Legal ResponsibilitiesLegal Responsibilities

• Health care professionals/Health care professionals/

workers must know and follow the workers must know and follow the state laws that regulate their state laws that regulate their licenses or registrations or set licenses or registrations or set standards for their professions.standards for their professions.

Legal and Ethical Practices

Law – a rule that must be followed

Laws are created andenforced by federal,state, or local governments

Two main types: criminal and civil

deals with offenses againstall persons, property, andsociety

Examples of Criminal Law

* Practicing in a health care profession without a license.

* Misuse of narcotics.* Theft.* Murder

Criminal Law: AKA Crime

An example of criminal law is:

A. [A divorce]B. [Practicing Medicine without a

license]C. [Child custody and child support]D. [Breech of contract]

Private Law is Civil Law!(This primarily affects health care)

Civil Law - deals with the legal relationships between people and the protection of a person’s rights

Two Main Types of Civil Law:� Torts� Contracts

TortsTortsTort - from the French word “wrong.”

It can be defined as a wrongful act that does not involve acontract

• Occurs when a person is harmed or Occurs when a person is harmed or injured because a health care provider injured because a health care provider does not meet the established or does not meet the established or expected standards of careexpected standards of care

MalpracticeMalpractice

• Failure of a professional to use the degree of skill and learning commonly expected in that individual’s profession

• called “professional negligence”.called “professional negligence”.• Causes injury, loss, or damage to the person Causes injury, loss, or damage to the person

receiving carereceiving care• Ex: physician not administering a tetanus Ex: physician not administering a tetanus

shot when pt. has a puncture woundshot when pt. has a puncture wound

[Which situation is malpractice if the patient is [Which situation is malpractice if the patient is injured as a result of a health care workers injured as a result of a health care workers actions?]actions?]

A.A. [A health care worker fails to wipe up some [A health care worker fails to wipe up some water that he/she spilled on the floor.]water that he/she spilled on the floor.]

B.B. [A health care worker forgets to put up the [A health care worker forgets to put up the patient’s bedside rail.]patient’s bedside rail.]

C.C. [A health care worker performs a special [A health care worker performs a special procedure on a patient that he/she is not procedure on a patient that he/she is not instructed to perform.]instructed to perform.]

D.D. [A heating pad with a defective cord is used [A heating pad with a defective cord is used on a patient even though the health care on a patient even though the health care worker knows it is defective.]worker knows it is defective.]

NegligenceNegligence

• Failure to give care that is normally expected of a person in a particular position.

• Results in injuryResults in injury

• Ex: patient falls out of bed when bedrails Ex: patient falls out of bed when bedrails are down, using defective equipment, are down, using defective equipment,

AssaultAssault

• any willful attempt or threat to injure another person with the apparent ability to do so.

• unlawful touching of another person without their consent.

BatteryBattery

[Dr. Williams is charged with assault and battery. [Dr. Williams is charged with assault and battery. What situation might have caused this charge?] What situation might have caused this charge?]

A.A. [A patient’s bandage will not stay [A patient’s bandage will not stay on]on]

B.B. [The patient leaves the hospital [The patient leaves the hospital without being discharged]without being discharged]

C.C. [Dr. Williams operates on a patient [Dr. Williams operates on a patient without consent]without consent]

D.D. [Dr. Williams accidentally removes [Dr. Williams accidentally removes the wrong body part.]the wrong body part.]

Informed ConsentInformed Consent

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

Informed ConsentInformed Consent

• The person has the right to The person has the right to withdraw consent at any timewithdraw consent at any time

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

Invasion of PrivacyInvasion of Privacy

• Unnecessary exposure of an individual, or revealing personal information about an individual without their consent.

• Ex: improperly draping a patient

[Two health care workers were overheard [Two health care workers were overheard discussing a co-worker who was admitted to the discussing a co-worker who was admitted to the hospital drunk and violent. What legal standard hospital drunk and violent. What legal standard was violated by the two workers?]was violated by the two workers?]

A.A. [Libel][Libel]

B.B. [Malpractice][Malpractice]

C.C. [Assault and battery][Assault and battery]

D.D. [Invasion of privacy][Invasion of privacy]

False ImprisonmentFalse Imprisonment• Restraining an individual,

or restricting an individual’s

freedom.

Ex: holding someone in a facility against their will or physically restraining them.

Sometimes treated as a crime.

[Chelsia charges a hospital with false [Chelsia charges a hospital with false imprisonment. What might have happened?]imprisonment. What might have happened?]

A.A. [A doctor would not write an order for Mrs. [A doctor would not write an order for Mrs. Daniel to be discharged]Daniel to be discharged]

B.B. [A nurse applied physical restraints on Mrs. [A nurse applied physical restraints on Mrs. Daniel without justification]Daniel without justification]

C.C. [A nursing assistant put up the bedside rails [A nursing assistant put up the bedside rails while Mrs. Daniel was sleeping]while Mrs. Daniel was sleeping]

D.D. [A ward secretary sent Mrs. Daniel’s chart to [A ward secretary sent Mrs. Daniel’s chart to her insurance company without her her insurance company without her permission]permission]

AbuseAbuse• Any care that results in physical harm, pain, or Mental anguish.

Abuse can be classified as:

Physical - hitting, forcingpersons against their will, restraining movements, depriving of food or H2O, or not providing physical care.

AbuseAbuse

Verbal Abuse – talking harshly, swearingor shouting, teasing, ridiculing,intimidating a person, usinginappropriate words to describe aperson's race or nationality, and/ or writing threats or abusive statements

AbuseAbuse

• Psychological-threating harm; denying rights; belittling, intimidating. Or ridiculing the person; and/or threatening to reveal information about the person

AbuseAbuse

Sexual Abuse –

anyunwanted sexual touchingor act, using sexualgestures, and/or

suggestingsexual behavior

AbuseAbuse

** Laws in all states require reporting of any form of abuse

to proper authorities. **

DefamationDefamationdamaging a person’s name andreputation by making public statementsthat are false and malicious

[An RN who has been fired from a medical [An RN who has been fired from a medical practice has been making negative, untrue practice has been making negative, untrue statements about her boss. What could he/she statements about her boss. What could he/she be charged with?]be charged with?]

A.A. [Immorality][Immorality]

B.B. [Defamation][Defamation]

C.C. [Invasion of Privacy][Invasion of Privacy]

D.D. [Negligence][Negligence]

DefamationDefamationThere are 2 types:

Libel - if the information released is written.

Slander - if the informationreleased is spoken.

[Grant is angry at a physical therapist who will not date him. He starts spreading ugly rumors around town about her. What is this?]

A. [Libel]B. [Malpractice]C. [Invasion of privacy]D. [Slander]

ContractsContracts

• A contract is a voluntary agreement

between two parties

ContractsContracts

• 3 parts to most contracts:3 parts to most contracts:• Offer: a competent individual offers Offer: a competent individual offers

to be a patientto be a patient• Acceptance: Health care provider Acceptance: Health care provider

gives an appointment to or gives an appointment to or examines a patientexamines a patient

• Consideration: payment is made for Consideration: payment is made for the services providedthe services provided

Types of ContractsTypes of Contracts

• Implied – contractual obligations by some action or inaction without verbally expressed terms.

• Ex: when a qualified health worker prepares a medication and the patient takes it-it is implied that the patient accepts treatment

Types of ContractsTypes of Contracts

• Expressed - actual agreement between the parties, the terms are stated in distinct and explicit

language, either orally or in writing.

Ex: surgical consent

Rules of a contractRules of a contract

• All parties in a contract must All parties in a contract must be free of be free of legal disabilitieslegal disabilities..

• A person with legal disabilities A person with legal disabilities does not have the legal does not have the legal capacitycapacity

to form a contract.to form a contract.

Legal DisabilityLegal Disability

• Minors- under 18• Mentally incompetent persons• Individuals under the influence of

drugs that alter the mental state• Semi- or unconscious people

Law of AgencyLaw of Agency

• Agency is a personal relationship, created by mutual consent:– Principal-an employer who has employees.

• Responsible for the actions of the employees

– Agent-the employee who acts on behalf of the employer

Privileged CommunicationPrivileged Communication

• Patient information cannot be toldto anyone else without the written consent

of the patient.

• Written consent should state:Written consent should state:• 1. What information can be released.1. What information can be released.• 2. Who can get the information.2. Who can get the information.• 3. Any time limits related to the release of3. Any time limits related to the release of• information.information.

Privileged CommunicationPrivileged Communication

• Medical Information Exempt by law• Births and Deaths• Injuries caused by Violence • Drug Abuse• Communicable Diseases• Sexually Transmitted Diseases

Health Care RecordsHealth Care Records

• Considered privileged communication because the record contains information on the care that has been provided to the patient.

Health Care RecordsHealth Care Records

• Medical records belongs 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

Health Care RecordsHealth Care Records

• Erasures are not allowed.• Errors should be crosses out with a

single line, correct the information, initial, and date.

Health Care RecordsHealth Care RecordsRecords must be kept until the statues of limitations has passed (2-7 years.)

When records are destroyed, they should beshredded or burned.

Health Care RecordsHealth Care Records

• Computer Confidentiality:Computer Confidentiality:

• Limit personnel who have accessLimit personnel who have access• Use codes to prevent access to Use codes to prevent access to

certain informationcertain information• Requiring passwords in order to Requiring passwords in order to

access specific informationaccess specific information

[Meredith is moving to Cleveland and needs to [Meredith is moving to Cleveland and needs to take her medical records. She is aware that take her medical records. She is aware that patients’ medical record are the property of the:]patients’ medical record are the property of the:]

A.A. [State][State]

B.B. [Patient and his or her family ][Patient and his or her family ]

C.C. [Owners of the facility where they [Owners of the facility where they were created]were created]

HIPAAHIPAA

• Standards used to protect informationStandards used to protect information• Patients must be:Patients must be:

• Able to see and obtain copies of their recordsAble to see and obtain copies of their records

• Given medical information by health care providers Given medical information by health care providers about how they use medical informationabout how they use medical information

• Allowed to set limits on how personal health information Allowed to set limits on how personal health information is usedis used

HIPAAHIPAA

• Permitted to request that health care providers take Permitted to request that health care providers take responsible care to keep communication confidentialresponsible care to keep communication confidential

• Given the right to state who has access to their Given the right to state who has access to their information and even to limit providing information to information and even to limit providing information to their familytheir family

• Provided with information on how to file a complaint Provided with information on how to file a complaint against a health care provider who violates the privacy against a health care provider who violates the privacy actact

EthicsEthics

• A set of principles relating to what A set of principles relating to what is morally right or wrong.is morally right or wrong.

• Provide a standard of conduct or Provide a standard of conduct or code of behaviorcode of behavior

ConfidentialityConfidentiality

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

Patient RightsPatient Rights

• Factors of care a patient can Factors of care a patient can expect to receive.expect to receive.– Patient Bill of RightsPatient Bill of Rights

• Considerate careConsiderate care• Obtain current informationObtain current information• Informed consentInformed consent• Advance directivesAdvance directives• PrivacyPrivacy

Patient RightsPatient Rights

• ConfidentialityConfidentiality• Reasonable response for a requestReasonable response for a request• Obtains information about the facilituObtains information about the facilitu• Right to refuse to participate in researchRight to refuse to participate in research• Be able to review medical records and Be able to review medical records and

billing.billing.• Be informed of disputes against the Be informed of disputes against the

facilityfacility

Advance DirectivesAdvance Directives

• Legal documents that allow Legal documents that allow individuals to state what medical individuals to state what medical treatment they want or do not treatment they want or do not want in the event they become want in the event they become incapacitated and are unable to incapacitated and are unable to express their wishes regarding express their wishes regarding health care.health care.

Discussion

• 1. The patient is restrained in a wheelchair without a physician’s order.

• 2. Jarrod operates on a patient and a surgical consent was never signed.

• 3. Madison reports on the news that the football players at Butler High School all have AIDs but it is not true.

• 4. Lindsey leaves the door open while bathing Grant and everyone walking down the hall can see his naked body.

• 5. Morgan sends information to an insurance company without the patient’s permission.

Living WillLiving Will

• Document that allows individual to Document that allows individual to state what measures should or state what measures should or should not be taken to prolong life should not be taken to prolong life when their conditions are terminal.when their conditions are terminal.– Must be signed when the person in Must be signed when the person in

competent and by witnessed by 2 competent and by witnessed by 2 peoplepeople

Do Not Resuscitate (DNR)Do Not Resuscitate (DNR)

• CPR is not performed when the CPR is not performed when the patient stops breathing, so the patient stops breathing, so the patient is allowed to die with peace patient is allowed to die with peace and dignityand dignity

Durable Power of Attorney Durable Power of Attorney (POA) (POA)

• Permits an individual (principal) to Permits an individual (principal) to appoint another person (agent) to appoint another person (agent) to make any decisions regarding make any decisions regarding health care if the principal should health care if the principal should become unable to make decisions.become unable to make decisions.

Patient Self-Determination Patient Self-Determination Act (PSDA)Act (PSDA)

• 1990 law that mandates all health 1990 law that mandates all health care facilities that receive any care facilities that receive any federal aid must:federal aid must:– Inform every adult (orally and written) Inform every adult (orally and written)

of their right to make decisions of their right to make decisions concerning medical careconcerning medical care

– Provide assistance in preparing Provide assistance in preparing advance directivesadvance directives

Patient Self-Determination Patient Self-Determination Act (PSDA)Act (PSDA)

• Have written statements detailing Have written statements detailing the Patient Rightsthe Patient Rights

• Affirm that there will be no Affirm that there will be no discrimination or effect on care discrimination or effect on care because of advance directivesbecause of advance directives

• Educate the staff on medical and Educate the staff on medical and legal issues concerning advance legal issues concerning advance directivesdirectives

The EndThe End