An ER has established a UR department under LC 4610 and hired a nurse to approve or deny requests. This is:

An ER has established a UR department under LC 4610 and hired a nurse to approve or deny requests. This is:

• A. Only a licensed physician may modify, delay, or deny requests for medical treatment
• B. Always permissible
• C. Never permissible
• D. Ok if the nurse has met CE requirements

Answer: (A)

Under California Labor Code 4610, decisions that modify, delay, or deny medical treatment through utilization review must be based on medical judgment and made by a licensed physician. A nurse cannot independently approve or deny treatment requests. The nurse’s role can involve gathering information and coordinating the review under physician supervision, but the final determination belongs to a physician. Therefore, establishing a UR department where a nurse is the decision-maker is not permissible. The other options don’t fit because CE alone doesn’t grant authority to deny care, and the requirement isn’t that such actions are always permissible or never permissible—they’re constrained by the physician’s involvement.

Under California Labor Code 4610, decisions that modify, delay, or deny medical treatment through utilization review must be based on medical judgment and made by a licensed physician. A nurse cannot independently approve or deny treatment requests. The nurse’s role can involve gathering information and coordinating the review under physician supervision, but the final determination belongs to a physician. Therefore, establishing a UR department where a nurse is the decision-maker is not permissible. The other options don’t fit because CE alone doesn’t grant authority to deny care, and the requirement isn’t that such actions are always permissible or never permissible—they’re constrained by the physician’s involvement.