© 2009 the mcgraw-hill companies, inc. all rights reserved 3-1 legal and ethical issues in medical...

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-1 LEGAL AND ETHICAL ISSUES in Medical Practice, Including HIPAA PowerPoint presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-2 3.1 Define ethics, bioethics, and medical law. 3.2 Discuss the measures a medical practice must take to avoid malpractice claims. 3.3 Discuss medical documentation and how it applies to medical law. Learning Outcomes

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-3 3.4Discuss the various types of health-care legislation and their impact on medical office practice. 3.5Describe OSHA requirements for a medical office. 3.6 Describe procedures for handling an incident of exposure to hazardous materials. Learning Outcomes (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-4 3.7 Compare and contrast quality control and quality assurance procedures. 3.8Discuss the impact that HIPAA regulations have in the medical office. 3.9 Explain how to protect patient confidentiality. 3.10Describe the different practice management models. Learning Outcomes (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-6 Medical Law and Ethics Knowledge of Medical Law and Ethics provides insight into The rights, responsibilities, and concerns of health-care consumers The legal and ethical issues facing society, patients, and health-care professionals as the world changes The impact of rising costs on the laws and ethics of health-care delivery

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-7 Medical Law and Ethics (cont.) Ethics is a standard of behavior. Moral values serve as the basis for ethical conduct. Family, culture, and society help form an individuals moral values. A law is a rule of conduct or action. Governments enact laws to maintain order and public safety. Criminal and civil laws pertain to health-care practitioners.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-8 Medical Law and Ethics (cont.) Criminal law Crimes against the state Criminal acts are Felonies or Misdemeanors Examples include: Murder Arson Sexual Assault Burglary Civil law Crimes against the person Includes a general category of laws known as torts Torts are either: Intentional (willful) Unintentional (accidental)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-9 False imprisonment Assault Defamation of character Fraud Invasion of privacy Open threat of bodily harm Interference with a persons right to be left alone Damaging a persons reputation by making false and malicious public statements An action that causes bodily harm to another, including touching without permission Intentional, unlawful restraint or confinement of a person Intentional Torts Depriving or attempting to deprive a person of his or her rights Battery

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-10 Acts that are committed with no intent to cause harm but done with a disregard for the consequences The term negligence is used to describe such actions when health-care practitioners fail to exercise ordinary care, resulting in patient injury Malpractice is the negligent delivery of professional services Unintentional Torts

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-11 Contracts A contract is a voluntary agreement between two parties in which specific promises are made for a consideration. AgreementConsideration Contractual CapacityLegal Subject Matter Four Elements of a Contract

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-12 Types of Contracts Expressed contracts Clearly stated in written or spoken words A payment contract is an example Implied contracts Actions or conduct of the parties, rather than words, create the contract A patient rolling up his or her sleeve to receive an injection is an example

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-13 Apply Your Knowledge What is the difference between law and ethics? ANSWER: A law is a rule of conduct or action and is enacted by governments to maintain order and public safety. Ethics is a standard of behavior based on moral values that are influenced by family, culture, and society.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-14 Patient-Physician Contract Physicians Do not have to treat every patient Do not have to return patient to original state of health Do not have to make a correct diagnosis in every case Do not have to guarantee success of treatment or operation Patients May choose their physician May terminate a physicians services American Hospital Associations Patient Bill of Rights

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-15 Patient-Physician Contract (cont.) Physician rights Set up a practice within the boundaries of his or her license to practice medicine Select where to set up an office and establish office hours Specialize Decide which services to provide and how those services will be provided Physician responsibilities Use due care, skill, judgment, and diligence Keep knowledge up-to-date Perform to the best of his or her ability Furnish complete information and instructions to the patient

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-16 Patient-Physician Contract (cont.) Patient responsibilities Follow physicians instructions and cooperate with care Provide relevant information to the physician Follow the physicians orders for treatment Pay the fees charged for services provided

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-17 Patient-Physician Contract (cont.) Consent Expressed gives verbal permission Implied actions imply permission Informed Patient receives all information necessary to make a decision regarding treatment Liability Legal responsibility for actions Understand scope of practice Understand standard of care and duty of care Health-care personnel are all held to the reasonable person standard

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-18 Apply Your Knowledge ANSWER: Patient responsibilities are: Follow physicians instructions and cooperate with care Provide relevant information to the physician Follow the physicians orders for treatment Pay the fees charged for services provided Patients have rights and responsibilities relating to health care. The rights are determined by the Patients Bill of Rights. What are the patients responsibilities?

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-19 Preventing Lawsuits Lawsuits Add to cost of health care Take a psychological toll on all involved Prevention Use of reasonable care to prevent professional liability

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-20 Malpractice claims are lawsuits by a patient for errors in diagnosis or treatment Negligence cases are those in which a person believes a medical professionals actions, or lack thereof, caused harm to the patient Malpractice Latin term which means The thing speaks for itself.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-21 Examples of negligence Abandonment Delayed treatment Legal terms used to classify negligence Malfeasance - unlawful act or misconduct Misfeasance - lawful act done incorrectly Nonfeasance - failure to perform an act that is ones required duty or that is required by law Malpractice (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-22 uty Patients must show that a physician-patient relationship existed. erelict Patients must show that the physician failed to comply with the standards of the profession. irect Cause Patients must show that any damages were a direct cause of a physicians breach of duty. amages Patients must prove that they suffered injury. Patients must be able to prove all 4 Ds in order to move forward with a malpractice suit. The 4 Ds of Negligence

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-23 Malpractice (cont.) Settling malpractice suits Arbitration People with special knowledge in the field listen to the case and decide the dispute Court Written court orders (subpoena) are delivered to involved parties. Subpoena duces tecum is a court order to produce documents such as patient records Civil law Concerned with an individuals private rights Torts Negligence Breach of contract Failure to adhere to a contracts terms

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-24 Law of Agency Employees are considered to be agents of the physician while performing professional tasks Physicians are responsible or liable for the negligence of employees Respondeat superior is a Latin term meaning Let the master answer Malpractice (cont.) Employees are also legally responsible for their own actions, and they can be sued directly.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-25 Malpractice (cont.) Reasons patients sue Unrealistic expectations Poor rapport and poor communication Greed and our litigious society Poor quality of care

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-26 The 4 Cs of Malpractice Prevention aring Sincere caring decreases the likelihood that a patient will sue if outcomes are unsatisfactory or adverse events occur. ommunication Develop trust and respect with patients by communicating professionally and confirming that you have been understood. ompetence Maintain competence and update knowledge and skills frequently. harting Documentation is proof of competence. Chart every conversation and interaction you have with a patient.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-27 Terminating Care of a Patient Reasons for terminating care of a patient Refusal to follow physician instructions Patient family member complaints Personality conflicts Failure to pay for services rendered Repeated failure to keep appointments When withdrawing from care, a physician must Provide written notification Reasons for withdrawing Recommend that the patient find another physician Send by certified mail with return receipt requested Document in the patient record reasons for terminating care and actions taken to inform the patient

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-28 Apply legal concepts to practice by Maintaining confidentiality Practicing within the scope of training and capabilities Preparing and maintaining medical records Documenting accurately Using proper guidelines when releasing information Standard of Care

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-29 Apply legal concepts to practice by Following legal guidelines and maintaining awareness of health-care legislation and regulations Maintaining and disposing of regulated substances appropriately Following risk-management and safety procedures Recognizing professional credentialing criteria Standard of Care (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-30 Administrative Duties and the Law Duties related to legal requirements Insurance billing Patient consent forms Documentation in the medical record Making appointments Appointment books are a legal document State reporting requirements Births Abuse Certain diseases Injuries from violent acts Deaths Phone calls Maintain privacy

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-31 Documentation Clear and complete Referrals Missed appointments Dismissals Patient contact Medical record correction Medical records Property of facility or physician Retention and storage Based on state law

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-32 Controlled Substances and the Law Medical assistants must follow the correct procedure for keeping and disposing of controlled substances Be familiar with correct dosages, potential complications, and refill rules Keep prescription pads secure

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-33 Legal Documents and the Patient States the types of treatment the patient does and does not want in an event of terminal illness, unconsciousness, or comatose state. Patients with living wills are asked to name someone that will make decisions on their behalf (durable power of attorney) if they are unable to do so. Uniform Donor Card A legal document that states a persons wish to donate one or more organs or whole body. Living Will (Advance Directive)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-34 Legal obligation to maintain confidentiality of patient information Discuss with patient privately Share patient information only when appropriate Do not discuss the case with anyone outside the medical office Confidentiality Issues

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-35 Apply Your Knowledge What are the 4 Cs of malpractice prevention? ANSWER: The 4 Cs of malpractice prevention are caring, communication, competence, and charting. Bravo!

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-36 Federal Legislation Affecting Health Care Health Care Quality Improvement Act (1986) Improved the quality of medical care nationwide National Practitioner Data Bank Encourages peer review Federal False Claims Act Qui tam To bring action for the king and ones self Control three types of illegal conduct False billing claims Kickbacks Self-referrals

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-37 OSHA Regulations The Occupational Safety and Health Administration (OSHA) is a division of the U.S. Department of Labor Regulations describe precautions that must be taken to protect workers from exposure to infectious diseases such as Human immunodeficiency virus (HIV) Hepatitis B virus (HBV)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-38 OSHA requires that medical practices follow Universal Precautions Hospitals are required to follow Standard Precautions, which is a combination of Universal Precautions and body substance isolation guidelines Both Universal Precautions and Standard Precautions were developed by the Centers for Disease Control and Prevention (CDC) OSHA Regulations (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-40 Decontamination All exposed work surfaces must be sprayed with a 10% bleach solution or other agent approved by the Environmental Protection Agency (EPA) Sharp equipment To prevent exposure, sharps are to be placed in a leak- proof, puncture-resistant, color-coded, labeled container Exposure incidents Incidents are to be reported immediately Current procedures may need to be modified OSHA Regulations (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-41 Post-exposure procedures Employers must offer a free medical evaluation to exposed employee Employers must also refer the employee to a licensed health-care provider for blood sampling, appropriate treatment, and counseling Employees may refuse treatment by signing a waiver When a medical worker is first employed, the employer must offer within 10 days the opportunity to have the HBV vaccination at no cost OSHA Regulations (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-42 Laundry All laundry must be labeled and bagged appropriately Hazardous materials Employers must keep an inventory of all hazardous materials in the workplace (MSDS sheets) Training requirements All employees that may be exposed must be given free, annual training during work hours OSHA Regulations (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-43 General Regulations General work area laws restrict: Eating and drinking Smoking Applying lip balm and cosmetics Handling contact lenses Storing food or drinks in refrigerators used to store blood or other potentially infectious materials Refrigerators must have thermometers Required procedures for on-the-job injuries OSHA Regulations (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-44 OSHA Regulations (cont.) Required documentation Intended to protect health-care providers Exposure control plan Keep necessary records as indicated OSHA inspections Done in response to complaints and at random Non-compliance Fines Suspension of laboratory payments from Medicare

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-45 Apply Your Knowledge List 4 things that OSHAs general work area laws restrict? ANSWER: General work area laws restrict: (list any four of these) Eating and drinking Smoking Applying lip balm and cosmetics Handling contact lenses Storing food or drinks in refrigerators used to store blood or other potentially infectious materials

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-46 Quality Control and Assurance The Clinical Laboratory Improvement Amendments of 1988 ( CLIA 88 ) Set standards for the quality of work performed in a laboratory and the accuracy of test results Medical office laboratories must comply with CLIA regulations and have a quality assurance program Three categories of laboratory tests Waived Moderate-complexity High-complexity

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-47 Elements of the quality assurance (QA) program Written policies on standards of patient care and professional behavior A quality control (QC) program Training and continuing education programs Instrument maintenance program Documentation requirements Evaluation methods Quality Control and Assurance (cont.)

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-48 Quality Control and Assurance (cont.) The laboratory QC program must cover Patient preparation procedures Collection of specimens Labeling Preserving and transporting specimens Test methods Inconsistent results Use and maintenance of equipment Personnel training Complaints and investigations Corrective actions

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-49 What are the three categories of laboratory tests? Apply Your Knowledge If a medical office performs laboratory procedures, what two things must the office do? ANSWER: The office must comply with CLIA regulations and have a quality assurance program. ANSWER: The three categories are waived, moderate-complexity, and high-complexity. Right!

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-50 HIPAA Health Insurance Portability and Accountability Act (1996) Improve efficiency and effectiveness of health-care delivery Protect and enhance the rights of patients Access to health-care information Control inappropriate use or disclosure Improve the quality of health care by restoring trust in the health-care system

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-51 Title I: Health Care Portability Increases workers ability to get health-care coverage when starting a new job Reduces workers probability of losing existing health-care coverage Helps workers maintain continuous health-care coverage when changing jobs Helps workers purchase health insurance on their own if they lose coverage under an employers group plan and have no other health-care coverage available

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-52 Title II: Prevention of Health Care Fraud and Abuse, Administrative Simplification and Medical Liability Reform HIPAA privacy rules Give patients more control over their health information Set boundaries on the use and release of health-care records Establish appropriate safeguards to protect the privacy of health information Hold violators accountable if they violate patients privacy rights Strike a balance when public responsibility supports disclosure of some forms of data

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-53 HIPAA (cont.) HIPAA allows the provider to use health-care information for: ayment perations reatment Providers are allowed to share information to provide care to patients. Providers are allowed to share information to receive payment for the treatment provided. Providers are allowed to share information to conduct normal business activities, such as quality improvement.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-54 HIPAA (cont.) Protected health information (PHI) Uses Movement within an organization Disclosure Transmitted between or among organizations Managing and storing Sharing Patient notification Notice of privacy practices Security measures HIPAA Security Rule Computer networks The Internet Disks, other storage media, and extranets Chart Reception area and clinical stations Fax, copier, and printer

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-55 HIPAA (cont.) Violations and penalties Civil Criminal For knowing, wrongful misuse of health information Administrative simplification Standardizing patient information Standardized codes

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-56 Apply Your Knowledge While you are documenting on the computer, you are called to a patient room for an emergency. What should you do before leaving the computer? ANSWER: You should close the patient record and log off the computer to protect the confidentiality of patient information.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-57 Confidentiality Issues and Mandatory Disclosure Principles for preventing improper release of information 1. When in doubt, do not release information. 2. It is the patients right to keep patient information confidential or disclose it. 3. All patients should be treated with the same degree of confidentiality. 4. Be aware of all applicable laws and of the regulations.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-58 Confidentiality Issues and Mandatory Disclosure (cont.) Principles for preventing improper release of information 5. When necessary to break confidentiality and when there is a conflict between ethics and confidentiality: Discuss it with the patient. If the law does not dictate what to do in the situation, the attending physician should make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others. 6. Get written approval from the patient before releasing information.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-59 A police officer enters the physicians office where you work and requests information about a patient. May you release this information? What should you do? Apply Your Knowledge ANSWER: No, you should not be the person to release this information. You should refer the officer to the patients physician, who will make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-60 Code of Ethics Principles of right and wrong Laws are based on ethical considerations Medical professionals are expected to act ethically Will have a positive effect On your reputation Employers practice

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-61 Code of Ethics (cont.) Bioethics Pertains to issues that arise due to medical advances Principles of medical ethics have developed over time dating back to Hippocrates A document called the Patients Bill of Rights lists ethical principles that protect the patient

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-62 Apply Your Knowledge Mr. Jones would like to try a new treatment for his Parkinsonism, but physician refuses to discuss a new treatment with Mr. Jones because he morally disagrees with this type of treatment. This is an example of what type of issue and what should the physician do? ANSWER: This is an example of a bioethical issue. The physician should refer the patient to another physician who specializes in this treatment. Good Answer!

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-63 Labor and Employment Laws Title VII of the Civil Rights Act of 1964 Law prevents employers from discriminating in hiring or firing or firing on the basis of race, color, religion, sex, or national origin Civil Rights Act of 1991 Provides monetary damages in cases of intentional employment discrimination Sexual harassment The victim has the responsibility to let the harasser know that the conduct is offensive The victim should also report any instance of sexual harassment to a supervisor or the personnel department

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-64 Labor and Employment Laws (cont.) Age Discrimination in Employment Act (ADEA) of 1967 Prohibits discrimination in hiring or firing based on age for persons aged 40 or older 1976 Discrimination Act Makes it illegal to fire an employee based on pregnancy, childbirth, or related medical conditions

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-65 Labor and Employment Laws (cont.) Titles I and V of the Americans with Disabilities Act of 1990 Ban discrimination against disabled persons in the workplace Mandate equal access for the disabled to certain public facilities Require all commercial firms to make existing facilities and grounds more accessible to the disabled

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-66 Labor and Employment Laws (cont.) 1938 Fair Labor Standards Act Prohibits child labor and firing employees for exercising their rights under the acts wage and hour standards Provides for overtime pay and a minimum wage Equal Pay Act of 1963 Requires equal pay for men and women doing equal work Family Leave Act of 1991 Allows employees to take unpaid leave time for maternity, for adoption, or for caring for ill family members

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-67 Apply Your Knowledge What are your responsibilities if you feel you have been a victim of sexual harassment? ANSWER: The victim has the responsibility to let the harasser know that the conduct is offensive and should also report any instance of sexual harassment to a supervisor or the personnel department.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-68 Legal Medical Practice Models Be aware of laws governing the practice model of your place of employment Four types of practice models Sole proprietorship Single physician Partnership Two or more physicians practice together Contract specifies rights, obligations, and responsibilities

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-69 Legal Medical Practice Models (cont.) (Types of practice models, continued) Group practice Three or more licensed physicians Physicians share the collective income, expenses, facilities, equipment, records, and personnel for the practice Professional corporation Corporation is a body formed and authorized by law to act as a single entity Physicians who form corporations are shareholders and employees of the organization Incorporators and owners have limited liability in case lawsuits are filed

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-70 Apply Your Knowledge What is the difference between a group practice and a professional corporation? ANSWER: A group practice is three or more physicians who share the practice income, expenses, and facilities. In a professional corporation the physicians are shareholders and employees of the corporation.

2009 The McGraw-Hill Companies, Inc. All rights reserved 3-71 In Summary To perform effectively as a medical assistant you must follow All state, federal, and individual practice rules and laws AAMA Code of Ethics for medical assistants OSHA safety regulations for the medical office CLIA QC and QA guidelines HIPAA guidelines

© 2009 the mcgraw-hill companies, inc. all rights reserved 3-1 legal and ethical issues in medical...

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