LEGAL AND ETHICAL

1. LEGAL AND ETHICAL CONTRACTS PRIVILEGED COMMUNICATION PRIVACY ACT

2. Contracts • An agreement between two or more parties • Most contracts have 3 parts: • Offer: a competent individual enters into a relationship with a health care provider and offers to be a new patient • Acceptance: the health care provider gives an appointment or examines or treats the patient • Consideration: the payment made by the patient for services provided

3. Contracts • Implied: those obligations that are understood without verbally expressed terms. Example, when a qualified health worker prepares a medication and a patient takes a medication, it is implied that the patient accepts this treatment • Expressed: stated in distinct and clear language, either orally or in writing. Example, a surgery permit. Promises of care must be kept. Therefore, all risks associated with treatment must be explained completely by the patient

4. Legal Disability • All parties entering into a contract must be free of it • Person does not have the legal capacity to form a contract • Examples are minors, mentally incompetent persons, individuals under the influence of drugs that alter the mental state, and semiconscious or unconscious people. • Parents, guardians, or others permitted by law must form the contract for the individual

5. Breach of Contract • If a contract is not performed according to the agreement, the contract is breached • Failure to provide care and giving improper care are breaches of contract • If the patient refuses to pay for care, this can be considered breach of contract and lead to legal action

6. Translator • Law required that a translator must be used when a contract is explained to a non-English speaking person • Many states require the use of translator services for those that are deaf or hard of hearing • At times, an English-speaking relative or friend of the patient can also serve as a translator

7. Agent • When a person works under the direction of another person, the employer is called the principal and the employee is called the agent. • The principal is responsible for the actions of the agent • He or she can be required to pay or otherwise compensate people who have been injured by the agent • Health care workers must be aware of their role as agents and work to protect the interests of their employees

8. Privileged Communications • Include all information given to helath care personnel by a patient • By law, this information must be kept confidential and shared only with other members of the patient’s health care team • It cannot be told to anyone else without the WRITTEN consent of the patient

9. Consent • The written consent must state: • What information is to be released • To whom the information should be given • Any time limits • Certain information is exempt by law and must be reported. Here are some examples: • Births and deaths • Injuries caused by violence (assault and battery, abuse, stabbings) that may require police involvement • Drug abuse • Communicable diseases • STDs

10. Health Care Records • Also privileged communications • The record belongs to the health care provider, but the patient has the right to obtain a copy of any info in the record • Can be used as legal records in a court of law • For this reason the following principles must be followed…..

11. Health Care records continued… • Erasures are NOT allowed • Errors should be crossed out with a single line so material is still readable • Correct information should then be inserted, initialed, and dated • If necessary, an explanation for the correction should also be provided

12. More Principles to Follow • Health care records must be properly maintained, stored in a locked or secure area, kept confidential, and retained for the amount of time required by stated law • If records are destroyed after the legal time for retention, they should be burned or shredded to maintain confidentiality

13. Computerized Records • The growing use of computerized records has created a dilemma in maintaining confidentiality • Many health care providers are creating safeguards to maintain confidentiality, such as: • Limiting personnel who access to such records • Using codes to prevent access to certain info • Requiring passwords in order to access specific information on records • Constantly monitoring and evaluating computer use

14. Privacy Act • The Health Insurance Portability and Accountability Act (HIPAA) • Created by Congress in 1996 • Required the U.S. Department of Health and Human Services (USDHHS) to establish standards to protect health info • USDHHS published the Standards for Privacy of Individually Identifiable Health Information (aka Privacy Rule) • Went into effect in 2003

15. Privacy Rule • Standards provide federal protection for privacy of health information in all states • Patients must be: • Able to see and obtain copies of their medical records • Given information by health care providers about how they use medical information • Allowed to set limits on how personal health information is used • Permitted to request that health care providers take reasonable care to keep communications confidential • Given the right to state who has access to their information and even to limit providing information to their family • Provided with information on how to file a complaint against a health care provider who violates the privacy act

16. “Last Thought” • Most health care agencies have specific rules, regulations, and standards that determine activities performed by individuals holding different positions of employment • IT IS YOUR RESPONSIBILITY TO LEARN EXACTLY WHAT YOU ARE LEGALLY PERMITTED TO DO AND TO FAMILIARIZE YOURSELF WITH YOUR EXACT RESPONSIBILITIES