DH 227 BOARD REVIEW LAW AND ETHICS Lisa Mayo, RDH, BSDH Concorde Career College.

DH 227 BOARD REVIEW LAW AND ETHICS

Lisa Mayo, RDH, BSDH

Concorde Career College

Ethics

General accepted standards of right and wrong, moral vs immoral

As a LICENSED professional you have a legal responsibility to provide all pts with standard of care

Founding principle of all health professions is nonmaleficence (Do no harm)

Over time this has grown to include preventing and removing harm

NBQ

The principle that states “Above all, do no harm” is the principle of

a. Justiceb. Autonomyc. Veracityd. Beneficencee. Nonmalefience

DH Code of Ethics

Purpose Increase our professional and ethical

consciousness and sense of ethical responsibility Lead us to recognize ethical issues and choices

and guide us in making more informed ethical decisions

Establish a standard for professional judgment and conduct

Provide a statement of ethical behavior the public can expect from us

GIVE ME AN EXAMPLE?

DH Code of Ethics

Fundamental Principles Universality

If one individual judges an action right or wrong in a situation, other people considering the same action in the same situation would make the same judgment

If your friends jumped off a bridge, would you? Complementarily

Recognizes the existence of obligation to justice and basic human rights. Involves considering the rights/values of others before making a decision/taking action

DH Code of Ethics

Fundamental Principles Ethics

General standards of right/wrong that guide behavior within society

Community Concern for bond between individuals,

community, and society in general Responsibility

Central to our ethics. Accept the responsibility of knowing and applying guidelines for making ethical choices

DH Code of Ethics

Core Values Individual autonomy and respect

Treat people with respect, pt’s have right to informed consent prior to tx, have right to full disclosure of info to make decision on tx

HIPPA Confidentiality/Fidelity

Respect pt information and acknowledge obligation to justify any violation of confidence

Can you talk to a patient’s spouse about their tx? Societal Trust

Pt trust is valued and public trust is based on our actions and behavior

DH Code of Ethics

Beneficence Do good, promote well being of pts by

engaging in health promotion and disease prevention

Justice and Fairness = tx for all, all pts should have access to

high-quality, affordable healthcare Veracity

Truthfulness and honesty, expect others will do the same

Ethical Theories

Utilitarian theory “Greatest good for greatest number”=universality AKA Mills “great happiness theory”

Deontological theory Focuses on action, rule, or practice of an act

rather than on the consequences; involves performing right action regardless of consequences(Kantian theory)

Virtue theory Focuses on judging traits of character as good or

bad; promotes good choices

NBQ

If you say “the end justifies the means”, you are thinking as a

Theorist Legalist Utilitarian Kohlbergian Deontologist

NBQ

If you say “it’s the principle of the thing”, you are thinking as a

a. Theoristb. Legalistc. Utilitariand. Kohlbergiane. Deontologist

NBQ

A person who concentrates on principles and rules in general as they apply to types of classes of actions is a(an)

a. Legalistb. Act Utilitarianc. Act Deontologistd. Rule Utilitariane. Rule Deontologist

NBQ

The person who focuses on the outcome of a single act under specific circumstances is a(an)

a. Legalistb. Act Utilitarianc. Act Deontologistd. Rule Utilitariane. Rule Deontologist

Profession

Defined as a limited group of persons who have acquired some special skill and are therefore able to perform that function in society better than the average person.

Characteristics of a true profession Specialized body of knowledge Intensive academic course of study Standards of practice External recognition by society Code of Ethics Organized association: ADHA, tripartide Service orientation True professions are considered to be medicine, dentistry,

ministry, and law.

NBQ

HYPAC was initiated by 1978 and stands for

a. Hygiene Policy Advisory Committeeb. Hygiene Planning Alliance Commissionc. Hygiene Pilot Articulation Committeed. Hygienist Political Action Committeee. Hygiene Program Accreditation

Committee

NBQ

The Commission on Accreditation of Dental and Dental Auxiliary Programs (now known as the Commission on Dental Accreditation) was established in 1973 by the

a. ADAb. Counsel of Allied Health Educationc. ADHAd. Counsel on Medical/Dental Educatione. American Association of Dental Schools

3 Models of Professionalism

Developed by Ozar Commercial Model

Relationship in which dentistry is a commodity, simple buying and selling of services

Needs of pt is not as important as what the pt is willing to pay for No obligation, pt makes decision

Guild Model Presents dentistry as an all-knowing profession Pt has needs, DDS provides care to meet needs, pt is uninformed

and passive in process Interactive

Pt and DDS have = roles in care delivery Obligation for care holds both parties = because neither can

achieve goal without the other Preferred model

Ethical Dilemma/Decision Making

Ethical dilemma- when 2 or more ethical principles are morally justifiable but only one is acted on. The outcome varies according to the principle chosen

Ethical Decision Making Gather relevant facts...Don’t make a decision

before getting all information Identify values (pt autonomy, avoid harm, respect

profession, be true to self, follow law), generate options review options, choose option & justify it

Use ADHA Code of Ethics as guide

Ethical Dilemma

Things to consider: Rights of the individual involved Duties of the professional involved Core values that apply Benefits of the care provided or offered Realistic alternatives Patient knowledge Financial or legal factors Need for outside consultation

Categories of Ethical Dilemmas Encountered by RDH

Substandard care Failure to diagnose, refer, or lack of infection control

Overtreatment Excessive services or unnecessary services that may

be influenced by your knowledge of tx Scope of Practice

Legally assigned scope is exceeded by DDS, RDH, or other staff member

Fraud Insurance claim is adjusted to benefit dental office or

pt’s financial situation Changing dates of service of SCRP

Categories of Ethical Dilemmas Encountered by RDH

Confidentiality Informed consent not met, or pt and/or child/parent

confidentiality is breached Impaired Professional

Case where professional can’t or shouldn’t practice b/c of dependence on drugs, alcohol or other substance

Sexual harassment Can be observed or subjected to by a dental team

member Abuse

Child, elder or spousal abuse that is observed or suspected. Most states have legal requirement to report

Laws

Legislative branch is generally responsible for the enactment of state dental practice act

State statutory law regulates the practice of DH (licensure requirements, CE requirements, Scope of Practice, etc)

Practice of DH is NOT nationally regulated, and therefore is different each state

On an annual basis, RDH should obtain a copy of the state dental practice act for the jurisdiction they are licensed and practicing.

NBQ

Dental and DH practice acts are enacted by the

a. Local courtsb. Federal courtsc. State legislaturesd. American Dental Associatione. State boards of dental examiners

Types of DH Licenses

Full Unrestricted practice within scope of practice of particular

state Temporary

Granted on basis of licensure in another jurisdiction, permits practice for a limited period of time while RDH pursues full licensure of new state

Volunteer Granted on basis of licensure in another jurisdiction, permits

practice for the purpose of volunteer (no pay) public service Faculty

Granted on the basis of prior licensure in another jurisdiction, permits faculty member to practice within scope of his or her educational duties

Prudent Dental Care

Measures that are used to help avoid legal action

Include reasonably prudent or sensible practitioner, admissions against interest, & proper documentation

Prove contributory negligence(pt contributed to harmful result)

Identify another cause (harm to pt may have resulted from another incident)

Prudent Dental Care

Transfer of Records Inactive pt records are typically kept for length of time required by

state practice act (7 years for TN) Active pt records are kept by DDS unless requested by another DDS

Insurance Claims Can include only services performed, falsifying information is fraudulent

and may result in legal action Statute of Limitations

Legal time span in which a lawsuit(civil) for a wrong must be filed Malpractice in most states must be within 2 years of time wrongful act

was committed Limitation for filing breach of contract is typically 6 years,

recommended in most states records be kept 10 years minimum for this reason

Liability Insurance Should be carried by each professional Respondent superior: employer is often named in suit in which an

employee caused harm to a pt

Prudent Dental Care

Keep accurate and complete dental records Single most important factor in defense of most malpractice

cases Record information in permanent ink (black or blue) If error in chart make a SINGLE line through error and initial

next to error Important factors:

Current med hx updated at each visit with pt signature Diagnosis should be recorded Tx plan should include ALL options given. Note that all benefits,

risks, and alternatives were explained verbally and in writing, have pt sign chart or tx plan stating that they understand

Record of tx should include date of tx, tx performed, drugs used/administered. Also indicate cancelled or broken appointments

All correspondence with pt, other doctors, and/or insurance should be kept

Consent

Informed Consent Disclose all options for tx (include risk and benefits) so pt can

understand and make decision Pt has the right to refuse or accept tx: SCRP,X-RAYS

Informed refusal-when pt refused tx against dental advice after being informed of risks associated with refusal

Types:1. Parental Consent- required when minor or pt is not

mentally able to make decision for themselves2. Implied Consent

1. Implied by actions of pt (comes to appt, sits in chair, etc)2. If pt is in danger of injury or death and can’t give consent,

emergency tx is given

3. Expressed Consent1. Informed consent that is given verbally or in writing (Most

protection legally for provider)

Consent

Who can give informed consent? Competent adults are solely responsible for

the determination of health care services to which they are willing to consent.

Informed consent to the tx of an adult pt may be sought from an authorized person only when pt is incapable of consenting b/c of incompetency or incapacity

Minor pts are generally unable to consent legally until 18 years of age

Civil Law

Involves crime against a person; concerned with actions that cause harm to an individual

Types: Contract, tort and criminal Contract (form of civil)

Involves a breach of contract; involves breaking of a contract by either party or failing to keep ones part of the contract

Can be written or expressed(pt shows up for appt and sits in chair)

Tort: civil wrong or injury to another person Intentional – deliberate and purposeful act that has

substantial certainty of negative consequences (to person or property)

Unintentional- no intent to cause harm although harm or injury occurs

Civil Law

Intentional Torts-assault and battery Assault- physical attack to body or threat to do

harm Battery- offensive bodily contact (intentional) Remember using pts bib as a tray for RDH is

considered battery! Unintentional Torts-negligence and malpractice

Negligence- failure to act in a reasonable manner as another person would under same circumstances

Malpractice-wrongful conduct of professional (form of negligence)

NBQ

A dental professional maybe criminally liable is the tort he or she commits is

a. Accidental b. Intentionalc. Contributoryd. Unintentionale. Caused by negligence

NBQ

The legal area covered by the term tort usually applies to

a. Propertyb. Civil offensesc. Practice agreementsd. Contract agreementse. Dental practice acts

Criminal Law

Pertains to actions that constitute a wrong against society

State officials respond to such actions, which convicted are punishable by death, imprisonment, fine, or removal from office Ex: practicing without a license

Legal Responsibilities and Duties Health Care Professional

Have valid license Protect and respect pt and tx of pt Provide only necessary care Exercise reasonable care, skill, and judgment Do not abandon pt Use standard materials, techniques and drugs for tx Charge reasonable fees Keep pt informed of tx and progress Refer when necessary Complete care in reasonable time frame

PT Pay reasonable fees Cooperate during tx (follow instructions)

HIPAA

Health Insurance Portability and Accountability Act PHI (protected health information) any info

about health status that can be linked to an individual. Includes ANY part of pt medical or payment history

Must be given training through your office Pts have right to file complain if they feel rights

have been violated Must give pt privacy act/disclosure before tx Pt must sign for disclosure

NBQ

The ethical principle that requires health professionals to fully inform their patients and protect the confidentiality of the patient is the principle of

a. Justiceb. Autonomyc. Veracityd. Beneficencee. Nonmalefience

Terms

Ethics study of conduct that is based on right or wrong

Justice treating others fairly and living by “golden rule.” What is owed due, deserved

Veracity honesty/ truth telling Maligning Saying or writing something that

may damage a pt’s reputation Criminal law offense when an individual

makes a wrongful act against society

Terms

Contributory negligence failure on part of pt to follow instructions given by DDS during and after tx

Respondent superior principle that makes DDS responsible for injuries caused by employees

Abandonment when a DDS or RDH is unavailable to pt at anytime during tx

Virtue based on appreciation of the goodness of the person who chooses to do the act or perform the duty

Double effect requires HCP to consider the risks and benefits whenever tx is possible. ADJUNCTS/LASERS

Terms

Paternalism- holds HCP as having superior knowledge and skill and pt wants HCP to make decisions for tx based on pts best interest

Due process- right of fair application of laws or regulations for each person; process established to ensure fairness and equity

Morals-Specific judgments about right and wrong; are often but not always based on strong religious convictions

Ultimacy-a judgment that has no higher standard Universality- principle by which it is determined that a

good reason for one individual’s behavior is a good reason for others to act the same way

Mores-Established practices of a group or society Values-Beliefs and attitudes

NBQ

The federal agency that proposed nullification of state restrictions that require DH to wok under supervision of a dentist was the

a. Federal Trade Commissionb. Counsel of State Governorsc. National Institutes of Healthd. Department of Health and Human

Servicese. Dept of Health, Education, Welfare

NBQ

In law, an acceptable defense against malpractice is

a. Good faithb. High ethicsc. Reasonable skill and cared. The practitioner’s educatione. The practitioner’s reputation

NBQ

An oral healthcare professional may legally discontinue treatment

a. By moving out of townb. Under no circumstancesc. By refusing to give further

appointmentsd. By refunding any money collected for

the treatmente. By referring the patient to another

qualified practitioner

NBQ

Suppose an RDH is employed and working for Dr.A, who pays salaries and benefits. She is loaned to Dr.B for a day while Dr.B RDH is out sick. While working in Dr.B office, RDH cuts a patient’s tongue. In addition the RDH, who would be liable

a. Dr.Ab. Dr.Bc. Both Dr’sd. Neither Dr’se. RDH alone

NBQ

Intentionally defaming someone in writing is known as

a. Liableb. Fraudc. Assaultd. Slandere. Battery

NBQ

Intentionally defaming someone in writing is known as

a. Liable – another name for defamationb. Fraudc. Assaultd. Slandere. Battery

DH 227 BOARD REVIEW LAW AND ETHICS Lisa Mayo, RDH, BSDH Concorde Career College.

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