIV, 190, 191
Louisburg, 203
Louisiana, viii, ix, 192, 193
Lowrey brothers, 199
M
Machias (Maine), 111
Machias River, 104
Maine, 18, 55, 62, 68, 83, 84, 85, 96, 97, 98, 100, 101, 102, 104,
105, 106, 107,110, 111, 112, 156
Malaga, 95
Malaya, 14, 16
Malay Archipelago, 5

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Law and Ethics for the Health

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