Legal, Ethical, & Standards of Care

1. Legal, Ethical, & Standards of Care Unit I Health Care Academy 2

2. Concepts • Concepts to be covered: • Federal laws that impact healthcare • Patients’ legal rights • Healthcare professional scope of practice • Legal responsibilities of the healthcare provider

3. Resources for information • Textbook, Chapter 5 • First Responder 4th edition • Class Notes • Class Discussions • Test Review

4. Legal Responsibility • Criminal Law • Crimes that are “wrong against a person, property, or society.” • Does harm • Examples??

5. Legal Responsibility Civil law • Protection of a person’s rights • 2 types: Tort & Contract • Examples of Tort • Malpractice Abuse • Negligence • Assault & Battery • Invasion of Privacy • False Imprisonment

6. Abandonment • Abandonment occurs when a trained healthcare professional leaves a patient before another healthcare professional arrives to take over care • Once you have started treatment, you must continue treatment until another licensed professional takes over

7. Negligence • When a healthcare provider does not deliver the standard of care & the result is further harm to the patient • For negligence, there must be 4 things present: • Duty to act • Breach of duty • Resulting injuries • Proximate cause

8. Cofidentiality • Healthcare professionals are required to maintain patient’s privacy

9. HIPAA • Health Insurance Portability & Accountability Act • Passed legislation in 1996 • Healthcare entities must be compliant by 2004 • Contains 5 major components • Health Care Access, Portability, & Renewability • Preventing Health Care Fraud & Abuse • Tax – Related Health Provisions • Application & Enforcement of Group Health Plan • Revenue Offsets

10. HIPAA • Privacy Act Component effective 2003 • PHI (Personal Health Information) • Any information that could identify a patient • Name • SSN • MR # • Diagnosis

11. Privacy Act • Patients must be given a copy of the Privacy Act before medical treatment • Patients must sign a “Release of Information” before patient information can be release to another party • EXCEPTIONS: Public Reported information • Births, Deaths, Communicable diseases, STD’s

12. Privacy Act • Patients are allowed: • To see & obtain a copy of their own medical records • to be informed how their medical information will be used • To set limits on how personal information is to be used • Request that personal information remain confidential • Limit family access to patient’s personal information • To know how to file a grievance if violated

13. HIPAA Violation • For knowingly obtaining or disclosing identifiable health information relating to an individual in violation of the Rule: • –Up to $50,000 & 1 year imprisonment • –Up to $100,000 & 5 years if done under false pretenses • –Up to $250,000 & 10 years if intent to sell, transfer, or use for commercial advantage, personal gain or malicious harm • ♦Enforced by DOJ Source: HHS/OCR 2003 42

14. Case Study • Zac Efron is admitted to Buccaneer Medical Center for abdominal pain. Sally, his nurse, texts all of her friends to tell them that she is taking care of Zac Efron. Is this a HIPAA violation? Why?

15. Good Samaritan Act • Protects medical professionals that assist others in an emergency situation • It does not protect individuals that “fail to give care” • Healthcare professionals are not protected from “gross negligence” of care but from “reasonable mistakes”

16. Good Samaritan Act in Alabama • Alabama’s Good Samaritan Act was revised in 2003. • Protects individuals that are licensed in medicine that acts “in good faith” to assist persons in an emergency situation as “any prudent person.” • Also, protect veterinarian's assistance to animals • http://www.legislature.state.al.us/SearchableInstruments/2004RS/Bills/HB11.htm

17. Case Study • Jill, a PA, is watching a Little League baseball game when a foul ball strikes a lady in the head. The paramedics are called. Jill goes to assist the woman. In good faith, She assesses her neurological status & stays with her until the paramedics arrive. Once the paramedics arrive, the woman is taken to the hospital, Jill stays at the baseball game. Can Jill be sued for her actions?

18. EMTALA • Enacted by Congress in 1986 under the Consolidated Omnibus Budget Reconciliation Act (COBRA) • Also referred to as the “anti-dumping” law • States that persons are entitled to medical evaluation regardless of the ability to pay • Once a patient needs medical attention, it is the facilities responsibility to treat the patient or transfer them to needed higher level of care

19. EMTALA • Hospitals can be penalties for violation can include: • Termination of Medicare reimbursement • Fines up to $50,000 per violation (Hospital) • Fines up to $50,000 per violation (Physician) • Physician is subject to civil legality • Reimbursement to receiving facility • Malpractice lawsuit

20. Patient Rights (pg 112) • Patients have the right to: • considerate & respectful care • Obtain complete information to treatment & care • Give consent prior to any medical treatment • Have an advance directive for healthcare or a right of refusal • Privacy concerning a medical care program • Review medical records & hospital bills • Be informed about grievance policies

21. Consent – give permission to treat • Informed Consent • Patient must be informed about: • Complete Procedure • Risks • Benefits • Alternative treatment • Patient must verbalize & acknowledge desire for treatment & care

22. Consent • Implied Consent • Life – threatening situation & assume the patient would give consent if able to do so • “Serious threat to life or limb” • Delusional • Unresponsive • Unconscious

23. Who can give consent? • Mentally unaltered Adults • Parents of minors • Persons that are legally responsible for mentally challenged patients • Emancipated minors • Married • Pregnant • legal

24. Right to refuse treatment • Mentally competent adults have the right to refuse treatment • Healthcare professionals must ensure that the patient is fully educated about the risks, benefits, & potential dangers of refusing treatment • Once a patient is fully informed, a healthcare professional must respect the patient’s right to refuse treatment

25. Right to refuse treatment • Some patients refuse treatment for religious or personal moral issues • A patient must sign a refusal of treatment document with a witness • AMA – Against Medical Advice

26. Is this valid consent? • A 34 year old man needs his appendix removed. Can he give informed consent? • A woman falls to the ground in Wal-Mart having a seizure and is unconscious. What type of consent would apply in this situation?

27. Living Will/Power of Attorney

28. Test Review