2. Legal and Ethical Perspectives Unit-F

3. Content Outline HT06.01 Analyze the legal responsibilities that apply to Torts. A. Malpractice B. Negligence C. Assault and battery D. Informed Consent E. Invasion of privacy F. False imprisonment G. Abuse H. Defamation I. Slander J. Libel

4. Legal Terms Civil law: a legal relationship between individuals. Criminal law: legal obligations between an individual and society or state. Felony: a more serious crime than a misdemeanor in which the punishment is imprisonment. Misdemeanor: a less serious offense than a felony; may be punishable by a fine or sentencing to a local prison for less than one year. Tort: a civil wrongful act causing harm or injury due to the healthcare worker not performing the standard of care.

5. Litigation The determining of a person’s legal rights either by a lawsuit or some form of legal action.

6. Malpractice Interpreted as “bad practice” Includes providing improper or unprofessional treatment or care that results in injury/harm to the patient. Performing a procedure on a patient that that the health care worker is not trained to perform is malpractice.

7. Negligence A person at fault failed to do what a reasonable & Careful person would DO. Also can be defined as failure to take reasonable precautions to protect others from the risk of harm. Injury to the patient

8. Assault Verbal aggravation meant to cause harm or offense.

9. Battery The unlawful touching of another that results in injury.

10. Informed Consent The patient/client understands the reason for treatment. They understand: 1) What will be done. 2) Who will do it. 3) How it will be done. 4) Expected outcomes

11. Invasion of Privacy Unnecessary exposure of an individual or revealing personal information about an individual without consent.

12. False Imprisonment Unlawful restraining, detention or freedom of movement of an individual. Not false imprisonment if voluntary commitment Not false imprisonment if a court order.

13. Illegal Restraint Holding a person against his/her will by using a restrictive device or other means.

14. Defamation of Character Any information that damages a person’s name and reputation by making public statements that are false and malicious. There are 2 types: Libel-It is written about Someone. 2 types of libel & liabel. Slander-It is spoken about someone.

15. Defamation If a health care worker makes false statements about a patient that cause the patient to be damaged or ridiculed.

16. Liable To be legally responsible for failing to perform professional duties to meet the standards of care and/or causing harm or injury.

17. Content Outline HT06.02 Analyze contracts, privileged communication and HIPAA A. Understand the elements of a contract 1. Offer, acceptance, and consideration 2. List the two types of contracts implied / expressed 3. Legal capacity vs. legal disability 4. Role of an agent in contract law B. Privileged communication 1. Written consent 2. Health care records C. Privacy Act 1.HIPPA ( Health Insurance Portability and Accountability Act) 2. Confidentiality

18. B. Contracts-Agreement between to parties. Parts of a contract 1. Offer - competent individual enters into a relationship with health care providers and offers to be a patient. 2. Acceptance - health care provider gives an appointment or examines or treats a patient. 3. Consideration - payment made by patient for services provided.

19. Implied Contract Obligations that are understood without verbally expressed terms. Example: a qualified health worker prepares a medication & a patient takes the medication, it is implied that the patient accepts this treatment.

20. Expressed Contract Actual agreement between the parties, the terms are stated in distinct and clear language, either orally or in writing. I.e. signing a surgical permit All risks associated with treatment must be explained completely to the patient.

21. Legal Disabilities 1. Mentally incompetent persons 2. Individuals under the influence of drugs that alter the mental state 3. Semi- or unconscious people. 4. Minors- anyone under 18 or the age of majority, is called “an infant” under law.

22. LAW OF THE AGENCY Agency is a personal relationship, created by the mutual consent of (Contract) : The Agent (employee) Principal (employer) wherein the employee acts on behalf of the principal while supervised by the principal.

23. Contract Law An agreement between two or more parties. A contract is an exchange of promises between two or more parties to do, or refrain from doing, an act which is enforceable in a court of law.

24. Breached Contract A patient who fails to pay his/her doctor’s, house, or car payment.

25. PRIVILEGED COMMUNICATION Covers all information given to health personnel by a patient. Physician - Patient Information cannot be told to anyone else without the written consent of the patient. Pt. care records & reports are privileged communication Written consent should state: 1. What information can be released. 2. Who can get the information. 3. Any time limits related to the release of information.

26. PRIVILEGED COMMUNICATION Public health has laws governing reportable illnesses such as TB, small pox, and sexually transmitted diseases. In these cases, the patient's identity is exposed in order to protect the general public. An exemption to this law is communicable diseases. I.e. TB

27. HIPAA Health Insurance Portability and Accountability Act of 1996 Federal legislation which requires the establishment of standards to protect health information. Strict Confidentiality Rules for “INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION” Only healthcare workers involved with the patients’ care should see health information.

28. Confidentiality Can you keep a secret? If you're really bad at it, you're going to have to learn if you want a career in health care. Confidentiality is a big issue for everyone, not just the celebrity patient. It's the law now; not just an issue of ethics.

29. HEALTH CARE RECORDS Contains information on the care that has been provided to the patient. Medical records belong to the health care provider but the patient has the right to obtain a copy. The medical record is a legal document and may be subpoenaed as evidence in court. Report all errors and mistakes immediately to supervisor. cat SJ If mistake is made: draw a line through it and initial

30. Medical Information If family members show up to hospital, which ones can medical information be shared with? –Only those that have been given permission

31. Medical Information Exempt by Law Births and Deaths. 2. Injuries caused by Violence. (negligence & abuse, etc.) 3. Drug Abuse. 4. Communicable Diseases. 5. Sexually Transmitted Diseases. AIDS

32. Errors must be corrected by drawing a single line through the mistake, writing in the correction, dating the change, and signing your initials. Records must be kept as required by state law ( 2-7 years). When records are destroyed, they should be shredded or burned. Health Care Records

33. Content Outline HT06.03 Evaluate ethical and professional standards in a health care setting. A. Ethics 1. Principles of right and wrong 2. Dilemmas 3. Ethical code 4. Confidentiality B. Patients’ Rights 1. Written policies in health care agencies 2. Patients Bill of Rights ( American Hospital Association) 3. OBRA Omnibus Budget Reconciliation Act 1987 4. Residents Bill of Rights

34. A.Ethical/Professional Standards - are a set of principles of : Right or Good Conduct. 1.Competent care, with compassion & respect for human dignity, & the patients rights. 2. Professionalism, be honest. 3. Respect the law I.e. Ethical or unethical Selling organs for money. Promoting health above all else. Keeping views about religion, politics, Or abortion to ones self. Gossiping or talking about others.

35. Ethical Dilemmas in Health Care Employees of hospitals should always follow organizational and professional codes, policies and protocols.

36. Ethical Dilemma Parents not wanting their child to receive blood products due to religious reasons. By following the standards of legal responsibilities, ethics, and patient rights we protect the employee, employer and the patients.

37. Written policies in Health Care Agencies Always follow the hospital or agencies policies and it keeps the staff safe. Performing procedures differently than the manual instructed, can get you fired.

38. PATIENT’S BILL OF RIGHTS A patient has the right to: 1. Considerate and respectful care 2. Obtain complete, current information concerning diagnosis, treatment, & prognosis 3. Receive information necessary to give informed consent prior to the start of any procedure or treatment.

39. PATIENT’S BILL OF RIGHTS 4. Refuse treatment to the extent permitted under law. 5. Privacy concerning a medical-care program. 6. Confidential treatment of all communications and records. 7. Reasonable response to a request for services. 8. Obtain information regarding any relationship of the hospital to other health care and educational institutions.

40. PATIENT’S BILL OF RIGHTS 9. Be advised of and have the right to refuse to participate in any research project. 10. Expect reasonable continuity of care and response to request for services. 11.Examine bills and receive and explanation of all charges. 12. Be informed of any hospital rules or regulations.

41. 5 Patient Rights Always check the identification band which is on the patient’s wrist and state patients name clearly.

42. OBRA Omnibus Budget Reconciliation Act of 1987 The Federal Nursing Home Reform Act or OBRA ‘87 creates a set of national minimum set of standards of care and rights for people living in certified nursing facilities.

43. Content Outline C. Advance Directives 1. Living Wills 2. Durable Power of Attorney 3. Patient Self Determination Act (PSDA) 1990 D. Professional Standards 1. Perform procedures you are trained and legally permitted 2. Follow step by step methods for tasks 3. Obtain proper identification authorization 4. Observe all safety precautions 5. Confidential information 6. Think before you speak 7. Treat all patients equally 8. Accept no bribes or tips 9. Report an error or mistake immediately 10. Behave professionally in dress, language, manners, and actions

44. Advanced Directives: Two types: Living Wills Durable Power of Attorney

45. Living Will Document that allow individuals to state what measures should or should not be taken to prolong life when their condition is terminal. Most states not have laws that allow the withholding of life- sustaining procedures and honor living wills. Frequently result in DNR (do not resuscitate) orders for terminally ill individuals. No CPR!

46. Durable Power of Attorney for Health Care (POA) A legal document that designates another person to make health care decisions in the event that the person is mentally or physically incapable of making their own.

47. Federal Law PSDA of 1990 The Patient Self-Determination Act This law states that all employees will be trained on medical and legal issues of advanced directives. The medical staff must give written information to all adults receiving services of their rights under State law to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and to prepare advance directives.

48. OMBUDSMAN Person, usually social worker, nurse, trained volunteer –Patient advocate –Point of contact for complaints or concerns –NOT directly involved with patient care

49. YOU BE THE JUDGE!! Dan, a medical office assistant in a busy clinic, is a sympathetic and understanding employee. Recently, when an elderly patient called the clinic complaining that she “just felt awful most of the time.” Dan consoled her. “ Don’t worry, Mrs. Smith,” he told the women. “Dr Jones will make you feel better in no time.”

50. 1. Has Dan, acting as Dr. Jones's agent, created an implied contract with Mrs. Smith? Why or why not? 2. If so, can Dr. Jones be sued by Mrs. Smith if he fails to fulfill the “terms” of the contract? Why or why not? 3. How would you have responded to Mrs. Smith?