Chapter 5LEGAL AND ETHICALRESPONSIBILITIES

5:1 Legal Responsibilities

Legal: Allowed by law: consists of ethics and morally right decisions.

Criminal Law: based on crimes/police: jail. something against government

Civil Law: peoples rights/people: pay a lot of money and can lose license. Protection against the abuse of a victim.

Tort Tort: illegal acts not involving contracts.

A tort occurs when a person is harmed or injured because the health care provider does NOT meet the established or expected standards of care.

Malpractice: practice not done correctly

Ex. Accidental puncture to patient

Negligence: fail to give care

Ex. Patient ignored

Tort Malpractice: practice not done correctly

“Bad Practice”

Failure to use the skill & learning commonly expected in that profession, resulting in injury or harm.

Ex. Doing a surgical procedure incorrectly

Or A nurse ordering an exam only a doctor can order

Negligence: fail to give care normally expected of a person in that job, which results in injury

Ex. If a patient falls if the side rails were left down, not reporting defective equipment

TORT

Assault

Ex: threat or attempt to injure (“If you don’t take this medication, I’m going to shove it down your throat.”)

Battery: any inappropriate physical contact

Ex: touching without permission, performing a procedure after pat refusal or rough handling

Patients MUST give consent for any care

And They have the right to refuse care

Informed Consent Permission granted voluntarily by a person who is of sound mind and all the risks have been explained in terms the person can understand.

Some procedures require written consent

Surgery, some diagnostic tests, experimental care, treatment of minors

Verbal consent required in all other cases

Ex. May I take your blood pressure, and patient nods head

Or I’m going to draw some blood, and pat raises arm

Was permission granted voluntarily?◦ Or are people forced into treatment or Dropped off at the hospital

Who can say who is of sound mind?◦ Mental patients, drugs, head trauma, mother caring her child

Have all the risks been explained?◦ No risks explained, some left out

Has the procedure & risks been explained in terms the patient can understand?

◦ Medical jargon, Language barrier

Tort False Imprisonment-being restrained against your will

Keeping patients hospitalized against their will or applying physical or chemical restraints without justification or an order. An Order comes from a Doctor or a Court of Law

The patient has the right to leave the hospital or health facility at any time without the doctor’s permission. (Unless quarantined)

AMA-Against Medical Advice, when a patient leaves the hospital against the doctors advice

TortsAbuse: a harm done to an individual Physical: not providing physical care Verbal: harm done with words Psychological: mental harm Sexual: unwanted touching

Torts Defamation - False information to ruin a persons reputation

Lies, Rumors or Gossip spread to discrete an individual, group or facility.

◦ Slander - information that is spoken◦ Libel - information that is written

Legal Responsibilities Contract; an agreement between two or more parties

A Doctor Patient relationship is established and made legal thru a contract

Components of contract◦ Offer-being offered the service ◦ Acceptance-accepting the service◦ Consideration-paying for the service

Implied-understood without paperwork

Expressed-clearly stated or written

Legal Responsibilities

Legal Disability - a person who doesn’t have legal capacity to form a contract

Examples)

Underage, semiconscious, influence of drugs, mentally incompetent

Non-English speaking party

Agent-a person that makes the medical decisions for another

Health care Proxy

TORT

Invasion of privacy: spilling the beans, when the nurse shares information about a patient to a 3rd party individual without consent

Privileged Communications

All information given to health care personnel from the patient which must be kept confidential and shared only with people who are privileged to know such info (other members of the health care team).

Written consent given by the patient is needed to release the information to anyone else

Certain info is except by law and must be reported:

Births, Deaths, Injuries caused by violence, Drug Abuse, Reportable Diseases (Communicable & Sexually transmitted)

Health Records◦ Considered Privileged Information◦ They belong to the Health Care Provider◦ But the patient may obtain copies◦ Can be used as legal records in court◦ Erasures are NOT allowed◦ Errors should be crossed out with a single line and left readable◦ Corrections inserted, initialed & dated◦ Sometimes corrections may be explained◦ Retained for an amount of time required by state law◦ Destroyed burned or shredded◦ Computer Records, limit access, using codes, use passwords, monitor use

Privacy Act Health Insurance Portability & Accountability Act (HIPAA) Establish Standards to Protect Health Information

Privacy Standards:◦ Able to see and obtain copies of medical records

◦ Given information on how their medical information will be used

◦ Allowed to set limits on how personal health information is used

◦ Request that reasonable care to keep information confidential

Ethics Set principles dealing with what is morally right or wrong

Provide a standard of conduct or code of behavior

Help health care worker analyze information and make decisions

Ethical Dilemmas Frequently created by modern medicine

Euthanasia Confidentiality of AIDS diagnosis

Aborted fetuses and research Continuing life support

Expensive treatments and paymentTransplant decisions

Legal issues and marijuana Animals and research

Genetic research Cloning

Stem cell research

Basic Rules of Ethics

Save lives and promote health

Patient comfort

Respect the patient’s right to die peacefully and with dignity

Treat all patients equally

Provide the best care possible

Maintain competent skills and knowledge

Respect rules of confidentiality

Refrain from immoral, unethical, and illegal practices

Show loyalty to patients, co-workers, and employers

Be sincere, honest, and caring

Patient Bill of Rights The Patient Has the Right To:

◦ Considerate & Respectful Care◦ Obtain complete & current Information◦ Have Advance Directives◦ Confidentiality◦ Reasonable response to a request for services◦ Refuse participation in any research project◦ Expect reasonable continuity of care◦ Review medical records, examine bills, explanation of all Care

& Charges ◦ Be informed of how to resolve disputes or grievances

5:4 Advance Directives for Health Care

Also known as legal directives

- Allow individuals to state what medical treatment they want or do not want in the event they become incapacitated and unable to express there wishes

Legal document

Two main directives◦ Living wills – What measures should or should not be taken to prolong life.

◦ Durable Power of Attorney (POA) – Permits the principal (Patient) to appoint an agent to make any decisions regarding healthcare if unable to

PSDA Patient Self-Determination Act

Right to make decisions on medical care including to refuse treatment & right–to-die

Give info & assist in making Advance Directives

Document Adv. Directives in the Patient Record

Document how the patient was involved in decisions

No discrimination because of advance directives

Educate staff on legal issues of advance directives

Health care workers must be aware of the act and honor it

Health care workers should give serious consideration to preparing their own advance directives

Summary By observing patient rights, health care workers assure patient’s safety, privacy, and well-being, and provide quality care

Advance directives must be recognized and respected by health care workers

Professional Standards1. Perform only those procedures for which you have been trained

and are legally permitted to do

2. Use approved, correct methods while performing any procedure

3. Obtain correct authorization before performing any procedure

4. Identify the patient

5. Obtain patient’s consent

6. Observe safety precautions

7. Keep all information confidential

Professional Standards(continued)

8. Think before you speak and watch everything you say

9. Treat all patients equally

10. Accept no tips or bribes for care you provide

11. If an error or a mistake occurs, report it immediately to your supervisor

12. Behave professionally in dress, language, manners, and actions

13. Always carry liability insurance