Medical Law and Ethics

1. Medical Law and Ethics

2. TOPICS • Key Terms • Legal responsibilities in health care • Ethics • Professional Standards

3. Law & Ethics in HC • The law affects all health care careers • Awareness of the law protects you, your co-workers, your patients and your employer • Laws are created/enforced by federal, state and local government

4. Law & Ethics in HC • Health care workers must follow laws that affect health care, as well as those laws that regulate their license, registrations and/or standards for their profession • Failure to follow the law may result in legal action against you and/or your employer

5. Legal Terminology • Liable: accountable under the law • Criminal Law: wrongs against a person, property or society (crime). Includes felonies and misdemeanors. • Civil Law: wrongful acts. Involve legal relationships between people and protection of rights • Civil law generally covers 2 areas: torts and contracts

6. Torts • Tort: wrongful act that does not involve a contract. Can be intentional or unintentional • Many torts can lead to legal action • Common torts that can affect health care workers:

7. Types of Torts • 1. Negligence: failure to give care normally expected for that position • Example: ? • 2. Malpractice: bad practice, professional negligence. Failure of a professional to use expected degree of skill; not following professional standards • Example: ?

8. 3. Assault: threaten to harm; results in fear • 4. Battery: unlawful touching without consent • 5. Invasion of Privacy: unnecessary exposure or revealing of personal information w/out consent • Example? • 6. False Imprisonment: unlawful restraint or confinement • Example?

9. 7. Abuse: treatment of another that results in physical harm or mental anguish • Can be physical, verbal, psychological, sexual • Health care workers are required by law to report • Signs?

10. 8. Defamation: false statements that damage reputation. Incorrect info given out in error can result in this • Slander: info. is spoken • Libel: info is written • Example? • 9. Fraud: deceitful practices depriving another of their rights • Example?

11. Contracts • Agreement between 2 or more parties; specific promises made for a consideration • Elements of a contract: • Agreement: offer is made and accepted • Consideration: something of value is bargained for as part of the agreement • Legal subject matter: legally enforceable • Contractual capacity: parties must be competent to enter contract

12. Two types of contracts: • 1. Implied Contract: obligations understood w/out verbal expression • 2. Expressed Contract: stated in distinct language either verbally or in writing

13. Consent • Permission from pt, either expressed or implied for something to be done. • Can be verbal, written or implied • All consent must be “informed”: implies that pt understands tx, why it is nec, tx risks, alternatives, risks if tx is refused • Pt must be of sound mind and legal age to give consent

14. Legal Disability • No legal capacity to enter into a contract • Includes: minor, mentally incompetent, unconscious, altered mental state • Parent, guardian, spouse must then form the contract for the legally disabled

15. Breach of Contract • Contract not performed according to the agreement • Ex: pt fails to pay or provider fails to provide care • Can lead to legal action

16. Contract Law • Employer: principal • Employee: agent • The principal is responsible for the actions of the agent

17. A case scenario • http://www.bestcare.org/mhsbase/mhs.cfm/SRC=SP/SRCN=serv_detail/GnavID=68/servid=420

18. Privileged Communication & Legal Responsibilities • All info given to hc personnel by the patient; held in confidence • Confidential and can only be shared w/ members of the hc team • Cannot be relayed w/out consent • Exempt: births, deaths, injury cb violence, drug abuse, communicable diseases, STDs

19. Medical Records • Privileged communication • Property of facility but pt owns the info and has right to review/obtain copies • Legal record • Must be kept in secure area • Shred after legal retention date expires

20. Legal Responsibilities • No erasures, blank spaces. • Errors according to policy • Shred carbons • Don’t share computer passwords • Faxes & computer screens in secure area • Limit personnel who can access • Pt can request to amend • De-identify for use by students

21. 5 C’s of Documentation • Concise • Complete (and objective) • Clear (and legible) • Correct • Chronological

22. HIPPA Health Info Privacy • Enacted 1996, effective 2003 • Standards to protect private communication • Patient rights: • Able to see/obtain med records • Able to set limits how health info used • Providers must keep PHI confidential • Right to state who can access • Info to report violations

23. Ethics • Set of principles associated w/ what is right and wrong • Provide standard of conduct & code of behavior • Allow HCW to analyze situations and make decisions based on what is right or wrong

24. Ethics • Many ethical dilemmas today; primarily due to advancing technology • Important for individuals to consider how they would handle situations that would require ethical decision making

25. Rules of Ethics • Saving a life, health promotion comes first • Keep pt comfortable, preserve life • Respect pt choices • Tx pts equally • Provide care for all to best of ability • Maintain a competent skill level • Pursue continued education

26. Ethics in HC • Maintain pt confidentiality • Refrain from all illegal, unethical, immoral practices • Show loyalty to pt, co-workers and employer • Be sincere, honest, respectful and caring • Treat others as you would want to be treated

27. Patient Rights • Federal and state law require • AHA: Patient Bill of Rights • The patient is entitled to certain rights: • Considerate and respectful care • Info re dx, tx, prognosis • Info necessary to give informed consent • Confidentiality and privacy • Advanced Directives

28. Patient Rights • To refuse to participate in research • Review med records and receive explanation of charges • Info about hosp rules, regs and policies • Continuity of care; Reasonable response to request for services • Info re: relationship of hosp to other hc and educational organizations

29. OBRA • OBRA: Residents Bill of Rights • Free to choose MD, tx, care • No abuse, chemical or physical restraints • Confidentiality and privacy • Accommodate needs and choice re activities, schedule and home care • Voice grievances • Participate in activities • Manage personal funds and possessions

30. Patient Rights • Unlimited access to family • No transfer or d/c except for med reasons, failure to pay • Info about med benefits, survey results and facility deficiencies • These rights vary by state

31. Advanced Directives • Legal documents that state what med tx may be carried out in the event that an individual becomes incapacitated or unable to express their wishes

32. 1. Living Will • What measures may or may not be taken to prolong life if there is a terminal condition or permanent unconsciousness • Must be signed when competent and witnessed by 2 adults • Most states have laws to protect this • May result in DNR

33. 2. Durable Power of Attorney • Permits the appointment of another to make medical decisions if you become unable to do so • Includes providing or withholding tx or procedures • Must be signed by both parties and witnessed • Usually spouse or adult children

34. Pt Self Determination Act • Federal Law requiring hc facilities to inform pts of: • Their right to make decisions to refuse tx and right to die • Provide info on Adv Directives • Document Adv Dir in chart • Not discriminate based on Adv Dir

35. Professional Standards • Standard of care: level of performance expected when carrying out prof duties • Practice w/in scope of expertise and training: perform procedures you are trained and legally permitted to perform • Use approved, correct methods • Obtain appropriate authorization • Identify pt and obtain consent • Observe safety precautions • Maintain confidentiality

36. Professional Standards • Accurate documentation • Follow legal and ethical guidelines • Meet requirements for professional credentialing • Think before you speak • Tx all pts = • No tips or bribes • Report all errors immediately • Professional manner, dress, language and action

37. Prof. Stand. protect you, your co-workers and your patients

38. Good Samaritan Law • Protects Dr’s, RN’s and some other professions from liability when rendering emergency care • Must act within scope of practice • Proven willful wrongs or gross negligence will result in liability • Laws vary by state

39. Job Classifications • Licensure: mandatory credentialing process; required by state; grants right to practice • Certification: voluntary credentialing process; usually national in scope, sponsored by private groups • Registration: entry in an official registry: list of names who have satisfied certain requirements. May involve fees and education.