Legal/ethical medical issues

1. Legal/ethical medical issues Mrs. Maury Rich RN,BSN

2. Bell Work Research on Phone • What is Medical Malpractice Act? • What does scope of practice mean? • What is a standard of care? • What is the difference between criminal law and civil law? • Define Confidentiality

3. Standard • 2) Analyze specific laws and ethical issues that impact professional practice such as confidentiality, informed consent, and patient self-determination. Citing specific textual evidence to support analysis, debate these issues in an oral or written format.

4. Objectives • Identify malpractice issues in healthcare and how they affect the every day operations of healthcare • Define key terms that are used within medical law • Understand Confidentiality and HIPAA • Compare and contrast advanced directives, living wills, durable power of attorney and give examples of how they are used in healthcare

5. Medical Malpractice Act Statute or law regulating the practice of medicine Safeguards patient’s safety and privacy Responsibility of all personnel in health care

6. Licensure Regulation to ensure competence May vary from state to state Renew and pay every 2 years Continued education

7. Revoking a License Conviction of crime such as a felony or fraud Unprofessional conduct, such as, addiction, breach of confidentiality, false advertising, unethical behavior, inability to perform duties, or fee splitting

8. Respondent Superior “Let the master answer” Physicians are legally responsible for their employees Hospitals carry malpractice insurance for it’s employees Employees should have their own malpractice insurance Certification ensures competence

9. Scope of Practice The range of services a professional can offer based on education, training, ability, and licensure For example, medical assistants are trained to assist with minor surgery…medical assistants cannot perform surgery!

10. Standard of Care The minimum safe professional conduct under specific conditions as determined by professional peer organizations Failure to perform is negligence Omission: failure to use good judgment that results in harm to the patient Commission: performance of improper act that results in harm to patient Unintentional tort: negligence resulting in harm to a patient

11. Consent Implied consent— patient consents to treatment through actions What would be an example of implied consent? Informed consent— written form, signed by patient explaining procedure or treatment, who will perform, risks, and expected results When would informed consent be necessary?

12. Barriers to Informed Consent • Interpreters may be necessary if a patient is hearing impaired or speaks a different language • Good Samaritan law protects emergency personnel when a patient may not be able to speak or give consent • When might the Good Samaritan law be used?

13. Malpractice Medical form of negligence proven by four criteria, the 4 “D’s” Duty: must prove relationship existed (how?) Dereliction of duty: Must prove standard of care was not met (Use of expert witness) Direct cause: Damages suffered were a direct result of action in question Damage: must prove injury occured

14. This patient received an overdose of an antibiotic, which was ultimately the fault of the pharmacy – the pharmacist and the pharmacy tech. She developed Stevens Johnson syndrome, which, to describe it in layman’s terms, burns you from the inside out.

15. This is the patient now…

16. The Lawsuit Process Subpoena—legal document requiring appearance in court or for a deposition Deposition—formal gathering of information Trial—information is gathered, date is set by court, expert witnesses, jury, verdict, and settlement Malpractice insurance—mandatory in most states Tort – Wrongful Act

17. Intentional Torts: gross negligence, a form of negligence that involved an intentional act or failure to act that causes harm Assault—threat or perceived threat of bodily harm to another person Battery—touching inappropriately without permission Defamation—slander False imprisonment—holding a patient against his or her will Fraud—intentional misrepresentation of facts for financial gain Invasion of privacy—release of private information

18. Criminal Law Protects the safety and welfare of the public Determines what is legal and illegal The crime is considered to be against society or the state

19. Civil Law Private law Protects the rights of individuals Most commonly exercised type of law in ambulatory care

20. Patient Noncompliance Physician and patient enter into contract Physician responsible for diagnosing and treating patient, being available for patient care and communication, and arranging for different physician if absent Patient responsible for truthfully relating medical history, following treatment recommendations, and keeping appointments Patients who fail to comply with treatment recommendations cannot expect the treating physician to be responsible for the outcome of their care

21. Patient Noncompliance • Either party may end the physician–patient contract • Physician must send certified letter to patient • If physician does not follow proper procedure, abandonment may be charged

22. Statute of Limitations Determined by each state Determines length of time during which a lawsuit may be filed Medical records Accurate documentation

23. Risk Management Medical staff and physician can best defend against medical malpractice lawsuits by preventing lawsuits from occurring Accurate, complete documentation provides the best back up Proper documentation, presenting reasonable expectations, and being kind and empathetic toward patients all decrease the risk of a malpractice lawsuit.

24. Confidentiality • Privileged information is confidential data and includes all medical and personal data, that is disclosed within the health care facility • Confidentiality is the most longstanding, consistent component in all Codes of Ethics

25. Confidentiality • Client information can only be discussed with other health care providers who are involved in the care • Confidentiality must be maintained in order to preserve human dignity • Trust is built between the client and health professional by maintaining confidentiality

26. Confidentiality • Confidentiality is an ethical and legal responsibility

27. Medical Record • All information recorded must be factual • Questionable information should be labeled as opinion or assumption • Any information that is not relevant to the care of the client should not be recorded

28. Confidentiality Patient’s medical and personal information used for treatment, payment, and administrative operations “Need to know” Authorized release of information HIPAA

29. What is H.I.P.A.A.? • Health Insurance Portability and Accountability Act • Established 1996 • Compliance required by all health care agencies by April 2003

30. Benefits of HIPAA • Reduces health care costs • Patients have total control on how information in their medical record is used • Patients are able to see and obtain copies of their records • Limits can be set by the patient on who can view and obtain their information • Provides healthcare workers accountability to keep patient care information private

31. What could HIPAA violations cost? • Alaska Dept Health and Human Services • 1.7 million • USB hard drive containing patient information • Drive stolen from an employees car • Found guilty due to inadequate safety measures and failure to properly train employees

32. What could HIPAA violations cost? • WellPoint insurance company • 1.7 million • 612,402 clients affected • PHI was available to unauthorized users on the internet for over 5 months after a software update • Company was found guilty

33. What could HIPAA violations cost? • CVS Pharmacy • 2.25 million • Found guilty of dumping PHI in public dumpster

34. What could HIPAA violations cost? • 2.2 million • New York Presbyterian Hospital • Guilty of disclosure of two patients’ protected health information (PHI) to film crews and staff during the filming of “NY Med,” an ABC television series, without first obtaining authorization from the patients. • In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop. 

35. Legal Exceptions • An emergency • Client is incompetent or incapacitated • Protecting third party • Required by law (ex. STD’s and child abuse) • Asking to commit or hospitalize a psychiatric client

36. Scenarios Kelly is a high school student who was given the opportunity to job shadow at the local hospital. While shadowing, one of the patients she worked with was Ms Smith, who attends the same church as Kelly. Two weeks later Kelly sees Ms. Smith and her daughter at church. Kelly: “Hi, Ms. Smith. I’m so glad to see you are out of the hospital and are healing from the fall you took!” Was the encounter between Ms. Smith and Kelly at church HIPAA compliant? Why or why not? If you do not think it was compliant how could she make it compliant?

37. Scenarios • Christy is a medical assistant that work in a large practice with several doctors. Her best friend comes into the office to see a doctor that Christy doesn’t work with. After Christy’s friend leaves Christy immediately pulls up her friends chart. Is it HIPAA compliant for Christy to access her friend’s chart? If you do not think it was compliant how could she make it compliant?

38. Scenarios • Jane is a R.N. at the local hospital. She is caring for a very difficult patient that needs constant attention. Lucy cared for the patient last time the difficult patient was in the hospital. Jane goes to Lucy for advice on how to care for the patient. Is it HIPAA compliant for Jane to talk to Lucy about the patient? If you do not think it was compliant how could she make it compliant?

39. Reporting Abuse Healthcare professionals are required by law to report all suspected abuse Procedures and forms vary from state to state Follow office policy and procedure manual

40. Child Abuse Neglect—child unattended, needs are not being met Emotional abuse—caregiver yells at child, fails to provide affection and attention Physical abuse—bruises, cigarette burns, and bites Sexual abuse—painful urination and unusual sexual knowledge for child’s age

41. Elder Abuse Neglect—unclean or unsafe living conditions, poor hygiene, and weight loss Physical abuse—frequent injuries, bruises, and patient’s fear of the caregiver

42. Think*Pair*Share • Using your phone or text book define the following: • Advance directive • Living Will • Durable Power of Attorney • With a partner discuss why these are important in healthcare

43. Durable Power of Attorney Legal document that is effective when a patient is unable to speak for himself or herself or make medical decisions Patient names another to make decisions States have standard forms What happens when someone has not appointed a durable power of attorney?

44. Living Will Document outlining type of care a patient requests in the event of severe injury Life support, feeding tubes, medications, kidney dialysis, ventilators, organ donation, etc. Advanced directive is a part of the living will https://www.youtube.com/watch?v=1rmlGJxdpMk