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HM 05.2 – 5.4 Medico-legal Framework. DR Kithsiri Edirisinghe MBBS, MSc , MD ( Medical Administration). The Topics. 5.2 Introduction to Medico-legal Issues in Healthcare Services Setting. Discussion topic:

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HM 05.2 – 5.4 Medico-legal Framework


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  1. HM 05.2 – 5.4 Medico-legal Framework DR Kithsiri Edirisinghe MBBS, MSc, MD ( Medical Administration)

  2. The Topics

  3. 5.2 Introduction to Medico-legal Issues in Healthcare Services Setting • Discussion topic: • Description on types of medico-legal cases; procedures to handle medico-legal cases; Police, investigations and court deliberations, death certificates; Court procedures in hospital setting, with civil and criminal cases related to hospitals. • Methodology: • Lecture and discussion  • Readings: • Manual of Management of Hospitals, Ministry of Health Sri Lanka, 2002

  4. 5.3 Medical Negligence and Malpractice •  Learning outcomes: • To give an overall view of medical negligence and malpractice in a healthcare services setting. • Discussion topic: • Definitions, scope and description ofmedical negligence and medical malpractice: areas of medical negligence and medical malpractice; laws related to medical negligence and medical malpractice; steps to curtail medical negligence and medical malpractice at the hospital and service level. • Readings • Procedure book on Ethics & medical practice, Ceylon Medical council • Medical negligence and the law, K.K.R. Murthi, Indian Journal of Medical Ethics • Medical Negligence, Sri Lankan cases, LST Review, 2001

  5. 5.3 Modular Evaluation • Discussion on the Hospital case studies related to Legal aspects given cases through word document ( 10 pages)

  6. HM 05.2 – 5.4 Medico-legal Issues in Healthcare Services Setting DR Kithsiri Edirisinghe MBBS, MSc, MD ( Medical Administration)

  7. Definitions • Medicine: The science and art of diagnosing, treating, and preventing disease. • Law: A system that provides for rights between parties. • Civil Law concerns disputes among private parties (individuals, businesses, corporations). • Criminal law concerns enforcement of societal rules against individuals.

  8. Sources of Law • Constitution • Statutory • Common • Administrative

  9. 1. Medical Law

  10. Medical Law • Sri Lankan Law is a mixture of Roman Dutch & British law • Very limited legislation specific to health- Medical law • There is no written document of doctor patient relationship in law and it is interpreted under common law • It is part of “Malpractice law” concerned with claiming injuries to the patient - “Torts” • Torts breech of duty & damages – concerned over wider area of negligence, accidents & defamation ( insult/offence)

  11. The Challenges in Medical Law • Medical law based on following: • Medical Ethics • Medical Professionals and their monopoly • Complexity of the medical errors • Implications of medical litigations on society

  12. A. Medical Ethics

  13. Health as a right • Health is not directly given as a right in Sri Lanka • Indirectly indicated as a right under normal law / civil law as “Fairness” • Coverage • Access • Affordability • Sustainability • Efficiency • Effectiveness

  14. Health as a right • Under fairness –He/she has a right to; • Treated with dignity • Information • Confidentiality • Choose treatment • Reference

  15. Medical Ethics • In medicine ethics is concerned with the code of conduct and actions of health professional.

  16. Code of conduct for health professionals • Devoid of discrimination • Provider of service should be competent , dedicated, honest & exhibit ethical behavior • Good interpersonal relation with other professionals • Abide by rule of law • Maintain optimum standard of care • Abstain from using patients / relations for any favours for the services rendered • Abstain using official facility for private use • Be an active member of professional body • Maintain confidentiality of patients • Gide the best option for patients treatment

  17. Healer Councilor Teacher Social Leader Donor Diplomat Gentlemen Lady Citizen Family Member Higher Social expectations from a doctor / Nurse

  18. Doctor -Patient relationship • Privacy • Confidentiality • Veracity • Fidelity

  19. 1. Privacy • Areas where patient does not want to reveal : • History • Examinations • Complicated process: • Social harm • Social benefit • Use your common sense

  20. 2. Confidentiality • Not reveling information collected from the patient: • Verbally • Examination • Records • Complicated process • Educate staff • Security of Medical documents

  21. 3.Veracity • Revealing truthful information to the patient: • As a professional • Cultural /social /Medical • harm • Benefit

  22. 4.Fidelty • Agreement with the patient • Verbal • Non verbal • Unwritten

  23. B. Medical Monopoly

  24. Monopoly • Cartel • Domination • Control • Medical Monopoly- Medical Professionals have a higher status in society leading to monopoly. • Medical Administrators nightmare & challenge

  25. B. Medical Monopoly • Monopoly – no choice “gods in their own right “ • They directly / indirectly Influence on • Medical information systems • Regulatory bodies - MOH, MC, SLMA • Regulators – MOH, Minister, president , parliament • Legislators / law makers • Protection of the medical community • Boards of specialty • Medical council • Trade unions -GMOA / Nurses union

  26. C. Complexity of Medical errors

  27. C. Complexity of Medical errors • Medical professionals deals with humans Vs others dealing with • Papers – lawyers / administrators/ politicians • Numbers – Accountants • Machineries buildings – Engineers • Plants – agriculture • Equipments – operators

  28. C. Complexity of Medical errors • Medical errors are catastrophic vs. the other professions • Majority gray areas – not clear black & white • Holding accountability individual Vs. team : most of the time a team is involved • Complexity of the process of treatment • Variation of the disease profiles • Variation with the client

  29. D. Implications of medical litigations on the society

  30. D. Implications of medical litigations on the society • Doctors make many clinical assumptions and judgments in diagnosing and treating patients based on : • best practices • experience • Majority of the cases the assumptions are beneficial to the patient in-terms : • of cost & time • Comfort & safety

  31. D. Implications of medical litigations on the society • Litigation can remove these assumptions leading to doctors practicing • “defense medicine”; • do “everything by the book” ASS -U - ME • They will safe guard them selves • Result: More tests, many referrals & specialist opinions , delay in treatment can lead to morbidly & mortality and great cost & suffering to the patients

  32. Assignment • Discuss how modern medical administrator could face effectively the threats and the challengers of the medical law and related issues. • Word document – Min 1000 words

  33. Rules governing healthcare sector, Sri Lanka

  34. Rules governing healthcare sector • Civil law / common law • Criminal law • Medical Ordinance • Nursing home act • Medical ethics • Private health services regulatory act

  35. Medical law • No direct legislation • Described under torts as doctor -patient relationship & it covers : • Negligence , accidents & defamation • 03 important issues on Medical law • Negligence • Consent • Confidentiality

  36. A. Medical Negligence

  37. Negligence - Definitions • ‘Tort’ is a legal wrong for which damages can be awarded in court. • Tort law is primarily “common law,” defined and evolving as courts decide cases. • ‘Statute of Limitations’ defines the period in which the lawsuit must be initiated.

  38. Typical Causes of Negligence • Not having required skills • Performing skills incorrectly • Performing unauthorized skills

  39. Medical Negligence • This is described under common professional negligence , not specific to health • 04 elements in negligence • Wrongful misconduct /duty of care • Fault • Causation • Patrimonial / Damages

  40. 1. Wrongful misconduct /duty of care Wrongful misconduct • Act or omission • Act – doing something • Omission – not doing something

  41. 1. Wrongful misconduct /duty of care Duty of care • Standards commonly practiced ,accepted by the responsible body of “Medical men” ( Medical council/ Specialized bodies ) • For investigation, diagnosis and treatment of patients • Vicarious liability – patient sue the hospital not the doctor ,since it has a “deep pocket “

  42. Standards of Care • “How a reasonable, prudent, properly trained medical Officer at the same level of training would perform under the same, ‘or similar’ circumstances.”

  43. General Standards • Provide Medically Correct Treatment Consistent with Scope of Practice • Ambulance • Ensure Vehicle is Appropriately Stocked & Supplies • Ensure Equipment is in Good Working Order • Operate Vehicle and Park in a Safe Manner

  44. 2. Fault / Breach of duty of care • Fault • Whether the act was well below the standard or acted carelessly • Breach of duty care • Accepted practice not followed • Verified by a medical expert in court of law

  45. 3. Causation • 03 main areas • Establishment of a duty of care • Establishment of a breach of duty of care • Establishment of breach of duty of care was the sole reason for the suffering of the patient - “ but for test “ indicate the direct line of relationship between duty of care & the breach of duty of care

  46. 4. Patrimonial / Damages • The damages • Financial • Physical • Psychological • Social • Material • Quantification of the damages

  47. Vicarious Liability • Occurs when employer held responsible for negligence of employee or someone under employer’s control

  48. B. Consent

  49. Description of consent • Based on medical ethics • Law interprets on autonomy and beneficence ( self determination) • Modern approach to self determination is the informed consent. This is based on • Knowledge • Appreciation of risk • General consent - willingness

  50. Types of Consent • Informed Consent • Expressed Consent • Implied Consent • Special Circumstances • Exception of informed consent id the “therapeutic privilege” – psychiatric, unconscious • Minors • Patients with Impaired Mental state