MEDICAL LAW AND ETHICS

OBJECTIVES Identify areas of medical ethics that have significance for medical assistant List primary elements of the American Association of Medical Assistants Code of Ethics Identify and define the three categories of medical transplants Describe the three parts of the physician-patient contract Define and give examples of abandonment and professional negligence Explain the use of consent form used in the medical office

INTRODUCTION The medical assistant is the link between the patient and the physician. Medical assistant must understand the legal issues involved in medical practice as they apply to the state, office, the patient, the employer.

ETHICAL CONSIDERATIONS Ethical standards concern moral rights and wrongs Laws concern requirements that must be obeyed or a penalty must be paid Ethical standards are established by the profession and administered by peer review Violation of ethical standards may result in suspension of membership

HISTORY Hippocratic Oath The first basic guideline for medical ethics was introduced during the life of Hippocrates, a classical Greek physician who lived between 460 and 377 BC. Hippocrates' three-word phrase created the first ethical law in the field of medicine. The phrase, now known as the Hippocratic Oath, began as the simple phrase, "Do no harm," and evolved into the 181-word vow recited at modern medical school graduation ceremonies.

HISTORY A century after the time of Hippocrates, the cultures of India and China had established a groundwork of morals and virtues to be exemplified by medical practitioners. These first guidelines established models of physician humility, concern, and compassion for patients. Religions of this time influenced the creation of this code of behavior by establishing a basic understanding of the sacred relationship between medical practitioners and their patients.

AMERICAN MEDICAL ETHICS HISTORY During the intellectual revolution of the eighteenth century, numerous medical advances took place in the West, including the publishing of the first book discussing medical ethics. Thomas Percival, a British physician, published his book "Code of Medical Ethics," in the year 1803. At nearly the same time, medical students attending the University of Pennsylvania, began to be lectured by physician Benjamin Rush regarding the importance of medical ethics.

MODERN ETHICAL CODES Modern codes of medical ethics are revised and replaced when ethical issues arise and create concern. Because medical ethics are an important area of study for medical professionals, more than 25 universities across Canada and the United States provide graduate degree programs in the field of medical ethics. Modern codes are published yearly with later editions including the most current guidelines. The books are written and revised by the Council on Ethical and Judicial Affairs of the American Medical Association

American Medical Association Code of Ethics I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. IX. A physician shall support access to medical care for all people.

ETHICS VS LAW

GOOD SAMARITAN ACT A person who renders emergency medical services or aid to an ill, injured or unconscious person, at the immediate scene of an accident or emergency that has caused the illness, injury or unconsciousness, is not liable for damages for injury to or death of that person caused by the person's act or omission in rendering the medical services or aid unless that person is grossly negligent.

CPR Cardiopulmonary resuscitation (CPR) is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example agonal respirations. It may be performed both in and outside of a hospital.

DO NOT RESUSCITATE In medicine, a "do not resuscitate" or "DNR" , sometimes called a "No Code", is a legal order written either in the hospital or on a legal form to respect the wishes of a patient to not undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing.

MEDICAL “MIRANDA” LAW Medical 'Miranda' warnings consist of a set of patient rights that health care provider organizations are now required to present to patients. This is in accordance with the Patient Self-Determination Act, passed as part of the omnibus budget bill in November 1990. Under this law, organizations must advise the patient of his right to refuse care and of the option of naming a proxy in the event that he becomes incompetent. This must be done if the organization is to continue to receive Medicare or Medicaid reimbursement. Providers are to develop written policies on the subject of refusing care, to give such information to the patient when he is admitted to ensure compliance with advance directives, and to educate staff and the community concerning such directives

UNIFORMED ANATOMICAL GIFT ACT Uniform Anatomical Gift Act an act established in 1968 to standardize state laws on the donation of organs and tissues from cadavers; it is based on the premise that an individual should be able to control the disposition of his or her own body after death. Uniform Anatomical Gift Act Legislation that allows a person to make an anatomic gift at the time of death–all or part of the body for medical education, scientific research, organ transplantation, by a signed document–eg, in a will or driver's license.

LIVING WILL A living will is a legal document that a person uses to make known his or her wishes regarding life prolonging medical treatments. It can also be referred to as an advance directive, health care directive, or a physician's directive

MEDICAL POWER OF ATTORNEY (POA) The medical POA is a legal document that designates an individual — referred to as person’s health care agent or proxy — to make medical decisions for one in the event that one is unable to do so. However, it is different from a power of attorney authorizing someone to make financial transactions for you.

ETHICS VS LAW Abortion When does life begin? Is it ethical to terminate a pregnancy with a birth defect? Genetic and prenatal testing What happens if you are a carrier of a defect? What if testing shows that your unborn baby has a defect? Is it ethical to harvest embryonic stem cells to treat diseases?

LICENSURE REQUIREMENTS FOR A PHYSICIAN Be of legal age Be of a good moral character Have graduate from an approved medical school Have completed an approved residency program Be a resident of the state Have passed exams administered by the National Board of Medical examiners of the state All licenses must be renewed annually

REASONS FOR REVOKING LICENSE Murder Rape Violations of narcotic law Tax evasion Unprofessional conduct Fraud Incompetence

LEGAL CONSIDERATIONS There are two types of law: PUBLIC LAW Criminal law- deals with offenses against all citizens Constitutional law – defines powers of the government and citizens Administrative law – deals with power of administrative agencies International law – concerned with agreements between countries

LEGAL CONSIDERATIONS PRIVATE / CIVIL /LAW Contract law Tort law – any of a number of actions done by one person or group of people that cause injury to another

CONTRACT LAW-PHYSICIAN – PATIENT CONTRACT A contract is established when all three parts have been performed: The offer – when a competent person expresses desire to become a patient of a practicing physician The acceptance – when an appointment is given and the physician examines the patient The consideration – when the payment is received for services provided

CONTRACT LAW-PHYSICIAN – PATIENT CONTRACT Contract may be: Implied – established just by the patient coming to see the physician Expressed / written/ - needed for: Surgery or invasive procedures Experimental drugs or risky treatments Third party involved in payment Both have implications for payment

INFORMED CONSENT Consent by a patient to a surgical or medical procedure or participation in a clinical study after achieving an understanding of the relevant medical facts and the risks involved. Seven criteria define informed consent: competence to understand and to decide voluntary decision making disclosure of material information recommendation of a plan comprehension of terms (3) and (4) decision in favor of a plan authorization of the plan. A person gives informed consent only if all of these criteria are met. If all of the criteria are met except that the person rejects the plan, that person makes an informed refusal.

VIOLATIONS OF CONTRACT LAW Abandonment Abandoning a patient under and in need of immediate professional care, without making reasonable arrangements for the continuation of care, or abandoning a professional employment by a group practice, hospital, clinic or other health care facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients.

LEGAL CONSIDERATIONS Tort law Negligence - a passive form of abuse in which a perpetrator is responsible to provide care for a victim who is unable to care for himself or herself, but fails to provide adequate care. Defamation – to attack the reputation of a person or group of people Libel – written statement Slander – spoken statement Assault - an intentional act by one person that creates an apprehension in another of an imminent harmful or offensive contact. Battery -is the criminal offence whereby one party makes physical contact with another party with the intention to harm them

LEGAL CONSIDERATIONS Violations of tort law Tort law - deals with breach of legal duty such as invasion of privacy, personal injury, malpractice, slander, libel Malpractice – professional negligence Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error.

MALPRACTICE Malpractice case requires evidence of treatment unlike another physician would have provided and injury resulted Expert testimony of another physicians is usually required Res ipsa loquitur – “The thing speaks for itself” The ABCDs of malpractice must be proven Acceptance of patient Breach of skills Causal connection Damage must be present

MALPRACTICE – RESPONDEAT SUPERIOR Respondeat superior – “Let the master answer” Physicians have responsibilities for their employees. MA and malpractice cases: If physician requests you to do more than you are trained to do and you do it MA performs procedure put of his/her degree of training without physician’s knowledge Never make a promise of a cure Be certain that the patient understands instructions Know how to reach the doctor at all times Be careful of what you say in front of a patient

STATUTE OF LIMITATIONS There is only a limited time during which a medical malpractice lawsuit can be filed. These time limits are set by statute in a common law.

MALPRACTICE CASE The infant-plaintiff was a 12-year old asthmatic, who had been diagnosed with pediatric asthma by one partner in a two partner pediatric practice. No one charted in his medical chart at the pediatricians’ office that he was asthmatic. Over a period of approximately 18 months, the infant-plaintiff received numerous renewals of asthma medications (inhaled steroids) without visits to the physicians' office and without the medications being charted in the infant-plaintiff's chart. During an evening the infant-plaintiff experienced an asthma attack at home and his parents administered several nebulizer treatments. The following day, the mother took the infant-plaintiff to the pediatricians’ office and additional nebulizer treatments were administered. On that day, the infant-plaintiff was treated as a non-asthmatic patient who was suspected of having bronchitis. The infant-plaintiff was discharged from the pediatricians’ office to home. In the car, on the way home, the infant-plaintiff suffered another asthma attack. The mother rushed the infant-plaintiff to the nearest health care provider; but, the infant-plaintiff was comatose and severely brain damaged by the time the mother was able to obtain medical care. The infant-plaintiff currently resides in a pediatric nursing home where he is not responsive to light or sound, is maintained on a ventilator, is tube fed and exists in a semi-vegetative state. The infant-plaintiff's condition is permanent and his life expectancy is 20 or more years

MALPRACTICE CASE Paralysis: A Lawrence County woman with complaints of shoulder pain went to a doctor who represented himself to be a pain anesthesiologist. He recommended that she have a cervical steroid injection. At the time of injection, he actually did two injections. The result was permanent quadriplegia or the inability to move her arms or legs. The case settled for an amount that allows her to live in her own home which was modified to accommodate her needs.

MALPRACTICE CASE A 60 year old woman had new onset vaginal bleeding. She went to her doctors who ordered an abdominal CT scan. The abdominal CT scan showed a pelvic mass. She was not informed of the results nor directed to get further testing. Two years later the bleeding returned and she was diagnosed with cervical cancer. Because of the delay in diagnosis her cancer had spread and was no longer curable. The case settled during trial in Allegheny County.

John Ritter Dies of Aortic Dissection He continues to make us laugh in reruns of “Three’s Company” and many other shows and films. That is why it was such a tragedy when he died in 2003 from a tear in his aorta, also known as an aortic dissection. His lawyers alleged that a denied chest x-ray two years before would have led to the correct diagnosis. Instead he has treated incorrectly for a heart attack.

. Kanye West’s Mother Dies From Surgery In 2007, Donda West died at age 58 from complications due to a tummy tuck and breast reduction. The doctor who operated on her suspected that the cause of death could have been a heart attack, pulmonary embolism, or massive vomiting. The scary part is that the doctor had two malpractice suits filed against him that ended in payouts and was arrested twice for driving under the influence, according to medical board records.

PROFESSIONAL LIABILITY

PHYSICIAN RIGHTS Has right to accept or refuse patients and responsibility to care for those accepted Not required to continue services to patients treated in an emergency Has right to choose practice type, office hours, charges, … Has right to change location of practice if patients are notified Can withdraw care of uncooperative patients

MEDICAL ASSISTAN RIGHTS Medical assistants support leading practitioners in clinics and hospitals. Although the main role of a medical assistant is to assist the doctors, she/he has her/his own set of responsibilities in the workplace Responsibilities such as providing care for patient up to established standards Responsibility to improve his/her skills and knowledge Rights which allows her to interact with patients and receive confidential information from them: Right to safe environment, freedom from discrimination and harassment

PATIENT RIGHTS Has a right to expect care equal to community standards Has a right to select physician. Has a right of informed consent Has a right reject observers Has a right of privacy Has a right to know prognosis Has a right to accept or reject treatment Has a right to change physician

MEDICAL LAW AND ETHICS