Legal & Ethical Legal & Ethical PerspectivesPerspectivesUnit-FUnit-FHealth Team Relations

Ethical Dilemmas in Health Care

Employees of hospitals should always follow organizational and professional codes, policies and protocols.

Ethical Dilemma

Parents not wanting their child to receive blood products due to religious reasons.

By following the standards of legal responsibilities, ethics, and patient rights we protect the employee, employer and the patients.

Legal implications in health care

Malpractice: Bad practice - harmful, incorrect, or negligent practice or treatment of a patient by a health care provider. (professional negligence)

Negligence: failure to give care that is normally expected in a particular position and results in injury to a patient.

Tort: a wrongful act that does not involve a contract – civil not criminal – pt harmed b/c standard of care not met

Illegal restraint: holding a person against his/her will by using a restrictive device or other means.

Invasion of privacy: the giving out of information about an individual or patient without his/her consent.

Liable: to be legally responsible for failing to perform professional duties to meet the standards of care and/or causing harm or injury.

Libel: a written statement that provides false information which can cause damage to a person’s reputation.

Slander: false verbal statements

Contract Law: an agreement between two or more parties

Defamation = false statements that cause a person to be ridiculed or cause damage to a person’s reputation

Slander and Libel are types of defamation

Assault and Battery

Assault – may include a threat or attempt to injure

Battery – unlawful touching of another person without consent

Written consent needed for surgery, certain diagnostic tests, and treatment of minors

Verbal consent acceptable for other procedures

Invasion of Privacy Unnecessary exposure of an

individual or revealing personal info about a person without their consent

False ImprisonmentRestraining an individual or

restricting an individual’s freedom

Abuse Any care that results in physical harm, pain,

or mental anguish1. Physical

2. Verbal

3. Psychological

4. Sexual

Contracts Agreement between two or more

parties 3 parts:

1. Offer

2. Acceptance

3. consideration

Implied Contract

Gives rise to contractual obligations by some action or inaction without verbally expressed terms.

i.e. nurse prepares medication and pt takes medication…implied pt accepts treatment

Expressed Contract

Actual agreement between theparties, the terms are stated indistinct and explicit language, either orally or in writing.

I.e. signing a surgical permit

Legal Disabilities

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.

i.e. minors, mentally incompetent persons, individuals under influence of drugs or alcohol, semiconscious or unconscious person

Breach of Contract

If contract not performed according to agreement then contract is breached

Can lead to legal action

i.e. pt refuses to pay for care

Minors i.e. a fifth grader Mentally incompetent persons Individuals under the

influence of drugs that alters the mental state

Semi- or unconscious people

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

OMBUDSMAN

Person, usually social worker, nurse, trained volunteer

– Patient advocate

– Point of contact for complaints or concerns

– NOT directly involved with patient care

HIPAA

Health Insurance Portability and Accountability Act of 1996

Federal legislation which requires the establishment of standards to protect health information.

Strict Confidentiality Rules for “INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION”

Only healthcare workers involved with the patients’ care should see health information.

LAW OF THE AGENCY

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

The Agent (employee) and the Principal (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.

PRIVILEGED COMMUNICATIONCovers 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.Pt. care records & reports are privileged communicationWritten 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.

PRIVILEGED COMMUNICATION

An exemption to this law is communicable diseases. i.e. TB

Other Medical Information Exempt by Law

1. Births and Deaths 2. Injuries caused by Violence. (abuse,

etc.) 3. Drug Abuse 4. Communicable Diseases 5. Sexually Transmitted Diseases

HEALTH CARERECORDS

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.

Medical records cont’d… 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 ( 2-7 years).

When records are destroyed, they should be shredded or burned.

Only those that have been given permission

Question…

If family members show up to hospital, which ones can medical information be shared with?

PATIENT’S BILL OF RIGHTS

A patient has the right to (pg 123) :

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

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 and response to request

for services

11. Examine bills and receive and explanation of all charges

12. Be informed of any hospital rules or regulations

OBRA Omnibus Budget Reconciliation Act of 1987

The Federal Nursing Home Reform Act or OBRA ‘87 creates a set of national minimum set of standards of care and rights for people living in certified nursing facilities.

A copy must be posted in every facility

Federal Law PSDA of 1990The Patient Self-Determination Act

This law states that all employees will be trained on medical and legal issues of advanced directives. The medical staff must give written information to all adults receiving services of their rights … concerning medical care, including the right to accept or refuse medical or surgical treatment and to prepare advance directives.

Invasion of Privacy

Unauthorized release of personal and medical information

Unlawful release of personal information protected by law

Subjecting patient to personal physical exposure of their body

Slander: spoken misrepresentations that are proven false and can damage another’s reputation.

Assault: the threatening or attempt to injure a person in an unlawful manner.

Battery: the unlawful touching of another that results in injury.

Litigation: the determining of a person’s legal rights either by a lawsuit or some form of legal action.

Civil law: a legal relationship between individuals.

Criminal law: legal obligations between an individual and society or state.

Felony: a more serious crime than a misdemeanor in which the punishment is imprisonment.

Misdemeanor: a less serious offense than a felony; may be punishable by a fine or sentencing to a local prison for less than one year.

Tort: a civil wrongful act causing harm or injury due to the healthcare worker not performing the standard of care.

Defamation If a health care worker makes

false statements about a patient that cause the patient to be damaged or ridiculed.

Legal documents in healthcare

Advanced directive: a written document that specifies if extraordinary measures are to be taken to prolong life if the patient can no longer make his/her own decision. The hospital is required to provide information and assistance.

Living will: a legal document prepared while a person is mentally competent that specifies what his/her wishes are regarding end-of life care.

Durable power of attorney: a legal document that designates another person to make health care decisions in the event that the person is mentally or physically incapable of making their own.

5 Patient Rights

Right Medication Right Dose Right Route Right Patient

Always check the identification band which is on the patient’s wrist and state patients name clearly.

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 women. “Dr Jones willmake you feel better in no time.”

1. Has Dan, acting as Dr. Jones's 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?