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ASHRM Certified Professional in Health Care Risk Management (CPHRM) Sample Questions (Q55-Q60):
NEW QUESTION # 55
Which of the following should prompt a risk manager to give notice to a malpractice carrier?
- A. internal incident report
- B. written medical record request from an attorney
- C. disclosure to a patient
- D. demand letter from a patient
Answer: D
Explanation:
Under Health Care Risk Management principles established by ASHRM and the American Hospital Association Certification Center, timely notice to a malpractice carrier is a critical obligation, particularly under claims-made policies. A demand letter from a patient constitutes a clear assertion of liability and a request for compensation, which typically meets the definition of a claim under most malpractice insurance policies. Failure to notify the carrier promptly may jeopardize coverage.
A written medical record request from an attorney may signal potential litigation, but it does not necessarily constitute a claim unless accompanied by an allegation of wrongdoing or a demand for damages. An internal incident report is a risk management tool used for quality and safety improvement and does not itself trigger insurance notification requirements. Similarly, disclosure to a patient regarding an adverse event aligns with transparency practices but does not automatically represent a formal claim.
Risk management objectives emphasize understanding policy language, particularly definitions of claim and reporting requirements. Because a demand letter explicitly alleges harm and seeks compensation, it most clearly triggers the duty to notify the malpractice carrier to preserve coverage and initiate appropriate claims handling procedures.
NEW QUESTION # 56
In enterprise risk management, which of the following are external factors that may affect risk?
- A. Option D
- B. Option B
- C. Option A
- D. Option C
Answer: D
Explanation:
According to Health Care Risk Management standards supported by ASHRM and enterprise risk management ERM principles, external factors include conditions outside the direct control of the organization that influence strategic, operational, financial, and regulatory risk exposures.
A physician shortage is an external workforce market condition that can affect staffing stability, access to care, and malpractice exposure. New regulations are also external factors, as legislative or regulatory changes may alter compliance requirements, reimbursement structures, or reporting obligations. Similarly, soft insurance market trends reflect external economic and underwriting environments that influence premium pricing, availability of coverage, and risk financing strategy.
Resolution of claims, however, is generally an internal operational or claims management outcome. While influenced by external legal environments, the resolution process itself is primarily part of internal risk management and litigation strategy rather than a broad external environmental factor.
ERM objectives emphasize analysis of external environmental drivers, including regulatory, workforce, economic, and market conditions. Therefore, physician shortages, new regulations, and soft insurance market trends are external factors affecting risk, while resolution of claims is not primarily classified as external.
NEW QUESTION # 57
Which of the following can be considered evidence in a malpractice claim?
* photographs of injuries
* thank you note from the patient to the physician
* patient journal of the hospital stay
* gift from the patient to a volunteer
- A. 1, 2, and 4 only
- B. 1, 2, and 3 only
- C. 2, 3, and 4 only
- D. 1, 3, and 4 only
Answer: B
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, evidence in a malpractice claim includes any relevant material that may help establish facts related to duty, breach, causation, or damages. Photographs of injuries are routinely admissible as demonstrative or documentary evidence to illustrate the nature and extent of harm. A thank you note from a patient to a physician may be introduced to reflect the patient's contemporaneous perception of care, credibility, or satisfaction at a particular time, depending on context. A patient's personal journal documenting experiences during hospitalization may also be considered evidence, particularly if it describes symptoms, interactions, or emotional distress relevant to damages.
A gift from a patient to a volunteer, however, is generally not probative of negligence or injury unless directly tied to issues of undue influence or misconduct. In typical malpractice litigation, such a gift does not establish standard of care, breach, or damages and would not ordinarily be considered relevant evidence.
Claims and litigation objectives emphasize careful documentation, preservation of relevant materials, and coordination with counsel regarding evidentiary matters. Therefore, photographs, written communications, and patient journals may be considered evidence in a malpractice claim.
NEW QUESTION # 58
Which of the following is an essential component of a risk management policy and procedure manual?
- A. medical staff bylaws
- B. actuarial report
- C. loss run report
- D. department organizational chart
Answer: D
Explanation:
According to Health Care Risk Management standards outlined by ASHRM and the American Hospital Association Certification Center, a risk management policy and procedure manual should clearly define the structure, authority, and operational framework of the risk management program. An organizational chart is an essential component because it identifies reporting relationships, lines of authority, and accountability within the department and in relation to executive leadership and governing bodies.
A clearly documented organizational structure supports regulatory compliance, facilitates communication, and ensures that responsibilities for event reporting, claims management, patient safety initiatives, and regulatory oversight are properly assigned. It also demonstrates governance alignment and helps accrediting bodies evaluate program effectiveness.
Medical staff bylaws are separate governance documents that outline credentialing, peer review, and clinical governance standards. Actuarial reports are financial analyses used in risk financing decisions but are not part of a policy and procedure manual. Loss run reports summarize historical claims activity and support financial review but do not define program structure.
Health Care Operations objectives emphasize formal documentation of authority, processes, and accountability within the risk management framework. Therefore, inclusion of the department organizational chart is an essential element of a comprehensive risk management policy and procedure manual.
NEW QUESTION # 59
For a liability claim to succeed, the claimant must establish duty owed, duty breached, proximate cause, and
- A. injury sustained.
- B. gross negligence.
- C. contributory negligence.
- D. punitive damages.
Answer: A
Explanation:
Under Health Care Risk Management principles outlined by ASHRM and the American Hospital Association Certification Center, a successful negligence claim requires proof of four essential legal elements: duty, breach of duty, causation, and damages. Duty refers to the legal obligation owed by the healthcare provider to the patient. Breach occurs when the provider fails to meet the applicable standard of care. Proximate cause establishes the direct link between the breach and the harm suffered.
The final required element is actual injury or damages sustained by the claimant. Without demonstrable harm, a negligence claim cannot succeed, even if duty and breach are proven. The injury may include physical harm, emotional distress, or financial loss, but it must be measurable and attributable to the breach.
Contributory negligence is a defense that may reduce or bar recovery but is not an element the claimant must prove. Punitive damages are awarded in exceptional cases involving egregious misconduct and are not required to establish liability. Gross negligence represents a higher degree of negligence but is not a required element in standard malpractice claims.
Therefore, proof of injury sustained is essential for a liability claim to succeed.
NEW QUESTION # 60
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