MDA 136 MEDICAL LAW AND ETHICS Chapter 2 Lecture

1. MDA 136MEDICAL LAW AND ETHICSChapter 2 Lecture

2. Differentiate between legal and ethical issues Describe the legal and ethical importance of maintaining patient privacy and confidentiality. Define and properly use medicolegal terminology Identify duties within the scope of practice for a Medical Assistant Discuss litigation situations and defenses Explain methods of protecting patient confidentiality COURSE OBJECTIVES

3. MEDICALETHICS Ethics – standards of conduct and moral guidelines generally expected by the professional community. Codes of ethics – each professional organization creates it’s own rules and guidelines for it’s members to follow. (Hippocratic oath, *AMA principles of ethics, and *AHIMA codes of ethics) *American Health Information Management Association *American Medical Association

4. MEDICAL ETHICS • Personal ethics- • guidelines for behavior based on a person’s moral and/or personal values. • Professional ethics- • standards of conduct set by professional organizations. This is something that is learned while studying for the profession or while on the job. As a professional, you must possess both personal and professional ethics!

5. MEDICAL ETHICS vs. MEDICAL LAW Medical ethics - refers to a moral obligation to follow the rules. Medical ethics deals primarily with morals, values and integrity (principles of right and wrong). Medical law - refers to a legal obligation to follow the rules. (Not following medical law can get you arrested and/or put in jail.)

6. There are some acts that are legal but unethical. example: not volunteering/helping in an emergency situation (car accident) There are acts that are ethical but illegal. example: euthanasia “mercy killing”

7. Ethical dilemma- there may be times when you are faced with an “ethical dilemma” which is often a conflict between what you think is “right” and what is legal. Although it may be a tough decision, always choose what is legal, regardless of how compelled you feel to do the opposite.

8. MEDICAL ETIQUETTE Medical etiquette -customs, common courtesy and manners of the medical profession. (Consideration for others)

9. MEDICAL ETIQUETTE VS. MEDICAL ETHICS Poor medical ethics could get you fired; poor medical etiquette could make people in your office upset. Medical etiquette has more to do with self conduct, behavior and common courtesy for those working with and around you.

10. MEDICOLEGAL TERMS 1. Liability-an obligation that legally binds an individual or organization to settle a debt or wrongful act. 2. Torts-wrongful acts committed against a person or property. Torts often result in emotional, mental and physical harm or death. 3. Tortfeasor- a person who commits the tort or wrongful act.

11. 4. Breach of contract- the failure to fulfill an obligation or agreement as outlined in a contract. 5. Intentional torts-committed by a person with the intent to do something wrong. 6.Nonintentional torts/unintentional torts-(accidental) acts committed by a person who does not intend to do so. Most medical malpractice lawsuits fall under this category. 7. Assault-to threaten or act in a way that causes the person to fear harm. (Non-physical) 8. Battery-battery is unlawful touching, with or without physical harm.

12. 9. Slander-verballyspreading lies or rumors about another person which causes harm to their reputation or employment. 10. Libel-writinglies or rumors about another person which causes harm to their reputation or employment. This includes all types of writing (texting, e-mailing, typing, faxing, etc.)

13. Invasion of privacy- to seek or give out information about another person’s private, personal matters or activities. Medical abandonment- occurs when the physician stops all forms of care and treatment with a patient who is still in need of care. In this situation, the physician fails to give the patient sufficient or proper notice.

14. 13. Fraud- a deceitful act with the intention to conceal the truth. 14. False imprisonment- keeping a person against their will. (Example- telling a patient they can’t leave until they pay their co-pay or office visit fee.)

15. Negligence- failing to take reasonable precautions to prevent harm to a patient. It can occur in one of two ways: Doing something that a reasonable person would not do. Not doing something that a reasonable person would do Malpractice-When a professional is negligent in their duties.

16. 17. Malfeasance-the performance of a wrong and unlawful act (example - giving medical treatment without the knowledge or presence of a doctor). 18. Misfeasance-the performance of a lawful act in an improper way (example- failing to use a sterile bandage when dressing a wound, resulting in an infection). 19. Nonfeasance-the failure to perform a necessary act (example- not doing CPR on a patient who has stopped breathing).

17. 20. Res ipsa loquitur- (res- ip- suh low- key- tor) a Latin term which means “the thing speaks for itself.” An obvious mistake made by the healthcare professional. (Example- A surgeon is to remove a patient’s left leg during surgery and instead removes the right leg by accident). 21. Respondeat superior/Vicarious liability- (ray-spon-deet) a Latin term which means “let the master answer.” This law makes physicians responsible for MOST of their employees actions while working under them.

18. Subpoena- orders issued by the court to obtain evidence. A subpoena can be for a person or an item. Plaintiff- the accuser in a lawsuit Defamation of character- malicious, false statements about a person’s character or reputation.

19. 25. Res judica/Res judicata- “the thing that has been decided” is a legal doctrine that a claim can’t be retried once a lawsuit has been decided or settled. Once a final judgment has been made on a case, the parties of the lawsuit are forever barred from bringing another lawsuit under the same claim or demand. One reason for this is to prevent the plaintiff from recovering damages from the defendant twice for the same injury. (fraud) (Example- if a physician is found innocent of a wrongdoing in a lawsuit, the patient can’t bring the same suit with a different attorney based on the same evidence.)

20. 26. Subpoena ducestecum- “ bring with you under penalty of punishment” : a command by the court ordering the party(s) to appear and produce records and /or tangible evidence (documents) for use at a hearing or trial. 27. Subpoena ad testificandum- “ under penalty to give testimony”: a command by the court ordering the appearance of a witness in order to give an oral testimony. 28. Remittitur- a ruling by a judge to lower the amount of damages (money) granted by the jury. 29. Additur- a ruling by a judge to increase the amount of damages (money) granted by the jury. This ruling is very rare.

21. Bioethics- Is concerned with moral issues that deal with human life. The study of the ethical and moral practices primarily in the area of medical research and technology. Self-Determination Act-A federal law that allows patients to appoint a healthcare surrogate and make decisions about his or her health before they become unable to do so.

22. Direct cause- any action that causes a secondary action or event to happen. Duty- a moral and/or legal commitment to someone or something. Dereliction of duty- The failure to obey a direct order or regulation, which includes the avoidance of any duty which may be properly expected. In addition to duty and direct cause, the plaintiff must be able to prove “dereliction of duty” in a negligence lawsuit.

23. 35. Standard of care- requires physicians to perform acts that a reasonable and prudent physician in a similar situation would perform. 36. Tort of outrage- intentionally causing severe emotional and/or mental distress to another person. 37. The Hippocratic Oath-traditionally taken by doctors; swearing to ethically practice medicine.

24. HIPPOCRATIC OATH: I SWEAR by Apollo the physician and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation -- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

25. Uniform Anatomical Gift Act- an act which governs organ/tissue donations, transplants and medical research cadavers.

26. Living will- also known as “advanced directive" allows an individual to legally document their wishes and treatment/care options in the event of their death. • Included in a living will: • DNR or resuscitation orders • Organ or tissue donation • Medical power of attorney

27. ARIZONA BOARD OF MEDICAL EXAMINERS Each state governs or regulates it’s Medical doctors and providers. In our state, this board is known as, “The Arizona Board of Medical Examiners,” “Arizona Medical Board” or “BoMex.” This board has the power to suspend and revoke medical licenses. The Medical Board not only holds physicians accountable for their actions, it makes this information known to the public. The Arizona Medical Board is comprised of 12 members – eight physicians and four public members. The Arizona Board of Medical Examiners also regulates Medical Assistants as well. An outline of our scope of practice and legal definition can also be found at this website. Patient’s who wish to file a complaint or malpractice claim can start here. www.azmd.gov

28. THE GOOD SAMARITAN LAW

29. The Good Samaritan law- a law designed to protect health care professions from being sued for injuries or negligence when helping or volunteering in emergency situations. A “Good Samaritan” is someone who unselfishly helps others. Although you are not legally required to help an injured person when you are not on the job, (unless you live in the state of Vermont), as a medical professional, you have an ethical duty to help.

30. Exceptions to the Good Samaritan law: 1. Standard of care- a medical professional is held at a higher standard of care than a person with no medical training. 2. Duty of care- once a person decides to help a victim, they are obligated to continue to help that person until someone more qualified arrives. 3. The Samaritan- victim relationship- a payment, “tip” or reward is never allowed to be accepted by a good Samaritan. Accepting a payment creates an “implied contract” between the good Samaritan and the victim. In this case, if something goes wrong, the good Samaritan would not be free from liability. 4. Scope of practice- the person performing CPR/emergency aid must stay within their scope of practice. They can only perform actions for which they have been trained and/or certified to perform.

31. 5. Gross negligence- extremely careless actions taken by the good Samaritan. (Example- treating the injured victims scraped knee instead of controlling the profuse bleeding from his head.) 6. Office/hospital emergencies- good Samaritan laws don’t apply to medical offices or hospitals. In medical facilities, medical professionals are required by law to help the victim. Consent- even in an emergency, you must get the victims consent for treatment. The only exception is if they are unconscious or incompetent. If the patient refuses help, you must obey their wishes. Exceptions? . . .Yes! If and when the patient becomes unconscious and/or stops breathing- you then can begin to help them, even if they refused help when they were conscious. (It then becomes a life threatening condition.)

32. Good Samaritan Laws: • Designed to protect health care professionals against liability for negligence in certain circumstances • Deal with treatment of accident victims • Encourage health care professionals to render emergency first aid

33. TYPES OF CONSENT

34. TYPES OF CONSENT 1. Implied consent- consent that is indicated by a person’s actions(body language or gestures) 2. Informed consent- a type of consent form given to the patient which explains facts, options and risk factors associated with a particular surgery or procedure. An “informed consent“ must be given to a patient and signed before all invasive surgeries. 3. Substituted consent- consent given by a person other than the patient. This consent is given on behalf of a person who is legally incompetent. (Minors, mentally handicapped, elderly etc.) 4. Express consent- consent that is indicated and presented verbally and in writing. This is the most important type of consent. Because it is signed by the physician and the patient, it is written “proof” that consent was given and the patient was informed of the risks.

35. THE PHYSICIAN - PATIENT RELATIONSHIP

36. The physician is obligated to . . . Perform to the best of his or her ability Always use their best professional judgment. Use established customary treatments Abstain from experiments Provide proper care instructions Prevent the spread of contagious diseases Advise patient’s against needless operations or procedures.

37. The physician is NOT obligated to . . . Restore the patient to the same condition as they were before treatment Effect the recovery Make a correct diagnosis Be free from mistakes of judgment Guarantee a successful result Treat beyond their capacity or knowledge Know a patients allergies which have not been disclosed or discovered.

38. The patient is obligated to . . . Have an open, honest relationship with their physician Provide any or all information that might be relevant to their condition, diagnosis, and treatment. Follow the physician’s instructions and/or advice Take all prescriptions and treatments as directed Pay all fees, copays and out-of-pocket costs in a timely manner or as agreed via a payment plan.

39. Once the physician- patient relationship is damaged in some way, it is best for the physician to discontinue care with the patient. This is done by sending the patient a “letter of intent to terminate care” or a letter of “disengagement”. This letter must be certified and is, in essence, the doctor “firing” the patient.

40. Sample letter terminating the physician-patient contract

41. THE PHYSICIAN- PATIENT RELATIONSHIP Physician’s letter of termination must state: • Why contract is being terminated • Date termination is effective • What patient should do to get a copy of their medical records • Strong recommendation to seek further treatment elsewhere

42. THE PHYSICIAN- PATIENT RELATIONSHIP Physicians may terminate the contract when: • Patients do not keep appointments • Patients refuse to follow orders • The physician has personal reasons which prevent him or her from being able to carry out their duties.

43. THE PHYSICIAN- PATIENT RELATIONSHIP • Emancipated minors • Reproductive health, including birth control • Abortion/adoption services • Testing and treatment for STDs • Substance abuse treatment and care • Mental health care and treatment • Pregnancy testing and obstetrical care Minor: a person under the age of consent. Usually the age is 18, but in some states the age of consent is 16 or 21. A minor is not legally allowed to give consent for their own treatment, but there are exceptions to the law. Examples:

44. CONFIDENTIAL COMMUNICATIONS Physicians and all other health care professionals have a legal and ethical responsibility to safeguard the patient’s privacy by keeping their medical information confidential. HIPAA requires you to keep this information safe and confidential! It’s the law! . . .Remember, you as the healthcare professional , are entrusted with access to personal, private patient information and you are legally and morally obligated to keep it confidential.

45. THE PATIENT BILL OF RIGHTS

46. THE PATIENT BILL OF RIGHTS Information disclosure Choice of providers and plans Access to emergency services Participation in treatment decisions Respect and nondiscrimination Confidentiality of health information Complaints and appeals

47. INFORMATION DISCLOSURE Patients have the right to clear and accurate information about their care plan, health care professionals, and health care facilities examples - If the patient speaks another language, a translator should be provided. If the patient has a physical or mental disability, the patient has a right to assistance.

48. CHOICE OF PROVIDERS AND PLANS Patients have the right to choose their health care provider and health insurance plan.

49. ACCESS TO EMERGENCY SERVICES If a patient’s health is in serious jeopardy, he or she has a right to emergency services, without prior authorization or financial penalty.

50. PARTICIPATION IN TREATMENT DECISIONS Patients have the right to know treatment options they have and to participate in decisions about their care and treatment. If necessary, the patient has the right to appoint someone else to make decisions for them. Patients have the right to refuse treatment.