1. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Agenda – Seminar 2 Email: Please add me to your “allowed sender” list so that you do not miss important messages. Joldaker@kaplan.edu Discussion Board Assignments – Crafting a response to discussion questions Unit 2 Quiz this week! Complete a study guide where you define all terms in bold from the assigned reading. “Option 1” Discussion Questions Overview of Chapter 3 & 4 Material

2. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Discussion Board Questions Question: Using the Three-Step Ethics Model (pages 15-16) from your text, evaluate the ethical dilemma associated with the refusal of a blood transfusion. (Jehovah’s Witnesses exception)

3. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Crafting a Discussion Board Initial Response Think about the question: Brainstorm Come up with a list of points/ideas that are most relevant to the question Elaborate on each of those points in a separate paragraph. Write a short introduction and a conclusion paragraph. Make a “roadmap” in your introductory paragraph.

4. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Example: A “Thought Question” Question: Do you think different health care disciplines with differing Codes of Ethics can work together seamlessly? Why or why not? Think: what are the potential problems of using different sets of ethics in the same area of professional practice? Are there any similarities between ethical codes? What types of problems could potentially arise? After thinking for a while, discussing with a friend, or googling search terms such as “healthcare ethical code disputes” or “medical nursing ethics code problems,” come up with a list. You decide that overall, different healthcare disciplines can work together seamlessly. Your brainstorm list states the following reasons: – Few potential problems could arise, because the disciplines are very compartmentalized in practice and there is very little interaction between the disciplines. – The ethical codes used across the healthcare profession are very similar. – The only opportunity for problems to arise are when the ethical codes are immensely different. Come up with an example. Your first paragraph should look like the previous bullet point (your roadmap).

5. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Review of Unit 1 Seminar Ethics: Branch of philosophy related to morals, moral principles, and moral judgment Medical Law: Addresses legal rights and obligations that affect patients and protect individual rights, including rights of health care employees. Provides yardstick to measure or judge actions. Punishes unlawful actions Bioethics: Moral dilemmas and issues resulting from advanced medicine and medical research relating to life

6. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Law and Ethics Importance of the Legal System for the Physician Chapter 3

7. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Practice Acts Establish examining boards Provide baseline for practice of medicine Determine prerequisites for licensure Forbid practice of medicine without a license Specify conditions for renewal, suspension, and revocation of licenses Vary from state to state

8. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Licensure of Physician Examination – National Board Medical Examination (NBME) – Federal Licensing Examination (FLEX) – U.S. Medical Licensing Examination (USMLE) Endorsement Reciprocity Registration

9. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. When Valid License Is Not Needed by a Physician When employed by federal medical facilities (but must be a licensed physician) In an emergency While establishing residency When engaged solely in research

10. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Revocation and Suspension Unprofessional conduct: falsifying records, gross immorality Commission of a crime: Medicare/Medicaid fraud, rape, murder, larceny, narcotics conviction Personal incapacity: physical or mental incapacity

11. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Licensure and Certification of Allied Health Professionals Licensure: graduate from accredited school and pass national exam of competency Certification: meet standards set by accreditation body and pass national exam of competency

12. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Accreditation Voluntary request of official review by accrediting agency Examine policy and procedures of agency Must demonstrate that the institution maintains high standards Examples: JCAHO (The Joint Commission on the Accreditation of Healthcare Organizations) and CAAHEP (The Commission on Accreditation of Allied Health Education Programs)

13. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Standard of Care Ordinary skill and care that must be used by medical practitioners Must provide same knowledge, care, and skill that similarly trained physician would provide under same circumstances Perform as “reasonable and prudent” person would perform

14. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Prudent Person Rule Must provide following information to patient: – Diagnosis – Risk and consequences of treatment – Expected benefits of treatment or procedure – Alternative treatments – Prognosis if no treatment – Cost and expected pain – Follow acceptable standard of care

15. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Confidentiality Keeping private all information about patient No disclosure without written consent Medical Patient Rights Act: gives all patients right to have privacy respected and records held confidential

16. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Statute of Limitations Period of time patient has to file lawsuit Usually one to three years Discovery Rule: begins when problem discovered

17. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Good Samaritan Laws State laws help protect health care professionals and ordinary citizens from liability while giving care in emergency No one is required to provide aid Only required to act within limits of acquired skill and training Once you start you must continue until help arrives or you physically cannot continue

18. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Respondeat Superior “Let the master answer” Employer liable for acts of employee within scope of employment

19. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Employee’s Duty to Carry Out Orders Duty to interpret and carry out orders Duty to clarify ambiguous or erroneous orders Duty to decline orders that appear dangerous for patient and to notify physician

20. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Scope of Practice Must understand and work within scope of practice for discipline Must understand and practice within guidelines of profession Must understand and follow chain of command so no employee makes decision he or she is unqualified to make

21. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Employer’s Duty to Employees Responsibility to provide safe environment for employees and staff Most have liability insurance to cover accidents and unforeseen incidents May bond employees who handle money Some have liability insurance for auto if used for work-related business

22. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Risk Management A practice used to control or minimize incidence of problem behavior that might result in injury to patients and employees and liability for physician/employer – Identify risk behaviors and practices – Develop and follow plan of action to eliminate problem behavior – Address corrective actions in policy and procedure books and employee handbooks

23. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Law and Ethics Medical Practice and Allied Health Professionals Chapter 4

24. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Today’s Health Care Environment Major changes in past 15–20 years – Increased life expectancy = more older adults – Technological discoveries Preventative care and patient education stressed (but not funded) Government legislation Fixed-payment plans—medical care for a fixed monthly fee Third-party payers

25. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Managed Care Organization (MCO) Gatekeeper Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO)

26. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Federal Assistance Programs Medicare – Health care coverage for elderly or seriously disabled or with end stage renal disease or other debilitating ailments regardless of wealth or income – Rationing of health care

27. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medicaid Medicaid: A joint Federal–State program Federal program implemented by individual states Financial assistance to insure poor and indigent Rationing takes place Not all providers accept Medicaid coverage

28. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnostic Related Groups (DRGs) Classifies Medicare patient by illness 467 illness categories Hospitals receive preset sum for treatment of category regardless of “bed days” used Discourages treatment of severely ill patients; patients often are discharged before ready

29. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ethical Considerations of Managed Care Wealthy may have greater access to care and treatment than poor patients Must provide minimum standard of care to everyone Patients must be fully informed of consequences of obtaining health care elsewhere Bait-and-switch Profit more important than patient

30. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Types of Medical Practice Solo practice Sole proprietorship Partnership Associate practice Group practice Professional corporation

31. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ethics of Fee Splitting Fee splitting: one physician offers to pay another for referral (unethical and illegal) Fee splitting vs. referrals Franchise: business run by individual to whom franchisor grants exclusive right to market product or service in certain market area (ethical) Franchisees: persons or companies that hold a franchise

32. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Specialty Boards Over 23 specialty boards Seek to improve quality of medical care Encourage physicians to further education and training Evaluate candidates who apply and pass exam Board-certify those who pass

33. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. American College of Surgeons – Fellow of American College of Surgeons (FACS) American College of Physicians – Fellow of American College of Physicians (FACP) Medical Specialty Boards (continued)

34. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Allied Health Professionals Licensed personnel – Registered nurse – Nurse practitioner – Licensed practical nurse – Pharmacist Certified personnel – Physician assistant – Medical assistant – Medical transcriptionist – Lab technician – Lab technologist

35. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Conscience Clause Enacted by several states Employees may have a moral or religious objection to assisting with certain procedures (sterilization, abortion) Employee cannot be discriminated against under the state’s statute

36. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Discussion What does it mean to be a health care professional? Why is it important for a healthcare professional to include his/her medical specialty and initials indicating their degree after their name? How should health care professionals conduct themselves? Besides these general standards, what standards might specific careers or professions require? Why? What personal qualities do you think would be successful in various health professions? How can differing personal attributes contribute to a strong professional team? Give an example of how various health professionals work together as a team to provide quality patient care.