1. Medical Law and Ethics

2. TOPICS Key Terms Legal responsibilities in health care Ethics
Professional Standards

3. Law & Ethics in HC The law affects all health care careers
Awareness of the law protects you, your co-workers, your patients and your employer
Laws are created/enforced by federal, state and local government

4. Law & Ethics in HC
Health care workers must follow laws that affect health care, as well as those laws that regulate their license, registrations and/or standards for their profession
Failure to follow the law may result in legal action against you and/or your employer

5. Legal Terminology Liable: accountable under the law
Criminal Law: wrongs against a person, property or society (crime). Includes felonies and misdemeanors.
Civil Law: wrongful acts. Involve legal relationships between people and protection of rights
Civil law generally covers 2 areas: torts and contracts

6. Torts
Tort: wrongful act that does not involve a contract. Can be intentional or unintentional
Many torts can lead to legal action
Common torts that can affect health care workers:

7. Types of Torts
1. Negligence: failure to give care normally expected for that position
Example: ?
2. Malpractice: bad practice, professional negligence. Failure of a professional to use expected degree of skill; not following professional standards

8. Types of Torts (Cont.) 3. Assault: threaten to harm; results in fear
4. Battery: unlawful touching without consent
5. Invasion of Privacy: unnecessary exposure or revealing of personal information w/out consent
Example?
6. False Imprisonment: unlawful restraint or confinement

9. Types of Torts (Cont.)
7. Abuse: treatment of another that results in physical harm or mental anguish
Can be physical, verbal, psychological, sexual
Health care workers are required by law to report
Signs?

10. Types of Torts (Cont.)
8. Defamation: false statements that damage reputation. Incorrect info given out in error can result in this
Slander: info. is spoken
Libel: info is written
Example?
9. Fraud: deceitful practices depriving another of their rights

11. Contracts
Agreement between 2 or more parties; specific promises made for a consideration
Elements of a contract:
Agreement: offer is made and accepted
Consideration: something of value is bargained for as part of the agreement
Legal subject matter: legally enforceable
Contractual capacity: parties must be competent to enter contract

12. Two types of contracts:
1. Implied Contract: obligations understood w/out verbal expression
2. Expressed Contract: stated in distinct language either verbally or in writing

13. Consent
Permission from pt, either expressed or implied for something to be done.
Can be verbal, written or implied
All consent must be “informed”: implies that pt understands tx, why it is nec, tx risks, alternatives, risks if tx is refused
Pt must be of sound mind and legal age to give consent

14. Legal Disability No legal capacity to enter into a contract
Includes: minor, mentally incompetent, unconscious, altered mental state
Parent, guardian, spouse must then form the contract for the legally disabled

15. Breach of Contract Contract not performed according to the agreement
Ex: pt fails to pay or provider fails to provide care
Can lead to legal action

16. Privileged Communication & Legal Responsibilities
All info given to hc personnel by the patient; held in confidence
Confidential and can only be shared w/ members of the hc team
Cannot be relayed w/out consent
Exempt: births, deaths, injury cb violence, drug abuse, communicable diseases, STDs

17. Medical Records Privileged communication
Property of facility but pt owns the info and has right to review/obtain copies
Legal record
Must be kept in secure area
Shred after legal retention date expires

18. Legal Responsibilities
No erasures, blank spaces.
Errors according to policy
Shred carbons
Don’t share computer passwords
Faxes & computer screens in secure area
Limit personnel who can access
Pt can request to amend
De-identify for use by students

19. 5 C’s of Documentation Concise Complete (and objective)
Clear (and legible)
Correct
Chronological

20. HIPPA Health Info Privacy
Enacted 1996, effective 2003
Standards to protect private communication
Patient rights:
Able to see/obtain med records
Able to set limits how health info used
Providers must keep PHI confidential
Right to state who can access
Info to report violations

21. Ethics Set of principles associated w/ what is right and wrong
Provide standard of conduct & code of behavior
Allow HCW to analyze situations and make decisions based on what is right or wrong

22. Ethics
Many ethical dilemmas today; primarily due to advancing technology
Important for individuals to consider how they would handle situations that would require ethical decision making

23. Rules of Ethics Saving a life, health promotion comes first
Keep pt comfortable, preserve life
Respect pt choices
Tx pts equally
Provide care for all to best of ability
Maintain a competent skill level
Pursue continued education

24. Ethics in HC Maintain pt confidentiality
Refrain from all illegal, unethical, immoral practices
Show loyalty to pt, co-workers and employer
Be sincere, honest, respectful and caring
Treat others as you would want to be treated

25. Patient Rights Federal and state law require
AHA: Patient Bill of Rights
The patient is entitled to certain rights:
Considerate and respectful care
Info re dx, tx, prognosis
Info necessary to give informed consent
Confidentiality and privacy
Advanced Directives

26. OBRA OBRA: Residents Bill of Rights Free to choose MD, tx, care
No abuse, chemical or physical restraints
Confidentiality and privacy
Accommodate needs and choice re activities, schedule and home care
Voice grievances
Participate in activities
Manage personal funds and possessions

27. Patient Rights To refuse to participate in research
Review med records and receive explanation of charges
Info about hosp rules, regs and policies
Continuity of care; Reasonable response to request for services
Info re: relationship of hosp to other hc and educational organizations

28. Patient Rights Unlimited access to family
No transfer or d/c except for med reasons, failure to pay
Info about med benefits, survey results and facility deficiencies
These rights vary by state

29. Advanced Directives
Legal documents that state what med tx may be carried out in the event that an individual becomes incapacitated or unable to express their wishes

30. 1. Living Will
What measures may or may not be taken to prolong life if there is a terminal condition or permanent unconsciousness
Must be signed when competent and witnessed by 2 adults
Most states have laws to protect this
May result in DNR

31. 2. Durable Power of Attorney
Permits the appointment of another to make medical decisions if you become unable to do so
Includes providing or withholding tx or procedures
Must be signed by both parties and witnessed
Usually spouse or adult children

32. Pt Self Determination Act
Federal Law requiring hc facilities to inform pts of:
Their right to make decisions to refuse tx and right to die
Provide info on Adv Directives
Document Adv Dir in chart
Not discriminate based on Adv Dir

33. Professional Standards
Standard of care: level of performance expected when carrying out prof duties
Practice w/in scope of expertise and training: perform procedures you are trained and legally permitted to perform
Use approved, correct methods
Obtain appropriate authorization
Identify pt and obtain consent
Observe safety precautions
Maintain confidentiality

34. Professional Standards
Accurate documentation
Follow legal and ethical guidelines
Meet requirements for professional credentialing
Think before you speak
Tx all pts =
No tips or bribes
Report all errors immediately
Professional manner, dress, language and action

35. Prof. Stand. protect you, your co-workers and your patients

36. Good Samaritan Law
Protects Dr’s, RN’s and some other professions from liability when rendering emergency care
Must act within scope of practice
Proven willful wrongs or gross negligence will result in liability
Laws vary by state

37. Job Classifications
Licensure: mandatory credentialing process; required by state; grants right to practice
Certification: voluntary credentialing process; usually national in scope, sponsored by private groups
Registration: entry in an official registry: list of names who have satisfied certain requirements. May involve fees and education.