1. EMS Law Chapter 16

2. Copyright © 2007 Thomson Delmar Learning Objectives Identify the tools that a state health agency responsible for emergency medical services uses to manage EMS. Explain how consent is a defense to assault, battery, and false imprisonment. Identify the two ways in which consent can be implied.

3. Copyright © 2007 Thomson Delmar Learning Explain that in order for consent to be valid, a patient must have both mental capacity and legal capacity. Explain the standard used to evaluate a patient’s mental capacity to consent. Identify the two categories of patients who lack the legal capacity to consent. Objectives

4. Copyright © 2007 Thomson Delmar Learning Explain the terms advanced directive, durable power of attorney for health care decisions, living will, and do not resuscitate order. Identify the potential liability concerns associated with refusals against medical advice and steps to minimize them. Objectives

5. Copyright © 2007 Thomson Delmar Learning Explain when force may be used to restrain a combative patient. Identify what types of information are subject to medical confidentiality laws and to whom such information may lawfully be given. Objectives

6. Copyright © 2007 Thomson Delmar Learning Law Governing EMS EMS world is heavily regulated States have delegated the authority and responsibility to an administrative agency –Direct –Oversee –Manage emergency medical services

7. Copyright © 2007 Thomson Delmar Learning Overview of EMS Act Two-tiered system of regulation –State level –Local level Laws governing delivery of prehospital emergency medical services

8. Copyright © 2007 Thomson Delmar Learning State level –Assess each emergency medical services area –Develop planning and implementation guidelines for EMS systems –Provide technical assistance to existing agencies Overview of EMS Act

9. Copyright © 2007 Thomson Delmar Learning Local level –Plan, implement, and evaluate an emergency medical services system –Develop a formal plan for the system –Coordinate and otherwise facilitate arrangements necessary to develop the emergency medical services system Overview of EMS Act

10. Copyright © 2007 Thomson Delmar Learning Regulatory Tools Managing EMS Licensing –Personnel –Vehicles –Organizations State or regional EMS protocols

11. Copyright © 2007 Thomson Delmar Learning Consent Must be informed –Obligation on the part of caregivers to provide enough information to patients so they understand the risks and benefits Failure to obtain a patient’s informed consent can be the basis of liability

12. Copyright © 2007 Thomson Delmar Learning Implied consent –Can legally be assumed to exist under the circumstances Two different but related contexts –Implied by virtue of participation –Lacking capacity but in need of medical attention Consent

13. Copyright © 2007 Thomson Delmar Learning Capacity Two groups lack legal capacity to consent –Minors –Those adjudicated to be incompetent Mental capacity –Must be capable of understanding what he or she is consenting to

14. Copyright © 2007 Thomson Delmar Learning Refusal against Medical Advice Competent patient has the right to decline aid Patient lacking capacity to consent also lacks capacity to refuse medical treatment Informed refusal Documentation

15. Copyright © 2007 Thomson Delmar Learning Combative Patients Restraint should be done with due caution Reasonable force to restrain may be used Firefighters and EMS personnel have the right to use reasonable force to defend themselves

16. Copyright © 2007 Thomson Delmar Learning Advanced Directives Durable power of attorney –Legal document by which a person designates someone to make health care decisions on his or her behalf should he or she become incapacitated –Legally binding upon health care providers

17. Copyright © 2007 Thomson Delmar Learning Living will –Statement of the person’s desire for (or the withholding of) life-prolonging treatment that is binding upon health care providers once the person is incapacitated –Legally binding upon health care providers Advanced Directives

18. Copyright © 2007 Thomson Delmar Learning Do Not Resuscitate (DNR) Order Instruction to other providers that the patient does not want life-support measures such as CPR performed should the patient go into cardiac or respiratory arrest –Legally binding upon health care providers

19. Copyright © 2007 Thomson Delmar Learning Negligence An act or an omission, damages, and a breach of the standard of care –What did the defendant-EMS provider do? –What should the reasonably prudent EMS provider of like skill and training have done?

20. Copyright © 2007 Thomson Delmar Learning Immunity Where EMS is provided, may offer liability protection for acts of negligence –Most states have specific EMS-related immunity statutes –Often statutory EMS immunity laws extend protection to private providers as well

21. Copyright © 2007 Thomson Delmar Learning Confidentiality Historical background –Simple measures –Locked file cabinets –Prior to computers

22. Copyright © 2007 Thomson Delmar Learning Sharing information –Fax –E-mails –Computer networks –Physicians –Insurance companies Confidentiality

23. Copyright © 2007 Thomson Delmar Learning State law and confidentiality –Typically prohibit health care providers from disclosing confidential medical information without the patient’s consent –Anything communicated between the patient and the health care provider related to care and treatment Confidentiality

24. Copyright © 2007 Thomson Delmar Learning HIPAA Health Insurance Portability and Accountability Act –Applicable to all 50 states –Standardizing certain aspects of medical confidentiality among the states

25. Copyright © 2007 Thomson Delmar Learning Covered entities –A health plan –A health care clearinghouse –A health care provider who transmits any health information in electronic form HIPAA

26. Copyright © 2007 Thomson Delmar Learning Compliance –Use and disclosure of private health information –Patient rights Penalties –Civil and criminal HIPAA

27. Copyright © 2007 Thomson Delmar Learning Summary Laws governing EMS Consent Capacity Refusals against medical advice Combative patients

28. Copyright © 2007 Thomson Delmar Learning Advanced directives and DNR orders Negligence and standard of care Immunity Confidentiality HIPAA Summary