ems law chapter 16. copyright © 2007 thomson delmar learning objectives identify the tools that a...

EMS Law

Chapter 16

Copyright © 2007 Thomson Delmar Learning

Objectives

• Identify the tools that a state health agency responsible for emergency medical services uses to manage EMS.

• Explain how consent is a defense to assault, battery, and false imprisonment.

• Identify the two ways in which consent can be implied.


• Explain that in order for consent to be valid, a patient must have both mental capacity and legal capacity.

• Explain the standard used to evaluate a patient’s mental capacity to consent.

• Identify the two categories of patients who lack the legal capacity to consent.

Objectives


• Explain the terms advanced directive, durable power of attorney for health care decisions, living will, and do not resuscitate order.

• Identify the potential liability concerns associated with refusals against medical advice and steps to minimize them.

Objectives


• Explain when force may be used to restrain a combative patient.

• Identify what types of information are subject to medical confidentiality laws and to whom such information may lawfully be given.

Objectives


Law Governing EMS

• EMS world is heavily regulated

• States have delegated the authority and responsibility to an administrative agency– Direct – Oversee– Manage emergency medical services


Overview of EMS Act

• Two-tiered system of regulation– State level– Local level

• Laws governing delivery of prehospital emergency medical services


• State level– Assess each emergency medical services area– Develop planning and implementation guidelines for

EMS systems– Provide technical assistance to existing agencies

Overview of EMS Act


• Local level– Plan, implement, and evaluate an emergency

medical services system– Develop a formal plan for the system– Coordinate and otherwise facilitate arrangements

necessary to develop the emergency medical services system

Overview of EMS Act


Regulatory Tools Managing EMS

• Licensing– Personnel– Vehicles– Organizations

• State or regional EMS protocols


Consent

• Must be informed– Obligation on the part of caregivers to provide

enough information to patients so they understand the risks and benefits

• Failure to obtain a patient’s informed consent can be the basis of liability


• Implied consent– Can legally be assumed to exist under the

circumstances

• Two different but related contexts– Implied by virtue of participation– Lacking capacity but in need of medical attention

Consent


Capacity

• Two groups lack legal capacity to consent– Minors– Those adjudicated to be incompetent

• Mental capacity– Must be capable of understanding what he or she

is consenting to


Refusal against Medical Advice

• Competent patient has the right to decline aid

• Patient lacking capacity to consent also lacks capacity to refuse medical treatment

• Informed refusal

• Documentation


Combative Patients

• Restraint should be done with due caution

• Reasonable force to restrain may be used

• Firefighters and EMS personnel have the right to use reasonable force to defend themselves


Advanced Directives

• Durable power of attorney– Legal document by which a person designates

someone to make health care decisions on his or her behalf should he or she become incapacitated

– Legally binding upon health care providers


• Living will– Statement of the person’s desire for (or the

withholding of) life-prolonging treatment that is binding upon health care providers once the person is incapacitated

– Legally binding upon health care providers

Advanced Directives


Do Not Resuscitate (DNR) Order

• Instruction to other providers that the patient does not want life-support measures such as CPR performed should the patient go into cardiac or respiratory arrest– Legally binding upon health care providers


Negligence

• An act or an omission, damages, and a breach of the standard of care– What did the defendant-EMS provider do?– What should the reasonably prudent EMS

provider of like skill and training have done?


Immunity

• Where EMS is provided, may offer liability protection for acts of negligence– Most states have specific EMS-related immunity

statutes– Often statutory EMS immunity laws extend

protection to private providers as well


Confidentiality

• Historical background– Simple measures– Locked file cabinets– Prior to computers


• Sharing information– Fax– E-mails– Computer networks– Physicians– Insurance companies

Confidentiality


• State law and confidentiality– Typically prohibit health care providers from

disclosing confidential medical information without the patient’s consent

– Anything communicated between the patient and the health care provider related to care and treatment

Confidentiality


HIPAA

• Health Insurance Portability and Accountability Act– Applicable to all 50 states– Standardizing certain aspects of medical

confidentiality among the states


• Covered entities– A health plan– A health care clearinghouse– A health care provider who transmits any health

information in electronic form

HIPAA


• Compliance– Use and disclosure of private health information– Patient rights

• Penalties– Civil and criminal

HIPAA


Summary

• Laws governing EMS

• Consent

• Capacity

• Refusals against medical advice

• Combative patients


• Advanced directives and DNR orders

• Negligence and standard of care

• Immunity

• Confidentiality

• HIPAA

Summary

ems law chapter 16. copyright © 2007 thomson delmar learning objectives identify the tools that a...

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