1. ETHICAL AND LEGAL PRACTICES
In the Health Care Setting

2. Terms and words that fly about
Criminal
Arrest
Go to jail
Sue
Malpractice
negligence
killed
ERRORS
Lose your medical license

3. LEGAL AND ETHICAL PRACTICES
Law - rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority.
Criminal Law - deals with offences against all citizens. Offender can go to prison or jail.

4. Examples of Criminal Law
Practicing in a health care profession without a license.
Misuse of narcotics
Theft
Murder

5. TORTS Tort - from the French word “wrong.”
It can be defined as a civil wrong committed against a person or property excluding breach of contract.

6. TORTS
Malpractice - Interpreted as “bad practice” and includes providing improper or unprofessional treatment or care that results in injury to the patient.
Negligence - Person at fault failed to do what a reasonable and careful person would have done, or did what a reasonable and careful person would not have done. Also can be defined as failure to take reasonable precautions to protect others from the risk of harm. i.e. Giving a pt. a medication that the pt. is allergic to.

7. TORTS
Assault - any willful attempt or threat to injure another person with the apparent ability to do so.
Battery - unlawful touching of another person without consent. Assault & Battery- A physician operated on a pt. without written consent.
Informed Consent
The patient / client understands the reason for treatment.
They understand:
What will be done.
Who will do it.
How it will be done.
Expected outcomes.
Patient must also understand treatment alternatives and the consequences of not having treatment.

8. TORTS Invasion of Privacy Unnecessary exposure of an
individual or revealing personal information about an individual without consent.
False Imprisonment
Restraining an individual or restricting an individual’s freedom. Who ever restrains the pt. is the person responsible for the FALSE IMPRISONMENT

9. TORTS
Defamation of Character - damaging a person’s name and reputation by making public statements that are false and malicious.
Libel - if the information released is written.
Slander - if the information released is spoken.

10. TORTS
Abuse
Any care that results in physical harm, pain, or medical anguish. Abuse can be classified as:
Physical - hitting, forcing
persons against their will,
restraining movements,
depriving of food or H2O, or
not providing physical care.
Verbal - talking harshly, swearing
or shouting, teasing, ridiculing,
intimidating a person.

11. TORTS Abuse ( continued) Sexual - any unwanted sexual touching or act.
** Laws in all states require
reporting of any form of
abuse to proper authorities. **

12. CONTRACTS Contract is a voluntary agreement between two parties
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.

13. CONTRACTS Types of Contracts:
1. Implied - gives rise to contractual obligations by some action or inaction without verbally expressed terms.
2. Expressed - actual agreement between the parties, the terms are stated in distinct and explicit language, either orally or in writing.
All parties in a contract must be free of legal disabilities. A person with legal disabilities does not have the legal capacity to form a contract.

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

15. CONTRACTS Contract is a voluntary agreement between two parties
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.

16. LAW OF THE AGENCY
Agency is a personal relationship, created by the mutual consent of:
The Agent (employee) and the
Principal (employer) wherein the employee acts on behalf of the principal while supervised by the principal.
Agency may be expressed or implied, but is usually implied in the medical office.

17. 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.
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.
Medical Information Exempt by Law
1. Births and Deaths.
2. Injuries caused by Violence. (abuse, etc.)
3. Drug Abuse.
4. Communicable Diseases.
5. Sexually Transmitted Diseases.

18. 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.

19. Health Care Records
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 ( i.e. 2-7 years).
When records are destroyed, they should be shredded or burned.

20. 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 woman. “Dr Jones will make you feel better in no time.”
1. Has Dan, acting as Dr. Jones’ 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?

21. PATIENT’S BILL OF RIGHTS A patient has the right to:
1. Considerate and respectful care
2. Obtain complete, current information concerning
diagnosis, treatment, and prognosis
3. Receive information necessary to give informed
consent prior to the start of any procedure or
treatment
4. Refuse treatment to the extent permitted under law
5. Privacy concerning a medical-care program
6. Confidential treatment of all communications and
records

22. PATIENT’S BILL OF RIGHTS (continued) The patient has the right to;
7. Reasonable response to a request for services
8. Obtain information regarding any relationship of
the hospital to other health care and educational
institutions
9. Be advised of and have the right to refuse to
participate in any research project
10. Expect reasonable continuity of care
11. Examine bills and receive and explanation of all
charges
12. Be informed of any hospital rules or regulations

23. Living Will
A written document by a person stating that they do not want any attempt to revive them when they die.
Basis sometimes for a Do Not Resuscitate Order (DNR) by a Medical Doctor.
NO CPR
Is an example of a legal directive.

24. Advanced Directives
Federal law requires health care facilities receiving any federal aid to provide patients with information about Advanced Directives.
This law is called the:
PATIENT SELF –DETERMINATION ACT

25. DURABLE POWER OF ATTORNEY
Written document by a person
Designates a person to act in their behalf if,
The person can not act on their own due to mental or physical incapacitation
Usually specifies what actions to be taken or used with advanced directive

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

27. MISREPRESENTATIONS Claiming to be someone (MD;RN;DDS;RPh)
Claiming to be capable of doing something
Usually not licensed to perform task or position
False claims of product or procedures success or abilities

28. HIPAA
Health Insurance Portability and Accountability Act of 1996 Strict Confidentiality Rules for “INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION”

29. HIPAA
HIPAA requires that the practice or facility document and comply with certain special privacy requests of your patients. Compliance involves all members of the staff. Includes pharmacies, insurance companies, hospitals, doctor’s offices.

30. OBRA Omnibus Budget Reconciliation
Act of The Federal Nursing Home Reform Act or OBRA ‘87 creates a set of national minimum set of standards of care and Resident’s Bill of Rights. This provides people living in long term care facilities with the right to freedom from abuse and chemical or physical restraints.

31. Dying & Grieving
Terminal disease is incurable resulting in death.

32. 5 Steps of Dying & Grieving Dr. Elisabeth Kubler-Ross
Denial-When confronted that you are dying, one will," This can’t happen to me!”
Anger-death is unfair, especially in the young. Blames others for sickness & diagnosis.
Bargaining-Except death but will bargain with family, doctors and even God for more time. Patients may turn to religion and spiritual beliefs.

33. Death & Dying Cont….
Anticipatory Grief-One is losing everyone they love. Severe depression, regrets, withdraw, & becomes quiet. Friends & family may experience the five stages of grieving.
Acceptance- Realizes death is near and comes in terms with it. Completes unfinished business and helps others deal with imminent death.

34. HOSPICE
Agency that takes care of the dying patient and assist the family with the death and dying process. No extreme measures should be taking to prolong life and individuals are usually on hospice for 6 months.
The organizations goal is allowing the patient to die with dignity.

35. The End