1. LeGal Responsibilities
DHO chapter 5

2. Legal responsibilities
Legal responsibilities are those that are based on law
Health care workers are required to know and follow the state laws that regulate their licenses
Failure to meet your legal responsibilities can result in legal action against you and your employer

3. Criminal vs civil law
2 main types of laws affect health care workers: criminal laws and civil laws
Criminal law=focuses on behavior know as crime; deals with the wrongs against a person, property, or society
Examples of criminal law: practicing in a health profession without having the required license, illegal possession of drugs, misuse of narcotics, theft, sexual assault, and murder

4. Criminal vs civil law
Civil law=focuses on the legal relationships between people and the protection of a person’s rights
Examples of civil law in healthcare=torts and contracts

5. torts Wrongful act that does not involve a contract
It is a civil wrong instead of a crime
A tort occurs when a person is harmed or injured because a health care worker does not meet the established or expected standards of care
Many different types of torts can lead to legal action

6. Examples of common torts:
Malpractice=“bad practice” Or “professional negligence”
Failure of a professional to use the degree of skill and learning commonly expected in that individual’s profession
It results in injury, loss, or damage to the person receiving care
Example: physician not administering a tetanus injection with a puncture wound; nurse performing minor surgery without having any training

7. Examples of common torts:
Negligence=failure to give care that is normally expected of a person in a particular position
It results in injury to another person
Example: falls & injuries when siderails are left down, using or not reporting defective equipment, infections caused by the use of nonsterile instruments, burns caused by improper heat

8. Examples of common torts:
Assault=threat or attempt to injure
Battery=unlawful touching of another person without consent
Example: performing a procedure after a pt has refused to give permission, threatening a pt, improper handling or rough treatment of a pt while providing care

9. Examples of common torts:
Assault & battery are closely related & often used together
Patients must give consent for any care
Patients have the right to refuse care
Some procedures require written consent (surgery)
Informed consent=permission granted voluntarily by a person who is of sound mind & who has been instructed, in terms they can understand, about all the risks involved

10. Examples of common torts:
Invasion of privacy – 2 kinds – physical & informational
Physical invasion of privacy=unnecessarily exposing an individual
Informational invasion of privacy=revealing personal info about an individual without their consent
Example: improperly draping a pt so that other pts or personnel can see the pt exposed; informing the news media about a pt’s condition without their permission

11. Examples of common torts:
False imprisonment=restraining an individual or restricting an individual’s freedom without authorization
Example: keeping pts hospitalized against their will; applying physical restraints without proper authorization or with no justification

12. Examples of common torts:
Abuse=any care that results in physical harm, pain, or mental anguish
Example: physical, verbal, psychological, and sexual
Health care workers should be alert to unexplained bruises, fractures, or injuries; signs of neglect such as poor personal hygiene; irrational fears; aggressive/withdrawn behavior

13. Examples of common torts:
Defamation=false statements either cause a person to be ridiculed or damage their reputation
2 types: slander and libel
Slander=incorrect info that is spoken
Libel=incorrect info that is written
Example: telling others a pt has a drug problem when another medical condition exists; saying a coworker is incompetent

14. contracts Contract=Agreement between 2 or more parties
Contracts in health care are implied or expressed
Implied contracts=obligations that are understood without verbally expressed terms
Example: pt takes med from nurse
Expressed contracts=stated in distinct and clear language, either orally or in writing
Example: surgery permit

15. contracts
Persons entering into a contract must be free of legal disability
Legal disability=minors, mentally incompetent persons, individuals under the influence of drugs that alter the mental state, semiconscious or unconscious people
Interpreter must be used when a contract is explained to a person who does not speak english

16. QUIZ
Informed Consent
If a patient gives permission for a procedure but is heavily drugged at the time, is that legal?
If a patient signs a consent form without reading the form, have the rules for informed consent been legally met?
If a patient signs a consent form and, while of sound mind, changes his mind about having the procedure, can the physician still perform the procedure?
Answer Key
No, because a patient must be of sound mind to legally sign a consent?
Possibly, yes. If the physician has properly informed the patient of the procedure, risks, and intended outcomes, then yes, the signature is legal. It is possible that the legality of the signature could be questioned if the all the rules for informed consent have not been followed. No

17. Privileged communication
Privileged communications comprise all info given to health care workers by a pt
It must be kept confidential and cannot be told to anyone else with the written consent of the pt
Health care record is considered privileged communication
Health care record belongs to the health care provider, but the pt has a right to obtain a copy of the record (can be charged $$ for it)

18. Privileged communication
Health care record can be used as legal records in a court of law
Erasures are not allowed on the health care record
Errors should be crossed out with a single line so the material is still readable
Correct info should then be inserted, initialed, and dated

19. Privacy act Hipaa=health insurance portability and accountability act
Standard that provides federal protection for privacy of health info
Pt must be informed about how their health info is used
Pt must sign consent before any info is released to any party
Births, deaths, injuries caused by violence that require police, abuse, communicable diseases, & STDs are exempt from HIPAA

20. HIPAA
QUIZ
Must a patient sign a HIPAA authorization form before his/her physician’s office files an insurance claim for the patient?
Can a physician give a son confidential information about his father’s condition without the father’s written consent?
Karen wants a copy of her dental x-rays. Can the dental office charge her $10 to provide her with a copy?
Brenda has a baby but does NOT want the information made public. Can she refuse to have the birth registered?
Answer Key:
Department of Health and Human Services
Yes
No – Many times a physician may talk with family members but they will not share confidential information.
Yes. HIPAA requires that patients can get a copy of their records but does not prevent offices from charging a fee.
No. Births and deaths are required by law to be reported and registered according to the laws of the state.

21. Scope of practice
Procedures, processes, and actions that health care providers are legally permitted to perform in keeping with the terms of their professional license

22. Patients’ rights Factors of care that patients can expect to receive
Read over the 10 points in the bill of rights (DHO8 page ) and summarize them for yourself.
Read over the 10 points in the Resident’s bill of Rights and summarize them for yourself.

23. QUIZ
Patient’s rights
A physician walks into a patient’s room with three medical students. Does the patient have the right to ask the medical students to leave?
Does a patient have the right to challenge charges on his/her hospital bill?
A nurse anesthetist visits a patient before surgery, but the patient is not comfortable with the anesthetist. What should he/she do?
Answer Key
Yes
Talk to the surgeon, share concerns, and request a different anesthetist
Opinion question

24. Advance directives
Legal documents that allow individuals to state what medical treatments they want or do not want in the event that they become incapacitated and are unable to express their wishes regarding medical care
2 main directives=living will and durable power of attorney (POA) for health care

25. Advance directives
Living will=state what measures should or should not be taken to prolong life when their conditions are terminal
Must be signed by 2 adults who cannot benefit from the death
Living wills frequently result in DNR orders

26. Advance directives
POA also called “Designation of Health Care Surrogate” or “Medical Power of Attorney”
Permits an individual (known as a principal) to appoint another person (known as an agent) to make healthcare decisions if the principal becomes unable to make decisions.
Usually given to spouse or adult children.
May be given to any qualified adult.
POA must be signed by the principal, the agent, and two adult witnesses.

27. QUIZ Advance Directives
If a patient legally signs a living will, can a physician refuse to cooperate?
Robert has never been married and has no children. Can he give durable power of attorney to his cat?
Barney is very ill. His daughter puts a pen in his hand and bullies him into signing a Living Will. Is that legal?
Joe has signed a living will and the doctor writes a DNR order. What should the nurse caring for him do if he experiences cardiac arrest?
Answer Key
Legally, if the facility accepts federal money, then the physician cannot refuse a living will request. Otherwise, it would depend on state law.
The intent of the PSDA is to protect a patient’s right to have an advance directive followed. No
The nurse should not call a code, or rather should notify the doctor and allow the patient to die with dignity.