Disclaimer

1. Disclaimer • This is an informational slide for instructors and not intended to be shown. • Every attempt has been made to ensure the accuracy of these materials. However, statutes and regulations do change and the person using these slides should be familiar with Alaska’s statutes and regulations related to emergency medical care. In the event that discrepancies are found, the statutes and regulations published by the State of Alaska have primacy. • Users are encouraged to customize these slides to make them more aesthetic and useful for particular audiences. Again, care must be taken to ensure consistency with the statutes and regulations.

2. Medicolegal Issues Prepared by the: Section of Community Health and Emergency Medical Services Division of Public Health Department of Health and Social Services Juneau, Alaska

3. Definitions • Medicine: The science and art of diagnosing, treating, and preventing disease. • Law: A system that provides for rights between parties. • Civil Law concerns disputes among private parties (individuals, businesses, corporations). • Criminal law concerns enforcement of societal rules against individuals.

4. Sources of Law • Constitution • Statutory • Common • Administrative

5. Areas of Vulnerability • Emergency Vehicle Operations • Confrontation, Lack of Rapport • Patients Who Refuse Treatment

6. Liability Litigation (1987 - 1992) • National Retrospective Computer Study • 76 cases met inclusion criteria • Half of cases involved ambulance collisions • Half of cases involved patient care • In almost half of cases, EMT was named as codefendant • Average of 1 claim per 25,000 patient encounters

7. Ambulance Collision Cases • Plaintiffs • Motor Vehicle Operator (30) • EMS Patient (5) • Other (3) • Settlements • $0 - 39.5% • $1 - $10,000 - 26.3% • $10,001 - $100,000 - 21.1$ • $100,001 - $1,000,000 - 10.5% • $1,000,000 - $2,000,000 2.6%

8. Patient Care Cases • Allegations of Negligence • Arrival Delay • Inadequate Assessment • Inadequate Treatment • Patient Transport Delay • No Transport Provided

9. Patient Care Cases • Settlements • $0 - 42.1% • $1 - $10,000 - 0% • $10,001 - $100,000 - 15.8$ • $100,001 - $1,000,000 - 31.6% • $1,000,000 - $2,000,000 - 10.5%

10. Protection Against Litigation • Good Patient Care • Rapport With Patient and Family • Comprehensive and Factual Written Reports • Compliance with Standing Orders and Safety Requirements • Safe Emergency Vehicle Operations

11. Standard of Care • “How a reasonable, prudent, properly trained EMT at the same level of training would perform under the same, ‘or similar’ circumstances.”

12. General Standards • Provide Medically Correct Treatment Consistent with Scope of Practice • Ensure Vehicle is Appropriately Stocked & Supplied • Ensure Equipment is in Good Working Order • Operate Vehicle and Park in a Safe Manner

13. Consent • Informed Consent • Expressed Consent • Implied Consent • Special Circumstances • Minors • Patients with Impaired Mentation

14. Battery (Tort) • Physical contact with a person without his consent and without legal justification. • The plaintiff may recover monetary damages for battery without proving the elements of negligence.

15. Consent to Treat Minors • The age of majority is 18 or when the individual becomes married. • Minors can give consent for medical treatment when: • the minor is living apart from parent or guardian and manages own finances; or • the parent or guardian cannot be contacted or is unwilling to either grant or withhold care AS 09.65.100

16. Consent to Treat Minors (Continued) • A minor parent can give consent for child’s care • Consent is valid if EMS personnel relied in good faith on assertion of minor that he or she could give consent under this statute AS 09.65.100

17. Refusal of Care • Mentally competent adult patients have the right to refuse medical treatment • Mentally competent parents have the right to refuse treatment for their children • Patient should sign refusal form • Ensure that all actions and the patient's condition are well documented, particularly LOC and assessment findings. The patient should be encouraged to seek medical care.

18. Negligence - Definitions • ‘Tort’ is a legal wrong for which damages can be awarded in court. • Tort law is primarily “common law,” defined and evolving as courts decide cases. • ‘Statute of Limitations’ defines the period in which the lawsuit must be initiated. In Alaska, the complaint must be filed within two years of discovery of the alleged negligence in a tort action. The statute of limitations for contracts is 6 years..

19. Typical Causes of Negligence • Not performing required skills • Performing skills incorrectly • Performing unauthorized skills

20. Requirements to Prove Negligence • The EMT had a ‘duty to act’ • The EMT’s act or omission did not conform to the ‘standard of care’ • Injuries occurred to the plaintiff • The acts or omissions were the proximate cause of the injuries • The injuries are of a kind for which damages can be awarded

21. Vicarious Liability • Also known as “respondeat superior” • Occurs when employer held responsible for negligence of employee or someone under employer’s control

22. Abandonment • Defined as ‘Terminating medical care without legal justification or turning the patient over to less qualified personnel resulting in injury to the patient’

23. Duty to Act • Generally, an EMT has a duty to act when he or she is on duty with an organization which is responsible for providing emergency care. • “Duty” can be defined more broadly to mean an obligation to conform to a particular standard of care. • Duties occur before, during, and after a run.

24. Anatomy of a Civil Lawsuit • Suspicious Incident • Investigation • Filing of Lawsuit Within Statute of Limitations • Service of Complaint • Legal Representation Obtained and Answer Filed

25. Anatomy of a Civil Lawsuit (Continued) • Discovery • Interrogatories (written) • Depositions (sworn, in person, and recorded) • Trial • Appeal • Settlement (Possible at any time)

26. Determination of Damages • Compensatory • Special Damages • General Damages • Punitive

27. If You’re Involved in a Suit • Always notify employer and medical director • Always make sure that complaint is answered

28. Principles of Confidentiality • Establishment of Physician-Patient Relationship • Legal Requirements to Maintain Confidentiality of Information • Increase in Legal Risks if Information is Misused

29. Alaska Statutes and Regulations • Statutes • Created by Legislature • Example AS 18.08.080 • Regulations • Created by Administrative Agency • Example 7 AAC 26.030

30. Specific Alaska Statutes and Regulations • These laws define many of the EMT’s responsibilities and should be clearly understood. • Most of the statutes related specifically to EMS can be found in AS 18.08.010 - AS 18.08.090.

31. Good Samaritan Law • Encourages people to render care by decreasing risks of liability. • Typically does not cover those with a duty to act. • Does not cover gross negligence or reckless or intentional misconduct AS 09.65.090

32. Requirements to be Certified • Individuals must be certified in order to claim to be state certified as an EMT-I. • Individuals must be certified and under medical direction in order to provide advanced life support. • Agencies must be certified and under medical direction in order to provide advanced life support. AS 18.08.084

33. Authority of EMTs • Statute requires that EMTs exercising this authority: • must respond to an emergency with an ambulance service or first responder service; and • must have a current emergency medical technician identification card in his or her possession. AS 18.08.075

34. Authority of EMTs (Continued) • An EMT under this statute may: • control and direct activities at the accident site or emergency until the arrival of law enforcement personnel; • order a person other than the owner to leave a building or place in the vicinity of the accident or other emergency for the purpose of protecting the person from injury; • temporarily block a public highway, street, or private right-of-way while at the scene of an accident, illness, or emergency;

35. Authority of EMTs (Continued) • trespass upon property at or near the scene of an accident, illness, or emergency at any time of day or night; • enter a building, including a private dwelling, or premises where a report of an injury or illness has taken place or where there is a reasonable cause to believe an individual has been injured or is ill to render emergency medical care; and • direct the removal or destruction of a motor vehicle or other thing that the emergency medical technician determines is necessary to prevent further harm to injured or ill individuals.

36. Authority of EMTs (Continued) • A person who knowingly refuses to comply with an order of an emergency medical technician authorized under (a) of this section is, upon conviction, guilty of a class B misdemeanor. In this subsection, "knowingly" has the meaning given in AS 11.81.900(a)

37. Immunity From Liability for EMTs • Covers certified persons and agencies • Covers physicians arranging transfer of patients • Covers emergency medical dispatchers and instructors • Does not cover gross negligence or intentional misconduct AS 18.08.086

38. Reporting Requirements • EMTs are required to report certain injuries or suspicions • EMS agencies usually have standard operating procedures and forms for reporting • There may be a criminal penalty for refusing to report • Usually, there is immunity from liability for reports made in good faith

39. Duty to Report Certain Injuries • 2nd or 3rd degree burns > 5% or more of body • Burns to upper airway, laryngeal edema from super-heated air • Bullet wounds, powder burns or injuries apparently caused by firearms AS 08.64.369

40. Duty to Report Certain Injuries (Continued) • Injuries apparently caused by a knife, axe, or other sharp object, unless injuries were clearly accidental • Non-accidental injuries likely to cause the death of patient AS 08.64.369

41. Duty to Report Certain Injuries (Continued) • Oral reports must be made promptly to the Department of Public Safety, or local law enforcement personnel. • Written reports must be made within 3 working days of treating the patient. AS 08.64.369

42. Child Abuse and Neglect • Reports must be made to AK Dept. of Health and Social Services, Division of Family and Youth Services • 465-1650 (Juneau) • (800)478-4444 • If child is in immediate danger, reports should be made to law enforcement personnel • Reports to supervisor or medical director do not fulfill the reporting requirement AS 47.17.020

43. Protection of Vulnerable Adults • “A vulnerable adult means a person 18 years of age or older who, because of physical or mental impairment, is unable to meet the person’s own needs or to seek help without assistance.” (AS 47.24.900) • Emergency Medical Technicians and Paramedics are required by statute to report suspicions of abandonment, exploitation, abuse, neglect, or self neglect must report within 24 hours after first having cause for the belief. AS 47.24.010

44. Protection of Vulnerable Adults • Reports should be made to the Division of Senior Service of the Department of Administration. • 269-3669 (Anchorage) • 1-800-478-9996 • Law enforcement personnel should be contacted if the adult in in danger. • A person who knowingly fails or refuses to make report may be charged with a crime. • Immunity from liability extended for reports made in good faith.

45. Organ Donors • Requires that law enforcement and medical personnel make a “reasonable search for a document of gift or other information identifying the bearer as a [an organ] donor or as an individual who has refused to make an anatomical gift” AS 13.50.016

46. Emergency Vehicle Operations • This is a major source of liability for EMS Agencies • EMS personnel should know and comply with state and local laws regarding emergency vehicle operations

47. Emergency Vehicle Operations • Lighting requirements for emergency vehicles are specified in 13 AAC 04.090. • Emergency vehicles may disregard laws regarding operation, parking, standing, and stopping vehicles when displaying the required lights and using the siren in response to an emergency.

48. Emergency Vehicle Operations • All operators of emergency vehicles must operate in a safe manner. • Studies have shown that: • In most cases, a lights and siren response saves little time; and • lights and sirens are used on more calls than is warranted by the patient’s condition.

49. Blue Light Laws • Authorization issued by DPS Commissioner or designee • Amended (6/97) regulations allow police chief, fire chief, or EMS chief to authorize if designated by DPS Commissioner • The flashing blue light used by EMS personnel may not be illuminated except when the driver of the vehicle is properly certified to render emergency lifesaving or medical services and his vehicle displays the "star of life" symbol. 13 AAC 04.100

50. Blue Light Laws (Continued) • A flashing blue light that must be visible from the front and sides for a distance of 300 feet in normal sunlight. • The flashing blue light authorized by this subsection may be illuminated only when the driver of the vehicle is a member of a fire or a police department responding to an emergency, and the vehicle must display a sign or plate that indicates the department membership and the name of the municipality or organization in which the driver is a member