Transcript Legal and Ethical

Human Relations
Legal Issues:
Professional Responsibility
 Personal responsibility
 Scope of practice
 Mistakes lead to injuries
Civil vs. Criminal
 Criminal law = crime
 Broken laws
 Civil law = tort
 Wrongs
 Law suits
Lawsuits
 It’s the information age
 Consumer rights
 Outcome based evaluation
Lawsuits
 Who may be sued?
 Physician
 Equipment suppliers
 Hospital / facility
 Drug manufacturers
 Staff members
Liability
 Being bound/responsible for ones own actions that
affect another person.
 Standards of practice determined by:
 Federal statutes
 State practice acts
 JCAHO
 Common practice
 Hospital/institution policies
Liability
 Burden of
proof falls on
the injured
person
Malpractice vs. Negligence
 Often synonymous in civil courts
 Negligence: Failure to use the care or skills that a
reasonably prudent person would do in the same
situation.
 Malpractice: Misconduct, unreasonable lack of skill or
judgement or illegal or immoral conduct.
 Professional negligence
Four Ds of Malpractice
 Duty
 Deviation / dereliction
 Damage
 Direct causation
Borrowed Servant Rule
 The “Captain of the Ship” is responsible.
 Surgeon is the captain
 Considered liable
 Today’s thoughts
 People responsible for themselves
 Surgeon may still be responsible
Independent Contractor
 Anyone who works in a facility but is not employed by
the facility
 Responsible for their own actions
 Examples
 Private scrub for physician
 Travelers
 Sales reps
Respondeat Superior
 Latin: Let the master answer
 Master-servant rule:
 Employer may be responsible for actions of employees
 Employers must verify credentials
 Master and servant can both be named in a suit
Doctrine of Reasonable Person
 Each person owes a duty to behave as a reasonable
person would under the same or similar
circumstances.
Doctrine of Res Ipsa Loquitor
 Latin: The thing speaks for itself
 Must meet conditions:
 Injury wouldn’t occur w/o negligent act
 Exclusive control of defendant
 Injured person could not have contributed to act
 Examples
 Retained instrument, burn, fall
Corporate Negligence
 Liability for failing to ensure an acceptable level of care
 i.e. Failure to ensure that staff was competent and
qualified to perform duties
Doctrine of Informed Consent
 Physician’s duty to inform patient and get consent
 Consent must be valid
 Consent must be witnessed
 Emergency consent
 Right to refuse
Extension Doctrine
 When can a surgeon go beyond the limits of consent?
 May be liable for assault and battery
 Implies that explicit consent also provides implicit
consent
Assault and Battery
 Assault: The threat to do harm
 Emotional distress
 Battery: The actual harm
 Surgery without consent
Invasion of Privacy
 Patient’s right to privacy is violated.
 Patient has the right to expect that their medical
records and any media obtained of them during the
course of treatment be kept confidential.
Abandonment
 Leaving the patient for any reason while the patient’s
care is dependant on the provider of care.
Liability in the OR
 Liability insurance
 Autonomy
 Mistakes
 Institutional insurance
 Individual vs. co-defendant
Liability in the OR: Prevention
 Be active in AST
 Document
 Remain current w/CE
 Adhere to policies &
procedures
 Establish rapport with
patients
 Report problems & take
action
 Comply with standards
of practice
 Good communication
Good Documentation
 Anything written should be
 On the appropriate form
 Legible in ink without erasures
 Stated factually
 Understandable
 Dated
 Signed with full name and title
Incident Reports
 Used for accident or unusual occurrence
 Sent to risk management
 Not necessarily documented in patient chart
Policies and Procedures
 Policies should reflect standards of practice
 Procedures define scope, purposes and instructions
 Annual review
 Care and safety guidelines
 Legal protection
 Staff accountability
Ethical Issues: What is Ethics?
 The branch of philosophy dealing with values relating
to human conduct, with respect to the rightness and
wrongness of certain actions and to the goodness and
badness of the motives and ends of such actions.
 What influences ethical behavior as a professional and
as a person?
Ethics
Professional
Ethics
 Laws
 Policies
 Societal codes
Personal
Ethics
 Life experiences
 Religious persuasion
 Ethnocultural
background
Behavioral Ethics
 Earnestness – be serious, understand your affect on others
 Truthfulness – state facts; true to self and others
 Honesty – express feelings openly, establish trust
 Integrity – stick to your values, professional standards
 Conscientiousness – differentiate right from wrong
 Sincerity – demonstrate your concern for others
Moral Principals in
Ethical Decision Making
 Autonomy
 Veracity
 Beneficence
 Fidelity
 Nonmaleficence
 Confidentiality
 Justice
 CHANGE
Bioethical Situations
 Sterilization
 Quality of life
 Abortion
 Euthanasia
 HIV
 Right to die
 Human experimentation
 Organ donation/
transplantation
Death and Dying
 Family may wish to see the body
 Coping strategies for staff
 Everyone involved is a team
 Believe in a power greater than team skills
 Share feelings with others
 Identify with loss
Surgical Conscience
 The golden rule.
Association of Surgical
Technologists: Code of Ethics
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To maintain the highest standards of professional conduct and patient care.
To hold in confidence, with respect to the patient's beliefs, all personal
matters.
To respect and protect the patient's legal and moral rights to quality patient
care.
To not knowingly cause injury or any injustice to those entrusted to our care.
To work with fellow technologists and other professional health groups to
promote harmony and unity for better patient care.
To always follow the principles of asepsis.
To maintain a high degree of efficiency through continuing education.
To maintain and practice surgical technology willingly, with pride and
dignity.
To report any unethical conduct or practice to the proper authority.
To adhere to the Code of Ethics at all times in relationship to all members of
the healthcare team.
http://www.ast.org/aboutus/documents/AST_Code_of_Ethics.pdf; also available in B&K, Page 52, Box 3-5
Good Samaritan Law
 Any person, who without compensation or the
expectation of compensation, renders emergency care
at the scene of an emergency or who participates in
transporting, shall not be liable for civil damages
resulting from any act or omission in the rendering of
such emergency care or transportation.
 RCW 4.24.300
 http://apps.leg.wa.gov/rcw/default.aspx?cite=4.24.300