LeGal Responsibilities

1. LeGal Responsibilities DHO chapter 5

2. Legal responsibilities • Legal responsibilities are those that are based on law • Health care workers are required to know and follow the state laws that regulate their licenses • Failure to meet your legal responsibilities can result in legal action against you and your employer

3. Criminal vs civil law • 2 main types of laws affect health care workers: criminal laws and civil laws • Criminal law=focuses on behavior know as crime; deals with the wrongs against a person, property, or society • Examples of criminal law: practicing in a health profession without having the required license, illegal possession of drugs, misuse of narcotics, theft, sexual assault, and murder

4. Criminal vs civil law • Civil law=focuses on the legal relationships between people and the protection of a person’s rights • Examples of civil law in healthcare=torts and contracts

5. torts • Wrongful act that does not involve a contract • It is a civil wrong instead of a crime • A tort occurs when a person is harmed or injured because a health care worker does not meet the established or expected standards of care • Many different types of torts can lead to legal action

6. Examples of common torts: • Malpractice=“bad practice” Or “professional negligence” • Failure of a professional to use the degree of skill and learning commonly expected in that individual’s profession • It results in injury, loss, or damage to the person receiving care • Example: physician not administering a tetanus injection with a puncture wound; nurse performing minor surgery without having any training

7. Examples of common torts: • Negligence=failure to give care that is normally expected of a person in a particular position • It results in injury to another person • Example: falls & injuries when siderails are left down, using or not reporting defective equipment, infections caused by the use of nonsterile instruments, burns caused by improper heat

8. Examples of common torts: • Assault=threat or attempt to injure • Battery=unlawful touching of another person without consent • Example: performing a procedure after a pt has refused to give permission, threatening a pt, improper handling or rough treatment of a pt while providing care

9. Examples of common torts: • Assault & battery are closely related & often used together • Patients must give consent for any care • Patients have the right to refuse care • Some procedures require written consent (surgery) • Informed consent=permission granted voluntarily by a person who is of sound mind & who has been instructed, in terms they can understand, about all the risks involved

10. Examples of common torts: • Invasion of privacy – 2 kinds – physical & informational • Physical invasion of privacy=unnecessarily exposing an individual • Informational invasion of privacy=revealing personal info about an individual without their consent • Example: improperly draping a pt so that other pts or personnel can see the pt exposed; informing the news media about a pt’s condition without their permission

11. Examples of common torts: • False imprisonment=restraining an individual or restricting an individual’s freedom without authorization • Example: keeping pts hospitalized against their will; applying physical restraints without proper authorization or with no justification

12. Examples of common torts: • Abuse=any care that results in physical harm, pain, or mental anguish • Example: physical, verbal, psychological, and sexual • Health care workers should be alert to unexplained bruises, fractures, or injuries; signs of neglect such as poor personal hygiene; irrational fears; aggressive/withdrawn behavior

13. Examples of common torts: • Defamation=false statements either cause a person to be ridiculed or damage their reputation • 2 types: slander and libel • Slander=incorrect info that is spoken • Libel=incorrect info that is written • Example: telling others a pt has a drug problem when another medical condition exists; saying a coworker is incompetent

14. contracts • Contract=Agreement between 2 or more parties • Contracts in health care are implied or expressed • Implied contracts=obligations that are understood without verbally expressed terms • Example: pt takes med from nurse • Expressed contracts=stated in distinct and clear language, either orally or in writing • Example: surgery permit

15. contracts • Persons entering into a contract must be free of legal disability • Legal disability=minors, mentally incompetent persons, individuals under the influence of drugs that alter the mental state, semiconscious or unconscious people • Interpreter must be used when a contract is explained to a person who does not speak english

16. QUIZ Informed Consent • If a patient gives permission for a procedure but is heavily drugged at the time, is that legal? • If a patient signs a consent form without reading the form, have the rules for informed consent been legally met? • If a patient signs a consent form and, while of sound mind, changes his mind about having the procedure, can the physician still perform the procedure?

17. Privileged communication • Privileged communications comprise all info given to health care workers by a pt • It must be kept confidential and cannot be told to anyone else with the written consent of the pt • Health care record is considered privileged communication • Health care record belongs to the health care provider, but the pt has a right to obtain a copy of the record (can be charged $$ for it)

18. Privileged communication • Health care record can be used as legal records in a court of law • Erasures are not allowed on the health care record • Errors should be crossed out with a single line so the material is still readable • Correct info should then be inserted, initialed, and dated

19. Privacy act • Hipaa=health insurance portability and accountability act • Standard that provides federal protection for privacy of health info • Pt must be informed about how their health info is used • Pt must sign consent before any info is released to any party • Births, deaths, injuries caused by violence that require police, abuse, communicable diseases, & STDs are exempt from HIPAA

20. QUIZ HIPAA • Must a patient sign a HIPAA authorization form before his/her physician’s office files an insurance claim for the patient? • Can a physician give a son confidential information about his father’s condition without the father’s written consent? • Karen wants a copy of her dental x-rays. Can the dental office charge her $10 to provide her with a copy? • Brenda has a baby but does NOT want the information made public. Can she refuse to have the birth registered?

21. Scope of practice • Procedures, processes, and actions that health care providers are legally permitted to perform in keeping with the terms of their professional license

22. Patients’ rights • Factors of care that patients can expect to receive • Read over the 10 points in the bill of rights (DHO8 page 114-115) and summarize them for yourself. • Read over the 10 points in the Resident’s bill of Rights and summarize them for yourself.

23. QUIZ Patient’s rights • A physician walks into a patient’s room with three medical students. Does the patient have the right to ask the medical students to leave? • Does a patient have the right to challenge charges on his/her hospital bill? • A nurse anesthetist visits a patient before surgery, but the patient is not comfortable with the anesthetist. What should he/she do?

24. Advance directives • Legal documents that allow individuals to state what medical treatments they want or do not want in the event that they become incapacitated and are unable to express their wishes regarding medical care • 2 main directives=living will and durable power of attorney (POA) for health care

25. Advance directives • Living will=state what measures should or should not be taken to prolong life when their conditions are terminal • Must be signed by 2 adults who cannot benefit from the death • Living wills frequently result in DNR orders

26. Advance directives • POA also called “Designation of Health Care Surrogate” or “Medical Power of Attorney” • Permits an individual (known as a principal) to appoint another person (known as an agent) to make healthcare decisions if the principal becomes unable to make decisions. • Usually given to spouse or adult children. • May be given to any qualified adult. • POA must be signed by the principal, the agent, and two adult witnesses.

27. QUIZ Advance Directives • If a patient legally signs a living will, can a physician refuse to cooperate? • Robert has never been married and has no children. Can he give durable power of attorney to his cat? • Barney is very ill. His daughter puts a pen in his hand and bullies him into signing a Living Will. Is that legal? • Joe has signed a living will and the doctor writes a DNR order. What should the nurse caring for him do if he experiences cardiac arrest?