unit 5. laws and legal responsibilities are a part of every day life. school driving (traffic laws)...

LEGAL / ETHICAL ISSUES

FOR HEALTH CARE WORKERS

Unit 5

Laws and legal responsibilities are a part of every day life.SchoolDriving (traffic laws)Work Related (age)Medical (proper training)

Laws are designed to protect you and society

Legal/Ethical (Don’t Write)

LawsA law is a rule that must be followedLaws are created and enforced by the

local, state and federal governmentHealth care professionals must know:

○Laws that regulate their license○Standards for their profession (Scope of

Practice)

Legal/Ethical (Start Writing)

LawsFailure to meet legal responsibilities

may result in legal action against you and/or your employer.

“I didn’t know.”“They told me to do it.”“Everyone else does it.”

Legal/Ethical

Types of LawsTwo main types of laws affect health

care workers:○Criminal Law○Civil Law

Legal/Ethical

Types of LawsCriminal Law:

○Commonly called a “crime”○A wrong against a person, property or

societyExamples:

○Practicing without a required license○Misuse of narcotics○Theft○Murder

Legal/Ethical

Types of LawsCivil Law:

○Legal relationships between people and protection of a person’s rights

○Much of civil law deals with Torts and Contracts

Legal/Ethical

TortsWrongful act that does not involve a

contractCivil wrong instead of a crimeWhen a person is harmed or injured

because a health care provider does not meet the established or expected standards of care

Legal/Ethical - Tort

MalpracticeFailure of a professional to use the

degree of skill and learning commonly expected in a particular profession

“Bad practice” / “Professional Negligence”

Causes injury, loss, or damage to the person receiving care


MalpracticeExamples:

○Physician not administering tetanus injection when a patient has a puncture wound

○Nurse performing minor surgery without any training


NegligenceFailure to give care that is normally

expected of a person in a particular position which results in injury to another person.

Legal/Ethical - Torts

NegligenceExamples:

○Falls and injuries that occur when side rails are left down (hospital different than long-term care)

○Using and/or not reporting defective equipment

○Infections caused by use of non-sterile instruments and/or supplies

○Burns caused by heat or radiation treatments


Assault & BatteryClosely related and often used

togetherAssault: can include a threat or

attempt to injure Battery: unlawful touching of another

person without consent


Assault & BatteryPatients MUST give consent prior to

any treatment

Patients have the right to refuse care (competency)


Assault & BatteryWritten consent is required for some

procedures:○Surgery○Certain diagnostic tests○Treatment of minors○Side rail releases (hospital different than

long-term care)


Assault & BatteryVerbal consent is permitted for some

procedures:Informed Consent: permissions

granted voluntarily by a person who is of sound mind after the procedure and all risks involved have been explained in terms the person can understand


Assault & BatteryInformed Consent: Person has right to withdraw consent

at any timeDo NOT perform procedure if patient

did not give consent


Assault & BatteryImplied Consent: When a person is unable to give

consent for treatment in an emergency situation and it would be prudent (what medical professionals would agree would be the “right thing to do”)for a medical professional to treat them (life threatening situation)


Assault & BatteryExamples of Assault & Battery:

○Performing procedure after the patient has refused to give permission

○Improper handling and rough treatment of patients


Invasion of PrivacyUnnecessary exposure of an

individual or revealing personal information about an individual without their consent


Invasion of PrivacyExamples:

○Not covering a patient properly during a procedure which allows others to see patient exposed

○Not closing door or pulling curtain when performing procedure

○Not knocking on the door of a long-term care resident and awaiting permission to enter room



○Speaking about a patient to friends, family or other persons not directly associated with the care of patient

○Reviewing the medical record of a patient you are not caring for

○Speaking about patient in public



○Sending information to an insurance company without patient knowing

○Informing news media about a patient’s condition without their consent.


False ImprisonmentRestraining an individual or restricting

an individual’s freedomExamples:

○Keeping patient hospitalized against their will

○Applying physical restraint without proper authorization or justification


AbuseAny care that results in physical harm,

pain, or mental anguish Types of Abuse

Physical – hitting, depriving food/water

Verbal – swearing, shouting, threatsPsychological – belittling, intimidatingSexual – unwanted sexual touching


AbusePatients may experience abuse prior to

entering health care facility Types of Abuse – (specific)

Domestic abuse – Intimate partner uses threatening, manipulative, aggressive or violent behavior to maintain power & control over another person

Child abuse – abuse directed toward a childElder abuse – abuse directed toward an older

person


AbuseBe alert for signs/symptoms of abuseExamples:

○Unexplained bruises, fractures, burns○Neglect; poor personal hygiene○Irrational fears, change in personality○Aggressive/withdrawn behavior○Statements made by patient


AbusePresence of signs/symptoms indicates

a need for further investigation. Health care workers are REQUIRED

by law to report any signs of abuse to immediate supervisor and/or proper legal authorities

State of Florida Abuse Registry1-800-962-2873


DefamationFalse statements that cause a person

to be ridiculed, or cause damage to a person’s reputation

Types of Defamation:○Libel - written○Slander - spoken


DefamationExamples:

○Stating that a person has a drug problem when another medical condition exists. (Diabetes)

○Stating a person has infectious disease (HIV/AIDS) incorrectly


ContractAn agreement between two or more parties

Three parts:○Offer – competent person offers to be pt.○Acceptance – Appt., exams, treats pt.○Consideration – Payment made for

services rendered

Legal/Ethical - Contract

ContractTypes of ContractImplied:

○Understood without verbal/written terms (nurse administers medication)

Expressed: ○Clear distinct language; orally or in writing (surgery permit, risk/benefit)


ContractLegal DisabilityDoes not have legal capacity to form a contract○Minors○Mentally incompetent○Persons under influence/altered

mental state (drugs/alcohol)○Semiconscious or unconscious


ContractLegal DisabilityParents, guardians or others permitted by law must form contract for these individuals


ContractBreach of ContractNot performing contract according to agreement, which can lead to legal action

Examples:○Failure to provide care○Giving improper care○Patient refuses to pay for care given


ContractLaw (Federal) requires that a translator be present when a contract is explained to a non-English-speaking individual

Deaf or hard of hearingEnglish speaking relative or friend can serve as translator


ContractPrincipal - employer

○Principal is legally responsible for actions of agent

Agent – works for employer; employee○Agent must be mindful of actions and

protect principal (employer)


Privileged CommunicationAll information given to health care personnel by patient is considered privileged.

Must be kept confidentialShared only with member directly caring for patient

Cannot be shared with anyone else without written consent from patient

Legal/Ethical - Communication

Privileged CommunicationWritten consent must state:

○What specific information can be shared○To whom the information can be shared

with○Time limit (if any) that information can be

shared for


Privileged CommunicationCertain information is exempt and MUST be shared/reported:○Births/Deaths○ Injuries Caused by violence○Drug abuse○Communicable diseases○Sexually transmitted diseases


Health Care RecordsPrivileged informationRecords belong to health care provider,

but patient has right to obtain copy of any information in record.

Can be legal record in court of lawErasures NOT allowed

○Cross out errors with single line○Insert correct information, initial, date


Health Care RecordsErasures NOT allowed

○ “Moderate edema observed on left ankle”○ “Moderate edema observed on left ankle”

○ “Moderate edema observed on right ankle”

○There are methods that exist to tell the age of the ink on a medical record.


CER 01/08/2010

Health Care RecordsMust be properly maintained, stored in

a locked, secure area, kept confidential and retained for the amount of time required by state law.

If records are to be destroyed (after legal storage time has elapsed) they must be shredded or burned, so confidentiality can be maintained.


Health Care RecordsComputerized medical recordsDocumentation is being completed on:

○Desktop computers○Laptops○I-Touch○I-Pad○Smart Phones


Health Care RecordsComputerized medical records

○ Persons having access to records○ Safeguards:

Limiting personnel who have access (passwords)Using additional security measures to protect more

sensitive information (lab results, x-ray, etc)Constant monitoring of computer usage


Health Insurance Portability & Accountability Act of 1996 (HIPAA)Department of Health & Human Services

established standards to protect medical information

Violation of HIPAAFines: $100 - $250,000 & 10 yrs. In JailAs of August 2009 – No institutions had

been fined. Source: bNet.com “HHS Office Will Be Funded Partly By The HIPAA Fines It Levies” August 2009


Standards for Privacy of Identifiable Health Information (2003)Falls under HIPAAProvides federal protection for privacy of health information in all states


Standards for Privacy of Identifiable Health Information (2003)Require that patients must be:

○Able to see & obtain copies of their medical record

○Given information about how medical information is used and sets limits on use

○Assured that health care providers will keep medical information confidential


Standards for Privacy of Identifiable Health Information (2003)Require that patients must be:

○Given the right to state who has access to their medical information

○Able to limit providing information to family by health care provider

○Provided with information on how to file a complaint against a health care provider who violates the privacy act


EthicsSet of principals dealing with what is morally right or wrong

Provide a standard of conduct or code of behavior

Allow health care provider to analyze and make decisions based on what people believe is right and good conduct

Legal/Ethical

Ethics (Ethical Dilemmas) Don’t write!Is euthanasia justified in certain patients?

Should a patient be told that their health care provider has AIDS?

When should life support be discontinued?

Legal/Ethical

Ethics (Ethical Dilemmas) Don’t write!Who decides if a 75 y/o patient or a 56 y/o patient gets a single kidney for transplant?

If a person can benefit from marijuana, should a physician be able to prescribe it as a treatment?

Legal/Ethical

Ethics GuidelinesSaving of life & promotion of health is above all else

Make every effort to provide comfort and preserve life

Respect patient’s choice to die peacefully and with DIGNITY when predetermined by advanced directives

Legal/Ethical

Ethics GuidelinesTreat ALL patients equally, regardless of race, religion, social or economic status, sex & nationality

Avoid bias, prejudice and discrimination

Provide care for ALL of your patients to the best of your ability – ALL THE TIME

Legal/Ethical

Ethics GuidelinesMaintain confidentiality

○Do NOT gossip about patientsMaintain competent level of skill Continuing education units/creditsRefrain from immoral, unethical, and illegal practices

REPORT illegal actions of others

Legal/Ethical

Ethics GuidelinesBe SincereBe HonestBe CaringBe EmpatheticShow respect/concern for feelings, dignity and rights of others

“Treat others the way you want to be treated”

Legal/Ethical

Patient’s RightsFactors of care that patients can expect to receive

• High quality hospital care. • A clean and safe environment. • Involvement in your care. • Protection of your privacy. • Help when leaving the hospital. • Help with your billing claims.

Legal/Ethical

Patient’s RightsFederal laws require health care institutions to have written policies concerning patient’s rights

All personnel must respect and honor these rights

Legal/Ethical

Resident’s Rights (Long-Term Care) Respect: You have the right to be treated

with dignity and respect. Services and Fees: You must be

informed in writing about services and fees before you enter the nursing home.

Money: You have the right to manage your own money or to choose someone else you trust to do this for you.

Legal/Ethical

Resident’s Rights (Long-Term Care) Privacy: You have the right to privacy, and to

keep and use your personal belongings and property as long as it doesn't interfere with the rights, health, or safety of others.

Medical Care: You have the right to be informed about your medical condition, medications, and to see your own doctor. You also have the right to refuse medications and treatments.

Legal/Ethical

Advanced Directives Also known as legal directives Legal documents that allow individuals to

state what specific measures should or should not be taken to prolong life when their condition is terminal

Legal/Ethical

Advanced Directives Two Main Types

Living WillDurable Power of Attorney (DPOA) for Health Care Decisions

Legal/Ethical


Living WillLegal document that allows individuals

to state measures that should/should not be done when their condition is terminal

Must be competent when signed; two witnesses who will not benefit from patient’s death

Legal/Ethical


Living WillDo Not Resuscitate (DNR) Order

○No CPR○Patient allowed to die with dignity

Legal/Ethical


Durable Power of Attorney (DPOA) for Health Care

Permits patient (Principal) to appoint another person (Agent) to make health care decisions if the Principal is unable to do so on their own

Legal/Ethical



DPOA can make specific decisions based on patient’s wishes○Withhold certain treatments/procedures○Spending/withholding funds○Having access to medical record

Legal/Ethical



Usually spouses or adult children are DPOA, but can be any competent adult the patient chooses

Must be signed by principal, agent, and two adult witnesses

Legal/Ethical

Advanced Directives Health care workers MUST be aware

of, and honor advanced directives Discuss advanced directives with

friends and family – be informed Give consideration to preparing your

own advanced directives

Legal/Ethical

Professional Standards Perform only those procedures for

which you have been trained and are legally permitted to do

Used approved, correct methods while performing any procedure

Identify patient and obtain patient’s consent before ANY procedure

Legal/Ethical

Professional Standards Document, document, document!

Paint the clearest picture possible with your documentation

Observe all safety precautions Keep all information confidential Treat all patients EQUALLY Accept no gifts from patients ($$$)

Legal/Ethical

Professional Standards If error occurs, report it to supervisor

immediately Behave professionally in dress,

language, manners and actions!!!!!! Liability insurance

Offered by private companies

Legal/Ethical

End of Lecture

unit 5. laws and legal responsibilities are a part of every day life. school driving (traffic laws)...

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