Health Occupations I

Legal & Ethical Issues

Legal Responsibilities

Laws & legal responsibilities in every aspect of life

Goal – protect you & society (traffic laws)

Health care workers have certain responsibilities as well– Important to be aware of & follow– Protects you, the employer, & the patient

Legal Responsibilities

Based on law Civil law or criminal law

– Civil law - dealing with legal relationships between PEOPLE & protection of a person’s RIGHTS

– Criminal law – dealing with WRONGS against a PERSON, PROPERTY, or SOCIETY

Health care mostly affected by CIVIL law– Contracts– Torts – wrongful act that does not involve a

contract

Legal Responsibilities

Criminal laws can apply– Practicing without a license– Misuse of narcotics– Theft– Murder

Health care professionals are required to know & follow state laws regulating licensure or registration & set standards for their profession

TORTS

Occurs when a person is harmed or injured because a HCP doesn’t meet the expected standards of care– Civil wrongs NOT crimes– Can lead to legal action (lawsuits)– Offenses may be complex & subject to

interpretation– Malpractice, negligence, assault & battery,

invasion of privacy, false imprisonment, abuse, defamation

Malpractice

“bad practice”, commonly called professional negligence

Failure of a professional to use the degree of skill & learning commonly expected in a particular profession

Results in injury, loss, or damage to person Examples –

– Puncture wound & dr. doesn’t order tetanus shot– Nurse performing minor surgery without training

Negligence

Failure to give care that is normally expected of a person in a particular position with resulting injury to another person

Examples– Falls due to side rails down– Using or not reporting defective equipment– Infections caused by non-sterile technique,

equipment, or supplies– Burns caused by improper heat or radiation

Assault & Battery Closely related & often used together Assault – includes a threat or attempt to injure Battery – unlawful touching of another person

without consent Patients must give CONSENT & have the right to

REFUSE Some procedures require written consent

– Surgery– Diagnostic tests– Treatment of minors– Side rail releases

Assault & Battery (cont) Verbal consent is permitted at times

– Must be INFORMED CONSENT- permission given• Voluntarily• Person of sound mind• After procedures & all risks involved have been explained in

terms person can understand

Can withdraw consent at any time Explain all procedures, DO NOT PERFORM if pt

does not give consent Examples

– Performing procedure after pt has refused tx– Improper handling & rough treatment

Invasion of Privacy

Unnecessary exposure of a person OR revealing personal info without consent

Examples– Improper draping or covering leaving pt

exposed to view– Sending info to an insurance company

without written permission– Informing news media about condition

without permission

False imprisonment

Restraining an individual or restricting another person’s freedom

Examples– Keeping pt hospitalized against his will– Application of physical restraints without

proper authorization or with no justification

Abuse

Any care that results in physical harm, pain, or mental anguish– Physical – hitting, forcing persons against their will,

depriving food/water, restraints, not providing personal care

– Verbal – shouting, swearing, harsh words, racism, abusive statements

– Psychological – threatening harm, denying rights, belittling, intimidating, ridiculing, threatening to reveal information

– Sexual – unwanted sexual touching or act, sexual gestures, suggesting sexual behavior

Abuse (cont)

Pts may experience abuse before entering your facility– Domestic abuse –threatening,

manipulative, aggressive, or violent behavior to maintain power & control

– Child abuse – directed toward a child– Elder abuse – directed toward an older

person

Abuse (cont)

Be alert to signs & symptoms indicating abuse– Unexplained bruises, fractures, burns,

injuries– Signs of neglect – poor personal hygiene– Irrational fears or change in personality– Aggressive or withdrawn behavior– Patient statements

Abuse (cont)

Presence of signs & symptoms indicate need for more investigation

Health care workers are REQUIRED to report any signs of abuse – MANDATED REPORTERS

Laws in all states protect reporting of any type of abuse to authorities

Defamation

False statements that cause a person to be ridiculed or cause damage to his/her reputation

Incorrect info given out in error– Libel – written information– Slander – information is spoken

Examples – – Reporting pt with an infectious disease to an

agency when lab results are inaccurate– Stating person has a drug problem when another

medical condition exists

Contracts

Agreement between two or more parties Three parts

– Offer – competent person enters into a relationship with HCP & offers to be a pt.

– Acceptance – HCP gives an appointment or examines or treats a pt.

– Consideration – payment made by pt for services provided

Contracts – Implied vs expressed

Implied – cause obligations that are understood without verbally expressed terms– Example – qualified HCP prepares meds & pt

takes meds (implied that pt accepts the treatment) Expressed – stated in distinct & clear

language, oral or written– Example – surgery permit– Promises of care must be kept– All risks associated with treatment must be

completely explained to pt.

Legal Disability All parties in contract must be free of legal

disability Person with a legal disability does not have the

legal capacity to form a contract Examples

– Minors – under legal age, differs by state– Mentally incompetent persons– Persons under influence of drugs or alcohol– Semiconscious or unconscious persons

Parents, guardians, or those permitted by law must form contract for these people

Breach of Contract

Contract requires certain standards of care by competent, qualified people

If contract not performed according to agreement, contract is BREACHED

Examples– Failure to provide care or giving improper care– Failure to pay according to consideration

Can lead to legal action

Translators

Must be used when contract is explained to a non-English speaking person

Many states require translator for deaf or hard of hearing

Most agencies have a list of translators English-speaking relative or friend can

serve as translator

Agent Person who works under direction or control of

another person Employer is principal

– Responsible for actions of agent & can be required to compensate people who have been injured by the agent

Employee is agent Example – dental assistant tells pt “your dentures

will look better than your real teeth” – dentist may have to compensate if statement is false

HCP must be aware that they are agents & work to protect employer’s interests

Privileged Communications

ALL information given to HCP by pt BY LAW, all info must be kept confidential &

shared only with other HCP that have the need to know

Cannot give any info to others unless the pt gives you written consent

Consent should give what info can be released, to whom the info can be given, & any time limits

Privileged communications that are exempt Some info is exempt by law and MUST

be reported– Births & deaths– Injuries caused by violence – assault &

battery, abuse, stabbings) that may require police involvement

– Drug abuse– Communicable diseases & STDs

Health Care Records

Contain info about care that has been provided to pt

Belong to HCP, but pt has right to obtain a copy of any info on record

LEGAL RECORD in court of law No erasures allowed

– Cross out errors with a single line– Insert correct info, initial & date

Health care records Must be properly maintained, kept confidential, &

retained for amount of time required by law To destroy, must shred or burn Use black ink to write in Signature – BMcGrory, RN

– First initial, last name, title Computer records – to safeguard

– Limit access & use codes to prevent access– Require passwords to access specific info– Monitor & evaluate computer use

Ethics Set of principles dealing with what is morally right

or wrong Provide a standard of conduct or code of behavior Allow a HCP to analyze info & make decisions

based on what people believe is right & good conduct

Modern health dilemmas?– Euthanasia– HCP has AIDS, should pt know?– Aborted fetuses used for research?– When should life support be discontinued?

Ethical dilemmas (cont)

Can parents refuse blood transfusions for their children?

Can a facility refuse expensive treatment to a person who cannot pay?

Who gets the kidney? What age? Can a person sell an organ for transplant? Animals in medical research? Cloning? Selection of specific genes for transplanting Stem cell research?

Basic rules of ethics

Saving life & promoting health #1 goal Keep pt. comfortable & preserve life when

possible Respect pt’s choice to die peacefully & with

dignity when all options have been discussed &/or predetermined by advance directives

Treat all pts equally Avoid bias, prejudice, discrimination Provide care to the best of your ability Maintain competent skills, CEUs

Basic rules of ethics (cont)

Maintain confidentiality Refrain from immoral, unethical, &

illegal practices Show loyalty to pts, co-workers, &

employer Be sincere, honest, caring

Patient’s rights

Factors of care that pts can expect to receive

Federal & state legislation requires agencies to have written policies about rights

All personnel must respect & honor these rights

AHA Pt’s Bill of Rights Considerate & respectful care Current info about diagnosis, treatment, & prognosis Informed consent Advanced directives & able to refuse Privacy Confidential treatment of records Reasonable response to requests Info about hospital & relation to other facilities Refuse research projects Review medical records & examine bill Informed of hospital rules, regs, policies

LTC Bill of Rights Established by OBRA in 1987 Must inform resident or caregiver & post a copy in

facility Free choice of dr, care, research Freedom from abuse & chemical or physical restraints Privacy & confidentiality Accommodation of needs & choice Voice grievances without retaliation Organize & participate in groups, social, religious, &

community activities

LTC Bill of Rights (cont)

Info about medical benefits, records, state survey results, advocacy, OMBUDSMAN

Manage own funds, use own things Unlimited access to immediate family Share a room with spouse if both residents Remain in facility & not be transferred for any

reason except medical, welfare of resident or others, failure to pay, or if facility can no longer meet the resident’s needs

LTC Bill of Rights

All states have adopted the federal rights & have added their own

Failure to follow & grant rights can lead to job loss, fines, & imprisonment

Advance Directives

Legal documents that allow people to state what medical treatment they want or do not want in event that they become incapacitated & unable to express their wishes

Living Wills– Documents that allow people to state what

measures should or should not be taken to prolong life when they are terminal

Advance Directives

Living wills (cont)– Must be signed when person is competent

& witnessed by 2 adults that will not benefit from that person’s death

– Most states now honor these– Frequently results in DNR order

• No CPR• Die with peace & dignity• Can be hard for HCP to honor this

Advance Directives

Durable Power of Attorney– Document that permits an individual (known as a

principal) to appoint another person (known as an agent) to make any decisions about health care if the principal is unable to make decisions

– Includes providing or withholding procedures, hiring or firing HCP, spending for health care, access to medical records

– Usually given to spouses or adult children, but can be anyone

– Needs to be signed by principal, agent, & 1 or 2 witnesses

Advance Directives

Patient Self-Determination Act (PSDA)– 1990 law that required all facilities receiving federal

dollars to• Inform every adult, orally & in writing, of their right to make

decisions, including right to refuse treatment• Provide info & assistance with advance directives• Document advance directives on med records• Have written statements to implement pt’s rights in making

decisions• No discrimination or affect on care due to advance

directives• Educate staff on medical & legal issues of advance

directives

Professional Standards

Perform only procedures for which you have been trained & can legally perform– Never perform unless qualified– Obtain training– If asked to do something you are not qualified to

do, state you have not been trained & refuse to do it

– If you are not legally permitted to perform procedures or sign documents, refuse due to legal limitations

Professional Standards Use approved, correct methods while performing

procedures– Follow procedure manual

Obtain correct authorization before performing any procedures– Dr’s order, verbal or written

Identify pt & obtain consent before performing procedures– Check name band– State pt’s name clearly & repeat if necessary– Explain procedure briefly – make positive statements

Professional Standards

I.D. pt (cont)– Obtain consent by lack of objection– If pt refuses, check with supervisor– Some procedures require written consent– Never witness a signature unless

authorized to do so

Professional Standards

Observe all safety precautions– Handle equipment carefully– Protect pts– Be alert to safety hazards & correct ASAP– Know & follow safety rules & regs

Think before you speak, watch everything you say– Don’t tell pt information unless instructed– Revealing info could cause problems

Professional Standards

Keep all info confidential– Written & oral– Don’t leave records open & out– Don’t reveal info without pt authorization &

consent– Make sure conversations can’t be

overheard– Avoid discussing pts at home, in social

situations, public places, or outside agency

Professional Standards

Treat all pts equally Accept no tips or bribes for care you

provide– You receive salary– Care should not change based on amount

of money pt can give you– Polite refusal necessary

Professional Standards

If error occurs, report it to your supervisor immediately– Never try to hide or ignore– Make every effort to correct ASAP– Take responsibility for actions

Behave professionally in dress, language, manners, & actions

Liability insurance – protects you