1. Medical Assisting Chapter 3
PowerPoint® to accompany
Medical Assisting Chapter 3
Second Edition
Ramutkowski  Booth  Pugh  Thompson  Whicker
Chapter 3
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

2. Legal and Ethical Issues in Medical Practice, including HIPAA
Objectives
3-1 Define ethics, bioethics, and law.
3-2 Discuss the measures a medical practice must take to avoid malpractice claims.
3-3 Describe OSHA requirements for a medical office.
3-4 Describe procedures for handling an incident of exposure to hazardous materials.

3. Legal and Ethical Issues in Medical Practice, including HIPAA
Objectives (cont.)
3-5 Compare and contrast quality control and quality assurance procedures.
3-6 Explain how to protect patient confidentiality.
3-7 Understand basic overview of HIPAA.

4. Medical Law and Ethics
Knowledge of Medical Law and Ethics provides insight into:
The rights, responsibilities, and concerns of health care consumers.
The legal and ethical issues facing society; patients, and health care professionals as the world changes.
The impact of rising costs on the laws and ethics of health care delivery.

5. Medical Law and Ethics (cont.)
A law is a rule of conduct or action.
Ethics is a standard of behavior.
Governments enact laws to maintain order and public safety.
Moral values serve as the basis for ethical conduct.
Family, culture, and society help form individual’s moral values.
Criminal and civil laws pertain to health care practitioners.

6. Medical Law and Ethics (cont.)
Criminal Law
Involves crimes against the state
Criminal acts are classified as either a felony or misdemeanor
Examples include:
Murder
Arson
Rape
Burglary
Civil Law
Involves crimes against the person
Includes a general category of laws known as torts
Torts are either:
Intentional (willful)
Unintentional (accidental)

7. Medical Law and Ethics (cont.) Intentional Torts
Assault
Battery
To cause another person to feel threatened.
An action that causes bodily harm to another. Even touching without permission.
Invasion of privacy
Fraud
Interference with a person’s
right to be left alone.
Depriving or attempting to deprive a person of his or her rights.
Defamation of Character
False Imprisonment
Damaging a person’s reputation
by making a public statement.
Intentional, unlawful restraint or confinement of a person.

8. Medical Law and Ethics (cont.) Unintentional Torts
Acts that are committed with no intent to cause harm
but are done with a disregard for the consequences.
The term negligence is used to describe such actions when health care practitioners fail to exercise ordinary care resulting in patient injury.
Malpractice is the negligent delivery of professional services.

9. Medical Law and Ethics (cont.) Contracts
A contract is a voluntary agreement between two parties in which specific promises are made for a consideration.
4 Elements of a Contract
Agreement
Consideration
Contractual Capacity
Legal Subject Matter

10. Medical Law and Ethics (cont.) Contracts
Types of Contracts
Expressed Contracts
Clearly stated in written or spoken words
A payment contract is an example
Implied Contracts
Actions or conduct of the parties rather than words, create the contract
A patient rolling up his or her sleeve to receive an injection is an example

11. Medical Law and Ethics (cont.) Terminating Care of a Patient
A physician who no longer wants to manage a patient’s care must withdraw in a formal, legal manner by:
Providing written communication to the patient
Recommending that patient seek another physician as soon as possible
Mail letter by certified mail with return receipt requested
Summarize all communication in patient chart and place copy of all documentation in chart

12. Medical Law and Ethics (cont.) Terminating Care of a Patient
Typical Reasons Physicians May Terminate Care of a Patient:
Refusal to follow physician instructions
Personality conflicts
Failure to pay for services rendered
Repeated failure to keep appointments
Patient family member complaints
Disagreement regarding medication orders

13. Medical Law and Ethics (cont.) Malpractice
Malpractice claims are lawsuits by a patient against a physician for errors in diagnosis or treatment.
Negligence cases are those in which a person believes a medical professional’s actions or lack thereof, caused harm to the patient.
Res ipsa loquitur
Latin term which means “The thing speaks for itself.”

14. Medical Law and Ethics (cont.) Malpractice
Examples of Negligence:
Abandonment
Delayed treatment
Legal Terms used to classify Negligence
Malfeasance (unlawful act or misconduct)
Misfeasance (lawful act done incorrectly)
Nonfeasance (failure to perform an act that is one’s required duty or that is required by law)

15. Medical Law and Ethics (cont.) Malpractice
The 4 Ds of Negligence D
amages
Patients must prove that they suffered injury.
erelict
Patients must show that the physician failed to comply with the standards of the profession.
uty
Patients must show that a physician-patient relationship existed.
irect Cause
Patients must show that any damages were a direct cause of a physician’s breach of duty.
Patients must be able to prove all 4 Ds in order to move forward with a malpractice suit.

16. Medical Law and Ethics (cont.) Malpractice
Settling Malpractice Suits
Arbitration
Persons outside the court system with special knowledge in the field listen to the case, and decide the dispute.
Court
Written court orders (subpoena) are delivered to involved parties.
Subpoena duces tecum is a court order to produce documents like patient records.

17. Medical Law and Ethics (cont.) Malpractice
Law of Agency
Employees are considered to be agents of the physician while performing professional tasks.
Physicians are thereby responsible or liable for the negligence of employees.
Respondeat superior is a Latin term meaning “Let the master answer.”
Employees are also legally responsible for their own actions and they can be sued directly.

18. Medical Law and Ethics (cont.) Standard of Care
According to the AAMA, medical assistants
should uphold legal concepts by:
Maintaining confidentiality.
Practicing within the scope of training and capabilities.
Preparing and maintaining medical records.
Documenting accurately.
Using proper guidelines when releasing information.

19. Medical Law and Ethics (cont.) Standard of Care (cont.)
Follow employer’s established policies dealing with the health-care contract.
Follow legal guidelines and maintain awareness of health-care legislation and regulations.
Maintain and dispose of regulated substances in compliance with government guidelines.
Follow established risk-management and safety procedures.
Recognize professional credentialing criteria.
Help develop and maintain personnel, policy and procedure manuals.

20. Medical Law and Ethics (cont.) Administrative Duties and the Law
Examples of duties related to legal requirements:
Vital statistics (births & deaths)
Abuse (drug abuse & child abuse)
Violent Injuries
STD’s (sexually transmitted diseases)
Patient consent forms
Insurance billing
Appointment books
Patient records and information

21. Medical Law and Ethics (cont.) Controlled Substances and the Law
Medical Assistants must follow the correct procedure for keeping and disposing of controlled substances.
Be familiar with correct dosages, potential complications, and refill rules.
Keep prescription pads secure and out of reach.

22. Medical Law and Ethics (cont.) Communication and the Law
Medical assistant’s are not allowed to decide what information is to be disclosed to the patient.
The role of the medical assistant is to foster supportive, respectful communication with patients.
Good, clear, nonjudgmental communication can prevent misunderstandings and legal confrontations.

23. Medical Law and Ethics (cont.) Legal Documents and the Patient
A legal document stating types of treatment the patient does and does not want in an event of terminal illness, unconsciousness or comatose state.
Living
Wills
(Advance
Directives)
Patients with living wills are asked to name someone that will make decisions on their behalf (durable power of attorney) if they are unable to do so.
Uniform
Donor
Card
A legal document that states a person’s wish to donate one or more organs as a gift. Even total body anatomical gifts are made.

24. Medical Law and Ethics (cont.) Confidentiality Issues
All patient information must be kept confidential and shared only with the appropriate staff involved in the care of the patient.
Confidential
Keep records out of sight so night workers and other patients can not view it.
Do not discuss the case with anyone outside the medical office.

25. Medical Law and Ethics Confidentiality Issues (cont.)
The Health Insurance Portability and Accountability Act (HIPAA)
August 21, 1996 is the date the U.S. Congress HIPAA was passed
Two main sections of the law:
Title I: Health Care Portability
Title II: Preventing Healthcare Fraud and Abuse; Administrative Simplification; Medical Liability Reform

26. Medical Law and Ethics Confidentiality Issues (cont.)
Title I: Health Care Portability
Portability deals with protecting healthcare coverage for employees who change jobs.
Reduces the risk that individuals will lose their existing health care coverage when changing jobs.
Allows workers to purchase insurance on their own if coverage is lost under their employer.

27. Medical Law and Ethics Confidentiality Issues (cont.)
Title II: HIPAA Privacy Rule
The HIPAA Standards for Privacy of Individually Identifiable Health Information is the first comprehensive federal protection for the privacy of health information.
The core of the HIPAA Privacy Rule is the protection, use, and disclosure of protected health information (PHI).

28. Medical Law and Ethics Confidentiality Issues (cont.)
Use and Disclosure are two important concepts under HIPAA that must be understood.
Information is used when it moves within an organization.
Information is disclosed when it is transmitted between or among organizations.
Examples of Use
Examples of Disclosing
Sharing
Employing
Applying
Utilizing
Examining
Analyzing
Release
Transfer
Provision of access to
Divulging in any manner

29. Medical Law and Ethics Confidentiality Issues (cont.)
HIPAA will allow the provider to use health care information for:
T P O
ayment
perations
reatment
Providers are allowed to share information in order to provide care to patients.
Providers are allowed to share information in order to receive payment for the treatment provided.
Providers are allowed to share information to conduct normal business activities, such as quality improvement.

30. Medical Law and Ethics Confidentiality Issues (cont.)
The following information may be disclosed without authorization:
Medical researchers
Emergencies
Funeral Directors/Coroners
Disaster Relief Services
Law enforcement
Correctional Institutions
Abuse and Neglect
Organ and Tissue Donation Centers
Work related conditions that may affect employee health
Judicial/administrative proceedings at the patient request or as directed by a subpoena or court order

31. Medical Law and Ethics Confidentiality Issues (cont.)
How are Patients Informed?
First these rights are communicated through a document called the Notice of Privacy Practices.
The next step is to implement a document that explains the policy of the medical facility on obtaining authorization for use and disclosure of patient information for purposes other than TPO (treatment, payment or healthcare operations).

32. Medical Law and Ethics Confidentiality Issues (cont.)
Security Rule
This rule specifies how patient information is protected on:
Computer networks
The internet
Disks and other storage media and extranets
Other Security Avenues to Consider
Chart security
Reception area security
Fax security
Medical Assistant clinical station security

33. Apply Your Knowledge
A 36-year old patient comes to her initial office visit and the medical assistant begins to register the patient. While the patient is completing her paperwork, she passes out in the waiting room lobby. She is carried to the local hospital and diagnosed with a severe stroke. As the patient recovers, she verbalizes a desire to bring a malpractice suit on the physician. Are all the elements required for malpractice present?

34. Apply Your Knowledge -Answer
A 36-year old patient comes to her initial office visit and the medical assistant begins to register the patient. While the patient is completing her paperwork, she passes out in the waiting room lobby. She is carried to the local hospital and diagnosed with a severe stroke. As the patient recovers, she verbalizes a desire to bring a malpractice suit on the physician. Are all the elements required for malpractice present?
No, for starters, duty has not yet been established which is the first required element.

35. OSHA Regulations
The Occupational Safety and Health Administration (OSHA) is a division of the U.S. Department of Labor.
Regulations describe precautions that must be taken to protect workers from exposure to infectious diseases such as:
Human immunodeficiency virus (HIV)
Hepatitis B virus (HBV)

36. OSHA Regulations (cont.)
OSHA requires that medical practices follow Universal Precautions.
Hospitals are required to follow Standard Precautions, which is a combination of Universal Precautions and Body Substance Isolation guidelines.
Both Universal Precautions and Standard Precautions were developed by the Centers for Disease Control and Prevention (CDC).

37. OSHA Regulations (cont.)
Protective Gear
More exposure = More protection
Disposable gloves
Masks
Goggles/Face Shield
Gowns
The law requires that the employer provide all necessary protective clothing to employees free of charge.

38. OSHA Regulations (cont.)
Decontamination
All exposed work surfaces must be sprayed with a 10% bleach solution or other agent approved by the Environmental Protection Agency (EPA)
Sharp Equipment
To prevent exposure, sharps are to be placed in a leak-proof, puncture-resistant, color-coded, labeled container
Exposure Incidents
Incidents are to be reported immediately
Current procedures may need to be modified

39. OSHA Regulations (cont.)
Postexposure Procedures
Employers must offer a free medical evaluation to exposed employee
Employers must also refer employee to a licensed health-care provider for blood sampling, appropriate treatment and counseling
Employees may refuse treatment by signing a waiver
When a medical worker is first employed, the employer must offer at no cost the opportunity to have the HBV vaccination within 10 days

40. OSHA Regulations (cont.)
Laundry
All laundry must be labeled and bagged appropriately.
Hazardous Materials
Employers must keep an inventory of all hazardous materials in the workplace (MSDS Sheets.)
Training Requirements
All employees that may be exposed must be given free, annual training during work hours.

41. OSHA Regulations (cont.)
General Regulations
General Work Area Laws Restrict:
Eating & Drinking
Smoking
Applying lip balm & cosmetics
Handling contact lenses
Storing food or drinks in refrigerators used to store blood or other potentially infectious materials

42. OSHA Regulations (cont.)
Documentation
Inspections are done in response to complaints and at random. The office must have a written Exposure Control Plan and keep necessary forms on file as indicated.
OSHA Inspections
Inspections are done in response to complaints and at random
Penalties include fines and monies are paid to the federal treasury
Serious violations in the laboratory may result in suspension of laboratory payments from Medicare

43. Apply Your Knowledge
A medical assistant working in a local medical office has a severe allergy to latex. What should she do when handling potentially hazardous materials?

44. Apply Your Knowledge -Answer
A medical assistant working in a local medical office has a severe allergy to latex. What should she do when handling potentially hazardous materials?
The physician, according to OSHA, must supply the necessary protective equipment so latex free gloves should be on hand in such situations.

45. Quality Control and Assurance
The Clinical Laboratory Improvement Amendments of 1988 (CLIA’88) set standards for the quality of work performed in a laboratory and the accuracy of test results.
CLIA requires that every medical office have a quality assurance program.
Three categories of laboratory tests:
Waived
Moderate-complexity
High-complexity

46. Quality Control and Assurance (cont.)
Elements of the Quality Assurance (QA) Program
Written policies on standards of patient care and professional behavior
A quality control (QC) program
Training and continuing education programs
Documentation requirements
Evaluation methods

47. Quality Control and Assurance (cont.)
The Laboratory QC Program must cover:
Patient Preparation Procedures
Collection of Specimens
Labeling
Preserving & Transporting Specimens
Test Methods
Inconsistent Results
Use & Maintenance of Equipment
Personnel Training
Complaints & Investigations
Corrective Actions

48. Code of Ethics Bioethics
Pertains to issues that arise due to medical advances
Principles of medical ethics have developed over time dating back to Hippocrates
A document called the Patient’s Bill of Rights lists ethical principles that protect the patient

49. Apply Your Knowledge
A 26-year old patient is very upset about her proposed treatment plan and refuses to be taken to the hospital as the physician has suggested. The patient attempts to leave the office but the physician instructs the medical assistant to give the patient a sedative so she can wait until her husband arrives. What are implications of this situation?

50. Apply Your Knowledge -Answer
A 26-year old patient is very upset about her proposed treatment plan and refuses to be taken to the hospital as the physician has suggested. The patient attempts to leave the office but the physician instructs the medical assistant to give the patient a sedative so she can wait until her husband arrives. What are implications of this situation?
Even though the physician believes he is acting on the best interest of the patient, the patient refused care and has the right to do so as long as she is competent. The administration of the sedative could be classified as a form of false imprisonment.

51. End of Chapter
End of Chapter