In Healthcare there are laws and legal responsibilities to protect you and society. - Being aware:  protects you  Protects your employer  Protects patient

Legal responsibilities are those authorized by on law. Can be Criminal or Civil  Criminal – focuses on wrongs against person, property or society  Civil – focuses on legal relationship between people and protection of person’s rights

 Practicing without a license  Misuse of narcotics (controlled substances)  Theft  Murder  Follow state regulations within respective field

Involving Contracts and Torts (Wrongful acts that do not involve contracts)  Contract law involves wrongs against a breach of contract – not doing what was agreed.  A tort occurs when a person is harmed or injured because injured because a healthcare worker did not meet a “standard of care”.  Torts can be complex and up for different interpretation.  Tort – no contract

1. Malpractice 2. Negligence 3. Assault and Battery 4. Invasion of Privacy 5. False Imprisonment 6. Abuse 7. Defamation

Commonly known as BAD PRACTICE  Failure of a professional to use the degree of skill and learning commonly expected in the profession.  Results in injury, loss or damage to person receiving care  Examples – nurse going beyond scope (doing surgery)  Doctor not giving a tetanus shot with puncture wound

Failure to give care that is normally expected of a person in a particular position, resulting in injury.  Examples  leaving bed side rails down  Using defective equipment  Using non sterile instruments  Using equipment improperly

Assault - Threat or attempt to injure Battery – Unlawful touching without consent  Closely related and often used together  Patients must give consent and have the right to refuse Consent (Permission) - verbal, written and informed. Informed consent – permission granted by a person of sound mind after the procedure and all risks are explained.

Unnecessarily exposing an individual or revealing personal information about an individual without consent.  Improper draping or covering a patient  Giving out information on a patient without permission (informing news, insurance, others)

Restraining or restricting an individuals freedoms  Keeping patients hospitalized against their will  Applying restraints without justification or authorization

Any care that results in physical harm, pain or mental anguish  Physical Abuse – hitting, forcing against will, restraining movement, depriving of food, water and not providing physical care  Verbal Abuse – speaking (written) harshly, swearing, shouting, using improper words to describe race or nationality or just abusive statements.

 Psychological Abuse – threatening to harm, denying rights, belittling, intimidating or ridiculing the person.  Includes threatening to reveal information about patient.  Sexual Abuse – any unwanted sexual touching or act, using sexual gestures and/or suggesting sexual behavior

 Failure to Report Domestic Abuse  Intimate partner uses violent behavior to maintain power or control over another person.  Unexplained bruises, fractures, burns or injuries  Signs of neglect – poor personal hygiene  Irrational fears or a change in personality  Aggressive or withdrawn behavior  Patient statements that indicate abuse

False statement either causes a person to be ridiculed or damaged the person’s reputation.  Incorrect information can given out in error can be defamation.  Slander – information that is spoken  Libel – information that is written Any information that is about individuals, news or government

A contract is an agreement between two or more parties Most contracts have three parts: 1. Offer – competent person offers to be a patient 2. Acceptance – provider gives an appointment, examines or treats a patient. 3. Consideration – payment made more services

Implied or Expressed  Implied Contracts – obligations that are understood without verbally expressed terms.  Expressed Contracts – Stated in distinct and clear language either orally or written. All parties entering into a contract must be free of legal disability – must have legal capacity to make agreement (minors, mentally incompetent, under influence of drugs/alcohol, semi-conscious or unconscious.

Use of a translator  A translator must be used when a contract is entered with a non-English speaking patient  Includes – Deaf or hard of hearing Role of an AGENT – a person works under the direction of another person.  Employer is called the Principal  Worker is called the Agent  Principal is responsible for the agent –  Dental assistant tells patient denture will be nicer than real teeth and they aren’t the dentist is responsible.

 Composed of all information given to healthcare personnel by a patient.  By law this information this information must be kept confidential  Shared with only members of patients healthcare team.  Can only be shared with written consent and has time limits  Certain circumstances are exempt: births, deaths, injuries caused by violence, abuse, stabbings, communicable diseases and sexually transmitted diseases.

Healthcare Records  All records about care of patient are to be kept private.  Shared only with healthcare team  Patient has legal right to all records.  Must be maintained a certain time limit.  7 years  Till 18 for minors  Burned or shredded to maintain confidentiality

Legal responsibilities are determined by law – Ethics are a set of principles  morality of right and wrong  Provide a standard of conduct  Code of Behavior

Modern healthcare has created dilemmas:  Euthanasia?  HIV Status?  When should life support be terminated?  Refuse treatment due to cost?  Sell Organs?  Genetic research, gene transplants, cloning?

Use ethical guidelines or codes:  Saving a life and promotion of health above all  Keep every effort to keep patient comfortable  Respect’s patient choice to die with dignity  Treat all patients equally  Provide care to the best of your ability  Stay competent in skills and knowledge  Maintain confidentiality  Refrain from illegal or immoral behavior-report others  Show loyalty to patient, co-workers and employers  Be sincere, honest and caring

Federal and State Law – written Patient Rights “Patient’s Bill of Rights” – AHA (American Hospital Association) Patient has the right to: 1. Considerate and respectful care 2. Obtain complete, current info on diagnosis, treatment and prognosis. 3. Receive necessary information to give consent 4. Have advance directives – DNR 5. Privacy concerning medical care 6. Confidentiality of all communications and records

Bill of Rights – Continued 7. Reasonable response time to requests 8. Obtain info on relationship between hospital and other healthcare facilities 9. Be advised and right to refuse being part of research study 10. Reasonable continuity of care 11. Review medical records and examine bills 12. Informed of any/all hospital rules, regulations policies and resources to resolve disputes

Long Term Care Facilities – Residents bill of Rights 1. Free choice regarding physician, treatment and participation in research 2. Freedom from abuse, chemical or physical restraints 3. Confidentiality of records 4. Accommodations and choice regarding activities, schedules and healthcare 5. Voice grievances without fear of retaliation 6. Organize and participate in family/resident socials, religious and community activities

7. Information on medical benefits, survey results, deficiency of facilities and advocacy groups. 8. Manage personal funds and use personal possessions 9. Unlimited access to immediate family or relatives 10. Remain in facility and not be transferred unless for medical reasons

Also known as legal directives – legal documents that allow patients to state what medical treatment they want and don’t want.  Living Wills – what measures should or should not be done to prolong life (includes DNR)  Durable Power of Attorney- document that permits an individual (principal) to appoint another person (agent) to make decisions regarding healthcare

Patient Self Determination Act federal law requiring healthcare facilities that receive federal aid do the following:  Inform every patient both orally and written they have the right to make decisions about medical care including refusal.  Provide information and assistance about advance directive  Document any advance directives on chart  Have written statements to implement patients rights in decision making process  Affirm there will be no discrimination or effect on care because of advance directives  Educate the staff on medical and legal issues of advance directives

Legal responsibilities, ethics, patient rights and advance directives protect the patient: Following Professional Standards protects: Healthcare worker (YOU) Employer

 Perform only those procedures for which you have been trained and are legally permitted to do.  Use approved methods while performing any procedure  Obtain proper authorization before performing a procedure  Identify the patient and obtain patient consent before performing procedure  Observe all safety prcautions

 Keep all information confidential  Think before you speak.  Treat all patients equally  Accept no tips or bribes for your care  If an error or mistake is made - report immediately  Behave professional in dress, language, manner and actions

Even when all is followed errors leading to legal action occur.  Have and maintain liability insurance  Insurance companies specializing in liability  Professional Organization  Homeowners or Business Insurance