1. Medical-legal and Ethical Issues

3. Legal duties and ethical responsibilities Liability / legal responsibilities Perform systematic patient assessment Perform systematic patient assessment Provide appropriate medical care Provide appropriate medical care Accurate and complete documentation Accurate and complete documentation

4. Ethics:Morality Good and evil Right and wrong

5. Ethical Standards {not laws} Promptly respond to both the physical and emotional needs of every patient Promptly respond to both the physical and emotional needs of every patient Treat all patients and their families with courtesy and respect Treat all patients and their families with courtesy and respect Maintain mastery of your skills and base knowledge Maintain mastery of your skills and base knowledge Continuing ED. Continuing ED.

6. Be critical of yourself and you performance Be critical of yourself and you performance Always seek to learn and improve Report honestly and be respectful of patient confidentiality. Report honestly and be respectful of patient confidentiality. Be cooperative of co-workers and colleagues Be cooperative of co-workers and colleagues

7. Legal System Constitutional Law Based on the constitution Based on the constitution Common law Case or judge-made law Case or judge-made law Societys acceptance of customs and norms over time Societys acceptance of customs and norms over time

8. Legislative law Statutory law Statutory law Made by legislative bodies Made by legislative bodies Administrative law Regulatory law Regulatory law Enacted by an administrative or governmental agency Enacted by an administrative or governmental agency

9. Administrative agencies such as OSHA produce rules and regulations necessary to implement Administrative agencies such as OSHA produce rules and regulations necessary to implement Civil Law Criminal Law

10. Scope of practice Negligence Duty to act Breach of duty Violation of standard of care Violation of standard of care Malfeasance; misconduct or wrong-doing Misfeasance; inappropriate action or intentionally give incorrect advise

11. From Wikipedia, the free encyclopedia Res ipsa loquitur the thing that speaks for itself A Latin phrase that literally means, "the thing speaks for itself". In the common law of negligence, the doctrine of res ipsa loquitur states that the elements of duty of care and breach can be sometimes inferred from the very nature of the accident, even without direct evidence of how any defendant behaved. Although modern formulations differ by jurisdiction, the common law originally stated that the accident must satisfy the following conditions: A Latin phrase that literally means, "the thing speaks for itself". In the common law of negligence, the doctrine of res ipsa loquitur states that the elements of duty of care and breach can be sometimes inferred from the very nature of the accident, even without direct evidence of how any defendant behaved. Although modern formulations differ by jurisdiction, the common law originally stated that the accident must satisfy the following conditions: common lawnegligenceduty of carebreachdefendantcommon law common lawnegligenceduty of carebreachdefendantcommon law... a "duty" exists for a person to act "reasonably"; and... a "duty" exists for a person to act "reasonably"; and... a "breach" of this duty occurs because a person acted outside this duty, or "unreasonably"; and... a "breach" of this duty occurs because a person acted outside this duty, or "unreasonably"; and... there was "causation in fact"...the result would not have occurred "but for" the "breach" of this duty; and... there was "causation in fact"...the result would not have occurred "but for" the "breach" of this duty; and... there were actual damages suffered by the plaintiff who did nothing wrong (i.e., no contributory negligence).... there were actual damages suffered by the plaintiff who did nothing wrong (i.e., no contributory negligence).contributory negligencecontributory negligence Upon a proof of res ipsa loquitur, the plaintiff need only establish the remaining two elements of negligence -- namely, that the plaintiff suffered damages, of which the accident was the legal cause. Upon a proof of res ipsa loquitur, the plaintiff need only establish the remaining two elements of negligence -- namely, that the plaintiff suffered damages, of which the accident was the legal cause.negligenceplaintifflegal causenegligenceplaintifflegal cause

12. http://www.lectlaw.com/de f/d003.htm Actual damages When damages, which have been suffered by someone as a result of another's wrongdoing, can be precisely measured, they are called actual damages. Examples of actual damages are: When damages, which have been suffered by someone as a result of another's wrongdoing, can be precisely measured, they are called actual damages. Examples of actual damages are: Loss of income because of an injury * medical expenses * costs of repairing damaged property, and * specific business losses occurring because of a breach of a contract. Loss of income because of an injury * medical expenses * costs of repairing damaged property, and * specific business losses occurring because of a breach of a contract.

13. http://legal- dictionary.thefreedictionary.com/pr oximate+cause Proximate cause An act from which an injury results as a natural, direct, uninterrupted consequence and without which the injury would not have occurred. An act from which an injury results as a natural, direct, uninterrupted consequence and without which the injury would not have occurred. Proximate cause is the primary cause of an injury. It is not necessarily the closest cause in time or space nor the first event that sets in motion a sequence of events leading to an injury. Proximate cause produces particular, foreseeable consequences without the intervention of any independent or unforeseeable cause. It is also known as legal cause. Proximate cause is the primary cause of an injury. It is not necessarily the closest cause in time or space nor the first event that sets in motion a sequence of events leading to an injury. Proximate cause produces particular, foreseeable consequences without the intervention of any independent or unforeseeable cause. It is also known as legal cause. To help determine the proximate cause of an injury in Negligence or other tort cases, courts have devised the "but for" or "sine qua non" rule, which considers whether the injury would not have occurred but for the defendant's negligent act. A finding that an injury would not have occurred but for a defendant's act establishes that the particular act or omission is the proximate cause of the harm, but it does not necessarily establish liability since a variety of other factors can come into play in tort actions. To help determine the proximate cause of an injury in Negligence or other tort cases, courts have devised the "but for" or "sine qua non" rule, which considers whether the injury would not have occurred but for the defendant's negligent act. A finding that an injury would not have occurred but for a defendant's act establishes that the particular act or omission is the proximate cause of the harm, but it does not necessarily establish liability since a variety of other factors can come into play in tort actions.Negligence Some jurisdictions apply the "substantial factor" formula to determine proximate cause. This rule considers whether the defendant's conduct was a substantial factor in producing the harm. If the act was a substantial factor in bringing about the damage, then the defendant will be held liable unless she can raise a sufficient defense to rebut the claims. Some jurisdictions apply the "substantial factor" formula to determine proximate cause. This rule considers whether the defendant's conduct was a substantial factor in producing the harm. If the act was a substantial factor in bringing about the damage, then the defendant will be held liable unless she can raise a sufficient defense to rebut the claims.

14. Defenses to charges of negligence Good Samaritan laws Good Samaritan laws Governmental Immunities Governmental Immunities Statue of Limitations Statue of Limitations Contributory or Comparative negligence Contributory or Comparative negligence

15. http://www.the-injury- lawyer- directory.com/negligence.ht ml Contributory Negligence Historically, contributory negligence was a common law defense available in tort actions. In the past, if two people were in an accident, the injured person could only recover for his/her injuries and damages if they did not contribute to the accident in any way. This approach was based on a policy originally established in England that stated a person who negligently causes harm to another cannot be held liable if that injured individual contributed to his own suffering and injury, even if it was only a very slight factor.

16. http://www.the-injury- lawyer- directory.com/negligence.ht ml Comparative Negligence In a comparative negligence system, the injured party may still recover some of his or her damages even if he or she was partially to blame for causing the accident. Plaintiffs financial recovery may be reduced, or even prohibited, depending how plaintiffs actions caused or contributed to the accident. In states using a comparative negligence system, a jury or judge determines the proportion of fault to be assigned to each responsible party.

17. Special liability concerns Liability of medical direction Liability of medical direction Borrowed servant doctrine Malpractice A principle under which the party usually liable for a person's actions– eg, a hospital responsible for a nurse, is absolved of that responsibility when that person is asked to do something–eg, by a surgeon, which is outside of the bounds of hospital policy. Malpractice A principle under which the party usually liable for a person's actions– eg, a hospital responsible for a nurse, is absolved of that responsibility when that person is asked to do something–eg, by a surgeon, which is outside of the bounds of hospital policy.

18. Violation of a patients civil rights Civil Rights: The rights belonging to an individual by virtue of citizenship, especially the fundamental freedoms and privileges guaranteed by the 13th and 14th Amendments to the U.S. Constitution and by subsequent acts of Congress, including civil liberties, due process, equal protection of the laws, and freedom from discrimination.

19. Off Duty

20. ConfidentialityConsent Informed Informed Expressed Expressed Implied Implied Minor Minor Refusal of Service DNR Reporting requirements Documentation