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3. Legal and Ethical Issues in Medical Practice, Including HIPAA. Introduction. Reasons to study medical law and ethics Function at the highest professional level Avoid legal problems. Knowledge of medical law and ethics provides insight into
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3 Legal and Ethical Issues in Medical Practice, Including HIPAA
Introduction • Reasons to study medical law and ethics • Function at the highest professional level • Avoid legal problems
Knowledge of medical law and ethicsprovides insight into The rights, responsibilities, and concerns of health-care consumers The legal and ethical issues facing society, patients, and health-care professionals as the world changes The impact of rising costs on the laws and ethics of health-care delivery Medical Law and Ethics
Medical Law and Ethics(cont.) Law Ethics A law is a rule of conductor action prescribed or formally recognized as binding or enforced by a controlling authority. Ethicsis a standard of behavior and a concept of right or wrong. Moral values serve as the basis for ethical conduct. Family, culture, and society help form an individual’s moral values.
Criminal law Crime against the state Criminal acts are Felonies or Misdemeanors Examples include: Murder Arson Sexual assault Burglary Civil law Crimes against the person Includes a general category of laws known as torts Torts are either: Intentional (willful) or Unintentional (accidental) Medical Law and Ethics(cont.)
Intentional Torts Open threat of bodily harm An action that causes bodily harm to another, including touching without permission Assault Battery Invasion of privacy Depriving or attempting to deprive a person of his or her rights Fraud Interference with a person’s right to be left alone False imprisonment Defamation of character Damaging a person’s reputation by making false and malicious public statements Intentional, unlawful restraint or confinement of a person
Unintentional Torts • Acts that are committed with no intent to cause harm but done with a disregard for the consequences • The term negligenceis used to describe such actions when health-care practitioners fail to exercise ordinary care, resulting in patient injury • Malpractice is the negligent delivery of professional services
Agreement Consideration Contractual Capacity Legal Subject Matter Contracts A contract is a voluntary agreement between two parties in which specific promises are made for a consideration. Elements of a Contract
Types of Contracts • Expressed contracts • Clearlystated in written or spoken words • An example is a payment contract • Implied contracts • Actions or conduct of the parties, rather than words, create the contract • An example is a patient rolling up his or her sleeve to receive an injection
Apply Your Knowledge What is the difference between law and ethics? ANSWER: A law is a rule of conduct or action and is enacted by governments to maintain order and public safety. Ethics is a standard of behavior based on moral values that are influenced by family, culture, and society. Good Answer!
Physician/Patient Contract • Reasonable limitations • Both parties have rights and responsibilities related to the contract
Physician Rights • Set up a practice within the boundaries of his or her license to practice medicine • Select where to set up an office and establish office hours • Specialize • Decide which services to provide and how those services will be provided • Physicians do not have to • Treat every patient • Return patient to original state of health • Make a correct diagnosis in every case • Guarantee success of treatment or operation
Physician responsibilities • Use due care, skill, judgment, and diligence • Keep knowledge up-to-date • Perform to the best of his or her ability • Furnish complete information and instructions to the patient Physician Responsibilities
Patient responsibilities Follow physician’s instructions and cooperate with care Provide relevant information to the physician Follow the physician’s orders for treatment Pay the fees charged for services provided Patients May choose their physician May terminate a physician’s services The Patient Care Partnership A list of standards that patients can expect in health care Formerly the Patient’s Bill of Rights Patient Rights/Responsibilities
Consent Implied – actions imply permission Informed Patient receives all information necessary to make a decision regarding treatment Doctrine of informed consent – legal basis for informed consent Liability Legal responsibility for actions Understand scope of practice Understand standard of care and duty of care Medical assistants are all held to the “reasonable person standard” Patient-Physician Contract (cont.)
Comply with HIPAA Notify patients in writing Give option of choosing another physician or make referral Secure or dispose of records appropriately Remain up-to-date on HIPAA laws Special Circumstances – Closing of a Practice
ANSWER: Patient responsibilities are: Follow physician’s instructions and cooperate with plan of care Provide relevant information to the physician Follow the physician’s orders for treatment Pay the fees charged for services provided Apply Your Knowledge Patients have rights and responsibilities relating to health care. The rights are determined by the Patient Care Partnership. What are the patient’s responsibilities? Good Job!
Lawsuits Add to cost of health care Take a psychological toll on all involved Prevention Use of reasonable care to prevent professional liability Preventing Lawsuits
Malpractice claims are lawsuits by a patient against a physician for errors in diagnosis or treatment Examples: post-operative complications, Res ipsaloquitur(the thing speaks for itself) Negligencecases are those in which a person believes a medical professional’s actions, or lack thereof, caused harm to the patient Examples: abandonment, delayed treatment Malpractice
Legal terms used to classify negligence Malfeasance - unlawful act or misconduct Misfeasance - lawful act done incorrectly Nonfeasance- failure to perform an act that is one’s required duty or that is required by law Malpractice (cont.)
amages Patients must prove that they suffered injury. Patients must show that the physician failed to comply with the standards of the profession. erelict Patients must show that a physician-patient relationship existed. uty Patients must show that any damages were a direct cause of a physician’s breach of duty. irect Cause The 4 Ds of Negligence D Patients must be able to prove all 4 Ds in order to move forward with a malpractice suit.
Settling malpractice suits Arbitration People with special knowledge in the field listen to the case and decide the dispute Court Written court orders (subpoena) are delivered to involved parties. Subpoena duces tecumis a court order to produce documents such as patient records Civil law Concerned with an individual’s private rights Torts Negligence Breach of contract Failure to adhere to a contract’s terms Malpractice (cont.)
Law of Agency Employees are considered to be agents of the physician while performing professional tasks Physicians are responsible or liablefor the negligence of employees Respondeat superioris a Latin term meaning “Let the master answer” Malpractice (cont.) Employees are also legally responsible for their own actions, and they can be sued directly.
Attend court proceedings as required and do not be late for scheduled hearings Bring required documents to court and present them when requested to Refresh your memory before testifying Speak slowly, clearly, and professionally Answer all questions in a straightforward manner Answer only the question asked Appear well groomed, and dress in clean, conservative clothing Courtroom Conduct
Reasons patients sue Unrealistic expectations Poor rapport and poor communication Greed and our litigious society Poor quality of care Professional Liability Coverage – protects the physician and staff against financial losses from lawsuits filed against them Malpractice (cont.)
Statute of limitations • Laws that set the deadline or maximum period of time within which a lawsuit or claim may be filed • Deadlines vary • Type of case • State vs. federal court Malpractice (cont.)
aring Sincere caring decreases the likelihood that a patient will sue if outcomes are unsatisfactory or adverse events occur. ommunication Develop trust and respect with patients by communicating professionally and confirming that you have been understood. ompetence Maintain competence and update knowledge and skills frequently. harting Documentation is proof of competence. Chart every conversation and interaction you have with a patient. The 4 Cs of Malpractice Prevention C
Reasons for terminating care of a patient Refusal to follow physician instructions Patient family member complaints Personality conflicts Failure to pay for services rendered Repeated failure to keep appointments When withdrawing from care, a physician must Provide written notification Reasons for withdrawing Recommend that the patient find another physician Send by certified mail with return receipt requested Document in the patient record reasons for terminating care and actions taken to inform the patient Terminating Care of a Patient
Standard of Care • Apply legal concepts to practice by • Maintaining confidentiality • Practicing within the scope of training and capabilities • Preparing and maintaining medical records • Documenting accurately • Using proper guidelines when releasing information
Apply legal concepts to practice by Following legal guidelines and maintaining awareness of health-care legislation and regulations Maintaining and disposing of regulated substances appropriately Following risk-management and safety procedures Recognizing professional credentialing criteria Standard of Care (cont.)
Duties related to legal requirements Administrative Duties and the Law • Insurance billing • Patient consent forms • Documentation in the medical record • Making appointments • Appointment books are a legal document • State reporting requirements • Births • Abuse • Certain diseases • Injuries from violent acts • Deaths • Phone calls • Maintain privacy
Clear and complete Referrals Missed appointments Dismissals Patient contact Medical record correction Medical records Property of facility or physician Doctrine of Professional Discretion Retention and storage Based on state law Documentation
Controlled Substances and the Law Be familiar with correct dosages, potential complications, and refill rules. Medical assistants must follow the correct procedure for keeping and disposing of controlled substances.
Legal Documents and the Patient States the types of treatment the patient does and does not want in an event of terminal illness, unconsciousness, or comatose state. Patients with living wills are asked to name someone that will make decisions on their behalf (durable power of attorney) if they are unable to do so. Living Will (Advance Directive) Uniform Donor Card A legal document that states a person’s wish to donate one or more organs or whole body.
Legal obligation to maintain confidentiality of patient information Discuss with patient privately Share patient information only when appropriate Do not discuss the case with anyone outside the medical office Confidentiality Issues Confidential
Health Care Quality Improvement Act (1986) Purpose: Improve the quality of medical care nationwide National Practitioner Data Bank Federal False Claims Act Qui tam To bring action for the king and one’s self Control three types of illegal conduct False billing claims Kickbacks Self-referrals Federal Legislation Affecting Health Care
The Occupational Safety and Health Administration (OSHA) is a division of the U.S. Department of Labor Regulations describe precautions that must be taken to protect workers from exposure to health hazards on the job, including exposure to infectious diseases such as Human immunodeficiency virus (HIV) AIDS Hepatitis B virus (HBV) OSHA Regulations
Exposure Plan • Personal protective equipment or gear • Immunizations against hepatitis B virus (HBV) • Information on what to do in case of exposure • Information on decontamination of waste products • Information on how to dispose of sharp equipment (needles, etc.) • Information on post-exposure evaluation and follow-up
Exposure Plan (cont.) • Information on how to keep an inventory of hazardous materials • Labeling for bio-hazardous wastes • Training, annual updates regarding hazardous materials and infectious substances • Recordkeeping and documentation to protect the legal rights and safety of employees
HIPAA • Health Insurance Portability and Accountability Act (1996) • Improve efficiency and effectiveness of health-care delivery • Protect and enhance the rights of patients • Access to health-care information • Control inappropriate use or disclosure • Improve the quality of health care by restoring trust in the health-care system
Title I: Health Care Portability • Increases workers’ ability to get health-care coverage when starting a new job • Reduces workers’ probability of losing existing health-care coverage • Helps workers maintain continuous health-care coverage when changing jobs • Helps workers purchase health insurance on their own if they lose coverage under an employer’s group plan and have no other health-care coverage available
Title II: Prevention of Health Care Fraud and Abuse, Administrative Simplification and Medical Liability Reform • HIPAA privacy rules • Give patients more control over their health information • Set boundaries on the use and release of health-care records • Establish appropriate safeguards to protect the privacy of health information • Hold violators accountable if they violate patients’ privacy rights • Strike a balance when public responsibility supports disclosure of some forms of data
Privacy Rule – protected health information (PHI) HIPAA (cont.) • Use – movement within an organization • Disclosure – transmitted between or among organizations • Managing and storing • Sharing • Notice of Privacy Practices (NPP) • Protection – security measures • HIPAA Security Rule • Computer networks • The Internet • Disks, other storage media, and extranets • Chart • Reception area and clinical stations • Fax, copier, and printer
Violations and penalties Civil Criminal – for the knowing, wrongful misuse of health information Administrative simplification Standardizing patient information Standardized codes and formats – electronic transaction records HIPAA (cont.)
Principles for preventing improper release of information When in doubt, do not release information It is the patient’s right to keep patient information confidential or disclose it All patients should be treated with the same degree of confidentiality Be aware of all applicable laws and of the regulations Confidentiality Issues and MandatoryDisclosure
Principles for preventing improper release of information When necessary to break confidentiality and when there is a conflict between ethics and confidentiality: Discuss it with the patient If the law does not dictate what to do in the situation, the attending physician should make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others Get written approval from the patient before releasing information Confidentiality Issues and MandatoryDisclosure (cont.)
Code of Ethics • Principles of right and wrong • Laws are often based on ethical considerations • Medical professionals are expected to act ethically
Bioethics Pertains to issues that arise due to medical advances Principles of medical ethics have developed over time dating back to Hippocrates AMA: defines ethical behavior for physicians Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities Replaced the Patient’s Bill of Rights Code of Ethics(cont.)
Legal Contract Elements • An agreement between two or more competent people to do something legal • Names and addresses of the people involved • Consideration (whatever is given in exchange, such as money, work, or property) • Starting and ending dates, as well as date(s) the contract was signed • Signature of the employer and employee
Apply Your Knowledge Mr. Jones would like to try a new treatment for his Parkinsonism, but his physician refuses to discuss a new treatment with Mr. Jones because he morally disagrees with this type of treatment. This is an example of what type of issue, and what should the physician do? ANSWER: This is an example of a bioethical issue. The physician should refer the patient to another physician who specializes in this treatment. Good Answer!