From Exam Room to Courtroom Chapter 1 From Exam Room to Courtroom

Personal Protection It is important to protect yourself from: Needless litigation Loss of reputation Loss of personal wealth Loss of earning power …by understanding basic principles of the law.

Importance of Legal Knowledge to Medical Office Personnel Learn to avoid lawsuits through: Understanding the nature and scope of the problem Knowing the basics of the law Recognizing situations that may lead to medical malpractice actions against you or your employer

Importance of Legal Knowledge to Medical Office Personnel Learn to avoid lawsuits through: Understanding the ingredients of a medical malpractice action Practicing preventative procedures Recognizing when you need an attorney 4

Informed Employee The informed employee must be aware of: Contractual agreement with an employer Issues of discrimination Sexual harassment Union membership and collective bargaining (where applicable) State regulations such as state medical practice acts, federal and state legislation

Patient Protection – License Licensure law, enacted to protect patients’ interests by defining the education and experience required to perform certain procedures License Indicates the basic minimum qualifications required by the state License requirements Control employers by setting standards for hiring that protect the public

Patient Protection – Licensing Boards Licenses are granted by licensing boards. Licensing boards have power to revoke licenses.

Patient Protection – Licensing Boards Grounds for revocation vary slightly from state to state, but may include: Unprofessional conduct Substance abuse, alcoholism Fraud in connection with examination or application Conviction of a felony Mental incapacity Purporting to act as another medical professional Forgery Theft Use of a legitimate license without the knowledge of the owner 8

Patient Protection – Privacy and Respect The requirements of privacy and respect for the confidential relationship between physician and patient must be met. Privacy and confidentiality have ethical as well as legal bases. Permission to touch and the right to perform certain procedures are interwoven with state medical practice acts.

HIPAA HIPAA is a federal law requiring every health plan and provider to maintain “reasonable and appropriate” safeguards to ensure confidentiality of health information. 10

Protecting the Public Health matters that must be reported: Births Deaths Venereal and other communicable diseases Injuries from violence Child and elder abuse Blindness Immunological proceedings Industrial poisoning Requests for plastic surgery to change a person’s fingerprints

Physician Protection Physicians are vicariously liable for the behavior of their employees while the employees are working within the scope of their employment. In the employment setting, this is known as respondeat superior—“Let the master answer.” It is sometimes difficult to decide whether an employee is acting within the scope of employment. The test is whether the behavior serves the interest of the employer or furthers the employer’s business.

Duty of the Physician Once it has been established that there is a doctor-patient relationship, the doctor has a duty to the patient to diagnose and treat the patient’s injury with due care. Due care Assumes that the doctor possesses the qualifications and training to provide competent medical care for the patient Requires the doctor to provide competent office personnel

Procedures Manual Should be properly written and identify employee’s: Responsibilities for duty to care for the patient Special qualifications for job tasks Parameters of a job description Behavior most likely be acceptable Standards of professionals

Standard of Care The distinction between professional and lay person is very important for employees working in health care positions. To be classified as a professional, an individual must have an independent basics of professional knowledge from which to make an independent decision.

Parameters of the Responsibility in the Medical Office Medical office personnel are the link between the patient the physician. Thus it is crucial the employees: Develop good relations between physician and patient Understand legal issues in practicing medicine Understand good staff-patient relations

Medical Assistants, State by State Professional status of medical assistants has grown. Many state laws and regulations either: Do not acknowledge the existence of the medical assisting profession or Do not authorize the delegation of some administrative and clinical duties to medical assistants

Medical Assistant Standard of Care Some physicians allow medical assistants to perform certain functions. The delegation of responsibility is based on the premise that the MA can perform the functions as well as the physician. The medical assistant may be held to the same standard of care as the doctor.

Medical Assistant Scope of Practice A medical assistant is neither licensed nor certified to practice medicine and cannot decide the course of treatment for a patient on behalf of a physician. There is no scope of practice law governing a medical assistant, because the medical assistant is not allowed to practice medicine in any form.

Mid-Level Providers Mid-level providers: Physician’s assistant Nurse practitioner Advanced practice registered nurse The precise limitations vary from state to state, but mid-level providers serve to extend the physicians’ ability to render care for patients.

Practicing Medicine The practice of medicine is held to mean diagnosis, treatment, and/or prescription …for the prevention or cure of any human disease, ailment, injury, deformity, or physical or mental condition.

Practicing Medicine Scope of practice is practicing medicine within statutory guidelines and accepted standards. Each individual who practices medicine is held to professional and/or statutory guidelines and accepted standards of care.