Health Occupations I

1. Health Occupations I Legal & Ethical Issues

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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?

28. 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?

29. 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

30. Basic rules of ethics (cont) • Maintain confidentiality • Refrain from immoral, unethical, & illegal practices • Show loyalty to pts, co-workers, & employer • Be sincere, honest, caring

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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