Medicolegal and Ethical Issues

1. Chapter 3 Medicolegal and Ethical Issues

2. Case History You respond to a nursing home to find a 90-year-old patient who has a “do not resuscitate order” (DNR). While you are transporting the patient to the hospital, he becomes unconscious and has no pulse.

3. Ethical Responsibilities Practice the golden rule when treating patients: “Do unto others as you would have them do unto you.”

4. Ethical Responsibilities • Making the physical/emotional needs of the patient a priority • Maintaining skills to the point of mastery • Continuing education • Call review • Follow-up with physician about patients treated • Critically reviewing performance • Honesty in reporting

5. Case History Your supervisor advises you that you have been subpoenaed to appear in court regarding a patient you treated 2 years ago. What would be your greatest areas of concern?

6. Key Concerns: Did I… • … maintain patient confidentiality? • … properly report a special situation? • … treat the patient according to the standard of care? • … have my equipment available and in working order? • … effectively document assessment and care? • … properly achieve consent for care? • … abandon care prematurely?

7. Confidentiality • Confidential information • Written release required to release information • Situations when no release required • Transfer to health care providers • Reporting of incidents mandated by state law • Third-party payer billing forms • Legal subpoena

8. Special Reporting Situations • Vary from state to state • Abuse • Crime • Wounds from guns and knives • Animal bites • Death • Infectious disease exposure • Patient restraint laws • Mentally incompetent (e.g., intoxicated with injuries)

9. Scope of Practice • Legal duties to the patient, medical director, and public • Defined by state legislation • Enhanced by medical direction • Protocols and standing orders • National Standard Curriculum • Legal right to function as an EMT-Basic • May be contingent on medical direction

10. Standard of Care • Knowledge, laws, standards, policies, and guidelines that provide the basis of practice • Examples • DOT National Standard Curriculum for the EMT-Basic • American Heart Association CPR guidelines • Protocols • State regulations • State laws may also define testing standards. • Expert witnesses may help define standard of care via deposition or testimony.

11. Equipment • Legally, the EMT-Basic is expected to • provide reasonable care • carry the appropriate equipment in working order • Equipment failure may provide a basis for a lawsuit • Equipment failure should be carefully documented in the patient record

12. Negligence • Deviation from the accepted standard of care resulting in injury to the patient • Ingredients of medical malpractice • Duty to act • Breach of duty • Injury/damages • Causal connection to EMT

13. Duty to Act • Implied • Patient calls and dispatcher confirms response • Patient treatment is initiated. • Formal • EMS agency has a written contract with a municipality • Legal duty to act may not exist. • Moral/ethical considerations may exist

14. Immunities • Good Samaritan Laws • Designed to protect volunteers • Medical • Lay rescuers • Protection of government workers (e.g., military)

15. Consent • Expressed • Implied • Children • Mentally incompetent patients

16. Assault/Battery • Unlawfully touching a person without consent • Providing care without consent

17. Refusals • Patient has the right to refuse treatment • Patient may withdraw from treatment at any time • Refusals must be made by mentally competent adults • Patient must be informed of risks and consequences of refusal • When in doubt • Contact medical direction. • Err in favor of providing care.

18. Documentation of Refusal –Process • Try to persuade the patient to allow treatment. • Ensure that the patient is competent to make decision. • Inform the patient of risks and consequences. • Consult medical direction (per local protocol). • Consider assistance from law enforcement. • Document any findings and care given. • Patient should sign a refusal form. • Never make an independent decision not to transport.

19. Abandonment Definition: Termination of patient care without ensuring the continuation of care at the same level or higher

20. Intoxicated, Irrational, and Emotionally Disturbed Patients • Emotionally disturbed patients represent an area of high legal risk. • Always exercise caution. • When forcible removal is necessary: • Care should be taken to not harm the patient • Soft restraints should be used • Precise documentation is essential

21. Advanced DirectivesDNR Orders • Patient has the right to refuse resuscitative efforts • Generally, a written physician order is required. • Follow state and local legislation/protocols. • When in doubt, begin resuscitation efforts.

22. Donor and Organ Harvesting • Individual may decide in advance to donate organs. • May be indicated on a driver’s license or donor card • Treat the same as any other patient. • If you become aware of a patient’s organ donor status, you should communicate this to the hospital or medical direction.

23. Crime Scene/Evidence Preservation • Dispatch should notify police. • Responsibility of EMT: • Emergency care is priority • Do not disturb scene unless emergency care requires it • Observe and document anything unusual at the scene • If possible, do not cut clothing from patient

24. Risk Management • Act according to the standard of care. • Act in the best interest of the patient. • Document your actions.