Medical Law and EthicsMedical Law and Ethics

TOPICSTOPICS

Key TermsKey Terms

Legal responsibilities in health careLegal responsibilities in health care

EthicsEthics

Professional StandardsProfessional Standards

Law & Ethics in HCLaw & Ethics in HC

The law affects all health care The law affects all health care careerscareers

Awareness of the law protects you, Awareness of the law protects you, your co-workers, your patients and your co-workers, your patients and your employeryour employer

Laws are created/enforced by Laws are created/enforced by federal, state and local governmentfederal, state and local government

Law & Ethics in HCLaw & Ethics in HC

Health care workers must follow laws Health care workers must follow laws that affect health care, as well as that affect health care, as well as those laws that regulate their those laws that regulate their license, registrations and/or license, registrations and/or standards for their professionstandards for their profession

Failure to follow the law may result in Failure to follow the law may result in legal action against you and/or your legal action against you and/or your employeremployer

Legal TerminologyLegal Terminology

Liable: accountable under the lawLiable: accountable under the law Criminal Law: wrongs against a Criminal Law: wrongs against a

person, property or society (crime). person, property or society (crime). Includes felonies and misdemeanors. Includes felonies and misdemeanors.

Civil Law: wrongful acts. Involve legal Civil Law: wrongful acts. Involve legal relationships between people and relationships between people and protection of rightsprotection of rights

Civil law generally covers 2 areas: Civil law generally covers 2 areas: torts and contractstorts and contracts

TortsTorts

Tort: wrongful act that does not Tort: wrongful act that does not involve a contract. Can be intentional involve a contract. Can be intentional or unintentionalor unintentional

Many torts can lead to legal actionMany torts can lead to legal action Common torts that can affect health Common torts that can affect health

care workers:care workers:

Types of TortsTypes of Torts

1. Negligence: failure to give care 1. Negligence: failure to give care normally expected for that positionnormally expected for that position Example: ?Example: ?

2. Malpractice: bad practice, 2. Malpractice: bad practice, professional negligence. Failure of a professional negligence. Failure of a professional to use expected degree professional to use expected degree of skill; not following professional of skill; not following professional standardsstandards Example: ?Example: ?

3. Assault: threaten to harm; results in fear3. Assault: threaten to harm; results in fear 4. Battery: unlawful touching without 4. Battery: unlawful touching without

consentconsent 5. Invasion of Privacy: unnecessary 5. Invasion of Privacy: unnecessary

exposure or revealing of personal exposure or revealing of personal information w/out consentinformation w/out consent Example?Example?

6. False Imprisonment: unlawful restraint or 6. False Imprisonment: unlawful restraint or confinementconfinement Example?Example?

Types of Torts (Cont.)

7. Abuse: treatment of another that results 7. Abuse: treatment of another that results in physical harm or mental anguishin physical harm or mental anguish

Can be physical, verbal, psychological, Can be physical, verbal, psychological, sexualsexual

Health care workers are required by law to Health care workers are required by law to reportreport

Signs?Signs?

Types of Torts (Cont.)

8. Defamation: false statements that 8. Defamation: false statements that damage reputation. Incorrect info given damage reputation. Incorrect info given out in error can result in thisout in error can result in this

Slander: info. is spokenSlander: info. is spoken Libel: info is writtenLibel: info is written Example?Example? 9. Fraud: deceitful practices depriving 9. Fraud: deceitful practices depriving

another of their rightsanother of their rights Example?Example?

Types of Torts (Cont.)

ContractsContracts

Agreement between 2 or more parties; Agreement between 2 or more parties; specific promises made for a specific promises made for a considerationconsideration

Elements of a contract: Elements of a contract: Agreement: offer is made and acceptedAgreement: offer is made and accepted Consideration: something of value is Consideration: something of value is

bargained for as part of the agreementbargained for as part of the agreement Legal subject matter: legally enforceableLegal subject matter: legally enforceable Contractual capacity: parties must be Contractual capacity: parties must be

competent to enter contract competent to enter contract

Two types of contracts: Two types of contracts: 1. Implied Contract: obligations 1. Implied Contract: obligations

understood w/out verbal expressionunderstood w/out verbal expression

2. Expressed Contract: stated in 2. Expressed Contract: stated in distinct language either verbally or in distinct language either verbally or in writingwriting

ConsentConsent

Permission from pt, either expressed Permission from pt, either expressed or implied for something to be done.or implied for something to be done.

Can be verbal, written or impliedCan be verbal, written or implied All consent must be “informed”: All consent must be “informed”:

implies that pt understands tx, why it implies that pt understands tx, why it is nec, tx risks, alternatives, risks if tx is nec, tx risks, alternatives, risks if tx is refusedis refused

Pt must be of sound mind and legal Pt must be of sound mind and legal age to give consentage to give consent

Legal DisabilityLegal Disability

No legal capacity to enter into a contractNo legal capacity to enter into a contract

Includes: minor, mentally incompetent, Includes: minor, mentally incompetent, unconscious, altered mental stateunconscious, altered mental state

Parent, guardian, spouse must then form Parent, guardian, spouse must then form the contract for the legally disabledthe contract for the legally disabled

Breach of ContractBreach of Contract

Contract not performed according to Contract not performed according to the agreementthe agreement

Ex: pt fails to pay or provider fails to Ex: pt fails to pay or provider fails to provide careprovide care

Can lead to legal actionCan lead to legal action

Privileged Communication & Privileged Communication & Legal Responsibilities Legal Responsibilities

All info given to hc personnel by the All info given to hc personnel by the patient; held in confidencepatient; held in confidence

Confidential and can only be shared w/ Confidential and can only be shared w/ members of the hc teammembers of the hc team

Cannot be relayed w/out consentCannot be relayed w/out consent Exempt: births, deaths, injury cb violence, Exempt: births, deaths, injury cb violence,

drug abuse, communicable diseases, STDsdrug abuse, communicable diseases, STDs

Medical RecordsMedical Records

Privileged communicationPrivileged communication Property of facility but pt owns the Property of facility but pt owns the

info and has right to review/obtain info and has right to review/obtain copiescopies

Legal recordLegal record Must be kept in secure areaMust be kept in secure area Shred after legal retention date Shred after legal retention date

expiresexpires

Legal ResponsibilitiesLegal Responsibilities

No erasures, blank spaces. No erasures, blank spaces. Errors according to policyErrors according to policy Shred carbonsShred carbons Don’t share computer passwordsDon’t share computer passwords Faxes & computer screens in secure Faxes & computer screens in secure

areaarea Limit personnel who can accessLimit personnel who can access Pt can request to amendPt can request to amend De-identify for use by studentsDe-identify for use by students

5 C’s of Documentation5 C’s of Documentation

ConciseConcise Complete (and objective)Complete (and objective) Clear (and legible)Clear (and legible) CorrectCorrect ChronologicalChronological

HIPPA Health Info Privacy HIPPA Health Info Privacy

Enacted 1996, effective 2003Enacted 1996, effective 2003 Standards to protect private Standards to protect private

communicationcommunication Patient rights:Patient rights: Able to see/obtain med recordsAble to see/obtain med records Able to set limits how health info usedAble to set limits how health info used Providers must keep PHI confidentialProviders must keep PHI confidential Right to state who can accessRight to state who can access Info to report violationsInfo to report violations

EthicsEthics

Set of principles associated w/ what Set of principles associated w/ what is right and wrongis right and wrong

Provide standard of conduct & code Provide standard of conduct & code of behaviorof behavior

Allow HCW to analyze situations and Allow HCW to analyze situations and make decisions based on what is make decisions based on what is right or wrongright or wrong

EthicsEthics

Many ethical dilemmas today; Many ethical dilemmas today; primarily due to advancing primarily due to advancing technologytechnology

Important for individuals to consider Important for individuals to consider how they would handle situations how they would handle situations that would require ethical decision that would require ethical decision makingmaking

Rules of EthicsRules of Ethics

Saving a life, health promotion Saving a life, health promotion comes firstcomes first

Keep pt comfortable, preserve lifeKeep pt comfortable, preserve life Respect pt choicesRespect pt choices Tx pts equallyTx pts equally Provide care for all to best of abilityProvide care for all to best of ability Maintain a competent skill levelMaintain a competent skill level Pursue continued educationPursue continued education

Ethics in HCEthics in HC

Maintain pt confidentialityMaintain pt confidentiality Refrain from all illegal, unethical, Refrain from all illegal, unethical,

immoral practicesimmoral practices Show loyalty to pt, co-workers and Show loyalty to pt, co-workers and

employeremployer Be sincere, honest, respectful and Be sincere, honest, respectful and

caringcaring Treat others as you would want to be Treat others as you would want to be

treatedtreated

Patient RightsPatient Rights Federal and state law requireFederal and state law require AHA: Patient Bill of RightsAHA: Patient Bill of Rights The patient is entitled to certain rights:The patient is entitled to certain rights: Considerate and respectful careConsiderate and respectful care Info re dx, tx, prognosisInfo re dx, tx, prognosis Info necessary to give informed Info necessary to give informed

consentconsent Confidentiality and privacyConfidentiality and privacy Advanced DirectivesAdvanced Directives

OBRAOBRA

OBRA: Residents Bill of RightsOBRA: Residents Bill of Rights Free to choose MD, tx, careFree to choose MD, tx, care No abuse, chemical or physical restraintsNo abuse, chemical or physical restraints Confidentiality and privacyConfidentiality and privacy Accommodate needs and choice re Accommodate needs and choice re

activities, schedule and home careactivities, schedule and home care Voice grievancesVoice grievances Participate in activitiesParticipate in activities Manage personal funds and possessionsManage personal funds and possessions

Patient RightsPatient Rights

To refuse to participate in researchTo refuse to participate in research Review med records and receive Review med records and receive

explanation of chargesexplanation of charges Info about hosp rules, regs and policiesInfo about hosp rules, regs and policies Continuity of care; Reasonable Continuity of care; Reasonable

response to request for servicesresponse to request for services Info re: relationship of hosp to other hc Info re: relationship of hosp to other hc

and educational organizationsand educational organizations

Patient RightsPatient Rights

Unlimited access to familyUnlimited access to family No transfer or d/c except for med No transfer or d/c except for med

reasons, failure to payreasons, failure to pay Info about med benefits, survey Info about med benefits, survey

results and facility deficienciesresults and facility deficiencies These rights vary by stateThese rights vary by state

Advanced DirectivesAdvanced Directives

Legal documents that state what Legal documents that state what med tx may be carried out in the med tx may be carried out in the event that an individual becomes event that an individual becomes incapacitated or unable to express incapacitated or unable to express their wishes their wishes

1. Living Will1. Living Will

What measures may or may not be What measures may or may not be taken to prolong life if there is a taken to prolong life if there is a terminal condition or permanent terminal condition or permanent unconsciousnessunconsciousness

Must be signed when competent and Must be signed when competent and witnessed by 2 adultswitnessed by 2 adults

Most states have laws to protect thisMost states have laws to protect this May result in DNRMay result in DNR

2. Durable Power of Attorney2. Durable Power of Attorney

Permits the appointment of another Permits the appointment of another to make medical decisions if you to make medical decisions if you become unable to do sobecome unable to do so

Includes providing or withholding tx Includes providing or withholding tx or proceduresor procedures

Must be signed by both parties and Must be signed by both parties and witnessedwitnessed

Usually spouse or adult children Usually spouse or adult children

Pt Self Determination ActPt Self Determination Act

Federal Law requiring hc facilities to Federal Law requiring hc facilities to inform pts of:inform pts of:

Their right to make decisions to Their right to make decisions to refuse tx and right to dierefuse tx and right to die

Provide info on Adv DirectivesProvide info on Adv Directives Document Adv Dir in chartDocument Adv Dir in chart Not discriminate based on Adv DirNot discriminate based on Adv Dir

Professional StandardsProfessional Standards

Standard of care: level of performance Standard of care: level of performance expected when carrying out prof dutiesexpected when carrying out prof duties

Practice w/in scope of expertise and Practice w/in scope of expertise and training: perform procedures you are training: perform procedures you are trained and legally permitted to performtrained and legally permitted to perform

Use approved, correct methodsUse approved, correct methods Obtain appropriate authorizationObtain appropriate authorization Identify pt and obtain consentIdentify pt and obtain consent Observe safety precautionsObserve safety precautions Maintain confidentialityMaintain confidentiality

Professional StandardsProfessional Standards

Accurate documentationAccurate documentation Follow legal and ethical guidelinesFollow legal and ethical guidelines Meet requirements for professional Meet requirements for professional

credentialingcredentialing Think before you speakThink before you speak Tx all pts =Tx all pts = No tips or bribesNo tips or bribes Report all errors immediatelyReport all errors immediately Professional manner, dress, language Professional manner, dress, language

and actionand action

Prof. Stand. protect you, your co-Prof. Stand. protect you, your co-workers and your patientsworkers and your patients

Good Samaritan LawGood Samaritan Law

Protects Dr’s, RN’s and some other Protects Dr’s, RN’s and some other professions from liability when professions from liability when rendering emergency carerendering emergency care

Must act within scope of practiceMust act within scope of practice Proven willful wrongs or gross Proven willful wrongs or gross

negligence will result in liabilitynegligence will result in liability Laws vary by stateLaws vary by state

Job ClassificationsJob Classifications

Licensure: mandatory credentialing Licensure: mandatory credentialing process; required by state; grants right to process; required by state; grants right to practicepractice

Certification: voluntary credentialing Certification: voluntary credentialing process; usually national in scope, process; usually national in scope, sponsored by private groupssponsored by private groups

Registration: entry in an official registry: Registration: entry in an official registry: list of names who have satisfied certain list of names who have satisfied certain requirements. May involve fees and requirements. May involve fees and education.education.