Medical/Legal Issues & Professional Ethics

1. Medical/Legal Issues & Professional Ethics Rad Tech A – Week 14

2. The Importance of a Professional Ethic Ethics: the systematic study of rightness and wrongness of human conduct and character as know by natural reason Professional Ethic: the ethical conduct of a profession

3. Definitions • Ethics – The systematic study of rightness and wrongness of human conduct and character as known by natural reason. • Morals – Generally accepted customs, principles, or habits of right living and conduct in a society and the individual’s practice in relation to these. • Values – Ideals & customs of a society toward which the members of a group have an affective regard; a value may be a quality desirable as an end in itself.

4. Professional Ethics • Internal controls of a profession based on human values or moral principles. • Standards of conduct beyond mere conformity to law. • Professionals may encounter conflicting values or belief systems that can compromise patient care.

5. ARRT Code of Ethics • A guide by which RT’s and Candidates may evaluate their professional conduct as it relates to patients, health care consumers, employers, colleagues, & other members of the health care team. • Comprised of 10 principles

6. ARRT Code of EthicsAppendix D pg. 435 • Professional manner, respond to pt needs, support colleagues • Provide services to humanity w/ full respect for mankind • Delivers pt care without discrimination • Practices & uses equipment appropriately • Acts in the best interest of the pt.

7. ARRT Code of Ethics 6. Obtains pertinent info for physician 7. Practices in accordance with accepted standards, minimizes radiation exposure 8. Practices ethical conduct 9. Respects confidences and pt right to privacy 10. Strives to improve knowledge & skills by participating in C.E.

8. Ethical Dilemma • Situation requiring moral judgment between two or more equally “right” alternatives. There are two or more competing norms. • Four components to solve an ethical dilemma: 1. Identify the problem 2. Develop alternative solutions 3. Select the best solution 4. Defend your selection

9. “I Think Dr. Jones Misread the Film” You have just finished a routine radiologic procedure on Mrs. Green. As you develop the film, it becomes clear that Mrs. Green is probably suffering from a rare form of bone disease. Dr. Jones, a young resident, glances at the film and smiles. “I didn’t think Mrs. Green had anything to worry about,” he says. “That joint pain she was complaining about must be all in her head.” Later, you see Dr. Jones talking to Mrs. Green’s family. He is smiling and joking with them as he signs Mrs. Green’s discharge papers. Shaken, you mutter to yourself, “I think Dr. Jones misread the film.” What should you do”

10. Ethical Theories • Consequentialism – Evaluates the rightness or wrongness of ethical decisions by assessing the consequences on the pt. • Nonconsequentialism – Belief that actions themselves, rather than consequences, determine the worth of actions; actions are right or wrong according to the morality of the acts. Ex: Lying to a pt if the lie might ultimately benefit the pt

11. Moral Principles • Beneficence – Bringing about good • Nonmaleficence – Preventing harm, to do no harm • Autonomy – Self-reliance, independence, liberty rights, individual choice, freedom of will • Veracity – Telling the truth • Fidelity – Being faithful • Justice – Acting with fairness or equity

12. Medical/Legal Issues • The liability of the technologist is not the same as the radiologist involved, but the liability is potentially real. • Although the law is often a mirror image of the failures of medicine, it is also a book of lessons from which we can learn.

13. Causes of Legal Action • Approx 10% of all medical negligence claims are somehow related to diagnostic imaging. • Medical Negligence – failure to use such care as a reasonably prudent health care professional would use in similar circumstances.

14. Schloendorf v. Society of New York Hospital • Basic principle of law and lays a foundation for the relation between patients and health care practitioners. • Every human being of adult years and sound mind has a right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages.

15. Doctrine Serves 6 Functions • Protects individual autonomy • Protects pt status as a human being • Avoids fraud and duress • Encourages health care practitioners to consider their decisions carefully • Fosters rational decision making by the pt • Involves the public in medicine

16. Standard of Care • Degree of skill (proficiency), knowledge, and care ordinarily possessed & employed by members in good standing within a profession. • To test whether the standard of care has been met, one must determine what a reasonable, prudent practitioner would have done under similar circumstances.

17. Practice Standards for Radiography Appendix A pg. 411 • Developed by a group of medical imaging professionals & adopted by ASRT • Outline the practice of medical imaging in three areas of Performance Standards: 1. Clinical Performance Standards 2. Quality Performance Standards 3. Professional Performance Standards

18. Causes of Legal Action • Approx 10% of all medical negligence claims are somehow related to diagnostic imaging. • Medical Negligence – failure to use such care as a reasonably prudent health care professional would use in similar circumstances.

19. Patient Fall in Radiology Dept~NEGLIGENCE~ • Favalora v. Aetna Casualty & Surety Co. • Pt. admitted to hospital for general checkup & GI series. • Pt complaint: Stomach pains, general fatigue, and fainting. • While undergoing x-ray exam, pt fainted, fell, and fx’d her neck & femur – requiring surgery. • Surgery caused a pulmonary embolism • Radiologist was negligent for not securing medical hx prior to exam, pt won lawsuit.

20. Four Elements to Prove Negligence • Must establish a duty to the patient by the health care provider • Breach of this duty by an act or by failing to perform some act. • A compensable injury • A causal relation between the injury and the breach of duty.

21. Cause of Legal Action • Tort – Civil wrong committed by one individual against another. May be classified as either intentional or unintentional. This type of claim arises from a breach of duty. • Assault – Any willful attempt or threat to inflict injury on the person and any intentional display of force that would give the victim reason to fear or expect immediate bodily harm.

22. Cause of Legal Action • Battery – An unlawful touching of another that is without justification or excuse. • False Imprisonment – Conscious restraint of another without proper authorization, privilege, or consent. • Defamation – Holding up a person to ridicule, scorn, or contempt in a respectable & considerable part of the community.

23. Patient Rights & Responsibilities • Patient rights informs the pt of the right to be well informed, to participate in treatment decisions, and to communicate openly with the physicians. • Patient also has the responsibility to provide accurate medical history, to ask questions, and inform if pt is unable to follow treatment. • Hospitals may (and do) list other very specific responsibilities.

24. Res Ipsa Loquitur • The thing speaks for itself • Burden of proof shifts from the plaintiff to the defendant. • Must have 3 elements: 1. Type of injury did not occur except for negligence. 2. Activity was under complete control of defendant. 3. Plaintiff did not contribute to his own injury

25. Res Ipsa Loquitur • Franklin v. Collins Chapel Correctional Hospital • 82 yr. senile female – wrongful death after sustaining 3rd degree water burns while bathing • Res Ipsa Loquitur - Injuries suffered by the resident do not occur in a nursing facility in the absence of negligence, and the deceased was in the defendant’s sole care custody & control.

26. Respondeat Superior • The master speaks for the servant; the master is liable in certain cases for the wrongful acts of his or her servants. “Deep Pockets” approach. • If a radiographer is sued, the hospital and physician would also be named as defendants. Well established theory that the physician or health care facility is responsible for the negligent acts of its employees.

27. Corporate Liability • Requires the hospital or health care entity to be responsible for the quality of care delivered to consumers. • Health care corp. must assess & evaluate the quality of care delivered & must be prepared to make changes as needed. • The corp. may be required to intervene if suboptimal care is being provided by one of its independent contractors.

28. Informed Consent • A person’s agreement to allow something to happen (i.e surgery) that is based on full disclosure of the facts: knowledge of benefits, risks, and alternatives to the procedure. • Required when a patient is subjected to any type of invasive procedure. • If the pt consents to a procedure & then revokes the consent, the doctor must stop the procedure.

29. Documentation • In court, if you testify that you properly assessed the patients medical risk and obtained consent from the patient verbally prior to the examination; will that serve as meeting the Technologist Standard of Practice?

30. HIPAA • The Health Insurance Portability and Accountability Act of 1996 mandates that federal laws or regulations ensure the confidentiality of medical records. • Patients or representatives should have access to all records except in the event the provider feels that it is not in the best interest of the patient’s health to have access or if the knowledge of the health care information could cause danger to the life or safety of any person.

31. HIPAA • Health Insurance Portability and Accountability Act • Privacy of records and confidentiality • Confidentiality standards establish guidelines for the storage, access, and transmission of individual health information. • Patients must authorize the release of health information.

32. HIPAA • Within radiology: Technologists are sometimes asked by patients if they can examine their records while in transit, waiting for a procedure or undergoing an examination. The record information should not be shred with the patient in this fashion as this may lead to misinterpretation of information.

33. HIPAA Video Must be viewed prior to observing at our affiliated hospitals. • Be careful ….. the walls sometimes have ears • Schedule for video

34. Case Study – Life or Death, the right to choose Pt. Vega & her husband (Jehova’s Witnesses) signed a release requesting that no blood or blood products be administered to her during her hospital stay to deliver a baby. Following her delivery, she began to bleed heavily. Her doctor ordered a D&C which she agreed to but refused a blood transfusion. She continued to bleed and was eventually transferred to the ICU. Her doctors told her that she would die if she did not receive the blood transfusion. Both her and her husband continued to refuse the blood transfusion. Because her doctor and the hospital felt that it was essential for her to receive the blood, they filed a complaint requesting that the court issue an injunction that would permit the hospital to administer the blood transfusion.