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MEDICOLEGAL ASPECT OF ER PRACTICE PREPARED BY ABU GHARBIEH MAZEN, MD. EMERGENCY DEPARTMENT MAKASSED HOSPITAL JERUSALEM. Palestinian laws Standard medical practices. ER Physician health care providers. Obligate. ACT. patients. Interface within the context of the

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Presentation Transcript
slide1
MEDICOLEGALASPECT OF ER PRACTICEPREPARED BYABU GHARBIEH MAZEN, MD.EMERGENCY DEPARTMENTMAKASSED HOSPITALJERUSALEM
slide2

Palestinian laws

  • Standard medical
  • practices
  • ER
  • Physician
  • health care providers

Obligate

ACT

patients

Interface

within the context of the

legal and justice systems

the state

slide3

CASES WITH

LEGAL ASPECTS

ASSAULT &

INJURIES

POISONING

slide4

What should ER health

Care providers know ?

Their duties

Rights of the

patient

slide5

Duties of Physician & health care providers

in ER

  • Awareness of legal obligations.
  • Recognize patterns of injury.
  • Documentation of Observations.
  • Processing evidences.
  • History and data collection: patient & witnesses.
slide6

Documentation of physical examination.

  • Using diagnostic and documentary tools.
  • Documentation of the injury by photography.
  • Case reporting: to state social services or law enforcement agencies.
  • Death declaration.
slide7

RIGHTS OF THE PATIENT’S

  • Respectful care.
  • To know, by name, the physician responsible for coordinating his or her care.
  • To obtain from his or her physician complete current information about diagnosis, treatment, and prognosis in easily understandable terms.
  • To receive from his or her physician information necessary to give informed consent prior to the start of any procedure or treatment. Except in emergencies.
  • To refuse treatment to the extent permitted by law.
slide8

To be transferred to another facility, providing the transfer is medically permissible, and the facility has agreed to accept the patient.

  • To expect that medical information, will be communicated to the referring physician.
  • To privacy concerning the medical care program. Case discussion, consultation, examination, and treatment are confidential and will be conducted discreetly.
  • The patient has the right to know in advance what appointment times and physicians are available and where to go for continuity of care provided by the Clinic.
slide9

Cases to be reported

  • Child and elderly abuse.
  • Domestic violence.
  • Suicidal cases.
  • Gun shot injuries.
  • Rape.
  • Illegal pregnancy.
  • MVA.
  • Infectious diseases:
      • AIDS.
      • TB.
      • Meningitis.
      • Cholera etc.
  • Drug and narcotic abuse.
  • Mammals bite mainly rabies prone.
  • Unexplained death for any age.
slide10

PATTERNS

OF INJURY

Mode of

production

components

circumstances

Abrasion

Bruise (ecchym)

Contusion

Laceration/tear

Stab/cut

Bite

Burn

Missile

penetration

9. Strangulation

blunt force

Homicidal

Accidental

Suicidal

electricity

sharp force

chemicals

  • missile

heat

Wound

Description

slide13
Physicians without forensic training should avoid giving any opinion regarding a wound being an entrance or exit.
  • Identification of the site of the entrance and exit of a gunshot wound path is an important step in the reconstruction of the shooting incident.
  • Clothing soiled with gunpowder residue must be protected and retained for collection by law-enforcement agencies for analysis in the crime lab.
slide14

HISTORY EVALUATION

POISONING

TOXIC

INGESTION

NON – TOXIC

INGESTION

SUBSTANCE/S

ROUT

QUANTITY

TIME

AVAILABILITY

REASON

S/S &

TOXODROMES

LOCATION

Home/work

slide15

MEDICAL RECORDS

  • Confidential.
  • Subject of a legal proceedings.
  • Central part of the court deliberations.
  • Testimony from the physician that created that record.
  • Cross-examine by the defendant or the accused.
  • Physicians must recognize the legal responsibility

that society places on them and be prepared to

provide competent, professional testimony when

required.

slide16
Should contains proper documentation & information.
  • make the record more representative > use tools and photos etc.
slide17
What do my medical records contain?
  • Patient medical history (mainly patient’s own words).
  • Family’s medical history.
  • Lab test results.
  • Prescribed medications.
  • Details of patient’s lifestyle (which can include smoking, high risk sports and alcohol and drug use).
slide18
Who holds and gives access to records?
  • GPs.
  • Hospitals.
  • Social Workers.
  • Courts.
  • Law enforcing agencies.
slide19
Who can see patient’s medical records?
  • Patient.
  • Anyone who has patient’s written permission.
  • Patient’s parent or guardian if they are under 16.
  • A representative appointed by a court.
  • After patient’s death >> his personal representative.
slide20
PRESERVATION AND COLLECTION OF EVIDENCE
  • extremely valuable.
  • Protocol > consultation with the local law– enforcement agency.
  • The use of a simple envelope that enables a physician to:
    • Identify the patient.
    • The date the evidence was recovered.
    • Where it was recovered from.
    • And to whom it was given.
    • Signed and sealed by the physician for its protection.
    • Use of an appropriate receipt form documenting the transfer

of this evidence.

slide21
Evidences to be collected and preserved
  • Weapons ( bullets, knifes etc ).
  • Wounds particles ( gun shot powder ).
  • Clothing.
  • Blood and other body materials. (evidence of sexual assault).
  • Gastric content.
  • Poisons and medications.
  • Photographs.
  • X – rays.
  • Notes & consultations.
slide22
REPORT OF DEATH
  • An important responsibility of the emergency physicians.
  • Notification: local law-enforcement agency & attorney general.
  • Case identification: those require an investigationof the

circumstances of the death.

  • Determination: whether an autopsy is necessary or not.
slide23
Such deaths are generally those:
  • individuals who die suddenly while not under theimmediate care of a physician.
  • any death associated with some type of injury.
  • suspicious or unusual death.
  • It should be emphasized that:
  • the length of time a patient has been in hospital
  • the age of an injury associated with the underlying cause of death

Are not a factor in determining whether the death should be reported

to the law authority.

slide24

Legal aspect of CPR

Rescuers are

Volunteers

(Good samaritan)

Rescuers are

Professionals

CPR is part of their job

Protected

Not protected

(Gross mistakes)

slide25
CPR: WHEN TO STOP IT ?

1. The victim's breathing & heart beats begin on their own.

2. Until other rescuers take over your effort.

3. Until you are exhausted & unable to continue.

4. Obvious signs of death are apparent.

5. A medical professional tells you to stop.

slide26
When not to start CPR
  • Obvious signs of death:
    • Dependent livido: black, blue or reddish discoloration of

the skin.

    • Rigor mortis: rigidity.
    • Algo mortis: low temperature.
    • Injuries that are incompatible with life.
  • Threats to rescuers safety.
  • Valid order of DNR ???.