Transcript Unit 5 - Legal - Ethicalx

Unit 5
Legal/Ethical (Don’t Write)
 Laws
and legal responsibilities are a
part of every day life.
 School
 Driving (traffic laws)
 Work Related (age)
 Medical (proper training)
 Laws
are designed to protect you and
society
Legal/Ethical (Start Writing)
 Laws
 A law is a rule that must be followed
 Laws are created and enforced by the
local, state and federal government
 Health care professionals must know:
○ Laws that regulate their license
○ Standards for their profession (Scope of
Practice)
Legal/Ethical
 Laws
 Failure to meet legal responsibilities
may result in legal action against you
and/or your employer.
 “I didn’t know.”
 “They told me to do it.”
 “Everyone else does it.”
Legal/Ethical
 Types
of Laws
 Two main types of laws affect health
care workers:
○ Criminal Law
○ Civil Law
Legal/Ethical
 Types
of Laws
 Criminal Law:
○ Commonly called a “crime”
○ A wrong against a person, property or
society
 Examples:
○ Practicing without a required license
○ Misuse of narcotics
○ Theft
○ Murder
Legal/Ethical
 Types
of Laws
 Civil Law:
○ Legal relationships between people
and protection of a person’s rights
○ Much of civil law deals with Torts and
Contracts
Legal/Ethical - Tort
 Torts
 Wrongful act that does not involve a
contract
 Civil wrong instead of a crime
 When a person is harmed or injured
because a health care provider does not
meet the established or expected
standards of care
Legal/Ethical - Tort
 Malpractice
 Failure of a professional to use the
degree of skill and learning commonly
expected in a particular profession
 “Bad practice” / “Professional
Negligence”
 Causes injury, loss, or damage to the
person receiving care
Legal/Ethical - Tort
 Malpractice
 Examples:
○ Physician not administering tetanus
injection when a patient has a puncture
wound
○ Nurse performing minor surgery
without any training
Legal/Ethical - Torts
 Negligence
 Failure to give care that is normally
expected of a person in a particular
position which results in injury to another
person.
Legal/Ethical - Tort
 Negligence
 Examples:
○ Falls and injuries that occur when side
rails are left down (hospital different
than long-term care)
○ Using and/or not reporting defective
equipment
○ Infections caused by use of non-sterile
instruments and/or supplies
○ Burns caused by heat or radiation
treatments
Legal/Ethical - Tort
 Assault
& Battery
 Closely related and often used
together
 Assault: can include a threat or
attempt to injure
 Battery: unlawful touching of another
person without consent
Legal/Ethical - Tort
 Assault
& Battery
 Patients MUST give consent prior to
any treatment
 Patients have the right to refuse care
(competency)
Legal/Ethical - Tort
 Assault
& Battery
 Written consent is required for some
procedures:
○ Surgery
○ Certain diagnostic tests
○ Treatment of minors
○ Side rail releases (hospital different than
long-term care)
Legal/Ethical - Tort
 Assault
& Battery
 Verbal consent is permitted for some
procedures:
 Informed Consent: permissions
granted voluntarily by a person who is
of sound mind after the procedure and
all risks involved have been explained
in terms the person can understand
Legal/Ethical - Tort
 Assault
& Battery
 Informed Consent:
 Person has right to withdraw consent
at any time
 Do NOT perform procedure if patient
did not give consent
Legal/Ethical - Tort
 Assault
& Battery
 Implied Consent:
 When a person is unable to give
consent for treatment in an
emergency situation and it would be
prudent (what medical professionals
would agree would be the “right thing
to do”)for a medical professional to
treat them (life threatening situation)
Legal/Ethical - Tort
 Assault
& Battery
 Examples of Assault & Battery:
○ Performing procedure after the patient
has refused to give permission
○ Improper handling and rough treatment
of patients
Legal/Ethical - Tort
 Invasion
of Privacy
 Unnecessary exposure of an
individual or revealing personal
information about an individual without
their consent
Legal/Ethical - Tort
 Invasion
of Privacy
 Examples:
○ Not covering a patient properly during
a procedure which allows others to see
patient exposed
○ Not closing door or pulling curtain
when performing procedure
○ Not knocking on the door of a longterm care resident and awaiting
permission to enter room
Legal/Ethical - Tort
 Invasion
of Privacy
 Examples:
○ Speaking about a patient to friends,
family or other persons not directly
associated with the care of patient
○ Reviewing the medical record of a
patient you are not caring for
○ Speaking about patient in public
Legal/Ethical - Tort
 Invasion
of Privacy
 Examples:
○ Sending information to an insurance
company without patient knowing
○ Informing news media about a patient’s
condition without their consent.
Legal/Ethical - Tort
 False
Imprisonment
 Restraining an individual or restricting
an individual’s freedom
 Examples:
○ Keeping patient hospitalized against
their will
○ Applying physical restraint without
proper authorization or justification
Legal/Ethical - Tort
 Abuse
 Any care that results in physical harm,
pain, or mental anguish
Types
of Abuse
 Physical – hitting, depriving food/water
 Verbal – swearing, shouting, threats
 Psychological – belittling, intimidating
 Sexual – unwanted sexual touching
Legal/Ethical - Tort
 Abuse
 Patients may experience abuse prior to
entering health care facility
 Types of Abuse – (specific)
 Domestic abuse – Intimate partner uses
threatening, manipulative, aggressive or
violent behavior to maintain power &
control over another person
 Child abuse – abuse directed toward a
child
 Elder abuse – abuse directed toward an
older person
Legal/Ethical - Tort
 Abuse
 Be alert for signs/symptoms of abuse
 Examples:
○ Unexplained bruises, fractures, burns
○ Neglect; poor personal hygiene
○ Irrational fears, change in personality
○ Aggressive/withdrawn behavior
○ Statements made by patient
Legal/Ethical - Tort
 Abuse
 Presence of signs/symptoms indicates
a need for further investigation.
 Health care workers are REQUIRED
by law to report any signs of abuse to
immediate supervisor and/or proper
legal authorities
 State of Florida Abuse Registry
1-800-962-2873
Legal/Ethical - Tort
 Defamation
 False statements that cause a person
to be ridiculed, or cause damage to a
person’s reputation
 Types of Defamation:
○ Libel - written
○ Slander - spoken
Legal/Ethical - Tort
 Defamation
 Examples:
○ Stating that a person has a drug
problem when another medical
condition exists. (Diabetes)
○ Stating a person has infectious disease
(HIV/AIDS) incorrectly
Legal/Ethical - Contract
 Contract
 An agreement between two or more
parties
 Three parts:
○ Offer – competent person offers to be pt.
○ Acceptance – Appt., exams, treats pt.
○ Consideration – Payment made for
services rendered
Legal/Ethical - Contract
 Contract
 Types of Contract
 Implied:
○Understood without verbal/written
terms (nurse administers medication)
 Expressed:
○Clear distinct language; orally or in
writing (surgery permit, risk/benefit)
Legal/Ethical - Contract
 Contract
 Legal Disability
 Does not have legal capacity to form
a contract
○ Minors
○ Mentally incompetent
○ Persons under influence/altered mental
state (drugs/alcohol)
○ Semiconscious or unconscious
Legal/Ethical - Contract
 Contract
 Legal Disability
 Parents, guardians or others
permitted by law must form contract
for these individuals
Legal/Ethical - Contract
 Contract
 Breach of Contract
 Not performing contract according to
agreement, which can lead to legal
action
 Examples:
○ Failure to provide care
○ Giving improper care
○ Patient refuses to pay for care given
Legal/Ethical - Contract
 Contract
 Law (Federal) requires that a
translator be present when a
contract is explained to a nonEnglish-speaking individual
 Deaf or hard of hearing
 English speaking relative or friend
can serve as translator
Legal/Ethical - Contract
 Contract
 Principal - employer
○ Principal is legally responsible for actions
of agent
 Agent – works for employer; employee
○ Agent must be mindful of actions and
protect principal (employer)
Legal/Ethical - Communication
 Privileged
Communication
 All information given to health care
personnel by patient is considered
privileged.
 Must be kept confidential
 Shared only with member directly
caring for patient
 Cannot be shared with anyone else
without written consent from patient
Legal/Ethical - Communication
 Privileged
Communication
 Written consent must state:
○ What specific information can be shared
○ To whom the information can be shared
with
○ Time limit (if any) that information can be
shared for
Legal/Ethical - Communication
 Privileged
Communication
 Certain information is exempt and
MUST be shared/reported:
○ Births/Deaths
○ Injuries Caused by violence
○ Drug abuse
○ Communicable diseases
○ Sexually transmitted diseases
Legal/Ethical - Communication
 Health
Care Records
 Privileged information
 Records belong to health care provider,
but patient has right to obtain copy of
any information in record.
 Can be legal record in court of law
 Erasures NOT allowed
○ Cross out errors with single line
○ Insert correct information, initial, date
Legal/Ethical - Communication
 Health
Care Records
 Erasures NOT allowed
○ “Moderate edema observed on left ankle”
○ “Moderate edema observed on left ankle”
○ “Moderate edema observed on right ankle”
○ There are methods that exist to tell the age
of the ink on a medical record.
Legal/Ethical - Communication
 Health
Care Records
 Must be properly maintained, stored in a
locked, secure area, kept confidential
and retained for the amount of time
required by state law.
 If records are to be destroyed (after
legal storage time has elapsed) they
must be shredded or burned, so
confidentiality can be maintained.
Legal/Ethical - Communication
 Health
Care Records
 Computerized medical records
 Documentation is being completed on:
○ Desktop computers
○ Laptops
○ I-Touch
○ I-Pad
○ Smart Phones
Legal/Ethical - Communication
 Health
Care Records
 Computerized medical records
○ Persons having access to records
○ Safeguards:
 Limiting personnel who have access (passwords)
 Using additional security measures to protect more
sensitive information (lab results, x-ray, etc)
 Constant monitoring of computer usage
Legal/Ethical - Communication
 Health
Insurance Portability &
Accountability Act of 1996 (HIPAA)
 Department of Health & Human
Services established standards to
protect medical information
 Violation
of HIPAA
 Fines: $100 - $250,000 & 10 yrs. In Jail
 As of August 2009 – No institutions had
been fined.
Source:
2009
bNet.com “HHS Office Will Be Funded Partly By The HIPAA Fines It Levies” August
Legal/Ethical - Communication
 Standards
for Privacy of Identifiable
Health Information (2003)
 Falls under HIPAA
 Provides federal protection for
privacy of health information in all
states
Legal/Ethical - Communication
 Standards
for Privacy of Identifiable
Health Information (2003)
 Require that patients must be:
○ Able to see & obtain copies of their
medical record
○ Given information about how medical
information is used and sets limits on use
○ Assured that health care providers will
keep medical information confidential
Legal/Ethical - Communication
 Standards
for Privacy of Identifiable
Health Information (2003)
 Require that patients must be:
○ Given the right to state who has access
to their medical information
○ Able to limit providing information to
family by health care provider
○ Provided with information on how to file a
complaint against a health care provider
who violates the privacy act
Legal/Ethical
Ethics
 Set of principals dealing with what is
morally right or wrong
 Provide a standard of conduct or
code of behavior
 Allow health care provider to
analyze and make decisions based
on what people believe is right and
good conduct
Legal/Ethical
Ethics (Ethical Dilemmas)
Don’t write!
 Is euthanasia justified in certain
patients?
 Should a patient be told that their
health care provider has AIDS?
 When should life support be
discontinued?
Legal/Ethical
Ethics (Ethical Dilemmas)
Don’t write!
 Who decides if a 75 y/o patient or a
56 y/o patient gets a single kidney
for transplant?
 If a person can benefit from
marijuana, should a physician be
able to prescribe it as a treatment?
Legal/Ethical
Ethics Guidelines
 Saving of life & promotion of health
is above all else
 Make every effort to provide comfort
and preserve life
 Respect patient’s choice to die
peacefully and with DIGNITY when
predetermined by advanced
directives
Legal/Ethical
Ethics Guidelines
 Treat ALL patients equally,
regardless of race, religion, social or
economic status, sex & nationality
 Avoid bias, prejudice and
discrimination
 Provide care for ALL of your
patients to the best of your ability –
ALL THE TIME
Legal/Ethical
Ethics Guidelines
 Maintain confidentiality
○Do NOT gossip about patients
 Maintain competent level of skill
 Continuing education units/credits
 Refrain from immoral, unethical, and
illegal practices
 REPORT illegal actions of others
Legal/Ethical
Ethics Guidelines
 Be Sincere
 Be Honest
 Be Caring
 Be Empathetic
 Show respect/concern for feelings,
dignity and rights of others
 “Treat others the way you want to be
treated”
Legal/Ethical
Patient’s Rights
 Factors of care that patients can
expect to receive






High quality hospital care.
• A clean and safe environment.
• Involvement in your care.
• Protection of your privacy.
• Help when leaving the hospital.
• Help with your billing claims.
•
Legal/Ethical
Patient’s Rights
 Federal laws require health care
institutions to have written policies
concerning patient’s rights
 All personnel must respect and
honor these rights
Legal/Ethical
 Resident’s
 Respect:
Rights (Long-Term Care)
You have the right to be treated
with dignity and respect.
 Services and Fees: You must be
informed in writing about services and
fees before you enter the nursing home.
 Money: You have the right to manage
your own money or to choose someone
else you trust to do this for you.
Legal/Ethical
 Resident’s
 Privacy:
Rights (Long-Term Care)
You have the right to privacy,
and to keep and use your personal
belongings and property as long as it
doesn't interfere with the rights, health, or
safety of others.
 Medical Care: You have the right to be
informed about your medical condition,
medications, and to see your own doctor.
You also have the right to refuse
medications and treatments.
Legal/Ethical
Advanced Directives
 Also
known as legal directives
 Legal documents that allow individuals to
state what specific measures should or
should not be taken to prolong life when
their condition is terminal
Legal/Ethical
Advanced Directives
 Two
Main Types
 Living Will
 Durable Power of Attorney (DPOA)
for Health Care Decisions
Legal/Ethical
Advanced Directives
 Two
Main Types
 Living Will
 Legal document that allows
individuals to state measures that
should/should not be done when
their condition is terminal
 Must be competent when signed; two
witnesses who will not benefit from
patient’s death
Legal/Ethical
Advanced Directives
 Two
Main Types
 Living Will
 Do Not Resuscitate (DNR) Order
○ No CPR
○ Patient allowed to die with dignity
Legal/Ethical
Advanced Directives
 Two
Main Types
 Durable Power of Attorney (DPOA)
for Health Care
 Permits patient (Principal) to appoint
another person (Agent) to make
health care decisions if the Principal
is unable to do so on their own
Legal/Ethical
Advanced Directives
 Two
Main Types
 Durable Power of Attorney (DPOA)
for Health Care
 DPOA can make specific decisions
based on patient’s wishes
○ Withhold certain treatments/procedures
○ Spending/withholding funds
○ Having access to medical record
Legal/Ethical
Advanced Directives
 Two
Main Types
 Durable Power of Attorney (DPOA)
for Health Care
 Usually spouses or adult children
are DPOA, but can be any
competent adult the patient chooses
 Must be signed by principal, agent,
and two adult witnesses
Legal/Ethical
Advanced Directives
 Health
care workers MUST be aware
of, and honor advanced directives
 Discuss advanced directives with
friends and family – be informed
 Give consideration to preparing your
own advanced directives
Legal/Ethical
Professional Standards
 Perform
only those procedures for
which you have been trained and are
legally permitted to do
 Used approved, correct methods
while performing any procedure
 Identify patient and obtain patient’s
consent before ANY procedure
Legal/Ethical
Professional Standards
 Document,
document, document!
 Paint the clearest picture possible with
your documentation
 Observe
all safety precautions
 Keep all information confidential
 Treat all patients EQUALLY
 Accept no gifts from patients ($$$)
Legal/Ethical
Professional Standards
 If
error occurs, report it to supervisor
immediately
 Behave professionally in dress,
language, manners and actions!!!!!!
 Liability insurance
 Offered by private companies
End of Lecture