Legal and Ethical Practices in Health Care: A Comprehensive Guide

1. Legal Practices in Medicine

2. Legal Responsibilities • Health care professionals/ workers must know and follow the state laws that regulate their licenses or registrations or set standards for their professions.

3. Legal and Ethical Practices Law – a rule that must be followed Laws are created and enforced by federal, state, or local governments Two main types: criminal and civil

4. Criminal Law: AKA Crime deals with offenses against all persons, property, and society Examples of Criminal Law • Practicing in a health care profession without a license. • Misuse of narcotics. • Theft. • Murder

5. An example of criminal law is: • [A divorce] • [Practicing Medicine without a license] • [Child custody and child support] • [Breech of contract]

6. Private Law is Civil Law!(This primarily affects health care) Civil Law - deals with the legal relationships between people and the protection of a person’s rights Two Main Types of Civil Law: • Torts • Contracts

7. Tort - from the French word “wrong.” It can be defined as a wrongful act that does not involve a contract Occurs when a person is harmed or injured because a health care provider does not meet the established or expected standards of care Torts

8. Malpractice • Failure of a professional to use the degree of skill and learning commonly expected in that individual’s profession • called “professional negligence”. • Causes injury, loss, or damage to the person receiving care • Ex: physician not administering a tetanus shot when pt. has a puncture wound

9. [Which situation is malpractice if the patient is injured as a result of a health care workers actions?] • [A health care worker fails to wipe up some water that he/she spilled on the floor.] • [A health care worker forgets to put up the patient’s bedside rail.] • [A health care worker performs a special procedure on a patient that he/she is not instructed to perform.] • [A heating pad with a defective cord is used on a patient even though the health care worker knows it is defective.]

10. Negligence • Failure to give care that is normally expected of a person in a particular position. • Results in injury • Ex: patient falls out of bed when bedrails are down, using defective equipment,

11. Assault • any willful attempt or threat to injure another person with the apparent ability to do so.

12. Battery • unlawful touching of another person without their consent.

13. [Dr. Williams is charged with assault and battery. What situation might have caused this charge?] • [A patient’s bandage will not stay on] • [The patient leaves the hospital without being discharged] • [Dr. Williams operates on a patient without consent] • [Dr. Williams accidentally removes the wrong body part.]

14. 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.

15. Informed Consent • The person has the right to withdraw consent at any time • All procedures must be explained to the patient, and no procedure should be performed if the patient does not give consent

17. Invasion of Privacy • Unnecessary exposure of an individual, or revealing personal information about an individual without their consent. • Ex: improperly draping a patient

18. [Two health care workers were overheard discussing a co-worker who was admitted to the hospital drunk and violent. What legal standard was violated by the two workers?] • [Libel] • [Malpractice] • [Assault and battery] • [Invasion of privacy]

19. False Imprisonment • Restraining an individual, or restricting an individual’s freedom. Ex: holding someone in a facility against their will or physically restraining them. Sometimes treated as a crime.

20. [Chelsia charges a hospital with false imprisonment. What might have happened?] • [A doctor would not write an order for Mrs. Daniel to be discharged] • [A nurse applied physical restraints on Mrs. Daniel without justification] • [A nursing assistant put up the bedside rails while Mrs. Daniel was sleeping] • [A ward secretary sent Mrs. Daniel’s chart to her insurance company without her permission]

21. Abuse • Any care that results in physical harm, pain, or Mental anguish. Abuse can be classified as: Physical- hitting, forcing persons against their will, restraining movements, depriving of food or H2O, or not providing physical care.

22. Abuse Verbal Abuse – talking harshly, swearing or shouting, teasing, ridiculing, intimidating a person, using inappropriate words to describe a person's race or nationality, and/ or writing threats or abusive statements

23. Abuse • Psychological-threating harm; denying rights; belittling, intimidating. Or ridiculing the person; and/or threatening to reveal information about the person

24. Abuse Sexual Abuse – any unwanted sexual touching or act, using sexual gestures, and/or suggesting sexual behavior

25. Abuse ** Laws in all states require reporting of any form of abuse to proper authorities. **

26. Defamation damaging a person’s name and reputation by making public statements that are false and malicious

27. [An RN who has been fired from a medical practice has been making negative, untrue statements about her boss. What could he/she be charged with?] • [Immorality] • [Defamation] • [Invasion of Privacy] • [Negligence]

28. Defamation There are 2 types: Libel - if the information released is written. Slander - if the information released is spoken.

29. [Grant is angry at a physical therapist who will not date him. He starts spreading ugly rumors around town about her. What is this?] • [Libel] • [Malpractice] • [Invasion of privacy] • [Slander]

30. Contracts • A contract is a voluntary agreement between two parties

31. Contracts • 3 parts to most contracts: • Offer: a competent individual offers to be a patient • Acceptance: Health care provider gives an appointment to or examines a patient • Consideration: payment is made for the services provided

32. Types of Contracts • Implied – contractual obligations by some action or inaction without verbally expressed terms. • Ex: when a qualified health worker prepares a medication and the patient takes it-it is implied that the patient accepts treatment

33. Types of Contracts • Expressed - actual agreement between the parties, the terms are stated in distinct and explicit language, either orally or in writing. Ex: surgical consent

34. Rules of a contract • All parties in a contract must be free of legal disabilities. • A person with legal disabilities does not have the legal capacity to form a contract.

35. Legal Disability • Minors- under 18 • Mentally incompetent persons • Individuals under the influence of drugs that alter the mental state • Semi- or unconscious people

36. Law of Agency • Agency is a personal relationship, created by mutual consent: • Principal-an employer who has employees. • Responsible for the actions of the employees • Agent-the employee who acts on behalf of the employer

37. Privileged Communication • Patient information cannot be told to anyone else without the written consent of the patient. • Written consent should state: • 1. What information can be released. • 2. Who can get the information. • 3. Any time limits related to the release of • information.

38. Privileged Communication • Medical Information Exempt by law • Births and Deaths • Injuries caused by Violence • Drug Abuse • Communicable Diseases • Sexually Transmitted Diseases

39. Health Care Records • Considered privileged communication because the record contains information on the care that has been provided to the patient.

40. Health Care Records • Medical records belongs to the health care provider but the patient has the right to obtain a copy. • The medical record is a legal document and may be subpoenaed as evidence in court

41. Health Care Records • Erasures are not allowed. • Errors should be crosses out with a single line, correct the information, initial, and date.

42. Health Care Records Records must be kept until the statues of limitations has passed (2-7 years.) When records are destroyed, they should be shredded or burned.

43. Health Care Records • Computer Confidentiality: • Limit personnel who have access • Use codes to prevent access to certain information • Requiring passwords in order to access specific information

44. [Meredith is moving to Cleveland and needs to take her medical records. She is aware that patients’ medical record are the property of the:] • [State] • [Patient and his or her family ] • [Owners of the facility where they were created]

45. HIPAA • Standards used to protect information • Patients must be: • Able to see and obtain copies of their records • Given medical information by health care providers about how they use medical information • Allowed to set limits on how personal health information is used

46. HIPAA • Permitted to request that health care providers take responsible care to keep communication confidential • Given the right to state who has access to their information and even to limit providing information to their family • Provided with information on how to file a complaint against a health care provider who violates the privacy act

47. Ethics • A set of principles relating to what is morally right or wrong. • Provide a standard of conduct or code of behavior

48. Confidentiality • Information about the patient must remain private and can be shared only with other members of the patient’s health care team.

49. Patient Rights • Factors of care a patient can expect to receive. • Patient Bill of Rights • Considerate care • Obtain current information • Informed consent • Advance directives • Privacy

50. Patient Rights • Confidentiality • Reasonable response for a request • Obtains information about the facilitu • Right to refuse to participate in research • Be able to review medical records and billing. • Be informed of disputes against the facility