Educate the Educator Legal Issues in

Healthcare

This module explores legal issues involving clients and healthcare workers including:

• Health care laws• Clients’ rights and responsibilities• Confidentiality• Liability• Documentation • Regulation.• The relationship between ethics and legal issues• Impact of healthcare systems’ laws and regulations.

Legal Issues in Healthcare

This module consists of 9 competencies.

Each competency is divided into unit competencies with learning activities to help students master the competency.

Each learning activity is explained on the Module Outline and the resources described.

Choose the learning activities that best meet your classroom needs.

Module Outline and Instructor Resources

Find these learning activities and resources on the website or create your own.

The Course Outline also has documents the instructor can use in teaching the lesson.

These competencies are listed on the following slide and will then be addressed throughout the remainder of the power point.

Module Outline and Instructor Resources

1. Explain the laws related to healthcare and their influence on the delivery system.

2. Describe one’s legal responsibility related to abuse, neglect, exploitation, and the Vulnerable Adults Law

3. Explain clients rights and responsibilities and how healthcare providers can ensure those rights.

4. Describe the components of healthcare employee and healthcare facility liability when delivering client care.

Legal Issues in Healthcare Competencies

5. Discuss how confidentiality must be maintained in healthcare facilities with clients and their medical records.

6. Explore legal issues such as sexual harassment, wrongful discharge, negligence, malpractice and violence in the workplace.

7. Identify the legal issues for accurate documentation, informed consent and advanced directives.

Legal Issues in Healthcare Competencies

8. Describe the consequences of inappropriate use of health data (including use of social media and email) in terms of disciplinary action.

9. Using a problem solving process applied to healthcare situations, describe how laws influence healthcare facilities and the care of clients.

Legal Issues in Healthcare Competencies

Competency #1

Explain the laws related to healthcare and their influence on the delivery system.• Discuss common legal terms.• Name the federal laws relating to healthcare.• Discuss state laws that relate to healthcare.• Explain why everyone should have a healthcare directive

whether ill or not.• Define differences between certification, registration, and

licensure.

Competency 1

Recommended Content

Many of our students may have some understanding of the law and yet may not know the legal terms in relation to healthcare.

At the beginning of this module it is beneficial to have a discussion about the definitions of common legal terms.

Review the Vocabulary List

Terms

Recommended Content

Healthcare facilities operate under federal, state and local laws.

All healthcare workers must function within these laws.

The six laws are addressed in the following slides.

Federal Laws

Equal Employment Opportunity Commission (EEOC)

The U.S. Equal Employment Opportunity Commission (EEOC) is responsible for enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person's race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability or genetic information.

Federal Laws

The EEOC is a governmental agency that handles sexual harassment complaints that cannot be settled in the workplace.

The EEOC defines sexual harassment as “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature”.

Federal Laws

American with Disabilities Act (ADA)

The Americans with Disabilities Act (ADA), passed by U.S. Congress in 1990 and fully implemented in 1994, prohibits discrimination on the basis of disability in employment, public services, and public accommodations.

Federal Laws

Purposes of ADA

Provide a clear and comprehensive national mandate for eliminating discrimination among individuals with disabilities.

Provide clear, strong, consistent, enforceable standards addressing discrimination against individuals with disabilities.

Ensure the federal government plays a central role in enforcing standards established under the act.

Federal Laws

Equal Pay Act• The Equal Pay Act requires that men and women in the same

workplace be given equal pay for equal work. The jobs need not be identical, but they must be substantially equal.

• All forms of pay are covered by this law, including salary, overtime pay, bonuses, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

• If there is an inequality in wages between men and women, employers may not reduce the wages of either sex to equalize their pay.

Federal Laws

Patient Self-Determination Act

Congress passed the Patient Self-Determination Act (PSDA) in 1990.  The regulations were implemented in December 1991. 

This act gives patients the right to make choices and decisions about the types and extent of medical care they wish for themselves. 

Federal Laws

Patients can specify if they want to accept or refuse specific medical care. 

They can also identify a legal representative for urgent healthcare decision purposes.  If they become unable to make decisions due to illness, the patient’s wishes have been clearly documented at an earlier point.

Federal Laws

Northern Virginia Community College. (n.d.).

Omnibus Budget Reconciliation Act

The Federal Nursing Home Reform Act or OBRA 1987 creates a

set of national minimum set of standards of care and rights for

people living in certified nursing facilities.

These minimum federal health and care requirements for nursing

homes are to be delivered through variety of established protocols

within nursing homes and regulatory agencies.

OBRA set in motion forces that changed the way state inspectors

approached all their visits to nursing homes.

Federal Laws

Turnham, H. (n.d.).

Health Insurance Portability and Accountability Act (HIPAA)

In 1996, a law was passed by Congress to:

Improve portability and continuity of health insurance coverage in the group and individual markets.

Combat waste, fraud, and abuse in health insurance and health care delivery.

Federal Laws

Health Insurance Portability and Accountability Act (HIPAA)

Reduces costs and administrative burdens of health care by improving efficiency and effectiveness of the health care system by standardizing the interchange of electronic data for specified administrative and financial transactions.

Ensures protecting the privacy of Americans’ personal health records by protecting the security and confidentiality of health care information.

Federal Laws

Maryland Department of Health and Mental Hygiene. (2002)

Recommended Content

Three state laws (Minnesota examples) to be discussed with the students are:

1. Criminal Background Checks

2. Good Samaritan Law

3. Vulnerable Adult Law

Details of each are discussed on the following slides.

State Laws

A background check or background investigation is the process of looking up and compiling criminal records, commercial records and financial records (in certain instances such as employment screening) of an individual.

Background checks are often requested by employers for job candidates and interns.

State Laws

Good Samaritan acts are laws designed to protect healthcare providers against the claims of malpractice when they provide assistance at the scene of an emergency.

A person who renders help in an emergency, at a level that would be provided by any reasonable prudent person under similar circumstances, cannot be held liable for his/her actions.

State Laws

The Vulnerable Adult Act outlines the types of abuse and the role of Adult Protective Services.

There are three basic kinds of maltreatment:

Abuse - physical, emotional or sexual

Neglect - caregiver neglect or self neglect

Financial exploitation

State Laws

Tips on teaching the material

Teaching advanced directives often provides students with information that they have never heard before and may not think that it pertains to them.

Having this conversation with students can be quite intense and bring up a variety of emotions -- especially when students come from different cultures and religions.

Advanced Directives

Recommended Content

The Advance Directive unit addresses terms and concepts such as:• Life-prolonging treatments• Terminal conditions• Persistent vegetative state• Do not resuscitate (DNR)

Advanced Directives

Minnesota Department of Health. (2011)

An advanced directive is a document that states what the patient wishes to happen to his/her body while alive but is unable to speak for him/herself.

The three parts of an advanced directive addressed in the curriculum are:

1. Living will

2. Healthcare proxy

3. Durable power of attorney

Advanced Directives

Living wills are written documents that direct treatment in accordance with a patient’s wishes in the event of terminal illness or condition.

The living will takes effect only when the patient is incapacitated and can no longer express his or her wishes. The living will states which medical treatments may be used and which may not be used to die naturally, without the patient’s life being artificially prolonged by various medical procedures.

The purpose of a living will is to allow you to make decisions about life support and direct others to implement your desires in that regard.

Advanced Directives

Kockrow, O.E. and Christensen, B.L. (2006)

Healthcare proxy is a person who has been designated to make medical decisions for the patient when he/she is unable to speak for him/herself.

Advanced Directives

A durable power of attorney for health care is a document that designates an agent, surrogate, or proxy to make health care decisions on his/her own behalf.

This agent is appointed to make health care treatment decisions based on the patient’s wishes.

Advanced Directives

Recommended Content

The curriculum address three credentials required for the healthcare profession to maintain its standard of practice.

Credentials required are:

1. Certification

2. Registration

3. Licensure

Certification, Registration, Licensure

Professional certification ensures that health professionals meet established levels of competency.

Professional certification is granted by national organizations and NOT by individual states and carries national recognition.

In health professions with no state licensure, professional certification may be required.

Certification, Registration, Licensure

Registration is a written record of an individual practicing within a field.

Professional registration means the listing of certified health professionals on an official roster kept by the state agency or health professional organization.

Certification, Registration, Licensure

Before a person can begin work in many health professions, a state license is required. An individual must complete certain steps, such as training, acquiring an academic degree in a particular area of study, and/or passing an exam before becoming eligible to receive a license.

Licensure is usually granted on the basis of education and examination, rather than performance.

Licensure has been set in place to protect the public from unqualified practitioners.

Certification, Registration, Licensure

If you are looking for an interactive learning activity, this might be something your students will enjoy!

Interactive Simulation for HIPAA training

HIPAA Learning Activity

Recommended Learning Activities

Competency 1: Laws Related to Healthcare

Assignment Resources Notes

LIH Competency 1: Team Assignment Organizations/Laws

Online websites This is a team based assignment in which the team researches an organization or law, and presents it to the group.

LIH Competency 1: Medical Grid

MN Healthcare Directive Toolkit

This assignment involves studying advanced directives, then having the student discuss with family members four different case scenarios and deciding upon an advanced directive in these situations for themselves.

Competency 2

Describe one’s legal responsibility related to abuse, neglect, exploitation, and Vulnerable Adults Law.

• Define abuse• Explain why abuse may occur.• Identify types of abuse.• Define neglect• Define exploitation.

Competency 2

Describe one’s legal responsibility related to abuse, neglect, exploitation, and Vulnerable Adults Law.

• Identify populations at risk for abuse, neglect, and exploitation.

• Identify federal and state laws protecting vulnerable persons.

• Explain an individual’s legal responsibility if abuse or neglect is suspected.

• Explain a facilities legal responsibility if abuse or neglect is suspected.

Competency 2

The first three units are easily presented together.

1. Define Abuse

2. Explain why abuse may occur

3. Identify types of abuse

Competency 2

Tips on presenting the material

This part of the module can be difficult to present and discuss, as many people have either witnessed or experienced abuse.

Consider ways to be sensitive to students’ personal disclosure of abuse, their experiences and stories.

Abuse

Abuse is defined as:

• any action that intentionally harms or injures another person.

• the willful infliction of injury, unreasonable confinement, intimidation, or punishment that results in physical harm, pain, or mental anguish.

Abuse also encompasses inappropriate use of any substance, especially those that alter consciousness (e.g., alcohol, cocaine, methamphetamines).

Abuse

Medical-Dictionary, n.d.

Abuse may occur

when a person feels stressed, tired, overwhelmed, or dealing with personal problems or loss of control.

There are several types of abuse. The curriculum addresses the following:

• Physical abuse

• Verbal abuse

• Psychological abuse

• Sexual abuse

Abuse

Physical abuse can be defined as abuse that consists of anything one person does to another that causes physical pain.

Abuse

Verbal abuse is: • Manipulative and controlling.• Unpredictable.• Threatening.• Ordering.• Is a lie told to you or about you.

Abuse

Psychological abuse includes:

Making the patient fearful of you, such as threatening not to respond when the patient calls.

Threatening the patient/resident with harm.

Threatening to tell something to others that the patient does not want to be known.

Threatening to withhold care.

Abuse

Sexual abuse is the use of physical means or verbal threats to force the patient/resident to perform sexual acts.

In many states, sexual abuse is any behavior that is seductive, demeaning, harassing, or reasonably interpreted as sexual by the patient.

Abuse

Neglect can be defined as: • A lack of care and attention • Lacking concern• To leave undone or leave out• Failure to act responsibly• Failure to act with the caution that a reasonable person

would exercise under the same circumstances

Neglect

Robinson, Benedictis, and Segal, 2011

This involves illegal use of a vulnerable adult’s funds or property, either by a caregiver or an outside scam artist.

An unscrupulous caregiver might:• misuse an elder’s personal checks, credit cards, or

accounts• steal cash, income checks, or household goods• forge an elder’s signature• engage in identity theft

Exploitation

Recommended Content

The curriculum identifies four populations at risk for abuse, neglect, or exploitation.

1. The aging population

2. Adults with a disability

3. People who cannot help themselves

4. Persons 18 years of age or older who:• Live in licensed facilities• Receive services from licensed agencies• Are in family settings but cannot report abuse or neglect

themselves

Populations at Risk

Recommended Content

There is a federal and state law that addresses the issue of the populations at risk.

Federal Child Abuse Prevention and Treatment Act

Vulnerable Adult Law (MN Example)

Federal and State Laws

Federal Child Abuse Prevention and Treatment Act (CAPTA)

The Child Abuse Prevention and Treatment Act (CAPTA) is the main piece of federal legislation addressing child abuse.

Puts forth a framework for defining types of child abuse and enables federal assistance for preventing, identifying and treating child abuse nationwide.

CAPTA provides a minimum definition of child abuse and neglect.

Federal and State Laws

Federal Child Abuse Prevention and Treatment Act (CAPTA)

Requires the reporting of physical and mental abuse of a child

Protects those who do the reporting

Patient confidentiality does not exist in cases of suspected abuse

Federal and State Laws

Example of Vulnerable Adult Law in Minnesota

The act declares that it is the public policy of Minnesota to:• protect adults who, because of physical or mental disability

or dependency on institutional services, are particularly vulnerable to maltreatment;

• to assist in providing safe environments for vulnerable adults; and to provide safe institutional or residential services, community-based services, or living environments for vulnerable adults who have been maltreated

Federal and State Laws

Recommended Content

The healthcare worker is responsible for reporting abuse immediately to the supervisor and should know the workplace’s reporting policy.

Laws protect workers who do the reporting. Confidentiality of the reporter is protected.

Individual’s Responsibility

Recommended Content It is critical to present a broad brushstroke of the

legal responsibilities of a facility if abuse or neglect is suspected.

The four areas to be presented for this module are listed on the following slide.

(see next slide)

Facilities Responsibility

• Develop an abuse protection plan

• Develop an individual abuse prevention plan for clients in the facility.

• Establish a written policy to ensure all cases of abuse or neglect are reported promptly.

• Keep records of incidents to monitor for the trends or repeated incidents.

Facilities Responsibility

Recommended Learning Activities

Competency 2: Legal Responsibilities

Assignments Resources Notes

LIH Competency 2: Scenarios – Abuses in Healthcare

Scenarios This learning activity provides three short scenarios for discussion on the type of abuse portrayed in each scenario.

LIH Competency 2: Scenario – Vulnerable Adults

Scenarios This scenario portrays elder abuse and offers questions for thoughtful discussion or assignment.

Center for Psychiatric Rehabilitation. (n.d.). The Americans with Disabilities Act (ADA). Retrieved from http://www.bu.edu/cpr/reasaccom/whatlaws-adaact.html

City of Minneapolis. (1997-2011). Vulnerable adults. Retrieved from http://www.ci.minneapolis.mn.us/police/crime-reporting/vulnerableadults.asp

Department of Health. (2011). Questions and answers about health care directives. Retrieved from http://www.health.state.mn.us/divs/fpc/profinfo/advdir.htm

Department of Justice, (2011). ADA Regulations and Technical Assistance Materials. Retrieved from http://www.ada.gov/publicat.htm#Anchor-ADA-44867

Fighel, T. (2011). Due process law in the workplace. Retrieved from http://ezinearticles.com/?Due-Process-Law-in-the-Workplaceandid=4003032

References

Fuzy, J. (2003). The nursing assistant’s handbook. Albuquerque, NM: Hartman Publishing Inc

Fuzy, J. and Leahy, W. (2005). The home health aide handbook. Albuquerque, NM: Hartman Publishing Inc.

Kockrow, O.E. and Christensen, B.L. (2006).Loss, grieving, dying, and death. In B.L. Christensen and E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 188-216). St. Louis, MO: Elsevier, Mosby

Maryland Department of Health and Mental Hygiene. (2002). Health Insurance Portability and Accountability Act. Retrieved from http://www.dhmh.state.md.us/hipaa/whatishipaa.html

References

Minnesota Board on Aging. (2010). Adult Protective Services Unit. Retrieved from http://www.mnaging.org/advisor/vulnerable.htm

Minnesota Department of Health. (1991, October). Recommended menu pattern and small portion guidelines: Developed in accordance with OBRA Regulations for Nursing Facilities. Information Bulletin 91-3: NH-3. Retrieved from http://www.health.state.mn.us/divs/fpc/profinfo/ib91_3.htm

Northern Virginia Community College. (n.d.). Patient Self-Determination Act: 1990. Retrieved from http://www.nvcc.edu/home/bhays/dogwood/selfdeterminationact.htm

pdf

References

Office of Reviser of Statutes, State of Minnesota. (2006). 604A.01, Minnesota Statutes 2006 : 604A.01 Good Samaritan Law. Retrieved from https://www.revisor.mn.gov/bin/getpub.php?type=sandnum=604A.01andyear=2006

Standfield, P.S., Cross, N., and Hui, U.H. (2008). Introduction to Health Professions (5th ed.). Sudbury, MA: Jones and Bartlett Publishers 

Turnham, H. (n.d.). OBRA ‘87 Summary. National Long Term Care Ombudsman Resource Center. Retrieved from http://www.allhealth.org/briefingmaterials/OBRA87Summary-984.

References

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“This workforce solution was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership.”   This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors: Dede Carr, BS, CDA, LDAPat Reinhart, RN