Why do States have broader powers to legislate than does the federal Gov’t?

John, a 34 year old father of two children, is a member of a health maintenance organization (hmo) in texas. john has made several trips to an area clinic recommended by his hmo to seek medical attention since finding blood in his bowel movements. he has been taking large amounts of aspirin for persistent headaches but did not realize that this could cause internal bleeding. john was always seen at the clinic by a physician assistant, robert m. but never by a physician. robert didn't ask john about taking any nonprescription medications. john didn't realize that he should mention his over the counter medication (aspirin) consumption. robert tells john to take an antacid preparation to control the bleeding, but does not order any tests. he tells john to return if he is not any better. two days later, john is rushed to the area emergency room with a bowel hemorrhage.1-¿what responsibility, if any, does robert have for john's emergency? 2- does the clinic have a responsibility to provide its hmo members with the services of a physician? 3- what responsibility, as a healthcare consumer, does john have for his own medical condition?