Legal and Ethical Issues

1. 5 Legal and Ethical Issues

2. Learning Outcomes 5.1 Explain the difference between laws and ethics. 5.2 Identify the responsibilities of the patient and physician in a physician-patient contract, including the components for informed consent that must be understood by the patient. 5.3 Describe the four Ds of negligence required to prove malpractice and explain the four Cs of malpractice prevention.

3. Learning Outcomes 5.5 Briefly summarize the purpose of the following federal healthcare regulations: HCQIA, Federal False Claims Act, OSHA and HIPAA. 5.6 Identify the six principles for preventing improper release of information from the medical office. 5.7 Explain the importance of ethics in the medical office. 5.8 Explain the differences among the practice management models.

4. Introduction • Medical law is important quality of patient care • You must understand • Medical law • Ethics • Health Insurance Portability and Accountability Act (HIPAA)

5. Introduction (cont.) • Basic knowledge of medical law and ethics • Rights, responsibilities, and concerns • Legal and ethical issues • Impact of rising costs • Protected information

6. Laws and Ethics • Law • Rule of conduct or action • Formally recognized as binding • Enforced by a controlling authority. • Ethics • Standard of behavior • Classification of Law • Criminal law • Civil law

7. Laws and Ethics (cont.) Intentional Torts Unintentional Torts Negligence Malpractice • Assault • Battery • Defamation • False imprisonment • Fraud • Invasion of privacy

8. Agreement Consideration Contractual Capacity Legal Subject Matter Contracts Elements of a Contract

9. Contracts (cont.) • Types of contracts • Expressed contracts – clearly stated • Implied contracts – conduct of the parties indicated acceptance • Legal elements

10. Contracts (cont.) • Employment Contract • Description of duties • Plans for handling change in job • Compensation • Benefits • Grievance procedures • Reasons for termination • Termination procedures • Special provisions

11. Apply Your Knowledge What is the difference between law and ethics? ANSWER: A law is a rule of conduct or action and is enacted by governments to maintain order and public safety. Ethics is a standard of behavior based on moral values that are influenced by family, culture, and society. Good Answer!

12. The Physician/Patient Contract • Reasonable limitations • Both parties have rights and responsibilities related to the contract

13. Physician Rights and Responsibilities • Rights • Set up a practice • Select a location to practice • Specialize • Determine what services to provide

14. Responsibilities Use due care, skill, judgment, and diligence Keep knowledge up-to-date Perform to the best of his or her ability Educate patients Physician Rights and Responsibilities (cont.)

15. Physician Rights and Responsibilities (cont.) • Medical Assistants and Liability • Know scope of practice • Understand • Standard of care • Duty of care

16. Patient Rights and Responsibilities Rights Responsibilities Follow instructions and cooperate Provide relevant information Follow physician’s orders Pay fees • Select a physician • Terminate services • Patient Care Partnership

17. Patient Rights and Responsibilities (cont.) • Consent • Implied consent – actions imply permission • Informed consent • Must receive all information necessary to make a decision regarding treatment • Doctrine of informed consent

18. Patient Rights and Responsibilities (cont.) • Those able to give consent • Adults of sound mind • Emancipated minors • Mature minors • Those who cannot give consent • Minors • Mentally incompetent persons • Foreign language speakers without an interpreter

19. Terminating the Physician/Patient Contract • Reasons for terminating care • Refusal to follow instructions • Complaints by family member • Personality conflicts • Failure to pay • Failure to keep appointments

20. Terminating the Physician/Patient Contract (cont.) • When terminating care • Provide written notification • Send letter by certified mail, return receipt • Place copy of letter medical record • Document in the patient record

21. Standard of Care • Maintain confidentiality • Practice within scope of training and capabilities • Prepare and maintain medical records • Document accurately • Use proper guidelines when releasing information

22. Follow legal guidelines Maintain and dispose of regulated substances appropriately Follow risk-management and safety procedures Meet criteria for professional credentialing Standard of Care (cont.)

23. Comply with and stay current on HIPAA laws Notify patients in writing Give option of choosing another physician or make referral Secure or dispose of records appropriately Closing a Medical Practice

24. ANSWER: Patient responsibilities are: Follow physician’s instructions and cooperate with plan of care Provide relevant information to the physician Follow the physician’s orders for treatment Pay the fees charged for services provided Apply Your Knowledge Patients have rights and responsibilities relating to health care. The rights are determined by the Patient Care Partnership. What are the patient’s responsibilities? Good Job!

25. Lawsuits Add to cost of healthcare Take a psychological toll on all involved Risk management Identify and track Develop improvement plans Monitor Assess Preventing Malpractice Claims

26. Medical Negligence • Malpractice claims • Medical negligence • Malfeasance • Misfeasance • Nonfeasance

27. Medical Negligence (cont.) D Four Ds of Negligence Duty Derelict Direct Cause Damages Patients must be able to prove all 4 Ds in order to move forward with a malpractice suit.

28. Medical Negligence (cont.) • Malpractice lawsuits – civil law • Tort • Breach of contract • Settling malpractice suits • Trial • Arbitration • Subpoena

29. Medical Negligence (cont.) • Law of Agency • Employees – agents of the physician • Respondeat superior – • “Let the master answer” • Physicians are responsible for the negligence of employees Employees are legally responsible for their own actions, and they can be sued directly.

30. Medical Negligence (cont.) • Courtroom conduct • Attend proceedings • Be on time • Bring required documents • Refresh your memory • Speak professionally • Answer all questions • Answer only the question asked • Appear well groomed

31. Medical Negligence (cont.) • Professional liability coverage • Protects against financial losses • High cost to practice

32. Unrealistic expectations Poor rapport and poorcommunication Greed and our litigious society Poor quality of care Reason Patients Sue

33. Statute of Limitations Laws that set the deadline or maximum period of time within which a lawsuit or claim may be filed Deadlines vary Type of case State vs. federal court Preventing Malpractice Claims (cont.)

34. Preventing Malpractice Claims (cont.) The 4 Cs of Malpractice Prevention C Caring Communication Competence Charting

35. Preventing Malpractice Claims (cont.) • Effective Communication • Good listening skills • Return calls • Be sure informed consent forms are signed • Avoid admitting guilt • Use tact, good judgment, and professional ability • Reach an understanding about fees

36. Apply Your Knowledge What are the 4 D of negligence needed to prove a malpractice and 4Cs of malpractice prevention? ANSWER: The 4 Ds are duty, derelict, direct cause, and damages. The 4 Cs are caring, communication, competence, and charting. Bravo!

37. Administrative Procedures and the Law • Risk management • Must meet legal standards • Insurance billing • Patient consent forms • Office correspondence • Documentation • Appointment scheduling

38. Documentation • Referrals • Missed appointments • Dismissals • All other patient contact

39. Documentation (cont.) • Medical record correction • Ownership of the patient record • Retention and storage of the patient record

40. Credentialing • Ensures healthcare providers are qualified • Medicare requirements • CMS Website • www.cms.gov/manuals/downloads. • Provider Enrollment Chain and Ownership System (PECOS). • Insurance carriers

41. FDA Regulatory Function • Drug manufacturing • Nonprescription or OTC drugs • Prescription drugs • Pregnancy categories • Controlled substances

42. FDA Regulatory Function (cont.) • Comprehensive Drug Abuse Prevention and Control Act • Drug Enforcement Administration • Doctor registration • Ordering controlled substances

43. Legal Documents and the Patient • Advance medical directive • Durable power of attorney • Uniform donor card

44. Apply Your Knowledge What are the legal implications of poor documentation? • ANSWER: Poor or incomplete documentation can contribute to the loss of medical liability cases. It is important that documentation demonstrate that nothing was neglected and that care given met standards. Good Job!

45. Federal Legislation Affecting Health Care • Health Care Quality Improvement Act (1986) • Improve the quality of medical care • Peer review • Limitation of damages • Protection to those providing information • National Practitioner Data Bank

46. Federal False Claims Act • Qui tam • To bring action for the king and one’s self • Control three types of illegal conduct • False billing claims • Kickbacks • Self-referrals

47. Division of the U.S. Department of Labor Protection of workers from exposure to health hazards on the job OSHA Blood-borne Pathogens Protection Standard –1991 Occupational Safety and Health Administration (OSHA)

48. Health Insurance Portability and Accountability Act (HIPAA) • Improve efficiency and effectiveness of health-care delivery • Protect and enhance the rights of patients • Improve the quality of health care

49. HIPAA (cont.) • Title I: Health Care Portability • Title II: Prevention of Health Care Fraud and Abuse, Administrative Simplification and Medical Liability Reform • The HIPAA Privacy Rule • HIPAA Security Rule.

50. HIPAA (cont.) • HIPAA Privacy Rule - PHI • Use • Disclosure • Managing and storing of patient information • Notice of Privacy Practices (NPP) • Sharing (TPO)