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Medical, Legal, & Ethical Issues Criminal Law
• Deals with wrongs against society or it’s members
• Crime & Punishment
Civil Law• Deals with non-criminal issues and
conflicts between two parties• Tort Law-Civil wrongs between two parties• Litigation-Process of carrying on a lawsuit• No cap on what private industry could pay
Good Samaritan Laws• Protect people who assist at the scene
of emergency.• Protect against civil liability• Makes a person immune if the act in
good faith, is not negligent, acts within the scope of his/her training, and does not accept payment for their services.
Scope of Practice• Outlines the care you are able to
provide for your patient.• Refined by your Medical Director• Refined by State & Local Rules• Defined by DOT Standards
Delegation of Authority• The granting of privileges by a physician
to a non-physician to perform skills and procedures.
• Medical Practice Act
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Standard of Care• How a reasonably prudent person with
similar training & experience would act under similar circumstances, with similar equipment in the same place.
• Factors taken into consideration:– General confusion at the scene– The needs of other patients.– The type of equipment available
Factors Considered for the Standard
• Locally Accepted Protocols• Standards Imposed by Law• Professional or Institutional Standards
Duty to Act• Individual’s responsibility to provide
patient care• Comes from either statue or function
A legal or contractualrequirement to provide care
Formal Duty:
Implied Duty:Call to 911, beginning care for patient
Duty to Act
Contractual obligation between agency and municipality
Off dutyOut of your EMS system, but
in an ambulance
Duty to Act: Ethical/ Moral Abandonment• Unilateral termination of patient care
without patient consent and without making provisions for continuing care at the same level of skills or higher
• Maybe both criminal &/or civil
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MalpracticeIndicates a failure to conform
to a standard of care.
Negligence• Failure to provide the same care that a
person of similar training would provide.• Deviation from an accepted standard of
care that results in further injury to the patient.
Four Things to Prove for Negligence:
• A duty to act• A breech of that duty• Injury • Causation
Vicarious LiabilityMakes you liable for the wrong doings of
another as long as you have a relationship to the wrongdoer
Defamation
• Communication of false information that damages reputation of a person– Libel if written– Slander if spoken
Defamation
• Defamation could happen with:– False statement on a run report– Inappropriate comments made during
conversation
• Run report should be accurate, relevant, and factual.
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Consent• The act of granting permission to treat• Types of consent:
– Informed Consent– Expressed Consent– Implied Consent– Involuntary Consent
Informed ConsentOnly after patient has had all benefits and
risks explained in a way they can understand
Expressed Consent• Verbal, non-verbal, or written
communication by a patient that he or she wants medical care
• Most common form of consent
Implied Consent• Situation involving an unconscious
patient where care is initiated under the premise that if the patient were conscious he or she would want medical care
• Commonly used in pediatric patients
Involuntary Consent• Consent based upon a court order that
go against a patient’s wishes• Commonly used in overdoses and
mentally disturbed patients
Problem Patients• Pediatrics• Patient’s under the influence• Mentally disturbed patients
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Can a patient withdraw consent at any time?
• A mentally competent patient may withdraw consent at any time
• Must be informed refusal• Must be documented carefully
What if I don’t get proper consent?
Assault & Battery• Assault:
– Placing a person in apprehension of immediate bodily injury without their consent
• Battery:– Unlawful touching of an individual without
their consent• Maybe both criminal &/or civil
False Imprisonment• Intentional and unjustifiable detention• Can be avoided by obtaining proper
consent
Kidnapping Confidentiality• Any type of information that pertains to
a patient is confidential• This includes oral and written
information• This information is only passed to other
healthcare professionals in direct contact with the patient
• HIPAA Mandates
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What if we break patient confidentiality?
• Found guilty of Libel or Slander– Libel=false or malicious writings– Slander=false or malicious words
• Decertification, Suspension, or Probation of your certification
• Civil liability• Criminal Liability
HIPAA• Safeguards patient confidentiality.• Limits EMS providers from obtaining
follow-up information.• Releases health information only with
patient’s permission.
What type of patient makes E.M.S. lose the most lawsuits?
RefusalsWhy?
Refusals• Biggest liability• Most successfully litigated• Protection is accurate and complete
documentation
Patient Refusals• Must do a Head to Toe Assessment• Vital Signs Obtained• Must be an Informed Refusal
– Risks/Benefits– Explanation of Signature Page– What the pt should do if the problem gets
worse– Explanations and forms were understood
• Signature of Patient or Guardian• Must be Witnessed• Remember People Under the Influence
Can’t Refuse!
Things we must report:• Suspected Child Abuse/Neglect• Suspected Elderly Abuse/Neglect• Domestic Violence• Deceased Individuals• Childbirth• Attempted Suicides• Any Type of Suspected Crime
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Obvious Death• Rigor Mortis• Lividity• Decomposition• Mortal Injuries
Special Situations• Organ donors
• Medical identification insignia
• OOHDNR
Advance Directives
• Advance directive specifies treatment should the patient become unconscious or unable to make decisions.
• A do not resuscitate (DNR) order is an advance directive that gives permission not to resuscitate.– “Do not resuscitate” does not mean “do not
treat.”
Advance Directives
• Advance directive is also called:– Living will– Health care directive
Advance Directives
• Some patients may have named surrogates to make decisions for them.– Durable powers of attorney for health care– Also known as health care proxies
Forcible Restraint
• Sometimes necessary with combative patient
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Forcible Restraint
• Is legally permissible– But generally you must consult medical
control for authorization.– In some states, only a law enforcement
officer may forcibly restrain.
Medical Examiner Cases• DOA• Unknown cause of death• Suicide• Violent death• Poisoning• Accidents• Suspicion of criminal action
Crime Scenes
• Move as little as possible• Patient maybe considered evidence• Preserve, Preserve, Preserve• If you move or destroy something, tell
someone• Report anything you see, hear, or smell• Document, Document, Document• You maybe called to court as a witness
Emergency Driving• Emergency vehicles MUST follow the
same traffic laws as other motorists.• Emergency vehicles must be operated
in a safe manner.• Failure to operate safely could be found
as negligent• Maybe both criminal &/or civil
Ethical ResponsibilitiesMake patient's needs a priority.Maintain skills, knowledge.
Critically review performance.
Prepare honest reports.(Seek ways to improve)
Records and Reports
• Compile record for all incidents involving sick or injured patients
• Important safeguard against legal complications
• Courts consider:– An action not recorded was not performed– Incomplete or untidy reports is evidence of
poor emergency medical care
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The EMT in Court
• You can end up in court as a:– Witness– Defendant
• Case can be civil or criminal.
Source: © Photodisc
The EMT in Court
• Whenever called to testify, notify:– Your service director– Legal counsel
• As witness:– Remain neutral– Review run report before court
The EMT in Court
• As a defendant, an attorney is required.• Defenses may include:
– Statute of limitations – Governmental immunity– Contributory negligence
The EMT in Court
• Discovery allows both sides to obtain more information through:– Interrogatories
• Written requests or questions
– Depositions• Oral requests or questions
The EMT in Court
• Most cases are settled following the discovery phase during the settlement phase.
• If not settled, the case goes to trial• Damages that may be awarded:
– Compensatory damages– Punitive damages