ETHICAL AND LEGAL ETHICAL AND LEGAL PRACTICESPRACTICES

In the Health Care SettingIn the Health Care Setting

Terms and words that fly aboutTerms and words that fly about

CriminalCriminal

MalpracticeSue

Go to jail

Arrest

Lose your medical lic

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ERRORS

LEGAL ANDETHICAL PRACTICES

Law - rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority.

Criminal Law - deals with offences against all citizens. Offender can go to prison or jail.

Examples of Criminal Law

•Practicing in a health care

profession without a

license.•Misuse of narcotics•Theft•Murder

TORTSTort - from the French word “wrong.”

It can be defined as a civil wrong committed against a person or property excluding breach of contract.

Malpractice - Interpreted as “bad practice” and includes providing improper or unprofessional treatment or care that results in injury to the patient.

TORTSTORTS

Negligence - Person at fault failed to do what a reasonable and careful person would have done, or did what a reasonable and careful person would not have done. Also can be defined as failure to take reasonable precautions to protect others from the risk of harm. i.e. Giving a pt. a medication that the pt. is allergic to.

Assault - any willful attempt or threat to injure another person with the apparent ability to do so.Battery - unlawful touching of another person without consent. Assault & Battery- A physician operated on a pt. without written consent.

Informed ConsentThe patient / client understands the reason for treatment.They understand:•What will be done.•Who will do it.•How it will be done.•Expected outcomes. Patient must also understand treatment alternatives and the consequences of not having treatment.

TORTSTORTS

Invasion of PrivacyUnnecessary exposure of an individual or revealing personal information about an individual without consent.

False ImprisonmentRestraining an individual or restricting an individual’s freedom. Who ever restrains the pt. is the person responsible for the FALSE IMPRISONMENT

TORTSTORTS

Defamation of Character - damaging a person’s name and reputation by making public statements that are false and malicious.

Slander - if the information released is spoken.

TORTSTORTS

Libel - if the information released is written.

AbuseAny care that results in physical harm, pain, or medical anguish. Abuse can be classified as:

Physical - hitting, forcing persons against their will, restraining movements, depriving of food or H2O, or not providing physical care. Verbal - talking harshly, swearing

or shouting, teasing, ridiculing,intimidating a person.

TORTSTORTS

Abuse ( continued)

Sexual - any unwanted sexualtouching or act. ** Laws in all states require reporting of any form of abuse to proper authorities. **

TORTSTORTS

CONTRACTS

Contract is a voluntary agreementbetween two parties

1. Offer - competent individual entersinto a relationship with health care providers and offers to be a patient.

2. Acceptance - health care provider gives an appointment or examines or treats a patient. 3. Consideration - payment made by patient for services provided.

Types of Contracts:1. Implied - gives rise to contractual obligations by some action or inaction without verbally expressed terms.

2. Expressed - actual agreement between the parties, the terms are stated in distinct and explicit language, either orally or in writing.

All parties in a contract must be free of legal disabilities. A person with legal disabilities does not have the legal capacity to form a contract.

CONTRACTS

Minors - anyone under 18 or the age of majority, is called “an infant” under the law.

Legal DisabilityLegal Disability

•Minors

•Mentally incompetent persons

•Individuals under the influence of drugs that alter the mental state

•Semi- or unconscious people

CONTRACTS

Contract is a voluntary agreementbetween two parties

1. Offer - competent individual entersinto a relationship with health care providers and offers to be a patient.

2. Acceptance - health care provider gives an appointment or examines or treats a patient. 3. Consideration - payment made by patient for services provided.

LAW OF THE AGENCY

Agency is a personal relationship, created by the mutual consent of:

The Agent (employee) and thePrincipal (employer) wherein the employee acts on behalf of the principal while supervised by the principal.

Agency may be expressed or implied, but is usually implied in the medical office.

PRIVILEGEDCOMMUNICATION

Covers all information given to health personnel by a patient.

Physician - Patient Information cannot be told to anyone else without the written consent of the patient.Written consent should state: 1. What information can be released. 2. Who can get the information. 3. Any time limits related to the release of information.

Medical Information Exempt by Law1. Births and Deaths.2. Injuries caused by Violence. (abuse, etc.)3. Drug Abuse.4. Communicable Diseases.5. Sexually Transmitted Diseases.

HEALTH CARE

RECORDS

Contains information on the care that has been provided to the patient.

Medical records belong to the health care provider but the patient has the right to obtain a copy.

The medical record is a legal document and may be subpoenaed as evidence in court.

Errors must be corrected by drawing a single line through the mistake, writing in the correction, dating the change, and signing your initials.

Records must be kept as required by state law ( i.e. 2-7 years).When records are destroyed, they should be shredded or burned.

Health Care Records

YOU BE THEJUDGE!!

Dan, a medical office assistant in a busy clinic, is a sympathetic and understanding employee. Recently, when an elderly patient called the clinic complaining that she “just felt awful most of the time.” Dan consoled her – “Don’t worry, Mrs.. Smith,” he told the woman. “Dr Jones will make you feel better in no time.”

1. Has Dan, acting as Dr. Jones’ agent, created an implied contract with Mrs. Smith? Why or why not?2. If so, can Dr. Jones be sued by Mrs. Smith if he fails to fulfill the “terms” of the contract? Why or why not?3. How would you have responded to Mrs. Smith?

PATIENT’S BILL OF RIGHTS

A patient has the right to:

1. Considerate and respectful care

2. Obtain complete, current information concerning diagnosis, treatment, and prognosis

3. Receive information necessary to give informed consent prior to the start of any procedure or treatment

4. Refuse treatment to the extent permitted under law

5. Privacy concerning a medical-care program

6. Confidential treatment of all communications and records

PATIENT’S BILL OFRIGHTS (continued)

The patient has the right to; 7. Reasonable response to a request for services

8. Obtain information regarding any relationship of the hospital to other health care and educational

institutions

9. Be advised of and have the right to refuse to participate in any research project

10. Expect reasonable continuity of care

11. Examine bills and receive and explanation of all charges

12. Be informed of any hospital rules or regulations

Living WillLiving Will

A written document by a person A written document by a person stating that they do not want any stating that they do not want any attempt to revive them when they attempt to revive them when they die.die.

Basis sometimes for a Do Not Basis sometimes for a Do Not Resuscitate Order (DNR) by a Resuscitate Order (DNR) by a Medical Doctor.Medical Doctor.

NO CPRNO CPR Is an example of a legal directive.Is an example of a legal directive.

Advanced DirectivesAdvanced Directives

Federal law requires health care Federal law requires health care facilities receiving any federal aid to facilities receiving any federal aid to provide patients with information about provide patients with information about Advanced Directives.Advanced Directives.

This law is called the:This law is called the:

PATIENT SELF –DETERMINATION PATIENT SELF –DETERMINATION ACTACT

DURABLE POWER OF ATTORNEYDURABLE POWER OF ATTORNEY

Written document by a personWritten document by a person Designates a person to act in their Designates a person to act in their

behalf if,behalf if, The person can not act on their own due The person can not act on their own due

to mental or physical incapacitationto mental or physical incapacitation Usually specifies what actions to be Usually specifies what actions to be

taken or used with advanced directivetaken or used with advanced directive

OMBUDSMANOMBUDSMAN

Person, usually social worker, nurse, Person, usually social worker, nurse, trained volunteertrained volunteer

Patient advocatePatient advocate Point of contact for complaints or Point of contact for complaints or

concernsconcerns NOT directly involved with patient careNOT directly involved with patient care

MISREPRESENTATIONSMISREPRESENTATIONS

Claiming to be someone Claiming to be someone (MD;RN;DDS;RPh)(MD;RN;DDS;RPh)

Claiming to be capable of doing Claiming to be capable of doing somethingsomething

Usually not licensed to perform task or Usually not licensed to perform task or positionposition

False claims of product or procedures False claims of product or procedures success or abilitiessuccess or abilities

HIPAAHIPAA

Health Insurance Portability and Health Insurance Portability and Accountability Act of 1996Accountability Act of 1996

Strict Confidentiality Rules for Strict Confidentiality Rules for “INDIVIDUALLY IDENTIFIABLE “INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION”HEALTH INFORMATION”

HIPAAHIPAA

HIPAA requires that the practice or HIPAA requires that the practice or facility document and comply with facility document and comply with certain special privacy requests of certain special privacy requests of your patients. Compliance involves your patients. Compliance involves all members of the staff. Includes all members of the staff. Includes pharmacies, insurance companies, pharmacies, insurance companies, hospitals, doctor’s offices.hospitals, doctor’s offices.

OBRAOBRA Omnibus Budget Reconciliation Omnibus Budget Reconciliation

Act of 1987. The Federal Nursing Act of 1987. The Federal Nursing Home Reform Act or OBRA ‘87 Home Reform Act or OBRA ‘87 creates a set of national minimum creates a set of national minimum set of standards of care and set of standards of care and Resident’s Bill of RightsResident’s Bill of Rights. This . This provides people living in long term provides people living in long term care facilities with the right to care facilities with the right to freedom from abuse and chemical or freedom from abuse and chemical or physical restraints. physical restraints.

Dying & GrievingDying & Grieving

Terminal disease is incurable Terminal disease is incurable resulting in death.resulting in death.

5 Steps of 5 Steps of Dying & GrievingDying & GrievingDr. Elisabeth Kubler-RossDr. Elisabeth Kubler-Ross

DenialDenial-When confronted that you are -When confronted that you are dying, one will," This can’t happen to dying, one will," This can’t happen to me!” me!”

AngerAnger-death is unfair, especially in the -death is unfair, especially in the young. Blames others for sickness & young. Blames others for sickness & diagnosis.diagnosis.

BargainingBargaining-Except death but will -Except death but will bargain with family, doctors and even bargain with family, doctors and even God for more time. God for more time. Patients may turn Patients may turn to religion and spiritual beliefs.to religion and spiritual beliefs.

Death & Dying Cont….Death & Dying Cont….

AnticipatoryAnticipatory GriefGrief-One is losing -One is losing everyone they love. everyone they love. Severe Severe depression, regrets, withdraw, & depression, regrets, withdraw, & becomes quiet.becomes quiet. Friends & family Friends & family may experience the five stages of may experience the five stages of grievinggrieving..

AcceptanceAcceptance- Realizes death is near - Realizes death is near and comes in terms with it. Completes and comes in terms with it. Completes unfinished business and helps others unfinished business and helps others deal with imminent death.deal with imminent death.

HOSPICEHOSPICE

Agency that takes care of the dying Agency that takes care of the dying patient and assist the family with the patient and assist the family with the death and dying process. No extreme death and dying process. No extreme measures should be taking to prolong measures should be taking to prolong life and individuals are usually on life and individuals are usually on hospice for 6 months.hospice for 6 months.

The organizations goal is allowing The organizations goal is allowing the patient to die with dignity.the patient to die with dignity.

The EndThe End