Legal & EthicalStandards inHealthcare

By: Cindy Quisenberry

Contrast laws, morals, and ethics.

Explain the purpose of professional codes of ethics.

Define the term standard of care.

Describe informed consent.

Discuss the importance of confidentiality and HIPAA for healthcare professionals.

Objectives

Explain what is an advance directive.

Compare a living will, a durable power of attorney, and a healthcare proxy.

Describe clients’ rights and responsibilities.

Name the qualities of a successful healthcare worker.

Objectives

Law – a body of rules, regulations, and legal opinions of conduct and action that are made by controlling authority and are legally binding.

Laws

Area of the law related to violations of statutes that pertain to public offenses or acts committed against the public.

Commission, if there is a law forbidding a certain act. Omission, in violation of a law requiring a certain act.

A healthcare provider can be prosecuted for criminal acts such as assault and battery, fraud, and abuse.

Criminal Law

Area of the law related to violations of private rights and remedies.Examples:

Contract violationSlander or libelProduct liabilityFamily mattersAutomobile accidents

Civil Law

Torts – a civil wrong committed against a person or property. May have caused physical injury, resulted in damage to someone’s property, or deprived someone of his or her liberty and freedom.Intentional (Willful) - caused by

negligenceUnintentional (Accidental) - acts that

were not intended to cause harm. However, they are committed without regard for consequences.

Civil Law

Unintentional Tort – acts that are not intended to cause harm. However they are committed “unreasonably”, or without regard for the consequences.Negligence – an unintentional tort

Medical Malpractice – an action taken by a healthcare professional that injures a patient, and fails to meet reasonable standards of professional care.

Civil Law

Negligence – is charged when a healthcare practitioner fails to exercise ordinary or expected care and a client is injured or sustains damages of some sort as a result. “Didn’t intend to do it” “ Should have known better”

Civil Law

Medical practice acts are state statutes that govern medical practices. They do the following:Cover requirements and methods

for licensing healthcare providersEstablish medical licensing boardsList ground for revoking licenses

Civil Law

Common Errors in Medical Malpractice Medication errors (causes injury or death in 1.5

million persons per year) Anesthesia errors Birth injury, including Cerebral Palsy, Erb's

Palsy, and Brain Damage Delayed diagnosis or failed diagnosis of a

medical condition (including cancer) Misdiagnosis (for example, heart attack

misdiagnosed as indigestion) Improper or inadequate treatment of an illness

or disease Surgical error

Civil Law

Plantiff – the person bringing the lawsuit

Defendant – the person facing the charges (defending the lawsuit)

Civil Law

The 3 D’s must be present for negligence to occur:Duty of Care – the extent to which a

healthcare provider must reasonably ensure that no harm comes to a patient under the provider's care

Dereliction of Duty – willful neglect; the act of abandoning; abandonment or neglect

Damages - Harm or injury to property or a person, resulting in loss of value or the impairment of usefulness

Civil Law

Assault – intentionally attempting or threatening to touch a person’s body without the person’s consent

Battery – touching a person’s body without his or her consent

Civil Law

Invasion of Privacy – violating a person’s right not to have his or her name, photo, or private affairs exposed or made public without giving consent

Civil Law

False Imprisonment – unlawful restraint or restriction of a person’s freedom of movement

Civil Law

Abuse – the intentional mistreatment or harm of another person

Defamation – injuring a person’s name and reputation by making false statements to a third person/party

Civil Law

NoncomplicanceNoncompliant healthcare workers

may face fines or prison sentences and can lose their licenses to practice their profession.

Unethical conduct may result in expulsion or censure from your professional organization, but only the state can revoke a license.

Civil Law

Privileged Communication – refers to information that is held private within a protected relationship, such as that between a physician and patientHealth Care RecordsHIPAA – Privacy ActAuthorization to release health

information

Legal Responsibility

Privileged Communication It is illegal and unethical for a

healthcare worker not to observe confidentiality.

Privileged communication refers to information held confidential within a protected relationship.

Legal Responsibility

Privileged CommunicationKeeping client medical information

confidential means: Not informing any unauthorized person about

the information contained in a patient’s medical records.

Not showing written information to an unauthorized third party.

Taking proper precautions when communicating such information over a computer, telephone, or fax machine.

Written consent must be obtained before releasing information to a third party.

Legal Responsibility

Privileged CommunicationGuidelines to follow if you have access to a

patient’s information: Do not decide if information is confidential based

on your approval or agreement. Do not reveal financial information about a

patient. Do not use the patient’s name or other

information if others in the room might overhear. Use caution in giving the results of medical tests

to patients over the telephone.

Legal Responsibility

Privileged CommunicationGuidelines to follow if you have access to a

patient’s information: Do not leave medical charts or insurance reports

where patients or others can see them. If the patient has not given written permission to

release information, do not release it. Do not discuss patients in public places where

others may overhear, such as the cafeteria or elevator.

Legal Responsibility

Privileged CommunicationConfidentiality for patient medical records

may be waived under the following circumstances: When a third party requests a medical

examination, such as a pre-employment examination, and that third party pays the patient’s bill.

When a patient sues a physician or other healthcare practitioner for malpractice.

When the patient signs a waiver allowing the release of information.

Legal Responsibility

Privileged CommunicationClients have the following rights under

HIPAA law: The right to notice of privacy practices. The right to limit or request restriction on their

PHI and its use and disclosure. The right to confidential communications. The right to inspect and obtain a copy of their

PHI. The right to request an amendment to their PHI. The right to know if their PHI has been disclosed

and why.

Legal Responsibility

Contract – an agreement consisting of one or more legally enforceable promises among two or more parties such as people, corporations, and partnerships; in healthcare, contracts are used to govern relationships, between employees and employers, insurers and the insured, or healthcare providers and patients

Legal Responsibility

Components of a ContractOfferAcceptanceConsideration

ImpliedExpressed

Legal Responsibility

Breach of Contract - failing to perform any term of a contract, written or oral, without a legitimate legal excuse

Legal Responsibility

Morals – formed from your personal values and reflect your concept of right and wrong (developed through the influence of family, culture, and society) – acting morally toward others involves treating them the way you would like to be treated

Ethical Responsibilities

Ethics – set of principles dealing with right and wrong; knowledge of what is right and wrong conductProvide a standard of conduct or code of behavior

Helps healthcare workers analyze information and make decisions

Medical Ethics – a system of principles governing medical conduct (ie: euthanasia, DNR, living wills, etc.)

Ethical Responsibilites

Frequently created by modern medicineEuthanasiaConfidentiality of AIDS diagnosisAborted fetuses and researchContinued life supportExpensive treatments and payment

Transplant decisions

Ethical Dilemmas

Frequently created by modern medicineLegal issues and marijuanaAnimals and researchGenetic researchCloningStem cell research

Ethical Dilemmas

Save lives and promote health

Patient comfort Respect of patient’s right to die peacefully and with dignity

Treat all patients equally Provide the best care possible Maintain competent skills and knowledge

Basic Rules of Ethics

Respect rules of confidentiality

Refrain from immoral, unethical, and illegal practices

Show loyalty to patients, co-workers, and employers

Be sincere, honest, and caring

Basic Rules of Ethics

Licensure – required for certain professions within a state; the granting of permission – official, legal, or both – to perform professional actions in various fields such as medicine, nursing, etc. that may not be legally done by persons who do not have such permission

Professional Standards

Registration – means a person’s name has been listed in an official registry or record as having satisfied the standards for a certain healthcare occupation; the recording of those who are registered or licensed to practice within a state

Professional Standards

Certification – usually voluntary and national in scope; most often achieved by taking an examination – passing the exam shows that an applicant has attained a certain level of knowledge and skill

Professional Standards

Reciprocity – a state licensing authority will accept a person’s valid license from another state without requiring reexamination

Professional Standards

Standard of Care – the level of performance (consistent with minimum safe professional conduct under specific conditions) expected of a healthcare professional in carrying out his or her duties

Professional Standards

Scope of Practice – based upon the job description, level of training, and qualifications (what a healthcare professional can do or cannot do)Perform only those procedures for which you have been trained and are permitted to do

Perform correctly

Professional Standards

Scope of PracticeWorking outside your scope of practice can

make you liable.Working within your scope of practice

ensures that you: Do not injure patients or put them at risk by

performing procedures that are beyond your ability.

Will not be held liable for a standard of care that is beyond your training, experience, and job description if a legal situation arises.

Professional Standards

Identify the patient Obtain patient’s consent Observe safety precautions Keep all information confidential

Think before you speak and watch everything you say

Treat all patients equally

Professional Standards

Accept no tips or bribes for the care you provide

If an error occurs, report it immediately to your supervisor

Behave professionally in dress, language, manners, and actions

Always carry liability insurance

Professional Standards

Liable – legally responsible for your actions

Libel – making false statements in print, writing, or through pictures or drawings

Civil Law

Law of Agency – an employer is legally liable for acts performed by employeesExample: the physicians affiliated with the medical office that hired the medical assistant could also be held liable in the case of a law suit

Civil Law

Informed Consent – a voluntary agreement made by a well-advised and mentally competent patient to be treated or randomized into a research study (risks, benefits, alternative, consequences, etc.)

Civil Law

Informed Consent in order for a client to make an informed decision regarding treatment, the client needs to be told the following: The proposed methods of treatment. Why the treatment is necessary. The risks involved in the proposed treatment. All available alternative types of treatment. The risks of any alternative methods of

treatment. The risks involved if treatment is refused.

Civil Law

Informed Consent People who cannot give informed consent

include: Minors – individuals under 18 years of age (21 in

some states). Exceptions include those deemed mature minors by the court.

Mentally incompetent individuals – persons judged by the court to be insane, senile, mentally retarded, or under the influence of drugs or alcohol.

Persons who do not speak English.

Civil Law

Agencies must have written policies for “Patients’ Rights”

All personnel must respect and honor these rights

Long-term care facilities post “Residents’ Bill of Rights”

Patients’ Rights

The American Hospital Association’s Patient’s Bill of Rights is followed in most states. It guarantees the client’s right to: Receive considerate and respectful care. Receive complete and current information

concerning his or her diagnosis, treatment, and prognosis.

Know the identity of physicians, nurses, and others involved with his or her care, as well as when those involved are students, residents, or trainees.

Patients’ Rights

The American Hospital Association’s Patient’s Bill of Rights (cont.) Know the immediate and long-term costs of

treatment choices. Receive information necessary to give informed

consent prior to the start of any procedure or treatment.

Have an advance directive concerning treatment or be able to choose a representative to make decisions.

Patients’ Rights

The American Hospital Association’s Patient’s Bill of Rights (cont.) Refuse treatment to the extent permitted by law. Receive every consideration of his or her privacy. Be assured of confidentiality. Obtain reasonable responses to requests for

services.

Patients’ Rights

The American Hospital Association’s Patient’s Bill of Rights (cont.) Obtain information about his or her healthcare

and be allowed to review his or her medical record and to have any information explained or interpreted.

Know whether treatment is experimental and be able to consent or decline to participate in proposed research studies or human experimentation.

Patients’ Rights

The American Hospital Association’s Patient’s Bill of Rights (cont.) Expect reasonable continuity of care. Ask about and be informed of the existence of

business relationships between the hospital and others that may influence the client’s treatment and care.

Know which hospital policies and practices relate to client care, treatment, and responsibilities.

Patients’ Rights

The American Hospital Association’s Patient’s Bill of Rights (cont.) Be informed of available resources for resolving

disputes, grievances, and conflicts, such as ethics committees or patient representatives.

Examine his or her bill and have it explained and be informed of available payment methods.

Patients’ Rights

Clients’ Responsibilities – clients are responsible for: Providing information about past illnesses,

hospitalizations, medications, and other matters related to their health status.

Participating in decision making by asking for additional information about their health status or treatment.

Providing healthcare agencies with a copy of their written advance directive if they have one.

Informing physicians and other caregivers if they anticipate problems in following a prescribed treatment.

Patients’ Responsibilities

Clients’ Responsibilities (cont.)Following a physician’s orders for

treatment. The client has the right to refuse treatment to the extent permitted by law.

Providing healthcare agencies with necessary information for insurance claims and working with the healthcare facility to make arrangements to pay fees when necessary.

Patients’ Responsibilities

Advanced Directives – a written document in the form of a living will or durable power of attorney prepared by a competent person that specifies what, if any, extraordinary procedures, surgeries, medications, or treatments the patient desires in the future, when he or she can no longer make such decisions about medical treatmentHealthcare workers must be aware of the Act (Patient Self-Determination Act – PSDA) and honor it

Civil Law

Living Will – (an advance directive) provides instructions directly to physicians, hospitals, and other healthcare providers involved in a client’s medical treatment regarding their end-of-life care (ie: intubation, feeding tubes, etc.)

Civil Law – Advanced Directives

Durable Power of Attorney (POA) – it gives one person the authority to make a variety of legal decisions on behalf of another person

Civil Law – Advanced Directives

$4,000,000 Medical Malpractice – Death $1,700,000 Medical Malpractice – Death $1,000,000 Medical Malpractice – left

residual tumor (did not get clear margins) $900,000 Birth Injury – Fetal Death $900,000 Medical Malpractice – Wrongful

Death (failed to dx and respond to pt’s complaints)

$825,000 Medical Malpractice (surgery error – performed surgery incorrectly)

$825,000 OB/GYN Malpractice (did not recognize early fetal distress)

$775,000 Failure to Diagnose

Civil Law - Awards