1. Responsible Medical Practice
Unit 3
Responsible Medical Practice
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

2. Legal Considerations Chapter 6
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

3. Sources of Law (Slide 1 of 3)
Constitutional law
Constitution and 27 amendments
Statutory law
Laws made by states
State laws can not override constitutional laws
Common law
“Judge-made” law
Decisions based on individual court decisions, interpretation of the U.S Constitution and statutory law, known as precedents
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3

4. Sources of Law (Slide 2 of 3)
Criminal law
Addresses wrongs committed against the welfare and safety of society as a whole
Malfeasance
Illegal conduct by an official
Felony
Serious crimes and serious punishments
Misdemeanor
Lesser crimes and lesser punishments
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4

5. Sources of Law (Slide 3 of 3)
Civil law
Affects relationships between individuals corporations, governmental bodies
Misfeasance
Lawful act improperly or unlawfully executed
Nonfeasance
Failure to perform an act, official duty, legal requirement
The most common forms are administrative, contract, and tort law
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5

6. Administrative Law (Slide 1 of 4)
Agencies given power to specialize and enact regulations that have the force of legal law
Health care professionals are bound by federal administrative law through the Medicare and Medicaid program rules
Affordable Care Act and Patients’ Bill of Rights
Contains several provisions, including ending preexisting condition exclusions and lifetime coverage limits
Makes certain that patients receive all the benefits of the law
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6

7. Administrative Law (Slide 2 of 4)
Health Insurance Portability and Accountability Act (HIPAA) of 1996
Requires national standards for electronic health care transactions
Assists in making health insurance more affordable and accessible when people change or lose their jobs
Electronic medical records software for the transfer of medical health records through the Health Information Technology for Economic and Clinical Health (HITECH) Act
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7

8. Administrative Law (Slide 3 of 4)
Controlled Substances Act of 1970
Five schedules (I, II, III, IV, V) according to potential for abuse and dependence
Regulates who administers, prescribes, and dispenses any drug listed in the five schedules
User must register with the Drug Enforcement Agency (DEA)
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8

9. Administrative Law (Slide 4 of 4)
Uniform Anatomical Gift Act of 1968
Allows persons 18 years and older to make a gift of all or parts of their body
Regulation Z of the Consumer Protection Act of (Truth in Lending Act)
Requires an agreement by providers and patients for medical bill payments in more than 4 installments, must be in writing
Medical Practice Acts
Statues that regulate the practice of medicine with the intent of protecting its citizens from harm
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9

10. Contract Law (Slide 1 of 2)
Contract between the provider and the patient
Expressed contracts
Written or verbal
Implied contracts
Indicated by actions
Majority of provider–patient contracts
Contract to be valid and binding, parties who enter into it must be competent
Medical assistants considered agents of their employers
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10

11. Contract Law (Slide 2 of 2)
Termination of contracts
Broken contract or breach of contract occurs when one party does not meet their contractual obligations
Patient discharges provider
Provider formally withdraws from patient care
Patient has been noncompliant
Treatment no longer needed by patient
(See Figure 7-1)
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11

12. Tort Law (Slide 1 of 2)
Wrongful act resulting in injury to one person or another
Negligence, malpractice
Four Ds of negligence
Duty
Derelict
Direct cause
Damage
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12

13. Tort Law (Slide 2 of 2) Medical assistant’s role in negligence
Maintain scope of practice
Each state is likely different
Classification of torts
Intentional torts are deliberate acts violating another’s rights
Negligent torts are not deliberate; result of omission or commission of an act
Common torts
Battery, defamation, invasion of privacy
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13

14. Informed Consent Nature of any procedure and how it is performed
Possible risks as well as expected outcomes of any procedure
Any other methods of treatment and those risks
Risks if no treatment is given
MA may be asked to be a witness
Expressed and implied consent
Legal Incompetence
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14

15. Risk Management (Slide 1 of 2)
Practicing good risk management makes medial assistants and providers less vulnerable to litigation
Perform only within your scope of practice
Comply with state and federal regulations
Keep clinic safe
Never leave a patient unattended
Keep all patient information confidential
Follow all clinic policies and procedures
Document fully, only facts
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15

16. Risk Management (Slide 1 of 2)
Log all telephone calls
Follow up on missed/cancelled appointments
Never advise treatment
Secure informed consent
Explain appointment delays
Professional liability coverage
Cover costs of litigation that may occur
Employees need professional liability coverage
Medical assistants can purchase from American Association of Medical Assistants (AAMA)
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16

17. Civil Litigation Process (Slide 1 of 2)
Subpoenas
Court order naming date, time, reason to appear
Portion or entire medical record may be subpoenaed
Health care provider may be subpoenaed to testify
Some sensitive records require more than subpoena; a court order required in many states
HIPAA law requires identification of what information will be released regarding patients
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17

18. Civil Litigation Process (Slide 2 of 2)
Discovery
Interrogatory, deposition, expert witnesses
Pretrial conference
Alternative dispute resolution (ADR)
Mediation/Arbitration
Trial
Held before a judge or judge and jury
If plaintiff’s case successful, judge or jury may award money or damages
If defendants case successful, case is dismissed 18

19. Statute of Limitations
Begin at time negligent act was committed
When act discovered
When care of patient and provider–patient relationship ended
Time limit for individuals to initiate legal action
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19

20. Public Duties Reportable diseases/injuries Abuse Good Samaritan laws
“Nationally Notifiable Infectious Diseases” listed on CDC’s Web site (
MedlinePlus/Electronic or telephone reporting
Local or state health departments provide lists of diseases and injuries
Abuse
Child/elder abuse
Intimate partner violence (IPV)
Good Samaritan laws
Encourage health care professionals to provide medical care within scope of training without fear of negligence
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 20

21. Fraud Most common violations: Billing for services not provided
Billing a non-covered service
Misrepresenting dates, locations, and providers of service
Incorrect reporting of diagnoses or procedures
Taking kickbacks or bribery
False or unnecessary issuance of prescription drugs, especially opioids
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 21

22. Advance Directives
Physician Orders for Life-Sustaining Treatment (POLST)
Living wills, advance directives, health care proxy
Durable power of attorney for health care
Patient Self-Determination Act (PSDA) of 1991
Advanced directives provided to patients’ providers, family members, any agent identified
© 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22