Medical-Legal Issues

1. Medical-Legal Issues 11/ 06/2011

2. Public has increasing awareness of expected standards of care when they don’t feel they have received treatment living up to that standard they are becoming more willing to seek legal compensation -$$$

3. Torts (Civil wrong) Area of law dealing with violations of civil rights, rather than criminal acts Court attempts to provide a remedy in form of an action for damages ($$$) 2 types- • Intentional Assault Battery False imprisonment Libel and slander Invasion of privacy • Unintentional acts (negligence)

4. Assault: Any act that creates apprehension in another of imminent, harmful, or offensive contact Or an attempt of an act with intent to commit a battery To be guilty: injury doesn’t have to occur or nor does attempt need to be successful - Throwing a rock and missing - A punch that doesn’t connect Assault could be telling Pt. you are going to do an exam they are not supposed to have!!

5. Not all assaults are unlawful! Making an arrest Defending yourself Professional sports

6. BatteryAccording to Calif. Penal Code 242 Any willful and unlawful use of force or violence upon the person of another (even if no bodily harm, pain or physical marks result!) Harmful or offensive touching of another Grabbing someone by clothing, or touching them in angry, vengeful, rude or hostile manner -even if its just that person’s perception

7. Examples of Battery • Spitting on someone • Kissing or hugging someone • Fondling or grabbing body parts • …could be construed as battery!

8. Battery cont’d Must be willful- intent must be there- act was notaccidental(bumping into someone, car accident- not willful) Assault is the attempt, battery is the success Battery implies assault- cannot be battery without assault

9. Parent Chastising Child is not guiltyof Assault and Battery If punishment is reasonable But, if an instrument is used likely to cause serious injury, - then parent could be prosecuted for criminal offense

10. Although battery implies willful act to harm or provoke – It is OK to restrain a Pt who is a danger to themselves or others A reassuring touch on Pt’s shoulder could be battery! if Pt. has forbidden you to touch them You might be guilty of battery if – you have not explained properly everything you are about to do and Pt freaks out and jumps up and hits head on tube

11. You could also be guilty of battery- If you take a radiograph against pt’s will Or radiograph the wrong pt Or radiograph the wrong body part Or take Excessive repeat exposures

12. How To Prevent Accusations Of Assault And Battery when dealing with Pts Make sure you are doing right Pt! Check identification prior to beginning exam Read requisition carefully -make sure you are doing right exam -on correct body part Explain exam fully Check if female pt. could be pregnant Shield!

13. Injury Reporting Tech must report any injury to supervisor immediately! No matter how minor the incident, or how unlikely there is an injury, err on side of caution! Be careful! Pt could get fingers caught in fluoroscopy unit as it moves, even if they do not mention it and show no signs of injury- you could still be liable! Make sure to check condition of Pt at all times!

14. “Snitch Law” According to Safe Medical Devices Act of 1991: Techs who fail to report defects and failures in medical devices .. Could be liable for Civil Penalties from $15,000 up to $1 million per case! Even broken measuring ruler on tube could be grounds for suit! Report any equipment breakdown immediately to supervisor!

15. False Imprisonment Intentional confinement without authorization using force, threat of force, confining clothing or structures (Becomes an issue when a pt wishes to leave and cannot do so) Inappropriate restraints can constitute false imprisonment, i.e., brat board to restrain a child without first explaining to parents Not immediately releasing child from pigg-o-stat if parent requests It is OK to restrain a Pt who is a danger to themselves or others

16. Libel And Slander Torts that effect person’s good name or reputation (information must be untrue) Slander • Oral defamation of character Libel • Written defamation of character Examples: spreading untrue rumors about Pt, staff or students Writing evaluations that are unfair or using false information Writing on request that Pt refused repeat, just to get out of doing it

17. Invasion of Privacy Touching a Pt inappropriately (may only be their perception of it!) Be careful when checking for landmarks or placing shielding on Pt Always explain first what you are about to do! Not protecting a Pt’s modesty: Not dressing a Pt properly in gown Not covering with sheet or blanket Gossiping about a Pt Not protecting confidentiality of records

18. What is a “Breach”? Afailure to live up to the requirements or standards set forth in an agreement, contract or promise…. What is the most common reason for pts suing hospital, doctor or other health care individual? Breach of confidentiality

19. Breach of Duty Not performing to standards of profession, hospital, or dept. Examples: Turning in x-rays which you know are not acceptable, and could be improved (if Pt gets worse because diagnosis could not be made because of poor films-could be lawsuit!) Not shielding Attempting to do an exam you are not qualified to do Not checking to see if Pt is pregnant

20. Negligence Radiographer unintentionally causes injury to Pt Between Tech and Pt there is implied contract to provide reasonable care Neglect or omission of reasonable care or caution in this relationship is negligence Can result in a malpractice lawsuit!

21. Negligence (cont’d) • Wantonly negligent or recklessness in exposing others to danger • Not shielding! • Over-exposing pt. to radiation when using CR or DR with use of intentionally high mAs in order to window and level after to make sure you don’t have to repeat image • Not guarding against Pt falling off table • (2 people walked Tania and I to car in wheel chair after dental surgery- waited until seatbelts on, engine started)

22. Respondeat Superior Latin phrase meaning “ let the master answer” Hospital must pay for torts committed by employees Injured pt doesn’t have to prove hospital negligent, only technologist Hospital automatically liable, but tech may still be sued

23. Res IpsaLoquitor Latin phrase meaning “thing speaks for itself” Usualllyplantiff has to prove defendant negligent In this case, defendant has to prove innocence Example: pt has radiation burns that could only be caused by negligence on part of tech. Tech must prove they were not the responsible party

24. For a radiographer to be held negligent in court, 4 factors must be established: • Duty was expected of the radiographer (Standard of care) • Breach of duty by radiographer • Injury to pt must actually have occurred • Cause of injury due to radiographer’s negligence(could a reasonably cautious Tech foreseen consequences?)

25. Doctrine of Reasonably Prudent Man(Radiologic Technologist) When judging whether a Tech has been negligent in their duties: How would a technologist who is: Reasonably prudent Has comparable education and skill Providing reasonable standard of care, skill and behavior respond in this situation? Court interviews experts in field to establish standards

26. Doctrine of Foreseeability Principle of law that holds individual liable for injury that results from a negligent act that could or should have been foreseen Examples: Not having enough assistance when moving Pt onto table Using table with broken foot rest Wallboard holder that’s not secure Outdated drugs Understaffing- (A Pt dies or suffers damage from too long of a wait, or Tech rushing to keep up with back log of Pts)

27. Cause and effect relationship Plaintiff (person initiating law suit) must must prove the connection between injury and Tech’s actions What if Pt was radiated and later found to be pregnant, and gave birth to a child with birth defects? Did Tech check if Pt was pregnant? Did Tech exercise reasonable caution even if Pt thought she wasn’t pregnant? Plaintiff would have to prove that birth defects were a result of x-rays

28. Doctrine of Personal Responsibility Even though hospital may be sued and held legally liable for actions- Law does not permit wrongdoer (YOU) from escaping legal liability! You are still legally responsible and accountable! Radiographer might want to consider getting personal medical malpractice insurance (You are not responsible for anything hospital or Radiologist may do)

29. What if Pt falls getting off table to vomit in sink while you are checking images, after complaining to you they felt nauseous? You are negligent under Doctrine of Personal Responsibility! Never leave Pt unattended in X-ray room!

30. If there is an injury- who is liable? IF : Supervisor knowingly assigns you to do a task you are not qualified to do, and you do it anyway? Both of you! IF: Student decides on their own to attempt an exam they have not been signed off on? If Supervisor did not assign or know student was going to do exam- student alone is liable (but hospital has deeper pockets and no doubt has insurance)

31. Sharing the blame Contributory negligence • Pt contributed to injury Comparative negligence • Fault of Pt and radiographer are equal Assumption of risk • Pt knew the dangers ahead of time • Had given informed consent

32. Informed Consent Pt has right to know and participate in his/her own health care Pt must be informed of: • Nature of treatment/procedure • Any risk, complications, expected benefits or effects of such treatment • Any alternatives to procedure and their risks and benefits

33. 3 Types Of Consent: Written consent Expressed consent • Verbal Implied consent • By action • What if pt. is unconscious when they arrive at ER? All are binding in court! If you perform exam without consent- you just committed battery!

34. Who May Give Consent for a Procedure? Any person over 18 who is declared conscious and competent Spouses have no authority to consent for each other Can a minor give consent for themselves? • -No! only parents and legal guardians can consent unless… • Minor is emancipated • If pregnant- automatically emancipated • Life threatening situation occurs during regular school hours- State can consent for minor