Legal and Ethical Responsibilities. Laws governing Health Care Workers 1 st Criminal Law: 1 st...

Legal and Ethical Legal and Ethical ResponsibilitiesResponsibilities

Laws governing Health Care WorkersLaws governing Health Care Workers

11stst Criminal Law: Criminal Law: Commonly called a crime.Commonly called a crime. Focuses on wrongs against a Focuses on wrongs against a

person, property, or society.person, property, or society.


Examples of Criminal LawsExamples of Criminal Laws Practicing without a required Practicing without a required

license.license. Misuse of narcoticsMisuse of narcotics TheftTheft MurderMurder


2nd Civil Law:2nd Civil Law: Focuses on legal relationship Focuses on legal relationship

between people and protection between people and protection of a person’s rights.of a person’s rights.

Deals with torts and contracts Deals with torts and contracts

Torts (cont)Torts (cont)

Wrongful act that does not involve Wrongful act that does not involve a contract.a contract.

Civil wrong instead of a crimeCivil wrong instead of a crime Person is harmed or injured Person is harmed or injured

because a health care provider because a health care provider does not meet the established or does not meet the established or expected standard of care.expected standard of care.

Can lead to legal actionCan lead to legal action


11stst Malpractice- described a “bad Malpractice- described a “bad practice”.practice”.

Commonly called “professional Commonly called “professional negligence”.negligence”.

Failure of a professional to use the Failure of a professional to use the degree of skill and learning commonly degree of skill and learning commonly expected in a particular profession.expected in a particular profession.

Causes injury, loss, or damage to the Causes injury, loss, or damage to the person receiving care.person receiving care.


Examples of Malpractice:Examples of Malpractice: Physician not administering a Physician not administering a

tetanus injection when a patient tetanus injection when a patient has a puncture wound.has a puncture wound.

Nurse performing minor surgery Nurse performing minor surgery without any training.without any training.


22ndnd Negligence-failure to give Negligence-failure to give care that is normally expected of care that is normally expected of a person in a particular position, a person in a particular position, results in injury to another results in injury to another person.person.


Examples of Negligence:Examples of Negligence: Falls and injuries that occur when Falls and injuries that occur when

siderails on the bed are left down.siderails on the bed are left down. Using and not reporting defective Using and not reporting defective

equipment.equipment. Infections caused by use of Infections caused by use of

nonsterile instruments and nonsterile instruments and suppliessupplies


33rdrd Assault and Battery-closely Assault and Battery-closely related and often use together, related and often use together, but can be used separately.but can be used separately.

Assault-includes a threat or Assault-includes a threat or attempt to injure.attempt to injure.

Battery-unlawful touching of Battery-unlawful touching of another person without consent another person without consent or permission.or permission.


Patients must give consent for any Patients must give consent for any care and they have the right to care and they have the right to refuse care.refuse care.

Written consent-required for some Written consent-required for some procedures such as: surgery, certain procedures such as: surgery, certain diagnostic testing, and treatment of diagnostic testing, and treatment of minors.minors.

Verbal consent must be supported by Verbal consent must be supported by written consent, otherwise it is your written consent, otherwise it is your word versus the patient’s word.word versus the patient’s word.


Examples of Assault and Battery:Examples of Assault and Battery: Operating on a minor without the Operating on a minor without the

parent’s written consent.parent’s written consent. Giving first aid care to a victim Giving first aid care to a victim

that when the victim has refused that when the victim has refused first aid assistance.first aid assistance.

Torts (cont)Torts (cont) 44thth Informed Consent-permission Informed Consent-permission

granted voluntarily by a person who is granted voluntarily by a person who is of sound mind after the procedure and of sound mind after the procedure and all risks involved have been explained all risks involved have been explained in terms the person can understand.in terms the person can understand.

All procedures must be explained to the All procedures must be explained to the patient, and no procedure should be patient, and no procedure should be performed if the patient does not give performed if the patient does not give consent.consent.

A person has the right to withdraw A person has the right to withdraw consent at any time.consent at any time.


Examples of breaching Informed Examples of breaching Informed Consent:Consent:

Performing a procedure after a Performing a procedure after a patient has refused to give patient has refused to give permission.permission.

Improper handling or rough Improper handling or rough treatment of a patient while treatment of a patient while providing care.providing care.


55thth Invasion of Privacy-involve Invasion of Privacy-involve unnecessarily exposure of a unnecessarily exposure of a patient.patient.

Also, caused by revealing Also, caused by revealing personal information about a personal information about a patient without the patient’s patient without the patient’s consent.consent.


Examples of Invasion of Privacy:Examples of Invasion of Privacy: Improperly draping or covering a patient Improperly draping or covering a patient

during a procedure so that other patients during a procedure so that other patients or personnel can see the patient exposed.or personnel can see the patient exposed.

Sending information regarding a patient Sending information regarding a patient to an insurance company without the to an insurance company without the patient’s written consent.patient’s written consent.

Informing the media about a patient’s Informing the media about a patient’s condition without the patient’s condition without the patient’s permission.permission.


66thth False Imprisonment-restraining False Imprisonment-restraining or restricting an individual’s or restricting an individual’s freedom.freedom.

Examples of False Imprisonment:Examples of False Imprisonment: Keeping a person in the hospital Keeping a person in the hospital

their will.their will. Applying physical restraints Applying physical restraints

without proper authorization or without proper authorization or without justification.without justification.


77thth Abuse-care that results in the Abuse-care that results in the physical harm, pain or mental physical harm, pain or mental anguish of a patient.anguish of a patient.

Physical Abuse-hitting, forcing Physical Abuse-hitting, forcing patients against their will, patients against their will, depriving patients of food and/or depriving patients of food and/or water, and not providing physical water, and not providing physical care.care.


Verbal Abuse-speaking harshly, Verbal Abuse-speaking harshly, swearing or shouting, using swearing or shouting, using inappropriate words to describe inappropriate words to describe a person’s race or nationality, a person’s race or nationality, and/or writing threats or abusive and/or writing threats or abusive statement.statement.


Psychological Abuse-threatening Psychological Abuse-threatening harm, denying rights, belittling, harm, denying rights, belittling, intimidating, or ridiculing the patient, intimidating, or ridiculing the patient, and/or threatening to reveal and/or threatening to reveal information about the patient.information about the patient.

Sexual Abuse-any unwanted sexual Sexual Abuse-any unwanted sexual touching or act, using sexual touching or act, using sexual gestures, and/or suggesting sexual gestures, and/or suggesting sexual behaviors.behaviors.

Torts (cont)Torts (cont) Examples of Abuse:Examples of Abuse: Unexplained bruises, fractures, burns, Unexplained bruises, fractures, burns,

or injuries.or injuries. Signs of neglect such as poor personal Signs of neglect such as poor personal

hygiene.hygiene. Irrational fears or changes in a Irrational fears or changes in a

patient’s personality.patient’s personality. Aggressive or withdrawn behaviors.Aggressive or withdrawn behaviors. Patient’s statement indicating abuse Patient’s statement indicating abuse

or neglect.or neglect.


Mandated reporters-even though Mandated reporters-even though the signs and symptoms do not the signs and symptoms do not always mean a person is being always mean a person is being abuse, health care workers are abuse, health care workers are required to report any signs or required to report any signs or symptoms of abuse to their symptoms of abuse to their immediate supervisor or to the immediate supervisor or to the individual in the health care facility individual in the health care facility responsible for reporting the responsible for reporting the suspicions to the proper authorities.suspicions to the proper authorities.


88thth Defamation-when false Defamation-when false statements either cause a person statements either cause a person to be ridiculed or damage the to be ridiculed or damage the person’s reputation.person’s reputation.

2 types of defamation:2 types of defamation: Slander-when false information is Slander-when false information is

spoken about a person.spoken about a person. Libel-when false information is Libel-when false information is

written about a person.written about a person.


Examples of Defamation:Examples of Defamation: Slander-telling others that patient Slander-telling others that patient

has a drug problem when another has a drug problem when another medical condition actually exists.medical condition actually exists.

Libel-reporting that a patient has Libel-reporting that a patient has an infectious disease to a an infectious disease to a government agency when government agency when laboratory results were incorrect.laboratory results were incorrect.

ContractsContracts Agreement between two or more Agreement between two or more

parties and are of legal age of consent:parties and are of legal age of consent: 11stst Part: Offer-a competent patient Part: Offer-a competent patient

enters into a relationship with a health enters into a relationship with a health care provider and offers to be a care provider and offers to be a patient.patient.

22ndnd Part: Acceptance-the health care Part: Acceptance-the health care provider gives an appointment or provider gives an appointment or examines or treats a patient.examines or treats a patient.

33rdrd Part: Consideration-the payment Part: Consideration-the payment made by the patient for the services made by the patient for the services provided.provided.

Contracts (cont)Contracts (cont)

Implied Contracts-obligations Implied Contracts-obligations understood without verbally understood without verbally expressing terms.expressing terms.

Example of Implied Contract:Example of Implied Contract: When a health care provider prepares When a health care provider prepares

a patient’s medication and the a patient’s medication and the patient takes the medication, it is patient takes the medication, it is implied the patient will accept this implied the patient will accept this treatment.treatment.


Expressed Contract-stated in distinct Expressed Contract-stated in distinct and clear language, either orally or in and clear language, either orally or in writing.writing.

Example of Expressed Contract:Example of Expressed Contract: When a patient is scheduled for surgery. When a patient is scheduled for surgery.

The surgical contract will contain all The surgical contract will contain all risks and treatments associated with risks and treatments associated with the surgery, which must be completely the surgery, which must be completely explained to the patient in terms that explained to the patient in terms that patient understands.patient understands.

Contracts (cont)Contracts (cont) Legal Disabilities-a person who does Legal Disabilities-a person who does

not have the legal capacity to form or not have the legal capacity to form or enter into a contract.enter into a contract.

Examples of Legal Disabilities:Examples of Legal Disabilities: Minors-under age of 18 years of ageMinors-under age of 18 years of age Mentally incompetent personsMentally incompetent persons Persons under the influence of drugs Persons under the influence of drugs

or alcohol (legal or illegal) that has or alcohol (legal or illegal) that has altered their mental statealtered their mental state

Semiconscious or unconscious personsSemiconscious or unconscious persons


Breach of Contract-when certain Breach of Contract-when certain standards of care are not standards of care are not performed accordingly to the performed accordingly to the agreement by health care agreement by health care providers.providers.

Failure to provide care and giving Failure to provide care and giving improper care are breaches of improper care are breaches of contract by a health care provider.contract by a health care provider.


Employer: Principal-is responsible for Employer: Principal-is responsible for the actions of the agent.the actions of the agent.

Employee: Agent-when a person Employee: Agent-when a person works under the direction of works under the direction of principal.principal.

Example: If a dental assistant tells a Example: If a dental assistant tells a patient “your dentures will look patient “your dentures will look better that your real teeth,” the better that your real teeth,” the dentist may have to compensate the dentist may have to compensate the patient financially should this patient financially should this statement prove to be false.statement prove to be false.

Privileged CommunicationPrivileged Communication

Includes all information given to Includes all information given to health care personnel by health care personnel by patients.patients.

By law, this information must be By law, this information must be kept confidential and only shared kept confidential and only shared with other members of the with other members of the patient’s health care team.patient’s health care team.

It cannot be told to anyone else It cannot be told to anyone else without the written consent of without the written consent of the patient.the patient.

Privileged Communication Privileged Communication (cont)(cont)

Written Consent:Written Consent: 11stst-what information is to be released -what information is to be released (Dr. Martin’s notes from January 1, 1990-(Dr. Martin’s notes from January 1, 1990-

December 31, 1990)December 31, 1990) 22ndnd-to whom the information should be -to whom the information should be

given given (Dr. Gant)(Dr. Gant) 33rdrd-give dates of time limits -give dates of time limits (November 18, 2009-November 18, (November 18, 2009-November 18,

2010)2010)


Certain information is exempt by Certain information is exempt by law and must be reported:law and must be reported:

Births and deathsBirths and deaths Injuries caused by violenceInjuries caused by violence Drug AbuseDrug Abuse Communicable diseasesCommunicable diseases Sexually Transmitted DiseasesSexually Transmitted Diseases


Health Care Records-are privileged Health Care Records-are privileged communication.communication.

Contains information about the care of the Contains information about the care of the patient.patient.

Records belong to the health care provider Records belong to the health care provider (hospital, physician, dentist, long-term care (hospital, physician, dentist, long-term care facility).facility).

Patients have a right to obtain a copy of any Patients have a right to obtain a copy of any information in the record ($$$$$).information in the record ($$$$$).

Health care records can be used as legal Health care records can be used as legal records in a court of law.records in a court of law.


Pertaining to health records:Pertaining to health records: Erasures are not allowed; proper Erasures are not allowed; proper

documentation is required to documentation is required to support corrections of mistakes.support corrections of mistakes.

Properly maintained and stored in a Properly maintained and stored in a locked or secure area for a locked or secure area for a minimum of 7 years.minimum of 7 years.

After legal time of retention, records After legal time of retention, records are to be burned or shredded to are to be burned or shredded to maintain confidentiality.maintain confidentiality.


Pertaining to health records (cont)Pertaining to health records (cont) Limit personnel to access of Limit personnel to access of

patients’ records.patients’ records. Use codes to prevent access to Use codes to prevent access to

certain information.certain information. Require password in order to access Require password in order to access

specific information.specific information. Constantly monitor computer usage Constantly monitor computer usage

of records.of records.

Privacy ActPrivacy Act

Health Insurance Portability and Health Insurance Portability and Accountability Act (HIPAA)Accountability Act (HIPAA)

Required by Congress and the U. Required by Congress and the U. S. Department of Health and S. Department of Health and Human Services (USDHHS) in Human Services (USDHHS) in 1996.1996.

Established to protect health Established to protect health informationinformation

Privacy Act (cont)Privacy Act (cont)

Under HIPAA, patients must be:Under HIPAA, patients must be: Able to see and obtain copies of their medical Able to see and obtain copies of their medical

records.records. Given information by health care providers Given information by health care providers

about how they will use medical information.about how they will use medical information. Given the right to state who has access to their Given the right to state who has access to their

information and even limit providing information and even limit providing information to their familyinformation to their family

Provided with information on how to file a Provided with information on how to file a complaint against a health care provider who complaint against a health care provider who violates the Privacy Act.violates the Privacy Act.

EthicsEthics

Principles relating to that which Principles relating to that which is morally right or wrong.is morally right or wrong.

Standard of Conduct or Code of Standard of Conduct or Code of Behavior for health care Behavior for health care providers based on what people providers based on what people believe is right and good believe is right and good conduct.conduct.

Ethics (cont)Ethics (cont)

Ethical Dilemmas-a serious medical Ethical Dilemmas-a serious medical problem or situation requiring health care problem or situation requiring health care providers to make a choice between providers to make a choice between unpleasant alternatives.unpleasant alternatives.

Examples of Ethical Dilemmas:Examples of Ethical Dilemmas: When should life support be discontinued?When should life support be discontinued? If a person can benefit from marijuana, If a person can benefit from marijuana,

should a physician be allowed to prescribe should a physician be allowed to prescribe it as a treatment? it as a treatment?

Ethics (cont)Ethics (cont)

Ethical Codes-established by each Ethical Codes-established by each health care career organization to health care career organization to provide guidelines for those provide guidelines for those health care providers that are health care providers that are challenged by ethical dilemmas.challenged by ethical dilemmas.

Ethical Codes will slightly differ, Ethical Codes will slightly differ, but most contain the same basic but most contain the same basic principles.principles.

Ethics (cont)Ethics (cont) Examples of Ethical Codes:Examples of Ethical Codes: Put saving of life and the promotion of health above all Put saving of life and the promotion of health above all

else.else. Make every effort to keep the patient as comfortable as Make every effort to keep the patient as comfortable as

possible and to preserve life whenever possible.possible and to preserve life whenever possible. Respect the patient’s choice to die peacefully and with Respect the patient’s choice to die peacefully and with

dignity when all options have been discussed with the dignity when all options have been discussed with the patient and family and/or predetermined by Advanced patient and family and/or predetermined by Advanced Directives.Directives.

Treat all patients equally, regardless of race, religion, Treat all patients equally, regardless of race, religion, social or economic status, sex, or nationality.social or economic status, sex, or nationality.

Maintain a competent level or skill consistent with your Maintain a competent level or skill consistent with your particular occupation.particular occupation.

ConfidentialityConfidentiality

Information about the patient must Information about the patient must remain private and can be shared only remain private and can be shared only with other members of the patient’s with other members of the patient’s health care team.health care team.

Patient gives written consent for this Patient gives written consent for this information to be shared with others information to be shared with others not associated with the health care not associated with the health care team.team.

Forerunner for HIPAAForerunner for HIPAA

Confidentiality (cont)Confidentiality (cont)

Examples of breaching confidentiality:Examples of breaching confidentiality: Gossiping about patients’ is ethically Gossiping about patients’ is ethically

wrong.wrong. Refrain from immoral, unethical, and Refrain from immoral, unethical, and

illegal practices.illegal practices. If you observe others taking part in If you observe others taking part in

illegal actions, report such actions to illegal actions, report such actions to the proper authorities and/or the proper authorities and/or supervisor.supervisor.

Patient’s RightsPatient’s Rights

Federal and state legislation Federal and state legislation requires health care agencies to requires health care agencies to have written policies concerning have written policies concerning factors of care that patients can factors of care that patients can expect to receive.expect to receive.

All health care providers are All health care providers are expected to respect and honor expected to respect and honor these rights.these rights.

Patient’s RightsPatient’s Rights

Patient’s Bill of Rights-adopted by Patient’s Bill of Rights-adopted by the American Hospital Association the American Hospital Association and govern patients in hospitals or and govern patients in hospitals or health care facilitieshealth care facilities

Resident’s Bill of Rights-adopted by Resident’s Bill of Rights-adopted by Omnibus Reconciliation Act (OBRA) Omnibus Reconciliation Act (OBRA) of 1987 and govern residents in of 1987 and govern residents in long-term care facilities.long-term care facilities.

Advanced DirectivesAdvanced Directives

Legal document that allows a person to state Legal document that allows a person to state what medical treatment they want or do not what medical treatment they want or do not want in the event that they become want in the event that they become incapacitated and are unable to express their incapacitated and are unable to express their wishes regarding medical care.wishes regarding medical care.

Helps to take the pressure off of family Helps to take the pressure off of family members when medical decisions are required.members when medical decisions are required.

Types of Advance Directives:Types of Advance Directives: 11stst Living Wills Living Wills 22ndnd Durable Power of Attorney (POA) Durable Power of Attorney (POA)

Advanced Directives (cont)Advanced Directives (cont)

Living Wills-document that allow persons Living Wills-document that allow persons to state what measure should or should to state what measure should or should not be taken to prolong life when their not be taken to prolong life when their condition are terminal (death is condition are terminal (death is expected).expected).

Document is signed by a competent Document is signed by a competent person.person.

Witnessed by two adults that will not Witnessed by two adults that will not benefit or profit from the person’s death.benefit or profit from the person’s death.


Do Not Resuscitate (DNR)-part of a Living Will.Do Not Resuscitate (DNR)-part of a Living Will. Cardiopulmonary Resuscitation (CPR) is not Cardiopulmonary Resuscitation (CPR) is not

performed when a patient stops breathing or performed when a patient stops breathing or heart stops beating.heart stops beating.

Patient is allowed to die with peace and dignity.Patient is allowed to die with peace and dignity. Extremely difficult at times for health care Extremely difficult at times for health care

providers to honor.providers to honor. Many patients believe quality of life is more Many patients believe quality of life is more

important and life on support systems important and life on support systems (ventilators) has no meaning or purpose for them.(ventilators) has no meaning or purpose for them.


Durable Power of Attorney (POA)Durable Power of Attorney (POA) Document that permits a person (principal) Document that permits a person (principal)

to appoint another person (agent) to make to appoint another person (agent) to make any decisions regarding health care if the any decisions regarding health care if the principal should be unable to make principal should be unable to make decisions.decisions.

Document is signed by competent person.Document is signed by competent person. Witnessed by one or two adults.Witnessed by one or two adults. May be spouse, adult children, or qualified May be spouse, adult children, or qualified

adult.adult.


Examples of Health Care POA:Examples of Health Care POA: Providing or withholding specific Providing or withholding specific

medical or surgical procedures.medical or surgical procedures. Hiring or dismissing health care Hiring or dismissing health care

providers.providers. Spending or withholding funds for Spending or withholding funds for

health care.health care. Accessibility to health care records.Accessibility to health care records.


Patient Self-Determination Act (PSDA) 1990- Patient Self-Determination Act (PSDA) 1990- mandates that all health care facilities receiving mandates that all health care facilities receiving any type of federal aid must:any type of federal aid must:

Inform every adult, both orally and in writing of Inform every adult, both orally and in writing of their rights to refuse treatment and right-to-die their rights to refuse treatment and right-to-die options.options.

Provide information and assistance in preparing Provide information and assistance in preparing advance directives.advance directives.

Document any advance directives on the patient’s Document any advance directives on the patient’s chart.chart.

Educate the staff on medical and legal issues of Educate the staff on medical and legal issues of advance directives.advance directives.

Professional StandardsProfessional Standards

1. Perform procedures you are trained and 1. Perform procedures you are trained and legally permitted to perform.legally permitted to perform.

2. Use approved, correct methods while 2. Use approved, correct methods while performing any procedures; follow step-by-performing any procedures; follow step-by-step methods for tasks.step methods for tasks.

3. Obtain proper authorization before 3. Obtain proper authorization before performing any procedure.performing any procedure.

4. Identify the patient and obtain the 4. Identify the patient and obtain the patient’s consent before performing any patient’s consent before performing any procedure.procedure.

Professional Standards (cont)Professional Standards (cont)

5. Observe all safety precautions.5. Observe all safety precautions. 6. Keep all information confidential.6. Keep all information confidential. 7. Think before you speak and 7. Think before you speak and

carefully consider everything you carefully consider everything you say.say.

8. Treat all patients equally 8. Treat all patients equally regardless of race, religion, social or regardless of race, religion, social or economic status, sex, or nationality. economic status, sex, or nationality.

Professional Standards (cont)Professional Standards (cont)

9. Accept no bribes for the care 9. Accept no bribes for the care you provide.you provide.

10. If any error occurs or you 10. If any error occurs or you make a mistake, report it make a mistake, report it immediately to your supervisor.immediately to your supervisor.

11. Behave professionally in 11. Behave professionally in dress, language, manners, and dress, language, manners, and actions.actions.

Questions?Questions?

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