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Health Occupations I. Legal & Ethical Issues. Legal Responsibilities. Laws & legal responsibilities in every aspect of life Goal – protect you & society (traffic laws) Health care workers have certain responsibilities as well Important to be aware of & follow
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Health Occupations I Legal & Ethical Issues
Legal Responsibilities • Laws & legal responsibilities in every aspect of life • Goal – protect you & society (traffic laws) • Health care workers have certain responsibilities as well • Important to be aware of & follow • Protects you, the employer, & the patient
Legal Responsibilities • Based on law • Civil law or criminal law • Civil law - dealing with legal relationships between PEOPLE & protection of a person’s RIGHTS • Criminal law – dealing with WRONGS against a PERSON, PROPERTY, or SOCIETY • Health care mostly affected by CIVIL law • Contracts • Torts – wrongful act that does not involve a contract
Legal Responsibilities • Criminal laws can apply • Practicing without a license • Misuse of narcotics • Theft • Murder • Health care professionals are required to know & follow state laws regulating licensure or registration & set standards for their profession
TORTS • Occurs when a person is harmed or injured because a HCP doesn’t meet the expected standards of care • Civil wrongs NOT crimes • Can lead to legal action (lawsuits) • Offenses may be complex & subject to interpretation • Malpractice, negligence, assault & battery, invasion of privacy, false imprisonment, abuse, defamation
Malpractice • “bad practice”, commonly called professional negligence • Failure of a professional to use the degree of skill & learning commonly expected in a particular profession • Results in injury, loss, or damage to person • Examples – • Puncture wound & dr. doesn’t order tetanus shot • Nurse performing minor surgery without training
Negligence • Failure to give care that is normally expected of a person in a particular position with resulting injury to another person • Examples • Falls due to side rails down • Using or not reporting defective equipment • Infections caused by non-sterile technique, equipment, or supplies • Burns caused by improper heat or radiation
Assault & Battery • Closely related & often used together • Assault – includes a threat or attempt to injure • Battery – unlawful touching of another person without consent • Patients must give CONSENT & have the right to REFUSE • Some procedures require written consent • Surgery • Diagnostic tests • Treatment of minors • Side rail releases
Assault & Battery (cont) • Verbal consent is permitted at times • Must be INFORMED CONSENT- permission given • Voluntarily • Person of sound mind • After procedures & all risks involved have been explained in terms person can understand • Can withdraw consent at any time • Explain all procedures, DO NOT PERFORM if pt does not give consent • Examples • Performing procedure after pt has refused tx • Improper handling & rough treatment
Invasion of Privacy • Unnecessary exposure of a person OR revealing personal info without consent • Examples • Improper draping or covering leaving pt exposed to view • Sending info to an insurance company without written permission • Informing news media about condition without permission
False imprisonment • Restraining an individual or restricting another person’s freedom • Examples • Keeping pt hospitalized against his will • Application of physical restraints without proper authorization or with no justification
Abuse • Any care that results in physical harm, pain, or mental anguish • Physical – hitting, forcing persons against their will, depriving food/water, restraints, not providing personal care • Verbal – shouting, swearing, harsh words, racism, abusive statements • Psychological – threatening harm, denying rights, belittling, intimidating, ridiculing, threatening to reveal information • Sexual – unwanted sexual touching or act, sexual gestures, suggesting sexual behavior
Abuse (cont) • Pts may experience abuse before entering your facility • Domestic abuse –threatening, manipulative, aggressive, or violent behavior to maintain power & control • Child abuse – directed toward a child • Elder abuse – directed toward an older person
Abuse (cont) • Be alert to signs & symptoms indicating abuse • Unexplained bruises, fractures, burns, injuries • Signs of neglect – poor personal hygiene • Irrational fears or change in personality • Aggressive or withdrawn behavior • Patient statements
Abuse (cont) • Presence of signs & symptoms indicate need for more investigation • Health care workers are REQUIRED to report any signs of abuse – MANDATED REPORTERS • Laws in all states protect reporting of any type of abuse to authorities
Defamation • False statements that cause a person to be ridiculed or cause damage to his/her reputation • Incorrect info given out in error • Libel – written information • Slander – information is spoken • Examples – • Reporting pt with an infectious disease to an agency when lab results are inaccurate • Stating person has a drug problem when another medical condition exists
Contracts • Agreement between two or more parties • Three parts • Offer – competent person enters into a relationship with HCP & offers to be a pt. • Acceptance – HCP gives an appointment or examines or treats a pt. • Consideration – payment made by pt for services provided
Contracts – Implied vs expressed • Implied – cause obligations that are understood without verbally expressed terms • Example – qualified HCP prepares meds & pt takes meds (implied that pt accepts the treatment) • Expressed – stated in distinct & clear language, oral or written • Example – surgery permit • Promises of care must be kept • All risks associated with treatment must be completely explained to pt.
Legal Disability • All parties in contract must be free of legal disability • Person with a legal disability does not have the legal capacity to form a contract • Examples • Minors – under legal age, differs by state • Mentally incompetent persons • Persons under influence of drugs or alcohol • Semiconscious or unconscious persons • Parents, guardians, or those permitted by law must form contract for these people
Breach of Contract • Contract requires certain standards of care by competent, qualified people • If contract not performed according to agreement, contract is BREACHED • Examples • Failure to provide care or giving improper care • Failure to pay according to consideration • Can lead to legal action
Translators • Must be used when contract is explained to a non-English speaking person • Many states require translator for deaf or hard of hearing • Most agencies have a list of translators • English-speaking relative or friend can serve as translator
Agent • Person who works under direction or control of another person • Employer is principal • Responsible for actions of agent & can be required to compensate people who have been injured by the agent • Employee is agent • Example – dental assistant tells pt “your dentures will look better than your real teeth” – dentist may have to compensate if statement is false • HCP must be aware that they are agents & work to protect employer’s interests
Privileged Communications • ALL information given to HCP by pt • BY LAW, all info must be kept confidential & shared only with other HCP that have the need to know • Cannot give any info to others unless the pt gives you written consent • Consent should give what info can be released, to whom the info can be given, & any time limits
Privileged communications that are exempt • Some info is exempt by law and MUST be reported • Births & deaths • Injuries caused by violence – assault & battery, abuse, stabbings) that may require police involvement • Drug abuse • Communicable diseases & STDs
Health Care Records • Contain info about care that has been provided to pt • Belong to HCP, but pt has right to obtain a copy of any info on record • LEGAL RECORD in court of law • No erasures allowed • Cross out errors with a single line • Insert correct info, initial & date
Health care records • Must be properly maintained, kept confidential, & retained for amount of time required by law • To destroy, must shred or burn • Use black ink to write in • Signature – BMcGrory, RN • First initial, last name, title • Computer records – to safeguard • Limit access & use codes to prevent access • Require passwords to access specific info • Monitor & evaluate computer use
Ethics • Set of principles dealing with what is morally right or wrong • Provide a standard of conduct or code of behavior • Allow a HCP to analyze info & make decisions based on what people believe is right & good conduct • Modern health dilemmas? • Euthanasia • HCP has AIDS, should pt know? • Aborted fetuses used for research? • When should life support be discontinued?
Ethical dilemmas (cont) • Can parents refuse blood transfusions for their children? • Can a facility refuse expensive treatment to a person who cannot pay? • Who gets the kidney? What age? • Can a person sell an organ for transplant? • Animals in medical research? • Cloning? • Selection of specific genes for transplanting • Stem cell research?
Basic rules of ethics • Saving life & promoting health #1 goal • Keep pt. comfortable & preserve life when possible • Respect pt’s choice to die peacefully & with dignity when all options have been discussed &/or predetermined by advance directives • Treat all pts equally • Avoid bias, prejudice, discrimination • Provide care to the best of your ability • Maintain competent skills, CEUs
Basic rules of ethics (cont) • Maintain confidentiality • Refrain from immoral, unethical, & illegal practices • Show loyalty to pts, co-workers, & employer • Be sincere, honest, caring
Patient’s rights • Factors of care that pts can expect to receive • Federal & state legislation requires agencies to have written policies about rights • All personnel must respect & honor these rights
AHA Pt’s Bill of Rights • Considerate & respectful care • Current info about diagnosis, treatment, & prognosis • Informed consent • Advanced directives & able to refuse • Privacy • Confidential treatment of records • Reasonable response to requests • Info about hospital & relation to other facilities • Refuse research projects • Review medical records & examine bill • Informed of hospital rules, regs, policies
LTC Bill of Rights • Established by OBRA in 1987 • Must inform resident or caregiver & post a copy in facility • Free choice of dr, care, research • Freedom from abuse & chemical or physical restraints • Privacy & confidentiality • Accommodation of needs & choice • Voice grievances without retaliation • Organize & participate in groups, social, religious, & community activities
LTC Bill of Rights (cont) • Info about medical benefits, records, state survey results, advocacy, OMBUDSMAN • Manage own funds, use own things • Unlimited access to immediate family • Share a room with spouse if both residents • Remain in facility & not be transferred for any reason except medical, welfare of resident or others, failure to pay, or if facility can no longer meet the resident’s needs
LTC Bill of Rights • All states have adopted the federal rights & have added their own • Failure to follow & grant rights can lead to job loss, fines, & imprisonment
Advance Directives • Legal documents that allow people to state what medical treatment they want or do not want in event that they become incapacitated & unable to express their wishes • Living Wills • Documents that allow people to state what measures should or should not be taken to prolong life when they are terminal
Advance Directives • Living wills (cont) • Must be signed when person is competent & witnessed by 2 adults that will not benefit from that person’s death • Most states now honor these • Frequently results in DNR order • No CPR • Die with peace & dignity • Can be hard for HCP to honor this
Advance Directives • Durable Power of Attorney • Document that permits an individual (known as a principal) to appoint another person (known as an agent) to make any decisions about health care if the principal is unable to make decisions • Includes providing or withholding procedures, hiring or firing HCP, spending for health care, access to medical records • Usually given to spouses or adult children, but can be anyone • Needs to be signed by principal, agent, & 1 or 2 witnesses
Advance Directives • Patient Self-Determination Act (PSDA) • 1990 law that required all facilities receiving federal dollars to • Inform every adult, orally & in writing, of their right to make decisions, including right to refuse treatment • Provide info & assistance with advance directives • Document advance directives on med records • Have written statements to implement pt’s rights in making decisions • No discrimination or affect on care due to advance directives • Educate staff on medical & legal issues of advance directives
Professional Standards • Perform only procedures for which you have been trained & can legally perform • Never perform unless qualified • Obtain training • If asked to do something you are not qualified to do, state you have not been trained & refuse to do it • If you are not legally permitted to perform procedures or sign documents, refuse due to legal limitations
Professional Standards • Use approved, correct methods while performing procedures • Follow procedure manual • Obtain correct authorization before performing any procedures • Dr’s order, verbal or written • Identify pt & obtain consent before performing procedures • Check name band • State pt’s name clearly & repeat if necessary • Explain procedure briefly – make positive statements
Professional Standards • I.D. pt (cont) • Obtain consent by lack of objection • If pt refuses, check with supervisor • Some procedures require written consent • Never witness a signature unless authorized to do so
Professional Standards • Observe all safety precautions • Handle equipment carefully • Protect pts • Be alert to safety hazards & correct ASAP • Know & follow safety rules & regs • Think before you speak, watch everything you say • Don’t tell pt information unless instructed • Revealing info could cause problems
Professional Standards • Keep all info confidential • Written & oral • Don’t leave records open & out • Don’t reveal info without pt authorization & consent • Make sure conversations can’t be overheard • Avoid discussing pts at home, in social situations, public places, or outside agency
Professional Standards • Treat all pts equally • Accept no tips or bribes for care you provide • You receive salary • Care should not change based on amount of money pt can give you • Polite refusal necessary
Professional Standards • If error occurs, report it to your supervisor immediately • Never try to hide or ignore • Make every effort to correct ASAP • Take responsibility for actions • Behave professionally in dress, language, manners, & actions • Liability insurance – protects you