Legal Responsibilities

1. Legal Responsibilities Mrs. Jessica Dean, RN, BSN

2. Daily Objectives: Identify and define legal terms related to health care Discuss legal issues in the health care field.

3. Introduction • Certain laws and legal responsibilities are in every aspect of life to protect you and society • Ex: Traffic laws • Health care workers also have certain responsibilities • Important to be aware of and follow legal regulations to protect you, your employer, and safety of the patient

4. Legal Responsibilities • Legal responsibilities: authorized or based on law. • It is your responsibility as a health care professional to know and follow the state laws that regulate their regulate their respective license or registrations. • Failure to meet your legal responsibilities can result in legal action against you and your employer.

5. Civil law: focuses on legal relationships between people and the protection of a person’s rights. • Criminal law: focuses on behavior known as crime; deals with the wrongs against a person, property, or society. • Ex:practicing in a health profession without having the required license, illegal possession of drugs, misuse of narcotics, theft, sexual assault, and murder.

6. Torts • Torts: a wrongful act that does not involve a contract. • A tort occurs when a person is harmed or injured because a health care provider does not meet the established or expected standards of care. • Many torts may lead to legal action

7. Malpractice • Malpractice: “bad practice”, commonly called “professional negligence.” • The failure of a professional to use the degree of skill and learning commonly expected in that individual’s profession, resulting in injury, loss, or damage to the person receiving care. • Ex: physician not administering a tetanus injection when a patient has a puncture wound, a nurse performing surgery without having any training.

8. Negligence • Negligence: failure to give care that is normally expected of a person in a particular position, resulting in injury to another person • Ex: falls occurring from side rails being left down, infections caused by unsterile equipment, not reporting defective equipment

9. Assault and battery • Assault: threat or attempt to injure • Battery: the unlawful touching of another person without consent • Ex: performing a procedure on a pt after the pt has refused to give permission and rough treatment of a pt while providing care. • Pt’s must give consent for any care and they have the right to refuse care.

10. Informed Consent • Informed Consent: permission granted voluntarily by a person who is of sound mind after the procedure and all risks involved have been explained in terms the person can understand. • Ex: Surgical consents

11. Invasion of Privacy • Invasion of Privacy: unnecessarily exposing an individual or revealing personal information about an individual without that person’s consent. • Ex: not covering a patient while performing a procedure, informing news media about pt’s condition without pt’s consent

12. False Imprisonment • False imprisonment: restraining an individual or restricting an individual’s freedom • Ex: keeping pt’s hospitalized against their will, applying restraints without proper authorization or without justification.

13. Abuse • Abuse: any care that results in physical harm, pain, or mental anguish • Physical, psychological, verbal, or sexual

14. Physical Abuse • Ex: Hitting, forcing people against their will, restraining movement, depriving people of food or water, and/or not providing physical care

15. Verbal Abuse • Ex: Speaking harshly, swearing or shouting, using inappropriate words to describe a person’s race or nationality, and/or writing threats or abusive statements

16. Psychological Abuse • Ex: threatening harm, denying rights; belittling; intimidating, or ridiculing the person; and/or threatening to reveal information about the person

17. Sexual Abuse • Any unwanted sexual touching or act, using sexual gestures, and/or suggesting sexual behavior

18. Defamation: false statements either cause a person to be ridiculed or damage the person’s reputation. • Slander: if the information is spoken • Libel: if the information is written • Ex: reporting that a pt has an infectious disease to a government agency when lab results are inaccurate, telling others that a person has a drug problem when another medical condition actually exists, or saying that a co-worker is incompetent.

19. Daily Objectives: Describe how contract laws affect health care State the legal regulations that apply to health care records

20. Contracts • Contract: an agreement between two or more parties • Implied: obligations that are understood without verbally expressed terms. Ex: nurse gives a pt medication and pt takes med- implied pt accepts treatment. • Expressed: stated in distinct and clear language. Ex: surgery permit.

21. Legal Disability • Legal Disability: does not have the legal capacity to form a contract. • Ex: minors, mentally incompetent persons, under the influence of drugs that alter mental state and semiconscious or unconscious people. • People with legal disabilities cannot sign contracts

22. Contract requires that certain qualities of care be provided by competent, qualified individuals. • If not performed according to agreement, the contract is breached.

23. Agent • Agent: when a person works under the direction or control of another person, the employer is called the principal, and the person working under the employee is called the agent. • The principal is responsible for the actions of the agent and can be required to pay or otherwise compensate people who have been injured by the agent. • Ex: if a dental assistant tells a patient “your dentures will look better than your real teeth,” the dentist may have to compensate the patient financially should this statement prove false.

24. Privileged Communications • Privileged Communications: comprise all information given to health care personnel by a patient. • Confidential • Must have a written consent form to release information • Some info is exempt by law: births, deaths, abuse cases, drug abuse, STD’s and communicable diseases.

25. Health Care Record • Health Care record: contain information on the care provided to the patient. • Must be kept confidential • Properly maintained • Retained for the amount of time required by state law • Whose property is your health record? • Belongs to the health care provider

26. HIPPA • Require every health care provider to inform patients about how their health information is used. • Patients must sign a consent form ascertaining that they have received the information before any health care provider can use the health information for diagnosis, treatment, billing, insurance claims, or quality care assessments.

27. Ethics • Ethics: are a set of principles relating to what is morally right or wrong. • Provide a standard of conduct or code of behavior • Modern health care advances have created many ethical dilemmas for health care providers.

28. Is euthanasia justified in certain patients? • Should a person be told that a health care provider has AIDS? • Should aborted fetuses be used for research? • When should life support be discontinued? • Do parents have a religious right to refuse a life-saving blood transfusion for their child? • Who decides whether a 75 year old patient or a 56 year old patient gets a single kidney available for transplant?

29. If a person can benefit from marijuana, should a physician be allowed to prescribe it as a treatment? • Should animals be used in medical research even if it results in the death of the animal? • Should human beings be cloned? • Should aborted embryos be used to obtain stem cells for research, especially since scientists may be able to use the stem cells to cure diseases such as diabetes, osteoporosis, and Parkinson’s?

30. Some guidelines are provided by an ethical code • Put the saving of a life and the promotion of health above all else. • Make every effort to keep the patient comfortable and to preserve life whenever possible. • Respect a patient’s choice to die peacefully

31. Confidentiality • Confidentiality: means that information about the patient must remain private and can be shared only with other members of the patient’s health care team.

32. What if Scenarios • You have one more paper to turn in for a course that is required for your job. You kept the weekend open to write it, but an old friend called and said he’s in town for the weekend and would like to spend some time with you. You know there won’t be enough time both to write the paper and to visit with your friend. You just happen to have a copy of a paper that someone else wrote for the same course two years ago that earned a grade of “B”. A new instructor who would never know you didn’t write the paper yourself is teaching the course.

33. Your supervisor asked you to attend a meeting in her place, but you forgot. You know she’ll be upset with you because she needs the information that was distributed. Someone else you know did go to the meeting and has agreed to give you copies of the materials. When you hand the information to your supervisor, she asks, “So what did you think of the meeting?”

34. A patient on your unit gets discharged. While cleaning the room for the next patient, you find an expensive watch in the drawer in the bedside table. • When you open your paycheck, you realize you got paid for a day that you didn’t work.

35. My Sister’s Keeper

36. #1 Given What you’ve just seen, which character are you most sympathetic too? Why?

37. #2 Imagine you are the mother: while Kate is dying, you discover that Anna refuses to give Kate the last possible life-saving treatment. How would you react? How would you try to keep your family together?

38. #3 • Do you think it is ethical to design and conceive a child that meets specific genetic requirements? • If so, is PGD ethical in all cases? (prevent miscarriages, prevent inheritable genetic diseases, sex selection for social reasons) • If not, do you believe there should be specific exceptions- such as saving another person’s life- or is this just a “slippery slope”?

39. #4 • Knowing what you now know about PGD, do you agree with the parent’s choice to “design” Anna to save Kate? • Is it ethically ok to screen embryos for desired genetic traits, and reject the “undesired” embryos?

40. #5 • How does the knowledge that Anna was conceived to save Kate affect Anna’s and Kate’s perceptions of themselves, and their relationship with each other? For instance, you might consider the following: • Will Kate feel guilty knowing that Anna was created to save her life? • What if Anna can’t save Kate? Will Anna face lifelong psychological damage? • Does Anna feel objectified as a “spare parts baby”? Does Kate feel objectified as a sick person?

41. #6 Do you think the parents went too far in their concern for Kate by making Anna a savior for Kate? When is it too far to save one child by using the body of another? By taking umbilical cord blood? Bone marrow transplants? Kidney donation? After Anna has spoken up in opposition to any further use of her body?

42. #7 Recall the physician in the movie who recommended PGD, an ethically questionable procedure, “off the record.” If you were a physician, would you recommend PGD to a couple in a similar situation?

43. Daily Objectives: Identify at least six rights of the patient who is receiving health care Justify at least eight professional standards by explaining how they help meet legal/ethical requirements

44. Patient’s Rights • “The customer is always right?” • Is the patient always right?

45. Patients’ Rights • Patients’ Rights: are factors of care that patients can expect to receive • Usually written policies • The American Hospital Association has affirmed a “Patient’s Bill of Rights” use by many hospitals and health care facilities.

46. Long-term Care Facilities • “Resident’s Bill of Rights” • Must be posted in facility • Resident and/or guardian are informed of rights ****Failure to follow and grant rights can lead to job loss, fines, and even imprisonment

47. Legal Directive for Health Care • Advance Directives: legal documents that allow individuals to state what medical treatment they want if they become incapacitated and are unable to express their wishes. • Two Types: • Living Will • Durable Power of Attorney (POA)

48. Living Wills: documents that allow individuals to state what measures should or should not be taken when death is imminent • Durable Power of Attorney (POA): permits an individual to appoint another person to make decisions regarding health care

49. Patient Self-Determination Act • Patient Self-Determination Act: requires all health facilities receiving any type of federal aid to provide patient with information regarding and assistance in preparing advance directives. • Create your own “Living Will”

50. Professional Standards • What are standards? • Never perform procedures which you have not been trained on and are not legally permitted to perform. • Use approved or correct methods while performing procedures • Obtain proper authorization before performing any procedure