Legal/ethical medical issues

1. Legal/ethical medical issues Mrs. Maury Rich RN,BSN

2. Bell Work 2-5-18 • Can you think of an example of an ethical dilemma you have personally experienced or know about to share with the class. • How do you differentiate between morals and ethics?

3. Standard • Summarize the Health Insurance Portability and Accountability Act (HIPAA), in particular those aspects related to maintaining confidentiality, patient rights, patient safety, and other ethical/legal directives governing medical treatment. Using medical terminology and accurate definitions of legal concepts, explain how the content of these ethical/legal ramifications affects patients’ rights for all aspects of care.

4. Ethics and Morals • Morals—personal beliefs of right and wrong behavior based on religious beliefs, cultural norms, family customs, and past experiences • Ethics—human behavior and its effect on society, more concerned with the big picture as well as the immediate situation

5. Ethics versus Morals • Morals are usually grouped into categories, including duties, rights, responsibilities, character traits and conditions of justice • Ethics: study of morals and moral judgements.

6. Laws and Ethics • Laws can be made to designate actions that are right and wrong even though the same action may not be viewed as unethical • Another action may be viewed by some as ethical but is considered illegal

7. Susan is a respiratory therapist at a large hospital. It was discovered that Susan had an affair with the chief of staff at the hospital. She was later fired by the board of the hospital. Were Susan’s actions illegal or unethical? • Illegal: go to the right side of the room by the window • Unethical: go to the left side of the room by the door • Both: go to the back of the room

8. Nonmaleficence • Pertains to health-care workers • “Do no harm” • Hippocratic Oath, professional codes • In medicine there is always a potential to do harm

9. Code of Ethics • Broad moral guidelines and a public document professing the group’s moral and ethical commitments to the profession and patient.

10. Autonomy • Right of patients for self-determination • Freedom of choice • Patient’s right to refuse or accept medical treatment • Obtain informed consent before treatment or procedures • https://www.youtube.com/watch?v=LSeiur_-0IU

11. Anatomy of an Ethical Dilemma • A decision must be made • The outcome will have profound consequences • There is a disagreement among involved parties about right course of action

12. Ethical Decision Making • Bias—response based on previous experience • Uses ethical reasoning process • Thoughtful decision making based on solid understanding of ethical principles and careful reasoning

13. Ethics Committees • Serve as resource to health-care organizations • Formulate institutional policies • Provide education for staff • Serve as consultant role between patients and providers

14. Scenarios • An adult Jehovah’s Witness patient because of acute massive bleeding which cannot be rapidly stopped requires life saving blood transfusion but is awake and refuses blood transfusions based on the patient’s religion. The patient is informed that with the transfusion, the patient will live and the underlying bleeding problem can be resolved with no long term medical consequences. Without the transfusion, the patient could most likely die. The patient still refuses but the physician, as the patient is beginning to lose consciousness, violates the patient’s autonomous demand and begins the blood transfusions. Is what the physician did ethical?

15. Scenario • Brain surgery of lesions is often performed on conscious patients to establish safe dissection around motor and sensory areas. A patient with skull opened and brain exposed demanded the surgeon to stop the operation at once despite understanding the consequences of fully terminating the surgery at this point and leaving the skull open. Instead of stopping, the surgeon had the patient anesthetized to allow proper closure of the skull thus was violating the patient's demand. Is what the surgeon did ethical?

16. Medical Malpractice Act Statute or law regulating the practice of medicine Safeguards patient’s safety and privacy Responsibility of all personnel in health care

17. Licensure Regulation to ensure competence May vary from state to state Renew and pay every 2 years Continued education

18. Revoking a License Conviction of crime such as a felony or fraud Unprofessional conduct, such as, addiction, breach of confidentiality, false advertising, unethical behavior, inability to perform duties, or fee splitting

19. Scope of Practice The range of services a professional can offer based on education, training, ability, and licensure For example, medical assistants are trained to assist with minor surgery…medical assistants cannot perform surgery!

20. Standard of Care The minimum safe professional conduct under specific conditions as determined by professional peer organizations Failure to perform is negligence Omission: failure to use good judgment that results in harm to the patient Commission: performance of improper act that results in harm to patient Unintentional tort: negligence resulting in harm to a patient

21. Consent Implied consent— patient consents to treatment through actions What would be an example of implied consent? Informed consent— written form, signed by patient explaining procedure or treatment, who will perform, risks, and expected results When would informed consent be necessary?

22. Barriers to Informed Consent • Interpreters may be necessary if a patient is hearing impaired or speaks a different language • Good Samaritan law protects emergency personnel when a patient may not be able to speak or give consent • When might the Good Samaritan law be used?

23. Malpractice Medical form of negligence proven by four criteria, the 4 “D’s” Duty: must prove relationship existed (how?) Dereliction of duty: Must prove standard of care was not met (Use of expert witness) Direct cause: Damages suffered were a direct result of action in question Damage: must prove injury occured

24. ASSIGNMENT: Part 1 • Break into groups and do the case scenarios online. One paper per group. Answer must be at least 2 sentences. Groups: Sugey, Lou, Rebecca Mary Mack, Katlyn, Madison Kennedy, Abby, Matt Anna, Harley, Elsayed Kelton, Madi, Josie Meagan, Daegan, Chrissy Caleb, Alison, Jaylie Taha, Jon and Hannah

25. Assignment Part 2 Moral Belief Questions: Complete in Course Activities in Notebook. • 1. Name the individual who has had the greatest influence on your understanding of right and wrong. Why? • 2. What do you value most? Why? • 3. What do you use as a benchmark for making moral decisions? Where did it come from? • 4. Who is your personal hero? Why? Who is your professional hero? Why? • State three (3) qualities you consider important in order to maintain professional integrity.

26. Assignment 3 – VocabularyPage 104 • Abuse Libel • Advance directive living will • Civil law Negligence • Confidentiality Slander • Criminal law Tort • Defamation • DPA • Ethics • Informed consent

27. Bell Work: Feb. 6, 2018 • 1. A patient’s right to refuse or accept medical treatment is called? • 2. Define Nonmaleficence

28. Confidentiality • Privileged information is confidential data and includes all medical and personal data, that is disclosed within the health care facility • Confidentiality is the most longstanding, consistent component in all Codes of Ethics

29. Confidentiality • Client information can only be discussed with other health care providers who are involved in the care • Confidentiality must be maintained in order to preserve human dignity • Trust is built between the client and health professional by maintaining confidentiality

30. Confidentiality • Confidentiality is an ethical and legal responsibility

31. Confidentiality Patient’s medical and personal information used for treatment, payment, and administrative operations “Need to know” Authorized release of information HIPAA

32. What is H.I.P.A.A.? • Health Insurance Portability and Accountability Act • Established 1996 • Compliance required by all health care agencies by April 2003 • Created privacy practice standards that the healthcare worker must follow

33. Benefits of HIPAA • Reduces health care costs • Patients have total control on how information in their medical record is used • Patients are able to see and obtain copies of their records • Limits can be set by the patient on who can view and obtain their information • Provides healthcare workers accountability to keep patient care information private

34. Why is it needed? • Provides patients with legal rights and voices in how healthcare groups/companies use the protected health information (PHI) • Other areas of HIPAA include “security requirements” for computer storage and transmission of healthcare data along with insurance claim "transaction requirements”

35. Violation of HIPAA • Civil penalties for violation of HIPAA regulation include fines • acted without knowing what you were doing was wrong • Criminal penalties can include fines and jail • knowing what you were doing is wrong and tried to get profit from it • Enforcement targets the healthcare provider and agency

36. Components of HIPAA • https://www.youtube.com/watch?v=KhF6v_WQOlo • Using PHI (Definitions) • Protecting PHI • PHI can be defined as any medical information concerning a patient identification; • Name • ID number • Or any means of identification

37. What could HIPAA violations cost? • Alaska Dept Health and Human Services • 1.7 million • USB hard drive containing patient information • Drive stolen from an employees car • Found guilty due to inadequate safety measures and failure to properly train employees

38. What could HIPAA violations cost? • WellPoint insurance company • 1.7 million • 612,402 clients affected • PHI was available to unauthorized users on the internet for over 5 months after a software update • Company was found guilty

39. What could HIPAA violations cost? • CVS Pharmacy • 2.25 million • Found guilty of dumping PHI in public dumpster

40. What could HIPAA violations cost? • 2.2 million • New York Presbyterian Hospital • Guilty of disclosure of two patients’ protected health information (PHI) to film crews and staff during the filming of “NY Med,” an ABC television series, without first obtaining authorization from the patients. • In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop. 

41. Scenarios Kelly is a high school student who was given the opportunity to job shadow at the local hospital. While shadowing, one of the patients she worked with was Ms Smith, who attends the same church as Kelly. Two weeks later Kelly sees Ms. Smith and her daughter at church. Kelly: “Hi, Ms. Smith. I’m so glad to see you are out of the hospital and are healing from the fall you took!” Was the encounter between Ms. Smith and Kelly at church HIPAA compliant? Why or why not? If you do not think it was compliant how could she make it compliant?

42. Scenarios • Christy is a medical assistant that work in a large practice with several doctors. Her best friend comes into the office to see a doctor that Christy doesn’t work with. After Christy’s friend leaves Christy immediately pulls up her friends chart. Is it HIPAA compliant for Christy to access her friend’s chart? If you do not think it was compliant how could she make it compliant?

43. Scenarios • Jane is a R.N. at the local hospital. She is caring for a very difficult patient that needs constant attention. Lucy cared for the patient last time the difficult patient was in the hospital. Jane goes to Lucy for advice on how to care for the patient. Is it HIPAA compliant for Jane to talk to Lucy about the patient? If you do not think it was compliant how could she make it compliant?

44. Reporting Abuse Healthcare professionals are required by law to report all suspected abuse Procedures and forms vary from state to state Follow office policy and procedure manual

45. Child Abuse Neglect—child unattended, needs are not being met Emotional abuse—caregiver yells at child, fails to provide affection and attention Physical abuse—bruises, cigarette burns, and bites Sexual abuse—painful urination and unusual sexual knowledge for child’s age

46. Elder Abuse Neglect—unclean or unsafe living conditions, poor hygiene, and weight loss Physical abuse—frequent injuries, bruises, and patient’s fear of the caregiver

47. Bell Work 2-7-18 • What does HIPAA stand for? • Give me two benefits of HIPAA • When a patient consents to treatment through actions, it is called?

48. Advance Directives • Directions a person leaves for family or caregiver in ADVANCE of a life-threatening situation • It can include: Living Will DNR (DO NOT Resuscitate Order) Durable Power of Attorney (Health Care Proxy)

49. Living Will Document outlining type of care a patient requests in the event of severe injury Life support, feeding tubes, medications, kidney dialysis, ventilators, organ donation, etc. Advanced directive is a part of the living will https://www.youtube.com/watch?v=1rmlGJxdpMk

50. DO NOT RESUSCITATE ORDER (DNR) • Order signed by Physician • Directs Resuscitative efforts of cardiac or respiratory arrest • Usually in Chronic illness when it has been determined that resuscitation would prolong suffering.