r u reasonable?
Post on 16-Jul-2015
28 Views
Preview:
TRANSCRIPT
Basis Behind Medical Legal Issues
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Describe the Reasonable Person Theory of Tort Law
What is required for Appropriate Informed Consent
List Three Charting Pitfalls
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Statutory Law Law is passed (i.e.) Nurse Practice Act
Common Law Legal Precedent
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Criminal
Intentional
Civil Unintentional
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Duty
Medical Legal—Duty to care
Breech
Not acting within your standard of care
Harm
Actual or imagined
Causation
Did the breech cause the harm
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Negligence Law
Each member of society has a duty to behave as to avoid unreasonable risks of harm to others
We Must Act:
As a reasonable person of ordinary prudence in similar circumstances
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Considers Personal Characteristics
Similar age, intelligence, experience
Similar circumstances
▪ Emergencies require less of a standard
Similar physical disabilities
Mental Disabilities do not relieve a person from conforming to Reasonable Person Standard
▪ Same is true of intoxication
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Used as a judgment:
Did a persons conduct fall below this standard…
▪ Was there a breech of Duty?
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Objective for two reasons Hypothetical Person
▪ Ideal attributes
Focused of behavior
▪ Rather than the subjective mental state
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Flexible
Tailored to the facts of the case
▪ Reasonable Foreseeablity
▪ Magnitude
▪ Social Utility
▪ Avoidance
▪ Context
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Could a reasonable person predict the foreseeable risk of harm
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
As the seriousness of the risk increases the duty to avoid the behavior increases
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
The more valuable the conduct to society, the less likely the breech
Good Samaritan Laws
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Emergencies do not need the same cautiousness and deliberation as planned events
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Diagnosis Purpose of Procedure Risks involved Success Rate Failure to Act Alternative treatments
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Landmark case for informed consent handed sown in US Appeals Court Washington District
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
1959 – 19 y/o clerk in DC with back pain sought tx and found to have bulging disc @ T4
Surgeon called and talked to mother in WV. No record of consent during conversation Surgery performed and mom arrived after surgery, consent
signed. On PO day 2 pt assisted OOB to void and was left
unattended and fell in process of voiding Lower extremity paralysis Months later, crutch walking with no bowl or bladder
function
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
“every human being of adult years and sound mind has a right to determine what shall be done with his own body”
Right to Self Determination
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Must be able to trace:
Knowledge of options
Risks of each
Magnitude of Risk
Risk of failure to act
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Required to communicate this to the patient
Medical training enables providers to a self-satisfying course of action
Prerogative is of the patient not the physician
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Justices found:
This is doctrinal emphasis not an addition to malpractice law
Settled the rule:
▪ Therapy not authorized equaled a tort –Common Law Battery
▪ Criminal Tort (intentional) not a Civil Tort (unintentional)
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Degree of care which a reasonable prudent person with like training would have experienced under similar circumstances
Physician performs at a higher level than a non-physician
Same of similar location/setting
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Are but an adaptation of general standards Required to act as reasonable men
possessing their medical talents would
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Unwilling to adopt full disclosure
Unrealistic to expect disclosure of every risk no matter how remote
What a reasonable practitioner would bare More importantly:
What a reasonable person would expect
▪ Patient prerogative
▪ Self-determination shapes duty to reveal
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Two exceptions to the rules:
Incapable of consenting and failure to treat would harm▪ Unconscious patient in the ED
Disclosure poses threat to the patients care
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Not Duress but undue influence Duress
Induced by threat
No reasonable alternatives
Undue Influence
A relationship exists
▪ Trust and Confidence
▪ Domination
Unfair persuasion
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Healthcare Insurance Portability Assurance Act
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
Too little Too Much Illegible
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
NCANA Dist. I & II Mtg. 2015 Jerry Coy, CRNA, PhD
top related