MEDICAL LEGAL CONCERNS OF HEALTH

1. MEDICAL LEGAL CONCERNS OF HEALTH PRESENTERS: C. JAIMBO S. NZAU DATE: 5TH OCTOBER 2017

2. INTRODUCTION • Health environment is an ever changing environment where health care providers and health care recipients interact • This interaction generates ethical and legal issues

3. SCOPE The scopes are: • Protection of individuals’ health • Protection of individuals’ rights • Protection of public health • Protection of health care providers • Both partners have obligations and rights which are regulated by a contract (Consent)

4. CONSENT • It a voluntary agreement between 2 parties • Specific promises are made for consideration

5. WHO CAN CONSENT? • Minor: In non emergency situations, a parent or legal guardian’s consent must be obtained • Emancipated Minor: The people in this group can give consent

6. WHO CAN CONSENT CONT? • Mature Minor: Doctrine of mature minors allows minors to make their own decisions regarding medical treatment if they are mature enough to comprehend a physician’s recommendation and give informed consent Under this doctrine, minors may seek medical treatment for venereal diseases, contraception, pregnancy and drug or alcohol related abuse without the consent of parent

7. WHO CAN CONSENT? • The Mentally Incompetent: Person must be capable to fully understand all terms and conditions People here include: Insane, senile, mentally retarded, those under influence of alcohol or drugs

8. INFORMATION • Information must be on: • Proposed mode of treatment • Why the treatment is necessary • Risk involved in the proposed mode of treatment • Available alternative mode of treatment

9. INFORMATION CONT • Risk of alternative mode of treatment • Risk involved if the treatment is refused • Benefit involved in the proposed mode of treatment • Benefit of alternative mode of treatment • Note: Patient/next of Kin must comprehend all information given by the physician

10. KEY ETHICAL PRINCIPLES OF NURSING • Non-maleficence Remain competent in the field and report suspected abuse No harm to clients • Beneficence: Have compassion , take positive actions to help others and follow through on the desire to do good All actions must benefit the welfare of the client

11. KEY ETHICAL PRINCIPLES OF NURSING • Fidelity: Keep commitments based on virtue of caring • Autonomy: Respect patient’s wishes even when you do not agree with them

12. KEY ETHICAL PRINCIPLES OF NURSING • Totality and integrity: Consider the entire person when deciding which therapies, medication and procedures a patient should receive • Justice: Treat all patients fairly and equally

13. DOCUMENTATION • Medical records are often used as evidence in professional medical liability cases • The healthcare professional who face any charges are at tremendous disadvantage if they cannot produce accurate, thorough legible medical records • Entries in the medical record must be objective, concise and legibly written

14. CORRECTION • Errors discovered while typing can be corrected in the usual manner • Errors discovered later must be corrected by drawing a single line through the mistake, writing in the correction and labeling correction dating change and signing initials

15. NURSING ACTIVITIES INVOLVED IN LITIGATION • Treatment • Communication • Medication • Monitoring • Observing • Supervising

16. HOSPITAL MANAGEMENT CAN BE SUED FOR • Failure to provide adequate staff • Failure to train our personnel • Failure to establish prompt report for medical treatment records • Failure to supervise • Failure to set up safety policy • Failure to establish causality • Negligence

17. DO NOT RESUSCITATE (DNR) ORDER • Efforts should be made to resuscitate patients who suffer cardiac or respiratory arrest except when circumstances indicate that cardiopulmonary resuscitation CPR, would be futile or not in accord with the desires or best interest of the patient

18. DNR ORDER CONT • Patients at risk of cardiac or respiratory failure should express in advance their wishes regarding CPR and this should be documented in their medical records • If patient is incompetent to make such decision then a surrogate decision maker should be named

19. DNR ORDER CONT • If in the judgment of the treating physician CPR would be futile, the physician may enter a DNR order into the patient’s record after a detailed explanation to the patient and/or patients surrogate

20. DNR ORDER CONT • DNR orders only prelude resuscitative efforts in the event of cardiopulmonary arrest and should not influence other therapeutic interventions that may be appropriate for the patient

21. TORT LAW • Determines when a person (including groups of persons, corporations or government) must pay for civil, non contractual wrong caused to others • Injuries here include intentional and non intentional • Functions of tort law: a) Compensation b) Prevention of harm by enforcing accountability

22. CASE STUDY • Mr. x , a 24 year old male patient was admitted in hospital after being involved in RTA • On arrival in A & E, GCS was 4/15, was intubated and put on M.V • Trauma series done revealed SHI with cerebral edema

23. CASE STUDY CONT. • Was admitted in ICU and family briefed on his progress • After 6 hours his condition deteriorated, Pupils at size 5 and non reactive to light

24. CASE STUDY CONT. • Repeat CT scan revealed worsening cerebral edema, midline shift with early signs of axonal herniation • Was taken to theatre for decompressive craniotomy

25. CASE STUDY CONT. • Day 2 in ICU, condition deteriorated further, Bp crashed and was started on inotropes-MAPS remained < 50mmhg • Caloric test was positive • Family conference was held, information passed & agreed a DNR order to be put in place

26. CASE STUDY CONT. • The institution did not have DNR order forms • This was done by word of mouth without documentation • The medical team executed the order

27. CASE STUDY CONT. • Day 3 and 4 in ICU, patient remained very sick with low BP. Nursing care and family counselling continued • Patient died on day 5 in ICU • The family sued the hospital for negligence and denied having discussed about DNR issues with the medical team

28. MEDICAL NEGLIGENCE • You guessed right. The family won the case

29. THANK YOU