Legal and Ethical Considerations

1. Legal and Ethical Considerations

2. Here’s what we will talk about: Civil LawFalse Imprisonmentnegligence Contracts consent ABUSEConfidentiality malpracticedefamation Agents/Principals the health care record Invasion of Privacy Torts Assault & Battery Slander/Libel ETHICSLegal Disability

3. Legal vs. Ethical(what’s the difference) Legal - Based on the LAW & enforced by local, state or federal government. Ethical - Based on personal beliefs of “right” or “good” morals or behavior. Health care works must follow both sets of “rules”.

4. IT’S THE LAW!!(criminal law or civil law) Criminal Law - CRIMES against a person, property or society. Examples: Murder, Theft, (for health care: misuse of narcotics, practicing without a license) Civil Law - Involve relationships between people. Disagreements. Often about a person’s rights. Judge Judy handles civil cases for people that don’t want to go to “real court”. (for health care: violating patient rights- TORTS)

5. FOCUS ON CIVIL LAW: Contracts and Torts Most health care legal cases involve Civil Law and deal with contracts and torts Contracts - agreements between 2 or more “parties” (people, businesses, groups) Torts- WRONGFUL ACTS that do not involve contracts It Rhymes! Wrongful acts Without contracts TORTS

6. CONTRACTS - (fill in the blanks)AN ____________ between __________________. 3 parts to a contract: Offer, Acceptance and Consideration. Each party has something to contribute/trade. If both parties agree the contract is made. Legal Disability- You must be LEGALLY ABLE to enter into a contract. If not, you are Legally Disabled *Must not be medicated or under the influence of drugs/alcohol*Must be of “sound mind” and competent *Must be 18 or over The contract is BREACHED if either party does not do their part .

7. Parts of a Contract Offer - what you have to trade Consideration - What the other person will give you for it Acceptance - Both parties agree and sign the contract. Examples in health care & in general…LET’S TALK ABOUT CONTRACTS

8. Contracts and Consent can be Implied or Expressed Implied Contracts and Implied Consent- Agreements made without verbally expressing the terms. Can you think of examples? Expressed Contracts and Expressed Consent- Agreements made and clearly stated verbally or in writing. Can you think of examples?

9. Employee / Employer Relationship?? Could this be considered a contract?? Is it an agreement with each party having something to trade? Is there an Offer, Consideration, Acceptance? Employee / Worker = AGENT Employer / Company / Boss = PRINCIPAL Both have responsibilities to each other: Principal is responsible for actions of the Agent. Agent is responsible for protecting the interests of the Principal.

10. Torts:(fill in the blanks)A tort is a “W_____ A___ not involving C______”. In health care, a tort occurs when a person/patient is harmed or injured because the worker does not deliver the proper standard of care. Torts are called “Civil Wrongs” not Crimes.. 7 torts are the most common in health care

11. Torts - Violations causing Harm or injury Many torts involve patient rights violations and often involve elderly patients in Nursing Homes or LTC facilities.

12. 7 Common Torts: Assault & Battery (These often go together) - Abuse Defamation False Imprisonment Invasion of Privacy Negligence Malpractice

13. Assault and Battery These are 2 different things that get categorized together because they often happen at the same time. Assault - Threatening or attempting to hurt a person. Battery - Physically touching a person to hurt them or touching without their permission.

14. Malpractice Negligence Mal = Bad (Bad Practice) Failure of a PROFESSIONAL to use the degree of skill/knowledge associated with that profession. Doing something you are not licensed to do OR Doing something you are licensed to do but doing it wrong / badly. MUST CAUSE HARM!! Failure to give the normal standard of care that is expected. Usually an unintentional mistake. Often falls or burns. Examples: Falls that happen because water was on the floor, burns because a heating pad was left on too long. MUST CAUSE HARM!!

15. Abuse -care that results in harm, pain, or mental anguish Abuse can be: Physical Verbal Psychological Sexual Financial

16. What does abuse look like?

17. Invasion of Privacy Related to their Body, Things/Belongings and Information Unnecessary exposure of body Opening drawers or going through someone’s belongings without permission Talking about a patient in a public location where others could hear Failure to close curtains or doors

18. Invasion of Privacy Related to their Body, Things/Belongings and Information Seeking private/unnecessary information about a person (reading someone’s mail or medical record) Sharing information that is confidential Leaving chart or computer screen open

19. False Imprisonment Restraining or restricting the freedom of an individual without proper justification Keeping someone in a location against their will. Patients have a right to leave the hospital - sign out AMA Against Medical Advice

20. Defamation - making FALSE statements that damage reputation or ridicule a person (harmful gossip)Statements may be written or verbal Spoken = Slander Saying something about someone that is not true and is harmful/hurtful to them Spreading gossip that is not true Written = Libel Incorrect information in newspaper, magazine or on-line Lies on facebook or in a text Wrong information on a report (police)

21. TELLING LIES - GIVING WRONG INFORMATIONTHAT IS HARMFUL TO A PERSON’S REPUTATION OR BELITTLES THEM

22. REMEMBER: Many torts involve patient rights violations and often involve elderly patients in Nursing Homes or LTC facilities.This will help you remember the 7 Torts Use this simple phrase: “Hey you two, Find Ma!” You Two (Assault and Battery) F. I. N. D. M. A.

23. Hey you two, find ma! Hey you 2 (Assault and Battery) F (False Imprisonment) I (Invasion of Privacy) N (Negligence) D (Defamation - could be libel orslander) M (Malpractice) A (Abuse)

24. Privileged Communications: • All information given to health care workers by a patient • This info must be kept confidential (it’s the law) • Only share this info with health care workers with a “Need to Know”. • For info to be shared with ANYONE there must be a written consent. (This includes husband/wife/etc…)

25. Privileged Communications: Aspecial right granted to a person or group. Information legally exempt from disclosure. • EXAMPLES • The Health Care Record • Stored data in electronic medical record • Information the patient tells you

26. Some Information must be told • Births and Deaths • Violent injuries - abuse, homicide, suicide • Communicable diseases • Sexually transmitted diseases • Things that need to be known to protect the public

27. Federal Law Protects Information • HIPAA - Health Insurance Portability and Accountability Act of 1996 • The Privacy Rule from USDHHS in 2003 • Health Care workers MUST abide by these regulations

28. Privileged Information Owned by the health care provider Patient has a right to see or get a copy of the record It is a LEGAL record and can be used in court Rules for Charting No erasures, No white out Properly maintained and stored in locked location for years Shredded or destroyed at the end of the holding period The Health Care Record (Patient Chart)

29. Patient Rights

30. Confidentiality Privacy Right to Refuse Treatment Respect Right to Choose Freedom from RestraintsPatient Rights / Resident RightsRight to make end of life choices Freedom on choice of doctorInformed Consent

31. Patient’s bill of Rights Created by the AHA (American Hospital Association) Resident’s Bill of Rights Created by Federal Government OBRA - Omnibus Budget Reconciliation Act of 1987 Protecting the Rights of Patients

34. Here’s what we talked about: Civil LawFalse Imprisonmentnegligence Contracts consent ABUSEConfidentiality malpracticedefamation Agents/Principals the health care record Invasion of Privacy Torts Assault & Battery Slander/Libel ETHICSLegal Disability